COVID -19 : Quinine Treatment May Work Where Chloroquine Fails - Chinedum, Professor of Pharmacy - THE DAILY CRUCIBLE

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Wednesday, June 10, 2020

COVID -19 : Quinine Treatment May Work Where Chloroquine Fails - Chinedum, Professor of Pharmacy

Professor Chinedum Peace Babalola is the Vice Chancellor of Chrisland University, Ogun State and  the first female Professor of Pharmacy at the premier University of Ibadan. Her research interest covers Pharmacokinetics, Pharmaceutical analysis, Pharmacogenetics and malaria. In this interview with The Daily Crucible, she casts light on why Chloroquine treatment for the novel Coronavirus seemed not to be working and why Quinine Treatment might do the magic where Chloroquine fails.


                        •Prof. Chinedum Babalola


There are a lot of confusion about chloroquine therapy for COVID - 19. Why some school of thoughts believe it works, others claimed it does not work and in some cases, it proved to be fatal to patients. Could you please explain why there are discordant tones about Chloroquine treatment?

I have done a research on chloroquine and quinine seven years ago.  We all used chloroquine to treat malaria until the parasite became resistance to chloroquine.  I have done study on these drugs, but as anti-malaria.  When the COVID-19 began and I began to read literatures to show that chloroquine can kill coronavirus, I got interested and those studies were carried out many years ago; early 2000. I was able to see the mechanism of action,  so, I said this can work against coronavirus. 

How does it work to fight the virus?

To start with, chloroquine can gain entrance into the virus and stop the replication especially in the presence of zinc, so, it make way for it.  When you take chloroquine with zinc, it create room to get into where the virus is and help to stop the virus from replicating itself. 
Chloroquine is actually being used to treat what we called auto-immune disease. Chloroquine is used by the western world today more than Africa to treat auto-immune disease. Coronavirus is an auto-immune diseases that triggers something like storm and your immunity begins to fight it.  

When is it appropriate to apply Chloroquine treatment?

Study has shown that chloroquine will only work at the starting stage,  there are many stages of the virus, around five. Chloroquine has a long life line, it helps you not to allow the virus to key into the body and when the virus is already there, it helps in preventing replication.  
But, by the time it has engaged the lungs and different body organs, it will be difficult for chloroquine to work.  So, at that stage, you need a drug that is invasive and that is really anti -viral drugs and you combined them with anti-biotics. 

Why do we have conflicting results about chloroquine treatment?
 
Almost 90 per cent of the people that are saying chloroquine did not work are using chloroquine at that severe level when it is not very effective; it is already too late by the time you are using ventilators and all that because the body is looking for oxygen(at that stage).  
The other thing why they said why chloroquine is toxic is because the dosage they are using are also at a toxic level.  They are higher than doses we are proposing. So, some of those doses are high and we are proposing that the doses should be reduced.  They should be higher than what we used for malaria because within three to four days, the parasite is gone in case of malaria, but for coronavirus, it engages so many organs, you can use it for longer period of five days and beyond.  

How can the appropriate dosage be ascertained or determined?

The only way we can know the exact dose is when we have done what we call the randomized clinical trials with pharmacokinetics then that is real research studies, and when it is done,  we then can come up with the right dose.  It is possible that the  chloroquine will work better in some places(stages) because of the metabolism.  In fact, some of us are proposing that Quinine will work at the severe stage, Quinine can penetrate in some places that chloroquine will not work; it is our research.  

Is there no way you can work in group or in collaboration with others on Chloroquine and COVID-19 Pandemic?

We have co-horts groups, COVID-19 pental, among others.  We are writing and we have written a paper to be published on this chloroquine as well.  The discouraging thing is that the more we are meeting and discussing, the more the Western world are releasing the negative results.  You know it is a political thing, actually when WHO said no, you will realise that  the task force(Presidential Task Force) also said no, but, NAFDAC said yes(that it will continue with the trial).  
I am in contact with Oyo state Task Force and University College Hospital(UCH), Ibadan for us to begin trial for the use of chloroquine and we are talking.  The Oyo state has started with the hypothesis, but our group and Oyo state are talking.  We also want to sell the idea to Ogun state on chloroquine trials.  

When WHO retracted we are happy because it is really political as well as some of the points I have made (earlier).  On the background, we are working, writting as an organ of dissemination.  The National University Commission(NUC) has called for proposals and Chrisland has submitted three or four proposals on COVID-19, but we are yet to get a response. In University of Ibadan, I founded a centre for Drugs Discovery. We are talking with that groups too. We are  also trying to see  what we can do especially with the pharmacokinetics as well as reviews on what I have said.  

Any collaborative effort between orthodox and herbal medicine practitioners to find cure?

There is a mileage between the natural products and orthodox; there have always been.  In Nigeria, we have almost 8,000 medicinal plants. COVID-19 has assisted in opening up good relationship between traditional medicine and orthodox medicine. 
With the COVID-19, NAFDAC has already received a number of applications. Also, the Herbal and Traditional Medicine Agency has also received a number of applications. The same thing with Science and Technology.
So, COVID-19 has hastened these collaborations, but whether we like it or not, they (herbal remedies) still need to be tested and proved to be effective.
Few days ago, the Nigerian Academy of Science which I belonged to is also putting up a paper to government to support testing of herbal products on COVID-19: pre-testing to see whether they are effective. 

What is the cost implications of testing drugs or herbal medicine?

To do the clinical trials we are talking about money, it requires millions and millions of US Dollars; it's money, even the other tests! So, apart from saying that we can do something to save lives of Nigerians infected by the coronavirus, we also need money to do them and do them well. If I'm to run a pharmacokinetic study now, it can't be less than N10 millions. Neimeth is using its own money to run clinical trials, so they need more money for it to be tested in many places. So, we need money and if get it, we will do more. So, there is relationship now coming up. We know many of these plants are immune boosters even if it's just to boost our immune system, that will be nice. Then, some may be anti-viral, but we need to test whether they're really anti -viral and that requires specific laboratories. We really don't have them, we have only one in Jos, Plateau state, if not, we need to go abroad to test them. 
So, these are some of the challenges.

What do you think the government can do to help?

I have heard of so many billions of naira being donated to states and federal government. I can only say that government, please, give our researchers some of these money. I know the Central Bank of Nigeria (CBN) has just released a call for research, but some of the conditions are not favourable in the sense that after carrying out your research and you get a product, it will belong to CBN. Then, you have stolen the intellectual property of such a researcher. How will it belong to CBN? 
If government wants to do something about this COVID-19, it requires money and they must set up these anti - vital testing laboratories; the levels 3 that we need. With about N200 million, they should be able to start one in each of the geopolitical zones in Nigeria.
Government should also recognise specific laboratories and fund them continuously and demand results from them. That is what I will suggest. Identify key people, key laboratories and fund them and you'll be amazed. Aren't Nigerians doing wonders abroad? The person that is testing rendizivial drugs on COVID-19 in the US is a Nigerian: I've collaborated with him in Chicago: he is one of my collaborators from here. So, that is what I will say; they need to do more.





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