I was just the other day thinking of making a video where I dress up as an ENT and pretend to have said person as a patient... and nearly offer the FX-322, for an affordable cost, but then retract it on the basis that tinnitus is character forming, and that most likely if said person had said treatment, he would probably go and listen to headphones—even at a low volume—and that would be the worst thing said person could possibly do.You should include Michael Leigh along with the ENTs and audiologists haha.
Haha, I'm completely talking out of my ass with the theory of turbulent perilymph via vibrations pushing it deeper. Probably the most efficient method is something boring like getting in the right position and letting gravity work.I guess they just need a higher dose of FX-322 and using low frequency sounds to reach the apex of the cochlea.
Haha, I was mindful of not derailing the thread but at the same time I could feel everyone's anxiety starting to creep through with results any day now. I don't mind some memes as a break from all the technical discussion and to help lighten the mood, but it appears we've started something we can't stop now lol. I actually loved your first one, it resonated with me on so many levels!I'm done meme-ing back, as I don't want to kill it. Aaron, what I think is so funny about your meme is that this how everyone feels when they post a theory -- like a regular person just trying their best, mispronouncing the scientific terms.
Haha, Yeah probably! but nothing is for sure with this experiments with the cochlea.Haha, I'm completely talking out of my ass with the theory of turbulent perilymph via vibrations pushing it deeper. Probably the most efficient method is something boring like getting in the right position and letting gravity work.
This thread is amusing, as it's all over the place. Some investor talk; some venting over fears; some memes; some theories; some of you, FGG, and Diesel mapping the human genome in real time on the thread; Bobb world; some freak-out over scheduled SEC exchanges from the executive team; some "how do you like me now" talk towards Leigh and TRT; some talk about study participants learning how to ace word tests; some history lessons; some ELI5 science lessons; etc.Haha, I was mindful of not derailing the thread but at the same time I could feel everyone's anxiety starting to creep through with results any day now. I don't mind some memes as a break from all the technical discussion and to help lighten the mood, but it appears we've started something we can't stop now lol. I actually loved your first one, it resonated with me on so many levels!
It just feels like we're all sitting patiently outside the Sistine Chapel now, waiting for the white smoke to come out of the chimney.
You're not kidding. The FX-322 thread is literally the cultural hub of Tinnitus Talk.This thread is amusing, as it's all over the place. Some investor talk; some venting over fears; some memes; some theories; some of you, FGG, and Diesel mapping the human genome in real time on the thread; Bobb world; some freak-out over scheduled SEC exchanges from the executive team; some "how do you like me now" talk towards Leigh and TRT; some talk about study participants learning how to ace word tests; some history lessons; some ELI5 science lessons; etc.
Yeah, these are crazy times.This thread is amusing, as it's all over the place. Some investor talk; some venting over fears; some memes; some theories; some of you, FGG, and Diesel mapping the human genome in real time on the thread; Bobb world; some freak-out over scheduled SEC exchanges from the executive team; some "how do you like me now" talk towards Leigh and TRT; some talk about study participants learning how to ace word tests; some history lessons; some ELI5 science lessons; etc.
I think "Meh" Case #2 is the most likely outcome, but the "Ideal" scenario is, of course, ideal.Now that we've got a lot more viewers, reposting this with some changes... to be clear... ANY of these outcomes are positive and would still lead to a pivotal phase. I am pretty optimistic FX-322 will end up approved, but there still may be work to do for a "2.0" version.
The Worst Case: Multi-Dosing doesn't have any significant effect. It becomes a "bigger" Phase 1/2.
Description:
The data shows that all 3 dose cohorts basically reproduce what we saw in the single dose Phase 1/2, except with 72 patients instead of 15.
The Good:
Word score improvements continue to be clinically meaningful / statistically significant.
Similar improvement rate at 8 kHz + on audiogram, but nothing lower.
The Okay:
Tinnitus scores (TFI) show improvement trend, but is not significant amongst cohorts
EHF audiogram shows improvement but not significant.
Word-in-Noise score shows improvement, but slightly more significant.
The Bad:
No improvement below 8 kHz on audiogram.
Multi-dosing didn't work.
What this may indicate: Need to change delivery method or formulation for an FX-322 "2.0" to work with multiple doses, or get enough to reach the apex of the cochlea. FX-322 will come out, but will require many to return to ENT for the "2.0".
The "Meh" Case 1: Multi-Dosing works, but didn't go deeper per cohort.
Description:
Data shows that multi-dosing does have a stratified effect, but stays concentrated in the EHF (8 kHz+).
The Good:
Word score improvements continue to be clinically meaningful / statistically significant.
Word-in-Noise score shows improvement that is clinically meaningful / statistically significant.
EHF audiogram shows significant improvement (20 dB+, 30 dB+, etc).
The Okay:
4-dose show more improvements at 8 kHz (10 dB+, 20 dB+, etc) + on audiogram, but nothing lower in frequency.
Tinnitus scores (TFI) show improvement trend, and is stratified at each cohort level (more doses, lower TFI).
The Bad:
No improvement below 8 kHz on audiogram.
What this may indicate: Dosing may need to be larger in concentration or closer together to increase diffusion per dose in the cochlea.
The "Meh" Case 2: Multi-Dosing works, goes deeper, but underwhelming response.
Description:
Data shows that multi-dosing does have a stratified effect in terms of depth, but the improvements are minor.
The Good:
Word score improvements continue to be clinically meaningful / statistically significant.
The Okay:
Word-in-Noise score shows improvement, but slightly more significant.
EHF audiogram shows improvement, but isn't groundbreaking (10-20 dB, etc).
4-dose improvements go below 8 kHz on audiogram (6 kHz, 4 kHz), but the gains don't get above 10 dB.
Tinnitus scores (TFI) show improvement trend, and is stratified at each cohort level (more doses, lower TFI).
The Bad:
No significant improvement in dB on normal audiogram above 10 dB at any given frequency.
Issues point to synaptopathy being a greater issue than anticipated (need PIPE-505, OTO-413).
What this may indicate: Similar to the above. Possibly more doses beyond 4x, and closer together in time.
The Ideal Outcome: Multi-Dosing goes deeper + significant response.
Description:
Data shows that multi-dosing does have a stratified effect in terms of depth, and the improvements are significant.
The Good:
Word score improvements continue to be clinically meaningful / statistically significant.
Word-in-Noise score shows improvement that is clinically meaningful / statistically significant.
EHF audiogram shows significant improvement from baseline(20 dB+, 30 dB+, etc).
4-dose improvements go below 8 kHz on audiogram (6 kHz, 4 kHz, 2 kHz), and show clear improvement per band: +30 dB @ 8 kHz, +20 dB @ 6 kHz, +10 dB @ 4 kHz.
Tinnitus scores (TFI) significant improvement trend, and is stratified at each cohort level (more doses, lower TFI).
The Okay:
Obviously doesn't go deeper into cochlea.
Hearing isn't restored to "like new" after 4 doses.
FX-322 is still many years from product.
What this may indicate: Enough FX-322 is sticking around so that more doses should continue to go deeper into the cochlea.
Yeah the prevalence of synaptopathy where FX-322 cannot cause regeneration of the new hair cell + synapse may be telling in these results.I think "Meh" Case #2 is the most likely outcome, but the "Ideal" scenario is, of course, ideal.
I don't have my thoughts organized in quite the same way but what I see:Now that we've got a lot more viewers, reposting this with some changes... to be clear... ANY of these outcomes are positive and would still lead to a pivotal phase. I am pretty optimistic FX-322 will end up approved, but there still may be work to do for a "2.0" version.
The Worst Case: Multi-Dosing doesn't have any significant effect. It becomes a "bigger" Phase 1/2.
Description:
The data shows that all 3 dose cohorts basically reproduce what we saw in the single dose Phase 1/2, except with 72 patients instead of 15.
The Good:
Word score improvements continue to be clinically meaningful / statistically significant.
Similar improvement rate at 8 kHz + on audiogram, but nothing lower.
The Okay:
Tinnitus scores (TFI) show improvement trend, but is not significant amongst cohorts
EHF audiogram shows improvement but not significant.
Word-in-Noise score shows improvement, but slightly more significant.
The Bad:
No improvement below 8 kHz on audiogram.
Multi-dosing didn't work.
What this may indicate: Need to change delivery method or formulation for an FX-322 "2.0" to work with multiple doses, or get enough to reach the apex of the cochlea. FX-322 will come out, but will require many to return to ENT for the "2.0".
The "Meh" Case 1: Multi-Dosing works, but didn't go deeper per cohort.
Description:
Data shows that multi-dosing does have a stratified effect, but stays concentrated in the EHF (8 kHz+).
The Good:
Word score improvements continue to be clinically meaningful / statistically significant.
Word-in-Noise score shows improvement that is clinically meaningful / statistically significant.
EHF audiogram shows significant improvement (20 dB+, 30 dB+, etc).
The Okay:
4-dose show more improvements at 8 kHz (10 dB+, 20 dB+, etc) + on audiogram, but nothing lower in frequency.
Tinnitus scores (TFI) show improvement trend, and is stratified at each cohort level (more doses, lower TFI).
The Bad:
No improvement below 8 kHz on audiogram.
What this may indicate: Dosing may need to be larger in concentration or closer together to increase diffusion per dose in the cochlea.
The "Meh" Case 2: Multi-Dosing works, goes deeper, but underwhelming response.
Description:
Data shows that multi-dosing does have a stratified effect in terms of depth, but the improvements are minor.
The Good:
Word score improvements continue to be clinically meaningful / statistically significant.
The Okay:
Word-in-Noise score shows improvement, but slightly more significant.
EHF audiogram shows improvement, but isn't groundbreaking (10-20 dB, etc).
4-dose improvements go below 8 kHz on audiogram (6 kHz, 4 kHz), but the gains don't get above 10 dB.
Tinnitus scores (TFI) show improvement trend, and is stratified at each cohort level (more doses, lower TFI).
The Bad:
No significant improvement in dB on normal audiogram above 10 dB at any given frequency.
Issues point to synaptopathy being a greater issue than anticipated (need PIPE-505, OTO-413).
What this may indicate: Similar to the above. Possibly more doses beyond 4x, and closer together in time.
The Ideal Outcome: Multi-Dosing goes deeper + significant response.
Description:
Data shows that multi-dosing does have a stratified effect in terms of depth, and the improvements are significant.
The Good:
Word score improvements continue to be clinically meaningful / statistically significant.
Word-in-Noise score shows improvement that is clinically meaningful / statistically significant.
EHF audiogram shows significant improvement from baseline(20 dB+, 30 dB+, etc).
4-dose improvements go below 8 kHz on audiogram (6 kHz, 4 kHz, 2 kHz), and show clear improvement per band: +30 dB @ 8 kHz, +20 dB @ 6 kHz, +10 dB @ 4 kHz.
Tinnitus scores (TFI) significant improvement trend, and is stratified at each cohort level (more doses, lower TFI).
The Okay:
Obviously doesn't go deeper into cochlea.
Hearing isn't restored to "like new" after 4 doses.
FX-322 is still many years from product.
What this may indicate: Enough FX-322 is sticking around so that more doses should continue to go deeper into the cochlea.
I thought that was a real thing that someone mentioned a while back. Or I imagined it...Haha, I'm completely talking out of my ass with the theory of turbulent perilymph via vibrations pushing it deeper.
I'm sorry, I just couldn't help myself.Now that we've got a lot more viewers, reposting this with some changes... to be clear... ANY of these outcomes are positive and would still lead to a pivotal phase. I am pretty optimistic FX-322 will end up approved, but there still may be work to do for a "2.0" version.
The Worst Case: Multi-Dosing doesn't have any significant effect. It becomes a "bigger" Phase 1/2.
Description:
The data shows that all 3 dose cohorts basically reproduce what we saw in the single dose Phase 1/2, except with 72 patients instead of 15.
The Good:
Word score improvements continue to be clinically meaningful / statistically significant.
Similar improvement rate at 8 kHz + on audiogram, but nothing lower.
The Okay:
Tinnitus scores (TFI) show improvement trend, but is not significant amongst cohorts
EHF audiogram shows improvement but not significant.
Word-in-Noise score shows improvement, but slightly more significant.
The Bad:
No improvement below 8 kHz on audiogram.
Multi-dosing didn't work.
What this may indicate: Need to change delivery method or formulation for an FX-322 "2.0" to work with multiple doses, or get enough to reach the apex of the cochlea. FX-322 will come out, but will require many to return to ENT for the "2.0".
The "Meh" Case 1: Multi-Dosing works, but didn't go deeper per cohort.
Description:
Data shows that multi-dosing does have a stratified effect, but stays concentrated in the EHF (8 kHz+).
The Good:
Word score improvements continue to be clinically meaningful / statistically significant.
Word-in-Noise score shows improvement that is clinically meaningful / statistically significant.
EHF audiogram shows significant improvement (20 dB+, 30 dB+, etc).
The Okay:
4-dose show more improvements at 8 kHz (10 dB+, 20 dB+, etc) + on audiogram, but nothing lower in frequency.
Tinnitus scores (TFI) show improvement trend, and is stratified at each cohort level (more doses, lower TFI).
The Bad:
No improvement below 8 kHz on audiogram.
What this may indicate: Dosing may need to be larger in concentration or closer together to increase diffusion per dose in the cochlea.
The "Meh" Case 2: Multi-Dosing works, goes deeper, but underwhelming response.
Description:
Data shows that multi-dosing does have a stratified effect in terms of depth, but the improvements are minor.
The Good:
Word score improvements continue to be clinically meaningful / statistically significant.
The Okay:
Word-in-Noise score shows improvement, but slightly more significant.
EHF audiogram shows improvement, but isn't groundbreaking (10-20 dB, etc).
4-dose improvements go below 8 kHz on audiogram (6 kHz, 4 kHz), but the gains don't get above 10 dB.
Tinnitus scores (TFI) show improvement trend, and is stratified at each cohort level (more doses, lower TFI).
The Bad:
No significant improvement in dB on normal audiogram above 10 dB at any given frequency.
Issues point to synaptopathy being a greater issue than anticipated (need PIPE-505, OTO-413).
What this may indicate: Similar to the above. Possibly more doses beyond 4x, and closer together in time.
The Ideal Outcome: Multi-Dosing goes deeper + significant response.
Description:
Data shows that multi-dosing does have a stratified effect in terms of depth, and the improvements are significant.
The Good:
Word score improvements continue to be clinically meaningful / statistically significant.
Word-in-Noise score shows improvement that is clinically meaningful / statistically significant.
EHF audiogram shows significant improvement from baseline(20 dB+, 30 dB+, etc).
4-dose improvements go below 8 kHz on audiogram (6 kHz, 4 kHz, 2 kHz), and show clear improvement per band: +30 dB @ 8 kHz, +20 dB @ 6 kHz, +10 dB @ 4 kHz.
Tinnitus scores (TFI) significant improvement trend, and is stratified at each cohort level (more doses, lower TFI).
The Okay:
Obviously doesn't go deeper into cochlea.
Hearing isn't restored to "like new" after 4 doses.
FX-322 is still many years from product.
What this may indicate: Enough FX-322 is sticking around so that more doses should continue to go deeper into the cochlea.
Yep, this is why I was asking about the TFI earlier.Tinnitus data will be tricky. If someone has a 2000 Hz tone, for instance, and the drug doesn't penetrate, it obviously won't affect THI/TFI scores. Without tone matching, it might be extremely hard to interpret the data. I'm glad tinnitus is just an "experimental" end point for that reason.
I was wondering, is there a diagram (or is it known) of which part of the cochlea is responsible for which frequencies?From Phase 1, the word scores were really impressive. As the vast majority of speech information is below 8000 Hz, I think the gains from a single injection were at least 15 dB in the EHF. My gut tells me it was even more considering that some word scores doubled.
As for what happens below 8000 Hz, I actually think we would see *some* audiogram changes in the multi dose cohort if they say measured at 7000 Hz but, as the next "rung" down is 4000 Hz, I am not so sure. These would obviously less substantial than in the EHF. It would be nice to know where the drug stops having an effect due diffusion issues/VPA concentration etc and I wish audiograms weren't so limiting. It's unfortunate that Frequency Therapeutics couldn't use custom audiograms with smaller intervals because recruitment depended on stable standard audiogram results. Yet another reason audiograms just suck.
Tinnitus data will be tricky. If someone has a 2000 Hz tone, for instance, and the drug doesn't penetrate, it obviously won't affect THI/TFI scores. Without tone matching, it might be extremely hard to interpret the data. I'm glad tinnitus is just an "experimental" end point for that reason.
Here is a schematic. Not sure if it is exactly to scale but shows an approximation of what you are asking anyway:I was wondering, is there a diagram (or is it known) of which part of the cochlea is responsible for which frequencies?
For example is 8000 Hz more on the outer part of the pathway, that with 1 dose we see a difference, and say 2000 Hz is more towards center of the cochlea?
Frequency Therapeutics has a pretty helpful diagram on their investor presentation.I was wondering, is there a diagram (or is it known) of which part of the cochlea is responsible for which frequencies?
For example is 8000 Hz more on the outer part of the pathway, that with 1 dose we see a difference, and say 2000 Hz is more towards center of the cochlea?
I hope it will reach at least partially to my loss (30 dB) of hearing and tinnitus at 3 kHz.Frequency Therapeutics has a pretty helpful diagram on their investor presentation.
As you can see, the blue shaded area is where the presence of drug has been measured after 1 injection. The belief is that multiple injections might cause more of the drug to diffuse deeper into the cochlea, if concentrations get high enough and deep enough, it may show up as an improvement on the audiogram.
@FGG, I was thinking about your previous comment. It's possible the standard audiogram they are using in the Phase 2A has a 6 kHz band, which might show some gains at the 4x dose group.
View attachment 43896
I was just looking at my own standard audiogram from December and it included 3 kHz and 6 kHz -- eight bands rather than six -- so it's possible.@FGG, I was thinking about your previous comment. It's possible the standard audiogram they are using in the Phase 2A has a 6 kHz band, which might show some gains at the 4x dose group.
My last one also had 6 kHz, so fingers crossed.I was just looking at my own standard audiogram from December and it included 3 kHz and 6 kHz -- eight bands rather than six -- so it's possible.
Hmm... mine didn't. I wonder how common each type of audiogram is and how that affected recruitment.I was just looking at my own standard audiogram from December and it included 3 kHz and 6 kHz -- eight bands rather than six -- so it's possible.
If that's the case, my hunch is we will see at least some blip at 6000 Hz. Hopefully a lot more.My last one also had 6 kHz, so fingers crossed.