ROLE OF MICRONUTRIENTS AS IMMUNOREGULATORS IN SARS-COV-2

Nutrition is a key determinant of well being and is a part of the treatment regimen for acute and chronic diseases and applies especially to diseases for which an etiologic therapy has not yet been found and approved.

The 2014-2016 Ebola virus outbreak in Western Africa exhibited that prompt supportive care significantly reduces Mortality rates. This may apply as well to the current COVID-19) pandemic.

Many evolving literatures on patients with COVID-19 indirectly emphasizes the significance of nutrition in possibly deciding their outcomes.

It has been suggested that the nutritional prominence might also play an important role as a driver of SARS-CoV-2 virulence.Lack of nutrition is the leading cause of immunodeficiency worldwide, involving mostly infants, children, adolescents, and the elderly, increasing their susceptibilityto infections.

SARS-CoV-2and dysregulation of the immune system

On entering, SARS-CoV-2 virus attaches to human alveolar epithelial cells, triggering the innate and adaptive immune systems, resulting in the onset of cytokine release syndrome. This systemic cytokine barrage dysregulates host immune responses, leading to the development of acute respiratory distress syndrome (ARDS).

Old patients- are at greater risk of cytokine storm, and more likely to be significantly impacted.COVID-19 infected patients have a high level of interleukin (IL)-6 – a critical inflammatory mediator involving in respiratory failure, shock and multi-organ dysfunction.

Patients infected with severe COVID-19 symptoms have high levels of circulating pro-inflammatory cytokines such as IL-2, IL-7, G-CSF, and TNFα.This advancement of cytokines leads to hyper-inflammation and a severe hyper-cytokinemic state of inflammation.

Micronutrients are essential for

• Developingbarriers to prevent pathogens from entering the body
• Identifying and wiping out pathogens
• Creating an immunological memory of the pathogen, considering fast protection against that microorganism if the host experiences it once more.

VITAMIN D

• Vitamin D improves innate cellular immunity through stimulation of expression of anti-microbial peptides, such as cathelicidin and defensins.
• Defensins maintain tight and gap junctions, adheres and enhance the expression of anti-oxidative genes.
• vitamin D modulates the adaptive immune response, by suppressing T helper type-1 (Th1) cell function and decreasing the production of pro-inflammatory cytokines IL-2 and interferon-gamma (INF-γ).
• Supplementation of vitamin D is suggested to boost immunity against COVID-19 and reduce human mortality.

VITAMIN C

• The pro-inflammatory cytokines, IL-1β and TNF-α increase rapidly after infection, and the acute response triggered by this stimulates further secretion of IL-6 and IL-8 promoting an ongoing pro-inflammatory state.
• Vitamin C is known to reduce the levels of pro-inflammatory cytokines including TNF-α and increase anti-inflammatory cytokines (IL-10).
• Clinical studies have demonstrated that intake of 1 g/day of vitamin C increases IL-10 secretion by peripheral blood mononuclear cells.
• IL-10 works as a negative feedback mechanism with IL-6 and controls inflammation, critical in COVID-19.

VITAMIN A

• Vitamin A has an established role in supporting immune function and protecting against viral infections.
• The effectiveness of viral vaccines is compromised by low serum vitamin A through the suppression of IgG1 and inflammatory responses.
• Vitamin A also modulates other immune components through its action on dendritic and natural killer cells.
• It is essential in maintaining epithelial tissue integrity , which is severely damaged in viral infections such as measles .

VITAMIN E

• The main biological role of vitamin E is as an antioxidant that quenches oxidative cascades.
• Though Numerous possible mechanisms of action are postulated, only few confirmatory studies are available.

VITAMIN B 6

• Vital for supporting biochemical reactions in the immune system.

POLYUNSATURATED FATTY ACIDS (PUFA)

Omega-3 fatty acids exert anti-viral effects by inhibiting influenza virus replication. According to the European Society for Parenteral and Enteral Nutrition expert statement, the use of omega-3 fatty acids may improve oxygenation in COVID-19 patients.

To conclude there is reason to be hopeful that supplements might help in the fight against COVID-19. But it is important to note that no vitamin or supplement alone can cure COVID-19.Nutrition and lifestyle should be a core component of a response plan to such a pandemic.

REFERENCE

1. Shakoor, H., Feehan, J., Al Dhaheri, A., Ali, H., Platat, C., Ismail, L., Apostolopoulos, V. and Stojanovska, L., 2021. Immune-boosting role of vitamins D, C, E, zinc, selenium and omega-3 fatty acids: Could they help against COVID-19. Maturitas, 143, pp.1-9.
2. Samad N, Dutta S, Sodunke TE, Fairuz A, Sapkota A, Miftah ZF, Jahan I, Sharma P, Abubakar AR, Rowaiye AB, Oli AN, Charan J, Islam S, Haque M. Fat-Soluble Vitamins and the Current Global Pandemic of COVID-19: Evidence-Based Efficacy from Literature Review. J Inflamm Res. 2021;14:2091-2110
3. Irfan, Jazib& Aslam, Sidra. (2017). Vitamins: Key Role Players in Boosting Up Immune Response-A Mini Review. 10.4172/2376-1318.1000153.
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7. Miner 6: 153. doi:4172/2376-1318.100015Irfan, Jazib& Aslam, Sidra. (2017). Vitamins: Key Role Players in Boosting Up Immune Response-A Mini Review. 10.4172/2376-1318.1000153.

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Dr Christopher S. K MBBS, DNB (Gen.Surgery), MNAMS, FIAGES, FMAS, FACRSI, FACS(USA), FAIS, FBMS(Taiwan), FRSPH(UK), D.MAS(France), FMIS(IRCAD), FICRS(WALS), F.MAS, D.MAS(WALS) Consultant Advanced Minimally Invasive Bariatric, GI & Laser Surgeon Specialised in Endoscopy, Laser, Laparoscopic & Robotic Surgery