SARS-CoV-2 Infection and Multiple Sclerosis: Proactive Approach in a Vulnerable Patient Group through Daily Vitamin D Supplementation?

VitD deficiency-risk factor pathologyHans-Klaus Goischke (2024) SARS-CoV-2 Infection and Multiple Sclerosis: Proactive Approach in a Vulnerable Patient Group through Daily Vitamin D Supplementation?rate was significantly lower than with values below or with deficiency 17.Current data suggest a protective role for VitD, particularly with a lower risk of intensive care unit admission and a reduced risk of death 18,19.In addition, the occurrence of Long-Covid is an aspect of implementing this simple, effective, safe and costeffective therapy with a broad therapeutic window for the prevention and treatment of .Although there is still no indisputable evidence that Vit D supplementation (VitD suppl.)reduces the risk of SARSCov-2 infection in healthy individuals, there is collective evidence that it benefits vulnerable individuals 23.PwMS with comorbidities, psychiatric illnesses, hypertension, obesity (an increased BMI may correlate with a severe course of Covid-19), age > 50 years, severe disability and methylprednisolone boost therapy as well as some DMTs (disease-modifying therapies) have a higher risk of infection and an increased risk of severe COVID-19 courses 24-26.Infections (SARS-COV-2) can increase MS symptoms (pseudo-relapses) or cause real relapses 27.In post-COVID syndrome (Long Covid), one in eight patients presents with symptoms such as fatigue, shortness of breath, cough, joint pain, chest pain, muscle pain, headache and paresthesia in the limbs after at least 3 months.The latter can also occur in PwMS per se 28,29.If vitamin D administration results in a lower risk of infection, severity of illness with admission to the intensive care unit or a reduced risk of death in people at risk, Long-Covid occurs less frequently 18,19,21,22,30-33, it is not ethically justifiable to withhold high dose vitamin-D administration from people at risk. Mechanisms of Action of Vitamin D in COVID-19Barrea et al. list in detail 14 mechanisms as described by Vit D suppl. the risk of COVID-19 infection can be reduced and sufficient Covid 19 vaccination is supported 19,29,32,[3435363738.Vit D and its metabolites inactivate viruses (increase in antimicrobial peptide cathelicidin, defensins), lead to reduction of the risk of cytokine storm, reduce matrix metalloproteinase-9 concentration and thereby increase the host's metabolic tolerance to damage, reduce the risk of pneumonia and myocarditis, lead to the reduction of the concentration of pro-inflammatory cytokines, especially interleukin 6 (IL-6), which promotes the permeability of the BBB, which leads to the potentiation of CNS damage in PwMS, is serious 29,[39404142. Vit D enables neuroprotection by reducing inflammation and oxidative stress.Low 25(OH)D levels were inversely correlated with high IL-6 levels and were independent predictors of COVID-19 severity and mortality 43.1,25(OH)2D3 inhibits immunoglobulin synthesis, regulates B cell activity and reduces auto-Ab production.It converts B cells into plasma cells 18.Vit D reduces the risk of infection with EBV 29.Current studies show evidence that chronic inflammation in Long Covid-19 Infection with reactivation of the latent Epstein-Barr virus (EBV) can lead to a worsening of the health status in PwMS 44-48.In MS, there is a high level of molecular mimicry between the EBV transcription factor EBNA-1 and the CNS protein GlialCAM (glial cell adhesion molecule of the central nervous system 49.Bernal et al. were able to detect EBV reactivation by detecting EBV DNA and antibodies against EBV-lytic genes 50.