Putative roles of vitamin D in modulating immune response and immunopathology associated with COVID-19

Virus Res. 2021 Jan 15;292:198235. doi: 10.1016/j.virusres.2020.198235. Epub 2020 Nov 21.


The first incidence of COVID-19 was reported in the Wuhan city of Hubei province in China in late December 2019. Because of failure in timely closing of borders of the affected region, COVID-19 spread across like a wildfire through air travel initiating a pandemic. It is a serious lower respiratory track viral infection caused by highly contagious, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Coronavirus including COVID-19 causing SARS-CoV-2 causes zoonotic diseases and thought to be originated from bats. Since its first incidence, the virus has spread all across the world, causing serious human casualties, economic losses, and disrupting global supply chains. As with SARS-CoV, COVID-19 causing SARS-CoV-2 follows a similar path of airborne infection, but is less lethal and more infectious than SARS and MERS. This review focusses on the pathogenesis of SARS-CoV-2, especially on the dysfunctional immune responses following a cytokine storm in severely affected persons. The mode of entry of SARS-CoV-2 is via the angiotensin converting enzyme 2 (ACE-2) receptors present on the epithelial lining of lungs, gastrointestinal tract, and mucus membranes. Older persons with weaker immune system and associated co-morbidities are more vulnerable to have dysfunctional immune responses, as most of them concomitantly have severe hypovitaminosis D. Consequently, causing severe damage to key organs of the body including lungs and the cardiovascular system. Since, vast majority of persons enters to the intensive care units and died, had severe vitamin D deficiency, thus, this area must be investigated seriously. In addition, this article assesses the role of vitamin D in reducing the risk of COVID-19. Vitamin D is a key regulator of the renin-angiotensin system that is exploited by SARS-CoV-2 for entry into the host cells. Further, vitamin D modulates multiple mechanisms of the immune system to contain the virus that includes dampening the entry and replication of SARS-CoV-2, reduces concentration of pro-inflammatory cytokines and increases levels of anti-inflammatory cytokines, enhances the production of natural antimicrobial peptide and activates defensive cells such as macrophages that could destroy SARS-CoV-2. Thus, this article provides the urgency of needed evidences through large population based randomized controlled trials and ecological studies to evaluate the potential role of vitamin D in COVID-19.

Keywords: Acute respiratory distress syndrome (ARDS); COVID-19; Coronavirus; Cytokine storm; Dexamethasone; Immune response; SARS-CoV-2; Treatment; Vitamin D.

Publication types

  • Review

MeSH terms

  • Adaptive Immunity
  • Animals
  • COVID-19 / immunology*
  • COVID-19 / physiopathology*
  • Clinical Trials as Topic
  • Cytokine Release Syndrome / immunology
  • Cytokine Release Syndrome / prevention & control
  • Disease Management
  • Humans
  • Immunity, Innate
  • Immunologic Factors
  • Inflammation / immunology
  • Inflammation / prevention & control
  • SARS-CoV-2
  • Vitamin D / immunology*
  • Vitamin D / therapeutic use
  • Zoonoses / immunology


  • Immunologic Factors
  • Vitamin D