Frequency Therapeutics — Hearing Loss Regeneration

Discussion in 'Research News' started by RB2014, Dec 8, 2016.

    1. Pete88

      Pete88 Member

      Tinnitus Since:
      02/2018
      Cause of Tinnitus:
      Likely noise
      Yeah, possibly!

      Again, remember when he showed up and so many people jumped down his throat and aggressively mocked him?
       
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    2. Joeseph Stope
      Innocent

      Joeseph Stope Member

      Tinnitus Since:
      1992
      Cause of Tinnitus:
      noise? infection? negative stress? other?
      One or two things to remember in this regard:

      a) Quite few people were emotionally involved in this new medical approach and had pinned their hopes on a successful outcome. On the face of it, it seems quite logical or at least plausible that hearing loss and tinnitus are connected. Lots of army personnel (think guns and explosives), lots of firemen, lots of musicians and lots of grade school teachers too (all those high-pitched screaming kids) come down with tinnitus.

      b) Some people had placed their hard-earned on the markets in the hopes of a retirement nest-egg.

      For @Bobb77 to come along and tell everyone that he was an expert and show his winnings (taxed too!) and tell all and sundry that he had got out before the "fit hits the shan" -- need I go on?

      It almost had its comic side to it except that tinnitus is such a life-changing disaster. :bag:
       
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    3. Chad Lawton

      Chad Lawton Member

      Tinnitus Since:
      2/19/18
      Cause of Tinnitus:
      Possible Ototoxicity + Noise Exposure
      The company has openly said that these are all exploratory studies to find out who FX-322 works on and who it doesn't. They need to first learn their target demographic so they can know who to target in future trials in order to gather enough evidence for the FDA to show it has clinical significance. To call the results lackluster because it only worked on a subset of patients (about 1/3 of patients in that trial) with hearing loss is like being disappointed if a new blood cancer drug came out and you consider it lackluster because it didn't treat all forms of blood cancer at once even if it shows efficacy for one or two types.
       
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    4. Pete88

      Pete88 Member

      Tinnitus Since:
      02/2018
      Cause of Tinnitus:
      Likely noise
      I agree. There was a lot of emotion riding on good results. All I'm saying is that people need to recognize when emotion is in the driver's seat.
       
    5. Pete88

      Pete88 Member

      Tinnitus Since:
      02/2018
      Cause of Tinnitus:
      Likely noise
      Yeah you're absolutely right. It's just that if you had the type of blood cancer the new drug didn't help, it would be personally disappointing. However, if you were just an impartial observer, any progress is incredible.

      Everyone was hoping FX-322 would fix all the hair cells it touched and idea was it would fix 8,000 Hz and above by at least 10 dB. So the apparent reality that this isn't the case is what makes it relatively disappointing. I guess the bar of expectations were set too high a while ago.
       
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    6. tommyd87

      tommyd87 Member

      Tinnitus Since:
      1999
      Cause of Tinnitus:
      tmj music
      I think that the biggest issue that Frequency Therapeutics has got right now is that it needs to reevaluate both the dosing methodology and also actually whether the medicine properties are sufficiently targeting what it needs to target too. There is evidence which indicates that the medicine is beneficial and working, however Frequency Therapeutics haven't looked at shifting their trials to evaluate alternatives which possibly would work with making the medicine more effective.

      There is no issue with continuing the dosing method or the amount of medicine used in the same way which they have done to date, however they also need to look at running alternative trials in conjunction with the existing trials which focuses on alternatives such as bigger volumes or using alternative methods.

      There is no certainty that Frequency Therapeutics can completely claim that they have truly completed the required and necessary exploratory elements of their medicine and trial until they branch out and attempt all alternatives to what they have engaged thus far to obtain comprehensive information. It won't be until after Frequency Therapeutics has done this that there will be any certainty over their medicine.
       
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    7. Chad Lawton

      Chad Lawton Member

      Tinnitus Since:
      2/19/18
      Cause of Tinnitus:
      Possible Ototoxicity + Noise Exposure
      I don't think it's the dosage that is the issue, it's administration. By using intratympanic injection, the drug is only diffusing into about the first 15% of the cochlea. This was confirmed with both their cochlear implant studies as well as their computer modeling.

      The blue shaded region is all the further FX-322 is reaching.

      Capture.PNG

      Not a lot of sq footage or I should say sq millimeters are dedicated to our high frequency region of hearing. There are about as many hair cells dedicated to the 6,000 Hz to 20,000 Hz range as there are hair cells from the 4,000 Hz to 6,000 Hz range alone. If they can find a method to get it deeper, I really think that is where we would see more significant improvements.
       
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    8. sensualmosquito
      Insomnious

      sensualmosquito Member

      Location:
      New Mexico
      Tinnitus Since:
      June 2020
      Cause of Tinnitus:
      6-8 khz HL, T and H from gunshots
      Well said.
       
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    9. AfroSnowman
      Balanced

      AfroSnowman Member Podcast Patron Benefactor

      Tinnitus Since:
      April 16 2019
      Cause of Tinnitus:
      Nonnatural energy source
      I would feel better about that interpretation if we saw good data on hearing thresholds above 6 kHz or 8kHz. I’m not saying audiograms are the whole ballgame, but would feel much more definitive than slight to modest word-in-noise improvements.
       
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    10. ploughna

      ploughna Member

      Tinnitus Since:
      2017
      Cause of Tinnitus:
      motor racing and power tools
      Is OTO-413 any better? They have their extended release formula, but I can't find any mention of how deep into the cochlea it goes?
       
    11. Aleksandar

      Aleksandar Member

      Tinnitus Since:
      09/2020
      Cause of Tinnitus:
      Covid19
      Great question. Is there any information as to which part of the cochlea OTO-313 and OTO-413 reach?
       
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    12. Chad Lawton

      Chad Lawton Member

      Tinnitus Since:
      2/19/18
      Cause of Tinnitus:
      Possible Ototoxicity + Noise Exposure
      Not sure, I haven't followed Otonomy very closely. I'd put my money on OTO-413 succeeding more over OTO-313 as OTO-413 actually addresses the underlying problem while OTO-313 just addresses the symptoms.
       
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    13. Pete88

      Pete88 Member

      Tinnitus Since:
      02/2018
      Cause of Tinnitus:
      Likely noise
    14. Trevor_phillips

      Trevor_phillips Member

      Tinnitus Since:
      2019
      Cause of Tinnitus:
      NIHL
      Not sure but I do think that Otonomy gel can hit the cochlea from the apex to the base. I'm saying that because OTO-413 has recently proved clinically meaningful improvements in word recognition in noise. So basing on the fact that speech frequencies are almost at the base of the cochlea, I think that their gel have a deep penetrance.
       
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    15. Chad Lawton

      Chad Lawton Member

      Tinnitus Since:
      2/19/18
      Cause of Tinnitus:
      Possible Ototoxicity + Noise Exposure
      I asked if the presentation was available for those who did not attend the conference and the company responded "The presentation is open only to conference registrants."

      I looked at the website and it was like $700 to register for a day or something like that.
       
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    16. patorjk

      patorjk Member Benefactor

      Tinnitus Since:
      2008
      Cause of Tinnitus:
      Several reasons
      According to their latest corporate presentation, they claim their gel delivers high drug levels throughout the inner ear. I remember reading something where they said the gel could help drugs could reach the apex of the cochlea too, but I don't have a reference for that.

      Also, in their latest corporate presentation they show charts for 4 responders to the OTO-413 study. The charts show various amounts of improvement at various dB signal to noise ratio levels. I would assume this is only possible if the drug is being delivered to various parts of the cochlea - though I'm out of my wheelhouse on this one so if someone knows for sure feel free to jump in.

      What I'm not sure of is if their gel would help FX-322. If it could, I would hope one of the companies would reach out to the other one about a possible collaboration. OTO-6XX is a long ways away, and OTO-413 and FX-322 aren't really competitors.

      slide.png
       
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    17. Jurger

      Jurger Member

      Tinnitus Since:
      2004
      Cause of Tinnitus:
      Hearing loss
      What’s ‘throughout the inner ear’? I want a delivery method that can hit all frequencies of the audiogram (250-8000 Hz).
       
    18. d'Wooluf

      d'Wooluf Member

      Tinnitus Since:
      2010
      Cause of Tinnitus:
      unknown
      I think they are pretty much. They're both going for improved clarity. Frequency Therapeutics haven't talked about improving thresholds for a long time.

      Collaboration between these small biotechs seems to be nil.
       
    19. Diesel

      Diesel Member Benefactor Ambassador Hall of Fame Advocate

      Tinnitus Since:
      1-2019
      Cause of Tinnitus:
      20+ Years of Live Music, Motorcycles, and Power Tools
      That means "all frequencies."
       
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    20. Jurger

      Jurger Member

      Tinnitus Since:
      2004
      Cause of Tinnitus:
      Hearing loss
      Can you point me to a source or is that your interpretation of ‘throughout’. I find it hard to believe it’s accurate, because it’s well documented that it’s very hard to reach the apex of the cochlea via intratympanic delivery, let alone in stable, therapeutic concentrations.
       
    21. Diesel

      Diesel Member Benefactor Ambassador Hall of Fame Advocate

      Tinnitus Since:
      1-2019
      Cause of Tinnitus:
      20+ Years of Live Music, Motorcycles, and Power Tools
      My first source is the American English language, which is my first language. Which happens to be the native language of the presenters and presumably, creators of this presentation. The use of "throughout" is exchangeable with "everywhere." My second source is the medical description of the "inner ear," which largely includes the whole cochlea. Saying in an investor deck, "reaching all frequencies" requires additional explanation and isn't valuable to the audience. It's shop talk. My third source is the Securities Exchange Commission and its many compliance rules relating to marketing/investor/public communication. This company cannot simply use the term "throughout" without evidence to back it up. Anything they put out to the public must go through regulatory review by a compliance officer of some type, or a 3rd party. This ensures that investors are not misled. Breaking these rules can result in fines, prison time, and/or the revocation of certain licenses by their personnel responsible compliance.

      Anatomy-of-Inner-Ear-It-consists-of-six-mechanoreceptor-structures_Q640.jpg
       
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    22. Jurger

      Jurger Member

      Tinnitus Since:
      2004
      Cause of Tinnitus:
      Hearing loss
      Why the thin-skinned reaction? It's not like it would be he first time a company overpromises and underlivers in the hearing field.

      "Local intratympanic administration into the middle ear would be a preferable option in this case, and the only option for many newly emerging classes of drugs, but it leads to the formation of drug concentration gradients along the extensive, narrow cochlea. The gradients are orders of magnitude and well outside the therapeutic windows."

      Local Drug Delivery to the Entire Cochlea without Breaching Its Boundaries (nih.gov)

      "Intratympanic administration of drugs relies on their remaining in contact with the round window membrane (RW) (a membranous opening in the bony wall of the cochlea into the middle ear) long enough to allow their diffusion into the perilymph of the scala tympani (ST). The ability of drugs to pass through the RW does not, however, guarantee their sufficient distribution along the cochlear spiral. Drug distribution in the ST is limited by the low flow rate of perilymph within the cochlea and by cochlear geometry. The longitudinal flow of perilymph in the cochlea has been shown to be relatively slow, if present at all (Ohyama et al., 1988), and drug distribution in the perilymph is dominated by passive diffusion. Passive diffusion along the ST is, however, constrained because the cochlea is a relatively long and narrow tube with a cochlear cross-section that decreases gradually from the RW at the base to the apex. It is in the cochlear apex where human speech processing is initiated (e.g., Nuttall et al., 2018) and where drug delivery to the cochlea has greatest potential therapeutic and socioeconomic impact."

      Frontiers | Drug Diffusion Along an Intact Mammalian Cochlea | Cellular Neuroscience (frontiersin.org)

      "In many of these cases, the drugs are delivered at the basal end of the cochlea, where the highest audible frequencies are detected, around 20 kHz in men. However, the frequencies that matter most for speech range from 300 Hz to 3 kHz and are sensed by hair cells further towards the apical end of the cochlea. This leads to the next stage of the delivery problem: distribution of the drug once it has been administered to the cochlea. Whilst there are methods such as micropumps, which can inject and distribute a drug, most of the current drug delivery methods rely on passive diffusion to reach the mid and apical region. This process is slow, inefficient, and difficult to control or verify."

      Steady streaming as a method for drug delivery to the inner ear | Scientific Reports (nature.com)

      "In general pharmacokinetics, the term bioavailability is commonly used to describe the rate and extent of drug input. For extracochlear applications, such as intratympanic injections to the round window niche, the percentage of drug entering the inner ear (bioavailability) is relatively low."

      Principles of Local Drug Delivery to the Inner Ear - FullText - Audiology and Neurotology 2009, Vol. 14, No. 6 - Karger Publishers

      "Thus, intratympanic drug administration faces the fundamental problem of limited passive diffusion within the cochlea, which undermines drug efficiency due to the inability of drugs to reach their targets within the therapeutic concentration window."

      Drug distribution along the cochlea is strongly enhanced by low-frequency round window micro vibrati (brighton.ac.uk)

      "For instance, IT delivery of drug-loaded gels to the round window niche is reliant upon permeation of compounds through the RWM, a process sensitive to numerous factors including the size, charge, and lipophilicity of the molecule [20,21]. In addition, permeation rates between individuals and between species vary widely, presenting challenges in terms of the number of studies and replicates required to gather reliable data, and for future regulatory approval based on the performance of the delivery technology."

      Intracochlear drug delivery systems: a novel approach whose time has come (cilcare.com)

      I can go on, and on, and on. The drawbacks of intratympanic injections are a well documented and fundamental challenge with regards to hearing restoration.
       
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    23. tommyd87

      tommyd87 Member

      Tinnitus Since:
      1999
      Cause of Tinnitus:
      tmj music
      Yes I think that the administration method might end up being the bigger culprit when it comes to the effectiveness of the medicine currently.

      There are a plethora of other options obviously to evaluate when it comes to dosing such as slow release gel, bigger volumes and cochlear pumping. Until Frequency Therapeutics evaluates these though, there is no definitive evidence that the dosing is the problem.
      \
      The incredibly difficult thing with OTO-413 is that the depth of the treatment is hard to measure because synapses are actually across all areas and you cannot measure them at a specific point or with a single metric like you could with a specific frequency tone or sound.

      Subsequently successful outcomes from medicine like OTO-413 etc may indicate it is working widely when injected, however until a treatment like OTO-6XX which can be measured specifically provides beneficial results, it is incredibly difficult to definitively answer such a question.
       
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    24. Diesel

      Diesel Member Benefactor Ambassador Hall of Fame Advocate

      Tinnitus Since:
      1-2019
      Cause of Tinnitus:
      20+ Years of Live Music, Motorcycles, and Power Tools
      Why the personal attack? Thanks for flexing the PubMed search? None of them cover Otonomy’s formula in an independent research setting, so it’s not all that useful of an argument to paste all that. Other problem is, just because something is difficult or challenge, doesn’t make it impossible. Otonomy clearly has their delivery gel patented, so they only have knowledge and research to back up their claims.
       
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    25. tommyd87

      tommyd87 Member

      Tinnitus Since:
      1999
      Cause of Tinnitus:
      tmj music
      Interestingly multiple of these papers don't actually rule out the use of intratympanic injections totally and also point to issues such as the technique and substance used among other factors as being the issue.
       
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    26. tracyNYC
      Frustrated

      tracyNYC Member Benefactor

      Location:
      NY NY
      Tinnitus Since:
      2009-2020 habituated; 1/2021 - severe
      Cause of Tinnitus:
      Noise; hearing loss
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    27. Street Novelist
      Depressed

      Street Novelist Member

      Location:
      Bay Area
      Tinnitus Since:
      February 2018
      Cause of Tinnitus:
      Listening to loud music through headphones
      I bet they won't have a new trial before the year ends. It's already mid-October. Recruitment takes months. Hopefully they reveal the results from the severe trial.
       
    28. Lucifer

      Lucifer Member Podcast Patron Benefactor Hall of Fame

      Location:
      Prison
      Tinnitus Since:
      -
      Cause of Tinnitus:
      -
      I really hope these next set of trials are going to be at the maximum a year for each phase. I can’t believe Audion/Regain Phase 2b trial is going to start September 2022 and finish in 2025. It is fucking ridicolous.
       
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    29. Chad Lawton

      Chad Lawton Member

      Tinnitus Since:
      2/19/18
      Cause of Tinnitus:
      Possible Ototoxicity + Noise Exposure
      They have been saying since June that they would initiate a new Phase 2 trial by end of year so I'm sure recruiting will begin by then but they probably won't have their final subject enrolled until 1st half of next year.
       
    30. Amv

      Amv Member

      Tinnitus Since:
      16/7/2017
      Cause of Tinnitus:
      -
      I still think, apart from Prof. Tzounopoulos, that the best treatment for the mid term will be neuromodulation, and probably long term will be pharma and Frequency Therapeutics. But something is saying me they will need to do more research.

      But neuromodulation looks promising.
       
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