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Thursday, October 10, 2019

More Research Links Immune Cells to Alzheimer’s Disease

Increasingly, as the primary focus of Alzheimer’s research moves away from the beta-amyloid theory, it is shifting towards the role of immune cells in the brain called microglia.
Researchers at Washington University School of Medicine in St. Louis have found further evidence that microglia are the key link between the accumulation of abnormal proteins, like beta-amyloid and tau, in the brain and the actual brain damage observed in Alzheimer’s patients. They published their research in the Journal of Experimental Medicine.
The researchers noted that it was well known that chronic activation of the brain’s innate immune system is a well-known feature of Alzheimer’s and other primary tauopathies. But the extent to which that innate immune reaction contributes to neurodegeneration compared to the protein-induced neurotoxicity wasn’t clear. Their research showed that damage as the result of microglia’s activity, rather than the toxicity caused by tau accumulation, is the leading component driving neurodegeneration, at least in a mouse model.
“Right now many people are trying to develop new therapies for Alzheimer’s disease, because the ones we have are simply not effective,” said David Holtzman, the Andrew B. and Gretchen P. Jones Professor and head of the Department of Neurology, as well as senior author of the study. “If we could find a drug that specifically deactivates the microglia just at the beginning of the neurodegeneration phase of the disease, it would absolutely be worth evaluating in people.”
Under normal situations, tau is involved in normal, healthy brain neuron function. When it clumps into tangles in the brain, it is a mark of neurodegenerative diseases like Alzheimer’s and chronic traumatic encephalopathy, which has recently been linked to brain trauma seen in football players and boxers.
The researchers felt that there was more going on with microglia than just attempting to limit tau. Research has shown that once tau tangles form, microglia can harm the neurons close by, which contributes to neurodegeneration. There is also significant inflammation that can cause damage during this process.
Holtzman and first author, postdoctoral research Yang Shi, genetically modified mice that have a mutant form of human tau. These mice typically begin developing tau tangles at about six months of age and show neurological damage by nine months.
They then focused on the gene APOE, which has been linked to Alzheimer’s disease. Individuals with the APOE4 variant are 12 times more likely to develop Alzheimer’s compared to people with other variants. The scientific team modified the mice to carry the human APOE4 variant or no APOE gene. APOE4 was previously shown to amplify the toxic effects of tau on neurons.
They then fed the mice a compound that depletes microglia in the brain. Other mice were fed a placebo. At nine-and-a-half months, the brains of mice with tau tangles and the high-risk genetic variant had significantly smaller brains as long as the microglia were present. But when the microglia were eliminated, the mouse brains were basically normal and healthy with less evidence of abnormal tau tangles, even with the EPOE4 variant.
“Microglia drive neurodegeneration, probably through inflammation-induced neuronal death,” Shi said. “But even if that’s the case, if you don’t have microglia, or you have microglia but they can’t be activated, harmful forms of tau do not progress to an advanced stage, and you don’t get neurological damage.”
This is completely consistent with other findings that it is not the proteins, amyloid or tau, that cause the actual damage, but the immune response and resultant inflammation, that cause the damage.
Unfortunately, the compound the researchers used on mice is not a good option for drug development because of side effects, but it could point the way for other drugs that have similar mechanisms without the adverse effects.
“If you could target microglia in some specific way and prevent them from causing damage, I think that would be a really important, strategic, novel way to develop a treatment,” Holtzman said.
https://www.biospace.com/article/more-research-links-immune-cells-to-alzheimer-s-disease/

Immunic completes enrollment in mid-stage study of MS candidate IMU-838

Immunic (NASDAQ:IMUX) announces the completion of enrollment of 210 subjects in a Phase 2 clinical trial, EMPhASIS, evaluating lead candidate IMU-838 in patients with relapsing-remitting multiple sclerosis (RRMS).
The primary endpoint is the cumulative number of combined unique active MRI lesions at week 24 compared to placebo. The estimated primary completion date is November 2020.
The company says IMU-838 is an orally available, next-generation immune modulator that dampens the immune response by inhibiting an enzyme called dihydroorotate dehydrogenase (DHODH) that plays a key role in intracellular metabolism of activated immune cells.
https://seekingalpha.com/news/3505144-immunic-completes-enrollment-mid-stage-study-ms-candidate-imuminus-838

PhRMA CEO warns Pelosi bill to cut drug prices would be ‘devastating’ for industry

The head of the main pharmaceutical industry lobbying group on Thursday warned that a bill to lower drug prices from Speaker Nancy Pelosi (D-Calif.) would have a “devastating” effect on the industry and weaken its ability to develop new treatments.
The Pharmaceutical Research and Manufacturers of America (PhRMA) is one of the most powerful groups in Washington, and its CEO, Steve Ubl, outlined on Thursday the arguments the group is making as it seeks to ward off a push from the House, Senate and Trump administration to crack down on its prices.
“If H.R. 3 becomes law, it is lights out for a lot of very small biotech companies that are pre-revenue and depend on attracting capital,” Ubl told reporters on Thursday, using the formal name for Pelosi’s bill.Pelosi’s measure is expected to pass the House as soon as the end of October.
But the bill faces tough odds in the Republican-controlled Senate, where Senate Majority Leader Mitch McConnell (R-Ky.) has vowed to block what he has called “socialist price controls.”
Pelosi hopes if President Trump, who has long railed against high drug prices, endorses her bill, it would push it toward the finish line, though a potential deal could be more unlikely given the House’s impeachment inquiry against Trump.
Ubl, though, said his group is treating Pelosi’s measure, which would allow the government to negotiate lower prices on up to 250 drugs per year, as a real threat of becoming law, and is pushing back accordingly.
“I think there may be a mistaken notion in certain quarters that this is a messaging bill that won’t become law and therefore it’s a free vote, and we’re here to say otherwise,” Ubl told reporters. “This type of policy would have a devastating effect on the industry and the patients that we serve and we’re going to continue to take it very seriously and engage with policymakers accordingly.”
Supporters of the measure say the industry’s arguments that cutting drug prices would reduce innovation in new drugs is always the argument that industry makes to protect their high prices.
“It’s not going to hurt innovation,” Pelosi said at an event earlier this week in Washington state, saying that the bill would invest in research at the National Institutes of Health.
“We will have savings that we can reinvest in innovation that benefits everyone and not just the bottom line of the pharmaceutical industry,” she said.
House Democratic lawmakers were given a memo last month from focus groups of swing voters conducted by the firm Hart Research Associates. “Pharmaceutical companies’ claims that this bill will stifle investment in R&D are met with skepticism and have a very limited impact on swing voters,” the memo states. “Many see pharma’s message point as a scare tactic that drug companies have used for years to avoid reforms that will cut into their profits.”
Many leading drug companies are highly profitable. PhRMA argued on Thursday that reducing its companies’ profits would reduce the incentive for investors to take a risk by investing in drug companies, whose new treatments often fail somewhere along the line in development.
“We rely on capital investment to develop our R&D to produce new medicines,” said Lori Reilly, chief operating officer for PhRMA. “If you do diminish the return element, or the profitability element of that, you take away the incentive for many investors to put money in here, because there’s lots of places you can invest in, lots of places that carry a lot less risk.”
Sens. Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.) have proposed a somewhat more modest drug pricing bill.
But PhRMA also opposes that measure, and many doubt McConnell will bring up even that more modest bill.
Ubl argued that his group is not opposed to all action on drug prices, though, and would support actions that lower what patients pay out of pocket, rather than cutting the overall sticker price of the drug.
“The industry would support a balanced package,” he said. “We’re not for the status quo.”
https://thehill.com/policy/healthcare/465257-phrma-ceo-warns-pelosi-bill-to-lower-drug-prices-would-be-devastating-for

Enrollment underway in mid-stage study of Jazz Pharma’s defibrotide

The first participant has been enrolled in an exploratory Phase 2 clinical trial evaluating Jazz Pharmaceuticals’ (NASDAQ:JAZZ) defibrotide for the prevention of neurotoxicity in patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL) receiving Gilead Sciences’ (NASDAQ:GILD) CAR T therapy Yescarta (axicabtagene ciloleucel).
The first part of the 35-subject two-part study will assess the safety of two doses of defibrotide. The second part will evaluate the safety and efficacy of defibrotide at the recommended dose for preventing CAR T-associated neurotoxicity. The primary endpoint is the incidence of said neurotoxicity. The estimated primary completion date is April 2021.
Defibrotide is mixture of single-stranded oligonucleotides purified from the intestines of pigs that acts locally as an anticoagulant and an anti-inflammatory and anti-ischemic agent.
https://seekingalpha.com/news/3505140-enrollment-underway-mid-stage-study-jazz-pharmas-defibrotide

Amid vaping crisis, U.S. to issue new advice for doctors on lung infections

U.S. health officials are preparing to release new guidance for doctors stressing the need to ask every patient with an apparent respiratory infection about their vaping history.
The updated guidance will also advise physicians on how to diagnose and manage patients who may have both a lung infection and a vaping injury.
Dr. Ram Koppaka, a medical officer with the Centers for Disease Control and Prevention (CDC), said doctors need to be aware that there is an overlap between the early symptoms of vaping injury and common respiratory infections.
The CDC has already recommended doctors start asking patients about their vaping history during routine visits, but gathering that information is especially important as doctors evaluate patients with respiratory symptoms from infectious causes.
“Both diagnoses must be evaluated,” Koppaka said in a phone interview.

The CDC reported on Thursday that as of Oct. 8, 1,299 people in the United States have had confirmed or probable cases of lung injuries linked to vaping, and 26 have died.
Some U.S. doctors have raised concerns that vaping injury cases will be missed in the crush of patients seeking treatment for seasonal flu and other respiratory ailments.
The early symptoms of vaping injury include shortness of breath, cough, chest pain, fever, and in some cases, gastrointestinal symptoms such as nausea, vomiting and diarrhea. “All of those can also be seen with influenza,” Koppaka said.
In the United States, flu activity starts to pick up in October and November and typically peaks between December and February.
“The fact that a given individual that presents for clinical evaluation could have flu, could have lung injury due to e-cigarettes, or both, makes it complicated for providers,” Koppaka said.

As many as 72% of the earliest vaping patients in Illinois and Wisconsin sought medical treatment in outpatient clinics and emergency rooms before doctors admitted them to a hospital with severe lung injuries from vaping, state officials reported last month in the New England Journal of Medicine.
Most of those patients initially were given antibiotics. When those failed, many responded to treatment with supplemental oxygen and steroids.

‘ENDED UP IN AGONY’

In addition to flu, many respiratory infections, including fungal infections, can cause symptoms that could confound doctors and delay a vaping diagnosis.
The University of Utah Hospital in Salt Lake City has treated 22 patients with vaping injuries, including Jeffrey Manzanares, 33, who was also infected with a cold and human metapneumovirus that led to pneumonia.
Manzanares first sought treatment at a local hospital on Sept. 3, where he was given an antibiotic and oxygen for his pneumonia and sent home, his vaping injury undetected, he said in a phone interview.
“I ended up in agony from the lack of oxygen. It felt like someone was stabbing a knife into my whole body,” he said.
He went to the University of Utah Hospital the next day, where he spent 21 days, including 17 in intensive care. During his illness, Manzanares said he lost 50 pounds (22.7 kg), a third of his normal body weight.
“He was wildly sick,” said Dr. Scott Aberegg, a pulmonologist who treated Manzanares. “If that is any harbinger of what is to come in viral pneumonia season, this could be very problematic.”
Aberegg participated in a conference call earlier this month with other doctors advising the CDC on how clinicians should diagnose and manage vaping patients.
He said many doctors who get back a positive flu test may just assume the patient has the flu and not realize they are also a vaper.
State health officials are on alert.
“We want to make sure to investigate all cases that are reported and make sure we don’t miss anything that may be thought of as flu or may be associated with vaping or vice versa,” Dr. Pam Pontones, Indiana’s deputy health commissioner and state epidemiologist, said in a phone interview.
Influenza can be deadly in people who have other underlying illnesses.
“It’s really important that anyone, but especially people who have underlying pulmonary infections of any kind, be vaccinated for influenza,” Pontones said.
The CDC recommends everyone over the age of six get a flu shot.
https://www.reuters.com/article/us-health-vaping-cdc-guidance/amid-vaping-crisis-u-s-to-issue-new-advice-for-doctors-focused-on-lung-infections-idUSKBN1WP2P1

U.S. appeals court will not disqualify judge in opioid cases or delay trial

The 6th U.S. Circuit Court of Appeals in Cincinnati said U.S. District Judge Dan Polster, who oversees nationwide opioid litigation, had not created an appearance of bias against the drug industry through his rulings, public statements, and efforts to encourage settlements.
Companies that sought Polster’s recusal included retailers CVS Health Corp, Rite Aid Corp, Walgreens Boots Alliance Inc and Walmart Inc, and distributors AmerisourceBergen Corp, Cardinal Health Inc, Henry Schein Inc and McKesson Corp.
The appeals court also said Ohio failed to show that letting the trial proceed would undermine its right to litigate on its own. Thirteen other states and Washington, D.C. joined Ohio’s effort to delay the trial.
AmerisourceBergen declined to comment. Lawyers for the other companies had no comment or did not immediately respond to requests for comment.
In a Thursday afternoon filing, Ohio Attorney General Dave Yost, who sought the trial delay, said he may appeal to the U.S. Supreme Court.
Polster oversees more than 2,300 of the roughly 2,600 lawsuits by state, local and tribal governments, hospitals and other entities seeking to hold the drug industry responsible for the toll of opioid abuse.
Opioid addiction claimed roughly 400,000 lives in the United States from 1999 to 2017, according to the U.S. Centers for Disease Control and Prevention.
The industry wants to avoid a prohibitively costly bill, and the retailers and distributors faulted Polster for saying it was his “personal mission” to address the crisis.
Ohio’s Cuyahoga and Summit countries are the only plaintiffs in the Oct. 21 trial in Cleveland, the first in a federal court over the crisis. Defendants include the four drug distributors, Walgreens and drugmaker Teva Pharmaceutical Industries Ltd.
The counties’ lawyers said in a statement they remained committed “whether through negotiation or litigation” to help communities address the opioid epidemic, and Polster was being “pragmatic” in encouraging a settlement.
In letting Polster stay on, the appeals court said judges in complex cases were encouraged to pursue settlements early.

It admonished the judge to be more careful talking to the press and in court, saying his comments may “in isolation” appear to reflect bias though they did not warrant recusal.
“We do not encourage Judge Polster to continue these actions,” especially in “a case of such enormous public interest and significance,” the court said.
https://www.reuters.com/article/us-usa-opioids-litigation/u-s-appeals-court-will-not-disqualify-judge-in-opioid-cases-or-delay-trial-idUSKBN1WP2F2

Five Prime to restructure, axe 70 jobs

Aimed at extending its cash runway, Five Prime Therapeutics (NASDAQ:FPRX) will restructure its operations, including cutting 70 jobs across all functions, most (70%) by year-end.
Management says the move should save ~$20M per year. It will record a ~$3M pre-tax charge for related costs.
The company reaffirms its 2019 guidance and expects to end the year with $148M – 153M in quick assets.
https://seekingalpha.com/news/3505122-five-prime-restructure-axe-70-jobs