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Vitamin D and COVID-19.
I saw @ChrisMasterjohn post something about how he wasn't taking vitamin D because it could potentially increase ACE-2 receptors. So, I started checking it on my admitted COVID patients out of curiosity. Invariably, it has been low <=30ng/mL
I saw @ChrisMasterjohn post something about how he wasn't taking vitamin D because it could potentially increase ACE-2 receptors. So, I started checking it on my admitted COVID patients out of curiosity. Invariably, it has been low <=30ng/mL
There has been a lot of focus on IL-6 inhibiting drugs, and there are reports that these medications have had some success with COVID patients.
Interestingly, researchers have described the exact mechanism for vitamin D's inhibition of IL-6.
Interestingly, researchers have described the exact mechanism for vitamin D's inhibition of IL-6.
https://www.jimmunol.org/content/188/5/2127
MKP-1 is upregulated by vitamin D. MKP-1 is known to inactivate p-38. p-38 phosphorylation, in this case, induced by LPS, increases IL6 and TNF-alpha.
The above study found that adequate vitamin D levels (30ng/ml) suppressed LPS phosphorylation of p-38
MKP-1 is upregulated by vitamin D. MKP-1 is known to inactivate p-38. p-38 phosphorylation, in this case, induced by LPS, increases IL6 and TNF-alpha.
The above study found that adequate vitamin D levels (30ng/ml) suppressed LPS phosphorylation of p-38
The suppressed phosphorylation of p-38 resulted in lower IL-6 and TNF-alpha levels in the study. Low vitamin D levels did NOT suppress phosphorylation with the LPS challenge, similar to MKP knockout mice, and IL-6 and TNF-alpha levels were significantly higher.
You know what else inhibits p-38? Chloroquine.
https://www.ncbi.nlm.nih.gov/pubmed/18055026?dopt=Abstract
In the above study, infection with HCoV-229E significantly induced phosphorylation of p38, but pretreatment with chloroquine inhibited the phosphorylation of p-38, just like vitamin D did in the first study
https://www.ncbi.nlm.nih.gov/pubmed/18055026?dopt=Abstract
In the above study, infection with HCoV-229E significantly induced phosphorylation of p38, but pretreatment with chloroquine inhibited the phosphorylation of p-38, just like vitamin D did in the first study
This has been observed elsewhere, like in this study of HIV infected patients. Vitamin D deficiency was associated with significantly elevated IL-6, TNF-alpha, d-dimer (something we're also seeing).
https://www.ncbi.nlm.nih.gov/pubmed/28464004
https://www.ncbi.nlm.nih.gov/pubmed/28464004
Does an adequate vitamin D level protect against some of the cytokine storm we're seeing with COVID-19? I don't know. I just haven't seen any vitamin D levels in the 40's or higher yet on ANY patient I've admitted with it. I'd be interested to see if others are seeing the same
At the very least, there is a well-defined mechanism for vitamin D's suppression of p38, like chloroquine, and it would seem very low risk to suggest that people ensure they have an adequate vitamin D level, at the very minimum over 30.
I'm an emergency physician and not a cell biologist, so those people are free to weigh in. @PeterAttiaMD , maybe you have some thoughts or people to run this by?
