Note: Kristine Ball replaced Gail Maderis as CEO in the spring of 2023. Congratulations Kristine and Gail on your accomplishments!
In this series, we explain why we invested in our current portfolio companies. In the process, we hope to highlight the white spaces in women’s health and the life sciences — as well as the people, products, and companies working to fill those gaps. The name “Under the Microscope” refers both to our extensive due diligence process and our investment focus on healthcare and the life sciences.
In August 2020, the World Health Organization announced its goal of ending cervical cancer as a public health problem by 2030. That objective and subsequent steps to fulfill it — including fully vaccinating girls against HPV, regularly screening women for HPV, treating women with pre-cancer, and managing those with invasive cancer — came two years after the WHO Director-General made a global call for action against cervical cancer: one of the most commonly diagnosed cancer in women worldwide and one of the leading causes of cancer death worldwide.
Implementation of the WHO’s strategy could prevent more than 62 million deaths over the next 100 years, in part due to its focus on human papillomavirus (HPV), which causes 99.7% of cervical cancers. HPV is one of the most commonly sexually transmitted infections; about 80% of women and about 65–70% of men will be infected before they turn 50. It is also preventable — but as of 2020, the CDC found that only 59% of U.S teens were up-to-date on their HPV vaccine. (In contrast, about 91% of teens and have been vaccinated against chicken pox and about 64% against the flu.) In 2016, researchers also found the rate of women up-to-date on their cervical cancers screenings was “unacceptably low” with African-American women 50% less likely and Asian women 30% less likely than white women to be current on their screenings.
On a global scale, meanwhile, only about 30% of the global target population as of 2019 has the HPV vaccine in their national vaccine schedule while the percent of women who have received screenings can be as low as the single digits. Both vaccines and regular screenings can help protect the health of individuals and their sexual partners: many who are infected with HIV may not know that they have the disease since they never experience symptoms and, for most — including 90% of women specifically — the disease clears up by itself in about two years without any treatment.
Others, though, may encounter a strain of HPV that does lead to symptoms and adverse — even life-threatening — health effects, including genital warts, various cancers, (including anal, cervical, oropharyngeal, penile, and vaginal), and precancerous conditions, such as cervical intraepithelial neoplasia (CIN). If left untreated, CIN, a condition in which abnormal cells grow on cervix’s surface, can develop from CIN 1 (the earliest stage in which abnormal cells are present in the lower third of the cervical surface layer) to CIN 2 and 3 (in which abnormal cells are present at two-thirds of to the full depth of the cervical surface layer respectively) to cervical cancer.
To prevent CIN from developing into cervical cancer, individuals can utilize treatment options such as cryotherapy (freezing and removing the abnormal tissue), laser ablation (destroying the abnormal tissue through a laser’s high-intensity energy) and excisional procedures (surgically removing the abnormal tissue).
Although these surgeries tend to be successful, they do pose risks, especially for women of child-bearing age. To protect herself and her child, women should pursue a treatment option; after all, a HPV infection shortly before or during pregnancy is associated with pre-term delivery (PTD), neonatal mortality, premature rupture of the membranes (PROM) — in which the amniotic membrane around the baby ruptures, increasing the risk for infection — and preterm premature rupture of the membranes (pPROM) — in which the amniotic membrane ruptures before week 37 of pregnancy. However, one study observed a strong correlation between preterm birth and the volume of excised cervical tissue for women who pursued an excisional procedure. Another study found that a specific excisional procedure, loop electrosurgical excision procedure or LEEP, was also associated with an increased risk of severe preterm delivery (< 32 weeks) and extreme preterm delivery (<28 weeks).
Women who received incomplete excision or ablation treatment, who have recurrent CIN, or for whom surgical treatment options might be inappropriate, may even be advised to pursue a hysterectomy: an option that would completely prevent them from having children in the future.
Antiva Biosciences is aiming to treat CIN and other pre-cancerous lesions caused by HPV through topical therapeutics that are convenient, improve access to care, and preserve women’s health.
The company’s first product, ABI-2280, is focused on treating CIN 2 and 3 before they become cancerous. The aims of ABI-2280 are twofold: to inhibit the replication of HPV in virus-infected cells to prevent the virus from spreading as well as to induce apoptosis — the death of — specific, infected, hyper-proliferating cells while surrounding, uninfected tissue is left untouched. The company dosed its first Phase I clinical trial patient in December 2021.
With ABI-2280, patients won’t have to pursue surgery and its various risks — and won’t require access to a skilled medical professional for the procedure. Instead, women can self-administer the ABI-2280 tablet intravaginally in the privacy of their home: a major convenience to all patients but especially those in areas in which GYN surgeons are scarce such as in developing countries. Antiva expects three doses of ABI-2880 over one week to be sufficient to clear CIN lesions.
We invested in Antiva Biosciences because it is poised to be the leader in non-surgical treatment for CIN, including becoming the first FDA-approved therapeutic for HPV-caused pre-cancerous lesions CIN 2 and 3. In the process of providing an alternate, accessible treatment option for women around the world with precancerous lesions, Antiva Biosciences can also help the World Health Organization achieve its goals — both of specifically treating women with pre-cancer and of generally eliminating cervical cancer as a public health issue.
At Avestria Ventures, we look for early-stage women’s health and female-led life science companies with products or technologies that improve healthcare quality and/or access, lower costs, induce clinical or behavioral change, are evidence based, have scalable commercialization plans, and have a sustainable competitive advantage. Know one? Contact us via our website, LinkedIn, or Twitter.