Vitamin C: From Bench to Bedside

Vitamin C (ascorbic acid) is a normal liver metabolite in most animals, with humans being a notable exception due to random genetic mutations that have occurred during our evolution. As such, it has become a vitamin (vital to life), with requirements increasing significantly during various illnesses, particularly severe infections.
Recent international clinical trials are highlighting the potential for intravenous vitamin C administration to improve clinical outcomes for patients, particularly those with severe respiratory illness, sepsis, and some cancers. Furthermore, there has been an upsurge in new discoveries and new mechanistic insights, particularly around epigenetic regulation by vitamin C, that are providing rationales for future targeted clinical trials. Although its role in scurvy has been recognized for close to a century, it appears that we still have much to learn about this small carbohydrate molecule. Well-designed observational and interventional studies that consider the baseline status and unique pharmacokinetics of vitamin C are needed moving forward to help address the current gaps in our knowledge. Underpinning mechanistic research will also further our ability to inform good clinical practice.