Immunity and Disease Prevention Research Unit, USDA Western Human Nutrition Research Center, and Nutrition Department, University of California, Davis, CA, USA.
Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon TyneNE2 4HH, UK.
Br J Nutr. 2021 Dec 14;126(11):1663-1672. doi: 10.1017/S0007114521000246. Epub 2021 Jan 20.
SARS-CoV2 infects respiratory epithelial cells via its cellular receptor angiotensin-converting enzyme 2, causing a viral pneumonia with pronounced inflammation resulting in significant damage to the lungs and other organ systems, including the kidneys, though symptoms and disease severity are quite variable depending on the intensity of exposure and presence of underlying conditions that may affect the immune response. The resulting disease, coronavirus disease 2019 (COVID-19), can cause multi-organ system dysfunction in patients requiring hospitalisation and intensive care treatment. Serious infections like COVID-19 often negatively affect nutritional status, and the resulting nutritional deficiencies may increase disease severity and impair recovery. One example is the viral infection measles, where associated vitamin A (VA) deficiency increases disease severity and appropriately timed supplementation during recovery reduces mortality and hastens recovery. VA may play a similar role in COVID-19. First, VA is important in maintaining innate and adaptive immunity to promote clearance of a primary infection as well as minimise risks from secondary infections. Second, VA plays a unique role in the respiratory tract, minimising damaging inflammation, supporting repair of respiratory epithelium and preventing fibrosis. Third, VA deficiency may develop during COVID-19 due to specific effects on lung and liver stores caused by inflammation and impaired kidney function, suggesting that supplements may be needed to restore adequate status. Fourth, VA supplementation may counteract adverse effects of SARS-CoV2 on the angiotensin system as well as minimises adverse effects of some COVID-19 therapies. Evaluating interactions of SARS-CoV2 infection with VA metabolism may thus provide improved COVID-19 therapy.
SARS-CoV2 通过其细胞受体血管紧张素转换酶 2 感染呼吸道上皮细胞，导致病毒性肺炎伴有明显炎症，导致肺部和其他器官系统（包括肾脏）严重受损，但症状和疾病严重程度因暴露强度和可能影响免疫反应的潜在疾病而异。由此产生的疾病，即 2019 年冠状病毒病（COVID-19），可导致需要住院和重症监护治疗的患者多器官系统功能障碍。像 COVID-19 这样的严重感染通常会对营养状况产生负面影响，由此产生的营养缺乏可能会增加疾病的严重程度并损害恢复。一个例子是麻疹病毒感染，其中相关的维生素 A（VA）缺乏会增加疾病的严重程度，而在恢复期间适时补充 VA 可以降低死亡率并加速恢复。VA 在 COVID-19 中可能发挥类似作用。首先，VA 对维持先天和适应性免疫很重要，以促进清除原发性感染并最大程度降低继发感染的风险。其次，VA 在呼吸道中发挥独特作用，可最大程度减少破坏性炎症，支持呼吸道上皮修复并预防纤维化。第三，由于炎症和肾功能受损对肺部和肝脏储存的特定影响，VA 缺乏可能在 COVID-19 期间发生，这表明可能需要补充剂来恢复足够的状态。第四，VA 补充可能会抵消 SARS-CoV2 对血管紧张素系统的不利影响，并最大程度地减少 COVID-19 治疗的一些不良反应。因此，评估 SARS-CoV2 感染与 VA 代谢之间的相互作用可能会提供改善 COVID-19 治疗的方法。
