The Effect of Berberine on Intestinal Function and Inflammatory Mediators in Severe Patients With Covid-19

COVID-19 Clinical Trial

— BOIFIM  

Official title:

The Effect of Berberine on Intestinal Function and Inflammatory Mediators in Severe Patients With Covid-19

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04479202
• Other study ID #: Berberine treats COVID-19
• Secondary ID: XJ2020005101
• Status: Completed
• Phase: Phase 4
• Start date: February 8, 2020
• Est. completion date: April 23, 2020

Study information

• Verified date: May 2020
• Source: Chinese Medical Association
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Coronavirus disease 2019 (COVID-19) rapidly spread across China and throughout the world, causing hundreds of thousands died. Studies had shown that "cytokine storms" and subsequent multiple organ dysfunction (MODS) are important causes for disease progression and death in patients with COVID-19. Similar to SARS-CoV infection, SARS-CoV-2 would infect humans via binding of S-protein to angiotensin-converting enzyme 2 (ACE2), a host cell receptor, and the S protein is activated and cleaved by cellular transmembrane serine proteases, allowing the virus to release fusion peptides for membrane fusion. In addition to the lungs, ACE2 is also highly expressed in the esophagus, small intestine and colon, suggesting that the gut might also be an important target organ for SARS-CoV-2. About 8-16% of severe pneumonia cases confirmed with SARS-CoV-2 infection developed gastrointestinal symptoms such as abdominal pain, vomiting, and diarrhea. Moreover, the stool of patient with COVID-19 also positive by real-time reverse-transcriptase-polymerase-chain-reaction (rRT-PCR) assay. Furthermore, elevated faecal calprotectin was observed in patients with COVID-19 suggested an inflammatory response in the gut, which was significantly correlated with IL-6. For severe and critical cases, control "cytokine storms" and maintain intestinal microenvironment balance have been included into the Diagnosis and Treatment Guideline of patients with COVID-19 (Edition 7). Berberine is a quaternary ammonium alkaloid isolated from rhizoma coptidis. It is often used in treatment of infectious diarrhea by bacteriostasis and inhibition of intestinal gland secretion. Berberine has also been found to have a role in intestinal immune regulation, inhibiting both AP-1 and NF- B, the key factors in cell signal transduction, and reducing the inflammatory response. Investigators conducted a prospective randomized controlled clinical trial to investigate the effects of berberine on intestinal function, serum concentrations of the inflammatory biomarkers, and organ function in severe patients with SARS-CoV-2 infection.

Description:

Patients aged 18-80 years who confirmed with COVID-19 and classified as severe were enrolled in the study, and then separated randomly into two groups: a berberine group (B group) and a control group (C group). The diagnostic criteria for severe cases are in accordance with the Diagnosis and Treatment Guideline of patients with COVID-19 issued by the National Health Commission of the People's Republic of China (Edition 7). In general, patients diagnosed with COVID-19 pneumonia must also meet any of the following criteria: appears shortness of breath, respiratory rate (RR) ≥ 30 times/min; SPO2 ≤ 93% at rest; the ratio of partial oxygen pressure of arterial blood (PaO2) to oxygen absorption concentration (FiO2) ≤ 300mmHg (1mmHg=0.133KPa); pulmonary imaging showed the lesion progression ＞50% within 24-48 hours. All enrolled patients were given general support therapy, oxygen therapy, antiviral drugs, in combination with antibiotics and small doses of glucocorticoids if necessary, nutritional and organ function support. Patients in the berberine group (B group) were given berberine 0.3g tid orally or tube feed daily, while patients in the control group (C group) were given montmorilonite orally if they presence of diarrhea. The duration of the study intervention was 14 days and followed up to discharge. Investigators record general information about patients at admission, including age, gender, age, exposure history, time from onset of symptoms to hospital, APACHE II score, the presentation of X-ray, comorbidity, mechanical ventilation, fever or not,gastrointestinal symptoms. Investigators also evaluate the gastrointestinal function daily,including gastrointestinal symptoms (nausea, vomiting, abdominal pain, abdominal distension or diarrhoea), frequency of diarrhea, the characteristics of stool (Bristol scal). Peripheral blood are collected on day 1,3, 7 and 14 after admission to determine the level of interleukin-6 (IL-6), interleukin-1β (IL-1β), interleukin-10 (IL-10) and tumor necrosis factor (TNF-α). Laboratory tests are also performed to evaluate leucocyte, c-reactive protein (CRP), and procalcitonin (PCT) levels at the same time. Glutamate transaminase (ALT), glutamate transaminase (AST), urea nitrogen (Bun), creatinine, prothrombin time (PT), partially activated prothrombin time (APTT), and Sequential Organ Failure Assessment (SOFA) score are used to evaluate organ function on day 1,3, 7 and 14 after admission. Investigators also record the adverse events associated with the drug, length of stay and the prognosis at discharge. The patients are blinded to the group allocation. Two physicians are responsible for data processing, one is responsible for recording and collecting, and the other is responsible for checking, and they are all blind to the research.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 76
• Est. completion date: April 23, 2020
• Est. primary completion date: April 18, 2020
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 80 Years

Eligibility

Inclusion Criteria:

• Patients confirmed with COVID-19 and classified as severe

Exclusion Criteria:

• inflammatory bowel disease;

• have other sources of infection;

• death is anticipate within 72 hours;

• participated in other clinical trials;

• pregnant or lactating women;

Related Conditions & MeSH terms

• Berberine
• COVID-19

Intervention

Drug:
• Berberine
Patients in the intervention group received berberine daily, regardless of gastrointestinal symptoms.If the patient has a serious drug-related adverse event, the drug will be discontinued and the patient will be excluded from the study.
• Montmorrillonite
Patients in the control group were routinely not given special treatment.However, if the patient has diarrhea symptoms, montmorillonite powder should be given orally.

Locations

Country	Name	City	State
China	Nanjing Drum Tower Hospital	Nanjing	Jiangsu

Sponsors (1)

Lead Sponsor	Collaborator
Chinese Medical Association

Country where clinical trial is conducted

China, 

References & Publications (3)

Effenberger M, Grabherr F, Mayr L, Schwaerzler J, Nairz M, Seifert M, Hilbe R, Seiwald S, Scholl-Buergi S, Fritsche G, Bellmann-Weiler R, Weiss G, Müller T, Adolph TE, Tilg H. Faecal calprotectin indicates intestinal inflammation in COVID-19. Gut. 2020 Au — View Citation

Jin X, Lian JS, Hu JH, Gao J, Zheng L, Zhang YM, Hao SR, Jia HY, Cai H, Zhang XL, Yu GD, Xu KJ, Wang XY, Gu JQ, Zhang SY, Ye CY, Jin CL, Lu YF, Yu X, Yu XP, Huang JR, Xu KL, Ni Q, Yu CB, Zhu B, Li YT, Liu J, Zhao H, Zhang X, Yu L, Guo YZ, Su JW, Tao JJ, L — View Citation

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Chen H, Cao B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Sequential Organ Failure Assessment (SOFA) score	evaluate the severity of the disease(the minimum 0 and maximum 24, a higher scores mean a worse outcome)	baseline (at admission), day 3, 7 and 14 after admission or until the date of discharge or date of death from any cause
Primary	Changes in diarrhea frequency and Bristol Stool Scale	Including diarrhea in times/day, Bristol Stool Scale (the minimum 1 and maximum 7, a higher scores mean a worse outcome) and whether patient has any one of gastrointestinal symptoms (nausea, vomiting, abdominal pain, abdominal distension or diarrhoea).	daily, from date of randomization until the date of discharge or date of death from any cause, assessed up to 2 weeks.
Secondary	IL-6 (ng/ml)	evaluate inflammatory response, blood sample collected at 6:00am	baseline (at admission), day 3,7 and14 after admission or until the date of discharge or date of death from any cause
Secondary	IL-10(ng/ml)	evaluate inflammatory response, blood sample collected at 6:00am	baseline (at admission), day 3,7 and14 after admission or until the date of discharge or date of death from any cause
Secondary	IL-1ß (ng/ml)	evaluate inflammatory response, blood sample collected at 6:00am	baseline (at admission), day 3,7 and14 after admission or until the date of discharge or date of death from any cause
Secondary	TNF-a (pg/ml)	evaluate inflammatory response, blood sample collected at 6:00am	baseline (at admission), day 3,7 and14 after admission or until the date of discharge or date of death from any cause
Secondary	leukocyte count (10^9/l)	evaluate inflammatory response, blood sample collected at 6:00am	baseline (at admission), day 3,7 and14 after admission or until the date of discharge or date of death from any cause
Secondary	c reactive protein (mg/l)	evaluate inflammatory response, blood sample collected at 6:00am	baseline (at admission), day 3,7 and14 after admission or until the date of discharge or date of death from any cause
Secondary	procalcitonin (ng/ml)	evaluate inflammatory response, blood sample collected at 6:00am	baseline (at admission), day 3,7 and14 after admission or until the date of discharge or date of death from any cause