ESPEN 2021 Abstract Submission

Topic: Vitamins, antioxidants and minerals

Abstract Submission Identifier: ESPEN21-ABS-1242

EFFECTS OF ANTIOXIDANTS SUPPLEMENTATION ON PRO-INFLAMMATORY CYTOKINES IN NON-CRITICALLY ILL COVID-19 PATIENTS

M. M. A. Abulmeaty^*, ^1, ², G. S. Aljuraiban ¹, S. M. Shaikh ³, N. E. ALEid ³, L. R. Al Mazrou ³, A. A. Turjoman ³, M. S. Aldosari ⁴, S. Razak ¹, M. M. El-Sayed ⁴, T. M. Areabi ³, R. M. Alsalafi ³, Y. S. Al-Helio ³, A. B. Almutairy ³, H. N. Molla ⁴ and Ministry of Health, Kingdom of Saudi Arabia, grant number #558

¹Clinical Nutrition Program, Community Health Sciences , KING SAUD UNIVERSITY, Riyadh, Saudi Arabia, ²Medical Physiology, Zagazig University, School of Medicine, Zagazig, Egypt, ³Prince Mohamed Bin Abdulaziz Hospital, ⁴KING SAUD UNIVERSITY, Riyadh, Saudi Arabia

Rationale: Pro-inflammatory cytokines play a role in COVID-19 pathogenesis. Antioxidants are frequently prescribed for SARS-CoV-2 infected patients. However, the clinical evidence is lacking¹. This study investigated the effect of oral antioxidants on the serum levels of interleukin-6 (IL-6), Tumor necrosis factor-α (TNF- α), and the general inflamatory biomarkers in mild to moderate COVID-19 cases.

Methods: A double-blinded, randomized controlled clinical trial was done in the Prince Mohammed Bin Abdulaziz Hospital, Riyadh, SA, (December 2020 and March 2021). This trial was registered under reference no: NCT04323228. A total of 44 hospitalized noncritically ill COVID-19 patients were randomized into (Antioxidant group, n=24) and (placebo group, n=20) for 10 days. The supplement included 250 mg Vitamin C, 1500 ug Vitamin A, 90 mg vitamin E, 15 ug Selenium, and 7.5 mg Zinc, while the placebo consisted of 0.3g cellulose powder. Both study groups received the standard medical therapy according to the protocol of the Ministry of Health, SA². Baseline and final serum levels of C-reactive protein (CRP), IL-6, and TNF- α were measured by ELISA kits (R&D Systems, UK). Also, total leukocyte count, lymphocytic count, and neutrophil to lymphocyte ratio (NLR) were measured by Sysmex XP 300 system (Sysmex co, Japan).

Results: Levels of lymphocyte count, NLR, and CRP were not significantly changed, while levels of IL-6, and TNF-α, were significantly reduced in the Antioxidant group (Table 1).

Table 1: Comparison of main parameters between study groups.

*Variables*	*Antioxidant (n=24***)	*Placebo (n=20***)	Sig. baseline	Sig. Final
*Variables*	Basal Mean±SD	Final Mean±SD	Sig. baseline	Sig. Final	P-value			Basal Mean±SD
Neutrophils (10^3/uL)	4.85±2.21	5.82±2.44	0.167	6.07±2.61	5.86±1.71	0.822	0.227	0.973
Lymphocytes (10^3/uL)	1.05±0.55	1.58±0.86	0.008	1.22±0.38	2.09±0.67	<0.001	0.498	0.135
NLR	6.29±4.43	5.70±5.46	0.664	5.59±3.13	3.17±1.81	0.011	0.796	0.190
CRP (mg/dL)	4.70±3.85	1.28±1.19	0.049	7.35±6.47	1.44±1.05	0.033	0.915	0.603
IL-6 (pg/mL)	22.09±6.58	8.91±4.23	<0.001	23.56±7.06	11.89±1.62	<0.001	0.692	0.035
TNF-α (pg/mL)	46.36±3.20	14.91±5.32	<0.001	47.11±3.62	21.11±3.89	<0.001	0.252	0.003

Conclusion: Antioxidants oral supplementation, as an adjuvant to the standard medical management, significantly ameliorated the COVID-19-associated IL-6 and TNF-α storm.

References: 1. Soto, M E. Guarner-Lans V. Soria-Castro E. Manzano Pech L. Pérez-Torres I. Is antioxidant therapy a useful complementary measure for Covid-19 treatment? An algorithm for its application. Medicina 2020; 56: 386.

2. Therapeutic protocol for COVID-19, Saudi MOH publication, 2020. (Accessed December 1, 2020 at https://www.moh.gov.sa/Ministry/MediaCenter/Publications/Documents/MOH-therapeutic-protocol-for-COVID-19.pdf)

Disclosure of Interest: None Declared

Keywords: ANTIOXIDANTS, COVID-19, Cytokines