ReviewPotential roles of micronutrient def i ciency and immune systemdysfunction in the coronavirus disease 2019 (COVID-19) pandemicAli Gorji M.D.a,b,c,d,e, *, Maryam Khaleghi Ghadiri M.D. ba Epilepsy Research Center, Westf €alische Wilhelms-Universit € at M € unster, M € unster, Germanyb Department of Neurosurgery, Westf €alische Wilhelms-Universit € at M € unster, M € unster, Germanyc Shefa Neuroscience Research Center, Khatam Alanbia Hospital, Tehran, Irand Neuroscience Research Center, Mashhad University of Medical Sciences, Mashhad, Irane Department of Neurology with Institute of Translational Neurology, Westf €alische Wilhelms-Universit € at M € unster, M € unster, GermanyA R T I C L E I N F OArticle History:Received 25 June 2020Received in revised form 1 October 2020Accepted 2 November 2020A B S T R A C TPreliminary studies indicate that a robust immune response across different cell types is crucial in recoveryfrom coronavirus disease 2019 (COVID-19). An enormous number of investigations point to the vital impor-tance of various micronutrients in the interactions between the host immune system and viruses, includingCOVID-19. There are complex and multifaceted links among micronutrient status, the host immune response,and the virulence of pathogenic viruses. Micronutrients play a critical role in the coordinated recruitment ofinnate and adaptive immune responses to viral infections, particularly in the regulation of pro- and anti-inf l ammatory host responses. Furthermore, inadequate amounts of micronutrients not only weaken theimmune system in combating viral infections, but also contribute to the emergence of more virulent strainsvia alterations of the genetic makeup of the viral genome. The aim of this study was to evaluate the evidencethat suggests the contribution of micronutrients in the spread as well as the morbidity and mortality ofCOVID-19. Both the presence of micronutrient def i ciencies among infected individuals and the effect ofmicronutrient supplementation on the immune responses and overall outcome of the disease could be ofgreat interest when weighing the use of micronutrients in the prevention and treatment of COVID-19 infec-tion. These investigations could be of great value in dealing with future viral epidemics.© 2020 Elsevier Inc. All rights reserved.Keywords:Viral epidemicsNutritionImmunityInfectionVitaminsCytokineIntroductionCoronaviruses (CoV) are a large group of RNA viruses that pri-marily target the human respiratory system and can lead to a widerange of illnesses from the common cold to severe respiratory syn-dromes. In the past 2 decades, outbreaks of CoV-related infections,including the severe acute respiratory syndrome (SARS)-CoV andthe Middle East respiratory syndrome (MERS)-CoV, led to great pub-lic health problems and concerns [1]. A new coronavirus termedCOVID-19 (coronavirus disease 2019) is currently associated with anincreasing number and rate of morbidities and fatalities. The geneticanalysis of the COVID-19 exhibited >50% sequence identity toMERS-CoV and 80% to SARS-CoV [2].The innate immune system represents the f i rst line of defenseagainst viruses, which can inhibit virus replication, improve virusclearance, promote tissue repair, and activate a prolonged adaptiveimmune response against the viruses [3]. Viruses, such as CoV,could affect the function of the immune system in different ways,such as dysregulation of the macrophage antiviral response, induc-tion of excessive cytokine-mediated immune system responses,and the activation of complement and coagulation cascades, whichmay result in enhanced infectivity and worse outcomes [4].Because there currently is no effective drug or vaccine, boostingthe immune system could be a reasonable option to combatCOVID-19. A functional immune system is a prerequisite for thehost’s ability to prevent or limit viral infections. It is well knownthat the nutrition of the host may inf l uence the immune systemand its susceptibility to viral infection. Numerous studies pointedto the increase in either susceptibility to or severity of various viralinfections in nutritionally def i cient individuals [5]. In addition tothe host’s response, various micronutrients can have a signif i cantinf l uence on disease severity via the modulation of viral pathogen-esis, such as mutations in the viral genome [6]. On the contrary, aAG conceived, designed, and coordinated the study, carried out the literaturereview, and f i nalized the draft. MKG carried out the literature review and draftedthe manuscript. Both authors read and approved the f i nal manuscript. The authorshave no conf l icts of interest to declare.*Corresponding author: Tel.: +49 251 8355564; Fax: +49 251 8347479.E-mail address: gorjial@uni-muenster.de (A. Gorji).https://doi.org/10.1016/j.nut.2020.1110470899-9007/© 2020 Elsevier Inc. All rights reserved.Nutrition 82 (2021) 111047Contents lists available at ScienceDirectNutritionjournal homepage: www.nutritionjrnl.com
