Chronic Periodontitis

中美至今未批准任何一款干细胞药物。 干细胞高端局在国内风起云涌，疗程一次标价7.8万元至20万元，2022年7月，有人在江西九江被骗450余万元。干细胞在医学界被称为万用细胞，被套利群体演绎成包治百病、返老还童的神药。只有当合规产品正常供给之后，这一领域才有可能河清海晏。 干细胞合规市场明年初迎来开天辟地时刻。Mesoblast于2024年7月向FDA重新提交remestemcel-L上市申请，PDUFA日期为2025年1月7日，有望成为美国首个获批的干细胞创新药。2024 年6月，铂生卓越生物的艾米迈托赛注射液成为国内首款获得国家药监局新药上市申请正式受理并纳入优先审评的干细胞新药。 成药性解决后，巨大的临床需求将在合规产品上集中释放。 从2018年到2024年7月，国内干细胞新药 IND获批83个，进入临床60个。据医药魔方数据不完全统计，国内干细胞创新药处于III期临床试验4项，II期临床试验11项。 等待一支穿云箭。 01  黎明降至 干细胞是人体中具有自我更新能力、多功能性和再分化能力的细胞，具有分化成各种组织和器官的潜能。作为重要的再生医学产品，干细胞进入人体，哪里有损伤、老化、病变，就在哪里聚集，可能应用到几乎涉及人体所有重要组织器官的修复及研究，攻克人类诸多医学医美难题，根治糖尿病、帕金森综合征、阿尔兹海默症，抗衰除皱，疤痕修复。 可见干细胞疗法是一种乌托邦药物，戳中富裕老人的每一个痛点，具有浓郁的老钱风，一度成为高端定制坑。 干细胞疗法面临着伦理和成药挑战。胚胎干细胞（ESC)效果最佳，却需要破坏人类胚胎，存在伦理争议。诱导性多能干细胞（iPSC）的发现克服这一担忧，却面临着另一场伦理争议，其无限的分化能力有朝一日可能应用于人类克隆，并且在临床治疗中仍具有高风险，这些细胞经移植可能会诱导肿瘤形成。虽然间充质干细胞被普遍认为是安全的，在当前临床应用中最多，从组织中分离获得并在体外培养和扩增，具有增殖能力强、分化潜力广泛的优点，但其持续监测和长期随访将是未来研究重点，需观察、避免治疗后形成肿瘤。间充质干细胞规模化生产需要突破，供体单次取材难以满足大规模商业化生产需求，而不同供体来源的细胞存在生物特性差异，只有保证细胞批次间产量和质量的稳定性才有可能提高制剂生产效率，获得可重复的临床疗效。 缓慢的进步始终在发生，FDA也快要动心。Mesoblast今年以来股价已上涨353%。 今年7月23日，FDA接受Mesoblast公司细胞疗法remestemcel-L的生物制品许可申请重新提交，用于治疗类固醇难治性急性移植物抗宿主病（SR-aGVHD）儿童，如果获得批准，将成为美国首个同种异体现货型细胞疗法，早于通用CAR-T取得突破。 remestemcel-L是一种同种异基因间充质干细胞疗法，其细胞来源于无关供体的骨髓，通过抑制T细胞增殖，和下调促炎细胞因子和干扰素的产生，来调节T细胞介导的炎症反应。此前已公开的一项III期试验结果显示，患者接受治疗后第28天的客观缓解率（ORR）为69％，与45%历史控制率相比，有统计学意义的显著增加。在接受至少一次输注治疗且随访100天的患者中，患者的死亡率为22％，而接受初始类固醇治疗无效的患者第100天死亡率高达70%。 即使Mesoblast遇挫，后面还有大将福泰制药为干细胞疗法托底。 一名叫Amanda Smith的35岁护士患有1型糖尿病，一直依赖胰岛素维持生命。直到2023年情人节，她接受一项开创性干细胞疗法。医生将实验室中从胚胎干细胞中培养出来的替代胰岛细胞移植到为Amanda Smith的肝脏供血的血管中。到8月，她不再需要胰岛素了，新细胞正在大量生产胰岛素。 Amanda Smith接受的干细胞疗法，是福泰制药的VX-880，正向关键临床阶段迈进。 VX-880是一种研究性同种异体干细胞衍生、完全分化、产生胰岛素的胰岛细胞疗法，其Ⅰ/Ⅱ期临床试验数据显示，所有接受全剂量单次输注的12名患者在第90天时均展现出胰岛细胞移植成功及对葡萄糖有反应的胰岛素生成，均达到HbA1c水平低于7.0%的目标水平。并有超过70%的时间血糖值处于正常范围(70-180 mg/dL)，其中11位患者减少外源性胰岛素使用或完全停用。 VX-880临床试验中2名患者死亡，后经独立监督委员会审查数据并确定死亡与试验治疗无关，临床试验恢复。福泰制药还有VX-880的升级版，将与VX880相同的同种异体干细胞衍生的胰岛细胞封装在类似于“海蜇”的装置中，大小约为一枚硬币，可通过手术植入患者体内，且无需使用免疫抑制疗法。 现在轮到中国药企上场了。 2024年5月30日，北京市药监局核发全国第一张干细胞《药品生产许可证》，获得者正是铂生卓越，引起轰动，预示着合规干细胞药物即将进入产业化阶段。 6月，铂生卓越自主研发的艾米迈托赛注射液（人脐带间充质干细胞）上市申请获得受理，适应症为激素失败的急性移植物抗宿主病（aGVHD），有望成为全国首款干细胞新药。 国内临床II期后干细胞创新药研发情况（不完全统计） 02  群起撞线 在铂生卓越身后，还有3款干细胞创新药也即将撞线，分别来自爱萨尔生物（膝骨关节炎，III期）、麦迪森再生医学（移植物抗宿主病，III期）、赛比曼/ 西比曼（膝骨关节炎，III期），行业渐呈汹涌澎湃之势。 中源协和布局干细胞全产业链，参股公司牙髓干细胞药物有望成为大单品。 公司主导或参与的11个干细胞临床研究项目完成备案，全资子公司武汉光谷药业核心产品VUM02共开发8个适应症，为自研的冷冻保存型细胞制剂，是由经筛选的健康新生儿脐带组织通过体外分离、扩增、收获、冻存后制备的人脐带源间充质干/基质细胞（UC-MSC）新药，其中用于治疗特发性肺纤维化（IPF）2023年8月获得FDA授予的孤儿药资格认定。 参股的北京三有利和泽生物与首都医科大学共同申报的人牙髓间充质干细胞注射液治疗慢性牙周炎是国内首个获得IND 受理的干细胞新药，于2023年5月进入II期临床试验，目前已有受试者入组给药。 传统牙周炎治疗聚焦炎症控制，阻止或延缓疾病进程，难以获得满意的牙周组织再生，目前临床常用的植骨术依赖手术方式实施。国内外尚无与“人牙髓间充质干细胞注射液”局部注射治疗类似的非侵入式的牙周组织再生引导技术。 牙周炎发病率高，危害大，是导致成年人牙齿缺失的最主要原因。据民生证券测算，2023年我国中重度牙周炎患者约10087万人，三有利牙髓干细胞预计2027年获批上市销售，至少在2031年前享有市场独占期，2033年销售额有望达到约77亿元。 天士力引进的remestemcel-L暂停研究，是悲是喜？ 2018 年7月，天士力与前文所述干细胞明星Mesoblast签署MPC-150-IM（rexlemestrocel-L）产品开发商业化协议。2023 年1月，公司公告决定暂停rexlemestrocel-L研究工作，主要是在美国审评审批遇到波折，是否倒在黎明前的黑暗？然而，2024 年3月，FDA支持Rexlemestrocel-L用于终末期射血分数降低（ HFrEF ）和植入左心室辅助装置（ LVAD ）心衰患者的加速批准申请。 在前沿领域的创新需要坚持的勇气。 不过，天士力从东方医院引进的人脐带间充质干细胞注射液（B2278注射液），今年1月获批开展心衰适应症的临床试验。 国内骨关节适应症干细胞创新药研发情况 干细胞疗法围攻关节炎大适应症。 骨关节炎( osteoarthritis，OA) 是一种严重影响患者生活质量的关节退行性疾病，随着我国人口老龄化程度的不断加剧，OA的患病率有逐渐上升的趋势。据《中国骨关节炎诊疗指南（2021年版）》，我国40岁及以上人群不同年龄段原发性 OA 患病率分别为：30.1%（40~49 岁）、48.7%（50~59岁）、62.2%（60~69岁）和62.1%（70岁以上）；由此估算我国OA患病人数约有3.59 亿。 2021 年9月6日，发表于《The Knee》的一项荟萃分析通过对 79 项（包含 8761名膝骨关节炎患者）的随机对照临床试验进行系统总结证实：在长达一年的随访中，干细胞注射对膝骨关节炎患者的疼痛和功能有最大的改善作用，优于其他骨关节炎治疗方式。 我武生物子公司我武干细胞持续开展干细胞领域的研究开发，完成自研完全培养基、分化培养基（成脂、成骨、成软骨）的开发，相关培养基已应用于干细胞治疗骨关节炎项目中，正全力推进干细胞治疗药物的临床前研究。 Biotech进度更快，西比曼与爱萨尔两家均已开展III期临床。新三板上市公司赛莱拉人脐带间充质干细胞注射液治疗膝骨关节炎新药I 期临床试验完成首例患者给药。 针对缺血性脑卒中后偏瘫是新兴热点。 ST 九芝堂子公司北京美科同种异体骨髓间充质干细胞治疗缺血性脑卒中处于I/ II期临床。据医药魔方数据，国内另有5家公司也在布局缺血性卒中干细胞产品。 成药性在日本得到验证。由于脑细胞不可再生，针对慢性运动功能障碍及其他后遗症一直缺乏有效的治疗手段，2024年7月，SanBio 开发的AKUUGO在日本获批成为全球首款用于此适应症的同种异体间充质干细胞。 首家干细胞Biotech上市公司能成吗？ 泽辉生物向港交所递表，将申请主板挂牌上市。 核心产品ZH901处于临床II期阶段，是国内首个也是唯一一个源自hESC（人胚干细胞）的干细胞来源细胞治疗在研产品，为可用现货细胞制剂，且可于气相液氮中稳定保存至少3年。 如前文所述胚胎干细胞存在伦理争议。用于新hESC系来源的胚胎是在父母双方知情同意的情况下通过体外受精诊所获得。只有无法用于不孕治疗的多余胚胎才能用于获取hESC。然而，这种获取通常需要破坏子宫外胚胎，此举会引起伦理问题，在诸多国家为法律所禁止。 泽辉生物还折射出一级市场Biotech的现金流危机。 2023年末，泽辉生物的现金及现金等价物为1.67亿元，而到今年8月底，已降至0.67亿元，这意味着历轮融资累计获得的6.88亿元已快烧完。 在另外一面，泽辉生物计划10亿元建设中山工厂，预计2024年底开工，2026年下半年完成，年产能约为500000支细胞疗法产品注射液。 奇迹会发生吗？

PHILADELPHIA, July 31, 2024 /PRNewswire/ -- Mast cells are found throughout the body close to blood vessels and are packed with granules containing the immune signaling compound histamine, and enzymes that attack pathogens and promote white blood cell recruitment. When triggered by a perceived threat, mast cells expel their contents. This activity protects against infection and aids healing, but it has also made mast cells infamous for driving allergic asthma and inflammatory skin disorders, such as rosacea and contact dermatitis. Despite their prominence, few researchers study these scarce and difficult-to-work-with cells. Hydar Ali, a professor in the Department of Translational Sciences at Penn Dental Medicine, belongs to a select group who focus on mast cells. His research explores how they function to protect the body and how things can go wrong. "These cells are relatively poorly understood, and yet we've been able to identify some of the most sought-after molecular targets to affect diseases like allergies and asthma that have the potential to kill," Ali says. He and his colleagues discovered a receptor, known as MRGPRX2, that only appears on mast cells. This research led them to find that small proteins called antimicrobial peptides could activate mast cells through MRGPRX2 to harness their protective function and help clear pathogens. In the context of an allergic response, however, he has shown that this receptor drives problematic inflammation. "It's two sides of the same coin," Ali says. More recently, his team has investigated mast cells' role in systemic allergic reactions that can lead patients to stop using the multiple sclerosis drug glatiramer acetate. Their experiments demonstrated that this medication activates MRGPRX2 receptors causing mast cells to expel histamine and their other contents, results suggesting MRGPRX2 inhibitors could treat these reactions and help patients remain on the medication. His lab is also investigating this receptor's role in periodontal disease, an inflammatory condition that damages the gums and connective tissue of the mouth. Their experiments have shown, for example, that mast cells expressing MRGPRX2 become more abundant in chronic periodontitis, the more severe form of the condition. Ultimately, he hopes to study the potential for MRGPRX2 blockers to reduce inflammation in periodontitis. Media Contact: Beth Adams, [email protected] SOURCE PENN DENTAL MEDICINE

Matcha, a finely ground green tea powder, may help keep bacteria that causes periodontitis at bay. Periodontitis is an inflammatory gum disease driven by bacterial infection and left untreated it can lead to complications including tooth loss. The disease also been associated with diabetes mellitus, preterm birth, cardiovascular disease, rheumatoid arthritis and cancer. One of the chief bacterial culprits behind periodontitis is Porphyromonas gingivalis, which colonizes biofilms on tooth surfaces and proliferates in deep periodontal pockets. Matcha, a finely ground green tea powder, may help keep P. gingivalis at bay. This week in Microbiology Spectrum, an open-access ASM journal, researchers in Japan report that matcha inhibited the growth of P. gingivalis in lab experiments. In addition, in a clinical study involving 45 people with periodontitis, people who used matcha mouthwash showed significantly lower levels of P. gingivalis in saliva samples than at the start of the study. "Matcha may have clinical applicability for prevention and treatment of periodontitis," the authors noted in the paper. Camellia sinensis is a green tea plant that has long been studied for its potential antimicrobial effects against bacteria, fungi and viruses. A previous study on mice found that green tea extract can inhibit the growth of pathogens, including Escherichia coli. Other research has found that the extract can inhibit the growth of P. gingivalis and reduce its adherence to oral epithelial cells. In addition, observational studies have associated green tea consumption with better health. Matcha, which is used in traditional ceremonies and for flavoring in beverages and sweets, is made from raw leaves of C. sinensis. For the new study, researchers from the Nihon University School of Dentistry at Matsudo, the National Institute of Infectious Disease in Tokyo and other institutions carried out a series of in vitro experiments to test the efficacy of a matcha solution against 16 oral bacterial species, including 3 strains of P. gingivalis. The matcha mouthwash showed little activity against strains of commensal oral bacteria. Within 2 hours, nearly all the cultured P. gingivalis cells had been killed by the matcha extract, and after 4 hours of exposure, all the cells were dead. Those findings suggested a bactericidal activity against the pathogen. The researchers then recruited 45 people diagnosed with chronic periodontitis at the Nihon University Hospital School of Dentistry at Matsudo for a follow up clinical study. The patients were randomly assigned to 3 groups: One group received barley tea mouthwash, the second received the mouthwash made from matcha extract, and the third received mouthwash that included sodium azulene sulfonate hydrate, which is used to treat inflammation. Saliva samples were collected before and after the intervention and analyzed using PCR, and participants were instructed to rinse twice daily. The analysis revealed that patients in the group that used matcha mouthwash showed a significant reduction in the level of P. gingivalis. Patients in the other 2 groups did not show that same significant reduction. While the new study isn't the first to probe the antimicrobial effects of tea-derived compounds on P. Gingivalis, the researchers note that it does support the potential benefits of matcha as part of a treatment plan for people with periodontal disease.