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. 2021 Nov 17;5(12):e10576. doi: 10.1002/jbm4.10576

Fig. 2.

Fig. 2

The vitamin D endocrine system tapers down the acute respiratory distress syndrome (ARDS). The vitamin D receptor (VDR) and enzymes of the vitamin D endocrine system are expressed in the cuboidal alveolar type 2 cells (ACII) and monocyte/macrophages/granulocytes and activated lymphocytes. The availability of 25OHD3 (calcidiol) is critical for synthesizing 1,25(OH)2D (calcitriol), which through endocrine, auto/paracrine action on VDR: (1) decreases the intensity of cytokine and chemokine storm, (2) modulates neutrophil activity, (3) maintains the integrity of the pulmonary epithelial barrier, (4) stimulates epithelial repair, and (5) decreases directly and indirectly the risk of hypercoagulability and pulmonary or systemic thrombosis. SARS‐CoV‐2 = severe acute respiratory syndrome coronavirus 2; IFN‐α, IFN‐γ = interferon gamma α and γ; IL‐1β, IL‐6, IL‐12, IL‐18, IL‐33 = interleukin‐1β, 6, 12, 18, 33; TNF‐α = tumor necrosis factor‐α; TGFβ = transforming growth factor α and β; CCL2, CCL3, CCL5 Chemokine = C‐C motif ligand 2, 3, 5; CXCL8, CXCL9, CXCL10 = C‐X‐C (motif chemokine ligand 8, 9, 10).