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.