Anti-diabetes agent as potential therapeutic treatment for COVID-19
Some therapeutic agents used to treat diabetes have shown evidence of effectiveness against Sars-Cov and MERS, epidemics similar to Sars-Cov-2. It is now known that in the most severe stages of COVID-19 infection an overactive and uncontrolled inflammatory host system caused by a cytokinic cascade is responsible for multi-organ dysfunction and serious fatal lung lesions. The use of metformin has shown a decrease in inflammatory markers in patients with Sars-Cov and MERS, however its use in the severe COVID-19 patient should be carefully assessed in view of the risks described above. (23)(24) The use of DPP IV inhibitors (glyptine) is being studied in the COVID-19 patient. The DPP4 protein is expressed in many cells including alveolar epithelium and inflammatory cells. MERS-CoV uses DPP4 to enter host cells (25), but it is not known whether Sars-Cov-2 also uses the same protein to enter the cell, in addition to ACE-2. If this is demonstrated, the use of glyptins could decrease the risk of Sars-Cov-2 infection but this has not been demonstrated so far. The potential benefit in the treatment of Sars-Cov-2 infection with DPP IV inhibitors remains to be further investigated (26). Similar to metformin, the effects of reducing inflammatory markers are also known for GLP-1RA and have also demonstrated a potential therapeutic benefit in acute lung lesions (27). However, the available data are limited to experimental models and their benefit still remains to be studied.