Rarecast

Many people living with a rare and undiagnosed disease face a prolonged diagnostic odyssey that can be financially and emotionally taxing as they seek to put a name to what ails them. Co-founder and executive director of the Rare and Undiagnosed Network Gina Szajnuk and Co-founder and acting executive director of the Undiagnosed Diseases Network Foundation Cristina Might, both know what the search for a diagnosis is like and are working to help people find answers faster. Ahead of Undiagnosed Rare Disease Day April 29, we spoke to Szajnuk and Might about their own diagnostic odysseys, efforts to speed the path to a diagnosis, and the upcoming Undiagnosed Rare Disease Day.

One of the challenges of delivering enzyme replacement and other therapies to treat rare diseases is the questions of how to best deliver them. EryDel is developing therapies that can be encapsultated in a patient’s red blood cells through its proprietary, point-of-care device. We spoke to Luca Benatti, CEO of EryDel, about the company’s technology for encapsulating medicines in red blood cells, its pipeline of rare disease therapies, and the advantages delivering treatments this way.

Mary Mecham, a mother of two children with rare genetic disorders to whom she reads every day, grew frustrated by the lack of books that had characters who resembled her children. She began to search for stories that featured people with disabilities and met authors with disabilities who wrote about their own struggles. To share these works, she created Disability Book Week, which runs from April 23 to 29. We spoke to Brianna TenBrink, autism advocate and Disability Book Week panelist, about the portrayal of people with disabilities in literature, how that’s changing, and some good reads to consider for anyone interested in participating.

When Julia Vitarello learned that her daughter Mila had the CLN7 form of the deadly, neurodegenerative condition Batten disease, it set her off on a search for a treatment that resulted in the development of a customized antisense oligonucleotide. In the wake of Mila’s case, a movement has emerged to develop so-called N-of-1 therapies for people with ultra-rare conditions. Vitarello, along with Boston Children's Hospital researcher Timothy Yu, who developed the ASO to treat Mila, has co-founded the N=1 Collaborative, an international group seeking to enable the development of N-of-1 therapies to treat the thousands of patients in need. We spoke to Vitarello, CEO of Mila’s Miracle Foundation and co-founder of the N=1 Collaborative, about the new organization, the issues it is trying to address, and what it would take to take enable the development of individualized therapies broadly for patients with ultra-rare disease.

Recessive dystrophic epidermolysis bullosa is a rare, genetic, progressive condition caused by the deficiency of collagen type VII. People with severe cases of the condition suffer from blistering, vision loss, disfigurement, and other serious medical problems. Castle Creek Biosciences is developing a therapy that involves genetically modifying a patient’s own fibroblasts—the cells in the connective tissue—to get them to produce collagen VII. The modified cells are injected where needed and can be dosed repeatedly. We spoke to Matthew Gantz, president and CEO of Castle Creek, about the company’s experimental therapy for RDEB, how it works, and how the company is building out its pipeline through dealmaking.

Aristea Therapeutics was spun out of AstraZeneca to develop medicines for rare, immunologic disorders. Its lead program in development is an experimental therapy for a rare skin condition that causes repeated outbreaks of painful pustules on the hands and feet and is being looked at for other neutrophil-mediated diseases. We spoke to James Mackay, president and CEO of Aristea, about the decision to form the company, its lead therapy in development, and its collaboration and development deal with Arena Pharmaceuticals that gives its partner an option to acquire it outright. 

RNA interference offers the potential disrupt the translation of instructions from genes with mutations into proteins that drive diseases. Silence Therapeutics is developing a pipeline of therapies based on its mRNAi Gold platform that allows it to target short interfering RNAs to liver cells. We spoke to Mark Rothera, who at the time served as CEO of Silence Therapeutics and Giles Campion, Silence’s chief medical officer and head of R&D, about the company’s platform technology, why it can be used to target a broad range of genetic diseases, and the company’s programs in development. Since recording this podcast, Rothera stepped down as CEO and the company named Craig Tooman, who had served as CFO of the company since January 2021, as its new president and CEO.

While advances have been made in the treatment of the rare blood cancer multiple myeloma, fundamental questions about how to optimize therapies for individual patients remain. The Multiple Myeloma Research Foundation launched CureCloud, an initiative to gather detailed genomic and health data from thousands of patients to both bring a precision medicine approach to the treatment of multiple myeloma and fuel the development of new breakthroughs. We spoke to Michael Andreini, president and CEO of the Multiple Myeloma Research Foundation, about the CureCloud initiative, the patient data it is gathering, and the potential to transform the treatment of multiple myeloma with precision medicine.

Carli Hamilton was diagnosed at age 2 with the degenerative neuromuscular disease spinal muscular atrophy. Though she wanted to be a mother once she got married, she feared passing the disease onto a child. She and her husband had genetic counseling to see if he was a carrier, but when her best friend became pregnant and told her that it was the hardest thing she had ever done and didn’t think Hamilton would be able to do it, she and her husband figured they would adopt. Nevertheless, Hamilton soon learned she was pregnant and today her daughter is 2. Hamilton, who has chronicled her pregnancy and motherhood on Instagram, discussed what pregnancy was like, how she handles the physical demands of motherhood, and what advice she would offer other SMA patients thinking of becoming pregnant.

The authors of four separate studies on the economic burden of rare diseases recently collaborated on piece in Health Affairs calling for concrete steps to address gaps in data that make it difficult to track rare diseases in the healthcare system. Though the authors came to similar conclusions in their reports, they were also stymied by existing data constraints, such as a lack of codes for rare diseases, differing data structures of electronic health records, and missed opportunities to gather data through public health surveys. We spoke to Joni Rutter, acting director of the National Center for Advancing Translational Sciences; and Annie Kennedy, chief of policy and advocacy for the Everylife Foundation for Rare Diseases, about the economic burden of rare diseases, the data constraints that limit a complete understanding of the impact they have, and what steps can be taken to improve the availability of patient data.

Rare Disease Week on Capitol Hill brings together rare disease community members from across the country to learn about federal legislative issues, meet other advocates, and share their stories with legislators. Because of ongoing concerns about the pandemic, this year’s event will be conducted virtually. We spoke to Britta Dornan, senior director of communications and marketing for the EveryLife Foundation and Sarah Tompkins, advocacy chair of Rare Disease Week on Capitol Hill 2022, about this year’s event, why rare disease patients should consider getting involved in legislative advocacy, and how rare disease patients and caregivers can best tell their stories to lawmakers.

One of the challenges various healthcare stakeholders face is making decisions based on limited and lagging data about the changing landscape. Komodo Health has collected a broad range of real-world data that allows it to capture a comprehensive view of patients moving through the healthcare system along with next-generation analytics to derive meaningful insights and drive decisions that improve patient outcomes. The company recently announced that it had entered into an agreement with the Chan Zuckerberg Initiative’s Rare As One network to provide software and analytic tools to help patient advocacy organizations in the network accelerate diagnoses, improve care, and advance research. We spoke to Web Sun, co-founder and president of Komodo Health, its platform technology, its potential to improve decision-making in the healthcare arena, and how members of CZI’s Rare As One network will be able to leverage its real-word data and analytic tools.

When Carly Flumer was 27 and working on her master’s degree in healthcare communication, she was diagnosed with thyroid cancer. Though she was successfully treated for the cancer, she now must live with the consequences of having had her thyroid removed, which requires lifelong care and treatment. The experience turned Flumer into a patient advocate as she has sought to share her story with others. We spoke to Flumer about her cancer journey, her experience in dealing with physicians who often spoke to her in terms she didn’t understand, and what she’d like other rare disease patients to learn from her experience.

Mammoth Biosciences is developing next-generation CRISPR products using alternatives to the Cas9 enzyme to read and write genetic code. The company, co-founded by Nobel laureate and CRISPR co-inventor Jennifer Doudna, is applying the technology broadly beyond therapeutics to include not only diagnostics, but agriculture, environmental monitoring, and biodefense. We spoke Trevor Martin, co-founder and CEO of Mammoth Biosciences, about the use of CRISPR as a diagnostic tool, the advantages alternatives to Cas9 may offer, and the company’s recently announced alliance with Vertex. Since recording this interview, Mammoth entered into a strategic collaboration with Bayer to use its CRISPR systems to develop in-vivo gene-editing therapies. That deal includes a $40 million upfront payment and more than $1 billion in potential milestones.

Antibody oligonucleotide conjugates are a new class of therapies that Avidity Biosciences is developing. These therapies combine the specificity of monoclonal antibodies with the precision of oligonucleotides. The company says by marrying these technologies together it is able to deliver RNA therapies to previously inaccessible tissue and cell types and more effectively target the underlying genetic drivers of diseases. The company is focused initially on muscle diseases but expects to expand out from there. We spoke to Sarah Boyce, CEO of Avidity Biosciences, about its antibody oligonucleotide conjugate platform, how its AOCs can deliver RNA therapies to tissue and cell types that were previously inaccessible, and it lead program in myotonic dystrophy type 1.

Illumina and the global nonprofit Genetic Alliance late last year unveiled the iHope Genetic Health program, which is aimed at providing whole-genome sequencing to patients across the globe impacted by genetic disease. At least half of iHope Genetic Health’s efforts will be focused on areas of the world in need outside the United States with more than one-third of Illumina’s support being dedicated to patients in Africa. Through the program, Illumina will enable Genetic Alliance to create networks of clinics, and laboratories equipped with the necessary genome technology to provide precision genomic diagnoses to patients suffering from rare genetic disease. We spoke to Ryan Taft, vice president of scientific research for Illumina, about the growing case for expanded use of genome sequencing as a diagnostic tool, the iHope Genetic Health program, and its efforts to expand use of the technology in low- and middle-income communities around the globe.

Primary biliary cholangitis is a rare, chronic, progressive, autoimmune disease of the liver. People with the condition suffer from inflammation, destruction of the intrahepatic bile ducts, and accumulate toxic bile acids that cause damage over time. The condition can lead to fibrosis, cirrhosis, and liver failure. CymaBay Therapeutics is developing an experimental therapy, Seladelpar, as a treatment for PBC. We spoke to Sujal Shah, president and CEO of CymaBay Therapeutics about PBC, Seladelpar, and why this first-in-class therapy has promise to address this condition with high unmet needs. 

Most endocrinologists focus on the level of corticosteroids circulating in the bloodstream when treating conditions like the rare endocrine disorder Cushing syndrome. Sparrow Pharmaceuticals believes it is active intracellular steroids that are primarily responsible for causing toxicity in patients. It is developing therapies that target HSD-1, the key regulator of active intracellular steroids. We spoke to David Katz, founder and chief scientific officer of Sparrow Pharmaceuticals, about the company’s efforts to develop new approach to treating Cushing syndrome, how it works, and why this has the potential to address the unmet needs of patients with endogenous Cushing syndrome.

The advent of noninvasive prenatal testing allow for the use of a simple blood draw from a pregnant woman to tests fetal DNA for genetic conditions. As with liquid biopsies, these test rely on capturing cell-free DNA from the fetus circulating in the mother’s blood. We spoke to Paul Billings, chief medical officer for Natera, about the state of non-invasive prenatal testing, the growing use of these tests, and the range of conditions they can detect. 

The growing concerns about equity, diversity, and inclusion has had particular resonance in the area of rare disease, where health disparities have been felt throughout the community. Eve Dryer, vice president of patient advocacy for Travere Therapeutics, has been involved in a number of efforts to address these issues and her company has played a critical role in funding initiatives to address health disparities that result from racial and socioeconomic drivers. On the heels of the recently completed Global Genes 2021 RARE Health Equity Summit, we spoke to Dryer about why Travere has focused on these issues, the work it is doing, and why it is such a critical issue for the rare disease community.