# Potential Role of Vitamins A, B, C, D and E in TB Treatment and Prevention: A Narrative Review
## 2 Results
### Vitamin E  
Vitamin E (VE) has a lengthy isoprenoid side chain attached at the 2 position of a 6-chromanol ring, and this distinguishes vitamin E from other fat-soluble vitamins, conferring peculiar biochemical properties: it is a powerful antioxidant, it promotes membrane stability, and it inhibits platelet aggregation. Vitamin E has been shown to provide numerous health benefits, including protection against infections. Vitamin E has immunological qualities that include boosting the body's defenses, improving humoral and cell immune responses, and increasing phagocytic functions [94]. VE is a potent antioxidant that removes free radicals and protects the structural components of cell membranes from peroxidation [95]), and it's also involved in T-cell differentiation and proliferation, with a role in preventing bacterial and viral infections. When studying the link between VE and TB, a controversial pathophysiological component should be considered: on the one hand, phagocytic immunity is a critical stage in the host response to TB; on the other hand, oxidative stress is a major reaction against _M. tuberculosis_. The trigger of this counteractive response is concentration-dependent: _M. tuberculosis_ releases DNA damage-responsive gene only if ROS levels are low, thus this mechanism does not result in protection against high levels of oxidative stress [96]. It has been observed that the nutritional status of TB patients shows lower levels of VE than non-TB people (together with other antioxidant agents such as VA, anti-oxidase and beta-carotene) [97]. The level of VE has been analyzed at the starting time of antituberculosis treatment (ATT) and during the course of ATT: poor levels have been observed but no increase related to the assumption of ATT [98; 99]. A study found negative connections between VE (and hence vitamin C and A) and oxidative stress, and nitrosative stress markers such as nitric oxide, carbonyl protein, and lipid peroxidation in TB [100]. In patients who recovered well, the alterations were reversed after six months of antitubercular medication, although the elevated stress was not totally removed [100]. VE has been claimed to play a part in boosting the level of immunoglobulins and T-cell types against TB when it comes to immunity empowerment [101]. From an epidemiological viewpoint, [PERSON] and colleagues have discovered a clinical match to laboratory findings of VE insufficiency and TB, observing that VE deficiency is linked to an elevated risk of TB progression in index TB case household contacts [102]. The in vivo link between VE and ATT has been studied by certain researchers. Pre-treatment with high dosages oftocopherol (100 mg/kg) may protect albino rabbits from Isoniazid and Rifampicin-induced hepatotoxicity [103]. It was shown that VE (and VC) positively controlled the sperm quality, hematological, and brain damage caused by anti-tuberculous drugs in rats [104; 105]. VE supplementation has also been investigated for its potential benefits. In this line, a research of 92 MDR-PTB patients conducted in Indonesia found that VE (as well as fat) intake improves quality of life [106]. Nonetheless, different study comes to no conclusions about this, and suggests that the only observed benefit from vitamin supplementation may be linked to weight growth rather than a direct good TB outcome and also on other infectious diseases such as surgical site infection and pneumonia [107]. In a recent study [PERSON] and colleagues have validated this suspicion, noting that there is insufficient evidence to recommend routine supplementation in TB patients, despite indications of reduced vitamin blood levels [108]. Furthermore, [PERSON] and colleagues, who conducted a prospective cohort research in Finland, found that VE may enhance the risk of TB in people who smoked heavily [109]. A Chinese study, on the other hand, has looked at vitamin supplementation from the perspective of public health.