Sepsis, a disease characterized by an unregulated inflammatory response, affects around 26 million people each year. Sepsis is associated with the disruption of the function of pro-inflammatory mediators. This usually leads to low blood pressure, making it difficult for the body to deliver enough oxygen to tissue in order to support organ function. In extreme cases, this could eventually lead to organ and tissue failure, resulting in the patient dying from hypoxia. In hypoxia, the reactive oxygen species (ROS) and the reactive nitrogen species (RNS) that get released are directly responsible for causing organ damage.
The Surviving Sepsis Campaign (SSC) has come up with treatment bundles which outline steps to take once a patient has been diagnosed with sepsis. However, none of those steps include ways to relieve the oxidative and inflammatory stress caused by the ROS and RNS.
Vitamin C has been looking more and more promising as a cost effective treatment for the oxidative and inflammatory stress common in sepsis because it can act as an antioxidant and can create catecholamines, vasopressin, and cortisol.
- ROS Perspective — Vitamin C works to stop NOX, an enzyme which plays a key role in activating reactive oxygen species that can damage endothelial layers and tight junctions, leading to vascular compromise. Further, Vitamin C inhibits nuclear factor kappa-B, which can result in lower inflammatory levels and more endothelial junctions.
- Vasopressor Perspective — Vitamin C helps synthesize vasopressin, which is severely depleted in septic patients. It also helps synthesize catecholamines like epinephrine and dopamine, which help in vasoconstriction and in increasing cardiac output.
- Immune System Perspective — Vitamin C is responsible for helping WBCs (such as leukocytes and NK cells) kill infectious organisms. Vitamin C may also help decrease bacterial replication.
Instead of using Vitamin C by itself, one study showed that using Vitamin C, hydrocortisone, and thiamine together resulted in a significant decrease in hospital mortality. Together, Vitamin C and steroids work together to better counteract the symptoms of sepsis. Vitamin C restores sensitivity to glucocorticoids which can help alleviate effects of inflammation in sepsis. Vitamin C and steroids together can also help in protect endothelial cells against lipopolysaccharides, which protect Gram-negative bacteria from its surroundings. Furthermore, septic patients often have low thiamine (Vitamin B1) levels, and thus administering thiamine may be an effective method to prevent lactic acidosis.
More research needs to be done in this area, but studies which have been done have show that Vitamin C has much potential to be a cheap and effective treatment against some of the more deleterious symptoms of sepsis. Combined with other treatments such as hydrocortisone and thiamine, it may prove to be a simple solution to a serious problem. However, in the absence of a clear outcome in a well-designed randomized controlled trial, it is hard to say whether Vitamin C will truly be able to improve patient outcomes.