Fiorino, Sirio
Gallo, Claudio
Zippi, Maddalena
Sabbatani, Sergio
Manfredi, Roberto
Moretti, Renzo
Fogacci, Elisa
Maggioli, Caterina
Travasoni Loffredo, Francesca
Giampieri, Enrico
Corazza, Ivan
Dickmans, Christoph
Denitto, Claudio
Cammarosano, Michele
Battilana, Michele
Orlandi, Paolo Emilio
Del Forno, Francesco
Miceli, Francesco
Visani, Michela
Acquaviva, Giorgia
De Leo, Antonio
Leandri, Paolo
Hong, Wandong
Brand, Thomas
Tallini, Giovanni
Jovine, Elio
Jovine, Roberto
de Biase, Dario http://orcid.org/0000-0002-0609-8817
Article History
Received: 18 June 2020
Accepted: 21 July 2020
First Online: 31 August 2020
Compliance with the standards
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: (1) We certify that this work is novel. (2) What this research specifically adds to the literature: SARS-CoV-2 represents a public health emergency of international concern, but no effective therapy against this virus is currently available. Therefore, studies investigating the mechanisms involved in the pathogenesis of this infection and the possible strategy for its treatment are strongly requested. We have taken advantage from studies carried out in patients suffering from some autoimmune diseases, such as rheumatoid arthritis and systemic lupus erythematosus. Furthermore, it must be considered that proper functioning of the immune system requires the presence of adequate concentrations of several micronutrients like vitamins A, D, E and C. However, a large part of the population, mainly the elderly individuals, presents significant deficiencies in these micronutrients. For the first time, we have postulated the potential role of vitamins A, D, E and C in interfering with the inappropriate host’s inflammatory response caused by SARS-CoV-2 and in attenuating it. In particular, the pathogenesis of autoimmune diseases and their treatment may serve as a paradigm for a better understanding of the mechanisms involved in the development of the cytokine release syndrome (CRS). This life-threatening condition emerges in about 15–20% of patients with SARS-CoV2 and its control is necessary to prevent the fatal outcome in these subjects. In our paper, we have indicated the potential targets of vitamins A, D, E and C in modulating the intense immune response arising during SARS-CoV-2 infection. This effect is probably due to the direct down-regulation in the synthesis, release or function of cytokines (such as IL-6, IL-8, IL-17 and TNF-α) or enzymes (such as cyclooxygenase-2 and lipoxygenase) with strong pro-inflammatory activities as well as to the shift of Th17-mediated immune-response towards a T-cell regulatory phenotype, as observed in patients with autoimmune diseases. Taken together, these observations provide the rationale for the use of these micronutrients as part of a multi-treatment strategy against SARS-CoV-2 infection for the therapy of patients with acute forms of infection or as a strategy for improving immune system function. This approach could produce a beneficial effect on several groups of the population, mainly elderly people, and should be considered for these individuals with preventive purposes. Well-designed trials should be carried out with the aim to confirm or deny this strategy.