Vitamina D, sus acciones “no clásicas” y su utilidad en la pandemia del COVID-19

  • José Luis Mansur Centro de Endocrinología y Osteoporosis, La Plata, Buenos Aires, Argentina
Palabras clave: vitamina D, 25-OH-vitamina D, COVID-19, SARS-CoV-2, coronavirus, síndrome respiratorio agudo severo, sistema renina angiotensina aldosterona, suplementación con vitamina D, dosificación

Resumen

El descubrimiento de que la síntesis de 1,25 vitamina D no fue solo renal, la enzima 1 alfa hidroxilasa se encuentra en numerosos tejidos del organismo, además de la evidencia de que la asociación entre el déficit de vitamina D y la presencia de enfermedades no óseas (cáncer, esclerosis múltiple, enfermedades autoinmunes, etc.) nos ofrece la posibilidad de intentar prevenir estas afecciones. Los estudios de suplementación contra placebo no han dado resultados positivos para algunas afecciones, aunque algunos de esos trials se realizaron en población “suficiente” y no “deficiente” de vitamina D. Sin embargo, otros metaanálisis han demostrado prevención en los grupos suplementados con déficit para algunas patologías (infecciones respiratorias, prediabetes). Además, existe evidencia de efecto antiviral de la misma. La acción antiinfecciosa e inmunomoduladora que ejerce y su efecto sobre el sistema renina angiotensina, estimulando la enzima convertidora de angiotensina 2 (que es el receptor virus del SARS-CoV), permiten sospechar, actualmente, que con niveles elevados podría ser más difícil, o menos grave, la infección por COVID-19. La suplementación con vitamina D es conveniente para prevenir enfermedades en sujetos con déficit, pero en medio de la grave pandemia 2020 administrarla, aún sin tener un dosaje previo en las poblaciones de mayor riesgo, podría disminuir la chance de esta enfermedad.

Citas

Rosen CJ, Abrams SA, Aloia JF, Brannon PM, Clinton SK, Durazo-Arvizu RA, et al. IOM committee members respond to Endocrine Society vitamin D guideline. J Clin Endocrinol Metab. 2012;97(4):1146-52. doi: 10.1210/jc.2011-2218.

Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Guidelines for preventing and treating vitamin D deficiency and insufficiency revisited. J Clin Endocrinol Metab. 2012;97(4):1153-8. doi: 10.1210/jc.2011-2601.

Manson JE, Cook NR, Lee IM, Christen W, Bassuk SS, Mora S, et al. Vitamin D supplements and prevention of cancer and cardiovascular disease. N Engl J Med. 2019;380(1):33-44. doi: 10.1056/NEJMoa1809944.

Pittas AG, Dawson-Hughes B, Sheehan P, Ware JH, Knowler WC, Aroda VR, et al.; D2d Research Group. Vitamin D supplementation and prevention of type 2 diabetes. N Engl J Med. 2019;381(6):520-530. doi: 10.1056/NEJMoa1900906.

Mansur JL. Vitamin D supplementation and prevention of type 2 diabetes. N Engl J Med. 2019;381(18):1785. doi: 10.1056/NEJMc1912185.

Martineau AR, Jolliffe DA, Hooper RL, Greenberg L, Aloia JF, Bergman P, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 2017;356:i6583. doi: 10.1136/bmj.i6583.

Barbarawi M, Zayed Y, Barbarawi O, Bala A, Alabdouh A, Gakhal I, et al. Effect of vitamin D supplementation on the incidence of diabetes mellitus. J Clin Endocrinol Metab. 2020;105(8):dgaa335. doi: 10.1210/clinem/dgaa335.

Zhang Y, Tan H, Tang J, Li J, Chong W, Hai Y, et al. Effects of vitamin D supplementation on prevention of type 2 diabetes in patients with prediabetes: a systematic review and meta-analysis. Diabetes Care. 2020;43(7):1650-8. doi: 10.2337/dc19-1708.

Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2011;96(7):1911-30. doi: 10.1210/jc.2011-0385. Erratum in: J Clin Endocrinol Metab. 2011;96(12):3908.

Sánchez A, Oliveri B, Mansur JL, Fradinger E, Mastaglia S. Diagnóstico, prevención y tratamiento de la hipovitaminosis D. Rev Argent Endocrinol Metab. 2013;50(2):140-55.

Rondanelli M, Miccono A, Lamburghini S, Avanzato I, Riva A, Allegrini P, et al. Self-care for common colds: the pivotal role of vitamin D, vitamin C, zinc, and echinacea in three main immune interactive clusters (physical barriers, innate and adaptive immunity) involved during an episode of common colds-practical advice on dosages and on the time to take these nutrients/botanicals in order to prevent or treat common colds. Evid Based Complement Alternat Med. 2018;2018:5813095. doi: 10.1155/2018/5813095.

Schwalfenberg GK. A review of the critical role of vitamin D in the functioning of the immune system and the clinical implications of vitamin D deficiency. Mol Nutr Food Res. 2011;55(1):96-108. doi: 10.1002/mnfr.201000174.

Kast JI, McFarlane AJ, Głobińska A, Sokolowska M, Wawrzyniak P, Sanak M, et al. Respiratory syncytial virus infection influences tight junction integrity. Clin Exp Immunol. 2017;190(3):351-9. doi: 10.1111/cei.13042.

Mora JR, Iwata M, von Andrian UH. Vitamin effects on the immune system: vitamins A and D take centre stage. Nat Rev Immunol. 2008;8(9):685-98. doi: 10.1038/nri2378.

Van Belle TL, Gysemans C, Mathieu C. Vitamin D in autoimmune, infectious and allergic diseases: a vital player? Best Pract Res Clin Endocrinol Metab. 2011;25(4):617-32. doi: 10.1016/j.beem.2011.04.009.

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):P497-506. doi: 10.1016/S0140-6736(20)30183-5.

Sharifi A, Vahedi H, Nedjat S, Rafiei H, Hosseinzadeh-Attar MJ. Effect of single-dose injection of vitamin D on immune cytokines in ulcerative colitis patients: a randomized placebo-controlled trial. APMIS. 2019;127(10):681-7. doi: 10.1111/apm.12982.

Lemire JM, Adams JS, Kermani-Arab V, Bakke AC, Sakai R, Jordan SC. 1,25-Dihydroxyvitamin D3 suppresses human T helper/inducer lymphocyte activity in vitro. J Immunol. 1985;134(5):3032-5.

Kalil AC, Thomas PG. Influenza virus-related critical illness: pathophysiology and epidemiology. Crit Care. 2019;23(1):258. doi: 10.1186/s13054-019-2539-x.

Cannell JJ, Vieth R, Umhau JC, Holick MF, Grant WB, Madronich S, et al. Epidemic influenza and vitamin D. Epidemiol Infect. 2006;134(6):1129-40. doi: 10.1017/S0950268806007175.

Lang PO, Samaras D. Aging adults and seasonal influenza: does the vitamin d status (h)arm the body? J Aging Res. 2012;2012:806198. doi: 10.1155/2012/806198.

Ginde AA, Mansbach JM, Camargo CA Jr. Association between serum 25-hydroxyvitamin D level and upper respiratory tract infection in the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2009;169(4):384-90. doi: 10.1001/archinternmed.2008.560.

Gruber-Bzura BM. Vitamin D and influenza-prevention or therapy? Int J Mol Sci. 2018;19(8):2419. doi: 10.3390/ijms19082419.

Urashima M, Segawa T, Okazaki M, Kurihara M, Wada Y, Ida H. Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. Am J Clin Nutr. 2010;91(5):1255-60. doi: 10.3945/ajcn.2009.29094.

Arihiro S, Nakashima A, Matsuoka M, Suto S, Uchiyama K, Kato T, et al. Randomized trial of vitamin D supplementation to prevent seasonal influenza and upper respiratory infection in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2019;25(6):1088-95. doi: 10.1093/ibd/izy346.

GrassrootsHealth Nutrient Research Institute. Scientists’ Call to D*action – The Vitamin D Deficiency Epidemic [Internet]. Disponible en: https://www.grassrootshealth.net/project/our-scientists/ (consulta: 25/07/2020).

Mansur JL, Tajer C, Mariani J, Inserra F, Ferder L, Manucha W. Vitamin D high doses supplementation could represent a promising alternative to prevent or treat COVID-19 infection. Clin Investig Arterioscler. 2020:S0214-9168(20)30048-6. doi: 10.1016/j.arteri.2020.05.003.

Grant WB, Lahore H, McDonnell SL, Baggerly CA, French CB, Aliano JL, et al. Vitamin D supplementation could prevent and treat influenza, coronavirus, and pneumonia infections. [Preprint from Preprints.org, Version 2: 29 Mar 2020]. doi: 10.20944/preprints202003.0235.v2.

Grant WB, Lahore H, McDonnell SL, Baggerly CA, French CB, Aliano JL, et al. Evidence that vitamin D supplementation could reduce risk of influenza and COVID-19 infections and deaths. Nutrients. 2020;12(4):988. doi: 10.3390/nu12040988.

Mansur JL. Letter: low population mortality from COVID-19 in countries south of latitude 35 degrees north supports vitamin D as a factor determining severity. Aliment Pharmacol Ther. 2020;52(2):411-2. doi: 10.1111/apt.15820.

Theron M, Huang KJ, Chen YW, Liu CC, Lei HY. A probable role for IFN-gamma in the development of a lung immunopathology in SARS. Cytokine. 2005;32(1):30-8. doi: 10.1016/j.cyto.2005.07.007.

Li W, Moore MJ, Vasilieva N, Sui J, Kee Wong S, Berne MA, et al. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature. 2003;426(6965):450-4. doi: 10.1038/nature02145.

Kuba K, Imai Y, Rao S, Gao H, Guo F, Guan B, et al. A crucial role of angiotensin converting enzyme 2 (ACE2) in SARS coronavirus-induced lung injury. Nat Med. 2005;11(8):875-9. doi: 10.1038/nm1267.

Fosbøl EL, Butt JH, Østergaard L, Andersson C, Selmer C, Kragholm K, et al. Association of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use with COVID-19 diagnosis and mortality. JAMA. 2020;324(2):168-77. doi: 10.1001/jama.2020.11301.

Lykkedegn S, Sorensen GL, Beck-Nielsen SS, Christesen HT. The impact of vitamin D on fetal and neonatal lung maturation. A systematic review. Am J Physiol Lung Cell Mol Physiol. 2015;308(7):L587-602. doi: 10.1152/ajplung.00117.2014.

Lin M, Gao P, Zhao T, He L, Li M, Li Y, et al. Calcitriol regulates angiotensin-converting enzyme and angiotensin converting-enzyme 2 in diabetic kidney disease. Mol Biol Rep. 2016;43(5):397-406. doi: 10.1007/s11033-016-3971-5.

Xu J, Yang J, Chen J, Luo Q, Zhang Q, Zhang H. Vitamin D alleviates lipopolysaccharide‑induced acute lung injury via regulation of the renin‑angiotensin system. Mol Med Rep. 2017;16(5):7432-8. doi: 10.3892/mmr.2017.7546.

Gatera VA, Abdulah R, Musfiroh I, Judistiani RTD, Setiabudiawan B. Updates on the status of vitamin D as a risk factor for respiratory distress syndrome. Adv Pharmacol Sci. 2018;2018:8494816. doi: 10.1155/2018/8494816.

Skov J, Persson F, Frøkiær J, Christiansen JS. Tissue renin-angiotensin systems: a unifying hypothesis of metabolic disease. Front Endocrinol (Lausanne). 2014;5:23. doi: 10.3389/fendo.2014.00023.

Ferder M, Inserra F, Manucha W, Ferder L. The world pandemic of vitamin D deficiency could possibly be explained by cellular inflammatory response activity induced by the renin-angiotensin system. Am J Physiol Cell Physiol. 2013;304(11):C1027-39. doi: 10.1152/ajpcell.00403.2011.

D'Avolio A, Avataneo V, Manca A, Cusato J, De Nicolò A, Lucchini R, et al. 25-Hydroxyvitamin D Concentrations Are Lower in Patients with Positive PCR for SARS-CoV-2. Nutrients. 2020;12(5):1359. doi: 10.3390/nu12051359.

Faul JL, Kerley CP, Love B, O'Neill E, Cody C, Tormey W, et al. Vitamin D Deficiency and ARDS after SARS-CoV-2 Infection. Ir Med J. 2020;113(5):84.

De Smet K, De Smet D, Ryckaert T, Laridon E, Heremans B, Vandenbulcke R, et al. Diagnostic performance of chest CT for SARS-CoV-2 infection in individuals with or without COVID-19 symptoms. Radiology. [In press. Published Online: Aug 10 2020]. doi: 10.1148/radiol.2020202708.

Panagiotou G, Tee SA, Ihsan Y, Athar W, Marchitelli G, Kelly D, et al. Low serum 25‐hydroxyvitamin D (25[OH]D) levels in patients hospitalised with COVID‐19 are associated with greater disease severity. Clin Endocrinol (Oxf). 2020 Jul 3: 10.1111/cen.14276. doi: 10.1111/cen.14276.

Merzon E, Tworowski D, Gorohovski A, Vinker S, Golan Cohen A, Green I, et al. Low plasma 25(OH) vitamin D level is associated with increased risk of COVID‐19 infection: an Israeli population‐based study. FEBS J. 2020 Jul 3:10.1111/febs.15495. doi: 10.1111/febs.15495.

Meltzer DO, Best TJ, Zhang H, Vokes T, Arora V, Solway J. Association of vitamin D status and other clinical characteristics with COVID-19 test results. JAMA Netw Open. 2020;3(9):e2019722. doi: 10.1001/jamanetworkopen.2020.19722.

Alipio, M. Vitamin D supplementation could possibly improve clinical outcomes of patients infected with Coronavirus-2019 (COVID-19). SSRN Electronic J. 2020 May 18. doi: 10.2139/ssrn.3571484.

Raharusun P, Priambada S, Budiarti C, Agung E. Patterns of COVID-19 mortality and vitamin D: an indonesian study. SSRN Electronic J. 2020 Apr. 26. doi: 10.2139/ssrn.3585561.

Maghbooli Z, Sahraian MA, Ebrahimi M, Pazoki M, Kafan S, Tabriz HM, et al. Vitamin D sufficiency, a serum 25-hydroxyvitamin D at least 30 ng/mL reduced risk for adverse clinical outcomes in patients with COVID-19 infection. PLoS One. 2020;15(9):e0239799. doi: 10.1371/journal.pone.0239799.

Sabetta JR, DePetrillo P, Cipriani RJ, Smardin J, Burns LA, Landry ML. Serum 25-hydroxyvitamin d and the incidence of acute viral respiratory tract infections in healthy adults. PLoS One. 2010;5(6):e11088. doi: 10.1371/journal.pone.0011088.

Quraishi SA, Bittner EA, Blum L, Hutter MM, Camargo CA Jr. Association between preoperative 25-hydroxyvitamin D level and hospital-acquired infections following Roux-en-Y gastric bypass surgery. JAMA Surg. 2014;149(2):112-8. doi: 10.1001/jamasurg.2013.3176.

Laviano E, Sánchez Rubio M, González-Nicolás MT, Palacian MP, López J, Gilaberte Y, et al. Association between preoperative levels of 25-hydroxyvitamin D and hospital-acquired infections after hepatobiliary surgery: A prospective study in a third-level hospital. PLoS One. 2020;15(3):e0230336. doi: 10.1371/journal.pone.0230336.

Ekwaru JP, Zwicker JD, Holick MF, Giovannucci E, Veugelers PJ. The importance of body weight for the dose response relationship of oral vitamin D supplementation and serum 25-hydroxyvitamin D in healthy volunteers. PLoS One. 2014;9(11):e111265. doi: 10.1371/journal.pone.0111265.

Seijo M, Oliveri B. Importancia de la vitamina D en la época de COVID-19. Actual Osteol. 2020;16(2):[en prensa]. Disponible en: http://osteologia.org.ar/files/pdf/rid64_2020-11-covid-final.pdf (consulta: 25/07/2020).

Amir E, Simmons CE, Freedman OC, Dranitsaris G, Cole DE, Vieth R, et al. A phase 2 trial exploring the effects of high-dose (10,000 IU/day) vitamin D(3) in breast cancer patients with bone metastases. Cancer. 2010;116(2):284-91. doi: 10.1002/cncr.24749.

Charoenngam N, Shirvani A, Kalajian TA, Song A, Holick MF. The effect of various doses of oral vitamin D3 supplementation on gut microbiota in healthy adults: a randomized, double-blinded, dose-response study. Anticancer Res. 2020;40(1):551-6. doi: 10.21873/anticanres.13984.

Shirvani A, Kalajian TA, Song A, Holick MF. Disassociation of vitamin D’s calcemic activity and non-calcemic genomic activity and individual responsiveness: a randomized controlled double-blind clinical trial. Sci Rep. 2019;9:17685. doi: 10.1038/s41598-019-53864-1.

McCullough PJ, Lehrer DS, Amend J. Daily oral dosing of vitamin D3 using 5000 TO 50,000 international units a day in long-term hospitalized patients: Insights from a seven year experience. J Steroid Biochem Mol Biol. 2019;189:228-39. doi: 10.1016/j.jsbmb.2018.12.010.

Schlingmann KP, Kaufmann M, Weber S, Irwin A, Goos C, John U, et al. Mutations in CYP24A1 and idiopathic infantile hypercalcemia. N Engl J Med. 2011;365(5):410-21. doi: 10.1056/NEJMoa1103864.

Publicado
2020-12-15
Cómo citar
1.
Mansur JL. Vitamina D, sus acciones “no clásicas” y su utilidad en la pandemia del COVID-19. Rev Nefrol Dial Traspl. [Internet]. 15 de diciembre de 2020 [citado 28 de marzo de 2024];40(4):330-4. Disponible en: http://vps-1689312-x.dattaweb.com/index.php/rndt/article/view/576
Sección
Artículo Especial