Cabbage and fermented vegetables: From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Jean Bousquet, Josep M. Anto, Wienczyslawa Czarlewski, Tari Haahtela, Susana C. Fonseca, Guido Iaccarino, Hubert Blain, Alain Vidal, Aziz Sheikh, Cezmi A. Akdis, Torsten Zuberbier, Amir Hamzah Abdul Latiff, Baharudin Abdullah, Werner Aberer, Nancy Abusada, Ian Adcock, Alejandro Afani, Ioana Agache, Xenofon Aggelidis, Jenifer AgustinM. beccel Akdis, Mona Al-Ahmad, Abou Al-Zahab Bassam, Hussam Alburdan, Oscar Aldrey-Palacios, Emilio Alvarez Cuesta, Hiba Alwan Salman, Ashraf Alzaabi, Salma Amade, Gene Ambrocio, Rosana Angles, Isabella Annesi-Maesano, Ignacio J. Ansotegui, Josep Anto, Paula Ara Bardajo, Stefania Arasi, Hasan Arshad, Maria Cristina Artesani, Estrella Asayag, Francesca Avolio, Khuzama Azhari, Claus Bachert, Diego Bagnasco, Ilaria Baiardini, Nissera Bajrović, Petros Bakakos, Sergio Bakeyala Mongono, Christine Balotro-Torres, Sergio Barba, Cristina Barbara, Elsa Barbosa, Bruno Barreto, Joan Bartra, Eric D. Bateman, Lkhagvaa Battur, Anna Bedbrook, Martín Bedolla Barajas, Bianca Beghé, Antra Bekere, Elizabeth Bel, Ali Ben Kheder, Mikael Benson, Emilia Camelia Berghea, Karl-Christian Bergmann, Roberto Bernardini, David Bernstein, Mike Bewick, Slawomir Bialek, Artur Białoszewski, Thomas Bieber, Nils E. Billo, Maria Beatrice Bilo, Carsten Bindslev-Jensen, Leif Bjermer, Irina Bobolea, Malgorzata Bochenska Marciniak, Christine Bond, Attilio Boner, Matteo Bonini, Sergio Bonini, Sinthia Bosnic-Anticevich, Isabelle Bosse, Sofia Botskariova, Jacques Bouchard, Louis-Philippe Boulet, Rodolphe Bourret, Philippe Bousquet, Fulvio Braido, Andrew Briggs, Christopher E. Brightling, Jan Brozek, Luisa Brussino, Roland Buhl, Roxana Bumbacea, Rosalva Buquicchio, María-Teresa Burguete Cabañas, Andrew Bush, William W. Busse, Jeroen Buters, Fernan Caballero-Fonseca, Moïses A. Calderon, Mario Calvo, Paulo Camargos, Thierry Camuzat, F. R. Canevari, Antonio Cano, G. Walter Canonica, Arnaldo Capriles-Hulett, Luis Caraballo, Vicky Cardona, Kai-Hakon Carlsen, Jonas Carmon Pirez, Jorge Caro, Warner Carr, Pedro Carreiro-Martins, Fredelita Carreon-Asuncion, Ana-Maria Carriazo, Thomas Casale, Mary-Ann Castor, Elizabeth Castro, A. G. Caviglia, Lorenzo Cecchi, Alfonso Cepeda Sarabia, Ramanathan Chandrasekharan, Yoon-Seok Chang, Victoria Chato-Andeza, Lida Chatzi, Christina Chatzidaki, Niels H. Chavannes, Claudia Chaves Loureiro, Marta Chelninska, Yuzhi Chen, Lei Cheng, Sharon Chinthrajah, Tomas Chivato, Ekaterine Chkhartishvili, George Christoff, Henry Chrystyn, Derek K. Chu, Antonio Chua, Alexander Chuchalin, Kian Fan Chung, Alberto Cicerán, Cemal Cingi, Giorgio Ciprandi, Ieva Cirule, Ana Carla Coelho, Enrico Compalati, Jannis Constantinidis, Jaime Correia de Sousa, Elisio Manuel Costa, David Costa, María del Carmen Costa Domínguez, André Coste, M. Cottini, Linda Cox, Carlos Crisci, Maria Angiola Crivellaro, Alvaro A. Cruz, John Cullen, Adnan Custovic, Biljana Cvetkovski, Gennaro D'Amato, Jane da Silva, Ronald Dahl, Sven-Erik Dahlen, Vasilis Daniilidis, Louei DarjaziniNahhas, Ulf Darsow, Janet Davies, Frédéric de Blay, Giulia de Feo, Eloisa de Guia, Chato de los Santos, Esteban de Manuel Keenoy, Govert de Vries, Diana Deleanu, Pascal Demoly, Judah Denburg, Philippe Devillier, Alain Didier, Sanja Dimic Janjic, Maria Dimou, Anh Tuan Dinh-Xuan, Ratko Djukanovic, Maria Do Ceu Texeira, Dejan Dokic, Margarita Gabriela Dominguez Silva, Habib Douagui, Nikolaos Douladiris, Maria Doulaptsi, G. rard Dray, Ruta Dubakiene, Eve Dupas, Stephen Durham, Marzia Duse, Mark Dykewicz, Didier Ebo, Natalija Edelbaher, Thomas Eiwegger, Patrik Eklund, Yehia el-Gamal, Zeinab A. el-Sayed, Shereen S. el-Sayed, Magda el-Seify, Regina Emuzyte, Lourdes Enecilla, Marina Erhola, Heidilita Espinoza, Jesús Guillermo Espinoza Contreras, John Farrell, Lenora Fernandez, Antje Fink Wagner, Alessandro Fiocchi, Wytske J. Fokkens, Folletti Lenia, Joao A. Fonseca, Jean-François Fontaine, Francesco Forastiere, Jose Miguel Fuentes Pèrez, Emily Gaerlan–Resureccion, Mina Gaga, José Luis Gálvez Romero, Amiran Gamkrelidze, Alexis Garcia, Cecilia Yvonne García Cobas, María de la Luz Hortensia García Cruz, Jacques Gayraud, Matteo Gelardi, Bilun Gemicioglu, Dimitra Gennimata, Sonya Genova, José Gereda, Roy Gerth van Wijk, Antonio Giuliano, Maximiliano Gomez, Sandra González Diaz, Maia Gotua, Christos Grigoreas, Ineta Grisle, Leo Gualteiro, Marta Guidacci, Nick Guldemond, Zdenek Gutter, Antonieta Guzmán, Ramsa Halloum, David Halpin, Eckard Hamelmann, Suleiman Hammadi, Richard Harvey, Enrico Heffler, Joachim Heinrich, Adnan Hejjaoui, Birthe Hellquist-Dahl, Luiana Hernández Velázquez, Mark Hew, Elham Hossny, Peter Howarth, Martin Hrubiško, Yunuen Rocío Huerta Villalobos, Marc Humbert, Husain Salina, Michael Hyland, Moustafa Ibrahim, Nataliya Ilina, Maddalena Illario, Cristoforo Incorvaia, Antonio Infantino, Carla Irani, Zhanat Ispayeva, Juan-Carlos Ivancevich, Edgardo e.J. Jares, Deborah Jarvis, Ewa Jassem, Klemen Jenko, Rubén Darío Jiméneracruz Uscanga, Sebastian L. Johnston, Guy Joos, Maja Jošt, Kaja Julge, Ki-Suck Jung, Jocelyne Just, Marek Jutel, Igor Kaidashev, Omer Kalayci, Fuat Kalyoncu, Jeni Kapsali, Przemyslaw Kardas, Jussi Karjalainen, Carmela A. Kasala, Michael Katotomichelakis, Loreta Kavaliukaite, Bennoor S. Kazi, Thomas Keil, Paul Keith, Musa Khaitov, Nikolai Khaltaev, You-Young Kim, Bruce Kirenga, Jorg Kleine-Tebbe, Ludger Klimek, Bernard Koffi N’Goran, Evangelia Kompoti, Peter Kopac, Gerard Koppelman, Anja KorenJeverica, Seppo Koskinen, Mitja Košnik, Kosta V. Kostov, Marek L. Kowalski, Tanya Kralimarkova, Karmen Kramer Vršcaj, Helga Kraxner, Samo Kreft, Vicky Kritikos, Dmitry Kudlay, Mikael Kuitunen, Inger Kull, Piotr Kuna, Maciej Kupczyk, Violeta Kvedariene, Marialena Kyriakakou, Nika Lalek, Massimo Landi, Stephen Lane, D. siree Larenas-Linnemann, Susanne Lau, Daniel Laune, Jorge Lavrut, Lan le, Martina Lenzenhuber, Marcus Lessa, Michael Levin, Jing Li, Philip Lieberman, Giuseppe Liotta, Brian Lipworth, Xuandao Liu, Rommel Lobo, Karin C. Lodrup Carlsen, Carlo Lombardi, Renaud Louis, Stelios Loukidis, Olga Lourenço, Jorge A. Luna Pech, Bojan Madjar, Enrico Maggi, Antoine Magnan, Bassam Mahboub, Alpana Mair, Yassin Mais, Anke-Hilse Maitland van der Zee, Mika Makela, Michael Makris, Hans-Jorgen Malling, Mariana Mandajieva, Patrick Manning, Manolis Manousakis, Pavlos Maragoudakis, Gianluigi Marseglia, Gailen Marshall, Mohammad Reza Masjedi, Jorge F. Máspero, Juan José Matta Campos, Marcus Maurer, Sandra Mavale-Manuel, Cem Meço, Erik Melén, Giovanni Melioli, Elisabete Melo-Gomes, Eli O. Meltzer, Enrica Menditto, Andrew Menzies-Gow, Hans Merk, Jean-Pierre Michel, Yann Micheli, Neven Miculinic, Luís Midão, Florin Mihaltan, Nikolaos Mikos, Manlio Milanese, Branislava Milenkovic, Dimitrios Mitsias, Bassem Moalla, Giuliana Moda, María Dolores Mogica Martínez, Yousser Mohammad, Mostafa Moin, Mathieu Molimard, Isabelle Momas, Monique Mommers, Alessandro Monaco, Steve Montefort, Dory Mora, Mario Morais-Almeida, Ralph Mösges, BadrEldin Mostafa, Joaquim Mullol, Lars Münter, Antonella Muraro, Ruth Murray, Antonio Musarra, Tihomir Mustakov, Robert Naclerio, Kari C. Nadeau, Rachel Nadif, Alla Nakonechna, Leyla Namazova-Baranova, Gretchen Navarro-Locsin, Hugo Neffen, Kristof Nekam, Angelos Neou, Eustachio Nettis, Daniel Neuberger, Laurent Nicod, Stefania Nicola, Verena Niederberger-Leppin, Marek Niedoszytko, Antonio Nieto, Ettore Novellino, Elizabete Nunes, Dieudonné Nyembue, Robyn O’Hehir, Cvetanka Odjakova, Ken Ohta, Yoshitaka Okamoto, Kimi Okubo, Brian Oliver, Gabrielle L. Onorato, Maria Pia Orru, Solange Ouédraogo, Kampadilemba Ouoba, Pier Luigi Paggiaro, Aris Pagkalos, Giovanni Pajno, Gianni Pala, S. P. Palaniappan, Isabella Pali-Schöll, Susanna Palkonen, Stephen Palmer, Carmen Panaitescu Bunu, Petr Panzner, Nikos G. Papadopoulos, Vasilis Papanikolaou, Alberto Papi, Bojidar Paralchev, Giannis Paraskevopoulos, Hae-Sim Park, Giovanni Passalacqua, Vincenzo Patella, Ian Pavord, Ruby Pawankar, Soren Pedersen, Susete Peleve, Simona Pellegino, Ana Pereira, Tamara Pérez, Andrea Perna, Diego Peroni, Oliver Pfaar, Nhân Pham-Thi, Bernard Pigearias, Isabelle Pin, Konstantina Piskou, Constantinos Pitsios, Davor Plavec, Dagmar Poethig, Wolfgang Pohl, Antonija Poplas Susic, Todor A. Popov, Fabienne Portejoie, Paul Potter, Lars Poulsen, Alexandra Prados-Torres, Fotis Prarros, David Price, Emmanuel Prokopakis, Francesca Puggioni, Elisa Puig-Domenech, Robert Puy, Klaus Rabe, Filip Raciborski, Josephine Ramos, Marysia T. Recto, Shereen M. Reda, Frederico S. Regateiro, Norbert Reider, Sietze Reitsma, Susana Repka-Ramirez, Erminia Ridolo, Janet Rimmer, Daniela Rivero Yeverino, José Angelo Rizzo, Carlos Robalo-Cordeiro, Graham Roberts, Nicolas Roche, M. nica Rodríguez González, Eréndira Rodríguez Zagal, Giovanni Rolla, Christine Rolland, Regina Roller-Wirnsberger, Miguel Roman Rodriguez, Antonino Romano, Jan Romantowski, Philippe Rombaux, Joel Romualdez, Jose Rosado-Pinto, Nelson Rosario, Lanny Rosenwasser, Oliviero Rossi, Menachem Rottem, Philip Rouadi, Nikoleta Rovina, Irma Rozman Sinur, Mauricio Ruiz, Lucy Tania Ruiz Segura, Dermot Ryan, Hironori Sagara, Daiki Sakai, Daiju Sakurai, Wafaa Saleh, Johanna Salimaki, Konstantinos Samitas, Boleslaw Samolinski, María Guadalupe Sánchez Coronel, Mario Sanchez-Borges, Jaime Sanchez-Lopez, Codrut Sarafoleanu, Faradiba Sarquis Serpa, Joaquin Sastre-Dominguez, Eleonora Savi, Bisher Sawaf, Glenis K. Scadding, Sophie Scheire, Peter Schmid-Grendelmeier, Juan Francisco Schuhl, Holger Schunemann, Maria Schvalbová, Jorgen Schwarze, Nicola Scichilone, Gianenrico Senna, Cecilia Sepúlveda, Elie Serrano, Mike Shields, Vasil Shishkov, Nikos Siafakas, Alexander Simeonov, Estelle FER Simons, Juan Carlos Sisul, Brigita Sitkauskiene, Ingelbjorg Skrindo, Tanja SoklicKošak, Dirceu Solé, Talant Sooronbaev, Manuel Soto-Martinez, Manuel Soto-Quiros, Barnaro Sousa Pinto, Milan Sova, Michael Soyka, Krzysztof Specjalski, Otto Spranger, Sofia Stamataki, Lina Stefanaki, Cristiana Stellato, Rafael Stelmach, Timo Strandberg, Petra Stute, Abirami Subramaniam, Charlotte Suppli Ulrik, Michael Sutherland, Silvia Sylvestre, Aikaterini Syrigou, Luis Taborda Barata, Nadejda Takovska, Rachel Tan, Frances Tan, Vincent Tan, Ing Ping Tang, Masami Taniguchi, Line Tannert, Pongsakorn Tantilipikorn, Jessica Tattersall, Filippo Tesi, Carel Thijs, Mike Thomas, Teresa To, Ana-Maria Todo-Bom, Alkis Togias, Peter-Valentin Tomazic, Vesna Tomic-Spiric, Sanna Toppila-Salmi, Elina Toskala, Massimo Triggiani, Nadja Triller, Katja Triller, Ioanna Tsiligianni, M. Uberti, Ruxandra Ulmeanu, Jure Urbancic, Marilyn Urrutia Pereira, Martina Vachova, Felipe Valdés, Rudolf Valenta, Marylin Valentin Rostan, Antonio Valero, Arunas Valiulis, Mina Vallianatou, Erkka Valovirta, Michiel van Eerd, Eric van Ganse, Marianne van Hage, Olivier Vandenplas, Tuula Vasankari, Dafina Vassileva, Cesar Velasco Munoz, Maria Teresa Ventura, C. cilia Vera-Munoz, Dilyana Vicheva, Pakit Vichyanond, Petra Vidgren, Giovanni Viegi, Claus Vogelmeier, Leena von Hertzen, Theodoros Vontetsianos, Dimitris Vourdas, Vu Tran Thien Quan, Martin Wagenmann, Samantha Walker, Dana Wallace, De Yun Wang, Susan Waserman, Magnus Wickman, Sian Williams, Dennis Williams, Nicola Wilson, Gary Wong, Kent Woo, John Wright, Piotr Wroczynski, Paraskevi Xepapadaki, Plamen Yakovliev, Masao Yamaguchi, Kwok Yan, Yoke Yeow Yap, Barbara Yawn, Panayiotis Yiallouros, Arzu Yorgancioglu, Shigemi Yoshihara, Ian Young, Osman B. Yusuf, Asghar Zaidi, Fares Zaitoun, Heather Zar, M. T. Zedda, Mario E. 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Abstract

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 have been 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 in particular 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: 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.
Original languageEnglish
Pages (from-to)735-750
Number of pages16
JournalAllergy: European Journal of Allergy and Clinical Immunology
Volume76
Issue number3
Early online date2020
DOIs
Publication statusPublished - Mar 2021

Keywords

  • COVID-19
  • Lactobacillus
  • angiotensin-converting enzyme 2
  • cabbage
  • diet
  • fermented vegetable
  • kimchi
  • sulforaphane

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