AnGes, Inc.

作为生物制药的一大前沿，细胞疗法越来越受业界重视，也成为不少国家抢占的高地，日本就是这样的代表。 2012年，因发现诱导多能干细胞（iPSC）技术，日本京都大学教授山中伸弥获得诺贝尔奖。此后，日本政府开始积极在细胞治疗领域布局。 通过建立《再生医学促进法》《再生医学安全法》等特殊法规监管途径，十多年来，日本不遗余力地鼓励细胞疗法的开发和商业化，批准了许多产品。它们大部分是由日本公司推出的，但也包括来自欧美MNC的CAR-T疗法。 然而，由于某些产品的疗效缺乏可预测性，日本近期修改了该领域的法规，谨慎地缩小附条件批准范围，降低价格补贴。 商业探索喜忧参半，一些细胞产品已退出日本市场。对于其他国家，能从日本的处境看到多少自己的影子？ 1 18种获批细胞疗法 到目前为止，日本已经批准了18种细胞疗法，包括两款基于附条件批准框架的产品。 适应症分布上，用于治疗血液瘤的产品最多，共计6种。在神经、眼科、骨科等其他疾病领域，也都有疗法覆盖。 从地域看，12种疗法来自日本，占比近七成。其中，光是J-TEC就推出5种。2015年之前，J-TEC的Jace（自体培养表皮）和Jacc（自体培养软骨）是日本仅有的两款获批细胞产品。 改变日本细胞疗法产业环境的关键之年是2012年，山中伸弥因相关研究获得诺贝尔奖。此后，被视为具有广阔前景的iPSC领域，也开始受到日本政府层面的支持。 很多适应症都是在那之后获得批准的。最近一款上市产品，是由日本公司SanBio开发的同种异体间充质干细胞疗法Akuugo，用于改善与创伤性脑损伤相关的慢性运动性麻痹。7月底，Akuugo首次获得附条件批准。 2 安倍“十年战略” 2013年，时任日本首相安倍晋三在其经济政策中指出，政府应牵头推动创新医疗研发的全国性举措，并承诺到2022年这10年间，投资1100亿日元（约合7.53亿美元）支持再生医学发展。 到2014年，安倍政府通过内阁府推动《健康医疗战略推进法》出台，并于2015年成立了专门负责协调和支持国内药物研发项目（不仅仅是细胞疗法）的日本医学研究开发机构（AMED）。 AMED旨在通过横跨厚生劳动省（MHLW）、经济产业省（METI）以及文部科学省（MEXT）三个部门，架起政府、公司和学术机构的桥梁。 从2015年到2020年，AMED每年提供约140亿到160亿日元（约合0.97亿到1.11亿美元）用于支持国内药物研发，其中近一半（65亿日元）用于iPSC领域。 3 附条件批准框架 大约在安倍政府提供资金支持的同一时间，日本颁布了《再生医学促进法》，对《药品和医疗器械法案》进行修订，引入细胞和基因疗法等再生医学产品的附条件批准框架。 改革前，小分子药物等疗法必须经过昂贵且繁琐的三个阶段临床试验，才能获得日本药品和医疗器械管理局（PMDA）的批准。 为了缩短上市时间，该方案允许在若干条件下，提前批准已证实安全性和具备“潜在”疗效的疗法。之后，这些产品需要开展上市后的试验以确认疗效，并在附条件批准期内提交申请以获得全面批准。 Nature刊登的一篇文章介绍，基于这个框架，再生医学疗法开发商将不必按照阶段推进临床，而是在一项试验研究中证明疗效。如果变化足够显著，则一次试验中至少要有10名患者；如果改善幅度较小，则要有几百名患者。 2014年11月，PMDA在一份解释性文件中表示，对iPSC相关产品的高期望和解决潜在安全风险的监管方法是该方案的关键。 从2017年开始，附条件批准框架扩大到包括非再生创新药物。 4 分化的商业市场 得益于这些转变，监管部门自2015年以来越来越频繁地对细胞和基因疗法产品点头。然而，日本也不得不的面临随之而来的问题，例如，产品附条件批准后的疗效不及预期，日本国民健康保险（NHI）计划中的成本与效益平衡压力。 2015年，JCR Pharmaceuticals申报的同种异体骨髓源间充质干细胞（MSC）产品Temcell、Terumo申报的自体成骨肌源性细胞片产品HeartSheet，分别获得附条件批准。 Temcell基于2003年由Osiris Therapeutics授权的MSC技术开发，被批准用于移植物抗宿主病，这是一种发生在同种异体骨髓移植患者中的严重并发症。Temcell每次治疗价格约为1400万日元，并成为日本最成功的细胞疗法之一，在2023年创造32亿日元（2210万美元）的收入。 不过，HeartSheet就没那么幸运了。最初，HeartSheet获得治疗严重心力衰竭的5年有条件批准，但由于其适应症小等诸多限制，后来在上市后试验中招募患者时遇到困难。 附条件批准期延长至8年后，Terumo在2023年申请全面批准，但未能证明其有效性。最终，Terumo决定在今年将HeartSheet撤出市场。 另一个与之相似的案例，是日本公司Nipro开发的自体骨髓来源MSC产品Stemirac，附条件批准期间从2018年到2025年，用于改善与创伤性脊髓损伤相关的神经症状和功能障碍。 自COVID-19以来，Nipro在Stemirac商业化方面受阻。最近该公司表示，它的目标是在2025年申请全面批准，并扩大与医疗机构的合作，以获得收入。 5月，Nipro披露的最新财务报告说：“COVID-19的两年中，由于优先考虑重症患者，对Stemirac的管理一直很困难，其收入未能达到最初的预测。” 5 收窄加速通道 附条件批准框架施行十年后，今年3月，MHLW发布一项新指南，以说明如何通过上市后的研究计划来认定细胞疗法的有效性。 指南提到，药企和监管机构应事先明确附条件批准后所开展试验的适当性，应涉及病例数、开展试验的地点数、参数的客观性、病例的随机化、评价的盲法、对照组的建立等方面。为此，指南还提出了统计学上可推测有效性的参考基准。 MHLW此举的背景是，2020年到2023年，日本政府根据此前“十年战略”的框架，对未来的创新药品政策进行一系列讨论。 6月，因为附条件批准期限届满，AnGes撤回了日本首款基因疗法Collategene的制造和营销批准申请。随着Collategene、HeartSheet等几款产品证明其疗效的失败，MHLW认为，通过哪种类型的数据，并以怎样的准确性“推测”疗效，成为日本的关键挑战之一。 “重要的是要有某种指导方针来推定有条件批准的效力。”去年，MHLW在就这一问题撰写的最终报告里写道。 截至2024年，没有任何附条件批准的细胞治疗产品在日本成功获得全面批准。 6 国家医保“砍价” 日本细胞疗法开发商面临的另一个挑战是，NHI降低了报销价格。有几种产品由于价格昂贵，已根据成本效益评估（CEA）框架进行了审查。 CEA框架自2019年推出，旨在通过增加另一种价格评估选项，来“补充日本的药品定价体系”，帮助维持NHI报销费率内的财务平衡。CEA导致的最大降价幅度为15%。MHLW指出，如果产品在初始定价中获得的溢价低于25%，则降价幅度将限制在10%以内；如果溢价超过25%，则降幅最高不超过15%。 数种CAR-T细胞疗法——包括吉利德的Yescarta，BMS的Breyanzi和Abecma，诺华的Kymriah——已在日本获得了报销价格。 MHLW最初通过成本计算方法，在2019年将Kymriah的报销价格定为约3411.37万日元（约合23.43万美元）。这是在诺华的基因疗法Luxturna于2023年登陆日本市场前，在NHI获得的最高价格。 2021年，通过CEA审查，和安进的Blyncito、辉瑞的Besponsa等其他几种疗法进行比较后，MHLW将Kymriah的价格下调了4.3%，至3264.78万日元。该机构指出，Kymriah在首次定价时的生产成本缺乏透明度（低于50%）。 Yescarta、Breyanzi和Abecma预计也将在日本的CEA框架下接受审查。 7 本土尚有后来者 尽管监管立场日趋谨慎，日本目前还有其他细胞疗法处于临床开发当中。 Healios K.K.的同种异体骨髓来源的多能祖细胞候选药物HLCM051，目前正处于治疗急性呼吸窘迫综合征的III期研究。1月，在美国开展的另一项治疗缺血性卒中的III期项目中，HLCM051错过了主要终点。 另一家专注于CAR-T疗法的日本公司Noile-Immune，旗下NIB101、NIB102已处于I期临床，分别靶向GM2和GPC3。 2023年6月，Noile-Immune在本土IPO，但目前股价跌幅超过70%。 Noile-Immune遭遇了几次挫折，包括终止与武田就NIB102的研发合作。不过，该公司近期表示，它仍将继续推进NIB102。 参考资料： 1.Progress Or Hype? Looking At A Decade Of Cell Therapy In Japan；Pink Sheet 2.Japan to offer fast-track approval path for stem cell therapies；Nature 3.医薬品医療機器総合機構（PMDA）のウェブサイト；PMDA 4.BRIEF—Collategene sales rights deal terminated in Japan and the USA；Pharma Letter 5.Japan’s CEA Scheme: How It Works And Impact So Far；Pink Sheet 6.Cell Therapy HLCM051 Fails to Improve Stroke Outcomes Despite Safe Profile；NeurologyLive 同写意媒体矩阵，欢迎关注↓↓↓

Fast Track Designation underscores the high unmet medical need for treatment and prevention of acute respiratory distress syndrome (ARDS) TORONTO--(BUSINESS WIRE)-- Vasomune Therapeutics, Inc., has announced today that the US Food and Drug Administration (FDA) granted Fast Track designation for AV-001 for the prevention or treatment of moderate-to-severe ARDS in patients hospitalized with viral and/or bacterial respiratory infections. AV-001 is a first-in-class fully synthetic PEGylated peptide targeting the Tie2 receptor which plays a critical role in vascular stability, barrier integrity and endothelial quiescence, particularly within the pulmonary space. Fast track designation represents a significant regulatory milestone and has been granted based on the potential for AV-001 to address an unmet medical need in ARDS, a global disease characterized by extremely high mortality rates, reaching up to 46% in patients with severe cases. Data from the Phase 1 study established safety, a pharmacokinetic pro to once-daily dosing and Tie2 activation demonstrating strong on-target activity. With the co-development support of AnGes Inc., AV-001 is currently in a Phase 2a clinical trial for prevention and treatment of ARDS in pneumonia and is actively recruiting. “Vasomune is focused on the persisting unmet needs of people grappling with ARDS and other diseases driven by vascular endothelial instability,” said Dr. Brian Jahns, President and Chief Operating Officer. “Vasomune is indebted to the United States Department of Defense Congressionally Directed Medical Research Programs award #PR191212 for support to advance AV-001 to the clinic and award #PR203503 for support to research AV-001 in Phase 2a. Vasomune is also grateful to the National Research Council of Canada Industrial Research Assistance Program for providing research and development funding which supported the Phase 1 study.” Ei Yamada, President & CEO of AnGes, said that “The FDA’s support of expedited development marks another important milestone in our endeavor to change the treatment paradigm with AV-001. We look forward to future success with the Phase 2a study, AV001-004.” About AV-001 Originally discovered and designed at Sunnybrook Research Institute at Sunnybrook Hospital in Toronto, AV-001 is being developed by Vasomune Therapeutics, Inc. under a co-development agreement with AnGes, Inc. [TYO: 4563]. AV-001 is a novel investigational medicine that targets the Tie2 receptor, a transmembrane protein most highly expressed on the surface of endothelial cells in the vasculature. AV-001 activates the nonredundant Tie2-Angiopoietin signaling axis, and through stimulation of multiple downstream pathways normalizes the vasculature by enhancing endothelial cell stability, restoring normal barrier defense, and blocking vascular leak. Vascular dysfunction contributes to the underlying disease pathophysiology in patients with bacterial and viral acute respiratory distress syndrome, sepsis, hemorrhagic shock, acute kidney injury, stroke, and vascular dementia. Importantly, in multiple pre-clinical studies AV-001 tightened endothelial cell-cell junctions and promoted endothelial cell survival, which reduced pulmonary edema, and improved lung function compared to untreated controls translating into significantly improved survival. About Vasomune Therapeutics, Inc. Vasomune Therapeutics, Inc. is a private clinical-stage biopharmaceutical company developing the next generation of medicines to harness the body’s ability to defend against illness. Founded in 2014, Vasomune has focused on vascular normalization strategies, and has progressed the lead candidate AV-001 from bench to bedside. Vascular dysfunction is associated with the pathology of several disease states, including bacterial and viral acute respiratory distress syndrome, sepsis, hemorrhagic shock, acute kidney injury, stroke, and vascular dementia. Vasomune’s corporate headquarters and laboratories are located in Toronto, Canada with US offices in Raleigh, NC. For more information about the company please visit . About AnGes, Inc. AnGes, Inc., a biopharmaceutical company founded in December 1999, focuses on the development of gene-based medicines. In March 2019, AnGes obtained conditional and time-limited approval for its lead product, Collategene® (Hepatocyte Growth Factor; HGF—plasmid gene therapy), for the treatment of lower limb ischemic ulcers. In September 2019, AnGes commenced commercialization in Japan of Collategene®, the world’s first marketed drug using plasmid DNA. AnGes is currently working on the development of a Tie2 tyrosine kinase receptor agonist (AV-001) for COVID-19, viral and bacterial-associated pneumonia and an NF-κB decoy oligonucleotide for chronic discogenic lumbar back pain. Furthermore, AnGes acquired EmendoBio in December 2020 to expand its capabilities in genome-editing technologies. For more information, visit .

Late-Breaking scientific poster at the American Thoracic Society Clinical and Scientific sessions will present Vasomune’s Phase 1 safety, and pharmacokinetic and pharmacodynamic data for AV-001 TORONTO--(BUSINESS WIRE)-- Vasomune Therapeutics Inc., a clinical-stage biopharmaceutical company focused on the development of AV-001 for the treatment of diseases associated with vascular dysfunction, today announced that the Company will present a Late-Breaking scientific poster at the upcoming 2024 American Thoracic Society (ATS) International Conference taking place May 17-22, 2024, at the Manchester Grand Hyatt, San Diego, CA. Vasomune’s lead drug candidate AV-001, codeveloped with AnGes Inc, is a first-in-class fully synthetic PEGylated peptide targeting the Tie2 receptor. Activation of the Tie2 receptor plays a critical role in promoting vascular stability, barrier integrity and endothelial quiescence. Activation of the Tie2 receptor by AV-001 has demonstrated therapeutic potential for the treatment of pneumonia and acute respiratory distress syndrome resulting from infection by SARS-CoV-2 or other viral or bacterial pathogens. AV-001 is currently being researched in NCT05123755, a Phase 2a study for patients hospitalized with pneumonia. “Peer-reviewed presentation of our Phase 1 development data is an important landmark in our development efforts for AV-001” said Dr. Brian E. Jahns, President and Chief Operating Officer. “Vasomune is grateful to the National Research Council Canada for grant #IRAP-965762 which supported the Phase 1 study. Vasomune is also indebted to the United States Department of Defense Congressionally Directed Medical Research Programs award #PR191212 for support to advance AV-001 into the clinic.” Ei Yamada, President & CEO of AnGes, said that “Our Phase 1 trial, NCT04737486, demonstrates that the safety, pharmacokinetics, and pharmacodynamics of AV-001 support further development. We look forward to future success with AV-001.” Clinical and Scientific Sessions Date: May 21, 2024 Presentation Time: 11:30 AM – 1:15 PM PT Session (C40): ARDS and Acute Respiratory Failure: Mechanism, Risk and Outcomes Poster: 14798 - A Randomized, Double‑Blind, Placebo‑Controlled Phase 1 Single and Multiple‑Dose Pharmacokinetic First‑In‑Human Study of AV‑001 in Healthy Subjects for the Treatment of Acute Respiratory Distress Syndrome A copy of the presentation materials can be accessed by visiting after the conclusion of the ATS Conference. About AV-001 Originally discovered and designed at Sunnybrook Research Institute at Sunnybrook Hospital in Toronto, AV-001 is being developed by Vasomune Therapeutics, Inc. under a co-development agreement with AnGes, Inc. [TYO: 4563]. AV-001 is a novel investigational medicine that targets the Tie2 receptor, a transmembrane protein most highly expressed on the surface of endothelial cells in the vasculature. AV-001 activates the nonredundant Tie2-Angiopoietin signaling axis, and through stimulation of multiple downstream pathways normalizes the vasculature by enhancing endothelial cell stability, restoring normal barrier defense, and blocking vascular leak. Vascular dysfunction contributes to the underlying disease pathophysiology in patients with bacterial and viral acute respiratory distress syndrome, sepsis, hemorrhagic shock, acute kidney injury, stroke, and vascular dementia. Importantly, in multiple pre-clinical studies AV-001 tightened endothelial cell-cell junctions and promoted endothelial cell survival, which reduced pulmonary edema, and improved lung function compared to untreated controls translating into significantly improved survival. About Vasomune Therapeutics, Inc. Vasomune Therapeutics, Inc. is a private clinical-stage biopharmaceutical company developing the next generation of medicines to harness the body’s ability to defend against illness. Founded in 2014, Vasomune has focused on vascular normalization strategies, and has progressed the lead candidate AV-001 from bench to bedside. Vascular dysfunction is associated with the pathology of several disease states, including bacterial and viral acute respiratory distress syndrome, sepsis, hemorrhagic shock, acute kidney injury, stroke, and vascular dementia. Vasomune’s corporate headquarters and laboratories are in Toronto, Canada with US offices in Raleigh, NC. For more information about the company please visit . About AnGes, Inc. AnGes, Inc., a biopharmaceutical company founded in December 1999, focuses on the development of gene-based medicines. In March 2019, AnGes obtained conditional and time-limited approval for its lead product, Collategene® (Hepatocyte Growth Factor; HGF—plasmid gene therapy), for the treatment of lower limb ischemic ulcers. In September 2019, AnGes commenced commercialization in Japan of Collategene®, the world’s first marketed drug using plasmid DNA. AnGes is currently working on the development of a Tie2 tyrosine kinase receptor agonist (AV-001) for COVID-19, viral and bacterial-associated pneumonia and an NF-κB decoy oligonucleotide for chronic discogenic lumbar back pain. Furthermore, AnGes acquired EmendoBio in December 2020 to expand its capabilities in genome-editing technologies. For more information, visit .