SARS-CoV-2 infection induces functional impairment of vitamin D receptor signaling to drive interleukin 6-dependent hyperinflammation in mononuclear phagocytes
et al., PLOS One, doi:10.1371/journal.pone.0357030, Sep 2026
Vitamin D for COVID-19
8th treatment shown to reduce risk in
October 2020, now with p < 0.0000000001 from 138 studies, recognized in 18 countries.
No treatment is 100% effective.
Protocols combine treatments.
In silico and in vitro study showing benefit with calcitriol (active vitamin D) against SARS-CoV-2-related IL-6 hyperinflammation in mononuclear phagocytes.
29 preclinical studies support the efficacy of vitamin D for COVID-19:
Vitamin D has been identified by the European Food Safety Authority (EFSA) as having sufficient evidence for a causal relationship between intake and optimal immune system function27-30.
Vitamin D inhibits SARS-CoV-2 replication in vitro17,24, mitigates lung inflammation, damage, and lethality in mice with an MHV-3 model for β-CoV respiratory infections17,24, reduces SARS-CoV-2 replication in nasal epithelial cells via increased type I interferon expression20, downregulates proinflammatory cytokines IL-1β and TNF-α in SARS-CoV-2 spike protein-stimulated cells16, attenuates nucleocapsid protein-induced hyperinflammation by inactivating the NLRP3 inflammasome through the VDR-BRCC3 signaling pathway21, may be neuroprotective by protecting the blood-brain barrier, reducing neuroinflammation, and via immunomodulatory effects31, may mitigate hyperinflammation and cytokine storm by upregulating TLR10 expression which downregulates proinflammatory cytokines13, downregulates ACE2 and TMPRSS2 in human trophoblasts and minimizes spike protein-induced inflammation19, may minimize cytokine storm by dampening excessive cytokine production2, may suppress viral entry and replication via LL-37 induction11,12, and minimizes platelet aggregation mediated by SARS-CoV-2 spike protein via inhibiting integrin αIIbβ3 outside-in signaling15.
Cholecalciferol and calcifediol directly bind two allosteric pockets on the SARS-CoV-2 Spike RBD, bias the trimer toward a closed state, weaken ACE2 engagement, and reduce viral entry in cell models1.
Calcitriol may destabilize the Spike protein architecture and inhibit IL-17R dimerization, blocking viral entry and mitigating hyperinflammatory cytokine storm32.
Vitamin D improves regulatory immune cell levels and control of proinflammatory cytokines in severe COVID-1933.
Calcifediol inhibits SARS-CoV-2 papain-like protease (PLpro), a critical enzyme for viral replication14.
Symptomatic COVID-19 is associated with a lower frequency of natural killer (NK) cells and vitamin D has been shown to improve NK cell activity34,35.
1.
García-Marín et al., Exploring SARS-CoV-2 Spike RBD Pockets as Targets for Generic Drugs: A Combined Computational, Biophysical, and Biological Approach, ACS Omega, doi:10.1021/acsomega.5c05175.
2.
Alzahrani, A., A new investigation into the molecular mechanism of cholecalciferol towards reducing cytokines storm, Octahedron Drug Research, doi:10.21608/odr.2024.308273.1043.
3.
Haque et al., Exploring potential therapeutic candidates against COVID-19: a molecular docking study, Discover Molecules, doi:10.1007/s44345-024-00005-5.
4.
Morales-Bayuelo et al., New findings on ligand series used as SARS-CoV-2 virus inhibitors within the frameworks of molecular docking, molecular quantum similarity and chemical reactivity indices, F1000Research, doi:10.12688/f1000research.123550.3.
5.
Chellasamy et al., Docking and molecular dynamics studies of human ezrin protein with a modelled SARS-CoV-2 endodomain and their interaction with potential invasion inhibitors, Journal of King Saud University - Science, doi:10.1016/j.jksus.2022.102277.
6.
Pandya et al., Unravelling Vitamin B12 as a potential inhibitor against SARS-CoV-2: A computational approach, Informatics in Medicine Unlocked, doi:10.1016/j.imu.2022.100951.
7.
Mansouri et al., The impact of calcitriol and estradiol on the SARS-CoV-2 biological activity: a molecular modeling approach, Scientific Reports, doi:10.1038/s41598-022-04778-y.
8.
Song et al., Vitamin D3 and its hydroxyderivatives as promising drugs against COVID-19: a computational study, Journal of Biomolecular Structure and Dynamics, doi:10.1080/07391102.2021.1964601.
9.
Qayyum et al., Vitamin D and lumisterol novel metabolites can inhibit SARS-CoV-2 replication machinery enzymes, Endocrinology and Metabolism, doi:10.1152/ajpendo.00174.2021.
10.
Al-Mazaideh et al., Vitamin D is a New Promising Inhibitor to the Main Protease (Mpro) of COVID-19 by Molecular Docking, Journal of Pharmaceutical Research International, doi:10.9734/jpri/2021/v33i29B31603.
11.
Roth et al., Vitamin D-inducible antimicrobial peptide LL-37 binds SARS-CoV-2 Spike and accessory proteins ORF7a and ORF8, Frontiers in Cellular and Infection Microbiology, doi:10.3389/fcimb.2025.1671738.
12.
Vercellino et al., Influence of Sex and 1,25α Dihydroxyvitamin D3 on SARS-CoV-2 Infection and Viral Entry, Pathogens, doi:10.3390/pathogens14080765.
13.
Knez et al., TLR10 overexpression modulates immune response in A549 lung epithelial cells challenged with SARS-CoV-2 S and N proteins, Frontiers in Immunology, doi:10.3389/fimmu.2024.1490478.
14.
Chen et al., In Vitro Characterization of Inhibition Function of Calcifediol to the Protease Activity of SARS-COV-2 PLpro, Journal of Medical Virology, doi:10.1002/jmv.70085.
15.
Wang et al., 1,25‐Dihydroxyvitamin D3 attenuates platelet aggregation potentiated by SARS‐CoV‐2 spike protein via inhibiting integrin αIIbβ3 outside‐in signaling, Cell Biochemistry and Function, doi:10.1002/cbf.4039.
16.
Alcalá-Santiago et al., Disentangling the Immunomodulatory Effects of Vitamin D on the SARS-CoV-2 Virus by In Vitro Approaches, The 14th European Nutrition Conference FENS 2023, doi:10.3390/proceedings2023091415.
17.
Campolina-Silva et al., Dietary Vitamin D Mitigates Coronavirus-Induced Lung Inflammation and Damage in Mice, Viruses, doi:10.3390/v15122434.
18.
Moatasim et al., Potent Antiviral Activity of Vitamin B12 against Severe Acute Respiratory Syndrome Coronavirus 2, Middle East Respiratory Syndrome Coronavirus, and Human Coronavirus 229E, Microorganisms, doi:10.3390/microorganisms11112777.
19.
Vargas-Castro et al., Calcitriol prevents SARS-CoV spike-induced inflammation in human trophoblasts through downregulating ACE2 and TMPRSS2 expression, The Journal of Steroid Biochemistry and Molecular Biology, doi:10.1016/j.jsbmb.2024.106625.
20.
Sposito et al., Age differential CD13 and interferon expression in airway epithelia affect SARS-CoV-2 infection - effects of vitamin D, Mucosal Immunology, doi:10.1016/j.mucimm.2023.08.002.
21.
Chen (B) et al., Vitamin D3 attenuates SARS‐CoV‐2 nucleocapsid protein‐caused hyperinflammation by inactivating the NLRP3 inflammasome through the VDR‐BRCC3 signaling pathway in vitro and in vivo, MedComm, doi:10.1002/mco2.318.
22.
Rybakovsky et al., Calcitriol modifies tight junctions, improves barrier function, and reduces TNF‐α‐induced barrier leak in the human lung‐derived epithelial cell culture model, 16HBE 14o‐, Physiological Reports, doi:10.14814/phy2.15592.
23.
DiGuilio et al., The multiphasic TNF-α-induced compromise of Calu-3 airway epithelial barrier function, Experimental Lung Research, doi:10.1080/01902148.2023.2193637.
24.
Pickard et al., Discovery of re-purposed drugs that slow SARS-CoV-2 replication in human cells, PLOS Pathogens, doi:10.1371/journal.ppat.1009840.
25.
Mok et al., Calcitriol, the active form of vitamin D, is a promising candidate for COVID-19 prophylaxis, bioRxiv, doi:10.1101/2020.06.21.162396.
26.
Fernandes de Souza et al., Lung Inflammation Induced by Inactivated SARS-CoV-2 in C57BL/6 Female Mice Is Controlled by Intranasal Instillation of Vitamin D, Cells, doi:10.3390/cells12071092.
27.
Galmés et al., Suboptimal Consumption of Relevant Immune System Micronutrients Is Associated with a Worse Impact of COVID-19 in Spanish Populations, Nutrients, doi:10.3390/nu14112254.
28.
Galmés (B) et al., Current State of Evidence: Influence of Nutritional and Nutrigenetic Factors on Immunity in the COVID-19 Pandemic Framework, Nutrients, doi:10.3390/nu12092738.
29.
EFSA, Scientific Opinion on the substantiation of a health claim related to vitamin D and contribution to the normal function of the immune system pursuant to Article 14 of Regulation (EC) No 1924/2006, EFSA Journal, doi:10.2903/j.efsa.2015.4096.
30.
EFSA (B), Scientific Opinion on the substantiation of health claims related to vitamin D and normal function of the immune system and inflammatory response (ID 154, 159), maintenance of normal muscle function (ID 155) and maintenance of normal cardiovascular function (ID 159) pursuant to Article 13(1) of Regulation (E, EFSA Journal, doi:10.2903/j.efsa.2010.1468.
31.
Gotelli et al., Understanding the immune-endocrine effects of vitamin D in SARS-CoV-2 infection: a role in protecting against neurodamage?, Neuroimmunomodulation, doi:10.1159/000533286.
32.
Fadel et al., Targeting asparagine and cysteine in SARS-CoV-2 variants and human pro-inflammatory mediators to alleviate COVID-19 severity; a cross-section and in-silico study, Scientific Reports, doi:10.1038/s41598-025-19359-y.
33.
Saheb Sharif-Askari et al., Increased blood immune regulatory cells in severe COVID-19 with autoantibodies to type I interferons, Scientific Reports, doi:10.1038/s41598-023-43675-w.
Valdés-López et al., 11 Sep 2026, USA, peer-reviewed, 9 authors.
Contact: maria.navas@udea.edu.co.
In vitro studies are an important part of preclinical research, however results may be very different in vivo.
Abstract:
Citation: Valdés-López JF, di Filippo D, Penagos S, Hernández-Sarmiento LJ, Arroyave-Ospina JC, Rojas M, et al. (2026) SARS-CoV-2 infection induces functional impairment of vitamin D receptor signaling to drive interleukin 6-dependent hyperinflammation in mononuclear phagocytes. PLoS One 21(9): e0357030. https://doi.org/10.1371/journal. pone.0357030
Editor: Muhammad Iqhrammullah, Universitas Muhammadiyah Aceh, INDONESIA
Received:
April 15, 2026
Accepted:
August 11, 2026
Published:
September 11, 2026
Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal. pone.0357030
Copyright: © 2026 Valdés-López et al. This is an open access article distributed under the
RESEARCH ARTICLE
SARS-CoV-2 infection induces functional impairment of vitamin D receptor signaling to drive interleukin 6-dependent hyperinflammation in mononuclear phagocytes
Juan Felipe Valdés-López 1,2 , Diana di Filippo 1 , Sharon Penagos 1 , Lady Johana Hernández-Sarmiento 2 , Johanna C. Arroyave-Ospina 1 , Mauricio Rojas 3 , Silvio Urcuqui-Inchima 2 , Wbeimar Aguilar-Jiménez 2 , Maria-Cristina Navas 1 *
- 1 Grupo Gastrohepatología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia,
- 2 Grupo Inmunovirología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia, 3 Grupo de Inmunología Celular e Inmunogenética (GICIG), Facultad de Medicina y Unidad de Citometría, Sede de Investigación Universitaria, Universidad de Antioquia , Medellín, Colombia
[* maria.navas@udea.edu.co](mailto:maria.navas@udea.edu.co)
Abstract
The dysregulated inflammatory response, particularly the interleukin 6 (IL-6)-driven cytokine storm, is a hallmark of severe COVID-19. Mononuclear phagocytes are key cellular populations in the pathogenesis of SARS-CoV-2 infection, but the underlying regulatory mechanisms remain incompletely defined. Based on existing evidence of vitamin D immunomodulatory properties in viral infections, we investigated its role during SARS-CoV-2 infection. We integrated transcriptional profiling of monocytes and myeloid dendritic cells (mDCs) from healthy individuals and COVID-19 patients (moderate/severe, with/without viremia) with an in vitro model of SARS-CoV-2-infected monocyte-derived macrophages (MDMs). Additionally, a functional assay using U937-derived monocytes and macrophages challenged with inactivated SARS-CoV-2 particles was used to assess the immunomodulatory effect of calcitriol (vitamin D) treatment. We found that SARS-CoV-2 infection triggers an NFκ B-dependent inflammatory signature associated with disease severity, both in monocytes from COVID-19 patients and in MDMs infected in vitro . This signature is characterized by hyperproduction of IL-6 and upregulation of its signaling components, including IL6R, JAK1/2, STAT3, and SOCS3. Moreover, we found some evidence of a novel viral-dependent suppression of the Vitamin D Receptor (VDR) pathway, demonstrated by downregulation of both VDR expression and its target genes, including CAMP, LYZ, and IRF5, in monocytes from patients with COVID-19 and in vitro SARS-CoV-2-infected MDMs. This resulted in functional impairment of VDR signaling. Importantly, calcitriol treatment potently suppressed SARS-CoV-2induced IL-6..
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"abstract": "<jats:p>\n The dysregulated inflammatory response, particularly the interleukin 6 (IL-6)-driven cytokine storm, is a hallmark of severe COVID-19. Mononuclear phagocytes are key cellular populations in the pathogenesis of SARS-CoV-2 infection, but the underlying regulatory mechanisms remain incompletely defined. Based on existing evidence of vitamin D immunomodulatory properties in viral infections, we investigated its role during SARS-CoV-2 infection. We integrated transcriptional profiling of monocytes and myeloid dendritic cells (mDCs) from healthy individuals and COVID-19 patients (moderate/severe, with/without viremia) with an\n <jats:italic>in vitro</jats:italic>\n model of SARS-CoV-2-infected monocyte-derived macrophages (MDMs). Additionally, a functional assay using U937-derived monocytes and macrophages challenged with inactivated SARS-CoV-2 particles was used to assess the immunomodulatory effect of calcitriol (vitamin D) treatment. We found that SARS-CoV-2 infection triggers an NF-κB-dependent inflammatory signature associated with disease severity, both in monocytes from COVID-19 patients and in MDMs infected\n <jats:italic>in vitro</jats:italic>\n . This signature is characterized by hyperproduction of IL-6 and upregulation of its signaling components, including IL6R, JAK1/2, STAT3, and SOCS3. Moreover, we found some evidence of a novel viral-dependent suppression of the Vitamin D Receptor (VDR) pathway, demonstrated by downregulation of both VDR expression and its target genes, including CAMP, LYZ, and IRF5, in monocytes from patients with COVID-19 and\n <jats:italic>in vitro</jats:italic>\n SARS-CoV-2-infected MDMs. This resulted in functional impairment of VDR signaling. Importantly, calcitriol treatment potently suppressed SARS-CoV-2-induced IL-6 production in our model of U937 cell line, suggesting that restoration of VDR signaling could temper this key inflammatory axis. Our findings reveal a dual-hit mechanism in severe COVID-19, in which SARS-CoV-2 infection simultaneously hyperactivates the pro-inflammatory pattern-recognition receptors/NF-κB/IL-6 axis and suppresses the anti-inflammatory VDR pathway in mononuclear phagocytes. The effective inhibition of IL-6 by calcitriol provides a potential role of vitamin D in mitigating pathological inflammation, positioning it as a plausible immunomodulatory strategy for severe COVID-19.\n </jats:p>",
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