Vitamin D3 supplementation in COVID-19 patients with cardiovascular disease and gut dysbiosis
R L Sanz, F García, A Gutierrez, S García Menendez, F Inserra, L Ferder, W Manucha
Hipertensión y Riesgo Vascular, doi:10.1016/j.hipert.2024.04.002
Background: The COVID-19 pandemic has highlighted the vulnerability of particular patient groups to SARS-CoV-2 infection, including those with cardiovascular diseases, hypertension, and intestinal dysbiosis. COVID-19 affects the gut, suggesting diet and vitamin D3 supplementation may affect disease progression. Aims: To evaluate levels of Ang II and Ang-(1---7), cytokine profile, and gut microbiota status in patients hospitalized for mild COVID-19 with a history of cardiovascular disease and treated with daily doses of vitamin D3. Methods: We recruited 50 adult patients. We screened 50 adult patients and accessed pathophysiology study 22, randomized to daily oral doses of 10,000 IU vitamin D3 (n = 11) or placebo (n = 11). Plasma levels of Ang II and Ang-(1---7) were determined by radioimmunoassay, TMA and TMAO were measured by liquid chromatography and interleukins (ILs) 6, 8, 10 and TNF-␣ by ELISA. Results: The Ang-(1---7)/Ang II ratio, as an indirect measure of ACE2 enzymatic activity, increased in the vitamin D3 group (24 ± 5 pg/mL vs. 4.66 ± 2 pg/mL, p < 0.01). Also, in the vitamin D3-treated, there was a significant decline in inflammatory ILs and an increase in protective markers, such as a substantial reduction in TMAO (5 ± 2 moles/dL vs. 60 ± 10 moles/dL, p < 0.01). In addition, treated patients experienced less severity of infection, required less Abbreviations: ACE2, angiotensin-converting enzyme 2; Ang II, angiotensin II; COVID-19, coronavirus disease 2019; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; Ang-(1---7), angiotensin 1---7; Vitamin D3, cholecalciferol; TMA, trimethylamine; TMAO, trimethylamine-N-oxide; IL-6, interleukin 6; IL-8, interleukin 8; IL-10, interleukin 10; TNF-␣, tumor necrosis factor-alpha; RT-PCR, reverse transcription polymerase chain reaction; 25-OH VitD, 25-hydroxyvitamin D; d9-TMA, deuterated trimethylamine; d9-TMAO,
Authors' contributions Raúl Lelio Sanz (data collect analysis and interpretation of the data), Federico García (data collect), Alejandro Gutierrez (data collect), Sebastián García Menendez (data collect), Felipe Inserra (data collect analysis and interpretation of the data, conception and design of the manuscript, drafting, review, approval of the submitted manuscript), León Ferder (conception and design of the manuscript), Walter Manucha (analysis and interpretation of the data, conception and design of the manuscript, drafting, review, approval of the submitted manuscript).
ARTICLE IN PRESS
Ethical responsibilities Protection of people and animals. For this work, the authors considered the basic principles of bioethics. Before the protocolization, each patient signed the informed consent. The Provincial Council for Research Ethical Evaluation and the Provincial Health Research Registry approved the protocol.
Confidentiality of the data The authors declare that patient data does not appear in this article. Right to privacy and informed consent. The authors declare that patient data does not appear in this article. Before the protocolization, each patient signed the informed consent.
Conflict of interests None of the authors declare a conflict of interest with the manuscript's content.
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