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Monday, October 10, 2022

TPG Capital closes $2.2B acquisition of claims-editing business ClaimsXten

 With UnitedHealth completing its $13 billion acquisition of Change Healthcare, private equity group TPG Capital finalized its $2.2 billion deal for Change Healthcare's claims-editing business, ClaimsXten.

TPG Capital agreed in April to buy the claims-editing software from UnitedHealth Group but the sale of the payment accuracy company was contingent on the closure of Change Healthcare's merger with UnitedHealth Group. The companies began shopping for a buyer for the payment integrity arm in a bid to secure federal backing to consummate the merger.

"We are pleased to complete our acquisition of ClaimsXten and look forward to working with the team to grow the newly established company," a TPG Capital spokesperson said in an email statement.

TPG funded the deal with $1.2 billion of equity and $1 billion in debt financing.

A federal judge on September 19 ruled that UnitedHealth Group's acquisition of Change Healthcare could proceed, dealing a blow to the Biden administration's healthcare antitrust efforts. District of Columbia Judge Carl Nichols issued a sealed opinion blocking the Department of Justice's attempt to intervene in the case, and ordering Change Healthcare to sell off its ClaimsXten business arm as planned.

The UnitedHealth-Change Healthcare deal went through earlier this month.

According to Nichols' opinion, the company plans to name Change Healthcare executive Carolyn Wukitch as CEO of the ClaimsXten business. She has has been leading ClaimsXten since 2000.

ClaimsXten “deploys automated rulesets to improve payment accuracy, reduce appeals and drive administrative savings," according to Change Healthcare in legal filings.

About 375 employees will continue working with ClaimsXten as part of the divestiture.

In an unsealed court document filed September 7, TPG revealed that it plans to more than double ClaimsXten’s R&D budget from $14 million in in the 2022 fiscal year to $30 million in 2026.

According to the document, TPG said it could accelerate ClaimsXten's growth by investing more in "innovative seeds that the [ClaimsXten] team had planted, but maybe hadn’t invested as thoroughly behind as they could have."

https://www.fiercehealthcare.com/health-tech/tpg-capital-closes-22b-acquisition-claims-editing-business-claimsxten

Improved vehicle for delivering gene therapies to the central nervous system

 The blood-brain barrier (BBB) is an imposing foe for gene therapy. Formed of cells wedged tightly together, the BBB keeps toxins and pathogens that may be present in the blood from entering brain tissue, but it also keeps out potential treatment for diseases that affect the central nervous system (CNS). Researchers have discovered some delivery vehicles — known as adeno-associated viruses (AAV) — that can cross the barrier under certain circumstances, but most of the time, AAVs are inefficient at ferrying gene therapies across. Investigators from Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system, are working to optimize AAVs as gene delivery vehicles, improving their efficiency and their potential to deliver drugs to treat brain cancers such as glioblastoma and genetic diseases that affect the central nervous system. In a paper published in Nature Biomedical Engineering, the research team reports on a new AAV variant tested in preclinical models that is significantly more efficient than previously developed delivery vehicles.

“Our study is exciting because it shows that we are one step closer to being able to deliver gene therapy across the blood-brain barrier in humans,” said Fengfeng Bei, PhD, of the Brigham’s Department of Neurosurgery. “Our findings demonstrate that AAVs could provide a valuable tool for developing systemic gene therapies against glioblastoma and other diseases where CNS delivery is required.”

AAVs are small, non-disease-causing viruses that can be engineered to carry and deliver DNA sequences to targeted cells. Previous studies have found them to be safe delivery vehicles for gene therapy, which aims to directly modify genes in cells to treat disease.

Recent advancements have led to the discovery of a new generation of AAVs that can penetrate the BBB in mouse models, but most AAVs identified to date are not efficient enough to be considered for use in clinical settings. To improve upon existing AAVs, Bei and colleagues turned to cell-penetrating peptides — a group of short peptides that are known to be able to cross biological membranes like the BBB. The team collected about 100 of these peptides and inserted them into a variety of AAVs and tested them one by one to look for the most efficient.

“We got lucky,” said Bei. “We got a hit right around number 16.”

The team tested out their finding in preclinical models, looking in both mice and non-human primates. While the AAV they identified — lucky number AAV.CPP.16 — showed a significant enhancement of delivery efficiency across the blood brain barrier than previously tested AAVs, Bei’s lab is looking to make further improvements.

“We’d like to develop a version that is even more efficient and more restricted to the central nervous system. Our studies to date tell us we’re headed in the right direction,” he said.

These data suggest the novel vector could be used to treat genetic diseases in which turning on protein production in a specified number of cells could reverse a disease. Yulia Grishchuk, PhD, who leads a lab in the Center for Genomic Medicine at Massachusetts General Hospital, recently collaborated with Bei and sees potential disease applications for his research team’s laboratory-based advancements.

“New treatments are urgently needed for neurometabolic diseases, lysosomal storage diseases and other diseases that affect both CNS tissue and other tissues in the body,” said Grishchuk. “What is exciting here is that this work could represent a way to treat a broad spectrum of CNS disorders that are hard to target with current treatment approaches.”

Disclosures: Bei and co-author E. Antonio Chiocca receive royalties from patents generated by this study. Bei is a co-founder and scientific advisor of Brave Bio Inc., an AAV gene therapy startup. The other authors declare no competing interests.

Funding: This study was supported by a Brigham and Women’s Hospital sundry fund.     

Paper cited: Yao Y et al. “Variants of the adeno-associated virus serotype 9 with enhanced penetration of the blood–brain barrier in rodents and primates” Nature Biomedical Engineering DOI: 10.1038/s41551-022-00938-7


JOURNAL

A potential target for developing broad-spectrum antiviral therapies

 Researchers have identified a promising strategy for development of broad-spectrum antiviral therapies that centers around promoting a strong immune response capable of stopping a number of viruses in their infectious tracks. 

Experiments in cell cultures and mice showed that blocking the function of a specific enzyme present in all cells triggers a powerful innate immune response, the body’s first line of defense against any foreign invader. When challenged by several types of viruses in the study, this response dramatically lowered replication of viral particles and protected mouse lungs from damage.

There are still several avenues to explore, but the scientists say the finding could help change the approach to developing antiviral medications.

“Typically, in antiviral development, the saying is, ‘one bug, one drug,’” said Jianrong Li, co-senior author of the study and a professor of virology in The Ohio State University Department of Veterinary Biosciences and Infectious Diseases Institute.

“A drug that can stimulate the immune system to have broad antiviral activities would be very attractive – one drug against multiple bugs would be an ideal situation.”

The study is published in the journal Proceedings of the National Academy of Sciences.

This discovery was enabled in part by a technique the researchers used to map the precise location of an RNA modification they were studying, and to see which enzyme made the modification. The mapping led them to determine that this enzyme’s work happens not in viruses, but in mammal hosts that viruses want to infect.

“If you can detect the modification, then you can study it and target it. But it took a while to figure this out – in the beginning of the pandemic, a lot of people, including our lab, were studying RNA modifications in hosts and viruses,” said co-senior author Chuan He, John T. Wilson Distinguished Service Professor of chemistry, biochemistry and molecular biology at the University of Chicago. “It turns out the key here is not a viral RNA modification, but a host RNA modification, and it triggers a host immune response.”

Viruses tested against the immune response in this study included two that can cause severe respiratory infections in infants and the elderly, human respiratory syncytial virus and human metapneumovirus, as well as a mouse respiratory virus called Sendai virus, the vesicular stomatitis virus found in cattle and the herpes simplex virus, a DNA virus. Replication and gene expression of all of these viruses were significantly reduced when the enzyme was blocked, and the researchers said preliminary data from earlier studies in cell cultures suggested the SARS-CoV-2 virus could be similarly controlled by this antiviral strategy.

The RNA modification itself, known as cytosine-5 methylation, or m5C, is actually what needs to be altered to trigger the immune system response. It is one of roughly 170 known chemical modifications on RNA molecules in living organisms that affect biological processes in a variety of ways.

In lieu of targeting the modification, researchers were able to inhibit the function of a key enzyme in that process, called NSUN2, to stop the RNA change. Suppressing NSUN2 using gene knockdown techniques and experimental agents, they found, sets off a cascade of cell activities that leads to robust production of type 1 interferon, one of the most potent fighters in the innate antiviral response.

“Amazingly, blockage of NSUN2 almost completely shuts down the replication of vesicular stomatitis virus, a model virus that normally kills the host cells within 24 hours and replicates to a very high titer, and strongly inhibits both RNA and DNA viruses,” said study co-first author Yuexiu Zhang, a PhD student in Li’s lab.

It turns out that blocking NSUN2’s function in cells exposes RNA snippets that, despite belonging to the host, are seen as foreign invaders, which triggers the type 1 interferon production. Once available at this high level, the protein will stop the real threat: viruses trying to cause infection.

The researchers verified this sequence of events during experiments in multiple types of cells and human lung models before observing the effects of blocking NSUN2 in mice.

“We compared NSUN2-deficient mice with wild-type mice to see how the viruses act,” Li said. “Once we inhibited NSUN2, viral replication in the lung decreased and there was less pathology in the lung, and that correlated with enhanced type 1 interferon production.

“This finding in mice and our other experiments proved that NSUN2 is a druggable target.”

Next steps include developing a drug designed specifically to suppress NSUN2’s function, the researchers said.

This study was supported by grants from the National Institutes of Health and the Howard Hughes Medical Institute, where He is an investigator.

Li-Sheng Zhang, a postdoctoral researcher in He’s lab, was co-first author of the work. Additional co-authors include Mijia Lu, Elizabeth Kairis, Valarmathy Murugaiah, Jiayu Xu, Rajni Kant Shukla, Xueya Liang, Estelle Cormet-Boyaka and Amit Sharma of Ohio State; Qing Dai and Zhongyu Zou of the University of Chicago; Phylip Chen and Mark Peeples of Nationwide Children’s Hospital; and Jianming Qiu of the University of Kansas Medical Center.

He is a scientific founder of the drug-development company Accent Therapeutics, and Li and He have filed a provisional patent.

#

Contacts:

Jianrong Li, Li.926@osu.edu
Chuan He, chuanhe@uchicago.edu

Written by Emily Caldwell, Caldwell.151@osu.edu

Estimated global proportion with persistent fatigue, cognitive, and respiratory symptoms after COVID

 About The Study: In this modeling study with data for 1.2 million individuals (from 22 countries) who had symptomatic SARS-CoV-2 infection in 2020 and 2021 and survived the acute phase, an estimated 6.2% experienced at least one of the three Long COVID symptom clusters (persistent fatigue with bodily pain or mood swings; cognitive problems; or ongoing respiratory problems) three months after acute infection onset. The risk of Long COVID was greater in females and in those who needed hospitalization for the initial SARS-CoV-2 infection, particularly among those needing intensive care unit care.

Authors: Theo Vos, Ph.D., of the University of Washington, Seattle, is the corresponding author.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jama.2022.18931)



Use this link to provide your readers free access to the full-text article This link will be live at the embargo time https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2022.18931?guestAccessKey=07377a3e-8fa8-4f8e-b336-381e6899b698&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=101022JOURNAL

New insight on the rise of omicron

 The omicron variant escapes the immune response better than other SARS-CoV-2 variants and their related coronaviruses in humans, bats and pangolins. This finding, published by a research team led by Duke-NUS Medical School and the National Center for Infectious Diseases (NCID), in the journal Nature Microbiology, suggests that omicron evolved from its ancestors to escape immunity from past infection or vaccination, especially that conferred by neutralizing antibodies, in humans during the COVID-19 pandemic.

"We present data indicating that SARS-CoV-2 variants have emerged under immune selection pressure and are evolving differently from related sarbecoviruses circulating in animals with less or no immune selection," said senior co-author of the study Professor Wang Linfa, from Duke-NUS' Emerging Infectious Diseases (EID) Program. Sarbecoviruses are members of the subgenus of beta coronaviruses that encompass SARS-CoV-1, which caused the SARS epidemic in 2003, SARS-CoV-2, which is responsible for the current COVID-19 pandemic, and multiple coronaviruses in bats and pangolins that have the potential to infect humans.

The  is better at escaping the immune response, but it has also helped the highly vaccinated and boosted populations to transition to living with COVID-19.

Senior co-author Professor David Lye, director, Infectious Disease Research and Training Office, NCID, explained, "Omicron's higher transmissibility has resulted in more people acquiring hybrid immunity, which protects better against reinfection and confers mucosal immunity. Mucosal immunity refers to an  in the mucosa, particularly the membrane lining of the nose and throat. Many respiratory viruses first enter the body through these passages, so, boosting localized immunity in these locations can halt pathogens before they spread to the rest of the body.

"A recent study by Duke-NUS found that long-lasting SARS-CoV-2-specific T cells were found in the nasal passages of people who had breakthrough infections following vaccination. Omicron infections in vaccinated and boosted patients are also much milder with much lower rates of lung infections and need for oxygen support."

Additionally, people who had received the Pfizer BioNTech vaccine and had been infected with SARS-CoV-2 had broader immune responses compared to those who had received the vaccine but had not been infected.

Prof. Wang and Prof. Lye were part of an international effort, including scientists in Singapore, Thailand, South Africa, Germany and the U.K., that analyzed immune responses against a variety of sarbecoviruses. They did this by investigating how well serum from people with different immune states was able to neutralize 20 different sarbecoviruses from humans, bats and pangolins, including omicron.

Variants generated in humans during the COVID-19 pandemic were able to escape neutralizing antibodies more efficiently than the sarbecoviruses that originated in animals, providing evidence that variants of concern (VOCs), especially , arose under immune pressure in humans.

"Our findings are highly important, as they will guide us in the future response to the pandemic, including the development of better and more broadly protective vaccines," said Prof Wang, who is also Executive Director of Singapore's Program for Research in Epidemic Preparedness and Response (PREPARE).


Explore further

New study boosts hopes for a broad vaccine to combat COVID-19 variants and future coronavirus outbreaks

More information: Chee Wah Tan et al, SARS-CoV-2 Omicron variant emerged under immune selection, Nature Microbiology (2022). DOI: 10.1038/s41564-022-01246-1
https://medicalxpress.com/news/2022-10-insight-omicron.html

Colonoscopy-screening does not prevent colorectal cancer as well as previously assumed

 On October 10 the world's first randomized study on using colonoscopy-screening to prevent colorectal cancer was presented during the 2022 United European Gastroenterology Week in Vienna.

The full study was also published in New England Journal of Medicine.

"Colonoscopy unfortunately is not a miracle cure for colorectal . According to our study, it probably is not better than the fecal samples," says Michael Bretthauer, professor at the University of Oslo and senior physician at Oslo University Hospital.

Previously, experts have assumed that the effect of using colonoscopy to detect colorectal cancer is higher than using fecal samples. Fecal samples are used in screening programs all over the world today. Researchers have assumed that up to 9 out of 10 colorectal cancer cases can be prevented using colonoscopy. With  the same is assumed to be 2–3 out of 10 cases. In the NordICC-study the researchers wanted to see if colonoscopy-screening actually can help prevent colorectal cancer.

In the study 1.2% of the people who were not randomized for colonoscopy-screening got colorectal cancer after 10 years, compared to 0.98% in the group who was offered screening.

"This means that new cases of colorectal cancer were reduced by 18% among the participants who were offered colonoscopy-screening," Bretthauer says.

The study is lead by Bretthauer and colleagues in the research group Clinical Effectiveness Research (uio.no) at the University of Oslo and Oslo University Hospital. The study is named NordICC, Nordic-European Initiative on Colorectal Cancer (uio.no).

The researchers followed 95,000 participants from four European countries over more than 10 years

The study includes 95,000 participants from Norway, Sweden, Poland and the Netherlands. It is one of the largest randomized studies ever conducted.

Healthy people between the age of 55 and 64 was randomized into two groups: One group was offered one screening with colonoscopy, the other was not offered screening at all. All the participants in the study were followed for over 10 years, to see if colonoscopy prevents colorectal cancer.

In Norway, screening centers were created at Sørlandet Hospital in Kristiansand and Arendal, which carried out thousands of colonoscopies for the study between 2009 and 2014.

Authorities should take the results from the study into consideration when forming Norway's new screening program

The mortality rate for colorectal cancer is generally low in the NordICC-study. Only 3 out of 1,000 died from the disease during the 10 years the researchers followed the participants, regardless of if they were offered screening or not. There was no significant decrease in the mortality rate for the screening group, compared to the group who was not offered screening.

"We are happy to see that the mortality rate is generally low in the study. The numbers are lower than expected when we started the study," Bretthauer says.

The main reason for the low mortality rates is that the  for colorectal cancer have become noticeably better the past 10 years. This makes colonoscopy-screening less effective to prevent patients from dying from colorectal cancer.

"This can mean that introducing screening with colonoscopy as a part of the  screening program in Norway can be less effective than previously assumed. Researchers and authorities should now discuss how the program should proceed from here, taking the results from the NordICC-study into consideration," Bretthauer says.

The researchers will follow the participants in the study the upcoming years, to see if the effect of  gets better with time. The next report from the study is planned published in two years.

More information: Michael Bretthauer et al, Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death, New England Journal of Medicine (2022). DOI: 10.1056/NEJMoa2208375

https://medicalxpress.com/news/2022-10-colonoscopy-screening-colorectal-cancer-previously-assumed.html

New antibiotic comes from a pathogenic bacterium in potatoes

 The growing threat of antimicrobial resistance has led researchers to search for new compounds everywhere. This week in mBio, a multinational team of researchers in Europe report the discovery of a new antifungal antibiotic named solanimycin. The compound, initially isolated from a pathogenic bacterium that infects potatoes, appears to be produced by a broad spectrum of related plant pathogenic bacteria.

Solanimycin acts against a wide range of fungi known to infect and wreak havoc on agricultural crops, according to the researchers. In lab studies, the compound also acted against Candida albicans, a fungus that occurs naturally in the body but can cause dangerous infections. The results suggest that solanimycin, and related compounds, could be useful in both agricultural and clinical settings.

Soil microbes, especially from the Actinobacteria phylum, produce most therapeutic antibiotics used today. The new discovery suggests plant-based microorganisms are worth a closer look, especially as crops develop resistance to existing treatments, says microbiologist Rita Monson, Ph.D., at the University of Cambridge. She co-led the study with molecular microbiologist Miguel Matilla, Ph.D., at the Spanish Research Council's Estación Experimental del Zaidín, in Granada.

"We have to look more expansively across much more of the microbial populations available to us," Monson said.

The pathogenic potato bacterium Dickeya solani, which produces solanimycin, was first identified more than 15 years ago. Researchers in the lab of molecular microbiologist George Salmond, Ph.D., at the University of Cambridge, began investigating its antibiotic potential about a decade ago.

"These strains emerged rapidly, and now they are widely distributed," said Matilla.

Solanimycin isn't the first antibiotic discovered from the microbe. In previous work, researchers found that D. solani produces an antibiotic called oocydin A, which is highly active against multiple fungal plant pathogens.

Those previous discoveries, together with the analysis of the genome of the bacterium, hinted that it might synthesize additional antibiotics, Matilla said, also with antifungal potential. That hint paid off: Matilla, Monson, Salmond and their colleagues found that when they silenced the genes responsible for the production of oocydin A, the bacterium continued to show antifungal activity.

That observation led to the identification of solanimycin and the identification of the gene clusters responsible for the proteins that make the compound.

The researchers found that the bacterium uses the compound sparingly, producing it in response to cell density. An acidic pH environment -- as that present in a potato -- also activates the solanimycin gene cluster. Monson said it almost looks like a clever protective mechanism.

"It's an antifungal that we believe that will work by killing fungal competitors, and the bacteria benefit so much from this," said Monson. "But you don't turn it on unless you're in a potato."

Monson said the researchers have begun collaborating with chemists to learn more about the molecular structure of solanimycin and better understand how it works. Then, she and Matilla said they hope to see continued testing of the compound in plant and animal models.

"Our future steps are focused on trying to use this antibiotic antifungal for plant protection," Matilla said. The research team see the discovery as an encouraging sign that plant pathogens -- like D. solani -- could be coaxed to make compounds that may be used against diseases in plants and people.

"We have to open to the exploration of everything that's out there to find new antibiotics," Matilla said.


Story Source:

Materials provided by American Society for MicrobiologyNote: Content may be edited for style and length.


Journal Reference:

  1. Miguel A. Matilla, Rita E. Monson, Annabel Murphy, Muriel Schicketanz, Alison Rawlinson, Caia Duncan, Juan Mata, Finian Leeper, George P. C. Salmond. Solanimycin: Biosynthesis and Distribution of a New Antifungal Antibiotic Regulated by Two Quorum-Sensing SystemsmBio, 2022; DOI: 10.1128/mbio.02472-22