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

Loganathan, Subramanian; Athalye, Sandeep N; Joshi, Shashank R

INTRODUCTION The rampant SARS CoV-2 pandemic across the world requires novel medical strategies to control the severity of disease and death due to complications. Of the 15-20% patients that develop pulmonary symptoms, there is a sub-set that develops acute respiratory distress syndrome (ARDS) which rapidly progresses into a critical condition. Marked elevation of cytokines and chemokines is observed in these patients. Additional markers of inflammation, coagulation and organ damage such as CRP, D-dimer, LDH, Ferritin, Troponin-I are also elevated. The hyperinflammatory condition leads to worsening of oxygen saturation due to pulmonary infiltration and exudation, organ damage and dysfunction of coagulation pathway which resembles disseminated intravascular coagulation (DIC) and may lead to multi-organ failure. Areas Covered: To focus on the role of anti-inflammatory monoclonal antibodies (mAb's), such as Itolizumab. Expert Opinion: Itolizumab is an anti-CD6 humanized IgG1 mAb that binds to domain 1 of CD-6, a receptor present on Teffector cells, responsible for priming, activation and differentiation of T-Cells. Itolizumab significantly reduces T-cell proliferation along with substantially downregulating the production of various chemokines and cytokines. It has been approved for moderate to severe chronic plaque psoriasis in 2013 and is currently being studied for addressing COVID-19 related cytokine storm and its complications. This current opinion reviews its use in COVID-19 infections; its dose, administration protocol, contra-indications and safety in patients suffering from moderate to severe ARDS in prevention and treatment of the cytokine storm and its complications.