Convos with Dr. Kate

Kate engages Dr. Luigi Boccuto, Associate Professor at Clemson University, about his work studying genes other than SHANK3 and their impact in Phelan-McDermid syndrome. They highlight a recent publication authored by Dr. Boccuto, Dr. Andy Mitz, and Dr. Audrey Thurm, linked below. Dr. Boccuto describes how multiple genes in the 22q13 region, when altered, can have overlapping impacts on neurodevelopment. Understanding the importance of each of these genes can help improve the management and treatment of Phelan-McDermid syndrome long-term as clinical care moves more towards personalized medicine. Publication link: https://onlinelibrary.wiley.com/doi/10.1111/cge.14503

This month we feature three representatives from Neuren Pharmaceuticals to answer frequently asked questions about the recent Phase 2 clinical trial, and plans for a Phase 3. Larry Glass, Neuren’s Chief Science Officer provides an insightful breakdown of NNZ-2591, the drug that was being tested. Additionally, Liza Squires, Chief Medical Officer, and Nancy Jones, VP of Clinical Development, offer an overview of the safety, tolerability, and efficacy results. Important links: Phase 2 top line results: https://pmsf.org/document/neuren-phase-2-trial-investor-presentation/?fbclid=IwAR2ytXd7HXVfjJ9hFxwUVlVgJvI_KkczBTpGJCNUOMLTzgUAI6lPy1ZZO9g Phase 2 inclusion and exclusion criteria https://clinicaltrials.gov/study/NCT05025241?cond=Phelan-mcdermid%20syndrome&term=NNZ-2591&rank=1#participation-criteria

Kate chats with Dr. Tony Persico, an Italian clinician and researcher who recently ran a clinical trial testing metabolic support therapy for Phelan-McDermid syndrome. This therapy is an antioxidant/vitamin combination consisting of Coenzyme Q10, Vitamin E, and Polyvitamin B. They discuss the rationale, the study design, positive results, potential side effects, access for families, and next steps. Learn more about the study here: https://www.oaepublish.com/articles/rdodj.2023.08 Dr. Tony Persico is an active member of the Italian Association for Phelan-McDermid syndrome and the Neuropsychiatric Consult Group.

Kate interviews Carla D’Imperio, fellow PMSF staff member and Family Support Specialist, on a program she leads to support mental health for Phelan-McDermid syndrome caregivers. This program, called Caregiver Support Groups, was started last year with funding from Global Genes and is continuing into 2024. Carla explains the decision to start this program and the positive impact it has made in the community. She delves into the importance of having licensed professionals lead these sessions. And she describes which groupings are offered, how to sign up, and how the program is changing over time. International families are welcome to join and the program is free to families. For more information or to sign up, see: https://pmsf.org/caregiver-support-groups/.

Kate sits down with Dr. Zigler, Associate Professor at Duke University, to discuss her efforts to more accurately capture communication in Phelan-McDermid syndrome and other neurodevelopmental disorders. The goal is to have a clinical assessment that better measures communication progress - for families, and for clinical studies and trials. With funding from the FDA, Dr. Zigler is adapting a current communication measure, the ORCA. Kate asks what the ORCA is, why it is being adapted, what's been done so far, and how families can play a role.

Kate engages Dr. Thomas Bourgeron, genetics expert, PMSF Scientific Advisory Committee member, and longstanding researcher in Phelan-McDermid syndrome. They discuss the importance of studying genetics to better understand disorders like Phelan-McDermid and autism. Dr. Bourgeron explains that in the early 2000’s, his lab and others identified a link between the SHANK3 gene and the occurrence of autism. He then explains the scientific journey - from identifying a gene of interest, to testing therapeutics in lab models, and describes a current clinical trial for lithium ongoing in France. He also summarizes his top goals for future research in Phelan-McDermid syndrome. A PMSF blog post on SHANK3 genetics: https://pmsf.org/shank3-in-phelan-mcdermid-syndrome/ A PMSF blog post on Phelan-McDermid syndrome versus autism: https://pmsf.org/phelan-mcdermid-syndrome-and-autism/

Join Kate, Scientific Director of PMSF, as she delves into how research funding works, how much money is required, and all the details of how PMSF's new Research Grants Program works. She explains how the program was set up, how funding categories were chosen, the review process used by scientists and families, and provides summaries of the three grants PMSF is funding in 2023/2024.

Kate highlights Dr. Sid Srivastava, a clinician at Boston Children's Hospital studying Phelan-McDermid syndrome in the Natural History Study. She asks - how did he become interested in rare diseases like Phelan-McDermid syndrome? What does a typical Natural History Study visit look like for families? What research projects is he working on? What are the biggest findings he's seen in studying the syndrome? For enrollment information on the Natural History Study, see: https://pmsf.org/enrollment-is-currently-open-for-phase-ii-of-the-phelan-mcdermid-syndrome-pms-natural-history-study/

Dr. Conny van Ravenswaaij runs an expert Phelan-McDermid syndrome clinic in the Netherlands, and was a leading force behind the European Phelan-McDermid syndrome clinical consensus guidelines. She and Kate discuss the clinical recommendations and how to share them with your clinicians. Conny also covers a clinical trial that she ran on intranasal insulin, and current work studying Ring 22 in Phelan-McDermid syndrome. Important links: Clinical synopsis of european guidelines: https://ern-ithaca.eu/wp-content/uploads/2023/05/Clinical-synopsis-PMS-1.pdf PMSF conference session on genetics (including Ring 22): https://www.youtube.com/watch?v=EOmPYpim3_8

Kate chats with Jaguar Gene Therapy about the progress the company has made in testing a gene therapy for Phelan-McDermid syndrome over the past couple of years. She asks what steps are still needed to take this therapy to clinical trials (if it proves safe and effective). Also covered: how gene therapy works, the target as SHANK3, ongoing animal testing, and timelines.

Recently, the Phelan-McDermid Syndrome Foundation was successful in applying for and receiving a specific ICD code (International Classification of Diseases code) for Phelan-McDermid syndrome from the Centers for Disease Control (CDC). Kate sits down with Annie Kennedy of the EveryLife Foundation, who has longstanding expertise in what a specific code can mean for progress for rare diseases. Kate asks - what exactly is an ICD code? What does this mean for progress in Phelan-McDermid syndrome research? Why didn't we have one already? Can it be used internationally? What was the process in getting one? What are some examples of progress after getting a code? What is the code not helpful for? Annie Kennedy is the Chief of Policy, Advocacy, and Patient Engagement at the EveryLife Foundation. She also previously served within the Parent Project Muscular Dystrophy and the Muscular Dystrophy Association. Her work includes building strong partnerships with policy makers, federal agencies, industry partners, and alliances to advance research and access in rare disease. She has developed an ICD code roadmap with the EveryLife Foundation, has conducted economic burden studies in rare disease, led efforts for newborn screening, led access efforts after the first therapies were approved by the FDA for Duchenne muscular dystrophy, and much more.

Dr. Kohlenberg and Dr. Rahman are both clinicians with expertise in neuropsychiatric illness in Phelan-McDermid syndrome. They discuss the first signs and symptoms, where to find treatment guidelines, how to connect your clinician with experts, and the difference between neuropsychiatric illness and regression. They discuss top research questions and progress. Kate points out where families can find key resources along the way. Dr. Kohlenberg is a pediatrician with decades of experience in child psychiatry. She is also mom to an adult daughter with PMS who was diagnosed as a result of neuropsychiatric illness, and Tesi has done a lot of work to understand how to best manage this for her daughter and many other people with PMS. She played a leadership role in starting the Neuropsych Consult Group, and is on PMSF's Medical Advisory Committee. Dr. Asif Rahman is a psychiatrist and is currently a fellow in Child and Adolescent Psychiatry on the Research Track at Mount Sinai. He is being funded by PMSF to do more research into neuropsychiatric illness in partnership with the Natural History Study and is being mentored by Dr. Alex Kolevzon.

Gabi Conecker leads the Inchstone Project, an effort to ensure people with conditions like PMS don't bottom out on clinical assessments and their progress is measured. For clinical trials, it is crucial to show a drug is making positive change, which requires sensitive assessments. PMSF is taking an active role in the Inchstone Project, and other projects to improve clinical assessments. Clinicians in PMS and other groups are also constantly working towards improved clinical assessments. This podcast discusses some of what it takes to improve assessments. Gabi Conecker is the Founder of Decoding Developmental Epilepsies, previously "Wishes for Elliott," named after her son with SCN8A epilepsy, alongside her mother JayEtta. She is also a leader of DEE-P connections which provides resources to people with rare severe epilepsies.

PYC Therapeutics is a pharmaceutical company developing an RNA therapeutic for Phelan-McDermid syndrome. Dr. Sue Fletcher (Chief Scientific Officer) and Rebecca Simmons (current Group Lead) describe these efforts. Kate asks what exactly are RNA therapeutics? What is this drug targeting and how does it work? What are the timelines and plans going forward? What will be measured to see if the drug is working? What types of challenges are associated with the approach? What can the foundation and families do to support drug development?

Dr. Billy Bennett has been working with the Foundation for the past year on two initiatives that are considered family engagement research. The first is focused on the genetic counseling process and some of the common challenges families face in these meetings. We review a federally-funded research project that collected feedback from families to improve the genetic counseling process, and cover the next steps we are taking to change this process alongside genetic counselors. We also review the findings from a second initiative, called CANDID, an NIH-funded conference. CANDID served to bring together families, clinicians, scientists, patient advocacy groups, and industry partners to consider how to better detect and treat GI disorders in people with PMS, autism, and other neurodevelopmental disorders. In this episode, we review the takeaways from CANDID and discuss the many steps that are occurring afterwards to advance research in this area. Dr. Billy Bennett is a pediatric gastroenterologist, and a clinical researcher at Indiana University. He is on both the medical and scientific advisory committees at PMSF. He is also a PMS dad to his daughter Cecilia, who is the inspiration for this work.

Dr. Kolevzon has been leading a team of clinicians to develop clinical guidelines for the management and monitoring of PMS. Kate asks - what are clinical consensus guidelines exactly? Which categories of medical care will be included? When will the guidelines be released? How can families best use this information? How are guidelines developed? How have the guidelines changed since the first iteration in 2014? What areas of research have seen the most growth? How can families bring forward patterns they notice to help shape the guidelines as they continue to evolve? Dr. Alex Kolevzon is a psychiatrist and professor at the Icahn School of Medicine at Mount Sinai. He is a long-standing expert in Phelan-McDermid syndrome research as a leader of the PMS Neuropsychiatric Consult Group, the PMS Natural History Study, the PMSF medical advisory committee, and he sees many people with PMS in the clinic.