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 Table of Contents    
LETTER TO THE EDITOR
Year : 2021  |  Volume : 53  |  Issue : 3  |  Page : 246-247
 

Potential effects of itolizumab treatment on plasma interleukin-6 levels in patients with severe COVID-19


1 Department of Pathology, International Higher School of Medicine, International University of Kyrgyzstan, Kyrgyzstan, China
2 Department of Public Health and Healthcare, I.K. Akhunbaev Kyrgyz State Medical Academy, Kyrgyzstan, China
3 Department of Hospital Internal Medicine, Occupational Pathology with a Course of Hematology, I.K. Akhunbaev Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan, China
4 Department of Anatomy and Neuroscience, Jinzhou Medical University, Jinzhou, Liaoning, China

Date of Submission12-Jan-2021
Date of Decision15-Apr-2021
Date of Acceptance18-May-2021
Date of Web Publication22-Jun-2021

Correspondence Address:
Dr. Yethindra Vityala
2-5-168, Opposite Maruthi Towers, Nakkalgutta, Warangal - - 506 001, Telangana
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijp.IJP_33_21

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How to cite this article:
Vityala Y, Tagaev T, Mamatov S, Aidarov Z, Harinath P. Potential effects of itolizumab treatment on plasma interleukin-6 levels in patients with severe COVID-19. Indian J Pharmacol 2021;53:246-7

How to cite this URL:
Vityala Y, Tagaev T, Mamatov S, Aidarov Z, Harinath P. Potential effects of itolizumab treatment on plasma interleukin-6 levels in patients with severe COVID-19. Indian J Pharmacol [serial online] 2021 [cited 2021 Jul 31];53:246-7. Available from: https://www.ijp-online.com/text.asp?2021/53/3/246/318969




Sir,

Coronavirus disease 2019 (COVID-19) causes only mild-to-moderate illness in many patients; however, some people develop severe or critical symptoms.[1] This severe disease is associated with cytokine storm syndrome (CSS), in which interleukin (IL)-6 plays an essential role.[2] The objective was to assess the ability of itolizumab treatment to reduce plasma IL-6 levels in patients with severe COVID-19.

Twelve patients with severe COVID-19 (mean age: 36.5 years [standard deviation: 9.6, range: 19–59]; 8 [60%] women) were enrolled and subjected to therapy with intravenous itolizumab (200 mg/dose); for three patients, a second dose was administered 72 h after the initial dose, together with standard therapy. Serum samples of circulating IL-6 were obtained 24–48 h after itolizumab administration and were analyzed using the human IL-6 ELISA kit (Sigma-Aldrich, Mexico, Missouri, USA). Baseline and demographic data are presented as means (±standard deviation) and n (%). The data were analyzed using GraphPad Prism v9.0.0 (GraphPad Software, San Diego, California, USA); P < 0.05 was considered statistically significant. Patient confidentiality was maintained, and informed consent was obtained. Patients were treated at home according to clinical protocol no. 2, approved by the Ministry of Health of Kyrgyzstan.[3] For all patients, the results of blood and biochemical analyses were normal, except for an increase in the neutrophil-to-lymphocyte ratio (6.214 ± 5.937). After treatment, the mean plasma IL-6 level was reduced from 279.4 pg/mL to 53.6 pg/mL, and the serum IL-6 level was reduced to 31.7 pg/mL, 48 h after one dose of itolizumab. After treatment, the reduction in IL-6 levels from baseline levels was 50 pg/mL (P = 0.006), and the median reduction was 2.35 pg/mL (P = 0.052).

Regulation of the IL-6 signaling pathway to prevent cytokine release syndrome (CRS) and inflammation is helpful to treat patients with COVID-19. A study from China reported a correlation between increased plasma IL-6 levels and severe side effects, including high case fatality rates, in patients with COVID-19.[4] This study revealed increased IL-6 levels in patients with severe COVID-19 and demonstrated that a single dose of itolizumab is safe and effective for decreasing IL-6 levels in these patients. Itolizumab controls the regulation of regulatory T cells and decreases T-cell traffic and infiltration at inflammatory sites.[5] The results of the present study showed that itolizumab also plays a crucial role in immunomodulation and regulates the hyperactivation of T cells to stop the progression to CRS.

Although this study demonstrated that itolizumab decreased IL-6 levels in patients with severe COVID-19, there were some limitations, such as the small sample size and that this was a single-center study. Interestingly, all 12 patients who received treatment with itolizumab in this study recovered and were observed to be healthy at the follow-up. Based on these results, we can conclude that itolizumab helps reduce the negative effects of CSS in patients with COVID-19.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020;323:1239-42.  Back to cited text no. 1
    
2.
Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ, et al. COVID-19: Consider cytokine storm syndromes and immunosuppression. Lancet 2020;395:1033-4.  Back to cited text no. 2
    
3.
Government of Kyrgyz Republic. Ministry of Health of the Kyrgyz Republic; 2020. Available from: http://med.kg/images/koronavirus/prikaz_219_05042020.pdf. [Last accessed on 2020 Oct 30].  Back to cited text no. 3
    
4.
Chen X, Zhao B, Qu Y, Chen Y, Xiong J, Feng Y, et al. Detectable serum SARS-CoV-2 viral load (RNAaemia) is closely correlated with drastically elevated interleukin 6 (IL-6) level in critically ill COVID-19 patients. Clin Infect Dis 2020;71:1937-42.  Back to cited text no. 4
    
5.
Nair P, Melarkode R, Rajkumar D, Montero E. CD6 synergistic co-stimulation promoting proinflammatory response is modulated without interfering with the activated leucocyte cell adhesion molecule interaction. Clin Exp Immunol 2010;162:116-30.  Back to cited text no. 5
    




 

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