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Saturday, May 5, 2018

Finding the ‘brain switch’ for courage

When we see danger, we react. Whether we choose to run and hide or confront our threat head-on, our “instant” decision is the result of a complex brain mechanism that integrates visual data and triggers an appropriate response. How does this occur? A new study explains.
In the animal kingdom, vision is vital for survival. This important sense informs the brain about predators and other threats, and in turn, the brain generates an appropriate reaction: courage or fear, fight or flight.
But how does this process take place? How do animals — humans included — integrate visual information with the appropriate brain circuits that control firstly our emotional states, and afterward, our behavior and actions?
New research brings us closer to an answer. Scientists led by Andrew Huberman, an associate professor of neurobiology and ophthalmology at Stanford University School of Medicine in California, have found the brain circuits “responsible” for the decision to either fight or flee in the face of danger.
Although the study was conducted in mice, the findings are relevant for humans. In fact, the results have important implications for understanding and managing post-traumatic stress disorder (PTSD), addiction, and phobias.
Lindsey Salay is the first author of the paper, which has now been published in the journal Nature.

The brain circuit of fear

To examine the rodents’ response to a threat, Salay and team simulated the approach of a bird of prey and used the c-Fos neuronal marker to track the activity of the mice’s neurons.
The researchers found increased activity in neurons that were grouped in a structure called the ventral midline thalamus (vMT).
Using brain mapping, the scientists were able to see what sensory information comes in and what information goes out of the vMT.
They revealed that the vMT receives information from a wide range of brain areas that process internal states, such as that of fear, but that it sends information out very selectively, to only two main areas: the basolateral amygdala and the medial prefrontal cortex.
The amygdala processes fear, aggression, and other emotions, while the medial prefrontal cortexuses its executive function to modulate emotional responses. The area is also deeply involved in anxiety.
Additional analysis shed yet more light on the trajectory of the brain circuit involved in the rodents’ response to the ominous predator.
Apparently, a nerve tract starts from the “xiphoid nucleus” — a cluster of neurons in the vMT — and continues to the basolateral amygdala.
Another tract follows an analogous path, this time from the so-called nucleus reuniens — another cluster of neurons built around the xiphoid nucleus — and leading up to the medial prefrontal cortex.

‘Turning on’ the courage switch

Having observed this trajectory in the brain, the researchers wondered whether or not selectively inhibiting certain neurons along these pathways produce specific fight-or-flight reactions.
To find out, Salay and team stimulated only the activity of the xiphoid nucleus while confronting the rodents with the image of the bird of prey. This made the mice freeze in front of the predator.
After that, they stimulated the activity of the tract that goes from the nucleus reuniens to the medial prefrontal cortex. This caused a surprising reaction: the mice became aggressive, getting ready to defend themselves.
Senior investigator Huberman describes the rodents’ behavior as one of undeniable courage. “You could hear their tails thumping against the side of the chamber,” he explains. “It’s the mouse equivalent of slapping and beating your chest and saying, ‘OK, let’s fight!'”
A second experiment confirmed the results: stimulating exclusively the nucleus reuniens for half a minute before showing the predator produced the same behavioral response: rather than hiding, the mice rattled their tails and exposed themselves in unprotected areas, ready to fight.
Huberman says that the findings are highly relevant to humans, given that human brains have a similar structure to the vMT.
He suggests that people living with phobias, anxiety, or PTSD might soon benefit from the findings, as reducing the activity in their vMT or in the adjacent neuronal clusters may help these people to overcome their fears.

Potential new treatments for dementia and Alzheimer’s Disease

A study published in the journal Human Molecular Genetics has uncovered why clinical drug trials that aim to reduce proteins in the brain, associated with the onset of Alzheimer’s Disease and dementia have been unsuccessful. The findings are a promising sign for the development of new treatments using currently available drugs.

The research team, comprised of US and Australian scientists, sourced evidence from a broad scope of animal models and human studies of diseases linked to dementia, to demonstrate that inflammation is a significant cause rather than a symptom.
Their research illustrates how a number of genes associated with dementia control our reaction and vulnerability to inflammatory damage.
For decades, scientists have thought that dementia and Alzheimer’s Disease are caused by protein aggregates forming in the brain. But recent clinical trials of drugs that reduce the aggregates have failed.”
Project leader Professor Robert Richards, from the University of Adelaide’s School of Biological Sciences.
This study was a collaborative effort between Richards, the National Institutes of Health (U.S.) and the University of Adelaide’s Medical School. It has long been acknowledged that inflammation can intensify as dementia-related diseases advance, but establishing it as the cause is a new discovery. It has hitherto been assumed that inflammation merely remove tissue damage sustained due to the protein aggregates.
We know that inflammation has different phases – early on it can be protective against a threat by actively degrading it, but if the threat is not removed, then persistent inflammation actually causes cell death,”
Professor Richards
These findings completely reverse the existing view that tissue damage occurs prior to inflammation, as the genetic linkages indicate the opposite.
Many genes linked with dementia operate at the level of controlling cellular inflammation. Both internal and external triggers interact with these genes to play a part. Inflammation is the point through which many triggers converge”
Professor Richards
Richards compares inflammation in the brain to a virus infection, saying that:
Inflammation is a very effective defense against foreign agents like viruses. But as we get older and accumulate mutations, our cells can make proteins and DNA products that mimic viruses, and these build up in the system”
“Normally, our cells bar-code their own products to tell them apart from foreign agents. When these bar codes aren’t in place, our cells can’t properly distinguish ‘self’ and ‘non-self’ trigger molecules. The result is inflammation that escalates and spreads – hence the term auto inflammatory disease.”
Specific forms of gene mutation bring about a premature or more frequent failure of these systems, and the older we grow, the more these can increase.
This indicates a possible explanation for the association of dementia development and older age. A positive outcome of the findings is that by alleviating some aspects of inflammation, dementia symptoms could potentially be relieved.
Richards concludes, “With this new understanding of the disease, we now need to test existing anti-inflammatory drugs for their effectiveness in treating dementia.”

Trump likely to target Medicare in quest for lower drug prices

Medicare could be in the crosshairs of the Trump administration’s search for a remedy to lower drug prices.
Department of Health and Human Services Secretary Alex Azar implied yesterday that Medicare Part B changes would be a major focus of the administration’s quest to lower drug prices.
In his speech at the World Health Care Congress in Washington, Azar noted that the White House’s strategy will be “building on the proposals in the President’s [2019] budget,” which included capping out-of-pocket spending under Medicare Part B, $5 billion in cuts to the Medicare program, and moving Part B drug coverage into Part D to foster better price negotiations.
However, skeptics have said these policies won’t do much to accomplish the goal of controlling and reducing costs, and many of the ideas were championed by pharmaceutical companies, which have not been targeted by President Donald Trump in his quest for lower costs.
The changes to Medicare Part D would likely run counter to the stated goals and actually raise costs for seniors, the Pharmaceutical Care Management Association said in a statement earlier this year.
Alex Azar
✔@SecAzar
I had lunch with @POTUS & @VP today to discuss our upcoming announcement on lowering prescription drug prices. This is a top priority for @HHSGov and we’re thrilled to have such a strong advocate in the @WhiteHouse.
The secretary’s comments are a lead-up to an expected speech by Trump on new initiatives to lower prescription drug prices, which is slated for early next week, sources familiar with the administration’s plans told FierceHealthcare. The announcement was planned for late April but has been postponed.
In a keynote speech at the Food and Drug Law Institute annual conference, Food and Drug Administration Commissioner Scott Gottlieb, M.D., hinted that the government may reexamine safe harbors for drug rebates under the Anti-Kickback Statute.
“Such a step could help restore some semblance of reality to the relationship between list and negotiated prices, and thereby boost affordability and competition,” he said, adding that Trump and Azar “will have more on this topic soon.”

The industry will be closely watching what Trump has to say. Drug pricing was a major issue of the Trump campaign, but industry, and consumers, have complained that those promises have not been kept.
Prescription drug prices have skyrocketed in recent years, especially prices of brand-name drugs, which have grown at 10 times the rate of inflation over the past five years, according to a congressional report.

Bayer’s Stivarga and Xofigo stall

Bayer blamed a strong euro for some obvious weak spots in its first-quarter numbers, but that explanation just doesn’t fly for its consumer health stall—or for the low turnout from cancer meds Xofigo and Stivarga.
Overall, Bayer’s first-quarter pharma sales did meet industry watchers’ expectations for the first time in several quarters. The German drugmaker reported €4.08 billion ($4.88 billion) in pharma revenue, and the “Big Five” consortium of crucial new meds—blood thinner Xarelto, eye med Eylea, pulmonary arterial hypertension drug Adempas, as well as Xofigo and Stivarga—collectively ginned up €1.66 billion, easily meeting analyst projections.
Not all five of the drugs lived up to individual expectations, though. Xofigo and Stivarga lost ground compared with the same period last year, and their €92 million and €70 million in sales fell short of estimates by double-digit margins.
Bayer argues that if it weren’t for a strong euro—which took a 7.1% toll on its pharma sales this quarter—Xofigo and Stivarga would have had better numbers to report, said the company. But even in adjusted currencies, the pair’s decline in the U.S. was obvious. Stivarga only registered €29 million in U.S. sales, plummeting by more than 12% year over year after the forex adjustment, and that’s with an FDA liver cancer nod it didn’t win till last April.
The consumer health business—once mooted as a growth engine—is now proving to be a long-term headache. Its reported sales slipped all over the world, and all together fell short of consensus at €1.41 billion. Its contribution to earnings was down more than 20% year over year, too.
Again, the U.S. operation was hit hardest. CEO Werner Baumann recently admitted his OTC business is hurting as consumers turn to online shopping. Supply issues, stemming from an FDA warning letter to a key plant in Germany, and ongoing fallout from China’s decision to make two sunscreen products prescription only, didn’t help.
On Thursday’s earnings call, the new unit chief described its Q1 performance as “flattish” if the manufacturing and China factors were taken out.
Bayer hopes its new recruit to head up the unit—Heiko Schipper, who came from Nestlé—can turn things around. Though he waved off some of the Q1 concerns, saying the numbers would have been “flattish” without the supply problems and Chinese sunscreen changes, he also said the unit is undergoing an “in-depth strategic review” and pledged better numbers for the second half of 2018.
As it moves forward with the Monsanto acquisition, the company confirmed its currency-adjusted forecast for 2018 but dialed down the actual reported sales number out of concerns for unfavorable exchange rates. It’s expecting overall sales and EBITDA to both decrease by low-single-digit margins rather than matching 2017 levels. It previously estimated €16.5 billion of sales from pharmaceuticals and €5.5 billion from consumer health.

Friday, May 4, 2018

U.S. drug agency suspends Louisiana distributor over opioid sales

The U.S. Drug Enforcement Administration said on Friday it had suspended a Louisiana pharmaceutical distributor from selling controlled substances for allegedly selling unusually large quantities of opioids to pharmacies without reporting the sales.
The DEA said it suspended Morris & Dickson Co, a privately owned drug wholesaler based in Shreveport, on Wednesday after an investigation showed “it failed to properly identify large suspicious orders for controlled substances sold to independent pharmacies with questionable need for the drugs.”
“Opioid distributors have a legal obligation not to facilitate the illicit diversion of drugs,” Attorney General Jeff Sessions said in the statement by the DEA, which is part of the U.S. Justice Department.
“That obligation has never been more important than it is right now as we face the deadliest drug crisis in American history,” Sessions said.
Morris & Dickson filed in federal court on Thursday for an injunction against the suspension, and U.S. District Judge Elizabeth Foote in Shreveport has scheduled a hearing for Tuesday on its request for a temporary restraining order, according to court records.
The probe, which focused on purchases of Oxycodone and Hydrocodone, showed that in some cases, pharmacies were allowed to buy as much as six times the quantity of narcotics they would normally order, the DEA statement said.
Family-owned Morris & Dickson was founded in 1841 and is the largest independently owned and privately held drug wholesale distributor in the United States, according to its court filing.
The U.S. government is trying to crack down on opioid abuse through a number of measures, including a proposal last month to tighten rules governing the amount of prescription opioid painkillers that drugmakers can manufacture in a given year.
Sessions has created an opioid task force and deployed prosecutors to hard-hit areas of the country with a mandate to bring more cases against traffickers.
According to the Centers for Disease Control and Prevention, 42,000 people died nationwide from opioid overdoses in 2016, the last year with publicly available data.

Ironwood fights off Denner addition to board post split talk

Ironwood sent a letter to shareholders on Wednesday morning, urging them to vote the “white” proxy card with its slate of three new board members ahead of its May 31 annual meeting. The Ironwood nominees include sitting board members Lawrence Olanoff, Amy Schulman and Douglas Williams. The company said that it “believes there is no compelling reason” to add hedge fund Sarissa Capital’s Chief Investment Officer Alex Denner to the board.
The letter added that “Dr. Denner has not made clear what skills or experience he would bring to the Ironwood Board that it does not already possess,” and noted that Sarissa Capital only own 2.5% of Ironwood shares. It encourages shareholders to discard the “gold” proxy card.

  • Ironwood Pharmaceuticals announced Tuesday that it will spin out several pipeline programs into a new, publicly traded company.
  • The existing Ironwood will keep three currently marketed products, including the constipation medicine Linzess, as well as two gastrointestinal-focused pipeline products.
  • The new company, on the other hand, will encompass R&D programs based on a soluble guanylate cyclase (sGC) research platform. The separation will be completed in the first half of 2019.

Ironwood has operated at a loss for the last several years, despite marketing three products and earning revenue from partnership agreements with Allergan. In 2017, the company brought in only $298 million in total revenues and reported a net loss of $116 million — greater than the loss of $81 million reported in 2016.
Ironwood management said in a statement the decision was made to separate “to unlock value, increase operational performance and strategic flexibility, and tailor capital structure for each business.”
The company expects legacy Ironwood will now be able to reach profitability in 2019.
The split comes after activist investor Alex Denner ratcheted up pressure on the company. Denner’s Sarissa Capital sought to nominate him to the Ironwood board of directors in early April. Denner is known for shaking things up; as a Carl Icahn protégé, that’s par for the course.
The new company will own two mid-stage programs — praliciguat for heart failure with preserved ejection fraction (HFpEF) and diabetic nephropathy; and olinciguat for sickle cell disease and achalasia. It will also have IW-6463 in development for severe CNS diseases, as well as other discovery programs targeting severe liver and lung diseases. The new company will focus on rare disease indications, while partnering out indications that apply to broader populations, Ironwood said.
Ironwood plans to make announcements over the coming months about the new company’s name as well as employee and leadership decisions.

Flailing obesity drug company Vivus tries a new tack

  • Struggling biopharma Vivus on Tuesday announced an agreement to pick up U.S. and Canadian rights to digestive aid Pancreaze from Johnson & Johnson’s Janssen unit.
  • The deal is the first of a planned set of product acquisitions by Vivus that are “designed to generate revenue and strengthen its financial position,” the company said in a statement.
  • Vivus stock, which trades below $1 per share, jumped higher on news of the deal but the company is still valued below its holdings of cash and available-for-sale securities as of Dec. 31, 2017.

The obesity market is floundering and it’s taking companies with it. In March 2018, Orexigen Therapeutics went under, filing for Chapter 11 bankruptcy and selling off all of its assets. Funding of $35 million from senior secured noteholders means that its diet drug Contrave (naltrexone/bupropion) will still be produced, however.
Other biotechs in the field have restructured to avoid a similar fate. Arena Pharmaceuticals ditched weight loss product Belviq (lorcaserin), moving its focus to pain and autoimmune disease. And now Vivus has picked up Janssen Pharmaceuticals’ Pancreaze (pancrelipase) delayed-release capsules in a first step to try to diversify its pipeline and turn itself around.
“Pancreaze serves as our initial product acquisition, one that will allow us to participate and be a meaningful product company in the global gastrointestinal marketplace …,” said Kenneth Suh, CEO of Willow Biopharma, a wholly-owned subsidiary of Vivus, in a May 1 statement. “We are hopeful to acquire additional products and through product life cycle management, leverage the Pancreaze platform for further growth.”
Vivus currently has only two products approved in the U.S. — its struggling diet product Qsymia (phentermine/topiramate) and Stendra (avanafil), a phosphodiesterase 5 (PDE5) inhibitor for erectile dysfunction. The company recorded a net loss of $10.1 million in the fourth quarter of 2017, as sales of Qsymia brought in just $8.9 million.
In order to secure new funds, Vivus has restructured a portion of its corporate debt and issued debt securities. According to John Amos, the newly-installed CEO at Vivus, the acquisition and the debt restructure demonstrate the company’s plan “to create a stronger and more financially capable Vivus.” Other new members of the company’s leadership team include Scott Oehrlein as chief operating officer.
“We intend to drive revenue in the future through innovative sales and marketing of our current product portfolio, disciplined product acquisition, strong product life cycle management and focused expense management,” Amos added.