Vitamin D also provides COVID Neuroprotection – April 2022

Vitamin D and its Possible Relationship to Neuroprotection in COVID-19: Evidence in the Literature

Current Topics in Medicinal Chemistry 2022 Apr 1 DOI: 10.2174/1568026622666220401140737
Saray Quintero-Fabián1’#, Cindy Bandala2,3’#, Luz Adriana Pichardo-Macías4, Itzel Jatziri Contreras- García5, Saúl Gómez-Manzo6, Beatriz Hernández-Ochoa7, José Arturo Martínez-Orozco8, Iván Ignacio- Mejía1,,l! and Noemí Cárdenas-Rodríguez9,í
1Laboratorio de Medicina Traslacional, Escuela Militar de Graduados de Sanidad, UDEFA, Mexico City, 11200, Mexico; 2Division de Neurociencias, Instituto Nacional de Rehabilitación, Secretaría de Salud, Mexico City, 14389, Mexico; 3Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, 11340, Mexico; 4Departamento de Fisiología, Instituto Politécnico Nacional, Escuela Nacional de Ciencias Biológicas, Mexico City, 07738, Mexi- co;5Laboratorio de Fisiología, Escuela Militar de Graduados de Sanidad, UDEFA, Mexico City, 11200, Mexico; 6Laboratorio de Bioquímica Genética, Instituto Nacional de Pediatría, Secretaría de Salud, Mexico City, 04530, Mexico; 7Laboratorio de Inmunoquímica, Hospital Infantil de México Federico Gómez, Secretaría de Salud, Mexico City, 06720, Mexico; 8Departmento de Infectología, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas, Secretaría de Salud, Mexico City, 14080, Mexico; 9Laboratorio de Neurociencias, Instituto Nacional de Pediatría, Secretaría de Salud, Mexico City, 04530, Mexico

Chart of Vitamin D and COVID

Chart of Vitamin D metabolism and genes

Table 1. Therapeutic effects of vitamin D in COVID-19 in clinical trials

Table 2. The neuroprotective role of vitamin D in some clinical conditions

Table 3. Clinical trials effect of vitamin D in neuro- COVID-19

Vitamin D is a hormone involved in the regulation of important biological processes such as signal transduction, immune response, metabolic regulation and also in the nervous and vascular systems. To date, coronavirus disease 2019 (COVID-19) infection does not have a specific treatment. However, various drugs have been proposed, including those that attenuate the intense inflammatory response, and recently, the use of vitamin D, in clinical trials, as part of the treatment of COVID-19 has provided promising results. It has been observed in some clinical studies that the use of cholecalciferol (vitamin D3) and its two metabolites the circulating form, calcidiol or calcifediol (25-hydroxycalciferol, 25-(OH)-D), and the active form, calcitriol (1,25-(OH)2-D), in different doses, improve the clinical manifestations, prognosis, and survival of patients infected with COVID-19 probably because of its anti-inflammatory, antiviral and lung-protective action. In relation to the central nervous system (CNS) it has been shown, in clinical studies, that vitamin D is beneficial in some neurological and psychiatric conditions because of its anti-inflammatory and antioxidant properties, modulation of neurotransmitters actions, and regulation of calcium homeostasis between other mechanisms.
It has been shown that COVID-19 infection induces CNS complications such as

• headache,
• anosmia,
• ageusia,
• neuropathy,
• encephalitis,
• stroke,
• thrombosis,
• cerebral hemorrhages,
• cytotoxic lesions, and
• psychiatric conditions

and it has been proposed that the use of dietary supplements, as vitamin and minerals, can be adjuvants in this disease. In this review, the evidence of the possible role of vitamin D, and its metabolites, as a protector against the neurological manifestations of COVID-19 was summarized.
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CONCLUSION

Even though more data from clinical trials pointing to the benefit of vitamin D supplementation for the treatment of patients infected with COVID-19 are still necessary, it is plausible to observe that vitamin D decreases the severity of lung damage, the need for intensive care, the severity and mortality of this disease, as well as improving survival in these patients. According to the previous observations, it can be suggested that vitamin D could present protective properties against the neurological manifestations of COVID-19 given that in some studies it has been suggested that supplementation with this vitamin may reduce the progression of the disease towards neurological damage, probably due to its immunomodulatory, anti-inflammatory effect that secondarily may limit the damage of endothelial cells and decrease the prothrombotic state characteristic of this disease; in addition to the fact that in patients with neurological or psychiatric diseases supplementation with vitamin D may decrease the risk of developing a severe manifestation of SARS CoV-2 infection while during the COVID-19 pandemic lockdown it also improves the mental health of patients with neurological or psychiatric diseases.

However, it is necessary to await the results of ongoing clinical trials to demonstrate that vitamin D supplementation can prevent or decrease the occurrence of SARS-CoV-2-induced neurological symptoms and to conduct further studies to demonstrate the biochemical or molecular mechanisms by which vitamin D exhibits benefits (including neuroprotective) properties in COVID-19. This becomes even more important because currently, there is no specific treatment and the available one does not preserve life in all cases. Taking into account the current situation, there is the possibility of periodic lapses of contagion and deaths due to severe COVID-19 in months when the population has less sun exposure. Therefore, to be able to define between cholecalciferol, calcidiol or calcitriol, which is the most useful form, in addition to other specific aspects such as dosage for pre-hospital or hospital use in patients with COVID-19 in order to decrease progression to critical illness, hospital care costs and improve the prognosis of patients' life is pressing.

Finally, other studies indicate that vitamin D can attenuate other virus infections, and further knowledge of this may provide useful indications for reducing mortality caused by other viruses that trigger systemic hyperinflammation.

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