Suramin as a possible treatment for Autism, ME CFS and Long Covid

Suramin for Autism trial by Naviaux where he tried a single dose with 5 children, and observed some temporary improvement. His hypothesis that it might also work for ME/CFS is based on his metabolomic studies showing parallels in both conditions related to the Cell Danger Response.

Low-dose suramin in autism spectrum disorder: a small, phase I/II, randomized clinical trial
http://onlinelibrary.wiley.com/doi/10.1002/acn3.424/abstract;jsessionid=7CE70079E7C886450E7B49B69C1B604A.f02t02#publication-history
 
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Naviaux talks on autism and Suramin


This talk seems to relate to the talk that Naviaux gave at the OMF event where he talked about Suramin being used to suppress signals to cells. He was suggesting a similar mechanism for ME.

 
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Copied from Robert Naviaux' Lab - News - from 2019 onwards
more discussion of Suramin on that thread.


Breakthroughs in the Cause and Treatment of Autism and Chronic Fatigue Syndrome

From the Naviaux Lab, University of California, San Diego Robert K. Naviaux, MD, PhD - December 2019
Founder and Co-director, the Mitochondrial and Metabolic Disease Center (MMDC) Professor of Genetics, Departments of Medicine, Pediatrics, and Pathology

http://naviauxlab.ucsd.edu/wp-content/uploads/2019/12/Naviaux-Lab-Newsletter-Winter-2019_v10_sm.pdf

8 page pdf

Headings:

Background
The autism-mitochondria connection
The SAT1 study (suramin in autism)
Newborn screening for autism
Exposomics and Metabolomics

Plans for 2020:
The SAT2 Trial
ME/CFS—Triggers and Networks that Connect the Metabolome and Exposome
Lyme disease
Back to the Future—The 2020 UMDF Symposium (mitochondrial medicine)
Tying it all together
Funding

Here is the ME/CFS section on page 5 with added paragraph breaks for easier reading:
ME/CFS—Triggers and Networks that Connect the Metabolome and Exposome

An unanswered question in the biology of ME/CFS is, “Why do patients who are able to recover still have a life-long risk of recurrence?”. Dr. Naviaux believes that life experiences and exposures to environmental chemicals and biotoxins come together with genes to create a “perfect storm” that causes ME/CFS. Even after recovery, this perfect storm leaves a mark—a metabolic and epigenetic memory that changes how the network of chemicals in the blood is regulated and how it responds to future exposures.

In 2020, we will launch a new study to examine the network connections between the metabolome and exposome. Using advanced machine learning and network dynamic analysis, this new study will help pave the way for the future suramin ME/CFS treatment trial.

Other exciting studies include a new collaboration with the brilliant virologist, Dr. Bhupesh Prusty at the University of Würzburg, Germany. Using a new, cell-based assay system, we are hot on the trail of both the identity and the biological control of the activity in ME/CFS blood that causes fatigue. This “fatigue factor” looks like it could be the same thing that coordinates the mitochondrial and metabolic features of the cell danger response (CDR) and inflammation5, changes impedance in the nanoneedle10, inhibits recovery from illness by blocking the healing cycle9, induces a dauer-like state11, and triggers collagen remodeling over time that can cause acquired forms of Ehlers Danlos-like syndromes.

If successful, these studies will help fill in missing details in how suramin, copaxone, and elamipretide (SS31) might work to treat ME/CFS.
 
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https://www.globenewswire.com/news-...h-virtual-investor-summit-microcap-event.html

PaxMedica to Present at the Jan 26th Virtual Investor Summit Microcap Event
January 20, 2023 13:31 ET | Source: PaxMedica, Inc.

Presentation on Thursday, January 26th, 2023 at 1:30 PM EST


TARRYTOWN, NY, Jan. 20, 2023 (GLOBE NEWSWIRE) -- via NewMediaWire -- PaxMedica, Inc. (Nasdaq: PXMD), a clinical stage biopharmaceutical company focusing on the development of novel anti-purinergic drug therapies (“APT”) for the treatment of disorders with intractable neurologic symptoms, today announced that it will be presenting virtually at the upcoming Virtual Investor Summit on January 26th.

Event: Q1 Investor Summit

Date: Thursday, January 26th, 2023

Presentation: January 26th at 1:30 PM ET

Location: https://us06web.zoom.us/webinar/register/WN_LRZ8iM38TTCNpbbgvkUvCA

  • The theme is 25 micro-cap companies with a catalyst and/or strong performance in the current market
  • 1x1s will be available for qualified investors
  • The conference is completely complimentary to qualified investors. Please register at Complimentary Investor Registration
About PaxMedica

PaxMedica is a clinical stage biopharmaceutical company focusing on the development of anti-purinergic drug therapies (“APT”) for the treatment of disorders with intractable neurologic symptoms, ranging from neurodevelopmental disorders, including Autism Spectrum Disorder (“ASD”), to Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (“ME/CFS”), a debilitating physical and cognitive disorder believed to be viral in origin and now with rising incidence globally due to the long term effects of SARS-CoV-2 (“COVID-19”). One of PaxMedica’s primary points of focus is the development and testing of its lead program, PAX-101, an intravenous formulation of suramin, in the treatment of ASD and the advancement of the clinical understanding of using that agent against other disorders such as ME/CFS and Long COVID-19 Syndrome, a clinical diagnosis in individuals who have been previously infected with COVID-19. For more information, please visit: www.paxmedica.com

About the Investor Summit

The Investor Summit is an exclusive, independent conference dedicated to connecting smallcap and microcap companies with qualified investors. The Q1 Investor Summit will take place virtually, featuring 30 companies and over 120 institutional, family office, and high net worth investors. Sectors Participating: Biotech, Communication Services, Consumer, Energy, Technology, Financial, Healthcare, Industrials, Materials, Real Estate. Contact: emily@investorsummitgroup.com

 
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PaxMedica Releases 2022 Shareholder Letter
https://www.globenewswire.com/news-release/2023/02/15/2608576/0/en/PaxMedica-Releases-2022-Shareholder-Letter.html
Only mention of ME/CFS:
“I’d like to close by thanking the team and the Board of Directors for their hard work and insight in our first year as
a public company. I’d also like to thank our shareholders and other stakeholders for their interest and support in the work that PaxMedica is doing to find treatments for disorders with intractable neurologic symptoms, including Autism Spectrum Disorder and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (“ME/CFS”).”
 
PaxMedica, Inc. Provides Business Update and Reports Fourth Quarter 2022 Financial Results
https://www.marketwatch.com/press-r...rth-quarter-2022-financial-results-2023-03-29

Takeaways:
  • They want to get suramin approved in the US for treating African sleeping sickness by analyzing existing data, which they expect to be finished in the second half of 2023. If I understand correctly, this is a complicated maneuver to get funding. The FDA will issue them a voucher for accelerated review if it's approved. But that voucher can be used on any drug, and can be sold. Instead of using it, PaxMedica will sell their voucher to fund their business. These vouchers go for around $100 million, which would leave Pax with ample funding to research suramin as a drug for ME or autism.
  • They want to apply to the FDA to study suramin in autism in 2024.
The rest of their update revolves around business matters, like funding and hiring. They're pursuing autism more than ME/CFS--not surprising, as autism has several times the prevalence (In the US, 5.4M with autism vs. 836k-2.5M with ME) and dramatically higher recognition and awareness.
 
An interesting and detailed press release

PaxMedica Completes HAT-301 Registrational Trial for PAX-101

HAT-301 is the Pivotal Efficacy Study to Support Upcoming NDA Filing

Top Line Results Planned for Release in July 2023

TARRYTOWN, NY, June 01, 2023 (GLOBE NEWSWIRE) -- via NewMediaWire – PaxMedica,
Inc. (Nasdaq: PXMD), a clinical stage biopharmaceutical company focusing on
the development of novel anti-purinergic drug therapies (APT) for the
treatment of Autism Spectrum Disorder (ASD), and other serious conditions with
intractable neurologic symptoms, today announced that the eligibility review
and final enrollment for the company’s Real World Evidence study (HAT-301) has
been completed. Patient eligibility was assessed for inclusion by an
Independent Study Adjudication Committee which included a total of three
subject matter expert medical reviewers.

The comparative arms for this pivotal Phase 3 Real World Evidence study
included:

* A total of 145 patients treated with suramin in Uganda and Malawi between
2000 – 2022, and
* A total of 204 natural history cases from patients in Uganda and Malawi
between 1900-1910, prior to the availability of suramin.

The HAT-301 study is the first and only retrospective clinical study of
suramin in the treatment of Rhodesian African Sleeping Sickness, also known as
Stage 1 Trypanosoma Brucei Rhodesiense Human African Trypanosomiasis (TBR
HAT), a rare and universally fatal infectious disease. Suramin has been the
standard of care for treating TBR HAT for many decades, solely based on
empirical evidence derived during mass epidemics of TBR HAT.

The official database lock for HAT-301 will occur in June 2023, with top-line
data for this study expected to be available in July 2023, and pave the way
for filing an NDA for the use of PAX-101 in TBR HAT in 2024. If approved,
suramin will be the first drug indicated for the treatment of TBR HAT in the
United States and would possibly qualify PaxMedica to receive a Priority
Review Voucher (PRV) under section 524 of the Food, Drug, and Cosmetics Act
(FD&C Act). A PRV, once granted, is an independently valued asset (see GAO
report 20-251), granted to a sponsor company after NDA approval and, according
to section b)2) of the act, can be sold by that sponsor to any
biopharmaceutical company to obtain FDA priority review in a future filing of
any NDA.

Howard Weisman, Chief Executive Officer of PaxMedica, commented, “Database
lock for the HAT-301 study is a significant threshold event for PAX-101. With
this achievement, PaxMedica has completed a critical step in filing for
potential U.S. market approval for this important, life-saving treatment. The
opportunity to raise significant non-dilutive funding, as a result of our
potential successful participation in the Neglected Rare Tropical Disease
Program through receipt of a PRV, may enable future large-scale trials of
PAX-101 in Autism, and other important conditions, in the very near future.
This remains central to our strategy to build and support sustainable long
term shareholder value.”

About the Phase 3 HAT-301 Trial

Launched in November 2022, the Phase 3 HAT-301 trial is a pivotal,
retrospective, controlled analysis of suramin for the treatment of the rare
and fatal tropical disease, TBR HAT. The study has been underway at multiple
primary HAT treatment sites in Uganda and Malawi using exclusively licensed,
retrospective clinical data that is being reviewed, and compared with a
natural history-controlled dataset comprised of exclusively licensed source
data.

The primary objective of the study is to demonstrate that the standard of care
treatment using suramin, as currently practiced in Uganda and Malawi, leads to
better clinical outcomes in patients with Stage 1 Trypanosoma Brucei
Rhodesiense Human African Trypanosomiasis than observed in an untreated
natural history cohort, that had documented illness prior to availability of
suramin. The World Health Organization lists suramin, discovered in 1916, and
found to be effective against Stage 1 Trypanosoma Brucei Rhodesiense Human
African Trypanosomiasis since at least 1920, as a standard of care for
Trypanosoma b. Rhodesiense.

About PaxMedica

PaxMedica is a clinical stage biopharmaceutical company focusing on the
development of anti-purinergic drug therapies (“APT”) for the treatment of
disorders with intractable neurologic symptoms, ranging from
neurodevelopmental disorders, including Autism Spectrum Disorder (“ASD”), to
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (“ME/CFS”), a debilitating
physical and cognitive disorder believed to be viral in origin and now with
rising incidence globally due to the long term effects of SARS-CoV-2
(“COVID-19”). One of PaxMedica’s primary points of focus is the development
and testing of its lead program, PAX-101, an intravenous formulation of
suramin, in the treatment of ASD and the advancement of the clinical
understanding of using that agent against other disorders such as ME/CFS and
Long COVID-19 Syndrome, a clinical diagnosis in individuals who have been
previously infected with COVID-19.

https://www.bloomberg.com/press-rel...etes-hat-301-registrational-trial-for-pax-101
 
You have got to be kidding me. What medical records did they keep in Malawi in 1900?

A total of 204 natural history cases from patients in Uganda and Malawi
between 1900-1910
 
Ummm clearing my throat……

https://wwwnc.cdc.gov/eid/article/10/4/02-0626_article

Reanalyzing the 1900–1920 Sleeping Sickness Epidemic in Uganda

Abstract
Sleeping sickness has long been a major public health problem in Uganda. From 1900 to 1920, more than 250,000 people died in an epidemic that affected the southern part of the country, particularly the Busoga region. The epidemic has traditionally been ascribed to T. b. gambiense, a parasite now confined to central and western Africa. The Busoga region still reports sleeping sickness, although it is caused by Trypanosoma brucei rhodesiense, commonly believed to have spread to Uganda from Zambia in the 1940s. Our analysis of clinical data recorded in the early 1900s shows that the clinical course of sleeping sickness cases during the 1900–1920 epidemic in Uganda was markedly different from T.b. gambiense cases, but similar to T.b. rhodesiense. These findings suggest that T.b. rhodesiense was present in Uganda and contributed to the epidemic. The historic context is reassessed in the light of these data.



 
They want to get suramin approved in the US for treating African sleeping sickness by analyzing existing data, which they expect to be finished in the second half of 2023. If I understand correctly, this is a complicated maneuver to get funding. The FDA will issue them a voucher for accelerated review if it's approved. But that voucher can be used on any drug, and can be sold. Instead of using it, PaxMedica will sell their voucher to fund their business. These vouchers go for around $100 million, which would leave Pax with ample funding to research suramin as a drug for ME or autism.


This is complicated.
 
So it seems that the Phase II trial in South Africa did not replicate Naviaux’s original finding of 20 mg being more effective than placebo. He had 5 patients per arm in the original trial if I recall. In this new trial, 10 mg appeared to be more effective in that it seemed to separate from placebo while 20 mg did not. This study appears to be unpublished. I searched Pubmed and couldn’t find it. The lack of a dose response relationship should be concerning to them. The CEO in the YouTube video glosses over these inconvenient findings and seems to think the study was a success.
 
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