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Thursday, July 11, 2019

Boosting CAR-T to treat solid tumors with a vaccine

Therapeutic cancer vaccines are designed to direct a person’s own immune cells against tumors. What if we could use that approach to prime CAR-T cells so that these engineered T cells—which are currently only able to tackle blood cancers—could work against solid tumors? Massachusetts Institute of Technology researchers did just that in mice.
Using a vaccine that super-charges CAR-Ts at the lymph nodes, an MIT team found that they could eliminate solid tumors in 60% of mice. After that, the animals also cleared re-injected tumor cells. The findings were published in Science.
CAR-T cell therapies use a patient’s own T Cells and a chimeric antigen receptor (CAR) to target cancer cells. Scientists believe one reason CAR-Ts don’t work well for solid tumors is that those cancers form a hostile environment around them that suppresses the T cells. The MIT team overcame this obstacle by stimulating CAR-T cells at the lymph nodes, the major sites of immune cells.
“Our hypothesis was that if you boosted those T cells through their CAR receptor in the lymph node, they would receive the right set of priming cues to make them more functional so they’d be resistant to shutdown and would still function when they got into the tumor,” Darrell Irvine, the study’s senior author, said in a statement.
Irvine’s team previously developed a method that delivers vaccines made of viral or bacterial antigens directly to lymph nodes, thereby provoking a stronger immune response. The vaccine is linked to a lipid tail that binds to albumin, a protein found in the bloodstream. Because albumin accumulates in lymph nodes, it allows the vaccine to hitchhike to the immune organ.
To build the new vaccine, the team used an antigen that stimulates the CAR-T cells. The antigen could be either the same tumor antigen to be targeted by the T cells, or a random molecule that the researchers selected.
The vaccines dramatically boosted CAR-T cell populations in mice, the researchers found. Mice given about 50,000 CAR-T cells sans vaccine showed nearly no CAR-T cells in the bloodstream. But CAR-T cells comprised up to 65% of the animals’ total T cell population in animals that got the vaccine.

The two-pronged eliminated such tumors as glioblastoma, breast and melanoma in 60% of mice, while solo CAR-T treatments produced no effect on those tumors, the team reported.
The animals that achieved tumor clearance were then re-challenged with tumor cells. Tumor cells that were identical to the original ones disappeared. Next, the researchers injected slightly different tumor cells, which did not express the antigen originally targeted by the CAR-T cells, and those tumor cells were eliminated, as well.
“That is another exciting aspect of this strategy,” Irvine said. “You need to have T cells attacking many different antigens to succeed, because if you have a CAR-T cell that sees only one antigen, then the tumor only has to mutate that one antigen to escape immune attack. If the therapy induces new T-cell priming, this kind of escape mechanism becomes much more difficult.”

Enthusiasm is swirling around the idea of using powerful CAR-T cells to treat solid tumors. Scientists at La Jolla Institute for Immunology found that removing a family of proteins called Nr4a transcription factors could rejuvenate CAR-T cells that have grown exhausted in the tumor microenvironment. Another team of scientists from MIT and Boston Children’s Hospital recently sought inspiration from alpacas and built CAR-T cells that can recognize certain proteins that protect tumors.
The MIT team’s technology has been licensed to Elicio Therapeutics, which raised $30 million to help fund its first human studies in the first half of 2020. “There’s really no barrier to doing this in patients pretty soon, because if we take a CAR-T cell and make an arbitrary peptide ligand for it, then we don’t have to change the CAR-T cells,” Irvine said in the statement. “I’m hopeful that one way or another this can get tested in patients in the next one to two years.”

CRISPR pioneer Zhang targets brain diseases with new RNA-editing system

Feng Zhang, a gene-editing pioneer at the Broad Institute of MIT and Harvard, has garnered headlines lately for starting up Beam Therapeutics and raising $222 million to fund its research. Now, Zhang is rolling out his latest invention—a new strategy for editing RNA that his team says could someday be used to treat brain diseases like Alzheimer’s.
Zhang and colleagues developed a new system they call RNA Editing for Specific C to U Exchange (RESCUE). In cells, they used the technology to convert the gene variant APOE4—a risk factor for late-onset Alzheimer’s disease—into the non-pathogenic variant APOE2. They described the research in the journal Science.
CRISPR editing of DNA uses the enzyme Cas9 to snip DNA at specific locations. Targeting RNA instead can offer some advantages, because it avoids altering DNA permanently. Zhang’s team used a deactivated form of a different enzyme, Cas13, to target RNA.
RESCUE targets one of the four main “bases” of RNA, cytosine. Using a programmable enzyme, Zhang’s team converted pathogenic cytosine into uridine, which in turn changed the instructions RNA provided for, say, protein synthesis.
The researchers showed they could use RESCUE to target natural RNAs in cells, as well as “24 clinically relevant mutations in synthetic RNAs,” they said in a statement. They fine-tuned the technology to avoid off-target editing, a major concern that has slowed down the development of CRISPR for use in people.

Zhang’s team wanted to test RESCUE in Alzheimer’s because there are only two differences between the amino acid sequence for the risk variant APOE4 and that of the non-pathogenic APOE2. The used the technology to convert APOE4’s cytosines into an APOE2 sequence, effectively erasing the Alzheimer’s risk, they reported.
Another advantage of RNA editing is that it can be reversed. The MIT researchers showed in their study that they could use RESCUE to temporarily ramp up the activation of the protein beta-catenin, which could be useful in wound healing.
RESCUE builds on another system developed at the Broad called RNA Editing for Programmable A to I Replacement (REPAIR), which Zhang’s team reported in 2017. That technology changes the nucleoside adenosine (A) to inosine (I), which the researchers said could prove useful in treating diseases like Duchenne muscular dystrophy and Parkinson’s.
Several other research groups are working on RNA-editing technologies, including a team at the University of California, San Diego (UCSD), which used an RNA-targeted Cas9 system in lab models of myotonic dystrophy two years ago. A UCSD spinoff that’s developing the technology, Locana, raised $55 million in May of this year and is now working on tackling diseases like Huntington’s and amyotrophic lateral sclerosis.
The Broad’s Zhang says more work will have to be done before RESCUE can be tested in people. Meanwhile, he’s making the tool publicly available through the repository Addgene, so other researchers can use it to study disease-related mutations.
“To treat the diversity of genetic changes that cause disease, we need an array of precise technologies to choose from,” Zhang said in the statement. “By developing this new enzyme and combining it with the programmability and precision of CRISPR, we were able to fill a critical gap in the toolbox.”

Mentally Stimulating Activities and Cognitive Impairment

The number of mentally stimulating activities adults participated in — and their timing — was tied to their risk of age-related memory loss, a prospective study of 2,000 older adults showed.
Engaging in two or more cognitively stimulating activities — such as reading books, computer use, crafts, social activities, and playing games — in late life was tied to a lower risk of incident mild cognitive impairment (MCI), reported Yonas Geda, MD, of the Mayo Clinic in Scottsdale, Arizona, and colleagues.
Engaging in any two activities in late life decreased MCI risk by 28%; three activities dropped the risk by 45%, and four activities lowered the risk by 56%, they wrote in Neurology.
“It is never too late,” Geda told MedPage Today. “If I am 84, I can still engage in mental activities and have good reason to assume I will have a better chance of reducing my risk of mild cognitive impairment.”
The analysis builds on the authors’ previous work that showed stimulating activities may diminish the risk of MCI in older people, even APOE4 carriers.
The earlier study generated a number of questions, noted co-author Janina Krell-Roesch, PhD, formerly of the Mayo Clinic and currently with the Karlsruhe Institute of Technology in Germany. In response, “this new research looked at two different things,” she told MedPage Today. “Does the timing of the activities matter? And does the number of activities matter?”
The current research followed 2,000 cognitively unimpaired people who were ages ≥70 in the Mayo Clinic Study of Aging, monitoring them for clinical progression to MCI over a median of 5 years. Participants completed a self-reported survey at baseline about the timing, number, and frequency of engaging in five mentally stimulating activities: reading books, computer use, social activities, playing games, and craft activities.
At baseline, participants had a median age of about 78 and education level of 14 years. Half of the group (49.9%) was male. Over the follow-up period, 532 people developed new onset MCI.
The number of mentally stimulating activities participants engaged in at midlife (from the ages of 50 through 65) showed no significant association with the risk of new onset of MCI. But in late life (ages ≥66), engaging in more activities was tied to a significantly reduced risk of incident MCI.
Engaging in any two activities in late life showed an HR for MCI of 0.72 (95% CI 0.53-0.99). Engaging in any three late-life activities had an HR of 0.55 (95% CI 0.40-0.77), four activities showed an HR of 0.44 (95% 0.30-0.65), and five had an HR of 0.57 (95% CI 0.34-0.96).
Computer use in midlife, computer use and craft activities in late life, and social activities, game playing, and computer use in combined late-life and midlife stages all were linked to a decreased incidence of MCI. In late life, a decreased risk of MCI was tied to reading books, playing games, or engaging in craft or social activities at least 2 to 3 times a month, or using a computer at least 5 to 6 times a week.
This analysis provides “evidence that there is an association between quality and quantity of mentally stimulating activities, which include both cognitive and social leisure activities, and reduced risk or slowing of the emergence of mild cognitive impairment,” noted Rebecca Amariglio, PhD, of Brigham and Women’s Hospital in Boston, and colleagues, in an accompanying editorial.
“The findings of this report could be of value to clinicians attempting to counsel midlife and older adults about how to stave off or delay the onset of mild cognitive impairment,” they added. While mentally stimulating activities may be low-cost interventions that could decrease the risk of cognitive decline,” important questions remain about why mentally stimulating activities remain primarily more protective in late life compared with midlife.”
The study has several limitations: it was observational and did not provide evidence that cognitively stimulating activities reduce incident cognitive impairment. Low engagement in activities may be the result of incipient MCI; other unmeasured variables also may account for the associations found in the study. Activities were self-reported and participants were asked to remember how often they engaged in activities as far back as middle-age, up to 2 decades before the study began.
Last Updated July 10, 2019
The study was supported by the NIH, the National Institute on Aging, the National Institute of Mental Health, the Robert Wood Johnson Foundation, the Robert H. and Clarice Smith and Abigail Van Buren Alzheimer’s Disease Research Program, the GHR Foundation, the Mayo Foundation for Medical Education and Research, the Edli Foundation, and the Arizona Alzheimer’s Consortium.
Researchers disclosed relevant relationships with Eli Lilly, Lysosomal Therapeutics, Biogen, Lundbeck, the Alzheimer’s Treatment and Research Institute, AstraZeneca, Roche, Merck, Genentech, and Janssen Alzheimer Immunotherapy.
The editorialists disclosed no relevant relationships with industry.

Indivior fights off generic challenges but the threat of litigation remains

Today’s 16% rise in Indivior’s share price has less to do with the group selling more of its opioid dependency treatment products than with the inability of its generic competitors to sell theirs.
Indivor thrilled the market with substantially upgraded full-year guidance for 2019, as it appeared that generics companies like Dr Reddy’s and Mylan had failed to convince patients to try their version of Indivior’s Suboxone film. The product, which has continued to defy conventional wisdom around generic sales erosion, still accounts for the majority of Indivior sales.
Another demonstration of Suboxone’s continued grip on the US opioid substitution market is that the product still makes up over 70% of opioid substitution products. This figure includes the 24% of sales contributed by the authorised generic Indivior launched in February as a countermeasure to copycats.
Despite the strong showing today Indivior’s shares, which have been falling since June 2018 when the FDA approved generic versions of Suboxone film, are still down 55% on the year.
Settling for a billion
Indivior’s guidance came on the same day that its former parent, Reckitt Benckiser, announced that it had reached an agreement with the Department of Justice and Federal Trade Commission to pay up to $1.4bn to settle claims it had participated in fraudulent marketing schemes to increase sales of Suboxone.
As the current owner of Suboxone, Indivior was also named in the investigation. But the UK company has denied the allegations, which it has described as “self-serving” and based on events four years before Indivior was spun out of Reckitt in 2014.
Reckitt’s $1.4bn settlement is one of the biggest the industry has seen, though it is still eclipsed by Glaxosmithkline’s eye-watering $3bn payout for failing to disclose safety information around diabetes drug Avandia.
Read-through?
While it might not be pharma’s largest payout, $1.4bn is still a large amount of money even if the compay on the hook for it has a market cap of £47bn. And here is the rub for Indivior, which for litigation purposes has far shallower pockets than Reckitt. So far Indivior, which only has a market cap of £389m ($480m), has set aside $438m for any form of payout.
Indivior has also chosen to go to trial to refute the DoJ/FTC allegations. A hearing is not expected until 2020 and could take up to two years to conclude, meaning any overhang to Indivior shares could continue for another three years.
But what today’s announcement by Reckitt shows is that it is possible to settle with the DoJ without any requirement to admit wrongdoing. This non-prosecution type agreement is important if Indivior wants to retain its current access to US government Medicare and Medicaid contracts, which currently represent around half of its US business.
As to the size of any settlement for which Indivior might be liable, some analysts are not expecting the amount forked out by Reckitt, which would effectively bankrupt Indivior. “The DoJ knows that they are not going to get $1.5bn out of Indivior, but they might get a bit more than what Indivior has set aside. If they can get $600m or $700m and settle then everyone can move on,” said one healthcare analyst.
Until then, despite its success in holding off the more immediate generic threats, Indivior will still remain a tricky investment case.

Soliton Expands Clinical Trial Sites to include Skin Care Physicians

Soliton, Inc. (SOLY) (“Soliton” or the “Company”), a medical device company with a novel and proprietary platform technology licensed from The University of Texas on behalf of the MD Anderson Cancer Center (“MD Anderson”), today announced that the company has identified an additional site and supervising physician for its upcoming expanded pivotal Cellulite Trial. The site is the second of four planned sites for the pivotal trial.
The proof-of-concept trial was conducted by Dr. Michael S. Kaminer at SkinCare Physicians in Boston in collaboration with Dr. Elizabeth L. Tanzi of Capital Laser and SkinCare in Chevy Chase, MD. The expanded Cellulite Clinical Trial will now include subjects treated at SkinCare Physicians, supervised by Dr. Kaminer, added to the subjects being treated at Capital Laser. Drs. Kaminer and Tanzi are members of the Company’s Scientific Advisory Board.

Novan up on advancement of SB206 Phase 3

Novan (NOVN +2.5%) perks up, albeit on light volume, following its announcement that its Phase 3 studies (B-SIMPLE 1&2) evaluating SB206 for the treatment of molluscum contagiosum are more than 50% enrolled.
Topline data should be available in Q1 2020.

Enzo Biochem to launch direct-to-consumer STI testing

Aimed at stoking growth in its diagnostic tests, Enzo Biochem (ENZannounces the following key initiatives:
New York State Health Department approval for oral and rectal sexually transmitted infection (STI) (recently OK’d for its gonorrhea and chlamydia tests for oral and rectal specimens).
Create a direct-to-consumer business for STI tests.
Build a new lab-to-labs business model that leverages the scale of its central lab with smaller labs.
Expand offerings to clinical research organizations, academic research institutions and the pharma industry.