The COVID-19 pandemic is one of the worst challenges the modern medicine has ever encountered. There is no standard treatment for this infection, and there are many ongoing clinical trials to find a possible treatment regimen. Among different tested medications, chloroquine was promising likely by having immunomodulating properties.
Strangely, the highest mortality rates of the COVID-19 have been reported in the developed countries with robust healthcare systems. The tropical countries have witnessed less fatal cases (1). The less fatality of this virus in these regions (with a high prevalence of malaria) may be related to Hemoglobin structure. Given the natural selection, the structure of Hemoglobin in these regions is slightly different than the rest of the world (e.g., high prevalence of the Hemoglobin S). It is possible that altered Hemoglobin not only helps these people to survive malaria but the COVID-19 virus as well. We suggest adding medications capable of changing the hemoglobin structure to COVID-19 clinical trials. Increasing hemoglobin F level may have a therapeutic effect in these patients (higher levels of hemoglobin F can be a reason for lower mortality in children as well). In this context, “Pomalidomide” appears to be a suitable candidate. Its role in increasing Hemoglobin F level as well as immunomodulatory effects have been well documented (2-4). The same as chloroquine, Pomalidomide can regulate the cytokines. By increasing the Hemoglobin F and immunomodulation, pomalidomide can have dual effects on this infection.
Ehsan Sotoudeh MD
Red Crescent Iranian Hospital in Dubai, Dubai, UAE
Houman Sotoudeh MD
University of Alabama at Birmingham, Alabama, USA
1. Coronavirus COVID-19 Global Cases by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU).
2. Chanan-Khan AA, Swaika A, Paulus A, et al. Pomalidomide: the new immunomodulatory agent for the treatment of multiple myeloma. Blood Cancer J 2013; 3: e143.
3. Meiler SE, Wade M, Kutlar F, et al. Pomalidomide augments fetal hemoglobin production without the myelosuppressive effects of hydroxyurea in transgenic sickle cell mice. Blood 2011; 118(4): 1109-12.
4. Richardson PG, Mark TM, Lacy MQ. Pomalidomide: new immunomodulatory agent with potent antiproliferative effects. Crit Rev Oncol Hematol 2013; 88 Suppl 1: S36-44.
Chronic viruses evade T-cell and natural killer (NK) immunity through downregulation of immune surface markers.
Pomalidomide (Pom) increases surface expression of major histocompatibility complex class I (MHC-I) in Kaposi sarcoma-associated herpesvirus-infected latent and lytic cells and restores ICAM-1 and B7-2 in latent cells. It increased expression of certain of these surface markers.
Article Pomalidomide increases immune surface marker expression and ...
Pomalidomide has severe side effects and is certainly not a candidate for treating COVID-19. The most common side effects include diseases of the blood and lymphatic system, including anemia (45.7%), neutropenia (45.3%) and thrombocytopenia (27%), as well as general complaints at the site of administration, including fatigue (28.3 %), pyrexia (21%) and peripheral edema (13%). Infections and infestations, including pneumonia, are also common (10.7%). Peripheral neuropathies were noted in 12.3% of the patients and venous embolic or thrombotic events (VTE) occurred in 3.3% of the patients. The most commonly reported grade 3 or 4 adverse reactions include neutropenia (41.7%), anemia (27%), thrombocytopenia (20.7%), and infections or infestations, including pneumonia (9%). (WP)
Never use it in COVID-19, due to a plethora of side effects and teraatogenicity.