Swiss to Take On Big Pharma With Cheaper Cancer Treatment

Some of Switzerland’s top university hospitals are teaming up to take on the soaring cost of cancer cell therapy offered by big pharma.

The hospitals are hoping to offer the treatment for between 150,000 Swiss francs ($151,026) and 200,000 francs. That’s about one-third cheaper than the commercialized process offered by the pharmaceutical industry.

“We are convinced that such cancer therapies can be realized at significantly lower costs,” Roger von Moos, president of the Swiss Association for Clinical Cancer Research and head physician at the Chur Cantonal Hospital, told Swiss newspaper NZZ am Sonntag.

Under commercial cancer cell therapy, a patient’s blood is drawn and certain immune cells are modified in a laboratory. The genetically modified cells are then returned to the patient and once back in the body, they identify and destroy tumor cells.

Pilot projects have started in Lausanne and Bern and university hospitals in Basel and Zurich are also planning to join, the newspaper reported.

They expect to reduce costs by treating cells in Switzerland instead of sending them abroad for genetic processing. Swiss pharmaceutical giant Novartis AG sends blood to Germany for processing while Gilead Sciences Inc. sends cells to the U.S., NZZ reported.

With the knowledge and infrastructure of local university hospitals, “Switzerland can become an academic competence center for cell therapy,” said Thomas Cerny, the president of Swiss Cancer League, who is co-developing the new university platform.

https://www.bloomberg.com/news/articles/2019-07-28/swiss-to-take-on-big-pharma-with-cheaper-cancer-treatment-nzz

Antibiotics can inhibit skin lymphoma

New research from the LEO Foundation Skin Immunology Research Center at the University of Copenhagen shows, surprisingly, that antibiotics inhibit cancer in the skin in patients with rare type of lymphoma.

Many patients with the rare lymphoma cancer, CTCL, contract staphylococcal infections in the skin. CTCL is a cancer in the so-called T-cells of the immune system, which shows in the skin. Therefore, the patient’s immune system is weakened and the skin is less resistant to bacteria.

In a new study, researchers from the LEO Foundation Skin Immunology Research Center at the Faculty of Health and Medical Sciences, the University of Copenhagen, have — in collaboration with Aarhus and Zealand University Hospitals and Aarhus University — shown that aggressive treatment with antibiotics not only inhibits the staphylococcal bacteria, but also the cancer cells. The number of cancer cells is reduced and the cancer is significantly diminished for a period of time in patients with severe skin inflammation.

During a staphylococcal infection, the healthy immune cells in the body are working at full throttle. They produce growth substances called cytokines, which are used to get the immune system up and running. The cancer cells latch onto the growth substances, using them to accelerate their own growth. The research results show for the first time that the antibiotic treatment can slow down this process.

‘When we inhibit the staphylococcal bacteria with antibiotics, we simultaneously remove the activation of the immune cells. This means that they do not produce as many cytokines, and therefore the cancer cells cannot get the extra ‘fuel’. As a result, the cancer cells are inhibited from growing as fast as they did during the bacterial attack. This finding is ground-breaking as it is the first time ever that we see this connection between bacteria and cancer cells in patients, says Professor Niels Ødum from the LEO Foundation Skin Immunology Research Center.

The finding is the result of many years’ research where the researchers have conducted molecular studies and laboratory tests, taken tissue samples from skin and blood and conducted clinical studies of carefully selected patients.

Eager to Find New Treatments

So far, CTCL patients with infections in the skin have only reluctantly been given antibiotics because it was feared that the infection would come back as antibiotic-resistant staphylococci after the treatment. The researchers behind the finding believe that the new results will change this.

‘It has previously been seen that antibiotics have had some kind of positive effect on some of these patients, but it has never been studied what it actually does to the cancer itself. Our finding shows that it may actually be a good idea to give patients with staphylococci on the skin this treatment because it inhibits the cancer and at the same time possibly reduces the risk of new infections’, says Niels Ødum.

It is still difficult to say whether the new knowledge may be transferred to other types of cancer. For the researchers at the LEO Foundation Skin Immunology Research Center, the next step is to initially look more closely at the link between cancer and bacteria.

‘We do not know if this finding is only valid for lymphoma. We see it particularly in this type of cancer because it is a cancer within the immune system. The cancer cells already ‘understand’ the signals that the immune cells send out. When the immune cells are put to work, so are the cancer cells. At any rate, it is very interesting and relevant to take a closer look at the interaction between bacteria and cancer, which we see here’, says Niels Ødum.

‘The next step will be the development of new treatments that only target the ‘bad’ bacteria, without harming the ‘good’ bacteria, which protects the skin’, he says.

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Story Source:

Materials provided by University of Copenhagen The Faculty of Health and Medical Sciences. Note: Content may be edited for style and length.

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Journal Reference:

1. Lise M. Lindahl, Andreas Willerslev-Olsen, Lise M. R. Gjerdrum, Pia R. Nielsen, Edda Blümel, Anne H. Rittig, Pamela Celis, Bjorn Herpers, Jürgen C. Becker, Birgitte Stausbøl-Grøn, Mariusz A. Wasik, Maria Gluud, Simon Fredholm, Terkild B. Buus, Claus Johansen, Claudia Nastasi, Lukas Peiffer, Linda Kubat, Michael Bzorek, Jens O. Eriksen, Thorbjørn Krejsgaard, Charlotte M. Bonefeld, Carsten Geisler, Tomas Mustelin, Erik Langhoff, Michael Givskov, Anders Woetmann, Mogens Kilian, Thomas Litman, Lars Iversen, Niels Odum. Antibiotics inhibit tumor and disease activity in cutaneous T cell lymphoma. Blood, 2019; blood.2018888107 DOI: 10.1182/blood.2018888107

https://www.sciencedaily.com/releases/2019/07/190725102937.htm

A look at people who have persistently high spending on health care

Health care spending is highly concentrated, with a small share of people accounting for a large share of expenditures during any year – just 5% of people are responsible for at least half of overall spending. This makes understanding and effectively managing the care for this group vital to improving the quality and efficiency of health care delivery.

People with high health care spending are not a homogeneous group: some have very high spending during a short spell of illness, while others have ongoing high spending due to one or more chronic illnesses. The patterns and types of medical spending also vary among these high-need patients: for example, those with acute spells of illness are more likely to have high hospital spending while those with chronic illnesses spend more on outpatient services and prescriptions. Those with persistently high spending, while few in number, are some of the most expensive users of care – the 1.3% of enrollees with high spending in each of three consecutive years (2015-2017) had an average spending in 2017 of almost $88,000, accounting for 19.5% of overall spending that year. The predictability and extent of their spending suggest that any efforts to reduce the total costs of care and improve health system quality must focus heavily on this group of people.

This analysis looks at the amounts and types of health spending for people with employer-based health insurance who have continuing high health care spending. To do this, we used the IBM MarketScan Commercial Claims and Encounters Database (MarketScan) database, which has clinical and enrollment information for millions of workers and their dependents. We looked at the spending for a subset of enrollees with three consecutive years of coverage (2015-2017), which we refer to as “continuously covered enrollees.” We then identified those who were in the top five percent of spenders in each of the three years, which were refer to as “people with persistently high spending.” We show the inpatient, outpatient and prescription spending in 2017 for people with persistently high spending, and compare those to the spending for all continuously covered enrollees and for those with high spending just in 2017 but not in either prior year (“people with high spending just in the last year”). We also analyze enrollees’ diagnoses to identify the health conditions that are most highly correlated with being a person with persistently high spending.

The MarketScan database has a significant advantage for this type of analysis because it contains diagnostic and claims information for a large number of people who can be followed over several years. One important limitation for this analysis is that the claims data show the retail cost for prescription drugs and does not include information about the value of rebates that may be received by payers. Some prescriptions used by people with high spending may be accompanied by substantial rebates (e.g., insulin), while prescriptions for some other drugs, such as sole-source drugs may not result in any rebates to payers.

People with persistently high spending averaged almost $88,000 in total claims spending in 2017

People with persistently high spending averaged $87,870 in health spending in 2017, which is almost 60% higher than the average spending for people with high spending just in the last year (those with high spending in 2017 but not in previous years) of $55,670, and about 15 times more than the average spending for all continuously covered enrollees ($5,870).

People with persistently high spending are a small share of enrollees but account for a large share of spending

While people with persistently high spending comprised only a small share of continuously covered enrollees (1.3%), they accounted for 19.5% of total spending in 2017 by the three-year group.

People with high spending just in the last year had higher spending for inpatient services

Although people with persistently high spending had higher overall average spending in 2017, people with high spending just in the last year spent more on average on inpatient services, $24,270 as compared to $15,970, likely related to the acute nature of their conditions. Both groups had average inpatient spending that was many times more than the overall average inpatient spending amount of $1,220 for all continuously covered enrollees.

People with persistently high spending on average spent about 40% more on outpatient services than people with high spending just in the last year

People with persistently high spending averaged $37,790 in spending on outpatient services in 2017, 44% more than the average amount for people with high spending just in the last year ($26,290). One reason is that they used more services: those with persistently high spending had an average of 137 outpatient claims in 2017, compared with 106 for people with high spending just in the last year. The overall average among continuously covered enrollees was 25 outpatient claims per enrollee in 2017.

People with persistently high spending also had much higher spending on retail prescription drugs

People with persistently high spending averaged almost $34,000 in spending on retail prescription drugs (not reflecting any rebates manufacturers may have paid), many times more than the average for people with high spending just in the last year or continuously covered enrollees overall. While this average amount was affected somewhat by a small share of enrollees with very high prescription spending, the median prescription spending for those with persistently high spending was about $23,000, demonstrating the pervasiveness of high prescription spending among this group.

Spending on prescriptions was a significant share of the total spending by people with persistently high spending

Spending on retail prescriptions comprised 39% of total spending by people with persistently high spending, a considerably higher share than for people with high spending just in the last year (9%) or for continuously covered enrollees overall (22%). This pattern, and the high amounts spent on prescriptions shown in the previous slide, show the importance of prescription medicines in treating people with chronic health conditions and ongoing care needs. While manufacturer rebates, which are not publicly known, would reduce this amount somewhat, there is no doubt that prescription drugs represent a disproportionate expense for those with persistently high spending.

In contrast, people with high spending just in the last year had a much higher share of their spending for inpatient services (44%) than those with persistently high spending (18%) or continuously covered enrollees overall (21%).

Who has persistently high spending?

People with persistently high spending are older on average

People with persistently high spending were over a decade older, on average, than continuously covered enrollees overall. While people of all ages have chronic illnesses, they are more prevalent at older ages. Only 7% of people with persistently high spending were under age 19, as compared to about a quarter of continuously covered enrollees.

Having certain health conditions increases the chances of having persistently high spending

We developed a logistic regression model to analyze the association between the health conditions continuously covered enrollees had in 2015 and having persistently high spending. All continuously covered enrollees were assigned to one or more of 283 distinct diagnostic categories based on the primary (first) diagnoses for any outpatient event or principal diagnosis for any inpatient admission. The chart shows the results for the conditions with the 20 highest odds ratios; the full results and an alternative specification are presented in Appendix.

The results show the increase in the odds that someone with each specified health condition in 2015 had persistently high spending as compared to the odds for someone who did not have the condition. The odds can be thought of as the probability of having persistently high spending divided by the probability of not having it. For example, the odds of having persistently high spending were about 259 times higher for a person with HIV as compared to a person without HIV, all else being equal. Cystic fibrosis and multiple sclerosis increased the odds of having persistently high spending 243 times and 206 times respectively. While these three conditions had the biggest impacts on the odds, having any of several other illnesses or conditions, such as regional enteritis and ulcerative colitis, rheumatoid arthritis, leukemia and multiple myeloma, also greatly increased the odds of having persistently high spending.

Almost 70% of people with persistently high spending have one or more of these diagnoses in 2015

Looking at the same 20 illnesses and conditions from the chart above, 69% of people with persistently high spending had one or more of these conditions in 2015, compared with just 6% of continuously covered enrollees overall. About 11% of those with persistently high spending had rheumatoid arthritis in 2015, 8% had HIV, and 13% had diabetes with complications. (Note the column sums to more than 69% percent because some people with persistently high spending had multiple conditions and were counted in more than one category).

That such a large share of people with persistently high spending fell into such a narrow range of disease categories helps us better understand who they are. Given their ongoing high health care need, identifying people with these (and similar) diagnoses early in their treatment and assessing the appropriateness and cost-effectiveness of their courses of care is clearly important to any efforts to improve value and lower overall spending.

Large shares of people with certain diagnoses in 2015 developed persistently high spending

Another way to look at who has persistently high spending is to focus on the share of people in each illness or condition category in 2015 who developed persistently high spending. This figure shows the 20 illnesses and condition categories with the highest share of people with persistently high spending among those diagnosed with the condition in 2015. For example, more than 60% of continuously enrolled individuals with HIV or multiple sclerosis in 2015 had persistently high spending.

One thing that stands out is the number of cancer diagnoses with a high share of people with persistently high spending. While many of these conditions are fairly rare, and most people with each of these diagnosis in 2015 do not develop persistently high spending, a quarter or more do so in each of the categories.

Discussion

Health spending is highly concentrated: a small share of people account for most health care in a year. This group changes from year to year as some people experience serious illness and recover, but a share of the group continues to have high spending for longer periods. We followed a subset of people with employer-based coverage who were continuously insured over a three-year period (2015-2017) and identified a group of people with persistently high spending whose health spending was in the top five percent in each of the three years. Overall, these people with persistently high spending comprised only 1.3% of the continuously covered  subgroup but accounted for 19.5% of total spending in the final year of the period (2017). Their extensive health care need and predictably high spending make them an important focus for any efforts to improve value and quality.

While those with persistently high spending had a variety of health conditions, a large proportion had claims in the first year that for a narrow set of diagnoses, including HIV, multiple sclerosis, cystic fibrosis, rheumatoid arthritis, as well as a number of cancers. While not everyone with these conditions has persistently high spending, knowing that there are large shares with persistently high spending within these disease groups helps us better understand where some of the most significant health needs and costs are concentrated.

Compared to people with high spending just in the last year, people with persistently high spending had higher spending for prescription drugs and lower spending for inpatient services. This underscores the importance of prescription drugs in treating people with chronic illnesses as well as the fact that some of these drugs are quite costly. This is both an opportunity and a challenge. There is bipartisan support to lower prescription drug costs, including some of the very expensive drugs that may be used to treat people with complex or relatively rare diseases. At the same time, medications underpin treatment for many people with chronic illnesses, and new medicines are often the best hope for future improvements in care, and, in some cases, lowering treatment spending overall. Balancing the legitimate concern about costs with the need to encourage research and dissemination of new drug therapies is among the most important challenges facing health policy today.

Methods

We analyzed a sample of medical claims obtained from the IBM MarketScan Commercial Claims and Encounters Database (MarketScan), which contains diagnostic and claims information provided by large employer plans for several million employees and their dependents. MarketScan allows for enrollees to be tracked for their duration at one contributing employer, and we used a subset of claims for enrollees covered in each of three years, 2015 through 2017. We only included claims for people under the age of 65. Our unweighted subset contains 12,668,720 of these continuously covered  enrollees, including 169,315 “people with persistently high spending” and 324,742 “people with high spending just in the last year.” People with persistently high spending had total claims spending in excess of the 95th percentile of total claims spending in each of the three years. People with high spending just in the last year had claims spending in excess of the 95th percentile of total claims spending in 2017 but not in 2015 or 2016.

The MarketScan database is a convenience sample and may not accurately represent the population of people with health benefits through large employers. To limit the impact of this bias, weights were applied to match counts from the Current Population Survey for enrollees at firms of a thousand or more by sex, age, state and whether the enrollee was a policyholder or dependent. Weights were trimmed at 8 times the interquartile range. This sample represented about 14% of the 86 million people in the large group market.

Claims data available in MarketScan allows an analysis of liabilities incurred by enrollees with some limitations. First, claims data show the retail cost for prescription drugs and do not include information about the value of rebates that may be received by payers. Rebates vary significantly by drug. Secondly, these data reflect cost sharing incurred under the benefit plan and do not include balance-billing payments that beneficiaries may make to health care providers for out-of-network services or out-of-pocket payments for non-covered services.

ICD-9 or ICD-10 diagnosis codes were used to classify 283 distinct illness and conditions. Disease classification are based on whether an enrollee received at least one primary diagnoses for any outpatient event or principal diagnosis for any inpatient admission at any point in 2015. We used the disease definitions developed by the Healthcare Cost and Utilization Project (HCUP). We modeled the association between conditions and illness and whether someone had persistently high spending using the “binominal” parameter of the glm function in R 3.6. This method applied a logistic regression, estimating the odds that a diagnosed person had persistently higher spending. We used a person’s diagnosis in 2015 for a separate model for each of the 283 conditions holding constant an enrollees’ state of residency, sex, age and whether they were the policyholder or a dependent. Conditions with fewer than 1,000 observations were excluded from the results.

Because many chronic conditions are treated with expensive drug regimens, we were concerned that not being able to account for rebates would exaggerate the effect of conditions with high drug costs and high rebate levels. Prescription drug rebates vary considerably across particular drugs and drug categories, which can affect the costs associated with the diagnoses those drugs are used to treat. To test the robustness of our coefficients, we applied a 25% reduction to all drug spending and re-specified the model. This reduction had a greater impact on enrollees with a higher share of drug spending. Both the original specification and alternate described here are available below.

All dollar values are reported in 2017 nominal dollars.

A look at people who have persistently high spending on health care

Medicare-for-All Would Eliminate Most or All of Medicaid, But None Talk About That

Here are a few questions moderators could ask of candidates supporting Medicare-for-all, if they want to get a little deeper on health care.

“You support Medicare-for-all. But Medicaid, along with CHIP, covers 73 million Americans, and Medicaid is larger than either the ACA or Medicare. Would you eliminate Medicaid? If you would, do you see states playing a much smaller role in the health system in the future? Why would your plan be better than Medicaid is today?”

There has been controversy about eliminating private insurance in a Medicare-for-all plan, but there has been radio silence about eliminating Medicaid. That may be because advocates of Medicare-for-all feel that a national program covering everyone and eliminating differences in coverage between states would be better than Medicaid. But Medicaid has become a popular program, defended fiercely by Democrats when Republicans have tried to cut and change it. Its elimination would fundamentally change the roles of the federal and state governments in health, and change health insurance and health care arrangements for many of the 73 million low-income Americans on Medicaid today. It is as worthy of discussion as abandoning private coverage is, even if many are ultimately persuaded that it makes sense.

Of the leading Medicare-for-all plans, the Sanders plan keeps institutional long-term care in Medicaid, but moves the acute portion to Medicare-for-all.  By contrast, the Jayapal plan adds long-term care to Medicare and eliminates Medicaid entirely.

Under the Jayapal plan, 73 million beneficiaries would lose Medicaid or CHIP coverage and gain coverage under the new Medicare-for-all plan. Under Sanders’ plan, beneficiaries receiving institutional long-term care would remain on Medicaid for those services, but most beneficiaries would shift to the new national plan. The popular CHIP program would be replaced under both plans.

Medicaid is the single largest item in most state budgets, and states would reap huge savings under either plan, though the savings under the Sanders bill would be smaller with states still responsible for covering institutional long-term care.

The uninsured in states that have not expanded Medicaid would be big winners. But many people know Medicaid by the names their states have given to it, and are loyal to their state program and have established connections with plans and providers which they value.

The effects on safety net hospitals and clinics would vary and are hard to predict. Many are substantially dependent on their Medicaid revenues and their fates would largely hinge on where people go for care with their new coverage and how payment rates under the new Medicare-for-all plan compare to Medicaid today.

The change would all but eliminate the role of states in health coverage for low-income people.  It comes at a time when state Medicaid programs have been leaders in experimenting with delivery and payment reforms, efforts to control drug costs, and experiments aimed at addressing social causes of ill health such as poverty and poor housing. Those reforms – and the idea of states as laboratories of reform – would pretty much disappear, and the balance of federalism in health would fundamentally change. For advocates of a single national plan that’s progress; for fans of maintaining a federal-state balance that’s a big problem.

It’s likely that some governors would press successfully for a waiver authority enabling them to operate their own single payer systems or to undertake other experiments in a Medicare-for-all world.

Advocates would argue that a single mainstream national program with no cost sharing and, in theory, access to a wider range of providers, would be an improvement.  But the details of how the country’s largest health insurance program would be eliminated matter. The needs of special populations such as disabled low-income children, the homeless, and the recently incarcerated would need to be addressed. Certainly, eliminating private insurance isn’t the only issue that warrants discussion.

Medicare-for-All Would Eliminate Most or All of Medicaid, But No One Is Talking About It

VA to spend $4.9B to maintain EHR over 10 years as it starts Cerner replacement

Veterans Affairs doesn’t have a firm grasp on how much it is going to cost to maintain its current home-grown electronic health record system over the next 10 years while it’s also rolling out a $10 billion Cerner EHR system, a Government Accountability Office official told members of Congress.

The VA pegs the price for keeping its current EHR VistA system running over the next 10 years at $5 billion.

But the cost likely will be higher as the VA’s cost data is unreliable and not comprehensive, according to Carol Harris, director of information technology acquisition management Information at GAO, testifying during a House Veterans’ Affairs Subcommittee on Technology Modernization hearing Thursday.

As the rollout to the new Cerner Millennium EHR across all VA hospitals will take 10 years, the agency plans to continue operating its 40-year-old legacy EHR system. At times VA clinicians will have to use both systems, VA officials testified on Thursday.

The VA decided to transition to a commercial EHR because its current medical records system does not possess the modern capabilities, analytics and functionalities that medical providers need ,and it is not interoperable with the Department of Defense’s EHR.

The VA signed a $10 billion deal with Cerner last May to move from the VA’s customized VistA platform to an off-the-shelf EHR to align with DOD, which has already started integrating Cerner’s MHS Genesis system.

Three pilot sites in the Pacific Northwest will go live with the new system in March 2020, VA officials have said.

There are 130 versions or instances of the legacy EHR system across 1,500 sites. In order to ensure clinicians have access to current patient records and to prevent interruption in the delivery of care, VA hospitals and clinics will continue using the older system, according to VA officials.

The VA’s Office of Information and Technology also is working to move all 130 versions of VistA to the cloud.

Lawmakers have been pressing VA for a total cost of ownership of VistA compared to a total cost of implementing and operating the Cerner system and the agency has struggled to report accurate cost information.

“It’s an important question and one we haven’t received an answer to. The complexity of this mixed environment is the biggest difficulty confronting VA,” Rep. Jim Banks, R-Indiana, ranking member on the subcommittee, said.

According to a GAO report released on Thursday, the VA doesn’t have a comprehensive definition of the IT capabilities that constitute VistA which makes it almost impossible for the agency to have accurate data on the cost to maintain it.

“Because of the decentralized nature of how VistA was developed, the VA is not in a position to be able to effectively draw that parameter around what is and isn’t Vista. As a result, they can’t accurately report the annual development sustainment costs. So they don’t have an accurate basis for ROI for moving to the Cerner system,” Harris told lawmakers.

Paul Tibbits, M.D., executive director of the office of technical integration office of information and technology at the VA, testified that it currently costs $426 million to sustain VistA through fiscal year 2019 and estimates it would cost $4.9 billion to keep it running over the next 10 years.

Harris said the VA is basing that number on unreliable data and has omitted costs associated with the EHR system. The VA said it cost about $2.3 billion to operate the EHR between 2015 and 2017. But of that $2.3 billion, VA demonstrated that only approximately $1 billion of these costs were reliable, Harris said.

The total price tag for operating the legacy EHR system over the next decade will likely be higher, Harris said, as the VA has omitted key costs from that $2.3 billion initial estimate such as costs for hosting health data by an outside vendor, as well as hosting backup VistA instances at each of the medical center sites.

“The VA can’t accurately report annual costs. As such, VA lacks reliable information needed to make critical management decisions for sustaining VistA over the next 10 years,” Harris said.

Tibbits said VA leaders agree with GAO’s recommendation that it needs a better accounting of VistA’s costs. “The VA is currently developing a methodology to update the cost data and define VistA,” he said.

When pressed by lawmakers on the high cost of running and upgrading the legacy EHR, Tibbits said the system’s age and technical complexity made it costly to operate.

VA officials also said they have transferred 23.5 million health records from the VA EHR to a shared data center with the DOD.

But until the switch from its current record to a Cerner system is complete, it’s expected that VA clinicians will have to use multiple EHRs, Thomas O’Toole, M.D., senior medical advisor at the Office of the Assistant Deputy Undersecretary for Health for Clinical Operations for the Veterans Health Administration, told lawmakers Thursday.

https://www.fiercehealthcare.com/tech/va-to-spend-4-9b-maintaining-current-ehr-over-10-years-while-it-rolls-out-cerner-system

Artificial protein programs cells to fight disease

What if cells could sense the onset of disease and then modulate the immune system to administer just the right amount of healing power to clear the illness without affecting normal tissues? Scientists at the University of California, San Francisco (UCSF) and the University of Washington have designed an artificial protein that they believe will make such “smart” therapies a reality.

A team of bioengineers described the invention, called Latching Orthogonal Cage-Key pRotein (LOCKR), in two new papers published in the journal Nature. LOCKR was built with a molecular “arm” that can be directed to control cellular processes by unlocking it with another engineered protein, according to a statement from UCSF.

So how exactly would LOCKR work in the treatment of disease? The researchers use traumatic brain injury (TBI) as an example. When TBI occurs, physicians respond by administering medicines to tamp down the massive brain inflammation that occurs when the body attempts to repair the damage. But sometimes these drugs work too well, and inflammation drops so low the brain can’t heal properly.

Installing LOCKR in the patient’s cells could help keep inflammation levels in check, leaving just enough to promote healing, the UCSF team said. They believe a similar concept could be used to treat a variety of diseases, from cancer to autoimmune disorders.

Because LOCKR is entirely human-made, it “provides an unprecedented level of control over the way the protein interacts with other components of the cell,” said Hana El-Samad, Ph.D., professor of biochemistry and biophysics at UCSF and co-senior author of the research, in the statement. That, she added, “will allow us to begin tackling unsolved—and previously unsolvable—problems in biology, with important implications for medicine and industry.” LOCKR was co-invented by University of Washington biochemistry professor David Baker, Ph.D.

The UCSF and University of Washington bioengineers developed a version of their new tool, dubbed degronLOCKR, which can be turned on to degrade specific proteins in cells. It includes “circuits” that regulate cellular activity in response to cues from the environment, they reported. When the circuits detected a disruption inside the cell, degronLOCKR destroyed proteins that caused the problem, then turned off once the cell returned to normal.

Reprogramming cells to fight disease is a concept that’s already been borne out, in CAR-T cell therapies for cancer, for example. But several research groups and companies are searching for the next generation of products that can, in essence, direct the body’s cells to fight off diseases.

Among them is Refuge Biotech, which recently described to FierceBiotech its process for using CRISPR gene editing to create “intelligent” T-cell therapies that the company’s scientists hope will be able to fight solid tumors.

And several tech giants, including Apple and IBM, are looking to combine their latest inventions with biology to fight a range of diseases. Earlier this year, Microsoft partnered with Princeton University, Oxford Biomedica and Synthace to improve gene-therapy technology using machine learning.

El-Samad, Baker and colleagues liken LOCKR to an electric switch for cells—one that they can use to build tiny but complex integrated circuits to control healing. They plan to build new versions of the system, similar to degronLOCKR, to create “precise and robust live cell therapies,” El-Samad said.

https://www.fiercebiotech.com/research/artificial-protein-programs-cells-to-fight-disease

WY city files own suit of opioid makers

Green River is the latest city in Wyoming to file a lawsuit against opioid manufacturers for their part in the addiction crisis that has spread across the country.

The lawsuit was filed Wednesday in U.S. District Court by Green River against Purdue Pharma, Johnson and Johnson, and a long list of other pharmaceutical companies that manufacture opioid-based medications. The western Wyoming city is seeking $10 million in damages from the companies for their efforts to downplay “the serious risk of addiction” from opioid-based medications, according to the lawsuit.

Requests for comment from legal representation for Green River and city officials were not returned by press time.

The suit alleges the deceptive practices of Purdue, Johnson and Johnson and the other manufacturers “led to a public health crisis in the City of Green River, Wyoming, which faces skyrocketing opioid addiction and opioid-related overdoses and deaths, as well as devastating social and economic consequences.”

Because of the increase in opioid addiction and the resulting strain on social services, law enforcement and other government sources, Green River is seeking damages to help compensate the city for those costs.

“Tax dollars are required to maintain public safety of places where the addicted homeless attempt to congregate, including city parks, schools and public lands,” the lawsuit reads. “Tax dollars are required to fight the injections disease brought by the addicted and particularly the addicted homeless.”

The suit mentions “Hepatitis B and C, HIV, sexually transmitted disease and Methicillin-resistant Staphylococcus aureus (MRSA) have been demonstrated to be spread by opioid abuse.”

Green River joins thousands of local and state governments across the country that have sued opioid manufacturers. Cheyenne filed its own lawsuit in March, and Sweetwater County filed a similar suit in January.

Sweetwater County’s lawsuit was filed in U.S. District Court in Wyoming, but was later moved to U.S. District Court in Ohio, where it was combined with a large group of similar lawsuits filed against pharmaceutical companies.

Green River is being represented by Rock Springs attorney Charles Barnum and Casper attorney Rick Koehmstedt, both of whom also represent Sweetwater in their suit.

Wyoming’s own suit was filed in late 2018 by the state Attorney General’s Office. As part of its claim of consumer fraud, the suit alleges Purdue invested heavily to counter doctors’ resistance to using opioid medicines. Through multiple on-site visits by sales representatives, paying doctors seven figures to extol the virtues of OxyContin, and secretly backing financially multiple pain advocacy groups to push for expanded opioid prescriptions, Purdue was able to push OxyContin sales nationally from $48 million in 1996 to more than $1 billion by 2000, according to the lawsuit.

According to the state’s lawsuit, Wyoming has paid millions in dealing with opioid addiction. The lawsuit claims the state paid $2.29 million in additional Medicaid claims to treat opioid-related addiction from 2008-2017.

“The Wyoming Attorney General’s Office has been working with over 40 states to understand how America’s opioid crisis developed,” said Wyoming’s chief deputy attorney general, John Knepper, after the state filed suit in 2018. “This investigation continues, but sufficient evidence exists for Wyoming to move forward now with a lawsuit alleging that Purdue Pharma has violated Wyoming’s Consumer Protection Act.”

https://www.marketscreener.com/JOHNSON-JOHNSON-4832/news/Johnson-Johnson-Green-River-files-its-own-lawsuit-against-opioid-manufactures-28973109/