Treatments for cancer have advanced a lot in recent years, but many still rely on the use of chemotherapy to either shrink tumors before surgery or help remove cancerous cells the surgery missed. The chemo can be very effective, but it’s also very toxic. Angiocrine Bioscience Inc. is developing a way to reduce those toxic side effects, and they just got a nice vote of confidence for that approach.
The US Food and Drug Administration (FDA) has granted Angiocrine Regenerative Medicine Advanced Therapy (RMAT) designation for their product AB-205.
RMAT is a big deal. It means the therapy, in this case AB-205, has already shown it is safe and potentially beneficial to patients, so the designation means that if it continues to be safe and effective it may be eligible for a faster, more streamlined approval process. And that means it can get to the patients who need it, outside of a clinical trial, faster.
What is AB-205? Well it’s made from genetically engineered cells, derived from cord blood, designed to help alleviate or accelerate recovery from the toxic side effects of chemotherapy for people undergoing treatment for lymphoma and other aggressive cancers of the blood or lymph system.
CIRM awarded Angiocrine Bioscience $6.2 million in 2018 to help carry out the Phase 2 clinical trial testing the therapy. In a news release ,CIRM President & CEO, Dr. Maria Millan, said there is a real need for this kind of therapy.
“This is a project that CIRM has supported from an earlier stage of research, highlighting our commitment to moving the most promising research out of the lab and into people. Lymphoma is the most common blood cancer and the 6th most commonly diagnosed cancer in California. Despite advances in therapy many patients still suffer severe complications from the chemotherapy, so any treatment that can reduce those complications can not only improve quality of life but also, we hope, improve long term health outcomes for patients.”
In a news release Dr. Paul Finnegan, Angiocrine’s CEO, welcomed the news.
“The RMAT designation speaks to the clinical meaningfulness and the promising efficacy data and safety profile of AB-205 based on our Phase 1b/2 study. This is an important step in accelerating the development of AB-205 towards its first market approval. We appreciate the thorough assessment provided by the FDA reviewers and the support from our partner, the California Institute for Regenerative Medicine.”
The investment in Angiocrine marked a milestone for CIRM. It was the 50th clinical trial we had funded. It was a cause for celebration then. We’re hoping it will be a cause for an even bigger celebration in the not too distant future.
The company hopes to start a Phase 3 clinical trial in the US and Europe next year.
Canavan disease is a fatal neurological disorder, the most prevalent form of which begins in infancy. It is caused by mutation of the ASPA gene, resulting in the deterioration of white matter (myelin) in the brain and preventing the proper transmission of nerve signals. The mutated ASPA gene causes the buildup of an amino acid called NAA and is typically found in neurons in the brain. As a result of the NAA buildup, Canavan disease causes symptoms such as impaired motor function, mental retardation, and early death. Currently, there is no cure or standard of treatment for this condition.
Fortunately, CIRM-funded research conducted at City of Hope by Yanhong Shi, Ph.D. is developing a stem cell-based treatment for Canavan disease. The research is part of CIRM’s Translational Stage Research Program, which promotes the activities necessary for advancement to clinical study of a potential therapy.
The results from the study are promising, with the therapy improving motor function, reducing degeneration of various brain regions, and expanding lifespan in a Canavan disease mouse model.
For this study, induced pluripotent stem cells (iPSCs), which can turn into virtually any type of cells, were created from skin cells of Canavan disease patients. The newly created iPSCs were then used to create neural progenitor cells (NPCs), which have the ability to turn into various types of neural cells in the central nervous system. A functional version of the ASPA gene was then introduced into the NPCs. These newly created NPCs were then transplanted inside the brains of Canavan disease mice.
The study also used iPSCs engineered to have a functional version of the ASPA gene. The genetically modified iPSCs were then used to create oligodendrocyte progenitor cells (OPCs), which have the ability to turn into myelin. The OPCs were also transplanted inside the brains of mice.
The rationale for evaluating both NPCs and OPCs was that NPCs typically stayed at the site of injection while OPCs tend to migrate, which might have been important in terms of the effectiveness of the therapy. However, the results of the study show that both NPCs and OPCs were effective, with both being able to reduce levels of NAA, presumably because NAA can move to where the ASPA enzyme is although NPCs do not migrate. This resulted in improved motor function, recovery of myelin, and reduction of brain degeneration, in both the NPC and OPC-transplanted Canavan disease mice.
“Thanks to funding from CIRM and the hard work of my team here at City of Hope and collaborators at Center for Biomedicine and Genetics, Department of Molecular Imaging and Therapy, and Diabetes and Metabolism Institute at City of Hope, as well as collaborators from the University of Texas Medical Branch at Galveston, University of Rochester Medical Center, and Aarhus University, we were able to carry out this study which has demonstrated promising results,” said Dr. Shi. “I hope that these findings can one day bring about an effective therapy for Canavan disease patients, who currently have no treatment options.”
Dr. Shi and her team will build on this research by starting IND-enabling studies using their NPC therapy soon. This is the final step in securing approval from the Food and Drug Administration (FDA) in order to test the therapy in patients.
Last year, CIRM awarded $5.53 million to Rosa Bacchetta, M.D. at Stanford University to complete the work necessary to conduct a clinical trial for IPEX syndrome. This is a rare disease caused by mutations in the FOXP3 gene, which leaves people with the condition vulnerable to immune system attacks on their organs and tissues. These attacks can be devastating, even fatal.
Flash forward to the present day and the CIRM-funded treatment that Dr. Bacchetta has been working on has received both an orphan drug and a rare pediatric disease designation from the Food and Drug Administration (FDA).
Orphan drug designation is a special status given by the Food and Drug Administration (FDA) for potential treatments of rare diseases that affect fewer than 200,000 in the U.S. This type of status can significantly help advance treatments for rare diseases by providing financial incentives in the form of tax credits towards the cost of clinical trials and prescription drug user fee waivers.
Under the FDA’s rare pediatric disease designation program, the FDA may grant priority review to Dr. Bacchetta if this treatment eventually receives FDA approval. The FDA defines a rare pediatric disease as a serious or life-threatening disease in which the serious or life-threatening manifestations primarily affect individuals aged from birth to 18 years and affects fewer than 200,000 people in the U.S.
“The designations granted by the FDA are a strong encouragement for our team to meet the goal of submitting the IND in 2021 and start the clinical trial for IPEX patients who are so much looking forward to new therapeutic options.” said Dr. Bacchetta.
But this begs the question, what exactly is IPEX syndrome? What is the approach that Dr. Bacchetta is working on? For those of you interested in the deeper scientific dive, we will elaborate on this complex disease and promising approach.
IPEX syndrome is a rare disease that primarily affects males and is caused by a genetic mutation that leads to lack of function of specialized immune cells called regulatory T cells (Tregs).
Without functional Tregs, a patient’s own immune cells attack the body’s own tissues and organs, a phenomenon known as autoimmunity. This affects many different areas such as the intestines, skin, and hormone-producing glands and can be fatal in early childhood.
Current treatment options include a bone marrow transplant and immune suppressing drugs. However, immune suppression is only partially effective and can cause severe side effects while bone marrow transplants are limited due to lack of matching donors.
Dr. Rosa Bacchetta and her team at Stanford will take a patient’s own blood in order to obtain CD4+ T cells. Then, using gene therapy, they will insert a normal version of the mutated gene into the CD4+ T cells, allowing them to function like normal Treg cells. These Treg-like cells would then be reintroduced back into the patient, hopefully creating an IPEX-free blood supply and resolving the autoimmunity.
Furthermore, if successful, this treatment could be adapted for treatment of other, more common, autoimmune conditions where Treg cells are the underlying problem.
The same day that CIRM approved funding for this approach, Taylor Lookofsky, a young man with IPEX syndrome, talked about the impact the condition has had on his life.
It’s a powerful reminder that syndromes like this, because they affect a small number of people, are often overlooked and have few resources devoted to finding new treatments and cures. After hearing Taylor’s story, you come to appreciate his courage and determination, and why the funding CIRM provides is so important in helping researchers like Dr. Bacchetta find therapies to help people like Taylor.
Convalescent plasma has been in the news a lot lately as a potential treatment for people infected with the coronavirus. In August the US Food and Drug Administration (FDA) granted emergency use authorization (EUA) to use these products based on preliminary data that suggested it might help people battling COVID. But there are still a lot of unanswered questions about this approach.
And that’s where you come in.
Plasma is a component of blood that carries proteins called antibodies that are usually involved in defending our bodies against viral infections. We also know that blood plasma from patients that have recovered from COVID-19, referred to as convalescent plasma, contain antibodies against the virus that can be used as a potential treatment for COVID-19.
That’s the theory, but the reality is that there are still a lot we don’t know, basic questions such as does it really work, how does it work, does it work for everyone or just some patients? A clinical grant includes testing the plasma in COVID-19 Positive patients that CIRM is funding with City of Hope, UC Irvine and Translational Genomics Research Institute (TGen) hopes to answer those questions.
The first step is getting the plasma from people who have recovered from COVID and then testing it to make sure it’s safe and to identify what blood type it is, so you can match that blood type with the person receiving it.
But plasma doesn’t contain just one kind of antibody, there are many antibodies and each one works in a slightly different way. For example, two antibodies, IGM and IGG, target in on the spike protein on the coronavirus. The goal is to block that spike and prevent the virus from spreading throughout the body. IGM has up to 10 ‘arms’ and so has the potential to bind multiple copies of the spike, whereas IGG has only 2 arms, but lasts longer. Both IGM and IGG also come in many different flavors, allowing them to bind to many different parts of the spike, some being more protective than others.
That’s one of the things that this trial is trying to find out. And you can help them do that. The trial needs volunteers, volunteers to donate the plasma and volunteers to try the therapy.
The team is evaluating changes that occur before and after plasma treatment. Many recipients have no immediate response, a few get dramatically better, and some continue to have symptoms long after discharge from the hospital. These so-called “long-haulers” can have debilitating problems, months after becoming infected. The study hopes to evaluate these variable responses to plasma treatment.
But more people are needed if we are to truly understand what works best. We need people who are newly infected, those being treated with plasma, and those that have recovered from the virus.
We are particularly interested in recruiting people from the Black and Latinx communities, groups that are often underserved when it comes to access to medical care.
The team has created a website to make it easy to find out more about the clinical trial, and to see if you are a good candidate to be part of it, either as a donor or recipient.
Lives are at stake and time is short so join us, help us find answers to the most pressing medical issue of our times. It’s a chance to do something that might benefit your family, your friends and your community.
We have all read about people who smoke a pack of cigarettes and drink a bottle of whiskey a day and somehow manage to live a long, healthy life. Then there are people like Sandra Dillon. She lived as healthy a life as you can imagine; she exercised a lot, ate a healthy diet and didn’t smoke. Yet at the age of 28 she was diagnosed with a rare and deadly form of blood cancer called myelofibrosis.
Sandra underwent the traditional forms of treatment but those proved ineffective and time seemed to be running out. Then she heard about a clinical trial for a new, experimental stem cell therapy, with Dr. Catriona Jamieson at the University of California San Diego.
Sandra says she wasn’t looking forward to it, but she was in a lot of pain, was getting much sicker and none of the treatments she tried was working.
“At the time I was actually quite afraid of seeing doctors or going to medical institutions. My experience had been rough, and I knew that I had to overcome my fear of going to hospitals and being treated. But it was a chance to have hope and to be on something that might work when there was nothing else available.”
Dr. Jamieson’s approach (CIRM helped support her early work in this area) had led to her identifying how abnormal gene activity was responsible for the progression of this form of blood cancer. With that knowledge she then identified a specific small molecule known to inhibit this mutant gene activity, and how it could halt the disease.
That’s what happened with Sandra. She says after years of pain and exhaustion, of fearing that she was running out of time, the treatment produced impressive results.
“It was pretty amazing. I had really low expectations from how sick I was and that this was experimental, and it was cancer and you expect it to be awful. And my experience was the opposite of what I’d expected. I started to feel incredible. The pain, after a few months, the side effects from my cancer started to come down.”
Today Sandra’s cancer is still in remission. She is back to her old, healthy, energetic self. She says she doesn’t consider herself a stem cell pioneer but is glad her participation in the trial might also benefit others.
“It’s helped me but the opportunity that it could also help other people is truly meaningful.”
The treatment she received was approved by the US Food and Drug Administration in 2019, the first approval for a therapy that had CIRM support.
I recently had the great pleasure of interviewing Sandra as part of our CIRM 2020 Grantee Meeting.
Over 650,000 Americans suffer from end-stage kidney disease – a life-threatening condition caused by the loss of kidney function. The best available treatment for these patients is a kidney transplant from a genetically matched living donor. However, patients who receive a transplant must take life-long immunosuppressive drugs to prevent their immune system from rejecting the transplanted organ. Over time, these drugs are toxic and can increase a patient’s risk of infection, heart disease, cancer and diabetes. Despite these drugs, many patients still lose transplanted organs due to rejection.
To tackle this problem Medeor is developing a stem cell-based therapy called MDR-101. This is being tested in a Phase 3 clinical trial and it’s hoped it will eliminate the need for immunosuppressive drugs in genetically matched kidney transplant patients.
The company takes blood-forming stem cells and immune cells from the organ donor and infuses them into the patient receiving the donor’s kidney. Introducing the donor’s immune cells into the patient creates a condition called “mixed chimerism” where immune cells from the patient and the donor are able to co-exist. In this way, the patient’s immune system is able to adapt to and tolerate the donor’s kidney, potentially eliminating the need for the immunosuppressive drugs that are normally necessary to prevent transplant rejection.
So how does getting RMAT designation help that? Well, the FDA created the RMAT program to help speed up the development and review of regenerative medicine therapies that can treat, modify, reverse, or cure a serious condition. If MDR-101shows it is both safe and effective RMAT could help it get faster approval for wider use.
In a news release Giovanni Ferrara, President and CEO of Medeor, welcomed the news.
“This important designation underscores the tremendous unmet medical need for alternatives to today’s immunosuppressive therapies for transplantation. We have the potential to help people live longer, healthier lives without the need for high dose and chronic immunosuppression and we thank the FDA for this designation that will assist us progressing as efficiently as possible toward a commercially available product.”
An antibody therapeutic, magrolimab, being tested for myelodysplastic syndrome (MDS), a group of cancers in which the bone marrow does not produce enough healthy blood cells , was granted breakthrough therapy designation with the Food and Drug Administration (FDA).
Breakthrough therapy designations from the FDA are intended to help expedite the development of new treatments. They require preliminary clinical evidence that demonstrates that the treatment may have substantial improvement in comparison to therapy options currently available. CIRM funded a Phase 1b trial in MDS and acute myeloid leukemia (AML), another type of blood cancer, that provided the data on which the breakthrough therapy designation is based.
Cancer cells express a signal known as CD47, which sends a “don’t eat me” message to macrophages, white blood cells that are part of the immune system designed to “eat” and destroy unhealthy cells. Magrolimab works by blocking the signal, enabling the body’s own immune system to detect and destroy the cancer cells.
Magrolimab was initially developed by a team led by Irv Weissman, M.D. at Stanford University with the support of CIRM awards. This led to the formation of Forty Seven, Inc., which was subsequently acquired by Gilead Sciences in April 2020 for $4.9 billion (learn more about other highlighted partnership events on CIRM’s Industry Alliance Program website by clicking here).
In CIRM’s 2019-2020 18-Month Report, Mark Chao, M.D., Ph.D., who co-founded Forty Seven, Inc. and currently serves as the VP of oncology clinical research at Gilead Sciences, credits CIRM with helping progress this treatment.
“CIRM’s support has been instrumental to our ability to rapidly progress Forty Seven’s CD47 antibody targeting approach.”
Magrolimab is currently being studied as a combination therapy with azacitidine, a chemotherapy drug, in a Phase 3 clinical trial in previously untreated higher risk MDS. This is one of the last steps before seeking FDA approval for widespread commercial use.
In a press release, Merdad Parsey, M.D., Ph.D., Chief Medical Officer at Gilead Sciences discusses the significance of the designation from the FDA and the importance of the treatment.
“The Breakthrough Therapy designation recognizes the potential for magrolimab to help address a significant unmet medical need for people with MDS and underscores the transformative potential of Gilead’s immuno-oncology therapies in development.”
This week saw the launch of the 45th startup company enabled by CIRM funding of translational research at California academic institutions. Graphite Bio officially launched with the help of $45M in funding led by bay area venture firms Versant Ventures and Samsara BioCapital to spinout a novel CRISPR gene editing platform from Stanford University to treat severe diseases. Graphite Bio’s lead candidate is for sickle cell disease and it harnesses CRISPR gene correction technology to correct the single DNA mutation in sickle cell disease and to restore normal hemoglobin expression in the red blood cells of sickle cell patients (Learn more about CRISPR from a previous blog post linked here).
Matt Porteus, M.D., Ph.D and Maria Grazia Roncarolo, M.D., both from Stanford University, are the company’s scientific founders. Dr. Porteus, Dr. Roncarolo, and the Stanford team are currently supported by a CIRM late stage preclinical grant to complete the final preclinical studies and to file an Investigational New Drug application with the FDA, which will enable Graphite Bio to commence clinical studies of the CRISPR sickle cell disease gene therapy candidate in sickle cell patients in 2021.
Josh Lehrer, M.D., was appointed CEO of Graphite Bio and elaborated on the company’s gene editing approach in a news release.
“Our flexible, site-specific approach is extremely powerful and could be used to definitively correct the underlying causes of many severe genetic diseases, and also is applicable to broader disease areas. With backing from Versant and Samsara, we look forward to progressing our novel medicines into the clinic for patients with high unmet needs.”
In a press release, Dr. Porteus take a retrospective look on his preclinical research and its progress towards a clinical trial.
“It is gratifying to see our work on new gene editing approaches being translated into novel therapies. I’m very excited to be working with Versant again on a start-up and I look forward to collaborating with Samsara and the Graphite Bio team to bring a new generation of genetic treatments to patients.”
CIRM’s funding of late stage preclinical projects such this one is critical to its funding model, which de-risks the discovery, translational development and clinical proof of concept of innovative stem cell-based treatments until they can attract industry partnerships. You can learn more about CIRM-enabled spinout companies and CIRM’s broader effort to facilitate industry partnering for its portfolio projects on CIRM’s Industry Alliance Program website.
You can contact CIRM’s Director of Business Development at the email below to learn more about the Industry Alliance Program.
One of our favorite things to do at CIRM is deliver exciting news about CIRM projects. This usually entails discussion of recent discoveries that made headlines, or announcing the launch of a new CIRM-funded clinical trial …. tangible signs of progress towards addressing unmet medical needs through advances in stem technology.
But there are equally exciting signs of progress that are not always so obvious to the untrained eye- those that we are privileged to witness behind the scenes at CIRM. These efforts don’t always lead to a splashy news article or even to a scientific publication, but they nonetheless drive the evolution of new ideas and can help steer the field away from futile lines of investigation. Dozens of such projects are navigating uncharted waters by filling knowledge gaps, breaking down technical barriers, and working closely with regulatory agencies to define novel and safe paths to the clinic.
These efforts can remain “hidden” because they are in the intermediate stages of the long, arduous and expensive journey from “bench to beside”. For the pioneering projects that CIRM funds, this journey is unique and untrod, and can be fraught with false starts. But CIRM has developed tools to track the momentum of these programs and provide continuous support for those with the most promise. In so doing, we have watched projects evolve as they wend their way to the clinic. We wanted to share a few examples of how we do this with our readers, but first… a little background for our friends who are unfamiliar with the nuts and bolts of inventing new medicines.
A common metaphor for bringing scientific discoveries to market is a pipeline, which begins in a laboratory where a discovery occurs, and ends with government approval to commercialize a new medicine, after it is proven to be safe and effective. In between discovery and approval is a stage called “Translation”, where investigators develop ways to transition their “research level” processes to “clinically compatible” ones, which only utilize substances that are of certified quality for human use.
Investigators must also work out novel ways to manufacture the product at larger scale and transition the methods used for testing in animal models to those that can be implemented in human subjects.
A key milestone in Translation is the “preIND” (pre Investigational New Drug (IND) meeting, where an investigator presents data and plans to the US Food and Drug Administration (FDA) for feedback before next stage of development begins, the pivotal testing needed to show it is both safe and effective.
These “IND enabling studies” are rigorous but necessary to support an application for an IND and the initiation of clinical trials, beginning with phase 1 to assess safety in a small number of individuals, and phase 2, where an expanded group is evaluated to see if the therapy has any benefits for the patient. Phase 3 trials are studies of very large numbers of individuals to gain definitive evidence of safety and therapeutic effect, generally the last step before applying to the FDA for market approval. An image of the pipeline and the stages described are provided in our diagram below.
The pipeline can be notoriously long and tricky, with plenty of twists, turns, and unexpected obstacles along the way. Many more projects enter than emerge from this gauntlet, but as we see from these examples of ‘works in progress”, there is a lot of momentum building.
Caption for Graphic:This graphic shows the number of CIRM-funded projects and the stages they have progressed through multiple rounds of CIRM funding. For example, the topmost arrow shows that are about 19 projects at the translational stage of the pipeline that received earlier support through one of CIRM’s Discovery stage programs. Many of these efforts came out of our pre-2016 funding initiatives such as Early Translation, Basic Biology and New Faculty Awards. In another example, you can see that about 15 awards that were first funded by CIRM at the IND enabling stage have since progressed into a phase 1 or phase 2 clinical trials. While most of these efforts also originated in some of CIRM’s pre-2016 initiatives such as the Disease Team Awards, others have already progressed from CIRM’s newer programs that were launched as part of the “2.0” overhaul in 2016 (CLIN1).
The number of CIRM projects that have evolved and made their way down the pipeline with CIRM support is impressive, but it is clearly an under-representation, as there are other projects that have progressed outside of CIRM’s purview, which can make things trickier to verify.
We also track projects that have spun off or been licensed to commercial organizations, another very exciting form of “progression”. Perhaps those will contribute to another blog for another day! In the meantime, here are a just a few examples of some of the progressors that are depicted on the graphic.
Project: stem cell therapy to enhance bone healing in theelderly
– Currently funded stage: IND enabling development, CLIN1-11256 (Dr. Zhu, Ankasa Regenerative Therapeutics)
The Deseret News is Utah’s oldest continuously published daily newspaper. It has a big readership too, with the largest Sunday circulation in the state and the second largest daily circulation. That’s why when they publish paid advertisements that look like serious news articles it can be misleading, even worse.
This week the Deseret News (that’s not a misspelling by the way, the name is taken from the word for honeybee in the Book of Mormon) ran an advertisement written by the East West Health Clinic. The advertisement is about regenerative medicine and its ability to help repair damaged knee, hip and shoulder joints. It quotes from some well-regarded scientific sources such as WebMD and the National Health Interview Survey.
They also quote CIRM. Here’s what they say:
“In theory, there’s no limit to the types of diseases that could be treated with stem cell research,” the California Institute for Regenerative Medicine (CIRM) explains. CIRM posits that stem cell therapy could be used to “replace virtually any tissue or organ that is injured or diseased.”
That’s from a page on our website that talks about the potential of stem cell research. And it’s all true. But then the advertisement switches quickly, and rather subtly, to talking about what the clinic is doing. And that’s where things get murky.
East West Health offers therapies using umbilical and cord blood that they claim can treat a wide range of diseases and disorders from tendonitis to arthritis and suggest they might even help people with Alzheimer’s and dementia. But none of these have been proven in an FDA-sanctioned clinical trial or approved by the FDA. In fact, if you scroll down to the bottom of the website you find this statement.
*These statements have not been evaluated by the FDA*
And they also say that “Individual results may vary”.
I bet they do.
There are many clinics around the US that claim that stem cells have almost magical powers to heal. They don’t.
What stem cells do have is enormous potential. That’s why we invest in solid, scientifically rigorous research to try and harness that potential and bring it to patients in need. But that takes years of work, meticulous testing in the lab long before it ever is tried in people. It takes working with the FDA to get their support in starting a clinical trial to show that the therapy is both safe and effective.
CIRM has long promoted the importance of the Three R’s, making sure research is regulated, reliable and reputable. We want to help advance promising regenerative medicine therapies and products while protecting patients from the risks posed by unproven interventions.
That’s why we have a commitment to only funding the best science, work that has undergone rigorous peer review. That’s why we collaborate with expert advisors, ensure all projects we fund are in alignment with FDA rules and regulations and that meet the highest standards set by the organizations like the National Institutes of Health.
There are no short cuts. No easy ways to just stick cells in someone and tell them they are good to go.
That’s why when we see advertisements like the one that ran in The Deseret News it concerns us, because people will see our name and think we support the work being done by the people who wrote the piece. We don’t. Quite the opposite.
If you would like to learn more about the kinds of questions you need to ask before signing up for a clinical trial or therapy of any kind just go to our website. And if you want to see the list of clinical trials we do support, you can go here.