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Tuesday, December 17, 2019

Sangamo updates on pipeline at R&D Day

Sangamo Therapeutics (NASDAQ:SGMO) is hosting an R&D Day this morning at 8:00 am ET. Highlights:
Transfer of gene therapy SB-525 for hemophilia A to collaboration partner Pfizer (NYSE:PFE) substantially completed. A Phase 3 trial should launch in 2020. Enrollment in a lead-in study is underway.
Phase 1/2 study evaluating gene therapy ST-920 in Fabry patients is in process.
IND for gene therapy ST-101 in PKU to be filed in 2021.
Early data on cell therapy line-up to be presented, including ST-400 beta thalassemia ex vivo gene-edited cell therapy being developed with Sanofi (NASDAQ:SNY).
Updates on CAR-TREG clinical and preclinical programs will be presented as well. CAR-TREGS are regulatory T cells equipped with a chimeric antigen receptor (CAR). TX200 is in development for the prevention of immune-mediated organ rejection in kidney transplant patients.
Other areas: gene editing with zinc finger nuclease in mucopolysaccharidosis type II (MPS II), genome editing candidates in neurodegenerative diseases, including Parkinson’s (ST-502) and Alzheimer’s (ST-501).
Buildout of GMP manufacturing facility in Brisbane, CA almost completed and should be online next year.

Monday, December 16, 2019

Anthem Will Use Blockchain To Secure Med Data For Its 40M Members In 3 Years

Anthem, the second-largest health insurance company in the U.S, has started to use blockchain technology to help patients securely access and share their medical data. The company plans to roll out the feature, which is in pilot testing now, to groups of members in the next few months. All 40 million members will have access to it in the next two to three years, according to company officials.
“What blockchain potentially gives us the opportunity to do is not worry about those trust issues,” said Anthem CEO Gail Boudreaux at the 8th Annual Forbes Healthcare Summit in New York last week. “We have an opportunity now to share data that people can make their own decisions on.”
In January, Anthem  announced that it was working with Aetna, Health Care Service Corporation, IBM and PNC Bank in a new partnership focused on blockchain. Their goal, says Rajeev Ronanki, chief digital officer at Anthem, is to help keep patient data private while increasing interoperability (the ability of different digital health systems to exchange information) and trust between partners.
Blockchain, made popular by cryptocurrencies such as bitcoin, is a decentralized database that creates a record of when data is accessed or exchanged. In the healthcare world, this allows companies, especially those that work with medical records, to move patient data securely and cut out redundancies. Executives at Anthem, which has patient medical data based on insurance claims, believe that using blockchain will give patients more immediate access to their records as well as allow them to control who views their health data.
In the current Anthem pilot program, users can open an app on their phones, scan a QR code, and instantly grant different healthcare providers access to their health records— but only for a limited amount of time. As soon as the appointment is over, users can revoke access and make their medical records private again. This system is live for a pilot test group of about 200 company employees, Ronanki says, and Anthem plans to roll it out in phases to members beginning in 2020.
Ronanki says Anthem is already using blockchain in several ways, and more programs are still in development. In total, they plan to have about a dozen uses for blockchain, Ronanki says, 40% of which are already live. The blockchains that they are using are Hyperledger Fabric, Burrow and Indy. Their current transaction volumes average about 300,000 a week for patient health data. “We think it’s a pretty transformative thing for health,” Ronanki says.
“We’re essentially creating a permission-based system that would allow consumers to own their healthcare data, and then make it available to providers as appropriate,” he says.
Another way the insurer is making use of blockchain: Anthem will eventually start using the technology to process insurance claims and coordinate benefits faster. Sometimes a patient is covered by more than one provider, Ronanki says, and it can take a lot of time to chase down information. Using blockchain, Anthem will be able to quickly access the most up-to-date data about which person or treatments are covered by which company. “We can create trusted partnerships, without having to share the underlying data,” Ronanki says.

Spending Bill Includes Seismic Retirement Changes, Curbs Stretch IRAs

The just released 1,773-page $1.4 trillion 2020 spending bill means many Americans will be rewriting their retirement plans—if it gets signed into law before the holidays as expected.  It includes the SECURE Act—Setting Every Community Up for Retirement Enhancement Act of 2019—which passed in the House 417-3 in May but stalled in the Senate. Basically, the whole SECURE Act was brought over, including the “pay for” revenue raising provisions.
“The most significant piece of retirement legislation in a decade could become a reality, after all,” says Brian Graff, CEO of the American Retirement Association.
The American Council of Life Insurers was quick to send out accolades: “[The SECURE Act] would mark a significant step toward modernizing America’s retirement system for workers.”
What’s in it for life insurers? A fiduciary safe harbor provision that will make it easier for employers to offer retirement plans with lifetime income options through annuities.
Also, there are increased tax incentives for small employers to offer retirement plans in the first place. The bill increases the tax credit for new plans from the current cap of $500 to $5,000, or $5,500 for plans that automatically enroll workers. Rule changes will make multi-employer retirement plans, where two or more employers band together to offer a plan, more workable too.
The pay-for that will get the most attention in the retirement planning community is the imposition of a 10-year payout rule for beneficiaries of inherited retirement accounts.
Here’s a rundown of some of the major retirement changes in the spending bill.
It would allow part-time workers to participate in 401(k) plans. 401(k) plans typically require employees to work 1,000 hours in a 12-month period to participate in the plan. The new threshold would be 500 hours for three consecutive years. Note: This isn’t mandatory, so it’s in the employers’ court, and it wouldn’t be effective until January 1, 2021.
It would increase the age for required minimum distributions from 70½ to 72. Instead of having to take out annual RMDs from your 401(k) and IRA starting when you turn 70 ½, the minimum age would be 72. This would be a boon to most taxpayers who can afford to delay taking money out (it’s estimated it will cost the Treasury $8.9 billion over the 10-year budget window).
It would eliminate the prohibition on traditional IRA contributions for those age 70 ½. So, older workers would be able to save on a pre-tax basis and boost their retirement kitties. This is important given that folks are working longer and facing increasing longevity.
It would allow penalty-free retirement plan withdrawals for new parents. Within a year after a birth or adoption, new parents could take up to $5,000 from a 401(k) or IRA or other qualified retirement plan.
It would require inherited IRAs to be depleted within 10 years. This is the provision that will pay for virtually everything else—bringing in an estimated $15.7 billion to the Treasury over 10 years. It will upend estate planning. Today IRAs can be stretched out over beneficiaries’ lifetimes, providing decades of tax-deferred (or tax-free in the case of Roth IRAs) compounding. Instead, most IRA beneficiaries (not a spouse) would be required to deplete an inherited IRA within 10 years, accelerating—and likely increasing— taxes owed and destroying creditor protection for IRAs held in trust. Forbes contributor Leon LaBrecque explains how the 10-year rule could cost your kids here.

New gene therapy strategy, courtesy of Mother Nature

Scientists have developed a new gene-therapy technique by transforming human cells into mass producers of tiny nano-sized particles full of genetic material that has the potential to reverse disease processes.
Though the research was intended as a proof of concept, the experimental therapy slowed tumor growth and prolonged survival in mice with gliomas, which constitute about 80 percent of malignant brain tumors in humans.
The technique takes advantage of exosomes, fluid-filled sacs that cells release as a way to communicate with other cells.
While exosomes are gaining ground as biologically friendly carriers of therapeutic materials – because there are a lot of them and they don’t prompt an immune response – the trick with gene therapy is finding a way to fit those comparatively large genetic instructions inside their tiny bodies on a scale that will have a therapeutic effect.
This new method relies on patented technology that prompts donated human cells such as adult stem cells to spit out millions of exosomes that, after being collected and purified, function as nanocarriers containing a drug. When they are injected into the bloodstream, they know exactly where in the body to find their target – even if it’s in the brain.
“Think of them like Christmas gifts: The gift is inside a wrapped container that is postage paid and ready to go,” said senior study author L. James Lee, professor emeritus of chemical and biomolecular engineering at The Ohio State University.
And they are gifts that keep on giving, Lee noted: “This is a Mother Nature-induced therapeutic nanoparticle.”
The study is published today (Dec. 16) in the journal Nature Biomedical Engineering.
In 2017, Lee and colleagues made waves with news of a regenerative medicine discovery called tissue nanotransfection (TNT). The technique uses a nanotechnology-based chip to deliver biological cargo directly into skin, an action that converts adult cells into any cell type of interest for treatment within a patient’s own body.
By looking further into the mechanism behind TNT’s success, scientists in Lee’s lab discovered that exosomes were the secret to delivering regenerative goods to tissue far below the skin’s surface.
The technology was adapted in this study into a technique first author Zhaogang Yang, a former Ohio State postdoctoral researcher now at the University of Texas Southwestern Medical Center, termed cellular nanoporation.
The scientists placed about 1 million donated cells (such as mesenchymal cells collected from human fat) on a nano-engineered silicon wafer and used an electrical stimulus to inject synthetic DNA into the donor cells. As a result of this DNA force-feeding, as Lee described it, the cells need to eject unwanted material as part of DNA transcribed messenger RNA and repair holes that have been poked in their membranes.
“They kill two birds with one stone: They fix the leakage to the cell membrane and dump the garbage out,” Lee said. “The garbage bag they throw out is the exosome. What’s expelled from the cell is our drug.”
The electrical stimulation had a bonus effect of a thousand-fold increase of therapeutic genes in a large number of exosomes released by the cells, a sign that the technology is scalable to produce enough nanoparticles for use in humans.
Essential to any gene therapy, of course, is knowing what genes need to be delivered to fix a medical problem. For this work, the researchers chose to test the results on glioma brain tumors by delivering a gene called PTEN, a cancer-suppressor gene. Mutations of PTEN that turn off that suppression role can allow cancer cells to grow unchecked.
For Lee, founder of Ohio State’s Center for Affordable Nanoengineering of Polymeric Biomedical Devices, producing the gene is the easy part. The synthetic DNA force-fed to donor cells is copied into a new molecule consisting of messenger RNA, which contains the instructions needed to produce a specific protein. Each exosome bubble containing messenger RNA is transformed into a nanoparticle ready for transport, with no blood-brain barrier to worry about.
“The advantage of this is there is no toxicity, nothing to provoke an immune response,” said Lee, also a member of Ohio State’s Comprehensive Cancer Center. “Exosomes go almost everywhere in the body, including passing the blood-brain barrier. Most drugs can’t go to the brain.
“We don’t want the exosomes to go to the wrong place. They’re programmed not only to kill cancer cells, but to know where to go to find the cancer cells. You don’t want to kill the good guys.”
The testing in mice showed the labeled exosomes were far more likely to travel to the brain tumors and slow their growth compared to substances used as controls.
Because of exosomes’ safe access to the brain, Lee said, this drug-delivery system has promise for future applications in neurological diseases such as Alzheimer’s and Parkinson’s disease.
“Hopefully, one day this can be used for medical needs,” Lee said. “We’ve provided the method. If somebody knows what kind of gene combination can cure a certain disease but they need a therapy, here it is.”
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This work was supported by the National Science Foundation; the National Natural Science Foundation of China; the National Heart, Lung, and Blood Institute; the National Institute of Neurological Disorders and Stroke; the Cancer Prevention and Research Institute of Texas, the American Brain Tumor Association; and the National Cancer Institute.
Ohio State co-authors Junfeng Shi, Jingyao Sun, Xinmei Wang, Yifan Ma, Veysi Malkoc, Chiling Chiang, Kwang Kwak, Yamin Fan, Paul Bertani, Jose Otero and Wu Lu also worked on the research.

Eli Lilly program for cheaper insulin not lowering costs, lawmakers say

Eli Lilly’s plan to sell a cheaper version of its Humalog insulin has failed to lower costs for diabetes patients, according to a survey released Dec. 16 by Sens. Elizabeth Warren, D-Mass., and Richard Blumenthal, D-Conn.
The drug giant has faced mounting criticism for the pricing of its insulin products, which the senators’ survey notes has gone up by 685 percent since 2001.
In March, Eli Lilly said it would sell Lispro, a version of insulin identical to its Humalog insulin, for 50 percent cheaper than Humalog as a way to help make the lifesaving drug more affordable and accessible for diabetes patients.
However, the senators surveyed 190 chain and 196 independent pharmacies in all 50 states between May and September and found that Lispro is often out of stock at pharmacies and many pharmacies are unaware the product is available, according to STAT.
The survey, called “Inaccessible Insulin: The Broken Promise of Eli Lilly’s Authorized Generic,”  found that 83 percent of pharmacies surveyed did not have Lispro in stock. In 14 states, none of the surveyed pharmacies had Lispro in stock, and in 17 states the drug was only available in one of the surveyed pharmacies.
Additionally, 69 percent of the pharmacies that didn’t have Lispro in stock said they weren’t able to order it, according to the survey.
In August, the Financial Times reported that most insurers and pharmacy benefit managers still hadn’t put Lispro on their lists of covered drugs.
The pharmacies that did have Lispro did not actively offer it to customers. Only 15 percent of pharmacies offered it without prompting, the survey found.
“Instead of giving patients access to its generic alternative, this pharmaceutical behemoth is still charging astronomical prices for a drug people require daily and cannot live without. Congress needs to step up and take action on skyrocketing drug prices,” the senators wrote.
An Eli Lilly spokesperson wrote to STAT, saying “Lilly has taken numerous steps to make pharmacists aware of Insulin Lispro’s availability, including numerous alerts and instructions on how to order Lispro from wholesalers.”
The spokesperson added that many pharmacists don’t stock Lispro because they have limited refrigeration space.
All insulin requires refrigeration.

Glaxo Study Shows Blood Cancer Drug Works in Heavily Treated Patients

  • Overall response rate (ORR) of 31% with 2.5 mg/kg regimen and no new safety signals in heavily pre-treated patient population who were refractory to an immunomodulatory drug and a proteasome inhibitor, and were refractory or intolerant to an anti-CD38 antibody
  • Data published in The Lancet Oncology highlight the potential of belantamab mafodotin for patients with multiple myeloma whose disease has progressed
  • GSK confirms submission of a Biologics License Application to the US Food and Drug Administration
GlaxoSmithKline plc (LSE/NYSE: GSK) today announced treatment with the investigational single-agent belantamab mafodotin resulted in a clinically meaningful 31% overall response rate (ORR) with the 2.5 mg/kg regimen in patients with heavily pre-treated multiple myeloma. Patients in the trial received a median of seven prior lines of treatment, were refractory to an immunomodulatory drug and a proteasome inhibitor and were refractory and/or intolerant to an anti-CD38 antibody. The median duration of response has not been reached at six months of follow-up.
Full results from the DREAMM-2 (DRiving Excellence in Approaches to Multiple Myeloma) study of belantamab mafodotin were published today in The Lancet Oncology. GSK also confirmed submission of a Biologics License Application to the US Food and Drug Administration (FDA) seeking approval of belantamab mafodotin for the treatment of patients with relapsed or refractory multiple myeloma whose prior therapy included an immunomodulatory agent, a proteasome inhibitor and an anti-CD38 antibody. Belantamab mafodotin is not currently approved for use anywhere in the world.
Dr Hal Barron, Chief Scientific Officer and President R&D, GSK said: “Patients with multiple myeloma whose disease has progressed despite currently available therapy have limited options and poor outcomes. Data from the DREAMM-2 study show that, if approved, belantamab mafodotin could offer an important new treatment option for these patients.”
DREAMM-2 is an open label study of belantamab mafodotin, a humanised, immunoconjugate against B-cell maturation antigen (BCMA).i Patients in the trial had actively progressing multiple myeloma that had worsened despite current standard of care and were randomised to two arms to receive either 2.5 mg/kg or 3.4 mg/kg belantamab mafodotin every three weeks. Overall, patients in DREAMM-2 had more advanced disease, poorer prognosis and performance status and also had a greater number of prior lines of therapy in comparison with patients in DREAMM-1, the first time in human study of belantamab mafodotin.

U.S. approves Roche-Spark merger

The FTC closes its probe into Roche’s (OTCQX:RHHBY) $4.8B acquisition of Spark Therapeutics (NASDAQ:ONCE).
The agency won’t require any asset sales for the merger to comply with antitrust laws.
The FTC says the investigation “did not indicate that Roche would have the incentive to delay or terminate Spark’s developmental effort for its hemophilia A gene therapy, or that the acquisition would affect Roche’s incentives” for its hemophilia drug.