Developing new treatments in partnership for primary mitochondrial disease: What does industry need from academics, and what do academics need from industry?

Developing novel therapeutics for primary mitochondrial disease is likely to require significant academia‐industry collaboration. Translational assessments, a tool often used in industry at target validation stage, can highlight disease specific development challenges which requires focused collaborative effort. For PMD, definition of pivotal trial populations and primary endpoints is challenging given lack of clinical precedence, high numbers of subgroups with overlapping symptoms despite common genetics. Disease pathophysiology has not been systematically assessed simultaneously with outcomes in available natural history studies, resulting in a lack of pathophysiology biomarker utilization in clinical trials. Preclinical model systems are available to assist drug development efforts, although these may require better standardization and access. Multistakeholder precompetitive efforts have been used to progress disease pathophysiology biomarker and confirmatory clinical trial endpoint readiness in neurological disease with limited treatment options, such as rare familial Parkinson's disease. This type of approach may be beneficial for PMD therapeutic development, although requires significant funding and time, supported by industry and other funding bodies. Industry expertise on chemistry, data quality and drug development know‐how is available to support academic drug development efforts. A combination of industry mindset—reduction of uncertainty to provide an indication statement supportable by evidence—together with academic approach—question‐based studies to understand disease mechanisms and patients—has great potential to deliver novel PMD therapeutics.