Skip to main content

Is Vitamin C Beneficial to Patients with CAP?

Current Infectious Disease Reports volume 18, Article number: 24 (2016) Cite this article

Abstract

Community-acquired pneumonia (CAP) is one of the most common causes of morbidity and mortality in elderly and children. Vitamin C is known as a physiological antioxidant, regulating innate immune system in the lung. Vitamin C has been used to prevent and treat CAP. However, the use of vitamin C for preventing and treating CAP has been a subject of controversy. We aim to review the most significant findings about vitamin C supplementation in patients with pneumonia based on literature from the PubMed. First, we reviewed recent advances about the role of oxidative stress in CAP. Oxidative stress is a crucial component of the host defense system and inflammatory response. However, excessive oxidative stress can cause a systemic inflammatory response leading to tissue damage. The degree of oxidative stress has been associated with the severity of CAP. Vitamin C is beneficial to the host defense system by regulating the innate immunity in the lungs. We also discuss the prophylactic use of vitamin C for pneumonia. Vitamin C supplementation decreased the pneumonia risk in patients with vitamin C deficiency. However, it is not beneficial for prophylactic use of vitamin C to prevent pneumonia in the well-nourished population. Finally, we summarize the effect of vitamin C on mechanical ventilation used during respiratory failure. Administration of vitamin C decreases the duration of mechanical ventilation by decreasing oxidative stress.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Nair H, Simoes EA, Rudan I, et al. Severe Acute Lower Respiratory Infections Working G, Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: a systematic analysis. Lancet. 2013;381:1380–90. The reference reported that incidence of admissions and deaths for severe acute lower respiratory infections. The results indicate that acute lower respiratory infections are a leading cause of morbidity and mortality in young children, and community-based management of severe disease could be an important complementary strategy to reduce pneumonia mortality and health inequities.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Schnoor M, Hedicke J, Dalhoff K, Raspe H. Schafer T, group Cs, Approaches to estimate the population-based incidence of community acquired pneumonia. J Infect. 2007;55:233–9.

    Article  PubMed  Google Scholar 

  3. Pletz MW, Rohde GG, Welte T, Kolditz M, Ott S, Advances in the prevention, management, and treatment of community-acquired pneumonia. F1000Res 2016;5.

  4. Niederman MS. Making sense of scoring systems in community acquired pneumonia. Respirology. 2009;14:327–35.

    Article  PubMed  Google Scholar 

  5. Aydogdu M, Ozyilmaz E, Aksoy H, Gursel G, Ekim N. Mortality prediction in community-acquired pneumonia requiring mechanical ventilation; values of pneumonia and intensive care unit severity scores. Tuberk Toraks. 2010;58:25–34.

    PubMed  Google Scholar 

  6. Lee YL, Chen W, Chen LY, et al. Systemic and bronchoalveolar cytokines as predictors of in-hospital mortality in severe community-acquired pneumonia. J Crit Care. 2010;25:176 e7–13.

    Article  PubMed  Google Scholar 

  7. Torres A, Sibila O, Ferrer M, et al. Effect of corticosteroids on treatment failure among hospitalized patients with severe community-acquired pneumonia and high inflammatory response: a randomized clinical trial. JAMA. 2015;313:677–86.

    CAS  Article  PubMed  Google Scholar 

  8. Cai Y, Li YF, Tang LP, et al. A new mechanism of vitamin C effects on A/FM/1/47(H1N1) virus-induced pneumonia in restraint-stressed mice. Biomed Res Int. 2015;2015:675149.

    PubMed  PubMed Central  Google Scholar 

  9. Hemila H, Louhiala P. Vitamin C may affect lung infections. J R Soc Med. 2007;100:495–8.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Valavanidis A, Vlachogianni T, Fiotakis K, Loridas S. Pulmonary oxidative stress, inflammation and cancer: respirable particulate matter, fibrous dusts and ozone as major causes of lung carcinogenesis through reactive oxygen species mechanisms. Int J Environ Res Public Health. 2013;10:3886–907.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Pruchniak MP, Arazna M, Demkow U. Biochemistry of oxidative stress. Adv Exp Med Biol. 2016;878:9–19.

    Article  PubMed  Google Scholar 

  12. Fialkow L, Wang Y, Downey GP. Reactive oxygen and nitrogen species as signaling molecules regulating neutrophil function. Free Radic Biol Med. 2007;42:153–64.

    CAS  Article  PubMed  Google Scholar 

  13. Manda-Handzlik A, Demkow U. Neutrophils: the role of oxidative and nitrosative stress in health and disease. Adv Exp Med Biol. 2015;857:51–60.

    Article  PubMed  Google Scholar 

  14. Chen Y, Luo G, Yuan J, et al. Vitamin C mitigates oxidative stress and tumor necrosis factor-alpha in severe community-acquired pneumonia and LPS-induced macrophages. Mediators Inflamm. 2014;2014:426740.

    PubMed  PubMed Central  Google Scholar 

  15. Arnold FW, Bordon J, Fernandez-Botran R, et al. Community-Acquired Pneumonia Inflammatory Study G, Macrolide use and neutrophil function/cytokine levels in hospitalized patients with community-acquired pneumonia: a pilot study. Lung. 2016;194:155–62.

    CAS  Article  PubMed  Google Scholar 

  16. Kim HW, Cho SI, Bae S, et al. Up-regulates expression of CD80, CD86 and MHC class ii on dendritic cell line, DC-1 via the activation of p38 MAPK. Immune Netw. 2012;12:277–83.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Bernard K, Hecker L, Luckhardt TR, Cheng G, Thannickal VJ. NADPH oxidases in lung health and disease. Antioxid Redox Signal. 2014;20:2838–53.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  18. Liang Y, Yeligar SM, Brown LA. Chronic-alcohol-abuse-induced oxidative stress in the development of acute respiratory distress syndrome. ScientificWorldJournal. 2012;2012:740308.

    PubMed  PubMed Central  Google Scholar 

  19. Bakoyiannis A, Delis S, Dervenis C. Pathophysiology of acute and infected pancreatitis. Infect Disord Drug Targets. 2010;10:2–4.

    CAS  Article  PubMed  Google Scholar 

  20. Yashiro M, Tsukahara H, Matsukawa A, et al. Redox-active protein thioredoxin-1 administration ameliorates influenza A virus (H1N1)-induced acute lung injury in mice. Crit Care Med. 2013;41:171–81.

    Article  PubMed  Google Scholar 

  21. Cao SS, Kaufman RJ. Endoplasmic reticulum stress and oxidative stress in cell fate decision and human disease. Antioxid Redox Signal. 2014;21:396–413.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  22. Palanisamy K, Krishnaswamy R, Paramasivan P, Chih-Yang H, Vishwanadha VP. Eicosapentaenoic acid prevents TCDD-induced oxidative stress and inflammatory response by modulating MAP kinases and redox-sensitive transcription factors. Br J Pharmacol. 2015;172:4726–40.

    CAS  Article  PubMed  Google Scholar 

  23. Lee IT, Yang CM. Role of NADPH oxidase/ROS in pro-inflammatory mediators-induced airway and pulmonary diseases. Biochem Pharmacol. 2012;84:581–90.

    CAS  Article  PubMed  Google Scholar 

  24. Chigusa Y, Hari Kishore A, Mogami H, Ann Word R, Nrf2 Activation inhibits effects of thrombin in human amnion cells and thrombin-induced preterm birth in mice. J Clin Endocrinol Metab 2016: jc20161059.

  25. Al-Asmari AK, Khan AQ, Al-Masri N, Mitigation of 5-fluorouracil-induced liver damage in rats by vitamin C via targeting redox-sensitive transcription factors. Hum Exp Toxicol. 2016.

  26. Valacchi G, Sticozzi C, Belmonte G, et al. Vitamin C compound mixtures prevent ozone-induced oxidative damage in human keratinocytes as initial assessment of pollution protection. PLoS One. 2015;10:e0131097.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kim JE, Jin DH, Lee SD, et al. Vitamin C inhibits p53-induced replicative senescence through suppression of ROS production and p38 MAPK activity. Int J Mol Med. 2008;22:651–5.

    CAS  PubMed  Google Scholar 

  28. Rayment SJ, Shaw J, Woollard KJ, Lunec J, Griffiths HR. Vitamin C supplementation in normal subjects reduces constitutive ICAM-1 expression. Biochem Biophys Res Commun. 2003;308:339–45.

    CAS  Article  PubMed  Google Scholar 

  29. Shaykhiev R, Crystal RG. Innate immunity and chronic obstructive pulmonary disease: a mini-review. Gerontology. 2013;59:481–9.

    CAS  Article  PubMed  Google Scholar 

  30. Li Y, Wang Y, Liu X. The role of airway epithelial cells in response to mycobacteria infection. Clin Dev Immunol. 2012;2012:791392.

    PubMed  PubMed Central  Google Scholar 

  31. Zalewski PD, Ruffin RE. Apoptosis-regulatory factors as potential drug targets in the epithelium of normal and inflamed airways. Curr Mol Pharmacol. 2008;1:38–49.

    CAS  Article  PubMed  Google Scholar 

  32. Larsson N, Rankin GD, Bicer EM, et al. Identification of vitamin C transporters in the human airways: a cross-sectional in vivo study. BMJ Open. 2015;5:e006979.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Schoultz I, McKay CM, Graepel R, et al. Indomethacin-induced translocation of bacteria across enteric epithelia is reactive oxygen species-dependent and reduced by vitamin C. Am J Physiol Gastrointest Liver Physiol. 2012;303:G536–45.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  34. Aggarwal NR, King LS, D’Alessio FR. Diverse macrophage populations mediate acute lung inflammation and resolution. Am J Physiol Lung Cell Mol Physiol. 2014;306:L709–25.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  35. Mohammed BM, Fisher BJ, Huynh QK, et al. Resolution of sterile inflammation: role for vitamin C. Mediators Inflamm. 2014;2014:173403.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Morandi AC, Molina N, Guerra BA, Bolin AP, Otton R. Fucoxanthin in association with vitamin C acts as modulators of human neutrophil function. Eur J Nutr. 2014;53:779–92.

    CAS  Article  PubMed  Google Scholar 

  37. Bozonet SM, Carr AC, Pullar JM, Vissers MC. Enhanced human neutrophil vitamin C status, chemotaxis and oxidant generation following dietary supplementation with vitamin C-rich SunGold kiwifruit. Nutrients. 2015;7:2574–88.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  38. Ferron-Celma I, Mansilla A, Hassan L, et al. Effect of vitamin C administration on neutrophil apoptosis in septic patients after abdominal surgery. J Surg Res. 2009;153:224–30.

    CAS  Article  PubMed  Google Scholar 

  39. Kim H, Jang M, Kim Y, Choi J, Jeon J, Kim J, Hwang YI, Kang JS, Lee WJ, Red ginseng and vitamin C increase immune cell activity and decrease lung inflammation induced by influenza A virus/H1N1 infection. J Pharm Pharmacol. 2016.

  40. Kimbarowski JA. Mokrow NJ, [Colored precipitation reaction of the urine according to Kimbarowski (FARK) as an index of the effect of ascorbic acid during treatment of viral influenza]. Dtsch Gesundheitsw. 1967;22:2413–8.

    CAS  PubMed  Google Scholar 

  41. Ugwa EA, Iwasam EA, Nwali MI. Low serum vitamin c status among pregnant women attending antenatal care at general hospital Dawakin Kudu, Northwest Nigeria. Int J Prev Med. 2016;7:40.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Michels AJ, Hagen TM, Frei B. Human genetic variation influences vitamin C homeostasis by altering vitamin C transport and antioxidant enzyme function. Annu Rev Nutr. 2013;33:45–70.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  43. Hemila H, Louhiala P. Vitamin C for preventing and treating pneumonia. Cochrane Database Syst Rev. 2013;8:CD005532. The reference assesses the prophylactic and therapeutic effects of vitamin C on pneumonia.They found that Current evidence is too weak to advocate prophylactic using vitamin C to prevent pneumonia in the general population. The results indicated that the use of vitamin C should be further investigated.

    PubMed  Google Scholar 

  44. Hunt C, Chakravorty NK, Annan G, Habibzadeh N, Schorah CJ. The clinical effects of vitamin C supplementation in elderly hospitalised patients with acute respiratory infections. Int J Vitam Nutr Res. 1994;64:212–9.

    CAS  PubMed  Google Scholar 

  45. Silva Bezerra F, Valenca SS, Lanzetti M, et al. Alpha-tocopherol and ascorbic acid supplementation reduced acute lung inflammatory response by cigarette smoke in mouse. Nutrition. 2006;22:1192–201.

    CAS  Article  PubMed  Google Scholar 

  46. Marrie TJ. Pneumonia in the elderly. Curr Opin Pulm Med. 1996;2:192–7.

    CAS  Article  PubMed  Google Scholar 

  47. Neuman MI, Willett WC, Curhan GC. Vitamin and micronutrient intake and the risk of community-acquired pneumonia in US women. Am J Med. 2007;120:330–6.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  48. Merchant AT, Curhan G, Bendich A, Singh VN, Willett WC, Fawzi WW. Vitamin intake is not associated with community-acquired pneumonia in U.S. men. J Nutr. 2004;134:439–44.

    CAS  PubMed  Google Scholar 

  49. Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C. Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. Cochrane Database Syst Rev. 2012;3:CD007176.

    PubMed  Google Scholar 

  50. Verona C, Hackenhaar FS, Teixeira C, et al. Blood markers of oxidative stress predict weaning failure from mechanical ventilation. J Cell Mol Med. 2015;19:1253–61. The reference reported that the weaning failure patients with mechanical ventilation presented higher oxidative damage. The results indicated that oxidative stress is a key mechanism contributing to mechanical ventilation-induced respiratory muscle dysfunction.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  51. Kahn SA, Beers RJ, Lentz CW. Resuscitation after severe burn injury using high-dose ascorbic acid: a retrospective review. J Burn Care Res. 2011;32:110–7.

    Article  PubMed  Google Scholar 

  52. Howe KP, Clochesy JM, Goldstein LS, Owen H. Mechanical ventilation antioxidant trial. Am J Crit Care. 2015;24:440–5.

    Article  PubMed  Google Scholar 

  53. Hemila H. Vitamin C and Community-acquired pneumonia. Am J Respir Crit Care Med. 2011;184:621–2.

    CAS  Article  PubMed  Google Scholar 

  54. Burzle M, Hediger MA. Functional and physiological role of vitamin C transporters. Curr Top Membr. 2012;70:357–75.

    CAS  Article  PubMed  Google Scholar 

Download references

Acknowledgments

This project was supported by the Chinese National Science Foundation (81170032).

Author information

Affiliations

  1. The First Clinic College, Chongqing Medical University, Chongqing, 401331, China

    Yin Li

  2. Inflammations and Allergic Diseases Research Unit in Respiratory Department, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China

    Guoping Li

Authors
  1. Yin Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Guoping Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Guoping Li.

Ethics declarations

Conflict of Interest

Yin Li & Guoping Li declare no conflicts of interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the author.

Additional information

This article is part of the Topical Collection on Respiratory Infections

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Li, Y., Li, G. Is Vitamin C Beneficial to Patients with CAP?. Curr Infect Dis Rep 18, 24 (2016). https://doi.org/10.1007/s11908-016-0530-0

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11908-016-0530-0

Keywords

  • Community-acquired pneumonia
  • Vitamin C
  • Oxidative stress