key: cord-0938156-6vmmm8rp
authors: Panarese, Alba; Shahini, Endrit
title: Letter: Covid‐19, and vitamin D
date: 2020-04-12
journal: Aliment Pharmacol Ther
DOI: 10.1111/apt.15752
sha: dcb946fcbbed18dc5f4ecf3a6eb6a5b83c917342
doc_id: 938156
cord_uid: 6vmmm8rp

LINKED CONTENT This article is linked to Tian et al and Tian and Rong papers. To view these articles, visit https://doi.org/10.1111/apt.15731 and https://doi.org/10.1111/apt.15764.

D deficiency which may also contribute to airway/gastrointestinal infectious illnesses. 3 Elderly Italians display a very high prevalence of hypovitaminosis D, especially during the winter. 3 Vitamin D has immuno-modulatory properties, that include downregulation of pro-inflammatory cytokines, [3] [4] [5] [6] [7] and has been shown to attenuate lipopolysaccharide-induced acute lung injury in mice by blocking effects on the angiopoietin (Ang)-2-Tie-2 signalling pathway and on the renin-angiotensin pathway. 8 Tsujino I et al have recently shown, both in a mouse model of bleomycin-induced interstitial pneumonia and in human cell lines, that vitamin D3 is locally activated in lung tissue and has a preventive effect on experimental interstitial pneumonitis. 9 Although it is more likely that any protective effect of vitamin D against

Covid19 is related to suppression of cytokine response and reduced severity/risk for ARDS, there is also evidence from a meta-analysis that regular oral vitamin D2/D3 intake (in doses up to 2000 IU/d without additional bolus), is safe and protective against acute respiratory tract infection, especially in subjects with vitamin D deficiency. 10 It therefore seems plausible that Vitamin D prophylaxis (without over-dosing) may contribute to reducing the severity of illness caused by SARS-CoV-2, particularly in settings where hypovitaminosis D is frequent. This will include people currently living in Northern countries and those with underlying gastroenterological conditions where vitamin D deficiency is more prevalent. This may become even more important with absence of sunlight exposure as a consequence of "shut-down" measures to control the spread of Covid19. For this to be effectively implemented will require worldwide government guidelines, and further studies looking at possible impacts of vitamin D deficiency on Covid-19 outcomes are urgently needed.

We thank everyone who is working to resolve the SARS-CoV-2 pandemic. Italian colleagues in this pandemic and grateful for their comments.

Interestingly, they found that northerly latitude is associated with increased mortality rate and hospitalisation rate for COVID-19 worldwide. 1 

Review article: gastrointestinal features in COVID-19 and the possibility of faecal transmission

Evidence for gastrointestinal infection of SARS-CoV-2

Chronic functional constipation is strongly linked to vitamin D deficiency

Vitamin D inhibits monocyte/macrophage proinflammatory cytokine production by targeting MAPK phosphatase-1

Modulation of the immune response to respiratory viruses by vitamin D

Vitamin D modulation of innate immune responses to respiratory viral infections

Vitamin D-mediated attenuation of miR-155 in human macrophages infected with dengue virus: Implications for the cytokine response

VDR attenuates acute lung injury by blocking Ang-2-Tie-2 pathway and renin-angiotensin system

Pulmonary activation of vitamin D3 and preventive effect against interstitial pneumonia

Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data