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Congenital pseudarthrosis of the tibia is a rare condition that can cause spontaneous fractures, mobility problems, and impede proper growth. It is treated surgically, but because the bone often breaks again, it can lead to amputation. Novadip is developing an autologous cell therapy to allow tissue regeneration of large bone defects. We spoke to Denis Dufrane, co-founder and CEO of Novadip, about the rare pediatric bone disorder, the company’s cell therapy to address the condition, and how it works.

CRISPR genome editing has the potential to revolutionize the treatment of diseases, but the imprecision of its editing abilities has limited its value. Emendo Biotherapeutics argues that rather than trying to make every disease fit into the standards CRISPR model, the answer lies in making CRISPR fit each disease. We spoke to Rafi Emmanuel, executive vice president of research and development for Emendo Biotherapeutics, about the limits of CRISPR today, the company’s experimental program in severe congenital neutropenia, and how the company is engineering CRISPR to optimize it and make it activity precise.

One of the challenges with rare diseases is how different their effects can be from one person to another. In order to get a deeper understanding of the impact and variation of the rare autoimmune condition myasthenia gravis on people, Argenx launched MyRealWorld MG, an app-based study that’s collecting real-world, longitudinal data from 2,000 patients over two years. We spoke to Deb Gelinas, neuromuscular executive director at Argenx, about myasthenia gravis, the company’s MyRealWorld MG study, and how she hopes the data will provide new insights into the rare, autoimmune condition.

When Terry Pirovolakis’ son Michael was diagnosed with the ultra-rare neurodegenerative disease spastic paraplegia type 50, he set out to raise money and engage researchers in developing a treatment. Now, after successfully dosing Michael with an experimental gene therapy as the first patient in a clinical trial, he has launched Elpida Therapeutics to develop multiple gene therapy programs for children with ultra-rare diseases. We spoke to Pirovolakis about the need Elpida is seeking to address, its unusual business model, and why he hopes to hand off its therapies at no cost to a partner once they win approval.

Parder-Willi syndrome is a rare, genetic disease that is characterized, in part, by hyperphagia—an intense and insatiable hunger. People with the condition are driven to constantly eat and seek out food. The syndrome is associated with severe obesity and obesity-related mortality. Tonix Pharmaceuticals is developing an experimental oxytocin nasal spray to treat hyperphagia in people with Prader-Willi syndrome. The approach, to date, has shown promise in animal models. We spoke to Seth Lederman, CEO of Tonix, about Prader-Willi syndrome, the unmet need for treatments, and why he believes an oxytocin nasal spray has potential to treat the condition.

A week before Deborah Ondrasik’s daughter Gabrielle turned 1, she suffered her first seizure. Within a year, Gabrielle was diagnosed with CACNA1A-related disorder, a rare, neurodegenerative condition. At the time she was the eighth known person to be diagnosed with the disorder. We spoke to Ondrasik, who is a pediatrician, along with CACNA1A Foundation Vice President Sunitha Malepati about the CACNA1A-related disorders, how it progresses, and what the CACNA1A Foundation is doing to advance research to speed the development of treatments and a cure.

Amy Dockser Marcus, in her new book We the Scientists, tells the story of a group of parents of children diagnosed with the rare and fatal genetic lysosomal storage disorder Niemann-Pick disease type C. When they were confronted with the fact that no treatment existed or would likely be developed in time to save the lives of their kids, they began collaborating with themselves, researchers, and physicians to accelerate the path to a treatment. We spoke Marcus about the lessons learned from the experience of the Niemann-Pick disease type C community, how these parents took an active role in the drug development process as citizen scientists, and how their efforts reflect a broader change in the way biomedical research is conducted. 

About 10 percent of children who are diagnosed with hearing loss at birth have an auditory neuropathy that is usually due to a genetic cause. One of the most common genetic causes of hearing loss is due to a mutation of the otoferlin gene, which encodes for a protein that enables communication between the sensory cells of the inner ear and the auditory nerve. Decibel Therapeutics is developing an experimental gene therapy intended to restore hearing in patients with a mutation of the otoferlin gene. It is part of a larger collaboration with Regeneron Pharmaceuticals. We spoke to Laurence Reid, CEO of Decibel, about the unmet need in genetic hearing loss, how these conditions can affect early development of children, and the case for gene therapies to treat these conditions.

While there is growing ability to pursue the development of therapies for ultra-rare diseases, they remain challenging because of economics. One major barrier is the difficulty in getting reimbursement for therapies in the absence of well-powered clinical trials that recruit enough participants to satisfy payors demands for adequate proof of the value of a therapy. The Muscular Dystrophy Association, earlier this year, awarded the nonprofit biotechnology Cure Rare Disease a grant to research novel reimbursement strategies for ultra-rare disease therapies. We spoke to Rich Horgan, founder and president of Cure Rare Disease, about the evolution of his organization, its growing pipeline of therapies, and why developing a viable reimbursement model is essential to creating sustainable development of ultra-rare disease therapies. 

Growth hormone deficiency is a rare condition that is the result of inadequate secretion of growth hormone from the pituitary gland. Though recombinant human growth hormone has long been used to treat people with pediatric growth hormone deficiency, it requires either daily or weekly injections and when injections are missed, results can be sub-optimal. Lumos Pharma is developing a once-daily oral therapy that works by promoting secretion of growth hormone. We spoke to Rick Hawkins, chairman and CEO of Lumos Pharma, about the company’s experimental therapy, how it works, and why it may be an attractive alternative to existing approaches.

GM1 gangliosidosis is a rare and deadly lysosomal storage disorder that causes progressive damage to neurons in the brain, as well as the heart, liver, bones and other tissues throughout the body. There are currently no approved therapies to treat the condition. Passage Bio, which has a collaboration with the Gene Therapy Program at the University of Pennsylvania, is developing a gene therapy to the condition. We spoke to Samiah Al-Zaidy, vice president of clinical development for Passage, about GM1 gangliosidosis, the company’s experimental therapy to treat the condition, and what’s known about the therapy from work that’s been done to date.

A significant obstacle to getting patients to participate in rare disease clinical trials, particularly children, is the burden placed on patients and their families to address the logistical challenges of arranging travel, fronting expenses, and completing paperwork for reimbursement. In fact, nearly two-third of patients and caregivers say travel stopped them from participating in a clinical trial. Clincierge seeks to remove the burden of participation in clinical trials on patients and caregivers by managing the logistics of travel and reimbursement, as well as assigning coordinators to them during the life of a study. We spoke to Scott Gray, co-founder and CEO of Clincierge, about the burdens placed on patients who want to participate in a clinical trial, how Clincierge works to eliminate those, and the impact its work has on recruitment and retention of patients in clinical studies.

Debra Miller’s son Hawken was diagnosed with Duchenne muscular dystrophy at the age of 5. Rather than just accept his fate with the rare neuromuscular condition, Miller and her husband Paul launched CureDuchenne to stimulate the development of treatments and potential cures for the condition. The organization subsequently launched a venture philanthropy fund that, to date, has financed 17 research projects that have advanced to human clinical trials and seen others invest nearly $3 billion in follow-on funding for companies that it has backed. We spoke to Miller about CureDuchenne’s experience with venture philanthropy, the case for patient advocacy organizations taking equity in exchange for their funding, and what other advocates hoping to stimulate drug development can learn from CureDuchenne’s experience. 

The ability to pinpoint the underlying genetic causes of diseases and rapidly generate genetic medicines to address them has created the potential for the development of individualized therapies to treat patients with ultra-rare diseases. EveryOne Medicines is seeking to industrialize this process and scale the development of N-of-1 therapies. We spoke to Irina Antonijevic, chief medical officer of Everyone Medicines, about the company’s business model for pursuing N-of-1 therapies for people with rare diseases, how it works, and whether it can be sustainable absent a mechanism for reimbursement.

Transthyretin amyloid cardiomyopathy, or ATTR-CM, is a progressive and potentially fatal heart disease. It is often overlooked because physicians tend to consider more common causes of heart failure. We spoke to Pfizer Vice President and North America Medical Lead Younos Abdulsattar and Pfizer Chief Medical Officer of Rare Disease Sonal Bhatia, about ATTR-CM; its disproportionate impact on the Black, African American, and Afro-Caribbean communities; and steps Pfizer is taking to work with community organizations to raise awareness and improve care for people with the condition.

Telomere biology disorders are a set of rare genetic diseases caused by a shortening of the protective DNA that appears at the ends of chromosomes. Between 80 and 90 percent of people with these conditions will suffer from bone marrow failure by age 30, the leading cause of mortality for people with these disorders. The only available treatment today is transplantation of donor human stem cells. Elixirgen is developing what it calls self-replicating RNA therapies to treat telomere biology disorders and other conditions. We spoke to Akihiro Ko, CEO Elixirgen Therapeutics, about telomere biology disorders, the company’s self-replicating RNA therapies, and the advantages this new therapeutic approach offers over more traditional mRNA therapies.

Limb-girdle muscular dystrophy type 2i is a rare, genetic condition that causes progressive muscle degeneration that can impact skeletal, respiratory, and cardiac muscles. As the condition progresses, people lose the ability to perform routine daily activities, such as walking or standing up without assistance. There are no therapies available today to slow, halt, or reverse the condition. ML Bio, a company founded by two patient families in search of treatments for the condition and later acquired by BridgeBio, is advancing an experimental therapy with the potential to become the first oral treatment for the limb-gridle. We spoke to Doug Sproule, chief medical officer of ML Bio Solutions, about limb girdle muscular dystrophy type 2i, the company’s experimental therapy to treat the condition, and the power of rare disease patient families to shape drug development. One note before we begin. Early in the discussion Sproule misspeaks. The founders of ML Bio are the McColl and Lockwood families and the company’s lead experimental therapy was discovered at the McColl-Lockwood Lab.

The National Institutes of Health in November named Joni Rutter Director of the National Center for Advancing Translational Sciences. Rutter had served as acting director since April 2021. She succeeded Chris Austin, the first permanent director of NCATS, who stepped down after ten years on the job. NCATS is charged with developing technologies and approaches to accelerate the process of moving new treatments from the lab to the patient. As part of its work, it has several program and initiatives that are focused specifically on rare diseases. We spoke to Rutter about NCATS’ priorities under her leadership, the challenges of translational science, and where she sees the biggest opportunities for accelerating the discovery and development of therapies for rare diseases. 

Casey McPherson hasn’t taken a typical path to becoming a bioentrepreneur. The singer-songwriter is the frontman for Alpha Rev, an up-and-coming indie band from Austin, Texas. Rather than focus on his music career, McPherson instead put his energy into finding a treatment for his daughter Rose, who was diagnosed with an ultra-rare, neurodevelopmental condition. The issues he faced in working with academic researchers led him to co-found Everlum Bio, a rare disease lab designed to provide a range of services for ultra-rare disease patients seeking to discover treatments for their conditions. We spoke to McPherson, chief innovation officer of Everlum, about what led him to create the company, its “rare-disease-lab-as-a-service model, and how he is working to change the discovery landscape for ultra-rare disease therapies. 

Fragile X syndrome is a rare, genetic, developmental disorder that is the leading known cause of both intellectual disability and autism spectrum disorder. People with the condition can have a range of behavioral symptoms, such as social avoidance and irritability. Zynerba is developing its experimental therapy Zygel, a topical cannabidiol gel that is delivered into the bloodstream through the skin to treat the behavioral symptoms of Fragile X. We spoke to co-director of the molecular diagnostics section of the Genetic Laboratory at Rush Medical College Elizabeth Berry-Kravis and Zynerba Chairman and CEO Armando Anido, about Fragile X, the company’s experimental therapy Zygel, and why the topical cannibidiol gel may hold promise for treating the behavioral symptoms of the condition.