scholarly journals Vitamin D supplementation as a rational pharmacological approach in the COVID-19 pandemic

2020 ◽  
Vol 319 (6) ◽  
pp. L941-L948 ◽  
Author(s):  
León Ferder ◽  
Virna Margarita Martín Giménez ◽  
Felipe Inserra ◽  
Carlos Tajer ◽  
Laura Antonietti ◽  
...  
Keyword(s):  
Public Health ◽  
Vitamin D ◽  
Severe Acute Respiratory Syndrome ◽  
Renin Angiotensin System ◽  
Vitamin D Supplementation ◽  
Therapeutic Effects ◽  
Pharmacological Agents ◽  
Angiotensin System ◽  
Therapeutic Measure ◽  
Oxidative Signaling

The COVID-19 pandemic has reached most of the countries worldwide causing death, which often results from an inflammatory storm associated with severe acute respiratory syndrome (SARS). This has prompted researchers to seek specific novel and definitive treatments urgently. In this context, it is interesting to evaluate the preventive and therapeutic effects of existing pharmacological agents that could be useful. In this regard, vitamin D supplementation, particularly in individuals likely to be deficient, may be a promising option. Vitamin D is a hormone that modulates many of the same inflammatory and oxidative signaling pathways triggered during COVID-19. For example, vitamin D suppresses the actions of the renin-angiotensin system, which has a determining role in the pathophysiology of the inflammatory response related to COVID-19. This paper analyzes the evidence that vitamin D supplementation might be a valuable preventive/therapeutic measure in groups at risk for or infected with COVID-19. It also discusses how clinical studies could be best designed to evaluate the possible advantages of vitamin D supplementation for the benefit of public health during the pandemic.

scholarly journals Association between Vitamin D and Heart Failure Mortality in 10,974 Hospitalized Individuals

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 335
Author(s):  
Kenya Kusunose ◽  
Yuichiro Okushi ◽  
Yoshihiro Okayama ◽  
Robert Zheng ◽  
Miho Abe ◽  
...  
Keyword(s):  
Heart Failure ◽  
Vitamin D ◽  
Hospital Mortality ◽  
Group Analysis ◽  
Renin Angiotensin System ◽  
Vitamin D Supplementation ◽  
Matched Cohort ◽  
Angiotensin System ◽  
Diagnosis Procedure Combination ◽  
Β Blocker

A broad range of chronic conditions, including heart failure (HF), have been associated with vitamin D deficiency. Existing clinical trials involving vitamin D supplementation in chronic HF patients have been inconclusive. We sought to evaluate the outcomes of patients with vitamin D supplementation, compared with a matched cohort using real-world big data of HF hospitalization. This study was based on the Diagnosis Procedure Combination database in the Japanese Registry of All Cardiac and Vascular Datasets (JROAD-DPC). After exclusion criteria, we identified 93,692 patients who were first hospitalized with HF between April 2012 and March 2017 (mean age was 79 ± 12 years, and 52.2% were male). Propensity score (PS) was estimated with logistic regression model, with vitamin D supplementation as the dependent variable and clinically relevant covariates. On PS-matched analysis with 10,974 patients, patients with vitamin D supplementation had lower total in-hospital mortality (6.5 vs. 9.4%, odds ratio: 0.67, p < 0.001) and in-hospital mortality within 7 days and 30 days (0.9 vs. 2.5%, OR, 0.34, and 3.8 vs. 6.5%, OR: 0.56, both p < 0.001). In the sub-group analysis, mortalities in patients with age < 75, diabetes, dyslipidemia, atrial arrhythmia, cancer, renin-angiotensin system blocker, and β-blocker were not affected by vitamin D supplementation. Patients with vitamin D supplementation had a lower in-hospital mortality for HF than patients without vitamin D supplementation in the propensity matched cohort. The identification of specific clinical characteristics in patients benefitting from vitamin D may be useful for determining targets of future randomized control trials.

scholarly journals Vitamin D, SARS-CoV-2 and Causal Associations in Transversal Studies: The Time-Series Analysis to Reveal Potential Confounders. Comment on Gaudio et al. Vitamin D Levels Are Reduced at the Time of Hospital Admission in Sicilian SARS-CoV-2-Positive Patients. Int. J. Environ. Res. Public Health 2021, 18, 3491

2021 ◽  
Vol 18 (13) ◽  
pp. 6793
Author(s):  
Cristiano Ialongo ◽  
Antonella Farina ◽  
Raffaella Labriola ◽  
Antonio Angeloni ◽  
Emanuela Anastasi
Keyword(s):  
Public Health ◽  
Vitamin D ◽  
Time Series ◽  
Severe Acute Respiratory Syndrome ◽  
Time Series Analysis ◽  
Hospital Admission ◽  
The State ◽  
Series Analysis ◽  
Vitamin D Levels ◽  
Time Of Admission

We read with great interest the paper by Gaudio and colleagues on vitamin D and on the state of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the time of admission [...]

scholarly journals Responsibility for vitamin D supplementation of elderly care home residents in England: falling through the gap between medicine and food

2020 ◽  
pp. bmjnph-2020-000129
Author(s):  
Joseph Williams ◽  
Carol Williams
Keyword(s):  
Public Health ◽  
Vitamin D ◽  
Elderly Care ◽  
Care Home ◽  
Vitamin D Supplementation ◽  
Care Homes ◽  
Vitamin D Status ◽  
Structured Interviews ◽  
Medical Responsibility ◽  
Vitamin D Supplements

IntroductionDaily vitamin D supplements are recommended for elderly care home residents; however, they are rarely given and vitamin D deficiency in care homes is widespread. This study aimed to understand the determinants of current practice and perceived responsibility for the vitamin D status of residents.MethodsThirteen semi-structured interviews were conducted with key informants in two areas of Southern England including care home managers, general practitioners (GPs) and public health professionals. Interviews were audio recorded and transcribed verbatim.ResultsInductive thematic analysis identified four themes: framing of vitamin D supplements as medicines; professional and sector boundaries whereby GPs are perceived as responsible for the vitamin D status of residents and care home managers felt unable to administer over-the-counter vitamin tablets; low awareness of national guidance; and ethical and practical issues. This results in vitamin D supplements requiring prescription by medical professionals and few residents receiving them.ConclusionThe medical framing of vitamin D supplements in care homes is a practical barrier to implementation of longstanding nutrition guidelines. A paradigm shift is needed so that vitamin D is understood as a protective nutrient as well as a medicine, and a public health as well as a medical responsibility. Vitamin D is important for musculoskeletal health. Possible links with COVID-19 are still being investigated. The pandemic has drawn attention to conditions in care homes and there is an opportunity to revise current guidance on vitamin D supplementation which will have lasting benefit for this vulnerable group.

scholarly journals Vitamin D Supplementation in Australia: Implications for the Development of Supplementation Guidelines

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Kellie Bilinski ◽  
Peter Talbot
Keyword(s):  
Public Health ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Vitamin D Supplementation ◽  
Supplement Use ◽  
The Past ◽  
Threefold Increase ◽  
Vitamin D Supplements ◽  
Vitamin D Supplement ◽  
Potential Public Health

High rates of vitamin D deficiency and testing have been reported in Australia, yet there are few reports regarding vitamin D supplement use. Australian wholesale sales data was obtained for vitamin D supplements for the period 2000–2011. There has been a threefold increase in supplement sales over the past decade, whereby over A$94 million supplements containing vitamin D in Australia were sold during the year 2010. There were eighty-nine manufacturers that produce a variety of 195 vitamin D products. The amount of vitamin D in these products varies considerably, from 40 to 1000 IU per unit, although supplements containing only vitamin D had the highest amount of vitamin D. There was a trend for sales to increase in winter months. Given the potential public health benefits of vitamin D, there is an urgent need for a better understanding of supplementation use and for the development of supplementation.

scholarly journals Severe Acute Respiratory Syndrome Coronavirus 2, COVID-19, and the Renin-Angiotensin System

Hypertension ◽  
2020 ◽  
Vol 76 (5) ◽  
pp. 1350-1367 ◽  
Author(s):  
Matthew A. Sparks ◽  
Andrew M. South ◽  
Andrew D. Badley ◽  
Carissa M. Baker-Smith ◽  
Daniel Batlle ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Renin Angiotensin System ◽  
Organ Damage ◽  
Experimental Models ◽  
Multiple Organ ◽  
Host Cells ◽  
Ang Ii ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
Organ Systems

The coronavirus disease 2019 (COVID-19) pandemic is associated with significant morbidity and mortality throughout the world, predominantly due to lung and cardiovascular injury. The virus responsible for COVID-19—severe acute respiratory syndrome coronavirus 2—gains entry into host cells via ACE2 (angiotensin-converting enzyme 2). ACE2 is a primary enzyme within the key counter-regulatory pathway of the renin-angiotensin system (RAS), which acts to oppose the actions of Ang (angiotensin) II by generating Ang-(1–7) to reduce inflammation and fibrosis and mitigate end organ damage. As COVID-19 spans multiple organ systems linked to the cardiovascular system, it is imperative to understand clearly how severe acute respiratory syndrome coronavirus 2 may affect the multifaceted RAS. In addition, recognition of the role of ACE2 and the RAS in COVID-19 has renewed interest in its role in the pathophysiology of cardiovascular disease in general. We provide researchers with a framework of best practices in basic and clinical research to interrogate the RAS using appropriate methodology, especially those who are relatively new to the field. This is crucial, as there are many limitations inherent in investigating the RAS in experimental models and in humans. We discuss sound methodological approaches to quantifying enzyme content and activity (ACE, ACE2), peptides (Ang II, Ang-[1–7]), and receptors (types 1 and 2 Ang II receptors, Mas receptor). Our goal is to ensure appropriate research methodology for investigations of the RAS in patients with severe acute respiratory syndrome coronavirus 2 and COVID-19 to ensure optimal rigor and reproducibility and appropriate interpretation of results from these investigations.

Vitamin D Supplementation Improves Cognitive Function Through Reducing Oxidative Stress Regulated by Telomere Length in Older Adults with Mild Cognitive Impairment: A 12-Month Randomized Controlled Trial

2020 ◽  
Vol 78 (4) ◽  
pp. 1509-1518
Author(s):  
Tong Yang ◽  
Hualou Wang ◽  
Ying Xiong ◽  
Chong Chen ◽  
Keran Duan ◽  
...  
Keyword(s):  
Public Health ◽  
Oxidative Stress ◽  
Older Adults ◽  
Vitamin D ◽  
Placebo Group ◽  
Cognitive Function ◽  
Repeated Measures ◽  
Controlled Trial ◽  
Vitamin D Supplementation ◽  
Repeated Measures Anova

Background: Cognitive decline in older adults is a serious public health problem today. Association between vitamin D supplementation and cognition remains controversial. Objective: To determine whether a 12-month vitamin D supplementation improves cognitive function in elderly subjects with mild cognitive impairment (MCI), and whether it is mediated through the mechanism in which telomere length (TL) regulate oxidative stress. Methods: This was a double-blind, randomized, placebo-controlled trial in Tianjin, China. Participants were all native Chinese speakers aged 65 years and older with MCI. 183 subjects were randomized to an intervention group (vitamin D 800 IU/day, n = 93) or a placebo group (the matching starch granules, n = 90), and followed up for 12 months. Tests of cognitive function and mechanism-related biomarkers were evaluated at baseline, 6 months, and 12 months. Results: Repeated-measures ANOVA showed substantial improvements in the full scale intelligence quotient (FSIQ), information, digit span, vocabulary, block design, and picture arrangement scores in the vitamin D group over the placebo group (p < 0.001). Leukocyte TL was significantly higher, while serum 8-OXO-dG, OGG1mRNA, and P16INK4amRNA revealed greater decreases in the vitamin D group over the placebo group (p < 0.001). According to mixed-model repeated-measures ANOVA analysis, vitamin D group showed a significant enhancement in the FSIQ score for 12 months compared with the control (estimate value = 5.132, p < 0.001). Conclusion: Vitamin D supplementation for 12 months appears to improve cognitive function through reducing oxidative stress regulated by increased TL in order adults with MCI. Vitamin D may be a promising public health strategy to prevent cognitive decline.

The Renin-Angiotensin System and the Cerebrovascular Diseases: Experimental and Clinical Evidence

2020 ◽  
Vol 27 (6) ◽  
pp. 463-475 ◽  
Author(s):  
Lucas M. Kangussu ◽  
Lucas Alexandre Santos Marzano ◽  
Cássio Ferraz Souza ◽  
Carolina Couy Dantas ◽  
Aline Silva Miranda ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Renin Angiotensin System ◽  
Cerebrovascular Diseases ◽  
Therapeutic Effects ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
Mas Receptor

Cerebrovascular Diseases (CVD) comprise a wide spectrum of disorders, all sharing an acquired or inherited alteration of the cerebral vasculature. CVD have been associated with important changes in systemic and tissue Renin-Angiotensin System (RAS). The aim of this review was to summarize and to discuss recent findings related to the modulation of RAS components in CVD. The role of RAS axes is more extensively studied in experimentally induced stroke. By means of AT1 receptors in the brain, Ang II hampers cerebral blood flow and causes tissue ischemia, inflammation, oxidative stress, cell damage and apoptosis. On the other hand, Ang-(1-7) by stimulating Mas receptor promotes angiogenesis in brain tissue, decreases oxidative stress, neuroinflammation, and improves cognition, cerebral blood flow, neuronal survival, learning and memory. In regard to clinical studies, treatment with Angiotensin Converting Enzyme (ACE) inhibitors and AT1 receptor antagonists exerts preventive and therapeutic effects on stroke. Besides stroke, studies support a similar role of RAS molecules also in traumatic brain injury and cerebral aneurysm. The literature supports a beneficial role for the alternative RAS axis in CVD. Further studies are necessary to investigate the therapeutic potential of ACE2 activators and/or Mas receptor agonists in patients with CVD.

scholarly journals Renin-Angiotensin System Blockers and the COVID-19 Pandemic

Hypertension ◽  
2020 ◽  
Vol 75 (6) ◽  
pp. 1382-1385 ◽  
Author(s):  
A.H. Jan Danser ◽  
Murray Epstein ◽  
Daniel Batlle
Keyword(s):  
Angiotensin Ii ◽  
Severe Acute Respiratory Syndrome ◽  
Angiotensin Converting Enzyme ◽  
Renin Angiotensin System ◽  
Converting Enzyme ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
Receptor Blockers ◽  
Renin Angiotensin System Blockers

During the spread of the severe acute respiratory syndrome coronavirus-2, some reports of data still emerging and in need of full analysis indicate that certain groups of patients are at risk of COVID-19. This includes patients with hypertension, heart disease, diabetes mellitus, and clearly the elderly. Many of those patients are treated with renin-angiotensin system blockers. Because the ACE2 (angiotensin-converting enzyme 2) protein is the receptor that facilitates coronavirus entry into cells, the notion has been popularized that treatment with renin-angiotensin system blockers might increase the risk of developing a severe and fatal severe acute respiratory syndrome coronavirus-2 infection. The present article discusses this concept. ACE2 in its full-length form is a membrane-bound enzyme, whereas its shorter (soluble) form circulates in blood at very low levels. As a mono-carboxypeptidase, ACE2 contributes to the degradation of several substrates including angiotensins I and II. ACE (angiotensin-converting enzyme) inhibitors do not inhibit ACE2 because ACE and ACE2 are different enzymes. Although angiotensin II type 1 receptor blockers have been shown to upregulate ACE2 in experimental animals, the evidence is not always consistent and differs among the diverse angiotensin II type 1 receptor blockers and differing organs. Moreover, there are no data to support the notion that ACE inhibitor or angiotensin II type 1 receptor blocker administration facilitates coronavirus entry by increasing ACE2 expression in either animals or humans. Indeed, animal data support elevated ACE2 expression as conferring potential protective pulmonary and cardiovascular effects. In summary, based on the currently available evidence, treatment with renin-angiotensin system blockers should not be discontinued because of concerns with coronavirus infection.

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