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Poxel passes 3rd straight Phase III diabetes trial in Japan, but what’s going on with US/EU partner Roivant? – Endpoints News

Posted: December 22, 2019 at 2:42 pm

Poxel and its new diabetes tablet are heading to regulators. Well, in Japan at least.

The French pharma and its Japanese partner Sumitomo Dainippon announced the third straight Phase III success for its new kind of diabetes tablet. In the year-long, open-label TIMES 2 trial, Imeglimin decreased blood sugar levels (HbA1c) as a monotherapy or in combination with one of any of 8 common diabetes drugs. That included a .92% decline when given with DDP-4 inhibitors, one of the most common diabetes meds in Japan.

The results keep Poxelon track for the same 2020 Japanese regulatory submission and 2021 approval they laid out after positive double-blind TIMES 1 results were announced in April. Top-line TIMES 3 results, also positive, were unveiled in November.

The results sent Poxels stock on the European exchange up 9.92% to 9.75 per share.

The TIMES 2 results represent a significant milestone for Imeglimin, with the completion of our robust Phase 3 program in Japan, Poxel CEO Thomas Kuhn said in a statement referring to all three trials. Taken together, these results feature Imeglimins potential to treat type 2 diabetes at multiple stages of the disease.

Poxels path to the rest of the world remains less clear. Nearly two years ago, the French group sold US and European rights to Vivek Ramaswamys Roivant in a deal worth $50 million upfront and up to $600 million in milestones. The deal had been long-sought; although Poxel had a positive Phase IIb in 2014 and dosing levels to go to Phase III, they needed a deeper-pocketed partner willing to take on the heavy financial burden of a global diabetes trial.

Updates, though, have been sparse since they signed that deal in February 2018. The Poxel website still lays out the 2018 plans under the Imeglimin US/EU tab, and the Roivant website refers back to the Poxel one. Clinicaltrials.gov lists only one active trial for the drug a Phase I in Munich for hepatic impaired subjects.

The compound, though, will enter the Japanese regulatory process with a bevy of evidence behind it. Part of a new class of oral chemical agents called glimins, the drug is designed to target all three key organs affected in Type II diabetes: Increasing insulin in the pancreas in a glucose-dependent manner, decreasing excess glucose production in the liver and enhancing insulin sensitivity in muscles.

Collectively, the three trials enrolled 1,100 patients. TIMES 2 was open-label but TIMES 1 and 3 were double-blind. All met primary endpoints.

Poxel should find a ready market, too. An aging population and rising obesity have swelled the number of suspected diabetics in Japan past 10 million as of 2016, according to past estimates from Nikkei.

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Poxel passes 3rd straight Phase III diabetes trial in Japan, but what's going on with US/EU partner Roivant? - Endpoints News

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Just two cups of filtered coffee a day could slash the risk of type 2 diabetes by 60% – Yahoo News

Posted: December 22, 2019 at 2:42 pm

Compounds in coffee may combat inflammation. [Photo: Getty]

Drinking just two cups of filtered coffee a day may reduce the risk of type 2 diabetes by 60%, research suggests.

Scientists from the Chalmers University of Technology in Gothenburg looked atbiomarkers for boiled or filtered coffee in the blood of more than 800 people.

READ MORE:Diabetes: the symptoms, treatment and everything else you need to know

The found those with more filtered coffee markers were less likely to develop the condition over the next seven years. The same was not true for the boiled version of the pick-me-up.

Coffee contains compounds that have been shown to affect the break down of fat, as well as targeting inflammation.

It can also be rich in the molecule diterpene, which negatively influences the metabolism of sugar. This is thought to get caught in filters, preventing it entering coffee prepared this way.

Boiled coffee is typically made by heating a mixture of coarsely ground beans and water, the scientists wrote in the Journal of Internal Medicine.

Filtered coffee starts with finely grounding beans, which are then placed in a filter with water passing through.

READ MORE:Can drinking coffee actually reduce dementia risk?

When it comes to coffee and health, studies have typically recorded consumption via food questionnaires, which may not specify the brewing method.

To learn more, the scientists looked at participants of the Vsterbotten Intervention Programme, aged 40-to-60. They provided blood samples, which were frozen.

The scientists selected 421 of the participants who developed type 2 diabetes around seven years after entering the study. These were matched to 421 healthy controls.

The original blood samples were then thawed and checked for coffee biomarkers.

At the same time, an additional 149 diabetic and healthy pairs also had their blood assessed.

Results revealed 24 and 32 blood biomarkers associated with boiled or filtered coffee, respectively.

The scientists found an inverse correlation between biomarkers for filtered coffee and type 2 diabetes.

READ MORE: 'Prediabetes' common in U.S. teens, young adults

Story continues

Our results clearly show filtered coffee has a positive effect in terms of reducing the risk of developing type 2 diabetes, but boiled coffee does not have this effect, study author Professor Rikard Landberg said.

Drinking just two-to-three cups a day reduced the risk by 60% compared to less than one mug of filtered coffee.

Boiled coffee was found to have no effect, which the scientists put down to diterpene.

When you filter coffee, the diterpenes are captured in the filter, Professor Landberg said.

As a result, you get the health benefits of the many other molecules present. In moderate amounts, caffeine also has positive health effects.

The scientists predict that due to espresso being brewed without filters, it may have a similar effect to boiled coffee.

The same may also apply to coffee brewed via a cafetire, or French press.

It is unclear whether instant coffee, the most popular in the UK, is more like filtered or boiled varieties, they added.

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Biden Exaggerates Science on Burn Pits and Brain Cancer – FactCheck.org

Posted: December 22, 2019 at 2:41 pm

Democratic presidential candidate and former Vice President Joe Biden claimed without evidence that more people are coming home from Iraq with brain cancer than any other war. He also suggested that burn pits open air waste incineration sites are behind the purported increase.

Existing statistics do not indicate that Iraq veterans are more affected by brain cancer than other veteran groups, although no comprehensive data is available to definitively say one way or the other.

The evidence on the cancer risk of burn pits is likewise inconclusive. A 2011 report by the National Academy of Sciences on the long-term health effects of burn pit exposure in Iraq and Afghanistan found that there was inadequate/insufficient evidence to determine whether there is an association with cancer. We didnt identify any published studies addressing a link to brain cancer since the review.

Bidens comments came during a CNN town hall in Iowa on Veterans Day, when he was asked by a woman in a military family how he, as president, would address the lack of mental health care and resulting homelessness among service members.

After promising to provide more services to veterans, Biden brought up his eldest son, Beau, who served in Iraq and died from an aggressive brain cancer known as glioblastoma in 2015.

Biden, Nov. 11: And I if youre my son did a year in Iraq. He came home we lost him, but he came home and, you know, one of the things we should be looking at is those burn pits that are there. That its just like, you know, when all the firemen in New York went down to 9/11, and so many got cancer, and particularly brain cancer, well, thats whats happening. More people are coming home from Iraq with brain cancer than ever before, than any other war.

And were in a situation where theres a direct connection between those burn pits and and and taking in that that that all that toxin thats available.

And we should say, anybody who was anywhere near those burn pits, thats all they have to show, that they and they get covered, they get all their health care covered.

Bidens comments echo previous statements he made in a PBS interview about his son and a potential link between military burn pits and brain cancer. In that 2018 interview, Biden said he was not aware of any direct scientific evidence tying cancer to burn pits, but postulated that the exposure which occurred in Iraq and also perhaps in Kosovo, where Beau had gone on a civilian mission may have played a role in his sons cancer.

The younger Biden deployed to Iraq for one year, from October 2008 until September 2009, as a captain in the Delaware Army National Guard. In 2013, he was diagnosed with a brain tumor and died two years later at the age of 46.

Well present whats known about burn pits and brain cancer, and also review the available statistics on how common brain cancer is among different veteran groups.

We were unable to find any support for Bidens claim that more people are coming home from Iraq with brain cancer than ever before, than any other war. His campaign did not reply to our request asking for a source for his statement.

The little data that exists does not suggest that Iraq veterans have developed brain cancer at higher rates than those who served in earlier wars.

According to a 2015 Veterans Affairs post-deployment surveillance report, which the agency said was the only current published data on this topic, brain cancer prevalence was 0.04% for Vietnam veterans and 0.03% for both Gulf War veterans and those who served in Iraq and Afghanistan post-9/11. The report documents the prevalence and incidence of brain cancer, among other health conditions, for users of VA health care between April 2014 and March 2015. The Iraq War started on March 20, 2003; the conflict in Afghanistan began on Oct. 7, 2001.

The report also lists the age-adjusted frequency of brain cancer among each veteran group by fiscal quarter. While these values fluctuate, the average of these frequencies for all veteran groups is approximately the same, around 4 to 5 cases per 100,000 service members, with post-9/11 veterans on the low end and Vietnam veterans on the high end.

Robert Bossarte, an epidemiologist at West Virginia University and the director of the VAs epidemiology program at the time of the 2015 report, told us in a phone interview that the brain cancer data in the report do not show much difference between any of the veteran groups.

But he also cautioned against thinking of the post-deployment data as definitive. The statistics, Bossarte noted, only cover one point in time, and are limited to veterans using VA services. That means the figures are missing large numbers of people who have already died and those who get their health care outside of the VA. Only about half of all veterans use the VA for their health care, and usage rates vary by era. As a result, he said, its difficult to draw conclusions from the data about how the different service groups compare.

Still, he said he was not aware of a single manuscript that has suggested there is a higher rate of brain cancer among post-9/11 veterans.

A VA spokesperson told us in an email that there is no evidence of increased brain cancer among Iraq War veterans, or any post-9/11 group, and directed us to the 2015 post-deployment report. She noted that the prevalence of brain cancer increases in all populations as one ages, and said that because cancers may take a long time to develop, the VA continues to study all causes of mortality for the deployed post 9/11 Veteran population.

The agency said it expects to release an updated post-deployment report in early 2020.

Bidens other main claim was his suggestion that burn pits are the reason why some veterans are developing brain cancer. There is little evidence to indicate thats true, although scientists have not ruled out a connection.

Burn pits are open areas in which trash from a military base is burned, typically because of a lack of other waste infrastructure, including incinerators. Although the U.S. military has significantly reducedthe use of burn pits, they once were common throughout war zones in the Middle East and Central Asia.

A 2010 Government Accountability Office report explains that before 2004, burn pits were the only method of waste management that the military used in Iraq and Afghanistan. In November 2009, the report adds, U.S. Central Command reported 50 active burn pits in Afghanistan and 67 in Iraq; by April 2010, this had changed to 184 and 52, respectively, and in August 2010, to 251 and 22.

U.S. Central Command created guidelines for burn pits in 2009, including prohibitions on burning certain materials, such as hazardous waste, plastic, batteries, tires and electronics, but the GAO report found that this guidance was not always followed.

The primary issue with burn pits is that the fumes from the combusted items contain toxins that could be harmful; many soldiers who returned complained of long-term health effects, especially breathing problems, that they believe stemmed from inhaling burn pit smoke.

Given these concerns, the VA asked the National Academy of Sciences to review the evidence on the long-term health effects of burn pits, including an analysis of raw air-sampling data taken from one of the most notorious burn pit sites, Joint Base Balad a large military base outside of Baghdad that in 2007 burned up to 200 tons of waste every day.

The resulting 2011 report was largely inconclusive. While recognizing the potential for serious health concerns and recommending further study, the committee concluded that it was unable to say whether long-term health effects are likely to result from exposure to emissions from the burn pit at JBB. The committee also suggested that long-term health effects might be more generally associated with service in Iraq and Afghanistan, rather than burn pit exposure per se, because of high levels of particulate air pollution on bases as a result of military activities and natural dust storms.

Based on a review of existing epidemiology studies, which evaluated similar, but not identical exposures, such as those experienced by firefighters and incineration workers, there was inadequate/insufficient evidence to determine whether there was an association between exposure to combustion products and a variety of health outcomes, including cancer, respiratory disease and circulatory disease. There was slightly more evidence to suggest a connection to reduced pulmonary function, which the report categorized as limited/suggestive evidence.

As the GAO report later summarized, while the NAS report did not determine a linkage to long-term health effects, because of the lack of data, it did not discredit the relationship either.

For brain cancer in particular, the report explained that while a few studies identified associations between firefighting and brain cancer, the largest cohort study and the only one that quantified exposure was negative. Given the mixed results and limitations of the studies, the committee could not make a determination about a potential link but said that [b]ecause of the carcinogenic nature of many of the chemicals potentially associated with burn pit emissions, it is prudent to continue investigations of cancer end points and other health outcomes that have long latency in exposed military populations.

A follow-up report from the National Academy of Sciences in 2017, which focused on an evaluation of the VAs Burn Pit Registry, reviewed new studies published since the 2011 report relating to burn pits, but the majority were focused on respiratory diseases. None of them addressed cancer.

We also did not find any studies since these reviews that assessed a potential link between burn pits and brain cancer in the biomedical literature.

David Savitz, an epidemiologist at Brown University, and chair of the National Academy committee that conducted the 2017 review, told us in a phone interview that he was not aware of any evidence specifically linking burn pit exposures to brain cancer, and added, It seems unlikely that were going to have such evidence.

Part of this, he said, has to do with how rare brain cancer is only about 1% of new cancer cases in the U.S. every year are due to brain tumors, making it hard to study. But also, he said, brain cancer is not at the top of the list of diseases that one would expect from burn pit exposure.

We dont know what the consequences of burn pit exposure are with a high degree of confidence, he said, but they go more toward respiratory diseases and cardiovascular risks, not brain cancer.

Indeed, very little is known about what causes brain tumors in general. Jill Barnholtz-Sloan, a brain tumor researcher at Case Western Reserve University, said in a phone interview that there are a few genetic risk factors, including some inherited predisposition syndromes and single-letter DNA changes, but these do not explain the vast majority of brain tumors.

Similarly, the only well-established environmental risk factor that increases risk is ionizing radiation to the head and neck, Barnholtz-Sloan said. High doses of ionizing radiation confer a 2-to-4 fold increase in risk, she said, depending on the type of brain tumor a fact revealed by studies of children immigrating to Israel in the 1950s who had their scalps irradiated to treat ringworm infection. Smoking, interestingly, is not associated with brain cancer.

The only other well-validated factor is a history of allergies, which appears to provide some protection against developing a brain tumor. Several studies have shown that people with allergies and related conditions, such as asthma, hay fever and eczema, have a reduced risk of brain cancer. While scientists dont fully understand why this might be, Barnholtz-Sloan said the running hypothesis is that people with these diseases may have revved up immune systems, which may be able to kill cells that turn cancerous more quickly.

The fact that there are not more environmental factors may stem from the brains naturally high level of defense. Evolutionarily, if you think about your brain as the epicenter of your body your CPU its highly protected, Barnholtz-Sloan said, noting the multiple membranes surrounding the brain, along with the blood-brain barrier and skull. Environmental exposures would have to permeate a lot of layers of hard things to get in to affect cells. This is one reason why its so hard to find drugs to treat brain diseases, she said.

While Savitz said that no long-term health effects have yet been clearly linked to burn pit exposure, he said that that should not be interpreted to mean that burn pits dont cause health problems.

The absence of evidence is not the evidence of absence, he said. There may well be a problem, its just a matter of direct evidence. He is conducting a three-year study to further investigate the long-term health effects of burn pits, but is unaware of anyone doing specific research on cancer.

The VAs Airborne Hazards and Open Burn Pit Registry allows eligible service members to report health concerns related to burn pits and other airborne hazards. The National Academy of Sciences, however, identified multiple flaws in the registry that led to low completion rates, and recommended numerous changes to increase the registrys utility. The committee also stated that as a voluntary, self-reported registry, it was fundamentally unsuitable for addressing the question of whether these exposures have, in fact, caused health problems.

In an email, the VA defended its registry, saying that it had completed most of the academys suggested improvements, and that the registry is a very good tool for health surveillance. The agency also pointed to its new research hub on airborne hazards and burn pits, which opened in May 2019, and said another consensus report from the National Academy of Sciences is expected in May 2020. That report, the VA said, will focus on the hazards of burn pits and other exposures, and will include cancer outcomes.

Other groups, too, have stepped in to collect data. Burn Pit 360, a nonprofit veterans group, set up its own voluntary registry for people to report health complaints from burn pits. Rosie Torres, one of the co-founders of the organization, told us that as of March 2019, there had been 97 reports of brain cancer out of approximately 6,000 submissions.

Savitz, however, said that neither registry likely will yield any concrete answers. They can generate possibilities, they can point to where problems may exist, he said, but theyre not a substitute for carefully designed research.

Although future studies may eventually come out to change scientific opinion, there is no direct evidence that burn pits cause brain cancer, and no indication that Iraq War veterans are especially affected by brain cancer, as Biden claimed.

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Pharma’s gene and cell therapy ambitions will kick into high gear in 2020despite some major hurdles – FiercePharma

Posted: December 21, 2019 at 7:49 pm

In January 2019, then-FDA commissioner Scott Gottlieb ushered in the new year with a bold prediction: The agency, he said, would be approving between 10 and 20 gene and cell therapies per year by 2025. At the time, there were a whopping 800 such therapies in the biopharma pipeline and the FDA was aiming to hire 50 new clinical reviewers to handle the development of the products.

That momentum will no doubt start to pick up in 2020, as several companies in late-stage development of their gene and cell therapies achieve key milestones or FDA approval. Among the companies expected to make major strides in gene and cell therapies next year are Biomarin, with valoctocogene roxaparvovec to treat hemophilia A, Sarepta and its gene therapy for Duchenne muscular dystrophy, plus multiple players developing CAR-T treatments for cancer, including Bristol-Myers Squibb and Gilead.

But with such explosive growth comes challenges. Gene and cell therapies require enormous up-front investing in complex manufacturing processes, as well asinnovative approaches to securing insurance coverage for products that come with eye-popping price tagssuch as Novartis $2 million gene therapy Zolgensma to treat spinal muscular atrophy. Those are just a few of the obstacles that will be front-and-center in 2020 as more gene and cell therapies make their way towardthe finish line.

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Pharma companies will face challenges figuring out how to incorporate gene and cell therapies into their overall business, said Michael Choy, partner and managing director at Boston Consulting Group, in an interview with FiercePharma. They dont fit well into the normal paradigms of budgeting and decision-making. They require a different pace of evolution and specialized expertise. For now, companies are shoe-horning gene therapies into their current model, but over the long-term there will have to be changes.

That will become increasingly clear in 2020 as both Big Pharma and small up-and-comers move towardthe clinic with their gene and cell therapies. John Zaia, M.D., director of the Center for Gene Therapy at City of Hope, predicts there will be at least three gene and cell therapy FDA approvals in 2020. He also expects to see momentum among companies seeking to improve on the technology to address unmet needs in medicine.

For example, Zaia believes off-the-shelf CAR-T cancer treatments will show promise in early studiesand will be met with enthusiasm in the cancer community, he told FiercePharma in an email. The first generation of FDA-approved CAR-T treatments, Novartis Kymriah and Gileads Yescarta, take several weeks to make because they require removing T cells from patients and engineering them to recognize and attack the patients'cancers. Several companies are advancing off-the-shelf CAR-T treatments, including Precision BioSciences, which has been building out a manufacturing plant equipped to make 10,000 doses per year.

RELATED: Biotech building facility to make genome-edited, off-the-shelf CAR-T therapies

Gene therapies for inherited diseases will make strides in 2020, too, Zaia predicts. City of Hope is one of the participants in a phase 1 study of CSL Behrings gene therapy to treat adults with sickle cell disease. CSL will be racing against several companies working on the disease, including Bluebird Bio, which is testing its beta thalassemia gene therapy Zynteglo in sickle cell. There is a big push from many research centers to cure sickle cell diseaseand early results with the use of gene therapy look very promising, Zaia said. Years of research is finally coming to realization.

With such robust R&D underway in gene and cell therapies, its no surprise several players are stepping up their investments in manufacturing. In October, Sanofi said it would retrofit a vaccine plant in France so it couldbe used for gene therapy manufacturing. Pfizer shelled out $19 million for a North Carolina facility that will serve as its manufacturing hub for gene therapies. Even Harvard University is getting into the game, working with a consortium of contract manufacturers to build a $50 million facility dedicated to making cell therapies and viral vectors for gene therapies.

But how will the healthcare system pay for all of these complex therapies? Its a question that will continue to dog the industry, BCGs Choy said. Theres a lot of interest in outcomes-based payments and payments over time, but the issue is theyre very difficult to implementbecause the infrastructure to track outcomes over time doesnt really exist, he said.

Still, payers and pharma companies are hinting at their willingness to put that infrastructure in place. Pfizer, which is developing DMD and hemophilia gene therapies, said recently its brainstorming with payers on innovative strategies for reimbursement. Novartis and Spark have already pioneered payment strategies that deviate from the standard pay-everything-up-front system. Novartis has some pay-for-performance contracts in place for the $475,000 Kymriah. And in September, Cigna agreed to cover Novartis Zolgensma and Sparks Luxturna on a per-month, per-member schedule.

RELATED: Novartis, Spark gene therapies win a boost with soup-to-nuts Cigna coverage

Despite the many challenges in cell and gene therapy, some players are showing theres likely to be a robust market for these innovative treatments. In its first quarter on the market, Zolgensma brought in $160 million in salesfar surpassing analysts expectations.

The promise of huge returns on gene and cell therapies will likely drive acquisitions in 2020, Choy predicted. These treatments are so transformative for patients, and as the clinical proof of effectiveness continues to grow, youre going to see a lot more deal-making in this area, he said.

Buyers will likely show a willingness to invest in early-stage gene and cell therapies, especially if they come with technology platforms that allow for the development of many follow-up products, Choy added. For these types of therapies, the lifecycles will be much shorter than they are for traditional pharmaceuticals, particularly for rare diseases, he said. If you administer a one-time therapy, that revenue peaks quite quickly and then drops off. So to have a sustainable revenue from a gene therapy business, you need to replace that, which requires managing a pipeline.

Judging from recent events in the burgeoning gene and cell therapy industry, the news flow in 2020 will be generated not just by the industrys largest players, but also by its upstarts. In December, Ferring Pharmaceuticals spinout FerGene turned heads with data showing that its gene therapy to treat non-muscle invasive bladder cancer eliminated tumors in more than half of participants in a phase 3 trial. And Gileads Kite Pharma just applied for FDA approval for its mantle cell lymphoma CAR-T, KTE-X19, based on a 93% overall response rate in a phase 2 trial.

There were 75 gene therapy clinical trials initiated in 2018, nearly doubling the trial starts of 2016momentum thats likely to continue next year, BCG said in a recent report. The scientific foundation is in place, BCG analysts concluded, but there is still much to do to deliver the full benefit of gene therapy to patients."

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Pharma's gene and cell therapy ambitions will kick into high gear in 2020despite some major hurdles - FiercePharma

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Charles River Labs snaps up HemaCare, eyeing the growing cell therapy market – FierceBiotech

Posted: December 21, 2019 at 7:49 pm

Charles River Labs is stumping up $380 million in cash to buy out cell therapy biomaterials producer HemaCare.

This will boost Charles Rivers work in cell therapy by adding HemaCares ability to produce human-derived cellular products for this growing market.

It supplies biomaterials, including human primary cell types, and cell processing services to support the discovery, development and manufacture of cell therapies, including allogeneic (donor-derived cells) and autologous (patient-derived cells) programs.

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This builds on the hope and hype around cell therapies like CAR-T and their capacity to hit back at certain oncology targets, namely blood cancers.

The CRO said that the deal will create a unique, comprehensive solution for cell therapy developers and manufacturers worldwide to help accelerate their critical programs from basic research and proof-of-concept to regulatory approval and commercialization.

James Foster, chairman, president and CEO Charles River, said: Cell and gene therapies are important new modalities, with an estimated 10 to 20 new product approvals per year within five years. In order to continue to enhance our ability to support our clients research efforts, particularly in biologics discovery and development, we are expanding our scientific capabilities in this emerging, high-growth market with the acquisition of HemaCare.

The addition of HemaCares innovative cell therapy products and services to our integrated, early-stage solutions will create a unique, go-to partner for clients to work with Charles River across a comprehensive cell therapy portfolio from idea to novel therapeutic.

RELATED: Charles River swoops on early-stage CRO Citoxlab

Pete van der Wal, president and CEO of HemaCare, added: We are very pleased to be joining the Charles River team, which is widely recognized as the industry-leading, early-stage contract research organization. Partnering with Charles River will strengthen the value proposition for our clients, enabling them to work seamlessly with one scientific partner to enhance the speed and efficiency with which they can advance their cell therapies. The transaction will offer compelling value to our shareholders. This is an exciting day that will usher in a new era for HemaCare and my talented colleagues.

Cell therapy is becoming a focus for biopharma, but the relatively new area requires cutting-edge tech to help nurture new research like CAR-T into an established market.

Charles River says its work in the area is currently making around $100 million a year, but it sees the addressable market for HemaCares products is expected to increase from approximately $200 million today to nearly $2 billion in 10 years and wants to be a part of that.

While spending nearly $400 million in cash (the company had a market cap of $257 million at the end of play last week, with Charles River paying a 33% premium), HemaCare is expected to immediately drive profitable revenue growth, with estimated revenue growth of at least 30% annually over the next five years, the CRO estimated.

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Fate Therapeutics: Using Cell Programming To Produce Better Cell Therapies – Seeking Alpha

Posted: December 21, 2019 at 7:49 pm

Introduction

I have written about companies working on research and development of cell therapies as the next frontier in cancer treatment. Current approved treatments such as CAR Ts are autologous treatments and require complex personalised manufacturing and can't be scaled up, which, in turn, drive up costs and limit patient's accessibility. It has been well documented that the approved CAR Ts are facing manufacturing issues and underperformed commercially.

To circumvent this, companies such as Atara Biotherapeutics (ATRA) and Allogene Therapeutics (ALLO) are working on allogeneic T cell therapies, which are derived from healthy donors and are less costly to manufacture. Fate Therapeutics (FATE) is taking a novel approach by developing programmed cellular immunotherapies for cancer and immune disorders.

In this article, I introduce Fate Therapeutics and give an overview of their technology and clinical pipeline.

Fate Therapeutics is a clinical-stage company that is developing first-in-class cell therapy product candidates based on a therapeutic approach known as cell programming. Fate does this by using human induced pluripotent stem cells ("iPSCs") to generate a clonal master iPSC line with preferred biological properties. The clonal master iPSC line is then directed to create their cell therapy product candidate.

Similar to how biologics such as monoclonal antibodies are manufactured from master cell lines, Fate believes that clonal iPSC lines can be made and used as a renewable source for manufacturing cell therapy products which are well-defined and uniform in composition, which, in turn, can be mass-produced repeatedly at significant scale in a cost-effective manner and can be delivered off-the-shelf to increase patient's accessibility. Figure 1 lists the advantages of using renewable master cell lines over healthy donor cells in cell therapy.

Figure 1: Advantages of Renewable Master Cell Line as Cell Source in Immunotherapy (Source)

With this approach, Fate is programming blood and immune cells, including natural killer (NK) cells, T cells, and CD34+ cells to advance a clinical pipeline of programmed cellular immunotherapies in the therapeutics areas of immuno-oncology and immuno-regulation.

In other cases, Fate also uses pharmacologic modulators, such as small molecules, to enhance the biological properties and therapeutic function of healthy donor cells ex vivo before their product candidates are administered to a patient.

In 2012, the Nobel Prize in Physiology was awarded to John Gurdon and Shinya Yamanaka for their ground-breaking discovery that fully differentiated mature human cells can be induced to a pluripotent state. iPSCs, with their unique capacity to be indefinitely expanded and differentiated into any type of cell in the body, hold revolutionary potential for creating better cell therapies.

Fate believes that iPSCs can be used to overcome key limitations inherent in many of the cell therapy product candidates undergoing development today, such as the requirement to source, isolate, engineer and expand cells from an individual patient or healthy donor with each batch of production. These batch-to-batch manufacturing requirements are logistically complex and expensive and can result in variable cell product identity, purity, and potency as well as manufacturing failures.

Fate is targeting to utilize clonal master iPSC lines as a renewable source for manufacturing cell therapy products which are uniform in composition and can be repeatedly mass-produced at significant scale in a cost-effective manner, to increase patient's accessibility. Fate is applying their expertise in iPSC biology to genetically engineer, isolate, and select single cell iPSCs to be used as clonal master iPSC lines. Such master iPSC lines are subsequently directed to create immune cells such as NK cells, T cells, and CD34+ cells.

Beyond iPSCs, Fate is also working on programming hematopoietic cells ex vivo by using advanced molecular characterization tools and technologies to identify small molecule and biologic modulators that promote rapid and supra-physiologic activation or inhibition of therapeutically-relevant genes and cell-surface proteins, such as those involved in the homing, proliferation, and survival of CD34+ cells or those involved in the persistence, proliferation, and antitumor activity of NK cells and T cells. Fate believes this approach systematically and precisely program the biological properties and therapeutic function of cells ex vivo prior to adoptive transfer is a reproducible, scalable and cost-effective approach to maximize the safety and efficacy of cell therapies.

As discussed earlier, currently approved T cell therapies are autologous and rely on the use of a patient's own cells. Manufacturing such highly personalised treatments are complex and costly, which drives up costs and limits patient's accessibility. While companies are working on allogeneic platform which is derived from healthy donors, Fate is taking it one step further by working on renewable master iPSC cell lines. Fate believes that their approach has the potential to improve cell product consistency and potency, reduce manufacturing costs, shorten time to treatment and importantly, increase patient's accessibility.

Fate is advancing a series of programmed cellular immunotherapies from both iPSC derived and donor derived cell sources, in therapeutic areas of immuno-oncology and immuno-regulation. Figure 2 lists down Fate's clinical pipeline.

At the 62nd American Society of Haematology Annual Meeting & Exposition ("ASH 2019 meeting"), Fate provided updates to several of its clinical programs, which I will cover in more detail in the below sections.

Figure 2: Fate Therapeutics' Clinical Pipeline (Source)

Since 2014, checkpoint inhibitors such as Merck's (MRK) Keytruda and Bristol-Meyer Squibb's (BMY) Opdivo have been approved to treat several cancer indications. Unfortunately, more than 60% of patients treated with checkpoint inhibitors will not respond or will relapse. Consequently, there is a huge unmet need for therapeutic approaches to overcome resistance to checkpoint inhibitors. NK cells have shown some potential to overcome such resistance and as such Fate is developing FT500, which is an off-the-shelf- NK cell therapy derived from a clonal master iPSC line, for the treatment of advanced solid tumors, both as a monotherapy and in combination with checkpoint inhibitor. In November 2018, FT500 was cleared by the FDA to be the first-ever iPSC-derived cell therapy cleared for clinical investigation in the United States.

Fate believes that the use of a clonal master iPSC line to produce FT500 provides a large, homogenous population of NK cells that is well-defined and displays potent activity, while also being available for repeat clinical dosing. At the ASH 2019 meeting, Fate reported results from the ongoing Phase 1 trial of FT500. Out of 12 patients, no dose-limiting toxicities or FT500-related serious adverse events were reported.

CD16 mediates antibody-dependent cellular cytotoxicity ("ADCC") which is a potent anti-tumor mechanism by which NK cells recognize, bind and kill antibody-coated cancer cells. CD16 occurs in two variants, 158V or 158F, that elicit high or low binding affinity. Numerous clinical trials with FDA approved monoclonal antibodies have demonstrated that patients homozygous for the 158V variant, have improved clinical outcomes. However, this patient group only accounts for 15% of the population. In addition, ADCC is dependent on NK cells maintaining active levels of CD16 expression, which has been shown to be considerably downregulated in cancer patients, which can significantly inhibit anti-tumor activity.

To this end, Fate is developing FT516, a targeted NK cell product candidate created from a master clonal iPSC line engineering to express a high-affinity, non-cleavable CD16 receptor, as an off-the-shelf immunotherapy for the treatment of haematological malignancies.

In February 2019, FT516 was cleared by the FDA as the first-ever clinical investigation of a cell product derived from a clonal master engineered iPSC line. A phase 1 trial evaluating FT516 as a monotherapy for the treatment of acute myeloid leukemia ("AML") and in combination with CD20-directed monoclonal antibodies for the treatment of advanced B-cell lymphoma is ongoing.

At the ASH 2019 meeting, Fate reported encouraging interim results from the phase 1 study. The first AML patient treated showed no morphologic evidence of leukaemia at Day 42 following treatment and evidence of hematopoietic recovery.

In 2017, 2 autologous CD19 CAR T were approved - Kymirah by Novartis (NVS) and Yescarta by Gilead (GILD) to treat relapsed/refractory ("r/r") leukemias and lymphomas. While both treatments have been revolutionary, not all patients respond to therapy and even for patient who initially respond, they may experience a relapse. The downregulation of CD19 from the tumor cell surface has been clinically demonstrated to be an important mechanism of resistance.

To over CD19 antigen escape, FT596 expresses a novel modified receptor to augment ADCC to enable coincident targeting of CD19 and additional antigens such as CD20. On top of a CAR targeting CD19, FT 596 also expresses a cytokine complex that promotes survival of NK cells. Combined, these features are intended to maximize potency of FT596.

In September 2019, FT596 was cleared by the FDA for clinical investigation as the first cellular immunotherapy engineered with three active anti-tumor components. At the ASH 2019 meeting, Fate reported encouraging preclinical results for FT596 and that it has managed to produce GMP doses of FT596 at approximately $2,500 per dose. This will enable it to overcome the limitations of the current generations of autologous CAR T. Phase 1 trial of FT596 is expected to be initiated in early 2020.

FT538 is an off-the-shelf NK cell therapy created from a clonal master iPSC line engineering to prevent expression of the cell surface protein, CD38, which is highly and uniformly expressed on Multiple Myeloma ("MM") cells. CD38 is also broadly expressed on NK cells, and as a result, NK cells can be significantly depleted in patients treated with anti-CD38 antibodies. However, NK cells are important for the antitumor activity of anti-CD38 antibodies via the ADCC mechanism.

FT538 is developed for use in combination with anti-CD38 antibodies for enhanced ADCC. FT538 is designed to provide a robust population of NK cells resistant to depletion when used in combination with anti-CD38 antibodies, with the aim of improving patient outcomes in MM.

FT819 is an off-the-shelf first-of-kind CD19 CAR T manufactured from a clonal master iPSC line. The technology was licensed from Memorial Sloan Kettering ("MSK"), led by Michel Sadelain, scientific co-founder of Juno Therapeutics. FT819 is designed to overcome current limitations in approved autologous CD19 CAR Ts, including safety, costs, scalability and patient's accessibility.

At the ASH 2019 meeting, Fate reported encouraging preclinical data on FT819, with plans to submit application to start clinical trials in the first half of 2020.

Beyond iPSCs derived immunology-oncology programs, Fate is also developing NK100, which is donor-derived NK cell therapy. NK100 is produced through a feeder-free, 7-day manufacturing process during which NK cells sourced from a healthy donor are activated ex vivo with pharmacologic modulators, inducing the robust formation of adaptive memory NK cells. NK100 is currently being evaluated in 3 separate Phase 1 studies in r/r AML, ovarian cancer and advanced solid tumors which have progressed on or failed available approved therapies.

Additionally, Fate is also developing ProTmune as a programmed cellular immunotherapy as a next-generation allogeneic hematopoietic cell transplantation ("HCT") cell graft. Thousands of patients with hematologic malignancies and rare genetic disorders seek curative outcomes through HCT. HCT is limited by the occurrence of graft-versus-host disease (GvHD) and severe infections. Around 50% of patients undergoing HCT die or experience relapse within the first two years after HCT. ProTmune is designed to optimize the therapeutic properties of the graft prior to administration to patient and Fate believes that it can reduce GvHD, severe infection and disease relapse. There are no approved therapies for prevention of GvHD in patient undergoing allogeneic HCT and Fate believe ProTmune is well positioned to solve a significant unmet clinical need. ProTmune is currently investigated in an ongoing phase 2 study and has been granted Fast Track and Orphan Drug Designation by the FDA and Orphan Medicinal Product Designation by the European Medicines Agency.

As of 30 September 2019, Fate's cash on hand was US$302.8M compared to US$201.0M at 31 December 2018. This was largely driven by the net proceeds of US$162.4M from a round of public offering of its common stock in September 2019. I expect this amount to be able to fund their clinical programs way into 2021 at the very least.

In addition, Fate also announced recently the completion of its GMP facility dedicated for iPSCs - derived cell therapies. The importance of manufacturing in cell therapies cannot be understated and having its own dedicated manufacturing facility is a step in the right direction.

Fate has made huge progress in the past 12 months, with 3 programs - FT500, FT516, FT596 being cleared by the FDA to start clinical trials. The market has also reacted positively to the encouraging recent updates at the ASH 2019 meeting, with stock price rising 41% for the period 6 November to 10 December 2019, which is the period where abstracts were announced and the last day of ASH 2019 meeting.

Arguably though, the biggest show of faith in Fate's technology comes from their competitor, Allogene Therapeutics. Allogene recently announced a collaboration with Notch Therapeutics to research and develop iPSC-derived allogeneic cell therapies. This clearly marks the belief of the importance of using a renewable cell source for cell therapies, which Fate is currently the market leader.

Investing in clinical-stage biotechnology companies is generally risky as such companies have no approved products to generate revenue. Fate's clinical pipeline is also relatively early stage, with no ongoing pivotal trials. Any clinical trial failure may cause huge downward swing in its share price.

Even if the event that its product eventually gets approved, there is no guarantee of commercial success. Many of Fate's competitors working on autologous cell therapy treatment such as Novartis, Gilead, and BMS have more resources and a stronger balance sheet and Fate may not be able to compete with them in the long run.

Allogeneic players such as Atara are also working on their own platform and are currently running a pivotal trial, to be completed by the second half of 2020. As stated above, Allogene is also working on iPSC-derived therapies and will compete with Fate. While I believe Fate is the current market leader in this space, circumstances may change in the future.

As always, investors should conduct their own due diligence before taking up any position. They should also have a relatively long-time horizon and risk appetite before investing in clinical-stage biotechnology companies.

In this article, I covered an overview of Fate's cell programming approach as well as their clinical pipeline. With the limitations of current generations of cell therapies, including high cost and complex manufacturing, Fate's cell programming platform offers a refreshing and alternative approach for future generations of cell therapies.

While they have made huge progress in recent months, Fate's clinical pipeline is still relatively early stage, with no pivotal trials ongoing. Investors should consider their time horizon and risk appetite before taking up any positions. While I am optimistic about Fate's technology, I personally will be waiting for more catalyst in 2020 before taking up any positions.

For investors who wish to invest in cancer immunotherapy, they can consider the CNCR ETF which offers a diversified portfolio in the field, reducing risks in selecting individual stock ticker. I have covered companies working in cell therapies/immunotherapy and will continue to cover more companies in the coming weeks and months.

Disclosure: I am/we are long ATRA. I wrote this article myself, and it expresses my own opinions. I am not receiving compensation for it (other than from Seeking Alpha). I have no business relationship with any company whose stock is mentioned in this article.

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Tessa Therapeutics to Open 90,000 Square Foot Commercial-Scale Cell Therapy Manufacturing Facility in Singapore in 2020 – PR Newswire UK

Posted: December 21, 2019 at 7:49 pm

SINGAPORE, Dec. 19, 2019 /PRNewswire/ -- Tessa Therapeutics (Tessa), a clinical-stage cell therapy company focused on the development of innovative cell therapies to treat cancer, today announced plans to open a 90,000 square foot commercial-scale cell therapy manufacturing facility in Singapore by end-2020, which will be one of the leading commercial-scale cell therapy manufacturing facilities in Asia.

Notably, the state-of-the-art facility will be built to run both clinical and commercial manufacturing of cell therapy products that is compliant with current Good-Manufacturing-Practice (cGMP) guidelines from the U.S. Food and Drug Administration, European Medicines Agency and key regulators in Asia.

"This facility will strengthen our ability to bring innovative cell therapies to thousands of patients around the world," said John Ng, Chief Operations Officer of Tessa Therapeutics. "As one of very few manufacturing facilities globally designed with the capabilities to meet clinical trial and registration requirements from multiple geographies, Tessa is poised to rapidly advance its role as a leading innovator of next-generation cancer cell therapies."

Operationally, the facility will integrate digital technology to monitor, in real-time, its manufacturing operations and vein-to-vein supply chain logistics. The ability to digitally manage the complex process involved in delivering cell therapies to patients worldwide will not only enhance the traceability and control of patient material, but also enable greater standardization, scalability and quality management across its operations. This ultimately translates into better decision-making and coordination at the hospital sites for improved patient care.

The new facility will expand on the company's proven record of successful global cell therapy manufacturing, shipments, and infusions to patients in a Phase III clinical trial setting. Currently, the Company has produced and delivered autologous, personalized cell therapies to more than 100 patients in 30 clinical sites across five countries. The new manufacturing facility will enable Tessa to deliver its cell therapies faster and more reliably.

The new facility will also build out Tessa's in-house process development capabilities and serve as a centre of excellence to advance CMC (Chemistry, Manufacturing and Controls) development efforts of its cell therapies from early phase clinical development through to commercialization.

The entire manufacturing hub, totalling 130,000 square feet, will include office space to house Tessa's Corporate Headquarters. Tessa has entered into a lease agreement to develop the facility within an existing high-tech industrial building in Singapore.

About Tessa Therapeutics

Tessa Therapeutics is a clinical-stage biotechnology company focused on the development of cell therapies for lymphomas and solid tumors. Tessa's Virus-Specific T cell (VST platform) has shown a strong safety profile and early efficacy in the treatment of solid tumors.

Tessa is currently conducting two pivotal studies of autologous cell therapies in nasopharyngeal cancer and classical Hodgkin lymphoma. Tessa also has an earlier-stage clinical pipeline of autologous and off-the-shelf, allogeneic therapies targeting a wide range of cancers.

The Company has built robust operational and supply chain capabilities, across Asia and the United States, to successfully deliver cell therapies on a global scale, creating a fully integrated approach to the treatment of cancer.

For more information on Tessa, please visit http://www.tessatherapeutics.com.

Tessa Therapeutics Media Contacts

Gladys Wonggladyswong@tessatherapeutics.com +65-6384-0755

Zara LockshinSolebury Troutzlockshin@troutgroup.com +1-646-378-2960

https://www.tessatherapeutics.com/

SOURCE Tessa Therapeutics

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Tessa Therapeutics to Open 90,000 Square Foot Commercial-Scale Cell Therapy Manufacturing Facility in Singapore in 2020 - PR Newswire UK

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BELINDA Trial Tests Earlier Use of Tisa-Cel in Aggressive B-Cell Non-Hodgkin Lymphoma – Cancer Therapy Advisor

Posted: December 21, 2019 at 7:49 pm

A multicenter phase 3 trial began enrolling patients earlier this year to test the safety and efficacy of tisagenlecleucel (tisa-cel/Kymriah) as a second-line therapy for aggressive B-cell non-Hodgkin lymphoma (NHL).

Tisa-cel, an anti-CD19 chimeric antigen receptor T-cell (CAR-T) therapy, has already been approved for use in patients who have relapsed after receiving 2 lines of therapy. But its possible that, if administered sooner across treatment regimens, CAR-T could help more patients avoid relapse. The new study on this topic, known as BELINDA, aims to answer that question.

The hypothesis is that CAR-T cells should improve upon progression-free survival as compared to standard of care, said Michael Bishop, MD, director of the hematopoietic stem cell transplantation program at the University of Chicago Medicine, Illinois, and one of the BELINDA coauthors. Dr Bishop presented the study protocol at the 34th Annual Meeting & Preconference Programs of the Society for Immunotherapy of Cancer, or SITC 2019, in National Harbor, Maryland.1

Around a third of patients with non-Hodgkin lymphoma (NHL) will relapse after receiving first-line immunochemotherapy, and another 10% to 15% do not respond to initial treatment. For these patients, the outlook is grim: median overall survival is less than 12 months. Second-line treatment consists of high-dose chemotherapy combined with autologous stem cell transplant, but fewer than half of patients will qualify for a transplant. Youve got half the patients who wont get the transplant, and the other half that do, only a quarter of those will have sustained remission, said Dr Bishop. Its a large unmet patient need.

Dr Bishop went on to explain that previous trials have indicated that some 30% to 40% of patients receiving CAR-T therapy for multiply relapsed or refractory NHL have achieved long-term remission. The other exciting thing about this trial is its moving CAR-T up the treatment algorithm, he said.

The BELINDA trial is a multicenter, phase 3, open-label trial, in which patients are randomly selected to receive treatment in 1 of 2 arms: tisa-cel, or standard of care. Similar to the ZUMA-7 trial,2 which tested another CAR-T therapy called axicabtagene ciloleucel (Yescarta), BELINDA is enrolling patients whose disease either does not respond to first-line therapy (rituximab and anthracycline) or has returned within 12 months, and who are eligible for autologous stem cell transplant.

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BELINDA Trial Tests Earlier Use of Tisa-Cel in Aggressive B-Cell Non-Hodgkin Lymphoma - Cancer Therapy Advisor

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A Multipronged Approach to Geriatric Assessment Before Hematopoietic Cell Transplantation – Hematology Advisor

Posted: December 21, 2019 at 7:49 pm

A geriatric assessment-guided multidisciplinary team clinic (MDC) approach for older hematopoietic cell transplantation (HCT) candidates appears to be feasible and may help reduce transplant-associated morbidity and mortality, according to a study published in Blood Advances. Researchers found that a greater adoption of this approach could lead to more widespread utilization of transplantation among older adults.

The team reported outcomes with an MDC approach that included a cancer-specific geriatric assessment and a team of providers who assessed candidacy of patients for HCT. The providers created an individualized optimization plan for allogeneic HCT candidates aged 60 years and older and for autologous HCT and adoptive T-cell therapy candidates aged 70 years and older.

The researchers treated 247 patients with this MDC model, with allogeneic HCT candidates comprising the majority of the cohort (60%), followed by autologous HCT candidates (37%) and older cellular therapy candidates (3%). Patients treated using the MDC approach experienced fewer inpatient deaths (P <.001), shorter length of stay (P <.001), and fewer discharges to nursing facilities (P =.0043) compared with patients treated prior to the implementation of this approach.

The 1-year rate of overall survival improved from 43% prior to implementation of the MDC approach to 70% with the MDC approach, and the 1-year nonrelapse mortality rate decreased from 43% to 18%. For 31 recipients of autologous HCT aged 70 years or older for whom treatment was optimized by the MDC approach, nonrelapse mortality and OS at 1 year were 0% and 97%, respectively.

The researchers noted that until recently, identifying risk factors for expected HCT complications aside from age had been difficult. The MDC approach outlined may offer a way to maximize resiliency to avoid biases of older age alone and more safely offer hematopoietic and cellular therapies.

However, the researchers cautioned that their findings have significant limitations because they come from a single institutional observational study of heterogeneous patients and transplant types. Thus, prospective studies are warranted that can more completely characterize the interventions and surrogate markers that may be of most benefit in this patient population.

Disclosures: Some authors have declared affiliations with the pharmaceutical industry. Please refer to the original study for a full list of disclosures.

Reference

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Charles River Labs forks over $380M cash for cell therapy player; Axsome soars on PhIII depression readout – Endpoints News

Posted: December 21, 2019 at 7:49 pm

Cell therapy R&D is hot, and Charles River Labs $CRL knows it. The CRO is paying $380 million to acquire HemaCare, a company that provides material and services for companies developing off-the-shelf and personalized cell therapies. Charles River says its developing a turnkey service for cell therapy developers and manufacturers.

Cell and gene therapies are important new modalities, with an estimated 10 to 20 new product approvals per year within five years, notes Charles River CEO James Foster.

At the beginning of the year, Axsome Therapeutics rolled out positive data from a mid-stage study testing its lead CNS drug for patients with major depressive disorder (MDD), causing their stock $AXSM to leap. Today, the company is celebrating another win, as AXS-05 met the primary endpoint in their Phase III GEMINI study. The drug rapidly and significantly improved symptoms of depression compared to placebo at Week 6 meaning reductions from baseline of 16.6 points for AXS-05 and 11.9 for placebo, based on the Montgomery-sberg Depression Rating Scale (MADRS).

Immuneering, which has spent over a decade helping its partners (including Teva and J&J) understand how their existing drugs tend to work using gene expression data has moved into the arena of drug development with $17 million in backing from investors. The Cambridge, MA-based companys lead experimental drug is being developed for cancer cachexia.

The industry often looks at drugs as a bullet, something thats taking out one very precise target, noted co-founder and chief Ben Zeskind in an interview with Endpoints News. And we actually, through studying all these drugs, we have come to view the most successful medicine kind of differently not so much as bullets, but more as signal inducersand actually, we think the best metaphor is the noise-canceling headset.

Last October Alexion Pharmaceuticals, shopping for targets to fatten its pipeline, forked over $22 million upfront to co-develop two preclinical RNAi therapies owned by Dicerna Pharmaceuticals, the company is now dishing out an additional $20 million ($10 million each) to kick off discovery efforts against two more targets within the complement pathway.

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