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Efficacy of Sunlight Activated Synthetic Porphyrin in COVID-19 Infected Patients (SnPPIX)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT04371822
Recruitment Status : Not yet recruiting
First Posted : May 1, 2020
Last Update Posted : May 29, 2020
Sponsor:
Information provided by (Responsible Party):
Mahmoud Ramadan mohamed Elkazzaz, Kafrelsheikh University

Brief Summary:

Efficacy of Sunlight and X- Ray Activated Synthetic Porphyrin in COVID-19 Infected Patients (SnPPIX)

Mahmoud ELkazzaz(1),Rokia Yousry Sallem(2)

______________________________________________________________________________________________________________________________________________________________________

Abstract :

The novel coronavirus pneumonia (COVID-19) is an infectious acute respiratory caused by the novel coronavirus. The virus is a positive-strand RNA virus with high homology to bat coronavirus. Depending on published study in which , conserved domain analysis, homology modeling, and molecular docking were used to compare the biological roles of specific proteins of the novel coronavirus. The principal investigator demonstrated according to previous researches that some viral structural and nonstructural proteins could bind to the porphyrin, respectively. At the same time, orf1ab, ORF10 and ORF3a proteins coordinated to attack heme on the 1-beta chain of hemoglobin, COVID-19 binds to the porphyrin of haem and displaces iron and a study denonestrated that Covid-19 could cause acquired acute porphyria which is the condition in which there is excess accumulation of porphyrin intermediate metabolites. This point can be taken advantage of X-ray induced visible luminescence of porphyrin for producing of Reactive Oxygen Species (ROS).Many porphyrins are benign in the dark but are transformed by sunlight into caustic, flesh-eating toxins Porphyrins have been used for photodynamic therapy (PDT) against a wide range of targets like bacteria, viruses and tumor cells It has been reported that ROS-based inactivation of viruses may occur due to several reasons, such as protein oxidation, single strand breaks in the RNA genome and protein-RNA crosslinking. Since ROS-based inactivation has a multi-targeted mechanism, it is much less likely that a virus would be able to develop resistance against it. Recently, porphyrins, already in use as photosensitizers for Photodynamic Therapy (PDT), were a study target to applications in medical area, namely as possible contrast agents in MRI. could be observed some examples of porphyrin derivatives already study as MRI contrast media. Low dark toxicity, neoplastic tissue affinity and synthetic accessibility are some of the important properties that contribute for its selection. In MRI studies was found that CM based on paramagnetic metalloporphyrins showed higher affinity for neoplastic tissues, observed by increased relaxation time of the neoplastic tissues, which is reflected on an increase in MRI signal and consequently in a better neoplastic lesions detection. A study demonestrated that The sulfonated tetranaphthyl porphyrin contrast agents in MRI (TNapPS), sulfonated tetra-anthracenyl porphyrin (TAnthPS), and sulfonated 2,6-difluoro-meso-tetraphenylporphine [TPP(2,6-F2)S] and its copper chelate [TPP(2,6-F2)S,Cu], which reduced HIV infection by 99, 96, 94, and 96%, respectively. Previous studies which showed that Covid -19 binds to the porphyrin of haem and displaces iron in addition to Sulfonated porphyrins and light-stimulated Sn- protoporphyrin IX have broad antiviral activity against more distinct types of viruses, Co-protoporphyrin IX and Sn-protoporphyrin IX inactivate Zika, Chikungunya and other arboviruses by targeting the viral envelope Porphyrins are amphipathic molecules able to interact with membranes and absorb light, being widely used in photodynamic therapy. Previously, we showed that heme, Co-protoporphyrin IX (CoPPIX) and Sn-protoporphyrin IX (SnPPIX) directly inactivate DENV and YFV infectious particles. Here we demonstrate that the antiviral activity of these porphyrins can be broadened to CHIKV, ZIKV, Mayaro virus, Sindb is virus and Vesicular Stomatitis virus. Porphyrin treatment causes viral envelope protein loss, affecting viral morphology, adsorption and entry into target cells ,Therefore, the principal investigator expects that treatment with x-ray induced visible luminescence of porphyrins will be effective in targeting of COVID-19, Finally, the principal investigator expect that viral load will be declined with sunlight because In particular, porphyrins absorb essentially all the UV/visible light wavelengths in the emission spectrum of the sun; hence they are active at very low doses .

Keywords: COVID 2019 ,Infection, Sulfonated porphyrins and X-ray induced visible luminescence of porphyrin


Condition or disease Intervention/treatment Phase
COVID-19 Drug: SnPP Protoporphyrin plus Sunlight exposure Drug: Sulfonatoporphyrin(TPPS) plus Sunlight exposure. Other: placebo Phase 1

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 56 participants
Allocation: Non-Randomized
Intervention Model: Sequential Assignment
Intervention Model Description:

Patients and method :

This study will performed on 56 participants tested positive for the presence of COVID-19 RNA by RT-PCR kit for RNA detection and 56 participants will divided into 8 equal groups

Masking: None (Open Label)
Masking Description:

Patients

This study will performed on 56 participants tested positive for the presence of COVID-19 RNA by RT-PCR kit for RNA detection and 56 participants will divided into 8 equal groups

Primary Purpose: Treatment
Official Title: Efficacy of Based MRI Contrast Media Against Covid-19
Estimated Study Start Date : May 2020
Estimated Primary Completion Date : June 2020
Estimated Study Completion Date : August 2020

Arm Intervention/treatment
Active Comparator: 5 mg SnPP dose plus sunlight exposure
7 subjects with COVID-19 infection and Serum ferritin < 500 ng/ml will receive a single dose of 5 mg of Stannous Protoporphyrin and They will be exposed to sunlight one hours every day for 14 days
Drug: SnPP Protoporphyrin plus Sunlight exposure
SnPP Protoporphyrin plus Sunlight exposure
Other Name: SnPP

Active Comparator: 7mg SnPP dose plus sunlight exposure
7 subjects with COVID-19 infection and Serum ferritin < 500 ng/ml will receive a single dose of 7 mg of Stannous Protoporphyrin and They will be exposed to sunlight two hours every day for 14 days
Drug: SnPP Protoporphyrin plus Sunlight exposure
SnPP Protoporphyrin and Sunlight exposure
Other Name: SnPP

Active Comparator: 9 mg SnPP dose plus sunlight exposure
7 subjects with COVID-19 infection and Serum ferritin < 500 ng/ml will receive a single dose of 9 mg of Stannous Protoporphyrin and They will be exposed to sunlight three hours every day for 14 days
Drug: SnPP Protoporphyrin plus Sunlight exposure
SnPP Protoporphyrin plus Sunlight exposure

Active Comparator: 5mg TPPS dose plus sunlight exposure
7 subjects with COVID-19 infection and Serum ferritin < 500 ng/ml will receive a single dose of 5 mg of sulfonatoporphyrin(TPPS), and They will be exposed to sunlight two hours every day for 14 days
Drug: Sulfonatoporphyrin(TPPS) plus Sunlight exposure.
Sulfonatoporphyrin(TPPS) plus Sunlight exposure.
Other Name: (TPPS)

Placebo Comparator: placebo
No intervention
Other: placebo
No Intervention




Primary Outcome Measures :
  1. lung injury score [ Time Frame: at 7and 14 days ]
    Proportion of lung injury score decreased or increased after treatment

  2. Serum ferritin [ Time Frame: at day 1-3-7 and 14 ]
    Serum ferritin


Secondary Outcome Measures :
  1. Absolute lymphocyte counts [ Time Frame: at day 7 and 14 ]
    lymphocyte counts

  2. Serum levels of CRP, ESR ,IL-1,IL-6,TNF and Type I interferon [ Time Frame: at day 7 and 14 ]
    Serum levels of CRP, ESR ,IL-1,IL-6,TNF and Type I interferon

  3. Serum level of COVID19 RNA [ Time Frame: at day 7 and 14 ]
    Serum level of COVID19 RNA

  4. All cause mortality rate [ Time Frame: at day 7 and 14 ]
    died

  5. Ventilation free days [ Time Frame: at 14 days ]
    ventilation free days

  6. ICU free days [ Time Frame: at 14 days ]
    ICU free days

  7. d-dimers [ Time Frame: at 3-5days ]
    less than 250 ng/mL, or less than 0.4 mcg/mL of blood sample

  8. Time to first negative SARS-CoV-2 PCR in NP swap [ Time Frame: within 14 days ]
    (if pos. at baseline)



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 80 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

Adult SARI patients with 2019-ncov infection confirmed by PCR; Absolute value of lymphocytes < 0. 6x 109/L; Severe respiratory failure within 48 hours and requires admission to ICU. (severe respiratory failure was defined as PaO2/FiO2 < 200 mmHg and was supported by positive pressure mechanical ventilation (including non-invasive and invasive mechanical ventilation, PEEP>=5cmH2O))

Exclusion Criteria:

  • History of malignancy except carcinoma in situ in the cervix, early stage prostate cancer or non-melanoma skin cancers. Cancer free for less than 5 years.
  • Use of investigational drugs or participation in another clinical trial within 30 days or 5 half-lives prior to screening, whichever is longer.
  • Serum ferritin > 500 ng/ml or who have received IV iron within 28 days of screening, or currently being treated with oral iron.
  • Women who are pregnant, breastfeeding, or planning to become pregnant while participating in the study.
  • Regular use of drugs of abuse and/or positive findings on urinary drug screening.
  • Subjects who are severely physically or mentally incapacitated and who, in the opinion of investigator, are unable to perform the subjects' tasks associated with the protocol.
  • Presence of any condition which, in the opinion of the investigator, places the subject at undue risk or potentially jeopardizes the quality of the data to be generated.
  • Subjects with history of photosensitivity or active skin disease, which, in the opinion of the investigator could increase the risk of photosensitivity.
  • Subjects with abnormal baseline liver tests or hepatitis serologies that suggest active infection.
  • Liver disease
  • Renal disease
  • Known hypersensitivity or previous anaphylaxis to SnPP and Sulfonated porphyrins

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04371822


Contacts
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Contact: M.Sc.Mahmoud Elkazzaz, M.Sc.Biochemistry 00201090302015 mahmoudramadan2051@yahoo.com

Locations
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Egypt
Kafr El-sheikh University
Cairo, Kafr El-sheikh, Egypt, 33511
Sponsors and Collaborators
Kafrelsheikh University
Investigators
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Study Chair: M.Sc. Mahmoud Elkazzaz, M.Sc.in Biochemistry Damitta University
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Responsible Party: Mahmoud Ramadan mohamed Elkazzaz, Principal Investigator, Kafrelsheikh University
ClinicalTrials.gov Identifier: NCT04371822    
Other Study ID Numbers: Proposed by Mahmoud Elkazz
First Posted: May 1, 2020    Key Record Dates
Last Update Posted: May 29, 2020
Last Verified: May 2020

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
Additional relevant MeSH terms:
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Protoporphyrin IX
Tin protoporphyrin IX
Photosensitizing Agents
Dermatologic Agents
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action