Jumping For Joy? Gene Therapy shows promise in Osteoarthritis

osteoarthritis-knee-pain-ssAs regular readers of SRxA’s Word on Health know, your blogger is one of the estimated 34 million US adults who suffer from osteoarthritis.  The disease, the most common form of arthritis, is characterized by degeneration of cartilage and its underlying bone within a joint as well as bony overgrowth. The breakdown of these tissues eventually leads to pain and joint stiffness. Disease onset is gradual and usually begins after the age of 40, although in some people, myself included, signs and symptoms can appear in your teens or twenties, usually as a result of the wear and tear of repeated sports injuries.

The joints most commonly affected are the knees, hips, hands and spine.

The specific causes of osteoarthritis are unknown, but are believed to be a result of both mechanical and molecular events in the affected joint. Treatment focuses on relieving symptoms and improving function, and can include a combination physical therapy, weight control, medications and joint replacement surgery. But there is currently no cure.

osteoarthritis-276x300So we were very interested to hear of a new study in mice in which researchers used gene therapy to reduce the risk of osteoarthritis.

And while there’s no way to know if the gene therapy treatment will help humans, or what the treatment’s side effects and costs might be, the findings are more than just good news for mice with creaky joints.

This work identifies an approach that can make a difference,” explained study co-author Brendan Lee MD, PhD, director of the Rolanette and Berdon Lawrence Bone Disease Program of Texas. “There’s a great need for treating and preventing osteoarthritis.”

mouse (1)His study examined a protein that appears to be crucial to the lubrication of joints.  Researchers injected a gene related to the protein into mice and found that not only did the rodents begin producing it themselves, they also appeared to be resistant to joint and cartilage damage resulting from injury and aging.

Still, before our creaky knees start jumping for joy, as with all early research, there are caveats.

The research was in mice, not humans; the next step is to test the approach in horses, whose joints are similar to those of people. And the gene therapy doesn’t seem to do anything for damage that’s already occurred.

This kind of therapy would probably not be very useful in patients who have advanced disease,” Lee said, adding that the treatment would likely have to be used with other strategies.

osteoarthritis 3Dr. Joanne Jordan, director of the Thurston Arthritis Research Center at the University of North Carolina at Chapel Hill, said the findings “would be really very exciting if this translates up into humans.” The study, she said, appears to be reasonable and especially strong because it looks at osteoarthritis in the mice from different angles.

We agree. Any research that provides insight into the mechanisms of osteoarthritis development and a potential protective approach to its treatment are very exciting indeed.  A future with no more horse pills sounds good!

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Does Belly Fat cause tumors to go Belly Up?

belly_fat6People store fat in two ways – one you can see and one you can’t. The fat you can see is just under the skin in the thighs, hips, buttocks, and abdomen. That’s called subcutaneous fat. The fat you can’t see is deeper inside, around the vital organs – heart, lungs, digestive tract, liver as well as in the chest, abdomen, and pelvis. That’s called visceral fat.

Many people are self-conscious about the fat they can see. But actually, it’s the hidden visceral fat that may be a bigger problem, even for thin people.  Having too much of it is linked to a greater chance of developing high blood pressure, type 2 diabetes, heart disease, dementia, and certain cancers.

According to a new study published in the journal Cancer Prevention Research, visceral fat is directly linked to an increased risk for colon cancer.

There has been some skepticism as to whether obesity per se is a bona fide cancer risk factor, rather than the habits that fuel it, including a poor diet and a sedentary lifestyle,” said Derek M. Huffman, Ph.D., postdoctoral fellow at the Institute for Aging Research at the Albert Einstein College of Medicine in Bronx, N.Y. “Although those other lifestyle choices play a role, this study unequivocally demonstrates that visceral adiposity is causally linked to intestinal cancer.

Prior research has shown that obesity markedly increases the likelihood of being diagnosed with, and dying from, many cancers. In this animal study, Huffman and his colleagues wanted to see if removing visceral fat in mice genetically prone to developing colon cancer might prevent or lessen the development of these tumors.

To do this they randomly assigned the mice to one of three groups. Mice in the first group underwent a sham surgery and were allowed to eat an unrestricted “buffet style” diet, which resulted in them becoming obese. Those in the second group were also provided an unrestricted diet and became obese, but they had their visceral fat surgically removed at the outset of the study. Mice in the third group underwent a sham surgery, but were then put on a calorie restricted diet causing them to lose visceral fat.

obese mouseOur sham-operated obese mice had the most visceral fat, developed the greatest number of intestinal tumors, and had the worst overall survival,” Huffman said. “However, mice that had less visceral fat, either by surgical removal or a calorie-restricted diet, had a reduction in the number of intestinal tumors. This was particularly remarkable in the case of our group where visceral fat was surgically removed, because these mice were still obese, they just had very little abdominal fat.”

The researchers then subdivided the groups by gender. In female mice, the removal of visceral fat was significantly related to a reduction in intestinal tumors, but calorie restriction was not. In male mice, calorie restriction had a significant effect on intestinal tumors, but removal of visceral fat did not.

abdominalobesityThese finding suggest what most women have known for years i.e., that there are important gender differences when it comes to weight. But it also provided an explanation for how belly fat, diet and cancer risk are linked.  In addition, the study emphasizes the need to promote strategies that reduce abdominal fat in obese individuals.

So how can you get rid of this dangerous deep belly fat?  According to experts, there are four: exercise, diet, sleep, and stress management.

Exercise: Vigorous exercise trims fat, including visceral fat. It can also slow down the build-up of visceral fat that tends to happen over the years. But forget spot-reducing. There aren’t any moves you can do that specifically target visceral fat. Half an hour of vigorous aerobic exercise, done four times a week is ideal.  Jog, if you’re already fit, or walk briskly at an incline on a treadmill if you’re not yet ready for jogging. Vigorous workouts on stationary bikes and elliptical or rowing machines are also effective.

Diet: There is no magic diet for belly fat. But when you lose weight on any diet, belly fat usually goes first.  A fiber-rich diet may help. Research shows that people who eat 10 grams of soluble fiber per day, without any other diet changes, build up less visceral fat over time than others. That’s as easy as eating two small apples or a cup of green slimpeas.

Sleep: Getting the right amount of shut eye helps. In one study, people who got six to seven hours of sleep per night gained less visceral fat over 5 years compared to those who slept five or fewer hours per night or eight or more hours per night.

Stress: It’s unavoidable, but what you do with your stress matters. When you’re stressed you  tend not to make the best food choices when they’re stressed. Getting social support from friends and family, meditating, and exercising can all help to tame stress.

Short on time? If you could only afford the time to do one of these things, exercise probably has the most immediate benefits, because it tackles both obesity and stress.

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Out Pacing Alzheimer’s

Woman and elderly mother talking to a doctorAlzheimer’s disease is the most common form of degenerative dementia, afflicting about 5.5 million Americans and costing more than $100 billion per year. In terms of U.S. health care expenditure it now ranks as the third costliest disease.

Alzheimer’s disease is not easily managed. It becomes progressively disabling with loss of memory, cognition, worsening behavioral function and a gradual loss of independent functioning. Currently there is no cure.

Kathy SandfordBut this may be all about to change. Last October, during a five-hour surgery at The Ohio State University Wexner Medical Center, Kathy Sanford became the first Alzheimer’s patient in the United States to have a pacemaker implanted in her brain.

Could this be the dramatic shift in the disappointing struggle to find something to slow the damage of this epidemic?  As yet, no one knows if it might work, and if it does, how long the effects might last.  Research is still in its infancy.

Dr. Douglas Scharre, neurologist and director of the division of cognitive neurology, and Dr. Ali Rezai, neurosurgeon and director of the neuroscience program are jointly conducting the study.

Sanford is the first of up to 10 patients who will be enrolled in the FDA-approved study to determine if using a brain pacemaker can improve cognitive and behavioral functioning in people with Alzheimer’s disease.

brain pacemakerThe study employs the use of deep brain stimulation (DBS), the same technology used to successfully treat patients with movement disorders such as Parkinson’s disease.

First, holes are drilled into the patient’s skull so tiny pacemaker wires can be implanted into just the right spot. A battery-powered generator near her collarbone then sends tiny shocks up her neck and into her brain.

It is hoped that zapping the brain with mild jolts of electricity will make the brain work better and stave off the cognitive, behavioral and functional effects of Alzheimer’s disease.

If the early findings that we’re seeing continue to be robust and progressive, then I think that will be very promising and encouraging for us,” says Ali Rezai MD, “But so far we are cautiously optimistic.”

Kathy Sanford says she volunteered for the study to help others avoid the angst she has suffered as Alzheimer’s slowly disrupted her life.  The Ohio woman’s early stage Alzheimer’s was gradually getting worse. She still lived independently, posting reminders to herself, but no longer could work. The usual medicines weren’t helping.
Her father is proud that his daughter is participating in the study. “What’s our choice? To participate in a program or sit here and watch her slowly deteriorate?” asked Joe Jester, 78.  He drives his daughter to follow-up testing, hoping to spot improvement.

cognitive testingSince having the surgery last October Sanford has undertaken a number of problem-solving tests while neurologists adjusted the voltage and frequency and watched her reactions.

She was cheered to see her test scores climb a bit during those adjustments. While she knows there are no guarantees, she says “if we can beat some of this stuff, or at least get a leading edge on it, I’m in for the whole deal.”

Her optimism and hope is shared by her neurologist. “We’re getting tired of not having other things work” said Douglas Scharre MD.  Alzheimer’s doesn’t just steal memories. It eventually robs sufferers of the ability to do the simplest of tasks.

Here’s hoping these brain pacemakers can reconnect some of the circuits and diminish such losses.

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Beating the Mets?

As fans of the New York Mets know all too well, in recent years they’ve been all too easy to beat.  However, another type of mets have remained somewhat harder to beat.

Metastatic cancer, more commonly referred to as “mets” is cancer that has spread from the place where it first started to another place in the body. The process by which cancer cells spread to other parts of the body is called metastasis.

Although some types of metastatic cancer can be cured, most cannot. In general, the best that can be done is to control the growth of the cancer or to relieve symptoms caused by it. In some cases, metastatic cancer treatments may help prolong life, but sadly, most people die of metastatic disease.

Now it seems there may be a way to beat the mets off the baseball field as well as on it.

Researchers are harnessing viruses to infect and subsequently destroy cancer cells without affecting normal tissue. Several types of viruses have been developed to date: adenovirus, poxvirus and picornavirus.  Even the herpes simplex virus is under consideration.

As are reoviruses, which are currently being studied by the National Institutes of Health (NIH).  Early results indicate that reoviruses could be especially effective in treating metastatic cancers.

Reoviruses are found everywhere in nature. They have been isolated from untreated sewage, river and stagnant waters. These viruses choose to colonize certain types of mutated cancer cells while sparing normal cells that lack these mutations. Approximately two-thirds of human cancers have the mutation that makes them a prime target for reoviruses.

One of the new drugs based on reovirus is known as REOLYSIN®, an acronym for Respiratory Enteric Orphan Virus, which is widely found in the environment. By adulthood, most people have been exposed to this reovirus. As it is non-pathogenic, infections are typically asymptomatic.

REOLYSIN®  was developed, based upon research conducted by Dr. Matt Coffey.  He found that the reovirus was able to infect and selectively destroy cancer cells. When a normal cell is infected with the reovirus, an antiviral response is activated, which prevents the virus from replicating within the cell. However, inside a cancer cell with one or more mutations on a growth pathway called the Ras pathway, there is an aberrant antiviral response that is unable to prevent the virus from replicating. This abnormality allows the reovirus to multiply to an extent that is fatal to the cancer cell.

Additionally, reovirus appears to spread particularly easily to organs where metastasis is common, so a concentration of the drug can be built up in those regions of the body.

REOLYSIN is currently being studied in combination with the chemotherapy drugs in six of the ten most common cancers diagnosed in men and five of the ten most diagnosed in women, including patients with head and neck cancer, non-small cell lung cancer, colorectal cancer, castration-resistant prostate cancer, drug-resistant ovarian cancer and pancreatic cancer. All of these indications are associated with metastatic disease.

The American Cancer Society estimates there will be more than 1.6 million new cancer cases diagnosed in the United States alone in 2012; more than 1,500 people a day are expected to die from the disease.

So, could a sewage water virus be the answer? SRxA’s Word on Health will be watching out for the results of these studies and let our readers know if they’ve truly found a way to  “beat the mets.”

Diabetes Drug may Repair Injured Brains

Here’s a good brain teaser for a Wednesday.  What do an old diabetes drug, brain injury and Alzheimer’s Disease have in common?

Here’s some clues to help you solve the riddle.

(i)           Metformin is a widely used treatment for type II diabetes

(ii)          An increasing proportion of people with Alzheimer’s Disease also have diabetes

(iii)         Hyperinsulinemia (excess levels of insulin in the blood) may enhance the onset and progression of neurodegeneration

Have you solved it?  If so, congratulations!

If not, the answer, according to data just published in the journal Cell Stem Cell is that the former may hold the clue to treating the latter.

In other words, the study suggests that metformin, an anti-diabetes drug first discovered in the 1920’s, is able to help activate the mechanism that signals stem cells to generate brain cells.

Principal investigator, Freda Miller, a Professor from the Department of Molecular Genetics at the University of Toronto
says “If you could take stem cells that normally reside in our brains and somehow use drugs to recruit them into becoming appropriate neural cell types, then you may be able to promote repair and recovery in at least some of the many brain disorders and injuries for which we currently have no treatment.”

The research involved laboratory experiments using both mouse and human brain stem cells, as well as learning and memory tests performed on live mice given the drug.

Miller and her colleagues started by adding metformin to stem cells from the brains of mice, then repeated the experiment with human brain stem cells generated in the lab. In both cases, the stem cells gave rise to new brain cells.

They then tested the drug in lab mice and found that those given daily doses of metformin for two or three weeks had increased brain cell growth and outperformed rodents not given the drug in learning and memory tasks.

In the key experiment, mice were forced to learn the position of a platform hidden under the surface of a water-filled maze and then asked rapidly to learn a new position.

Mice were injected with either metformin or saline for 38 days. On days 22 through 38, they learned the initial position of the platform, which provided an escape from the water-filled maze.  Then the platform was moved to the opposite side of the maze, and the animals were asked again to learn its position. In both tasks, the mice learned the platform positions with equivalent speed.

But when they were put back in the maze – this time with the platform removed – control mice spent more time searching for it in the original position, while the metformin-treated animals preferentially looked in the new region.

The implication  is that metformin helped the mice form their new memories of the second platform position. Further analysis showed that their enhanced ability was paralleled by an increase in the number of  neurons.

In a separate study researchers have shown that metformin can increase lifespan and delay the onset of cognitive impairment in a mouse model of Huntington’s disease.

Taken together, these findings raise the possibility that metformin’s ability to enhance neurogenesis might have a positive impact in some nervous system disorders.

Miller’s team is already planning a pilot study to test metformin in young patients with acquired brain damage, either as result of treating a childhood brain tumor or from a traumatic head injury.

We will report back to you with results, as they are published.

Insulin Patch Offers Hope of Needle Free Diabetes Management

Transdermal Specialties Inc. (TSI) is hoping to change the face, not to mention the abdomen, upper arm and thighs, of patients with diabetes.  The company’s new “Set IT And Forget IT” insulin delivery system will be unveiled at the American Diabetes Association’s 72nd Annual Scientific Meeting, June 9 -11, 2012 in Philadelphia.

Called the U-STRIP™, this breakthrough product is a programmable transdermal insulin patch which offers totally non-invasive insulin delivery for both Type-1 and Type-2 diabetic patients.

Using a patented alternating ultrasonic waveform process to enlarge the diameter of the skin pores, the U-Strip enables large molecule drugs, such as insulin, to permeate through the skin into the dermis and then into the blood stream. All without needles!

According to TSI, the key advantages of the U-Strip include:

  • Delivers insulin for both basal and bolus needs
  • Patches available in four different doses: 25, 50, 100 & 150 Units
  • Electronic delivery system tracks dosing history and glucose readings
  • Downloads data to physician for progress monitoring

12 clinical trials in over 125 diabetics have already been successfully completed. The company hopes to complete the last two clinical trials needed for FDA approval in the next 18 months.

The HPT- 6 trial will investigate whether the patch can reach the same glucose levels as a pump with less insulin, and will also compare the speed of delivery vs. injection to determine if the patch can be more effective in morning glucose reduction for those patients waking with high blood sugar levels.

The HPT-7 trial (slated for 2013) will focus on a real-world study of 500 Type-2 diabetics, who will conduct an at-home study to track their A1C levels. The A1C test measures average blood glucose control for the past 2 to 3 months.

The U-Strip represents a major advance in diabetes care” says Bruce K. Redding, Founder, President and CEO of TSI. “The insulin patch component offers a safe and painless alternative to injections with the promise of reduced side effects and improved insulin uptake efficiencies for the patient. The ultrasound actually reduces the quantity of insulin needed for effective glucose control and speeds the delivery over a pump or even direct injection. Improved patient monitoring and reporting of the Control Device enables better tracking of treatment programs and the new “Set-it and Forget-it”  function means more regular glucose control during both evening and daytime hours.

All of which sound like good news for the 27 million diabetics in the US, who eagerly await an alternative to injections. Over the years, various attempts, some more successful than others, have been made to capture this $3 billion market.

SRxA’s Word on Health will be keeping a watch on all diabetes developments and we’ll bring you further news as it happens.

You Can Teach an Old Drug New Tricks

Drug discovery is a laborious process.

From initial discovery of a promising target to the final medication becoming available, is an expensive, and lengthy process. At present, the costs of bringing a single new drug to market is around $1.2 billion, an amount that doubles every five years.

Aside from the cost, it takes, on average, 12 years for an experimental drug to progress from bench through FDA approval to market.

Annually, North American and European pharmaceutical industries invest more than $40 billion to identify and develop new drugs. Even so, for every 5,000 compounds that enter pre-clinical testing, only five, on average, are tested in human trials, and only one of these five receives approval for therapeutic use.

So, it’s hardly surprising that many pharmaceutical companies are choosing to take a closer look at old drugs. Last week, SRxA’s Word on Health brought you news of a host of potential new uses for aspirin.

And aspirin is not alone.  Old drugs often get a surprising second shot at life. In the past few weeks, the news has buzzed about the skin cancer drug – bexarotene – that may cure Alzheimer’s; a common antimalarial drug – hydroxychloroquine – that may help to destroy cancerand, a leukemia drug that inhibits the Ebola virus.

Then, of course, there’s the personal favorite of many women – Latisse.  Originally developed as a glaucoma treatment , it was found to have the desirable side effect of making eyelashes fuller and longer and is now FDA approved for this purpose.

Testing drugs already approved for one use to see if they can treat other conditions, can reduce time and money. Since these known drugs have already undergone toxicology and safety testing, the clinical development program can be streamlined.

Sometimes it’s pure serendipity.

Take Viagra for example. Although these days it’s the stuff of pharmaceutical industry legend , in the early 1990s, it was just a chest pain drug that wasn’t performing very well in clinical trials. So how did the little blue pill go from heart to crotch?  Pfizer was ready to call it quits when they decided to look into one unexpected but common side effect: long-lasting erections. Then came the drug patent and the rest is history.

The discovery that lithium could be used to treat manic episodes in bipolar patients was equally fortuitous. In 1949, Australian psychiatrist John Cade was injecting guinea pigs with urine extracts from schizophrenia patients to try and isolate a compound that caused mental illness. By accident he happened to use a compound with lithium – which at the time was used as a treatment for gout, as the control. Although he didn’t find the compound that caused mental illness, he did find one that treated it!

Back in 2010 we reported on the repurposing of thalidomide. Although the drug caused serious birth defects when it was launched in the 1960’s as a morning sickness pill it has since been found to be useful in reducing severe and frequent bleeding in patients with  hemorrhagic telangiectasia (HHT); in the treatment of patients with newly diagnosed multiple myeloma when taken  in combination with dexamethasone; and for the acute treatment of the cutaneous manifestations of moderate to severe erythema nodosum leprosum

The National Institutes of Health (NIH) recently established The Learning Collaborative (TLC) to study how to more easily repurpose known drugs to treat rare forms of blood cancers.

TLC is a dedicated collaboration between the NIH Chemical Genomics Center (NCGC) and its Therapeutics for Rare and Neglected Diseases (TRND) program, The Leukemia & Lymphoma Society (LLS), and Kansas University Cancer Center (KUCC) to discover and develop new drug therapies for rare blood cancers. TLC is creating a pipeline of new therapies to treat leukemia from both the discovery of new treatments as well as identifying new uses for approved and abandoned drugs.  For example, Auranofin, a drug originally used for rheumatoid arthritis, is now in clinical trials for treating chronic lymphocytic leukemia.

Word on Health will continue to follow the drug recycling trend and bring you news as it breaks. In the meantime if you have noticed any beneficial side effects from the medicines you’re taking, we’d love to know.

Of Mice and Men…and Mental Health

One in five Americans suffers a major depressive episode in their lifetime. Twenty-eight per cent will develop an anxiety disorder, such as post-traumatic stress, phobias, obsessions, or compulsions. Another 15% will fall prey to alcoholism or drug addiction. If you gather 100 people from any square mile on earth, odds are that one will have autism or schizophrenia.

Just about everything we know about drug treatments for psychiatric disorders we learned from mice.  Just how the mouse became our avatar is part tradition and part biological accident. In the past, rats were traditionally used to test experimental drugs. Rats are small enough to be affordable but big enough to make their brains easy to dissect. And they are smarter than mice. You can swiftly teach a rat to solve a maze, for instance, and then test whether your new drug has a side effect of making rats forgetful.

However, rats missed the knockout revolution of the late 1980s. Knockout technology allows researchers to silence, or knock out, individual genes.

With mice, researchers can insert altered DNA in a mouse stem cell, insert the cell in a newly fertilized egg, and insert the egg in a surrogate mother. That egg might develop as a normal mouse or a knockout. The offspring born with knocked-out genes are mated for a few generations to create a pure strain. Once the geneticists perfected these procedures, mice almost instantly assumed the lead role in modeling human mental malfunctions.

These days, you won’t find more mentally ill mice per square mile anywhere than in Bar Harbor, Maine. Mice with anxiety, depression, autism, learning disabilities, anorexia or schizophrenia – they all congregate here. Name an affliction of the human mind, and you can probably find its avatar on this sprucy, secluded island built for America’s richest and most powerful families — including the Rockefellers, the Fords, the Vanderbilts, the Carnegies, the Astors and the Morgans.

The imbalanced mice are kept under the strictest security, in locked wards at the Jackson Laboratory, a nonprofit biomedical facility internationally renowned for its specially bred deranged rodents.

There are no visiting hours, because strangers fluster the mice and might carry in contagious diseases. The animals are attended only by highly qualified caregivers.

But, accurately reproducing a human mental illness in the tiny brain of a mouse is still hugely challenging. The basic structure of a mouse brain is mostly analogous to a human brain.  They have a hippocampus, we have a hippocampus; they have a prefrontal cortex, we have a prefrontal cortex, albeit one that is much larger. We even share about 99% of their genes. But no one would mistake you for a mouse. The mouse is a nocturnal animal with poor eyesight, adapted to fear predators that strike from above. Mice are fundamentally alarmed by light, open spaces, and sudden movements. It is no surprise then, that they manifest depression and anxiety differently than humans do, if they manifest such ailments at all.

You cannot mimic an entire human psyche in a mouse or a rat,” says 
Jacqueline Crawley, a behavioral neuroscientist at the National Institutes of Health (NIH) “Mice aren’t a one-to-one correspondence to humans. But they are better than zero.”

Disorders like depression and schizophrenia are each linked to hundreds of genes. No one gene is likely to make much difference. But genes are only one part of the story. Other clues to human mental health can be found in the neural circuits of mouse brains. By tracing the wiring that connects one brain region to the next, researchers hope to develop more precisely targeted medications.

Many vintage psychiatric drugs, such as Valium, Ritalin, and antipsychotics, were stumbled upon rather than tailor-made to solve a problem. As a result, they are too broad.  They affect more than one type of receptor, on more than one kind of nerve cell, in more than one part of the brain. Many patients decide the cure is not worth the many side effects.

Mice may be the best models we have of psychiatric disorders, but best does not mean great, or even decent. Gerald Dawson, founder and chief scientific officer of P1Vital, a pharmaceutical consulting firm in the United Kingdom, had his heart broken by the mouse mismatch. In the late 1990s, Dawson set out to eliminate the drowsiness from anxiety drugs.The class of drugs he wanted 
to modify, benzodiazepines such as Valium, Xanax, Ativan, and Klonopin, target the GABAa system.

As with most neurotransmitters, the GABAa system is so evolutionarily ancient that it has diversified to serve many purposes. Hence, the brain has six different GABAa receptor types, presumably to perform six different jobs. Dawson had a suspicion that the sleepiness side effect originated from just one of those six receptors. If he could determine which one, corporate chemists could design a molecule that would avoid activating it. He began to make mice.

One by one, he manipulated the receptor genes, breeding a new line of mice each time. With each new strain, he would administer a tiny dose of Valium. If the animals grew drowsy, he knew he had not yet knocked out the right receptor. Knocking out receptor 1 made little difference. Receptor 3 proved too hard to knock out. Receptor 5 seemed to account for the amnesia that people (and mice) experience when they take anxiety drugs. Targeting receptor 2, Dawson identified a chemical that reduced a mouse’s startle response—a measure of anxiety—without impairing its ability to balance. Success!

Or, so he thought. “When these compounds went into humans, they turned out to be just as sedating as the original drugs.”

Dawson blames the mice. “There’s not enough predictability in animal research.”

But, for all Dawson’s frustration with mice, the rodents did yield a couple of interesting drug leads.

That receptor 5 implicated in the amnesia side effect?  An experimental chemical that blocked its action created temporary geniuses: Mice on it were whizzes in the Morris water maze. A drug company is testing the compound to treat people with Down syndrome. And in the process of trying to eliminate drowsiness, Dawson and his team homed in on one of the chemical switches that cause mammals to go to sleep. Ambien locks onto that switch associated with receptor 1.

So, despite the problems, mice remain the undisputed top animal for research on mental health therapies.

Which just goes to show that mice, like us, have minds of their own.

Time to Give Pharma a Break?

The pharmaceutical industry has been under attack again this week. It’s not unusual for people to complain about the price of medicines and the fat profits of pharma, yet even when the industry tries to reduce the payment burden, or provide educational assistance, it is criticized.

First, there was a series of lawsuits filed by several union health plans against eight large drugmakers. They charge that, rather than save consumers money, prescription drug coupons illegally subsidize co-pays for brand-name meds and can actually increase health insurance premiums.

Then the US Department of Veteran Affairs issued a tough ruling on how sales reps can promote drugs to VA medical facilities in the future. One of the new restrictions concerns educational programs. Starting next month, reps will have to submit educational materials for VA review 60 days in advance of any scheduled meeting.  Additionally, materials will be approved only if industry sponsorship is adequately disclosed; if industry-sponsored data is adequately compared with non industry-sponsored data and if materials do not contain a company name or logo.

Both of these developments are worrying.  The pharmaceutical industry is already the most regulated business in the world. Further restrictions will result in fewer incentives to bring new drugs to market and will further stifle innovation.

Not convinced that it’s time to give pharma a break?  Then consider this:

During the Super Bowl, a representative of Eli Lilly posted the on the company’s corporate blog that the average cost of bringing a new drug to market is $1.3 billion. A price that would buy 371 Super Bowl ads, 16 million official NFL footballs, two pro football stadiums, pay almost all NFL football players, and every seat in every NFL stadium for six weeks in a row. This is, of course, is ludicrous.

Ludicrous and wrong!   In fact, the average drug developed by a major pharmaceutical company costs at least $4 billion, and it can be as much as close to $12 billion.

Company N° of approved drugs R&D Spending Per Drug ($Mil) Total R&D Spending 1997-2011 ($Mil)
AstraZeneca 5 11,790.93 58,955
GlaxoSmithKline 10 8,170.81 81,708
Sanofi 8 7,909.26 63,274
Roche 11 7,803.77 85,841
Pfizer 14 7,727.03 108,178
Johnson & Johnson 15 5,885.65 88,285
Eli Lilly & Co 11 4,577.04 50,347
Abbott Laboratories 8 4,496.21 56,202
Merck & Co Inc 16 4,209.99 67,360
Bristol-Myers Squibb Co. 11 4,152.26 45,675
Sources: InnoThink Center For Research In Biomedical Innovation; Thomson Reuters Fundamentals via FactSet Research Systems

However, in all fairness to our Lilly rep, the drug industry has been tossing around the $1 billion number for years. It is based largely on an industry sponsored study by Joseph DiMasi of Tufts University performed 12 years ago. It’s always been a nice number for the pharmaceutical industry because it seemed to justify the idea that medicines should be pricey without making it seem that inventing new medicines is so expensive an endeavor as to be ultimately futile.

But as can be seen from the table above, that figure is badly outdated.

The range of money spent is stunning. AstraZeneca has spent $12 billion in research money for every new drug approved, as much as the top-selling medicine ever generated in annual sales. Bristol-Meyers Squibb spent just $3.7 billion. At $12 billion per drug, inventing medicines is a pretty unsustainable business. At $3.7 billion, you might just be able to make money –assuming it can keep generating revenue for at least ten years.

So, why is the cost of drug development so high?  Well, a single clinical study can cost $100 million, at the high end. But the main expense, and the main reason for the differences noted above, is failure of potential new drugs during their development.

Has this blog helped to change your views on the industry? As always, SRxA’s Word on Health would love to hear from you.

A new approach to new drug approvals?

Few topics inspire more heated discussion among drug developers and pharmaceutical industry watchers than the regulation of new products.  For those unfamiliar with the debate, the two sides of the argument can be summarized as follows.

Industry veterans feel that excessively conservative regulators squelch innovation in a desire to cover their own behinds, while industry critics contend that regulators aren’t strict enough, and that pharmaceutical companies should be held to an even higher standard and warrant even greater supervision.

In the meantime, patients wonder why modern science hasn’t produced the medicines they so desperately need.

Now it seems there may be an answer that could satisfy everyone.  Susan Desmond-Hellmann, Chancellor of the University of California, San Francisco (UCSF) and former Genentech executive, suggests turning drug approvals from a discrete yes or no variable into a continuous moving target.

The fundamental problem with the current system, Desmond-Hellmann observes, is that regulators have only two options, when in fact, it might make a lot more sense for them to have a range of choices. She proposes that agencies, such as the FDA, could approve a drug for limited use, or use with limited promotion, following the submission of initial acceptable evidence of safety and efficacy. Permission for broader use, and less restrictive promotion, could be given after additional data are obtained.

This solution appears to make sense on many levels. It acknowledges:

  • the long time it takes to become familiar with a drug and learn some of it’s more subtle effects – good, as well as bad
  • the importance of accelerating the time it takes to get potentially useful drugs into the hands of patients who might need them
  • the technologies now available to track and assess the performance of new drugs

FDA Approval Process

One advantage of such a system would be the emphasis it would place on durable results, as full approval would likely require not just success in a clinical trial, but continued demonstration of success under “real world” conditions.  Such a requirement would almost certainly stimulate the development of integrated “health solutions,” a bundled assortment of patient- and physician-support programs accompanying the drug.

Although a graduated regulatory approval process would not be perfect; it is almost certainly a significant step in the right direction.

Patient and physician educational and adherence programs make sense, but many companies have been reluctant to invest in them.  In the context of an offering that would need to succeed in order for a drug to be fully approved, the incentives are considerably more apparent, and would almost certainly stimulate interest in companies striving to deliver the most effective patient support programs.

However, the big questions still remain.  Are regulators ready for such change? Is the Industry ready to take on the responsibility and cost of ensuring appropriate use of their products and long-term pharmacovigilance? Would patients and consumer watchdog organizations accept a tiered approach?

What do you think?  SRxA’s Word on Health would love to know.