Title:DPP4 Inhibitors: Could they be One of the Solutions for COVID-19 Patients
with Prediabetes?
Volume: 18
Issue: 1
Author(s): Ntethelelo Hopewell Sibiya*, Bongeka Cassandra Mkhize and Andile Khathi
Affiliation:
- Department of Pharmacy and Pharmacology, Rhodes University, Grahamstown 6139, South Africa
Keywords:
COVID-19, prediabetes, DPP4 inhibitors, SARS-CoV2, inflammation, glycaemic control.
Abstract: Recent reports suggest that prediabetes is a risk factor for developing severe COVID-19
complications through underlying mechanisms involving undiagnosed sub-clinical inflammation.
However, we remain without a clinical approach for managing COVID-19 in prediabetic cases. The
subclinical inflammation in prediabetes is associated with elevated DPP4 levels and activity. DPP4 has
pleiotropic actions, including glycaemia regulation and immuno-modulation. Recently, DPP4 has been
recognised as a co-receptor for COVID-19 for entering host cells. In addition to improving glycaemia,
DPP4 inhibition is associated with reduced inflammation. In this submission, we explore the potential
use of DPP4 inhibitors as therapeutic agents for prediabetic patients in managing the deleterious effects
of COVID-19. DPP4 inhibitors (gliptins), such as linagliptin and sitagliptin, have therapeutic effects,
which have been shown to extend beyond glycaemic control with no risk of hypoglycaemia. By
the nature of their mechanism of action, gliptins are not associated with hypoglycaemia, unlike their
anti-glycaemic counterparts, as they mainly target postprandial glycaemia. Moreover, DPP4 inhibitors
may represent a safer option for prediabetic individuals in managing prediabetes either as a prophylactic
or curative treatment for COVID-19. We envisage that beyond improved glycaemic control, the use
of DPP4 inhibitors would also alleviate the cytokine storm, resulting in a reduction in the severity of
COVID-19 symptoms and consequently reducing the morbidity and mortality in prediabetic COVID-
19 patients.
