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THERAPEUTIC EFFECT OF VITAMIN A ON COVID-19 PATIENTS AND ITS PROPHYLACTIC EFFECT ON CONTACTS

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role of vitamin A on covid-19 patients and its prophylactic effect on contacts
Sys Rev Pharm 2021;12(1):207-210
A multifaceted review journal in the field of pharmacy
Systematic Reviews in Pharmacy Vol 12, Issue 1, Jan-Feb 2021
207
THERAPEUTIC EFFECT OF VITAMIN A ON COVID-19
PATIENTS AND ITS PROPHYLACTIC EFFECT ON
CONTACTS
Mahmood M. Al-Sumiadai1, Hazim Ghazzay2, Rafi Khaleel Al-Ani3
1DCH/ Ministry of Health- Anbar health directorate/ Ramadi city/ MOH/Iraq.
2F.I.C.M.S / Internal medicine/Department of medicine / Collage of medicine / university of Anbar/Iraq.
3CIB/ Ministry of Health- Anbar health directorate/Iraq
alsumaidaidrmah@gmail.com
ABSTRACT
Background: No other similar study was done on the role of
vitamin A in the treatment of COVID-19.
Objective: To find the effect of vitamin A on patients with
COVID-19 and its protective effect on contacts.
Patient and Methods: A cross-sectional study was done on two
groups. The first group of 100 diagnosed mild to moderate
patients with COVID-19, 50 patients received two doses of
vitamin A (200,000 I.U.) for two days, another 50 patients
received a placebo. Data about clinical features, SPO2, and the
mean duration of symptoms collected after 24 and 48 hours from
the administration, in addition to the number of patients who
deteriorate their SPO2. A second group was contacted to patients
diagnosed with COVID-19, part of them received two doses
(200,000 I.U.) of vitamin A and others received a placebo. The
comparison was between the percentage of getting the infection
and the duration of symptoms among those who got the
infection.
Results: A significant improvement in symptoms, shorter
duration of illness, with a lower number of patients who
deteriorate their SPO2 among patients given vitamin A
compared to control. A lower incidence of infection among
contacts who received vitamin A in comparison to contacts
received placebo with shorter duration of symptoms among
those who got the infection.
Conclusions; A great benefit of the use of vitamin A in patients
with COVID-19 and to contacts. Adding vitamin, A to the
protocol management of COVID-19 is recommended.
Keywords; COVID-19, Vitamin A, Therapy, Contacts,
Prophylaxis.
Running title; Vitamin A in treatment of COVID-19.
INTRODUCTION
Coronavirus disease 2019 (COVID-19) is caused by SARS-
CoV-2, a newly emergent coronavirus, that was first
recognized in Wuhan, China, in December 2019. Genetic
sequencing of the virus suggests that it is a beta coronavirus
closely linked to the SARS virus.By way of definition, a
symptomatic COVID-19 case is a person who has developed
signs and symptoms suggestive of COVID-19.1
Vitamin A is a fat-soluble micronutrient that cannot be
synthesized de novo by mammals, thus it is an obligatory
dietary factor. It is now well established that all vertebrates
require vitamin A for adequate growth, cell and tissue
differentiation, vision, development and function of the
immune system, and survival.2Concentrations of preformed
vitamin A are highest in liver and fish oils. Other sources of
preformed vitamin A are milk and eggs, which also include
some provitamin A. Most dietary provitamin A comes from
leafy green vegetables, orange and yellow vegetables, tomato
products, fruits, and some vegetable oils .3
The doses of vitamin A used in children with measles
(100,000-200,000 IU) are given once or twice.2The
recommended dose in children for more than one year and
adults with xerophthalmia (vitamin A deficiency) is (200,000
IU) for two days. 4Dosages of vitamin A in the order of 100
times the recommended daily allowance are required to
produce toxicity in adults, and for this reason, acute toxicity
is quite uncommon. Symptoms of acute toxicity include
gastrointestinal upset and neurological symptoms of
headaches, blurred vision, vertigo, and muscular
incoordination.5Intakes of vitamin A greater than 10,000 IU
per day are not recommended for well-nourished pregnant
women.6
The mechanism of vitamin A on infections could be by
enhancing the immune response by deferent ways, including;
morphological formation of the epithelium, epithelial
keratinization, and functional maturation of epithelial cells
which are regarded as the first-line defense against pathogen
invasion.7,8 Regulate the apoptosis of thymocytes.9-11 Induces
T cell migration to the thymus where they developed into
mature T cells.12,13 Promoting T cell activation and T helper
cell responses at minimal levels.14 Lastly, the effect of
vitamin A on B cell may by enhancing antibody production,
15,16 and regulating B cell activity.17,18
There are many applications of using vitamin A in the
treatment of infectious diseases including;
1. Tuberculosis. A longitudinal cohort study of tuberculosis
Therapeutic Effect Of Vitamin A On Covid-19 Patients And Its Prophylactic Effect On
Contacts
208 Systematic Reviews in Pharmacy Vol 12, Issue 1, Jan-Feb 2021
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showed that vitamin A deficiency is dose-dependently
correlated to the occurrence of tuberculosis.19-21
2. Acquired Immune Deficiency Syndrome (AIDS). Vitamin
A, vitamin C, and vitamin E are all-natural antioxidants, and
by inhibiting the oxidative stress of the organism, it is
postulated that these vitamins can ameliorate the progression
of AIDS.22,23
3. Infectious diseases in children, vitamin A has
demonstrated a therapeutic effect, to some extent, in diseases
transmitted through the respiratory system, such as
pneumonia and measles in children, or in contagious
digestive diseases in children, such as infantile diarrhea and
hand, foot, and mouth disease. 24-26
Aim of the study;
This study was designed to;
1. Show the therapeutic effect of vitamin A on patients with
COVID 19.
2. Show the protective effect of the vitamin A administration
on contacts.
Subject and method
The study was done in the Anbar governorate west of Iraq
from the beginning of June 2020 on diagnosed patients with
COVID-19 and contacts with diagnosed patients. Informed
consent was taken from families after giving them a full
explanation about the purpose of the study. Two groups of
samples were taken in this study;
1. The first group consists of 100 diagnosed patients with
COVID-19. The selected cases were from mild to moderate
groups, previously healthy, from deferent genders and the
same residential area. 50 patients were given (200,000)
international units of vitamin A on the first day and the same
dose was repeated the next day. Another 50 patients were
given a placebo. The vitamin and placebo were given to the
patients as early as the diagnosis was established.
Exclusion criteria;
a. Patients with old ages >60 years.27
b. Patients with diabetes, hypertension, cardiac disease,
chronic lung disease, cerebrovascular disease, chronic kidney
disease, immunosuppression, and cancer.27
c. Patients with severe disease (respiratory rate > 30
breaths/min, or SpO2 < 90% on room air).1,27
d. Pregnant women.6
A questionnaire data form was prepared for each patient
before giving the vitamin A and after 24 and 48 hours from
therapy about the clinical features and clinical findings
according to WHO classification 1,26 including;
1.Cough.
2.Fever.
3.Fatigability.
4.Loss of smell and taste.
5.Headache.
6.Anorexia.
7. SpO2 .
8. The duration of illness. Recorded from the time of given
vitamin A or placebo.
9.Number and percentage of patients who deteriorated to
severe disease.
2. The second group, the study was done on contacts of
patients with COVID-19 patients. Part of them given
vitamin A (200,000 international unit) on the first day and
repeated the next day, another part of contacts was given a
placebo. The comparison was done on the incidence of
getting COVID-19 from contacts, and the duration of the
symptoms among those who got the infection.
Data collected were checked for accuracy and completeness
and were coded and entered into the Statistical Package for
Social Sciences (SPSS), Descriptive statistics for all studied
variables and Chi-squared test were used and P-value level
<0.05 was considered significant throughout the study.
RESULTS
Regarding the first group of 100 patients. There was a
significant improvement of clinical features (fever, headache,
anorexia, and fatigue) among the 50 patients who received
vitamin A in comparison to the other 50 patients who
received a placebo. Table 1. Mean SPO2 changes among
patients given vitamin A after 24 and 48 hours had a slightly
non-significant improvement than that reported among the
placebo. Table 2. The mean duration of symptoms among
patients given vitamin A was (2.9) while among those
receiving placebo was (4.64). Table 3. Two patients (4%)
from those given vitamin A deteriorate their SPO2 and need
admission in isolation centers while 6 patients (12%) of those
given placebo deteriorate their SPO2 and need admission in
isolation centers. Table 4.
Regarding the second group, contacts to diagnosed COVID-
19. From 97 contacts given vitamin A, only 20 (20.62%) of
them got an infection with COVID-19. While from 112
contacts given placebo 65(58.03%) got the infection with
COVID-19, with a significant difference. The duration of
symptoms of infected contacts was (4.6) among those who
received vitamin A comparing to (6.72) among those given
placebo. Table 5.
DISCUSSION
Studies were limited or not done on the use of vitamin A in
the treatment of COVID-19, but there were many other
studies on the use of vitamin A in the treatment of deferent
virus diseases especially in childhood viral infections like
measles, chickenpox, and infantile diarrhea.28Even in some
bacterial and protozoan infections.29
In the present study, we recommend the trial therapy with
supplementation of vitamin A to patients diagnosed with
COVID-19, and the results were compared with other
patients with the same conditions not supplemented with
vitamin A. Among the first group of mild to moderate
patients, we found a significant improvement in clinical
features, and duration of the symptoms of the disease, in
addition to a lower number of patients who deteriorated to
the severe stage among patients given vitamin A in
comparison to control.
Regarding contacts with patients with COVID-19, in this
study, we found that there was a lower significant difference
in getting the infection in those who received vitamin A from
those not received. And also, we found that symptoms among
contacts who got the infections were shorter in those who
received vitamin A from those not received.
The underlying mechanism of vitamin A in the treatment of
COVID-19, may due to its anti-inflammatory property, or its
effect on enhancing the humeral, cellular, or phagocytic
immunity against the virus, or its repairing action on
epithelial cells of the respiratory tract which needs further
studies to explain this mechanism.
The limitations of the study included a small sample size, and
excluding severe cases.
CONCLUSION
1. There was a significant improvement in signs and
symptoms among patients with mild to moderate severity
whose given vitamin A in comparison to control, with a
shorter duration of symptoms.
2. A significantly lower number of patients who deteriorate
to severe disease among patients given vitamin A.
3. A significantly lower incidence of infection among
contacts received vitamin A with a shorter duration of the
disease.
Therapeutic Effect Of Vitamin A On Covid-19 Patients And Its Prophylactic Effect On
Contacts
209 Systematic Reviews in Pharmacy Vol 12, Issue 1, Jan-Feb 2021
Systematic Reviews in Pharmacy Vol 12, Issue 2, Jan-Feb 2021
RECOMMENDATION
From the above results, the followings are recommended;
1.The addition of vitamin A in the treatment of COVID-19
protocol.
2.The use of vitamin A to all contacts and medical staff.
3. A big case-control study covering the whole country about
the use of vitamin A in the management of COVID-19.
ACKNOWLEDGMENT
I would like to express my deepest gratitude and respect to
the patients and their families, and all medical workers on the
diagnosis of COVID-19 for their helpful advice, patience,
and guidance throughout the execution of this study.
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TABLES
Therapeutic Effect Of Vitamin A On Covid-19 Patients And Its Prophylactic Effect On
Contacts
210 Systematic Reviews in Pharmacy Vol 12, Issue 1, Jan-Feb 2021
Systematic Reviews in Pharmacy Vol 12, Issue 2, Jan-Feb 2021
Table.1. Number and percentage of patients among different symptoms before and after vitamin A and placebo administration.
Symptoms
Variables
No and %
before
No and % after 24
hr
Significant
Fever
Vitamin A
35 (70%)
15 (30%)
P=0.006
Placebo
32 (64%)
25 (50%)
Anorexia
Vitamin A
32 (64%)
13 (26%)
P=0.002
Placebo
39 (78%)
23 (46%)
Headache
Vitamin A
42 (85%)
18 (36%)
P<0.0001
Placebo
44 (88%)
32 (64%)
Fatigability
Vitamin A
40 (80%)
22 (44%)
P<0.0001
Placebo
38 (76%)
41(82%)
Cough
Vitamin A
25 (50%)
25 (50%)
P=0.345
Placebo
30 (60%)
31 (62%)
Loss of smell
and taste.
Vitamin A
23 (46%)
23 (46%)
P=0.47
Placebo
25 (50%)
30 (60%)
Table 2. SPO2 changes after 24 and 48 hours with vitamin A and placebo administration.
Variables
Mean before giving
Mean after 24 hr
Mean after 48 hr
Vitamin A administration
95.4%
97.17%
97.24%
Placebo administration
96.8%
94.42%
95.72%
P-value among mean SPO2 changes was =0.87
Table 3. Mean duration of symptoms among patients given vitamin A and placebo.
Variables
Mean duration of symptoms
Vitamin A administration
2.9
Placebo administration
4.64
Table 4. Number and percentage of patients who convert to the severe form.
Variable
Number of patients
Convert to severe disease
Percentage
Vitamin A administration
50
2
4%
Placebo administration
50
6
12%
P-value among deferent variables was <0.0001
Table 5. Incidence of getting infection and duration of symptoms among contacts in between that given vitamin A and placebo.
Variables
Number of contacts
Number and percentage of
getting the infection
Mean duration of symptoms to
infected patients
Vitamin A administration
97
20(20.62%)
4.6
Placebo administration
112
65(58.03%)
6.72
P-value among the incidence of the disease was <0.0001
... In a study of 100 COVID-19 patients with mild to moderate disease severity (50 patients on placebo and 50 on treatment), patients in the treatment group received 2 doses of vitamin A (200,000 IU) for 2 days. [22] The study showed that the symptoms of the patients in the treatment group decreased after 48 hours of supplementation, while the symptoms did not decrease in the placebo group. [22] Re-infection was seen in 20.62%, and 58.03% of the cases, while symptoms persisted for 4.6, and 6.72 days, respectively. ...
... [22] The study showed that the symptoms of the patients in the treatment group decreased after 48 hours of supplementation, while the symptoms did not decrease in the placebo group. [22] Re-infection was seen in 20.62%, and 58.03% of the cases, while symptoms persisted for 4.6, and 6.72 days, respectively. [22] In addition, in a clinical study (IRCT20210205050247N1) vitamin A was included in the treatment process of 90 patients to restore the loss of smell that occurs with the disease due to reduction in olfactory cells associated with vitamin A deficiency (https://www.irct.ir/trial/54178). ...
... [22] Re-infection was seen in 20.62%, and 58.03% of the cases, while symptoms persisted for 4.6, and 6.72 days, respectively. [22] In addition, in a clinical study (IRCT20210205050247N1) vitamin A was included in the treatment process of 90 patients to restore the loss of smell that occurs with the disease due to reduction in olfactory cells associated with vitamin A deficiency (https://www.irct.ir/trial/54178). Vitamin A given in pharmacological or high doses increased the formation of regulatory T cells while inhibiting the activity of T cells that might induce the development of the disease and the release of pro-inflammatory cytokines. ...
... Therefore, vitamin A plays a key role in viral infections first by boosting the immune response. Vitamin A improves the movement of T cells toward the thymus so that T cells mature and affect B cells to increase antibody release and regulate B cell activity (Al-Sumiadai et al. 2021). Secondly, involving in epithelial formation and differentiation and improving the functional maturation of epithelial cells is a protective mechanism for the body in general. ...
... Figure 2 shows the schematic representation of immunologic and nonimmunologic effects of vitamin A through COVID-19. Scientists conducted a study to analyze the effect of vitamin A on COVID-19 symptoms (Al-Sumiadai et al. 2021), and reported that the patients who consumed vitamin A regularly showed a significant improvement in their symptoms with a shorter duration of treatment compared to the control group. Additionally, fewer of those patients had low levels of blood oxygen saturation (SpO2) (Al-Sumiadai et al. 2021). ...
... Administration of vitamin A (200,000 I.U.), two doses for two days, showed a significant improvement in COVID-19 symptoms, duration of illness, deterioration rate compared with the control group [50]. Besides, the administration of vitamin A to contacts of COVID-19 patients also showed a beneficial effect related to the incidence of infection [50]. ...
... Administration of vitamin A (200,000 I.U.), two doses for two days, showed a significant improvement in COVID-19 symptoms, duration of illness, deterioration rate compared with the control group [50]. Besides, the administration of vitamin A to contacts of COVID-19 patients also showed a beneficial effect related to the incidence of infection [50]. ...
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Background Coronavirus disease 2019 (COVID-19) is a viral disease that causes a respiratory disorder, started in December of 2019 in China. Several vitamins and trace elements could help in enhancing host immunity producing antioxidant or anti-inflammatory action. This work aimed to identify the role of different nutrition, vitamins, and trace elements on the immunity status of the infected subject and the possibility of the beneficial role of these elements in the management of COVID-19. Main body After collecting (PubMed, scholar, OVID, Embase, Cochrane Library) and investigating published articles, testing the effect of these elements on viral infection, it was found that most of these elements have a significant role during viral infection through a different mechanism, like antioxidant, anti-inflammatory, and immunomodulation. Nutritional interventions in COVID-19 infections are very important currently, and it was reported that vitamin C and D reduce the risk of acute respiratory infections. In addition, low vitamin A diets compromise the effectiveness of inactivated bovine coronavirus vaccines. Administration of N-acetyl cysteine showed a beneficial inhibitory effect in viral infections and enhanced glutathione production. The deficiency of selenium on COVID-19 subjects has a significant impact on the clinical outcome of the subjects. In addition, supplementation with vitamins proved to enhance immune response during viral infection. Vitamins and trace elements not only showed a beneficial effect but also Omega 3 fatty acids showed an immunomodulating effect during infections. Short conclusions Assessment of levels for these trace elements at the baseline and providing supplementation containing different vitamins and elements could result in better control and clinical outcomes in the case of COVID-19.
... Still seeking to understand the in uence of vitamin A in the context of SARS-CoV-2 infection, a study was conducted by AL-SUMIADAI et al., (2021) (30) in Anbar province, western Iraq with two groups of patients, the rst consisting of people who tested positive for COVID-19, and the second with patients who had contact with people in the rst group. ...
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It is known that nutrition plays an important role in maintaining the immune system. In addition, viral infections can culminate in the depletion of vitamins, such as vitamins A and E, and inadequate levels of nutrients can be harmful to health, it is important to verify its relationship with COVID-19, a disease caused by the SARS-CoV-2, the new coronavirus first identified in Wuhan (China), and has spread rapidly worldwide, affecting the immune system and causing exacerbated inflammation. The aim of the study is to investigate whether COVID-19 affects the levels of these vitamins, and how they can help fighting the infection, it is relevant since they can be included as therapy against the disease. A systematic search was performed according to the PRISMA statement, using the PubMed, Web of Science, and EMBASE databases. We selected articles that presented the controlled descriptors present in the title or abstract without language exclusion. Abstracts, conferences, editorials, book chapters, review articles, letters, short communications, supporting information, or articles unavailable for download were excluded. The quality of studies was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS). From a total of 4,572 articles, 10 met all inclusion criteria. Three of them were related with vitamin A, two with vitamin E and five relating both vitamins to COVID-19. Of these, 70% were studies that evaluated the concentrations of vitamins, and 30% that evaluated the impact of supplementation of these micronutrients. Adult and elderly patients had decreased vitamin A and E concentrations, being below or close to the reference values for deficiency, especially in critical patients. Supplementation of these vitamins was associated with better prognosis of patients. However, the therapeutic capacity of these vitamins requires additional biological validation through more robust studies, such as randomized clinical trials and assessment of food intake of these vitamins. In addition, studies that assess serum levels of these vitamins before infection are also required.
... As mentioned earlier, vitamin A was identified to exhibit a potential therapeutic effect in COVID-19 patients, where it decreased the incidence of infection and shortened the duration of the disease [191]. Previous studies reported multiple mechanisms of action of vitamin A in infections including enhancement of T cell migration to the thymus as well as promotion of T cell activation and antibody production by B cells, which opens the door to possible interactions of vitamin A and immunomodulatory drugs such as monoclonal antibodies [192][193][194][195][196]. Furthermore, vitamin A is an inhibitor of CYP2C19, which is involved in the metabolism of some drugs involved in COVID-19 treatment [197]. ...
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COVID-19 is a recent pandemic that mandated the scientific society to provide effective evidence-based therapeutic approaches for the prevention and treatment for such a global threat, especially to those patients who hold a higher risk of infection and complications, such as patients with autoimmune diseases and cancer. Recent research has examined the role of various fat-soluble vitamins (vitamins A, D, E, and K) in reducing the severity of COVID-19 infection. Studies showed that deficiency in fat-soluble vitamins abrogates the immune system, thus rendering individuals more susceptible to COVID-19 infection. Moreover, another line of evidence showed that supplementation of fat-soluble vitamins during the course of infection enhances the viral clearance episode by promoting an adequate immune response. However, more thorough research is needed to define the adequate use of vitamin supplements in cancer and autoimmune patients infected with COVID-19. Moreover, it is crucial to highlight the vitamin–drug interactions of the COVID-19 therapeutic modalities and fatsoluble vitamins. With an emphasis on cancer and autoimmune patients, the current review aims to clarify the role of fat-soluble vitamins in SARS-CoV-2 infection and to estimate the risk-to-benefit ratio of a fat-soluble supplement administered to patients taking FDA-approved COVID-19 medications such as antivirals, anti-inflammatory, receptor blockers, and monoclonal antibodies.
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Background A significant aspect of the SARS-CoV-2 pathology involves oxidative stress, characterized by an imbalance between the production of harmful free radicals and the body’s antioxidant defenses. With the ongoing evolution of SARS-CoV-2, the investigation into non–virus-specific therapeutic options, such as antioxidant therapy, has gained importance. Objectives This systematic review and meta-analysis aimed to summarize data from randomized control trials (RCTs) to evaluate the effectiveness and safety of antioxidant therapy in patients with SARS-CoV-2 infection. Methods We searched the peer-reviewed indexed literature on MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, EMBASE, International Pharmaceutical Abstracts, and Scopus, from inception to July 2023. Results The search identified 3306 articles from which 25 were included for quantitative synthesis, with 5 studies eligible for meta-analysis. Antioxidant therapies included zinc, vitamin A, vitamin C, and combination treatments. Zinc interventions showed mixed results regarding intensive care unit admissions and hospital stays. Vitamin A studies indicated improvements in inflammatory markers. Vitamin C studies displayed inconsistent effects on clinical improvement and hospitalization. Combination treatments suggested benefits in symptom clearance and cytokine storm reduction. Meta-analysis of vitamin C studies found no significant difference in C-reactive protein concentrations (−0.50; 95% CI: −3.63, 2.63; I² = 0%), intensive care unit stay duration (pooled mean difference: 1.44; 95% CI: 0.07, 2.81; I² = 0%), or mortality (pooled odds ratio: 0.55; 95% CI: 0.28, 1.09; I² = 0%), with a slight trend favoring reduced hospitalization duration (pooled mean difference: −2.37; 95% CI: −2.99, −1.76; I² = 49%). Of the 25 studies, 8 were high quality with low bias, 6 had some concerns, and 11 were low quality with high bias. Conclusions The review presents mixed efficacy of antioxidant therapies for SARS-CoV-2, with some studies indicating potential benefits. Further well-designed large-scale RCTs are warranted to determine the definitive role of antioxidants in SARS-CoV-2 treatment. This systematic review was registered at PROSPERO as CRD42023430805.
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Coronavirus disease-19 (COVID-19), a serious pandemic due to the SARS-CoV-2 virus infection, caused significant lockdowns, healthcare shortages, and deaths worldwide. The infection leads to an uncontrolled systemic inflammatory response causing severe respiratory distress and multiple-organ failure. Quick development of several vaccines efficiently controlled the spread of COVID-19. However, the rise of various new subvariants of COVID-19 demonstrated some concerns over the efficacy of existing vaccines. Currently, better vaccines to control these variants are still under development as several new subvariants of COVID-19, such as omicron BA-4, BA-5, and BF-7 are still impacting the world. Few antiviral treatments have been shown to control COVID-19 symptoms. Further, control of COVID-19 symptoms has been explored with many natural and synthetic adjuvant compounds in hopes of treating the deadly and contagious disease. Vitamins have been shown to modulate the immune system, function as antioxidants, and reduce the inflammatory response. Recent studies have investigated the potential role of vitamins, specifically vitamins A, B, C, D, and E, in reducing the immune and inflammatory responses and severity of the complication. In this brief article, we discussed our current understanding of the role of vitamins in controlling COVID-19 symptoms and their potential use as adjuvant therapy.
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Objective: To find the effect of administration of vitamin A on patients with severe COVID-19. Material and Methods: A cross-sectional and retrospective study was done on two groups of patients with severe COVID-19 in isolation centers in the Anbar governorate. The first group was patients with severe COVID-19 given two doses of vitamin A (200,000 I.U.) for two days from the first day of admission and three doses per day of salbutamol and budesonide nebulizers.. Data about the respiratory rate and SPO2 were collected after 48 and 96 hours from the administration in addition to the death rate among those patients. In a second group, the data was collected from files of patients with severe COVID-19 previously admitted to isolated centers and not receiving vitamin A. Results: A significant improvement in SPO2 and respiratory rate among severe COVID-19 patients given vitamin A as compared to those not given vitamin A. A lower death rate was recorded among severe COVID-19 patients who received vitamin A from those not received. Conclusions; A great benefit of using vitamin A in patients with severe COVID-19. Adding vitamin A to the regime COVID-19 therapy is recommended.
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Vitamin A (VitA) is a micronutrient that is crucial for maintaining vision, promoting growth and development, and protecting epithelium and mucus integrity in the body. VitA is known as an anti-inflammation vitamin because of its critical role in enhancing immune function. VitA is involved in the development of the immune system and plays regulatory roles in cellular immune responses and humoral immune processes. VitA has demonstrated a therapeutic effect in the treatment of various infectious diseases. To better understand the relationship between nutrition and the immune system, the authors review recent literature about VitA in immunity research and briefly introduce the clinical application of VitA in the treatment of several infectious diseases.
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Background: Strategies to reduce the risk of mother-to-child transmission of the human immunodeficiency virus (HIV) include lifelong antiretroviral therapy (ART) for HIV-positive women, exclusive breastfeeding from birth for six weeks plus nevirapine or replacement feeding plus nevirapine from birth for four to six weeks, elective Caesarean section delivery, and avoiding giving children chewed food. In some settings, these interventions may not be practical, feasible, or affordable. Simple, inexpensive, and effective interventions (that could potentially be implemented even in the absence of prenatal HIV testing programmes) would be valuable. Vitamin A, which plays a role in immune function, is one low-cost intervention that has been suggested in such settings. Objectives: To summarize the effects of giving vitamin A supplements to HIV-positive women during pregnancy and after delivery. Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) up to 25 August 2017, and checked the reference lists of relevant articles for eligible studies. Selection criteria: We included randomized controlled trials conducted in any setting that compared vitamin A supplements to placebo or no intervention among HIV-positive women during pregnancy or after delivery, or both. Data collection and analysis: At least two review authors independently assessed study eligibility and extracted data. We expressed study results as risk ratios (RR) or mean differences (MD) as appropriate, with their 95% confidence intervals (CI), and conducted random-effects meta-analyses. This is an update of a review last published in 2011. Main results: Five trials met the inclusion criteria. These were conducted in Malawi, South Africa, Tanzania, and Zimbabwe between 1995 and 2005 and none of the participants received ART. Women allocated to intervention arms received vitamin A supplements at a variety of doses (daily during pregnancy; a single dose immediately after delivery, or daily doses during pregnancy plus a single dose after delivery). Women allocated to comparison arms received identical placebo (6601 women, 4 trials) or no intervention (697 women, 1 trial). Four trials (with 6995 women) had low risk of bias and one trial (with 303 women) had high risk of attrition bias. Trials show that giving vitamin A supplements to HIV-positive women during pregnancy, the immediate postpartum period, or both, probably has little or no effect on mother-to-child transmission of HIV (RR 1.07, 95% CI 0.91 to 1.26; 4428 women, 5 trials, moderate certainty evidence) and may have little or no effect on child death by two years of age (RR 1.06, 95% CI 0.92 to 1.22; 3883 women, 3 trials, low certainty evidence). However, giving vitamin A supplements during pregnancy may increase the mean birthweight (MD 34.12 g, 95% CI −12.79 to 81.02; 2181 women, 3 trials, low certainty evidence) and probably reduces the incidence of low birthweight (RR 0.78, 95% CI 0.63 to 0.97; 1819 women, 3 trials, moderate certainty evidence); but we do not know whether vitamin A supplements affect the risk of preterm delivery (1577 women, 2 trials), stillbirth (2335 women, 3 trials), or maternal death (1267 women, 2 trials). Authors' conclusions: Antepartum or postpartum vitamin A supplementation, or both, probably has little or no effect on mother-to-child transmission of HIV in women living with HIV infection and not on antiretroviral drugs. The intervention has largely been superseded by ART which is widely available and effective in preventing vertical transmission.
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Background Vitamin A plays numerous roles in immune system. Its deficiency alters both the innate and adaptive immunity. Previous results reported that the micronutrients deficiency, particularly vitamin A, is observed in patients with tuberculosis. Thus, we aimed in this study to assess vitamin A concentrations in Moroccan patients with tuberculosis to set up a large efficacy study of vitamin A supplementation for TB infected patients. Plasma retinol concentration was measured by HPLC in 44 recently diagnosed TB patients and 40 healthy controls. Results We showed that plasma vitamin A is significantly lower in tuberculosis patients as compared to healthy controls (p < 0.0001). Moreover, no significant association was found between vitamin A deficiency and, TB severity and patients’ ages. Conclusion Our study confirms the association between low vitamin A levels and tuberculosis disease.
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Background: HIV and TB infections are both associated with elevated oxidative stress parameters. Anti-oxidant supplementation may offer beneficial effects in positively modulating oxidative stress parameters in HIV and HIV-TB infected patients. We investigated the effects of vitamin A and C supplementation on oxidative stress in HIV infected and HIV-TB co-infected subjects. Methods: 40 HIV/TB co-infected and 50 HIV mono-infected patients were divided into 2 equal groups. Participants provided demographic information and blood was collected to determine oxidative stress parameters before and after vitamin A (5000 IU) and C (2600 mg) supplementation for 1 month. Results: There was a significantly (p < 0.05) higher level of Malondialdehyde (MDA) at baseline for HIV infected subjects compared with HIV-TB co-infected subjects. There was a significantly (p < 0.05) lower level of MDA and higher level of Catalase (CAT) in subjects administered supplementation compared to subjects without supplementation for the HIV infected group. There was a significantly lower level of Reduced Glutathione (GSH), Superoxide Dismutase (SOD) and higher level of MDA after one month of supplementation compared with baseline levels for HIV/TB co infected subjects. A similar result was also obtained for the HIV mono-infected groups which had a significantly lower level of SOD, MDA and CAT compared to the baseline. There was a significantly lower level of GSH and SOD, and higher level of MDA after supplementation compared with the baseline for HIV/TB co-infected subjects. Comparing the indices at baseline and post no-supplementation in HIV/TB co-infection showed no significant differences in the oxidative stress parameters. Conclusion: HIV/TB co-infection and HIV mono-infection seems to diminish the capacity of the anti-oxidant system to control oxidative stress, however exogenous anti-oxidant supplementation appears not to have beneficial roles in positively modulating the associated oxidative stress.
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Retinoic acid (RA) is a critical regulator of the intestinal adaptive immune response. However, the intrinsic impact of RA on B cell differentiation in the regulation of gut humoral immunity in vivo has never been directly shown. To address this issue, we have been able to generate a mouse model where B cells specifically express a dominant-negative receptor α for RA. In this study, we show that the silencing of RA signaling in B cells reduces the numbers of IgA(+) Ab-secreting cells both in vitro and in vivo, suggesting that RA has a direct effect on IgA plasma cell differentiation. Moreover, the lack of RA signaling in B cells abrogates Ag-specific IgA responses after oral immunization and affects the microbiota composition. In conclusion, these results suggest that RA signaling in B cells through the RA receptor α is important to generate an effective gut humoral response and to maintain a normal microbiota composition. Copyright © 2015 by The American Association of Immunologists, Inc.
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Objective: To investigate the effect and safety of vitamin A supplementation in children with pneumonia through a systematic review. Methods: Cochrane Library, EMbase, PubMed, China Biology Medicine disc, CNKI, and Wanfang Data were searched for randomized controlled trials (RCTs) on vitamin A as an adjuvant therapy for pneumonia in children. Two reviewers independently screened the studies and evaluated their quality according to the inclusion and exclusion criteria. RevMan5.3 was used for the Meta analysis. Results: A total of 15 RCTs with 3 021 patients were included. The Meta analysis showed that vitamin A supplementation did not reduce the mortality of children with pneumonia (P>0.05), but it increased the overall clinical response rate (P<0.05) and shortened the duration of pyrexia and cough, clearance time of signs and abnormal chest X-ray results, and length of hospital stay (P<0.05). As an adjuvant therapy, vitamin A did not increase the incidence rates of adverse reactions such as nausea, vomiting, diarrhea, allergy, and bregma bulging. Conclusions: Current evidence shows that in the treatment of pneumonia in children, vitamin A supplementation helps to relieve clinical symptoms and signs and shorten the length of hospital stay.The adjuvant therapy does not increase the incidence rates of adverse reactions.
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The present study extends an earlier report that retinoic acid (RA) down-regulates IgE Ab synthesis in vitro. Here, we show the suppressive activity of RA on IgE production in vivo and its underlying mechanisms. We found that RA down-regulated IgE class switching recombination (CSR) mainly through RA receptor α (RARα). Additionally, RA inhibited histone acetylation of germ-line ε (GL ε) promoter, leading to suppression of IgE CSR. Consistently, serum IgE levels were substantially elevated in vitamin A-deficient (VAD) mice and this was more dramatic in VAD-lecithin:retinol acyltransferase deficient (LRAT(-/-)) mice. Further, serum mouse mast cell protease-1 (mMCP-1) level was elevated while frequency of intestinal regulatory T cells (Tregs) were diminished in VAD LRAT(-/-) mice, reflecting that deprivation of RA leads to allergic immune response. Taken together, our results reveal that RA has an IgE-repressive activity in vivo, which may ameliorate IgE-mediated allergic disease.
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Background: Vitamin A is a potent regulator of adaptive immunity. The impact of the endogenous metabolite 9-cis retinoic acid (9cRA) on allergic sensitization is unknown. Objective: To investigate whether and to what extent 9cRA modulates the humoral immune response. Methods: BALB/c mice were sensitized and challenged with ovalbumin (OVA). 9cRA was applied repeatedly together with the antigen. Immunoglobulin production and cellular analysis were performed by ELISA, ELISPOTs and flow-cytometry. Human CD19(+) B cells were activated in vitro in the presence or absence of 9cRA and activation markers, proliferation and secreted Ig were analyzed by flow-cytometry and ELISA. Results: 9cRA applied together with repeated OVA challenges transiently increased specific serum IgA, IgE and IgG1 serum levels (2.0-8.9-fold). After OVA recall, specific IgE concentrations were reduced by a mean of 57% after adding 9cRA, while IgA was strongly induced (20-fold) and IgG1 remained unchanged. Correspondingly, less specific IgE- and more IgA secreting cells resided in the spleen in the 9cRA groups. Additionally, 9cRA promoted the migration of specific B cells to the mesenteric, but not the draining lymph nodes. In purified stimulated human B cells, 9cRA markedly reduced IgE production and enhanced IgA production. B cell activation was modulated by 9cRA reducing the expression of CD86 and promoting IL-10. Conclusions: Our data indicate that 9cRA modulates the allergic immune response by reducing the IgE response but promoting the IgA response. Thus, 9cRA can modulate the allergic immune response towards a non-IgE condition.
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Vitamin A plays an essential role during fetal development; however, if consumed at high doses it can produce teratogenic effects. Synthetic retinoids are potent teratogens and are contraindicated during pregnancy. β-Carotene is free of toxic effects. Intakes of vitamin A less than 10,000 IU per day during pregnancy have not been associated with birth defects. However, there are conflicting results for intakes of 10,000 IU to 30,000 IU per day. Intakes of vitamin A greater than 10,000 IU per day are not recommended for well-nourished pregnant women. Intakes of 30,000 IU per day of vitamin A in nonpregnant women produce only minor increases in the primary teratogen of vitamin A embryopathy. In vitamin A–deficient populations, doses of vitamin A less than 10,000 IU per day or 25,000 IU per week are considered beneficial to pregnant women without risk to the fetus. In these populations, the risks of teratogenicity from high vitamin A intake may need to be balanced against those from a deficiency.