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CBD may improve steroid therapy in autoimmune, Covid-19 patients Israeli startup Stero Therapeutics says cannabis component could enhance steroid treatment or enable reduced steroid dosage to avoid negative effects. By Brian Blum JUNE 18, 2020, 8:30 AM Cannabis component CBD may enhance effects of steroids. Image by HQuality via Shutterstock.com Can cannabis help treat Covid-19? Israeli canna-tech startup Stero Therapeutics wanted to find out. But unexpectedly good news threw a hitch in those plans. At the height of the corona crisis, the Bnei Brak-based company was set to launch a clinical trial with 10 Covid-19 patients at Rabin Medical Center in Petah Tikva when the hospital ran out of patients. Rabin and several other Israeli medical centers closed their coronavirus wards as the number of new cases slowed to a trickle. Stero is now turning its attention toward Europe, where there is, unfortunately, still no shortage of people suffering from the virus. With cases spiking again in Israel, though, a clinical trial closer to home is no longer out of the question. While Covid-19 has occupied Stero’s interest for the past two months, it was never the company’s main focus. The overlap was steroids. Stero aims to determine if CBD, the non-psychoactive component in cannabis, can enhance the effect of corticosteroids — the first line of treatment for autoimmune illnesses like inflammatory bowel disease and lupus — or enable reducing steroid dosage while maintaining or improving its therapeutic effects. Stero founder and CEO David Bassa. Photo: courtesy Stero founder and CEO David Bassa’s previous company, Talent Biotech, had developed expertise in using CBD to prevent and treat graft vs. host disease (GvHD), a life-threatening immune condition that can occur following an organ transplant. In GvHD, immune cells from the donor attack the recipient’s tissues. The primary therapy for GvHD is also steroids. Talent had reached Phase 2b trials when Canadian cannabis company Kalytera bought the company for $10 million in 2017 — the Israeli cannabis industry’s first major “exit.” Kalytera has taken Talent’s technology toward Phase 3 trials with an eye on FDA and European CE approval as early as the end of this year. Now no longer with Kalytera, Bassa set his sights on an even bigger medical goal: whether CBD could reduce, improve and possibly even replace steroids as a first line of treatment in just about any kind of immune system overreaction. Crohn’s, hives… and Covid? Bassa established Stero after receiving a broad US patent covering 130 autoimmune and inflammatory diseases, including Crohn’s disease, hepatitis, arthritis and chronic urticaria (hives). “The patent covers botanic and synthetically produced CBD, at any dosage and in combination with other drugs,” Bassa tells ISRAEL21c. Stero chose two indications to start with – Crohn’s and urticaria. They had enrolled Crohn’s disease patients in a clinical trial and were just starting with urticaria when Covid-19 upended everything. Steroids are also used to fight off Covid-19’s most deadly effect in acute infections: an immune system over-response known as a cytokine storm. Cytokines are a signalling molecule released in response to a virus. They activate inflammation as a way of containing and eradicating the pathogen. In a cytokine storm, the immune system releases too many of these molecules. The result is often more collateral damage than the virus itself would have caused. In a landmark UK trial, researchers found that use of dexamethasone, a type of steroid, reduced deaths for COVID-19 patients on ventilators by a third and cut deaths for those receiving just oxygen by 20%. The researchers say that if the drug had been used at the beginning of the pandemic, up to 5,000 British lives could have been saved. Stero had proposed to investigate whether CBD can boost the therapeutic effectiveness of steroids in Covid-19 patients. For its trials with Crohn’s and urticaria research, the aim is to see if CBD can reduce the need for high dosages of steroids with all the negative side effects they cause. Meanwhile, the Medical Cannabis Research and Innovation Center at Rambam Health Care Campus in Haifa has proposed a trial of its own to determine if certain strains of cannabis can save severely ill Covid-19 patients from cytokine storms. Four-month trial Stero’s first focus is the approximately 30 percent of Crohn’s disease patients who are steroid dependent, Bassa explains. In the four-month randomized, double-blind trial, half the patients will get CBD oil and half will get a lookalike placebo. In the first month, the steroid dosage will be reduced while the CBD (or placebo) is introduced. If a patient has a major Crohn’s flareup and is receiving the placebo, he or she will be dropped from that arm of the trial and given CBD instead. Patients who flare up while receiving CBD will be put back on their regular dose of steroids. Bassa cautions readers with inflammatory conditions against experimenting at home. The amount of CBD in the trial is 300 mg a day – about 10 times the amount usually used by consumers of CBD as a wellness product where it’s legal. Stero’s CBD is synthetically produced, making it more expensive than CBD from plants, but Bassa says synthetic CBD “assures us a clearer eventual path with the FDA.” Serendipity and a promise The CBD-steroid connection was discovered by accident. Dr. Moshe Yeshurun, Stero’s senior medical adviser, directs the bone marrow transplantation unit at Rabin Medical Center. He had GvHD patients “who were suffering very much and he wanted to ease their pain by giving them medical cannabis,” Bassa tells ISRAEL21c. But the patients also started to get better and show less signs of disease. Bassa’s story has a similar unexpected twist. He was a successful software entrepreneur when his mother was diagnosed with multiple myeloma, a deadly blood cancer. In looking for a drug that could help her, he discovered that Prof. Moshe Mittleman, from Tel Aviv Sourasky Medical Center, was investigating whether off-label use of erythropoietin, a molecule generally used to boost blood hemoglobin, could ease multiple myeloma. Bassa’s mother began taking erythropoietin. “She lived another 11 years instead of the three that was predicted,” Bassa says. Bassa’s mother made him promise to “take the solution that worked for her to the world,” he recalls. He raised $2 million to build a company to commercialize erythropoietin for blood cancer, but he was ultimately not successful. “Luckily for patients, there are newer treatments today that have already replaced erythropoietin,” he explains. What he couldn’t do for erythropoietin he is trying to do in the cannabis space. Cannabis Innovation Center Stero, which has raised $1 million, is one of a half-dozen companies Bassa operates out of his Cannabis Innovation Center in Bnei Brak. He has a partnership with Clalit, Israel’s largest HMO. Indeed, most of Bassa’s team of 20 works in Clalit hospitals and clinics. Mor Research Applications, the technology-transfer office of Clalit, is Stero Biotech’s main shareholder. Bassa’s other companies include CannaLean Biotechs, which is exploring whether CBD can help lower cholesterol; CannaMore, which is studying CBD’s potential role in treating bronchiolitis obliterans, a pulmonary disease; and BioSeedXL, a tech incubator for cannabis companies. For more information on Stero Biotechs, click here. https://www.israel21c.org/cbd-may-improve-steroid-therapy-in-autoimmune-covid-19-patients/ https://www.israel21c.org/13-promising-covid-treatments-emerging-from-israel/

Israeli company develops rapid diagnostic kit for COVID-19 ‘This kit has undergone testing by several central laboratories and hospitals that have now verified its ability to diagnose COVID-19.’ By Abigail Klein Leichman MARCH 1, 2020, 3:33 PM BATM’s rapid diagnostic array. Photo: courtesy Israeli company BATM of Hod Hasharon announced that its biomedical division has developed a diagnostics kit to detect coronavirus from saliva samples in less than half an hour. CEO Dr. Zvi Marom tells ISRAEL21c that the test is compatible with the current hospital-based method for diagnosing COVID-19, reverse-transcription polymerase chain reaction (RT-PCR) – a type of gene sequencing that takes about eight hours. “This kit has undergone testing by several central laboratories and hospitals that have now verified its ability to diagnose COVID-19,” says Marom, referring to the disease caused by coronavirus infection. Marom, who has degrees in medicine and in industrial electronics, said BATM already has an advanced diagnostics kit that detects SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome). The COVID-19 aspect will be added to that kit. “BATM is working with academic and research institutions, mainly in Europe, to progress the kit to make it at a price point suitable for large-scale production,” says Marom. “The kit, which supports all the Centers for Disease Control and Prevention (CDC) recommendations, has already received interest from customers in several countries.” By next year, BATM expects that the test will be commercialized as part of its NATLab doctor’s office solution using artificial intelligence and individual disease cartridges to diagnose bacterial, viral or fungal infections within 90 minutes. For now, only meningitis can be diagnosed with NATLab, produced by BATM subsidiary Ador Diagnostics in Rome. “Once NATLab is ready, it will change the way infectious diseases are diagnosed because you don’t have to send people to hospitals and it doesn’t require special training,” says Marom. A Chinese company, WuXi Diagnostics, also announced the development of rapid diagnostic kits for COVID-19. Marom says several Chinese kits were studied in Israel and found to be too expensive for general use and too prone to false positives. “Nearly eight years ago we decided to try to find a new way to diagnose pathogens because we believe the current diagnostic methods are not good enough,” says Marom. “We are now gearing to build large quantities of our kit at a reasonable price.” https://www.israel21c.org/israeli-company-develops-rapid-diagnostic-kit-for-covid-19/

Israeli MDs give free counseling to coronavirus patients Physicians from some of Israel’s largest hospitals have volunteered for the Innonation social project geared to helping isolated patients all over the world. By Abigail Klein Leichman MARCH 1, 2020 Illustrative photo by Mongkolchon Akesin via Shutterstock.com Thanks to a new social-action project, Chinese coronavirus patients were able to ask Israeli primary care physician Dr. Rachel Libenson Vansh how to maintain proper health and hygiene while confined at home. Using a Zoom video link over China’s Weibo social network, Libenson Vansh answered their questions in English with immediate translation into Chinese. This remarkable setup, which took place over a week ago, was the first in a series of interactive video broadcasts spearheaded by Israeli organization Innonation, which links talents, companies and organizations across borders through its hubs in Israel and China. One hundred Israeli physicians have volunteered to speak remotely with quarantined COVID-19 patients on topics of concern — such as family and children; dermatology (including sensitivity to protective masks); diet; psychology (as well as dealing with anxieties); pregnancy; and signs of serious illness that require immediate attention. Figures today show the COVID-19 virus has infected 86,584 people in more than 60 countries and caused 2,976 deaths. Many people who have been put into quarantine, or are self-isolated at home, are worried and fearful and have many questions about their situation and how to look after themselves. “The health systems in countries affected by the coronavirus are under tremendous pressure. They find it difficult to deal with the medical needs of people living under quarantine and with the general population that fears going to clinics and hospitals,” says Amit Gal-Or, who cofounded Innonation in 2016 with his father, Amir, and brother, Raz. “This Israeli volunteer initiative will provide them with the necessary knowhow to deal with the daily medical difficulties that currently are not being met.” The online project will target people in China, Japan, South Korea, Italy, the United States, Israel and any other countries where there are quarantines and fears about going out in public. Israeli physician Dr. Ishay Lev leads a remote medical instruction seminar aided by Chinese translator Mazal Liu. Photo courtesy of Innonation Doctors from major medical centers The doctors who volunteered for the Innonation video project are from some of Israel’s major medical centers, including Sheba, Tel Aviv, Rambam, Wolfson and Soroka. In cooperation with companies that agreed to supply practical technology and medical databases, Innonation has started operating broadcast stations at all the participating hospitals. “The technology bridges the medical gap in these countries, while the recruitment of Israeli medical institutions and the impressive volunteering of the best doctors in Israel help realize this project and meet the tremendous demand for the necessary medical knowledge,” says Gal-Or. Speaking to ISRAEL21c last Thursday, Amit Gal-Or said three sessions were completed with Chinese patients and another three are planned this week with patients recruited via social media in other countries. “The way it works is that first we do a live session where people apply to join and send their questions. That is capped to about 100 people so we can have a real give and take,” says Gal-Or. “Then we edit the videos and release them for publishing all over the world. It’s a mix of the personal and the necessary scale to help large numbers of people.” Donation of medical supplies to China Amit Gal-Or, one of the founders of Innonation. Photo: courtesy The video project follows on Innonation’s previous initiative of recruiting donors for medical equipment sorely needed in China. Board members and partners of Innonation and the Israeli Chamber of Commerce in China (IsCham) have so far donated some 500,000 pieces of protective gear including masks, gowns and gloves. Gal-Or, 23, has lived and been educated in China for 12 years. He is currently in Tel Aviv, where Innonation has an office in addition to branches in Chinese regions including Beijing, Hangzhou and Hong Kong. The Gal-Or family has been active in technology, telecommunications and real estate deals in the Chinese market for about 20 years. “We are experts at connecting, and this issue of the coronavirus hit us very personally,” he says. “We wanted to figure out ways to contribute aside from the donations of supplies. The Jewish tradition is about sharing knowledge. And the quality of expertise and technology in Israel’s medical field is very high quality. So we felt that the way to really contribute is through knowledge sharing.” Innonation reached out to managers of several medical centers with which it has ties. “It was incredible to see how quickly doctors wanted to volunteer and managers wanted to support this project,” says Gal-Or. Innonation has also established a company to facilitate the building of new hospitals and the transfer of Israeli medical technology. This global initiative is run by teams in China and Israel with the goal of improving medical systems and facilitating joint R&D projects internationally. But the video project is Gal-Or’s focus for the time being. He acknowledged that Innonation doesn’t profit from this activity aside from the positive publicity it engenders. “This is about connecting people in crisis with doctors and hospitals. We will continue until we see the virus disappear.” https://www.israel21c.org/israeli-mds-give-free-counseling-to-coronavirus-patients-worldwide/

What is the Coronavirus? The coronavirus belongs to a large family of viruses identified as the cause of certain animal diseases and can cause disease in humans, too. The name 'coronavirus' refers to their resemblance to a crown (corona in Latin) when viewed in an electron microscope. The severity of human illness depends on the particular virus strand of this family and ranges between mild ailment, such as a cold, up to a serious disease that can negatively affect the lungs and lead to multiple organ failure, such as the Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). What is the novel coronavirus? The novel coronavirus had not been previously identified as a cause of disease in humans. In December 2019, it was identified as the pathogen causing a cluster of pneumonia cases in Wuhan, Hubei province, central mainland China, and later on, it was found to spread to all provinces of mainland China as well as internationally. In terms of its genetic makeup, the SARS virus, which was the cause of severe morbidity in 2003/4, is the most similar to the novel virus in China among all other coronaviruses that cause human morbidity. On 11.2.20, the World Health Organization decided on an official name for the virus - SARS-CoV-2, and the disease it causes - COVID-19. How is the novel coronavirus transmitted to humans? The vast majority of the index patients worked or visited Wuhan's live animal and seafood market. This is why it was thought that there was animal-to-person spread. The animal causing the infection has not been identified with certainty. Person-to-person spread of the virus has been identified; infection probably occurs upon exposure to respiratory secretions when sneezing or coughing. How contagious the infection is remains unclear, but it appears to be like the flu. People can most likely infect others before symptoms appear - this is known to occur in other viral infections. What are the symptoms? The symptoms of the infection caused by the novel coronavirus are similar to those of influenza: fever, cough, shortness of breath, and respiratory distress. In a medical evaluation, it is not possible to distinguish between a coronavirus infection and other respiratory diseases. The infection might lead to acute pneumonia, Severe Acute Respiratory Syndrome (SARS), renal failure and can be fatal. The percentage of severe cases is not yet known. How severe is the 2019 corona illness? The clinical knowledge concerning the new disease is not yet complete. The data coming out of mainland China indicate that the illness is mild in most cases. Up to 20% of the confirmed patients develop complications and the mortality rate is approximately 2% of the patients. It is most probable that not all those infected in China had a medical evaluation, and that some have not been diagnosed. It is not clear what the risk factors of a severe illness are. Currently, available information suggests that older adults and people with a weak immune system or chronic medical condition, such as diabetes or a cardiovascular disease, may be at risk for more severe illness. How is the Coronavirus treated? There is currently no specific treatment for the novel coronavirus infection. People infected with the coronavirus receive supportive care; medical care is given according to the patient's medical condition. As yet, there is no vaccine, but countries are working on a virus, such as Israel.

Guidance Coronavirus (COVID-19): latest information and advice Information for the public on the outbreak of coronavirus, including the current situation in the UK and information about the virus and its symptoms. Published 24 January 2020 Last updated 3 March 2020 — see all updates From: Department of Health and Social Care and Public Health England Contents Number of cases Risk level Returning travellers Information about the virus Recent government action Diagnosis and analysis Further information Go to NHS.UK/coronavirus for information about the virus and how to protect yourself. Number of cases As of 3 March, a total of 13,911 people have been tested in the UK, of which 13,860 were confirmed negative. 51 were confirmed as positive. The Department of Health and Social Care will be publishing updated data on this page every day at 2pm until further notice. This data is accurate as of 9am on the day of publication. If more cases are confirmed in the UK, it will be announced by the Chief Medical Officer of the affected country. Risk level Based on the World Health Organization’s declaration that this is a public health emergency of international concern, the UK Chief Medical Officers have raised the risk to the UK from low to moderate. Returning travellers Stay indoors and avoid contact with other people immediately if you’ve travelled to the UK from: Hubei province in China in the last 14 days, even if you do not have symptoms Iran, lockdown areas in northern Italy or special care zones in South Korea since 19 February, even if you do not have symptoms other parts of mainland China or South Korea, Hong Kong, Japan, Macau, Malaysia, Singapore, Taiwan or Thailand in the last 14 days and have a cough, high temperature or shortness of breath (even if your symptoms are mild) other parts of northern Italy (anywhere north of Pisa, Florence and Rimini), Cambodia, Laos, Myanmar or Vietnam since 19 February and have a cough, high temperature or shortness of breath (even if your symptoms are mild) Use the 111 online coronavirus service to find out what to do next. Do not go to a GP surgery, pharmacy or hospital. In Scotland call your GP or NHS 24 on 111 out of hours. In Wales call 111 (if available in your area) or 0845 46 47. In Northern Ireland call 111. Lockdown areas in northern Italy: in Lombardy: Codogno, Castiglione d’Adda, Casalpusterlengo, Fombio, Maleo, Somaglia, Bertonico, Terranova dei Passerini, Castelgerundo and San Fiorano in Veneto: Vo’ Euganeo Special care zones in South Korea: Daegu Cheongdo See maps of the specified areas. This guidance is based on the recommendations of the UK Chief Medical officers. These areas have been identified because of the volume of air travel from affected areas, understanding of other travel routes and number of reported cases. This list will be kept under review. For areas with direct flights to the UK we are carrying out enhanced monitoring. Passengers will be told how to report any symptoms they develop during the flight, at the time of arrival, or after leaving the airport. Read more about what you should do if you’re asked to self-isolate. Information about the virus A coronavirus is a type of virus. As a group, coronaviruses are common across the world. Typical symptoms of coronavirus include fever and a cough that may progress to a severe pneumonia causing shortness of breath and breathing difficulties. Generally, coronavirus can cause more severe symptoms in people with weakened immune systems, older people, and those with long-term conditions like diabetes, cancer and chronic lung disease. Novel coronavirus (COVID-19) is a new strain of coronavirus first identified in Wuhan City, China. The NHS website has more information about how coronavirus is spread and answers common questions about the virus. Recent government action The government published its coronavirus action plan on 3 March. On 10 February, the Secretary of State for Health and Social Care, Matt Hancock, announced strengthened legal powers to protect public health. The Health Protection (Coronavirus) Regulations 2020 have been put in place to reduce the risk of further human-to-human transmission in this country by keeping individuals in isolation where public health professionals believe there is a reasonable risk an individual may have the virus. Diagnosis and analysis The UK is one of the first countries outside China to have a prototype specific laboratory test for this new disease. Healthcare professionals who are contacted by a patient with symptoms following travel to an affected area have been advised to submit samples to Public Health England (PHE) for testing. Individuals should be treated in isolation After the experience of severe acute respiratory syndrome (SARS) in 2003, PHE developed a series of diagnostic tests to detect any member of the family of coronaviruses. These have been used for several years, and were able to detect the first UK case of Middle East respiratory syndrome (MERS) in 2012. With the first reported publication of the genome sequence of a 2019 novel coronavirus, PHE was able to rapidly develop further specific tests for this virus, working with WHO and global network of laboratories. When a clinician suspects novel coronavirus (COVID-19), they take samples from the nose, throat and deeper respiratory samples, package and send them safely to PHE Colindale. PHE can provide a laboratory result from this specific virus on the same working day. PHE also has the capability to sequence the viral genome and compare this to published sequences from China, if a case occurs. This will provide valuable information on any mutations in the virus over time and allow an improved understanding of how it spreads. Further information Coronavirus (COVID-19): UK government response Foreign and Commonwealth Office travel advice Published 24 January 2020 Last updated 3 March 2020 + show all updates https://www.gov.uk/guidance/coronavirus-covid-19-information-for-the-public

Overview-Coronavirus (COVID-19) Contents Overview Advice for travellers Common questions COVID-19 is a new illness that can affect your lungs and airways. It's caused by a virus called coronavirus. What's the risk of coronavirus in the UK? The UK Chief Medical Officers have raised the risk to the public from low to moderate. Health professionals are working to contact anyone who has been in close contact with people who have coronavirus. What's the risk of coronavirus for travellers? There are some countries and areas where there's a higher chance of coming into contact with someone with coronavirus. See our coronavirus advice for travellers. Symptoms of coronavirus The symptoms of coronavirus are: a cough a high temperature shortness of breath But these symptoms do not necessarily mean you have the illness. The symptoms are similar to other illnesses that are much more common, such as cold and flu. How coronavirus is spread Because it's a new illness, we do not know exactly how coronavirus spreads from person to person. Similar viruses are spread in cough droplets. It's very unlikely it can be spread through things like packages or food. Do I need to avoid public places? Most people can continue to go to work, school and other public places. You only need to stay away from public places (self-isolate) if advised to by the 111 online coronavirus service or a medical professional. How to avoid catching or spreading coronavirus Do wash your hands with soap and water often – do this for at least 20 seconds always wash your hands when you get home or into work use hand sanitiser gel if soap and water are not available cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze put used tissues in the bin immediately and wash your hands afterwards try to avoid close contact with people who are unwell Don't do not touch your eyes, nose or mouth if your hands are not clean Check if you need medical help NHS 111 has an online coronavirus service that can tell you if you need medical help and advise you what to do. Use this service if: you think you might have coronavirus in the last 14 days you've been to a country or area with a high risk of coronavirus – see our coronavirus advice for travellers you've been in close contact with someone with coronavirus Use the 111 coronavirus service Information: Do not go to a GP surgery, pharmacy or hospital. Call 111 if you need to speak to someone. Getting help in Scotland, Wales or Northern Ireland Scotland: call your GP surgery or call 111 if your surgery is not open Wales: call 111 Northern Ireland: call 111 How to self-isolate if you're asked to If there's a chance you could have coronavirus, you may be asked to stay away from other people (self-isolate). This means you should: stay at home not go to work, school or public places not use public transport or taxis ask friends, family members or delivery services to do errands for you try to avoid visitors to your home – it's OK for friends, family or delivery drivers to drop off food You may need to do this for up to 14 days to help reduce the possible spread of infection. Read more coronavirus self-isolation advice. Treatment for coronavirus There is currently no specific treatment for coronavirus. Antibiotics do not help, as they do not work against viruses. Treatment aims to relieve the symptoms while your body fights the illness. You'll need to stay in isolation away from other people until you've recovered. More information GOV.UK: coronavirus action plan GOV.UK: information on coronavirus and the situation in the UK NHS England: coronavirus information for health professionals https://www.nhs.uk/conditions/coronavirus-covid-19/