The purpose of this research study is to evaluate the safety and potential efficacy of Intravenous Infusion of Zofin for treatment of moderate to severe Acute Respiratory Syndrome (SARS) related to COVID-19 infection vs Placebo.
A human coronavirus (HCoV-19) has caused the novel coronavirus disease (COVID-19) outbreak
worldwide. Common symptoms of COVID-19 include fever, cough, and shortness of breath. The
majority of cases result in mild symptoms, but some can progress into pneumonia and
multi-organ failure. According to the severity it is divided into mild, normal, severe and
critically ill, which is associated with ICU admission and mortality. At present, the
standard treatment of COVD-19 patients is oxygen therapy, mechanical ventilation, and
medications to maintain blood pressure. As of today, no specific antiviral therapy is
available for patients with COVID-19. Immune activation in some patients, and the appearance
of cytokine storm syndrome (CSS) is one of the important causes of severe damage to lungs and
other organs, which may lead to death. There is an urgent need to develop new interventions
to suppress the excessive immune response in a timely manner during the course of disease,
protect alveolar function, and reduce lung and systemic organ damage.
Zofin is an acellular, minimally manipulated product, derived from human amniotic fluid
(HAF). This product contains over 300 growth factors, cytokines, and chemokines as well as
other extracellular vesicles/nanoparticles derived from amniotic stem and epithelial cells.
The product contains a mean concentration of 5.24x10^11 particles/mL with a mean mode size of
125.2nm. Surface marker analysis confirmed the presence of exosome associated proteins CD63,
CD81, and CD9 in addition to high expression of CD133. The completed sequencing revealed 102
commonly expressed miRNA (with a 100-copy expression minimum). Bioinformatics analysis linked
63 miRNAs to 1216 RNA targets. Major players in the proinflammatory cytokine cascade found to
be targeted by miRNA were discovered in Organicell's product include TNF, IL-6, and IL-8.
Additionally, a broader array of pro-inflammatory cytokines is also targeted by the
collection of miRNA such as FGF2, IFNB1, IGF1, IL36a, IL37, TGF-B2, VEGFA, CCL8, and CXCL12.
It has been suggested in published research that inhibition or suppression of this
pro-inflammatory cytokine cascade may reduce the severity of symptoms associated with
elevated immune response. Furthermore, the miRNA was found to target 148 genes associated
with immune response.
The property of Zofin demonstrates the therapeutic potential as a suppressor of cytokine
activation for the reduction of COVID-19 infection severity. This study aims to investigate
safety and potential efficacy of HAF derived acellular product in subjects suffering form
COVID-19 infection with severe acute respiratory syndrome (SARS).
Biological: Zofin
Biological: Zofin will be administered intravenously with 1ml, containing 2-5 x 10^11 particles/mL in addition to the Standard Care. The Zofin dose will be diluted in 100 mL of sterile saline at subject's bedside.
Other: Placebo
Other: Placebo Placebo (saline) will be administered intravenously with 1ml in addition to the Standard Care. The Placebo dose will be diluted in 100 mL of sterile saline at subject's bedside.
Inclusion Criteria:
1. Provide written informed consent
2. Subjects age > 18 years at the time of signing the Informed Consent Form.
3. Male or Female
4. Must have a clinical diagnosis of COVID-19, with at least one of clinical symptoms
(e.g., fever ≥38°C, fatigue, cough) and a positive result by the reverse-
transcription polymerase chain reaction (RT-PCR) testing or equivalent.
5. Individuals with moderately to severe COVID-19 symptoms.
Moderate ARDS according to Berlin Criteria:
Symptoms include: abnormal chest imaging or any degree of hypoxia requiring
supplemental oxygen. Bilateral opacities-not fully explained by effusions, lobar/lung
collapse, or nodules. Oxygenation: 100 mm Hg < PaO2/FIO2 /=5
cm H2O
Severe ARDS according to Berlin Criteria:
Symptoms include: abnormal chest imaging or any degree of hypoxia requiring
supplemental oxygen. Bilateral opacities-not fully explained by effusions, lobar/lung
collapse, or nodules. Oxygenation: PaO2/FIO2 /= 5 cm H2O
6. Hospitalized and symptomatic (cough, fevers, SOB, or sputum production)
7. Adequate venous access
8. Ability to provide informed consent or an authorized representative can sign the
informed consent
9. For female patients only, willingness to use FDA- recommended birth control
(http://www.fda.gov/downloads/ForConsumers/ByAu
dience/ForWomen/FreePublications/UCM356451.pdf ) until 6 months post treatment.
10. Must agree to comply with all study requirements and be willing to complete all study
visits
11. Willingness of study participant to accept this treatment arm, and signed informed
consent; Need in- patient admission.
Exclusion Criteria:
1. Intubated or on a ventilator.
2. Be a female who is pregnant, nursing, or of childbearing potential while not
practicing effective contraceptive methods. Female subjects must undergo a blood or
urine pregnancy test at screening and within 36 hours prior to infusion.
3. Inability to perform any of the assessments required for endpoint analysis.
4. Active listing (or expected future listing) for transplant of any organ.
5. Be a solid organ transplant recipient. This does not include prior cell-based therapy
(>12 months prior to enrollment), bone, skin, ligament, tendon or corneal grafting.
Have a history of organ or cell transplant rejection.
6. History of drug abuse (illegal "street" drugs except marijuana, or prescription
medications not being used appropriately for a pre-existing medical condition) or
alcohol abuse (≥ 5 drinks/day for ˃ 3 months), or documented medical, occupational, or
legal problems arising from the use of alcohol or drugs within the past 24 months
7. Be serum positive for HIV, hepatitis BsAg or hepatitis C.
George C. Shapiro
New York, New York, United States