Page last updated: 2024-10-18

kynurenine and Depressive Disorder, Treatment-Resistant

kynurenine has been researched along with Depressive Disorder, Treatment-Resistant in 12 studies

Kynurenine: A metabolite of the essential amino acid tryptophan metabolized via the tryptophan-kynurenine pathway.
kynurenine : A ketone that is alanine in which one of the methyl hydrogens is substituted by a 2-aminobenzoyl group.

Depressive Disorder, Treatment-Resistant: Failure to respond to two or more trials of antidepressant monotherapy or failure to respond to four or more trials of different antidepressant therapies. (Campbell's Psychiatric Dictionary, 9th ed.)

Research Excerpts

ExcerptRelevanceReference
"The kynurenine pathway (KP) and inflammation are substantial in depression pathogenesis."8.12A kynurenine pathway enzyme aminocarboxymuconate-semialdehyde decarboxylase may be involved in treatment-resistant depression, and baseline inflammation status of patients predicts treatment response: a pilot study. ( Aslan, S; Bolu, A; Bozkurt, A; Bukan, N; Cevik, C; Cicek, S; Ekmekci Ertek, I; Karadag, RF; Kocak, C; Sen, B; Ucar, H; Yilmaz, NS, 2022)
"The kynurenine pathway (KP) and inflammation are substantial in depression pathogenesis."4.12A kynurenine pathway enzyme aminocarboxymuconate-semialdehyde decarboxylase may be involved in treatment-resistant depression, and baseline inflammation status of patients predicts treatment response: a pilot study. ( Aslan, S; Bolu, A; Bozkurt, A; Bukan, N; Cevik, C; Cicek, S; Ekmekci Ertek, I; Karadag, RF; Kocak, C; Sen, B; Ucar, H; Yilmaz, NS, 2022)
"Cytokines in plasma from patients with major depressive disorder (MDD; n = 19) and healthy volunteers (n = 14) were analyzed with electrochemiluminescence detection."1.43Electroconvulsive therapy suppresses the neurotoxic branch of the kynurenine pathway in treatment-resistant depressed patients. ( Bhat, M; Erhardt, S; Frye, MA; Johansson, AG; Jungholm, O; Landén, M; Samuelsson, M; Schuppe-Koistinen, I; Schwieler, L; Sellgren, CM, 2016)

Research

Studies (12)

TimeframeStudies, this research(%)All Research%
pre-19900 (0.00)18.7374
1990's0 (0.00)18.2507
2000's0 (0.00)29.6817
2010's5 (41.67)24.3611
2020's7 (58.33)2.80

Authors

AuthorsStudies
Tateishi, H2
Setoyama, D2
Kato, TA2
Kang, D2
Matsushima, J2
Nogami, K1
Mawatari, S2
Kojima, R2
Fujii, Y2
Sakemura, Y2
Shiraishi, T2
Imamura, Y1
Maekawa, T2
Asami, T2
Mizoguchi, Y2
Monji, A2
Yilmaz, NS1
Sen, B1
Karadag, RF1
Aslan, S1
Ekmekci Ertek, I1
Bozkurt, A1
Cicek, S1
Bolu, A1
Ucar, H1
Kocak, C1
Cevik, C1
Bukan, N1
Levin, G1
Ein-Dor, T1
Badawy, AA1
Murata, S1
Murphy, M1
Hoppensteadt, D1
Fareed, J1
Welborn, A1
Halaris, A1
Park, LT1
Kadriu, B1
Gould, TD1
Zanos, P1
Greenstein, D1
Evans, JW1
Yuan, P1
Farmer, CA1
Oppenheimer, M1
George, JM1
Adeojo, LW1
Snodgrass, HR1
Smith, MA1
Henter, ID1
Machado-Vieira, R1
Mannes, AJ1
Zarate, CA1
Kikuchi, J1
Fukuchi, J1
Serafini, G1
Adavastro, G1
Canepa, G1
Capobianco, L1
Conigliaro, C1
Pittaluga, F1
Murri, MB1
Valchera, A1
De Berardis, D1
Pompili, M1
Lindqvist, D1
Brundin, L1
Amore, M1
Thomas, J1
Khanam, R1
Vohora, D1
Allen, AP1
Naughton, M1
Dowling, J1
Walsh, A1
O'Shea, R1
Shorten, G1
Scott, L1
McLoughlin, DM1
Cryan, JF1
Clarke, G1
Dinan, TG1
Yang, JJ1
Wang, N1
Yang, C1
Shi, JY1
Yu, HY1
Hashimoto, K1
Schwieler, L1
Samuelsson, M1
Frye, MA1
Bhat, M1
Schuppe-Koistinen, I1
Jungholm, O1
Johansson, AG1
Landén, M1
Sellgren, CM1
Erhardt, S1

Clinical Trials (2)

Trial Overview

TrialPhaseEnrollmentStudy TypeStart DateStatus
Cyclooxygenase-2-Inhibitor Combination Treatment for Bipolar Depression: Role of Inflammation and Kynurenine Pathway Biomarkers[NCT01479829]Phase 488 participants (Actual)Interventional2011-03-31Completed
An Investigation of the Antidepressant Effects of the Glycine Receptor Antagonist AV 101 (4-chlorokynurenine) in Major Depressive Disorder[NCT02484456]Phase 222 participants (Actual)Interventional2015-10-14Completed
[information is prepared from clinicaltrials.gov, extracted Sep-2024]

Trial Outcomes

Model Adjusted Means for Beck Depression Score

The Beck Depression Inventory (BDI) is a 21-item measure of depression with each question on a 4-point scale ranging from 0=minimal to 3 = more severe (full list score values = 0,1,2,3). Total scores are a sum of individual items. The minimal depression = 0-13, mild depression = 14-19, moderate depression = 20-28, and severe depression = 29-63. The maximum score being 63 and the minimum possible score = 0. (NCT02484456)
Timeframe: Post Dose Day 0

Interventionscore on a scale (Mean)
AV 101 (4-chlorokynurenine)25.35
Placebo25.79

Model Adjusted Means for Beck Depression Score

The Beck Depression Inventory (BDI) is a 21-item measure of depression with each question on a 4-point scale ranging from 0=minimal to 3 = more severe (full list score values = 0,1,2,3). Total scores are a sum of individual items. The minimal depression = 0-13, mild depression = 14-19, moderate depression = 20-28, and severe depression = 29-63. The maximum score being 63 and the minimum possible score = 0. (NCT02484456)
Timeframe: Post Dose Day 1

Interventionscore on a scale (Mean)
AV 101 (4-chlorokynurenine)24.76
Placebo24.75

Model Adjusted Means for Beck Depression Score

The Beck Depression Inventory (BDI) is a 21-item measure of depression with each question on a 4-point scale ranging from 0=minimal to 3 = more severe (full list score values = 0,1,2,3). Total scores are a sum of individual items. The minimal depression = 0-13, mild depression = 14-19, moderate depression = 20-28, and severe depression = 29-63. The maximum score being 63 and the minimum possible score = 0. (NCT02484456)
Timeframe: Post Dose Day 13

Interventionscore on a scale (Mean)
AV 101 (4-chlorokynurenine)25.86
Placebo23.84

Model Adjusted Means for Beck Depression Score

The Beck Depression Inventory (BDI) is a 21-item measure of depression with each question on a 4-point scale ranging from 0=minimal to 3 = more severe (full list score values = 0,1,2,3). Total scores are a sum of individual items. The minimal depression = 0-13, mild depression = 14-19, moderate depression = 20-28, and severe depression = 29-63. The maximum score being 63 and the minimum possible score = 0. (NCT02484456)
Timeframe: Post Dose Day 2

Interventionscore on a scale (Mean)
AV 101 (4-chlorokynurenine)25.88
Placebo26.14

Model Adjusted Means for Beck Depression Score

The Beck Depression Inventory (BDI) is a 21-item measure of depression with each question on a 4-point scale ranging from 0=minimal to 3 = more severe (full list score values = 0,1,2,3). Total scores are a sum of individual items. The minimal depression = 0-13, mild depression = 14-19, moderate depression = 20-28, and severe depression = 29-63. The maximum score being 63 and the minimum possible score = 0. (NCT02484456)
Timeframe: Post Dose Day 3

Interventionscore on a scale (Mean)
AV 101 (4-chlorokynurenine)25.64
Placebo24.64

Model Adjusted Means for Beck Depression Score

The Beck Depression Inventory (BDI) is a 21-item measure of depression with each question on a 4-point scale ranging from 0=minimal to 3 = more severe (full list score values = 0,1,2,3). Total scores are a sum of individual items. The minimal depression = 0-13, mild depression = 14-19, moderate depression = 20-28, and severe depression = 29-63. The maximum score being 63 and the minimum possible score = 0. (NCT02484456)
Timeframe: Post Dose Day 7

Interventionscore on a scale (Mean)
AV 101 (4-chlorokynurenine)25.82
Placebo24.22

Model Adjusted Means for Hamilton Anxiety Rating Score

The Hamilton Anxiety Rating Scale (HAM-A) is a 14-item global measure of anxiety symptoms. Each item is scored on a scale of 0 (not present) to 4 (severe) (full score list = 0,1,2,3,4), with a total score range of 0-56 (0 = minimum score and 56 = maximum), where <17 indicates mild severity, 18-24 mild to moderate severity and 25-30 moderate to severe. Total scores are a sum of individual items. (NCT02484456)
Timeframe: Post Dose Day 0

Interventionscore on a scale (Mean)
AV 101 (4-chlorokynurenine)15.71
Placebo16.20

Model Adjusted Means for Hamilton Anxiety Rating Score

The Hamilton Anxiety Rating Scale (HAM-A) is a 14-item global measure of anxiety symptoms. Each item is scored on a scale of 0 (not present) to 4 (severe) (full score list = 0,1,2,3,4), with a total score range of 0-56 (0 = minimum score and 56 = maximum), where <17 indicates mild severity, 18-24 mild to moderate severity and 25-30 moderate to severe. Total scores are a sum of individual items. (NCT02484456)
Timeframe: Post Dose Day 1

Interventionscore on a scale (Mean)
AV 101 (4-chlorokynurenine)17.30
Placebo16.67

Model Adjusted Means for Hamilton Anxiety Rating Score

The Hamilton Anxiety Rating Scale (HAM-A) is a 14-item global measure of anxiety symptoms. Each item is scored on a scale of 0 (not present) to 4 (severe) (full score list = 0,1,2,3,4), with a total score range of 0-56 (0 = minimum score and 56 = maximum), where <17 indicates mild severity, 18-24 mild to moderate severity and 25-30 moderate to severe. Total scores are a sum of individual items. (NCT02484456)
Timeframe: Post Dose Day 13

Interventionscore on a scale (Mean)
AV 101 (4-chlorokynurenine)18.33
Placebo16.28

Model Adjusted Means for Hamilton Anxiety Rating Score

The Hamilton Anxiety Rating Scale (HAM-A) is a 14-item global measure of anxiety symptoms. Each item is scored on a scale of 0 (not present) to 4 (severe) (full score list = 0,1,2,3,4), with a total score range of 0-56 (0 = minimum score and 56 = maximum), where <17 indicates mild severity, 18-24 mild to moderate severity and 25-30 moderate to severe. Total scores are a sum of individual items. (NCT02484456)
Timeframe: Post Dose Day 2

Interventionscore on a scale (Mean)
AV 101 (4-chlorokynurenine)17.83
Placebo17.66

Model Adjusted Means for Hamilton Anxiety Rating Score

The Hamilton Anxiety Rating Scale (HAM-A) is a 14-item global measure of anxiety symptoms. Each item is scored on a scale of 0 (not present) to 4 (severe) (full score list = 0,1,2,3,4), with a total score range of 0-56 (0 = minimum score and 56 = maximum), where <17 indicates mild severity, 18-24 mild to moderate severity and 25-30 moderate to severe. Total scores are a sum of individual items. (NCT02484456)
Timeframe: Post Dose Day 3

Interventionscore on a scale (Mean)
AV 101 (4-chlorokynurenine)16.48
Placebo17.87

Model Adjusted Means for Hamilton Anxiety Rating Score

The Hamilton Anxiety Rating Scale (HAM-A) is a 14-item global measure of anxiety symptoms. Each item is scored on a scale of 0 (not present) to 4 (severe) (full score list = 0,1,2,3,4), with a total score range of 0-56 (0 = minimum score and 56 = maximum), where <17 indicates mild severity, 18-24 mild to moderate severity and 25-30 moderate to severe. Total scores are a sum of individual items. (NCT02484456)
Timeframe: Post Dose Day 7

Interventionscore on a scale (Mean)
AV 101 (4-chlorokynurenine)18.42
Placebo17.25

Model Adjusted Means for Hamilton Depression Rating Score

The Hamilton Depression Rating scale is a 17-item global measure of depressive symptoms on a 5-point scale ranging from 0 = not present to 4 = severe (full score values = 0,1,2,3,4). Some items rated on a scale of 0-2 (0, 1, 2) with 0 = not present to 2 = more severe. Total scores are a sum of the individual items. The maximum total score being 52 on the 17-point scale, and the minimum score being 0.Total scores of 0-7 are considered as being normal, 8-16 suggest mild depression, 17-23 moderate depression and scores over 24 are indicative of severe depression. (NCT02484456)
Timeframe: Post Dose Day 0

Interventionscore on a scale (Mean)
AV 101 (4-chlorokynurenine)20.22
Placebo20.56

Model Adjusted Means for Hamilton Depression Rating Score

The Hamilton Depression Rating scale is a 17-item global measure of depressive symptoms on a 5-point scale ranging from 0 = not present to 4 = severe (full score values = 0,1,2,3,4). Some items rated on a scale of 0-2 (0, 1, 2) with 0 = not present to 2 = more severe. Total scores are a sum of the individual items. The maximum total score being 52 on the 17-point scale, and the minimum score being 0.Total scores of 0-7 are considered as being normal, 8-16 suggest mild depression, 17-23 moderate depression and scores over 24 are indicative of severe depression. (NCT02484456)
Timeframe: Post Dose Day 1

Interventionscore on a scale (Mean)
AV 101 (4-chlorokynurenine)20.22
Placebo20.06

Model Adjusted Means for Hamilton Depression Rating Score

The Hamilton Depression Rating scale is a 17-item global measure of depressive symptoms on a 5-point scale ranging from 0 = not present to 4 = severe (full score values = 0,1,2,3,4). Some items rated on a scale of 0-2 (0, 1, 2) with 0 = not present to 2 = more severe. Total scores are a sum of the individual items. The maximum total score being 52 on the 17-point scale, and the minimum score being 0.Total scores of 0-7 are considered as being normal, 8-16 suggest mild depression, 17-23 moderate depression and scores over 24 are indicative of severe depression. (NCT02484456)
Timeframe: Post Dose Day 13

Interventionscore on a scale (Mean)
AV 101 (4-chlorokynurenine)21.52
Placebo19.69

Model Adjusted Means for Hamilton Depression Rating Score

The Hamilton Depression Rating scale is a 17-item global measure of depressive symptoms on a 5-point scale ranging from 0 = not present to 4 = severe (full score values = 0,1,2,3,4). Some items rated on a scale of 0-2 (0, 1, 2) with 0 = not present to 2 = more severe. Total scores are a sum of the individual items. The maximum total score being 52 on the 17-point scale, and the minimum score being 0.Total scores of 0-7 are considered as being normal, 8-16 suggest mild depression, 17-23 moderate depression and scores over 24 are indicative of severe depression. (NCT02484456)
Timeframe: Post Dose Day 2

Interventionscore on a scale (Mean)
AV 101 (4-chlorokynurenine)20.75
Placebo20.41

Model Adjusted Means for Hamilton Depression Rating Score

The Hamilton Depression Rating scale is a 17-item global measure of depressive symptoms on a 5-point scale ranging from 0 = not present to 4 = severe (full score values = 0,1,2,3,4). Some items rated on a scale of 0-2 (0, 1, 2) with 0 = not present to 2 = more severe. Total scores are a sum of the individual items. The maximum total score being 52 on the 17-point scale, and the minimum score being 0.Total scores of 0-7 are considered as being normal, 8-16 suggest mild depression, 17-23 moderate depression and scores over 24 are indicative of severe depression. (NCT02484456)
Timeframe: Post Dose Day 3

Interventionscore on a scale (Mean)
AV 101 (4-chlorokynurenine)19.51
Placebo20.74

Model Adjusted Means for Hamilton Depression Rating Score

The Hamilton Depression Rating scale is a 17-item global measure of depressive symptoms on a 5-point scale ranging from 0 = not present to 4 = severe (full score values = 0,1,2,3,4). Some items rated on a scale of 0-2 (0, 1, 2) with 0 = not present to 2 = more severe. Total scores are a sum of the individual items. The maximum total score being 52 on the 17-point scale, and the minimum score being 0.Total scores of 0-7 are considered as being normal, 8-16 suggest mild depression, 17-23 moderate depression and scores over 24 are indicative of severe depression. (NCT02484456)
Timeframe: Post Dose Day 7

Interventionscore on a scale (Mean)
AV 101 (4-chlorokynurenine)21.28
Placebo20.43

Model Adjusted Means for Montgomery-Asberg Depression Rating Score

"The Montgomery-Asberg Depression Rating Scale (MADRS) is a 10-item global measure evaluating core symptoms of depression. Questions concern how the patient has felt over the past week. Each item is rated on a scale from 0 to 6, with 0 being normal/not present and 6 being extreme (full score list = 0,1,2,3,4,5,6). Maximum score = 60, minimum score = 0. Total scores are a sum of the individual items." (NCT02484456)
Timeframe: Post Dose Day 0

Interventionscore on a scale (Mean)
AV 101 (4-chlorokynurenine)29.28
Placebo29.48

Model Adjusted Means for Montgomery-Asberg Depression Rating Score

"The Montgomery-Asberg Depression Rating Scale (MADRS) is a 10-item global measure evaluating core symptoms of depression. Questions concern how the patient has felt over the past week. Each item is rated on a scale from 0 to 6, with 0 being normal/not present and 6 being extreme (full score list = 0,1,2,3,4,5,6). Maximum score = 60, minimum score = 0. Total scores are a sum of the individual items." (NCT02484456)
Timeframe: Post Dose Day 1

Interventionscore on a scale (Mean)
AV 101 (4-chlorokynurenine)28.75
Placebo28.79

Model Adjusted Means for Montgomery-Asberg Depression Rating Score

"The Montgomery-Asberg Depression Rating Scale (MADRS) is a 10-item global measure evaluating core symptoms of depression. Questions concern how the patient has felt over the past week. Each item is rated on a scale from 0 to 6, with 0 being normal/not present and 6 being extreme (full score list = 0,1,2,3,4,5,6). Maximum score = 60, minimum score = 0. Total scores are a sum of the individual items." (NCT02484456)
Timeframe: Post Dose Day 13

Interventionscore on a scale (Mean)
AV 101 (4-chlorokynurenine)29.70
Placebo27.06

Model Adjusted Means for Montgomery-Asberg Depression Rating Score

"The Montgomery-Asberg Depression Rating Scale (MADRS) is a 10-item global measure evaluating core symptoms of depression. Questions concern how the patient has felt over the past week. Each item is rated on a scale from 0 to 6, with 0 being normal/not present and 6 being extreme (full score list = 0,1,2,3,4,5,6). Maximum score = 60, minimum score = 0. Total scores are a sum of the individual items." (NCT02484456)
Timeframe: Post Dose Day 2

Interventionscore on a scale (Mean)
AV 101 (4-chlorokynurenine)29.51
Placebo29.84

Model Adjusted Means for Montgomery-Asberg Depression Rating Score

"The Montgomery-Asberg Depression Rating Scale (MADRS) is a 10-item global measure evaluating core symptoms of depression. Questions concern how the patient has felt over the past week. Each item is rated on a scale from 0 to 6, with 0 being normal/not present and 6 being extreme (full score list = 0,1,2,3,4,5,6). Maximum score = 60, minimum score = 0. Total scores are a sum of the individual items." (NCT02484456)
Timeframe: Post Dose Day 3

Interventionscore on a scale (Mean)
AV 101 (4-chlorokynurenine)29.85
Placebo30.81

Model Adjusted Means for Montgomery-Asberg Depression Rating Score

"The Montgomery-Asberg Depression Rating Scale (MADRS) is a 10-item global measure evaluating core symptoms of depression. Questions concern how the patient has felt over the past week. Each item is rated on a scale from 0 to 6, with 0 being normal/not present and 6 being extreme (full score list = 0,1,2,3,4,5,6). Maximum score = 60, minimum score = 0. Total scores are a sum of the individual items." (NCT02484456)
Timeframe: Post Dose Day 7

Interventionscore on a scale (Mean)
AV 101 (4-chlorokynurenine)30.45
Placebo28.64

Reviews

2 reviews available for kynurenine and Depressive Disorder, Treatment-Resistant

ArticleYear
A unified model of the biology of peripartum depression.
    Translational psychiatry, 2023, 04-28, Volume: 13, Issue:1

    Topics: Biology; Depression; Depression, Postpartum; Depressive Disorder, Treatment-Resistant; Female; Human

2023
Abnormalities in Kynurenine Pathway Metabolism in Treatment-Resistant Depression and Suicidality: A Systematic Review.
    CNS & neurological disorders drug targets, 2017, Volume: 16, Issue:4

    Topics: Animals; Depressive Disorder, Treatment-Resistant; Humans; Kynurenine; Suicide

2017

Trials

2 trials available for kynurenine and Depressive Disorder, Treatment-Resistant

ArticleYear
Effects of adjunctive inflammatory modulation on IL-1β in treatment resistant bipolar depression.
    Brain, behavior, and immunity, 2020, Volume: 87

    Topics: Bipolar Disorder; Celecoxib; Citalopram; Depressive Disorder, Treatment-Resistant; Humans; Interleuk

2020
A Randomized Trial of the N-Methyl-d-Aspartate Receptor Glycine Site Antagonist Prodrug 4-Chlorokynurenine in Treatment-Resistant Depression.
    The international journal of neuropsychopharmacology, 2020, 07-29, Volume: 23, Issue:7

    Topics: Adolescent; Adult; Aged; Animals; Antidepressive Agents; Brain; Brain Chemistry; Cross-Over Studies;

2020

Other Studies

8 other studies available for kynurenine and Depressive Disorder, Treatment-Resistant

ArticleYear
Changes in the metabolites of cerebrospinal fluid induced by rTMS in treatment-resistant depression: A pilot study.
    Psychiatry research, 2022, Volume: 313

    Topics: Depression; Depressive Disorder, Treatment-Resistant; Humans; Kynurenine; Pilot Projects; Prefrontal

2022
A kynurenine pathway enzyme aminocarboxymuconate-semialdehyde decarboxylase may be involved in treatment-resistant depression, and baseline inflammation status of patients predicts treatment response: a pilot study.
    Journal of neural transmission (Vienna, Austria : 1996), 2022, Volume: 129, Issue:12

    Topics: Biomarkers; Depression; Depressive Disorder, Treatment-Resistant; Electroconvulsive Therapy; Humans;

2022
Kynurenine pathway and suicidal ideation in treatment-resistant depression.
    Journal of psychopharmacology (Oxford, England), 2023, Volume: 37, Issue:11

    Topics: Depression; Depressive Disorder, Treatment-Resistant; Humans; Kynurenine; Suicidal Ideation; Suicide

2023
The changes in kynurenine metabolites induced by rTMS in treatment-resistant depression: A pilot study.
    Journal of psychiatric research, 2021, Volume: 138

    Topics: Depression; Depressive Disorder, Treatment-Resistant; Humans; Kynurenine; Pilot Projects; Transcrani

2021
Activation of indoleamine 2, 3- dioxygenase pathway by olanzapine augments antidepressant effects of venlafaxine in mice.
    Psychiatry research, 2017, Volume: 258

    Topics: Animals; Antidepressive Agents; Antipsychotic Agents; Benzodiazepines; Depression; Depressive Disord

2017
Kynurenine pathway metabolism and the neurobiology of treatment-resistant depression: Comparison of multiple ketamine infusions and electroconvulsive therapy.
    Journal of psychiatric research, 2018, Volume: 100

    Topics: Adult; Antidepressive Agents; Biomarkers; Cytokines; Depressive Disorder, Treatment-Resistant; Elect

2018
Serum interleukin-6 is a predictive biomarker for ketamine's antidepressant effect in treatment-resistant patients with major depression.
    Biological psychiatry, 2015, Feb-01, Volume: 77, Issue:3

    Topics: Antidepressive Agents; Biomarkers, Pharmacological; Depressive Disorder, Major; Depressive Disorder,

2015
Electroconvulsive therapy suppresses the neurotoxic branch of the kynurenine pathway in treatment-resistant depressed patients.
    Journal of neuroinflammation, 2016, Feb-29, Volume: 13, Issue:1

    Topics: Adult; Chromatography, High Pressure Liquid; Cohort Studies; Cytokines; Depressive Disorder, Major;

2016