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February 26, 2025 17 mins

This week on Biotech Nation, Dr. Ari Azhir, Founder and CEO of Neuvivo, shares the incredible journey of an ALS drug that was once abandoned, but is now making its way toward FDA approval. After two failed phase two trials, the drug was left behind until Dr. Azhir and her team discovered a crucial mistake in the trial data. Now with new insights and groundbreaking survival results, Neuvivo is giving hope to ALS patients and exploring its potential for other neurodegenerative diseases like Huntington’s and Alzheimer’s. 

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Dr. Moira Gunn (00:11):
This is the biotech equivalent of an old
story, the one which starts witha guy walks into a bar. However,
this being the biotechequivalent, it goes something
like this. A promising newbiotech with a very new approach
gets significant funding. Itsdrug fails after two phase two

(00:33):
trials, and they shut theirdoors. It's unfortunate.
It's expensive, but it happens.And then what? Normally,
nothing, unless the originalfounder scientists just don't
believe that the drug couldfail. Doctor Ari Asher is the
founder and CEO of NuVivo. Shetells us about the regenesis of

(00:58):
this promising ALS drug, how itwas reacquired, how they figured
out what the problem was, howthey went back and got even more
data from the same patients, andabout its new drug application
recently submitted to the FDA.
Additionally exciting, this drughas other potential. Neuvivo is

(01:21):
ready to initiate phase twostudies in Huntington's
Alzheimer's disease and vasculardementia. Doctor Azhir, welcome.

Dr. Ari Azhir (01:30):
Glad to be here, Moira.

Dr. Moira Gunn (01:32):
Now we're gonna be talking about a lot today.
Yes. There are medicalconditions that, NuVivo is
working on and has had somesuccess in, such as ALS,
Huntington's, musculardystrophy, frontotemporal
dementia, and more, but we'realso talking about how biotech
companies can take out whatwe'll call it perhaps a misstep

(01:54):
or a missing of the opportunity,and this is one for the books, I
must say. Let's start withNeuvivo's lead compound, n p
zero zero one, and there alreadyis a good story there. Those of
you in biotech know that acompany develops a number of
drug candidates, all somewhatdifferent, and they're numbered

(02:17):
from one to however many drugcompounds they're working on.
Normally, a company's very firstdrug that they would take into
human trials might be number sixten or number three zero two if
they were just a start up andand had just working on
variations on their one drug.But this is the very first time

(02:38):
that I've seen it. Neuvivo'sfirst drug in clinic is number
one. And why? Because you,doctor Azhir, started Neuvivo by
purchasing this drug fromanother company where it had
failed in human trials.
And you purchased the drug, andall its human data and all its

(02:59):
intellectual property becauseyou knew the drug. How did you
know the drug?

Dr. Ari Azhir (03:05):
Well, I know this drug because I actually started
a company called Noreltos, andthis was the drug that I was one
of the founders and have thepatent holder, and I developed
it in Noreltos. So we took it upto phase one and phase two human
clinical trial. And it was veryexciting data, and the company

(03:29):
decided they wanted to havesomebody from big pharma running
the company after me. I was aCEO and a founder of the company
at that time, and then I left.

Dr. Moira Gunn (03:39):
Uh-huh. So we needed somebody from the big
pharmaceutical area, and you hadto exit. So no longer with the
company. Yes. How long ago wasthat?

Dr. Ari Azhir (03:49):
I left in 02/2011.

Dr. Moira Gunn (03:52):
So that's thirteen years ago. Very
exciting. Very exciting. Now bymy count, they went through five
CEOs in the meantime before youpurchased the drug, and we'll
return to that story. Solistener put a pin in it.
But now we're gonna talk aboutALS as the drug was developed to
treat ALS. So describe what ALSis like for people with the

(04:17):
condition. What is it?

Dr. Ari Azhir (04:19):
ALS is neurodegenerative disease. That
means gradually within two tofour years after diagnosis, the
patient die. They it can startfrom top, you know, from the
speech pattern, graduallydifferent muscles lose function,
and so on. So it's a very heartdisease, and the duration is

(04:42):
very short.

Dr. Moira Gunn (04:43):
I understand that it's very difficult to
diagnose.

Dr. Ari Azhir (04:46):
Well, because as I told you, it starts from
different part of the body. Andthe diagnosis at the moment, I
think, is still a challenge forpeople. So people come and they
have sort of hand, tremble. Sothey don't know whether it's ALS
or something else. And they havea speech problem.

(05:07):
They don't know whether it's ALSor something else, and they have
to go to neurologist to be ableto be able to diagnose. They
start with normally, you know,general practitioner, and then
they will go to neurologist.

Dr. Moira Gunn (05:22):
How many people have ALS? How is this very
widespread?

Dr. Ari Azhir (05:26):
No. It's an orphan drug. There is a at the
moment, they said it's thirtythousand people. And thirty
thousand people, I think there'sa lot of people who are
misdiagnosed. The problem ismore than that.
The the first time it wasdiagnosed was Lou Gehrig eighty
years ago. And since then, therehas never been any, therapy for

(05:48):
treatment of ALS.

Dr. Moira Gunn (05:50):
So if you're diagnosed with it and they're
sure it is, then within severalyears, you just can't expect to
recover.

Dr. Ari Azhir (06:00):
Yes. Within two to four years, you probably die,
unfortunately.

Dr. Moira Gunn (06:04):
And the drug that we're talking about, was it
a pill, an injection? How howwould the patients take it?

Dr. Ari Azhir (06:11):
Oh, it's an injection. They take it. The
first month, they take five daysin a row. And then after that,
three treatments a month for sixmonths. That was the study that
we have conducted.

Dr. Moira Gunn (06:28):
Now how is this drug different from other
approaches to treating ALS?

Dr. Ari Azhir (06:32):
Oh, this is wonderful. Because I think
everybody else has tried tofigure out what is missing,
which neuron is damaged, and tryto figure out the, healing that
neuron. We our approach is verydifferent. We think, ALS starts
in immune system. So if we canregulate immune system, we can

(06:55):
stop any attack, and the bodycan automatically recover from
any attack it takes, whetherit's a neuro damage, whether
it's extra proteins, whether itis, viruses or bacteria
infection.
If we can regulate the immunesystem, it recurs from all these
attacks.

Dr. Moira Gunn (07:15):
Now what exactly is wrong with the immune system
in the case of ALS?

Dr. Ari Azhir (07:20):
There is because it's been attacked very
intensely, it is missing amolecule which normally uses for
recovery of the immune system.This molecule is called toluene.
So we provide this molecule sothe the system can recover, has
the ability to recover.

Dr. Moira Gunn (07:41):
So you're not in the brain. You're in the immune
system treating ALS.

Dr. Ari Azhir (07:46):
Yes. Correct.

Dr. Moira Gunn (07:47):
So let me get this straight. That company took
this drug through phase one,phase two a, two b, you know,
two trials there in tube inphase two. And it's a failure.
It doesn't work. Right?

Dr. Ari Azhir (08:07):
Yes. But we didn't believe it.

Dr. Moira Gunn (08:09):
So along with the drug trial failure, the
company failed. And and usually,that's that. But you acquired
it, and now you could reallytake a look at the protocols of
the trials, at the data that hadbeen collected and had been
looked at, you know, which whichhad determined that the drug had
failed. Some 200,000 pages ofpaper, which is just shocking to

(08:35):
anyone. What did you learn whenyou looked at all this?

Dr. Ari Azhir (08:38):
So what we learned, first, we were
surprised because usually whenyou do another trial, you repeat
what you find the first time. Sothey didn't do that. So we start
looking at the data veryextensively from all direction.
We found there was aprogramming, mistake, so we

(08:59):
fixed that. And then we startlooking at the data to
understand how our moleculeworks.
So we have looked at manydifferent ways of understanding
the way that the molecule works.And also in this process, we
were lucky because the sciencehas also came up and we have
some other supporting otherscientists telling us our way of

(09:20):
looking at immune system is theright way. So we looked at the
molecule. We understood it underit impacts the ability to
breathe. The the reason thesepeople die is because we stop.
They have a breathing problem.And so we said, oh my god. The
ability to breathe. And then weunderstood why does it, the

(09:45):
ability of breathe, where doesit impact? It was a diaphragm,
so it's a muscle impact.
So we decided to look at othermuscle functions in the body.
You know, we added both trialtogether. There were two phase
two trials. We added together,and we looked at the impact on
functionality of how differentmuscles and, function impacted

(10:07):
in ALS, like the ability totalk, the ability to eat, the
ability to walk, the ability tobreathe, the ability to putting
a jacket on. So we looked atevery single muscle function,
and we saw that it improves.
The totality of the data showsit significantly, impacts for

(10:30):
people mainly 65 years andyounger. The the reason is,
like, you know, like anything,after 65 years old, you know,
our muscle deteriorates, ourskin is, as not as good as when
we were younger. Also, immunesystem declines. So these
people, 65 youngers, theirimmune system was still able to

(10:54):
engage, to be able to get re themolecule n p zero zero one and
recover from any attack that thebody has been under.

Dr. Moira Gunn (11:03):
So here you are. You've got all this data from
phase two a and phase two b, thethe two phase two trials, and
you've reprogrammed it. So youget the true results here
showing very positive results.And let's not forget that this

(11:24):
is, an orphan drug, so, youdon't need to do a big phase
three trial. If this had beensuccessful the first time out in
phase two a and b, you would goright to a new drug application,
an NDA to say, great.
We're ready to go to a new drugapplying to the FDA. And so what

(11:46):
do you do then? You've got thispositive data. What do you do
then?

Dr. Ari Azhir (11:51):
That's a really good question. So we went we
told, okay. We have an impact onrespiratory function, so we need
to know whether it's a survivalbenefit. So we had the patients,
but we hadn't collected how longdid they live after they took
the treatment. So we hired thiscontract research organization.

(12:13):
They went back to all theclinical investigators who had
enrolled this patient and in ablinded fashion. So we didn't
know who was on a a drug and whowas on a placebo. And they
collected the last state thatthese patients were alive. This
was eleven years of trackingevery single patient. And then

(12:35):
we did the survival study, whichwas statistically significant
for patient 65 years old.
So we got obviously veryexcited, and now we decide to
put the new drug application. Sofor the entire population, the
extension of survival was fourfour months. There is nothing in

(12:57):
the, in the pipeline that anytreatment extends the survival
more than two and three months.Then we looked at 65 years and
younger. And in that patientpopulation, the extension of
survivor was seventeen point onemonth, which is unheard of after

(13:18):
six months of treatment, justafter six months of treatment.
So we thought, okay. Now we havea drug. So we decided to put a
new drug application packagetogether, and we took us, like,
six months to put the packagetogether as, Moira said it took

(13:38):
200,000 pages, and we submittedto FDA about six weeks ago. And
we are hoping to get approval insummer or spring next year.

Dr. Moira Gunn (13:51):
This is very exciting. Now, obviously, this
will help somewhat people 65,but 65, this is phenomenal news,
you know, a year and a halfmore, just with six months of
treatment. Now the question thatI have is, like, why wasn't it
any better for people 65?

Dr. Ari Azhir (14:11):
Well, the people 65, their immune system has
declined, so they are notnecessarily able to engage in
recovery. So it is too muchfurther down because of other
diseases. Some people havediabetes. Some people have
cancer. Some people havecardiovascular.

(14:32):
So the inflammation is far morethan just ALS inflammation.

Dr. Moira Gunn (14:37):
Now I know you're also working on other
medical conditions,Huntington's, muscular
dystrophy, frontotemporaldementia, and others. Is it the
same drug you are using?

Dr. Ari Azhir (14:49):
Yes. We are hoping to use the same drug, and
might be different formulation.And, so the the orphan drug like
Huntington, we think with onestudy, we can actually apply for
new drug application for thatdisease as well. But for bigger
drugs, you know, an indicationlike Alzheimer's, Parkinson,

(15:10):
front you know, that might bedifferent. We might need to do
two two studies.

Dr. Moira Gunn (15:14):
But as we said earlier, this is a whole new
approach. You're not looking atthe neurons and the neurological
part to treat. You're backing itup to the immune system and the
missing molecule that is therecovery molecule.

Dr. Ari Azhir (15:31):
Yes. It I mean, that's why it's so exciting
because we're getting the bodyto act as a healthy body that
they can recover by themself.And that's really what is so
exciting about our findings.

Dr. Moira Gunn (15:45):
Well, yours is an exceptional journey. What
would you say to entrepreneursout there, biotech and
otherwise?

Dr. Ari Azhir (15:52):
I would say, first of all, more important,
you need to understand yourdata, and your data can be
understood by scientists,medical profession who knows the
science behind the drug, andalso the disease, how the
disease works. So you reallyneed to look at every single

(16:14):
data point that you have. And,you know, we call it in in our
profession biomarkers. Like, howdo we know the muscle is
improving? There when you go toclinical labs, there is
something that's calledcreatinine.
You they measure it, and thattells you that your muscle is
working, your kidney is working.Very simple. You don't really
need to do much. And you we hadthis data. We just needed to

(16:36):
analyze.

Dr. Moira Gunn (16:37):
Well, I think that the lesson is if doctor
Ashir is looking to buy acompany, stand next to her and
and buy some of it too.

Dr. Ari Azhir (16:47):
But thank you.

Dr. Moira Gunn (16:49):
Doctor Azhir, thank you so much for joining
us, and I hope you'll come backand see us again.

Dr. Ari Azhir (16:53):
Thank you, Moira. It was a pleasure. I'm you know,
I love to share my experience soother people can learn from it
and not give up so soon.

Dr. Moira Gunn (17:02):
Doctor Ari Azhir is the founder and CEO of
Neuvivo. More information isavailable on the
web@neuvivo.com. That's neuvivo,neuvivo Com.
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