Improving access to medicines for neurological disorders – World Health Organization (WHO)

Overview

Neurological disorders are the leading cause of disability globally and access to essential medicines for neurological disorders remains a critical global health challenge.

The Improving access to medicines for neurological disorders report comprehensively describes the status of access to medicines for neurological disorders worldwide. Using epilepsy and Parkinson disease as tracer conditions, it highlights the wide unavailability and unaffordability of these medicines, explores the different health system barriers affecting access, and showcases special scenarios where some of the challenges can be exacerbated. The report offers a framework for multi-level, multi-sectoral actions, and serves as a call to action for all stakeholders to commit to tangible, sustainable improvements in the accessibility of medicines for neurological disorders.

The report is intended for use by policy-makers, public health professionals, health programme managers and planners, healthcare insurance authorities, health-care providers, researchers, the pharmaceutical industry, and prescribers working in national health ministries, in subnational health offices, or at the district level, as well as health initiatives led by nongovernmental organizations.

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Improving access to medicines for neurological disorders - World Health Organization (WHO)

MSU, UM form unprecedented joint venture to grow neurological care in mid-Michigan – Grand Rapids Business Journal

University of Michigan Health and Michigan State University Health Care plan to expand neurological care in the Lansing area and mid-Michigan through a new joint venture.

The two formed the Neuro Care Network to partner on inpatient and outpatient care for patients with neurological diseases such as Parkinsons and dementia or who have suffered a stroke. The partnership includes inpatient and outpatient neurology, neurosurgery, electrodiagnostic and infusion services.

The partnership took effect immediately and marks an unprecedented collaboration between the states two leading academic institutions, University of Michigan President Santa Ono told the Board of Regents, which approved formation of the joint venture Thursday afternoon.

The Neuro Care Network will include practitioners from both institutions to enhance care in the region, Ono said.

Under this new agreement, a dedicated team of neurosurgeons and neurologists will provide world-class care at University of Michigan Health-Sparrow in Lansing and MSU Health Care in East Lansing, Ono said. Together, they will care for more patients, help recruit more neurology specialists to mid-Michigan and, most importantly, transform more lives.

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The partnership will bring a higher level of care in neurology to the mid-Michigan market at a time when incidence rates are rising. The Neuro Care Network will examine future community needs in the market and recruit specialists to mid-Michigan residents, alleviating the need for patients with complex conditions to travel elsewhere for the care they need.

Neurological care and neuroscience care, these are two areas where the diseases and the growth will only be higher, and there will only be more disease rates over time, MSU Health Care CEO Seth Ciabotti said. For us to come together and offer really world-class neurological care, neurological and neurosurgery care for mid-Michigan, and really the state, is something were really excited about. Its something that was lacking, frankly, within mid-Michigan.

On top of the clinical improvements, the partnership can increase clinical research in the region for neurological disease, said Margaret Dimond, president of the University of Michigan Health Regional Network.

Our top research institutions are aligned on expanding our clinical work and seeking more opportunities for research in the neuroscience area, Dimond said. This is a unique and progressive partnership that will set an example for multi-university collaboration on key diagnostic and treatment breakthroughs. It is just the best thing for mid-Michigan in terms of clinical and research for neurological conditions.

MSU Health Care and University of Michigan Health have collaborated for 40 years in a variety of different ways within the neurologic sciences, said Dr. David Kaufman, a professor of neurology and assistant vice president for clinical affairs for the Office of Health Sciences at MSU and medical director of neurology at UM Health-Sparrow.

Weve done this at clinical level research education, but never at this level, Kaufman said. This joint operating agreement helps unite this states top two research intensive universities for the clinical benefit of people within mid-Michigan.

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MSU, UM form unprecedented joint venture to grow neurological care in mid-Michigan - Grand Rapids Business Journal

WHO calls for better access to medicines to reduce vast treatment gap for neurological disorders – World Health Organization (WHO)

Despite the significant progress made in developing effective, safe, and cost-effective medicines that enhance the quality of life of individuals with neurological disorders, these medicines remain largely inaccessible.

A new WHO report, Improving Access to Medicines for Neurological Disorders, sets out the barriers that prevent access to these essential medicines, and presents a framework for action to address these challenges.

The impact of neurological disorders can be significantly decreased and quality of life improved, if people living with these disorders are provided access to the essential medicines they need, says Dvora Kestel, Director or WHOs Department of Mental Health, Brain Health and Substance Use. However, most people with neurological disorders struggle to access the treatment they need for their conditions because these medicines do not reach them or are too expensive.

Neurological disorders are the leading cause of disability and over 80% of neurological deaths and health loss occur in low- and middle-income countries. The treatment gap (the difference between the number of people with a condition and those receiving appropriate treatment) for neurological disorders is extremely high, exceeding 75% in most low-income countries and 50% in most middle-income countries.

Evidence shows that the treatment gap for epilepsy, for example, can reach 90% in low-income countries that means that 9 out of 10 people living with epilepsy do not receive the care and treatment they need.

Barriers to accessing medicines for neurological disorders

Using epilepsy and Parkinson disease as tracer conditions, WHO published a report that sets out the complex and inter-linking challenges that prevent access to treatment for neurological disorders, including:

These challenges are further compounded by existing health inequities, disproportionately affecting populations in low- and middle-income countries, individuals living in poverty, rural areas, and other vulnerable groups, creating a fundamental obstacle to achieving universal health coverage.

WHO report provides a framework for action

The report offers a framework for stakeholders to step up multi-level, multi-sectoral action and address the many barriers impeding sustained access to essential medicines for neurological disorders. The proposed actions address multiple areas across the health system, including policy and regulatory environments, health infrastructure and education systems. The report also emphasizes the importance of engaging with individuals with lived experience and the power of collaboration at country, regional and global levels, as well as among stakeholder groups.

Actions proposed in this report have clear synergies with the WHO Roadmap for access to medicines, vaccines and other health products. With the proposed approach for neurological medicines, we have a robust set of actions and a clear way forward to improve access to these essential medicines, says Christophe Rerat, Senior Technical Officer in the Medicines and Health Products Division, WHO.

Supporting countries to improve access to medicines for neurological disorders

This report is an important tool in the implementation of the Intersectoral global action plan on epilepsy and other neurological disorders (IGAP) 20222031, which is supporting countries to scale up access to the essential medicines and technologies needed to manage neurological disorders by 2031.

Some countries are already taking significant steps to address these challenges. In Ghana, neurological disorders such as epilepsy and Parkinson disease have been prioritized. The recent update of the national essential medicines list and standard treatment guidelines included several medicines and clinical guidance for treatment of neurological disorders.

In the United Republic of Tanzania, a national coordination committee for epilepsy and other neurological disorders is being established to provide technical support to policymakers. The countrys Medical Stores Department is conducting special procurements of medicines for neurological disorders in order to address the lack of access. Significantly, the United Republic of Tanzanias National Health Insurance Fund package 2024, now includes several medicines for neurological disorders, including epilepsy and Parkinson disease. These actions represent a major step towards ensuring more people living with these disorders can access the treatment they need.

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WHO calls for better access to medicines to reduce vast treatment gap for neurological disorders - World Health Organization (WHO)

MSU Health Care, UM Health unite to provide expanded neurology services for mid-Michigan residents – MSUToday

The Neuro Care Network, a new joint operating agreement between MSU Health Care and University of Michigan Health-Sparrow, will offer more convenient local neurological services for an improved patient experience. Effective immediately, the collaborative effort will include inpatient and outpatient neurology, neurosurgery, electrodiagnostic and infusion service lines from both institutions.

MSU Health Care provides neurology services to thousands of local patients each year and we expect that number to continue to grow, said Seth Ciabotti, chief executive officer of MSU Health Care, the academic health system of Michigan State University. The Neuro Care Network enables patients to receive this high level of care as well as additional services. As MSU Health Care continues to build a health system of the future, partnerships like this will help us design experiences that revolve around the needs of patients.

MSU Health Care and University of Michigan Health have a history of working together to provide neurology care to the mid-Michigan community. MSU Health Care providers have supported patients at the MSU Clinical Center and University of Michigan Health-Sparrow, contributing to its designation as a comprehensive stroke center.

The agreement will formalize and advance having University of Michigan Health and Michigan State University neurological specialty providers work collaboratively on a variety of clinical advancements and research potential, said Margaret Dimond, president of UM Health Regional Network, which includes UM Health-Sparrow and UM Health-West. This collaboration will provide access to a more comprehensive and coordinated experience for patients in Michigan who require specialized care for any neurologic condition. Its a unique and progressive partnership that will set an example for multi-university collaboration on key diagnostic and treatment breakthroughs.

According to the National Center for Health Workforce Analysis, Michigans supply of neurology specialists will fulfill just 88% of the demand by 2031, which is below national projections for the same period. The Neuro Care Network will work to identify future community needs and collaboratively recruit specialists so that mid-Michigan residents have convenient access to inpatient and outpatient neurology services.

As our population ages and the rates of neurological diseases such as Parkinsons, stroke and dementia increase, the demand for neurology specialists will continue to outpace the supply, said John Goudreau, neurologist and interim chair of the MSU Department of Neurology and Ophthalmology. Working collaboratively strengthens our position to recruit top neurological talent and care for our patients.

MSU Health Care and UM Health-Sparrow will be partnering to provide outstanding new services, thus expanding access for our mid-Michigan patients to advanced specialty care without needing to leave the region, added Aditya Pandey, chair of the UM Health Department of Neurosurgery.

New service lines are also anticipated as a result of this collaboration and will be announced as they are ready for patients. To learn more, visit the MSU Health Care website.

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MSU Health Care, UM Health unite to provide expanded neurology services for mid-Michigan residents - MSUToday

NYU Langone Health Ranks No. 1 in the Nation for Neurology and Neurosurgery for the Third Consecutive Year – PR Newswire

With nine clinical specialties ranked in the top five nationally, NYU Langone is also No. 1 in New York for cardiology

NEW YORK, July 16, 2024 /PRNewswire/ -- NYU Langone Health has reaffirmed its position as the nation's top hospital for neurology and neurosurgery, securing the No. 1 ranking for the third straight year in U.S. News & World Report'sannual assessment of leading hospitals. NYU Langone also climbed two spots to secure the No. 1 ranking in pulmonology and lung surgery.

Additionally, NYU Langone was recognized as the top hospital in New York for cardiology, heart surgery, and vascular surgery, ranking second nationally.

While U.S. News no longer numerically ranks hospitals, it named NYU Langone to its honor roll of the top 20 hospitals in the nation. The accolades extend across NYU Langone inpatient locations, including Tisch Hospital, Kimmel Pavilion, and NYU Langone Orthopedic Hospital in Manhattan; NYU Langone HospitalLong Island; and NYU Langone HospitalBrooklyn.

"At NYU Langone Health, our culture of exceptionalism continues to deliver the best outcomes for our patients with one consistently high standard of care across all of our locations," saidRobert I. Grossman, MD, CEO of NYU Langone and dean of NYU Grossman School of Medicine. "Not only is our overall ranking one of the highest in the United States, but nine of our specialties are among the top five in the nation. We are unique in that exceptional patient outcomes come from all of our hospitals, with each of these contributing to our ranking.I am so proud of each and every one of our employees for helping deliver these fantastic results."

All 13 of NYU Langone's ranked clinical specialties placed in the top 20 nationally, with nine of those ranking in the top five.

NYU Langone's full clinical rankings:

Also of note, NYU Langone received High Performing ratings for all 20 procedures and conditions included in the Common Adult Procedure and Condition Ratings, underscoring its comprehensive capabilities across various medical specialties. Among them are kidney failure, diabetes, cardiac care, cancer surgery, chronic obstructive pulmonary disease (COPD), leukemia, lymphoma and myeloma, orthopedic surgery, pneumonia, and stroke.

Beyond its recognition by U.S. News & World Report, NYU Langone has consistently earned top marks for quality and safety from other healthcare evaluators. Vizient Inc. named NYU Langone the top inpatient and outpatient network nationwide, the Leapfrog Group awarded an "A" safety rating to every NYU Langone inpatient facility, and the U.S. Centers for Medicare and Medicaid Services bestowed a 5-star rating for safety, quality, and patient experience.

NYU Langone comprises six inpatient locations, its Perlmutter Cancer Center, and more than 300 outpatient sites across the New York area and Florida. The system also includes two medical schools, in Manhattan and on Long Island, and a vast research enterprise.

Media Inquiries

Lacy Scarmana Phone: 646-754-7367 [emailprotected]

SOURCE NYU Langone Health

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NYU Langone Health Ranks No. 1 in the Nation for Neurology and Neurosurgery for the Third Consecutive Year - PR Newswire

Subcutaneous Immunoglobulin Shows Superiority Over IVIG in Treating CIDP, Meta-Analysis Shows – Neurology Live

A recently published meta-analysis using more than 20 studies with nearly 1400 patients showed that subcutaneous immunoglobulin (SCIG) provides a more feasible alternative for treating chronic demyelinating polyneuropathy (CDIP) than intravenous immunoglobulin (IVIG). Overall, SCIG showed more considerable cost reductions over time, was more preferred by patients, and demonstrated comparable, and sometimes superior, health outcomes.1

Published in Neurological Sciences, the systematic review comprised 50 studies up till 2024, with 22 involved in the meta-analysis. Included studies offered clinical data on patients with CIDP, mostly from western Europe and the US, representing nearly 10% of their entire CIDP populations. Almost all studies included considered SCIG to be a maintenance therapy in their context, and thus, the primary goal of those studies was to reduce relapse rate and sustain or enhance neuromuscular functions.

Led by Mostafa Ramzi Shiha, of Cairo University, meta-analysis showed that SCIG significantly improved muscle strength and sensory function, had fewer and milder adverse events (AEs), reduced relapse rates, and received a strong preference. On muscle strength, a collection of 18 studies comprising 542 individuals with CIDP demonstrated a significant improvement in muscle strength post-SCIG treatment. Overall, the pooled standardized mean difference in Medical Research Council Scale (MRC) scores was 0.68 points (95% CI, 0.28-1.08), with statistically significant enhancement (P = .0008).

When evaluating muscle strength by dose level, results showed that the high dose subgroup showed a significant effect (SMD, 2.39; 95% CI, 0.79-3.98) and high heterogeneity (I2 = 95%), whereas there was no significant effect in the low dose subgroup (SMD, 0.05; 95% CI, 0.22 to 0.14). The medium dose subgroup showed a small but not statistically significant effect (SMD, 0.18; 95% CI, 0.04 to 0.40).

Overall, treatment with SCIG was associated with a 22% decreased risk of AEs compared with IVIG (P <.0001). An analysis of 2 studies found a significant difference in headache occurrence in the SCIG group (OR, 0.14; 95% CI, 0.07-0.30; P <.0001). Infusion site reactions, a concern for subcutaneous treatments, were not significantly more common with SCIG in 2 studies, with an OR of 1.75 (P = .50). In addition, there was no significant between-group differences in severe AEs as well (OR, 0.23; P =.19).

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As to why SCIG leads to fewer AEs relative to IVIG, investigators attributed this to the "slower absorption into the bloodstream with SCIG, which avoids the high peak levels of immunoglobulin G seen after IVIG administrations."

The Inflammatory Neuropathy Cause and Treatment (INCAT) disability score, developed in 2001, was used as an assessment for overall function and disability. Across 5 studies with available data comprising 67 patients, treatment with SCIG led to a significant improvement in sensory function as measured by INCAT Sensory Score. The pooled mean difference showed a reduction of 1.73 points (95% CI, 2.29 to 1.17), which was statistically significant (P <.00001). This improvement indicated enhanced sensory function following SCIG therapy.

On INCAT results, there was high heterogeneity (I2 = 92%) among the included studies. "For impaired functional mobility, no worsening was observed in the analysis of 9-hole peg test and timed meter walk test scores, indicating that patients preserved their functional mobility upon SCIG maintenance treatment, Shiha et al wrote.

In terms of relapse rate reduction, patients with CIDP treated with SCIG had significant reductions observed, with a risk ratio of 0.146 (95% CI, 0.090-0.202; P <.001) across 8 included studies. In comparison with conventional IVIG treatment, a previous 52-week open-label study found that IVIG administered as maintenance therapy resulted in a relapse rate of 10.5%, similar to the results of high-dose SCIG treatment in the 48-week, open-label PATH extension trial relapse rate of 10.8%. Overall, the findings from the meta-analysis indicated that both IVIG and SCIG might have comparable efficacy in terms of relapse rates.

Quality of life and health status also remained stable after treatment with SCIG, which was consistent with IVIG treatments. Interestingly, 2 included studies that used a more IgG treatment oriented scale like LQI that considers many items related to patients convenience, comfort, and independence, according to the IgG route of administration, showed better quality of life measures after SCIG. In addition, patients treatment preferences, when analyzed, unanimously demonstrated a preference for SCIG across all studies.

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Subcutaneous Immunoglobulin Shows Superiority Over IVIG in Treating CIDP, Meta-Analysis Shows - Neurology Live

Neurological conditions claim the lives of thousands of children every year. New treatments in the womb may save them – BBC.com

Cutting-edge therapies delivering treatment to foetuses diagnosed with neurological defects have the potential to change natal care as we know it.

Michelle Johnsons fourth pregnancy was all going according to plan until the specialist giving her the standard 20-week ultrasound stiffened slightly while prodding her belly. The ultrasonographer got "really awkward" and was erratically asking questions, Johnson recalls, like if they already had kids. Several days later, the departments head radiologist called. His tone was sombre as he fumbled for words and said that it was rare in his experience, but Johnson needed to see a gestational foetal medicine specialist immediately because her child had spina bifida.

Known to science as myelomeningocele, spina bifida is when the spinal cord which starts developing in children as a cannoli-shaped tube, folding onto itself to encapsulate the nervous system doesn't fully fuse close. It leaves the superhighway of nerves to spill into a small bulge somewhere along the spine. This nervous system birth defect can lead to lifelong cognitive issues as well as chronically impaired mobility and paralysis from the hips down.

"It was just devastating," says Johnson, who was 35 years old at the time and living in Portland, Oregon, US. "I was just in shock."

Each year around 1,400 babies are born in the US with spina bifida. The exact cause of this complex condition is not known, but it is thought to involve a combination of genetic and environmental factors. Low levels of folic acid intake during pregnancy or certain anti-seizure medications, for example, have been associated with a higher risk of the condition, but it is not clear how great a role these play.

Spina bifida is customarily treated in the 24 to 48 hours immediately following childbirth: surgeons sew up the spinal cord and tuck it back into the baby's body, preventing the condition from degenerating any further. But while making calls for appointments with a specialist, a nurse on the phone told Johnson about a new programme in California that uses stem cells to treat children with spina bifida while they are still in the womb.

If she chose to be involved, her baby would be the second human patient to ever undergo this type of treatment. Johnson knew it was a chance she wanted to give her unborn child.

Since the procedure had to happen before the 26th week of pregnancy, "it was like a race", says Johnson. Several scans, blood tests, and interviews later, she embarked on something larger than life.

Prenatal screening for neurological conditions has progressed in leaps and bounds over the past couple of decades. Technology including genetic analysis, neuroimaging, and high-resolution foetal magnetic resonance imaging (MRI) are allowing doctors to peer into the nervous systems of developing foetuses and already diagnose them earlier and more frequently with any life-altering conditions they'll experience once born. But throughout this advancement, there hasn't been much doctors could do about those diagnoses until the child emerged from the womb. And a significant portion of crucial brain development happens long before a child is born.

Now, a new wave of pioneering in-utero neuroscience therapies are helping to change that. Several seminal trials are underway to test both surgical and medical treatments allowing doctors to reverse conditions in babies before they are born. And the field is "right on the precipice" of a whole new dimension of therapies, says Jeffrey Russ, a pediatric neurologist at Duke University who recently wrote an academic essay describing in-utero treatment as the "next frontier" in neurology.

One of these frontier treatments is the current first Food and Drug Administration (FDA) approved clinical trial treating spina bifida in utero with placental stem cells. The project, known as the CuRe Trial, is the culmination of 25 years of work of foetal surgeon Diana Lee Farmer, from the University of California, Davis.

In-utero operations where the spinal cord opening is sewn shut have become standard care for cases of very severe spina bifida. They slow the degeneration of the disease throughout the pregnancy and improve patient outcomes more than post-birth surgeries, as years of work by Farmer suggest . But her new project aims to take it a step further. By mending the open neural tube with a patch seeded with stem cells from bits of the mother's placenta known as "mesenchymal stromal cells", derived and cultured in a painstakingly precise four-day process the cells should actively go in and reverse the damage that has already occurred by the time of diagnosis.

These stem cells "are very smart", says Aijun Wang, the bioengineer who developed this stem cell technology for the CuRe trial. "They can protect neurons from being killed by the environment."

Preliminary data from running this experiment on lambs with spina bifida suggested the treatment allowed them to prance around without any noticeable disability when they would have otherwise been paralysed in their hind legs. The same was observed when the procedure was performed on bulldogs.

More than 30 people were in the operation room when Johnson, just a day shy of the 26-week pregnancy cutoff, became the second human patient to undergo this surgery. An incision was made into her watermelon-shaped belly, the uterus was pulled almost fully out of the body, and the foetus was floated up to the opening in the uterus. This allowed doctors to reach the hernia on the minuscule baby spine, and delicately apply the stem cell patch. The doctors used special microscopes to perform their surgery because the baby was so small.

If the child a boy to be named Tobias had remained untreated, he would have been born with paralysis from the hips down. On 1 February 2022, he was born via caesarian-section at 7lbs 13oz (3.5kg), legs kicking, toes wriggling. "It just feels like we won the lottery," says Johnson.

Tobias will have to be monitored until he turns 30 months old his last in-person visit is upcoming this summer before officially assessing the full safety and efficacy of the procedure, for the sake of the experiment. And doctors will likely continue to follow him until he turns at least five. At the time of writing, 10 more patients have received CuRe treatment, and Farmer's team has secured $15m (12m) of funding for 29 more patients, with the hopes of enrolling about 10 patients a year. It will not be till 2028 that Farmers team will be able to review all of the data collected and confirm whether this new therapy could become standard for children across the country.

"I'm hopeful that we may be able to make a very significant improvement in the outcome of these kids with spina bifida," says Farmer. "But like every good scientific project, you answer one question and that opens the door to another question."

This is cutting-edge science for anatomic conditions that can be surgically repaired, according to Russ. But another frontier where in-utero therapies have the potential to turn the tables of neurological conditions in newborn babies is where therapies can be delivered at a molecular or genetic level. This is a "totally new concept" that will "open a whole new realm", says Russ.

His colleagues at Duke University contributed to the design of a protocol for the first-ever in-utero treatment for Pompe's disease a rare genetic disease that causes cells to hold onto too many complex sugars, leading to neurological conditions, breathing problems, heart issues, and muscle weakness. Most patients die within one or two years of birth.

Since Pompe's is caused by the lack of an enzyme called acid alpha-glucosidase, it's usually treated with enzyme replacement therapy (ERT), where children receive regular injections of the enzyme. Like with spina bifida, though,data has shown that starting ERT as soon as the baby is born can improve symptoms but it cannot fully stop the disease from manifesting.

So, when doctors at The Ottawa Hospital in Ontario, Canada, ran tests on an unborn girl called Ayla Bashir in February 2021, revealing she had inherited the same genes that led two of her siblings, Zara and Sara, to be diagnosed with Pompe's after birth they knew they had to act quickly. Both Zara and Sara had died aged 29 months and eight months, respectively. But with Ayla's in-utero diagnosis, the medical team could intervene sooner.

On March 24, 2021, doctors delivered the first dose of enzyme replacement to Ayla while she was still in her mother's womb at 24 weeks and five days of gestation. They injected into the umbilical vein a liquid formula containing a copy of the missing enzyme called alglucosidase alfa. This approach allows the manufactured enzyme to make its way into the foetus's bloodstream while it is still developing. It means it barely notices the drug as foreign to itself, and doesn't have the strong immune response that can occur during treatment after birth. Six more infusions every two weeks followed. Ayla was born on June 22, 2021, and ever since she has been getting enzyme injections every week.

"Ayla is a very happy, mobile three year old who is meeting all her neurodevelopmental milestones," says Karen Fung-Kee-Fung, the maternal foetal medicine specialist at The Ottawa Hospital who treated her. "[I] just saw a video of her jumping up and down."

Similarly to Tobias, doctors will continue to follow Ayla for at least five years to monitor any disease progression, as the therapy does not completely prevent irreversible organ damage. But Ayla's story paves the way for setting up prenatal medical treatments that intervene in disorders like these with a simple injection.

"We were hoping to change the paradigm for when you can treat a genetic disease," says Tippi Mackenzie, one of the foetal surgeons at the University of California, San Francisco who led the development of the protocol which was used to treat Ayla.

There are several treatments currently offered to newborns that could potentially be offered during the foetal phase, says Mackenzie. She has established an ongoing five-year clinical trial for a total of 10 patients underway in California to help officially establish in-utero ERT as an approved procedure for Pompe's and other rare diseases such as Neuronopathic Gaucher disease, Mucopolysaccharidosis, and Wolman disease. Two babies with Mucopolysaccharidosis were already treated as part of the trial and "updates are positive", says Mackenzie. They are continuing to enroll patients for the trial, which is open for international patients.

Developing a foetal treatment for conditions like these would also help to raise awareness about the need for more testing for genetic diseases in the first place "changing the equation" by allowing a virtuous cycle of more diagnoses and more treatments, says Mackenzie. "The diagnosis and treatment, I call them a yin and yang, they go together," she says.

And while enzyme replacement is the least invasive type of treatment for genetic disorders and requires multiple dosages throughout a patient's lifetime this new method could be adapted to deliver other hotly debated gene therapies for editing an unborn baby's DNA, by either snipping out a defective gene or replacing a missing one.

Mackenzie's work is "laying the foundation for these types of advanced therapies in the future", says William Peranteau, a professor of surgery at the Children's Hospital of Philadelphia. "If those trials can demonstrate a benefit to treating the diseases before birth with an enzyme replacement therapy, then the obvious next question is a more definitive therapy like in-utero gene editing."

When it comes to estimating how long it'll be until gene-editing therapies will get human trials, though, it's always a very difficult question to answer, and "it always takes longer than we want or expect it to", says Peranteau. Maybe five to 10 years. "It's a matter of just doing the work," he says.

For now, as these trials pick up pace, it'll be imperative to consider the ethical and practical implications of these advancements.

"We'll have to start with really specific examples, where it's very clear that the benefits outweigh the risks," says Russ. Obviously, not all conditions can and should be treated with stem cells, enzyme replacement, and gene-editing technology before birth.

And it's still too early to have a clear picture of the long-term effects of these in-utero treatments. Most of the patients from these in-utero trials are still babies or very young children. We also still don't have long-term data from adult patients who are currently undergoing gene editing therapies, either. So while surgeries and chemical therapies like those developed by Farmer and Mackenzie are mostly short-lived procedures, once doctors edit the genetic code of an unborn baby these changes, and their effects, will be forever.

Crucially, in-utero therapies are unique procedures with double the risks and stakes, since they involve the mother as well as her unborn child, says Russ: "You're not just treating one patient, you're treating two."

Johnsons family travelled back to California a little over a year after the procedure. Johnson got to meet other mothers from the CuRe trial, and the hospital staff all took turns coming by, saying hello, and playing with Tobias in the courtyard, bringing him cake and candles to celebrate his first birthday.

"It was really special," says Johnson. "Really full circle for them to see all the work they're doing and to meet this miracle baby and see how healthy and happy he is."

At the time of writing, Tobias is more than two years old, and he has learned to walk.

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Neurological conditions claim the lives of thousands of children every year. New treatments in the womb may save them - BBC.com

New Type of Age-Related Memory Loss Identified – Neuroscience News

Summary: Researchers established new criteria for Limbic-predominant Amnestic Neurodegenerative Syndrome (LANS), a memory-loss condition often mistaken for Alzheimers disease.

Unlike Alzheimers, LANS progresses more slowly and has a better prognosis. The criteria help doctors diagnose LANS in living patients using brain scans and biomarkers. This advancement aids in better management and tailored treatments for memory loss.

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Source: Mayo Clinic

Researchers atMayo Clinichave established new criteria for a memory-loss syndrome in older adults that specifically impacts the brains limbic system. It can often be mistaken for Alzheimers disease.

The good news: Limbic-predominant Amnestic Neurodegenerative Syndrome, or LANS, progresses more slowly and has a better prognosis, and is now more clearly defined for doctors working to find answers for memory loss patients.

Prior to the researchers developing clinical criteria published in the journalBrain Communications, the hallmarks of the syndrome could be confirmed only by examining brain tissue after a persons death.

The proposed criteria provide a framework for neurologists and other experts to classify the condition in patients living with symptoms, offering a more precise diagnosis and potential treatments. They consider factors such as age, severity of memory impairment, brain scans, and biomarkers indicating the deposits of specific proteins in the brain.

The criteria were developed and validated using data from more than 200 participants in databases for theMayo Clinic Alzheimers Disease Research Center, theMayo Clinic Study of Agingand the Alzheimers Disease Neuroimaging Initiative.

Understanding the condition will lead to better management of symptoms and more tailored therapies for patients suffering from this type of cognitive decline, distinct from Alzheimers disease, saysDavid T. Jones, M.D., a Mayo Clinic neurologist and senior author of the study.

In our clinical work, we see patients whose memory symptoms appear to mimic Alzheimers disease, but when you look at their brain imaging or biomarkers, its clear they dont have Alzheimers. Until now, there has not been a specific medical diagnosis to point to, but now we can offer them some answers, Jones says.

This research creates a precise framework that other medical professionals can use to care for their patients. It has major implications for treatment decisions, including amyloid-lowering drugs and new clinical trials, and counseling on their prognosis, genetics and other factors.

Decades of work to understand and classify different types of dementia is ongoing, says Nick Corriveau-Lecavalier, Ph.D., the papers first author. These findings build upon scientists continued efforts to untangle neurological conditions that often have similar symptoms or can occur simultaneously, but can have drastically different treatments and prognoses.

Historically, you might see someone in their 80s with memory problems and think they may have Alzheimers disease, and that is often how its being thought of today, Corriveau-Lecavalier says.

With this paper, we are describing a different syndrome that happens much later in life. Often, the symptoms are restricted to memory and will not progress to impact other cognitive domains, so the prognosis is better than with Alzheimers disease.

Without signs of Alzheimers disease, the researchers looked at the involvement of one possible culprit a buildup of a protein called TDP-43 in the limbic system that scientists have found in the autopsied brain tissue of older adults.

Researchers have classified the build-up of these protein deposits aslimbic-predominant age-related TDP-43 encephalopathy, or LATE. These protein deposits could be associated with the newly defined memory loss syndrome, but there are also other likely causes and more research is needed, the authors say.

With clinical criteria established by Jones, Corriveau-Lecavalier and co-authors, practitioners could soon diagnose LANS in patients so those living with memory loss might better understand options for treatment and potential progression of the disease, opening doors for research to further illuminate the characteristics of the disease.

Funding: The research was funded in part by National Institutes of Health grants P30 AG062677, P50 AG016574, U01 AG006786, R37 AG011378 and R01 AG041851 and by the Robert Wood Johnson Foundation, the Elsie and Marvin Dekelboum Family Foundation, the Liston Family Foundation, the Edson Family, the Gerald A. and Henrietta Rauenhorst Foundation and the Foundation Dr. Corinne Schuler.

Drs. Jones and Corriveau-Lecavalier reported no conflicts of interest. A complete list of co-authors and financial disclosures is available in the manuscript.

Author: Emily DeBoom Source: Mayo Clinic Contact: Emily DeBoom Mayo Clinic Image: The image is credited to Neuroscience News

Original Research: Open access. Clinical criteria for a limbic-predominant amnestic neurodegenerative syndrome by David T. Jones et al. Brain Communications

Abstract

Clinical criteria for a limbic-predominant amnestic neurodegenerative syndrome

Predominant limbic degeneration has been associated with various underlying aetiologies and an older age, predominant impairment of episodic memory and slow clinical progression. However, the neurological syndrome associated with predominant limbic degeneration is not defined.

This endeavour is critical to distinguish such a syndrome from those originating from neocortical degeneration, which may differ in underlying aetiology, disease course and therapeutic needs.

We propose a set of clinical criteria for a limbic-predominant amnestic neurodegenerative syndrome that is highly associated with limbic-predominant age-related TDP-43 encephalopathy but also other pathologic entities.

The criteria incorporate core, standard and advanced features, including older age at evaluation, mild clinical syndrome, disproportionate hippocampal atrophy, impaired semantic memory, limbic hypometabolism, absence of neocortical degeneration and low likelihood of neocortical tau, with degrees of certainty (highest, high, moderate and low).

We operationalized this set of criteria using clinical, imaging and biomarker data to validate its associations with clinical and pathologic outcomes.

We screened autopsied patients from Mayo Clinic and Alzheimers Disease Neuroimaging Initiative cohorts and applied the criteria to those with an antemortem predominant amnestic syndrome (Mayo,n= 165; Alzheimers Disease Neuroimaging Initiative,n= 53) and who had Alzheimers disease neuropathological change, limbic-predominant age-related TDP-43 encephalopathy or both pathologies at autopsy.

These neuropathology-defined groups accounted for 35, 37 and 4% of cases in the Mayo cohort, respectively, and 30, 22 and 9% of cases in the Alzheimers Disease Neuroimaging Initiative cohort, respectively.

The criteria effectively categorized these cases, with Alzheimers disease having the lowest likelihoods, limbic-predominant age-related TDP-43 encephalopathy patients having the highest likelihoods and patients with both pathologies having intermediate likelihoods.

A logistic regression using the criteria features as predictors of TDP-43 achieved a balanced accuracy of 74.6% in the Mayo cohort, and out-of-sample predictions in an external cohort achieved a balanced accuracy of 73.3%. Patients with high likelihoods had a milder and slower clinical course and more severe temporo-limbic degeneration compared to those with low likelihoods. S

tratifying patients with both Alzheimers disease neuropathological change and limbic-predominant age-related TDP-43 encephalopathy from the Mayo cohort according to their likelihoods revealed that those with higher likelihoods had more temporo-limbic degeneration and a slower rate of decline and those with lower likelihoods had more lateral temporo-parietal degeneration and a faster rate of decline.

The implementation of criteria for a limbic-predominant amnestic neurodegenerative syndrome has implications to disambiguate the different aetiologies of progressive amnestic presentations in older age and guide diagnosis, prognosis, treatment and clinical trials.

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New Type of Age-Related Memory Loss Identified - Neuroscience News

Ascidian Therapeutics Enters Collaboration with Roche for Discovery and Development of RNA Exon Editing … – PR Newswire

Ascidian to receive $42 million in initial payment, and up to $1.8 billion in research, clinical and commercial milestone payments, as well as commercial royalties

Per-target agreement enables Ascidian to pursue additional internal and collaborative programs within neurology and other therapeutic areas

Combines RNA Exon Editors with next generation CNS delivery capabilities of Roche to develop novel medicines for difficult to treat neurological diseases

BOSTON, June 18, 2024 /PRNewswire/ --Ascidian Therapeutics, a biotechnology company seeking to treat human diseases by rewriting RNA, today announced a research collaboration and licensing agreement with Roche (SIX: RO, ROG;OTCQX: RHHBY) for the discovery and development of RNA exon editing therapeutics targeting neurological diseases.

Ascidian's RNA exon editing platform is designed to advance the therapeutic possibilities of RNA medicine and treat diseases not addressed by today's gene editing technologies. The company designs and develops RNA exon editing therapeutics that edit RNA exons at the kilobase scale.

Under the agreement, Ascidian will provide Roche exclusive, target-specific rights to Ascidian's RNA exon editing technology for undisclosed neurological targets. Ascidian will conduct discovery and certain preclinical activities in collaboration with Roche, and Roche will be responsible for certain preclinical activities, and further clinical development, manufacturing, and commercialization. Ascidian will receive an initial payment of $42 million and is eligible to receive up to $1.8 billion in research, clinical, and commercial milestone payments, as well as royalties on commercial sales worldwide. Based on the terms of the agreement, Ascidian is free to develop programs against other neurological targets internally or with other collaborators.

"Roche is known and respected worldwide for their expertise in complex neurological diseases, and I am proud of the scientific rigor and quality of the work done at Ascidian that has led to this partnership," saidMichael Ehlers,M.D., Ph.D., President and Chief Executive Officer of Ascidian Therapeutics. "The potential of treating disease by large-scale exon editing of RNA is vast. We look forward to working with the Roche team to develop first-in-class RNA exon editing medicines for multiple neurological diseases, with a mission and passion to relieve suffering and improve lives."

"Our partnership with Ascidian is an opportunity to harness advanced RNA exon editing technology, which has the potential to deliver transformative one-time therapeutics by editing multiple whole exons at the RNA level with a single treatment," said James Sabry, M.D., Ph.D., Global Head of Pharma Partnering at Roche.

Ascidian's platform enables targeting of large genes and genes with high mutational variance while maintaining native gene expression patterns and levels. By rewriting RNA, Ascidian's exon editing technology is designed to provide the durability of gene therapy, while sharply reducing risks associated with direct DNA editing and gene replacement.

About Ascidian Therapeutics

Ascidian Therapeutics, an ATP company, is redefining the treatment of disease by rewriting RNA. By editing exons at the RNA level, Ascidian therapies enable precise post-transcriptional editing of genes, resulting in full-length, functional proteins at the right levels, in the right cells, at the right time. With discovery, preclinical, and clinical programs in retinal, neurological, neuromuscular, and genetically defined diseases, Ascidian's approach has the potential to treat patients with one dose of an RNA exon editor, opening new therapeutic possibilities for patients and their families who are seeking breakthroughs. Earlier this year, Ascidian announced U.S. FDA IND clearance for the first-ever RNA exon editing candidate, ACDN-01, which targets Stargardt disease and other ABCA4 retinopathies. Ascidian is currently executing the Phase 1/2 STELLAR clinical trial to evaluate the safety and efficacy of ACDN-01. For more information, visit http://www.ascidian.com.

SOURCE Ascidian Therapeutics

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Ascidian Therapeutics Enters Collaboration with Roche for Discovery and Development of RNA Exon Editing ... - PR Newswire

Neurology ‘House Calls’ to Improve Quality of Care and Life for ALS Patients – Mega Doctor News

Dr. Keelie Denson, a second-year neurology resident at Houston Methodist, watched first-hand as her father James and family faced ALS from her childhood until his death when she was 13. Image of illustration purposes

Mega Doctor News

ByPattiMuckHouston Methodist

Newswise Robert Amar, a U.S. Army veteran, was diagnosed with Amyotrophic Lateral Sclerosis when he was a fit and healthy 45 years old. Fourteen years later, he has lost his ability to walk, talk, swallow and breathe on his own.

His high school sweetheart Angela, and the couples three adult children Victoria, Robert and Marissa and a few dedicated caregivers are his 24/7 caretakers. Commonly known as Lou Gehrigs disease after the New York Yankees hero of the 1930s, ALS is an incurable disease of the neuromuscular system. The diseases progression and symptoms vary widely from patient to patient, ultimately giving the patient a ringside seat as their bodies melt away, says Dr. Stanley Appel, director of the Johnson Center for Cellular Therapeutics at Houston Methodist and internationally respected ALS expert. He founded the nations first multidisciplinary ALS Clinic at Houston Methodist in 1982.

You hear those three letters A-L-S and it just changes your whole life forever, says Angela, Roberts wife of 29 years. We just love him so much and we would do anything for him.

Robert is among the first Houston Methodist ALS patients enrolled in a research study designed to provide a multidisciplinary standard of care to those whose disease has rendered them homebound.

24 ALS patients enrolled in first-of-its-kind study

Dr. Keelie Denson, a second-year neurology resident at Houston Methodist, watched first-hand as her father James and family faced ALS from her childhood until his death when she was 13. As patients progress in their disease, it becomes harder and harder for them to make it to multidisciplinary care visits in a clinic setting, says Dr. Denson. These are already geographically sparse to begin with.

Eventually, ALS patients and their families can be overwhelmed by the struggle to obtain consistent continuity of care from their team of specialists neurologists, social workers, speech therapists, physical and occupational therapists and dietitians. Worst case scenario? They stop attending clinic and drop off physicians radar.

Were being pulled out at the stage of the disease where our patients are most vulnerable and need us most, says Dr. Denson. There are no studies or resulting data to address this critical need. Until now.

Supported by Dr. Ericka Greene and the multidisciplinary ALS team at Houston Methodist, Dr. Denson designed a study, Caring for the Homebound Patient with ALS, that is following 24 patients and an optional 24 caregivers for 16 months. Patients live within 50 miles of Houston and cant physically visit their neurology team any longer, maybe because theyre too weak and on a ventilator or they dont have transportation, lack access to technology or have financial hardship. For one reason or another, theyve missed one or more clinic visits and are basically on their own in the final stages of their disease.

Half the patients the control group will receive telehealth visits with a neurologist. The other half the intervention group will get quarterly home visits from a neurologist and a social worker, accompanied by a live video conference that includes physical and occupational therapists, a dietitian, a speech therapist, and a medical equipment expert.

Before each visit and at the end of the study, patients and caregivers will complete the gold standard quality of life surveys that will provide data to prove or disprove the theory that multidisciplinary home health care visits improve life for these ALS patients.

If this program meets its endpoints and proves to be feasible, there will be an opportunity to create guidelines and curriculum for other institutions to replicate the program across the nation, Dr. Denson says. Our hope is that this program will become a covered health care service for patients who are homebound because of ALS.

Back to the Basics

Early in the study planning stage, Dr. Denson questioned her ALS families about what they found lacking in ALS care. For the Amar family, the answer was easy: Hands-on care for our loved ones, Angela recalls. As her husbands disease progressed, getting him to the ALS Clinic and other appointments became a monumental struggle. For Robert, leaving home was becoming impossible. It is also very difficult to find caregivers and nurses experienced in caring for someone on a ventilator, feeding tube dependent, non-verbal and paralyzed.

Still, the close-knit family counted their blessings. They were able to celebrate milestones that many ALS families never get to see. Robert met his goal of watching all three children graduate from high school, and then from Texas A&M University. His oldest daughter Victoria hopped on his lap and they did an impromptu wheelchair dance at her wedding. Recently, the first and only grandson Gavin attended his first Houston Astros game at Minute Maid Park and brought his grandfather an Astros T-shirt to Houston Methodist Hospital where Robert was recovering from a recent tracheostomy surgery. A season ticketholder before ALS entered his life, Robert and his family attended Astros World Series games twice. He always made it a point to cheer on his favorite team.

Robert has always been very determined, and he has this positive attitude that Im going to live each day like I always have to the fullest. Angela says.

On the day of his first home visit, Robert was cleaned up, comfortable in his bed, happy and ready to see his team. Five minutes later, complications with his new tracheostomy for breathing, combined with the movement of the morning routine, sent his oxygen levels plummeting. Things can change in a heartbeat, Angela says. Im usually very strong, but I did break down a little bit. It was a very bad day for Robert, but the team got to see the good and the bad. Youre sharing your life with them, and you can see in their faces how concerned they are and how much they care.

Dr. Densons presentation of the ALS home care study generated considerable enthusiasm at an ALS symposium in Switzerland last year, and results will be compiled into a formal report following the 16-month trial.

For more information on Houston Methodists ALS Clinic, visitwww.houstonmethodist.org/ALS-Clinic

This study is possible because of support from The Constance M. and Byron F. Dyer Fellowship and The Lou and Eleanor Gehrig Family Foundation.

Postscript:Robert Amar passed away shortly after his 59thbirthday in mid-May 2024. His life of courage and determination lives on in Kingwood High Schools annual Robert Amar Mental Toughness Award and in his participation in Caring for the Homebound Patient with ALS, the research program outlined in this story designed to help ALS patients now and in the future.

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Neurology 'House Calls' to Improve Quality of Care and Life for ALS Patients - Mega Doctor News

Inherited Alzheimer’s: Whether It’s From Mom or Dad Could Matter – HealthDay

MONDAY, June 17, 2024 (HealthDay News) -- Genetics can play a role in a person's odds for Alzheimer's disease, and new research suggests differences in that risk are based on which parent had the illness.

In a study of 4,400 people still "cognitively unimpaired," there was higher buildup of amyloid protein plaques in the brain (a hallmark of Alzheimer's) if either the person's mother, or both parents, had Alzheimer's, compared to folks where Alzheimer's had only struck the father.

People with an Alzheimer's-affected mother may therefore be at special risk, said a team from Mass General Brigham, in Boston.

"Maternal inheritance of Alzheimers disease may be an important factor in identifying asymptomatic individuals for ongoing and future prevention trials, said study co-author Dr Reisa Sperling, a neurologist at Mass General.

The findings were published June 17 in the journal JAMA Neurology.

The study was based on data from a clinical trial focused on Alzheimer's prevention. People in the study were asked about whether or not either of their parents had ever been diagnosed with Alzheimer's disease, and when their parent's memory began to fail.

Sperling and colleagues then compared those answers to levels of amyloid in people's brains.

Having had a father who developed Alzheimer's symptoms relatively late in life did not seem to be related to levels of amyloid in people's brains, the research showed.

However, there was a correlation between the accumulation of brain plaques and having had a mother whose Alzheimer's symptoms began at any age, or having a father whose symptoms began relatively early, the team reported.

If your father had early-onset symptoms, that is associated with elevated [amyloid] levels in the offspring, said study first author Dr. Mabel Seto, a postdoctoral research fellow in the hospital's department of neurology. However, it doesnt matter when your mother started developing symptoms -- if she did at all, its associated with elevated amyloid.

The sex of the study participant did not seem to matter when it came to the relationship between amyloid buildup and parental histories, the researchers noted.

Its also important to note a majority of these participants are non-Hispanic white, Seto added in a Brigham news release. We might not see the same effect in other races and ethnicities.

More information

Find out more about Alzheimer's disease and genetics at the Alzheimer's Association.

SOURCE: Mass General Brigham, news release, June 15, 2024

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Inherited Alzheimer's: Whether It's From Mom or Dad Could Matter - HealthDay

Neurology residents offering virtual field trip into the brain – University of Nebraska Medical Center

A group of UNMC neurology residents are offering Nebraska students a field trip into the human brain.

For the Nebraska 4-H programs virtual field trips series, residents Isha Snehal, MBBS, Kanchan Kumari, MD, and Zaid Najdawi, MD, worked with the University of Nebraska-Lincolns Nebraska Extension to create a video on brain issues around epilepsy, stroke and concussions.

The series is geared toward Nebraska high school students and originally was established during the pandemic to offer engaging virtual experiences in STEM and ag-related fields, said Sarah Paisley, an associate educator with Nebraska Extension based out of Garden and Morrill Counties.

The program reached out to the UNMC Department of Neurological Sciences, hoping to show the complexity of the brain and what happens after a trauma.

Click Play below to see the video titled, Neurology Whats Going on with My Brain?

Dr. Snehal said awareness of strokes, epilepsy and concussions is important because of the large number of people they affect. Not only have many high school students heard or experienced those issues in different ways, they also could learn how to help if those problems happen around them, she said.

The hope is that the outreach can educate and create awareness about these issues among as many kids as possible, Dr. Snehal said, and they can use some of the tips when they do find themselves in a situation to help others.

Paisley said the video also highlights some great neurological studies going on right here in Nebraska at UNMC.

If students are interested in health care as a career, it allows them to explore an area they could pursue, Paisley said. If it wasnt an area of interest before, she said, the field trip exposes them to UNMC and neurology for the future.

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Neurology residents offering virtual field trip into the brain - University of Nebraska Medical Center

A neurologist took DIY treatments seriously. Has it sparked a breakthrough? – WHYY

Vitamins, unapproved serums in glass vials, even acupuncture programs. His patients slowly opened up to Bedlack about dozens of supposedly effective elixirs and therapies touted on sketchy websites or anonymous forums that they were trying. The kind of treatments that were easy for physicians to dismiss or ignore.

Really they werent even being recorded, much less talked about like they werent getting into any medical records at the time, said Bedlack. When people were checking in, nurses were only interested in medicines. They werent interested in vitamins and supplements and products that maybe couldnt even be characterized. So, one day I asked, What is all this stuff? and somebody said, well, I figured you probably wouldnt want to talk about this. And then, the more I thought about it, I said, Wow, if this is a common thing that people are doing this, shouldnt I be interested?

His patients simply didnt have time to wait on the conclusions of lengthy clinical trials that might never come for these products and programs. If they were looking elsewhere for answers, Bedlack felt he had a responsibility to weigh in on what they were trying rather than dismiss it all off-hand.

Shouldnt I want to partner with patients using my years of training to try to help them make more informed decisions about these? said Bedlack.

Many of his colleagues in medicine disagreed.

The majority of my peers said, this is a terrible idea because all youre going to do is lend some legitimacy to some of these strange products and websites that are out there. Theyre going to say, you know, this product is under investigation by Dr. Bedlack at Duke and this team of respected scientists, and theyre right. said Bedlack.

But he thought the potential good outweighed the risks.

I just feel like you have to put it all together and ask yourself: How does it all shake out? To me, the need for this in the patient community, the desire for it, far outweighs any of that criticism that I got in the beginning.

In 2009, Bedlack connected a cohort of like-minded researchers to create ALSUntangled a group dedicated to investigating alleged or emerging ALS treatments that spring up online.

What if we work together,? What if we crowdsource this? Like, built a team of clinicians and scientists who were interested in doing this together.

Together, they dug into one of the groups first product reviews: Iplex, a drug that contained a man-made insulin-like growth factor whose dysregulation has long been thought to be involved in ALS. ALSUntangled concluded that data from a seemingly promising Italian study lacked a control group and was potentially tainted with selection bias.

The problem with that is the time that it takes to really investigate one thing. It takes a while, Bedlack said. Ive found that it takes about 40 hours to do a really good investigation of just one product. And, nobody has time, if theres hundreds of these things out there, which there are, nobody has time to do them all.

Since that first review, the ALSUntangled team has grown to over 130 researchers across 11 countries.

Since 2009, there hasnt been a single day that I havent at some point been working on a review of a product that a patient asked about, said Bedlack.

ALSUntangled has reviewed dozens of products and therapies keeping the information up to date whenever new evidence becomes available.

Most have been relatively unremarkable, some pretty dangerous. But a minority have actually shown real promise.

The work has given Bedlack and his team permission to wander down strange paths, just to see where they might lead. And now one of the strangest of paths of them all may finally be paying off.

Two years after publishing that first ALSUntangled review, Bedlack stumbled across yet another seemingly unreliable internet rumor related to ALS.

I came across a video of a woman from Virginia who said that she had ALS, that it was rapidly progressing, that she had lost almost all of her function.

Her name is Nelda Buss a mother of two whose ALS journey began in the mid-80s, when she told her primary care doctor about some foreboding, mysterious symptoms she was experiencing.

It started with my weak hands, said Buss. And then my legs sort of were getting weak. I fell a couple of times. I went back to him and he said, Well, Ill make the neurology appointment like in January.

Buss believed her doctor didnt want to be the one to give her the bad news. She was officially diagnosed with ALS when she was 47. By then she was having difficulty walking.

My husband got up, came up and picked me up. And I think we cried all the way home.

Buss consulted with ALS experts some of the best in the business at the time, according to Rick Bedlack. But she just kept getting worse.

I was diagnosed in January and by July I was in a wheelchair, said Buss.

Desperate, she sought help from Dean Kraft, a man from New York City who claimed to be an energy healer. She had heard about him from a magazine article.

The first time I went to him he gave me the first treatment and my diaphragm was beginning to weaken and I couldnt breathe as well as I could before, Buss told the hosts of the daytime talk show The View back in 1998. And I noticed I could cough and blow my nose better.

Every other week for over a year, Buss and her husband would drive up to New York City from their home in Virginia, where she was carried into Dean Krafts small office. Kraft would place his hands above Buss head and claim to release healing energy.

He would work like two hours on Saturday on me and two hours on Sunday. said Buss.

In total, Buss said she paid Kraft about $25,000 for these sessions.

He said, you just cant always believe the doctors, said Buss.

The first time I went to him he gave me the first treatment and my diaphragm was beginning to weaken and I couldnt breathe as well as I could before, Buss told the hosts of the daytime talk show The View back in 1998. And I noticed I could cough and blow my nose better.

Every other week for over a year, Buss and her husband would drive up to New York City from their home in Virginia, where she was carried into Dean Krafts small office. Kraft would place his hands above Buss head and claim to release healing energy.

He would work like two hours on Saturday on me and two hours on Sunday. said Buss.

In total, Buss said she paid Kraft about $25,000 for these sessions.

He said, you just cant always believe the doctors, said Buss.

Dean Kraft died in 2013 of a massive heart attack. He was 63. Kraft was also featured in the same segment from the View and other videos about Buss story.

I dont require people to believe in religion, he told the hosts. They dont even have to believe in me. I just lay my hands on them and fortunately the majority of people get well.

And after a couple of years, Buss said thats what happened to her.

I had a walking party at the Marriott hotel and invited all our friends, so I had Dean come to the party. So they came down from New York and he wanted me to dance with him.

Rick Bedlack was shocked when he came across the story of Nelda Buss.

She completely recovered and in fact the video was pretty convincing, said Bedlack.

Again, the doctors curiosity kicked in. He contacted Buss and asked if she would give permission for her doctors to send Bedlack her medical records.

She obliged.

By the time I finished those, I was absolutely convinced that she really did have ALS, that she progressed to where she was nearly dead, and then she made a full recovery over the next two years under the care of this energy healer, said Bedlack. What I wasnt convinced of is that it was the energy healing that made her better, in part because it had no plausible mechanism. Like, there is no known biological mechanism where a person can have energy come out of their hands that heals the body dying motor neurons. And so I didnt understand that part.

Bedlack reached out to Kraft to try to organize a study of his methods.

[I] said,I dont know how it is that this happened, but Id like to do a small study of your technique and about 10 more patients. And Ill never forget his response. He said, Richard, for those who believe no more proof is necessary. And for those who dont, no proof is ever going to be enough. And thats the last I ever heard of him.

But the story started a conversation within ALSUntangled about other inexplicable disease reversals his fellow researchers had seen.

They said, did you know these kinds of cases have actually been reported in the literature since the 1960s? And in fact, many of the people on the ALSUntangled team had said, well, you know, I saw somebody that I thought had ALS and they progressed for a while and then they recovered.

His colleagues said they just thought those patients had been misdiagnosed that they didnt really have ALS. But for Bedlack, this was a light bulb moment.

And I was like, Wait a second. How are we not studying these people? How many of them are there? I mean, theres a precedent for studying people who are unexpectedly resistant to diseases and finding pathways that have never been manipulated and finding treatments to manipulate those pathways that wind up helping everyone. said Bedlack.

So Bedlack started yet another program to study these reversal cases. He began digging out medical records, sending out questionnaires, and trying to find commonalities.

Suddenly Im in a whole other direction for the past 12, 13 years, this whole ALS reversals research. But I have to say thats also gotten quite interesting.

Bedlack has confirmed 22 other ALS reversals. And just last year, his searching spawned a breakthrough.

We actually found a target, said Bedlack. About a third of these patients appear to have a genetic abnormality thats very, very rare in people with typically progressive ALS. I think thats the most likely explanation for at least a third of these ALS reversals. And we are now doing a much larger study to see in a huge population of people with ALS: is there a relationship? If there is a relationship, I will be dropping just about everything and engaging in a clinical trial. But again, here I am in a space in a direction that I never thought I would be.

Nelda Buss is now 82 years old and she still believes Dean Kraft saved her life. But she remains open to other explanations, assuming Rick Bedlack and his tireless team of researchers can find one.

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Switching From S1P-Modulating Therapies to Other DMTs – Neurology Live

At the 2024 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, NeurologyLive sat down with MS expert Donald Negroski, MD, to discuss several of the top presentations and data on treatment switches and aging in MS. Negroski provided an overview of various presentations, offering his clinical perspective and how findings may impact care going forward.

In this segment, Negroski provided commentary on a retrospective analysis highlighting the reasons for switching from sphingosine 1-phosphate (S1P)-modulating agents to ozanimod (Zeposia; BMS), another FDA-approved disease-modifying therapy. In addition, he spoke on the financial toll some patients face when choosing between approved therapies.

Transcript edited below for clarity.

Donald Negroski, MD: In the abstract, they (investigators) asked healthcare providers why patients switched from the various S1Ps to ozanimod, and the major driver was actually copay assistance and some financial issues with lack of copay as well as tolerability less so. The take-home message is that copay assistance and financial burden on patients is starting to drive treatment decisions, which is something unusual. In the past, neurologists have seemed to think thatand rightly sothey know who should go on what particular drugs and some of these recent abstracts suggest that there's other drivers, more from a financial standpoint.

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Switching From S1P-Modulating Therapies to Other DMTs - Neurology Live

Roche, Ascidian to develop gene therapies for neurological diseases – LabPulse

Roche has announced a research collaboration and licensing agreement with biotech firm Ascidian Therapeutics to develop gene therapies for neurological diseases.

According to the terms of their agreement, Roche will pay Ascidian $42 million upfront for exclusive, target-specific rights to use Ascidian's RNA exon-editing technology to develop therapeutics for undisclosed neurological diseases, the firms said in a statement. Furthermore, Roche will pay Ascidian up to $1.8 billion in total as research, clinical, and commercial milestones are reached. Ascidian is also eligible to receive royalties on commercial sales worldwide for any therapies that are developed under the collaboration.

Under their arrangement, Ascidian will be responsible for conducting discovery and certain preclinical activities in collaboration with Roche, and Roche will be responsible for certain other preclinical activities, as well as further clinical development, manufacturing, and commercialization, Ascidian said. While Roche will have exclusive rights to the technology for the targeted diseases, Ascidian can pursue other disease targets outside of its agreement with Roche.

Boston-based Ascidian's exon-editing technology is designed to correct the RNA produced by damaged exons, the regions of DNA containing the blueprints to make proteins. Correcting the RNA produced by damaged exons greatly mitigates the risks associated with direct DNA editing and gene replacement, such as off-target edits, Ascidian said.

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Roche, Ascidian to develop gene therapies for neurological diseases - LabPulse

University of Colorado Anschutz Medical Campus Receives $2 Million Gift from the Cline Dion Foundation to Advance … – PR Newswire

The investment will fund the Celine Dion Foundation Endowed Chair in Autoimmune Neurology at CU Anschutz

AURORA,Colo., June 18, 2024 /PRNewswire/ -- TheUniversity of Colorado Anschutz Medical Campus announced the creation of the Celine Dion Foundation Endowed Chair in Autoimmune Neurology, made possible by a $2 million philanthropic investment from the Celine Dion Foundation.

The investment will fund initiatives to advance research inautoimmune neurological disorders, such as stiff person syndrome (SPS), and support Amanda Piquet, MD, associate professor ofneurologyat theUniversity of Colorado School of Medicine, who has been named the inaugural chairholder. Piquet specializes in diagnosing, treating and advancing research for SPS, a rare, chronic and progressive autoimmune neurologic disease characterized by muscle stiffness, painful spasms and difficulty walking.

Piquet is also the director of theAutoimmune Neurology Program at CU Anschutz, where the program's mission is to provide the best neurological care and improve the well-being of patients with an autoimmune neurological disorder.

Celine Dion, who has been deeply committed to advancing healthcare for all, was diagnosed with SPS in 2022 and is an advocate forsupporting all who have been affected by the disease. Dion is being treated for SPS by Piquet at UCHealth University of Colorado Hospital on the CU Anschutz Medical Campus.

The disease currently has no cure but can be managed with symptomatic and immune therapies to make quality of life better.

This gift will help boost this field of study and expedite research discoveries, ensuring that individuals receive the most informed treatments as they become available. To enable this vision, this investment will support the following key priorities:

"SPS and other rare autoimmune neurological disorders can be difficult to diagnose and treat because they often affect individuals differently. This generous gift from the Celine Dion Foundation and the overall increased awareness for SPS will change the future of not only diagnosing the disease but will catapult research efforts to explore new approaches of treatment," said Piquet.

The $2 million investment will be provided to the campus over the next five years and allow Piquet to build upon her current success treating patients with rareautoimmune neurological disorders.

About the University of ColoradoAnschutz Medical CampusThe University of Colorado Anschutz Medical Campusis a world-class medical destination at the forefront of transformative science, medicine, educationand patient care. The campusencompassesthe University of Colorado health professional schools, more than 60 centers and institutes, and two nationally ranked independenthospitals-UCHealth University of Colorado HospitalandChildren's Hospital Coloradowhich see more than 2 million adult and pediatric patient visits yearly. Innovative, interconnected and highly collaborative, the University of Colorado Anschutz Medical Campusdelivers life-changingtreatments, patient care and professional training and conducts world-renowned research fueled by $705 million in research grants.For more information, visitwww.cuanschutz.edu.

Contact: Julia Milzer, University of Colorado Anschutz Medical Campus, 303-725-0733,[emailprotected]

Find the latestUniversity of Colorado Anschutz Medical Campus news here.

SOURCE University of Colorado Anschutz Medical Campus

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University of Colorado Anschutz Medical Campus Receives $2 Million Gift from the Cline Dion Foundation to Advance ... - PR Newswire

New study suggests cancer drug could be used to target protein connection that spurs Parkinson’s disease – EurekAlert

image:

Neurons express Aplp1 (in white), a key protein that allows brain cells to absorb Parkinsons-disease causing alpha-synuclein.

Credit: Yasuyoshi Kimura, Ph.D.

FOR IMMEDIATE RELEASE

In studies with genetically engineered mice, Johns Hopkins Medicine researchers say they have identified a potentially new biological target involving Aplp1, a cell surface protein that drives the spread of Parkinsons disease-causing alpha-synuclein.

The findings, published May 31 in Nature Communications, reveal how Aplp1 connects with Lag3, another cell surface receptor, in a key part of a process that helps spread harmful alpha-synuclein proteins to brain cells. Those protein buildups are hallmarks of Parkinsons disease.

Notably, the researchers say, Lag3 is already the target of a combination cancer drug approved by the U.S. Food and Drug Administration (FDA) that uses antibodies to teach the human immune system what to seek and destroy.

Now that we know how Aplp1 and Lag3 interact, we have a new way of understanding how alpha-synuclein contributes to the disease progression of Parkinsons disease, says Xiaobo Mao, Ph.D., associate professor of neurology at the Johns Hopkins University School of Medicine and a member of the Institute for Cell Engineering. Our findings also suggest that targeting this interaction with drugs could significantly slow the progression of Parkinsons disease and other neurodegenerative diseases.

Mao co-led the research along with Ted Dawson, M.D., Ph.D., Leonard and Madlyn Abramson Professor in Neurodegenerative Diseases at the Johns Hopkins University School of Medicine and director of the Johns Hopkins Institute for Cell Engineering, Valina Dawson, Ph.D. and Hanseok Ko, Ph.D., professors of neurology at the school of medicine and members of the Institute for Cell Engineering.

Long-standing studies have shown that by clumping together and forming protein deposits, misfolded alpha-synuclein proteins journey from brain cell to brain cell, killing those responsible for producing a neurotransmitter called dopamine, and causing Parkinsons disease to progress through a type of programmed cell death that Johns Hopkins researchers have identified. The process, parthanatos (from the Greek word for death), leads to impairments in movement, emotional regulation and thinking.

Aplp1s bond with Lag3 on the cells surface enables healthy brain cells to absorb traveling clumps of alpha-synuclein, leading to cell death, the researchers say.

In mouse studies published in 2016 and 2021, Mao and Dawsons team identified Lag3s role in binding with alpha-synuclein proteins, causing Parkinsons disease to spread. However, those studies indicated that another protein was partially responsible for the cells absorption of misfolded alpha-synuclein.

Our work previously demonstrated that Lag3 wasnt the only cell surface protein that helped neurons absorb alpha-synuclein, so we turned to Aplp1 in our most recent experiments, says Valina Dawson.

To determine whether Aplp1 indeed contributed to the spread of harmful alpha-synuclein proteins, researchers used a line of genetically engineered mice lacking either Aplp1 or Lag3 or both Aplp1 and Lag3. In mice without Aplp1 and Lag3, cell absorption of the harmful alpha-synuclein protein dropped by 90%. After injecting mice with the Lag3 antibody, they found that this drug also blocks the interaction of Aplp1 and Lag3, meaning healthy brain cells could no longer absorb disease-causing alpha-synuclein clumps.

The researchers say the Lag3 antibody nivolumab/relatlimab, a drug FDA approved in 2022 for cancer treatment, could play a role in preventing cells from absorbing alpha-synuclein.

The anti-Lag3 antibody was successful in preventing further spread of alpha-synuclein seeds in the mouse models and exhibited better efficacy than Lag3-depletion because of Aplp1s close association with Lag3, Ted Dawson says.

This research has potential applications in treating other neurodegenerative conditions that have no cures, Mao says. In Alzheimers disease, which is associated with symptoms of memory loss, mood instability and muscle problems, tau proteins become misfolded and clump together in neurons at high levels, worsening the condition. In Alzheimers research, Mao says scientists could try to target Lag3 which also binds with the dementia-related tau protein with the same antibody.

With the success of using the Lag3 antibody in mice, Ted Dawson says the next steps would be to conduct anti-Lag3 antibody trials in mice with Parkinsons disease and Alzheimers disease. The Johns Hopkins researchers are also looking into how they could prevent unhealthy cells from releasing disease-causing alpha-synuclein in the first place.

Other researchers on this study are Hao Gu, Donghoon Kim, Yasuyoshi Kimura, Ning Wang, Enquan Xu, Ramhari Kumbhar, Xiaotian Ming, Haibo Wang, Chan Chen, Shengnan Zhang, Chunyu Jia, Yuqing Liu, Hetao Bian, Senthilkumar Karuppagounder, Fatih Akkentli, Qi Chen, Longgang Jia, Heehong Hwang, Su Hyun Lee, Xiyu Ke, Michael Chang, Amanda Li, Jun Yang, Cyrus Rastegar, Manjari Sriparna, Preston Ge, Saurav Brahmachari, Sangjune Kim, Shu Zhang, Haiqing Liu, Sin Ho Kweon, Mingyao Ying and Han Seok Ko from Johns Hopkins; Yasushi Shimoda from the Nagaoka University of Technology; Martina Saar and Ulrike Muller from Heidelberg University; Creg Workman and Dario Vignali of the University of Pittsburgh School of Medicine and Cong Liu of the Chinese Academy of Sciences.

This work was supported by grants from the National Institutes of Health (R01NS107318, R01AG073291, R01AG071820, 1135 RF1NS125592, K01AG056841, R21NS125559, R01NS107404, P01AI108545, R01AI144422), the Parkinsons Foundation, the Maryland Stem Cell Research Foundation, the American Parkinson Disease Association, the Uehara Memorial Foundation, the JPB Foundation, the Adrienne Helis Malvin Medical Research Foundation, and the Parkinsons Disease Foundation.

DOI: 10.1038/s41467-024-49016-3

Nature Communications

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New study suggests cancer drug could be used to target protein connection that spurs Parkinson's disease - EurekAlert

Neurology Devices Market Size 2024 Analysis by Market Dynamics, Industrial Trends, Developments and Forecast till … – openPR

Latest Report, titled "Neurology Devices Market" Trends, Share, Size, Growth, Opportunity and Forecast 2024-2031, by Coherent Market Insights offers a comprehensive analysis of the industry, which comprises insights on the market analysis. The report also includes competitor and regional analysis, and contemporary advancements in the market.

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Ravina Pandya, Content Writer, has a strong foothold in the market research industry. She specializes in writing well-researched articles from different industries, including food and beverages, information and technology, healthcare, chemical and materials, etc. (https://www.linkedin.com/in/ravina-pandya-1a3984191)

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Neurology Devices Market Size 2024 Analysis by Market Dynamics, Industrial Trends, Developments and Forecast till ... - openPR

Roche and Ascidian enter neurological disease partnership worth over $1.8bn – PMLiVE

Roche and Ascidian Therapeutics have partnered to develop RNA exon editing therapies for neurological diseases, with the deal worth over $1.8bn.

The research collaboration and licensing agreement gives Roche exclusive, target-specific rights to Ascidians RNA exon editing technology for undisclosed neurological targets.

Ascidian will conduct discovery and certain preclinical activities in collaboration with Roche, which will be responsible for further preclinical work as well as clinical development, manufacturing and commercialisation.

In exchange, Ascidian will receive an initial payment of $42m and will be eligible to receive up to $1.8bn in research, clinical and commercial milestone payments, plus royalties on global commercial sales.

More than three billion people worldwide were living with a neurological condition in 2021, according to a new major study released earlier this year by The Lancet Neurology.

Among the top ten neurological conditions contributing to loss of health in the same year were stroke, neonatal encephalopathy, dementia, diabetic neuropathy, epilepsy and nervous system cancers.

Ascidian said its technology allows for the therapeutic targeting of large genes and genes with high mutational variance while maintaining native gene expression patterns and levels. The approach is designed to provide the durability of gene therapy and reduce the risks associated with direct DNA editing and gene replacement.

James Sabry, global head of pharma partnering at Roche, said: Our partnership with Ascidian is an opportunity to harness advanced RNA exon editing technology, which has the potential to deliver transformative one-time therapeutics by editing multiple whole exons at the RNA level with a single treatment.

Also commenting on the alliance, Michael Ehlers, Ascidians president and chief executive officer, said: The potential of treating disease by large-scale exon editing of RNA is vast.

We look forward to working with the Roche team to develop first-in-class RNA exon editing medicines for multiple neurological diseases, with a mission and passion to relieve suffering and improve lives.

The partnership comes just one week after Roche entered into a strategic licence agreement for the use of ALZpaths pTau217 antibody to develop and commercialise a diagnostic blood test for Alzheimers disease.

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Roche and Ascidian enter neurological disease partnership worth over $1.8bn - PMLiVE

Roche and Ascidian Therapeutics Collaborate on Treatments for Neurological Diseases – Pharmaceutical Technology Magazine

The research collaboration and licensing agreement will focus on the discovery and development of RNA exon editing therapeutics.

Ascidian Therapeutics, a biotechnology company developing treatments by rewriting RNA, announced on June 18, 2024 that it has signed a licensing agreement with Roche to collaborate on the discovery and development of RNA exon editing therapeutics to treat neurological diseases (1). The collaboration will combine RNA exon editors with Roches next-generation central nervous system (CNS) delivery capabilities. Ascidian enables precise post-transcriptional editing of genes by editing exons at the RNA level.

As part of the agreement, Ascidian will receive an initial payment of $42 million with up to $1.8 billion in research, clinical, and commercial milestone payments, including commercial royalties. The partnership will allow Ascidian to create internal and collaborative programs within the neurology area. Roche will receive exclusive, target-specific rights to Ascidians RNA exon editing technology and will perform certain preclinical activities. Roche will also be responsible for further clinical development, manufacturing, and commercialization.

Roche is known and respected worldwide for their expertise in complex neurological diseases, and I am proud of the scientific rigor and quality of the work done at Ascidian that has led to this partnership, Michael Ehlers, MD, PhD, president and chief executive officer of Ascidian Therapeutics, said in a press release. The potential of treating disease by large-scale exon editing of RNA is vast. We look forward to working with the Roche team to develop first-in-class RNA exon editing medicines for multiple neurological diseases, with a mission and passion to relieve suffering and improve lives.

Our partnership with Ascidian is an opportunity to harness advanced RNA exon editing technology, which has the potential to deliver transformative one-time therapeutics by editing multiple whole exons at the RNA level with a single treatment, James Sabry, MD, PhD, global head of Pharma Partnering at Roche, said in the release.

In May 2024, Ascidian presented preclinical data that enabled the clearance of an investigational new drug (IND) application through Phase I/II testing for its RNA exon editor, ACDN-01, at the American Society of Gene & Cell Therapy (ASGCT) annual meeting in Baltimore, Md. FDA granted ACDN-01 Rare Pediatric Disease Designation as well as Fast Track Designation.

ACDN-01 is the only clinical-stage therapeutic targeting the genetic cause of Stargardt disease, and we look forward to sharing the preclinical data that led to its IND clearance, along with the plans for the first-in-human trial, said Ehlers in a press release (2). ACDN-01 is designed to overcome challenges that have long kept Stargardt disease out of reach and to provide persistent therapeutic benefit with one dose. Our progress with ACDN-01 speaks to its therapeutic potential in Stargardt disease and the broader promise of our RNA exon editing platform to significantly expand the possibilities of RNA medicines.

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Roche and Ascidian Therapeutics Collaborate on Treatments for Neurological Diseases - Pharmaceutical Technology Magazine