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Animal drug could be repurposed to help osteoarthritis sufferers

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Millions of osteoarthritis sufferers across the world could soon benefit from a pain relief drug currently used to treat joint issues in horses, cats, dogs and even racing camels.

Australian late-stage clinical development company Paradigm Biopharma is investigating injectable pentosan polysulfate sodium (iPPS) as a potential disease-modifying treatment for knee osteoarthritis (KOA).

The plant-derived, semi-synthetic drug has been used in the veterinary space for over 80 years to improve joint health and preserve cartilage integrity. It is registered for use by vets in more than 20 countries.

Until now, pentosan polysulfate sodium has only been used in humans over the age of 16 to treat blood clots and the discomfort or bladder pain associated with interstitial cystitis.

However, a number of current and former Australian Football League (AFL) players have been using Paradigm’s iPPS under a Special Access Scheme (SAS). This is a programme set up by the Therapeutic Goods Administration (TGA) for doctors to prescribe medications that are not listed on the Australian Register of Therapeutic Goods (ARTG).

After being repurposed and provided via subcutaneous injections in various trials, Paradigm has said the drug’s capabilities are proving to be more applicable in treating osteoarthritis, caused by the breakdown of cartilage in joints.

Now the company aims to bring hope to the estimated half a billion osteoarthritis sufferers around the world – 70% of whom are affected by the degenerative joint disease in the hip or knee.

There are currently no disease-modifying osteoarthritis drugs approved for the treatment of KOA. Instead non-steroidal anti-inflammatory drugs, analgesics and glucocorticoid injections are commonly prescribed for treatment.

But each of these drugs only deal with the symptoms, leaving the underlying degenerative problems untreated.

With osteoarthritis expected to become the single greatest cause of disability globally by 2030, there is a considerable unmet medical need for a disease-modifying drug.

Paradigm, which has its head office in Melbourne, Victoria, is focused on improving patients’ health and quality of life through the development of known therapeutics to address unmet medical needs in conditions where sustained inflammation is present.

People with osteoarthritis need alternative therapeutic solutions, as the current treatments often don’t provide sufficient relief, leaving them in pain and with a reduced quality of life.

Former Geelong, Sydney Swans’ and Carlton AFL player, Greg ‘Diesel’ Williams, 59, understands only too well how knee OA can have a devastating impact on your life.

Greg, who played AFL for 14 years during the 1980s and 1990s and is a dual Brownlow Medal winner who at his peak was the then-highest-paid player in the history of the sport, suffers with severe knee OA. A one-time world class athlete, he now can’t run, and has difficulty walking.

He explained: “If you’ve got OA people really don’t understand what we’re going through. It’s so painful. It’s so sore. It’s so, so hard to put up with. And it’s about time we did something about it.”

He has tried all kinds of medication, and spoken with the best surgeons, but is still in severe pain with KOA. He added: “If I could find a solution that’s medical, not surgical, yeah, I’d be going for that 100mph.”

As yet he doesn’t want to go down the path of having a knee replacement. “I may have stopped playing, but I don’t want to stop living,” he said.

Dr Philip Bloom, a specialist sports physician with over 20 years’ experience and specialist training in treating and managing musculoskeletal injuries and diseases to maximise function, explained: “Osteoarthritis of the knee is not just an isolated pain in the knee. It has a trickle-down effect on the rest of your life, particularly in regards to losing the ability to be active, which causes obesity, more aches and pains in other joints, and also psychological problems such as depression and anxiety.”

Whilst anyone can get osteoarthritis, most cases affect adults over the age of 45 and it is a major cause of disability in people aged 65 and over. Women are more likely than men to suffer from the condition – often referred to as ‘wear and tear’ arthritis – especially after the age of 50.

Results from a six-month long phase 2 trial run by Paradigm Biopharma have already shown that iPPS may slow the progression of KOA.

The exploratory 61-patient phase 2 randomised, double blind, placebo-controlled trial for synovial biomarkers in knee osteoarthritis showed changes consistent with disease modifying efficacy in subjects with moderate to severe osteoarthritis. Seventy eight per cent of subjects had moderate to severe osteoarthritis of the knee.

The six-month data indicated disease modifying potential for the drug in KOA based on less cartilage loss, as measured by MRI, in the iPPS group compared to those on placebo. MRIs of the placebo group cartilage showed an increase in its loss.

Levels of synovial biomarkers of cartilage and aggrecan disintegration were down at six months in the iPPS group. The same biomarkers increased in the placebo group.

Statistically significant reductions in bone marrow lesions, measured by MRI, were seen compared to placebo, with a trend towards reduced marginal osteophytes (bone spurs) compared to an increase in the placebo group.

Paradigm is now undertaking a comprehensive global phase 3 clinical trial designed to maximise the potential of iPPS, which it will market under the name Zilosul.

To this end the company has launched a clinical trial website to facilitate current and potential trial participants and support its development programme for KOA therapy called Hope4OA.com.

Here people living in either Australia or the US, can put their name forward as a potential trial participant, and find the answers to commonly asked KOA questions alongside patient support.

Wellness

Study reveals link between cheese and dementia

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A 25-year Swedish study links higher cheese intake to lower Alzheimer’s risk in people without known genetic risk, with cream also tied to lower dementia risk.

However, researchers emphasise that the results should be interpreted with caution.

The study tracked 27,670 people over 25 years.

During that time, 3,208 participants were diagnosed with dementia.

Among individuals without a known genetic risk for Alzheimer’s disease, those who consumed more than 50 grams of full-fat cheese per day showed a 13 to 17 per cent lower risk of developing Alzheimer’s.

This association did not appear in participants who carried genetic risk factors for the disease.

People who consumed more than 20 grams of full-fat cream per day also showed a lower risk of dementia overall, ranging from 16 to 24 per cent.

No meaningful links were found for low-fat or high-fat milk, fermented or non-fermented milk, or low-fat cream.

The results stand out because public health guidance has long encouraged people to choose low-fat dairy to protect heart health.

This connection matters because cardiovascular disease (conditions affecting the heart and blood vessels) and dementia share many underlying risk factors, including high blood pressure, diabetes and obesity.

When evidence from previous studies is combined, analyses suggest that cheese consumption may also be linked to a lower risk of heart disease, and that full-fat dairy does not necessarily increase cardiovascular risk.

Several other studies have explored whether similar patterns apply to brain health, but the results are mixed.

Evidence overall suggests that studies conducted in Asian populations are more likely to report benefits of dairy consumption for cognitive health (the ability to think, remember and reason), while many European studies do not.

One possible explanation is that average dairy intake tends to be much lower in Asian countries, meaning modest consumption may have different effects than higher intakes.

For example, one Japanese study reported a reduced dementia risk among people who ate cheese, but overall consumption levels were very low and the research was sponsored by a cheese producer.

In contrast, another Japanese study funded by government grants found no protective effect of cheese.

Some long-term European studies have also reported benefits.

In a Finnish study of 2,497 middle-aged men followed for 22 years, cheese was the only food associated with a lower dementia risk, reduced by 28 per cent.

Other dietary factors also appear to matter.

Higher consumption of milk and processed red meat was associated with worse performance on cognitive tests, while fish intake was linked to better results.

A large study in the UK that followed nearly 250,000 people found lower dementia risk among those who ate fish two to four times a week, fruit daily and cheese once a week.

However, these studies have important limitations.

What people eat is usually self-reported, and changes in memory can affect both eating habits and how accurately people remember what they have eaten. To deal with this, the Swedish researchers took two extra steps.

First, they excluded anyone who already had dementia when the study began.

Then they repeated the same calculations after removing people who went on to develop dementia within the first ten years of the study.

This did not mean starting the study again or recruiting new participants. It simply meant re-checking the results using a smaller group of people who remained dementia-free for longer.

The reason for doing this is that the early stages of dementia can subtly change behaviour long before diagnosis.

People may eat differently, lose appetite or struggle to recall their usual diet. By focusing on participants who stayed cognitively healthy for many years, the researchers reduced the chance that these early changes were influencing the results.

Another important question is whether substitution played a role.

Some of the apparent benefits may reflect replacing red or processed meat with cheese or cream, rather than an effect of dairy itself.

Supporting this idea, the Swedish study found no association between full-fat dairy and dementia risk among participants whose diets remained stable over five years.

Most importantly, foods should not be considered in isolation.

Dietary patterns matter more than individual ingredients. Diets such as the Mediterranean diet, which is consistently associated with lower risks of both dementia and heart disease, include cheese alongside vegetables, fish, whole grains and fruit.

In the Swedish study, people who consumed more full-fat cheese and cream were also more educated, less likely to be overweight and had lower rates of conditions linked to dementia, including heart disease, stroke, high blood pressure and diabetes.

All of these factors independently reduce dementia risk.

This suggests that higher cheese intake tended to occur within healthier overall lifestyles, rather than alongside excess calorie consumption or poor metabolic health.

Overall, the evidence does not support the idea that full-fat dairy causes dementia, nor that fermented milk products reliably protect against it.

Full-fat cheese contains several nutrients relevant to brain health, including fat-soluble vitamins A, D and K2, as well as vitamin B12, folate, iodine, zinc and selenium.

These nutrients play roles in neurological function and may help support cognitive health.

That said, the data do not justify eating large amounts of cheese or cream as protective foods against dementia or heart disease.

The most consistent message remains that balanced diets, moderation and overall lifestyle matter far more than any single item on the cheese board.

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New obesity and diabetes drug set for Boots clinical trial

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Boots will run an obesity drug trial for a new type 2 diabetes medicine at selected stores in England, the chain has revealed.

Boots has partnered with Civia Health to set up clinical research sites at four stores in Nottingham, Brighton, Peterborough and Birmingham, connecting communities to local research opportunities for obesity, diabetes and cardiovascular conditions.

Marc Donovan is director of healthcare development at Boots.

He said: “Clinical research plays a vital role in the development of new treatments and therapies, and we are proud to support increased clinical research participation to drive better health outcomes for all.”

The company said this is the first time dedicated clinical research units have been set up in high street pharmacies, enabling people to take part in convenient locations.

Boots said the first study to be conducted by Civia Health at its stores is a Phase 3 trial, a late-stage study that tests safety and effectiveness before approval, focused on a new obesity and type 2 diabetes medicine.

Customers at Boots stores will be able to join Civia Health’s longitudinal health registry, Thrive, which tracks participants’ health over time, and access free health screenings.

The screenings will include measurements such as height, weight, blood pressure and blood tests to help people understand their health and identify studies for which they may be eligible.

Civia will deploy its clinical teams, technology and operational standards to the participating Boots stores to screen and enrol participants, bringing research capability to the high street and providing convenient locations for study appointments.

As part of the partnership, Boots will also provide details of research opportunities to its customers to support recruitment.

Mark Campbell, chief executive of Civia Health, said: “For too long, clinical research sites have been in out-of-town and hard-to-find locations that can feel unfamiliar.

“Instead of relying on the small number of people who actively seek out studies, we’re bringing research to a broader, more diverse group – people who might benefit but would never have found us otherwise.”

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New study links Alzheimer’s memory loss to disrupted brain “replay” during rest

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Memory problems in Alzheimer’s may be linked to disrupted brain replay during rest, new research suggests.

The study, conducted in mice, points to a disrupted brain process that normally helps strengthen and preserve memories.

Researchers say the findings could inform future drugs that target this malfunctioning process and guide tools for earlier detection.

Scientists at University College London (UCL) found that replay events occurred as often in mice with amyloid plaques (protein deposits linked to Alzheimer’s) as in healthy mice, but the underlying patterns were no longer organised.

Instead of reinforcing memories, the coordinated activity of place cells became scrambled.

Dr Sarah Shipley, co-lead author from UCL Cell and Developmental Biology, said: “Alzheimer’s disease is caused by the build-up of harmful proteins and plaques in the brain, leading to symptoms such as memory loss and impaired navigation, but it’s not well understood exactly how these plaques disrupt normal brain processes.

“We wanted to understand how the function of brain cells changes as the disease develops, to identify what’s driving these symptoms.

“When we rest, our brains normally replay recent experiences, this is thought to be key to how memories are formed and maintained.

“We found this replay process is disrupted in mice engineered to develop the amyloid plaques characteristic of Alzheimer’s, and this disruption is associated with how badly animals perform on memory tasks.”

This replay activity takes place in the hippocampus, a region essential for learning and memory. During rest, specific neurons known as place cells activate in rapid sequences that mirror recent experiences.

Place cells, discovered by Nobel Prize-winning UCL neuroscientist Professor John O’Keefe, are neurons that correspond to particular locations.

As a person or animal moves through a space, different place cells fire in sequence. Later, during rest, those same cells typically reactivate in the same order, helping the brain store the experience as a memory.

To study this process, researchers tested how mice performed in a simple maze while recording brain activity at the same time.

Using specialised electrodes, they monitored roughly 100 individual place cells simultaneously as the animals explored and then rested.

This approach allowed the team to compare normal replay patterns with those seen in mice that had developed amyloid pathology associated with Alzheimer’s disease.

The researchers also observed that place cells in affected mice grew less stable over time. Individual neurons stopped reliably representing the same locations, especially after rest periods, which are normally when replay should strengthen memory signals.

These changes had clear behavioural effects.

Mice with disrupted replay performed worse in the maze, frequently revisiting paths they had already explored and appearing unable to remember where they had been.

Professor Caswell Barry, co-lead author from UCL Cell and Developmental Biology, said: “We’ve uncovered a breakdown in how the brain consolidates memories, visible at the level of individual neurons.

“What’s striking is that replay events still occur, but they’ve lost their normal structure. It’s not that the brain stops trying to consolidate memories, the process itself has gone wrong.”

Professor Barry added that the findings may help researchers identify Alzheimer’s earlier or develop treatments that focus on restoring normal replay activity.

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