1 - Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
2 - Department of Dermatology and Allergy, Berlin Institute of Health, Comprehensive Allergy Center, Berlin, Germany.
3 - MACVIA-France and CHU, Montpellier, France.
4 - Centre for Research in Environmental Epidemiology (CREAL), ISGlobAL, Barcelona, Spain.
5 - IMIM (Hospital del Mar Research Institute), Barcelona, Spain.
6 - Universitat Pompeu Fabra (UPF), Barcelona, Spain.
7 - CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
8 - MASK-Air, Montpellier, France.
9 - Medical Consulting Czarlewski, Levallois, France.
10 - Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Finland.
11 - Faculty of Sciences, GreenUPorto - Sustainable Agrifood Production Research Centre, DGAOT, University of Porto, Porto, Portugal.
12 - Department of Advanced Biomedical Sciences, Federico II University, Napoli, Italy.
13 - Department of Immunoallergology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
- Publicação em versão integral em revista internacional. Vol. 76, Allergy: European Journal of Allergy and Clinical Immunology. Blackwell Publishing Ltd; 2021. p. 735–50.
Resumo: Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage were associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin converting enzyme 2 (ACE2). As a result of SARS-Cov-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT1R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block the AT1R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are given: Kimchi in Korea, westernized foods and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects helpful in mitigating COVID-19 severity.
Palavras Chave: COVID-19, diet, Angiotensin converting enzyme 2, fermented vegetable