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Tuesday, June 7, 2022

Why Novavax Stock Dipped, Then Soared

 Just after the market opened on Monday, Novavax (NVAX 6.21%) shares were hit by an investor sell-off. This was an immediate, sharply negative reaction to a set of Food and Drug Administration (FDA) briefing documents concerning the company's NVX-CoV2373 coronavirus vaccine.

However, probably realizing that this reaction was panic-driven and perhaps unjustified, Novavax's shares staged an impressive recovery. They ultimately notched a gain on the day, closing more than 6% higher and trouncing the S&P 500 index.


The source of investor concern was the FDA's citing of four cases of myocarditis, a heart inflammation, recorded among the patients of a phase 3 clinical trial of the vaccine. The regulator wrote in its briefing, "These events raise the concern for a causal association with this vaccine, similar to the association documented with mRNA COVID-19 vaccines."

Any instance of a potentially fatal illness arising from vaccine administration is, of course, serious cause for concern. 

But it's worth zooming out to look at the bigger picture. Nearly 30,000 individuals participated in the late-stage trial conducted by the vaccine specialist, which, by the way, demonstrated that NVX-CoV2373 had an efficacy of over 90%.The FDA wrote that based on this performance that "it is more likely than not that the vaccine will provide some meaningful level of protection against COVID-19 due to Omicron, in particular against more severe disease."

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Novavax also did an admirable job in quickly reassuring the world that our current understanding of myocarditis as it relates to coronavirus vaccines is a "correlation does not imply causation" situation.

"Throughout the pandemic, as publicly available vaccines have been administered, there have been numerous investigations into findings related to myocarditis," the company wrote in a press release published Monday. "We have learned that we can expect to see natural background events of myocarditis in any sufficiently large database, and that young males are at higher risk. Myocarditis is most often caused by nonspecific viral infections."  

Novavax added that it will continue to "monitor all adverse events." 

https://www.fool.com/investing/2022/06/06/why-novavax-stock-dipped-then-soared-on-monday/

Time to move past Aduhelm and focus on a broader Alzheimer’s drug pipeline

 When Alzheimer’s disease was believed to be caused solely by the accumulation of amyloid protein in the brain, pinning all hopes on an amyloid-targeting drug like Aduhelm — the first drug approved to treat Alzheimer’s in 17 years — made sense. But newer knowledge that ties Alzheimer’s to the biology of aging indicates the disease is caused by a combination of age-related changes in the brain that affect different people in different ways.

That means neither Aduhelm nor any anti-amyloid drug on its own will be a cure for the estimated 6.2 million Americans living with Alzheimer’s. The next phase of research must focus on promising drugs that target a host of underlying pathologies that contribute to Alzheimer’s.

Today more than ever, research is embracing this new understanding, taking a more diversified “multiple shots on goal” approach to new drug targets. More than three in four treatments currently in clinical development work against non-amyloid targets. These include drugs to reduce inflammation in the brain, improve blood flow, clear misfolded proteins, improve how the brain metabolizes energy, and more.

To complement these pathways, new biomarkers are needed that will give physicians like me the tools needed to zero in on the causes of each patient’s Alzheimer’s and tailor combinations to provide precision personalized medicine.

Alzheimer’s research is notoriously challenging and expensive, outstripping cost estimates for research in most other therapeutic areas. The brain is incredibly complex, and while Alzheimer’s is the most common cause of dementia, it is not the only one. But I’m more optimistic than ever about what’s coming down the pipeline because Alzheimer’s research has moved into a modern era, not only in the breadth of its targets but in its ability to implement more rigorous clinical trials that track and determine the relationship between biomarker and clinical outcomes.

If Aduhelm and other anti-amyloid antibodies that follow it are, at best, just one incremental piece of the puzzle, how do the blanks get filled in? For a start, it is time for everyone in the Alzheimer’s ecosphere to look toward a broader and more diverse approach to curing this devastating disease and speed the development of new, effective therapies to treat and prevent Alzheimer’s disease and related dementias.

More — and better — biomarkers

A critical driver of better and faster clinical trials are biomarkers — objectively measurable biological and behavioral characteristics that correlate with Alzheimer’s disease — that are essential for improving trial design and quickly advancing the current pipeline of novel targets.

Biomarkers are already being used to great effect in early-stage trials, quickly telling researchers whether an experimental drug is engaging with its intended target in the brain. They are also playing a larger role in later-stage trials, providing better and quicker ways to screen and enroll patients whose Alzheimer’s disease profile includes the characteristic the experimental drug is meant to work on, and then by providing an easy means for tracking the effects of treatment. Biomarker data from brain amyloid PET scans, for example, provided the primary data for Aduhelm’s Food and Drug Administration accelerated approval.

Biomarkers are also making their way into clinical practice. Physicians can now use tests of blood and cerebrospinal fluid to measure brain amyloid levels in people experiencing early signs of mild cognitive impairment or dementia. The day will soon come when a simple blood sample, retina scan, or even a smartphone app will be able to identify underlying causes of Alzheimer’s during a doctor visit, allowing for treatment to be matched to a patient’s unique pathology.

As more drugs are developed against a wide range of targets, biomarkers must play a bigger role than ever in clinical trials. Researchers worldwide are working toward validating additional blood and other non-invasive tests that can measure brain levels of everything from tau and other toxic proteins to biological indicators of neuroinflammation, synaptic malfunction, and changes in metabolism. These new biomarker tests will be essential for both clinical trials and clinical practice.

Value-generating exploratory trials

Alzheimer’s researchers need to work together to conduct more biomarker-powered exploratory trials to more quickly and effectively assess whether a drug has promise. By adopting best practices in designing exploratory trials, researchers and companies can be more confident in using their results to make the all-important go/no-go decisions about advancing drugs to larger, later-stage trials.

In 2019, the Alzheimer’s Drug Discovery Foundation (which I co-founded) and the Association for Frontotemporal Degeneration convened an advisory panel of experts to provide recommendations on ways to optimize the design and application of exploratory trials. The panel’s recommendations, published last year in the journal Neurology, are designed to improve trial designs and engage patients more efficiently. When it comes to clinical trials, participants are a limited resource, so it is vitally important, especially for rarer forms of dementia, that they are matched to the right trials and that these trials run as efficiently as possible so each patient’s involvement is valued and maximized.

Repurposed drugs

Policies that support efforts to bring repurposed drugs to the market are also urgently needed. Repurposed drugs start with an advantage because some of the research, including essential information about safety in humans, has already been done. But they are hampered by the economic disadvantage of limited returns on investment.

The pressure from patient advocacy groups for the FDA to approve and for Medicare to cover Aduhelm — a drug that was at best only going to have a modest incremental benefit — reflects the understandable public hunger for new Alzheimer’s treatments. It also underscores the urgent need for better ways to get effective drugs to market for the millions living with Alzheimer’s.

It’s encouraging to see broader consensus in the research community for the need to take fresh looks at the biology of aging. In a 2021 Alzheimer’s Clinical Trials report, the Alzheimer’s Drug Discovery Foundation analyzed the approximately 120 clinical trials underway that are tackling a variety of age-related pathways.

These efforts will open the doors to new breakthroughs and the kinds of combination therapies that have changed the lives of people with cancer, diabetes, HIV, and other diseases. At this pivotal moment, academia, industry, regulatory agencies, patient advocates, venture philanthropists, and others need to work together as a community to accelerate the move into this new era of treatment possibilities for people with Alzheimer’s.

Howard M. Fillit is a neuroscientist and geriatrician, the co-founder and chief science officer of the Alzheimer’s Drug Discovery Foundation, and a clinical professor of geriatric medicine and palliative care, medicine, and neuroscience at the Icahn School of Medicine at Mount Sinai. He reports having consulted for various pharmaceutical companies, including Alector, LifeWorx, Eli Lilly, Otsuka Pharmaceuticals, and others. 

https://www.statnews.com/2022/06/07/its-time-to-move-past-aduhelm-and-focus-on-a-broader-alzheimers-drug-pipeline/

Looming Patent Cliff will be Pharma’s Moment of Truth

 A patent cliff is looming once again for the biopharma industry, putting some $236 billion in pharmaceutical sales at risk between now and 2030. For context, the top 10 biopharmas in 2021 had total, global sales of approximately $512 billion. In the next eight years, more than 190 drugs will go off-patent for these companies. Of those, 69 are blockbuster drugs.

“Depending on the company, on paper, the losses represent from 14% to 79% of their revenues,” Maria Whitman, global head of ZS Associates’ pharmaceutical and biotech practice, told BioSpace. “That’s $6 to $38 billion that any one company will lose in revenues. Another way to think about it is, five of today’s top 10 pharmas (by income) will have more than 50% of their revenues at risk.”

Many of the affected drugs are biologics, including – in the latter half of the decade – newer drugs like Keytruda. “Chronic obstructive pulmonary disease (COPD), non-small cell lung cancer, HIV, type II diabetes and oncology are the top areas that will be affected,” Whitman said, and BMSAbbVie and Novartis – in that order – are expected to be hardest-hit.

Maria Whitman_ZS AssociatesThe industry faced a similar patent cliff that began around 2008. Compared to that cliff, “The curve will be a bit slower, in part because of the biologics,” she said. For example, in the previous cliff, traditional molecules often saw 90% of their revenues lost to generics in a three-to-six-month period. This coming patent cliff may see market share declines of the biologics in the range of 30% to 70% in the first year in the United States and Europe, respectively, linked – largely – to biosimilar adoption across global healthcare systems.

Companies won’t make up the losses with their current pipelines or by adding an asset or two this time.

“The replenishment rate – the ability to make up the losses within five years – is decreasing. Projecting out the risk-adjusted pipeline through 2026, the top ten will still have an average of 44% of their revenues at risk,” Whitman said. “That’s partially because of the scale of these companies and because the historic return on investment for the big players has been creeping down toward zero. As of 2020, the ROI was about 2%.

A focus on AI and automation in R&D are helping to change the tide. Even so, innovation has to come from outside the company, through alliances, business development and licensing in the increasingly proliferative (60-80% of new innovation) and competitive biotech space.” Biotech accounts for 60 to 80% of the innovation in the industry today, she said.

“With about $180 billion in ‘dry powder’ sitting with the top 12 companies alone, we can anticipate more mergers and acquisitions activity,” Whitman predicted. In this new reality, other survival strategies from the previous patent cliff are less effective than previously. Therefore, companies need to drive more value, reduce costs and enhance their capabilities.

Focus R&D Efforts  

Last year, ZS conducted research to understand whether there was value in focusing on certain therapeutic categories to build scientific and commercial synergies. “We found that 66% of the revenue from the top 20 companies comes from three therapy areas (which vary, depending on the organization). The companies that have average-to-better focus achieved a 7% annualized growth rate, versus 0.2% for other companies, and added 50% more to their market capitalization.

“So, if you are a very diverse pharma company, your best move is to focus,” she continued. Conversely, if your company is focused on one key area, consider what that market will be in the future, where you should go next and how you can have impact. “Oncology, for example, represents 22% of worldwide revenues now and will represent 27% in 2030, but it is also the number one area of development, and the bar of “unmet need” will be higher for differentiation.

“The next era is about outcomes,” Whitman said, “and pharma is at a moment of truth in company strategies around focus, innovation and in particular, how they can affect patient outcomes beyond the medicine. For example, in the past, we spent time helping the doctor find the patient, and now we have to help the patient find the right doctor and the right care.”

Local Market vs. Centralized Support

Whitman added that companies need to significantly reduce their selling, general and administrative (SG&A) costs. That’s already starting, “but when you look globally, pharma companies are reflecting on how to balance serving markets at a local level versus centralizing support.”

Leaders in the industry are, therefore, focusing their operational infrastructure on local support for the countries that are most meaningful to them, and are using a centralized approach to cover the others.

Any structure must be flexible for policy and access changes. European drugmakers, for instance, proposed a plan by which drugmakers would file for pricing and reimbursement in all EU member states within two years of EU market authorization. (The current timeframes range from 133 days for Germany to 899 days for Romania, thus delaying access to therapeutics.)

For China, pharma companies are taking highly varied approaches from building infrastructure to watching and waiting, Whitman said. “There are a lot of regulatory changes in China,” she noted, predicting that it will be an innovator and will compete with the West.

Leverage Digitization in Pipeline Decisions

Digitization also presents opportunities for biopharma efficiency and cost-containment. Opportunities exist in the R&D process, regulatory submissions, data fluidity and artificial intelligence (AI) to become faster and more effective throughout a drug’s lifecycle. “Therefore, many companies are building data science capabilities in a more thoughtful and strategic way for both commercial and R&D operations,” Whitman said.

This includes using AI to assess possible assets and alliances in terms of the potential for regulatory approval and commercial ROI. Applying AI and machine learning to the assessments is improving companies’ abilities to predict which molecules and alliances will succeed. ZS has an exclusive consulting partnership with Intelligencia AI, which, on a Phase II oncology program using these methods accurately predicted 73% of the drugs that were eventually approved and 78% of the drugs that were not approved, Whitman said. Such insights can help partners and investors develop more accurate valuations for assets to fill their pipelines.

Improve Launch Strategies

The success of any asset also requires a successful product launch. Therefore, she said, “We have to become better at launching fewer blockbusters and more products that are less sizable and that peak earlier than anything we’ve experienced in the past, and we have to do this better than we do today.”

ZS data shows that of 142 drugs launched between 2019 and 2021, 53% failed to meet launch expectations. Under-performing launches accounted for 53% of big pharma launches, 63% of launches from emerging pharmas that had launch experience and 42% of launches from first-time launchers. Overall, 38% of drug launches overperformed and 9% of drug launches met expectations.

There are a few reasons for this, Whitman said. “First launchers do a bit better because they have to be specific and focused.” Additionally, ZS research shows that “Safety and efficacy only get you so far. The definition of ‘unmet needs’ is shifting.” For example, adherence and convenience become more important in markets with multiple effective competitors.

Clearly, companies need to be increasingly agile and thoughtful about every aspect of operations. How they prepare to meet the coming challenges will determine whether today’s top companies will also be on top in 2030.

https://www.biospace.com/article/looming-patent-cliff-will-be-pharma-s-moment-of-truth/

CDC raises monkeypox alert to level 2, recommends masks during travel

 The CDC raised its alert level for monkeypox to level 2 on Monday, recommending that travelers wear masks, among other health measures.

While not on the level of COVID-19, monkeypox has spread across the globe out of Africa since March. Monkeypox symptoms begin as relatively flu-like but soon expand to the swelling of lymph nodes and a rash across the body and face. Ultimately, painful lesions form on rash areas, leaving severe scarring.

“Cases of monkeypox have been reported in Europe, North America, South America, Africa, Asia, and Australia,” the CDC wrote in its alert.

“Some cases were reported among men who have sex with men. Some cases were also reported in people who live in the same household as an infected person,” it added.

The disease may have gone undetected in Western countries under the guise of an STI, according to Dr. Amesh Adalja. There are a number of STIs that have similar symptoms to monkeypox.

“What’s likely happened is an endemic infectious disease from Africa found its way into a social and sexual network and then was greatly aided by major amplification events, like raves in Belgium, to disseminate around the world,” Adalja told NBC News.

https://nypost.com/2022/06/06/cdc-raises-monkeypox-alert-to-level-2-recommends-masks-during-travel/

Monday, June 6, 2022

Phase separation found in immune response within cells

 Protein complexes that play a critical role in launching an immune response assemble in droplets that form within the liquid environment in cells much like oil droplets in water, UT Southwestern scientists report in a new study. The findings, published in Molecular Cell, could lead to new interventions to regulate immunity in individuals with overactive or underactive immune responses.

"These droplets basically function as microreactors that concentrate proteins and their substrates within. It's like forming compartments without needing membranes to surround them," said study leader Zhijian "James" Chen, Ph.D., Professor of Molecular Biology and Director of the Center for Inflammation Research at UTSW, a Howard Hughes Medical Institute Investigator, and winner of the 2019 Breakthrough Prize in Life Sciences.

More than two decades ago, the Chen lab discovered that a protein called ubiquitin assembles into chains inside cells when the cells are exposed to inflammatory molecules, such as interleukin-1β (IL-1β) or tumor necrosis factor α (TNFα). Dr. Chen and his colleagues showed that the chains are key for promoting an immune response and can activate a group of proteins known as the IκB complex (IKK), which includes a component known as NEMO. This complex in turn triggers a protein called NF-κB to move to the nucleus and turn on hundreds of immune-related genes. But how the polyubiquitin chains, NEMO, and IKK come together has been unclear.

To answer this question, Dr. Chen's team mixed ubiquitin and NEMO in test tubes with a protein called TRAF6, which promotes ubiquitin to assemble into chains. They saw that NEMO and the polyubiquitin chains assembled into liquid droplets that stayed separate from the liquid medium in the test tubes. Experiments in human cells showed that NEMO and the polyubiquitin chains displayed the same "phase separation" behavior after the cells were exposed to IL-1β or TNFα. When IKK entered these droplets, it became activated and triggered NF-κB to move to the nucleus. The longer the polyubiquitin chains, the larger the droplets they formed with NEMO and the stronger the immune response they triggered, Dr. Chen explained.

The team further studied this process using NEMO that was altered by mutations associated with a rare disease known as NEMO deficiency syndrome, which severely blunts immune response to bacterial infections. NEMO that carried these mutations could not effectively condense into droplets with polyubiquitin chains, preventing the cascade of events that triggers an immune response.

Dr. Chen noted that better understanding of this liquid phase separation phenomenon could eventually lead to treatments for NEMO deficiency syndrome and interventions to counteract overactive or underactive immunity, the root cause of autoimmune disorders and increased susceptibility to infection, respectively.

Dr. Chen is a George L. MacGregor Distinguished Chair in Biomedical Science and a member of the National Academy of Sciences.

Mingjian Du, Ph.D., a postdoctoral fellow in the Chen lab, is lead author of this study. Other UTSW researchers who contributed to this study include Chee-Kwee Ea and Yan Fang.

This research was supported by grants from the Cancer Prevention and Research Institute of Texas (RP180725, RP210041) and The Welch Foundation (I-1389).


Story Source:

Materials provided by UT Southwestern Medical CenterNote: Content may be edited for style and length.


Journal Reference:

  1. Mingjian Du, Chee-Kwee Ea, Yan Fang, Zhijian J. Chen. Liquid phase separation of NEMO induced by polyubiquitin chains activates NF-κBMolecular Cell, 2022; DOI: 10.1016/j.molcel.2022.03.037

New evidence for an autoimmune cause of schizophrenia

 Schizophrenia is a disorder that affects how people act, think, and perceive reality. It is often very difficult to treat because it has many different causes and symptoms. In a study published last month in Cell Reports Medicine, researchers from Tokyo Medical and Dental University (TMDU) have identified an autoantibody -- a protein that is produced by the immune system to attach to a specific substance from the individual's own body, rather than to a foreign substance like a virus or bacteria -- in some patients with schizophrenia. Notably, they also found that this autoantibody caused schizophrenia-like behaviors and changes in the brain when they injected it into mice.

When considering possible autoantibodies that might cause schizophrenia, the research team had a specific protein in mind. Previous research has suggested that neural cell adhesion molecule (NCAM1), which helps cells in the brain talk to one another via specialized connections known as synapses, may have a role in the development of schizophrenia.

"We decided to look for autoantibodies against NCAM1 in around 200 healthy controls and 200 patients with schizophrenia," explains lead author of the study Hiroki Shiwaku. "We only found these autoantibodies in 12 patients, suggesting that they may be associated with the disorder in just a small subset of schizophrenia cases."

The research team didn't stop there -- they wanted to know whether these autoantibodies could cause any changes that commonly occur in schizophrenia, so they purified autoantibodies from some of the patients and injected them into the brains of mice.

"The results were impressive," says Hidehiko Takahashi, senior author. "Even though the mice only had these autoantibodies in their brains for a short time, they had changes in their behavior and synapses that were similar to what is seen in humans with schizophrenia."

Specifically, mice with the patient autoantibodies had cognitive impairment and changes in their regulation of the startle reflex, which are both seen in other animal models of schizophrenia. They also had fewer synapses and dendritic spines, which are structures that are important for the connections between brain cells, and are also affected in schizophrenia.

Given that schizophrenia can present very differently among patients and is often resistant to treatment, the results of this study are promising. If schizophrenia is indeed caused by autoantibodies against NCAM1 in some patients, this will lead to important improvements in their diagnosis and treatment.


Story Source:

Materials provided by Tokyo Medical and Dental UniversityNote: Content may be edited for style and length.


Journal Reference:

  1. Hiroki Shiwaku, Shingo Katayama, Kanoh Kondo, Yuri Nakano, Hikari Tanaka, Yuki Yoshioka, Kyota Fujita, Haruna Tamaki, Hironao Takebayashi, Omi Terasaki, Yukihiro Nagase, Teruyoshi Nagase, Tetsuo Kubota, Kinya Ishikawa, Hitoshi Okazawa, Hidehiko Takahashi. Autoantibodies against NCAM1 from patients with schizophrenia cause schizophrenia-related behavior and changes in synapses in miceCell Reports Medicine, 2022; 3 (4): 100597 DOI: 10.1016/j.xcrm.2022.100597