COVID-19 i vitamin D – postoji li poveznica? ; COVID-19 and Vitamin D – Is There a Link?
Vitamin D može smanjiti rizik od virusnih infekcija respiratornog trakta te smanjiti težinu i dužinu trajanja bolesti. Sama činjenica da stanice respiratornog epitela, monociti/makrofazi, dendritične stanice, T i B limfociti posjeduju receptore za vitamin D i da mogu autonomno aktivirati vitamin D koji onda djeluje autokrino i parakrino, ukazuje na značajan imunomodulatorni učinak vitamina D u urođenome i stečenome imunom odgovoru. Mehanizmi obrane od respiratornih virusa, uključujući i virus SARS-CoV-2, a koji su pod utjecajem aktivnog oblika vitamina D uključuju: indukciju stvaranja katelicidina antivirusnog proteina respiratornog epitela koji može smanjiti opterećenje virusom, poticanje urođenog imunog odgovora na virusnu infekciju, čuvanje integriteta respiratornog epitela kroz učvršćivanje uskih spojeva između stanica te kroz smanjenje prekomjernog stvaranja proupalnih citokina i pojačanje stvaranja protuupalnih citokina omogućavajući uravnotežen imuni odgovor na infekciju, time smanjujući nepotrebno oštećenje tkiva i takozvanu citokinsku oluju i posljedičnu akutnu ozljedu pluća koja u najtežim slučajevima bolesti COVID-19 rezultira respiratornim distres sindrom. Nadoknada vitamina D je jednostavna, sigurna i jeftina te bi trebala biti neizostavni dio javnozdravstvene politike sprječavanja zaraznih bolesti uključujući i COVID-19, posebice stoga što su za vrijeme pandemije ljudi dodatno izloženi nedostatku vitamina D jer su prisiljeni boraviti u zatvorenom prostoru, čime je onemogućen glavni put sinteze vitamina D u koži djelovanjem UV zraka. Za vrijeme pandemije virusom SARS-CoV-2 racionalno je nadoknadu provesti višim dozama, do 10 000 IJ dnevno, kako bi se u kratkom vremenu postigle koncentracije u krvi potrebne za nekalcemijske učinke vitamina D. ; Vitamin D may reduce the risk of respiratory tract viral infection, and the severity and duration of the disease as well. Respiratory epithelial cells, monocytes/macrophages, dendritic cells, T and B lymphocytes express vitamin D receptors, and can autonomously activate vitamin D. This points to a significant immunomodulatory effect of vitamin D in the innate and acquired immune response to viral infection. Defense mechanisms against respiratory viruses, including SARS-CoV-2, that are under the influence of the active form of vitamin D are: enhanced production of cathelicidin - an antiviral protein of the respiratory epithelium, induction of innate immune response to viral infection, preservation of the integrity of the respiratory epithelium, suppression of pro-inflammatory cytokine production and enhancement of anti-inflammatory cytokine production. The immunomodulatory effect of vitamin D supports a balanced immune response to viral infection and may reduce the risk of a cytokine storm and consequent acute lung injury, which in the most severe cases of COVID-19 disease results in respiratory distress syndrome. Vitamin D supplementation is simple, safe and inexpensive and should be an indispensable part of public health policy to reduce the risk of infectious diseases, including COVID-19. During a pandemic, the risk of vitamin D deficiency is increased because people are forced to stay indoors, thus disabling the main route of vitamin D synthesis in the skin under the effects of ultraviolet light. During the SARS-CoV-2 pandemic, Vitamin D supplementation should be prescribed with higher doses, up to 10,000 IU per day, to more rapidly achieve blood concentrations required for non-calcemic effects of vitamin D.