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Gene therapy may cure rare diseases. But drugmakers have few incentives, leaving families desperate

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Gene therapy may cure rare diseases. But drugmakers have few incentives, leaving families desperate
News

News

Gene therapy may cure rare diseases. But drugmakers have few incentives, leaving families desperate

2024-06-21 12:36 Last Updated At:12:41

Robin Alderman faces an agonizing reality: Gene therapy might cure her son Camden’s rare, inherited immune deficiency. But it’s not available to him.

In 2022, London-based Orchard Therapeutics stopped investing in an experimental treatment for the condition, Wiskott-Aldrich syndrome. And there are no gene therapy studies he can join.

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Robin Alderman, right, looks up to her son, Camden Alderman, 21, who has a rare disease called Wiskott-Aldrich syndrome, as they pose for a portrait near their home in Greensboro, N.C., Wednesday, June 12, 2024. (AP Photo/Chuck Burton)

Robin Alderman faces an agonizing reality: Gene therapy might cure her son Camden’s rare, inherited immune deficiency. But it’s not available to him.

Camden Alderman, 21, who has a rare disease called Wiskott-Aldrich syndrome, holds some of the drugs and medical equipment he uses near his home in Greensboro, N.C., Wednesday, June 12, 2024. (AP Photo/Chuck Burton)

Camden Alderman, 21, who has a rare disease called Wiskott-Aldrich syndrome, holds some of the drugs and medical equipment he uses near his home in Greensboro, N.C., Wednesday, June 12, 2024. (AP Photo/Chuck Burton)

Robin Alderman, right, and her son, Camden Alderman, 21, who has a rare disease called Wiskott-Aldrich syndrome, pose for a portrait near their home in Greensboro, N.C., Wednesday, June 12, 2024. (AP Photo/Chuck Burton)

Robin Alderman, right, and her son, Camden Alderman, 21, who has a rare disease called Wiskott-Aldrich syndrome, pose for a portrait near their home in Greensboro, N.C., Wednesday, June 12, 2024. (AP Photo/Chuck Burton)

Camden Alderman, 21, who has a rare disease called Wiskott-Aldrich syndrome, holds with an infusion pump he uses near his home in Greensboro, N.C., Wednesday, June 12, 2024. When he was a toddler, doctors removed his spleen because of uncontrolled bleeding. As a young boy, he wound up in the hospital many times and was told he couldn’t play baseball. (AP Photo/Chuck Burton)

Camden Alderman, 21, who has a rare disease called Wiskott-Aldrich syndrome, holds with an infusion pump he uses near his home in Greensboro, N.C., Wednesday, June 12, 2024. When he was a toddler, doctors removed his spleen because of uncontrolled bleeding. As a young boy, he wound up in the hospital many times and was told he couldn’t play baseball. (AP Photo/Chuck Burton)

Robin Alderman, right, and her son, Camden Alderman, 21, pose for a portrait near their home in Greensboro, N.C., Wednesday, June 12, 2024. Camden, 21, was diagnosed as a baby with a rare disease called Wiskott-Aldrich syndrome, which is caused by a mutated gene on the X chromosome. It primarily affects boys – up to 10 out of every million — and can cause frequent infections, eczema and excessive bleeding. (AP Photo/Chuck Burton)

Robin Alderman, right, and her son, Camden Alderman, 21, pose for a portrait near their home in Greensboro, N.C., Wednesday, June 12, 2024. Camden, 21, was diagnosed as a baby with a rare disease called Wiskott-Aldrich syndrome, which is caused by a mutated gene on the X chromosome. It primarily affects boys – up to 10 out of every million — and can cause frequent infections, eczema and excessive bleeding. (AP Photo/Chuck Burton)

“We feel like we are the forgotten,” said Alderman, who's advocated for her 21-year-old son since he was a baby.

Collectively, about 350 million people worldwide suffer from rare diseases, most of which are genetic. But each of the 7,000 individual disorders affects perhaps a few in a million people or less. There’s little commercial incentive to develop or bring to market these one-time therapies to fix faulty genes or replace them with healthy ones. This leaves families like the Aldermans scrambling for help and some trying to raise money themselves for cures that may never come.

“These kids have been unfortunate twice: A, because they got a genetic disease, and B, because the disease is so rare that nobody cares,” said Dr. Giulio Cossu, a professor of regenerative medicine at the University of Manchester in England. “Companies want to make a profit.”

Scientists say this dynamic threatens to thwart progress in the nascent gene therapy field, erasing the potential of a new type of medicine just as a steady stream of research points toward promising treatments for various disorders. Researchers are seeking solutions, often turning to charitable organizations, patient groups and governments.

A major Italian charity announced in February that it’s taking over the Wiskott-Aldrich treatment Orchard had been pursuing. And an arm of the charitable Foundation Fighting Blindness helped launch a company, Opus Genetics, to advance gene therapy work by University of Pennsylvania researcher Dr. Jean Bennett and a colleague.

In many ways, that effort was inspired by patients' families.

“Some of them have bake sales. One family mortgaged their house to give some money for a study for their rare disease,” Bennett said. “I just feel responsible to help them.”

The Aldermans have faced years of pain and frustration.

Camden Alderman was diagnosed as a baby with Wiskott-Aldrich, caused by a mutated gene on the X chromosome. It primarily affects boys – up to 10 out of every million — and can cause frequent infections, eczema and excessive bleeding.

When he was a toddler, doctors removed his spleen because of uncontrolled bleeding. As a young boy, he wound up in the hospital many times and was told he couldn't play baseball.

One treatment is a bone marrow transplant. But he is Black and has Korean heritage, making it difficult to find a donor — people are most likely to match with someone of similar ancestral or ethnic backgrounds. Robin Alderman recalls one doctor saying: “Basically, your son’s only chance at a cure is going to be gene therapy.”

He also told her researchers weren’t then accepting U.S. residents into a clinical trial, which “just kind of broke my heart,” she said.

Today, Camden Alderman is a rising senior at North Carolina Agricultural and Technical State University. He takes penicillin daily and gives himself weekly immunoglobulin infusions under his skin, which help fight infection. Still, he’s landed in the hospital a few times in recent years and has developed a kidney problem.

While he doesn’t view gene therapy as a cure-all, he said, “it would just help me kind of lead an easier life.”

That’s proved true for patients who underwent the experimental therapy, such as Dr. Priya Stephen’s 14-year-old son, who participated in a clinical trial in Italy that accepted Americans at the time.

While Stephen is grateful, she said, she can't help feeling guilty that her family got an opportunity others don't: “It’s ethically just not acceptable to have a treatment that we know works, that we know is safe, that people all of a sudden can’t access."

For a while, it seemed gene therapy for Wiskott-Aldrich was on track for wider availability. Genethon, a French nonprofit research organization, sponsored promising clinical trials but didn’t have funding to continue development, CEO Frédéric Revah said.

Drugmaker GlaxoSmithKline transferred another therapy to Orchard, which announced in 2019 that it had secured a designation from the U.S. Food and Drug Administration meant to speed up development and review. But Orchard discontinued investment in this and two other rare-disease treatments a couple of years ago, with CEO Dr. Bobby Gaspar saying the company sympathized with affected families and would look for other ways to advance the therapies.

“There’s a huge number of diseases out there that could benefit from gene therapy but for which there is no profitability model because the investment for research is high, the cost of production is high and the number of patients is very low,” Revah said.

Most genetic conditions are rare — each affecting fewer than 200,000 people in the U.S. at any given time. Research hasn't made it past early stages for many of them.

Lacey Henderson's daughter, 5-year-old Estella, has alternating hemiplegia of childhood, a neurological condition that affects 300 people in the U.S. Estella is cognitively delayed, has limited use of her hands and becomes temporarily paralyzed in part or all of her body, Henderson said. Medications can curb symptoms, but there’s no cure.

Her Iowa family fundraises through a GoFundMe and a website to develop a gene therapy. They've brought in around $200,000.

“We have three different projects with various researchers," Henderson said. “But the problem is everything is underfunded.”

Financial disincentives plague the process, from drug discovery to development, scientists say.

The amount of work to get from a lab to human testing and through the drug-approval process is “incredibly expensive,” said Dr. Donald Kohn, professor of microbiology, immunology and molecular genetics at the University of California, Los Angeles.

In the last couple of years, he said, gene-therapy investment has largely dried up.

“If you have to spend $20 million or $30 million to get approval and you have five or 10 patients a year, it’s hard to get a return on investment,” Kohn said. “So we have successful, safe therapies, but it’s more the financial, economic elements that are limiting them from becoming approved drugs.”

Ultimately, most biotechnology companies become public and must focus on shareholder profit, said Francois Vigneault, CEO of the Seattle biotech Shape Therapeutics.

“The board is the thing that gets in the way; they’re trying to maximize gain,” said Vigneault, whose company is privately held. “That’s just greed. That’s just incentive misaligned between corporate company structure and what we should do that’s good for the world.”

Even when treatments make it to market, they might not stay there. The same year Orchard stopped investing in the Wiskott-Aldrich treatment, it also stopped distributing a drug called Strimvelis, approved in Europe to treat the rare disease ADA-SCID, or “bubble boy syndrome.”

Claire Booth, professor of gene therapy and pediatric immunology at University College London, is among those working for change. She co-founded Access to Gene Therapies for Rare Disease, which brings together people across Europe representing academic groups, patient advocates, regulators, funders and drugmakers. They hope to create an independent nonprofit that can support market authorization and access to therapies that aren’t commercially sustainable.

A related effort in the U.S., The Bespoke Gene Therapy Consortium, was organized by the Foundation for the National Institutes of Health and includes the FDA, various NIH institutes, and several drug companies and nonprofits. The group’s goals include supporting a handful of clinical trials and exploring ways to streamline regulatory processes.

Some researchers are trying to address the problem scientifically. Dr. Anna Greka said the Broad Institute of MIT and Harvard has launched an effort to look at commonalities behind various conditions — or nodes, which can be likened to branches meeting at a tree trunk. Fixing the nodes with gene therapies or other treatments, rather than particular “misspellings” in DNA responsible for one disorder, could address multiple diseases simultaneously.

“What this does is it increases the number of patients who can benefit from the therapy,” said Greka, a Broad member. “It also makes it infinitely easier or more attractive to anyone, like a biopharmaceutical company, to take the project forward and try to bring it toward the clinic, because they’re going to have a bigger market.”

Meanwhile, affected families are partnering with each other and scientists to help move the needle. Genethon was created by an association of patients and their relatives to develop treatments for several rare diseases. And a leader of the foundation involved in Opus Genetics has a child with a rare genetic retinal disease.

There’s also new hope for families dealing with Wiskott-Aldrich and bubble boy disease. Last year, the Telethon Foundation in Italy took on responsibility of producing and distributing Strimvelis. This year, the charity announced it was selected for a pilot program of the European Medicines Agency that could help guide its Wiskott-Aldrich gene therapy through the regulatory process there.

Still, scientists say these efforts don’t negate the larger financial quandary surrounding therapies for rare diseases, and it may be a while before such genetic treatments are available to patients worldwide.

“This is a massive challenge, and I’m not entirely sure we’re going to be able to overcome it,” Booth said. “But we have to give it a go because we’ve spent decades and millions making these transformative treatments. And if we don’t try, then it feels like the end of an era.”

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

Robin Alderman, right, looks up to her son, Camden Alderman, 21, who has a rare disease called Wiskott-Aldrich syndrome, as they pose for a portrait near their home in Greensboro, N.C., Wednesday, June 12, 2024. (AP Photo/Chuck Burton)

Robin Alderman, right, looks up to her son, Camden Alderman, 21, who has a rare disease called Wiskott-Aldrich syndrome, as they pose for a portrait near their home in Greensboro, N.C., Wednesday, June 12, 2024. (AP Photo/Chuck Burton)

Camden Alderman, 21, who has a rare disease called Wiskott-Aldrich syndrome, holds some of the drugs and medical equipment he uses near his home in Greensboro, N.C., Wednesday, June 12, 2024. (AP Photo/Chuck Burton)

Camden Alderman, 21, who has a rare disease called Wiskott-Aldrich syndrome, holds some of the drugs and medical equipment he uses near his home in Greensboro, N.C., Wednesday, June 12, 2024. (AP Photo/Chuck Burton)

Robin Alderman, right, and her son, Camden Alderman, 21, who has a rare disease called Wiskott-Aldrich syndrome, pose for a portrait near their home in Greensboro, N.C., Wednesday, June 12, 2024. (AP Photo/Chuck Burton)

Robin Alderman, right, and her son, Camden Alderman, 21, who has a rare disease called Wiskott-Aldrich syndrome, pose for a portrait near their home in Greensboro, N.C., Wednesday, June 12, 2024. (AP Photo/Chuck Burton)

Camden Alderman, 21, who has a rare disease called Wiskott-Aldrich syndrome, holds with an infusion pump he uses near his home in Greensboro, N.C., Wednesday, June 12, 2024. When he was a toddler, doctors removed his spleen because of uncontrolled bleeding. As a young boy, he wound up in the hospital many times and was told he couldn’t play baseball. (AP Photo/Chuck Burton)

Camden Alderman, 21, who has a rare disease called Wiskott-Aldrich syndrome, holds with an infusion pump he uses near his home in Greensboro, N.C., Wednesday, June 12, 2024. When he was a toddler, doctors removed his spleen because of uncontrolled bleeding. As a young boy, he wound up in the hospital many times and was told he couldn’t play baseball. (AP Photo/Chuck Burton)

Robin Alderman, right, and her son, Camden Alderman, 21, pose for a portrait near their home in Greensboro, N.C., Wednesday, June 12, 2024. Camden, 21, was diagnosed as a baby with a rare disease called Wiskott-Aldrich syndrome, which is caused by a mutated gene on the X chromosome. It primarily affects boys – up to 10 out of every million — and can cause frequent infections, eczema and excessive bleeding. (AP Photo/Chuck Burton)

Robin Alderman, right, and her son, Camden Alderman, 21, pose for a portrait near their home in Greensboro, N.C., Wednesday, June 12, 2024. Camden, 21, was diagnosed as a baby with a rare disease called Wiskott-Aldrich syndrome, which is caused by a mutated gene on the X chromosome. It primarily affects boys – up to 10 out of every million — and can cause frequent infections, eczema and excessive bleeding. (AP Photo/Chuck Burton)

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The Latest: RNC set to begin in the aftermath of Trump assassination attempt

2024-07-15 20:05 Last Updated At:20:11

The Republican National Convention kicks off this week, with delegates and officials descending on Wisconsin amid the tumult that follows a Saturday assassination attempt on former President Donald Trump as he prepares to become the GOP’s official nominee.

The quadrennial event takes place not only as Trump leads a party in lockstep behind him, but also as Democrats roil over President Joe Biden’s viability and if they should replace him as their nominee.

Follow the AP’s Election-2024 coverage at: https://apnews.com/hub/election-2024

Here's the Latest:

Milwaukee’s mayor says he knows Americans will have questions about security at the Republican National Convention after Saturday’s assassination attempt against former President Donald Trump, but the event has the highest security level possible “so I feel pretty confident.”

“The folks on the ground here have confidence in the work that they’ve put in over the last 18 months,” Mayor Cavalier Johnson said at a Monday morning briefing. “And I have faith and confidence as well in the Secret Service and the police and fire departments and other agencies providing security today.”

The director of the U.S. Secret Service says she’s confident in the plan to secure the Republican National Convention that begins Monday in the wake of an attempt on the life of presidential candidate Donald Trump.

In a statement, Kim Cheatle said Monday the security plans for the event are “designed to be flexible.”

“The Secret Service will continuously adapt our operations as necessary to ensure the highest level of safety,” she said.

Cheatle says the plan will change as necessary to ensure the continued safety of attendees at the Milwaukee event.

A man shot at Trump from a rooftop near a Pennsylvania rally on Saturday. Trump is recovering and will attend the convention. President Joe Biden ordered a national security review of the incident over the weekend.

King Charles III has written to Donald Trump after the assassination attempt at a rally in Pennsylvania, Buckingham Palace said.

The palace did not disclose the contents of the monarch’s private message, which was delivered on Sunday through the British Embassy in Washington, D.C.

The message follows a call to Trump on Sunday by British Prime Minister Keir Starmer, who condemned the violence, expressed condolences for the victims and their families and wished a quick recovery for the former president and those injured.

Donald Trump spent much of Sunday on the phone with friends, news hosts and local and foreign officials the day after he was injured in an assassination attempt.

Ohio Pastor Darrell Scott, a longtime ally, said Trump “was in great spirits” when they spoke Sunday morning, hours after the shooting.

“He was great, like he always is. He didn’t even make a big deal of it,” Scott said. “He was actually trying to downplay it somewhat, asking how I was doing.”

Former RNC chair Reince Priebus, who also served as Trump’s White House chief of staff, told ABC’s “This Week” that Trump was “grateful for the miracle of what happened, in his case. ... One quarter inch turned the other direction and we’re obviously talking about something very different this morning.”

Tony Perkins, among the most influential Christian conservatives in the Republican Party, was preparing to mount a confrontation with convention planners over his disdain for how debate during the RNC’s platform committee was shut down on Monday, all but eliminating objections to the Trump campaign’s desire to soften language on abortion.

The attempted assassination changed all that, Perkins told The Associated Press after a prayer service in suburban Milwaukee Sunday evening.

“We live in a violent society. And we run the risk of becoming callous to it. And if we become callous to it, we’re going to have more of it,” Perkins said. “I’m hoping and praying it’s a wake-up call in many ways.”

“So, as a result, I’m stepping back from forcing the issue on the platform,” he added. “More divisiveness would not be healthy.”

Perkins called social media “a contagion” for toxic rhetoric passed along by people who do not feel that they’re heard by their government or leaders, and attributed the Jan. 6, 2021, attack on the U.S. Capitol in part to the notion of overheated online rage.

“We need to stop,” he said.

And while thanking God during the service for Trump’s survival, Perkins told more than 100 in the Pewaukee church, “Lord, I believe that our nation is at such a volatile moment that yesterday could have torn this nation right in half.”

The 20-year-old man who tried to assassinate former President Donald Trump first came to law enforcement’s attention at Saturday’s rally when spectators noticed him acting strangely outside the campaign event. The tip sparked a frantic search, but officers were unable to find him before he managed to get on a roof, where he opened fire.

In the wake of the shooting that killed one spectator, investigators are hunting for any clues about what may have drove Thomas Matthew Crooks, of Bethel Park, Pennsylvania, to carry out the shocking attack. The FBI said they were investigating it as a potential act of domestic terrorism, but the absence of a clear ideological motive by the man shot dead by Secret Service allowed conspiracy theories to flourish.

The FBI said it believes Crooks, who had bomb-making materials in the car he drove to the rally, acted alone. Investigators have found no threatening comments on social media accounts or ideological positions that could help explain what led him to target Trump.

Crooks graduated from Bethel Park High School in 2022. His senior year, Crooks was among several students given an award for math and science, according to a Tribune-Review story at the time.

He tried out for the school’s rifle team but was turned away because he was a bad shooter, said Frederick Mach, a current captain of the team who was a few years behind Crooks at the school.

Jason Kohler, who said he attended the same high school but did not share any classes with Crooks, said Crooks was bullied at school and sat alone at lunch time. Other students mocked him for the clothes he wore, which included hunting outfits, Kohler said.

Former President Donald Trump told The Washington Examiner that he has rewritten the speech he was set to deliver at the Republican National Convention in Milwaukee on Thursday after being the target of an attempted assassination at his rally Saturday.

“The speech I was going to give on Thursday was going to be a humdinger,” he told the news outlet in an article posted Sunday evening.

In the interview, the presumptive Republican presidential nominee says he will now call for a new effort at national unity, noting that people from different political views have called him.

“This is a chance to bring the whole country, even the whole world, together. The speech will be a lot different, a lot different than it would’ve been two days ago,” he said.

Trump also reflected on the moment a bullet pierced the upper part of his right ear. He said he was saved from death because he turned from the crowd to look at a screen showing off a chart he was referring to.

“That reality is just setting in,” he told the news outlet as he boarded his plane in Bedminster, New Jersey, for Milwaukee. “I rarely look away from the crowd. Had I not done that in that moment, well, we would not be talking today, would we?”

Law enforcement officers gather at campaign rally site for Republican presidential candidate former President Donald Trump is empty Saturday, July 13, 2024, in Butler, Pa. Trump's campaign said in a statement that the former president was "fine" after a shooting at his rally in Butler (AP Photo/Evan Vucci)

Law enforcement officers gather at campaign rally site for Republican presidential candidate former President Donald Trump is empty Saturday, July 13, 2024, in Butler, Pa. Trump's campaign said in a statement that the former president was "fine" after a shooting at his rally in Butler (AP Photo/Evan Vucci)

Republican presidential candidate former President Donald Trump is surrounded by U.S. Secret Service agents at a campaign rally, Saturday, July 13, 2024, in Butler, Pa. (AP Photo/Evan Vucci)

Republican presidential candidate former President Donald Trump is surrounded by U.S. Secret Service agents at a campaign rally, Saturday, July 13, 2024, in Butler, Pa. (AP Photo/Evan Vucci)

Republican presidential candidate former President Donald Trump waves from the stage as he is surrounded by U.S. Secret Service agents at a campaign rally, Saturday, July 13, 2024, in Butler, Pa. (AP Photo/Evan Vucci)

Republican presidential candidate former President Donald Trump waves from the stage as he is surrounded by U.S. Secret Service agents at a campaign rally, Saturday, July 13, 2024, in Butler, Pa. (AP Photo/Evan Vucci)

Republican presidential candidate former President Donald Trump pumps his fist as he is helped off the stage at a campaign event in Butler, Pa., on Saturday, July 13, 2024. (AP Photo/Gene J. Puskar)

Republican presidential candidate former President Donald Trump pumps his fist as he is helped off the stage at a campaign event in Butler, Pa., on Saturday, July 13, 2024. (AP Photo/Gene J. Puskar)

President Joe Biden speaks, Saturday, July 13, 2024, in Rehoboth Beach, Del., addressing news that gunshots rang out at Republican presidential candidate former President Donald Trump's Pennsylvania campaign rally. (AP Photo/Manuel Balce Ceneta)

President Joe Biden speaks, Saturday, July 13, 2024, in Rehoboth Beach, Del., addressing news that gunshots rang out at Republican presidential candidate former President Donald Trump's Pennsylvania campaign rally. (AP Photo/Manuel Balce Ceneta)

A person watches news in a local bar near the Fiserv Forum watching news ahead of the 2024 Republican National Convention, Saturday, July 13, 2024, in Milwaukee. Former president Donald Trump was whisked off the stage at a rally in Butler, Pennsylvania after apparent gunshots rang through the crowd.(AP Photo/Matt Rourke)

A person watches news in a local bar near the Fiserv Forum watching news ahead of the 2024 Republican National Convention, Saturday, July 13, 2024, in Milwaukee. Former president Donald Trump was whisked off the stage at a rally in Butler, Pennsylvania after apparent gunshots rang through the crowd.(AP Photo/Matt Rourke)

Republican presidential candidate former President Donald Trump is surrounded by U.S. Secret Service agents at a campaign rally, Saturday, July 13, 2024, in Butler, Pa. (AP Photo/Evan Vucci)

Republican presidential candidate former President Donald Trump is surrounded by U.S. Secret Service agents at a campaign rally, Saturday, July 13, 2024, in Butler, Pa. (AP Photo/Evan Vucci)

Republican presidential candidate former President Donald Trump is helped off the stage at a campaign event in Butler, Pa., on Saturday, July 13, 2024. (AP Photo/Gene J. Puskar)

Republican presidential candidate former President Donald Trump is helped off the stage at a campaign event in Butler, Pa., on Saturday, July 13, 2024. (AP Photo/Gene J. Puskar)

Police snipers return fire after shots were fired while Republican presidential candidate former President Donald Trump was speaking at a campaign event in Butler, Pa., on Saturday, July 13, 2024. (AP Photo/Gene J. Puskar)

Police snipers return fire after shots were fired while Republican presidential candidate former President Donald Trump was speaking at a campaign event in Butler, Pa., on Saturday, July 13, 2024. (AP Photo/Gene J. Puskar)

Republican presidential candidate former President Donald Trump is covered by U.S. Secret Service agents at a campaign rally, Saturday, July 13, 2024, in Butler, Pa. (AP Photo/Evan Vucci)

Republican presidential candidate former President Donald Trump is covered by U.S. Secret Service agents at a campaign rally, Saturday, July 13, 2024, in Butler, Pa. (AP Photo/Evan Vucci)

Republican presidential candidate former President Donald Trump is covered by U.S. Secret Service agents at a campaign rally, Saturday, July 13, 2024, in Butler, Pa. (AP Photo/Evan Vucci)

Republican presidential candidate former President Donald Trump is covered by U.S. Secret Service agents at a campaign rally, Saturday, July 13, 2024, in Butler, Pa. (AP Photo/Evan Vucci)

Republican presidential candidate former President Donald Trump is surround by U.S. Secret Service agents at a campaign rally, Saturday, July 13, 2024, in Butler, Pa. (AP Photo/Evan Vucci)

Republican presidential candidate former President Donald Trump is surround by U.S. Secret Service agents at a campaign rally, Saturday, July 13, 2024, in Butler, Pa. (AP Photo/Evan Vucci)

Republican presidential candidate former President Donald Trump is helped off the stage at a campaign event in Butler, Pa., Saturday, July 13, 2024. (AP Photo/Gene J. Puskar)

Republican presidential candidate former President Donald Trump is helped off the stage at a campaign event in Butler, Pa., Saturday, July 13, 2024. (AP Photo/Gene J. Puskar)

Missouri State Trooper Cpl. Piccinino, right, is reflected in a mylar wall as he stands his post at the 2024 Republican National Convention at the Fiserv Forum, Sunday, July 14, 2024, in Milwaukee. (AP Photo/Charles Rex Arbogast)

Missouri State Trooper Cpl. Piccinino, right, is reflected in a mylar wall as he stands his post at the 2024 Republican National Convention at the Fiserv Forum, Sunday, July 14, 2024, in Milwaukee. (AP Photo/Charles Rex Arbogast)

An exterior general view at the 2024 Republican National Convention at the Fiserv Forum, Sunday, July 14, 2024, in Milwaukee. (AP Photo/Paul Sancya)

An exterior general view at the 2024 Republican National Convention at the Fiserv Forum, Sunday, July 14, 2024, in Milwaukee. (AP Photo/Paul Sancya)

A general view during rehearsals at the 2024 Republican National Convention at the Fiserv Forum, Sunday, July 14, 2024, in Milwaukee. (AP Photo/Paul Sancya)

A general view during rehearsals at the 2024 Republican National Convention at the Fiserv Forum, Sunday, July 14, 2024, in Milwaukee. (AP Photo/Paul Sancya)

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