A new discovery about how the body transports dexamethasone, a drug that can increase the survival chances of patients with severe COVID-19, suggests diabetes and other factors may reduce its potentially lifesaving effectiveness. Based on their findings, the researchers say doctors may need to rethink how they dose the drug for certain groups of patients.
The team of scientists, based at the University of Virginia School of Medicine, the University of South Carolina, and in Poland, has determined how a protein in our blood called serum albumin picks up dexamethasone and takes it where it is needed. Low serum albumin levels are already considered a major risk factor for severe COVID-19, as is diabetes.
The new research suggests diabetes or low albumin levels may make it difficult for patients to get the benefits of dexamethasone, a corticosteroid that calms the hyperactive immune response that can lead to death in severe COVID-19.
Diabetes is associated with high blood sugar levels, which results in a modification of albumin that may alter the binding site for dexamethasone. Other drugs may also compete with dexamethasone for the limited space in serum albumin’s cargo holds. Albumin’s cargo capacity is also naturally decreased when there is a low albumin level in the blood.
The researchers published their findings in the scientific journal IUCrJ, and the research will be featured on the journal’s cover. The research team consisted of Shabalin, Mateusz P. Czub, Karolina A. Majorek, Brzezinski, Marek Grabowski, David R. Cooper, Mateusz Panasiuk, Maksymilian Chruszcz, and Minor.