Melatonin and REGN-CoV2 combination as a vaccine adjuvant for Omicron variant of SARS-CoV-2

Abstract

The omicron variant (B.529) of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which emerged in late 2021, caused panic worldwide due to its contagiousness and multiple mutations in the spike protein compared to the Delta variant (B.617.2). There is currently no specific antiviral available to treat Coronavirus disease 2019 (COVID-19). However, studies on neutralizing monoclonal antibodies (mAb) developed to fight COVID-19 are growing and gaining traction. REGN-COV2 (Regeneron or imdevimab-casirivimab combination), which has been shown in recent studies to be less affected by Omicron's RBD (receptor binding domain) mutations among other mAb cocktails, plays an important role in adjuvant therapy against COVID-19. On the other hand, it is known that melatonin, which has antioxidant and immunomodulatory effects, can prevent a possible cytokine storm, and other severe symptoms that may develop in the event of viral invasion. Along with all these findings, we believe it is crucial to evaluate the use of melatonin with REGN-COV2, a cocktail of mAbs, as an adjuvant in the treatment and prevention of COVID-19, particularly in immunocompromised and elderly patients.

Potential Therapeutic Approach of Melatonin against Omicron and Some Other Variants of SARS-CoV-2

“…A cross-sectional clinical trial experiment and adjuvant therapy found that the dose of 3 to 10 mg of melatonin has preventative and therapeutic effects for COVID-19 disease, but it must be further evaluated, especially in children, and the efficacy of melatonin against the Omicron variant requires investigation [ 45 , 48 ]. Recently, a mini review hypothesized, according to an experiment, that melatonin with REGN-CoV-2 adjuvant therapy might significantly prevent the infection of Omicron variant in immunocompromised and elderly patients [ 49 ].…”

The Concomitant Use o f Melatonin and Bebtelovimab as a Treatment Strategy for Omicron and Future Variants of Concern

“…As a result, detrimental consequences such as DNA damage, protein oxidation, and lipid peroxidation can be avoided [50]. Matrix metalloproteinase (MMP) expression is increased due to reactive oxygen species [1]. The negative consequences of excessive MMP production can be significantly diminished by melatonin supplementation with ROS scavenging action [1,40].…”

“…Matrix metalloproteinase (MMP) expression is increased due to reactive oxygen species [1]. The negative consequences of excessive MMP production can be significantly diminished by melatonin supplementation with ROS scavenging action [1,40]. Melatonin could help to alleviate the pulmonary inflammation brought on by COVID-19 by reducing oxidative stress and cell death.…”

“…Melatonin could help to alleviate the pulmonary inflammation brought on by COVID-19 by reducing oxidative stress and cell death. According to the studies, melatonin has a higher level of antioxidant activity than other well-known ROS scavengers [1]. Additionally, the severity of the effects induced by pro-inflammatory cytokines produced in the cytokine storm brought on by SARS-CoV-2 infection is associated with the intensity of the inflammatory immune response [50].…”

“…The World Health Organization (WHO) declared coronavirus disease (COVID -19) a pandemic in early March 2020 [1]. Since then, thousands of people have suffered and died from COVID-19 [1,2].…”