The primary goal of the review was to highlight the possible therapeutic role of vitamins A, B, C, D, E, and K and micronutrients as immunity boosters in COVID-19 patients. In the study, researchers aimed to discuss and present recent data regarding the role of vitamins and minerals in the treatment of COVID-19. Researchers noted that a deficiency of these vitamins and minerals in the plasma concentration may lead to a decrease in the effective performance of the immune system, which is one of the factors that lead to a poor immune state.

The review indicated that vitamin A controls various genes involved in innate and adaptive immune responses. Several studies have revealed the protective nature of natural and synthetic retinoids on some viruses, including hepatitis B virus, norovirus, influenza, and cytomegalovirus. The authors also indicated that vitamins under the B complex category are critical for the normal physiologic functioning of the body as they assist the body in the use of nutrients such as carbohydrates, proteins, and fat. While B1, thiamine, is a coenzyme that is vital for nervous- and immune-system functioning and has an anti-inflammatory effect, a deficiency affects the immune system, leading to expanded inflammation and oxidative stress. Adequate levels of thiamine help build immunity against SARS-CoV-2 as it eliminates the SARS-CoV-2 virus by triggering humoral and cell-mediated immunity.

Vitamin B2 (riboflavin) is a neuroactive compound with immunomodulatory impressions and can reduce pathogens in the blood of COVID-19 patients thus reducing transfusion–transmission risk in COVID-19. Vitamin B3 [niacin (nicotinic acid, pantothenic acid)] has an anti-inflammatory impact, and recent studies demonstrate that it can help decrease inflammation in patients with COVID-19 and can even be used as an adjunct therapy. Vitamin B6 (pyridoxine) influences innate/adaptive immunity and the proliferation of immune cells. The publication also indicated that a recent study revealed that pyridoxine supplementation relieves COVID-19 symptoms via diminishing proinflammatory cytokines, improving immune responses, and preventing hypercoagulability. With regard to vitamin B9 (folic acid, folate), the authors noted that it is essential for DNA and protein synthesis and plays a vital role in the adaptive immune response.

According to a recent study, folic acid inhibits the enzyme furin and blocks the binding of the SARS-CoV-2 spike protein, which makes it beneficial in controlling respiratory disease in COVID-19. Vitamin B12 (cobalamin/cyanocobalamin) may regulate chemokine/cytokine formation and mediate the communication among immune cells in pathophysiological pathways and thus protect against various bacterial and viral infections, including COVID-19. The review also indicated that vitamin C is known to support the immune system in its fight against bacterial and viral infections. The authors stated that IV vitamin C administration substantially decreases sepsis and acute respiratory distress syndrome. Direct and indirect evidence reveals the role of vitamin C in treating COVID-19 patients.

With regard to vitamin D, which has antioxidant and anti-inflammatory properties that inhibit the overexpression of inflammatory cytokines IL-1α, IL-1β, and tumor necrosis factor-α, literature reveals that vitamin D has been explored for use in treating acute respiratory tract infections. It has been reported that it modulates ACE2 expression in lung tissue, a pathogenic factor in COVID-19. Moreover, the authors noted that vitamin E is a potent antioxidant and plays a crucial role in the regulation of immune system function. Studies have revealed that increased vitamin E intake helps maintain immunity in elderly individuals. Lastly, the authors discussed vitamin K, which is a fat-soluble vitamin naturally present in some foods and is a coenzyme involved in hemostasis. Vitamin K1 is involved in the activation of hepatic coagulation factors and thus helps fight thrombotic complications in COVID-19 patients.

The researchers noted that mineral supplementation has been shown to positively impact immunity in viral infections and thwart and decrease cardiovascular and cerebrovascular diseases, which are features of severe COVID-19 infections. The authors concluded that based on the above evaluation of the role of vitamins and minerals in fighting COVID-19, it can be concluded that vitamins and micronutrient supplementation may positively impact COVID-19 outcomes and may be a promising approach towards treatment of SARS-CoV infection.

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