This blog is in response to a note I received this week from a shareholder. I thought it would be useful to post my reply.
'Dear Prof. Kelly
I was reading this article from the Wall Street Journal .....
....and was wondering how Veyonda would fit into this picture.'
I read the WSJ article too and found it thoughtful. It certainly goes to the heart of what Noxopharm is hoping to do with Veyonda in the current pandemic.
I am not an infective diseases specialist or an epidemiologist. But I listen to people who are. So please accept this response with that proviso.
It seems to me our faith in our world returning to normal soon on the back of the vaccine roll-out might be overly optimistic. We face two massive problems: the sheer logistics of a global vaccination program designed to achieve a global level of herd immunity in a short timeframe and the high rate that new strains of SARS-Cov-2 are emerging, some of which, such as the Brazilian strain, are reportedly showing resistance to current vaccines. The two are connected because the longer it takes to achieve global herd immunity, the more likely we are to see more mutant strains emerge.
This suggests to me that this pandemic is going to be with us for many years. In fact, I personally see a strong parallel with the influenza virus situation, where that virus undergoes seasonal mutations, so-called ‘seasonal drift’, necessitating vaccines against new strains each year. This means that we are always barely ahead of the virus, but even with that slight advantage, hundreds of thousands of people still continue to die worldwide each year of septic shock from influenza infection. With COVID-19 having a much higher death rate than influenza virus, we are potentially looking at high rates of morbidity and mortality that will put many health services under pressure for years.
Vaccines are only going to do so much, and the WSJ article was asking what else we can do to ameliorate that pressure on health services from the inevitable millions of people who will fall through the vaccine cracks each year.
Better vaccines and better anti-viral drugs will help enormously. There are plenty of people working on both approaches and the world can only wish them well.
In the meantime …
At Noxopharm, we are focusing on what is the single largest cause of hospitalisation and death in the current pandemic, and that cause is the bizarre way some individuals’ immune system responds to the damage occurring in the lungs. For the great majority of people, that damage can leave them feeling unwell (headaches, breathlessness, fatigue) for a week or two, but then they recover because their immune system responds appropriately, going on to eradicate the virus and to repair the lung damage.
The problem arises when, for reasons that still remain unclear, the immune system in some individuals goes into overdrive in response to the lung damage and instead of repairing the damage, creates even more damage, tipping the individual over into a cascade of events called septic shock that can lead to extensive and permanent organ damage and even death. This is where the pressure on health services is coming from, and this is what we are hoping that Veyonda will be able to address.
Based on its mechanism of action, Noxopharm has previously said we believe that Veyonda has the potential to be used by those patients whose immune systems are at the tipping point of responding normally or abnormally, preventing the patient descending into the septic shock cascade. If we can get patients out of hospital more quickly, or even stop them from needing to be hospitalised in the first place, then we hope to significantly de-pressure the pandemic.
But there is another side of COVID-19 which, in the long run, might emerge as an even greater problem for healthcare systems. That is the so-called ‘long COVID-19’ symptoms. By definition this describes symptoms that persist for more than 3 months, with an estimated 1 in 50 COVID-19 individuals experiencing them. Symptoms include:
- anxiety and depression
- chest pains
- joint or muscle pain
- not being able to think straight or focus (‘brain fog’).
The question now being asked is whether this is just the tip of the iceberg, with concerns about the risk of even longer and more serious problems emerging. One particular concern is over autoimmune diseases with several studies now underway in the U.S. looking at whether rates of autoimmune diseases are rising in recovered patients because of a misfiring immune system.
We are watching this development very closely because of our interest in the STING signaling pathway. STING is a forward scout that detects the presence of damage in the body and triggers an immune response. The COVID-19 patients who fall into septic shock mostly do so because their STING response has gone into overdrive. Veyonda blocks the STING response, which is why we are testing it in COVID-19 patients.
However, there also is growing evidence pointing to a role for STING in autoimmunity generally, and with STING signaling being abnormally high in some COVID-19 patients, suggesting that a link between COVID-19 and increased risk of developing an autoimmune disease is not that far-fetched.
Noxopharm believes Veyonda is the only STING inhibitor to reach the clinic, and the pre-clinical data we released two days ago (ASX announcement 6 April 2021) confirms that it is a potent STING inhibitor. We currently are testing the ability of Veyonda to prevent the acute consequences of septic shock in COVID-19. Time will tell whether it could have an extended role to play in preventing consequences emerging over the long term.