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Cabbage and fermented vegetables: from death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19
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  • Jean Bousquet,
  • Josep Anto,
  • Wienczyslawa Czarlewski,
  • Tari Haahtela,
  • Susana Fonseca,
  • Guido Iaccarino,
  • Hubert Blain,
  • Alain Vidal,
  • Aziz Sheikh,
  • Cezmi Akdis,
  • Torsten Zuberbier
Jean Bousquet
Université Versailles, St-Quentin-en-Yvelines
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Josep Anto
ISGLoBAL
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Wienczyslawa Czarlewski
Medical Consulting
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Tari Haahtela
Helsinki University Hospital
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Susana Fonseca
GreenUPorto - Sustainable Agrifood Production Research Centre
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Guido Iaccarino
Federico II University Hospital
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Hubert Blain
CHU Montpellier
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Alain Vidal
World Business Council for Sustainable Development (WBCSD)
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Aziz Sheikh
University of Edinburgh
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Cezmi Akdis
University of Zurich
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Torsten Zuberbier
Charité Universitätsmedizin Berlin
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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 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, 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. 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.

Peer review status:ACCEPTED

29 Jul 2020Submitted to Allergy
30 Jul 2020Submission Checks Completed
30 Jul 2020Assigned to Editor
30 Jul 2020Reviewer(s) Assigned
31 Jul 2020Review(s) Completed, Editorial Evaluation Pending
31 Jul 2020Editorial Decision: Revise Minor
31 Jul 20201st Revision Received
03 Aug 2020Submission Checks Completed
03 Aug 2020Assigned to Editor
04 Aug 2020Review(s) Completed, Editorial Evaluation Pending
04 Aug 2020Editorial Decision: Accept