Title : Therapeutic repositioning of the monoclonal antibodies itolizumab and nimotuzumab in COVID-19.
Since the first case of COVID 19 was reported in China in 2019, the world has turned to seek therapeutic alternatives for the treatment of this disease and search vaccines against it. About 300 million people in the world have been affected by the pandemic without recognizing ages until now, however, in older people the consequences have been worse since the presence of certain comorbidities such as high blood pressure, diabetes mellitus, renal failure among others were consolidated as aggravating predictors of mortality. The first patient in Cuba was reported in March 2020 and from this moment the use of two monoclonal antibodies (Mab) in the treatment of new pneumonia was repositioned: itolizumab and nimotuzumab. itolizumab Mab is an anti-CD6 receptor and is able to blocks it in the activated lymphocytes due to the infection, with this therapy the inhibition of them was sought to avoid the syndrome of release of inflammatory cytokines such as IL6 , IFN gamma among others. In a second moment of the pandemic and after the role played by the epidermal growth factor receptor (EGFR) was reported, patients were treated with the Mabnimotuzumab, an anti EGFR that has been used for more than 20 years in the treatment of tumors of epithelial origin with recognized anti-tumor activity as an inhibitor of cell proliferation, metastasis, angiogenesis among other functions. In both treatment schemes, a recovery of more than 80% was achieved for severe patients and 90% for moderate patients, avoiding the critical stage of the disease. It was determined in both studies that the neutrophil / lymphocyte inflammatory indices (NLR) were predictors of the severity of the disease and that these were restored to normal with the treatments. The increase in IL6 levels was reduced. Patients who received mAbs had a risk of dying at least two times lower than those who did not. In the case of mAb nimotuzumab, pulmonary recovery was found without the appearance of fibrosis or its decrease one month after receiving the treatment, thereby reducing the sequelae of COVID-19. Today both monoclonal antibodies are part of the country's therapeutic arsenal in patients with the disease.