Safety and effectiveness of oral medium to high dose blonanserin in patients with schizophrenia: subgroup analysis from a prospective, multicenter, post-marketing surveillance study in mainland China

BACKGROUND

Blonanserin (BNS) had been undergoing post-market surveillance (PMS) since September 2018. Using the surveillance data, we did this analysis to assess the safety and effectiveness of different doses of BNS to explore a sufficient dose range of BNS in Chinese patients with schizophrenia (SZ).

METHODS

A 12-week, prospective, observational, single-arm, multicenter, open-label PMS was conducted. In this analysis, we divided the patients from PMS into low, medium to high, and high dose groups based on the dose of BNS they received, with medium to high dose group being the focus. The Brief Psychiatric Rating Scale (BPRS) scores at week 2 or 4, 6 or 8, and 12 were calculated to evaluate the effectiveness of BNS in improving psychiatric symptoms. The safety of BNS was reported as the incidence of adverse drug reactions.

RESULTS

364 patients were included in the medium to high dose group, of which 321 completed the surveillance, with a dropout rate of 11.8%. The mean daily dose was 15.1 ± 1.92 mg. The BPRS total score was 50.1 ± 11.95 at baseline and decreased to 26.6 ± 7.43 at 12 weeks (P < 0.001). When compared with other groups, the median to high dose group achieved significantly more reduction in BPRS score at week 12 (P = 0.004 versus low dose and P = 0.033 versus higher dose). Extrapyramidal symptoms [EPS (46.4%)] were the most common adverse reactions in the medium to high group. The average weight gain during the surveillance was 0.5 ± 2.56 kg and prolactin elevation occurred in 2.2% patients. Most adverse reactions were mild.

CONCLUSIONS

BNS at medium to high doses (mean 15.1 mg/d) significantly improved symptoms of SZ and was well-tolerated. Most ADRs were mild, and the likelihood of causing metabolic side effects and prolactin elevations was low. Medium to high dose of BNS is a more potent treatment choice for SZ.

TRIAL REGISTRATION NUMBER

ChiCTR2100048734. Date of registration: 2021/07/15 (retrospectively registered).

Effectiveness and safety of blonanserin in young and middle-aged female patients with schizophrenia: data from a post-marketing surveillance

BACKGROUND

A post-marketing surveillance of blonanserin has been ongoing since September 2018. The aim of this study was to assess the effectiveness and safety of oral blonanserin in Chinese young and middle-aged female patients with schizophrenia in real clinical settings, using the data from the post-marketing surveillance.

METHODS

A 12-week, prospective, multi-center, open-label, post-marketing surveillance was conducted. Female patients aged 18-40 years were included in this analysis. The Brief Psychiatric Rating Scale (BPRS) was used to evaluate the effectiveness of blonanserin in improving psychiatric symptoms. The incidence of adverse drug reactions (ADRs) such as of extrapyramidal symptoms (EPS), prolactin elevation and the weight gain were used to evaluate the safety profile of blonanserin.

RESULTS

A total of 392 patients were included both in the safety and full analysis sets, 311 patients completed the surveillance protocol. The BPRS total score was 48.8 ± 14.11 at the baseline, decreasing to 25.5 ± 7.56 at 12 weeks (P < 0.001, compared with baseline). EPS (20.2%) including akathisia, tremor, dystonia, and parkinsonism were found as the most frequent ADRs. The mean weight gain was 0.27 ± 2.5 kg at 12 weeks from the baseline. Four cases (1%) of prolactin elevation were observed during the period of surveillance.

CONCLUSION

Blonanserin significantly improved the symptoms of schizophrenia in female patients aged 18-40 years; the drug was well tolerated and had a low tendency to cause metabolic side effects, including prolactin elevation in these patients. Blonanserin might be a reasonable drug for the treatment of schizophrenia in young and middle-aged female patients.

Safety and Effectiveness of Blonanserin in Chinese Patients with Schizophrenia: An Interim Analysis of a 12-Week Open-Label Prospective Multi-Center Post-marketing Surveillance

Schizophrenia is an unexplained, complex and serious mental illness. Blonanserin (BNS) is a new antipsychotic drug widely used in the treatment of schizophrenia. However, large-scale clinical studies have not been conducted in China. A multi-center, prospective, open-label, 12-week surveillance was carried out to evaluate the safety and effectiveness of BNS in patients with schizophrenia in China. Safety assessments included adverse drug reactions (ADRs), extrapyramidal symptoms (EPS), akathisia, concomitant medications for EPS by the end of treatment, and the changes in body weight from baseline by the end of treatment. The effectiveness was evaluated by the Brief Psychiatric Rating Scale (BPRS). From September 2018 to May 2020, of the 1,060 patients enrolled, 1,018 were included in the full analysis set (FAS) and safety set (SS), respectively. ADRs were developed in 205 patients among the included, the incidence being 20.1%. ADRs of EPS occurred in 169 patients, the incidence being 16.6%, ADRs of akathisia occurred in 90 patients, the incidence being 8.8%; concomitant therapeutic and prophylactic agents for EPS accounts for 19.2%; 4.0% of patients had a ≥7% increase in body weight from baseline at 12 weeks after initiating treatment. Using the last-observation-carried-forward (LOCF) method, the changes in total BPRS scores were -11.2 ± 10.17 (N = 1,018), -16.8 ± 12.69 (N = 1,018) and -20.6 ± 13.99 (N = 1,018) after 2/4, 6/8, or 12 weeks, respectively. 53.5% (545/1,018) patients showed response to blonanserin treatment in week 12. The post-marketing surveillance results of BNS demonstrates safety profile and effectiveness of the drug.

Generation of VEGF knock-in Cashmere goat via the CRISPR/Cas9 system

Cashmere is a rare and specialised animal fibre, which grows on the outer skin of goats. Owing its low yield and soft, light, and warm properties, it has a high economic value. Here, we attempted to improve existing cashmere goat breeds by simultaneously increasing their fibre length and cashmere yield. We attempted this by knocking in the vascular endothelial growth factor (VEGF) at the fibroblast growth factor 5(FGF5) site using a gene editing technology and then studying its hair growth-promoting mechanisms. We show that a combination of RS-1 and NU7441 significantly improve the efficiency of CRISPR/Cas9-mediated, homologous-directed repair without affecting the embryo cleavage rate or the percentages of embryos at different stages. In addition, we obtained a cashmere goat, which integrated the VEGF gene at the FGF5 site, and the cashmere yield and fibre length of this gene-edited goat were improved. Through next-generation sequencing, we found that the up-regulation of VEGF and the down-regulation of FGF5 affected the cell cycle, proliferation, and vascular tone through the PI3K-AKT signalling pathway and at extracellular matrix-receptor interactions. Owing to this, the gene-edited cashmere goat showed impressive cashmere performance. Overall, in this study, we generated a gene-edited cashmere goat by integrating VEGF at the FGF5 site and provided an animal model for follow-up research on hair growth mechanisms.

Surprising Anticancer Activities of Psychiatric Medications: Old Drugs Offer New Hope for Patients With Brain Cancer

Despite decades of research and major efforts, malignant brain tumors remain among the deadliest of all cancers. Recently, an increasing number of psychiatric drugs has been proven to possess suppressing activities against brain tumors, and rapid progress has been made in understanding the potential mechanisms of action of these drugs. In particular, the traditional mood stabilizer valproic acid, the widely used antidepressants fluoxetine and escitalopram oxalate, and the atypical psychiatric drug aripiprazole have demonstrated promise for application in brain tumor treatment strategies through multiple lines of laboratory, preclinical, and clinical evidence. The unexpected discovery of the anticancer properties of these drugs has ignited interest in the repurposing of other psychiatric drugs to combat brain cancer. In this review, we synthesize recent progress in understanding the potential molecular mechanisms underlying the brain cancer-killing activities of representative psychiatric drugs. We also identify key limitations in the repurposing of these medications that must be overcome to enhance our ability to successfully prevent and treat brain cancer, especially in the most vulnerable groups of patients, such as children and adolescents, pregnant women, and those with unfavorable genetic variants. Moreover, we propose perspectives that may guide future research and provide long-awaited new hope to patients with brain cancer and their families.

Blocking of YY1 reduce neutrophil infiltration by inhibiting IL-8 production via the PI3K-Akt-mTOR signaling pathway in rheumatoid arthritis

Our previous study revealed that Yin Yang 1(YY1) played an important part in promoting interleukin (IL)-6 production in rheumatoid arthritis (RA). However, whether YY1 has any role in regulation of IL-8 in RA remains unclear. YY1 and IL-8 expression in RA patients were analyzed by real-time polymerase chain reaction (PCR). Ingenuity pathway analysis (IPA) was used to analyze the signaling pathway involved in YY1-induced IL-8 production. The expression of YY1 and proteins involved in the pathway were detected by Western blot and enzyme-linked immunosorbent assay (ELISA). Migration of neutrophils was performed by chemotaxis assay. In this study, we found that high expression of IL-8 was positively associated with YY1 expression in RA. Blocking YY1 expression by YY1-short hairpin (sh)RNA lentivirus reduced IL-8 production. Mechanistically, we showed YY1 activated IL-8 production via the phosphatidylinositol-3-kinase/Akt/mammalian target of rapamycin (PI3K/Akt/mTOR) signaling pathway. Further, using a co-culture system consisting of peripheral blood mononuclear cells (PBMC) and neutrophils, we found that migration of neutrophils would be inhibited by YY1 RNA interference. Finally, using the collagen-induced arthritis animal model, we showed that treatment with the YY1-shRNA lentivirus led to reduction of IL-8 levels and attenuation of inflammation and neutrophil infiltration in vivo. Our results reveal a role of YY1 involved in neutrophil infiltration in RA via the PI3K/Akt/mTOR/IL-8 signaling pathway. YY1 may be a new therapeutic target for treatment of RA.

A preliminary study on the relationship between iron and black extrinsic tooth stain in children

Black extrinsic tooth stain, which has long troubled many people, is common among children and influences the aesthetics of teeth. The pigment was proposed to be a black insoluble ferric compound, but this is controversial. To determine whether iron exists in black stain, we collected 10 samples of black stain and 10 samples of plaque separately from children with and without black stain using sterile titanium implant curettes, and analysed the samples by inductively coupled plasma-mass spectrometry. Iron was present in both black stain and plaque, with concentrations ranging from 76·12 to 1116·88 μg g^-1 . The contents of iron in black stain were significantly higher than in plaque. Because bacteria may be involved in the aetiology of black stain, we assessed the functional genes of bacteria in black stain based on 16S rRNA gene sequencing results obtained using Phylogenetic Investigation of Communities by Reconstruction of Unobserved States. Of 253 Kyoto Encyclopedia of Gene and Genomes (KEGG) pathways tested, 56 differed in abundance between samples from children with and without black stain. Genera altered in black stain were related to many of the pathways. Some KEGG Orthology groups showed differences between black stain and plaque of control group were found to be related to iron.

SIGNIFICANCE AND IMPACT OF THE STUDY

In this study, we have confirmed the existence of iron in black extrinsic tooth stain by ICP-MS. It was the first time the functional genes of bacteria in black stain were accessed and the genes associated with iron were found. These findings provided clues on the research of aetiology of black stain, which troubled millions of children. It also revealed the association between metabolic pathway of microbiota and oral phenomenon.

Abnormality of glycometabolism related factors in non-psychotic offspring of schizophrenic patients

Schizophrenic patients appear to have higher rates of abnormality of glycometabolism. It has been suggested that these could be secondary to the use of antipsychotics. However, findings indicate that abnormal glucose metabolism may be potentially involved in the pathogenesis of schizophrenia. The present study examined the fasting plasma levels of glycometabolism related factors in healthy offspring of schizophrenic patients. Our objective was to test the hypothesis that abnormal glucose metabolism might be potentially involved in the pathogenesis of schizophrenia. Thirty-two healthy offspring of schizophrenic inpatients who met DSM-IV criteria for schizophrenia and 37 comparison subjects were recruited. Fasting plasma levels of glucose, insulin, insulin-like growth factor 1 (IGF-1), growth hormone (GH), leptin and cortisol were tested for all subjects. Compared with controls, offspring of schizophrenic patients had significantly higher mean plasma insulin and insulin resistance, and lower mean plasma IGF-1 level. Meanwhile, the mean fasting plasma levels of glucose, GH, leptin and cortisol did not differ significantly between offspring of schizophrenic patients and healthy comparison subjects. Offspring of schizophrenic patients showed significant differences from comparison subjects in glycometabolism related factors. Abnormal glucose metabolism might be potentially involved in the pathogenesis of schizophrenia.

Comparative evaluations of cellulosic raw materials for second generation bioethanol production

AIMS

To evaluate sugar recoveries and fermentabilities of eight lignocellulosic raw materials following mild acid pretreatment and enzyme hydrolysis using a recombinant strain of Zymomonas mobilis.

METHODS AND RESULTS

Dilute acid pretreatment (2% H(2) SO(4) ) with 10% (w/v) substrate loading was performed at 134°C for 60 min followed by enzyme hydrolysis at 60°C. The results demonstrated that hydrolysis of herbaceous raw materials resulted in higher sugar recoveries (up to 60-75%) than the woody sources (<50%). Fermentation studies with recombinant Z. mobilis ZM4 (pZB5) demonstrated that final ethanol concentrations and yields were also higher for the herbaceous hydrolysates. Significant reduction in growth rates and specific rates of sugar uptake and ethanol production occurred for all hydrolysates, with the greatest reductions evident for woody hydrolysates. Further studies on optimization of enzyme hydrolysis established that higher sugar recoveries were achieved at 50°C compared to 60°C following acid pretreatment.

CONCLUSIONS

Of the various raw materials evaluated, the highest ethanol yields and productivities were achieved with wheat straw and sugarcane bagasse hydrolysates. Sorghum straw, sugarcane tops and Arundo donax hydrolysates were similar in their characteristics, while fermentation of woody hydrolysates (oil mallee, pine and eucalyptus) resulted in relatively low ethanol concentrations and productivities. The concentrations of a range of inhibitory compounds likely to have influence the fermentation kinetics were determined in the various hydrolysates.

SIGNIFICANCE AND IMPACT OF THE STUDY

The study focuses on lignocellulosic materials available for second generation ethanol fermentations designed to use renewable agricultural/forestry biomass rather than food-based resources. From the results, it is evident that relatively good sugar and ethanol yields can be achieved from some herbaceous raw materials (e.g. sugarcane bagasse and sorghum straw), while much lower yields were obtained from woody biomass.

Modeling of a deep-seated geothermal system near Tianjin, China

A geothermal field is located in deep-seated basement aquifers in the northeastern part of the North China Plain near Tianjin, China. Carbonate rocks of Ordovician and Middle and Upper Proterozoic age on the Cangxian Uplift are capable of yielding 960 to 4200 m3/d of 57 degrees C to 96 degrees C water to wells from a depth of more than 1000 m. A three-dimensional nonisothermal numerical model was used to simulate and predict the spatial and temporal evolution of pressure and temperature in the geothermal system. The density of the geothermal water, which appears in the governing equations, can be expressed as a linear function of pressure, temperature, and total dissolved solids. A term describing the exchange of heat between water and rock is incorporated in the governing heat transport equation. Conductive heat flow from surrounding formations can be considered among the boundary conditions. Recent data of geothermal water production from the system were used for a first calibration of the numerical model. The calibrated model was used to predict the future changes in pressure and temperature of the geothermal water caused by two pumping schemes. The modeling results indicate that both pressure and temperature have a tendency to decrease with time and pumping. The current withdrawal rates and a pumping period of five months followed by a shut-off period of seven months are helpful in minimizing the degradation of the geothermal resource potential in the area.

Mineralized nodule formation by human dental papilla cells in culture

Human dental papilla cells were enzymatically separated from deciduous tooth germs of an 8-month-old embryo legally aborted. The second passage cells were cultured up to 35 days in 3 groups. The beta-GP group was cultured in the Dulbecco MEM containing ascorbic acid and beta-glycerophosphate supplemented with 15% fetal bovine serum. The Dex group was in the same medium, in addition containing dexamethasone. The control group contained none of the 3 chemicals. Mineralized nodules were formed after 15 days in the beta-GP and Dex groups. Only in the presence of ascorbic acid and organic phosphate did they mineralize. The addition of dexamethasone caused a significant increase in the number of nodules. By electron microscopy, the nodules contained needle-shaped crystals associated with a network of collagen fibrils. Calcium and phosphorus were detected by energy-dispersive X-ray microanalysis in the nodules. Furthermore, the crystalline material exhibited a pattern consistent with hydroxyapatite and dentin when examined by X-ray diffractometry. Cells showed high levels of alkaline phosphatase activity, which was increased 2-3 times in the presence of the 3 chemicals. These results indicated that human dental papilla cells have the ability to form dentin in culture. The formation of mineralized nodules by human dental papilla in vitro provides a useful model for studying the morphogenesis and differentiation of dental papilla ectomesenchyme.

Interspecies-specific ovarian autoantigens involved in neonatal thymectomy-induced murine autoimmune oophoritis

PROBLEM

Thymectomy of mice on day 3 after birth (3d-Tx) gives rise to the appearance of a particular type of ovarian lesion known as experimental autoimmune oophoritis (AIO).

METHOD

In the present study, the spleen cells from BALB/c mice having undergone 3 day-Tx AIO were fused with X63-Ag8-6.5.3 myeloma cells, and a number of hybridoma clones producing autoantibodies against ovarian tissue were established.

RESULTS

On the basis of immunohistochemical and protein-chemical analysis, two independent clones, designated at T2.2 and S1.6, were found to react with interstitial tissues surrounding the follicles. These monoclonal antibodies showed broad cross-species reactivity, in that they recognized similar antigenic macromolecules in the rat, pig, human, and mouse. The antigenic determinants were strongly resistant to heat and acid, especially to the treatment of periodic acid, indicating that the antigenic determinants had no relation with carbohydrate components.

CONCLUSIONS

By antibody affinity chromatography, two kinds of autoantigens were identified. SDS-PAGE, under reduced or nonreduced conditions, revealed an 80/85 kDa protein for T2.2, and an 82 kDa for S1.6, respectively.