• Kadek Anggiswari Pradnya Angela RSUD Tabanan
  • I Nyoman Sutarka RSUD Tabanan



COVID-19, Vitamin D, Immunomodulation Effect


COVID-19 infection is marked by SARS-CoV-2 binds with ACE-2 receptors. In this process, the virus will avoid immunity systems, followed by a cytokine storm in some patients. Aside from calcium homeostasis and bone metabolism role, vitamin D plays role in reducing inflammation process and immunoregulation, which is known as the immunomodulation effect. Vitamin D plays a role against pathogens in adaptive and innate immune systems. Vitamin D modulates T-helper (Th) cells response inducing response shift from Th1 to Th2, increasing T-regulatory (Treg) cells development, and balancing T-helper cells response against pathogens and reducing pro-inflammatory cytokines production. Vitamin D may reduce production of pro-inflammatory cytokines such as TNF-?, IL-6, IL-1?, IL-12, and IFN-?, caused by inhibition of nuclear factor kB (NF-kB) activation. Vitamin D also induces ACE-2 vasorelaxant converting Angiotensin II into Angiotensin VII, a vasodilator, to prevent Acute Respiratory Distress Syndrome (ARDS) from happening. Few studies show COVID-19 patients has vitamin D deficiency. A meta-analysis study of 360,972 COVID-19 patients shows 37.7% of them with vitamin D deficiency and 32.2% with vitamin D insufficiency. Vitamin D deficiency correlates with COVID-19 severity and mortality. A study of 42 patients with acute respiratory failure caused by COVID-19 in Bari, Italy shows patients with vitamin D levels < 10 ng/ml have 50% mortality rate after 10-days of care. Vitamin D level examination is recommended for COVID-19 patients. The recommendation for vitamin D supplementation is vitamin D3 4000 IU/day dose for 7 days continued with 800-1000 IU/day maintenance dose for vitamin D deficiency patients.

Author Biography

I Nyoman Sutarka, RSUD Tabanan

Divisi Ginjal dan Hipertensi, KSM Ilmu Penyakit Dalam RSUD Tabanan 


1. WHO. WHO Coronavirus (COVID-19) Dashboard | WHO Coronavirus (COVID-19) Dashboard With Vaccination Data [Internet]. [cited 2022 Apr 5]. Available from:
2. Rahman S, Montero MTV, Rowe K, Kirton R, Kunik F. Epidemiology, pathogenesis, clinical presentations, diagnosis and treatment of COVID-19: a review of current evidence. Expert Review of Clinical Pharmacology [Internet]. 2021;14(5):601–21. Available from:
3. Farid N, Rola N, Koch EAT, Nakhoul N. Active vitamin D supplementation and COVID-19 infections: review. Irish Journal of Medical Science. 2021;190(4):1271–4.
4. Xu Y, Baylink DJ, Chen CS, Reeves ME, Xiao J, Lacy C, et al. The importance of Vitamin D metabolism as a potential prophylactic, immunoregulatory and neuroprotective treatment for COVID-19. Journal of Translational Medicine. 2020;18(1):1–12.
5. Bae M, Kim H. Mini-Review on the Roles of Vitamin C, Vitamin D, and Selenium in the Immune System against COVID-19. Molecules. 2020;25(22):1–12.
6. Ghelani D, Alesi S, Mousa A. Vitamin D and COVID-19: An overview of recent evidence. International Journal of Molecular Sciences. 2021;22(19).
7. Isaia G, Medico E. Associations between hypovitaminosis D and COVID-19: a narrative review. Aging Clinical and Experimental Research [Internet]. 2020;32(9):1879–81. Available from:
8. Kumar R, Rathi H, Haq A, Wimalawansa SJ, Sharma A. Putative roles of vitamin D in modulating immune response and immunopathology associated with COVID-19. 2020;(January).
9. Jovic TH, Ali SR, Ibrahim N, Jessop ZM, Tarassoli SP, Dobbs TD, et al. Could vitamins help in the fight against covid-19? Nutrients. 2020;12(9):1–30.
10. Ali N. Role of vitamin D in preventing of COVID-19 infection, progression and severity. 2020;(January).
11. Grant WB, Lahore H, McDonnell SL, Baggerly CA, French CB, Aliano JL, et al. Evidence that vitamin d supplementation could reduce risk of influenza and covid-19 infections and deaths. Nutrients. 2020;12(4):1–19.
12. Im JH, Soo Y, Baek J, Chung M, Yoon H. Nutritional status of patients with COVID-19 Jae. 2020;(January).
13. Ghasemian R, Shamshirian A, Heydari K, Malekan M, Alizadeh-Navaei R, Ebrahimzadeh MA, et al. The role of vitamin D in the age of COVID-19: A systematic review and meta-analysis. International Journal of Clinical Practice. 2021;75(11):1–16.
14. Munshi R, Hussein MH, Toraih EA, Elshazli RM, Jardak C, Sultana N, et al. Vitamin D insufficiency as a potential culprit in critical COVID-19 patients. Journal of Medical Virology. 2021;93(2):733–40.
15. Carpagnano GE, di Lecce V, Quaranta VN, Zito A, Buonamico E, Capozza E, et al. Vitamin D deficiency as a predictor of poor prognosis in patients with acute respiratory failure due to COVID-19. Journal of Endocrinological Investigation [Internet]. 2021;44(4):765–71. Available from:
16. Hadizadeh F. Supplementation with vitamin D in the COVID-19 pandemic? Nutrition Reviews. 2021;79(2):200–8.
17. Griffin G, Hewison M, Hopkin J, Kenny R, Quinton R, Rhodes J, et al. Vitamin D and COVID-19: Evidence and recommendations for supplementation. Royal Society Open Science. 2020;7(12).




How to Cite

Kadek Anggiswari Pradnya Angela, & I Nyoman Sutarka. (2022). ROLE OF IMUNOMODULATION EFFECT OF VITAMIN D IN COVID-19 MANAGEMENT. Jurnal Kedokteran, 11(2), 927–933.



Literature Review