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FDA finds lack of evidence for dry eye disease drug approval

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Patient with dry eye disease using eye drops

Aldeyra Therapeutics has received a Complete Response Letter (CRL) from the US Food and Drug Administration (FDA) for the New Drug Application (NDA) of reproxalap, an investigational drug candidate, for the treatment of dry eye disease.  

The CRL states that there is “a lack of substantial evidence consisting of adequate and well-controlled investigations” and that “the application has failed to demonstrate efficacy in adequate and well controlled studies in the treatment of signs and symptoms of dry eye disease.”  

The letter also stated that the “inconsistency of study results raises serious concerns about the reliability and meaningfulness of the positive findings” and that the “totality of evidence from the completed clinical trials does not support the effectiveness of the product.” However, no safety or manufacturing concerns were identified. 

The FDA has recommended that the reasons for failure in certain trials be explored, and that populations or certain conditions in which reproxalap may be effective be identified.  

“To the thousands of American and Canadian patients who participated in our clinical trials and to the tens of millions of patients with dry eye disease worldwide, I want to assure you that we will work with urgency to support the FDA in enabling market access to what is, to our knowledge, the only drug with clinical activity within minutes of administration in patients with dry eye disease, a condition that is today treated with medications that require weeks or months of treatment to achieve even modest improvement,” stated Todd Brady, President and Chief Executive Officer of Aldeyra. 

Share prices for the company were down more than 75% following the news. In response, law firm Block & Leviton has announced it is investigating Aldeyra for potential securities law violations and encouraged investors who have lost money to get in touch.

The post FDA finds lack of evidence for dry eye disease drug approval appeared first on Drug Discovery World (DDW).

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Spatiotemporal Multiomics Charts Cellular Dynamics of Liver Metastasis

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Metastasis remains one of cancer’s most difficult biological transitions to capture: tumor cells must leave a primary tumor, survive circulation, enter a distant organ, and then either disappear, persist, or eventually grow into clinically detectable lesions. A spatiotemporal study in mice and human samples identifies transient tumor-cell and immune-niche states that may offer windows for intercepting metastatic colonization.

A new study published in Science provides a high-resolution look at that process in liver cancer, suggesting that metastatic colonization unfolds through ordered changes in both disseminated tumor cells and the immune microenvironments that surround them.

In the study, “Spatiotemporal multiomics uncover tumor ecosystem dynamics during metastatic colonization,” researchers led by Yunfan Sun, MD, PhD, at Zhongshan Hospital, Fudan University, applied spatiotemporal multiomics to experimental hepatocellular carcinoma mouse models and human metastatic samples. Their goal was to reconstruct how disseminated tumor cells, or DTCs, survive the earliest stages of lung colonization and later transition into metastatic outgrowth.

The team integrated high-resolution spatial transcriptomics, single-cell RNA sequencing, and chromatin-accessibility profiling across nine sequential stages of lung colonization in mouse models. The resulting atlas followed liver cancer cells from their first arrival in the lungs through later metastatic progression, while also mapping changes in nearby immune cells.

The analysis indicated that early metastatic seeding is not simply a random survival event. “After a massive innate immune clearance, primarily by neutrophils and natural killer (NK) cells, a rare subpopulation of DTCs survived by entering a transient, quiescent Phgdhhigh state,” the authors write. These cells were associated with an immune-scarce niche, allowing them to avoid elimination during a vulnerable early window.

Mechanistically, the authors linked this state to metabolic and epigenetic remodeling. Alveolar type 2 cells enriched near surviving DTCs appeared to promote the Phgdhhigh phenotype. Elevated PHGDH activity fueled one-carbon metabolism and increased levels of S-adenosylmethionine (SAM). That shift was tied to H3K27me3-mediated silencing of proinflammatory chemokine genes, including Ccl2 and Cxcl10, which would otherwise help recruit immune cells to the niche.

Perturbing this axis genetically or pharmacologically restored chemokine expression, increased immune surveillance, and reduced metastatic outgrowth in the models, according to the study. Lineage-tracing experiments further suggested that many macrometastases derived from ancestors that had passed through the transient Phgdhhigh state.

The researchers also identified a second niche-remodeling step before rapid metastatic expansion. At this stage, Cx3cr1high interstitial macrophages accumulated in the DTC niche. These “macrophages recruited immunosuppressive cells (T regulatory cells, neutrophils, and alveolar macrophages) and provided growth signals through the IGF1-IGF1R axis that trigger the transition of DTCs from quiescence to rapid proliferation,” the authors report in the study. Depleting these macrophages reduced metastatic burden in mouse experiments.

Together, the findings point to metastatic colonization as a temporally organized process shaped by reciprocal interactions between tumor cells and their local microenvironment. First, a rare tumor-cell state helps establish early immune evasion. Later, macrophage-driven remodeling appears to convert a quiescent niche into one that supports metastatic outgrowth.

Although the work is largely preclinical, the authors suggest that these transient states may represent vulnerabilities for micrometastasis-targeting approaches. By defining when and how early DTCs evade immune attack, the study offers a framework for developing interventions aimed not only at established metastases, but also at the earliest stages of metastatic colonization.

The post Spatiotemporal Multiomics Charts Cellular Dynamics of Liver Metastasis appeared first on GEN – Genetic Engineering and Biotechnology News.

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Replimune overcomes ‘messy data’ to secure positive adcomm vote for melanoma therapy

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The FDA’s Cellular, Tissue and Gene Therapies advisory committee voted 10 to 3 in favor of Replimune’s immunotherapy for advanced melanoma in combination with Bristol Myers Squibb’s Opdivo, but trial design was a major sticking point as the panel deliberated.

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Replimune melanoma drug wins support of FDA panel

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The positive vote came despite persistent concerns from FDA scientists and positions the company to bounce back from two earlier rejections.

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