School of Molecular & Life Sciences, Curtin University, Perth, WA, Australia.
Eur J Pharmacol. 2021 May 15;899:174031. doi: 10.1016/j.ejphar.2021.174031. Epub 2021 Mar 13.
Interleukin 6 (IL-6), which is involved in the cytokine storm phenomenon, is a therapeutic target in COVID-19, but monoclonal receptor antibody therapeutic agents such as tocilizumab have demonstrated mixed results. Could Vitamin D, which modulates IL-6, be more effective than currently deployed IL-6 antagonists, including tocilizumab, thereby presenting a useful therapeutic option in COVID-19? A narrative review of published trials examining the effect of Vitamin D administration in COVID-19 patients was conducted, and the theoretical basis for the use of tocilizumab as an IL-6 antagonist was compared with the immunomodulatory effect of Vitamin D on IL-6 production. Four of the six included studies reported a positive effect of Vitamin D on outcomes. While tocilizumab non-selectively blocks both anti-inflammatory and pro-inflammatory actions of IL-6, Vitamin D lowers immune cell IL-6 production, potentially reducing pro-inflammatory effects, but does not specifically target IL-6 receptors, avoiding any deleterious effect on the anti-inflammatory actions of IL-6. Vitamin D may have advantages over tocilizumab as an IL-6 immunomodulator, and, given that it is safe if administered under clinical supervision, there is a strong rationale for its use.
白细胞介素 6（IL-6）参与细胞因子风暴现象，是 COVID-19 的治疗靶点，但白细胞介素 6 单克隆受体抗体治疗药物，如托珠单抗，疗效不一。维生素 D 可调节白细胞介素 6，是否比目前使用的白细胞介素 6 拮抗剂（包括托珠单抗）更有效，从而为 COVID-19 提供一种有用的治疗选择？对已发表的研究进行了叙述性综述，以检查维生素 D 在 COVID-19 患者中的作用，比较了托珠单抗作为白细胞介素 6 拮抗剂的理论依据与维生素 D 对白细胞介素 6 产生的免疫调节作用。纳入的六项研究中有四项报告了维生素 D 对结果的积极影响。虽然托珠单抗非选择性地阻断白细胞介素 6 的抗炎和促炎作用，但维生素 D 降低免疫细胞白细胞介素 6 的产生，可能降低促炎作用，但不专门针对白细胞介素 6 受体，避免对白细胞介素 6 的抗炎作用产生任何有害影响。维生素 D 作为白细胞介素 6 免疫调节剂可能优于托珠单抗，而且，如果在临床监督下使用，它是安全的，因此有充分的理由使用它。
