Magnesium in Infectious Diseases in Older People

Abstract

Reduced magnesium (Mg) intake is a frequent cause of deficiency with age together with reduced absorption, renal wasting, and polypharmacotherapy. Chronic Mg deficiency may result in increased oxidative stress and low-grade inflammation, which may be linked to several age-related diseases, including higher predisposition to infectious diseases. Mg might play a role in the immune response being a cofactor for immunoglobulin synthesis and other processes strictly associated with the function of T and B cells. Mg is necessary for the biosynthesis, transport, and activation of vitamin D, another key factor in the pathogenesis of infectious diseases. The regulation of cytosolic free Mg in immune cells involves Mg transport systems, such as the melastatin-like transient receptor potential 7 channel, the solute carrier family, and the magnesium transporter 1 (MAGT1). The functional importance of Mg transport in immunity was unknown until the description of the primary immunodeficiency XMEN (X-linked immunodeficiency with Mg defect, Epstein–Barr virus infection, and neoplasia) due to a genetic deficiency of MAGT1 characterized by chronic Epstein–Barr virus infection. This and other research reporting associations of Mg deficit with viral and bacterial infections indicate a possible role of Mg deficit in the recent coronavirus disease 2019 (COVID-19) and its complications. In this review, we will discuss the importance of Mg for the immune system and for infectious diseases, including the recent pandemic of COVID-19.

Magnesium in Aging, Health and Diseases

“…Mg deprivation, low serum Mg levels, and reduced dietary Mg intake have all been associated in preclinical, epidemiological and clinical human studies with an increased production of free radicals of oxygen, with low-grade systemic inflammation, increased levels of inflammation markers and proinflammatory molecules (IL-6, tumor necrosis factor-alpha (TNF-alfa), IL-1-beta, vascular cell adhesion molecule (VCAM)-1, and plasminogen activator inhibitor (PAI)-1, complement, alfa2-macroblobulin, fibrinogen) [16,[35][36][37][38][39][40][41][42].…”

The relevance of magnesium homeostasis in COVID-19

“…The overall prevalence of hypomagnesemia in geriatric patients reaches 36% [ 30 ], among diabetic patients ranges from 19% to 29% [ 31 , 32 ], and in patients with high blood pressure, it has been found to be 63.8% [ 33 ]. In addition, it has been reported that magnesium deficiency is associated with obesity and the increased incidence of hypertension, cardiovascular disease, congestive heart failure, arrhythmias, and chronic kidney disease, particularly in patients under dialysis [ 34 – 36 ]. Furthermore, it has been noted that mortality by cardiovascular deaths in subjects with hypomagnesemia is significantly higher as compared with individuals exhibiting normal magnesium levels [ 37 ].…”

“…In humans, the fundamental importance of magnesium in immunity and the underlying mechanisms have been highlighted by the discovery of the primary immunodeficiency XMEN (X-linked immunodeficiency with magnesium defect, Epstein–Barr virus infection, and neoplasia), which is characterized by chronic Epstein-Barr virus infection [ 51 ]. However, general evidence that magnesium deficiency may confer a higher predisposition to infectious diseases is mostly indirect [ 34 ]. An optimal magnesium status is necessary for the synthesis, transport, and activation of vitamin D [ 52 ].…”

“…Indeed, as highlighted in the previous section, vitamin D is necessary for a healthy immune system. The activity of vitamin D is strictly intertwined with magnesium [ 34 ]. Clearly, magnesium deficiency leads to reduced amounts of active vitamin D, thus generating a fertile soil for SARS-CoV-2 infection.…”

Magnesium and Microelements in Older Persons

“…Other authors have explored the importance to supplement Mg for increasing vitamin D levels in postmenopausal women [11] and for improving several cardiovascular biomarkers [12]. These novel findings could partly explain the role of Mg in improving outcomes in infectious diseases [13] and for improving hypertension [14], one of the most common condition in older subjects, as discussed in two reviews. Furthermore, the correct assessment of Mg status, particularly in older people, is often problematic.…”