Not directly related to AD, but rather to CNS disorders in general.
After reading the rejection of this https://globaldossier.uspto.gov/#/details/US/15522260/A/94964 patent, the following question came to my mind:
Most of the rejections refer to the fact that (according to the authorities) there is insufficient evidence (neither in animal nor in human trials) that a-MSH has a chance of success in the diseases mentioned.
Is there any chance that
a) Clinuvel has done animal studies since final rejection, which sufficiently proof the potential efficacy of afamelanotide?
b) Clinuvel seeks an "agreement" with the authorities such as: If first human studies produce positive results (stroke is also one of the diseases mentioned!), Clinuvel is allowed to ask for reopening the application?
If b) applies: What would prevent them from announcing all CNS diseases mentioned in their patent as "6th indication"? This might explain the timely delay they are facing...I still can´t get over PWs smile when talking about the sixth, it has to be something groundbreaking.
Disclaimer: I personally know 0,0 about patent applications and authorities, so the previous theses might be pure none-sense.
@Alexius I think in the Biogen studies for their drug Aduhelm they had something like 3000+ patients involved which would be a costly undertaking for one indication let alone several. I know what you're asking: could the CNS disorders fall under one banner and be treated as such. If I read the Luger patent applications correctly, they do group inflammatory and neurodegenerative disorders together and then MS. But since Luger's and Clinuvel's patents were rejected, Luger's MS patent application was amended to exclude a broad claim for inflammatory/neurodegenerative disorders to appease the Examiner and yet the application has still come to grief (Luger's MS patent application is the only one still alive having already been rejected once). Knowing that, it's a struggle to see how a drug authority would say yes to an overarching CNS program for the 6th indication. On the other hand, should MS be approved as an indication for a-msh, I can see short approval paths for AHLE and ELE as they are demylinating diseases as well. (Both mentioned in one of Luger's patents and of which ELE was used as a substitute disorder for MS with accompanying mouse models to try and win the patent).
What's curious is that for Alzheimer's disease patents concerning a-msh there are none in play. Clinuvel's was abandoned, and Luger's application has been pared back with CNS disorders removed except for MS, AHLE and ELE. Why? After reading into the patent further, Luger talks a lot about the BBB, reducing inflammation causing neuronal death, progression of neurodegenerative disorders etc, but nothing specific about the pathology of Alzheimer's disease. I had a look at the research paper from Luger and Karin Loser and there is nothing in there (as far as I can see) that talks specifically about the effects of a-msh on Alzheimer's disease. (please someone correct me if I'm wrong on this, it just appears Luger's patent is directly related to his research at the University of Muenster and in the research it mentions the ELE mouse models). Knowing this, I think Luger tried a blanket patent application to hem AD in to the patent but failed.
There is substantial research from the likes of Daniella Guiliani and the well known paper showing some reduction of plaques in AD bred mice (https://www.jneurosci.org/content/jneuro/34/20/6736.full.pdf). I don't know why a patent application hasn't been submitted from those results, maybe it's in the internet somewhere. Google Patents throws up 18,000+ results for AD. Even I'm not keen on digging that much
So as it stands at the moment, from what I can see, AD is a free-for-all. And the company who can bring a melanocortin peptide to the AD market first will be able to submit a patent application based on their findings from AD/a-msh trials if one doesn't currently exist. If Clinuvel came to terms with Luger, perhaps they intend to go for MS first and then tackle AD later. If they go for AD alone, the risk is elevated but the potential is immense.
Following the FDA's controversial decision to grant approval to Biogen's drug Aduhelm, I'm betting a lot of shareholders in various pharma companies are possibly excited about future prospects not least of all because the FDA will pass any turkey now. I don't think I've ever seen such a self inflicted injury to a Western regulatory body's reputation as damaging as this. The optics are poor indeed. But in an attempt to hose down my own expectations and giddiness at possible ramifications for Clinuvel concerning AD, I wanted to better understand just how much of a possibility it is for Clinuvel to treat this disorder.
In the paper from the link posted in the previous post (Melanocyte Stimulating Hormone Prevents GABAergic Neuronal Loss and Improves Cognitive Function in Alzheimer’s Disease), the main benefits that resulted from this study were: restoring GABAergic function leading to increased cognition, and alleviating anxiety levels in the experimental mice. A key feature of this study IMO was there was no significant reduction in insoluble or soluble amyloid plaque proteins between the control group and the a-msh treated group. However, the improvement in cognition and anxiety levels suggests, according to the authors, "preservation of behaviour independent of amyloid plaque/proteins". That appears to be in direct contrast to Biogen's drug, which is known only to remove amyloid plaque clumps, which in itself is not indicative of improved cognition. A-msh led to an improved neurological outcome for the mice regardless of levels of amyloid proteins.
Concerning the reduction of amyloid protein levels, the experimental mice in the aforementioned study were engineered to express 3 copies of APP (amyloid precursor protein). In Daniella Giuliani's paper from 2014 (Melanocortins protect against progression of Alzheimer’s disease in triple-transgenic mice by targeting multiple pathophysiological pathways), the experimental mice in that study were engineered to express one copy of APP only. These mice were treated with a prophylactic treatment of a potent a-msh analog before the onset of amyloid pathology occurred, which led to reductions in amyloid deposits. Or in other words:
- one group of mice bred to over-produce amyloid proteins and treated with a-msh therapeutically will not see significant reductions in amyloid proteins, yet they will see relative improvements in cognition and anxiety levels,
- the other group of mice producing normal levels of amyloid proteins treated prophylactically will see both a reduction in amyloid deposits and improved cognition.
According to the authors of the first study, there are several studies in which different treatments were used (i.e. beta peptide immunisation) leading to improved cognition regardless of the amount of amyloid proteins present. Clinuvel's abandoned CNS patent was intended to specifically target juvenile forms of CNS disorders, especially AD before the age of 65. This says to me their calculus is based around the prophylactic treatment of AD rather than as a therapeutic option. However, the scope is there for afamelanotide (or a more potent analog) to be used therapeutically as well as it can lead to a measure of improved cognition in more advanced AD sufferers irrespective of amyloid protein/plaque levels.
It would be remiss to disregard Aduhelm entirely without reading through its data and outcomes to better understand how it works. But at the moment, from what I can tell reading anecdotal evidence and the fact the FDA advisory board overwhelmingly voted against recommending it for use in AD, (not to mention 3 members resigning in protest), the drug doesn't lead to what I would consider meaningful improvement across a range of pathophysiological processes of AD. In contrast, a-msh seemingly goes beyond by improving cognition and other neurological aspects in advanced AD while in juvenile AD it can reduce amyloid proteins as an additional benefit.
With all things considered, I think its worth the risk to at least investigate with a small study a prophylactic treatment for juvenile AD perhaps centred around Scenesse (since its approved already). The risk will be manageable and within Clinuvel's capability, but of course it remains to be seen whether non-human experimental results can translate successfully to human trials. CNS and AD were certainly on PW's mind as the abandoned patent proves, hopefully Biogen's approval has emboldened him to take the gamble.
Alzheimer’s disease (AD) is the sixth-leading reason of fatality and is 70% present in all cases of dementia. The global burden of AD is expected to accelerate from 26.6 million cases in 2006 to 106.8 million by 2050. The total assumed worldwide costs of dementia were US$ 604 billion in 2010...
Pathophysiological processes of Alzheimer's disease and how a-msh interacts with these: (Edited as new information comes in)