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Table of Contents
Year : 2020  |  Volume : 8  |  Issue : 3  |  Page : 152-153

Intradermal purified protein-derivative injection in the prevention of COVID-19 in highly risk individuals

Department of Dermatology and Venereology, Kafr El Sheikh General Hospital, Kafr El Sheikh, Egypt

Date of Submission30-Mar-2020
Date of Decision05-Jun-2020
Date of Acceptance05-Jun-2020
Date of Web Publication15-Jul-2020

Correspondence Address:
Dr. Naguib El Farnawany
Department of Dermatology and Venereology, Kafr El Sheikh General Hospital, Kafr El Sheikh 31155
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/AJIM.AJIM_24_20

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How to cite this article:
Farouk A, El Farnawany N. Intradermal purified protein-derivative injection in the prevention of COVID-19 in highly risk individuals. APIK J Int Med 2020;8:152-3

How to cite this URL:
Farouk A, El Farnawany N. Intradermal purified protein-derivative injection in the prevention of COVID-19 in highly risk individuals. APIK J Int Med [serial online] 2020 [cited 2020 Oct 31];8:152-3. Available from: https://www.ajim.in/text.asp?2020/8/3/152/289788


According to the pandemic COVID-19, there are many trials for manufacturing or reuse of previously approved medications to fight this virus. In this letter, we will declare a method for the prevention of COVID-19. As dermatologists, we use immunotherapy injection in our field for the treatment of viral infections as the human papilloma virus according to many clinical studies with high success rate. We wish to use this method in frightening COVID-19.

Interferon-gamma (IFNG) is a pleiotropic cytokine that modulates both innate and adaptive immune networks; it is the most potent activator of macrophages and a signature cytokine of activated T-lymphocytes. Although IFNG is now appreciated to have a multitude of roles in immune modulation and broad-spectrum pathogen defense, it was originally discovered, and named, as a secretory factor that interferes with viral replication.[1]

During the innate and adaptive immune response to virus infection, major histocompatibility complex class I and II induction and activation, as well as the differentiation of T-cells and the activation of macrophages, is influenced by interferons (IFN-s).[1] IFN-s are produced by the cells of the innate immune system: macrophages, neutrophils, plasmacytoid dendritic cells, and natural-killer (NK) cells. Type 1 (IFN-α and IFN-β) and type 2 (IFN-γ) IFN-s impede viral replication through similar cell-signaling mechanisms, inducing the production of proteins that inhibit translation and cell growth, induce apoptosis, and promote the down regulation of mRNA in virus-infected cells.[2]

In human medicine, IFN-γ has been used as a therapeutic adjuvant in the wide range of diseases from atopic dermatitis to ovarian cancer. The prophylactic use of IFN-γ was effective in patients with chronic granulomatous disease.

Immunotherapy is defined as a type of biological therapy that uses the substances to stimulate or suppress the immune system to help the body fight cancer, infection, and other diseases. The immunotherapeutic agents may be applied topically, injected intralesional or administered through systemic route.[3]

Purified protein derivative (PPD) or tuberculin is a sterile protein extract from the culture of Mycobacterium tuberculosis. It is used in skin testing to detect the exposure to the bacillus. It stimulates the cell-mediated immunity (CMI) nonspecifically by activating NK cells, Th1 cells, and cytokine production. An increase in interleukin-12 (IL-12) as a part of the enhanced CMI contributes to its mechanism of action as an immunotherapeutic agent.[4]

Intralesional injection of previously sensitized antigen as PPD might induce CMI and activate T-helper 1 (Th1) cells. Th1 cells under the effect of IL-12 secrete the high levels of cytokines (e.g., IL-2 and IFN-g). Both IL-12 and IFN-g have antiviral activities; further, the antiviral activity of IL-12 is mediated through endogenous IFN-g. In addition, IL-12 acts in synergy with other activating cytokines such as IL-2, IL-18, and IL-27 for IFN-g production.

PPD administration has been shown to boostin vitro IFN-γ production in the case of bTB. In another study founded that skin testing alone significantly induced PPD-specific IFN-γ-producing cells in humans.

Recently, there is hopeful news about using BCG vaccine as the prophylaxis for COVID-19. Here, in this letter, we recommend the use PPD instead of BCG which is contraindicated in immunocompromised, HIV and patients on immunosuppressive drugs, in contract to PPD which is safe in all previous conditions.[5]

As PPD is safe and available material used off label as immunotherapy to boost immune response through increasing the production of interferon gamma which has the antiviral role can help in the management and prevention of viral infection. We concluded that PPD can be safe effective method for immunotherapy used for health-care workers and highly risk individuals to decrease or prevent catching COVID-19 infection. These clinical experiences need randomized clinical study to prove its efficacy.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Kang S, Brown HM, Hwang S. Direct antiviral mechanisms of interferon-gamma. Immune Netw 2018;18:e33.  Back to cited text no. 1
Takaoka A, Yanai H. Interferon signaling network in innate defense. Cell Microbiol 2006;8:907-22.  Back to cited text no. 2
Thappa DM, Chiramel MJ. Evolving role of immunotherapy in the treatment of refractory warts. Indian Dermatol Online J 2016;7:364-70.  Back to cited text no. 3
[PUBMED]  [Full text]  
Abd-Elazeim FM, Mohammed GF, Fathy A, Mohamed RW. Evaluation of IL-12 serum level in patients with recalcitrant multiple common warts, treated by intralesional tuberculin antigen. J Dermatolog Treat 2014;25:264-7.  Back to cited text no. 4
The BCG Vaccine: Information and Recommendations for Use in Australia. Available from:https://www1.health.gov.au/internet/ main/publishing.nsf/Content/cda-cdi3001e.htm. [Last accessed on 2020 Jun 05]  Back to cited text no. 5


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