WEBVTT - Targeting IgA Nephropathy (Sponsored Content) 0:00:00.360 --> 0:00:03.880 Since you're a subscriber to this Bloomberg podcast, we thought 0:00:03.880 --> 0:00:07.360 you'd be interested in a six episode sponsored podcast called 0:00:07.800 --> 0:00:12.560 Targeting the Toughest Diseases produced by Vertex Pharmaceuticals and Bloomberg 0:00:12.600 --> 0:00:17.520 Media Studios. It explores the innovative tools, methods, and unique 0:00:17.520 --> 0:00:21.840 philosophy Vertex Pharmaceuticals is using to search for treatments for 0:00:21.880 --> 0:00:29.560 some of humanity's most challenging diseases. Here's a recent episode. 0:00:30.440 --> 0:00:34.240 Two year olds are a handful. They're full of energy 0:00:34.440 --> 0:00:38.120 and full of laughter. A lot of work for sure, 0:00:38.640 --> 0:00:40.520 but also a source of joy. 0:00:43.320 --> 0:00:46.120 I definitely feel my calling in life was to be 0:00:46.159 --> 0:00:48.479 a mother, and I just feel so blessed to be 0:00:48.520 --> 0:00:52.400 able to have that opportunity to have a child. So 0:00:52.440 --> 0:00:53.640 it's been great. 0:00:56.600 --> 0:01:00.280 That's Rachel Benton, also known as Stetson's. 0:00:59.760 --> 0:01:06.240 Small Stetson is his name, Stetson Corey Benton. I've always 0:01:06.560 --> 0:01:10.000 liked unique names. I never knew of anyone named Stetson before. 0:01:11.120 --> 0:01:13.840 The thing about Stetson is, and he doesn't even know 0:01:13.920 --> 0:01:19.560 this yet, but he may have already saved his mom's life. 0:01:20.920 --> 0:01:24.039 A routine medical test that Rachel only took because she 0:01:24.160 --> 0:01:28.160 was pregnant showed protein in her urine That led to 0:01:28.200 --> 0:01:32.440 further tests, a biopsy, and eventually a phone call delivering 0:01:32.440 --> 0:01:35.520 a diagnosis. It was a. 0:01:35.480 --> 0:01:40.479 Pretty quick conversation. We know it is igiena fhropathy. It's 0:01:40.520 --> 0:01:43.560 a rare kidney disease. There is not a cure. We 0:01:43.640 --> 0:01:44.800 don't have a cause. 0:01:46.520 --> 0:01:56.480 The call was short, but for Rachel it changed everything. Hi. 0:01:56.880 --> 0:02:00.360 I'm Jordan Gospore, a member of the University of Southern 0:02:00.360 --> 0:02:05.120 California's Center for Health Journalism. This is Targeting the Toughest 0:02:05.120 --> 0:02:10.560 Diseases a podcast produced by Bloomberg Media Studios and Vertex Pharmaceuticals. 0:02:11.600 --> 0:02:14.600 In this series, we look at some of humanity's most 0:02:14.800 --> 0:02:19.440 challenging diseases and how Vertex, a Boston based biotech company, 0:02:19.919 --> 0:02:24.040 is using innovative tools, methods, and a unique philosophy to 0:02:24.080 --> 0:02:29.519 search for treatments and cures. Today, we're looking at immunoglobulin 0:02:29.600 --> 0:02:35.080 A nephropathy, more commonly known as IgA nephropathy. It's a 0:02:35.120 --> 0:02:39.919 progressive chronic kidney disease that, for too long, was underreported 0:02:40.040 --> 0:02:44.400 and under researched. We'll talk to experts inside and outside 0:02:44.400 --> 0:02:47.240 of Vertex about the latest work being done in this field, 0:02:48.080 --> 0:02:59.120 But first back to Rachel's story. At the age of thirty, 0:02:59.440 --> 0:03:02.880 Rachel bent and was living a great life. She was 0:03:02.919 --> 0:03:06.600 a licensed mortgage broker running her own agency. She owned 0:03:06.639 --> 0:03:10.000 her own house, and that fall she decided to throw 0:03:10.240 --> 0:03:11.800 a big Halloween. 0:03:11.360 --> 0:03:15.600 Party and he came with one of our mutual friends 0:03:15.800 --> 0:03:17.800 and we sort of rekindled from there. 0:03:18.520 --> 0:03:21.880 He was Tom, a guy she had dated on and 0:03:21.919 --> 0:03:23.400 off during her twenties. 0:03:23.200 --> 0:03:26.680 And then it was the end of November of twenty 0:03:26.760 --> 0:03:29.200 twenty that he asked me to marry him. 0:03:29.639 --> 0:03:32.400 A year later, they got married, and shortly after that, 0:03:32.880 --> 0:03:40.000 Rachel got pregnant. During her pregnancy, Rachel had regular medical checkups, 0:03:40.440 --> 0:03:42.080 including routine yearine tests. 0:03:42.680 --> 0:03:45.640 We did a yearine test, a twenty four hour year 0:03:45.680 --> 0:03:48.520 in test, and that's where you have to take this 0:03:48.600 --> 0:03:51.360 big jug home and you have to peece straight into 0:03:51.360 --> 0:03:53.440 this jug every time for twenty four hours. And so 0:03:54.360 --> 0:03:56.960 I bring it to the doctor and they test it, 0:03:57.040 --> 0:03:59.960 and sure enough, they found protein in my earn. 0:04:01.080 --> 0:04:04.360 The doctor told her she wasn't facing any immediate risk, 0:04:04.840 --> 0:04:07.760 so they agreed to put that result aside, focus on 0:04:07.840 --> 0:04:10.960 having a healthy baby, and that they would investigate further 0:04:11.080 --> 0:04:16.680 once the baby was born Stetson. Corey Benton was born 0:04:16.720 --> 0:04:20.440 in May and as a new parent, Rachel's life instantly 0:04:20.480 --> 0:04:21.359 became a whirlwind. 0:04:21.800 --> 0:04:24.520 Honestly, I completely even forgot about the kidney stuff. 0:04:25.160 --> 0:04:27.599 But around the nine month mark she reached out to 0:04:27.600 --> 0:04:32.200 her doctor. She retested her urine, which confirmed she still 0:04:32.279 --> 0:04:35.520 had protein in her urine, so they decided to do 0:04:35.520 --> 0:04:39.120 a kidney biopsy. A biopsy is where a doctor uses 0:04:39.240 --> 0:04:43.039 a long needle to extract tiny pieces of tissue so 0:04:43.080 --> 0:04:46.640 they can do further tests. Rachel got the results over 0:04:46.680 --> 0:04:47.400 the phone. 0:04:49.400 --> 0:04:52.000 And he's like, you know, we did confirm some things. 0:04:52.440 --> 0:04:57.480 You have a rare kidney disease called IgA nephropathy or 0:04:57.560 --> 0:05:02.760 I GAN. So my fir question was, you know, what 0:05:02.920 --> 0:05:05.640 do I do now? How do I stop this? Is 0:05:05.720 --> 0:05:06.360 there a cure? 0:05:06.560 --> 0:05:06.800 You know? 0:05:06.880 --> 0:05:09.520 Just thinking of anything, like what's the next steps? What 0:05:09.560 --> 0:05:10.840 about medication? Blah blah blah. 0:05:10.839 --> 0:05:14.839 And he's like, well, the answer to almost all of 0:05:14.880 --> 0:05:19.920 her questions was we're not sure or it depends. 0:05:21.839 --> 0:05:26.080 I got off the phone and just cried. I think 0:05:26.120 --> 0:05:30.760 for probably two days straight. I just was overwhelmed with 0:05:30.839 --> 0:05:36.480 obviously the diagnosis and not knowing where this would take 0:05:36.520 --> 0:05:39.640 me in life. What the next You know, twenty four 0:05:39.640 --> 0:05:42.560 hours would look like a year or ten years. You know, 0:05:42.800 --> 0:05:44.440 how is this going to affect me in my day 0:05:44.480 --> 0:05:48.320 to day life and my son and my husband. 0:05:51.360 --> 0:05:54.720 She's adjusted her diet and takes medication to address her 0:05:54.760 --> 0:05:58.400 blood pressure and cholesterol, but the progress of the disease 0:05:58.640 --> 0:06:04.680 is variable. At one point, Rachel's kidney function dropped thirty 0:06:04.800 --> 0:06:09.159 points over two months. The doctor told her that at 0:06:09.160 --> 0:06:14.120 that rate, she'd be needing dialysis within a year. She's rebounded, 0:06:14.720 --> 0:06:18.640 but she doesn't know if that recovery will hold. She 0:06:18.680 --> 0:06:23.359 also deals with fatigue, not just new mom tiredness, but 0:06:23.600 --> 0:06:28.760 debilitating fatigue, where she'll sleep for twelve hours and still 0:06:28.920 --> 0:06:32.919 need a midday nap. In fact, Rachel says that for 0:06:32.960 --> 0:06:36.039 a couple of years before her diagnosis, she was already 0:06:36.120 --> 0:06:39.480 dealing with extreme tiredness, but never really considered it a 0:06:39.520 --> 0:06:44.320 medical condition or something that needed attention. In hindsight, she 0:06:44.440 --> 0:06:48.880 wishes she had gotten it checked out. Looking forward, her 0:06:48.920 --> 0:06:51.320 long term health and her ability to be the kind 0:06:51.320 --> 0:06:53.720 of mom she wants to be is uncertain. 0:06:54.880 --> 0:06:57.120 I have my days where I just feel very, very 0:06:57.120 --> 0:07:02.200 guilty being a other to him with a rare disease 0:07:02.360 --> 0:07:06.640 and not knowing in a year, ten years, however long, 0:07:07.080 --> 0:07:10.560 how I'm going to be and how active I get 0:07:10.560 --> 0:07:13.120 to be in his life. Every day. I just try 0:07:13.120 --> 0:07:15.000 to make the best of it though, and you know, 0:07:15.120 --> 0:07:17.320 whatever he wants to do, I put on a smile 0:07:17.360 --> 0:07:18.880 and try to push. 0:07:18.680 --> 0:07:26.680 Through immunoglobulin A nephropathy or IGAN. It's not a high 0:07:26.720 --> 0:07:31.560 profile disease. It's a pronic kidney disease that historically has 0:07:31.640 --> 0:07:34.720 not been well understood, but that's changing. 0:07:35.600 --> 0:07:39.120 So I do clinics, so I see patients with gramariala disease. 0:07:39.760 --> 0:07:42.800 I run clinical trials, and I have my research work 0:07:42.920 --> 0:07:44.440 at the university and the laboratory. 0:07:46.560 --> 0:07:49.920 That's doctor Jonathan Barrett. He's based at the University of 0:07:50.000 --> 0:07:52.640 Leicester in England and as a world renowned leader in 0:07:52.720 --> 0:07:53.480 kidney research. 0:07:54.600 --> 0:07:57.520 So most of my career, no one was really interested 0:07:57.520 --> 0:08:01.120 in Nigeria property apart from a few people. Now it 0:08:01.160 --> 0:08:03.120 is you can't move at a kidney meeting without people 0:08:03.120 --> 0:08:04.360 talking about igenafropathy. 0:08:05.080 --> 0:08:07.800 One reason it was so under researched is that in 0:08:07.840 --> 0:08:11.040 the early stages, symptoms are often hard to detect. 0:08:11.520 --> 0:08:14.600 Normally, the patients I see have no idea why they're 0:08:14.600 --> 0:08:15.760 coming to see a kidney doctor. 0:08:16.160 --> 0:08:20.000 In many cases, it starts with an asymptomatic person having 0:08:20.040 --> 0:08:23.440 a urine test, like in Rachel's case, with a routine 0:08:23.560 --> 0:08:24.840 urine test during pregnancy. 0:08:25.080 --> 0:08:27.280 Perhaps you've joined a new gym, you get a physical, 0:08:27.320 --> 0:08:29.680 so you want to get a mortgage. You might have 0:08:29.760 --> 0:08:32.640 a job that requires you to have a physical and 0:08:32.720 --> 0:08:34.800 someone dips your urine and they don't wait a minute, 0:08:34.840 --> 0:08:36.160 there's blood and protein in here. 0:08:37.040 --> 0:08:38.720 Here's what we do know about the disease. 0:08:40.720 --> 0:08:43.560 So each kidney contains about a million filters and they 0:08:43.559 --> 0:08:47.360 are continually filtering the blood to generate the urine, and 0:08:47.440 --> 0:08:52.000 in igenafropathy, this protein called IgA starts sludging up those 0:08:52.040 --> 0:08:56.360 filters and stopping them from working properly. And if the 0:08:56.400 --> 0:09:01.079 filters don't work very well, they become leaky and blood 0:09:01.120 --> 0:09:02.679 and protein can appear in the urine. 0:09:03.800 --> 0:09:08.760 Over time, sometimes months, sometimes years, your kidney function declines. 0:09:10.080 --> 0:09:13.200 Some patients do really well with igenafropathy, and others end 0:09:13.280 --> 0:09:15.840 up on dialysis relatively quickly. And that's the bit we 0:09:15.840 --> 0:09:17.240 haven't quite worked out yet. 0:09:18.400 --> 0:09:21.200 In fact, we know the majority of adult patients with 0:09:21.280 --> 0:09:26.080 igaafhropathy will progress to instage kidney disease, which requires them 0:09:26.160 --> 0:09:29.640 to go on dialysis or get a transplant within twenty 0:09:29.720 --> 0:09:34.040 years of diagnosis. Doctor Barrett says there is evidence of 0:09:34.080 --> 0:09:37.680 a genetic component, but the connections aren't strong enough to 0:09:37.679 --> 0:09:42.240 do genetic screening right now. The only way to diagnose 0:09:42.280 --> 0:09:44.720 iganaphropathy is with the kidney biopsy. 0:09:45.720 --> 0:09:48.800 But what we think is that the major driver for 0:09:48.840 --> 0:09:53.160 this disease is the type of ida we normally produce 0:09:53.200 --> 0:09:55.920 in our gut and in our respiratory tract that normally 0:09:55.920 --> 0:09:59.480 gets into our sputum, into our tears, into our saliva. 0:10:00.000 --> 0:10:02.000 It's there to stop bugs entering the body, and it 0:10:02.000 --> 0:10:04.720 does a very very good job. But in igenic property, 0:10:04.840 --> 0:10:07.679 some of that ida actually gets into the bloodstream. When 0:10:07.679 --> 0:10:10.440 it's in the bloodstream, it's a bit out of place, 0:10:10.960 --> 0:10:13.200 and it tends to stick to itself, to stick to 0:10:13.240 --> 0:10:16.920 other proteins. There are antibodies in the circulation it sticks to, 0:10:17.360 --> 0:10:20.160 and that forms these large what we call immune complexes, 0:10:20.200 --> 0:10:25.120 which are essentially big aggregates of protein. If you've got 0:10:25.160 --> 0:10:27.440 big globs of protein, it's completely reasonable to think that 0:10:27.440 --> 0:10:30.040 those globs approtein are going to start clogging up the filter, 0:10:30.600 --> 0:10:33.040 which is exactly what happens, and when they clog up 0:10:33.040 --> 0:10:37.439 the filter, there's inflammation, they're scarring, and that's what eventually 0:10:37.480 --> 0:10:39.000 causes kidney failure. 0:10:39.360 --> 0:10:43.600 For people diagnosed with IgA nefhropathy. The biological effects are 0:10:43.640 --> 0:10:45.199 only part of the problem. 0:10:45.679 --> 0:10:49.280 The big challenge is actually the impact on mental wellness. 0:10:49.600 --> 0:10:53.320 Because if you're a young person and I tell you 0:10:53.320 --> 0:10:57.240 you've got this disease, it's incurable. There's a risk it 0:10:57.240 --> 0:10:59.280 could cause kidney failure in the future, but I can't 0:10:59.280 --> 0:11:01.520 tell you when you might need to go on diallasis 0:11:01.559 --> 0:11:03.480 have you get your transplant, but I can't tell you when. 0:11:03.960 --> 0:11:08.720 That sense of uncertainty can be absolutely devastating for young people. 0:11:08.760 --> 0:11:11.720 You imagine developing your career, wanting to pay that big 0:11:11.720 --> 0:11:14.600 amount of money for a house, getting married, thinking about children, 0:11:15.000 --> 0:11:17.600 and you have this threat hanging over you of a 0:11:17.600 --> 0:11:21.400 disease that the doctors can't really predict. 0:11:25.320 --> 0:11:29.120 Addressing that fear and uncertainty requires showing patients there is 0:11:29.200 --> 0:11:32.160 a way forward, and that's what the team at Vertex 0:11:32.280 --> 0:11:39.240 is doing. Igienephropathy represents exactly the kind of medical problem 0:11:39.360 --> 0:11:42.599 Vertex is targeting. There's a long history of research to 0:11:42.640 --> 0:11:46.520 build on there's new technology available or Vertex thinks they 0:11:46.520 --> 0:11:49.960 can develop it. There's a large unmet need, and Vertex 0:11:50.040 --> 0:11:53.439 thinks it may be possible to tackle the underlying disease. 0:11:55.679 --> 0:11:59.080 Simply put, Verticy's goal is to help people suffering from 0:11:59.160 --> 0:12:01.920 serious diseases, and we do that by investing in the 0:12:01.960 --> 0:12:04.760 scientific innovation to create what we believe could be truly 0:12:04.760 --> 0:12:06.959 transformative medicines for people with these diseases. 0:12:07.679 --> 0:12:10.880 That's Mark Bunnage. He's the head of research at Vertex 0:12:10.920 --> 0:12:15.400 Pharmaceuticals and leads research on the company's pipeline of serious diseases. 0:12:16.520 --> 0:12:18.880 Now, we focus on cause of human biology and on 0:12:18.960 --> 0:12:22.200 human validated targets, and then we ask the question what's 0:12:22.240 --> 0:12:26.160 the right approach to take, and we are completely metalitiagnostic. 0:12:27.080 --> 0:12:29.240 We'll use whatever is the right tool in the toolbox 0:12:29.240 --> 0:12:32.000 if you like, to address their biology and then to 0:12:32.000 --> 0:12:36.880 come up with a transformative therapy. 0:12:37.960 --> 0:12:42.800 Earlier, doctor Barrett explained how igianophropathy occurs. It's a build 0:12:42.880 --> 0:12:45.920 up of what he calls big globs of protein that 0:12:45.960 --> 0:12:49.240 deposit and cause injury to the filters in your kidneys. 0:12:50.360 --> 0:12:53.360 But how can we stop that from happening. To answer that, 0:12:53.800 --> 0:12:57.120 I sat down with doctor Maniche Maski. He's a board 0:12:57.160 --> 0:13:03.240 certified nephrologist helping lead Vertex research into IgA nephropathy. Doctor 0:13:03.320 --> 0:13:06.760 Maski explained that B cells, an important part of our 0:13:06.760 --> 0:13:10.280 immune system to fight off infections, can lose control and 0:13:10.400 --> 0:13:14.240 produce antibodies that hurt our own organs, in this case, 0:13:14.400 --> 0:13:19.400 the kidneys. Can you tell us a little bit about 0:13:19.440 --> 0:13:21.840 where the field is going and what's being done for 0:13:21.920 --> 0:13:23.800 people living with IgA nephropathy. 0:13:24.400 --> 0:13:28.880 Absolutely, we now understand that loss of B cell control 0:13:29.760 --> 0:13:35.000 is what leads to the downstream mechanisms resulting in kidney 0:13:35.000 --> 0:13:39.240 injury and kidney function loss. So lots of research has 0:13:39.280 --> 0:13:43.920 been performed to try to understand what is influencing the 0:13:43.960 --> 0:13:47.960 B cell to lose control. It turns out that two 0:13:48.000 --> 0:13:53.239 proteins called Bath and april are key drivers. 0:13:57.400 --> 0:14:00.520 Okay, so B cells are a type of white blood 0:14:00.559 --> 0:14:04.000 cell that helps power our immune system. Can you tell 0:14:04.040 --> 0:14:06.560 us a little bit more about what Bath and April 0:14:06.600 --> 0:14:09.080 are and how they're involved in B cell control and 0:14:09.120 --> 0:14:11.400 how all that relates to iganephropathy. 0:14:12.520 --> 0:14:17.280 So, first, Jordan, you're absolutely right that B cells, when 0:14:17.320 --> 0:14:21.160 they're doing what they're supposed to do, protect us from infections. 0:14:21.600 --> 0:14:25.040 They make cand of bodies that help us neutralize various pathogens. 0:14:26.200 --> 0:14:30.520 When B cells lose control, they can set off a 0:14:30.840 --> 0:14:36.200 cascade of events that result in processes that harm the body, 0:14:36.320 --> 0:14:42.840 so called autoimmune diseases. Bath and April are two similar 0:14:43.120 --> 0:14:47.960 but distinct proteins that control the life cycle of the 0:14:48.000 --> 0:14:52.160 B cell. So bath more in the early stage of 0:14:52.760 --> 0:14:55.440 development and maturation of the B cell and april more 0:14:55.480 --> 0:14:59.120 in the later stage of the B cell development all 0:14:59.120 --> 0:15:02.440 the way through to becoming an antibody secreting cell. Bath 0:15:02.480 --> 0:15:07.160 in april really seem to be two of the most 0:15:07.200 --> 0:15:12.520 critical proteins driving this transition from something that would protect 0:15:12.600 --> 0:15:17.480 us to something that would actually make antibodies that will 0:15:17.760 --> 0:15:19.080 harm our native tissues. 0:15:21.120 --> 0:15:25.160 This is a complex scenario. What's the innovative thinking that 0:15:25.280 --> 0:15:26.760 Vertex is considering here. 0:15:27.840 --> 0:15:31.040 We know that the levels of bath in april are 0:15:31.040 --> 0:15:34.440 actually elevated in people with ig and ephropathy, and that 0:15:34.480 --> 0:15:38.160 these levels correlate with measures of kidney function and damage. 0:15:38.320 --> 0:15:41.080 So through that we believe both of these drivers are 0:15:41.160 --> 0:15:44.560 involved in uncontrolled B cells. Not Bath alone and not 0:15:44.680 --> 0:15:47.480 april alone. There's a need to cast the widest net 0:15:47.680 --> 0:15:51.960 to catch the main actors involved in the pathogenesis of 0:15:52.000 --> 0:15:55.240 IgA and nephropathy. What we hope to see with this 0:15:55.280 --> 0:15:59.320 approach is the potential to restore immune balance for our 0:15:59.360 --> 0:16:04.080 patients and give them the best chance at remission in 0:16:04.120 --> 0:16:06.960 the protin area, which is the protein spilling in the 0:16:07.080 --> 0:16:10.000 urine he maturia, which is the spilling of blood in 0:16:10.040 --> 0:16:13.880 the urine with associated stabilization of kidney function. 0:16:16.920 --> 0:16:21.560 For Rachel Benton, living with uncertainty has become a constant burden. 0:16:23.560 --> 0:16:27.760 It really scares me. For my son, I feel like 0:16:27.800 --> 0:16:30.560 I let him down. I guess, you know, it's not 0:16:30.800 --> 0:16:33.720 fair for him to have a mom that is going 0:16:33.800 --> 0:16:35.840 to be sick for the rest of our life. It 0:16:35.920 --> 0:16:38.960 might not be bad today, but we don't know about tomorrow, 0:16:39.120 --> 0:16:41.960 you know. And I just I feel guilt in that 0:16:42.040 --> 0:16:46.240 aspect of him just not having a healthy mom. Same 0:16:46.320 --> 0:16:48.920 for my husband, for him to have a wife that 0:16:49.040 --> 0:16:52.800 just doesn't healthy and it breaks my heart for them really. 0:16:54.360 --> 0:16:56.760 But I try to stay positive and take care of 0:16:56.760 --> 0:16:59.880 myself as much as I can, but it definitely does 0:17:00.120 --> 0:17:04.640 play a huge role on your mental health for sure. 0:17:04.840 --> 0:17:05.400 Day to day. 0:17:05.920 --> 0:17:07.840 Some days I can be like, you know what, I 0:17:07.880 --> 0:17:11.400 am a warrior I got this. Everything's great. In other 0:17:11.480 --> 0:17:15.280 days it's like I am not okay, and I feel 0:17:15.280 --> 0:17:17.520 like I could just crawl under a rock and stay there. 0:17:18.320 --> 0:17:21.480 Rachel, like a lot of people living with IgA nephropathy, 0:17:21.920 --> 0:17:25.080 has become an advocate, encouraging others to get checked. 0:17:25.840 --> 0:17:28.560 All of my friends because of this, I'm like, please 0:17:28.720 --> 0:17:31.720 get your yearlys done, but also ask for that urine test. 0:17:32.359 --> 0:17:34.919 You know, if you see any sign of protein in 0:17:34.960 --> 0:17:37.240 your urine, just double check it. Why not? 0:17:38.560 --> 0:17:43.520 Exactly why not? Kidney health is not top of mind 0:17:43.520 --> 0:17:46.639 for most people, but it's worth talking to your doctor about. 0:17:47.520 --> 0:17:51.680 You can also go to Vertex's website vrtx dot com 0:17:51.720 --> 0:17:55.760 for more information on Vertex's commitment to IgA nephropathy and 0:17:55.840 --> 0:18:02.760 other serious kidney diseases. This is Targeting the Toughest Diseases 0:18:03.160 --> 0:18:07.760 a podcast from Bloomberg Media Studios and Vertex Pharmaceuticals. If 0:18:07.800 --> 0:18:10.439 you like what you hear, subscribe and leave us a review. 0:18:11.200 --> 0:18:13.640 I'm Jordan Gospore. Thanks for listening.