Amid the market carnage of the past weeks, one group of small caps has seen their share prices make steady upward progress.
The reason relates to the drugs the group are developing.
All are in one way or another working on drugs either to help cure lung disease or alleviate the symptoms.
Lung disease front and centre
And as the pictures coming out of Italy and now Spain have highlighted, developments of new respiratory therapies are essential and urgent.
Like the HIV virus, it’s the complications arising from catching coronavirus that can be fatal.
In this outbreak, it is chronic lung disease that has been the killer with the elderly, infirm and people with prior conditions most at risk.
Tiziana Life Sciences saw its share price soar by more than 200% when it announced that within its portfolio is an IL-6 inhibitor or the same active ingredient that medical teams in Italy are using to treat people with severe respiratory conditions arising from coronavirus.
Gabriele Corone, chief executive, admits he only became aware of the potential when he saw people in Naples being treated with Actemra, a drug produced by Swiss giant Roche that uses a similar antibody to block the pathogen that causes lung problems.
Italy's experience gives a lead
Tiziana’s TZLS-501 is a class of monoclonal antibody (mAb) called an anti-interleukin-6 receptor, or anti-IL6R for short.
On-the-ground testing in China also revealed anti-IL6R mAbs have a role to play in treating patients and recommended the Roche blockbuster, Actemra, for patients infected with coronavirus with serious lung damage and elevated IL-6 levels.
Sanofi and Regeneron are currently exploring the use in this setting of Kevzara, another FDA-approved anti-IL-6 receptor arthritis therapy.
Tiziana, worth £61.5mln at 45p, will start assessing its drug in patients as soon as is practicable and will administer TZLS-501 using its proprietary formulation technology.
This delivery method gives “distinct advantages” over Actemra and Kevzara in treating severely affected coronavirus patient and Tiziana has just raised US$10mln gross to fund TZLS-501’s development.
interferon beta another option
Synairgen PLC (LON:SYG), up 135% to 23.1p since the start of February, is currently undertaking a two-part phase II trial evaluating SNG001, an inhaled interferon beta drug candidate designed for people with chronic obstructive pulmonary disease (COPD).
Also known as smoker’s cough, COPD is associated with severe breathing difficulties and something is often fatal when it is exacerbated by additional conditions such as coronavirus.
Topline data from the phase II study is expected in the second quarter of 2020, but samples have already shown that treatment with inhaled interferon beta boosts the lungs' antiviral defences.
Richard Marsden, chief executive, adds that interferon beta, a cytokine, is the first thing the body throws at a virus when it recognises one and it is effective against lots of different types.
Synairgen’s treatment, SNG001, is a formulation of interferon beta delivered by a nebuliser designed to protect the lungs of patients with COPD from exacerbations such as coronavirus.
It is especially important with people with pre-existing conditions as by that stage the lungs are compromised too much to cope with any additional exacerbation and they become very ill.
Synairgen, now worth £28mln, believes it can either stop those people becoming unwell or accelerate their recovery.
Faron Pharmaceutical’s Traumakine is also an interferon-beta treatment, but is intravenously administered and is targeting acute respiratory distress syndrome or ARDS, something that has become common among severely ill patients in the current coronavirus outbreak.
ARDS an issue
An earlier phase III trial missed its endpoints because the therapeutic effect was affected by a combination with cortical steroids, which are often administered to reduce inflammation of the lungs.
Faron, though, has just received approval from the US regulator to resubmit Traumakine for a new trial without glucocorticoids.
The company believes this will demonstrate a benefit in people affected by coronavirus and other viral infections.
Markku Jalkanen, chief executive, remains optimistic Traumakine can be the first line of defence against the virus and critically for patients and health services boost ventilator-free days for those who lose respiratory capacity and need an external oxygen supply.
Shares have risen to 257.5p valuing the company at £108mln.
Admittedly, none of the three companies mentioned here will likely have a drug ready to go in the immediate future but government ministers now suggest the pandemic might last well into 2021.
All, though, are likely to be heavily involved in the fight against coronavirus and if they show any signs of success the rewards will be substantial.