agents and potential efficacy against COVID-19
Gliptins (sitagliptin, vildagliptin, etc..) are DPP-4 inhibitors with undoubted therapeutic efficacy in the anti-diabetes field. Recently for this class of drugs evidence has shown extra pancreatic pleiotropic activity of glycemic normalization. The DPP-4 protein has several actions, in particular it plays an important role in the regulation of the immune system by activating T cells and regulating CD86 expression, and is responsible for increasing inflammation in patients with diabetes. It should also be noted that the activity of DPP-4 can influence the function of several cytokines, chemokines and growth factors. Some studies have suggested that a higher mortality rate and complications in people with diabetes and MERS infected may be associated with a dysregulated immune response mediated by the DPP-4 protein (10-11), so a potential therapeutic role of glyptins in fighting COVID-19 infection is also to be assumed. However, to date, the effects of DPP-4 inhibition on the immune system and inflammation are still not fully understood.
A meta-analysis has shown that upper respiratory tract infections do not increase significantly with inhibitory treatment of DPP-4 (12), moreover MERS-CoV uses DPP-4 to enter host cells (13), but it is not known whether Sars-Cov-2 uses the same protein to enter the cell as well, in addition to ACE-2, If this were demonstrated, the use of glyptin could decrease the risk of Sars-Cov-2 infection, but for now it is only a hypothesis. The potential benefit in the treatment of Sars-Cov-2 infection with DPP-IV inhibitors remains to be investigated. To date, it is not entirely clear whether DPP-IV inhibition may play an important role in controlling inflammation in patients with diabetes and COVID-19, but it may be a potential target to prevent and reduce the risk and progression of acute airway complications that a patient with diabetes may have in addition to COVID-19 infection (14).Conclusions
The COVID-19 global pandemic represents one of the greatest health challenges in the history of mankind. Patients with comorbidities such as diabetes may be at greater risk of complications if infected with COVID-19. Treatment of diabetes in a patient with COVID-19 must be carefully managed, for some anti diabetes agents such as gliptins there is evidence of extra pancreatic pleiotropic effects and glycemic normalization, which could be an added value in the fight against COVID-19 infection in the patient with diabetes.