Itolizumab, an anti-CD6 monoclonal antibody, as a potential treatment for COVID-19 complications

• Published in: Expert opinion on biological therapy Vol. 20; no. 9; pp. 1025 - 1031
• Main Authors: Loganathan, Subramanian, Athalye, Sandeep N., Joshi, Shashank R.
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01.09.2020
• Subjects: Anti-CD6; Antibodies, Monoclonal, Humanized - pharmacology; Antibodies, Monoclonal, Humanized - therapeutic use; Antigens, CD - immunology; Antigens, Differentiation, T-Lymphocyte - immunology; Betacoronavirus; Cell Differentiation - drug effects; Cell Differentiation - physiology; Cell Proliferation - drug effects; Cell Proliferation - physiology; Coronavirus Infections - drug therapy; Coronavirus Infections - immunology; COVID-19; cytokine storm; Cytokines - antagonists & inhibitors; Cytokines - immunology; Humans; inflammatory; Itolizumab; Lymphocyte Activation - drug effects; Lymphocyte Activation - physiology; monoclonal antibodies; Pandemics; plaque psoriasis; Pneumonia, Viral - drug therapy; Pneumonia, Viral - immunology; SARS-CoV-2; T-Lymphocytes - drug effects; T-Lymphocytes - immunology; Treatment Outcome; COVID-19; Anti-CD6; Itolizumab; cytokine storm; inflammatory; plaque psoriasis; monoclonal antibodies
• DOI: 10.1080/14712598.2020.1798399
• ISSN: 1471-2598

The globally rampant SARS CoV-2 pandemic requires novel medical strategies to control the severity of disease and death due to complications. Of the 15-20% patients that develop pulmonary symptoms, a sub-set develops an acute respiratory distress syndrome (ARDS) rapidly progressing into a critical condition. Marked elevation of cytokines/chemokines is observed with elevation of additional markers of inflammation, coagulation, and organ damage such as CRP, D-dimer, LDH, Ferritin and Troponin-I. This hyperinflammation leads to worsening of oxygen saturation due to pulmonary infiltration and exudation, organ damage, and dysfunction of coagulation pathway and may lead to multi-organ failure. The role of anti-inflammatory monoclonal antibodies such as Itolizumab, in cytokine storm. Itolizumab, an anti-CD6 humanized IgG1 mAb, binds to domain-1 of CD-6 that is responsible for priming, activation, and differentiation of T-cells. Itolizumab significantly reduces T-cell proliferation along with substantial downregulation of the production of cytokines/chemokines. Approved for moderate to severe chronic plaque psoriasis in 2013 it is currently being studied for addressing COVID-19 related cytokine storm and its complications. This article reviews its use in COVID-19 infections; its dose, administration protocol, contra-indications, and safety in treating moderate-to-severe ARDS by preventing and treating the cytokine storm and its complications.