WEBVTT - Special Episode: Human African Trypanosomiasis & Drug Development 0:00:43.400 --> 0:00:46.720 Hi, I'm Aaron Welsh and this is this podcast will 0:00:46.800 --> 0:00:51.560 Kill You. Welcome back. You are listening to another bonus episode, 0:00:51.720 --> 0:00:55.200 our second in our mini series of bonus content, exploring 0:00:55.240 --> 0:00:58.000 in more depth the topics we covered the previous week. 0:00:58.720 --> 0:01:01.960 As we always say on the podcast, A we're not experts, 0:01:02.040 --> 0:01:06.280 and B we can't cover absolutely everything about a disease 0:01:06.400 --> 0:01:09.480 or a topic in our regular episodes, and those two 0:01:09.520 --> 0:01:13.600 things probably aren't going to change. But we can talk 0:01:13.640 --> 0:01:16.480 to actual experts in the subject we covered the previous 0:01:16.520 --> 0:01:20.000 week and get to explore some aspects of that topic 0:01:20.080 --> 0:01:23.720 in more detail than we did in our regular season episode. 0:01:23.800 --> 0:01:27.200 In our first bonus episode, I followed up our hepatitis 0:01:27.240 --> 0:01:31.000 B episode with a conversation with doctor Sherry Cohen about 0:01:31.040 --> 0:01:34.160 the stigma and discrimination that people living with hepatitis B 0:01:34.360 --> 0:01:38.039 often face and how it impacts their lives. This week, 0:01:38.440 --> 0:01:42.800 I'm very excited to chat with doctor Wilfried Matombolkoloji and 0:01:42.880 --> 0:01:47.080 doctor Natalie Stroborgaft from the Drugs for Neglected Diseases initiative 0:01:47.240 --> 0:01:51.800 about Human African tripanisamiasis. In particular, I wanted to learn 0:01:51.880 --> 0:01:55.360 more about the development of fecsinidzol, a new drug to 0:01:55.400 --> 0:01:58.880 treat this disease, one that is much safer and easier 0:01:58.920 --> 0:02:02.400 to use than those that have been historically available. How 0:02:02.520 --> 0:02:05.400 is this drug discovered, what are some of the challenges 0:02:05.480 --> 0:02:08.359 in making sure people who need it have access to it? 0:02:08.880 --> 0:02:12.280 And what impact has it had on control efforts? These 0:02:12.320 --> 0:02:14.880 are just some of the questions I want to explore 0:02:14.919 --> 0:02:18.240 in this bonus episode. If you haven't listened to our 0:02:18.320 --> 0:02:22.280 Human African tripanasimiasis episode yet, you may want to do 0:02:22.360 --> 0:02:25.760 so before you listen to this bonus episode because there's 0:02:25.919 --> 0:02:29.720 just so much to that story and it'll probably help 0:02:29.800 --> 0:02:33.200 give a bit of context for this interview. But either way, 0:02:33.440 --> 0:02:38.359 I'll give a quick overview before we begin. Human African tripanasimiasis, 0:02:38.520 --> 0:02:42.680 also known as hat hat or sleeping sickness, is a 0:02:42.720 --> 0:02:47.679 neglected tropical disease caused by two subspecies of tripanosome parasites, 0:02:48.200 --> 0:02:52.920 one of which Tripanosoma brucei gambience, is much more common 0:02:53.000 --> 0:02:58.040 than the other, Tripanosoma brucei rdisience. These parasites, which are 0:02:58.080 --> 0:03:01.399 transmitted through the bite of a setzifly, have been infecting 0:03:01.520 --> 0:03:05.040 humans for thousands of years and cause a disease that 0:03:05.160 --> 0:03:09.079 is considered fatal without treatment. Over the past fifty years 0:03:09.200 --> 0:03:12.639 or so, there have been substantial global and national efforts 0:03:12.639 --> 0:03:16.960 to reduce the prevalence of human African tripanisimiasis, and we've 0:03:16.960 --> 0:03:21.399 made a great deal of progress towards elimination. For instance, 0:03:21.800 --> 0:03:25.040 from two thousand and nine to twenty twenty, the number 0:03:25.080 --> 0:03:28.840 of recorded cases dropped from just under ten thousand to 0:03:29.120 --> 0:03:34.080 six hundred and sixty three, which is absolutely amazing. But 0:03:34.200 --> 0:03:38.200 still these parasites persist in thirty six countries in Sub 0:03:38.240 --> 0:03:42.720 Saharan Africa, with some countries carrying a disproportionate burden of disease, 0:03:42.960 --> 0:03:46.120 such as the Democratic Republic of Congo, where seventy percent 0:03:46.120 --> 0:03:49.440 of cases reported over the past ten years have occurred. 0:03:49.920 --> 0:03:54.480 Control and elimination efforts for human African tripanisimiasis face many 0:03:54.560 --> 0:03:58.920 different challenges. For instance, these vector borne parasites have a 0:03:58.960 --> 0:04:03.640 supercomplex eco pology, Diagnosis of the disease can be quite tricky, 0:04:04.200 --> 0:04:08.000 and there are many logistical difficulties in providing care to 0:04:08.080 --> 0:04:11.680 those who need it. Funding for research or drug discovery 0:04:11.760 --> 0:04:15.920 is always a challenge, and for decades the only available 0:04:15.960 --> 0:04:19.960 treatments were either arsenic based with toxic side effects. These 0:04:20.040 --> 0:04:25.599 drugs are called arsibol or malarsaprol or extremely complicated to administer. 0:04:26.440 --> 0:04:29.320 These last points have changed in the past few years 0:04:29.360 --> 0:04:32.839 with the discovery and approval of fecsinitisol, which is an 0:04:33.000 --> 0:04:36.279 oral treatment effective for both the first and second stages 0:04:36.720 --> 0:04:42.000 of gambience human African tripanisimiasis. This drug was developed through 0:04:42.040 --> 0:04:45.800 a collaboration between the French healthcare company Santo FI and 0:04:45.839 --> 0:04:49.320 the Drugs of Neglected Diseases Initiative. And I am super 0:04:49.400 --> 0:04:52.000 thrilled that I get to speak with not one, but 0:04:52.080 --> 0:04:57.080 two amazing scientists at DNDI about this exciting new development 0:04:57.200 --> 0:04:59.719 and what it means for the global elimination of human 0:04:59.760 --> 0:05:05.200 eye African tapanis miasis. Doctor Motombo Colomgi and doctor Stuboorgaft 0:05:05.279 --> 0:05:08.200 have both been involved in many different aspects of human 0:05:08.240 --> 0:05:13.240 African tapanistas's control efforts, from regional fieldwork to clinical trials, 0:05:13.279 --> 0:05:17.120 and from drug research and development to forming industrial partnerships 0:05:17.160 --> 0:05:19.640 to bring these drugs from the lab to where they 0:05:19.640 --> 0:05:22.480 are most needed. And I will let them tell you 0:05:22.560 --> 0:05:25.320 a bit more about themselves and jump into the interview 0:05:25.600 --> 0:05:27.479 right after we take this short break. 0:05:51.120 --> 0:05:56.599 I'm Wilfrid m I'm a medical doctor. I'm based in 0:05:56.800 --> 0:06:02.039 DRC in Democratic Republic of Hongo in Kinshasa, and I'm 0:06:02.120 --> 0:06:08.200 working for the NDI currently, I am coordinating our local 0:06:09.040 --> 0:06:12.640 R and D T and we're working up current you 0:06:12.720 --> 0:06:20.080 on three diseases, Scenario, disease and COVID, so I'm coordinating 0:06:20.760 --> 0:06:22.600 all our R and D projects. 0:06:23.760 --> 0:06:27.640 My name is Natalie football Geft. I'm a medical doctor 0:06:27.720 --> 0:06:31.240 by training. I've been with d NDI since two thousand 0:06:31.279 --> 0:06:36.520 and nine and I've been leading the NTD, R and 0:06:36.600 --> 0:06:42.560 D activities and started the vaccini as our program in 0:06:42.640 --> 0:06:46.000 two thousand and nine until it came to access to 0:06:46.120 --> 0:06:48.400 patients in two thousand and eating. 0:06:50.000 --> 0:06:52.640 Thank you so much for taking the time to chat 0:06:52.720 --> 0:06:56.280 about d NDI and vaccinate as all. So I wonder 0:06:56.480 --> 0:07:00.320 if you could start off by telling me how did 0:07:00.400 --> 0:07:04.440 you both get involved with DNDI. What brought you to 0:07:04.640 --> 0:07:05.520 this type of work. 0:07:07.080 --> 0:07:09.560 My first term to hear from the NDA was in 0:07:09.640 --> 0:07:15.160 two thousand and six. I was working as a doctor 0:07:15.280 --> 0:07:18.400 in a remote village, so I heard that the NDA 0:07:18.680 --> 0:07:24.120 was preparing the project of clinical trial on art human Africans. 0:07:24.840 --> 0:07:28.440 So I was interested because I was treating those passions 0:07:28.480 --> 0:07:31.680 and so I was aware of issue we had with 0:07:32.080 --> 0:07:36.880 this disease, and then I applied and I was selected 0:07:37.080 --> 0:07:41.720 to be a local PI principal investigator for one of 0:07:41.920 --> 0:07:46.840 clinical side study, so it since two thousand and six. 0:07:47.480 --> 0:07:48.600 That was my first. 0:07:48.440 --> 0:07:52.880 Contact, and then after I continue, I was investigator in 0:07:52.920 --> 0:07:57.440 another clinical trial that was called Nightfield, and then after 0:07:58.240 --> 0:08:02.960 from two thousand and twelve, I start working as coordinating 0:08:03.040 --> 0:08:07.960 and a skepter of affecting as all projects and seis 0:08:08.040 --> 0:08:11.400 two and sixteen full staff of the NDA. 0:08:12.680 --> 0:08:15.760 As for me, it's a bit different. I've been working 0:08:15.840 --> 0:08:19.800 before in the pharmaceutical industry and in some biotechs, and 0:08:20.080 --> 0:08:23.560 in fact, in two thousand and three, when DNDI was launched, 0:08:23.640 --> 0:08:28.200 I was informed via friends and I kept watching the 0:08:28.360 --> 0:08:33.400 DNDI website for interest because I've always been interested in 0:08:33.520 --> 0:08:39.880 doing something that adds value to public health. And once 0:08:40.160 --> 0:08:44.280 I saw a position that was opened for clinical development 0:08:44.400 --> 0:08:46.640 director and I called them and I said, this is me, 0:08:47.440 --> 0:08:49.199 this is me, and they were at the end of 0:08:49.520 --> 0:08:53.360 the process, so they accepted to receive my CV. I 0:08:53.480 --> 0:08:56.280 went through interviews and I got the position, and that's 0:08:56.320 --> 0:08:59.160 how I came with d NDI, and I'm still. 0:08:58.960 --> 0:09:04.800 There wonderful so today will mostly be chatting about human 0:09:04.880 --> 0:09:10.760 African tripanasamiasis, but DNDI is involved in control efforts for 0:09:11.000 --> 0:09:15.199 many other neglected diseases. So can you talk briefly about 0:09:15.320 --> 0:09:18.840 the general missions of DNDI and what type of work 0:09:18.960 --> 0:09:21.960 the initiative does so you know, in. 0:09:22.040 --> 0:09:24.559 Fact, yes, the NDI was founded in two thousand and 0:09:24.760 --> 0:09:31.080 three after MSF Doctors Without Borders received their peace Nobel price, 0:09:31.400 --> 0:09:35.440 and some people at MSF, in fact, doctors who were 0:09:35.600 --> 0:09:40.000 working in the field, were facing terrible dilemma where they 0:09:40.000 --> 0:09:43.000 couldn't treat patients who they were trying to take care 0:09:43.080 --> 0:09:46.840 of because they didn't have the proper tools, the proper treatments, 0:09:47.640 --> 0:09:50.280 and so they started looking a little bit more and 0:09:50.400 --> 0:09:53.000 it was very clear that there were a range of 0:09:53.360 --> 0:09:57.880 patients or diseases that were totally neglected by the efforts 0:09:57.960 --> 0:10:03.199 of the industry because they were targeting diseases and all 0:10:03.679 --> 0:10:07.200 populations that had no economic power and for which there 0:10:07.240 --> 0:10:10.719 would never be what was expected to be needed, i e. 0:10:11.400 --> 0:10:15.120 Return of investment. So they developed the model, and at 0:10:15.160 --> 0:10:18.280 that time there were a few others that started developing 0:10:18.400 --> 0:10:23.160 what was called product development partnerships, looking at ways of 0:10:23.800 --> 0:10:28.400 developing treatment options that would be responding to the needs 0:10:28.440 --> 0:10:33.160 of those that are neglected by this industry, and that's 0:10:33.240 --> 0:10:37.839 how the NDI decided to focus initially on developing a 0:10:37.920 --> 0:10:43.559 combination of foral treatment for malaria fixed those combinations that 0:10:43.840 --> 0:10:47.440 was aligned with what the WHO was asking for at 0:10:47.480 --> 0:10:51.640 that time, but also focus on some specific diseases where 0:10:52.280 --> 0:10:56.640 there was both a need some partners and a hope 0:10:56.760 --> 0:11:01.360 for short, medium and long term response. And that's how 0:11:01.920 --> 0:11:05.920 a few diseases were selected from the list of neglected 0:11:05.960 --> 0:11:12.600 tropical diseases, which included mostly kinitoclastic related diseases so parasitic 0:11:12.720 --> 0:11:19.959 diseases including sleeping sickness, jagas and lehmanniasis. And then we 0:11:20.160 --> 0:11:24.160 expended every three four years we had a revision of 0:11:24.320 --> 0:11:27.679 the strategic plan and based on needs and opportunities, we 0:11:27.840 --> 0:11:33.280 expanded to encore psarkiasis, to pediatric HIV, which might come 0:11:33.320 --> 0:11:37.200 as a surprise but very neglected in sub Saharan Africa, 0:11:38.600 --> 0:11:44.520 and also hepatitis C and then mycetoma also extremely neglected. 0:11:45.160 --> 0:11:49.240 And then in twenty twenty we started, as wolf Kind mentioned, 0:11:49.360 --> 0:11:52.760 to engage in two COVID response, but COVID response for 0:11:52.880 --> 0:11:54.160 low and middle income countries. 0:11:55.559 --> 0:11:59.920 The global efforts towards elimination of human African trim panicema, 0:12:00.760 --> 0:12:05.559 they've been amazingly successful over the past ten years. For instance, 0:12:05.679 --> 0:12:09.000 I saw that only six hundred and sixty three cases 0:12:09.120 --> 0:12:11.920 were reported in twenty twenty, which is a drop of 0:12:12.080 --> 0:12:16.000 over three hundred from the year before. That's an incredible 0:12:16.320 --> 0:12:19.160 drop in cases and it shows that real progress is 0:12:19.280 --> 0:12:22.560 being made. What do you think are the biggest factors 0:12:22.679 --> 0:12:27.679 contributing to this decline in human African tripeness and ISS cases. 0:12:29.640 --> 0:12:34.520 It was the dagnostic that was very, very difficult, and 0:12:34.679 --> 0:12:37.319 the second and very big challenge was the treatment. 0:12:37.520 --> 0:12:40.320 Because the treatment we used to lose was. 0:12:42.000 --> 0:12:50.000 Archobal with arsenic and that treatment was toxic and less effective, 0:12:50.200 --> 0:12:53.559 was losing its effectiveness. And I think the great moment 0:12:54.240 --> 0:12:58.400 was when the NDA was involved with all his partner 0:12:58.600 --> 0:13:02.920 and when we change the treatment. The first wed step 0:13:03.240 --> 0:13:07.840 was to change to switch from the arsable to net 0:13:08.480 --> 0:13:13.359 the combination of thirty knox and this was the first. 0:13:13.559 --> 0:13:15.040 Quick step we did. 0:13:15.800 --> 0:13:20.480 But this changing of treatment, we had a very effective 0:13:20.600 --> 0:13:26.600 drug and less toxic and so we we have very 0:13:26.800 --> 0:13:30.839 very few relapse and even people was very comfortable to 0:13:30.920 --> 0:13:34.360 receive this treatment. This was I think for me, the 0:13:34.520 --> 0:13:38.480 very critical moment, and with our involvement of d n 0:13:38.520 --> 0:13:42.719 D and this partner, we are still working on the 0:13:42.880 --> 0:13:45.920 best way to ease the treatment and now we are 0:13:46.080 --> 0:13:47.160 on oral treatment. 0:13:47.679 --> 0:13:52.520 So all this was very important and very critical step 0:13:53.760 --> 0:13:54.760 toward the elimination. 0:13:55.960 --> 0:13:59.679 Yeah, so maybe I think we should also recognize the 0:14:00.280 --> 0:14:02.719 from the I mean, this is what Wilfred mentioned, but 0:14:03.000 --> 0:14:07.400 under the umbrella of national sleeping Sickness control programs and 0:14:08.360 --> 0:14:12.280 collaboration with many partners, which I think under you know, 0:14:12.400 --> 0:14:15.319 they're also the leadership of the who all of this, 0:14:15.520 --> 0:14:19.800 there was a momentum and a push to consolidate to 0:14:19.960 --> 0:14:24.640 have joined efforts on diagnostic and treatment. A lot of 0:14:24.760 --> 0:14:30.240 training activities performed via the national programs, and since Wilfred 0:14:30.440 --> 0:14:32.960 was also part of the national programs, maybe that's why 0:14:33.040 --> 0:14:36.400 he's being modest, But I think we should recognize that 0:14:36.520 --> 0:14:40.000 the organization at the country level was was also absolutely 0:14:40.120 --> 0:14:42.800 crucial in making this reality. 0:14:44.480 --> 0:14:47.200 So you have both been working in this field for 0:14:47.280 --> 0:14:50.400 a number of years and have had this opportunity to 0:14:50.640 --> 0:14:54.320 witness this drap in cases firsthand. So how do you 0:14:54.480 --> 0:14:58.480 feel that this field has changed since you first became involved. 0:15:00.040 --> 0:15:05.520 I did my medical training in the side province, so 0:15:06.000 --> 0:15:10.240 this was one of anemic areas of sleeping sickness. So 0:15:10.880 --> 0:15:14.440 even during my training, I was seeing how those passions 0:15:14.720 --> 0:15:18.640 was treat with melasoprol. And when I became a medical doctor, 0:15:18.720 --> 0:15:21.360 I was in charge of managing those persions in my 0:15:21.640 --> 0:15:24.640 small village where I was working, and you know, I 0:15:24.800 --> 0:15:27.160 was receiving those passions and the only drug we had 0:15:27.240 --> 0:15:31.720 at that time was melasoprol. This was terrible drug. I 0:15:31.760 --> 0:15:35.800 even lose lost two of my patients. It was a sad, 0:15:35.960 --> 0:15:39.080 very bad experience. You know, when we were treating passion 0:15:39.160 --> 0:15:43.400 with a SOB, it was stressful not only for health worker, 0:15:44.320 --> 0:15:44.800 but you. 0:15:44.880 --> 0:15:50.080 Know even for passion family. So but since we have 0:15:50.800 --> 0:15:51.840 those new drug. 0:15:51.960 --> 0:15:55.960 Things change, you know, we have even health worker are 0:15:56.200 --> 0:15:58.520 more comfortable, more confident. 0:15:59.080 --> 0:16:02.880 This is a which change and I think the key 0:16:02.960 --> 0:16:06.680 point is also that people are less less afraid of 0:16:06.840 --> 0:16:11.600 going for treatment. But maybe also with time they will 0:16:11.640 --> 0:16:16.280 also be less stigmatized because you know, less mystery is 0:16:16.400 --> 0:16:20.280 surrounding this disease. They can with with vacciny asert patients 0:16:20.320 --> 0:16:24.360 can be treated in the village. There's nothing magic about 0:16:24.640 --> 0:16:27.560 you know, the treatment patients come and some of our 0:16:27.680 --> 0:16:30.680 colleagues used to say the success will be one day 0:16:30.800 --> 0:16:34.800 when you consider sleeping sickness as any other infection, it 0:16:34.960 --> 0:16:39.440 has been, you know, impacted by a lot of stigma. 0:16:39.600 --> 0:16:43.200 That this stigma I think may decrease with getting a 0:16:43.240 --> 0:16:47.680 treatment that looks like any other treatments. It's tablets, there's nothing, 0:16:48.520 --> 0:16:52.840 no specific requirements regarding you know, its use, protection of 0:16:53.240 --> 0:16:55.680 activities you shouldn't be doing when you take the dragon, 0:16:56.120 --> 0:16:58.520 a lot of things which make it really more normal, 0:16:58.920 --> 0:17:02.360 and that's really important because what we need is patients 0:17:02.440 --> 0:17:05.240 to be treated. What we have observed is that patients 0:17:05.800 --> 0:17:10.359 have come, sometimes come very late for treatment because treatment 0:17:10.520 --> 0:17:15.440 before meant going to hospital, which meant not being able 0:17:15.520 --> 0:17:18.800 to work, which meant maybe having an economic impact on 0:17:18.920 --> 0:17:21.480 the family, which meant also that the family had to 0:17:21.600 --> 0:17:25.000 accompany patients at the hospital pay for fees. I mean 0:17:25.359 --> 0:17:28.560 a lot of things which are impacting the quality of 0:17:28.680 --> 0:17:32.840 life and the acceptability of treatment. So it's a huge change. 0:17:35.080 --> 0:17:37.280 One of the things that I wanted to ask about 0:17:37.560 --> 0:17:41.399 was the COVID nineteen pandemic. How has this had an 0:17:41.440 --> 0:17:44.280 impact on control efforts? Do you think that we'll see 0:17:44.320 --> 0:17:49.280 another decline and reported cases of human African tripanismiasis from 0:17:49.359 --> 0:17:53.800 twenty twenty one or has the pandemic impacted control efforts? 0:17:55.200 --> 0:17:59.680 So sure, yes, the pandemic is an impact on control efforts. 0:17:59.720 --> 0:18:03.639 You know, most of the National program works with what 0:18:03.840 --> 0:18:09.399 we call mobile team, and those mobile teams walk twelve months. 0:18:09.680 --> 0:18:12.680 Every twelve month, they spend more than twenty days or 0:18:12.760 --> 0:18:16.040 more than fifteen days going from a village to another 0:18:16.160 --> 0:18:20.760 doing the screening of population. So it's not easy for 0:18:20.880 --> 0:18:24.560 them to go from a village to another village due 0:18:24.560 --> 0:18:29.560 to COVID restuction, and since we have this COVID problem, 0:18:29.680 --> 0:18:32.359 you know, they are not able to have a twelve 0:18:32.440 --> 0:18:35.399 months of work. This is another problem. And you know 0:18:35.920 --> 0:18:41.080 we work with many partner, many founding partner with COVID. 0:18:41.280 --> 0:18:45.600 Their impact to SAW the National program you know, receive 0:18:47.119 --> 0:18:50.520 not the entire money for their activities. So this is 0:18:50.560 --> 0:18:54.200 a second impact and another impact. You know, if we go, 0:18:54.440 --> 0:18:57.440 for instance, in the field of another elective disease like 0:18:57.560 --> 0:19:01.359 filarial disease, they do what we call mass rog administration. 0:19:02.119 --> 0:19:03.320 They can do it. 0:19:03.720 --> 0:19:06.360 You know, last week I was leiting some remote areas 0:19:06.760 --> 0:19:09.640 and then the mass rog adminisation was not done. 0:19:09.840 --> 0:19:12.840 Due to this COVID issue, due to this restriction of 0:19:13.000 --> 0:19:14.800 movement and due to. 0:19:15.240 --> 0:19:20.320 The decrease of finance. So this COVID will have a 0:19:20.440 --> 0:19:23.960 good impact and we must be aware of this. 0:19:25.840 --> 0:19:27.879 I was wondering if you could talk a little bit 0:19:28.000 --> 0:19:32.399 more about the stigma surrounding human African tripanosamiasis. 0:19:34.040 --> 0:19:38.040 Yes, as you know this it's a chronic disease. The 0:19:38.160 --> 0:19:42.800 first step is what we call a molempathic step. The 0:19:42.920 --> 0:19:47.240 second stage, it's neurological stage. And at that stage, you know, 0:19:47.440 --> 0:19:51.280 can become like a foolish you know, mostly pe and 0:19:51.480 --> 0:19:54.560 so on, with a trouble of theev and so on. 0:19:54.920 --> 0:19:59.320 And for those who suffer from sleeping sickness, this was 0:19:59.359 --> 0:20:03.400 a very with sigma. That was one of the factors 0:20:03.760 --> 0:20:07.200 that could avoid some people to come to receive the treatment. 0:20:07.640 --> 0:20:11.639 But now sleeping sickness are more and more accept and 0:20:11.840 --> 0:20:15.639 are being humanized, you know, now things are changing. 0:20:17.160 --> 0:20:21.960 In our episode on human African tripanos semiasis, we touched 0:20:22.000 --> 0:20:24.720 briefly on vacting it as All, which is this oral 0:20:24.840 --> 0:20:29.200 medication recently developed to treat this disease. Can you tell 0:20:29.280 --> 0:20:32.760 us a bit more about the drug, starting with how 0:20:32.920 --> 0:20:33.879 exactly it works. 0:20:35.520 --> 0:20:39.399 We haven't fully elucidated the mechanism of action of vacciny desert, 0:20:39.480 --> 0:20:42.639 but we know it interacts with the enzi material of 0:20:42.720 --> 0:20:45.680 the parasite that is responsible for the disease, so it 0:20:45.960 --> 0:20:47.240 is innocence, it kills it. 0:20:48.200 --> 0:20:50.720 How effective is it for gambiensa? 0:20:51.840 --> 0:20:56.040 So it's really effective. So we did a study, a 0:20:56.200 --> 0:21:00.520 very robust study in comparison with the NEXT, which is 0:21:00.680 --> 0:21:04.399 the standard of care mentioned earlier by we FEED, and 0:21:04.600 --> 0:21:08.480 we showed that it was non inferior to it, which 0:21:08.640 --> 0:21:13.000 was the statistical hypothesis, within a limit of thirteen percent, 0:21:13.880 --> 0:21:18.320 which means that in essence, it is almost as equivalent 0:21:18.520 --> 0:21:23.560 as NEXT, with slightly lower efficacy, but within a range 0:21:23.640 --> 0:21:27.200 that is considered as really what the physicians wanted and 0:21:27.320 --> 0:21:31.520 what the regulators accept. So it's very important because it 0:21:31.680 --> 0:21:34.920 means that with an aal treatment you can replace an 0:21:34.960 --> 0:21:38.760 injectible treatment and something else, a combination of an injectible 0:21:38.800 --> 0:21:42.400 and oral treatment. But I think something we haven't yet 0:21:42.600 --> 0:21:46.200 mentioned is that to administer the standard of care, which 0:21:46.280 --> 0:21:50.560 is NEXT, you need to have patients being hospitalized, but 0:21:50.720 --> 0:21:53.880 before that they need to go through a lumber puncture 0:21:54.520 --> 0:21:58.720 to verify if they are eligible to this complex but 0:21:59.000 --> 0:22:02.800 very effective treatment combining an infusion and a normal treatment, 0:22:03.400 --> 0:22:08.000 or if they can stay with an intramuscular treatment, which 0:22:08.119 --> 0:22:13.040 is simpler to use, but still to get this standard 0:22:13.080 --> 0:22:15.720 of care, they need this lumber puncture. The lumber punctures 0:22:15.720 --> 0:22:19.360 are painful. Some of us who have had lumber punctures 0:22:19.400 --> 0:22:22.480 in the past, we have access to anastasia, but that's 0:22:22.560 --> 0:22:25.080 not the case when you do lumber puncture to test 0:22:25.160 --> 0:22:29.720 patients for treatment allocation. You have headaches first lumber puncture, 0:22:29.760 --> 0:22:33.560 and that's also one of the factors that made sometimes 0:22:33.680 --> 0:22:37.280 patients want to avoid being tested just for the sake 0:22:37.320 --> 0:22:40.040 of not having to go through this lumber puncture. Now, 0:22:40.760 --> 0:22:43.600 with vaccin need as a you don't systematically need a 0:22:43.680 --> 0:22:47.119 lumber puncture. You may need it if patients are experiencing 0:22:47.240 --> 0:22:51.840 severe neurological symptoms, where maybe they would benefit more from 0:22:52.000 --> 0:22:55.800 this standard of care treatment, but otherwise, once a patient 0:22:55.920 --> 0:22:59.840 has been tested with the parasite, that patient, provided he 0:23:00.240 --> 0:23:05.040 doesn't have very severe symptoms, can get oral treatment immediately. 0:23:05.840 --> 0:23:08.800 It has also shown us that it has really high 0:23:08.800 --> 0:23:12.760 efficacy in stage one, meaning that those patients were not severe, 0:23:13.400 --> 0:23:17.359 and it's also as efficicious in children, which is very 0:23:17.440 --> 0:23:21.160 important as well, because otherwise those small kids would require 0:23:21.240 --> 0:23:23.639 the lumber puncture if they are in the advanced stage, 0:23:23.960 --> 0:23:27.600 and would require the infusion, the combination of infusions and 0:23:28.000 --> 0:23:33.040 oral treatment. So overall it is almost the same as 0:23:33.119 --> 0:23:36.679 the standard of care, but it's oral and doesn't need 0:23:36.720 --> 0:23:37.560 the lumber puncture. 0:23:38.359 --> 0:23:42.240 That's wonderful. Yeah, And I'd love to hear more about 0:23:42.320 --> 0:23:45.920 the story of the drugs discovery. How is it selected 0:23:46.119 --> 0:23:49.480 as a potential candidate for a sleeping sickness medication and 0:23:49.520 --> 0:23:50.639 then what happened after that? 0:23:51.680 --> 0:23:54.600 So that came from the well, the way we worked 0:23:54.600 --> 0:23:58.120 at the NDI, and it was our predecessor, so elsto 0:23:58.200 --> 0:24:03.040 Rele and bernardet Bourdain who evaluated drugs of the class 0:24:03.160 --> 0:24:06.639 nitro medesol class because they were known to have a 0:24:06.720 --> 0:24:10.720 potential for this disease, and looked at a library or 0:24:11.280 --> 0:24:14.240 I think of almost seven hundred drugs and started looking 0:24:14.359 --> 0:24:18.160 at the potential for those drugs. Vaccini Desol came out. 0:24:18.280 --> 0:24:23.520 It had been developed earlier on by predecessor of Sanufi 0:24:24.240 --> 0:24:27.400 and put on shelves before it came to clinical stage, 0:24:27.680 --> 0:24:32.200 just for probably you know, strategic reasons. Nothing else so 0:24:32.359 --> 0:24:36.520 it was identified back from the shelves and then as 0:24:36.880 --> 0:24:41.320 the value chain of clinical development evolved, meaning looking at 0:24:42.280 --> 0:24:47.560 individro testing on parasite labs, going to animals to test 0:24:47.960 --> 0:24:52.119 the efficacy of the drug in animals infected by the parasites. 0:24:52.760 --> 0:24:57.760 We selected the end vacciny as a clinical candidate, at 0:24:57.800 --> 0:25:02.720 which point we also signed contract agreement with Sanofi and 0:25:02.800 --> 0:25:07.240 then started engaging in the standard phase one healthy volunteer study, 0:25:07.400 --> 0:25:12.040 followed by the very large study in Africa that was 0:25:12.119 --> 0:25:16.679 called by Wildfree and doctor comt in the DRS. 0:25:18.080 --> 0:25:22.600 The historical lack of funding for human African tripanasamiasis and 0:25:22.880 --> 0:25:27.080 all other neglected tropical diseases it has meant that drugs 0:25:27.119 --> 0:25:30.240 are slow to be developed and once available, there are 0:25:30.400 --> 0:25:34.439 many logistical challenges that prevent access by people who need them. 0:25:34.920 --> 0:25:37.359 So can you talk about how important it is to 0:25:37.560 --> 0:25:41.879 form industrial partnerships to connect drug development with setting up 0:25:41.920 --> 0:25:44.560 infrastructure for actually administering those drugs. 0:25:46.040 --> 0:25:48.879 Having a disease that has priority for public health that 0:25:49.080 --> 0:25:52.520 is on the wtual list of diseases that need to 0:25:52.640 --> 0:25:57.879 have you solution is one way of attracting funders together 0:25:58.040 --> 0:26:02.480 with an organization that can bring elements to show it 0:26:02.600 --> 0:26:06.760 can deliver, which was something we did with the development 0:26:06.840 --> 0:26:10.360 of Azak, which in fact we had done also with SENUFI. 0:26:11.119 --> 0:26:15.000 On the other hand, SENUFI, as part of their global 0:26:15.320 --> 0:26:19.639 Corporate Responsibility activity or access to Drug engagement for a 0:26:19.760 --> 0:26:25.760 long time, had been supporting the WHOW financially. Therefore, it 0:26:25.960 --> 0:26:29.320 was kind of a natural partner for us to go 0:26:29.480 --> 0:26:34.120 with SENUFI to engage into this partnership where we would 0:26:34.160 --> 0:26:37.000 be doing the development and looking for funds to do that, 0:26:38.000 --> 0:26:41.199 which we got from public funding as well as private 0:26:41.280 --> 0:26:46.760 funding them doing the manufacturing and distribution together with the 0:26:47.440 --> 0:26:52.080 writ show via a donation of Vaccini as a two 0:26:52.160 --> 0:26:56.560 countries via w O Shoe. So it's a bit complex, 0:26:56.920 --> 0:27:00.280 and I think for each disease it's different, and it's 0:27:00.320 --> 0:27:02.639 clear that we have to continue to promote the need 0:27:02.760 --> 0:27:07.359 to fund research for neglected tropical diseases. But there is 0:27:08.000 --> 0:27:11.920 you know, a kind of move to public health firm 0:27:12.440 --> 0:27:16.240 interest in doing that, although still not as much as 0:27:16.280 --> 0:27:19.320 we have seen for tibing, malaria and HIV. 0:27:20.640 --> 0:27:22.760 So I want to take a quick pause here and 0:27:22.920 --> 0:27:25.080 then when we get back, I want to dive deeper 0:27:25.160 --> 0:27:27.920 into the story of vaccing it as all specifically with 0:27:28.000 --> 0:27:57.920 the clinical trials process. Welcome back everyone. So I was 0:27:58.000 --> 0:28:01.040 wondering if you could talk about what went into the 0:28:01.119 --> 0:28:04.680 clinical trials to test the safety and efficacy of this 0:28:04.880 --> 0:28:07.879 drug and what were some of the biggest challenges in 0:28:08.080 --> 0:28:09.440 conducting these trials. 0:28:10.520 --> 0:28:12.280 This is a good question. 0:28:12.600 --> 0:28:15.680 You know, to conduct technical tyers, you need to go 0:28:15.800 --> 0:28:19.359 where pasions are and those persons are. 0:28:19.320 --> 0:28:20.760 Living in remote areas. 0:28:21.680 --> 0:28:26.640 As you may know, our health facilities in remote areas 0:28:27.359 --> 0:28:31.399 are in very bad states. So the first challenge we 0:28:31.520 --> 0:28:35.959 have many challenges. First, we need to improve those health facilities, 0:28:36.440 --> 0:28:42.200 passion towards laboratory sanitation, all those things, and even to 0:28:42.320 --> 0:28:47.160