This topic was presented in a COVID Awareness Webinar Series webinar conducted by SRM Institute of Science and Tecnology

1. ADJUVANT THERAPY: MINERALS AND
VITAMINS AS IMMUNE BOOSTERS
FOR COVID -19
Dr. C.SHEELA SASIKUMAR
HEAD- CLINICAL RESEARCH
HYCARE SUPER SPECIALITY HOSPITAL
CHENNAI

3. Researcher ID: I-8326-2014
http://orcid.org/0000-00023633-3486
www.researchgate.net › profile › Changam_Sheela_Sasikumar
linkedin.com › dr-c-sheela-sasikumar-92989a54

4. The schematic representation of individual risk management strategies to reduce
the risk of SARS-CoV-II infection and moderate the severity of COVID-19.

5. Current Scenario……
 Recently, a novel flu‐like coronavirus (COVID‐19) related to the MERS
and SARS coronaviruses was found at the end of 2019 in China
 Evidence of human‐to‐human transmission was confirmed among close
contacts.
 Significant threats to international health and the economy.
 In the absence of a specific treatment for this novel virus, there is an
urgent need to find an alternative solution to prevent and control the
replication and spread of the virus.
 We need to seek ways either to potentially protect from the viral infection
or to alleviate its effects once trapped.
 Search for potential protective and therapeutic antiviral strategies is of
particular and urgent interest

6. Is Nutrition Concerned with immunity
 Nutritional status, as a modifiable factor, is a key element in the functioning
and maintaining of our immune system integrity
 Immune system depends on adequate amounts of nutrients (carbohydrates
+fats + proteins+ water +vitamins +minerals).
 It is well stated that deficiency or insufficiency in nutrients, caused by
inadequate intake, reduced absorption or bioavailability require
corrections to properly maintain the immune system function.
 The European Journal of Clinical Nutrition concluded that “Without adequate
nutrition, the immune system is clearly deprived of the components
needed to generate an effective immune response”
 The WHO guidance on diet, especially during the current pandemic states that
“good nutrition is crucial for health, particularly in times when the immune
system might need to fight back” (WHO, 2020).

7. Adjuvant therapy –A Combination
therapy
Minerals and Vitamins as Supportive
Therapy

8. ZINC :
 Micronutrient homeostasis is a key factor in maintaining a healthy immune
system.
 Trace element zinc is a critical cofactor for many proteins involved in cellular
processes like differentiation, proliferation
 An average adult weighing 70kg has a body zinc content of 1.4～2.3 gm, the
highest tissue concentration being in the prostate, seminal fluid, uveal tissue, and
skin.
 RDA of zinc for an average adult male is 11mg and the requirement increases
from 8 mg/d to up to 12 mg/d in females during pregnancy and lactation.
 Zinc deficiency -inadequate intake, poor gastrointestinal absorption or
augmented excretion that the imbalance of zinc cause diseases and promote
disease progression

10. ROLE OF ZINC IN COVID
 Modulate antiviral and antibacterial immunity and regulate inflammatory
response
 Zinc deficiency is surprisingly common in modern-day lifestyle and results in
dysfunction of both humoral and cell‐mediated immunity and increases
susceptibility to infectious diseases
 Improved antiviral immunity by zinc may also occur through up-regulation of
interferon α production and increasing its antiviral activity
 In vitro experiments demonstrate that Zn2+ possesses antiviral activity through
inhibition of SARS-CoV RNA polymerase.
 Indirect evidence also indicates that Zn2+ may decrease the activity of
angiotensin-converting enzyme 2 (ACE2), known to be the receptor for
SARS-CoV-2.

11.  Improved Zn status may also reduce the risk of bacterial co-infection by
improving mucociliary clearance and barrier function of the respiratory
epithelium, as well as direct antibacterial effects against S. pneumoniae
 Several studies have reported that zinc has a broad-spectrum antiviral activity
against a variety of viruses.
 Zinc status is also tightly associated with risk factors for severe COVID-19
including ageing, immune deficiency, obesity, diabetes, and atherosclerosis,
since these are known risk groups for zinc deficiency
 Increased intracellular Zinc concentrations inhibit RNA-dependent RNA
polymerases and other proteins essential for the completion of different
phases of the virus life cycle.
 Increasing the concentration of intracellular zinc with zinc‐ionophores like
pyrithione can efficiently impair the replication of a variety of RNA viruses.

12.  Zn may possess protective effect as preventive and adjuvant therapy of
COVID-19 through reducing inflammation, improvement of mucociliary
clearance, prevention of ventilator-induced lung injury, modulation of antiviral
and antibacterial immunity. However, further clinical and experimental studies
are required.
 Zinc supplementation has been documented to decrease oxidative stress
biomarkers (reactive oxygen species)
 Results in decreased generation of inflammatory cytokines by upregulating
A20, a zinc transcription factor, which inhibits the activation of NF-κB
 Consumption of up to 50 mg zinc per day may provide a protective role
against the COVID-19 pandemic, likely by improving the host's resistance
against viral infection
 The individual assessment for the possible dietary, nutritional, lifestyle, and
environmental risks, together with the proper risk management, is the sensible
way to deal with the pandemic of SARS-CoV-II.

13. Vitamin C and its role in Infections
 Role in the synthesis of collagen in connective tissues and acts as an
antioxidant.
 Humans cannot synthesize vitamin C, so we must obtain it only from our diet.
 Supports immune functions and protects against infection caused by a
coronavirus.
 weak antihistamine agent to provide relief from flu‐like symptoms such as
sneezing, a running or stuffy nose, and swollen sinuses.
 Vitamin C deficiency is associated with increased susceptibility to infections, a
less robust immune response, poor wound healing, and an increased risk of
pneumonia.
 People with certain conditions, such as cancer, diabetes, inflammatory
conditions, immunosuppression, or who smoke are more likely to be deficient

14.  Ascorbic acid positively affects the development and maturation
of T-lymphocytes, in particular NK (natural Killer) cells involved in
the immune response to viral agents.
 Inhibition of ROS production and to the remodulation of the
cytokine network typical of systemic inflammatory syndrome.
 Blocks the expression of ICAM-1 and activation of NFKappaB that
are involved in inflammatory, neoplastic, and apoptotic processes by
the inhibition of TNFalfa.
 When sepsis happens, the cytokine surge caused by sepsis is
activated, and neutrophils in the lungs accumulate in the lungs,
destroying alveolar capillaries.
 In addition it can help to eliminate alveolar fluid by preventing the
activation and accumulation of neutrophils, and reducing alveolar
epithelial water channel damage.

15.  Three human controlled trials had reported that there was significantly lower
incidence of pneumonia in vitamin C‐supplemented groups, suggesting that
vitamin C might prevent the susceptibility to lower respiratory tract
infections under certain conditions.
 The COVID‐19 had been reported to cause lower respiratory tract infection, so
vitamin C could be one of the effective choices for the treatment of COVID‐19.
 Vitamin C supplementation is thus the sensible option to prevent and
support the immune responses in the micronutrient-deficit individual at risk for
COVID-19.
 Given the fact that high -dose Vitamin C is safe, healthcare professionals
should take a close look at this opportunity.
 Obviously, well -designed clinical studies are absolutely needed to develop
standard protocols for bedside use.

16. Table 1: Recommended Dietary Allowances (RDAs) for Vitamin C
Age Male Female Pregnancy Lactation
0–6 months 40 mg* 40 mg*
7–12 months 50 mg* 50 mg*
1–3 years 15 mg 15 mg
4–8 years 25 mg 25 mg
9–13 years 45 mg 45 mg
14–18 years 75 mg 65 mg 80 mg 115 mg
19+ years 90 mg 75 mg 85 mg 120 mg
Smokers Individuals who smoke require 35 mg/day
more vitamin C than nonsmokers.

22. Vitamin D
 Sun Shine vitamin has many mechanisms by which it reduces risk of microbial
infection and death.
 A recent review regarding the role of vitamin D in reducing risk of the common
cold grouped those mechanisms into three categories: physical barrier,
cellular natural immunity, and adaptive immunity
 COVID-19 infection is associated with the increased production of pro-
inflammatory cytokines, C-reactive protein, increased risk of pneumonia
,sepsis, acute respiratory distress syndrome, and heart failure.
 Serum 25(OH)D concentrations tend to decrease with age which may be
important for COVID-19 because case-fatality rates (CFRs) increase with age
 Reasons include less time spent in the sun and reduced production of vitamin
D as a result of lower levels of 7-dehydrocholesterol in the skin

23.  In addition, some pharmaceutical drugs reduce serum 25(OH)D concentrations by
activating the pregnane-X receptor
 Drugs include antiepileptics, antineoplastics, antibiotics, anti-inflammatory
agents, antihypertensives, antiretrovirals, endocrine drugs, and some herbal
medicines. Pharmaceutical drug use typically increases with age.
 Vitamin D deficiency is associated with increased risk of acute viral respiratory
infection and community acquired pneumonia, with several molecular mechanisms
proposed to explain this association.
 Vitamin D supplementation also enhances the expression of genes related to
antioxidation (glutathione reductase and glutamate–cysteine ligase modifier
subunit)
 The increased glutathione production spares the use of ascorbic acid (vitamin
C), which has antimicrobial activities, and has been proposed to prevent and treat
COVID-19

24.  Vitamin D supplementation has also been shown to reduce the risk of
respiratory infection.
 Vitamin D prophylaxis (without over‐dosing) may contribute to reducing the
severity of illness caused by SARS‐CoV‐2, particularly in settings where
hypovitaminosis D is frequent.
 This will include people with underlying gastroenterological conditions where
vitamin D deficiency is more prevalent.
 This may become even more important with absence of sunlight exposure as a
consequence of “shut‐down” measures to control the spread of Covid19
 Moreover, a former director of the Center for Disease Control and Prevention,
Dr. Tom Frieden, proposed using vitamin D to combat the COVID-19 pandemic
on 23 March 2020 (https://www.foxnews.com/opinion/former-cdc-chief-tom-
frieden-coronavirus-risk-may-be-reduced-with-vitamin-d).

26. What can you do to boost your immune system?
 Awareness of Boosting Your Immunity is enticing, but the ability to do so has
proved elusive for several reasons.
 Multiple factors weaken immunity, particularly poor diet and malnutrition,
stress, lack of sleep, excess alcohol consumption, smoking and similar
bad habits.
 The immune system is not a single entity. To function well, it requires balance
and harmony
 Immune system consists of a complex collection of cells, processes, and
chemicals that constantly defends your body against invading pathogens,
including viruses, toxins, and bacteria
 Providing a diet high in nutritious foods rich in vitamins and minerals supports
optimal function of the immune system
 Especially we need to provide antioxidants to slow damage of cells caused by
free radicals or assisting in T-cell production

27. Measures you can undertake to improve your immunity.
 Reducing stress: Stress have negative impact the production of
lymphocytes.
 Exercise: Regular exercise promotes cardiovascular health, lowers blood
pressure, helps control body weight, and offers protection against diseases.
 Eat a balanced diet with fruits and vegetables: Previous evidence
suggested that lack of these nutrients can alter the immune response.
 Get enough sleep: Studies showed that people who get an optimal sleep
(sleeping 7-8 hours for adults and up to 10 hours for children and teenagers)
are less likely to be at risk of viral infections.
 Supplements: Vitamin C and D, Zinc may improve the function of white blood
cells that fights infection.
 Stay Hydrated :8-10 glasses of water every day, to stay hydrated. Hydration
will help flush out the toxins from the body and lower the chances of flu.

28. Prescription
PROPHYLAXIS
1.Zinc - 100 mg/day
2.Vitamin C- 500 mg/day
TREATMENT
1.Zinc- 225 mg/day
2.Vitamin C -1 gm /day
Dr T.Mohanasundaram ,MD.,
Asst Professor ,General Medicine
Kilpauk Medical College
Chennai

29. THANKYOU
LET US BOOST OUR IMMUNE SYSTEM