Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-26T12:25:10.507Z Has data issue: false hasContentIssue false

Selenium supplementation may improve COVID-19 survival in sickle cell disease

Published online by Cambridge University Press:  17 September 2021

George D. Henderson*
Affiliation:
Human Potential Centre, Auckland University of Technology, Auckland, New Zealand
Rights & Permissions [Opens in a new window]

Abstract

Sickle cell disease is associated with lower selenium levels, and the serum selenium level is inversely associated with haemolysis in SCD. The SCD population is more vulnerable to adverse COVID-19 outcomes. SARS-CoV-2 infection lowers the serum selenium level and this is associated with severity of COVID-19. Selenium supplementation is proposed to improve COVID-19 outcomes in the sickle cell disease population.

Type
Letter to the Editor
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Nutrition Society

Further to Ulfberg & Stehlik’s letter of September 29th, further evidence supports the role of Se in COVID-19 virulence(Reference Ulfberg and Stehlik1). In their pre-print analysis by machine learning of Medicare patients, Dun et al. found that the leading comorbidity associated with COVID-19 mortality, adjusted for age and race, was sickle cell disease (aOR, 1·73; (95 % CI 1·21, 2·47)), followed by chronic kidney disease (aOR, 1·32; (95 % CI 1·29, 1·36))(Reference Dun, Walsh and Bae2).

Both SCD and kidney disease can lower Se levels by decreasing tubular Se resorption and are associated with deficient Se status(Reference Delesderrier, Cople-Rodrigues and Omena3,Reference Iglesias, Selgas and Romero4) .

Se status or intake has been correlated with COVID-19 outcomes, including mortality and recovery rates, in four patient groups in China, Germany, South Korea and southern India(Reference Zhang, Taylor and Bennett5Reference Majeed, Nagabhushanam and Gowda8). SARS-CoV-2, like other RNA viruses, sequesters Se causing Se levels to drop during infection(Reference Moghaddam, Heller and Sun6,Reference Wang, Huang and Sun9) . SARS-CoV-2 may infect cells in bone marrow, supressing red blood cell formation(Reference Reva, Yamamoto and Rasskazova10). Se status is inversely associated with haemolysis in SCD and may both inhibit haemolysis and enhance erythropoiesis in SCD(Reference Delesderrier, Cople-Rodrigues and Omena3,Reference Jagadeeswaran, Lenny and Zhang11) .

Se is required for the actions of both vitamin D and dexamethasone(Reference Schütze, Fritsche and Ebert-Dümig12,Reference Rock and Moos13) . Se infusion is safe, including in critically ill and dialysis patients, and Se supplementation has had favourable effects in other RNA virus infections(Reference Zhao, Yang and Mao14Reference Steinbrenner, Al-Quraishy and Dkhil16).

It should be noted that vitamin C and Mg are also commonly deficient nutrients and are required for the activation of vitamin D3 by hydroxylation(Reference Cantatore, Loperfido and Magli17Reference Cooper, Crofts and DiNicolantonio19). Deficiency of ascorbate has been associated with COVID-19 and COVID-19 outcomes in hospital populations(Reference Carr and Rowe20).

Se, supplemented if necessary with its cofactors in vitamin D metabolism, is proposed to be an important protective factor in the general population, but has the potential to reduce mortality from SARS CoV-2 infection in the sickle cell disease population to an even greater extent.

Acknowledgements

George Henderson reports that he has no conflict of interest to report in regard to this letter.

References

Ulfberg, J & Stehlik, R (2020) Finland’s handling of selenium is a model in these times of coronavirus infections. Br J Nutr, 12.Google Scholar
Dun, C, Walsh, CM, Bae, S, et al. (2020) A machine learning study of 534,023 Medicare beneficiaries with COVID-19: implications for personalized risk prediction. medRxiv.Google Scholar
Delesderrier, E, Cople-Rodrigues, CS, Omena, J, et al. (2019) Selenium status and hemolysis in sickle cell disease patients. Nutrients 11, 2211.CrossRefGoogle ScholarPubMed
Iglesias, P, Selgas, R, Romero, S, et al. (2013) Selenium and kidney disease. J Nephrol 26, 266272.CrossRefGoogle ScholarPubMed
Zhang, J, Taylor, EW, Bennett, K, et al. (2020) Association between regional selenium status and reported outcome of COVID-19 cases in China. Am J Clin Nutr 111, 12971299.CrossRefGoogle ScholarPubMed
Moghaddam, A, Heller, RA, Sun, Q, et al. (2020) Selenium deficiency is associated with mortality risk from COVID-19. Nutrients 12, 2098.CrossRefGoogle ScholarPubMed
Im, JH, Je, YS, Baek, J, et al. (2020) Nutritional status of patients with coronavirus disease 2019 (COVID-19). Int J Infect Dis 100, 390393.CrossRefGoogle Scholar
Majeed, M, Nagabhushanam, K, Gowda, S, et al. (2020) An exploratory study of selenium status in normal subjects and COVID-19 patients in south Indian population: case for adequate selenium status: selenium status in COVID-19 patients. Nutrition 82, 111053.CrossRefGoogle Scholar
Wang, Y, Huang, J, Sun, Y, et al. (2020) SARS-CoV-2 suppresses mRNA expression of selenoproteins associated with ferroptosis, ER stress and DNA synthesis. BioRxiv.Google Scholar
Reva, I, Yamamoto, T, Rasskazova, M, et al. (2020) Erythrocytes as a target of SARS CoV-2 in pathogenesis of covid-19. Archiv EuroMedica 10.CrossRefGoogle Scholar
Jagadeeswaran, R, Lenny, H, Zhang, H, et al. (2018) The impact of selenium deficiency on a sickle cell disease mouse model. Blood 132, Suppl. 1, 3645.CrossRefGoogle Scholar
Schütze, N, Fritsche, J, Ebert-Dümig, R, et al. (1999) The selenoprotein thioredoxin reductase is expressed in peripheral blood monocytes and THP1 human myeloid leukemia cells – regulation by 1,25-dihydroxyvitamin D3 and selenite. Biofactors 10, 329338.CrossRefGoogle ScholarPubMed
Rock, C & Moos, PJ (2009) Selenoprotein P regulation by the glucocorticoid receptor. Biometals 22, 9951009.CrossRefGoogle ScholarPubMed
Zhao, Y, Yang, M, Mao, Z, et al. (2019) The clinical outcomes of selenium supplementation on critically ill patients: a meta-analysis of randomized controlled trials. Medicine 98, e15473.CrossRefGoogle ScholarPubMed
Manzanares, W, Lemieux, M, Elke, G, et al. (2016) High-dose intravenous selenium does not improve clinical outcomes in the critically ill: a systematic review and meta-analysis. Crit Care 20, 356.CrossRefGoogle Scholar
Steinbrenner, H, Al-Quraishy, S, Dkhil, MA, et al. (2015) Dietary selenium in adjuvant therapy of viral and bacterial infections. Adv Nutr 6, 7382.CrossRefGoogle ScholarPubMed
Cantatore, FP, Loperfido, MC, Magli, DM, et al. (1991) The importance of vitamin C for hydroxylation of vitamin D3 to 1,25(OH)2D3 in man. Clin Rheumatol 10, 162167.CrossRefGoogle ScholarPubMed
Dai, Q, Zhu, X, Manson, JE, et al. (2018) Magnesium status and supplementation influence vitamin D status and metabolism: results from a randomized trial. Am J Clin Nutr 108, 12491258.CrossRefGoogle ScholarPubMed
Cooper, ID, Crofts, CAP, DiNicolantonio, JJ, et al. (2020) Relationships between hyperinsulinaemia, magnesium, vitamin D, thrombosis and COVID-19: rationale for clinical management. Open Heart 7, e001356.CrossRefGoogle ScholarPubMed
Carr, AC & Rowe, S (2020) The emerging role of vitamin C in the prevention and treatment of COVID-19. Nutrients 12, 3286.CrossRefGoogle ScholarPubMed