- Durante los últimos meses, se han publicado varios artículos revisados por pares sobre el papel que se cree que desempeña la vitamina D en la reducción de la morbilidad y la mortalidad asociadas con las infecciones virales COVID-19. A medida que se acerca el invierno en el hemisferio norte, la luz solar está menos disponible para estimular la producción de vitamina D.
Para leer ( escrito en ingles) La deficiencia de vitamina D y la contaminación del aire exacerban COVID-19 mediante la supresión del péptido antiviral LL37. Front. Public Health 8: 232. doi: 10.3389 / fpubh.2020.00232, haga clic aquí. Pero si simplemente desea comprender un poco más sobre esta fascinante hormona / vitamina, siga leyendo.
Las vitaminas se necesitan en pequeñas cantidades para apoyar los procesos vitales normales. La mayoría se puede obtener de fuentes alimentarias. Sin embargo, dado que las dietas varían, algunas deben obtenerse de suplementos. La vitamina D es un caso especial. En realidad, es una hormona que se obtiene a partir de alimentos o suplementos, pero que también produce el cuerpo en condiciones favorables. Los seres humanos podemos producir nuestra propia vitamina D cuando nuestra piel está expuesta a la luz solar. Exponer los brazos y las piernas durante unos 15 minutos al día, cuando el sol está al menos a la mitad del horizonte, puede ser de gran ayuda para proporcionar lo que el cuerpo necesita para producir vitamina D.
¡Una nota de precaución! Las quemaduras solares son peligrosas y el tiempo prolongado al sol no significa que su cuerpo produzca más vitamina D. Nuestros sistemas tienen un mecanismo de apagado natural. Después de cierto punto, el cuerpo deja de producir vitamina D, por lo que este es uno de esos casos en los que demasiado puede ser peor que insuficiente.
En esta época de COVID-19, se han escrito muchos artículos sobre los posibles beneficios de la vitamina D para reducir el impacto de la enfermedad. Algunos han analizado la evidencia de los registros de pacientes que comparan sus niveles de vitamina D medidos previamente con qué tan enfermos se enfermaron con COVID-19. Otros han analizado información establecida sobre qué grupos de personas tienden a tener niveles adecuados de vitamina D y qué grupos tienden a tener niveles bajos y deficientes de vitamina D. Muchos de estos artículos apuntan a la evidencia de que la vitamina D tiene un beneficio protector cuando se combate el virus respiratorio. infecciones en general. También señalan evidencia reciente de que COVID-19 es menos grave cuando los niveles de vitamina D son adecuados.
Como hormona, la vitamina D tiene una amplia gama de efectos en el cuerpo. Ayuda a regular más de mil genes, muchos de los cuales están relacionados con el sistema inmunológico. La vitamina D modula las respuestas inmunitarias, lo que permite una respuesta equilibrada del cuerpo a los desafíos de bacterias y virus. Desempeña un papel clave en la producción de moléculas que atacan y destruyen microbios. También es compatible con la señalización de célula a célula, lo que hace posible que el sistema inmunológico responda sin excesos que pueden ser tan peligrosos como los microbios.
¿Cómo saber si está obteniendo suficiente vitamina D? Se encuentran disponibles análisis de sangre simples para determinar si su nivel es suficiente para satisfacer las necesidades de su cuerpo. La deficiencia e insuficiencia de vitamina D se encuentran ampliamente en las sociedades industrializadas de todo el mundo, especialmente en áreas a más de 37 grados de latitud distantes del ecuador. La deficiencia también es común en adultos mayores, en personas con diabetes, enfermedades cardíacas, obesidad, hipertensión y algunas formas de cáncer. En los EE. UU., Se ha documentado que la deficiencia de vitamina D es común en personas con herencia genética afroamericana. La deficiencia de vitamina D se define como tener un nivel de 25-hidroxivitamina D por debajo de 20 ng / ml (50 nmol / litro). Cuando la vitamina D se encuentra entre 21-29 ng / ml (52,5-72,5 nmol / litro), se define como insuficiente. Si está disponible, solicite una prueba a su proveedor médico.
Las fuentes difieren en la cantidad de vitamina D que deben tomar las personas. En 2011, The Endocrine Society, un prestigioso grupo de endocrinólogos profesionales que tratan a pacientes con trastornos hormonales, recomienda de 1.500 iu (37,5 mcg) a 2.000 iu (50 mcg) para cualquier persona mayor de 19 años para elevar el nivel sanguíneo de 25 (OH ) D consistentemente por encima de 30 ng / ml (75 nmol / litro). Para los menores de 19 años, sugieren que se pueden requerir al menos 1000 UI / día de vitamina D para alcanzar y mantener un nivel constantemente por encima de 30 ng / ml (75 nmol / litro). Reconocen que los grupos específicos en riesgo pueden necesitar niveles más altos de suplementos de vitamina D para lograr y mantener suficiente vitamina D. La Sociedad de Endocrinas también establece que una dosis diaria máxima segura no debe exceder los 10,000 UI (250 mcg). Los científicos que realizan el ensayo VITAL (vitamina D y Omega 3) también han elegido una dosis de 2000 UI / día para los participantes del estudio que reciben suplementos de vitamina D. Sin embargo, este estudio está en curso con resultados probables en 2021 o más allá.
Independientemente de estas recomendaciones y estudios, muchos médicos recomiendan dosis más altas. La forma más segura y eficaz de determinar su necesidad de vitamina D y la dosis correcta es consultar a su proveedor médico para obtener asesoramiento profesional.
Para leer (escrito en ingles) La deficiencia de vitamina D y la contaminación del aire exacerban COVID-19 mediante la supresión del péptido antiviral LL37. Front. Public Health 8: 232. doi: 10.3389 / fpubh.2020.00232, haga clic aquí.
Para leer el abstracto en espanol haga clic aqui
Esperamos que comparta esta información con sus colegas.
Front. Public Health, 28 May 2020 | https://doi.org/10.3389/fpubh.2020.00232
La deficiencia e insuficiencia de vitamina D (VDD) son ampliamente reconocidos como factores de riesgo de infecciones del tracto respiratorio. La vitamina D influye en la expresión de muchos genes con relevancia bien establecida para las infecciones de las vías respiratorias y relevante para la función del sistema inmunológico. Recientemente, se ha demostrado que la VDD es un factor de riesgo para la adquisición y la gravedad de COVID-19. Por lo tanto, el tratamiento de VDD presenta una oportunidad segura y económica para modular la gravedad de la enfermedad. La VDD es común en las personas mayores de 60 años, muchas con afecciones comórbidas y en personas con pigmentación cutánea suficiente para reducir la síntesis de vitamina D. La exposición a la contaminación del aire por partículas finas también se asocia con peores resultados de COVID19. La vitamina D estimula la transcripción de catelicidina que se escinde para generar LL37. LL37 es un antimicrobiano innato con actividad demostrada contra una amplia gama de microbios, incluidos los virus de la envoltura. LL37 también modula la señalización de citocinas en el sitio de las infecciones. Las partículas finas en la contaminación del aire pueden interferir con la destrucción de virus LL37 y pueden reducir la modulación de señalización inmunológica efectiva por LL37. Si bien la vitamina D influye en la transcripción de muchos genes relacionados con la inmunidad, la respuesta antimicrobiana debilitada de las personas con VDD contra el SARS-CoV-2 puede deberse en parte a la reducción de LL37.
Conclusión: La vitamina D juega un papel importante en la reducción del impacto de los procesos de enfermedades pulmonares virales. La deficiencia de vitamina D es una amenaza para la salud pública reconocida que justifica la acción de toda la población para reducir la morbilidad y la mortalidad por COVID-19. Si bien la vitamina D influye en la transcripción de muchos genes relacionados con la inmunidad, la respuesta antimicrobiana debilitada de las personas con VDD contra el SARS-CoV-2 puede deberse en parte a la reducción de LL37. Se necesitan acciones para abordar los riesgos asociados con COVID-19 de contaminación del aire de la industria, el transporte, las fuentes domésticas y el humo de tabaco primario y pasivo.
Ver el texto completo en inglés o descargarlo gratuitamente de Frontiers in Public Health https://www.frontiersin.org/articles/10.3389/fpubh.2020.00232/full
Front. Public Health, 28 May 2020 | https://doi.org/10.3389/fpubh.2020.00232
- 1Department of Immunology and Microbiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- 2Bodymind Science, LLC, Arlington, VT, United States
- 3Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
Vitamin D deficiency and insufficiency (VDD) are widely recognized as risk factors for respiratory tract infections. Vitamin D influences expression of many genes with well-established relevance to airway infections and relevant to immune system function. Recently, VDD has been shown to be a risk factor for acquisition and severity of COVID-19. Thus, treating VDD presents a safe and inexpensive opportunity for modulating the severity of the disease. VDD is common in those over 60 years of age, many with co-morbid conditions and in people with skin pigmentation sufficient to reduce synthesis of vitamin D. Exposure to fine particulate air pollution is also associated with worse outcomes from COVID19. Vitamin D stimulates transcription of cathelicidin which is cleaved to generate LL37. LL37 is an innate antimicrobial with demonstrated activity against a wide range of microbes including envelope viruses. LL37 also modulates cytokine signaling at the site of infections. Fine particles in air pollution can interfere with LL37 destruction of viruses and may reduce effective immune signaling modulation by LL37. While vitamin D influences transcription of many immune related genes, the weakened antimicrobial response of those with VDD against SARS-CoV-2 may be in part due to reduced LL37.
Conclusion: Vitamin D plays an important role reducing the impact of viral lung disease processes. Vitamin D deficiency is an acknowledged public health threat that warrants population-wide action to reduce COVID-19 morbidity and mortality. While vitamin D influences transcription of many immune related genes, the weakened antimicrobial response of those with VDD against SARS-CoV-2 may be in part due to reduced LL37. Action is needed to address COVID-19 associated risks of air pollution from industry, transportation, domestic sources and from primary and second hand tobacco smoke.
Full text view or download freely available from Frontier in Public Health https://www.frontiersin.org/articles/10.3389/fpubh.2020.00232/full
Innate immunity in the context of COVID-19
This post is an adapted excerpt from our recent paper published in Frontiers in Public Health. Download the full article freely here: https://www.frontiersin.org/articles/10.3389/fpubh.2020.00232/full
Mammals have complex immune systems. Survival depends on the ability to integrate and coordinate adaptive and innate responses to microbial threats. Adaptive immune responses take days to weeks to produce antibodies to new bacteria and viruses. In the mean time, the body has to fight off the infection. Innate immunity is that first line of defense. Also, it is the entire defense against a novel pathogen before the slower adaptive immune system has an opportunity to respond. This is the reality and challenge that we face in COVID-19.
Humans have multiple layers of innate protection. Skin on the outside of the body and mucosal epithelial cells, like those found in the respiratory and digestve tracts, provide barrier protection. Many cell types are sensitive to the presence of microbes, providing cellular surveillance and communications between cells found at mucosal surfaces with other parts of the immune system. As part of this system of defense, virtually all metazoan animals, including humans, release antimicrobial peptides (AMPs) that both kill invading microbes and act as immune signaling mediators. Most immune communications are complex but subtle. Under optimal conditions, regulators of immune responses maintain balanced responses, neither too strong nor too weak. An example of an immune system regulator is vitamin D. Many people world wide are vitamin D deficient. Without adequate vitamin D, the body’s immune system cannot maintain optimal balance to protect against microbes.
Because of innate immunity, most microbes are not dangerous to other life forms, including humans. The antimicrobial peptides, AMPs that we mention above, are key element in successfully maintaining boundaries between the mammalian host and the ever present microbial flora to which all life forms are exposed. An example of antimicrobial innate protection is cathelicidin and a smaller fragment of it known as LL37. LL37 is a broad-spectrum antibacterial and antiviral AMP best known for its role in protecting against the organism that causes tuberculosis. Interestingly, LL37 can also destroy envelope viruses, similar to the virus that causes COVID-19.
Our publication in Frontiers in Public Health tells more of the story. We explain how Vitamin D regulates the production of LL37 and how carbon particles in air pollution can interfere.
This post is an adapted excerpt from our recent paper published in Frontiers in Public Health. Download the full article freely here: https://www.frontiersin.org/articles/10.3389/fpubh.2020.00232/full
Citation: Crane-Godreau MA, Clem KJ, Payne P and Fiering S (2020) Vitamin D Deficiency and Air Pollution Exacerbate COVID-19 Through Suppression of Antiviral Peptide LL37. Front. Public Health 8:232. doi: 10.3389/fpubh.2020.00232
Keywords: COVID-19, Vitamin D deficiency, cathelicidin/LL37, air pollution, citrullination of peptide, carbon nanoparticles, African American, tobacco smoke
FOR IMMEDIATE RELEASE Update 6 June, 2020
Contact: Mardi Crane-Godreau, PhD EMAIL: mardi.dartmouth.related@gmail.com
Innate immune protection against COVID-19 is compromised by vitamin D deficiency & air pollution.
Protection against COVID-19 requires both adequate vitamin D and clean air.
Absence of LL37, a naturally occurring anti-viral secretion of the human respiratory tract, may explain serious vs. mild COVID-19 symptoms. Production of LL37 is regulated by Vitamin D. Individuals with vitamin D deficiency may not produce adequate LL37 to protect against the COVID-19 or other viral infections.
LL37 destroys envelope viruses by damaging their envelope. This happens by virtue of its positive electrical charge. When fine particles in air pollution come in contact with LL37, they neutralize the positive charge of LL37, leaving LL37 inert. This leaves viruses to reproduce and spread freely. Consistent with observations of high death rates and high levels of pollution in COVID-19 hot spots, the neutralization of LL37 by nanoparticles may explain these phenomena.
Protection against COVID-19 requires both adequate vitamin D and clean air. Interestingly, the absence of either or both, has adverse impact on the ability to fight any viral infection. Since LL37 also modulates immune responses, its absence not only leaves those with viral infections vulnerable to direct viral damage but also to inflammatory responses by the immune system.
Crane-Godreau, Clem, Payne and Fiering, a team of Dartmouth scientists, published their insights in Frontiers in Public Health. https://www.frontiersin.org/articles/10.3389/fpubh.2020.00232/full
Dr. Crane-Godreau, explained, “Our innate immune system is the first line of defense against infection and the only line of defense when the body is challenged by a novel microbe. It takes days to weeks to develop antibodies, but in the mean time, you have to survive the infection. LL37 plays a critical role in protecting against both viral and bacterial infections. The body requires adequate vitamin D to regulate its production. This is consistent with reports by scientist and doctors, that vitamin D is playing a role in reducing the impact of the virus.”
Crane-Godreau commented, “Early in the pandemic, while we felt that LL37 was likely protecting populations with adequate vitamin D levels, we were perplexed by the high death rates in various high pollution hot spots. Further investigation led to our understanding that LL37 can be neutralized by coming in contact with carbon nanoparticles. Those are the fine particles found in industrial and transportation associated air pollution. Risk exists from other sources of air pollution including wood burning stoves and primary and second-hand smoke. ”
Emergency medicine clinician and co-author, Dr. Kathleen Clem, pointed to the link between adequate vitamin D levels and better outcomes in patients who contract COVID-19. She added “Air quality is also a factor. While mask-wearing decreases spread of the virus, the correct types of masks can also protect against poor air quality. We see both clean air and adequate vitamin D levels as necessary to minimize illness and deaths from COVID-19.”
LL37 has demonstrated antiviral activity against several other envelope viruses including Respiratory Syncytial Virus, Influenza A, Hepatitis C, Dengue Virus, HIV-1 and Vaccinia Virus. It does this by destroying the envelope with its positive charge.
The paper calls for development of relevant protocols for prevention and treatment of COVID-19. The authors also call for mitigation of exposure to fine particles from industrial and transportation associated air pollution as well as from primary and second-hand tobacco smoke and other domestic sources.
Mardi Crane-Godreau, PhD
- Over the last several months a number of peer reviewed papers have been published about the role that vitamin D is believed to play in reducing morbidity and mortality associated with COVID-19 viral infections. As winter approaches in the northern hemisphere, sunlight is less available to stimulate production of vitamin D.
To read Vitamin D Deficiency and Air Pollution Exacerbate COVID-19 Through Suppression of Antiviral Peptide LL37. Front. Public Health 8:232. doi: 10.3389/fpubh.2020.00232, click here. But if you simply want to understand a little more about this fascinating hormone/vitamin, read on.
Vitamins are needed in small quantities to support normal life processes. Most can be obtained from food sources. However, since diets vary, some need to be obtained from supplements. Vitamin D is somewhat of a special case. It’s actually a hormone, obtained from food or supplements, but also made by the body under favorable conditions. We humans are able to make our own vitamin D when our skin is exposed to sunlight. Exposing arms and legs for about 15 minutes per day, when the sun is at least halfway up from the horizon, can go a long way to provide what is needed by the body to make vitamin D.
A note of caution! Sunburn is dangerous and extended time in the sun does not mean that your body will make more vitamin D. Our systems have a natural shut off mechanism. After a certain point, the body stops making vitamin D, so this is one of those instances where too much can be worse than not enough.
In this time of COVID-19, many articles have been written about the possible benefits of vitamin D in reducing the impact of the disease. Some have looked at evidence from patient records comparing their previously measured vitamin D levels with how sick they became with COVID-19. Others have looked at established information about which groups of people tend to have adequate vitamin D levels and which groups tend to have low, deficient levels of vitamin D. Many of these articles point to evidence that vitamin D has a protective benefit when fighting respiratory viral infections in general. They also point to recent evidence that COVID-19 is less severe when vitamin D levels are adequate.
As a hormone, vitamin D has a wide range of effects on the body. It helps to regulate over a thousand genes, many of which are related to the immune system. Vitamin D modulates immune responses allowing for a balanced response by the body to challenges from bacteria and viruses. It plays a key role in making molecules that attack and destroy microbes. It also supports cell to cell signaling, making it possible for the immune system to respond without excesses that can be as dangerous as the microbes.
How do you know if you are getting enough vitamin D? Simple blood tests are available to determine if your level is sufficient to meet the needs of your body. Vitamin D deficiency and insufficiency are found widely in industrialized societies world wide, especially in areas more than 37 degrees latitude distant from the equator. Deficiency is also common in older adults, in individuals with diabetes, heart disease, obesity, hypertension and some forms of cancer. In the US, vitamin D deficiency is documented to be common in those with African American genetic heritage. Vitamin D deficiency is defined as having a level of 25-hydroxyvitamin D below 20 ng/ml (50 nmol/liter). When vitamin D is between 21–29 ng/ml (52.5–72.5 nmol/liter) it is defined as insufficient. If available, ask your medical provider for a test.
Sources differ on how much vitamin D individuals should take. In 2011, The Endocrine Society, a prestigious group of professional endocrinologists who treat patients with hormonal disorders, recommends from 1,500 iu (37.5 mcg) to 2,000 iu (50 mcg) for anyone over 19 years old to raise the blood level of 25(OH)D consistently above 30 ng/ml (75 nmol/liter). For those 19 and under, they suggest that at least 1000 IU/d of vitamin D may be required to achieve and maintain a level consistently above 30 ng/ml (75 nmol/liter). They acknowledge that specific at-risk groups may need higher levels of vitamin D supplementation to achieve and maintain sufficient vitamin D. The Endocrines Society also states that a maximum safe daily dose should not exceed 10,000 iu (250 mcg). Scientists conducting the VITAL (vitamin D and Omega 3) Trial also have chosen a dose of 2,000 iu/day dose for those in the study, who are receiving vitamin D supplements. However this study is ongoing with results likely in 2021 or beyond.
Irrespective of these recommendations and studies, many physicians recommend higher doses. The safest and most effective way to determine your need for vitamin D and the correct dose, is to consult your medical provider for professional advice.
Mardi A. Crane-Godreau
Kathleen J. Clem
Peter Payne
Steven Fiering
You must be logged in to post a comment.