A Parkinson's therapy makes its way through the "valley of death"

Andrew West is pursuing a compound to inhibit LRRK2, an enzyme that appears to be a central enabler of the brain cell death seen in Parkinson's disease.
In its long journey from the petri dish to the first human patient, every new drug has to cross a wasteland called the "valley of death." Therapeutic programs enter, but most don’t come out the other side.
"The government is good at funding basic research to identify drug targets, and Big Pharma is good at taking drugs and putting them through clinical trials," says Andrew West, Ph.D., John A. and Ruth R. Jurenko Endowed Professor in Neurology at UAB. "But all of the in-between work, the pre-clinical and drug development components, is called the 'valley of death' for research, because nobody funds it, nobody pays attention to it. That's a big part of the lack of new drugs."
In fact, less than 10 percent of drugs that make it into preclinical testing will end up getting FDA approval, according to the agency's figures. But West is part of a new approach to the drug-discovery process designed to upend those odds: a partnership between UAB and Birmingham-based Southern Research Institute known as the Alabama Drug Discovery Alliance (ADDA).
The partnership is built around the strengths of each institution. UAB labs identify molecular targets that play a key role in disease. In West's case, that's the enzyme LRRK2 (pronounced "lark two"), which appears to be a central enabler of the brain cell death seen in Parkinson's disease.
Southern Research has decades of experience in drug discovery and testing. It employs a host of researchers who are adept at the chemical tweaking needed to make a drug work in humans. Southern Research scientists are also experts at proving a drug's safety and efficacy to the FDA and to large pharmaceutical companies. Big Pharma is often willing to step in and fund new drug projects—but only after they have demonstrated initial success.
Thanks to several years of work, "we're most of the way through the valley of death now," West says. "We have dozens of compounds that are fantastic drugs. We just have a little bit left to go—sometimes the last mile of the marathon can be the most painful."

On the Move

This month, West's lab published a new study in the Proceedings of the National Academy of Sciences that suggests LRRK2 inhibitors could play a wide role in slowing the progression of Parkinson's disease, or even preventing it altogether.
"This is a critical first step showing that inhibition of LRRK2 may be beneficial to protect against the cell loss and degeneration that occurs in Parkinson's disease," says West. It's another sign that the team's approach is taking it in the right direction across the valley of death—and a welcome oasis to recharge their efforts.
Robotic systems at Southern Research Institute allow UAB investigators such as Andrew West to screen hundreds of thousands of potential compounds to find the best candidates for new therapeutics.

Screen Team

The LRRK2 project's first step was high-throughput screening—using the advanced robotic testing machines at Southern Research to analyze hundreds of thousands of potential compounds and find candidates capable of slowing down LRRK2.
They emerged with hundreds of potential compounds. Further analysis has whittled that down to the best candidates. What makes a "drug great in a tissue culture dish may not be a great thing for a preclinical candidate," West says. "We want to know how well it crosses the blood-brain barrier, if it interacts with any other protein besides LRRK2, how fast it metabolizes, if it collects anywhere abnormally in the body, and if it causes toxicity."
Medicinal chemists at Southern Research specialize in taking promising chemicals and tweaking them to make them even better. "We make very small changes," says West. "We'll put a nitrogen here, a carbon there, and look at the effects in a hypothesis-driven way."
The collective knowledge of the Southern Research scientists is an extremely valuable resource, West emphasizes. "Most of the time you only see these people at big pharmaceutical companies. The relationship between UAB and Southern Research in the ADDA is unique. I haven't seen it built anywhere else in the country, where we get a high-throughput group, drug development group, and biologists sitting at the same table every two weeks discussing the issues."

Getting Close

In the next few months, West's lab will evaluate each remaining compound in its animal models of Parkinson's disease. The best ones will then move into toxicology studies, "and hopefully next year we'll begin first-in-man studies," West says.
The team has already come very close. "We had a great candidate last year that passed all of the key measures," West says. "It went to the brain perfectly, had good potency, seemed to only interact with LRRK2, no side effects, no toxicity." But when the drug got to living models, "we discovered that the metabolism was way off the charts," says West. "It only survived 15-20 minutes in the body before it was destroyed by the liver. We were close—if we could just have slowed what the liver did by a little bit, we'd be in humans now. But it turns out that was not the right molecular scaffold."
The good news, says West, is that "we have two or three other series that are getting to that same point now." Even more important, he says, "we have a clear pipeline to go to a phase 1 clinical trial," the first evaluation of a potential new drug in humans.

Strong Local Support

It's important to note that these advances have been accelerated significantly "through local philanthropic support," says West. "There are many people in this area who are disappointed to see that the government doesn't fund a lot of research into Parkinson's disease cures. I think patients are frustrated. You get a diagnosis of Parkinson's disease and there is nothing you can do to stop it. The best advance we have, L-dopa, was developed 50 years ago. There’s really been no breakthrough like that since."
But West is convinced that is about to change. "As soon as I found during post-doctoral work in 2006 that all mutations we know about that cause Parkinson's disease increase LRRK2 activity, the next step in my career was finding somewhere I could do something about that," he says. "And the only place I found in the country was Birmingham, so I moved here immediately."
Now, eight years later, the end may be in sight. "We have to take these drugs to the next level and make them suitable for use in humans," West says. "It's a formidable trek, but I think we have some really good compounds, and more important, the right people that will get us there."

 nita limdiA new program formalizes UAB research and initiatives to tailor the selection and dosing of medications based on a patient’s genetic makeup and clinical characteristics to provide more effective therapies.

The UAB’s new Personalized Medicine Institute, or PMI, approved by the University of Alabama System Board of Trustees June 13, will be housed in the School of Medicine and directed by Nita Limdi, Pharm.D., Ph.D., associate professor in the UAB Department of Neurology.

The PMI framework will enable researchers to ask questions regarding racial and ethnic disparities, diabetes, cardiovascular disease, neurosciences and other areas to expand UAB’s translational capacity for genomic discovery. “This program will continually differentiate us from our local and regional peers and make us a national player in the development of new treatment therapies based on our understanding of the human genome,” Limdi said.

Among the resources the PMI will create and manage is the BioBank — cache of DNA samples that will improve understanding of the ways genetic factors, lifestyle, behavior and environment interact to affect health. “It will provide UAB researchers a tangible advantage when competing for grant funding, especially in areas where we serve unique populations,” Limdi said.

Transplantation is one example. National kidney-transplant rates are disproportionately low for African-Americans; yet at UAB, one of the nation’s busiest kidney-transplant centers, more than half of all kidney transplants in the past 10 years were in African-Americans.

“Most research centers don’t have this wealth of data about minority populations,” said Limdi, who noted that breadth and depth enables UAB to evaluate the effectiveness of interventions in a racially diverse population.

The School of Medicine will dedicate funds that will enable UAB to retain faculty, recruit new physicians and scientists and build an administrative infrastructure to facilitate more federal and private research grants. Educating physicians, trainees and the broader biomedical community, including bioethicists, will build partnerships and improve the overall health of the population, Limdi says.

Strategic Funding Accelerates Research

By Matt Windsor • Illustrations by Ernie Eldredge

In July 2005, after months of troubling symptoms,
inconclusive tests, and incomplete answers, Ken Cater finally received the definitive diagnosis he wanted—and the answer he dreaded. Cater, like actor Michael J. Fox, had early-onset Parkinson’s disease.
“I went into that spot where you don’t like to go and had my moment and cried on the sofa with my dog and family,” says Cater, an executive at SSOE Group, a global engineering firm. “After that I didn’t look back. I’m an engineer. I’m used to having a problem, finding a solution, and moving on.”
Cater arranged a meeting with Ray L. Watts, M.D., an international expert on Parkinson’s disease who was then chair of the UAB Department of Neurology and is now the university’s president. “I said, ‘What can I do to help?’” Cater recalls. Watts said his top priority was recruiting David Standaert, M.D., Ph.D., to UAB from Harvard University. “Dr. Watts said, ‘He’s the best there is, and I want to get him here,’” says Cater. “I responded, ‘What do we have to do to make that happen?’”
Cater’s financial support, along with Watts’s vision for a new kind of research program, helped convince Standaert to come to Birmingham to lead the UAB Center for Neurodegeneration and Experimental Therapeutics, known as CNET. The center’s mission is “to accelerate progress,” Standaert explains. “Dr. Watts and I are both physicians, and we’ve been treating patients with Parkinson’s and other diseases for a long time. We work with patients every day who are desperate for a cure, and we really felt there was a need for a group that would try to move this agenda forward, to take the discoveries going on in the lab and turn them into therapies.”
To attain that goal, Standaert launched his own recruiting drive. In seven years, CNET has grown “from just me to 50 scientists, students, postdocs, and staff,” Standaert says. “And we’re still recruiting.” CNET researchers have contributed to an explosion in Parkinson’s discoveries, says Standaert, who is now chair of the Department of Neurology. “The amount we’ve learned in the past five years exceeds everything we knew from the previous 200 years.”
CNET is a major participant in the Alabama Drug Discovery Alliance (ADDA), a partnership among UAB, Southern Research Institute, and the Birmingham Business Alliance that is designed to speed the translation of UAB discoveries into clinic-ready treatments. CNET researchers already have two promising drug compounds, Standaert says. Andrew West, Ph.D., is testing a compound that inhibits LRRK2, “a molecule closely related to Parkinson’s,” Standaert explains, while Erik Roberson, M.D., Ph.D., is studying several molecules that could impact Alzheimer’s disease. (Roberson and West are now co-directors of CNET.) “Within a matter of months, we have moved these much farther than many places could have done in years,” Standaert says. (For more on new discoveries in the ADDA drug pipeline, see “Discovery Zone" below.)
The Power of Philanthropy
The recruitment of West and Roberson, Standaert emphasizes, would not have been possible without philanthropic giving. “Dr. West is supported by John Jurenko through a very generous gift that not only founded his lab but has endowed his position,” Standaert says. “Dr. Roberson is one of the top Alzheimer’s disease researchers in the country. A lot of places wanted to have him, but Virginia and Bill Spencer created an endowment that helped us land him here.” In fact, “almost all of the major faculty recruitments we have done have been based on philanthropic gifts,” Standaert says.
Philanthropic gifts have become particularly important as the nation’s research funding environment has changed in recent years, Standaert says. “The National Institutes of Health (NIH) has contracted what they are willing to do. They are not taking any risks because they have such limited funds. If you have a new idea and you want it to move quickly, the way you do that is through research acceleration funds—philanthropic gifts that enable us to launch projects, get them moving, and then go out and seek federal or industry funding to carry them forward to the conclusion.”
The Parkinson’s Association of Alabama (PAA), currently led by Cater, has played a role in several major recruitments for CNET, including the next generation of promising researchers, Standaert says. Talene Yacoubian, M.D., Ph.D., came to UAB from Harvard University in 2012 as the first Parkinson’s Association of Alabama Scholar in Parkinson’s Research. The PAA “supported her lab and transition costs and has helped launch her research,” Standaert says.
The PAA’s initial $100,000 investment allowed Yacoubian to receive an $800,000 NIH grant, Cater notes. “That’s an amazing rate of return, any way you look at it,” he says. Funding from the PAA has also helped encourage graduate students to enter the Parkinson’s field. “We have a lot of students at UAB who would like to get involved in this research, but finding support for them is not always that easy,” Standaert says. “So the PAA has stepped up with philanthropic funding that has let us go out and bring in the top students and put them to work on Parkinson’s disease here in the lab.” 
“If we change the life and outlook of even one person, it’s worth every dollar,” Cater says. But he is optimistic that CNET research will change many more lives. “I believe we have the tools in place in Alabama and at UAB to solve the problem of Parkinson’s disease.”
0214 StandaertCaterWith support from Ken Cater (left) and other donors, David Standaert (right) has recruited top research talent to UAB and helped spark an explosion in discoveries related to Parkinson’s disease.

Discovery Zone

Three of a number of promising compounds developed by UAB researchers as part of the Alabama Drug Discovery Alliance:
LRRK2 inhibitors
Most patients with Parkinson’s disease are still treated with a 42-year-old drug called L-dopa, which only temporarily limits tremor, rigidity, and other symptoms. But LRRK2 inhibitors actually counter the inflammation and nerve cell death causing Parkinson’s symptoms. UAB researchers are now working to find the best drugs that inactivate LRRK2. The investigators believe their current version is better on many levels than any other drugs being considered for LRRK2, and that even more effective drug candidates are right around the corner.
CD38 inhibitors
The enzyme CD38, which seems to reduce oxidative stress, is overexpressed in several cancers, particularly B cell lymphomas such as leukemia and multiple myeloma that often affect older patients. That’s a problem, because chemotherapy causes oxidative stress in order to damage the DNA of cancer cells and cause them to self-destruct. UAB researchers have been looking for an effective CD38 inhibitor, and they have identified several candidates thanks to screening tests conducted by scientists at Southern Research Institute, UAB’s partner in the ADDA. These compounds are now being tested in UAB labs.
Cytochrome C oxidase inhibitors
The brain cancer known as glioblastoma multiforme is particularly lethal because its cells quickly become resistant to treatment. Previous UAB research found that the enzyme cytochrome C oxidase was abundant in cells resistant to therapy. Patients who have an overactive version of the gene responsible for making cytochrome C oxidase live less than half as long as patients with a less active version. A compound being developed by UAB researchers to inhibit cytochrome C oxidase could increase survival by six months—a significant advance for this patient population.

Track Record

As of 2013, the UAB Research Foundation has helped create 58 start-up companies and negotiate more than 430 option and license agreements exceeding $68 million in revenues.

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On June 18, neurosurgeons at the University of Alabama at Birmingham implanted a new type of electrical stimulator to control seizures in patients with difficult-to-control epilepsy.

It marked the first time in the Southeast the RNS system by NeuroPace had been implanted since the device gained FDA approval in November 2013. The first patient was a 24-year-old woman from central Alabama.

RNS stands for responsive neurostimulation.

“It is designed to record patient’s specific brain activity and recognize patterns that are associated with seizures,” said Kristen Riley, M.D., associate professor in the Department of Neurosurgery. “The RNS system then delivers stimulation in order to help modulate and control the seizures.”

The system consists of electrodes attached by leads to a generator which can communicate with a computer. The generator is curved so that it can be placed within a patient’s skull. It is a little bigger than a flash drive.

“We drill a trough for the device so that it is flush within the skull,” said Riley. “There is not a raised area; it’s basically hidden within the skull.”

The RNS system is for patients with severe seizures who do not respond to medications and are not candidates for surgery because the location of their seizure onset is at a sensitive part of the brain. It is also only for patients whose seizure onset can be traced to just one or two locations in the brain.
The electrodes are placed near the location in the brain where a patient’s seizures are triggered. Jerzy Szaflarski, M.D., Ph.D., professor in the Department of Neurology and director of the UAB Epilepsy Center, says the RNS system can be customized for each individual patient so that it learns which patterns of brain activity lead to seizures in that patient. He says data from research studies dating back several years indicate that many patients will respond to the stimulation and have significant reduction in their seizures.

“This is not a treatment that will cure epilepsy,” he said. “This is a treatment that will help control seizures in a very specific group of patients who are not otherwise candidates for surgery. I don’t expect too many patients to become seizure-free; but if we can decrease their seizures by even half, we can make huge improvements in their lives.”

The RNS system is for patients with severe seizures who do not respond to medications and are not candidates for surgery because the location of their seizure onset is at a sensitive part of the brain. It is also only for patients whose seizure onset can be traced to just one or two locations in the brain.

“We’re very excited to offer this therapy to our patients who are not candidates for more traditional therapies for epilepsy,” said Szaflarski. “We see multiple patients like that every year, and the RNS system could make a huge difference in the lives of those patients. There is already data to show that the quality of life of those patients has improved significantly with RNS.”

For more information on the RNS system, contact the UAB Epilepsy Center or make an appointment via the Kirklin Clinic at 205-801-8986.

Bob Shephard
UAB Media Relations