Hypothesis: Low Vitamin A and D Levels Worsen Clinical Outcomes When Children with Sickle Cell Disease Encounter Parvovirus B19

Abstract

Human parvovirus B19 causes life-threatening anemia due to transient red cell aplasia (TRCA) in individuals with sickle cell disease (SCD). Children with SCD experiencing profound anemia during TRCA often require red blood cell transfusions and hospitalization. The prevalence of vitamin deficiencies in SCD is high and deficiencies are associated with respiratory and pain symptoms, but the effects of vitamins on acute infection with parvovirus B19 remain unclear. We performed a clinical study in which 20 SCD patients hospitalized with parvovirus B19 infections (Day 0) were monitored over a 120-day time course to query relationships between vitamins A and D and clinical outcomes. There were significant negative correlations between Day 0 vitamin levels and disease consequences (e.g., red blood cell transfusion requirements, inflammatory cytokines). There were significant positive correlations (i) between Day 0 vitamins and peak virus-specific antibodies in nasal wash, and (ii) between Day 0 virus-specific serum plus nasal wash antibodies and absolute reticulocyte counts. There was a significant negative correlation between Day 0 virus-specific serum antibodies and virus loads. To explain the results, we propose circular and complex mechanisms. Low baseline vitamin levels may weaken virus-specific immune responses to permit virus amplification and reticulocyte loss; consequent damage may further reduce vitamin levels and virus-specific immunity. While the complex benefits of vitamins are not fully understood, we propose that maintenance of replete vitamin A and D levels in children with SCD will serve as prophylaxis against parvovirus B19-induced TRCA complications.

Retinol Binding Protein, Sunlight Hours, and the Influenza Virus-Specific Immune Response

“…Levels of vitamins A and D exert significant influences on pediatric and adult immune health. While cause–effect relationships are not always proven, low vitamin A levels have been associated with poor immune responses and/or severe disease consequences in numerous contexts, including (i) children with severe asthma [ 45 ], (ii) children with sickle cell disease [ 46 , 47 ], an animal model of cystic fibrosis [ 48 ], vitamin-A-deficient (VAD) mice following bacterial and/or viral infections [ 7 , 8 , 49 , 50 ], vaccinated children [ 1 ], and children with measles [ 5 ]. High levels of vitamin D have been associated with a decreased incidence of tuberculosis, in part due to the 25(OH)D-mediated enhancement of cathelicidin production by macrophages [ 13 ].…”

Aspectos nutricionais na Anemia falciforme: Uma revisão integrativa

“…Assim, a hipovitaminose pode enfraquecer a resposta imune específica. Portanto, propõe-se que a manutenção de níveis abundantes de vitamina A e D em crianças com DF funciona como profilaxia contra as complicações dessa infecção (PENKERT et al, 2022).…”