Altacor’s pipeline targets important and fast-growing areas of the ophthalmology market, including glaucoma, glaucoma surgery and cataract surgery.
Glaucoma is a group of diseases affecting the optic nerve that is frequently characterised by raised intraocular pressure (IOP) and results in vision loss. Glaucoma is the second leading cause of blindness in the world according to the World Health Organization. It is estimated that around 2% of the general population at age 40-50 years and 8% of people over 70 years suffer from raised IOP.
The most common form of glaucoma is primary open-angle glaucoma (POAG) and this is initially treated with long-term use of eye drops containing drugs designed to lower IOP.
Altacor has two projects for glaucoma, one with a novel patented mechanism of action, and the second for steroid-induced glaucoma.
There are broadly two types of surgery depending on the type and severity of glaucoma:
Doctors sometimes recommend laser surgery [Argon Laser Trabeculoplasty (ALT) or Selective Laser Trabeculoplasty (SLT)] unless IOP is very high or the optic nerve is badly damaged. A focussed beam of light is used to irradiate the trabecular meshwork. The trabecular meshwork is the eye’s drainage system and laser treatment helps increase the flow of fluid out of the eye by improving the drainage system, thereby restoring normal intraocular fluid outflow and relieving raised IOP.
Filtering microsurgery (i.e. trabeculectomy) is the mainstay of surgical treatment to control raised IOP. This procedure involves creating an artificial drainage hole for the eye. This new opening allows intraocular fluid to bypass the blocked drainage system and flow out of the newly formed drainage canal. One of the most common complications of glaucoma surgery is scarring caused by the build-up of excess extracellular matrix, which can lead to blockage or partial blockage of the artificial drainage hole. Over a period of time scarring can lead to increased IOP and failure of the drainage hole. Following trabeculectomy, scarring is at least partially driven by the upregulation of growth factors such as transforming growth factor-β (TGF-β).
ALT 401 – Prevention of Scarring Following Glaucoma Surgery
Altacor is developing an improved formulation of an existing molecule (re-profiling) acting through a novel mechanism (modulation of TGF beta release) to prevent scarring following trabeculectomy. This product has been granted orphan drug status in both the US and EU, which provides market protection for 7 and 10 years, respectively.
There are many surgical procedures in ophthalmology both routine (such as cataracts) and major, as well as the increasing use of intravitreal injections (i.e. into the vitreous cavity of the eye). All these procedures require the use of a disinfectant before the procedure to prevent post-operative infection.
ALT 005 – Opthadine Surgical Antiseptic
ALT 005 is used to disinfect the eye and ocular region in preparation for any surgical procedure. The development of ALT 005 is based on the reformulation of a well-characterised antiseptic that has been designed specifically for ophthalmic use.
Cataract surgery is the removal of the natural lens of the eye that has developed an opacification, which is referred to as a cataract. Metabolic changes of the lens fibres over time lead to the development of the cataract and loss of transparency, causing impairment or loss of vision. Many patients' first symptoms are strong glare from lights and small light sources at night, along with reduced acuity at low light levels. During cataract surgery, a patient's cloudy natural lens is removed and replaced with a synthetic lens to restore the lens' transparency.
Following surgical removal of the natural lens, an artificial intraocular lens implant is inserted. Cataract surgery is generally performed in an out-patient setting, using topical local anaesthesia, usually causing little or no discomfort to the patient. Well over 90% of operations are successful in restoring useful vision, with a low complication rate.
Solo – Intra-ocular Lens Injector
Solo is a pre-loaded single-use intraocular lens (IOL) injector that can be used to deliver both hydrophobic and hydrophilic IOLs. It has broad potential applications in cataract surgery and the increasingly performed lens replacement procedures for correction of vision defects. Solo’s design includes a patented novel mechanism that ensures rapid and efficient placement of IOLs, lower risk of contamination, higher comfort to the patient and a low incidence of damaged lenses during insertion.
Age-related Macular Degeneration (AMD)
AMD is the leading cause of blindness in patients over the age of 50 years in the industrialised world. There are two types of macular degeneration, the non-exudative (dry) and exudative (wet; neovascular) forms. Although dry AMD is more common, wet AMD accounts for more than 80% of the cases with severe loss of vision. In wet AMD, abnormal blood vessels grow under and into the retina in a process called choroidal neovascularisation (CNV). These new blood vessels leak fluid into and under the retina accompanied by the deposition of fibrous tissue which results in visual deterioration over days to months. CNV is progressive and has a poor prognosis both with respect to vision loss and quality of life.
There is currently no approved treatment for dry AMD but in wet AMD the standard of care has become either Lucentis (ranibizumab) or Avastin (bevacizumab). These monoclonal antibody based products bind to, and inhibit the action of vascular endothelial growth factor (VEGF) leading to inhibition of neovascularisation. These drugs are injected intra-vitreally once a month and although the agents are effective in slowing the progression of CNV and AMD symptoms there is an unmet medical need for a treatment that could be more conveniently delivered.
Diabetic retinopathy results from damage to the retina caused by complications of diabetes, and can eventually lead to blindness. Diabetic retinopathy develops, to some degree, in up to 80% of patients who have had diabetes for more than 10 years and is the most common cause of new cases of blindness among adults. The most predominant causes of vision loss are macular edema (ME) and proliferative diabetic retinopathy (PDR). Diabetic ME is treated by topical use of corticosteroids and PDR is often treated with the same anti-VEGF drugs used to treat wet AMD.