By Dr Ross Macdonald, CEO Cynata Therapeutics
Originally appeared in Asia Pacific Biotech News. Adapted from original.
As our global population ages, degenerative conditions associated with ageing, such as osteoarthritis, diabetes, stroke, and heart disease are on the rise, accounting for 23% of the total disease burden globally. So too are the costs associated with delivering a high standard of healthcare to our ageing citizens, placing a punishing financial burden on a shrinking younger population. At Cynata Therapeutics, we are working to prolong our “healthspan” so that we can live better for longer.
The problem – The burden of diseases of the aging
The United Nations estimate a global average life expectancy of 72.6 years for 2019 – the global average today is higher than in any country back in 1950. And new research suggests we could live to 150!
But as populations get older, the treatment cost burden of diseases of ageing rises, putting increased pressure on governments and younger generations to support a high standard of healthcare. Moreover, GDP can slow due to a decline in labour force growth.
According to the IMF, many advanced economies already have a declining working-age population. In Europe it will fall more than 20 percent between 2015 and 2055, with an attendant decline in GDP growth.
In Australia alone, total healthcare expenditure is projected to increase faster than ever over the next 40 years, increasing from 19% of total government spending in 2021-22 to 26% in 2060-61. 
But it’s not just about the cost, and the economic impacts. It’s about our quality of life as we age.
Healthy life expectancy is different to life expectancy. Healthy life expectancy is the number of years lived without a disability that impacts considerably on quality of life.
In high income countries, according to Our World in Data, people tend spend more years with disability or disease burden than in countries with lower incomes (around 10-11 years versus 7-9 years at lower incomes). With modern medicines extending our life span without necessarily improving it, what is the point in living longer if we are unable to enjoy those extra years by living a productive and active lifestyle?
Typically, most medicines only provide symptomatic relief for diseases of the ageing such as osteoarthritis, chronic pain, diabetes etc, without preventing progression (worsening) of the disease.
If we are to enjoy a longer lifespan then our healthspan must also be lengthened. And this is done by addressing the underlying health problem, hence the rapidly growing interest in stem cell medicines, with their powerful properties of repair and regeneration.
The technology and trials
Cynata’s proprietary Cymerus™ stem cell technology provides a potential treatment that may be able to halt and even perhaps reverse many of the health conditions that afflict us as we grow old. It can do so through addressing the underlying disease process and by solving one of the fundamental challenges to industrialisation of stem cells in medicine, that is the ability to manufacture these exciting products consistently and reproducibly at scale.
The particular type of stem cell receiving the most interest, with over 1000 clinical trials having been initiated, is called a mesenchymal stem cell (MSC). Because of their regenerative capabilities and profound effects on modulating the immune system, MSCs are being intensively studied in a wide range of diseases, particularly degenerative diseases of ageing. Through a proprietary manufacturing process, Cynata’s Cymerus MSCs are highly consistent and potent, making them ideal candidates as potential new medicines.
Cynata has a broad and robust clinical development pipeline with multiple active trials and near-term catalysts for conditions that include those caused by aging:
The Company’s first Phase 3 trial is the SCUlpTOR (structure-modifying treatment for medial tibiofemoral osteoarthritis) osteoarthritis trial, with the University of Sydney as sponsor. The trial aims to enrol a total of 440 patients with osteoarthritis of the knee and is designed to assess the effect of CYP 004, Cynata’s Cymerus mesenchymal stem cell (MSC) product for osteoarthritis, compared to placebo on clinical outcomes and knee joint structure over a two-year period.
Put simply, the trial hopes find out whether or not stem cell injections into the knee improve symptoms and slow disease progression in people with mild to moderate knee OA – to improve underlying disease and therefore quality of life. There is no current cure for osteoarthritis and current medicines simply treat the symptoms, meaning the underlying disease in the joint progresses and gets worse.
Patient enrolment has been steadily growing. Following enrolment, each participant receives injections of Cymerus MSCs (or placebo in the case of the control group) on three occasions over a one-year period with continued follow ups for an additional year, with results expected in CY2025.
Diabetic Foot Ulcers
Foot ulcers that are very slow to heal are a frequent complication in patients with diabetes. They can severely impact quality of life, and often result in hospitalisation, amputation and even death. Existing treatment options often fail to heal diabetic ulcers (DFU) in a timely manner, if at all, so new and more effective treatments are urgently needed. The estimated market value for diabetic foot ulcer treatments is already approaching US$10b, and that figure is likely to grow significantly in the future. Cynata’s Phase I DFU trial opened for recruitment in late December 2021. A total of 30 patients will be randomly assigned to receive CYP-006TK (a polymer-coated silicon dressing seeded with MSCs) or standard care of treatment. The treatment period will be four weeks, and each patient will be evaluated for a total of 24 weeks. The trial is expected to complete in CY2023.
Graft-versus-host disease (GvHD) is a devastating condition that occurs in patients who have undergone a bone marrow transplant as part of their treatment of cancer. Cynata’s lead product candidate, CYP-001, met all clinical endpoints and demonstrated positive safety and efficacy data for the treatment of steroid-resistant acute GvHD in a Phase 1 trial. Planning for a Phase 2 clinical trial in acute GvHD is currently underway. Cynata plans to execute its US development strategy by conducting a Phase 2 acute GvHD trial in the US under an IND (cleared by the US FDA in May 2022), and in other countries, expected to commence in 1Q23.
Japan leading the way
Japan has invested heavily in stem cell medicine to combat its aging population and the reliance on high care. In 2020, the median age of population for Japan was 48.36 years and growing at an average annual rate of 5.68%.. This is a substantial increase from the median of 22.35 years in 1950. The median age is expected to reach 54.7 by 2050.
In 2014, two laws were introduced in Japan to provide a fast track to the market for stem-cell-based treatments and other types of regenerative medicine. This highly progressive initiative places Japan at the forefront of development of new regenerative medicines and underscores that Country’s desire to ensure its citizens can enjoy a productive and active old age.
Cynata has an active exposure on many fronts in Japan. It has a strategic partnership with global giant FUJIFILM, one of the leading companies in the regenerative medicine space. FUJFILM is a ~6% shareholder in Cynata. Furthermore, in January of this year, Cynata received a Decision to Grant from the Japanese Patent Office for a patent application covering its proprietary Cymerus™ mesenchymal stem cell technology. The was especially exciting for the Company given Japan’s leadership in regenerative medicine.
Along with Japan’s many initiatives to address the health issues associated with ageing, Europe and the United States, and other countries, have implemented their own policies and programs to enhance the development pathway for regenerative medicines. For example, in 2004 California created the publicly funded California Institute for Regenerative Medicine, with over US$8 billion having been allocated to finance the Institute’s programs.
The team here at Cynata is committed to harnessing the body’s own regenerative and repair processes into new medicines to relieve disease and enhance our quality of life. By developing treatments that address the underlying disease, we hope to prolong people’s activity and health span versus lifespan, allowing people to enjoy active lives for as long as possible, enjoying the freedom of movement and doing what they love.
Cynata has received a Notice of Allowance from the United States Patent and Trademark Office for a patent application covering its proprietary Cymerus™ mesenchymal stem cell platform technology. This is a very important achievement in a key commercial jurisdiction for Cynata – the US.
Expected to commence next year, Cynata along with leading transplant centre Leiden University Medical Center (LUMC) in the Netherlands, will collaborate on a new clinical trial in patients who have received a kidney transplant. The trial will investigate Cynata’s MSCs as a treatment for renal graft rejection and to potentially reduce the requirement for anti-rejection drugs.
Today is World Arthritis Day. Arthritis is the third most prevalent long-term health condition in Australia affecting 12.5% of Australians.
There is no cure for arthritis, with treatment options largely focused on alleviating pain, including pain relief medication, arthroscopy, or joint replacement.
Thankfully, Australia is at the forefront of clinical research and trials, which is helping those living with the disease to better manage their arthritis and hopefully one day cure it.
Leading rheumatology clinician researcher Professor David Hunter and Arthritis Australia CEO Jonathan Smithers say it’s important for people to know about their arthritis and how to manage it, and be across studies and trials for which they may be eligible.
Although sounding contradictory to people with joint pain, physical activity has well established benefits for knee osteoarthritis. However, 90% of people with OA do not meet physical activity guideline recommendations or walk regularly for exercise.
To better assess the benefits of exercise, the Epipha-knee trial in 198 subjects will investigate individualised physiotherapist-led walking, strengthening, and OA/activity education programs. One group of subjects will receive additional contemporary physiotherapist-delivered pain science education (PSE) about OA/pain and activity to improve patients’ knowledge.
The trial aims to determine whether the addition of PSE is more effective than simply undertaking the individualised program alone.
Full details and how to register: https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-021-04561-6
Professor Hunter is leading a 440-person trial into the potential modification of osteoarthritis using Cynata’s mesenchymal stem cells (MSCs) in people over 40 with osteoarthritis (OA) in their knees, and who have lived with moderate plus pain for several years.
Cynata Therapeutics CEO Dr Ross Macdonald says the trial is one of the world’s largest trials investigating the use of stem cells for OA. “It’s a gold-standard study: a randomised, double-blind, placebo controlled clinical trial designed to discover whether or not stem cell injections into the knee improve symptoms and slow disease progression to improve underlying disease and therefore quality of life,” he said.
Full details and registration: https://www.sydney.edu.au/research/volunteer-for-research-study/other/the-sculptor-study.html
We did a lot of it in lockdown but according to a 212-person trial, a 12-week online unsupervised yoga program improved knee stiffness, quality of life, and arthritis self-efficacy improved more with yoga than the control intervention (those that didn’t do the program). Unfortunately, the yoga didn’t improve knee pain, nor was it sustained at 24 weeks.
Therefore, those with OA of the knee should still consider other forms of pain management.
Full study details: https://pubmed.ncbi.nlm.nih.gov/36122378/
They certainly get a workout as our smartphone addiction grows. Luckily a randomised, parallel trial that compared conservative treatments with an education comparator found that combined treatments improve hand function for those with thumb base osteoarthritis.
This 204-person trial split participants with half receiving education on self-management and ergonomic principles, a base-of-thumb splint, hand exercises, and diclofenac sodium (Voltaren), 1%, gel. The comparator group received education on self-management and ergonomic principles alone. Intervention use was at participants' discretion from 6 to 12 weeks.
The combination intervention led to improvements in both pain and function compared to education alone.
Full study details: https://pubmed.ncbi.nlm.nih.gov/33683300/
Education is key so Arthritis Australia has developed a comprehensive online hub designed to help people manage the symptoms of joint pain or OA enabling them to live a more active and pain free life. An evaluation of My Joint Pain, found improvements in self-management, lifestyle, and weight reduction.
Arthritis Australia CEO Jonathan Smithers says “We know that people living with osteoarthritis want more information and options to manage their condition. My Joint Pain includes a wealth of free, evidence based resources to help consumers live well with arthritis.”
Users can register to My Joint Pain to undergo a personalised risk assessment, find information tailored to their needs and access a personalised management plan that includes resources on medication, exercise, diet, lifestyle choices, pain management and healthcare providers.
Registered users can also manage and track their osteoarthritis over time by answering weekly questions to see how they are progressing https://www.myjointpain.org.au/