COVID-19: Collecting Measurements of Renin-angiotensin-system Markers, Such as Angiotensin-2 and Angiotensin 1-7

A Multi-center, Investigator-blinded, Randomized Clinical Trial, 18-months, Parallel-group to Compare the Efficacy of Tomeka® Foods Versus Vernonia Amygdalina in the Prevention and Maintenance of Remission of COVID-19 in DRC

Investigators study meet the World Health Organization definition of a clinical trial because it is a prospective study in which participants will be assigned to intervention groups to investigate the effects on health outcomes. Investigators highlighted clearly the real problem that indigeneous patients are facing now in the Democratic Republic of the Congo: Poverty meaning the lack of money to buy goods and drugs. From the news report, investigators learned that "In the Democratic Republic of the Congo, indigenous communities in Kananga, Tshikapa and in the Kasai region are increasing their consumption of "Vernonia amygdalina," a traditional plant believed to cure several diseases, including alleviating COVID-19." Based on an unpublished work, quite a few extract molecules of Vernonia amygdalina are excellent antiviral candidates which are the family members of Remdesivir in terms of their antiviral mechanisms. Furthermore, the antiviral capabilities of these molecules are significantly stronger than or at least equivalent to Remdesivir. The target zones of these molecules in the human body cover a set of important organs and tissues. For example, Vernolide (C19H22O7) is able to reside firmly at bronchi, the upper respiratory tract, and blood vessels.

From the news report, investigators learned also that Herbs used in Tanzania include lemon, ginger, neem tree leaves, mango tree leaves, orange tree leaves. These traditional medicines contain, more or less, antiviral molecules whose capacities range from good to outstanding levels. Those herbs have been used worldwide to fight COVID-19.

In conclusion traditional medicines have been playing important roles not only in Africa but also in Asia, in South America, etc. Herbs prove themselves with effective efficacies in many therapeutic practices.

So maybe after careful considerations, the World Health Organization may support the use of herbs for poor patients who cannot afford modern drugs and used traditional medicines after a positive COVID-19 test in the Democratic Republic of the Congo. Investigators are talking about a randomisation's nuance process to follow participants who decide by themselves if diagnosed positive to COVID-19 to begin to take herbs not waiting for a physician prescription.

Background Selenium supplementation is suggested for an intervention better in food intake. The Tomeka Prevention Trial (TPT) is a randomized double blind nutri prevention trial. Initial blood collection will be specifically for the analysis of Selenium [antioxidant] and storage of serum. An additional blood collection will be carried out using anticoagulants so that plasma and white blood cells can be isolated. Plasma will allow the analysis of additional biomarkers collecting measurements of renin-angiotensin-system markers such as Angiotensin-2 and Angiotensin 1-7. This serum will be used (among other possible uses) for studies to investigate the antioxidant effect of Vernonia amygdalina in organs which may influence COVID-19 risk in emergency situations.

The TOMEKA WBC [white blood cell] sample will be available to TOMEKA investigators as well as outside researchers who have important, timely hypotheses to test. Because the sample bank is a limited resource, proposals to use it will be evaluated in terms of scientific relevance, significance, and validity as well as the potential impact of the proposed study. The amount and type of material needed will also be considered and the efficient use of material will be required. Strict confidentiality will be exercised and the information provided to investigators will not contain personal identifiers.

When specific uses of the TOMEKA WBC samples will be approved, the protocol will be amended.

Objectives To provide a resource for studies of early markers, etiology, and genetic risk factors for COVID-19. To collect measurements of renin-angiotensin-system markers, such as angiotensin-2 and angiotensin 1-7.

Methods Because the original model consent form did not specifically address herbal studies, participants will be asked to sign an additional consent form to document their consent to the collection and submission of additional blood samples for storage and future testing (including laboratory analysis). WHO? Everyone aged 15 and up experiencing symptoms of fever, cough, or shortness of breath with confirmed active COVID-19. WHY? To see if the investigational use of Tomeka® will prevent hospitalization and death, in COVID-19 patients. WHAT? The study type is observational after using patient individual data and investigators are assigned prospectively to monitor symptoms of the COVID-19 with a questionnaire. At the slightest symptom associated with the COVID-19 virus present in the patient's individual data, namely: fever (38 degrees c or 100, 4 degrees F), new or exacerbated cough, shortness of breath, sore throat, loss of smell, sudden onset without nasal congestion or loss of taste, digestive symptoms (nausea, vomiting / diarrhea), general weakness, headache, myalgia. Participants from the patient individual database will be randomized (like flipping a coin) to one of two groups. The intervention is education that needs to be evaluated with the suggested Tomeka® foods (nutraceuticals).

Conclusion The protocol presents a treatment model developed in its early stages with individual medical files. The principal investigator had the idea to create a treatment build or based on the principle of antioxidant supplementation, proteins, lipids, energy intake. The protocol is leading to a serious need of nutraceuticals solution faced to the missing cheap COVID-19 vaccine problem when it will be available. The nutritional status of each COVID-19-infected patient should be assessed prior to undertaking treatments. The outcome objective is to teach. The total budget required for the project is from 250.000 US$ to 1.000.000 US$ for education based on individual patient data and implementation on a global scale. This theoretical study merits further investigation for possible inclusion of nutraceuticals as an alternative for fighting and eradicating COVID-19.

Inclusion Criteria:

Patients eligible for the trial must comply with all of the following at randomization:

1. Age ≥15 years
2. Current admission under the care of the heart-failure service at the site
3. Fulfill Inclusion criteria and accept
4. COVID-19 patients confirmed
5. be regular on appointments
6. No voluntary patient (see: having signed the informed consent) The criteria for choosing subjects: subjects who are themselves exposed to the consumption of Vernonia amygdalina (Kananga, Tshikapa or in Kasaï region). This group can be part of the cohort. tare: to compare with a no exposure group which is external to the cohort.

Here is the follow-up procedure for the two groups throughout the study:

• follow-up modality: visits, letters, work-study
• frequency of contacts: monthly
• total duration of follow-up: 9 months Patients enrolled in the individual data investigational study are potential candidates for TOMEKA intervention. As the TOMEKA protocol does not involve any investigational agents or techniques, patients would be eligible for dual randomization if they are themselves on stable doses of Vernonia amygdalina (the investigational herbs drugs may equivalent to Remdesivir).

Exclusion Criteria:

1. COVID-19 suspected clinically

2. Children

3. Refuse to participate

4. Recover when possible the cause of a study exit:

   • refusal of follow-up
   • move
   • death If the patient is no longer followed in the study without any cause being identified, then he is lost to follow-up.