National Institutes of Health Lead New Clinical Trials Push


From the Annual Meeting of the American Society of Human Genetics

WASHINGTON – Breakthroughs in human genetics, combined with funding from the Affordable Care Act, have poised the National Institutes of Health to make real progress in the areas of orphan human diseases, according to NIH Director Francis S. Collins.

Speaking with enthusiasm to those he addressed as his “peeps” at the meeting, Dr. Collins shared his excitement at the state of human genetics in the postgenomic world, in large part driven by technology that has significantly lowered the cost of DNA sequencing, in turn speeding genetic research tremendously.

This, combined with new ACA funding, has enabled the NIH to fund and pursue translational research, moving laboratory results toward and into clinical trials, something that is a new way of thinking for the agency, Dr. Collins said.

Rather than relying on pharmaceutical and biotechnology companies to take charge of the translational research, Dr. Collins encouraged academic researchers to consider partnering with NIH, at least for those orphan disease conditions in which the federal government would not be seen as being in competition with private enterprise.

“There is a serious crisis underway in the way in which this pipeline for drug discovery has been floundering. … Pharma has been investing a larger and larger amount of money(between $40 and $50 billion dollars a year) and yet in spite of that, [Food and Drug Administration] approvals of new molecular entities – that is, genuinely new drug therapeutics, not 'me-toos' – have been dropping steadily over the last 15 years,” he said.

The reasons are complex, he added, but a big part of the problem involves coming up with appropriate targets and targeting compounds. He said this is an area in which the NIH is and can be very much involved.

The NIH now encourages academic researchers to take their targets to the assay stage and beyond, providing high-throughput screening (HTS) assistance from the NIH Chemical Genomics Center. Subsequent medicinal chemistry assistance is available to help to modify HTS hits to enable compounds to become more druglike and to match current ADME (absorption, distribution, metabolism, and excretion) criteria.

With NIH assistance, more than 150 lead compounds have reached this stage in the last 4–5 years; more than half are “poised to go to the next step” of preclinical trials in animals, or the “Valley of Death,” Dr. Collins said, “because this is where projects often go to die.”

The NIH can now assist in this high-risk area through the Therapeutics for Rare and Neglected Diseases (TRND) program in its Office of Rare Diseases Research. The TRND was funded at $24 million in fiscal year 2009. The agency also is positioned to assist researchers in early phase human trials of orphan diseases through its 240-bed clinical center, Dr. Collins said.

“And we have 50 and soon we will have 60 clinical and translational science awards scattered all across the country which will also be set up to conduct these sorts of trials for new molecular entities,” he added.

This new direction in research funding has involved unprecedented cooperation with the FDA, he said, with an NIH-FDA leadership council formed to ensure that new drug candidates are most safely and efficiently moved into the clinical trials framework in ways that would best enable FDA analysis and validation, particularly for rare diseases.

Dr. Collins was particularly excited about five instances in which NIH is using this new model of helping “de-risk” the drug development process for orphan or neglected diseases through TRND. These include four rare diseases (Niemann-Pick disease type C, hereditary inclusion body myopathy, sickle cell disease, and chronic lymphocytic leukemia) and one neglected disease (schistosomiasis).

If and when these compounds and those for other rare diseases become ready for marketing and production, NIH would then work with private companies to achieve licensing agreement to enable their manufacture and sale, according to Dr. Collins.

Dr. Collins reported having no financial conflicts of interest with regard to his presentation.

Despite annual investments of up to $50 billion by the drug industry, FDA approvals of new entities have dropped steadily.


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