NEWS RELEASE-FDA Science Board to Meet on June 14

News Release
FOR IMMEDIATE RELEASE
P07-100
June 8, 2007
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The U.S. Food and Drug Administration's (FDA) Science Board will hold a public meeting on June 14, 2007. The board, an advisory committee to the FDA, provides the agency with expert outside advice on specific technical issues, as well as emerging issues within the scientific community, industry, and academia. Members counsel the agency on regulatory science, the formulation of an appropriate research agenda, and on upgrading FDA's scientific and research facilities.

"Science provides the foundation for FDA's regulatory decisions," said Janet Woodcock, M.D., FDA's deputy commissioner and chief medical officer. "Science and technology are creating products with enormous promise and, frequently, considerable challenges. This in-depth review of our scientific capacity is critical to assuring that FDA will continue to meet the regulatory challenges of the future."

Members of the board will address food protection, the agency's interim safety/risk assessment of melamine, a report on the Antimicrobial Resistance Monitoring System (NARMS), and an agency-wide review of FDA science. For a complete agenda, briefing documents, and a list of subject matters experts that serve as advisors to the subcommittee and their affiliations, please see: www.fda.gov/ohrms/dockets/ac/oc07.htm#ScienceBoard.

The board, chaired by Kenneth Shine, M.D., University of Texas System, Austin, is composed of nine members. Other members include: Gail H. Cassell, Ph.D., Eli Lilly and Company, Indianapolis; Susan Kay Harlander, Ph.D., BT Safety, LLC, Eden Prairie; Lonnie King, D.V.M., Centers for Disease Control and Prevention, Atlanta; Barbara J. McNeil, M.D., Ph.D., Harvard Medical School, Boston; David R. Parkinson, M.D., Biogen Idec, San Diego, Calif.; F. Xavier Pi-Sunyer, M.D., St. Luke's-Roosevelt Hospital Center, New York; Allen D. Roses, M.D., GlaxoSmithKline, Research Triangle Park, N.C.; and Larry D. Sasich, Pharm.D., consumer representative, Erie, Pa.

Last year, the board established the Subcommittee for the Review of FDA Science to determine whether the FDA's current science portfolio is properly positioned to deal new regulatory challenges stemming from developments in science and technology.

During the daylong meeting, the Subcommittee will provide an update on the progress of their review. The subcommittee, chaired by Gail H. Cassell, Ph.D., of Eli Lilly and Company, will submit a draft written report of its preliminary findings to the board this summer. The subcommittee has asked 28 scientific subject-matter experts, drawn from government, industry and academia, to contribute to the report.

The Science Board meeting is scheduled for June 14 from 8 a.m. to 4:30 p.m. at the Holiday Inn, 2 Montgomery Village Ave., Gaithersburg, Md.

Public comments can be submitted; please see the Federal Register notice for this meeting for more information: www.fda.gov/OHRMS/DOCKETS/98fr/E7-9737.htm.

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WHAT OTHERS ARE SAYING;-Star Tribune of Minneapolis, on the use of antibiotics in animals:

Wisconsin dairy farmer John Vrieze wants FDA permission to give his cows a powerful antibiotic, cefquinome, that is now the drug of choice and last resort for several difficult-to-treat human conditions. He shouldn’t get that permission.
By all accounts, Vrieze is a very good dairy farmer who embraces advanced techniques for keeping his cows happy, healthy and producing. So when one of his cows comes down with bovine respiratory disease, he’d like to treat the animal with a powerful drug, cefquinome. The manufacturer of cefquinome has petitioned the Food and Drug Administration for permission to begin selling the drug for use in animal husbandry.
That has set up a tug of war between those opposed to wider use of antibiotics in animals and those who favor it. In this battle, the opponents are the good guys; they include the American Medical Association, other health groups and the FDA’s own advisory panel.
The problem is that the disease-causing microbes which antibiotics attack constantly mutate. The wider the use of an antibiotic, the sooner one of those mutations will defeat the drug.
Widespread use of antibiotics in animals accelerates this process tremendously, leaving humans more vulnerable to diseases once controllable. ...
Enter cefquinome. ... Worried that using cefquinome in animals puts the efficacy of cefepime at risk, the advisory board at the FDA’s Center for Veterinary Medicine recommended against approving animal use.

FDA turning resistant to the public interest

There exists a class of super antibiotics never approved for use in animals, and for good reason: They are critically needed for treating certain serious life-threatening infections in humans, and any risk of weakening their ability to fight them -- of making bacteria more resistant to drugs through overexposure -- is one most doctors and scientists will not take. But now, despite dire warnings from health groups including the American Medical Association, and even though its own advisory board is against it, the Food and Drug Administration is poised to approve the use of one of those drugs to treat a common respiratory disease in cattle. Use of the drug, cefquinome, in animals also could undermine the effectiveness of a similar drug, cefepime.
''There is reasonable certainty of no harm to public health,'' the product development director of cef-quinome's manufacturer, InterVet, assured the FDA last fall. While "reasonable certainty" is good enough for the people who stand to profit from the drug, it is disturbingly unreasonable for those concerned about individuals paying with their health. A similar scenario unfolded in the mid-'90s when the FDA approved the use of Baytril (produced by Bayer) and SaraFlox (Abbott Laboratories) in poultry. Subsequently, people treated with this antibiotic for a diarrheal disease found the germ began developing resistance to the drug, which also is prescribed for a bacterium that causes anthrax. SaraFlox was pulled from the market after the FDA sought a ban, but not until 2005, after much antagonism, was Baytril withdrawn. By that time, its resistance in humans had increased dramatically.
That InterVet has not withdrawn the drug, the advisory group's opposition notwithstanding, tells us the company has the FDA's assurance it will be approved. What makes the agency's willingness to give the green light to cefquinome even more objectionable is the availability on the market of other medicines that effectively treat the respiratory ailment in cattle. Why not use what is available rather than speed the emergence of microbes resistant to antibiotics that are looked upon as a last resort in humans? And how is it that the FDA is not planning to impose limits on the drug's application to minimize bad consequences?
With the medical and scientific communities angrily calling for the FDA not to approve cefquinome in cattle and pressure against its use in cattle building in Congress, there is a chance the agency will back down and do the right thing. If it thinks the poison pet food scare, which it is currently focused on, is a health crisis, wait until people who could have been saved by an unnecessarily weakened antibiotic start dying.
http://www.suntimes.com/news/commentary/358607,CST-EDT-edits26a.article

Scientists Look to Vaccines in the War on E. Coli

Shousun C. Szu, a scientist at the National Institutes of Health, says the best way to prevent people from being poisoned by deadly E. coli would be to vaccinate all infants against the bacteria. Graeme McRae, a Canadian biotechnology executive, says it would be more practical to inoculate cows instead. Vaccines for people and for cattle are just two approaches under development to prevent or treat food poisoning by the strain E. coli O157:H7. Right now, scientists can do little medically to fight the pathogen, which was responsible for two severe outbreaks last fall, one from contaminated bagged spinach and a second from tainted lettuce served in chain taco restaurants. The main approach has been to try to prevent contamination through careful handling, rigorous inspections and government regulation. Slaughterhouses have already sharply reduced contamination through practices like washing carcasses with hot water, steam or acids. Now the focus is on new procedures and regulations for the fresh-produce industry. Some researchers say medical approaches could eventually supplement food-processing measures. To pave the way, an advisory committee of the Food and Drug Administration met on April 12 to discuss how to run clinical trials of drugs to treat E. coli infections. On the animal side, a vaccine for cattle developed by Mr. McRae’s company, Bioniche Life Sciences, was approved in December for distribution to veterinarians in Canada. Studies have shown that the vaccine can reduce but not eliminate the E. coli shed into manure. Not only does that make the cows cleaner as they go into the slaughterhouse, but it could also conceivably reduce the risk that the germ will spread from a feedlot to a nearby produce field though water or wild animals. Cows and their manure are considered the major sources of the pathogen. “If we can reduce the likelihood that animals are going to carry the bacteria, then we might reduce over time what they put out into the environment,” said Guy Loneragan, a veterinary epidemiologist at West Texas A&M University, who has received financing from the beef industry. Other methods being tested include cattle antibiotics, an industrial chemical, bacterial-killing viruses and friendly bacteria to displace the evil ones. One big potential barrier is that ranchers and feedlots may have little incentive to pay for such treatments, because they do not make the cows grow faster. Nor do they keep the cows healthy, because O157 does not sicken the cows that harbor it. “The cattle industry is within pennies of making a profit or not,” said Carolyn Hovde Bohach, a professor of microbiology at the University of Idaho who is working on a different E. coli vaccine for cattle. “Would it be their responsibility to protect vegetables?” Efforts to develop drugs and vaccines for people also face barriers. Because outbreaks are rare and sporadic, for instance, it would be difficult to test such treatments in clinical trials. It might be hard to diagnose the infection in time to intervene medically. And any treatment would have to be very safe, because it would be given to children and because most people improve without any intervention. E. coli O157:H7 causes 75,000 cases of infection and 61 deaths in the United States each year, according to a 1999 estimate by the Centers for Disease Control and Prevention posted on its Web site. The actual number of confirmed cases has dropped since then, particularly in 2003 and 2004, but increased in 2005 and 2006, in part because of the outbreaks tied to spinach and lettuce. As few as 10 bacteria can make someone ill. The bacteria release one or two potent toxins that cause bloody diarrhea. In 15 percent of children younger than 10, and more rarely for adults, the infection causes hemolytic uremic syndrome, in which red blood cells are destroyed and the kidneys fail. In a small percentage of such cases, the syndrome proves fatal. Dr. Phillip I. Tarr, an expert at Washington University in St. Louis, says treatment is difficult because the bloody diarrhea that signals infection may not occur until three to four days after ingestion of the bacteria. By then, a patient could be well on the way to kidney failure. Antibiotics, the usual treatment for bacterial infection, only make things worse by killing the bacteria and releasing more of their toxin, Dr. Tarr said. He added that the sole treatment shown to reduce the severity of kidney problems was intravenous fluids. Other scientists are trying. Thallion Pharmaceuticals of Montreal and Teijin Pharma of Japan have separately developed monoclonal antibodies that can latch on to the toxin molecules and neutralize them. Monoclonal antibodies, a synthetic version of the body’s own infection fighters, are commonly used to treat cancer and other diseases. Thallion and Teijin have shown that the antibodies can protect laboratory animals from lethal doses and have conducted preliminary safety testing in people. But at the recent F.D.A. advisory committee meeting, both said it would be prohibitively expensive to test whether their drugs could prevent hemolytic uremic syndrome. Some outside scientists question whether a treatment that starts after the toxin is already in the bloodstream would be effective. Dr. Szu of the health institutes said a better approach would be to vaccinate people so their immune systems could dispense with the bacteria before they had a chance to multiply and release their toxin in the bloodstream. She and colleagues have developed a vaccine made of the complex sugar that is on the surface of the bacteria, the very O-type polysaccharide that gives O157 its name. The sugar is linked to a protein taken from another bacterium to make it more potent in stimulating the immune system. Dr. Szu and collaborators have tested the vaccine on adult volunteers and on children 2 to 5. The volunteers were not exposed to O157 — that would be unethical — but they developed antibodies to it. Moreover, when the bacteria were exposed in the laboratory to blood samples from vaccinated people, the microbes were killed. Dr. Szu said the next test would be in infants. The vaccine is years from the market. As with drugs, testing effectiveness would be difficult, and some experts say it may not make sense to vaccinate every child to protect a small number. “A lot of the economics of it would not be very favorable,” said James B. Kaper, an expert on O157 at the Center for Vaccine Development at the University of Maryland. Dr. Szu disagreed, saying, “All human lives are precious, especially if you talk to parents who lost their children.” The cattle vaccine developed by Bioniche is based on the work of B. Brett Finlay of the University of British Columbia, who helped discover how O157 bacteria attach themselves to the cattle intestines, where they can then multiply. The bacteria use a type of microscopic syringe to shoot proteins into the cells lining the intestine, and the cells erect a protein pedestal, to which the bacteria can bind. The Bioniche vaccine consists of proteins involved in the attachment. The idea is that the cow’s immune system would make antibodies to attack the proteins, thereby blocking the attachment. The bacteria could still pass through the cow and into manure. But if they could not colonize, their levels should remain low. Tests at the University of Nebraska found that the vaccine reduced by 70 percent the number of cows shedding O157 into their manure, said Rodney A. Moxley, a professor of veterinary science there. Mr. McRae, president of Bioniche in Belleville, Ontario, said the company would begin to distribute the vaccine in Canada in June or July after it increases manufacturing capacity. The approval there is conditional, and the company has to provide more data showing that the vaccine works. Mr. McRae said he hoped to obtain approval to sell the vaccine in the United States from the Agriculture Department this year. He said feedlots would be charged no more than $2.20 a dose, with two doses needed. Randall D. Huffman, vice president for scientific affairs at the American Meat Institute, which represents beef processors, said that the cost was “not trivial” and that the vaccine “might not be right for everyone,” because it was not 100 percent effective. Still, Mr. Huffman said, “If there is technology that is proven effective and is reasonable in cost, I think you’ll see it adopted.” His organization and the National Cattlemen’s Beef Association helped pay for the research on the vaccine and other approaches to reducing the shedding of O157. One approach already in use is probiotics, the idea that friendly bacteria fed to cattle will displace O157. The Nutrition Physiology Corporation of Guymon, Okla., sells a feed additive with lactobacillus, the same type of bacterium used in yogurt. The additive is sold to aid cattle digestion, but some studies suggest that it also reduces O157 in manure. An experimental approach is to feed cows sodium chlorate, a chemical used in the pulp and paper industry. This idea takes advantage of the fact that O157 has an enzyme that allows it to survive without oxygen, which is not true for most desirable bacteria. That enzyme will convert sodium chlorate to sodium chlorite, which poisons the pathogen. “It’s like a suicide pill to the E. coli,” said Robin C. Anderson, a microbiologist for the Agriculture Department in College Station, Tex. Dr. Anderson said the treatment did not harm the cow. Eka Chemicals, which makes sodium chlorate for the paper industry, is working to obtain regulatory approval for a cattle treatment. The antibiotic neomycin has also been shown to reduce O157 levels in manure. Using antibiotics in animals raises concerns of spurring development of human pathogens resistant to the medicines. Another approach being studied involves phages, viruses that infect and kill bacteria. Experts say multiple approaches might be used in parallel, because no single approach works perfectly. Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said he was skeptical about all the approaches. “What really is a concern to me about this issue is we always have a tendency to want high-tech responses to what in many cases are common-sense low-tech solutions,” Dr. Osterholm said. He is a consultant to Fresh Express, the leading seller of bagged salads, and is head of a committee that will disburse $2 million from the company for research on how the produce industry should handle E. coli. He said stringent safety procedures had kept that company from having any contamination incidents. In any case, even if a high-tech solution was desired, there does not seem to be a vaccine for spinach as there is for cattle. Greens are now often rinsed in chlorine solution, but that is not always effective because surface nooks and crannies can shelter the bacteria, said James Gorney, senior vice president for food safety and technology at the United Fresh Produce Association, a trade group. A possible alternative is to use a gas like chlorine dioxide instead of a liquid wash, Dr. Gorney said. Irradiation can also kill the bacteria. But he said the amount of radiation needed could damage fruits or vegetables. And some consumers object to the technique. “Any one of these technologies doesn’t offer us a pasteurization step,” Dr. Gorney said. “So we are left with prevention, prevention and prevention, preventing the contamination from ever occurring.”

Banning antimicrobials not effective, study says

A team of University of Georgia scientists suggest that curbing the use of antimicrobials on poultry farms will do little to reduce rates of infection with antimicrobial-resistant bacteria that have the potential to threaten human health.
Dr. Margie Lee, professor at the UGA College of Veterinary Medicine, and her colleagues have found that chickens raised on antimicrobial-free farms, and even those raised under pristine laboratory conditions, have high concentrations of bacteria that are resistant to common antimicrobials. Her findings, published in the March issue of the journal Applied and Environmental Microbiology, suggest that poultry come to the farm harboring resistant bacteria, possibly acquired as they were developing in their eggs.
The study was funded by grants from the Food and Drug Administration and the Department of Agriculture.
"This issue of antibiotic resistance is more complicated than once thought," Dr. Lee said. "These findings suggest that banning antibiotics at the farm level may not be as effective as assumed. We need further studies to identify which management practice would be effective."
The concern over the emergence of microbes resistant to antimicrobials that are used to treat human and animal infections led the European Union to ban the marketing and use of antimicrobials as growth promoters in animal feed. The final step in the phaseout was completed in January 2006.
In the United States, the Food and Drug Administration announced in July 2005 that it would ban the distribution or use of the antimicrobial enrofloxacin for poultry, which was marketed by Bayer Corporation under the name Baytril 3.23% Concentrate Antimicrobial Solution. The FDA said enrofloxacin caused resistance in Campylobacter jejuni when used to treat respiratory infections in poultry.
"They banned Baytril in 2005, and if you look at Baytril resistance in Campylobacter now, it's essentially unchanged," Dr. Lee said.
Currently, Congress is considering legislation to reduce routine use of antimicrobials in animal agriculture. The Preservation of Antibiotics for Medical Treatment Act (S. 549/H.R. 962) would phase out the use of certain antimicrobial drugs in food-producing animals for nontherapeutic purposes such as growth promotion, feed efficiency, weight gain, routine disease prevention, and other routine uses. Turn to page 976 in the April 1 issue of JAVMA News to learn why the AVMA has not supported passage of the legislation in the past.