Forty Seven: Early Indications Suggest Magrolimab Could Be A Winner – Seeking Alpha

Investment Thesis

Forty Seven (FTSV) management must be pleased with the progress they made in December '19.

First of all, early results from clinical trials of the company's flagship drug magrolimab were positive. In a trial evaluating magrolimab in combination with azacitidine for the treatment of myelodysplastic syndrome ("MDS") and acute myeloid leukaemia ("AML"), Complete Response ("CR") rates of 50% and Overall Response Rates ("ORR") of 92% were observed in untreated patients with higher risk MDS.

In Patients with Untreated AML who are ineligible for induction chemotherapy CR and ORR rates were 55% and 64% respectively. Furthermore, the combination of magrolimab and azacitidine was well tolerated, meaning the treatment may be safe for fragile, sicker and older patients.

The strong results appeared to take the market by surprise and Forty Seven's share price accelerated immediately. The stock gained 84% on 28x average volume in a single day to reach $39 and continued its ascent to reach an all-time high of over $44 (price at the time of writing is a little lower at just over $38).

Secondly, after releasing the results Forty Seven management wisely decided to issue a public offering of 5.59m shares at $35 per share, successfully raising $195.6m. (Source: Bloomberg). Given that the last fundraising, in July of last year, raised $86m at an offer price of just $8, the latest raise must be a cause of satisfaction. It is also a clear indication that investors are starting to see Forty Seven and magrolimab as the frontrunner amongst a plethora of biotechs focused on CD-47 directed therapies, in my view.

The company reported cash, cash equivalent and short-term investments of $166.7m on its Q319 earnings call which includes proceeds from the July raise and a $15.7m upfront licence payment from a collaboration with Ono Pharmaceuticals (Source: Globenewswire) which will see the Japanese firm develop, market and commercialise magrolimab across Japan and the ASEAN region.

Management stated this funding would be sufficient for Forty Seven to support its operations - which include up to ten clinical trials of magrolimab plus pre-clinical trials of anti-SIRPa antibody FSI 189 and anti-cKIT antibody FSI-174 - through to the first quarter of 2021.

Factor in December's raise and we can see that Forty Seven is now in a strong position to pursue and meet its stated goal of being the first company to release an approved therapy targeting the CD47 checkpoint of the innate immune system.

This being biotech, there are many reasons why Forty Seven's best efforts may fall short of winning approval for commercialisation from the FDA. Magrolimab is still in the early stages of being tested and its good results to date will count for nothing should Phase II or III trials reveal safety concerns or a failure to meet the primary endpoint.

Forty Seven does not have a strong pipeline to fall back on should magrolimab ultimately fail to secure commercialisation, meaning investing at this time comes with a high chance of making a loss.

A rival company could produce a CD47-directed treatment that proves to be more effective in which case Fifty Seven will struggle to sell magrolimab even if it is approved. Clinical tests could go on for longer than expected requiring further funding and there is no guarantee the company will be able to raise enough cash. Or, an alternative therapy, such as gene editing or RNAi could outperform all other treatments, rendering the company's development efforts fruitless.

Despite these concerns, however, if I were to pick a CD47 focused immunology company to back today, it would be Forty Seven. With no current concerns on the funding front and with such impressive early trial results from its lead candidate the near-term future certainly looks bright.

There are further reasons for optimism. The company owns exclusive rights to magrolimab which means should the drug be approved Forty Seven will retain the bulk of the profits from its sale. If results continue to impress Forty Seven represents an attractive acquisition target for a big pharma firm. And perhaps most importantly, besides MDS and AML magrolimab has the potential to be approved for numerous indications. Non Hodgkin's Lymphoma, for example, as well as ovarian cancer, colorectal cancer and bladder cancer.

In other words, magrolimab has blockbuster potential, and therefore, despite the obvious risks - one bad trial result could decimate the current share price - in my view Forty Seven should be carefully considered as an investment due to its upside potential. There has not been a new treatment available for Myelodysplastic syndromes ("MDS") in over a decade. Some investors may feel the rewards on offer for a successful treatment are significant enough to justify the risks.

Forty Seven was founded in 2014 in Menlo Park, California by a group of Stanford scientists, most notably Irv Weissman. Weissman played an instrumental role in identifying and developing CD47 as a potential cancer treatment.

Forty Seven went public in June 2018. The company raised $112m at a price of $16 giving it a valuation just shy of $480m. Today, thanks to the recent share price gain, Forty Seven's market cap stands at over $1.5bn.

Forty Seven's lead drug candidate magrolimab is an anti-CD47 antibody formerly known as 5f9. 5f9 has the ability to "switch off" the "don't eat me" signalling pathway used by cancerous cells to avoid detection by macrophages.

Macrophages are the innate immune system's first line of defence against abnormal cells. CD47 is expressed by healthy cells as a means of sending a "don't eat me" signal to macrophages, thereby exempting themselves from a process known as phagocytosis whereby a macrophage consumes abnormal cells to protect the body.

Nearly all cancerous cells over-express CD47 as a means of disguising themselves against macrophages to avoid being swallowed up and eliminated. The "don't eat me" message is sent when the cancerous cell binds to a receptor on macrophages known as SIRP-alpha.

Weissman's research at Stanford demonstrated three things. That blocking the "don't eat me" signalling pathway leads to elimination of many types of tumours and increases a patient's chances of survival. That boosting "eat me" signals found on cancer cells using therapeutic antibodies can work in conjunction with blocking CD47. And that, besides phagocytosis, macrophages activate tumor specific antigens that can activate T-cells against the cancerous cells, meaning that blocking CD47 can also work in conjunction with T-cell based therapies. (Source: FTSV Fundraising prospectus Dec '19)

FTSV 3-fold strategy. Source: FTSV Website

This has led directly to Forty Seven's three pronged development strategy. Monotherapy, e.g. facilitating phagocytosis, synergizing with other tumor targeting antibodies and T-cell activation, and using pro-phagocytic signals on tumor cells in conjunction with chemotherapy.

5F9 is a humanized IgG4 subclass monoclonal antibody that Forty Seven say is designed to combine with a proprietary dosing regimen to help overcome the toxicity limitations of rival anti-CD47 therapies developed by other companies.

Besides 5F9 / magrolimab, Forty Seven are also advancing FSI-189, an anti-SIRPa antibody, and FSI-174, an anti-cKIT antibody. FSI-189 is expected to enter solid-tumor trials this year, whilst cKIT - an antibody targeting stem cell growth factor inhibitors and issuing an "eat me signal" - may prove effective in treating leukemia, melanoma and gastrointestinal stroma tumors.

Forty Seven has 6 clinical trials of magrolimab ongoing that have progressed beyond the pre-clinical stage.

The trial that has produced the most positive results to date (referred to in the introduction of this article) is evaluating magrolimab both as a monotherapy and in conjunction with azacitidine as a treatment for MDS and AML in patients with haemotological malignancies.

Trial investigator David Sallman, M.D., H Lee Moffit Cancer Center and Research Institute had this to say on the publication of the encouraging early data:

The data that continue to emerge from this clinical trial are incredibly exciting, suggesting that the combination of magrolimab and azacitidine may offer the first new therapeutic regimen in over a decade, with the potential to induce meaningful and lasting responses in patients with higher-risk disease. Importantly, these results also support magrolimabs tolerability profile, further differentiating it as a safe treatment that may be used even in more fragile, sicker, and older patients.

Forty Seven have subsequently entered discussions with the FDA with regard to initiating a registration-enabling program with the goal of securing accelerated approval, and also hope to submit a biologics license application ("BLA") in Q421.

MDS is regarded by Forty Seven management as one of its most important treatment targets given its high incidence in the US (as illustrated in the chart below) and due to the paucity of treatment options available to patients.

Source: FTSV Investor Presentation Dec '19

Research suggests that 75% of MDS patients receive only supportive care with the only other options: chemotherapy drugs Vidaza (the brand name version of azacitidine), revlimid and Dacogen, or allogeneic stem cell therapy, being ineffective.

As we can also see from the above chart, diffuse large B-cell lymphoma ("DLBCL") represents another target for Forty Seven and it is the subject of a second planned clinical trial of magrolimab, this time in conjunction with rituximab, a monoclonal antibody that targets a protein known as CD20.

The trial will enrol 100 patients who have failed at least two prior lines of therapy, and will begin, management say, in Q120 with the earliest interim efficacy data slated to be made available in Q420. On the Q319 earnings call Forty Seven CEO Mark McCamish stated his desire to advance into earlier lines of treatment as early as possible referring to a "substantial unmet need" in treatment of DLBCL.

McCamish also updated investors and analysts concerning the phase 1b solid tumor trials. Results from both magrolimab combined with avelumab to treat patients with brain cancer, and in combination with cetuximab in patients with colo-rectal cancer will be made available in meetings scheduled for Q120 with abstracts of early data having already been submitted.

McCamish also announced a collaboration with gene therapy specialists Bluebird Bio. Forty Seven intend to leverage Bluebird's LentiGlobin platform to evaluate FSI-174 and move forward the cKIT program with a focus on pretransplantation and avoiding the need for chemotherapy or radiation toxicities or secondary malignancies when performing stem cell transplants.

Targeting blood-forming stem cells that express cKIT with FSI-174 releases macrophages to clear the steam cells, and, used in conjunction with magrolimab could, McCamish says:

massively expand the number of patients eligible for transplantation and therefore enable many more people to benefit from the curative potential transplantation.

During Q3 Forty Seven had an R&D spend of $27.1m - up from $18m in Q318, ascribed to the advancement of clinical trials and contract manufacturing costs for the proposed BLA.

In total, the company made a loss of $15.1m, down from $21.7m the previous year. In the first nine months of 2019 losses totalled $61.2m. As mentioned previously, Forty Seven should have more than enough funding to complete its trials and submit the BLA without having to dilute investors further - but it would be wise not to rule anything out. One failed trial could set the whole process back by years. (Source: FTSV 10Q Submission Q319).

There is no doubt that Forty Seven faces stiff competition. Amongst the companies competing in the CD47 antibody space are Surf therapeutics (SURF), Trillium Therapeutics (TRIL), Celgene (CELG), China based biotech Innovent Biologics, and Netherlands Based Aurigene and Synthon. (Source: PM Live)

All are worth studying in more detail and both SURF and TRIL represent a far cheaper investment opportunity, with shares priced at just $1.94 and $1.26 respectively. Neither have experienced a "Forty Seven moment", delivering outstanding results from early stage trials, but the price of Trillium recently spiked as Morgan Stanley reported a 5% holding. (Source: Benzinga)

For my money, however, Forty Seven is the frontrunner, and although it is priced at a premium to some of its rivals, there are good reasons for this, as I have discussed above. Another reason Forty Seven is at a competitive advantage is the 187+ patents it owns protecting magrolimab and FSI-189.

Additionally, although it was painful at the time, in 2018 Forty Seven agreed to make $47m of milestone payments to Synthon to secure non-exclusive rights to several CD-47- and SIRPa- directed antibodies, including rituximab. Other companies will need to make similar agreements if they want to develop their drugs with the same freedom that Forty Seven now has. Further analysis can be found in this informative recent SA article.

The average analyst price target for Forty Seven at time of writing is $39.25 (Source: Nasdaq) with a high of $48 and a low of $35 with the majority of analysts issuing "buy" ratings for the stock.

In my view, provided trial results remain positive, each new development can move the share price higher. Given the size of the addressable market (the global market for MDS treatment alone is set to reach $2.4bn by 2022, at a CAGR of 9.7% according to research from Grand View) and the urgent need for new and better treatments for diseases such as NHL, MDS, AML and DLBCL, the potential upside here is substantial.

If Forty Seven were to perform as well as, for example, gene-silencing treatment developer Arrowhead (ARWR) has done in 2019, buoyed by positive data, the share price could easily double as Arrowhead's has done. That is a big "if", however.

Biotech investing is inherently risky and it is all too easy to get sucked into a "next big thing" such as CD47 antibodies. In Forty Seven's case, however, the exciting premise is backed by years of research and real clinical data. Importantly, the FDA has issued Forty Seven with accelerated approval status both for magrolimab as a treatment for MDS, AML and DLBCL, as well as follicular lymphoma.

The company has treated over 190 relapsed or refractory cancer patients with magrolimab and will shortly enter a pivotal phase III trial, ENHANCE, enrolling 90 new patients to evaluate the combination of azacitidine and magrolimab together, plus it has the BLA scheduled for submission before the end of 2021.

The management team are experienced with big pharma backgrounds including Abbott Laboratories, Amgen, Genentech, Gilead, Janssen Global Services, LLC, PDL Biopharma, Inc. and Sandoz Inc.

Furthermore, Forty Seven has agreed collaborations with big pharma companies Merck and Genentech, a subsidiary of the Roche group to explore opportunities within ovarian and bladder cancer.

On balance, I think there are enough positive signals to make Forty Seven are worthwhile, if speculative investment.

Disclosure: I/we have no positions in any stocks mentioned, and no plans to initiate any positions within the next 72 hours. I wrote this article myself, and it expresses my own opinions. I am not receiving compensation for it (other than from Seeking Alpha). I have no business relationship with any company whose stock is mentioned in this article.

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Forty Seven: Early Indications Suggest Magrolimab Could Be A Winner - Seeking Alpha

What the standard health insurance product offers – Livemint

With a host of health insurance policies available in the market, buyers often get confused and do not know how to compare them. To curb this confusion and to encourage more people to buy health insurance, the Insurance Regulatory and Development Authority of India (Irdai) has mandated all general and health insurers to offer a standard individual health insurance product with a maximum sum insured of up to 5 lakh. Find the circular, which was issued last week.

The product will be named Arogya Sanjeevani followed by the insurers name. It will have to be made available starting 1 April 2020. Standardization of a product offering will help customers get a parity-based understanding of product benefits, simplifying the purchase decision. It leaves no room for ambiguity for the customer in terms of product comparison, since they are assured of the fact that other insurers do not offer a different coverage," said Anuj Gulati, managing director and chief executive officer, Religare Health Insurance Co. Ltd.

While a standard product will surely simplify health insurance for you, do keep in mind that this may not be the best product in the market. We give you the features and details of the new standard plan.

Main features

Like a typical health insurance plan, Arogya Sanjeevani will be an annual policy renewable for life and will pay for hospitalization expenses. This means costs incurred on the surgeon, anaesthetist, consultants, specialist fees, operation theatre charges, oxygen, surgical equipment, costs towards diagnostics and so on are covered too. Further, expenses incurred on hospitalization under the Ayush system of medicine will also be covered without any sub-limits. Pre-hospitalization (from 30 days prior to the date of admission) and post-hospitalization expenses (60 days from the date of discharge) will be included too.

The policy will also cover dental treatment and plastic surgery necessitated due to a disease or injury, all day-care treatments and expenses incurred on road ambulance. The ambulance expenses will be capped at 2,000 a day.

Anyone between 18 and 65 years can buy this product, but it cant be customized to your needs.

However, there are some important caveats to consider. The policy will cover room, boarding and nursing expenses but only up to 2% of the sum insured, subject to a maximum of 5,000 a day.

Gurdeep Singh Batra, head, retail underwriting, Bajaj Allianz General Insurance Co. Ltd, said the intention of the policy is to insure the non-insured population of the country, particularly in tier-2 and tier-3 cities, which is why the sum insured is capped at 5 lakh. Room rent makes for a large chunk of the hospitalization expense and not having a cap would push the premiums. Instead of a 1% cap, theyve capped it at 2% or 5,000, which is reasonable because in tier-2 and tier-3 cities, most nursing homes and hospitals offer good rooms within 5,000," said Batra.

The policy also covers expenses on intensive care unit (ICU) and intensive cardiac care unit (ICCU) facilities up to 5% of the sum insured, up to 10,000 a day.

The mandatory covers prescribed by Irdai are inclusive enough for a standard product but this could have been enhanced by increasing some of the limits restricting the coverage such as cap on room rent, pre- and post-hospitalization expenses, and restricting ambulance charges up to 2,000 per hospitalization. Existing products offered by insurers offer flexibility and superior covers with no capping on room rent or a cover for more number of pre- and post-hospitalization days along with higher limits for ambulance," said Biresh Giri, appointed actuary, head of product development and chief risk officer, Acko General Insurance Ltd.

The product will come with a fixed co-pay of 5%, across all age groups. A 5% co-payment clause would mean that you will pay 5% of the claim amount and the insurer will pay the rest.

Theres also a limit on how much the policyholder can claim for cataract surgery. Irdai said, for each eye, expenses incurred on the treatment of cataract will be covered only up to 25% of the sum insured or 40,000, whichever is lower. Irdai has also listed the conditions that insurers shall cover after a prescribed waiting period.

What is positive about this policy is that it takes into account the ever-evolving healthcare ecosystem. The policy will cover modern treatments like stem cell therapy and balloon sinuplasty up to 50% of the sum insured. This (including modern treatments) is a good proposition from an insured viewpoint. Currently, other products are also being re-looked for such extended coverage in line with guidelines issued on standardization of exclusions in health insurance," said Batra.

Premiums and bonus

The regulator has allowed insurers to determine the price of the policy keeping in view the mandatory covers they would need to offer. Insurers, however, will have to comply with Irdai norms while doing so. Pricing for any insurer is a factor of risk assessment, estimated claims, consumer behaviour and long-term sustainability of the product.

The range of pricing should largely be similar for most insurers but its too soon to be sure, said Gulati.

While insurers are not allowed to offer any add-ons or optional covers with this product, they can package it in the form of a family floater plan where the premium is decided based on the age of the oldest member of the family. Giri said the premiums could start from 5,000 for an individual policy with a sum insured of 5 lakh and 15,000 for a family floater plan with a sum insured of 5 lakh.

Note that a cover of 5 lakh may not be sufficient for a whole family but is still better than having no insurance at all. For a floater policy, 5 lakh may not be adequate. Nevertheless, we have a huge untapped market where most people dont have any insurance and are paying out of their own pockets or not getting properly treated," said Prasun Sikdar, MD and CEO, ManipalCigna Health Insurance Co Ltd. Like other health products, policyholders will get the option of paying premiums on a monthly, quarterly, half-yearly and annual basis. The cumulative bonus on this product, according to Irdai, shall increase by 5% in respect of each claim-free year, subject to a maximum of 50% of the sum insured but only if the policy is renewed without a break. If a claim is made in any particular year, the bonus will decrease at the same rate at which it was accrued: 5%. Also, no deductibles are allowed.

Mint take

Sikar said it is difficult to say whether premiums will drive this product or awareness campaigns by Irdai, or the brand name of the insurers. But this will definitely benefit the industry and increase penetration," he added. Batra said this product is specifically targeted towards the lower middle-income group where medical expenses, especially the cost of hospitalization is still lower than metro cities.

Experts also said that this may impact the retail health insurance business in the long run as it will bring more uniformity and standardized policy wordings, making it easier for customers to choose.

However, keep in mind that this policy suffers from two major setbacks: room rent capping and co-payment. While this may make the policy affordable, in case of a claim, you will have to shell out a part of the claim from your pocket. Given the low sum insured, this policy comes with restrictive clauses that also make it more affordable. Before you buy the new standard product, compare the premiums and choose the least restrictive option. If you havent bought a policy due to high premiums, this can be a good entry point. Whether the product will enhance the adoption of health insurance remains to be seen.

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What the standard health insurance product offers - Livemint

Global Animal Stem Cell Therapy Market- Industry Emerging Trends, Future Growth and Productivity Data Analysis, Reliability, Competitive Analysis and…

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South America Market (Brazil, Argentina)

The Middle East & Africa Market (South Africa, Saudi Arabia)

Europe Market (Spain, U.K., Italy, Germany, Russia, France)

North America Market (U.S., Mexico, Canada)

Asia-Pacific Market (China, Japan, India, Southeast Asia)

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Chapter One: Animal Stem Cell Therapy Market Overview

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Chapter Four: Global Animal Stem Cell Therapy Market Size by Regions

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Chapter Six: Europe Animal Stem Cell Therapy Revenue by Countries

Chapter Seven: Asia-Pacific Animal Stem Cell Therapy Revenue by Countries

Chapter Eight: South America Animal Stem Cell Therapy Revenue by Countries

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Global Animal Stem Cell Therapy Market- Industry Emerging Trends, Future Growth and Productivity Data Analysis, Reliability, Competitive Analysis and...

Super Naturals: the high-tech natural beauty brands changing the face of modern skincare – Evening Standard

The latest lifestyle, fashion and travel trends

A high-end bio-beauty boom is in full bloom thanks to a host of revolutionary brands set on changing the face of modern skincare. These are the five to know...

Hailing from the Napa Valley, where founder April Gargiulo spent two years researching and developing her Holy Grail skincare products using the same meticulous approach her family took to their fine wine business, Vintners Daughter champions just two products that promise dramatic, multi-correctional results using some of the worlds most active organic and foraged botanicals. The original Active Botanical Serum (175) is hailed as the face oils to end all face oils and is built around the brands signature Phyto Radiance Infusion. This process starts with consciously grown whole plants such as calendula and super green alfalfa, known in ancient times as the foods of life, which undergo a methodical three-week long extraction to glean every last drop of their nutritional benefits. Just five drops using the brands 30-second Push/Press Method of application promises to deliver visible radiance, brightness and unparalleled nourishment particularly when used in conjunction with its preparatory Active Treatment Essence (210) (goop.com).

The undisputed Queen of Green, Tata Harper is a pioneer of the farm-to-face beauty movement with all-natural formulations handcrafted in the brands laboratory in Vermont and bottles stamped with a code to trace how fresh your product is and who it was made by. The beauty editors favourite is going one step further with the launch of its Supernaturals 2.0 line of six products boasting 155 ultramodern green ingredients from 46 countries and of course, no synthetic chemicals. The Elixir Vitae Serum (391) alone boasts 34 new radical engineered ingredients from 25 countries, including kelp polymers from France developed to target cellular ageing. Other highlights from the range include the Concentrated Brightening Serum (257), which contains 24 ingredients to hydrate, 17 to reduce wrinkles, 15 to brighten and 13 to even skin tone, and the Boosted Contouring Serum (257), designed to lift, firm and restore youthful elasticity with a combination of Edelweiss stem cells and skin revitalising pomegranate. (tataharperskincare.com)

The brainchild of cosmetologist Anna Buonocore and naturalist Jeanette Thottrup, Seed To Skin believes that effective skincare is threefold. Firstly, that wild ingredients foraged from the land and sea used in conjunction with those sourced from its organic Tuscan farm are among the most potent nature has to offer. Secondly, that just like feeding your body skin requires a healthy, balanced diet and formulas that neither starve nor overload with any one element. Finally, that the most effective absorption relies on a precise mix of perfectly-sized molecules to ensure each ingredient is delivered exactly where it needs to go. As a result, its award-winning product line is loaded with game changers try The AlcheMist Super Active Serum Spray (145) to feed your skin a nutrient-rich drink whenever it needs a boost, or the Black Magic Detoxifying Oxygen Therapy Mask (119) which contains activated charcoal and volcanic clay for a one-stop facial in a jar (libertylondon.com).

(Wildsmith )

Inspired by the arboretums progressive approach to cultivation at Hampshires Heckfield Place and named after its mastermind William Walker Wildsmith, this ethical crafted-in-England skincare brand is designed for those who desire natural products but demand clinical results. Exclusive to Harrods beauty halls, the hero additions to its product line-up include the Platinum Booster (175) a powerful skin-firming treatment powered by encapsulated oxygen and moss cell cultures and a reviving, collagen-boosting Copper Peptide Cream and Serum Duo (150) which delivers a luminous finish to your complexion and comes in a compostable mycelium box (wildsmithskin.com; harrods.com).

After turning to flower arranging as a weekly dose of mindfulness, beauty entrepreneur Kelly S Chung endeavoured to harness the healing power of nature or Flower Therapy, as she has coined it in another form; and Femmue was born. Fusing K-beauty innovation with a clean beauty ethos and the cellular energy of plants, the camellia flower is at the heart of the range and renowned for its antioxidant and restorative qualities. The Divine Camlia Facial Oil (100) is the purest form with 99.8 per cent camellia seed oil, while other must-try products in the line include the bestselling Flower Infused Fine Mask (40) formulated with camellia petals, geranium oil and cactus extract and the lavender-loaded Brilliant Cleansing Oil (73) (net-a-porter.com).

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Super Naturals: the high-tech natural beauty brands changing the face of modern skincare - Evening Standard

Insights on precision oncology developments in Japan and beyond – MobiHealthNews

Cancer has been the leading cause of death in Japan since 1981 and this is compounded by the fact that the country has a hyper-aging society, which means that Japan will face a substantial increase in the number of elderly cancer patients, according to a review article by Matsuda and Saika published in the Annals of Cancer Epidemiology in 2018. Prof Yasushi Goto of the National Cancer Center Hospital in Japan shared with MobiHealthNews on some of the latest developments in precision oncology in Japan, the interest of pharmaceutical companies in targeted therapy and a nationwide cancer genome screening project named SCRUM.

Q. Could you tell us more about your role at the National Cancer Center Hospital?

A. National Cancer Center Hospital (NCCH) is based in Tokyo, Japan and is the largest cancer center in the country. The other is national cancer center is located in Chiba, Japan. One of the special characteristics of NCCH apart from the research institute hospital, is that we also do research for every kind of cancer activity in our hospital. We dont only do clinics, but also genetic oncology, rare cancers.

My main work is at thoracic oncology which mainly covers lung cancer. I also am a member of Rare Cancer Center so I also cover, malignant mesothelioma, thymic cancer, neuroendocrine tumors, and all others. Since Japan has launched national genomic project, and National Cancer Center is playing the central role in this project, I am also joining Section of Knowledge Integration in Center for Cancer Genomics and Advanced Therapeutics.

Q. What are your observations on the development of precision oncology in the APAC region? How would you describe precision oncology in the most straightforward manner?

A. Testing for patients with cancer is prevalent in the APAC region. Compared to other countries, people in Asia are generally accustomed to genetic testing for precision medicine. Our capabilities may not be as advanced as the United States for full gene sequencing, perhaps because of cost issues, but we are catching up.

For precision oncology to develop further, more patients should be tested for genetic testing and target therapy. We are looking to putting in place a proper system to support this right now, especially in the rare cancer field.

There was a recent nationwide project in Japan called SCRUM, conducted by the National Cancer Center East Hospital. SCRUM is the first industry-academia collaboration nationwide cancer genome screening project. I believe early access to drugs is partly due to this project.

Q. Medtech or healthtech startups are also getting into the precision medicine space and seeing a lot of interest from investors. For instance, genomic medicine startup Lucence from Singapore recently raised $20 million in Series A funding. What opportunities do you see in these startups in terms of working together with hospitals such as the National Cancer Centre Hospital? Are there any notable startups in Japan in the precision medicine space?

A. In Japan, many pharmaceutical companies are looking at targeted therapy. Prominent companies include Daichi-Sankyo, Chugai, and Takeda. NCCH is currently working closely with Daichi-Sankyo, Takeda and Chugai.

The approval system is different between blockbuster drugs and targeted therapy. If you only have one patient in Japan and globally there are only 20 or so there can be a scenario where the drug is effective, but it is not approved in our country as there is only a single patient. This is why some pharmaceutical companies are looking at precision medicine.

Companies including Sysmex are also actively looking into the testing of panel sequencing. NCCH has also worked with Sysmex to make a cancer sequencing panel.

Q. The high incidence of cancer in modern societies is worrying and also very costly how do you think precision oncology can help tackle some of these challenges?

A. Cost is a global issue, for both the development side (e.g. the pharmaceutical companies) and the consumption side (e.g. governments, individuals). We also need some basic infrastructure for precision oncology, to screen patients. Currently each drug needs its own testing. With many drugs that need to be tested, we need a platform to do panel sequencing in order to annotate any genetic changes in the patients for treatment.

In Japan, we are now trying to make this infrastructure because the government recently approved the panel sequencing in 2019. This means that after standard therapy, every patient is able to test for panel sequencing. As more patients are screened, in this way I think cancer treatment will be improved in the future.

Q. What do you think will be the key developments and breakthroughs in precision oncology in the next 3-5 years?

A. There will be no blockbuster development, but there will be steady progress in the detecting genetic changes earlier in the next 3-5 years. Some of the topics at the ESMO Asia Congress 2019 in Singapore were on advancements in detecting mutations/previously overlooked genes. Since we are able to find these abnormalities earlier, we now have new anti-cancer agents to target them.

See more here:
Insights on precision oncology developments in Japan and beyond - MobiHealthNews

Pune to host fifth edition of global Drosophila conference – The Hindu

The city is set to host the fifth edition of the Asia Pacific Drosophila Research Conference (APDRC5), which is being organised in the country for the first time by the Indian Institute of Science Education and Research (IISER).

This biennial conference, which is to be held between January 6 and 10, aims to promote the interaction of Drosophila researchers in the Asia-Pacific region with their peers in the rest of the world. It will bring together scientists from all over the world who use the fruit fly, Drosophila, as a model organism to address basic and applied questions.

Drosophila is one of the most widely-used and preferred model organisms in biological research across the world for the last 100 years. Several discoveries in biology have been made using this. Its genome is entirely sequenced and there is enormous information available about its biochemistry, physiology and behaviour, said professor (biology) Sutirth Dey of IISER.

The event will feature 430 delegates: 330 Indian and 100 foreign. It will see the participation of two Nobel laureates, professors Eric Wieschaus and Michael Rosbash, known for their seminal contribution to the fields of development biology and chronobiology respectively.

Prof. Wieschaus, an American evolutionary developmental biologist, shared the Nobel in Physiology in 1995 with Edward B. Lewis and Christiane Nsslein-Volhard for his work on genetic control of embryonic development, while Prof. Rosbash shared the Nobel in 2017 in Physiology along with Michael Young and Jeffrey Hall for their discoveries of molecular mechanisms controlling the circadian rhythm.

This event is one of the largest meetings of Drosophila researchers in the whole world and attracts scientists working in diverse disciplines ranging from cell and molecular biology to ecology and evolution, said Prof. Dey.

Explaining the choice by the APDRC board of IISER to organise the meet, he said the institute is one the premier scientific research institutes of the country and is very strong in Drosophila research, given that there are five professors and 30 Ph.D. scholars who were using Drosophila to answer questions in developmental biology.

A total 57 talks and 240 posters on topics ranging from gametogenesis and stem cells, morphogenesis and mechanobiology, hormones and physiology, cellular and behavioural neurobiology, infection and immunity and ecology and evolution are scheduled for the conference.

One of the highlights of this conference is that we are explicitly encouraging undergraduates from various institutes of the world to participate in it. There is a pre-conference symposium called signals from the gut in collaboration with the National Centre for Cell Science, as well as a pre-conference microscopy workshop on super-resolution microscopy. This will feature microscopes from fluorescence imaging to super resolution imaging (50 nm resolution) which are vital for certain kinds of fly work, Prof. Dey said.

The last four editions of this conference took place in Taipei, Seoul, Beijing and Osaka.

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Pune to host fifth edition of global Drosophila conference - The Hindu

New protocol could signal shift in bone regenerative medicine – Yahoo Finance

A new, safe and efficient way to coax stem cells into bone cells is reported in a recently published article from STEM CELLS Translational Medicine (SCTM).

DURHAM, N.C., Jan. 6, 2020 /PRNewswire-PRWeb/ -- A new, safe and efficient way to coax stem cells into bone cells is reported in a recently published article from STEM CELLS Translational Medicine (SCTM). The protocol, developed by researchers at the University of Sydney, Australian Research Centre (ARC) for Innovative BioEngineering, could lead to a shift in the treatment of bone regenerative medicine.

Large bone defects and loss due to cancer or trauma can result in scar tissue that impairs the bones' ability to repair and regenerate. The current gold standard therapy, autografting, has inherent drawbacks, including limited availability and donor site morbidity. This leaves researchers seeking an alternative source of bone cells and makes bone tissue engineering a growing field with considerable translational potential.

"The success of induced pluripotent stem cell (iPSC) technology to reprogram fibroblasts into progenitor cells of various lineages offers an exciting route for tissue repair and regeneration," said Zufu Lu, Ph.D., a member of the University of Sydney's Biomaterials and Tissue Engineering Research Unit and a research associate at the ARC for Innovative BioEngineering. He is a co-lead investigator of the SCTM study, along with Professor Hala Zreiqat, Ph.D., head of the research unit and director of the ARC Training Centre for Innovative BioEngineering.

"However, while iPSC technology represents a potentially unlimited source of progenitor cells and allows patients to use their own cells for tissue repair and regeneration thus posing little or no risk of immune rejection the technology has several constraints. Among them are the requirement for complex reprogramming using the Yamanaka factors (Oct3/4, Sox2, Klf4, c-Myc). To add to the complexity, specific stimuli are required to direct iPSCs to re-differentiate to progenitor cells of the lineage of interest.

"In addition," Dr. Lu said, "any remaining iPSCs pose the risk of tumors following implantation."

One potential way around this, as demonstrated by recent studies, is through the direct reprogramming of fibroblasts into bone cells. "Fibroblasts are morphologically similar to osteoblasts. Their similar transcriptomic profiles led us to hypothesize that distinct factors produced by osteoblasts may be capable of coaxing fibroblasts to become osteoblast-like cells," Prof. Zreiqat said.

Previous studies aimed at using fibroblasts to produce various cell types relied on the genetic manipulation of one or more transcription regulators. But just as with iPSCs, reprogramming fibroblasts in this manner has its own inherent technical and safety issues. The Lu-Zreiqat team, however, surmised that an approach employing natural factors might just allow better control over reprogramming and improve the safety.

"Unlike genetic reprogramming, chemical induction of cell reprogramming is generally rapid and reversible, and is also more amenable to control through factor dosage and/or combinations with other molecules," Dr. Lu explained.

The team initially determined that media conditioned by human osteoblasts can induce reprogramming of human fibroblasts to functional osteoblasts. "Next," said Prof. Zreiqat, "our proteomic analysis identified a single naturally bioactive protein, insulin growth factor binding protein-7 (IGFBP7), as being significantly elevated in media conditioned with osteoblasts, compared to those with fibroblasts."

This led them to test IGFBP7's ability as a transcription factor. They found it, indeed, successfully induced a switch from fibroblasts to osteoblasts in vitro. They next tested it in a mouse model and once again experienced success when the fibroblasts produced mineralized tissue. The switch was associated with senescence and dependent on autocrine IL-6 signaling.

"The approach we describe in our study has significant advantages over other commonly used cell sources including iPSCs and adult mesenchymal stem cells," Dr. Lu and Prof Zreiqat concluded.

"Bone tissue engineering is a growing field where cell therapies have considerable translational potential, but current cell-based approaches face limitations," said Anthony Atala, M.D., Editor-in-Chief of STEM CELLS Translational Medicine and director of the Wake Forest Institute for Regenerative Medicine. "The novel observation described in this study could potentially lead to a shift in the current paradigm of bone regenerative medicine."

Story continues

This study was conducted in collaboration with the Charles Perkins Centre and the Children's Hospital at Westmead, University of Sydney.

The full article, "Reprogramming of human fibroblasts into osteoblasts by insulin-like growth factor binding protein 7," can be accessed at https://stemcellsjournals.onlinelibrary.wiley.com/doi/abs/10.1002/sctm.19-0281.

About STEM CELLS Translational Medicine: STEM CELLS Translational Medicine (SCTM), co-published by AlphaMed Press and Wiley, is a monthly peer-reviewed publication dedicated to significantly advancing the clinical utilization of stem cell molecular and cellular biology. By bridging stem cell research and clinical trials, SCTM will help move applications of these critical investigations closer to accepted best practices. SCTM is the official journal partner of Regenerative Medicine Foundation.

About AlphaMed Press: Established in 1983, AlphaMed Press with offices in Durham, NC, San Francisco, CA, and Belfast, Northern Ireland, publishes two other internationally renowned peer-reviewed journals: STEM CELLS (http://www.StemCells.com), celebrating its 38th year, is the world's first journal devoted to this fast paced field of research. The Oncologist (http://www.TheOncologist.com), also a monthly peer-reviewed publication, entering its 25th year, is devoted to community and hospital-based oncologists and physicians entrusted with cancer patient care. All three journals are premier periodicals with globally recognized editorial boards dedicated to advancing knowledge and education in their focused disciplines.

About Wiley: Wiley, a global company, helps people and organizations develop the skills and knowledge they need to succeed. Our online scientific, technical, medical and scholarly journals, combined with our digital learning, assessment and certification solutions, help universities, learned societies, businesses, governments and individuals increase the academic and professional impact of their work. For more than 200 years, we have delivered consistent performance to our stakeholders. The company's website can be accessed at http://www.wiley.com.

About Regenerative Medicine Foundation (RMF): The non-profit Regenerative Medicine Foundation fosters strategic collaborations to accelerate the development of regenerative medicine to improve health and deliver cures. RMF pursues its mission by producing its flagship World Stem Cell Summit, honouring leaders through the Stem Cell and Regenerative Medicine Action Awards, and promoting educational initiatives.

SOURCE STEM CELLS Translational Medicine

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New protocol could signal shift in bone regenerative medicine - Yahoo Finance

Researchers at Baylor College of Medicine Discover How to Improve Bone Repair – Gilmore Health News

Researchers at Baylor College of Medicine have discovered a new mechanism that helps maintain and repair bones in adults. Ultimately, this could help develop new therapeutic strategies to improve bone healing.

Knee Bones

Osteoporosis is a skeletal disease characterized by reduced bone density and changes in the microarchitecture of bones. These changes weaken the bone and increase the risk of fractures.

Osteoporosis develops particularly in older people. Today, a new study could eventually lead to the development of therapeutic strategies to improve bone regeneration in these patients. Results published in the journal Cell Stem Cell on the 5th December 2019 have laid out a new mechanism that contributes to the maintenance and repair of bones in adults.

Adult bone repair relies on the activation of bone stem cells, which still remain poorly characterized. Bone stem cells have been found both in the bone marrow inside the bone and also in the periosteum: the outer layer of tissue that envelopes bone. Previous studies have shown that these two populations of stem cells share many characteristics; however, they also have unique functions and specific regulatory mechanisms, said Dr. Dongsu Park, assistant professor of molecular and human genetics, pathology and immunology at Baylor College of Medicine.

Of these two populations, periosteal stem cells are the least known. Although scientists know that this is a heterogeneous population of cells that can contribute to the thickness, formation, and repair of bone fractures, no one has yet been able to distinguish between the different subtypes of bone stem cells in order to study the regulation of their different functions.

Read Also:HGH Is Now A Solid Treatment For Osteoporosis According To Studies

Here, however, Dr. Dongsu Park and colleagues were able to develop a technique in mice to identify different subpopulations of periosteal stem cells, define their contribution to the repair of bone fractures and identify the specific factors that regulate their migration and proliferation under physiological conditions.

The researchers identified a specific subset of stem cells that contribute to lifelong bone regeneration in adults. They also observed that periosteal stem cells react to inflammatory molecules, chemokines, which are normally produced in bone injuries.

In detail, periosteal stem cells have receptors that bind to the CCL5 chemokine. The CCL5 chemokine sends a signal to the cells to migrate to the injured bone and repair it. By suppressing the CCL5 gene in rats, the researchers found defects in bone repair that delayed healing. However, when they gave CCL5 to rats that had lost CCL5, the bones recovered faster.

Read Also:The Exciting Future of Joint and Cartilage Repair

Our findings contribute to a better understanding of the healing of adult bones. We believe this is one of the first studies to show that bone stem cells are heterogeneous and that different subtypes have unique properties that are regulated by specific mechanisms, said Dr. Dongsu Park.

In conclusion, this study has allowed for the identification of different stem cell subtypes and their distinguishing markers and their roles in bone repair. This discovery gives insight into new therapeutic strategies for the treatment of bone damage in adults, particularly in the setting of osteoporosis or diabetes. Indeed, people with diabetes may be prone to falls and fractures due to neurological, visual or renal complications. In addition, bone fragility in diabetics is likely to be due to changes in bone remodeling and, in particular, an increase in bone resorption.

Read Also:Implants from Own Stem Cells May Offer Solution to Back Pain, Researchers Say

https://www.cell.com/cell-stem-cell/fulltext/S1934-5909(19)30458-8?

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Researchers at Baylor College of Medicine Discover How to Improve Bone Repair - Gilmore Health News

Gene editing breakthroughs that cured genetic diseases in 2019 – The Star Online

IN the summer of 2019, a mother in Nashville, Tennessee in the United States, with a seemingly incurable genetic disorder finally found an end to her suffering by editing her genome.

Victoria Grays recovery from sickle cell disease, which had caused her painful seizures, came in a year of breakthroughs in one of the hottest areas of medical research gene therapy.

I have hoped for a cure since I was about 11, the 34-year-old said.

Since I received the new cells, I have been able to enjoy more time with my family without worrying about pain or an out-of-the-blue emergency.

Over several weeks, Grays blood was drawn so that doctors could get to the cause of her illness stem cells from her bone marrow that were making deformed red blood cells.

The stem cells were sent to a Scottish laboratory, where their DNA was modified using Crispr/Cas9 pronounced Crisper a new tool informally known as a molecular scissors.

The genetically-edited cells were transfused back into Grays veins and bone marrow. A month later, she was producing normal blood cells.

Medics warn that caution is necessary, but theoretically, she has been cured.

This is one patient. This is early results. We need to see how it works out in other patients, said her doctor, Haydar Frangoul, at the Sarah Cannon Research Institute in Nashville.

But these results are really exciting.

In Germany, a 19-year-old woman was treated with a similar method for a different blood disease beta thalassemia.

She had previously needed 16 blood transfusions per year. Nine months later, she is completely free of that burden.

For decades, the DNA of living organisms such as corn and salmon has been modified. But Crispr, invented in 2012, made gene editing more widely accessible.

It is much simpler than preceding technology, cheaper and easy to use in small labs.

The technique has given new impetus to the perennial debate over the wisdom of humanity manipulating life itself.

Its all developing very quickly, said French geneticist Emmanuelle Charpentier, one of Crisprs inventors and the co-founder of Crispr Therapeutics, the biotech company conducting the clinical trials involving Gray and the German patient.

Gene cures

Crispr was the latest breakthrough in a year of great strides in gene therapy, a medical adventure that started three decades ago, when the first TV telethons were raising money for children with muscular dystrophy.

Scientists practising the technique insert a normal gene into cells containing a defective gene.

It does the work the original could not, such as making normal red blood cells in Grays case or making tumour-killing super white blood cells for a cancer patient.

Crispr goes even further: instead of adding a gene, the tool edits the genome itself.

After decades of research and clinical trials on a genetic fix to genetic disorders, 2019 saw a historic milestone: approval to bring to market the first gene therapies for a neuromuscular disease in the US and a blood disease in the European Union.

They join several other gene therapies bringing the total to eight approved in recent years to treat certain cancers and an inherited blindness.

Serge Braun, the scientific director of the French Muscular Dystrophy Association, sees 2019 as a turning point that will lead to a medical revolution.

Twenty-five, 30 years, thats the time it had to take, he said. It took a generation for gene therapy to become a reality. Now, its only going to go faster.

Just outside Washington, at the US National Institutes of Health (NIH), researchers are also celebrating a breakthrough period.

We have hit an inflection point, said US NIHs associate director for science policy Carrie Wolinetz.

These therapies are exorbitantly expensive, however, costing up to US$2 million (RM8.18 million) meaning patients face grueling negotiations with their insurance companies.

They also involve a complex regimen of procedures that are only available in wealthy countries.

Gray spent months in hospital getting blood drawn, undergoing chemotherapy, having edited stem cells reintroduced via transfusion and fighting a general infection.

You cannot do this in a community hospital close to home, said her doctor.

However, the number of approved gene therapies will increase to about 40 by 2022, according to Massachusetts Institute of Technology (MIT) researchers.

They will mostly target cancers and diseases that affect muscles, the eyes and the nervous system.

In this Oct 10, 2018, photo, He speaks during an interview at his laboratory in Shenzhen, China. The scientist was recently sentenced to three years in prison for practicing medicine illegally and fined 3 million yuan (RM1.76 million). AP

Bioterrorism potential

Another problem with Crispr is that its relative simplicity has triggered the imaginations of rogue practitioners who dont necessarily share the medical ethics of Western medicine.

In 2018 in China, scientist He Jiankui triggered an international scandal and his excommunication from the scientific community when he used Crispr to create what he called the first gene-edited humans.

The biophysicist said he had altered the DNA (deoxyribonucleic acid) of human embryos that became twin girls Lulu and Nana.

His goal was to create a mutation that would prevent the girls from contracting HIV (human immunodeficiency virus), even though there was no specific reason to put them through the process.

That technology is not safe, said Kiran Musunuru, a genetics professor at the University of Pennsylvania, explaining that the Crispr scissors often cut next to the targeted gene, causing unexpected mutations.

Its very easy to do if you dont care about the consequences, he added.

Despite the ethical pitfalls, restraint seems mainly to have prevailed so far.

The community is keeping a close eye on Russia, where biologist Denis Rebrikov has said he wants to use Crispr to help deaf parents have children without the disability.

There is also the temptation to genetically edit entire animal species, e.g. malaria-causing mosquitoes in Burkina Faso or mice hosting ticks that carry Lyme disease in the US.

The researchers in charge of those projects are advancing carefully however, fully aware of the unpredictability of chain reactions on the ecosystem.

Charpentier doesnt believe in the more dystopian scenarios predicted for gene therapy, including American biohackers injecting themselves with Crispr technology bought online.

Not everyone is a biologist or scientist, she said.

And the possibility of military hijacking to create soldier-killing viruses or bacteria that would ravage enemies crops?

Charpentier thinks that technology generally tends to be used for the better.

Im a bacteriologist -- weve been talking about bioterrorism for years, she said. Nothing has ever happened. AFP Relaxnews

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Gene editing breakthroughs that cured genetic diseases in 2019 - The Star Online

Radical treatment of oral infection is not necessary before stem cell transplantation, says study – ANI News

ANI | Updated: Jan 05, 2020 19:56 IST

Washington D.C. [USA], Jan 5 (ANI): A recent scientific study suggests that contrary to the conventional belief, oral infection has no association with the risk of patients that people developing serious infectious diseases within six months of undergoing stem cell transplantation.The study was conducted by the researchers of the University of Helsinki and was published in the journal - PLOS ONE.During the study, researchers investigated to find out if oral infections are associated with infectious complications as well as mortality rate after stem cell transplantation."Contrary to our assumptions, untreated oral infections had no connection with post-stem cell transplantation survival during the six-month follow-up period. Another surprise was that they had no link with any serious infectious complications occurring during the follow-up period," said lead researcher Tuomas Waltimo.The process of hematopoietic stem cell transplantation is used for treating cancers and other severe blood and autoimmune diseases.Owing to long durations required for recovery of the human immune system following stem cell transplantation procedure, patients generally have a heightened risk of infections. (ANI)

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Radical treatment of oral infection is not necessary before stem cell transplantation, says study - ANI News