The DPP4 family/system was implicated in various physiological processes and diseases of the immune system, and DPP4/CD26 is variously expressed on epithelia and endothelia of the systemic vasculature, lung, kidney, small intestine and heart. DPP4 distribution in the human respiratory tract may facilitate the entrance of the virus into the airway tract itself and could contribute to the development of cytokine storm and immunopathology in causing fatal COVID-19 pneumonia.

The use of DPP4 inhibitors, such as gliptins, in patients with COVID-19 with, or even without, type 2 diabetes, may offer a simple way to reduce the virus entry and replication into the airways and to hamper the sustained cytokine storm and inflammation within the lung in patients diagnosed with COVID-19 infection.

The supportive treatment of severe respiratory illnesses requires careful management of fluid balance. Oxytocin can cause water retention and hyponatremia as it also reacts with the vasopressin receptor.

This would have significant adverse effects in COVID-19 pneumonia.

Dear Professor Rajkumar Rajendram,

Thank you for your caution but...

From my limited understanding...

There is no good treatment for this global pandemic and logically it would be wise to see if the drug works before excluding it.

The potential risks and side effects are known as oxytocin has been in constant use globally for decades.

The mechanism and benefits in the literature are many including, but not limited to

diabetes, cardiovascular, immune modulation, muscle regeneration.

If oxytocin proves to be a good treatment I am sure a good ITU team would take these risks into consideration and mitigate them.

Oxytocin could be used on the ward, for post-COVID-19 rehabilitation as well as ITU.

Oxytocin can be administered IV, as an intranasal spray, nebulised and there is even a dry inhaler.

Again thank you for your engagement in the discussion, it is valuable.

Oxytocin dry inhaler for diabetic COVID-19 patients in less developed areas?

One of the practical limitations of oxytocin is the need for refrigeration.

This limits its use in less developed areas of the world where consistent refrigeration can not be maintained.

However this has been mitigated by the new oxytocin dry inhaler (1).

In theory this could be used to treat diabetic COVID-19 patients on the wards in less developed areas of the world.

If this reduced progression to ITU that would be of great help.

In areas where refrigeration is limited ITU capacity would also be limited.

It would be safe (in the correct dosage) and inexpensive compared to the newer possible drugs.

Many lives could theoretically be saved!

1.

https://www.researchgate.net/publication/273703237_Heat-Stable_Dry_Powder_Oxytocin_Formulations_for_Delivery_by_Oral_Inhalation

Article published here:

https://www.researchgate.net/publication/348547761_Oxytocin_May_be_Superior_to_Gliptins_as_a_Potential_Treatment_for_Diabetic_COVID-19_Patients