Effects of pomegranate juice (Punica Granatum) on inflammatory biomarkers and complete blood count in patients with COVID-19: a structured summary of a study protocol for a randomized clinical trial
Authors: Yousefi Mojtaba , Sadriirani Mohammadreza , PourMahmoudi Azizollah , Mahmoodi Sara , Samimi Bahar , Hosseinikia Mahboobe , Saeedinezhad Zaker , Panahande Seyed Bahman 
Published: April 2021

Abstract
Objectives
This study is conducted to investigate efficacy of pomegranate juice on inflammatory biomarkers, C-reactive protein (CRP), interleukin 6(IL-6), erythrocyte sedimentation rate (ESR) and complete blood count (CBC) in hospitalized patients with mild to moderate coronavirus disease 2019 (COVID- 19).

Trial Design
This is a randomized, placebo-controlled, double-blind, parallel 2-arm (1:1 ratio) clinical trial.

Participants
Patients with COVID-19 admitted to hospitals in Yasuj City, Kohgiluyeh and Boyer-Ahmad Province, Iran.

Inclusion Criteria

Informed consent

Patients 18 years of age or older

Diagnosis of COVID-19 based on real-time polymerase chain reaction (RT-PCR) test

Exclusion Criteria

Pregnancy or lactation

Immunoglobulin A (IgA) level <61 mg/dl

Disseminated intravascular coagulation or any other types of coagulopathy

Severe congestive heart failure

Participation in any clinical trial within 30 days prior to enrollment in this RCT

Other contraindications determined by the specialist.

Intervention and Comparator
Intervention: 500 ml pomegranate juice and standard of care hospital treatment for COVID-19
Comparator: matching placebo containing 500 ml of red water and standard of care hospital treatment for COVID-19
Both intervention and comparator to be taken twice a day, after lunch and dinner, for 14 days.

Criteria for Discontinuing
Transfer of patients to intensive care unit (ICU)
Death
Unwillingness to continue participating in the study

Main Outcomes
The main outcomes of this study are levels of inflammatory biomarkers, CRP, IL-6, ESR, and CBC after 14 days of treatment.

Randomization
Eligible patients will be randomly assigned into the intervention or control group in a 1:1 ratio. Randomization will be performed based on 8 permuted blocks with block sizes of 6 and they will be stratified according to sex and age categories. Randomization sequences will be prepared by the trial’s pharmacist using computer-generated random numbers.

Blinding (Masking)
This study is a double-blind clinical trial (participant, researcher). The pomegranate juice and placebo juice are packaged in identical bottles, and the researcher and all the patients will be unaware of the study assignment until the end of the study. To ensure blinding, the randomization sequences will be kept in identical, opaque, sealed, and sequentially numbered envelopes.

Numbers to Be Randomized (Sample Size)
The calculated total sample size is 48 patients, with 24 patients assigned into each group.

Trial Status
The protocol is Version 1.0, on March 3, 2021. Recruitment started on February 28, 2021, and is anticipated to be completed by May 21, 2021.

Trial Registration
The Name of registering trial
Effects of Pomegranate Juice (Punica Granatum) on Inflammatory Biomarkers and CBC in Patients with COVID-19: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.
Iranian registry of clinical trials (IRCT) Registration Number: IRCT20150711023153N2
Date of Trial Registration
February 28, 2021, retrospectively registered

Full Protocol
The full protocol is attached as an additional file, accessible from the Trials҆ website (Additional file 1). In the interest of expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.