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Prospects of Hyaluronidase Therapy in Novel COVID-19 Infection with Damage to Lungs

INTRODUCTION: In recent years, the production and regulation of synthesis of hyaluronic acid in COVID-19 has been actively studied. Hyaluronan plays a significant role in development of severe lung damage in COVID-19 and is a potential therapeutic target the action on which will probably improve prognosis for patients with COVID-19. 
AIM: To study prospects of using bovhyaluronidaze azoximer in complex treatment of patients with COVID-19 with lung damage at the inpatient stage. 
MATERIALS AND METHODS: Thirty five patients (6 men and 29 women) aged 58.9 12.9 years hospitalized with COVID-19 infection, were examined. Capillary blood saturation (SpO2) was 80.1 8.6%, the volume of lung damage in X-ray computed tomography (X-ray CT) was 45.1 19.4% on the right and 40.0 19.5% on the left. All the patients received treatment according to the Temporary Guidelines: prevention, diagnosis and treatment of novel coronavirus infection. Ver. 14 (27.12.2021). Besides, as part of complex treatment for COVID-19, bovhyaluronidaze azoximer was administered intramuscularly on the 21.9 6.8th day of illness with a course of 10 injections (once in 3 days). 
RESULTS: In the course of comprehensive treatment including bovhyaluronidaze azoximer, increase in SpO2 was recorded: in 7 patients ― after 1 injection (4.2 1.7%), in 24 ― after 2 injections (5.4 0.6%), another 4 patients did not show any significant increase in SpO2 after the first two injections. Increase in SpO2 after the 1st injection inversely correlated with age (r = -0.34; p 0.05) and the initial saturation (r = -0.38; p 0.05). Increase in SpO2 after the second injection correlated with the day of illness on which treatment with bovhyaluronidaze azoximer began (r = -0.36; p 0.05). 
CONCLUSION: Use of bovhyaluronidaze azoximer in complex treatment for COVID-19 with the lung damage at the inpatient stage can be effective in younger patients with more expressed initial reduction of SpO2, and also in case of administration of the drug in the early stages of the disease. The data obtained in the pilot study, dictate the necessity of studying the level of hyaluronic acid in blood of patients with COVID-19 and lung damage and its role in risk stratification of such patients.