Analysts weigh in on speculation of further slimming by Pfizer

As economists puzzle over the future direction of global markets, there is a growing consensus among pharmaceutical industry analysts that slimming down will reap profits for Pfizer. Last week the company saw its stock price increase after an analyst at Goldman Sachs wrote that Pfizer’s chief executive, Ian Read, had signaled in a meeting she attended that he may go beyond the divestitures the company has already announced. Pfizer is already in the midst of spinning off its nutritional and animal health businesses, and last week’s news raised speculations from analysts that other divisions may also be destined for the chopping block in the near future.

The time scale for further spin-offs by Pfizer is probably two to five years, says Damien Conover, an analyst at Morningstar in Chicago. “This is a good strategy to unlock value within the company,” he says, adding that “the most likely next step would be to get rid of the over-the-counter business.” It wouldn’t be the first pharma giant to do so: New York-based Bristol-Myers Squibb sold its own over-the-counter division in 2009.

Although there have also been rumblings that the Pfizer might also consider spinning off its generics business, he and others say such a move would be both unprecedented and ill-advised because of the synergy between generic and new drug research and development at the company. “Investors have signaled they welcome streamlining, but [selling] generics is not on the table,” says Jamie Davies, head of pharmaceuticals and healthcare analysis at Business Monitor International in London.

Pfizer is not the only company in the process of scaling back. Illinois’s Abbott Laboratories last week unveiled the name of its new non-pharmaceutical sister company, AbbVie. The trend is a predictable reaction to the merger-mania of the last three years, says Lindsay Meyers, an analyst at Canaan Partners in Menlo Park, California. “It takes a lot of clean-up when you’ve been through a merger or acquisition,” she says.

Meyers expects more companies both in the US and in Europe to begin consolidating and selling off inefficient businesses in the coming years. “Pfizer is not the only company that made a big purchase in the last few years,” she says. But others think the trend will remain a US phenomenon. “European companies have to look more broadly because the markets in their domestic region are contracting,” explains Davies, who says shrinking profits at home are an incentive for European companies to stay big and diverse in order to tap into new markets.

European companies such as British GlaxoSmithKline, French Sanofi and Swiss Novartis have all grown in recent years. “This trend speaks to more European exposure to emerging markets,” says Conover, “and emerging markets are good for diverse product lines.”

Photo courtesy of Pfizer

FDA needs to export know-how to import safer drugs, reports says

The US Food and Drug Administration must share more safety inspection and training responsibilities with regulators in other developed countries, says a new report published today by the independent, non-governmental US Institute of Medicine (IOM) in Washington, DC. The report calls on the FDA, for example, to collaborate with its European counterparts on the gathering of inspection information related to manufacturing facilities overseas. Among the other 13 recommendations in the report, it also advises that the FDA partner with agencies abroad to help train regulators in nations such as India and China, where drugs are increasingly manufactured for the international market.

“If you look at the magnitude of drugs, the number of manufacturers and the complexity of the supply chains, there’s just no way one agency can do it alone,” says Jim Riviere, a pharmacologist at North Carolina State University in Raleigh and the report’s lead author. “This requires a broad, international collaboration. It’s impossible to inspect our way out of this alone or at the border.”

Recent cases of drug contamination, spoilage and counterfeiting highlight the need for such reforms. In 2007 and 2008 more than 80 people died in the US after being given contaminated doses of the blood thinner heparin, the active ingredient of which had been manufactured in China. And just this week, the FDA said that counterfeit versions of the cancer drug Avastin that originated in countries including Turkey and Egypt continue to be illegally marketed to US consumers.

To prevent such lapses in the future, according to the report, the FDA will need to collaborate with regulatory bodies in Europe and other developed countries to create a standardized and widely available international curriculum. “There’s not an enormous tradition of regulators cooperating together,” says committee member Thomas Bollyky, a senior fellow at the Council on Foreign Relations in Washington, DC. “But to get the kind of action you need, you need all those participants involved. It’s really in everyone’s best interest.”

Beyond urging global outreach by the FDA, the report emphasizes that responsibility for ensuring drug safety also falls on importers in US.  “It’s important to hold companies liable for what happens in the supply chain,” says Bollyky, who says the FDA should pursue both litigation and incentives for companies to monitor their own pipelines more carefully.

The report, which was commissioned by the FDA, will also inform the spending decisions of the agency’s new deputy commissioner for global regulatory operations and policy, a position created in July 2011 to oversee the global food and drug markets. One of the first actions by the deputy’s office has been to champion a law expected to pass this summer that will raise approximately $300 million per year from generic drug makers for surveillance of overseas drug manufacturing plants. The recommendations in today’s IOM report will be the foremost tool in determining exactly how that money is spent. “This is not a simple issue of putting more [FDA] boots on the ground in one or two countries,” says Riviere. “They have to use both carrot and stick policies.”

Photo courtesy of the Institute of Medicine

Autism reaches record high levels in the US

The US Centers for Disease Control and Prevention today reported that the number of children with autism spectrum disorders (ASD) has risen to an estimated 1 in 88 (1.1%), up from 1 in 110 (0.9%) according to agency estimates from two years previous. The prevalence figure is the highest since the CDC began its biennial nationwide survey of children ten years ago.

The survey released today assessed rates of autism in eight-year-olds at sites in fourteen states in 2008. The new US rate is on par with the 1% rate reported in the UK, and is significantly lower than the 2.6% prevalence observed in South Korea, according to reports from last September.

“Some of the increase is due to an increase in diagnosis, although how much is due to this is unknown,” Coleen Boyle, director of the CDC’s National Center on Birth Defects and Developmental Disabilities, said in a press telebriefing today. In the last decade, doctors, parents and teachers have gotten better at recognizing symptoms of ASD. But “a large portion of the increase, some 50%, remains unexplained,” said Mark Roithmayr, president of Autism Speaks, a New York-based advocacy group. “We need more research into potential environmental causes.”

Roithmayr is not alone in his concern that environmental factors may be partly to blame for the rise in autism. As Nature reported in November, the steady increase in ASD prevalence has led epidemiologists at the CDC and elsewhere to launch multiple studies in the past five years that have gathered environmental, developmental and genetic information from large numbers of children in the hopes of pinpointing the driving factors behind the disease. Yet, despite a slew of genetic markers have been correlated to high rates of autism, their actual importance and how and why those genes are expressed remains a mystery. The harrowing history of false alarms, such as the discredited link between vaccines and autism, raises the bar for such studies.

Regardless of the cause, all the experts at today’s press conference agreed that earlier detection of ASD is critical. Today’s report shows that the average age of diagnosis continues to hover near four years old, nearly unchanged from recent years, meaning that although detection is getting better overall, services are not getting to children any earlier. And, as the University of Rochester’s Susan Hyman, chairperson of the autism subcommittee of the American Academy of Pediatrics, pointed out, “To meet the need presented by increasing ASD diagnoses, federal autism resources will need to expand.”

Photo courtesy of the US Centers for Disease Control and Prevention

As massive cancer databases come online, some still fret about target validation

Researchers today unveiled the two largest ever databases of information about cancer cells, which they say will help them and others test new chemotherapy treatments and speed them to the clinic.

Before today’s publication of these databases in Nature, the most sophisticated cancer cell-line library was the US National Cancer Institute’s NCI-60 panel, which is composed of 60 cancer cell lines that have been tested against thousands of potential drugs over the last twenty years. The new databases, compiled at the Dana Farber Cancer Institute and Massachusetts General Hospital, both in Boston, boast 479 and 507 cancer cell lines, respectively, and have information about a broader range of DNA and RNA mutations and drug responses than the NCI-60.

“You want as many cell types as possible in order to establish a spectrum of [cancer cell] behavior in response to a potential drug,” says John Weinstein, a computational biologist at MD Anderson Cancer Center in Houston, Texas. Weinstein, who was not involved with either project, says the breadth of the new collections will make it more likely that scientists will identify cell lines with mutations that match those found in tumors from specific patients. Having access to information about how those cell lines respond to different chemotherapy treatments will help physicians suggest the best drug options to their patients.

“This is going to enable us to realize the vision we have for personalized medicine,” says Levi Garraway, a molecular pharmacologist at the Dana Farber Cancer Institute and senior author of the first paper. And, he says, such extensive cancer cell line data will speed up the preclinical process because in the future it will allow drug companies to predict the effectiveness of experimental compounds, decreasing their reliance on slow and costly animal studies. “If you have robust genetic or molecular indicators, that can be sufficient,” he says. “You don’t necessarily need mouse models.”

But other scientists say cell-line data cannot replace testing in animal models. “Validation models are always necessary, whether it’s testing potential drugs in freshly isolated tumor cells, or using several genetically engineered mouse models to recapitulate the heterogeneity of human tumors,” says Lee Ellis of MD Anderson Cancer Center. In a commentary also published today in Nature, Ellis and cancer researcher Glenn Begley, formerly of the drug company Amgen in Thousand Oaks, California emphasize that cell line data is only the first step in bringing new treatments into the clinic. They point out that even large numbers of cell lines cannot predict how immune mechanisms and the tumor micro-environment will factor into a drug’s effectiveness.

They are not alone in their concerns about lax preclinical testing. An analysis last September in Nature Reviews Drug Discovery said that new drug targets fail to be reproduced in follow-up studies 65% of the time, meaning that many drugs are making it to the clinic without being adequately validated.

“Preclinical validation is expensive,” Ellis says, “but going to clinic is not only expensive, it puts patients at risk.”

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Greater oversight needed for genomic tests, experts say

With an eye to advancing ‘personalized medicine’, clinicians have tried to predict who will respond to certain therapies using biomarkers gleaned from tests that probe genomics, proteomics and other branches of biomedicine. But according to a report from the US Institute of Medicine (IOM), such ‘omics-based’ tests require greater regulatory oversight and more transparent data-sharing before they should be allowed to move from the lab to the clinic.

“Nothing short of patient safety and public trust are at stake,” IOM committee chairman Gilbert Omenn, a computational biologist at the University of Michigan Medical School in Ann Arbor, said in a press conference this afternoon.

The report was commissioned by the US National Cancer Institute and the US Food and Drug Administration (FDA) after a genomic test developed by Anil Potti and his colleagues at Duke University in Durham, North Carolina proved to be worthless. The test, reported in and then retracted from Nature Medicine, supposedly assessed the molecular traits of a malignant tumor to determine which chemotherapy would be most effective; it also triggered a storm of lawsuits and resignations. The IOM was tasked with determining how such a faulty test ever got through the regulatory and institutional review board systems.

The centerpiece of today’s nearly 300-page report, called Evolution of Translational Omics, is the finding that institutional review boards are not adequately assessing clinical protocols for diagnostic tests and the FDA is not demanding sufficient evidence of safety and efficacy before allowing the tests to hit the market. The report cites six case-studies of commercially-available genomic and proteomic tests, including two faulty tests for ovarian cancer, Lab-Corp’s OvaSure and Correlogic’s OvaCheck, which were licensed and, in the case of OvaSure, even sold to patients before they were shown to be ineffective. “This is a wake-up call for people doing translational research,” Omenn said. “There’s a big incentive to get tests to patients, but it’s got to be done right.”

The report also calls for public disclosure of all data and algorithms from studies related to genomic tests being developed for clinical settings. “It’s very important to release data and computer code to address issues of reproducibility,” committee member Nathan Price, a biostatician at the Institute for Systems Biology in Seattle, told reporters at the press briefing. “When you start to compare across many different studies, your idea of whether the test is effective gets better.”

Photo courtesy of the Institute of Medicine

Top Canadian biomedical prize goes to antibody pioneer

The immunologist who revealed the structure and function of the crucial Fc region of antibodies was one of the researchers recognized today by the Toronto-based Gairdner Foundation for his contributions to biomedicine. Jeffrey Ravetch (pictured), along with six leading scientists in the fields of genetics, neurobiology and infectious diseases, has received one of the prestigious Gairdner awards, which have been called the ‘Canadian Nobels’. The awards come with a hefty C$100,000 ($101,000) cash prize for each winner.

Ravetch, now of Rockefeller University in New York, published a series of trailblazing immunology papers in the late 1980s and early 1990s showing that antibodies in the immune system possess a region called the Fc (or ‘fragment, crystallizable’) region. He found the Fc region is essential for initiating an inflammatory response and also that antibodies have both activating and inhibiting functions, a finding which overturned centuries of dogma about the regulation of the immune system. In subsequent years, he has gone on to show that the Fc region is part of a pathway that suppresses inflammation, publishing a  paper in Nature Medicine in 2000 that demonstrated Fc regions contribute to the effectiveness of tumor-destroying antibodies. “That paper was quite heretical at the time,” says Ravetch. Since then, engineering the Fc region has become a central concern for anyone designing antibodies as therapies for diseases such as breast cancer and lymphoma, and Ravetch’s work may also have applications for improving current antibody-based treatments for autoimmune disorders such as lupus and rheumatoid arthritis.

Such clinical advances are one reason that the Gairdner Foundation chose to honor Ravetch among its 2012 winners. “Dr. Ravetch changed the way we understand how antibodies work, leading to the design of new therapeutic approaches to autoimmunity and cancer,” says John Dirks, president and scientific director of the foundation.

Other International Award winners announced today include Rockefeller University’s Michael Young and his collaborators Jeffrey Hall and Michael Rosbash of Brandeis University, located just outside Boston, for their work on the genetic mechanisms of circadian clocks, and Thomas Jessell of Columbia University in New York for his research into the connections between sensory and motor neurons. Brian Greenwood of the London School of Hygiene and Tropical Medicine locked up the Gairdner Global Health Award for showing that the pneumococcal vaccine and insecticide-treated bed nets both greatly reduce mortality among children in Africa—and for his advocacy efforts to bring such prophylactics to the region.

On 25 October the Gairdner prizes will be formally awarded in Toronto. To read about last year’s winners, click here.

Photo courtesy of Jeffrey Ravetch

VIDEO: ‘Resting state’ brain scans give diagnosis by default

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Brain scans that map differences in how brain regions communicate while people lie idle in the imaging machine are providing a possible new way to diagnose attention disorders. Michael Milham of the Child Mind Institute in New York talks about the work being done on so-called ‘resting state’ brain scans and explains how they are expanding the field of functional MRI.

For more, check out our news feature on the clinical utility of resting state fMRI from the March 2012 issue of Nature Medicine.

Fluke’s testimony highlights broad uses of birth control, but pain applications go beyond ovarian cysts

The Affordable Care Act contraceptive coverage currently being debated in the US Congress could allow institutions that provide health insurance to opt-out of covering birth control pills for religious or moral reasons. Such policies have, in the past, raised difficulties for women prescribed the drugs for noncontraceptive uses, such as the treatment of pain from ovarian cysts. On 23 February, a law student at Georgetown University named Sandra Fluke testified before the US House Committee on Oversight and Government Reform that when insurance coverage doesn’t cover contraceptives, it can deny women such a friend of Fluke’s with polycystic ovarian syndrome access to birth control prescribed to treat the condition. And although such treatments do not cure the underlying causes of such conditions—oral contraceptives do not shrink ovarian cysts—there is accumulating evidence that they can be used as analgesics, allowing women to avoid invasive surgeries to remove abnormal tissue from the uterus or ovaries. The debate over limiting coverage by private insurance for contraceptives raises the question of whether denying access will cause real, physical pain to women in the US.

Prescription for pain from ovarian cysts is just one of many noncontraceptive uses of popular combination hormonal birth control pills such as Yaz, Orthocept and Ortho Novum, which prevent pregnancy by suppressing ovulation or blocking proliferation of the endometrial lining of the uterus, deterring implantation of an egg. “Birth control is also a widely prescribed treatment for pain from endometriosis and fibroid tumors in the uterus,” says Joyce King, a nurse at Emory University in Atlanta who studies the benefits of contraceptives.

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Chimeras: bloodthirsty myth or genetic revolution?

NEW YORK — Chimeras, part one species and part another, have a long and violent history in the world of art and religion. But the way society views the mythical creatures is changing, thanks in part to the advent of genetic engineering.

“If you look back at depictions of chimeras, it is clear that there have been changes in our relationship with the animal within us, whether we fear it or try to harness its power,” Robert Klitzman, a psychiatrist and bioethicist at Columbia University in New York, told Nature Medicine.

At a lecture here this week at the Solomon R. Guggenheim Museum, Klitzman argued that art reflects our changing attitudes toward the differences between humans and animals, a line which is increasingly being blurred by genetic technologies such as the creation of chimeric mice and monkeys for research.

Klitzman’s survey of artistic representations of chimeras began in ancient Egypt, when the duality of the gods was their most terrifying trait. For example, Anubis, god of the afterlife, had the head of a conniving jackal and the body of a man, and Sekhmet, the warrior goddess who carried out heavenly punishments on earth bore the head of a lion. By the time of the Greeks, the most famous chimera, the murderous sphinx, had evolved to have the haunches of a lion, the wings of an eagle, the tail of a serpent and the head of a woman.

But attitudes have changed, Klitzman said, and “modern artists like Magritte, Picasso, and Dali saw animalistic traits as integral and powerful parts of their identities.” Their paintings reflected this, featuring powerfully self-aware chimeras that appeared to gain strength and poise from their animal traits rather than becoming blood-thirsty beings, banished like their predecessors in art and myth. In this way, early twentieth-century art signaled the beginning of a greater modern acceptance of the line between human and animal, a feeling which has only grown with the advent of modern genome manipulation.

“To some extent, we still fear chimeras,” said Klitzman, author of the new book Am I My Genes?: Confronting Fate and Family Secrets in the Age of Genetic Testing. “But it’s also becoming clear that there is a lot to be gained—longer, healthier, more productive lives—from genetic engineering.” How we decide to adjust our beliefs and morals as a society faced with new biological possibilities, he noted, could ultimately determine how future generations view chimeras and where they draw the line between man and beast.

Photo courtesy of Shutterstock


 

Even without antibodies, B cells can thwart viruses

Evidence is emerging that B cells, once thought to fight infection solely by producing antibodies, might also prevent disease without them. In the traditional view, antibodies specific to a bacterium or virus are produced by B cells and maintained against future infection by certain classes of T cells as part of the slow-but-smart ‘adaptive’ immune response. However, it seems that B cells also play an important role in the short-term immediate immune response to pathogens.

Recent research on this expanded B cell function was thought to apply only to bacterial infection, but a paper published today in Immunity suggests it also applies to viral infection. The study demonstrates that mice without adaptive immune systems, whose B cells have been rendered incapable of producing antibodies, nonetheless survive infection by vesicular stomatitis virus (VSV), a pathogen closely related to rabies that attacks the nervous system. They found B cells were producing type 1 interferon signaling protein that prompted macrophages to recognize the virus and destroy it, protecting the body from invasion, all without antibodies.

“B cells are clearly the difference between life and death from this virus, but antibodies are not the reason for this difference,” says senior author Ulrich von Andrian, an immunologist at Harvard Medical School in Boston.

Taken together, the bacterial and viral studies revolutionize how immunologists understand B cells. “These findings are getting a lot of attention, as they should,” says Lyle Moldawer, an immunologist at the University of Florida in Gainesville and the first to publish evidence of an innate B-cell response in bacterial infection. “B cells are the last cell population that anyone considered to be involved in primary response to a viral or bacterial infection.” Moldawer’s August 2011 study was the first to demonstrate that B cells communicating via type 1 interferon contributed to protection against primary infection.

Immunologists are quick to warn that their findings do not undercut the importance of vaccines, which guard against future infection by priming B cells to create antibodies against a particular pathogen. “What we are beginning to understand is an additional function of B cells in preventing infection, not an alternative function,” says von Andrian. However, the additional role of B cells could provide new targets for treating bacterial and viral disease, he says, potentially by boosting the interferon response to protect the body soon after infection.

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