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Hyperinflammation and cytokine storm have been reported in severe coronavirus disease (COVID-19) patients. Persistent elevated levels of inflammatory cytokines may lead to an increased risk of vascular hyperpermeability, multiorgan failure, and eventually death over time. Repurposed Itolizumab, a humanized recombinant anti-CD6 monoclonal antibody, is found to inhibit T-cell proliferation and reduce IFN-g , IL-6, and TNF-a production, thereby leading to reduction in the T-cell infiltration at the sites ofinflammation. Here we report a case of a 69 year old COVID-19 confirmed male patient who presented with a history of fever, cough and fatigue. The patient had elevated levels of serum ferritin and CRP. His SpO2 was 80% and ground glass opacities were observed in his chest X-ray. The patient was initiated on oxygen (using HFR mask) along with best supportive care and saturation was maintained at SpO2 of 85%. Itolizumab (1.6 mg/kg) was administered as an intravenous infusion (Day 1). On Days 3 and4, the patient continued on oxygen and maintained a SpO2 90% - 92%. On Day 7, there was a 87.86% reduction in the inflammatory marker CRP from baseline. On Day 8, the patient was off oxygen. On Day 9, there was further clinical improvement and the chest x-ray revealed reduction of opacities at the basal and hilar regions. Day 10 showed further CRP reduction of 97.69% from baseline. On Day 12, the patient was discharged. Itolizumab, along with best supportive care, shows potential to reduce hyperinflammation leading to clinical and radiological improvement in COVID-19 patients with severe disease.Keywords: Acute respiratory distress syndrome, Anti CD6 humanised monoclonal antibody, Cytokines, Cytokine storm, Hyperinflammation, Itolizumab, COVID-19.

indian journal of immunology and respiratory medicine

Itolizumab in addressing symptoms of acute respiratory distress syndrome (ARDS) with weaning off oxygen requirements in a COVID-19 patient: A case study