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Brain links to embryonic immunity, guiding response of the troops that battle infections – Tufts Now

Posted: February 4, 2020 at 7:46 pm

MEDFORD/SOMERVILLE, Mass. (February 4, 2020)Researchers led by biologists at Tufts University have discovered that the brains of developing embryos provide signals to a nascent immune system that help it ward off infections and significantly improve the embryos ability to survive a bacterial challenge. Using frog embryos, which continue to develop with their brains removed, the researchers found that embryos without a brain are not able to marshall the forces of immune cells to an injury or infection site, leading the embryo to succumb to an infection more quickly. By contrast, the presence of a brain crucially helps direct immune cells to the site of injury to overcome the bacterial threat. The study was published today in NPJ Regenerative Medicine.

In a developing embryo, both brain and immune system are not fully formed. The immune system, for its part, consists mostly of an innate system of cells that respond immediately to infection and do not require training or produce antibodies. Nevertheless, these cells require signals that prompt them to move toward an infection site and trigger a response.

The research team found that the brain appears to contribute to the signals that guide the nascent immune system. When brainless frog embryos were infected with E. coli, only about 16% of embryos survived, while the presence of a brain protected more than 50% from the infection. By following markers of immune cells, researchers confirmed that the effect is not due to the missing brain somehow hampering immune system development because the composition of the immune cells remained the same with or without a brain. Instead, they found that the effect was due to the brain sending signals to the immune cells to move toward the site of an infection.

We found that macrophages innate immune system cells that can swallow up bacteria and destroy them to reduce the burden of an infection do not migrate appropriately without the presence of the brain said Michael Levin, Vannevar Bush Professor of Biology at Tufts Universitys School or Arts and Sciences and Associate Faculty at Harvards Wyss Institute, director of the Allen Discovery Center at Tufts and corresponding author of the study. Without the brain and its neurotransmitter signals, gene expression and innate immune system activity go awry, resulting in increased susceptibility to bacterial pathogens.

Other roles for the embryonic brain signaling during infection may include inducing cellular responses, for example preventing cell death or reducing inflammation, that help protect against the harmful effects of the infection.

Immune system abberations were also observed in brainless embryos that were further developed. When the researchers tracked myeloid cells, a class of immune cells that includes macrophages, neutrophils and others, after an injury, they found that the myeloid cells in brainless embryos gathered in locations far from the injury site. By contrast, myeloid cells in normal embryos with intact brains would pile up at the injury site to assist in healing. In fact, in the brainless embryo, the myeloid cells tended to cluster around abnormal, disorganized peripheral nerve networks, also a by-product of brain absence, as demonstrated in earlier studies.

An examination of aberrations in genetic expression in brainless embryos also pointed to the reduction of the neurotransmitter dopamine (a signaling chemical used in the brain for learning and motivation), and that dopamine may play a role in activating immune cells to migrate in the early stages of an infection. The absence of an immune cell quorum at the infection site leads the brainless embryos to become more susectible to its lethal effects.

Our results demonstrate the deep interconnections within the bacteria-brain-body axis: the early brain is able to sense the pathogenic bacteria and to elaborate a response targeted to fight against the cellular and molecular consequences of the infection, said Celia Herrera Rincon, Research Scientist II at the Allen Discovery Center at Tufts, and first author of the study.

Other authors of this study include: Jean-Francois Par, Christina Harrison, Alina Fischer, and Sophia Jannetty at the Allen Discovery Center at Tufts; Christopher Martyniuk, associate professor in the Department of Physiological Sciences at University of Florida; and Alexandre Dinis and Vishal Keshari, graduate students, and Richard Novak, senior staff engineer at the Wyss Institute for Biologically Inspired Engineering, Harvard Universiy.

This research was supported by the Templeton World Charity Foundation Independent Research Fellowship (TWCF0241) and the Allen Discovery Center program through The Paul G. Allen Frontiers Group (12171), as well as The Defense Advanced Research Projects Agency(DARPA, W911NF-16-C-0050), and the National Institutes of Health (AR055993, AR061988). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Herrera-Rincon, C., Par, J-F, Martyniuk, C.J., Jannetty, S.K., Harrison, C., Fischer, A., Dinis, A., Keshari, V., Novak, R., and Levin, M. An in vivo brainbacteria interface:

the developing brain as a key regulator of innate immunity. NPJ Regenerative Medicine (31 Jan 2020) DOI: 10.1038/s41536-020-0087-2

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About Tufts University

Tufts University, located on campuses in Boston, Medford/Somerville and Grafton, Massachusetts, and in Talloires, France, is recognized among the premier research universities in the United States. Tufts enjoys a global reputation for academic excellence and for the preparation of students as leaders in a wide range of professions. A growing number of innovative teaching and research initiatives span all Tufts campuses, and collaboration among the faculty and students in the undergraduate, graduate and professional programs across the university's schools is widely encouraged.

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Noise-induced hearing loss blocked with drug compound – Washington University School of Medicine in St. Louis

Posted: February 4, 2020 at 7:46 pm

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Signals that cause damage blocked in mice

Inner hair cells of the cochlea (green and blue) excite auditory nerve fibers (red) by releasing glutamate, a chemical signal that helps convert sound waves into electrical signals that travel to the brain. But too much glutamate can be harmful, leading to noise-induced hearing loss. Studying mice, researchers at Washington University School of Medicine in St. Louis and their colleagues have shown that a drug compound can block damage caused by too much glutamate signaling, raising the possibility of medication that prevents noise-induced hearing loss.

Loud noise can damage the inner ear and cause hearing loss. Studying mice, researchers at Washington University School of Medicine in St. Louis and the University of Iowa have shown that a drug compound can block damage caused by loud noise, raising the possibility of medication that prevents noise-induced hearing loss.

The study is published the week of Feb. 3 in the Proceedings of the National Academy of Sciences.

The spiral-shaped cochlea of the inner ear is responsible for detecting sound. Inner hair cells lining the cochlea transform the mechanical vibrations of sound waves into chemical signals. These chemicals primarily one called glutamate are then released from the hair cells and received by glutamate receptors on the auditory nerve fibers that then send electrical impulses to the brain. There, the signals are interpreted as language, music or signs of danger, for example.

The junction between a hair cell and a nerve fiber is called a synapse. Loud noise can release too much glutamate, overwhelming the glutamate receptors, which leads to loss of synapses and, eventually, a condition called sensorineural hearing loss. More than 460 million people worldwide live with hearing loss that negatively impacts their daily lives, according to the World Health Organization. By 2050, that number is projected to increase to more than 900 million.

Sensorineural hearing loss is the most common sensory deficit worldwide, and there are no medicinal treatments for preventing it, said co-author Mark A. Rutherford, PhD, an assistant professor of otolaryngology at Washington University. Glutamate receptors are essential for hearing, but overstimulating them can lead to irreversible damage to synapses. What we have found is that glutamate receptors are not all the same, allowing us to block some while leaving others unblocked. When we blocked one subclass of glutamate receptor while leaving the other active, we prevented the damage while maintaining hearing function.

These two different types of receptors those that allow calcium to pass through and those that dont are present at the same synapses. Normally, both are activated when transmitting sound information to the auditory nerve. Rutherford and his collaborators at the University of Iowa found that a compound called IEM-1460 blocks the portion of these receptors that allows more calcium to pass through. In doing so, they prevent the damage, but the receptors that are not blocked allow hearing to continue.

Blocking all of the receptors would, in theory, protect hearing but also cause temporary deafness perhaps similar to the effect of wearing ear plugs. This perhaps would be helpful for long-term hearing preservation but not ideal in situations where people are exposed to dangerous levels of noise but still need to hear what is happening around them.

For military personnel going into combat, for example, its important to find a way to protect hearing from noise damage while still allowing them to hear in that moment, Rutherford said. We showed that this compound selectively blocks the receptors responsible for the damage, while allowing other receptors to continue working normally so there is little interference with the hearing function.

Said senior author Steven H. Green, PhD, of the University of Iowa: Even moderate noise can cause damage to these synapses, and the damage accumulates as we age. With our aging population, the number of people living with disabling hearing loss is increasing rapidly. This is the motivation behind our labs collaboration: We are seeking preventive therapies that can protect this vital sensory function in the setting of damaging noise levels while still letting people hear as they normally would.

For this preliminary study in mice, a surgical procedure was used to apply the drug directly into the inner ear in a continuous flow. With potential therapies in mind, future work involves examining whether delivery of the drug by injection or orally or by placing it into the ear canal, in the form of ear drops, for example, or some combination of delivery methods could achieve the same effect. The IEM-1460 compound has never been tested in people, but it has been safely administered to small mammals as well as nonhuman primates in other types of neurobiology research, according to the investigators.

This work was supported by the National Institutes of Health (NIH), grant numbers DC002961 and DC014712; the Department of Defense (DOD), grant number W81XWH-14-1-0494; and the American Hearing Research Foundation.

Hu N, Rutherford MA, Green SH. Protection of cochlear synapses from noise-induced excitotoxic trauma by blockade of Ca2+-permeable AMPA receptors. Proceedings of the National Academy of Sciences. Feb. 3, 2020.

Washington University School of Medicines 1,500 faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Childrens hospitals. The School of Medicine is a leader in medical research, teaching and patient care, ranking among the top 10 medical schools in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Childrens hospitals, the School of Medicine is linked to BJC HealthCare.

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Hoth Initiates Preclinical Gene Therapy Program with NC State for the Treatment of Asthma and Allergic Inflammation – BioSpace

Posted: February 4, 2020 at 7:46 pm

NEW YORK, Feb. 4, 2020 /PRNewswire/ --Hoth Therapeutics, Inc. (NASDAQ:HOTH), a biopharmaceutical company focused on unique targeted therapeutics for patients suffering from dermatological indications ranging from atopic dermatitis, psoriasis and acne along with gene therapy treatment for asthmatics, is pleased to announce the initiation of a preclinical study for the treatment of asthma and allergic inflammation in collaboration withNorth Carolina State University(NC State).

The study has begun thedelivery and distribution of nebulized particleswhich willenable the therapeutic oligonucleotide (oligo), short DNA and RNA molecules that have a wide range of applications in gene testing.Hoth has appointed Dr. Glenn Cruse to its Scientific Advisory Board and will oversee the Company's gene therapy programs advancements.

Mr.Robb Knie, Chief Executive Officer of Hoth Therapeutics, Inc. commented,"We are extremely pleased that our gene therapy program with NC State has officially begun and that Dr. Cruse who is overseeing the advancement ofexperimentshas joined our Scientific Advisory Board. Commencement of this initiative is an important step in the development and growth of our company. Dr. Cruse's expertise asa leading mast cell biologist in allergic and inflammatory diseases will be invaluable for the preclinical development of Splice-switching oligonucleotides (SSOs) for asthma."

In November 2019 Hoth entered into a licensing agreement with North Carolina State University (NC State) to study NC State's Exon Skipping Approach for Treating Allergic Diseases. This Exon Skipping Approach was developed by Dr. Glenn Cruse, Principal Investigator and Assistant Professor in the Department of Molecular Biomedical Sciences at the NC State College of Veterinary Medicine. During Dr. Cruse's research, a new approach for the technique of antisense oligonucleotide-mediated exon skipping to specifically target and down-regulate IgE receptor expression in mast cells was identified. These findings set a breakthrough for allergic diseases as they are driven by the activation of mast cells and the release of mediators in response to IgE-directed antigens.

Glenn Cruse completed his Ph.D. at Glenfield Hospital, The University of Leicester, UK in 2009. He then moved to the National Institutes of Health in Bethesda, Maryland in January 2010 to start a visiting postdoctoral fellowship in the Laboratory of Allergic Diseases, NIAID, In January 2015, Dr. Cruse was appointed as a Research Fellow in the same laboratory. Dr. Cruse joined the Department of Molecular Biomedical Sciences at NC State in January 2016 as an Assistant Professor.

Dr. Cruse is a mast cell biologist that has authored and co-authored over 30 publications including articles in top journals such as the New England Journal of Medicine, Proceedings of the National Academy of Sciences USA and Immunity. The Cruse lab is interested in the role that mast cells play in allergic and inflammatory diseases and identifying novel therapeutics that target mast cells. Since mast cells act as sentinel cells that participate in both innate and acquired immunity, particularly at biological barriers, emphasis on diseases in tissues at the interface with the environment such as the lung, skin, gastrointestinal tract and even the neuro-immune axis are the main focus of the lab.

About Hoth Therapeutics, Inc.Hoth Therapeutics, Inc. isa clinical-stage biopharmaceutical company focused on developing new generation therapies for dermatological disorders. HOTH's pipeline has the potential to improve the quality of life for patients suffering from indications including atopic dermatitis, chronic wounds, psoriasis, asthma and acne. To learn more, please visitwww.hoththerapeutics.com.

Forward Looking StatementsThis press release includes "forward-looking statements" within the meaning of the Private Securities Litigation Reform Act of 1995. Forward-looking statements in this press release include, but are not limited to, statements that relate to the advancement and development of the BioLexa Platform, the commencement of clinical trials, the availability of data from clinical trials and other information that is not historical information. When used herein, words such as "anticipate", "being", "will", "plan", "may", "continue", and similar expressions are intended to identify forward-looking statements. In addition, any statements or information that refer to expectations, beliefs, plans, projections, objectives, performance or other characterizations of future events or circumstances, including any underlying assumptions, are forward-looking. All forward-looking statements are based upon Hoth's current expectations and various assumptions. Hoth believes there is a reasonable basis for its expectations and beliefs, but they are inherently uncertain. Hoth may not realize its expectations, and its beliefs may not prove correct. Actual results could differ materially from those described or implied by such forward-looking statements as a result of various important factors, including, without limitation, market conditions and the factors described under the caption "Risk Factors" in Hoth's Form 10K for the period endingDecember 31, 2018, and Hoth's other filings made with the Securities and Exchange Commission. Consequently, forward-looking statements should be regarded solely as Hoth's current plans, estimates and beliefs. Investors should not place undue reliance on forward-looking statements. Hoth cannot guarantee future results, events, levels of activity, performance or achievements. Hoth does not undertake and specifically declines any obligation to update, republish, or revise any forward-looking statements to reflect new information, future events or circumstances or to reflect the occurrences of unanticipated events, except as may be required by law.

ContactsInvestor Relations Contact:Phone: (646) 756-2997Email:investorrelations@hoththerapeutics.comwww.hoththerapeutics.com

KCSA Strategic CommunicationsValter Pinto(212) 896-1254Hoth@kcsa.com

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Injecting nanoparticles in the blood curbed brain swelling in mice – Science News

Posted: February 4, 2020 at 7:46 pm

Injecting a swarm of nanoparticlesinto the blood of someone who has suffered a brain injury may one day help tolimit the damage if experimental results in mice can be translated to humans. In mice, these nanoparticlesseemed to reduce dangerous swelling by distracting immune cells from rushing to aninjured brain.

The results, describedonline January 10 in the Annals ofNeurology, hint that the inflammation-fighting nanoparticles might somedaymake powerful medicine, says John Kessler, a neurologist at NorthwesternMedicine in Chicago. All the data we have now suggest that theyre going to besafe, and theyre likely to work for people, Kessler says. But we dont knowthat yet.

After an injury, tissueoften swells as immune cells flock to the damage. Swelling of the brain can be dangerousbecause the brain is contained within the skull and theres no place to go, Kesslersays. The resulting pressure can be deadly.

But nanoparticles might serveas an immune-cell distraction, the results in mice suggest.

Headlines and summaries of the latest Science News articles, delivered to your inbox

Two to three hours after ahead injury, mice received injections of tiny biodegradable particles made ofan FDA-approved polymer the same sort thats used in some dissolving sutures. Instead of rushing towardthe brain, a certain type of immune cell called monocytes began turning theirsights on these invaders. These monocytes engulfed the nanoparticles, and thecells and their cargo got packed off to the spleen for elimination, theresearchers found. Because these nanoparticles are quickly taken out ofcirculation, the researchers injected the mice again one and two days later, inan effort to ease inflammation that might crop back up in the days after theinjury.

Mice that received the nanoparticles fared better after their brain injuriesthan mice that didnt get the nanoparticles. Ten weeks after the injury, thedamaged spots themselves were about half as big as the spots in mice thatdidnt receive the treatment, suggesting the damage was stalled in the micethat got nanoparticles.

Other tests showed that bothbrain swelling and scarring were less severe in mice that had receivednanoparticles. Mices vision cells performed better in response to light. And behaviorimproved, too. Mice were able to walk better across a ladder if they had receivedthe nanoparticle decoys. The scope of the animals improvements was a muchbigger effect than you actually expected or hoped for, Kessler says.

Other potential nanoparticle therapies rely on tethering drugs or other cargo to thenanoparticles themselves (SN: 3/7/19).But in this study, the nanoparticles were bare. Thats different from what wetypically think of as a nanoparticle treatment, says Forrest Kievit, abiomedical engineer at the University of NebraskaLincoln. That simplicity might make the manufacturingof these particles more straightforward than other, more complicatednanoparticles, a benefit for potential clinical trials.

Kievit cautions, however,that there are many differences between mice and human brain injuries: the typeand severity of the injuries and the timelines for recovery are different, forinstance. And the ways that the brain suffers after a hard hit involves morethan just a harmful immune response. Toxic substances can accumulate and spreadto unaffected areas, for instance.

Still, Kessler is optimisticthat these nanoparticles hold promise not just for treating brain injuries, butalso for a wide range of ailments that involve a potentially damaging immuneresponse. In 2014, researchers found that nanoparticlesdistracted monocytes from causing inflammation in other circumstances in mice. Similar nanoparticles seemed toimprove mices heart health after undergoing a blockage that mimics a heartattack. Nanoparticles also seemed to ease signs of inflammatory bowel disease,and boosted survival of mice infected with West Nile virus.

There are few ways to treat traumaticbrain injuries, Kessler says. Theres nothing thats really been able to makea dent in this disease. Thats why it would be so exciting if it really works.

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Edited Transcript of VRTX earnings conference call or presentation 30-Jan-20 9:30pm GMT – Yahoo Finance

Posted: February 4, 2020 at 7:46 pm

Q4 2019 Vertex Pharmaceuticals Inc Earnings Call

Cambridge Feb 4, 2020 (Thomson StreetEvents) -- Edited Transcript of Vertex Pharmaceuticals Inc earnings conference call or presentation Thursday, January 30, 2020 at 9:30:00pm GMT

TEXT version of Transcript

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Corporate Participants

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* Charles F. Wagner

Vertex Pharmaceuticals Incorporated - Executive VP & CFO

* Jeffrey Marc Leiden

Vertex Pharmaceuticals Incorporated - Chairman, CEO & President

* Michael Partridge

Vertex Pharmaceuticals Incorporated - SVP of IR

* Reshma Kewalramani

Vertex Pharmaceuticals Incorporated - Chief Medical Officer

* Stuart A. Arbuckle

Vertex Pharmaceuticals Incorporated - Executive VP & Chief Commercial Officer

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Conference Call Participants

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* Alethia Rene Young

Cantor Fitzgerald & Co., Research Division - Head of Healthcare Research

* Brian Corey Abrahams

RBC Capital Markets, Research Division - Senior Biotechnology Analyst

* Cory William Kasimov

JP Morgan Chase & Co, Research Division - Senior Biotechnology Analyst

* Konstantinos Biliouris

Morgan Stanley, Research Division - Research Associate

* Liisa Ann Bayko

JMP Securities LLC, Research Division - MD and Senior Research Analyst

* Michael Jonathan Yee

Jefferies LLC, Research Division - Equity Analyst

* Paul Andrew Matteis

Stifel, Nicolaus & Company, Incorporated, Research Division - Co-Head of the Biotech Team, MD & Senior Analyst

* Philip M. Nadeau

Cowen and Company, LLC, Research Division - MD & Senior Research Analyst

* Robyn Kay Shelton Karnauskas

SunTrust Robinson Humphrey, Inc., Research Division - Research Analyst

* Salveen Jaswal Richter

Goldman Sachs Group Inc., Research Division - VP

Story continues

* Whitney Glad Ijem

Guggenheim Securities, LLC, Research Division - Senior Analyst of Biotechnology

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Presentation

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Michael Partridge, Vertex Pharmaceuticals Incorporated - SVP of IR [1]

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Good evening. Welcome to the Vertex Full Year and Fourth Quarter 2019 Financial Results Conference Call. This is Michael Partridge, Senior Vice President of Investor Relations for Vertex. Making prepared remarks on the call tonight, we have Dr. Jeff Leiden, Chairman and CEO; Dr. Reshma Kewalramani, Chief Medical Officer; Stuart Arbuckle, Chief Commercial Officer; and Charlie Wagner, Chief Financial Officer. We recommend that you access the webcast slides on our website as you listen to this call. This conference call is being recorded, and a replay will be available on our website.

We will make forward-looking statements on this call that are subject to the risks and uncertainties discussed in detail in today's press release and our filings with the Securities and Exchange Commission. These statements, including, without limitation, those regarding Vertex's marketed CF medicines, our pipeline and Vertex's future financial performance are based on management's current assumptions. Actual outcomes and events could differ materially.

I will now turn the call over to Dr. Jeff Leiden.

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Jeffrey Marc Leiden, Vertex Pharmaceuticals Incorporated - Chairman, CEO & President [2]

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Thanks, Michael. Good evening, everyone. We saw many investors and analysts at the JPMorgan Conference 2 weeks ago. So I'll spend just a few moments highlighting our 2019 achievements in what we believe sets Vertex apart for the future.

2019 was a truly remarkable year for Vertex. All parts of our business met or exceeded the goals we set at the start of the year. And as a result, we are very well positioned to bring our CF medicines to many more people and to advance our broad pipeline in additional diseases in 2020.

In cystic fibrosis, the U.S. approval of TRIKAFTA for patients 12 and older in October, 5 months ahead of our PDUFA date, was the most significant milestone to date in our efforts to bring new CF medicines to all people with this disease. TRIKAFTA is a remarkable medicine that holds the potential to treat up to 90% of all people with CF. As you'll hear from Stuart, the U.S. launch of TRIKAFTA in patient ages 12 and older is off to a very strong start. There's clear interest in TRIKAFTA across all groups of eligible patients, and the early feedback from both patients and doctors is highly positive.

Outside the U.S., in 2019, we reached a number of key reimbursement agreements for our CF medicines that will allow many thousands of new patients to begin treatment with our CFTR modulators in countries, including England, France, Spain, Australia and many others throughout 2020.

We're also making excellent progress advancing and broadening our pipeline beyond CF. As we enter 2020, we are now in the clinic with multiple new medicines in 5 diseases outside of CF. We continue to implement our strategy of advancing a portfolio of medicines into clinical development for each of the disease areas. Key programs include alpha-1 antitrypsin deficiency. Our AAT program, where we have multiple small molecule correctors in the clinic, aimed at addressing the underlying cause of disease in both the liver and the lung. These include VX-814, which has recently entered Phase II clinical development.

Beta-thalassemia and sickle cell disease, where we announced clinical data for 2 patients treated with CTX001, a onetime CRISPR-Cas9 ex vivo gene editing therapy, which suggest that we may be able to functionally cure these diseases.

FSGS, where our first small molecule aimed at halting the progression of the disease will move into Phase II development in 2020. And type 1 diabetes, where we are developing an autologous islet transplantation therapy with cells alone and a second with a combination of cells and a device to correct islet cell function and potentially transform the treatment of this disease.

Importantly, these pipeline programs now span multiple modalities, including small molecules where Vertex has excelled in the past, but also new approaches such as cell and genetic therapies. For these new modalities, we've acquired or partnered with leading companies who have the best teams and unique expertise to manufacture and deliver transformational therapies for diseases that fit our strategy.

And in business development, we completed more transactions in 2019 than in the 4 prior years, including our acquisitions of Semma with a leading cell therapy approach for type 1 diabetes, and Exonics, the leader in gene editing for DMD and DM1.

In summary, 2019 was the combination of almost a decade of focused execution against our strategy of discovering and developing transformative medicines for serious diseases in specialty areas, by focusing on validated targets and predictive biomarkers that will improve the probability of clinical success. Our strategy is playing out exactly as we had planned and will position us for continued short-term and long-term growth. The company has never been stronger or better positioned for future success in CF and beyond.

Let me now turn the call over to Reshma, who will talk in more detail about the year ahead.

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Reshma Kewalramani, Vertex Pharmaceuticals Incorporated - Chief Medical Officer [3]

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Thanks, Jeff. Our 2019 progress has positioned us for continued growth in 2020 and for many years to come. We are focused on bringing our CF medicines to more people, advancing our pipeline and building financial strength to support continued investment in internal and external innovation. In 2020, we expect to gain approval for the triple combination in Europe in patients 12 years and older and to submit TRIKAFTA for approval in the U.S. for children ages 6 to 11.

Beyond CF, we are advancing multiple molecules in our pipeline through late preclinical and early clinical development and are now entering a period of multiple proof-of-concept data readouts and clinical advances with potentially transformative medicine. With our AAT program, we recently initiated a Phase II proof-of-concept study of the small molecule corrector VX-814 in patients with 2 copies of the Z mutation and expect data from the study in 2020. In APOL1-mediated FSGS, we completed a Phase I study of VX-147 in late 2019 and expect to initiate an open-label Phase II proof-of-concept study in 2020 to evaluate the reduction in protein levels in the urine with VX-147.

In pain, having established proof-of-concept data from NaV1.8 inhibition with VX-150 in multiple Phase II studies, our focus is now to find the optimal molecule or molecules to advance into mid- and late-stage studies. We are continuing to advance a portfolio of medicines into clinical development, and we'll be advancing an additional molecule into Phase I development in the first half of 2020. We have discontinued Phase I development of VX-961 because it did not display an optimal PK and tolerability profile.

Beyond our small molecule programs, we've made significant progress in building and progressing a portfolio of cell and genetic therapies in line with our research strategy, primarily through our business development activities. We are highly encouraged by our recent clinical data for our CRISPR-Cas9 ex vivo gene editing treatment, CTX001, for beta-thalassemia and sickle cell disease. Both studies continue to enroll, and we expect to provide additional data for this program in 2020.

I'd also like to highlight our cell therapy approach for Type 1 diabetes. This program comes to us from our acquisition of Semma Therapeutics in October of 2019. The team of scientists at Semma have cracked the biology on both the production and scale-up of fully mature islet cells and has developed a novel implantable device to protect these cells from the immune system, while preserving cell health and function. We have set an ambitious goal to progress this program into clinical development in late 2020 or early 2021.

In summary, we've made outstanding progress in CF and multiple other diseases in 2019. And I look forward to updating you on our progress over the coming months and years.

I'll now turn the call over to Stuart.

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Stuart A. Arbuckle, Vertex Pharmaceuticals Incorporated - Executive VP & Chief Commercial Officer [4]

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Thanks, Reshma. I am pleased to review with you this evening, our strong commercial performance for 2019. Our full year 2019 CF revenues were $4 billion, up from $3 billion in 2018, which represents year-over-year growth of 32%. This growth in total revenues was driven primarily by the full year impact of the SYMDEKO launch in the U.S. and Germany, label expansions for our CF medicines globally and the early approval and launch of TRIKAFTA in the U.S.

The launch of TRIKAFTA is off to a very strong start. Our fourth quarter total CF product revenues were approximately $1.25 billion, including TRIKAFTA revenues of $420 million, making TRIKAFTA already our top-selling medicine. I would note that our fourth quarter revenues include, as expected, launch-related stocking of approximately $100 million. Approximately 18,000 patients are eligible for TRIKAFTA in the U.S., which represents the largest patient population eligible for one of our CF medicines at the time of approval and launch. For 6,000 of these people, this is the first time they have had a medicine to treat the underlying cause of their CF. We are seeing strong interest from all groups of eligible patients, including new initiations as well as patients transitioning from our other CFTR modulators.

Our commercial supply, market access, patient support, marketing and field teams were ready for an early approval. And since October, these teams have been doing a phenomenal job with CF centers and commercial and government payers. The centers and their multidisciplinary teams have done a remarkable job responding to the high patient demand. And while still early in the launch, we are on track to obtain broad reimbursement for TRIKAFTA in the U.S., similar to what we have seen for our other CF medicines. Together, these factors have combined to produce the strong start to the launch.

Outside the U.S., we reached multiple reimbursement agreements in 2019 in key countries, which will enable many thousands of patients to initiate treatment with certain Vertex medicines for the first time. While TRIKAFTA will be the main driver of Vertex's revenue growth in 2020, we also expect an increase in international revenues based on more patients initiating treatment with our medicines outside the U.S.

In summary, I am pleased that we are bringing our medicines to many more patients around the globe.

And with that, I'll now turn the call over to Charlie.

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Charles F. Wagner, Vertex Pharmaceuticals Incorporated - Executive VP & CFO [5]

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Thanks, Stuart. I will provide additional remarks this evening regarding our 2019 financial results, and I will also discuss our 2020 financial guidance. All of the results and guidance I will discuss are non-GAAP.

As Stuart mentioned, we had fourth quarter total CF product revenues of approximately $1.25 billion, a 45% increase compared to 2018. Our fourth quarter 2019 combined R&D and SG&A expenses were $496 million, including the operating expenses of Exonics and Semma compared to $400 million in the fourth quarter of 2018. Significant growth in revenues and disciplined spending in the fourth quarter resulted in operating income of $593 million, a 70% increase compared to the fourth quarter of 2018.

Net income for the fourth quarter of 2019 was $444 million compared to $337 million for the fourth quarter of 2018. Our full year financial results reflect a similar story of strong revenue growth and disciplined spending, resulting in exceptional operating income growth.

Our total CF revenues for 2019 were $4 billion, a 32% increase over full year 2018. Our 2019 combined R&D and SG&A expenses were $1.69 billion compared to $1.53 billion for 2018. Our full year operating income was $1.79 billion for 2019 compared to $1.11 billion for 2018, a year-over-year increase of more than 60%.

As our profitability and cash flow increased as a result of treating more CF patients globally, we have deliberately reinvested in both internal and external innovation to create future medicines. In 2019, we invested approximately $1.6 billion in external innovation through new acquisitions and collaborations. Even with the significant BD activity, we ended the year with approximately $3.8 billion in cash and marketable securities compared to $3.2 billion at the end of 2018. As we look ahead to 2020 and beyond, we expect continued increases in cash flow to provide more flexibility for additional investments to fuel our long-term growth.

Now on to 2020 guidance. Today, we're providing 2020 financial guidance for total CF product revenues as well as for combined non-GAAP R&D and SG&A expenses and our anticipated effective tax rate. The strong uptake of TRIKAFTA and the recent completion of reimbursement agreements outside the U.S. have positioned Vertex for continued strong revenue growth in 2020. Our 2020 guidance for total CF product revenues is $5.1 billion to $5.3 billion, which at the midpoint reflects approximately 30% growth over 2019.

I would note a few dynamics that are reflected in our 2020 guidance. As part of the strong launch of TRIKAFTA, that Stuart mentioned, we saw an expected launch-related inventory build of approximately $100 million in the fourth quarter that we do not expect to repeat in 2020. Also, as we move through 2020, as with all of our CFTR modulators, persistence and compliance dynamics will affect TRIKAFTA revenues, and therefore, our experience with our other CF medicines is factored into our guidance.

Lastly, we expect gross to net adjustments of 13% to 14% for 2020. Focusing in on Q1 2020, we expect our revenues to be modestly higher than Q4 2019 revenues. This reflects the impact of the fourth quarter inventory build as well as gross-to-net adjustments in the first quarter of each year that are generally higher relative to the previous quarter.

We expect 2020 combined R&D and SG&A expenses of $1.95 billion to $2 billion. The increase compared to 2019 is primarily driven by the launch of TRIKAFTA globally and the expansion of our R&D pipeline into additional diseases. Our R&D expense growth includes increased investment to advance our programs and selling genetic therapies, including type 1 diabetes and DMD.

Now to tax guidance, where we expect our full year non-GAAP tax rate to be 21% to 22%. The tax rate may fluctuate quarter-to-quarter, with the highest rate occurring in the fourth quarter. The vast majority of our tax provision will be noncash expense until we fully use our net operating losses. As Jeff noted, Vertex has a unique long-term growth potential that is based on continued revenue growth in CF and an expanding pipeline, and with continued spending discipline, we expect operating margins, earnings and cash flow to continue to increase.

Now back to Jeff for a few concluding comments.

--------------------------------------------------------------------------------

Jeffrey Marc Leiden, Vertex Pharmaceuticals Incorporated - Chairman, CEO & President [6]

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Bent into shape: The rules of tree form – Knowable Magazine

Posted: February 4, 2020 at 2:46 am

Theres a place in West Virginia where trees grow upside-down. Branches sprout from their trunks in the ordinary fashion, but then they do an about-face, curving toward the soil. On a chilly December day, the confused trees bare branches bob and weave in the breeze like slender snakes straining to touch the ground.

Its really kind of mind-boggling, says plant molecular biologist Chris Dardick, waving toward the bizarro plum trees. Theyre completely messed up.

Im visiting an orchard at the Appalachian Fruit Research Station, an outpost of the US Department of Agriculture nestled in the sleepy Shenandoah Valley. Here, at Dardicks workplace, the disoriented plums are but one in an orchard of oddities, their outlines, seasonally stripped of leaves, standing out in stark relief.

There are trees with branches that shoot straight up, standing to attention in disciplined rows, with nary a sideways branch. There are trees with branches that elegantly arch, like woody umbrellas; others with appendages that lazily wander this way and that.

Dwarf trees crouch, sporting ball-like crowns akin to Truffula trees. Compact trees poke from the ground in clumps of scraggly, knee-high sticks. Apple trees with some hidden predicaments grow in a greenhouse nearby: Their roots reach sideways rather than down. The topsy-turvy growth of all of these trees comes from genetic variations that cause the dialing up, dialing down or elimination altogether of the activity of key genes controlling plant architecture.

Understanding these misfits has real-world applications: It could help grow the next generation of orchards that, densely packed with trees, produce more fruit while using less land and labor than today. But Dardick is also trying to answer a fundamental question: How do different trees get their distinctive shapes? From the towering spires of spruce and fir, the massive spreading limbs of an oak to the stately arching canopies of an elm, the skeletal shapes of trees offer signature silhouettes.

Dardicks work and that of other researchers also could help to explain how the shapes of individual trees are far from fixed. Trees, much more than we can, will morph in response to their literal neck of the woods. Limbs in the shade reach toward spots of sunlight. Trees on windswept hills bend trunk and branches into gnarled architectures.

The familiar shape of a regular plum tree (left) is transformed by dialing down the activity of certain plant architecture genes, leading to plums with erect branches that shoot straight up (middle) or plums with branches that cascade downward (right).

CREDIT: C. HOLLENDER (LEFT), C. DARDICK (CENTER AND RIGHT)

Work by breeders, biologists and botanists have revealed sizable pockets of knowledge about the hormones, genes and processes that yield the diverse shapes of trees and other plants, between species and within species. It has not been easy: Two of trees most appealing attributes their long lives and large sizes make them intractable research subjects.

But as scientists pursue these questions, commonalities are emerging between vastly different species. The puzzle of shape diversity and adaptability turns out to be tied to the fundamentals of being a plant: grappling with gravity, fighting for sunlight, all while anchored in one place for a lifetime.

Plants are stuck. The best they can do is grow toward something, says Courtney Hollender, a former postdoc of Dardicks who now runs her own lab in the Department of Horticulture at Michigan State University in East Lansing. Thats all theyve got; they cant run, they have to adapt to their environment. And theyve developed brilliant ways to do it.

Scientists have a word for the ability to adapt so readily: plasticity. In plants, this feature is both obvious and astounding. Most animals are born in specific shapes then just grow larger, but plants are modular they grow in various iterations of two building blocks: shoots and roots.

It is the first of these where and when a shoot grows or doesnt grow that governs the basic form a tree takes.

Some aspects are hardwired. Leaves emerge in a pattern that is usually fixed throughout the trees life, with structural arrangements that tend to be shared by members of a given plant family. And shoots emerge where leaves meet the stem. So, for example, plants in the maple family, which have leaves set opposite each other, have branches in the same format. Members of the beech family have leaves, and thus branches, that alternate up the stem.

But the interplay between physiology and external forces also plays a large part. Take your standard-issue plant with a main central stem that grows upward and has few side branches. Most plants, from basil to birch, start out this way, a growth habit that probably evolved because it enables them to quickly reach the light more rapidly than the competition. Called apical dominance (the tip of the plant is the apex), this is largely under the purview of the plant hormone indole acetic acid, also known as auxin. Made in the tip, auxin diffuses downward and blocks the growth of side branches.

This is why pinching the tips off of basil or geranium makes them bushy you are removing the source of that bossy auxin, freeing buds on the stems sides from the prohibition and allowing them to grow. (Though auxin is mighty, its not the only player here. Other plant hormones, along with light intensity and access to nutrients, also wield power.)

Another related and less-understood phenomenon occurs in some tree species. Called apical control, it also is imposed by the tip of a tree and probably also by auxin. But rather than operating at the scale of a branch, it commandeers the whole dang tree.

Think of a pine. At the top, theres a pointy tip, then upper branches that tend to reach skyward. Moving down, the branches become more horizontal, growing out more than up. But unlike a basil plant, a pine tree does not become bushy when you lop off the top. Instead, a new bud near the top grows upward, becoming the new leader. Or an existing branch reorients to grow up and become the new dominant tip.

These two principles are always in the back of arborists minds as they work. They have to consider, If we cut a branch here, that bud below is going to break and well just get a branch in basically the same spot, Dardick says. All of their rules of what to prune and where are based on these physiological factors that contribute to tree shape.

Physiology also underpins the plastic responses trees have to more extreme situations they may face. A tree on a high mountain peak or windswept coast must contend with exposure to mechanical forces that could topple and kill it. To survive, such trees become short and stocky, their bent, asymmetric crowns reducing drag and presumably protecting a tree from violent gusts. The driver is the winds very touch a response now called thigmomorphogenesis that has been observed for hundreds of years.

How it works is still unclear, but over the past decade researchers have made some headway. Theyre actively studying force-sensing proteins and processes that may be involved. And recent work suggests an important role for hormones such as jasmonate, which accumulates in all kinds of plants in response to damage and mechanical stress. In experiments with a weedy mustard called Arabidopsis, plants became stunted when researchers bent their leaves back and forth twice a day.Mutants that couldnt make jasmonate, though, grew normally.

Sometimes, wind does more than gust against a tree: It blows the whole tree over, and that tree, if still rooted, must reorient the growth of its branches and buds toward the sky. Avalanches, erosion and landslides deal similar fates. And trees in all sorts of circumstances must grow around obstacles, away from competitors and toward the light. To get these jobs done, trees make a special kind of wood called reaction wood.

Trees may become contorted in challenging physical environments, such as this ridge in the Rocky Mountains. The touch of wind and other forces prompt physiological responses by the plant that yield a shorter, stockier stature, gnarled asymmetric shape and the development of specialized wood. This characteristic tree form is called a krummholz (German for crooked wood).

CREDIT: BRYCE BRADFORD / FLICKR

Hardwoods such as maple, beech, oak and poplar form this tough stuff (in this case called tension wood) on the upper side of their stems. Incredibly, it creates a tensile force thatpullsthe stem upward. If you walk around the woods, you can see that most species, if not all species, have this kind of reaction wood response, says Andrew Groover, a research geneticist with the USDA Forest Services Pacific Southwest Research Station in Davis, California.

The hardwood tree first discerns that it is off-kilter using specialized gravity-sensing cells. Where these cells reside in trees the woody stem? the tip of new shoots? was unknown until Groover and colleagues detected them in woody and soft tissues of poplar, a few years back. The cells contain organelles called statoliths that sink down in the cell and indicate to the plant that its leaning one way or the other. This, in turn, causes that influential auxin to mobilize, triggering the growth of tension wood on the top. Cellulose with a peculiar gelatinous layer is thought to act as the muscle that generates the pulling-up force.

In this experiment, young, potted poplar trees were placed sideways to investigate the plantsgravity-sensing machinery. The poplar in this time-lapse movie, taken over two weeks, responded to being tipped on its side by reorienting its growth upward. The plant hormone auxin is key to this response. Mutants that cannot respond appropriately to auxins signaling instructions do not right themselves this way. (This particular poplar also received a dose of a chemical called gibberellic acid that interacts with auxin, so that scientists could learn more about its role.)

CREDIT: ANDREW GROOVER AND SUZANNE GERTTULA, US FOREST SERVICE, PACIFIC SOUTHWEST RESEARCH STATION DAVIS CA

Much of the knowledge about the architecture of plants is rooted in millennia of human efforts to alter crop shapes to make them more suitable for cultivation, and modern science is now revealing the genetic changes that lie behind these creations. The lessons, it turns out, apply broadly across the plant kingdom, to herbaceous and woody species alike.

It is hard to overstate the importance to human history of some of these plant-shape changes, says plant molecular geneticist Jiayang Li, who details some of their genetic underpinnings in the Annual Review of Plant Biology. A classic example is the transformation of the ancestor of corn (maize) into a key staple crop for much of the world. It arose from a species of the Central American grasses called teosintes bushy plants with many branches. Domestication, among other things, abolished that branching, yielding the single-stalked upright corn we plant today.

Similarly, explains Li, who works at the Chinese Academy of Sciences Institute of Genetics and Developmental Biology, the green revolution of the 20th century ushered in compact, dwarf varieties of wheat and rice. By modifying the height and thickness of the stems of these grasses, breeders developed varieties that could carry more grain without toppling over in wind and rain.

Much of Lis own research has focused on architectural variation in rice, although the work turns out to have implications for the architecture of plants in general, from lowly mosses to towering trees. Like other grasses, rice grows shoots called tillers specialized, grain-bearing branches that emerge from the base. In cultivated rice, the angle at which these tillers grow varies widely: Some varieties are squat and wide-spreading, others have shoots that are more upright. Breeders are interested in altering tiller angle because upright plants can be grown more densely, giving farmers more bang for their acreage.

In a key advance, in 2007, a team including Li reported theyd discovered the genetic cause of the spread-out architecture trait. The scientists named the responsible gene TAC1, short for tiller angle control. A functional TAC1 gene increases rices tiller angle, leading to open, widely branching plants. Mutations in TAC1 lead to the opposite: plants with erect shoots that reach up, instead of out.

That same year, Lis team and a group in Japan both reported another major achievement: finding a long-sought gene behind a curious trait in some rice varieties that gives plant branches a scruffy, lounging look. The trait, known as lazy, had intrigued plant breeders and geneticists since the 1930s, when researchers described its extreme manifestation in corn: The lazy plants grow along the ground, following the unevenness of the surface.

In ordinary rice (left), the hormone auxin helps to tell the plant which direction is up. Auxin transport within the plant goes awry when a gene called LAZY malfunctions, leading to confused plants with sprawling branches (right).

CREDIT: B. WANG ET AL / AR PLANT BIOLOGY 2018

The cause, it turns out, was errors in a gene that normally makes branches shoot straight up. Li and his colleagues surveyed some 30,000 mutant rice plants to pin down that gene, now called LAZY (names of genes, confusingly, often refer to what happens when a gene is mutated and doesnt work, rather than when it is functioning properly). And they provided convincing evidence for an idea batted around for decades that lazy plants have muddled perceptions of gravity and that auxin is centrally involved.

A common test for whether a plants gravity-perception machinery is working is to lay the plant on its side. If it knows up from down, it wont continue to grow sideways, but will start to grow up again, akin to the reaction-wood response of a toppled trees branches. An important step in this reorienting involves auxin pooling on the bottom side of the shoot. But in lazy mutants, proteins that help ferry auxin around the plant are malfunctioning, so instead of shoots growing in the correct direction, theyre prone to casually sprawl about.

Scientists now know that LAZY genes come in multiple versions. Some appear to operate in plant roots, telling them which way is down, probably using similar, auxin-related signals. If those genes are absent or inactive, confused roots grow upward. And though the genes were first found in monocots, a branch of the plant kingdom including rice and corn, researchers now know that LAZY genes exist in numerous plants, including the plums growing in the fruit research station in West Virginia.

A lazy mutant of corn (left) compared with normal corn (right). Such corn mutants were described nearly 100 years ago, but it took 21st century molecular biology to nail down the growth habitscause: genetic malfunctions that meddle with responses to gravity.

CREDIT: T.P. HOWARD III ET AL / PLOS ONE 2014

As our boots crunch along the uneven ground, Dardick points at an errant orchard cat watching our tree tour from a distance. One row of trees stands so upright that a fencepost at the end of it is enough to block the row from view. These regimented trees are pillar peaches, and they are favorites of landscapers (one reason: its easy to get around them with a lawnmower). They also were key to uncovering genes like LAZY and TAC1 at the Shenandoah Valley station.

By comparing ordinary peaches to pillar peaches, and drawing on decades of work by former lead scientist Ralph Scorza, a team of station scientists and others in the US and Germany discovered the cause of the pillar trait: mutations in the peach version of TAC1.

Many of the strange plant architectures under investigation existed as naturally occurring varieties that were developed by breeders for ornamental gardens or orchards; only recently have the genes underlying these forms been identified. Its now known that the upright growth habit of the pillar peach (center), available commercially under the nameCrimson Rocket,results from mutations in a gene that helps plants branch outward.

CREDIT: C. DARDICK

The team also found that LAZY was at work in many of their misfits. Just as with the corn plants described nearly 100 years ago, mutations in LAZY made plums grow topsy-turvy, their branches seeking the soil. Apple trees with LAZY mutations have similarly disoriented roots. And when multiple copies of LAZY genes malfunction in the weed Arabidopsis, its roots grow up, its shoots down.

In the last decade, researchers have found that TAC1 influences branch angle in plums, poplar trees, the grass Miscanthus and Arabidopsis, and it appears to affect leaf angle in corn. But LAZY genes have even deeper roots. Theyre found in all manner of plants, including the evolutionarily older Loblolly pine and even more ancient mosses.

This finding suggests a very old role for LAZY: It may have allowed plants to grow up, literally, when they first colonized land. Plants got their start in water. There, rootless and leafless, they were buoyed, unconcerned with gravity. The transition to land spurred the development of proper roots and stems, and plants then had to figure out up from down. LAZY seems to have allowed plants to orient their above-ground growth away from gravity and up toward the sun.

Scientists think that TAC1 evolved somewhat later, providing a counterpoint to LAZY ensuring that branches dont only grow straight up, but also reach out. Together, these genes laid critical groundwork for the diversity of plant forms we see today, all seeking sustenance in their own ways.

Once you start to grow up as a vascular plant, you need to maximize your resources, you need to capture as much sun as possible, says Hollender, who has been working on yet another gene, called WEEP, that when nonfunctional lends plants a weeping, waterfall-like structure seen here and there in trees of ornamental gardens. (But its probably not responsible for the shape of weeping willow trees.) Modifying your shoot angles is an important adaptive trait for plants that allows them to capture light. Its essential for them to survive.

This kind of research has broad economic implications. Fruit and nut trees bring $25 billion annually in the US alone and there are hefty costs associated with pruning, bending and tying branches; spraying hormones; and the manual labor of picking fruit from an unruly cacophony of limbs. Understanding the genetic controls behind tree architecture could help scientists breed trees that make the whole fruit-farming enterprise more efficient and environmentally friendly.

Orchard systems are not the most sustainable in the world, Dardick says. The idea is, if we can modify tree architecture, if we could reduce their size and limit the amount of area they take up, then we could plant them at higher density and potentially increase their sustainability.

And there may be odder outcomes than friendlier outdoor orchards: In collaboration with NASA, the USDA team is investigating genetic tweaks that might even help bring fruit to space. On that December day, Dardick takes me to a greenhouse tucked in a corner of the lab. In it are plum and apple trees whose shape is so transformed that they look more like the love children of shrubs and vines. This strange growth habit is a side-effect of efforts to breed plants that flower and make fruit sooner and then do so continuously, rather than flowering after growing for several years, and then only in the spring.

The genetic tweaks that sent the trees developmental program into overdrive have also transformed their architecture. In the greenhouse, these precocious trees sprawl, draping lazily along wire trellises, happily flowering and heavy with fruit. Theyre growing almost like tomatoes, Dardick says. So were broaching the concept of, can we bring an orchard indoors?

The strange, vine-like growth of this plum results when a gene controlling the timing of flower development malfunctions. Such unusually shapedtrees may facilitate indoororchards that produce fruit many months of the year.

CREDIT: C. SRINIVASAN

Those ambitions aside, Dardick has his hands full trying to answer numerous basic-science questions about how trees do what they do. Researchers still dont know how different tree species set the angles of their branches going wide like an oak, or arching like an elm. They dont know how trees alter those angles during the course of mature growth, as branches sprout from branches sprouted from branches, until some of them finally point down. Trees are both kindred and foreign to us, their various forms so familiar, but their architectural rules still in so many ways opaque.

I find myself looking at trees all the time now in a new way; they fill space so beautifully and efficiently, Dardick says. They are the biggest organism we have thats visible, thats in our face all the time. But theres so much we dont know.

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Delegate Wilson Introduces Bill to Limit Gender Reassignment and Hormone Therapy for Minors – WOAY NEWSWATCH

Posted: February 4, 2020 at 2:45 am

CHARLESTON, W.Va. Delegate S. Marshall Wilson, I-Berkeley, today announced the introduction of a bill to limit gender reassignment surgeries and hormone replacement therapies to consenting adults in this state.

House Bill 4609 would create new code stating that any minor seeking gender reassignment surgery before 18 years of age shall be denied any such request on the basis that the minor cannot provide consent for gender reassignment surgery by any licensed healthcare provider that provides services in this state.

It is my belief that its simple common sense to recognize that irreversible, life-altering decisions such as permanently changing the appearance and function of ones body or losing the ability to procreate should be made by thoughtful adults rather than by adolescents, said Delegate Wilson.

Additionally, the bill states parents, guardians, or other legal custodians of a minor child seeking gender reassignment surgery may not substitute his or her consent for that of the minor child for purposes of circumventing this proposed new law, if passed.

House Bill 4609 was introduced Jan. 30 and was referred to the House Judiciary Committee.

Tyler Barker is currently the News Director and Digital Content Manager for WOAY-TV. He was promoted to this job in Mid-November. He still will fill in on weather from time to time. You can Follow Tyler on Facebook and Twitter @wxtylerb. Have any news tips or weather questions? Email him at tbarker@woay.com

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Forum: Evaluate stance on hormone replacement therapy due to risks – The Straits Times

Posted: February 4, 2020 at 2:45 am

Breast cancer is the most common cancer in women. Also, it is a cancer that, after treatment, can recur more often, even after many years of remission. In the light of this, it is important to consider any factor that increases the risk.

A meta-analysis published in the medical journal The Lancet last August has added to the body of evidence which highlights the risk of breast cancer with hormone replacement therapy (HRT).

The meta-analysis points to an excess breast cancer risk associated with the use of all types of HRT, except vaginal oestrogens.

It also found that the excess risk of breast cancer with systemic HRT persisted after stopping HRT for more than 10 years, when compared with newer users.

The potential harm may outweigh the potential benefits for women who are using HRTs for the long-term prevention of osteoporosis. There are other non-HRT therapies for the treatment and prevention of osteoporosis.

Also, HRT does not protect post-menopausal women against cardiovascular events and heart disease, and hence should not be used for this purpose.

After the publication of studies highlighting the risk in 2002 and 2003, the use of HRT declined for a while.

However, there seems to be a resurgence in the use of HRT, with doctors dismissing the risk as minimal and communicating that HRT use for a short time is relatively safe.

In the light of the Lancet publication, there needs to be an evaluation of such a stance, especially as breast cancer is not a cancer to be taken lightly.

Quek Koh Choon

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Women faces months waiting for out-of-stock hormone replacement therapy treatments – Evening Standard

Posted: February 4, 2020 at 2:45 am

The latest headlines in your inbox

Women going through the menopause face more shortages of hormone replacement therapy drugs.

Health Secretary Matt Hancock has pledged to intervene but drugs companies admit some treatments will be out of stock until later this year.

Munira Wilson, the Lib-Dem MP for Twickenham, said the lack of availability of HRT drugs for some women was critical. She challenged Mr Hancock in Parliament to address the shortages, which first emerged about a year ago.

She told the Standard: Anecdotal evidence I have picked up from talking to people, and what Ive found out, has concerned me. HRT helps manage a lot of difficult symptoms of the menopause.

One London woman said she began experiencing problems obtaining Elleste Duet pills almost a year ago. She suffered extreme tiredness, night sweats and sleep deprivation after having to switch medications.

Health Secretary Matt Hancock said shortages of HRT therapies were an incredibly important issue (AFP via Getty Images)

She had to find the next best alternative herself because her GP had little knowledge of the menopause and HRT.

If you find the drug you have tried and tested is no longer available, it is quite difficult, the woman said. You cant just instantly swap to another one [without side-effects]. My experience was when I went to the pharmacist, they were not able to tell me why it was out of stock. They just say its not available.

She added: People think the menopause is something old ladies have. But there will be millions affected.

Andre Frieze, a mother of two and councillor in Richmond, said she had been unable to obtain Evorel patches since the start of the month.

She said they had dramatically improved her quality of life when she started taking them last summer.

How will UK healthcare change after Brexit?

I was sleeping a lot of the time, which is unlike me, she said. Im normally somebody who has quite a lot of energy. Emotionally I would say I was a bit all over the place. My husband started to say he was slightly scared of me.

The day after I had the first patch I just felt myself again. This [supply shortage] is not just about the headaches. It seriously impacts on my ability to live my life as a working woman.

Mr Hancock said shortages of HRT therapies were an incredibly important issue and stemmed from problems with factories abroad. Last October the Government imposed restrictions on exports of UK-manufactured HRT medications in a bid to shore up supplies.

The British Menopause Society this week warned that Indivina tablets will be out of stock until the end of next month, some Evorel patches will not be available until March and some FemSeven patches may be unavailable until next year. Problems are said to include manufacturing issues, shortages of raw ingredients, regulatory issues and some firms withdrawing products.

The Department of Health and Social Care believes supplies will improve by the end of February. It did not know how many women had been unable to receive HRT.

A spokesman said: We understand how distressing the HRT shortage is for women who need these medicines and we have been doing everything we can to ensure they can access them as soon as possible We are working closely with all suppliers to resolve this issue as soon as possible.

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Heart Disease Risk Grows as Women Move Through Menopause – Newswise

Posted: February 4, 2020 at 2:45 am

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Newswise PITTSBURGH, Feb. 3, 2020 A marker for heart disease risk considerably worsens as women transition through menopause, according to a new analysis from the largest and longest running study of womens health in midlife, the Study of Womens Health Across the Nation (SWAN). Black women experience this accelerated decline earlier in menopause than their white counterparts.

According to the research team, led by scientists at the University of Pittsburgh Graduate School of Public Health, the findings add to growing evidence that menopause is a critical time for changes in cardiovascular health and underscore the importance of women and their doctors focusing on heart health during the menopausal transition. The results are reported online and will appear in the March issue of Arteriosclerosis, Thrombosis, and Vascular Biology, a journal of the American Heart Association.

Midlife is not just a period where women have hot flashes and experience other menopausal symptoms said senior author Samar R. El Khoudary, Ph.D., M.P.H., associate professor of epidemiology at Pitt Public Health. Its a time when their cardiovascular disease risk is increasing as we see significant changes in multiple clinical measures of their physical health.

El Khoudary and her team used a subset of data from SWAN Heart, an ancillary study that enrolled women from Pittsburgh and Chicago between 2001 and 2003 and included two examinations of early markers of cardiovascular health over time. Ultimately, 339 women were included in this study, 36% black and the rest white.

The study focused on how arterial stiffness changes as women transition through menopause. Arterial stiffness refers to the elasticity of arteries and is measured by looking at how fast blood flows through arteries. Stiffer arteries can lead to dysfunction in how well the heart pumps and moves blood, and damage to the heart, kidneys and other organs.

The researchers tracked the women through SWAN for up to 12.5 years, or until they reached menopause, allowing them to confidently anchor the arterial stiffness measure to the menopausal transition.

On average, as women went through menopause, their arterial stiffness increased by about 0.9% up to one year before their last menstrual period to about 7.5% within one year before and after their last period, a considerable acceleration. The black women in the study experienced greater increases in arterial stiffness earlier in the transition than white women, more than a year before menopause. The findings held after adjusting for numerous factors that could affect heart health, including waist circumference, blood pressure, lipids, smoking status, physical activity levels and financial stress.

SWAN is a unique source of data on changes in womens health over several decades, and this is the latest in a long line of research by our team and others that indicates the menopausal transition is a very important time for heart health, said lead author Saad Samargandy, M.P.H., a Ph.D. student at Pitt Public Health. While there are limitations to our study, including that a sizeable minority of the women had their arterial stiffness measured at only one time point, we were still able to see that major changes to cardiovascular disease risk happen around menopause.

This study follows several others that link the menopausal transition to the accumulation of heart fat, changes in cholesterol, inflammation and coronary artery calcification, among other heart disease risk factors.

Our study is not able to tell us why were seeing these changes during the menopausal transition, El Khoudary said. But we speculate that the dramatic hormonal changes accompanying menopause might play a role by increasing inflammation and affecting vascular fat deposition, a hypothesis that we would like to test in future studies.

Clinical trials will be needed to test if lifestyle interventions, such as changes to diet or physical activity; medications, such as statins or hormone replacement therapy; or even increased screening and tracking of measures of heart health could be beneficial as women go through menopause, she said.

But we can say, right now, that women should be made aware that their cardiovascular health is likely to worsen as they go through menopause, El Khoudary said. Therefore, frequent monitoring of cardiovascular risk factors may be prudent, particularly in black women who are at even greater risk earlier in the menopausal transition.

Additional authors on this research include Karen A. Matthews, Ph.D., Maria M. Brooks, Ph.D., Emma Barinas-Mitchell, Ph.D., and Jared W. Magnani, M.D., M.Sc., all of Pitt; Imke Janssen, Ph.D., of Rush University; and Steven M. Hollenberg, M.D., of Cooper University Hospital.

This research was funded by National Institutes of Health grants U01NR004061, U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495, HL065581 and HL065591.

To read this release online or share it, visit https://www.upmc.com/media/news/020320-el-khoudary-arterial-stiffness.

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Heart Disease Risk Grows as Women Move Through Menopause - Newswise

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