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Fierce JPM Week: After ‘objectively astonishing’ progress on mRNA, biotech looks to tinker with winning formula – FierceBiotech

Posted: January 20, 2022 at 2:40 am

Messenger RNA (mRNA) technology became a household name so quickly thanks to the COVID-19 vaccines by Pfizer-BioNTech and Moderna, and, now, biotech leaders are taking a moment to reflect on where the field goes from here.

When so much progress has been made, as the past two years, which is objectively astonishing, it can be hard to realize that it's also the beginning, said Geoffrey von Maltzahn, Ph.D., co-founder, and CEO of Tessera Therapeutics, during a Fierce JPM Week panel on "The Next mRNA Wave."

Now, companies that were involved in mRNA before the pandemic have a validated platform on their hands to develop new therapeutics and vaccines, which leads to the inevitable question: What comes next?

mRNA is not new, but it's still in infancy, said Jean-Francois Toussaint, Ph.D., head of research and development for Sanofi Pasteur. There is room to improve it much further down the road, and that's what we are doing.

mRNAs are essentially copies of genetic instructions that can direct your body to make proteins that can then be used to fight or prevent disease. This technology can be harnessed in multiple ways to create different types of medicines. Tessera, for instance, is combining the idea with genetic medicine to allow modifications to the genome that were previously thought to be difficult or impossible.

RELATED: With $3.2B, Sanofi takes in mRNA partner Translate Bio in buyout

Ultragenyx, meanwhile, is focusing on protein replacement using mRNA as a delivery mechanism, according to Chief Medical Officer Camille Bedrosian, M.D.

Sanofi is focusing its research on vaccines that can be implemented into regular inoculation schedulesthink RSV, acne vaccines or potentially chlamydia, according to Toussaint. But where Sanofi really wants to make an impact is on improving the known challenges of mRNA: storage and tolerability.

A known issue with the COVID-19 vaccines has been the side effects a day or so after, when many patients report headaches, chills or even fever. This is absolutely an acceptable outcome in a global pandemic where the need to protect against a deadly disease is so great, but Toussaint said these kinks have to be worked out for the next generation of therapies and vaccines.

Vaccines are given to people that are healthy people that go to work every day, and of course, you don't want them to miss work; you don't want them to stay in bed for one day because they received a vaccine, Toussaint said.

RELATED:Tessera Therapeutics scores $230M to ramp up 'gene writing' tech to cure disease

Von Maltzahn remembers just five years ago more than a few whispers that this would never work. Just before the pandemic, there were more than a dozen clinical trials underway with mRNA involved in some way, and the modality seemed to have landed on a trajectory toward becoming a major part of drug development someday.

It's kind of hard to go pre-moon landing and remember all of the challenges that it took to get onto the moon, von Maltzahn said. But those challenges were plentiful: manufacturing and delivery chief among them.

Now, in the third year of the pandemic, the modality has been accelerated by at least five years to a decade, according to von Maltzahn.

Lipid nanoparticle compositions have now been administered to probably more people than all biologicals, he said, referring to the delivery system that underpins the mRNA-based COVID-19 vaccines.

RELATED: The mRNA era has arrived thanks to COVID-19. What's next in the pipeline?

As Sanofi tinkers with improving the mRNA model, Toussaint said one key part of the delivery equation could be solving the cold storage requirements that initially limited the launch of vaccines from Pfizer-BioNTech and Moderna to major centers that had the proper equipment.

The COVID-19 vaccines certainly accelerated the field, but, because they were approved via emergency use authorizations that are slowly turning into full approvals, their path to market may not be a great comparison for therapies to come. But theres one very important way the shots have helped: awareness.

Ultragenyx recently advanced an mRNA therapeutic for glycogen storage disease type III into the clinic, according to Bedrosian. She shared the story of a patient who asked, When can I get my GST 3 vaccine?

mRNA was a foreign concept. It rolls off the tongue of everybody in the country and in the world now, she said.

Toussaint also suspects regulators will be more comfortable with mRNA therapies and vaccines to come.

RELATED:Sanofi snaps up Origimm for early-phase acne vaccine, opening new front in mRNA strategy

Now that the delivery challenges have been for the most part resolvedwith, of course, room to improve and build on the current methodvon Maltzahn thinks mRNA is poised to have applications across medicine.

It's fairly easy to speculate that we're going to open up multiple categories of new medicines as the field advances, he said.

And on delivery mechanisms, he added, that's probably an unheralded success in what we've called mRNA vaccines. We might have called them lipid nanoparticle vaccines.

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Fierce JPM Week: After 'objectively astonishing' progress on mRNA, biotech looks to tinker with winning formula - FierceBiotech

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Is precision medicine the future of obesity treatment? – Clinical Trials Arena

Posted: January 20, 2022 at 2:40 am

A study conducted by the Department of Twin Research and Genetic Epidemiology at Kings College London and the National Institute for Health Research (NIHR) BioResource has uncovered new insights on the genetic mechanisms controlling human metabolism. The study analysed the plasma levels of 722 metabolites from blood samples provided by 8,809 European subjects, making it the largest genome-wide association study of metabolite levels to date. Due to the scale of the analyses, the study identified 74 novel genomic regions, influencing human metabolism, that had not been recognised in any previous literature. The findings, which have been published in the journal Metabolites, could aid in the development of precision medicines for conditions such as obesity.

While precision medicines that are tailored to patients genetic profiles have revolutionised the treatment of many cancers, this approach has yet to be applied in clinical practice to conditions like obesity. At present, the dominant therapeutic strategy in obesity pharmacological management involves targeting the glucagon-like peptide 1 receptor (GLP1R), which has the effect of regulating appetite. This mechanism is employed by Novo Nordisks Saxenda (liraglutide), which has remained a leading global therapy in obesity since 2014, as well as Saxendas successor Wegovy (semaglutide), which was launched in the US in June last year.

Wegovy subsequently received approval in the UK and Canada and has been recommended for marketing authorisation by the European Medicines Agencys Committee for Medicinal Products for Human Use (CHMP). The drug, which demonstrated unprecedented efficacy results in Phase III trials and boasts a convenient once-weekly dosing regimen, has generated a great deal of interest within the obesity field. Despite some initial manufacturing issues that will lead to a short supply of the drug in the US in the first half of this year, Wegovy is expected to attain blockbuster status in the near future.

Although Novo Nordisk is currently dominating the obesity market, a wide range of other companies are attempting to enter this space. According to GlobalDatas pipeline products database, there are 233 companies active within the research and development (R&D) landscape that are collectively developing 363 investigational candidates. In addition to its substantial size, the obesity pipeline is also diverse, with 150 distinct molecular targets identified.

While the size and diversity of the pipeline are encouraging, new companies entering the R&D landscape may face an intense level of competition. Obesity is a condition associated with significant heterogeneity, however. Investing in therapies capable of demonstrating strong efficacy or reduced side effects in specific patient subsets could set new players apart from the competition, potentially enabling them to monopolise certain subsections of the market.

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Dilated Cardiomyopathy Gene Mutations Point to Possible Therapeutic Strategy – GenomeWeb

Posted: January 20, 2022 at 2:40 am

NEW YORK A team from Japan has detected loss-of-function mutations in a gene involved in protein homeostasis that appear to contribute to juvenile-onset forms of dilated cardiomyopathy, a heart condition affecting ventricular dilation and systolic dysfunction that can lead to heart failure and the need for a heart transplant.

"Familial DCM is reportedly caused by mutations in more than 50 genes, requiring a precise disease stratification based on genetic information," senior and corresponding author Yoshihiro Asano, a cardiovascular medicine researcher at the Osaka University, and his co-authors explained in Science Translational Medicine on Wednesday, reasoning that "[i]dentifying the further genetic causes of DCM could improve the utility of genetic testing and might lead to new insights into the pathogenesis of heart failure."

As part of the "Genome registry and stratification of cardiovascular disease" (GRAND-STAR) study, the researchers searched for new contributors to inherited DCM, including mutations in genes associated with heart sarcomeres, cytoskeleton, and other structures.

Along with genetic clues found in exome sequence data for more than 1,800 individuals represented in the GRAND-STAR database, they used RNA sequencing to profile transcriptional features in heart tissue samples from three inherited DCM patients and as many unaffected controls.

By focusing on genes containing rare variants that were upregulated in DCM cases with heart failure, the team identified five individuals with severe DCM from four families who carried truncating, loss-of-function mutations affecting both copies of the BAG5 gene, which codes for a heat shock cognate (HSC70) protein nucleotide exchange factor from the Bd-2-associated athanogene, or BAG,protein family.

In mouse model experiments, the group saw signs that the introduction of BAG5 alterations stymied HSC70 activation a process previously linked to protein homeostasis, or proteostasis and led to DCM-like symptoms in the mice.

The researchers were able to reverse such features by treating the mutant mice with adeno-associated virus serotype 9, or AAV9,viral vectors containing a wild-type version of BAG5 and a cardiac troponin T promoter. Based on such findings, they suggested that gene therapy strategies may eventually preclude the need for heart transplantation in a subset of inherited DCM patients with mutations that lop out BAG5.

"[W]e demonstrated that BAG5 mutations led to loss of functional BAG5 protein, which could be restored through administration of an AAV9-BAG5 vector in a murine model," the authors reported. "This finding suggests that AAV gene therapy should be further investigated as a possible treatment alternative to heart transplantation for patients who are BAG5 deficient."

The researchers noted that hereditary DCM stems from autosomal recessive inheritance of the BAG5 mutations. Even so, they tracked down truncating mutations affecting one copy of the BAG5 gene in three individuals with a reversible DCM subtype called tachycardia-induced cardiomyopathy. The results hinted that heterozygous BAG5 alterations may contribute to TIC, though they cautioned that "the effect of BAG5 mutations on TIC needs to be analyzed in larger groups of patients."

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Roche revives a closely watched Huntington’s disease drug – BioPharma Dive

Posted: January 20, 2022 at 2:40 am

Dive Brief:

As 2021 began, Huntington's drug research appeared to be on the verge of turning a corner.

Both Roche and Wave Life Sciences were advancing drugs that were similarly designed to block production of a protein implicated in disease progression. For Roche, the stakes were particularly high: A successful result could've led to an approval application for the first drug that might slow the march of the deadly, inherited disease.

By the end of the first quarter, however, both companies reported negative data, raising questions about their drugs as well as researchers' understanding of Huntington's. It also dialed up pressure on companies with earlier stage projects, such as UniQure and Passage Bio.

But it turns out Roche isn't done with tominersen after all, a decision that could have implications for others. While the new clinical trial will be a small, Phase 2 test that will require follow-up studies, tominersen remains one of the most advanced disease-modifying drug in clinical development for Huntington's.

The Swiss drugmaker is in "the early stages" of designing the new trial, Ionis said, which will evaluate different doses of tominersen in younger patients with less severe disease. Roche will share the design of the trial with Huntington's disease specialists in medical meetings later this year, according to Ionis.

Ahead of the trial design presentations, Roche later this week will begin a series of webinars to discuss with Huntington's specialists the after-the-fact analysis of GENERATION-HD1 that hinted at a benefit for the younger, less severe patients.

Roche's Huntington's collaboration with Ionis dates back to 2013, when the big drugmaker acquired initial licensing rights for $30 million and promised up to $362 million in future payouts. Following positive signs in early testing, Roche paid $45 million to license tominersen and cover clinical development as well as commercial costs.

As a disease caused by an identifiable genetic defect, Huntington's seems to be a good target for a medicine that can block the mutation, which results in a flawed version of a protein called huntingtin. Tominersen is a type of medicine known as antisense oligonucleotide and works by going after the RNA that encodes for the protein.

Gene therapies are also aimed at the disease's genetic cause, but work by replacing the defective gene with what could in theory be a one-time treatment. Tominersen, by comparison, was given to patients once every eight or 16 weeks in GENERATION-HD1.

An estimated 41,000 people in the U.S. have Huntington's disease, although many are undiagnosed.

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Genome Editing Market: Rise in drug discovery and development activities to drive the market – BioSpace

Posted: January 20, 2022 at 2:40 am

Genome Editing Market: Snapshot

Genome editing tools have come a long way from the mid-twentieth century. In 1970s and 1980s, gene targeting was done using largely homologous combination, but was only possible in mice. Since then, the expanding science of genetic analysis and manipulation extended to all types of cells and organisms. Advent of new tools helped scientists achieve targeted DNA double-strand break (DSB) in the chromosome, and is a key pivot on which revenue generation in the genome editing market prospered. New directions for programmable genome editing emerged in the decades of the twenty-first century, expanding the arena.

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Cutting-edge platforms at various points in time continue to enrich genome editing market. Various classes of nucleases emerged, most notable of which is CRISPR-Cas. Research labs around the world have extensively used the platforms in making DSBs at any target of choice. Aside from this, agricultural sciences and medical sectors make substantial use of zinc-finger nucleases (ZFNs), transcription activator-like effector nucleases (TALENs) in genome editing. Strides made in stem cell therapies, particularly in rectifying an aberrant mutation, have boosted the growth of the genome editing market. Genetic diseases such as muscular dystrophy and sickle cell disease present an incredible revenue prospect in the genome editing market. Ongoing research on novel vectors and non-vector approaches are expected to bolster the outlook of the market.

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Genomic editing refers to the strategies and techniques implemented for the modification of target genetic information of any living organism. Genome editing involves gene modification at specific areas through recombinant technology, which increases precision in insertion and decreases cell toxicity. Current advancement in genome editing is based on programmable nucleases. The genome editing market is presently witnessing significant growth due to increase in R&D expenditure, rise in government funding for genomic research, technological advancements, and growth in production of genetically modified crops. Companies have made significant investments in R&D in the past few years to develop cutting-edge technologies, such as, CRISPR and TALEN. For instance, Thermo Fisher Scientific is investing significantly in the development of its CRISPR technology for providing better efficiency and accuracy in research and also to fulfil the unmet demands in research and therapeutics. Cas9 protein and FokI protein have been combined to form a dimeric CRISPR/Cas9 RNA-guided FokI nucleases system, which is expected to have wide range of genome editing applications.

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The genome editing market is growing rapidly due to its application in a large number of areas, such as mutation, therapeutics, and agriculture biotechnology. Genome editing techniques offer large opportunities in crop improvement. However, the real potential of homologous recombination for crop improvement in targeted gene replacement therapy is yet to be realized. Homologous recombination is expected to be used as an effective methodology for crop improvement, which is not possible through transgene addition. Rise in the number of diseases and applications is likely to expand the scope of genome editing in the near future. It includes understanding the role of specific genes and processes of organ specific stem cells, such as, neural stem cells and spermatogonial stem cells. Genome editing has a significant scope to treat genetically affected cells, variety of cancers, and agents of infectious diseases such as viruses, bacteria, parasites, etc. However, genetic alteration of human germline for medicinal purpose has been debated for years. Ethical issues, comprising concern for animal welfare, can arise at all stages of generation and life span of genetically engineered animal.

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The global genome editing market can be segmented based on technology, application, end-user, and geography. In terms of technology, the genome editing market can be categorized into CRISPR, TALEN, ZFN, and other technologies. Bioinformatics has eased the process of data analysis through various technological applications. On the basis of application, the global genome editing market can be classified cell-line engineering, animal genome engineering, plant genome engineering, and others. Based on end-user, the genome editing market can be segmented into pharmaceutical and biotechnological companies and academic and clinical research organizations. In terms of region, the global genome editing market can be segmented into North America, Europe, Asia Pacific, Latin America, and Middle East & Africa. North America is projected to continue its dominance in the global genome editing market owing to high government funding for research on genetic modification in the region. Asia Pacific is a rapidly growing genome editing market due to rise in investments by key players in the region. Rise in drug discovery and development activities, coupled with increasing government initiatives toward funding small and start-up companies in the biotechnology and life sciences industry, is a major factor expected to drive the genome editing market in North America during the forecast period. Players should invest in the emerging economies and the countries of Asia-Pacific like China, South Korea, Australia, India and Singapore in which the genome editing market is expected to grow at rapid pace in future, due to growing funding in research.

Key players operating in the global genome editing market are CRISPR Therapeutics, Thermo Fisher Scientific, GenScript Corporation, Merck KgaA, Sangamo Therapeutics, Inc., Horizon Discovery Group, Integrated DNA Technologies, New England Biolabs, OriGene Technologies, Lonza Group, and Editas Medicine.

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Searching for Medicine’s Answers in the Most Powerful Library on Earth – BioSpace

Posted: January 20, 2022 at 2:40 am

Enveda CEOViswa Colluru, Ph.D./Courtesy Enveda Biosciences

Two-year-old biotech company Enveda Biosciences believes the answers to humanitys most challenging diseases can be found by harnessing the complexity of the natural world. Envedas home base in Boulder, Colorado where many ponder the wonders of the Rocky Mountains every day could not be more fitting.

For centuries, human societies have been using plant-based and other natural products to treat illness, but as Enveda Founder and CEO Viswa Colluru, Ph.D. told BioSpace, we are in a different place today than we were in the late 1990s when interest in biochemistry and natural products first peaked. Indeed, in 2019, when Colluru founded Enveda, machine learning and computational metabolomics had finally arrived, and he wanted to leverage both to their full potential to uncover the fundamental biology of disease and speed up the drug discovery process.

We started Enveda with the vision to build the first high-resolution chemical map of planet Earth and change where we look for new medicines, Colluru said. Because if you ask me, the most powerful library on Earth is one that has spent about 4 billion years in evolution.

Enveda plans to maximize this library by specifically modulating previously inaccessiblebiology, such as undruggable proteins, RNA, or even microbes for therapeutic use. The companys platform is made up of two parts; the first, a Google-like chemical search engine with an algorithm that can directly predict structure from mass spectrometry. This search engine takes the chemistry in the world of which 95% remains unknown and allows Enveda to draw insights from those compounds at scale without needing to isolate each one. It can then determine the specific activity and therapeutic potential of each compound drawing on high-throughput biological experiments conducted in Envedas labs.

The second piece is the knowledge graph, which Colluru called the largest digitized knowledge base of humanity's use of plants as medicine integrated into all of modern biochemistry. Through this technology, Enveda is identifying how new regions of chemical space could drive drug discovery for specific diseases. It takes about 16 million relationships of all known proteins, cellular processes and disease symptoms, and maps it to our data, he explained. One compound, for example, might have an anti-inflammatory effect in the brain and could be useful for treating Parkinsons disease.

During just Envedas first screening campaign for the target, the team uncovered a potential source of a small molecule to modulate Proprotein convertase subtilisin/kexin type 9 (PCSK9), which Colluru described as a holy grail cardiometabolic target. Inflammasome pathway modulators were another big discovery. By studying the protein targets they bind, weve rediscovered known but undrugged inflammasome pathway targets and many potential new ones, he shared.

So, why this specific approach to drug discovery? The answer, Colluru said, is found in historical success rates. Natural products or their derivatives account for one-third of all approved small molecule medicines. This, despite science having only discovered about 150,000 natural products to date. Colluru contrasted that with synthetic libraries, through which large pharmaceutical companies screen roughly 5 to 8 million compounds, accounting for the other two-thirds. If you do the math, historically, natural products have been 10 times more successful at yielding an approved medicine.

Colluru gave his theory as to why this is.

Many of the sources of natural compounds, plants, for example, have co-evolved withcomplex life. Plants can't stand up and walk away from an environment they don't like, so instead, they produce a lot of compounds that allow them to modulate their environment. This environment consisted of microbes, insects, and even mammals. Today, we know that we have as much if not more microbial DNA in our own body and our proteins share homology with those of other mammals. This makes nature a much more relevant chemical dataset, he said, emphasizing that only about 5% of the chemistry on Earth is known. So, imagine what the other 95% would do for drug discovery and beyond.

To accomplish this ambitious mission, Colluru has brought on an executive team with serious gravitas. Theres Sotirios Karathanasis, Ph.D., chief science officer, who comes to Enveda following stints as CSO at Eli Lilly and vice president and head of biosciences at AstraZeneca, and Bryan Norman, Ph.D., VP of drug discovery, who spent 25 years leading drug discovery efforts at Lilly and Searle.

For Karathanasis, the time to maximize natural products in therapeutics is here.

"While it is common knowledge that natural products have historically been a productive source of new drugs, the consistency of active compound discovery from natural products has been challenging. Advanced technologies, including large-scale untargeted metabolomics and modern machine learning algorithms, are overcoming this challenge to provide novel, evolution-optimized pharmacophores for the treatment of multiple diseases, he said. Characterization of these compounds also provides unique opportunities for discovery of fundamental biology analogous to the discovery of the mTOR pathway using Rapamycin and last years Nobel-winning discovery of pain mechanisms using Capsaicin. If Enveda's platform had existed when I was leading large teams in big pharma, we may never have moved away from natural products."

Then, there is Colluru himself who brings his formative experience from Recursion Pharmaceuticals, a unicorn known for integrating technological innovations across biology, chemistry, automation, data science and engineering. Recently, Enveda tapped August Allen, whom Colluru knew from his Recursion days, as chief platform officer. This is a relatively new role in biotech, but one Colluru said is the right fit for Enveda.

Our fundamental strength as a company is our differentiated technology platform, he said. The goal of the chief platform officer is to operationalize and scale the execution of our platform and generate data which in turn feeds its evolution. August joins us after several very impactful years at Recursion, scaling their platform from its very earliest stages.

The foundation for much of Envedas science is based upon the work of Pieter Dorrestein, Ph.D., a leading computational metabolomics researcher and Envedas scientific co-founder. Dorrestein, a professor at the University of California San Diego (UCSD), built the first cloud-scale repositories for mass spec data, along with an algorithm that was able to analyze the entire repository, regardless of whether the identity of the chemical was known.

Envedas therapeutic scope is driven by the lack of success in complex diseases from traditional ways of thinking about single targets or modalities, Colluru said. The company is prioritizing therapeutic targets in the cardiovascular, metabolic and neurological spaces where Enveda has an entry point to a rare disease or those that have shared mechanisms with a rare indication. Two examples of this are Parkinsons and Amyotrophic Lateral Sclerosis (ALS), both of which Enveda is in the early stages of exploring.

In order to offer the maximum benefit for patients, Enveda is exploring partnerships with companies that bring complementary expertise in disease areas outside of its immediate scope. This could include indications such as respiratory disease or large diseases in the cardiometabolic space, Colluru said.

We recognize that the biggest outcome for patients is likely from being able to use all of the excess productivity of our platform, Colluru said. Right now, it is producing more chemical substrate and exciting early data than we know what to do with.

While Envedas short-term objective is to discover new natural small molecule therapeutics, Colluru sees broader long-term potential for the platform.

One application could be using the algorithm to predict unknown metabolites in blood. That will herald a new era of precision medicine, based not on genomics, but on metabolomics, he said. Another potential use is in agriculture, as natures metabolites could inform the functions of nature, enabling an understanding of the basis of food, nutrition, taste and pest resistance. This could become particularly relevant as climate change continues to impact the world.

Another potential breakthrough is the identification of chemical fingerprints, which could have applications in forensics. Just like we all have our DNA fingerprints, we all have our chemical fingerprints, and this is very different from our physical fingerprint or genetic fingerprint. Dorrestein published a paper showing that it was possible to track the cosmetics used on the human body for several days.

Since founding Enveda with $70 thousand of his own savings, Colluru and his team have been on what many would call a remarkable pace. In June 2021, the company raised $51M in a Series A funding round led by Lux Capital. Enveda also found its way into BioSpaces NextGen Bio Class of 2022, a list of the most promising recently-launched life sciences companies in North America.

Colluru credits this rapid progress to two factors: one, hiring amazing people, and then, creating the culture and the habit of getting out of their way, and two; learning to get comfortable with uncertainty. I think it is very, very unlikely that you'll ever be able to see the full staircase, but that should never stop you from taking the first two steps. At Enveda, we have the attitude and culture that we're okay venturing into the unknown, and as a result, it's driven a lot of our discoveries and success.

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BridgeBio Announces Clinical Collaboration with Amgen to Study BBP-398, a Potentially Best-in-class SHP2 Inhibitor, in Combination with LUMAKRAS…

Posted: January 20, 2022 at 2:40 am

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- First clinical combination study of BBP-398 and LUMAKRAS set to evaluate safety and preliminary efficacy in solid tumors with the KRAS G12C mutation

PALO ALTO, Calif., Jan. 13, 2022 (GLOBE NEWSWIRE) -- BridgeBio Pharma, Inc. (Nasdaq: BBIO) (BridgeBio), a commercial-stage biopharmaceutical company focused on genetic diseases and cancers, today announced a non-exclusive clinical collaboration with Amgen Inc. (Amgen) to evaluate the combination of BBP-398, a potentially best-in-class SHP2 inhibitor, with LUMAKRAS (sotorasib), a KRASG12C inhibitor, in patients with advanced solid tumors with the KRAS G12C mutation.

The Phase 1/2 study will include a dose escalation period followed by dose expansion and optimization, and is designed to evaluate the safety, tolerability, pharmacokinetics, pharmacodynamics and preliminary efficacy of BBP-398 in combination with LUMAKRAS. Under the terms of the non-exclusive collaboration, BridgeBio will sponsor the study and Amgen will provide a global supply of LUMAKRAS.

BBP-398 is a potent small-molecular inhibitor of SHP2 developed in collaboration with The University of Texas MDAnderson Cancer Centers Therapeutics Discovery division. SHP2 is a protein-tyrosine phosphatase that links growth factor, cytokine and integrin signaling with the downstream RAS/ERK MAPK pathway to regulate cellular proliferation and survival. By combining SHP2 inhibition with KRASG12C inhibition in patients with the KRAS G12C mutation, there is potential that the investigational combination could prevent oncogenesis and overactive cellular proliferation.

Overactivity of the MAPK pathway is a significant cause of many types of difficult-to-treat cancers and by combining these two agents, we aim to reduce the oncogenic potential of tumor cells, said Frank McCormick, Ph.D., chairman of oncology at BridgeBio. Building on our collaborations with Bristol Myers Squibb and LianBio, we are excited to be working with Amgen on this new collaboration. By harnessing the power of BBP-398 as a potentially best-in-class SHP2 inhibitor with LUMAKRAS, we are hopeful that we will be able to provide substantial relief for cancer patients in need. We will continue to pursue additional collaborations that we believe hold promise for patients.

KRAS mutations occur in approximately 17% of malignant solid tumors. BBP-398, as a monotherapy or in combination with other targeted therapies, could potentially be a promising therapy for patients with the KRAS G12C mutation.

BridgeBio is currently advancing its Phase 1 clinical trial of its SHP2 inhibitor, BBP-398, in patients with solid tumors driven by mutations in the MAPK signaling pathway, including RAS and receptor tyrosine kinase genes. BBP-398 is part of BridgeBios growing precision oncology pipeline and is one of 14 programs in the broader portfolio that are being advanced in the clinic or commercial setting.

About BBP-398BBP-398 is a potentially best-in-class SHP2 inhibitor. Earlier this year, BridgeBio entered a non-exclusive, co-funded clinical collaboration with Bristol Myers Squibb to evaluate the combination of BBP-398 with OPDIVO (nivolumab) in patients with advanced solid tumors with KRAS mutations. BridgeBio previously also entered into a strategic collaboration with LianBio for clinical development and commercialization of BBP-398 in combination with various agents in solid tumors such as non-small cell lung cancer, colorectal cancer and pancreatic cancer in mainland China and other major Asian markets.

About BridgeBio Pharma, Inc.BridgeBio Pharma (BridgeBio) is a biopharmaceutical company founded to discover, create, test and deliver transformative medicines to treat patients who suffer from genetic diseases and cancers with clear genetic drivers. BridgeBios pipeline of over 30 development programs ranges from early science to advanced clinical trials and its commercial organization is focused on delivering the companys two approved therapies. BridgeBio was founded in 2015 and its team of experienced drug discoverers, developers and innovators are committed to applying advances in genetic medicine to help patients as quickly as possible. For more information visitbridgebio.comand follow us onLinkedInandTwitter.

BridgeBio Pharma, Inc. Forward-Looking StatementsThis press release contains forward-looking statements. Statements we make in this press release may include statements that are not historical facts and are considered forward-looking within the meaning of Section 27A of the Securities Act of 1933, as amended (the Securities Act), and Section 21E of the Securities Exchange Act of 1934, as amended (the Exchange Act), which are usually identified by the use of words such as anticipates, believes, estimates, expects, intends, may, plans, projects, seeks, should, will, and variations of such words or similar expressions. We intend these forward-looking statements to be covered by the safe harbor provisions for forward-looking statements contained in Section 27A of the Securities Act and Section 21E of the Exchange Act and are making this statement for purposes of complying with those safe harbor provisions. These forward-looking statements, including statements relating to expectations, plans, and prospects regarding the success of our non-exclusive clinical collaboration with Amgen, the timing and success of a Phase 1/2 study to evaluate the safety and preliminary efficacy of BBP-398 in combination with LUMAKRAS in patients with advanced solid tumors with the KRAS G12C mutation, the ability of combining SHP2 inhibition with KRASG12C inhibition in patients with the KRAS G12C mutation to prevent oncogenesis and overactive cellular proliferation, our ability to provide substantial relief for cancer patients in need, the promise of targeted therapies for patients with KRAS mutations, the success and status of current and future relationships with third-party collaborators and academic partners, the continuing success of our clinical collaboration with Bristol Myers Squibb to evaluate the combination of BBP-398 with OPDIVO (nivolumab), and the potential ability of our product candidates to treat genetically driven diseases and cancers with clear genetic drivers, reflect our current views about our plans, intentions, expectations, strategies and prospects, and are based on the information currently available to us and on assumptions we have made and are not forecasts, promises nor guarantees. Although we believe that our plans, intentions, expectations, strategies and prospects as reflected in or suggested by these forward-looking statements are reasonable, we can give no assurance that the plans, intentions, expectations or strategies will be attained or achieved. Furthermore, actual results may differ materially from those described in the forward-looking statements and will be affected by a number of risks, uncertainties and assumptions, including, but not limited to, the success of our product candidates to treat genetically driven diseases and cancers with clear genetic drivers, the continuing success of our collaboration with Amgen and other third parties, our ability to enter into future collaboration agreements, potential adverse impacts due to the global COVID-19 pandemic such as delays in regulatory review, manufacturing and clinical trials, supply chain interruptions, adverse effects on healthcare systems and disruption of the global economy, as well as those risks set forth in the Risk Factors section of BridgeBios most recent Annual Report on Form 10-K and BridgeBios other SEC filings. Moreover, we operate in a very competitive and rapidly changing environment in which new risks emerge from time to time. Except as required by applicable law, we assume no obligation to update publicly any forward-looking statements, whether as a result of new information, future events or otherwise.

BridgeBio Media Contact:Grace RauhGrace.rauh@bridgebio.com(917) 232-5478

BridgeBio Investor Contact:Katherine Yaukatherine.yau@bridgebio.com(516) 554-5989

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BridgeBio Announces Clinical Collaboration with Amgen to Study BBP-398, a Potentially Best-in-class SHP2 Inhibitor, in Combination with LUMAKRAS...

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Tuning protein half-life in mouse using sequence-defined biopolymers functionalized with lipids – pnas.org

Posted: January 20, 2022 at 2:40 am

Significance

Functionalization of proteins and biopolymers with chemical modifications can be utilized to alter their chemical and biophysical properties. In contrast to traditional chemical functionalization strategies, the use of nonstandard amino acids enables precise positioning of functional groups. Here, we report that multisite conjugation of fatty acids, at precise sites harboring genetically encoded nonstandard amino acids with bioorthogonal chemical handles, can be employed to tune the half-life of proteins in a mouse model. This programmable approach could offer a technical foundation for the modification of protein and peptide therapeutics to improve their efficacy or pharmacokinetic profile (e.g., to prevent rapid clearance and reduce frequency of administration).

The use of biologics in the treatment of numerous diseases has increased steadily over the past decade due to their high specificities, low toxicity, and limited side effects. Despite this success, peptide- and protein-based drugs are limited by short half-lives and immunogenicity. To address these challenges, we use a genomically recoded organism to produce genetically encoded elastin-like polypeptideprotein fusions containing multiple instances of para-azidophenylalanine (pAzF). Precise lipidation of these pAzF residues generated a set of sequence-defined synthetic biopolymers with programmable binding affinity to albumin without ablating the activity of model fusion proteins, and with tunable blood serum half-lives spanning 5 to 94% of albumins half-life in a mouse model. Our findings present a proof of concept for the use of genetically encoded bioorthogonal conjugation sites for multisite lipidation to tune protein stability in mouse serum. This work establishes a programmable approach to extend and tune the half-life of protein or peptide therapeutics and a technical foundation to produce functionalized biopolymers endowed with programmable chemical and biophysical properties with broad applications in medicine, materials science, and biotechnology.

A major goal of synthetic biology is to harness biological systems to produce valuable products, such as new therapeutics, renewable chemicals, and functionalized materials. In the case of proteins, the native translation process uses information encoded in DNA to guide their template-directed production at monomeric precision, albeit limited to the chemistry of the 20 natural amino acids. Work in genetic code expansion with nonstandard amino acids (nsAAs) has expanded the chemical palette of biology through the template-directed biosynthesis of proteins with synthetic chemistries (1). To date, such work has been limited to only one or a few instances of site-specific incorporation of nsAAs per protein, constraining biopolymer synthesis to tag-and-modify approaches or simple protein decorations. Recent advances include an increase in the number and chemical diversity of nsAAs (1), the development of highly active translation machinery for efficient incorporation of nsAAs into proteins (2, 3), and engineered strains of Escherichia coli with recoded genomes possessing open coding channels that can be dedicated to the incorporation of nsAAs (46). Together, these advances enable multisite incorporation of nsAAs to endow proteins and sequence-defined biopolymers with new chemical and biophysical properties.

An active area of interest for the use of nsAAs is to enhance the functionality of protein and peptide pharmaceuticals. They represent a versatile and fast-growing class of biological therapeutics (7, 8) that are particularly attractive as potential pharmaceuticals due to their high specificity, high activity and, in the case of peptides, rapid tissue penetration (7). However, major barriers prevent the widespread clinical use of many peptide or protein-based therapeutics (7): 1) the need to administer them by injection, 2) their rapid clearance by the kidneys, and 3) their rapid proteolytic degradation. As a result, these pharmaceuticals must be frequently administered at high doses, leading to a peak-and-valley pharmacokinetic profile. These characteristics can negatively affect therapeutic efficacy, can cause undesirable side effects with reduced patient compliance (912), and can trigger an immune response, including the induction of a neutralizing antibody response (13, 14).

To address these challenges, proteins and peptides are frequently functionalized to extend their half-life and improve immunotolerance. A widely adopted strategy is the conjugation of poly(ethylene glycol) (PEG), which increases the radius of the protein and reduces proteolytic cleavage, and consequently reduces clearance (15). However, the development of alternatives to PEGylation remains important, as PEGylation does not always offer the desired effect on pharmacokinetics, and in certain cases, safety concerns about its immunogenicity and accumulation in tissues have been raised (1618). An alternative strategy is to conjugate or fuse the therapeutic protein or peptide to serum proteins with long half-lives, such as serum albumin, antibodies (e.g., full-length or fragments of IgG), or blood components, such as red blood cells (17, 18). Similarly, many approaches use chemical moieties or peptides to promote noncovalent binding interactions to the same serum proteins and complexes in order to extend half-life (1720). One effective and safe option is the use of fatty acids (FAs) to promote binding to serum albumin. For example, insulin and glucagon-like peptide-1 (GLP-1) conjugated with a single FA are clinically used to treat diabetic patients (2123).

A major hurdle to the development of functionalized therapeutics is to selectively and predictably modify the protein while maintaining bioactivity. Conventional strategies for PEGylation and functionalization with chemical moieties utilize chemistries that modify the target protein at their termini, or at residues with reactive side-chains (24). The functionalization at C or N termini can be highly selective and predictable, but it can reduce bioactivity and is thus incompatible with many proteins. In contrast, modifications at reactive side-chains (e.g., cysteine or lysine) is less restrictive, but it can be difficult (or practically impossible) to identify unique reactive sites in the peptide sequence for site-specific conjugation. To address this problem, amino acids in the protein are typically mutagenized, which can result in reduced bioactivity. Recently, nsAAs have been successfully employed for modification of proteins and peptides, offering bioorthogonal chemistries for functionalization at predetermined positions within the protein (2426). For example, human growth hormone (hGH) and fibroblast growth factor 21 (FGF21) were site-specifically PEGylated, prolonging their function through extended serum half-life in clinical trials (27, 28). In other cases, site-specific lipidation at a single nsAA was shown to extend half-life in mouse models (29, 30). Although these approaches have improved protein half-life, typically these designs are constrained to a single instance of the nsAA, which limits the versatility and tunability (e.g., customized range of half-lives) of these functionalized peptides and proteins.

In this study, we present a synthetic biology platform to biosynthesize proteinpolymer fusions with sequence-defined conjugation sites for multisite lipidation in order to extend and tailor the half-life of proteins invivo. Specifically, we encoded up to 10 instances of the nsAA para-azidophenylalanine (pAzF) in elastin-like polypeptide (ELP) fusion proteins at high yields in an engineered bacterium with a recoded genome (4), and demonstrate the ability to precisely control the position and number of FAs per biopolymer. We found that the number of FAs per protein is strongly correlated with the binding affinity to serum albumin, enabling us to tune the invivo serum half-life of proteins without accumulation in organs or eliciting an inflammatory response in mouse. These advances could be applied to extend and tune the half-life of protein or peptide therapeutics and establish a technical foundation to produce sequence-defined programmable biopolymers endowed with bespoke chemical and biophysical properties with broad applications in medicine, materials science, and biotechnology.

To enable the biosynthesis of sequence-defined synthetic biopolymers with template-directed conjugation sites, we utilized a recently described synthetic biology expression system that allows efficient incorporation of nsAAs (e.g., pAzF) at UAG codons (Fig. 1A) (2). This system possesses two unique properties. First, the expression host is the genomically recoded organism (GRO) (4), an E. coli MG1655 derivative, in which all instances of UAG stop codons were recoded to synonymous UAA codons, followed by the deletion of release factor 1 (RF1). This GRO establishes an open codon by eliminating competition between an orthogonal tRNACUA/aminoacyl tRNA synthase (aaRS) pair and termination at UAG codons by RF1. Second, aaRSs evolved for aminoacylation with nsAAs typically have significantly reduced activities compared to native enzymes, resulting in low levels of nsAA-tRNA and low yields for proteins with multiple instances of an nsAA (31). Here, we use a tRNACUA/aaRS derived from Methanocaldococcus jannaschii that was evolved for enhanced activity, enabling efficient multisite incorporation of nsAAs into proteins (2). Together, this expression system enables the biosynthesis of polypeptide polymers with multiple pAzF residues at high yields and accuracy.

Biosynthesis and functionalization of genetically encoded biopolymers for half-life extension of proteins. (A) Site-specific multisite incorporation of pAzF at UAG codons in the GRO. All 321 TAG codons in E. coli were genomically recoded to TAA. To create the GRO, RF1 was deleted. The canonical amino acids and pAzF are shown as black and red circles, respectively. The TAG codon is converted into a sense codon for multisite incorporation of pAzF. (B) Schematic of the ELP-protein with 10 pAzF residues. The chemical structure of pAzF and the sequence of a single ELP repeat are shown. (C) Functionalization of azido groups in ELPs through copper(I)-mediated click chemistry with alkynyl palmitic acid. (D) Functionalized biopolymers are characterized in mice to study impact on half-life.

To study the effect of the number of FA conjugates on the invivo serum half-life, we chose to introduce the nsAA in an ELP with 10 consecutive pentadecapeptide repeats for functionalization. ELPs have previously been fused to active therapeutic peptides for a variety of indications, including type 2 diabetes and cancer (32), and serve as a versatile module to alter their pharmacokinetics. Within each repeat of the ELP, we encoded either a tyrosine or a pAzF residue at a designated guest residue position (henceforth named the target residue) (Fig. 1B), such that the genetic template controls the number and position of pAzF residues in the ELP-GFP. In turn, the bioorthogonal copper(I)-catalyzed azide-alkyne Huisgen cycloaddition (click-chemistry) reaction between pAzF residues and palmitic acid alkynes (with an terminal alkyne, such that the carboxyl group is exposed) ensures site-specific conjugation (Fig. 1 C and D). Alkynyl palmitic acid was used for functionalization because it had previously been shown to strongly promote binding to albumin (23).

To evaluate if we could produce proteins with a genetically controlled number of FAs, we expressed ELP-GFP with 0, 1, 5, or 10 UAG codons at a yield of 70 mg/L (Fig. 2A and SI Appendix, Fig. S1). To carefully examine the fidelity and efficiency of each step in our system, we performed quantitative mass spectrometry (MS) analysis of the ELPs digested with thermolysin, which liberates each of the 10 constituent ELP units. To account for differences in ionization efficiency between the different peptide species, ion counts were quantified using a standard curve for each peptide (SI Appendix, Fig. S2). We first evaluated the efficiency of pAzF incorporation and found that the abundance of ELP units with pAzF was directly proportional to the number of UAG codons in the construct (SI Appendix, Fig. S3). Consistent with prior work (2), when all 10 ELP units contained a UAG codon, we detected minor (<5%) tyrosine misincorporation.

Analysis of the purity and bioactivity of multisite lipidated biopolymers. (A) Schematic representation of ELP-GFP reporter constructs with 1, 5, or 10 pAzF residues. Target positions for pAzF are indicated in red. (B) Relative abundance of detected nonstandard amino acids at target residues of ELP units based on quantitative MS. Treatment with ISAz selectively converts reduced pAzF residues, pAF, back into pAzF. (C) Click-chemistry with FA alkynes functionalizes all pAzF, but not pAF, residues (n = 3, error bars: mean SD). (DG) Intact MS of full-length ELP(FA)-GFP after click-chemistry with (blue) or without (black) ISAz treatment. (H) Activity of recombinant trx, trx-ELP(10pAzF), and trx-ELP(10FA) at protein quantities ranging from 25 to 150 pmol per well. (I) Effect of HSA on the activity of recombinant trx, trx-ELP(10pAzF) and trx-ELP(10FA) using 100 pmol of each protein and 500 pmol HSA. Data are normalized to the activity of each protein without HSA (n = 3, error bars: mean SEM). *P < 0.05, **P < 0.01.

While examining the fidelity of pAzF incorporation, we observed significant levels of para-aminophenylalanine (pAF) (Fig. 2B), the reduced form of pAzF, which cannot participate in click-chemistry. In our system, pAF is the result of pAzF reduction (2, 33), and causes significant impurities and heterogeneity in the final preparations if left unresolved. To overcome this impurity, we developed a method to selectively recover pAzF from pAF with the diazotransfer reagent imidazole-1-sulfonyl azide (ISAz) (Materials and Methods) (34). We previously demonstrated that this approach enabled effective conversion of pAF residues to pAzF, without introducing azides at other primary amines found in ELP-GFPs (34). Consistent with this prior work, after treatment with ISAz we observed less than 5% of pAF via quantitative MS in each of the digested ELP-GFP constructs (Fig. 2B).

We then used click-chemistry to attach alkynyl palmitic acid at the precise positions where pAzF was encoded and assessed the purity of each ELP-GFP construct. These functionalized constructs are denoted as ELP(nFA)-GFP, where n indicates the number of UAG codons encoding pAzF in the template. We observed that all pAzF residues were converted to FA conjugates and no further reduction to pAF was detected during this reaction (Fig. 2C), emphasizing the high efficiency of this conjugation strategy. To complement the quantification at the peptide level, we used MS of the intact protein to evaluate the purity of the products (Materials and Methods). We consistently observed one dominant peak at the expected mass after ISAz treatment, whereas untreated samples demonstrated heterogeneous modification of the ELP-GFP (Fig. 2 DG). For example, the ELP(10FA)-GFP without ISAz treatment showed multiple distinct peaks corresponding to an impure biopolymer with variable number of FAs. The peak profile correlates with a binomial distribution determined by the availability of pAzF residues (SI Appendix, Fig. S4) and suggests pAzF reduction is probabilistic.

Finally, we evaluated if the addition of multiple FAs per protein would impair solubility of the resulting constructs. The solubility of unmodified ELP-GFP and ISAz-treated proteins with 1, 5, or 10 FAs were determined by dynamic light scattering (DLS) analysis. All constructs, before and after FA conjugation, were soluble (>99% by volume) and did not self-assemble in solution (SI Appendix, Fig. S5). Together, these results demonstrate that the genetically controlled placement of pAzF and chemical regeneration of reduced pAF residues enable the programmable and robust functionalization of biopolymers at multiple sites.

We evaluated the effect of ELP and FA conjugation of peptide bioactivity on the activity of two proteins. We first quantified the effect of FA conjugation on GFP fluorescence, and found that it is reduced by 14 to 25% (SI Appendix, Fig. S6). In addition, to examine the effect of ELP fusion and FA conjugation on enzymatic activity, we produced and characterized thioredoxin (trx)-ELP fusion proteins. We evaluated the activity of recombinantly produced trx, trx-ELP(10pAzF), and trx-ELP(10FA), after ISAz treatment. Similar bioactivity was observed for trx and trx-ELP(10pAzF), while trx-ELP(10FA) retained greater than 50% bioactivity (Fig. 2H). In addition, we evaluated the effect of human serum albumin (HSA) binding on the activity of these proteins. To this end, we performed an activity assay in the presence of fivefold excess HSA concentration, and found that HSA binding reduced the activity of trx-ELP(10FA) by 50%, while activity of trx and trx-ELP(10pAzF) were not significantly reduced (Fig. 2I). Although FA conjugation and HSA binding may partially reduce bioactivity, these analyses demonstrate that posttranslational functionalization with FAs is compatible with bioactive proteins.

Since prior work with single FA conjugations of insulin showed that serum half-life is correlated with the binding affinity to albumin (23), we hypothesized that multisite lipidation of ELP-GFPs would significantly enhance binding affinity to mouse serum albumin (MSA), and consequently extend serum half-life, compared to a single conjugated FA. To study the impact of increasing the number of FAs, we analyzed ELP-GFP constructs (both with and without ISAz treatment) with surface plasmon resonance (SPR). The KD values of our constructs were estimated based on the steady-state binding (Table 1). There was no detectable binding between MSA and the negative control without conjugated FAs [ELP(0FA)-GFP]. For untreated biopolymers, we found that the KD with a single FA, ELP(1FA)-GFP (KD = 126 32 M), was lowered 12- to 45-fold for ELP(5FA)-GFP (KD = 10.4 4.0 M) and ELP(10FA)-GFP (KD = 2.8 0.2 M), respectively. For the ISAz-treated biopolymers, we observed much stronger binding overall: treated ELP(1FA)-GFP presented a KD of 25.9 7.1 M, and an increase to 5 and 10 FAs per protein further lowered the KD to 4.0 1.6 M and 2.22 0.03 M, respectively. These data indicate that the affinity for MSA is strongly enhanced by conjugation of multiple FAs per protein and confirm that the binding affinity is correlated with the number of FAs.

Binding affinity of ELP-GFP constructs for serum albumin

We next determined if the tighter binding affinity is translated to prolonged half-life in C57BL/6J mice. A total of 50 g of each protein variant (10 M in phosphate-buffered saline [PBS]) was injected intravenously and blood was collected after 1, 4, 8, 16, and 24 h, followed by daily collections for 7 d. The blood levels of ELP(nFA)-GFP constructs were measured using a GFP-specific ELISA, and their pharmacokinetic profiles were calculated (SI Appendix, Fig. S7 and Table S1). We observed a striking 16- to 19-fold increase in half-life from 1.7 h for ELP(0FA)-GFP to 28 to 33 h for ISAz-treated ELP(5FA)-GFP and ELP(10FA)-GFP, as well as for untreated ELP(10FA)-GFP (Fig. 3A). Notably, when the same constructs were injected subcutaneously, we observed a delayed peak concentration, but the half-lives were equivalent to intravenous injections (SI Appendix, Figs. S8 and S9). Furthermore, these data show that the half-life of tight binding ELP-GFP constructs with multiple FA conjugates approaches the half-life of MSA in mice (35 h) (35), and is similar to the half-life of 28 h reported for proteinMSA fusion proteins (36).

In vivo characterization of lipidated biopolymers in mouse. (A) Serum half-life measurements of lipidated biopolymers with or without treatment with ISAz. Measurements were collected after a single intravenous injection of 50 g biopolymer in C57BL/6J mice. ELP(0FA)-GFP after ISAz treatment was not measured (n = 4, error bars: mean SD). (B) Correlation between the KD and half-life of lipidated biopolymers with or without ISAz treatment. The horizontal, black dotted line shows the half-life of MSA, the dashed gray line shows model predictions (n = 4 to 8, error bars: mean SD, n.d. = not detected). (C) Distribution of biopolymers in mouse organs, 3 and 48 h after intravenous injection of Alexa Fluor 648labeled ELP(0FA)-GFP or ELP(10FA)-GFP. The biopolymers were treated with ISAz. The data are representative of four independent measurements. (D) Quantification of average Alexa Fluor 648 intensity for organs shown in C (n = 4, error bars: mean SEM). For each organ separately, a one-way ANOVA was used to determine whether the differences between the means of the five treatment groups were statistically significant. After multiple testing correction, *P < 0.05 and **P < 0.005. (E) Serum concentration of select inflammatory cytokines at 3 and 48 h after injection. Endotoxin (100 g) and PBS were used as positive and negative controls, respectively. Measurements below the lower limit of detection (20 pg/mL) or above the upper limit of detection (5,000 pg/mL) are plotted at their limit of detection (n = 3, error bars: mean SD).

Finally, we note that the observed KD values can be approximated by dividing the KD of ELP(1FA)-GFP (ISAz-treated) by the average number of conjugated FAs (SI Appendix, Fig. S10). This correlation has two key implications. First, biopolymers with high numbers of FA conjugates [i.e., ISAz-treated ELP(5FA)-GFP, and both treated and untreated ELP(10FA)-GFP] will have similar binding affinities to albumin, and therefore also similar half-lives. Second, tuning of the binding affinity and half-life is most pronounced at lower numbers of conjugated FAs. In the case of ISAz-treated ELP(10FA)-GFP, we found a small decrease (although not statistically significant) in half-life compared to treated ELP(5FA)-GFP and untreated ELP(10FA)-GFP. We hypothesize that denser packing of the 10 FAs does not improve, or may even reduce, the availability of FAs for albumin binding, highlighting the value of being able to precisely control the number of FAs per protein.

We computationally modeled the system to gain a deeper understanding of the correlation between the binding affinity and half-life (SI Appendix, Supplementary Information Text and Fig. S11). In brief, a set of ordinary differential equations describes the binding and release of ELP-GFP from albumin as a function of the KD, as well as the clearance of both bound and unbound ELP-GFP. Here, unbound ELP-GFP has a half-life of 1.7 h, as empirically determined, and bound ELP-GFP is cleared at the same rate as albumin (35 h for mice) (35). Importantly, the half-life of the protein is determined by three parameters in this model: 1) the half-life of unbound protein, 2) the half-life of serum albumin, and 3) the binding affinity between the protein and albumin. By simulating the kinetics over time, we were able to calculate the overall clearance rate, and predictions made by the model were in good agreement with the empirical measurements for KD and half-life (Fig. 3B and SI Appendix, Fig. S11). This suggests predictive capability for the half-life based on empirically determined KD values, or the model can provide a target KD based on the desired half-life. Together, our results confirm that titrating the number of FAs allows predictable tuning of the protein half-life by modifying the binding affinity to albumin.

To evaluate the biocompatibility of the ELP-GFP constructs, we assessed the biodistribution and inflammatory response in mouse. ELP(0FA)-GFP and ELP(10FA)-GFP labeled with Alexa Fluor 647 dye were administered intravenously, and after 3 or 48 h, the brain, lungs, heart, spleen, liver, kidneys, and blood were collected and imaged for far-red fluorescence (Fig. 3 C and D and SI Appendix, Fig. S12). In the case of ELP(0FA)-GFP, most of the reporter had cleared from the blood after 3 h, and a strong signal was observed in the kidney, whereas ELP(10FA)-GFP was clearly observed in the blood, and to a lesser extent in the kidney. For both samples, a small increase (20 to 30%) in signal was observed in the liver. After 48 h, the Alexa Fluor 647 signal was only observed in the blood of ELP(10FA)-GFPinjected mice, whereas the intensity in all other organs had returned to the basal level seen in the PBS injection control. These results are consistent with the rapid clearance of ELP(0FA)-GFP, which is likely to occur mostly through excretion from the kidneys. The blood from each of these conditions was further analyzed for signs of inflammation. We did not detect any elevation of proinflammatory cytokine levels after injection of ELP-GFP constructs compared to PBS injection, whereas injection with lipopolysaccharide (LPS) as positive control gave a clear inflammatory response at both 3 and 48 h (Fig. 3E). Together, these results show that FA conjugation enables half-life extension without long-term accumulation in organs, or eliciting an inflammatory response after intravenous injection.

Considering applications of this technology for peptide and protein drug delivery in humans, we evaluated if the use of multiple FAs per protein conveyed similar increases in binding affinity to HSA. We observed KD values of 19.3 3.9 M, 3.2 0.6 M, and 1.6 0.2 M for ELP-GFP constructs with 1, 5, and 10 FAs per protein, respectively (Table 1). These binding affinities closely mirror the values observed for MSA, suggesting that multisite lipidation of proteins could be a promising strategy to tailor protein half-life in humans.

In this study, we describe the design and production of sequenced-defined synthetic biopolymers conjugated with a programmable number of FAs to tailor the serum half-life of proteins. Specifically, the genetically encoded pAzF residues facilitate precise and programmable functionalization with FAs, which enables titration of the binding affinity to both MSA and HSA. We determined that the binding affinity to albumin was predictive of the serum half-life in mice, suggesting that the protein clearance can be tuned by controlling the number of conjugated FAs per protein. Notably, we measured serum half-lives of up to 33 h, which is 94% of the 35-h half-life of MSA. Importantly, with similar binding affinities for MSA and HSA, we hypothesize that the half-life of these same constructs will be higher in humans, given that HSA has a significantly longer half-life (19 d) (37). Furthermore, activity analysis of a trx fusion protein, trx-ELP(10FA), indicate at most a 50% activity loss (in the absence or presence of HSA), as compared with free trx. This compares favorably with other carriers reported to cause an 30- to 500-fold reduction in the activity of other peptides (3842). Although, as is true for any carrier, the effect of ELP fusion and FA conjugation on activity is expected to vary for each individual peptide, protein, or molecule, our proposed fusion partner is highly tunable, in ELP size, sequence, and FA number and position, which should enable future optimization of both pharmacokinetics and bioactivity of each drug candidate.

Lipidation is an appealing alternative to PEG, which has come under scrutiny due to concerns about immunogenicity (43, 44), and uncertainty about its degradation and clearance from the body (45). The use of FAs has clinical precedence, offers greater tunability than direct fusion to albumin, and has a well-established safety profile (46). However, the utility of current lipidation strategies is constrained by two factors. First, typically only moderate half-life extensions are achieved due to weak binding of pharmaceuticals with single FAs to albumin. Second, the ability to identify uniquely reactive residues without impacting bioactivity remains challenging with conventional labeling strategies. Our work addresses both limitations with a general methodology that enables tuning the half-life extension by titrating the number of FAs per protein, and the ability to design conjugation sites at monomeric precision enables facile screening of permissive residues to maintain bioactivity.

Unique to this work is the multisite and programmable placement of nsAAs to produce a biopolymer with tunable properties, enabled by sequence-defined insertion of multiple FAs per biopolymer for functionalization. The ELP can be placed at either of the termini, or pAzF residues can be positioned in the primary sequence of the protein, permitting the optimization of both bioactivity and half-life extension, which highlights the flexibility of this approach. Furthermore, bioorthogonal conjugation sites, such as pAzF residues, allow the attachment of a wide variety of chemical moieties to expand the palette of biological chemistry far beyond FAs at genetically encoded positions throughout the protein to enhance its functionality. This establishes a foundation for a new class of synthetic, sequence-defined biopolymers comprised of a combination of natural and synthetic monomers that unites the diversity of the chemical world with the monomeric precision of translation in biological systems. These biopolymers are uniquely enabled by recoded organisms with open coding channels dedicated to the template-directed incorporation of synthetic monomers. We envision that this work, together with further recoding efforts to open up additional coding channels dedicated for multiple distinct nsAAs (46), establishes the basis for novel and programmable biopolymers (47, 48) with broad utility in biological research, pharmaceuticals, materials science, and biotechnology.

All proteins were expressed in the GRO (E. coli C321.A, CP006698.1, GI:54981157) (4) containing a previously described OTS plasmid pAcFRS.1.t1 with a p15A origin of replication and chloramphenicol acetyltransferase selection marker (2). The ELP-GFP genes were expressed from a plasmid with colE1 origin of replication and a kanamycin resistance marker (SI Appendix, Fig. S13). Each ELP-GFP construct had 10 repetitive units of 15 amino acids (VPGAGVPGXGVPGGG), where residue X is either tyrosine or pAzF (SI Appendix, Tables S2 and S3). The gene for trx was chemically synthesized (IDT) and cloned using EcoRI and PpuMI restriction enzymes into an expression vector containing to create trx-ELP(10UAG) (SI Appendix, Table S4). The same trx gene was cloned into an empty-expression vector for expression of unfused trx.

All cultures were grown at 34C under shaking (220 rpm). Before expression, the expression strains were grown to confluence in 50 mL 2xYT media. This culture was used to inoculate 1 liter of 2xYT, containing 30 g/mL chloramphenicol, 20 g/mL kanamycin, 0.2% arabinose, and 1 mM pAzF. After 4 h, expression of ELP-GFP was induced, using a final concentration of 60 ng/mL anhydrotetracycline. Cells were harvested 24 h after inoculation by centrifugation at 4,000 g for 15 min at 4C.

The cell pellet was resuspended in PBS, pH 7.4, and lysed by sonication (12 cycles of 10-s sonication separated by 40-s intervals, 40% amplitude). Poly(ethyleneimine) was added to each lysed suspension to a final concentration of 1.25%, after which the soluble fraction was separated from the cell debris by 15 min of centrifugation at 4,000 g. ELP-GFP proteins were then purified by phase transition triggered by sodium citrate, followed by centrifugation at 15,000 g for 3 min to eliminate contaminant proteins that did not precipitate. Finally, native E. coli proteins were denatured at 75C, and removed by centrifugation. After three purification cycles, the ELP-GFP proteins to >95% purity as judged by Coomassie staining of SDS/PAGE gels.

When stated, pAF residues from ELP-GFP proteins were regenerated using ISAz, as previously described. In brief, diazotransfer reactions were performed for proteins at a concentration of 20 M using 200 equivalents of ISAz in 10 PBS (1.4 M NaCl, 0.1 M phosphate, 0.03 M KCl) pH 7.2 at room temperature. After 72 h, reactions were stopped by exchanging the buffer to PBS (1, pH7.4).

The ELP-GFP proteins were reacted with palmitic acid alkyne using copper(I)-catalyzed azide-alkyne Huisgen cycloaddition (click-chemistry). For this reaction, proteins were diluted to a final azide concentration of 30 M, 35% DMSO, 0.16 mM palmitic acid alkyne, 0.1 mM CuSO4 and 0.5 mM THPTA (premixed for 30 min), 5 mM aminoguanidine hydrochloride, and 5 mM sodium ascorbate. The click-chemistry reaction was incubated for 1 h at room temperature under constant, gentle mixing. After the reaction, the protein was buffer exchanged to PBS (pH 7.4) using Amicon filters (10 kDa molecular weight cutoff [MWCO]).

Proteins for biodistribution studies were further labeled at primary amines with an Alexa Fluor 647 succinimidyl ester. Proteins were diluted to 0.1 mg/mL, and mixed with 5 g/mL fluorophore in PBS for mild labeling. Excess dye was removed using Amicon filters (10 kDa MWCO).

Endotoxins were removed from all protein preparations used for animal experiments, using Pierce high-capacity endotoxin removal columns following the manufacturers protocol (Thermo Fisher Scientific, catalog # 88274). Prior to injection, endotoxin levels were confirmed to be under 0.1 endotoxin unit (EU) per injection using Gel-Clot LAL reagent with sensitivity of 0.06 EU/mL (Charles River, catalog #R12006).

The purity at the target residue was determined by quantitative MS. The ELP-GFP proteins were buffer exchanged and diluted to 15 M in digestion buffer (50 mM Tris, pH 8.0, and 0.5 mM CaCl2), and were digested with 1.5 M thermolysin (Promega) for 6 h at 80C. The resulting ELP-peptides were quantified using standard curves based on synthetic peptides (SI Appendix, Fig. S2). High-resolution MS data were collected using an Agilent iFunnel 6550 quadrupole time-of-flight (TOF) MS with an electrospray ionization (ESI) source, coupled to an Agilent Infinity 1290 ultrahigh-performance liquid chromatography system with an Agilent Eclipse Plus C18 1.8 m, 4.6 50-mm column. Solvents used were (solvent A) water 0.1% formic acid and (solvent B) CH3CN 0.1% formic acid. Mass spectra were gathered using Dual Agilent Jet Stream ESI in positive mode. The mass range was set from 110 to 1,700 m/z with a scan speed of three scans per second. The capillary and nozzle voltages were set to 5,500 and 2,000 V, respectively. The source parameters were set with a gas temperature of 280C and a flowrate of 11 liters/min, nebulizer at 40 psig, and sheath gas temperature at 350C at a flow of 11 liters/min. MS data were acquired with MassHunter Workstation Data Acquisition (version B.06.01, Agilent Technologies) and analyzed using MassHunterQualitative Analysis (version B.07.00, Agilent Technologies).

For MALDI-TOF analysis, 2 L of the protein samples were mixed in a ratio of 1:1:1 with 2% trifluoroacetic acid solution and then with the matrix solution (375 L of 20 mg/mL solution of 2,5-DHAP [2,5-dihydroxy acetophenone] in ethanol and 125 L of 18 mg/mL of aqueous DAC [diammonium hydrogen citrate solution]) by pipetting, until crystallization of the mixture. Then 0.5 L of the protein sample was loaded on MALDI steel target plate and analyzed after solvent evaporation.

MALDI-TOF MS spectra were acquired using an MALDI-TOF/TOF autoflex speed mass spectrometer (Bruker Daltonik), equipped with a smartbeam-II solid-state laser (modified Nd:YAG laser, = 355 nm), at the Ilse Katz Institute for Nanoscale Science and Technology (Ben-Gurion University of Negev, Beer-Sheva, Israel). The instrument was operated in positive ion, linear mode within a mass range from m/z 10 kDa to 50 kDa. Laser fluence were optimized for each sample. The laser was fired at a frequency of 1 kHz and spectra were accumulated in multiples of 500 laser shots, with 1,500 shots in total. Calibration was performed using protein calibration standard from Bruker. Spectrum analysis was performed by the Flexanalysis software.

Protein solubility and self-assembly was analyzed using a Zetasizer Nano ZS (Malvern Pananalytical). For each sample, 11 to 15 acquisitions (determined automatically by the instrument) were obtained at 25C for 10 M protein solutions in PBS. Three separately prepared samples were analyzed, and the analysis for each sample was repeated three times. Populations comprising less than 1% of the total mass (by volume) were excluded from the analysis.

Binding assays were performed on a Biacore T200 instrument. HSA (Sigma, catalog #A3782) or albumin from mouse serum (Sigma, catalog #A3139) were immobilized by amine coupling to research grade CM5 chip (GE Healthcare, catalog #BR100530) from 20 g/mL solutions in 10 mM acetate pH 5.0. High-density surfaces were created ranging from 1,300 to 12,800 RUs to minimize nonspecific binding of ELP-GFP derivatives. Binding was measured with 60-s association phase and 600-s dissociation phase with either no regeneration, or surfaces were regenerated with two 30-s pulses of 50 mM NaOH. ELP-GFP derivatives were injected in duplicates from twofold dilution series with at least six different concentrations ranging from 0.28 to 60 M (depending on the polymer and its expected Kd); PBS was used as running buffer. Data were doubly referenced against the signal collected on the reference cell and responses generated on the active cells during buffer injections. Data were analyzed using Evaluation software and fit into a steady-state affinity binding model. Each reported affinity is an average from four to eight independent measurements.

The activity of recombinant trx and trx fusion proteins were determined using the Proteostat thioredoxin-1 activity assay (Enzo). Trx catalyzed reduction of insulin and consequent aggregation of insulin in the presence of dithiothreitol (DTT) was monitored by a fluorescent dye. Trx activity was determined using a standard curve using a concentration range of bacterial trx, and the activity of samples were determined to be within the linear range of the assay. Fluorescence emission was monitored using a Biotek spectrophotometric plate reader.

All experiments were performed in C57BL/6J mice in accordance with the guidelines of the Animal Care and Use Committee of Yale University. Recommendations from the Guide for the Care and Use of Laboratory Animals (49) were followed during these experiments.

The half-lives of ELP-GFP constructs were calculated from concentrations measured from blood samples collected over the course of a week. The experiments were initiated by injecting 120 L of 10 M ELP-GFP intravenously or subcutaneously. At indicated times, 2 L blood was collected from a tail puncture, and diluted 1:25 in heparin tubes. The blood sample was vortexed briefly and cells were pelleted by centrifugation (2 min at 14,000 g). The soluble fraction was collected and frozen at 20C until analysis. ELP-GFP concentrations of the samples were determined using a GFP ELISA Kit (Abcam, catalog #ab171581). The samples were diluted in PBS as needed, to ensure that the concentration fell within the quantifiable range of the standard curve.

To study the immunogenicity and biodistribution of ELP-GFP, 120 L of 10 M Alexa Fluor 647 labeled constructs were injected, and blood and organs were collected at indicated times. As positive control for an inflammatory response, 100 g LPS was injected, and an injection of PBS was performed as negative control. Organs were imaged using Amersham Imager 600 RGB, and signal visualization and quantification were performed with FIJI (https://imagej.net/software/fiji/). For cytokine quantification, blood was allowed to coagulate, and serum was collected. Cytokines were quantified from the serum samples using the BD CBA Mouse Inflammation Kit (Fisher Scientific, catalog #BD 552364).

Data supporting the findings of this work are available within the paper and its supporting information files. The strains and plasmid (sequences) have been deposited in GenBank or Addgene: Genetically recoded organism C321.deltaA (RRID: Addgene_48998), aminoacyl tRNA synthetase (RRID: Addgene_73545), ELP-GFP reporter (Genbank: KT996142). All other study data are included in the article and/or SI Appendix.

We thank Jesse Rinehart, Michael Grome, and members of the F.J.I. laboratory for discussions and feedback on the manuscript; Terence Wu (Yale West Campus Analytical Core) for technical support; and Dr. Mark Karpasas from the Ilse Katz Institute for Nanoscale Science & Technology at Ben-Gurion University for professional help with the intact mass spectrometry experiments. We acknowledge support from the Gruber Foundation (K.V.), NIH Grant K99EB019501 (to M.A.), the Dahlia Greidinger Anti Cancer Fund (M.A.), Ben-Gurion University (M.A.), NIH Grant R01GM117230 (to F.J.I.), NSF Grant MCB-1714860 (to F.J.I.), the Arnold and Mabel Beckman Foundation (F.J.I.), DuPont Inc. (F.J.I.), and Yale University (F.J.I.) for funding.

Author contributions: K.V., P.A.-G., D.H., W.M.S., M.A., and F.J.I. designed research; K.V., P.A.-G., M.K., D.H., A.G., F.Y., E.F.-S., and M.A. performed research; K.V., P.A.-G., D.H., E.F.-S., and M.A. contributed new reagents/analytic tools; K.V., P.A.-G., M.K., D.H., E.F.-S., W.M.S., M.A., and F.J.I. analyzed data; and K.V., W.M.S., M.A., and F.J.I. wrote the paper.

Competing interest statement: K.V., P.A.-G., M.A., and F.J.I. have filed patents describing this work. F.J.I. is a cofounder of Pearl Bio, Inc.

This article is a PNAS Direct Submission.

This article contains supporting information online at https://www.pnas.org/lookup/suppl/doi:10.1073/pnas.2103099119/-/DCSupplemental.

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Tuning protein half-life in mouse using sequence-defined biopolymers functionalized with lipids - pnas.org

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This weird mouse with a tuft of human hair could be the future of a stem cell treatment for baldness – Boing Boing

Posted: January 20, 2022 at 2:37 am

Researchers are harnessing the tools of genetic engineering to develop potential treatments for human hair loss. dNovo, a biotech startup, claims to have reprogrammed human stem cells into follicle-forming cells and transferred them into the mouse above which you can see has grown a nice tuft, albeit in an odd location. From Technology Review:

In addition to dNovo, a company called Stemson (its name is a portmanteau of "stem cell" and "Samson") has raised $22.5 million from funders including from the drug company AbbVie. Cofounder and CEO Geoff Hamilton says his company is transplanting reprogrammed cells onto the skin of mice and pigs to test the technology[]

So is stem-cell technology going to cure baldness or become the next false hope? Hamilton, who was invited to give the keynote at this year'sGlobal Hair Loss Summit, says he tried to emphasize that the company still has plenty of research ahead of it. "We have seen so many [people] come in and say they have a solution. That has happened a lot in hair, and so I have to address that," he says. "We're trying to project to the world that we are real scientists and that it's risky to the point I can't guarantee it's going to work."

image: dNovo

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This weird mouse with a tuft of human hair could be the future of a stem cell treatment for baldness - Boing Boing

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5 questions facing gene therapy in 2022 – BioPharma Dive

Posted: January 20, 2022 at 2:37 am

Four years ago, a small Philadelphia biotech company won U.S. approval for the first gene therapy to treat an inherited disease, a landmark after decades of research aimed at finding ways to correct errors in DNA.

Since then, most of the world's largest pharmaceutical companies have invested in gene therapy, as well as cell therapies that rely on genetic modification. Dozens of new biotech companies have launched, while scientists have taken forward breakthroughs in gene editing science to open up new treatment possibilities.

But the confidence brought on by such advances has also been tempered by safety setbacks and clinical trial results that fell short of expectations. In 2022, the outlook for the field remains bright, but companies face critical questions that could shape whether, and how soon, new genetic medicines reach patients. Here are five:

Food and Drug Administration approval of Spark Therapeutics' blindness treatment Luxturna a first in the U.S. came in 2017. A year and a half later, Novartis' spinal muscular atrophy therapy Zolgensma won a landmark OK.

But none have reached market since, with treatments from BioMarin Pharmaceutical and Bluebird bio unexpectedly derailed or delayed.

That could change in 2022. Two of Bluebird's treatments, for the blood disease beta thalassemia and a rare brain disorder, are now under review by the FDA, with target decision dates in May and June. BioMarin, after obtaining more data for its hemophilia A gene therapy, plans to soon approach the FDA about resubmitting an application for approval.

Others, such as CSL Behring and PTC Therapeutics, are also currently planning to file their experimental gene therapies with the FDA in 2022.

Approvals, should they come, could provide important validation for their makers and expand the number of patients for whom genetic medicines are an option. In biotech, though, approvals aren't the end of the road, but rather the mark of a sometimes challenging transition from research to commercial operations. With price tags expected to be high, and still outstanding questions around safety and long-term benefit, new gene therapies may prove difficult to sell.

A record $20 billion flowed into gene and cell therapy developers in 2020, significantly eclipsing the previous high-water mark set in 2018.

Last year, the bar was set higher still, with a total of $23 billion invested in the sector, according to figures compiled by the Alliance for Regenerative Medicine. About half of that funding went toward gene therapy developers specifically, with a similar share going to cell-based immunotherapy makers.

Driving the jump was a sharp increase in the amount of venture funding, which rose 73% to total nearly $10 billion, per ARM. Initial public offerings also helped, with sixteen new startups raising at least $50 million on U.S. markets.

Entering 2022, the question facing the field is whether those record numbers will continue. Biotech as a whole slumped into the end of last year, with shares of many companies falling amid a broader investment pullback. Gene therapy developers, a number of which had notable safety concerns crop up over 2021, were hit particularly hard.

Moreover, many startups that jumped to public markets hadn't yet begun clinical trials roughly half of the 29 gene and cell therapy companies that IPO'd over the past two years were preclinical, according to data compiled by BioPharma Dive. That can set high expectations companies will be hard pressed to meet.

Generation Bio, for example, raised $200 million in June 2020 with a pipeline of preclinical gene therapies for rare diseases of the liver and eye. Unexpected findings in animal studies, however, sank company shares by nearly 60% last December.

Still, the pace of progress in gene and cell therapy is fast. The potential is vast, too, which could continue to support high levels of investment.

"I think fundamentally, investment in this sector is driven by scientific advances, and clinical events and milestones," said Janet Lambert, ARM's CEO, in an interview. "And I think we see those in 2022."

The potential of replacing or editing faulty genes has been clear for decades. How to do so safely has been much less certain, and concerns on that front have set back the field several times.

"Safety, safety and safety are the first three top-of-mind risks," said Luca Issi, an analyst at RBC Capital Markets, in an interview.

Researchers have spent years making the technology that underpins gene therapy safer and now have a much better understanding of the tools at their disposal. But as dozens of companies push into clinical trials, a number of them have run into safety problems that raise crucial questions for investigators.

In trials run by Audentes Therapeutics and by Pfizer (in separate diseases), study volunteers have tragically died for reasons that aren't fully understood. UniQure, Bluebird bio and, most recently, Allogene Therapeutics have reported cases of cancer or worrisome genetic abnormalities that triggered study halts and investigations.

While the treatments being tested were later cleared in the three latter cases, the FDA was sufficiently alarmed to convene a panel of outside experts to review potential safety risks last fall. (Bluebird recently disclosed a new hold in a study of its sickle cell gene therapy due to a patient developing chronic anemia.)

The meeting was welcomed by some in the industry, who hope to work with the FDA to better detail known risks and how to avoid them in testing.

"[There's] nothing better than getting people together and talking about your struggles, and having FDA participate in that," said Ken Mills, CEO of gene therapy developer Regenxbio, in an interview. "The biggest benefit probably is for the new and emerging teams and people and companies that are coming into this space."

Safety scares and setbacks are likely to happen again, as more companies launch additional clinical trials. The FDA, as the recent meeting and clinical holds have shown, appears to be carefully weighing the potential risks to patients.

But, notably, there hasn't been a pullback from pursuing further research, as has happened in the past. Different technologies and diseases present different risks, which regulators, companies and the patient community are recognizing.

"We're by definition pushing the scientific envelope, and patients that we seek to treat often have few or no other treatment options," said ARM's Lambert.

Last June, Intellia Therapeutics disclosed early results from a study that offered the first clinical evidence CRISPR gene editing could be done safely and effectively inside the body.

The data were a major milestone for a technology that's dramatically expanded the possibility for editing DNA to treat disease. But the first glimpse left many important questions unanswered, not least of which are how long the reported effects might last and whether they'll drive the kind of dramatic clinical benefit gene editing promises.

Intellia is set to give an update on the study this quarter, which will start to give a better sense of how patients are faring. Later in the year the company is expecting to have preliminary data from an early study of another "in vivo" gene editing treatment.

In vivo gene editing is seen as a simpler approach that could work in more diseases than treatments that rely on stem cells extracted from each patient. But it's also potentially riskier, with the editing of DNA taking place inside the body rather than in a laboratory.

Areas like the eye, which is protected from some of the body's immune responses, have been a common first in vivo target by companies like Editas Medicine. But Intellia and others are targeting other tissues like the liver, muscle and lungs.

Later this year, Verve Therapeutics, a company that uses a more precise form of gene editing called base editing, plans to treat the first patient with an in vivo treatment for heart disease (which targets a gene expressed in the liver.)

"The future of gene editing is in vivo," said RBC's Issi. His view seems to be shared by Pfizer, which on Monday announced a $300 million research deal with Beam Therapeutics to pursue in vivo gene editing targets in the liver, muscle and central nervous system.

With more and more cell and gene therapy companies launching, the pipeline of would-be therapies has grown rapidly, as has the number of clinical trials being launched.

Yet, many companies are exploring similar approaches for the same diseases, resulting in drug pipelines that mirror each other. A September 2021 report from investment bank Piper Sandler found 21 gene therapy programs aimed at hemophilia A, 19 targeting Duchenne muscular dystrophy and 18 going after sickle cell disease.

In gene editing, Intellia, Editas, Beam and CRISPR Therapeutics are all developing treatments for sickle cell disease, with CRISPR the furthest along.

As programs advance and begin to deliver more clinical data, companies may be forced into making hard choices.

"[W]e think investors will place greater scrutiny as programs enter the clinic and certain rare diseases are disproportionately pursued," analysts at Stifel wrote in a recent note to investors, citing Fabry disease and hemophilia in particular.

This January, for example, Cambridge, Massachusetts-based Avrobio stopped work on a treatment for Fabry that was, until that point, the company's lead candidate. The decision was triggered by unexpected findings that looked different than earlier study results, but Avrobio also cited "multiple challenging regulatory and market dynamics."

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5 questions facing gene therapy in 2022 - BioPharma Dive

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