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Rationale Combination treatment with reboxetine, a selective norepinephrine reuptake inhibitor, and betahistine, a histamine H1 receptor agonist/H3 antagonist, was developed to produce complementary action in CNS pathways regulating appetite and body weight. In the present placebo-controlled study, we evaluated whether a reboxetine–betahistine combination attenuates olanzapine-induced weight gain in schizophrenia patients. Method Forty-three inpatients with DSM-IV schizophrenic disorder participated in a randomized double-blind study. Reboxetine (4 mg/day) with betahistine (48 mg/day) ( N  = 29) or placebo ( N  = 14) was co-administered with olanzapine (10 mg/day) for 6 weeks. Mental status was assessed at baseline and endpoint with relevant rating scales. Intention-to-treat method was used for statistical analysis. Results Seven patients in the study group and four in the placebo group discontinued the trial. At the end of the trial, patients in the olanzapine/reboxetine + betahistine group gained significantly less weight than those in the olanzapine/placebo group [2.02 ± 2.37 and 4.77 ± 3.16 kg, respectively; t  = 2. 89, degrees of freedom ( df ) = 41, p  = 0.006]. The weight-attenuating effect of this combination was twofold larger than the weight-attenuating effect previously demonstrated with reboxetine alone. Significantly fewer patients in the study group than in the comparison group increased their initial weight by >7 %, the cutoff for clinically significant weight gain [3/29 (10.3 %) and 6/14 (42.9 %), respectively; χ 2  = 6.03, df  = 1, p  = 0.014]. The reboxetine–betahistine combination was safe and well tolerated. Conclusions Reboxetine–betahistine combination produces a clinically meaningful attenuation of olanzapine-induced weight gain. These results justify direct comparison between the reboxetine–betahistine combination and reboxetine alone.

Combination treatment with reboxetine, a selective norepinephrine reuptake inhibitor, and betahistine, a histamine H1 receptor agonist/H3 antagonist, was developed to produce complementary action in CNS pathways regulating appetite and body weight. In the present placebo-controlled study, we evaluated whether a reboxetineâ[euro]\"betahistine combination attenuates olanzapine-induced weight gain in schizophrenia patients. Forty-three inpatients with DSM-IV schizophrenic disorder participated in a randomized double-blind study. Reboxetine (4 mg/day) with betahistine (48 mg/day) (Nâ[euro][per thousand]=â[euro][per thousand]29) or placebo (Nâ[euro][per thousand]=â[euro][per thousand]14) was co-administered with olanzapine (10 mg/day) for 6 weeks. Mental status was assessed at baseline and endpoint with relevant rating scales. Intention-to-treat method was used for statistical analysis. Seven patients in the study group and four in the placebo group discontinued the trial. At the end of the trial, patients in the olanzapine/reboxetine + betahistine group gained significantly less weight than those in the olanzapine/placebo group [2.02â[euro][per thousand]±â[euro][per thousand]2.37 and 4.77â[euro][per thousand]±â[euro][per thousand]3.16 kg, respectively; tâ[euro][per thousand]=â[euro][per thousand]2. 89, degrees of freedom (df)â[euro][per thousand]=â[euro][per thousand]41, pâ[euro][per thousand]=â[euro][per thousand]0.006]. The weight-attenuating effect of this combination was twofold larger than the weight-attenuating effect previously demonstrated with reboxetine alone. Significantly fewer patients in the study group than in the comparison group increased their initial weight by >7 %, the cutoff for clinically significant weight gain [3/29 (10.3 %) and 6/14 (42.9 %), respectively; Ï[double dagger] ^sup 2^â[euro][per thousand]=â[euro][per thousand]6.03, dfâ[euro][per thousand]=â[euro][per thousand]1, pâ[euro][per thousand]=â[euro][per thousand]0.014]. The reboxetineâ[euro]\"betahistine combination was safe and well tolerated. Reboxetineâ[euro]\"betahistine combination produces a clinically meaningful attenuation of olanzapine-induced weight gain. These results justify direct comparison between the reboxetineâ[euro]\"betahistine combination and reboxetine alone.[PUBLICATION ABSTRACT]

Background In order to proliferate indefinitely, all tumors require a telomere maintenance mechanism. The expression of human telomerase reverse transcriptase (hTERT) enables telomere maintenance and provides cancer cells with limitless replicative potential. As such, it may serve as an attractive biomarker for oncogenic activity. This study explored whether a liquid biopsy that analyses blood derived exosomal hTERT transcript (e‐hTERT‐trans) may serve as such a biomarker in gliomas and meningiomas when compared to healthy controls. Methods Exosomes were isolated from the pre‐operative sera of patients' samples stored in the biobank of both Rabin and Sheba Medical Centers. The levels of e‐hTERT‐trans were measured in 81 healthy controls, 117 meningiomas, 17 low‐grade gliomas, and 61 glioblastomas. Clinical parameters of the patients were collected retrospectively and compared to the levels of the e‐hTERT‐trans. Results The upper normal limit of controls e‐hTERT‐trans was 1.85 relative quantitation (RQ). The rate of detection increased with rising tumor grade and correlated with tumor recurrence in meningiomas: mean RQ without recurrence (2.17 ± 11.7) versus with recurrence (3.59 ± 4.42; p = 0.002). In glioblastomas, preoperative measurements correlated with tumor volume and with the disease course on serial sampling. Conclusions We demonstrated for the first time that the expression of e‐hTERT‐trans transcript can be measured in the serum of primary brain tumors. This exosomal marker carries the potential to serve as a biomarker once used in conjunction with other clinical and radiological parameters. Future studies are required to investigate whether the sensitivity could be augmented and whether it can be implemented into routine patients care. Our study demonstrates for the first time that the expression of hTERT mRNA transcript can be measured in the serum of both meningioma and glioma patients. As it correlated with tumor recurrence in meningiomas and with tumor volume and the disease course in glioblastomas it carries the potential to serve as a biomarker once used in conjunction with other clinical and radiological parameters.

BackgroundCD19 chimeric antigen receptor T (CAR-T) cells demonstrate remarkable remission rates in pediatric and adult patients with refractory or relapsed (r/r) acute lymphoblastic leukemia (ALL) and non-Hodgkin's lymphoma (NHL). In 2016, we initiated a clinical trial with in-house produced CD19 CAR-T cells with a CD28 co-stimulatory domain. We analyzed, for the first time, differences in production features and phenotype between ALL and NHL patients.MethodsNon-cryopreserved CAR-T cells were produced from patients’ peripheral blood mononuclear cells within 9 to 10 days. 93 patients with r/r ALL and NHL were enrolled under the same study. CAR-T cells of ALL and NHL patients were produced simultaneously, allowing the head-to-head comparison.ResultsAll patients were heavily pretreated. Three patients dropped out from the study due to clinical deterioration (n=2) or production failure (n=1). Cells of ALL patients (n=37) expanded significantly better and contained more CAR-T cells than of NHL patients (n=53). Young age had a positive impact on the proliferation capacity. The infusion products from ALL patients contained significantly more naïve CAR-T cells and a significantly higher expression of the chemokine receptor CXCR3. PD-1, LAG-3, TIM-3, and CD28 were equally expressed. 100% of ALL patients and 94% of NHL patients received the target dose of 1×10e6 CAR-T/kg. The overall response rate was 84% (30/36) in ALL and 62% (32/52) in NHL. We further compared CAR-T cell infusion products to tumor infiltrating lymphocytes (TIL), another common type of T cell therapy, mainly clinically effective in solid tumors. CAR-T cells contained significantly more naïve T cells and central memory T cells and significantly less CCR5 compared to TIL infusion products.ConclusionsThe in-house production of CAR-T cells is highly efficient and fast. Clinical response rate is high. CAR-T cells can be successfully produced for 99% of patients in just 9 to 10 days. Cells derived from ALL patients demonstrate a higher proliferation rate and contain higher frequencies of CAR-T cells and naïve T cells than of NHL patients. In addition, understanding the differences between CAR-T and TIL infusion products, may provide an angle to develop CAR-T cells for the treatment of solid tumors in the future.Trial registration numberClinicalTrials.gov; CAR-T: NCT02772198, First posted: May 13, 2016; TIL: NCT00287131, First posted: February 6, 2006.

Background & aims: Janus kinase (JAK) inhibitors modulating JAK-STAT (signal transducers and activators of transcription) signaling pathway, are used for the treatment of patients with inflammatory bowel diseases (IBD). We aimed to identify the molecular effects of JAK inhibition in the human intestinal mucosa, considering the IBD location and phenotype. Methods: Colonic and ileal explants from patients with ulcerative colitis (UC), Crohn's disease (CD), or non-IBD controls (NC) were treated ex-vivo with the JAK inhibitor, tofacitinib. Phosphorylated STAT (p-STAT) levels were assessed by Western blot and Immunofluorescence. Inflammatory genes expression was assessed with Nanostring nCounter system. Human intestinal organoids were used to assess JAK inhibitors' effects on p-STATs and iNOS expression. Results: Explants were collected from 68 patients (NC=28; UC=20; CD=20). JAK inhibition reduced p-STAT1/3/5 expression in all explants. While p-STAT inhibition rates varied among patients (10%-88%), higher inhibition rates were observed in colonic compared to ileal explants. Significant alterations in 120 of 255 inflammatory genes were observed in colonic explants, while only 30 were observed in ileal NC explants. In colonic explants from UC, significant alterations were observed in 5 genes, including STAT1 and NOS2. Various JAK inhibitors reduced IFN-γ-induced increase in p-STAT1 and iNOS expression in organoids. Conclusions: A site-specific anti-inflammatory effect of JAK inhibition by tofacitinib was noticed, whereby the colon was more robustly affected than the ileum. Ex-vivo response to tofacitinib is individual. JAK inhibition may attenuate inflammation by decreasing iNOS expression. Ex-vivo mucosal platforms may be a valuable resource for studying drug impact and evaluating personalized treatment effects. Keywords: Tofacitinib; JAK inhibitors; Human intestinal mucosa; OrganoidsCompeting Interest StatementKK, HAT, JA, ESB, NW, LHM, AF, ALB, ZL, HBE, IAB, SCK and KMR declare no conflict of interests. IG reports: research support from Gilead, Boehringer Ingelheim, Pfizer, and AbbVie. HY reports: institutional research grants from Pfizer and the ISF; consulting fees from AbbVie, Janssen, Pfizer, Takeda, Bristol Myers Squibb, and Elly Lilli; honoraria for lectures from AbbVie, Janssen, Pfizer, and Takeda; participation in a Data Safety Monitoring Board or Advisory Board for AbbVie, Pfizer, Takeda, Bristol Myers Squibb, and Elly Lilli. JEO reports: speaker fees from Takeda, Pfizer, Jansen, AbbVie, and Novartis; grant support from Pfizer; participation in Advisory Board of Takeda. ID has served as a speaker, consultant, and advisory board member AbbVie, Altman Research, Athos, Celltrion, Celgene/BMS, Ferring, Eli-Lilly, Gilead, Galapagos, Gutreat, Harp Diagnostics, Iterative Scopes, Janssen, Pfizer, Roche/Genentech, Sangamo, Sublimity, Sandoz, Takeda, Prometheus