In recent years, many companies have stepped away from neuroscience after repeated clinical setbacks. But Stefan Albrecht, Chief Scientific Officer and Chief Medical Officer at Merz Therapeutics, believes advances in biomarkers, neuroimaging, digital monitoring, and patient phenotyping are beginning to change what is possible.
At Merz Therapeutics, that belief is being tested through work on botulinum toxin – a molecule still primarily associated with muscle relaxation, but one that may have broader effects on sensory nerves and pain pathways. The family-owned company is now exploring its potential in chronic neuropathic pain, an area where many single-target approaches have struggled.
We spoke with Albrecht about his move from clinical medicine into drug development, the renewed optimism around neuroscience, and why botulinum toxin’s story may not end with muscle relaxation.
What drew you from clinical medicine into research and drug development?
During my medical training in the late 1990s, we became increasingly good at diagnosing chronic neurological disorders such as multiple sclerosis or Parkinson’s disease. But once you had made the diagnosis, there was often very little you could truly offer patients in terms of modifying the course of disease or significantly improving their lives.
I also have a PhD in clinical pharmacology, so I had experience in laboratory science, and eventually I felt I wanted to move more deeply into research and development to help create better therapies for patients.
How would you characterize the current state of the neuroscience field?
I think neuroscience is entering a very exciting phase again. For some years, many companies stepped away from neurology because clinical failure rates were high. But now we are seeing renewed investment and renewed interest.
Part of that comes from better science. Advances in biomarkers, neuroimaging, digital monitoring, and patient phenotyping are improving our ability to design clinical trials and identify the right patient populations.
In chronic neuropathic pain specifically, we are also beginning to understand that pain is extraordinarily complex. Single-target approaches are often insufficient because multiple pathways are involved.
When did you first become interested in botulinum toxin research?
I became fascinated quite early during my clinical training, when botulinum toxin was first entering neurological medicine for conditions such as blepharospasm and cervical dystonia.
Blepharospasm can effectively leave patients functionally blind because they cannot keep their eyes open. They cannot work, they cannot walk independently, and they become isolated from normal life.
Then suddenly you inject very small amounts of botulinum toxin into these muscles, and patients can open their eyes again. The effect was immediate and dramatic. From that moment onwards, I found it a truly fascinating molecule.
At the time, the focus was entirely on muscle relaxation and motor neurons.
What led you to consider botulinum’s utility for chronic neuropathic pain?
One reason I believe botulinum toxin may hold promise is its multimodal mechanism of action. Rather than simply blocking a single pain channel, the toxin appears to act at multiple levels of the nervous system, including peripheral sensory neurons, dorsal root ganglia, and spinal pain circuits.
It silences sensory neurons and not only the muscles.
Pain sensation itself is extraordinarily complex, which is one reason many single-target approaches struggle to produce meaningful long-term relief. By modulating multiple layers of pain signaling simultaneously, I think botulinum toxin could eventually become an important treatment option for chronic neuropathic pain conditions.
What are the next steps for developing botulinum toxin in chronic neuropathic pain?
Our botulinum toxin program is already in Phase III development for migraine (chronic and episodic) and Phase II development for peripheral neuropathic pain, so the next challenge is successful translation into larger late-stage clinical trials for these newer pain indications.
One advantage with botulinum toxin is that we already know a great deal about the molecule from a safety perspective because it has been used clinically for many years. That allows us to focus heavily on demonstrating efficacy in the right patient populations.
Patient selection is critical in neurology. Chronic neuropathic pain, for example, is highly subjective. There is no objective measurement equivalent to blood pressure. So, we need better phenotyping tools to identify which subsets of patients are most likely to respond.
I think combining strong mechanistic science with more precise patient characterization will significantly improve the probability of success in neuroscience in the future.
One of the main reasons so many neurological clinical trials have failed is not necessarily because the drug did not work. Often, it was simply not the right patient population in the clinical trial.
Increasingly, I think digital wearables and longitudinal patient monitoring may help us better phenotype patients, cluster them into subgroups, and identify which patients are most likely to benefit from specific therapies.
Why did you decide to pursue this within a family-owned company?
The family-owned structure is one of the reasons I have stayed at Merz Therapeutics for more than 15 years.
The culture is very special. There is a genuine long-term commitment to programs and to patients. We are not driven by short-term market expectations, which allows us to pursue ambitious neurological programs with stability and focus.
When we commit to something, everybody aligns behind the same goal. Our founder always highlighted asking whether a program truly solves a meaningful patient problem. That philosophy still shapes how we operate today.
I believe smaller, highly focused companies may be particularly well positioned in neuroscience, where long timelines and clinical complexity can discourage shorter-term investment strategies.
We also learned very early that you cannot solve these problems in isolation. You need strong external partners – universities, clinical experts, and other companies – because neuroscience is simply too complex for any one group to tackle alone.
Collaboration is everything. You need to partner up, bring expertise together, and create a true team working toward the same goal.
Do you think neuroscience needs more people willing to challenge conventional thinking?
Absolutely. One of the biggest mistakes science can make is simply following dominant ideas without questioning them. If everybody pursues the same mechanism and that mechanism turns out not to be the solution, then progress becomes very limited.
I believe the field benefits enormously from diverse scientific approaches and from companies willing to pursue different ideas. Ten years ago, many people would have dismissed the idea of botulinum toxin for chronic neuropathic pain entirely.
But dogma can slow scientific progress. You must trust your expertise, follow your own ideas, and remain open to unconventional possibilities.
These are extraordinarily complex diseases, and progress is rarely linear. You may spend years pursuing an idea before the field fully understands its value.
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