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Friday, May 1, 2020

Gilead: After the data come the commercial realities

Gilead’s (NASDAQ:GILD) Q1 results were unsurprisingly overshadowed by discussions on remdesivir, Barclays analyst Carter Gould writes in a note to clients.
Disclosures of up to $1B in remdesivir spend this year and the lack of any meaningful color on its economics will likely weigh on shares near term.
Importantly, donating 1.5M doses also delays any clarity on pricing strategy for at least the next month.
GILD is appropriately reading the room. But the market “has priced in such an optimistic view of remdesivir’s commercial potential that we suspect the near-term uncertainty will weigh on shares notably.”
Upcoming data from the NIAID and SIMPLE studies over the next few weeks should provide further characterization of remdesivir’s profile.
Retains Sell rating. Price target of $67 from $62 implies 24% downside.
Shares are -3.5% on light premarket volume.
https://seekingalpha.com/news/3567471-gilead-after-data-come-commercial-realities

AbbVie Q1 Humira sales up 6%; non-GAAP EPS guidance maintained

AbbVie (ABBV) Q1 results:
Revenues: $8,619M (+10.1%); Immunology: $5,089M (+14.5%); Hematologic Oncology: $1,549M (+32.1%); HCV: $564M (-30.8%).
Key product sales: Humira: $4,703M (+5.8%); Imbruvica: $1,232M (+20.6%); Skyrizi: $300M; Mavyret: $559M (-29.2%); Venclexta: $317M (>100%); Creon: $276M (+21.9%); Lupron: $233M (+1.7%); Synthroid: $205M (+12.3%); Synagis: $270M (-5.6%).
Net Income: $3,010M (+22.6%); EPS: $2.02 (+22.4%); non-GAAP Net Income: $3,613M (+13.2%); non-GAAP EPS: $2.42 (+13.1%).
2020 Guidance: EPS: $7.60 – 7.70 from $7.66 – 7.76; non-GAAP EPS: $9.61 – 9.71 (unch).
Q2 Guidance: non-GAAP EPS: $2.10 – 2.16.
Shares are up 1% premarket.
https://seekingalpha.com/news/3567605-abbvie-q1-humira-sales-up-6-non-gaap-eps-guidance-maintained

Downgrades roll in on Gilead; shares off 5%

What’s special about COVID-19,” asked Leerink’s Geoff Porges in the conversation from last earnings call that everyone is talking about (transcript here).
GILD -5.15% premarket.
Porges: “Should we assume the capital returns and the profitability for providing a global treatment for Covid long-term, after the first 200K-300K courses are provided on a donation basis? Should we assume the returns are going to be similar to the returns that you’ve generated in other parts of the business?”
CEO Daniel O’Day: “There’s been no other time like this in the history of the planet… There is no rulebook out there, other than that we need to be very thoughtful about how we can make sure we provide access of our medicines to patients around the globe… So points well taken.” O’Day continued that it’s too early to discuss potential revenue. “We understand our responsibility.”
Raymond James rings the register, downgrading to Market Perform. “We aren’t going to wild guess remdesivir NPV,” goes the title of their note.
SunTrust downgrades to Sell from Hold: “Lack of visibility to growth.” Their $70 price target suggests nearly 20% downside from last night’s close.
JPMorgan downgrades to Neutral from Overweight.
https://seekingalpha.com/news/3567591-downgrades-roll-in-on-gilead-shares-off-5

Thursday, April 30, 2020

3 of 4 largest U.S. airlines now require facial masks on flights

United Airlines (NASDAQ:UAL), Delta Air Lines (NYSE:DAL) and American Airlines (NASDAQ:AAL) announce they will require facial coverings on all U.S. flights to address the spread of the coronavirus and convince reluctant passengers to resume flying.
Delta and United’s new rules start May 4, while American’s requirements begin May 11.
Southwest Airlines (NYSE:LUV) is the only one of the four largest U.S. airlines that has not yet required facial coverings.
JetBlue started the “new flying etiquette” earlier this week, and the other domestic carriers are now following suit.
Airlines in the U.S. have suffered a 95% drop in passengers and are striving to reassure customers about the safety of air travel by instituting new cleaning and social distancing procedures.
https://seekingalpha.com/news/3567437-three-of-four-largest-u-s-airlines-now-require-facial-masks-on-flights

Blood clotting a significant cause of death in patients with COVID-19

A study led by clinician scientists at RCSI University of Medicine and Health Sciences has found that Irish patients admitted to hospital with severe COVID-19 infection are experiencing abnormal blood clotting that contributes to death in some patients.
The study, carried out by the Irish Centre for Vascular Biology, RCSI and St James’s Hospital, Dublin, is published in current edition of the British Journal of Haematology. (DOI: 10.1111/bjh.16749)
The authors found that abnormal blood clotting occurs in Irish patients with severe COVID-19 infection, causing micro-clots within the lungs. They also found that Irish patients with higher levels of blood clotting activity had a significantly worse prognosis and were more likely to require ICU admission.
“Our novel findings demonstrate that COVID-19 is associated with a unique type of blood clotting disorder that is primarily focussed within the lungs and which undoubtedly contributes to the high levels of mortality being seen in patients with COVID-19,” said Professor James O’Donnell, Director of the Irish Centre for Vascular Biology, RCSI and Consultant Haematologist in the National Coagulation Centre in St James’s Hospital, Dublin.
“In addition to pneumonia affecting the small air sacs within the lungs, we are also finding hundreds of small blood clots throughout the lungs. This scenario is not seen with other types of lung infection, and explains why blood oxygen levels fall dramatically in severe COVID-19 infection.
“Understanding how these micro-clots are being formed within the lung is critical so that we can develop more effective treatments for our patients, particularly those in high risk groups.
“Further studies will be required to investigate whether different blood thinning treatments may have a role in selected high risk patients in order to reduce the risk of clot formation,” Professor O’Donnell said.
Emerging evidence also shows that the abnormal blood-clotting problem in COVID-19 results in a significantly increased risk of heart attacks and strokes.
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Professor O’Donnell led the cross disciplinary study, with joint first authors Dr Helen Fogarty and Dr Liam Townsend, along with Consultants from multiple specialities within St James’s Hospital and researchers at RCSI University of Medicine and Health Sciences and Trinity College Dublin.
Further research on these findings will continue under Irish COVID-19 Vasculopathy Study (iCVS) which has been jointly funded by the Health Research Board and Irish Research Council as part of the Irish government’s COVID-19 Rapid Response Research Funding.
https://www.eurekalert.org/pub_releases/2020-04/r-bca043020.php

Nanodevices for the brain could thwart formation of Alzheimer’s plaques

Alzheimer’s disease is the sixth leading cause of death in the United States, affecting one in 10 people over the age of 65. Scientists are engineering nanodevices to disrupt processes in the brain that lead to the disease.
People who are affected by Alzheimer’s disease have a specific type of plaque, made of self-assembled molecules called β-amyloid (Aβ) peptides, that build up in the brain over time. This buildup is thought to contribute to loss of neural connectivity and cell death. Researchers are studying ways to prevent the peptides from forming these dangerous plaques in order to halt development of Alzheimer’s disease in the brain.
In a multidisciplinary study, scientists at the U.S. Department of Energy’s (DOE) Argonne National Laboratory, along with collaborators from the Korean Institute of Science and Technology (KIST) and the Korea Advanced Institute of Science and Technology (KAIST), have developed an approach to prevent plaque formation by engineering a nano-sized device that captures the dangerous peptides before they can self-assemble.
We’ve taken building blocks from nanotechnology and biology to engineer a high-capacity cage’ that traps the peptides and clears them from the brain.” — Elena Rozhkova, scientist, Center for Nanoscale Materials
The β-amyloid peptides arise from the breakdown of an amyloid precursor protein, a normal component of brain cells,” said Rosemarie Wilton, a molecular biologist in Argonne’s Biosciences division. In a healthy brain, these discarded peptides are eliminated.”
In brains prone to the development of Alzheimer’s, however, the brain does not eliminate the peptides, leaving them to conglomerate into the destructive plaques.
The idea is that, eventually, a slurry of our nanodevices could collect the peptides as they fall away from the cells — before they get a chance to aggregate,” added Elena Rozhkova, a scientist at Argonne’s Center for Nanoscale Materials (CNM), a DOE Office of Science User Facility.

Decorating the surface

The researchers covered the surface of the new nanodevice with fragments of an antibody — a type of protein — that recognizes and binds to the Aβ peptides. The surface of the nanodevice is spherical and porous, and its craters maximize the available surface area for the antibodies to cover. More surface area means more capacity for capturing the sticky peptides.
To find the optimal coating, the scientists first searched previous literature to identify antibodies that have high affinity to Aβ peptides. It was important to choose an antibody that attracts the peptides but doesn’t bind to other molecules in the brain. Then the team, led by Wilton, produced the antibodies in bacteria and tested their performance.
A full antibody molecule can be up to a few dozen nanometers long, which is big in the realm of nanotechnology. However, only a fraction of this antibody is involved in attracting the peptides. To maximize the effectiveness and capacity of the nanodevices, Wilton’s group produced tiny fragments of the antibodies to decorate the nanodevice’s surface.

Engineering and testing the nanodevice

The scientists at CNM constructed the base of the porous, spherical nanodevices out of silica, a material that has long been used in biomedical applications due to its flexibility in synthesis and its nontoxicity in the body. Coated with the antibody fragments, the nanodevices capture and trap the Aβ peptides with high selectivity and strength.
Many attempts to prevent Alzheimer’s have focused on inhibiting enzymes from cutting β-amyloid peptides off of the cell’s surface,” said Rozhkova, who led the project at CNMOur elimination approach is more direct. We’ve taken building blocks from nanotechnology and biology to engineer a high-capacity cage’ that traps the peptides and clears them from the brain.”
At CNM, the scientists tested the effectiveness of the devices by comparing how the peptides behaved in the absence and presence of the nanodevices. Using in vitro transmission electron microscopy (TEM), they observed a notable decline in peptide aggregation in the presence of the nanodevices. They further analyzed the interactions using confocal laser scanning microscopy and microscale thermophoresis measurement, two additional techniques for characterizing interactions at the nanoscale.
The scientists also performed small-angle X-ray scattering to study the processes that make the nanodevices porous during synthesis. The researchers performed the X-ray characterization, led by Byeongdu Lee, a group leader in Argonne’s X-ray Science division, at beamline 12-ID-B of the lab’s Advanced Photon Source (APS), a DOE Office of Science User Facility.
These studies supported the case that the nanodevices sequester the peptides from the pathway to aggregation by more than 90 percent compared to the control silica particles without the antibody fragments. However, the devices still needed to demonstrate their effectiveness and safety within cells and brains.
Joonseok Lee — who originally proposed this experiment at Argonne as a Director’s Postdoctoral Appointee and pioneered the design for the nanodevice — continued the study of the therapeutic potential of this device at KIST and KAIST.
The Director’s Postdoctoral Position is a rare opportunity offered at Argonne that allows for unique research projects and cross-field collaborations that might not otherwise be possible,” said Rozhkova. We have incredible minds at the lab who want to explore topics that don’t fall under a predefined area of research, and this program encourages this creativity and innovation.”
The in vivo experiments — experiments that took place in living cells — performed by Lee and his collaborators showed that the nanodevices are nontoxic to cells. They also tested the effectiveness of the devices in the brains of mice with Alzheimer’s, demonstrating around 30 percent suppression of plaque formation in brains containing the nanodevices compared to control brains.  The research on mice was conducted at KIST and KAIST in South Korea with appropriate government approvals.
This study combined the strengths of antibody engineering and nanotechnology, the power of two DOE User Facilities at Argonne and innovative collaboration resulting from the laboratory’s postdoctoral program to explore a technological approach to preventing Alzheimer’s.
Using a similar approach, scientists may also be able to pair the silica nanoparticles with different antibodies that target molecules related to other neurodegenerative diseases, such as Huntington’s disease and Parkinson’s disease, which also involve abnormal protein aggregation. The porous nanoparticles may be further upgraded for use in imaging applications including fluorescent imaging and magnetic resonance imaging.
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A paper on the research, titled Silica nanodepletors: Targeting and clearing Alzheimer’s β-amyloid plaques“, was published in the April issue of Advanced Functional Materials and was featured on its cover.
This research was supported by the Korea Institute of Science and Technology Institutional Program and the National Research Foundation via the Creative Research Initiative Center and Basic Science Research Program, Republic of Korea. The researchers also acknowledge the Director’s Postdoctoral Fellowship from Argonne National Laboratory.
https://www.eurekalert.org/pub_releases/2020-04/dnl-nft043020.php

Cytokine storms and T cell counts may offer clues on how to treat COVID-19

Cytokine storms may affect the severity of COVID-19 cases by lowering T cell counts, according to a new study published in Frontiers in Immunology. Researchers studying coronavirus cases in China found that sick patients had a significantly low number of T cells, a type of white blood cell that plays a crucial role in immune response, and that T cell counts were negatively correlated with case severity.
Interestingly, they also found a high concentration of cytokines, a protein that normally helps fight off infection. Too many cytokines can trigger an excessive inflammatory response known as a cytokine storm, which causes the proteins to attack healthy cells. The study suggests that coronavirus does not attack T cells directly, but rather triggers the cytokine release, which then drives the depletion and exhaustion of T cells.
The findings offer clues on how to target treatment for COVID-19, which has become a worldwide pandemic and a widespread threat to human health in the past few months. “We should pay more attention to T cell counts and their function, rather than respiratory function of patients,” says author Dr. Yongwen Chen of Third Military Medical University in China, adding that “more urgent, early intervention may be required in patients with low T lymphocyte counts.”
Chen says he and his co-authors became interested in examining T cells when they noticed that many of the patients they treated for COVID-19 had abnormally low numbers of lymphocytes, a type of white blood cell that includes T cells. “Considering T cells’ central role of response against viral infections, especially in the early stage when antibodies are not boosted yet, we took the T cells as our focal point,” says Chen.
Authors examined 522 patients with coronavirus along with 40 healthy controls. All patients studied were admitted to two hospitals in Wuhan, China between December 2019 and January 2020, and ages ranged between 5 days and 97 years old. Of the 499 patients who had their lymphocytes recorded, 76% had significantly low total T cell counts. ICU patients had significantly lower T cell counts compared with non-ICU cases, and patients over the age of 60 had the lowest number of T cells.
Importantly, the T cells that did survive were exhausted and could not function at full capacity. Not only does this have implications for COVID-19 patient outcomes, but T cell exhaustion leaves patients more vulnerable to secondary infection and calls for scrupulous care.
Chen says that future research should focus on finding finer subpopulations of T cells in order to discover their vulnerability and effect in disease, along with identifying drugs that recover T cell numbers and boost function.
Authors say that Tocilizumab is an existing drug that may be effective, but that it needs to be investigated in the context of coronavirus. Antiviral treatments, such as Remdesivir, may also prevent the progression of T cell exhaustion, but all future treatments will require further study.
In the meantime, this new research deepens our understanding of how the novel coronavirus affects the body and it indicates ways to lessen its impact.
https://www.eurekalert.org/pub_releases/2020-05/f-csa042320.php