Boston Scientific Corp.’s latest deal, a takeover of privately held Millipede Inc., is a good strategic fit that will help the company build out its franchise of heart-valve repair and replacement treatments, Needham analysts said Thursday.
Millipede is developing the IRIS Transcatheter Annuloplasty Ring System, a treatment for patients with severe mitral regurgitation (MR) who are unable to tolerate open-heart surgery. Mitral regurgitation is a condition in which a leaky valve doesn’t close the way it should, allowing some blood to flow backward into the left atrium, according to the Mayo Clinic. Left untreated, the disorder can cause heart failure or arrhythmia.
“Upon commercialization, we believe the IRIS system can meet the needs of a currently underserved patient population that requires physiological, less invasive options to treat functional mitral regurgitation in patients with progressive heart failure,” said Professor Ian Meredith, executive vice president and global chief medical officer at Boston Scientific BSX, +0.55% in a statement.
Needham analysts welcomed the deal despite the price tag.
“While there are still clinical, commercialization, and integration risks and BSX is paying a high price for Millipede, we believe this transaction could lay the foundation for the mitral leg of BSX’s Structural Heart franchise, particularly given Neovasc’s issues (a BSX TMVR investment) and we reiterate our Strong Buy rating,” Needham analysts Mike Matson and David Saxon wrote in a note.
Neovasc NVCN, +2.34% is also developing a device to treat mitral regurgitation.
Boston Scientific first invested in Millipede by purchasing $90 million of existing and new shares with the option to acquire the rest for $325 million at closing, with a $125 million milestone payment due upon reaching certain commercial goals. The deal is expected to close in the first quarter and to be dilutive to adjusted per-share earnings for each of the next several years, with the impact expected to be absorbed by internal trade-offs.
Needham analysts said the deal is the third leg of Boston Scientific’s structural heart franchise, along with its transcatheter aortic valve replacement and left atrial appendage closure. At the company’s 2017 investor day, management said they expect the structural heart end markets to reach $6.5 billion by 2021 and the mitral market alone to reach $3 billion by 2025.
“Management has commented that they intend to compete with a ‘toolbox’ approach in mitral and we wouldn’t be surprised to see BSX make more investments ……especially the mitral vertical given the large repair and replacement market potential,” said the note.
Separately Thursday, Stephens dropped Boston Scientific from its Best Ideas list.
Boston Scientific shares were last down 1.7%, but have gained 34% in 2018, while the S&P SPX, -0.12% as fallen 10%.
Growth in Amazon.com Inc.’s AMZN, +1.12% Solimo-labeled products is slowing down, according to Jefferies.
In a note sent to investors on Thursday, Jefferies analysts led by Brian Tanquilut said the firm’s monthly web scrape of Amazon’s private label products showed decelerating growth in the tech giant’s Solimo-branded stock keeping units. The number of SKUs increased by 3% in December, a smaller increase than in previous months, the note said. The number of SKUs increased by 6% in November, according to a note from last month.
Growth in Solimo, which makes everything from plastic cups to vitamins to melatonin tablets, a range of products traditionally found in drugstores, is slowing even though its net prices are still lower than at Walgreen’s Boots Alliance Inc.WBA, -0.45% or CVS Health Corp CVS, -0.08% , Tanquilut wrote.
That’s not necessarily a bad thing, Tanquilut told MarketWatch. It just means Amazon has likely already penetrated a lot of the non-prescription health market, he said.
“We figured Amazon was close to topping out on the health care side in terms of what they could sell without going into prescription drugs,” Tanquilut said. Amazon made a big push into the prescription drugs space earlier this year when it acquired online pharmacy PillPack.
Most of Solimo’s product growth over the last two months has been items that are not directly related to health, Tanquilut noted. New product categories enjoying growth include packaged foods, and kitchen, household and pet supplies. That includes snacks, teas, flavored drink mixes, syrups, honey, oil and sauces, along with cleaning supplies and pet food.
There’s a big market there, said Tanquilut. “We always thought Amazon would continue to find ways to expand their product categories,” he said.
Amazon shares were last down 3.9% but have gained 21% in 2018. Walgreens was down 1.55, and is down 8% in the year, while CVS was down 2.8% and is down 13% in 2018.
A former patient has filed the first lawsuit against a New Jersey surgery center that may have exposed nearly 3,800 patients to HIV and hepatitis due to poor sterilization and medication practices.
The HealthPlus Surgery Center in Saddle Brook recently told the patients that a state probe of its facilities found “lapses in infection control” and “the injection of medications” could have exposed them to the diseases.
A state report released on Friday said operating rooms at the center were not properly cleaned and surgical tools were sometimes found with “brown rust-like stains” before use.
It was the latest scare at a new Jersey healthcare facility after 11 children died at a rehabilitation center since October in a deadly viral outbreak.
Friday’s lawsuit was filed in Bergen County against the surgery center on behalf of a woman who was a patient there between Jan. 1 and Sept. 7 2018, according to a statement by her lawyer Michael Maggiano.
It claimed the center showed “wanton misconduct — on a continuing basis” for exposing patients to dangerous pathogens.
It was not immediately clear whether the woman had been infected by any disease due to treatment at the center. Though criticizing the center’s sanitation practices, the health department report said risks of infection were low and it was not aware of any illness as a result of the infection control issues.
In a statement on Friday, HealthPlus lawyer Mark Manigan said the center now conducted weekly inspections and had been in compliance with health department regulations since Sept. 27.
The company is testing patients who attended the center between Jan. 1 and Sept. 7 for possible infections.
Unlike the effervescent bubbles that stream to the top of champagne flutes on New Year’s Eve, what I call brain bubbles are far from celebratory. These bubbles are metaphorical rather than physical, and they distort the stream of reality processed by our brains. Like a real estate bubble that reflects an inflated perception of home values, a brain bubble twists your perception of the world around you. And when either of these bubbles bursts, the results can be devastating.
Problems arise when distorted information results in flawed decisions that negatively affect our lives. As a neuroscientist who’s worked closely with laboratory rats for over three decades, I’ve gleaned from them a few good strategies people can use to burst brain bubbles and enhance well-being in the year ahead. Rat brains are small but have the same general areas and neurochemicals we have, so these rodents are valuable laboratory models for human behavior.
Getting back down to Earth
Psychoactive drug use, aspects of privilege and poverty, psychiatric illness and, in some cases, religious and political beliefs can all create brain bubbles. Even daily excursions to the virtual world of apps, social media and cybergames sever our connections to concrete aspects of the real world and let distorting brain bubbles develop.
This is especially problematic for children’s brains that are still developing. An ongoing National Institutes of Health study suggests that two hours of screen time each day distorts language and thinking abilities in these junior digital users.
As our attention is hijacked by the closest screen while a Roomba cleans the floor and Alexa orders pizza to be delivered to the front door, what’s left for our brains to do? Sure, we likely face cognitive challenges at work each day, but human brains are built for sophisticated and complex activity – even though we’re often lulled into mindlessly scrolling through a virtual feed. In fact, a brain area often associated with reward and pleasure, the nucleus accumbens, is smaller in people who spend more time checking Facebook posts on their smartphones.
Obviously, some of these distortion-generating circumstances are out of our control. But a heightened awareness of our authentic world can move us toward a more reality-based, well-grounded brain – free of those brain bubbles.
The rats that my students and I train in our studies to physically work for coveted treats (Froot Loops cereal is a favorite) develop healthier emotional responses than the animals we call “trust-fund rats” because they’re merely given their sweet rewards. The harder-working rats have healthier stress hormone levels and engage in more sophisticated search strategies when they encounter a surprise challenge – such as when we move their expected Froot Loop rewards. They’re more persistent as they spend time trying to solve the problem, rather than quickly giving up and walking away.
So whereas one popular New Year’s resolution involves saving up to build financial capital, we can keep our brains in peak condition for the year ahead by building up experiential capital. Real-world experiences represent the best currency for our brain circuits, providing neural security for our future decisions in the coming year. Spending time engaged in hobbiessuch as knitting or gardening, for example, with complex movements and rich sensory experiences, provides a valuable yield for our brains.
Savor the anticipation
When the calendar flips to a new year, it’s common to reflect on the past and look to the future. According to the neuroscience literature, this anticipation could be one of the most pleasurable – and healthy – tasks our brains engage in all year long.
Rats in the lab suggest active minds are better able to overcome stress and surprise adversity. Credit: Kelly Lambert, CC BY-ND
Dopamine is the poster neurotransmitter for the cognitive endeavor of anticipating. Traditionally known for its role in pleasure, this neurochemical system can be hijacked by psychoactive drugs such as cocaine that serve as potent creators of reality-distorting brain bubbles.
Rodent research provides fascinating insights here, however. Researchers use sophisticated techniques to measure dopamine activity as rats press laboratory levers that reward them with drugs. Surprisingly, this neurochemical system surges when the animal merely anticipates taking the drug as it approaches the drug lever, as well as when the drug is actually infused into the brain.
Anticipating a new start and a new year may be a scaled-down version of approaching the experimental lever for a hit of cocaine – a legal and healthy dopamine dose in this case. You can try to keep this emotional high going through the year by amping up the anticipation in your daily life: Focus more on delayed than immediate gratification. Buying and planning for experiences is more satisfying than material purchases. Mapping out a menu, shopping for ingredients and cooking a meal provides more dopamine time – and brain-engaging behaviors – than nuking a frozen meal and eating it three minutes later.
Seize the reins of your stress
Another way to enhance our well-being through the year is to gain some sense of control over the stress in our lives. Real-time and authentic interactions with the environment can help us gain a sense of control over the inevitable uncertainty and unpredictability we face each day.
I see evidence of this in the lab. When I furnish my rats’ housing with natural elements such as dirt, hollowed-out logs and rocks, they’re busier and less likely to sit around the edge of the cage than animals in boring empty cages. After building their experiential capital, these enriched rats have healthier stress and resilience hormone profiles and engage in bolder behaviors, such as diving to the bottom of swim tanks instead of staying on the top doing their best impression of a dog paddle. As I watch these animals in various tasks, they appear to be gaining control over the challenges they encounter.
Perhaps this is why retired U.S. four-star admiral William McRaven emphasized simple life strategies in his 2014 University of Texas commencement speech, declaring that “if you want to change your life and maybe the world, start off by making your bed.” Then, even if you have a terrible day, you will come home to a made bed, evidence that you had a positive impact in at least one area of your life that day.
Lessons from the laboratory rats also provide potential explanations for some of my own personal favorite New Year’s Day traditions – including the mundane tasks of cooking a familiar southern meal, cleaning my closet and watching HGTV’s Dream House giveaway with my family while we all declare what we would do if we won the beautiful house. Move in? Sell it? Make it an Airbnb rental?
Thinking like a neuroscientist, I know that cooking and cleaning are active endeavors with clear outcomes that allow me to gain a small sense of control, decreasing stress hormones. Playfully anticipating winning a new home taps into that feel-good dopamine system as we contemplate more serious options for the new year. And, perhaps the best neurochemical hit of all is the spike in oxytocin, the neurochemical involved in positive social connections, as I spend time with loved ones.
Although it’s common to turn to pharmaceuticals to lift our emotions and improve our mental health, the emotional benefits of many New Year’s traditions remind me that basic responses can serve as what I call “behaviorceuticals” that enhance well-being. New Year’s resolutions may take the form of New Year’s Rx’s as we consider healthy lifestyle choices for the coming year: Shrink those distorting brain bubbles and build realistic connections to enrich life’s simple pleasures.
Isotretinoin, a form of vitamin A, has been prescribed to treat acne for decades. It reduces oil production in the skin, which helps prevent acne from forming.
But new research from Washington University School of Medicine in St. Louis has uncovered a previously unknown benefit of the medication. It shifts the skinmicrobiome of acne patients to more closely resemble that of people with normal skin. The new study is published Dec. 21 in the Journal of Investigative Dermatology.
The study sheds light on how isotretinoin works and provides information that could lead to developing microbiome-based acne treatments, according to the lead researchers, Makedonka Mitreva, associate professor of medicine; and William H. McCoy, MD, PhD, an instructor in medicine, and their colleagues. There is a need for such alternatives because isotretinoin—while effective—causes severe birth defects, so doctors must take added precautions for women of child-bearing age.
Doctors often prescribe antibiotics that target bacteria called Cutibacterium acnes — also called Propionibacterium acnes — which is associated with acne. But such antibiotics can contribute to the development of resistant strains of bacteria and can kill off potentially beneficial microbes as well. Isotretinoin is not an antibiotic. It is largely thought to treat acne by drying out the skin, making it a less inviting place for acne-causing and acne-promoting microbes to flourish. It is the only therapy that can reliably clear acne long term.
“There are greasy areas of the skin that support the growth of certain communities of bacteria, and we know that some of them appear to be associated with acne,” said McCoy, a dermatologist and the study’s first author. “We asked whether we would see fewer of those bad bacteria on the skin after isotretinoin treatment, and we did. But we also know that this drug doesn’t work on the bacteria themselves. It changes the patient’s skin. So if the microbes are changing, it’s in response to changes in the patient’s skin. The drug appears to make the skin less hospitable to acne-causing bacteria.”
The researchers studied bacteria sampled from facial skin swabs at four time points over the course of the 10-month study. The samples came from 17 patients whose acne was treated with isotretinoin and, as a comparison, eight untreated subjects. Of these eight, four had normal skin and four had acne. The researchers found that isotretinoin therapy increased the diversity of microbes found on the skin. Through DNA sequencing, the researchers also identified four types of bacteria that bloomed with isotretinoin treatment. None had previously been associated with improved acne.
Isotretinoin also reduced the overall number of Propionibacteriumbacteria, even as the treatment increased the diversity of the individual types of this bacteria. The 38 percent of isotretinoin-treated patients who did not show this beneficial pattern in the Propionibacterium communities is similar to the proportion of isotretinoin-treated patients in other studies who ended up needing additional rounds of therapy.
The study’s findings, according to the researchers, suggest that isotretinoin creates a “bottleneck” that selects for beneficial communities of Propionibacteria and other bacteria that appear to be healthy, creating a skin microbial community that reduces the chances of the acne returning, even when normal oil production returns to the skin after treatment stops.
“When you have a bottleneck, you create an opening for other microbes to move in and increase in abundance,” said Mitreva, the study’s senior author and an assistant director of the McDonnell Genome Institute at Washington University School of Medicine. “We see this happening here. After the treatment, the microbial communities shift to a mix of populations that appears to be healthier, and that shift persists months after the treatment.”
The researchers said it’s important to understand how isotretinoin works, in an effort to create new therapies that might be more effective or have fewer side effects. Since isotretinoin is known for causing birth defects, it should not be prescribed to women who are pregnant or trying to become pregnant. Women of reproductive age who take isotretinoin are prescribed birth control for the same reason.
“Women often will go without treatment for acne during their pregnancies because there just aren’t good therapies that are totally safe to use during that time,” McCoy said. “They need other options. Our study suggests there could be a way to provide some type of microbial ‘fertilizer’ or ‘weed killer’ on the skin to help promote the growth of healthy microbes. We’re conducting a larger study to look more closely at these questions.”
More information: William H. McCoy et al. Skin Ecology During Sebaceous Drought—How Skin Microbes Respond to Isotretinoin, Journal of Investigative Dermatology (2018). DOI: 10.1016/j.jid.2018.09.023
Anxiety disorders are severe mental disorders in which patients suffer from intense fears and anxiety or from sudden, inexplicable panic attacks. In extreme cases, the affected individuals barely leave their homes, which can have serious consequences for their relationships with family and friends as well as for their professional lives. Scientists at the Max Planck Institute for Experimental Medicine in Göttingen have now identified a synaptic protein which, when inactivated, has an anxiolytic effect in mice.
Around 10 percent of the population suffer from anxiety disorders, and current treatment options only offer effective help for a proportion of those affected. One of the changes observed in the brains of patients with anxiety disorders is an increased neuronal activity in the amygdala, a brain region that plays a key role in processing emotions such as anxiety or fear. An overactivation of the amygdala is thought to be involved in causing exaggerated anxiety. Many anxiolytic medications such as benzodiazepines presumably normalize this overactivation by strengthening the function of inhibitory synapses.
Synapses are connections between nerve cells in the brain, at which information is transmitted from one nerve cell to another. At inhibitory synapses, this transmission results in a reduction in the activity of the neighbouring nerve cells. In the amygdala, for instance, this inhibits the transmission of stimuli that trigger fear and anxiety. Benzodiazepines strengthen this inhibitory effect—but unfortunately they affect not only those inhibitory synapses that transmit anxiogenic stimuli but also many other inhibitory synapses in the brain. This can lead to significant side effects such as pronounced sedation and impaired concentration. Accordingly, scientists are searching for new, more specific targets for anxiolytic medications.
Mice with anxiety disorder
Animal research with mice played a key role in helping the researchers in Göttingen to study anxiety disorders. Whereas healthy animals curiously investigate an empty test chamber, rodents with a pathological anxiety phenotype withdraw into a corner because they are afraid. However, when the scientists blocked the production of the recently discovered protein IgSF9b in these mice, the animals moved freely around the chamber again. IgSF9b produces a protein bridge at inhibitory synapses between two neighbouring nerve cells. “Blocking IgSF9b in pathologically anxious mice has an anxiolytic effect and normalises anxiety behaviour in these animals. This protein could therefore be a target for pharmacological approaches to treating anxiety disorders,” explains Olga Babaev from the Max Planck Institute for Experimental Medicine who carried out the experiments as part of her doctoral work..
An investigation of the amygdala in these animals revealed that the overactivation of the amygdala was normalized, and that this effect resulted from a strengthening of the synaptic transmission at inhibitory synapses in the amygdala. “Our research shows that protein structures at inhibitory synapses in the centromedial amygdala, and particularly the protein IgSF9b, constitute promising new targets for potential treatments. It thus provides an important contribution toward understanding the biological causes of anxiety disorders and for the development of new anxiolytic medications,” study leader Dilja Krueger-Burg says.
More information: Olga Babaev et al. IgSF9b regulates anxiety behaviors through effects on centromedial amygdala inhibitory synapses, Nature Communications (2018). DOI: 10.1038/s41467-018-07762-1
Sodium intake is associated with the long-term risk of new-onset atrial fibrillation (AF), according to a study recently published in the Annals of Medicine.
Tero Juho Wilhelm Pääkkö, from the University of Oulu in Finland, and colleagues used hospital discharge records and seven-day food diaries from 716 participants in the Oulu Project Elucidating Risk of Atherosclerosis cohort to evaluate the association between dietary sodium intake and the incidence of new-onset AF during a 19-year period.
The researchers found that the cumulative proportional probabilities for AF events were greater in the highest quartile of sodium consumption (16.8 percent) than in the lower quartiles (first quartile, 6.7 percent; second quartile, 7.3 percent; third quartile, 10.6 percent). As a continuous variable, sodium consumption (g/1,000 kcal) was independently associated with AF events (hazard ratio, 2.1) when age, body mass index, smoking (pack-years), office systolic blood pressure, left atrium diameter, left ventricular mass index, and the use of any antihypertensive therapy were added as covariates.
“Although further confirmatory studies are needed, our results suggest that people who are at an increased risk of atrial fibrillation may benefit from restricting salt in their diet,” Pääkkö said in a statement.
Study authors disclosed financial ties to pharmaceutical companies.
