Evolution of Business Models in Regenerative Medicine: Effects of a Disruptive Innovation on the Innovation Ecosystem

Overcoming the "valleys of death" in advanced therapies: The role of finance

Advanced therapies are the frontier of medical research and have a relevant therapeutic potential and a profound social value. Despite this, their funding is hindered by many heterogeneous factors that obstruct their translation and survival on the market, even when approved and effective. Using an extensive bibliometric and systematic review of 174 articles published between 2001 and 2023, this study aims to identify the factors hindering the financing of advanced therapies and suggest future research lines to overcome the biomedical and economic "valleys of death". This study is the first review focused on advanced therapies from a financial perspective, and it contributes to advancing scientific knowledge in several ways. First, it highlights that finance academics paid little attention to the topic and most of their contributions are now outdated; therefore, there is the need to explore the new opportunities and solutions offered by financial innovation and the application of new technologies to financial activity. Second, it asks for an interdisciplinary approach to exploring advanced therapies' barriers from a holistic and process perspective and exploiting the social value generated by the development of innovative therapies. Finally, it analyzes the obstacles and value destroyed by the absence of an organic and coordinated process of public intervention, underscoring the imperative for further research to explore new public-private financial models and risk-sharing schemes and extend evaluation models by integrating financial and social value logic.

Multi-layer platform coordination for open innovation in oligonucleotide therapeutics

As technology evolves and medical needs diversify, the pharmaceutical industry must accelerate its openness. This study analysed inter-organizational alliances in R&D for the new modality of oligonucleotide therapeutics to explore the requirements for establishing new markets. The results confirmed that the market has developed in stages, employing open innovation for different purposes according to technological progress. At each stage, it was crucial to form platforms among biotech companies on the drug discovery side, among pharmaceutical companies on the regulatory side and contract development manufacturing organizations (CDMOs) on the manufacturing side. These findings clarify the dynamics of open innovation in the biopharmaceutical industry and provide strategic implications for sustainable value creation in drug R&D.

Development of scaffold-free tissue-engineered constructs derived from mesenchymal stem cells with serum-free media for cartilage repair and long-term preservation

Synovial mesenchymal stem cells (sMSCs) have great potential for cartilage repair, but their therapeutic design to avoid adverse effects associated with unknown factors remains a challenge. In addition, because long-term preservation is indispensable to maintain high quality levels until implantation, it is necessary to reduce their fluctuations. This study aimed to investigate the properties and feasibility of novel scaffold-free tissue-engineered constructs using serum-free media and to develop long-term preservation methods. sMSCs were cultured in serum-free media, seeded at high density in a monolayer, and finally developed as a sheet-like construct called "gMSC1". The properties of frozen gMSC1 (Fro-gMSC1) were compared with those of refrigerated gMSC1 (Ref-gMSC1) and then examined by their profile. Chondrogenic differentiation potential was analyzed by quantitative real-time polymerase chain reaction and quantification of glycosaminoglycan content. Xenografts into the cartilage defect model in rats were evaluated by histological staining. gMSC1 showed nearly similar properties independent of the preservation conditions. The animal experiment demonstrated that the defect could be filled with cartilage-like tissue with good integration to the adjacent tissue, suggesting that gMSC1 was formed and replaced the cartilage. Furthermore, several chondrogenesis-related factors were significantly secreted inside and outside gMSC1. Morphological analysis of Fro-gMSC1 revealed comparable quality levels to those of fresh gMSC1. Thus, if cryopreserved, gMSC1, with no complicated materials or processes, could have sustained cartilage repair capacity. gMSC1 is a prominent candidate in novel clinical practice for cartilage repair, allowing for large quantities to be manufactured at one time and preserved for a long term by freezing.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10616-024-00637-y.

Key drivers of investment initiatives in Uganda's pharmaceutical industry

This study examines the key drivers of investment initiatives in Uganda's pharmaceutical industry. We adopted a qualitative research design using an in-depth interview guide to collect data from 12 board chairpersons/assistants at the selected manufacturing, marketing and sales pharmaceutical firms. The theory of Investment Behavior (Jorgenson, 1967) was used to underpin the actors' investment objectives beyond profit maximization locus subject to utility maximization. The results indicate two complementary investment drivers in pharmaceuticals: an investment gap and government policy initiatives. We recommend that the government should formulate an integrated human resource planning policy and further establish a one-in-all-stop hub to support pharmaceutical investments in the country. Besides, the hub should take charge of the operationalization of government policy initiatives intended to close the investment gap in the pharmaceutical industry.

A management model in blood, tissue and cell establishments to ensure rapid and sustainable patient access to advanced therapy medicinal products in Europe

Blood, tissue and cell establishments (BTCs) stand out in the management of donor selection, procurement and processing of all types of substances of human origin (SoHO). In the last decades, the framework created around BTCs, including hospitals and national health system networks, and their links to research, development and innovation organizations and agencies have spurred their involvement in the study of groundbreaking advanced therapy medicinal products (ATMP). To further improve strategic synergies in the development of ATMPs, it will be required to promote intra- and inter-European collaborations by creating an international network involving BTCs and major stakeholders (i.e., research organizations, hospitals, universities, patient associations, public agencies). This vision is already shared with the European Blood Alliance, the association of non-profit blood establishments, with 26 member states throughout the European Union and European Free Trade Association states. Herein we present and analyze the "BTC for ATMP Development And Manufacture" (BADAM) model, an ethically responsible business model based on the values and missions of BTCs and their commitment to health equity, patient access and education (based on voluntary donation of SoHO to address unmet clinical needs, while contributing to training professionals and scientific literacy of our Society).

A review and analysis of the business model innovation literature

Business model innovation (BMI) is an emerging field that has attracted much attention from scholars and practitioners. However, the literature on BMI is fragmented and inconsistent, lacking a comprehensive and systematic framework. This study aims to fill this gap by conducting a literature review of 272 peer-reviewed articles on BMI published between 2010 and 2022. We analyze the articles based on six dimensions: antecedents, processes, types, barriers, outcomes, and moderators/mediators of BMI. We synthesize the findings and propose an integrated theoretical model that captures the complex relationships among these dimensions. We also identify several research gaps and directions for future studies. This study contributes to the BMI literature by providing a clearer understanding of this phenomenon and offering practical guidance for various types of businesses.

The political economy of the African pharmaceutical sector's "industrial underdevelopment" lock-in: The importance of understanding the impact of persistent colonial extractive institutions

Improved African pharmaceutical manufacturing has been on global and local agendas since the 1970s, yet the industry has been locked-in into low technologies for decades. What caused the technological and industrial stagnation for such a critical sector for local and global health security? What are the political economy roots of such long-running industrial underdevelopment lock-in? What do colonial extractive economic and political institutions and their setup and mixes have to do with the sector? This study considers how extractive economic and political institutions' architectures and infrastructures shaped the African pharmaceutical industry's underdevelopment. We argue that extractive economic and political institutions shaped contemporary institutions in former colonial countries, and these institutions persist for a long time. The pivotal argument of innovation systems is that technological change-driven innovation is important for building superior economic performance and competitiveness, and institutions are a vital component of the system. However, institutions are not value-neutral; they carry the political and economic objectives and aspirations of the agents who design them. Innovation systems theory needs to incorporate the analysis of extractive economic and political institutions and the role they played in locking-in the African pharmaceutical industries into underdevelopment.

Uncovering the potential of innovation ecosystems in the healthcare sector after the COVID-19 crisis

Industry 4.0 technologies are expected to enhance healthcare quality at the minimum cost feasible by using innovative solutions based on a fruitful exchange of knowledge and resources among institutions, firms and academia. These collaborative mechanisms are likely to occur in an innovation ecosystem where different stakeholders and resources interact to provide ground-breaking solutions to the market. The paper proposes a framework for studying the creation and development of innovation ecosystems in the healthcare sector by using a set of interrelated dimensions including, technology, value, and capabilities within a Triple-Helix model guided by focal actors. The model is applied to an exemplary Italian innovation ecosystem providing cloud and artificial intelligence-based solutions to general practitioners (GPs) under the focal role of the Italian association of GPs. Primary and secondary data are examined starting from the innovation ecosystem's origins and continuing until the COVID-19 crisis. The findings show that the pandemic represented the turning point that altered the ecosystem's dimensions in order to find immediate solutions for monitoring health conditions and organizing the booking of swabs and vaccines. The data triangulation points out the technical, organizational, and administrative barriers hindering the widespread adoption of these solutions at the national and regional levels, revealing several implications for health policy.

The Advanced Therapies Treatment Centres and their Network: a Model for the Accelerated Adoption of Advanced Therapies

Emerging advanced therapies that include cell and gene therapies and tissue-engineered products offer substantial therapeutic benefits. They also present challenges for health services in their modes of delivery to patients. Funding was made available in the UK to establish three Advanced Therapies Treatment Centres (ATTCs) and a network to coordinate their activities, supported by the Cell and Gene Therapy Catapult (CGTC). The aim of this initiative was to grow the advanced therapies sector in the UK by enhancing access to the NHS for patients and industry through close collaboration between advanced therapy companies and publicly funded services and regulators. Here, we describe the initiative's antecedents, its collaborative structures and management and its activities. A guiding concept in shaping and assessing progress has been the idea of institutional readiness, an idea developed in the context of social sciences that defines and so can measure movement towards an organisation's full competence in delivering new technologies and approaches. We also report the initiative's outcomes and impacts as assessed by ourselves and by third parties. As the initiative has progressed it has excited increasing interest from advanced therapy companies who were not aware of or engaged in it at the outset and from healthcare systems that wished to learn from its practices. It is to further that end that we present our work.

Manufacturing Mesenchymal Stromal Cells for the Treatment of Osteoarthritis in Canine Patients: Challenges and Recommendations

The recent interest in advanced biologic therapies in veterinary medicine has opened up opportunities for new treatment modalities with considerable clinical potential. Studies with mesenchymal stromal cells (MSCs) from animal species have focused on in vitro characterization (mostly following protocols developed for human application), experimental testing in controlled studies and clinical use in veterinary patients. The ability of MSCs to interact with the inflammatory environment through immunomodulatory and paracrine mechanisms makes them a good candidate for treatment of inflammatory musculoskeletal conditions in canine species. Analysis of existing data shows promising results in the treatment of canine hip dysplasia, osteoarthritis and rupture of the cranial cruciate ligament in both sport and companion animals. Despite the absence of clear regulatory frameworks for veterinary advanced therapy medicinal products, there has been an increase in the number of commercial cell-based products that are available for clinical applications, and currently the commercial use of veterinary MSC products has outpaced basic research on characterization of the cell product. In the absence of quality standards for MSCs for use in canine patients, their safety, clinical efficacy and production standards are uncertain, leading to a risk of poor product consistency. To deliver high-quality MSC products for veterinary use in the future, there are critical issues that need to be addressed. By translating standards and strategies applied in human MSC manufacturing to products for veterinary use, in a collaborative effort between stem cell scientists and veterinary researchers and surgeons, we hope to facilitate the development of quality standards. We point out critical issues that need to be addressed, including a much higher level of attention to cell characterization, manufacturing standards and release criteria. We provide a set of recommendations that will contribute to the standardization of cell manufacturing methods and better quality assurance.

State-of-the-art knowledge on the regulation of advanced therapy medicinal products

Advanced therapy medicinal products (ATMPs) constitute therapeutic agents based on obtained cells, tissues or genes representing a novel treatment opportunity in medicine. In addition, ATMPs are administered into the cells or tissues of humans from the patient's own cells, donors, or genetically modified cells. Recently, the field of developing ATMPs has become a point of attention due to the clinical efficacy expected in defeating incurable diseases such as cancers and neurodegenerative disorders. Currently, there are two modes regarding the distribution of ATMPs. First, ATMPs that might be legally authorized for marketing. Second, the patients are able to access unapproved ATMPs through the hospital exemption (HE) or clinical practice program or through the compassionate use and expanded access program. The aim of this review is to discuss state-of-the-art knowledge on the regulation of ATMPs and provide regulatory recommendations.

DISRUPTIVE INNOVATION IN HEALTHCARE: A REVIEW AND FUTURE RESEARCH AGENDAS

Disruptive innovation (DI) refers to a mode of low cost high ancillary performance innovation that starts at the lower end of the market and gradually moves up to eventually displace its incumbent counterparts. The concept of DI has become more and more popular in the healthcare sector. The paper studies how healthcare research has embraced the concept of DI in various areas within the healthcare sector. Areas of healthcare, where DI has been adopted as a management strategy, were identified in the last two decades, through initially shortlisting 157 papers and the final reviewed set of 117 papers. Through a multi-method approach comprising of co-word analysis, identification of themes, mapping of research work across these themes and geography, the study found that, although from a management perspective there are 13 major themes, the majority of the focus is on four major themes—healthcare delivery and services, healthcare administration, technology and equipment, and nursing and palliative care. Furthermore, the majority of the geography-specific research was conducted in developed countries, especially the USA. It was also observed that organisational strategies for successfully implementing DI in the healthcare sector are still in the nascent stage and the focus is mostly in the area of healthcare delivery and administration from the management perspective. Future research studies could aim at looking at the role that DI plays in the healthcare sector of the developing countries, as well as using DI in other areas of healthcare, rather than a few concentrated areas.

Responsible innovation in health and health system sustainability: Insights from health innovators' views and practices

Although healthcare managers make increasingly difficult decisions about health innovations, the way they may interact with innovators to foster health system sustainability remains underexplored. Drawing on the Responsible Innovation in Health (RIH) framework, this paper analyses interviews (n=37) with Canadian and Brazilian innovators to identify: how they operationalize inclusive design processes; what influences the responsiveness of their innovation to system-level challenges; and how they consider the level and intensity of care required by their innovation. Our qualitative findings indicate that innovators seek to: 1) engage stakeholders at an early ideation stage through context-specific methods combining both formal and informal strategies; 2) address specific system-level benefits but often struggle with the positioning of their solution within the health system; and 3) mitigate staff shortages in specialized care, increase general practitioners’ capacity or patients and informal caregivers’ autonomy. These findings provide empirical insights on how healthcare managers can promote and organize collaborative processes that harness innovation towards more sustainable health systems. By adopting a RIH-oriented managerial role, they can set in place more inclusive design processes, articulate key system-level challenges, and help innovators adjust the level and intensity of care required by their innovation.

Reinforcing Collaboration and Harmonization to Unlock the Potentials of Advanced Therapy Medical Products: Future Efforts Are Awaited From Manufacturers and Decision-Makers

Some advanced therapy medicinal products (ATMPs) hold great promises for life-threatening diseases with high unmet needs. However, ATMPs are also associated with significant challenges in market access, which necessitates the joint efforts between all relevant stakeholders to navigate. In this review, we will elaborate on the importance of collaborations and harmonization across different stakeholders, to expedite the market access of promising ATMPs. Manufacturers of ATMPs should proactively establish collaborations with other stakeholders throughout the whole lifecycle of ATMPs, from early research to post-market activities. This covered engagements with (1) external developers (i.e., not-for-profit organizations and commercial players) to obtain complementary knowledge, technology, or infrastructures, (2) patient groups and healthcare providers to highlight their roles as active contributors, and (3) decision-makers, such as regulators, health technology assessment (HTA) agencies, and payers, to communicate the uncertainties in evidence package, where parallel consultation will be a powerful strategy. Harmonization between decision-makers is desired at (1) regulatory level, in terms of strengthening the international standardization of regulatory framework to minimize discrepancies in evidence requirements for market authorization, and (2) HTA level, in terms of enhancing alignments between regional and national HTA agencies to narrow inequity in patient access, and cross-border HTA cooperation to improve the quality and efficiency of HTA process. In conclusion, manufacturers and decision-makers shared the common goals to safeguard timely patient access to ATMPs. Collaboration and harmonization will be increasingly leveraged to enable the value delivery of ATMPs to all stakeholders.

Partnership agreements for regenerative medicines: a database analysis and implications for future innovation

Aim: Partnerships have been leveraged to advance the regenerative medicines (RMs) development. This study analyzed the evolution of partnership landscape for regenerative medicines (RMs). Methods: Partnership agreements publicly announced from January 2014 - June 2020 were described. Results: 1169 partnership agreements with total amount of US$63,496 million were identified. Most agreements concerned RMs that were for oncology (25.3%), in the discovery or preclinical phase (66.9%) and gene-based products (45.3%). The most common partnership type is collaborative agreements without licensing. The partnerships between 'biotechnology companies and not-for-profit organizations' represented the largest number (n = 416; 35.6%). 'Big Pharma' preferred collaboration and licensing agreements with a higher amount. Conclusion: Collaborations between highly specialized players with complementary expertise promote the successful translation of scientific discovery to RMs.

The impact of COVID-19 on the cell and gene therapies industry: Disruptions, opportunities, and future prospects

Coronavirus 2019 (COVID-19) has caused significant disruption to the cell and gene therapy (CGT) industry, which has historically faced substantial complexities in supply of materials, and manufacturing and logistics processes. As decision-makers shifted their priorities to COVID-19-related issues, the challenges in market authorisation, and price and reimbursement of CGTs were amplified. Nevertheless, it is encouraging to see that some CGT developers are adapting their efforts toward the development of promising COVID-19-related therapeutics and vaccines. Manufacturing resilience, digitalisation, telemedicine, value-based pricing, and innovative payment mechanisms will be increasingly harnessed to ensure that market access of CGTs is not severely disrupted.

Comparative lessons in regenerative medicine readiness: learning from the UK and Japanese experience

This paper explores how 'regenerative readiness' varies between different national research and healthcare systems. Here, 'readiness' refers to both the readiness of a given technology and the ability of a given setting to adopt a new technology. We compare two settings that have taken active yet dissonant approaches to improve readiness: the UK and Japan. Existing scholarship observes that disruptive technologies such as regenerative medicine require many adaptations to become useable and function along the principles of their design. We incorporate the sociotechnical systems framework to consider the range of adaptive measures taken across elements of the sociotechnical system for novel technological adoption. Building upon existing works on technology readiness and institutional readiness, we also expand the conceptualization of readiness toward system-wide readiness.

Evaluation of institutional readiness at sites within the UK NHS using a novel advanced therapy medicinal product assessment tool

Aim: This paper reports on a study to assess institutional readiness (IR) of UK National Health Service sites that form part of the Northern Alliance Advanced Therapy Treatment Centre to deliver advanced therapy medicinal products (ATMPs). The paper discusses the development of an assessment tool to support self-assessment of IR in healthcare institutions. Methods: The tool utilized criteria developed by clinicians to self-assess IR to deliver four classes of ATMP over a series of time points. Each assessment was independently analyzed and validated by independent expert groups. Results & conclusion: The collated results indicated an overall trend toward IR for all classes of ATMP. The study highlighted areas where IR is evidenced, areas where work is ongoing and areas where further work is required to achieve IR. The study also facilitated validation of the IR assessment tool.

Spatiotemporal readiness is key to preparing regenerative medicine for the clinic

Tweetable abstract Successful translation of regenerative medicine projects to the clinic requires attention to the complex interaction of spatial and timing issues from manufacturing to clinical use.