1
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Elsallab M, Maus MV. Expanding access to CAR T cell therapies through local manufacturing. Nat Biotechnol 2023; 41:1698-1708. [PMID: 37884746 DOI: 10.1038/s41587-023-01981-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 09/05/2023] [Indexed: 10/28/2023]
Abstract
Chimeric antigen receptor (CAR) T cells are changing the therapeutic landscape for hematological malignancies. To date, all six CAR T cell products approved by the US Food and Drug Administration (FDA) are autologous and centrally manufactured. As the numbers of approved products and indications continue to grow, new strategies to increase cell-manufacturing capacity are urgently needed to ensure patient access. Distributed manufacturing at the point of care or at other local manufacturing sites would go a long way toward meeting the rising demand. To ensure successful implementation, it is imperative to harness novel technologies to achieve uniform product quality across geographically dispersed facilities. This includes the use of automated cell-production systems, in-line sensors and process simulation for enhanced quality control and efficient supply chain management. A comprehensive effort to understand the critical quality attributes of CAR T cells would enable better definition of widely attainable release criteria. To supplement oversight by national regulatory agencies, we recommend expansion of the role of accreditation bodies. Moreover, regulatory standards may need to be amended to accommodate the unique characteristics of distributed manufacturing models.
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Affiliation(s)
- Magdi Elsallab
- Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
- Cellular Immunotherapy Program, Cancer Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Marcela V Maus
- Cellular Immunotherapy Program, Cancer Center, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Cancer Center, Massachusetts General Hospital, Boston, MA, USA.
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2
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Rejon-Parrilla JC, Espin J, Garner S, Kniazkov S, Epstein D. Pricing and reimbursement mechanisms for advanced therapy medicinal products in 20 countries. Front Pharmacol 2023; 14:1199500. [PMID: 38089054 PMCID: PMC10715052 DOI: 10.3389/fphar.2023.1199500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 11/06/2023] [Indexed: 02/12/2024] Open
Abstract
Introduction: Advanced Therapy Medicinal Products are a type of therapies that, in some cases, hold great potential for patients without an effective current therapeutic approach but they also present multiple challenges to payers. While there are many theoretical papers on pricing and reimbursement (P&R) options, original empirical research is very scarce. This paper aims to provide a comprehensive international review of regulatory and P&R decisions taken for all ATMPs with centralized European marketing authorization in March 2022. Methods: A survey was distributed in July 2022 to representatives of 46 countries. Results: Responses were received from 20 countries out of 46 (43.5%). 14 countries reimbursed at least one ATMP. Six countries in this survey reimbursed no ATMPs. Conclusion: Access to ATMPs is uneven across the countries included in this study. This arises from regulatory differences, commercial decisions by marketing authorization holders, and the divergent assessment processes and criteria applied by payers. Moving towards greater equality of access will require cooperation between countries and stakeholders, for example, through the WHO Regional Office for Europe's Access to Novel Medicines Platform.
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Affiliation(s)
- Juan Carlos Rejon-Parrilla
- Health Technology Assessment Area (AETSA), Andalusian Public Foundation Progress and Health (FPS), Seville, Spain
| | - Jaime Espin
- Andalusian School of Public Health, Granada, Spain
- Instituto de Investigación Biosanitaria ibs, Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Cátedra de Economía de la Salud y Dirección de Organizaciones Sanitarias (Esalud2), Granada, Spain
| | - Sarah Garner
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Stanislav Kniazkov
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - David Epstein
- Department of Applied Economics, University of Granada, Granada, Spain
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3
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Ikonomou L, Cuende N, Forte M, Grilley BJ, Levine AD, Munsie M, Rasko JEJ, Turner L, Bidkhori HR, Ciccocioppo R, Grignon F, Srivastava A, Weiss DJ, Zettler P, Levine BL. International Society for Cell & Gene Therapy Position Paper: Key considerations to support evidence-based cell and gene therapies and oppose marketing of unproven products. Cytotherapy 2023; 25:920-929. [PMID: 37517865 DOI: 10.1016/j.jcyt.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 08/01/2023]
Abstract
The field of regenerative medicine, including cellular immunotherapies, is on a remarkable growth trajectory. Dozens of cell-, tissue- and gene-based products have received marketing authorization worldwide while hundreds-to-thousands are either in preclinical development or under clinical investigation in phased clinical trials. However, the promise of regenerative therapies has also given rise to a global industry of direct-to-consumer offerings of prematurely commercialized cell and cell-based products with unknown safety and efficacy profiles. Since its inception, the International Society for Cell & Gene Therapy Committee on the Ethics of Cell and Gene Therapy has opposed the premature commercialization of unproven cell- and gene-based interventions and supported the development of evidence-based advanced therapy products. In the present Guide, targeted at International Society for Cell & Gene Therapy members, we analyze this industry, focusing in particular on distinctive features of unproven cell and cell-based products and the use of tokens of scientific legitimacy as persuasive marketing devices. We also provide an overview of reporting mechanisms for patients who believe they have been harmed by administration of unapproved and unproven products and suggest practical strategies to address the direct-to-consumer marketing of such products. Development of this Guide epitomizes our continued support for the ethical and rigorous development of cell and cell-based products with patient safety and therapeutic benefit as guiding principles.
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Affiliation(s)
- Laertis Ikonomou
- Department of Oral Biology, University at Buffalo, The State University of New York, Buffalo, New York, USA; Cell, Gene and Tissue Engineering Center, University at Buffalo, The State University of New York, Buffalo, New York, USA.
| | - Natividad Cuende
- Andalusian Transplant Coordination, Servicio Andaluz de Salud; Sevilla, Spain
| | | | - Bambi J Grilley
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston Methodist Hospital, Houston, Texas, USA; Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Aaron D Levine
- School of Public Policy, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Megan Munsie
- Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - John E J Rasko
- Gene and Stem Cell Therapy Program Centenary Institute, University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Cell & Molecular Therapies, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Leigh Turner
- Department of Health, Society, and Behavior, Program in Public Health; Stem Cell Research Center; Institute for Clinical and Translational Science; Department of Family Medicine; University of California, Irvine; Irvine, California, USA
| | - Hamid R Bidkhori
- Stem Cell and Regenerative Medicine Research Department, Academic Center for Education, Culture and Research (ACECR)-Khorasan Razavi, Mashhad, Iran
| | - Rachele Ciccocioppo
- Gastroenterology Unit, Department of Medicine, A.O.U.I. Policlinico G.B. Rossi & University of Verona, Verona, Italy
| | - Felix Grignon
- International Society for Cell & Gene Therapy, Vancouver, Canada
| | - Alok Srivastava
- Department of Haematology, Christian Medical College, Ranipet Campus, Ranipet & Centre for Stem Cell Research (a unit of inStem Bengaluru) CMC Campus, Vellore, India
| | - Daniel J Weiss
- University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Patricia Zettler
- Moritz College of Law, Drug Enforcement and Policy Center, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Bruce L Levine
- Center for Cellular Immunotherapies, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
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4
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Torrents S, Grau-Vorster M, Vives J. Illustrative Potency Assay Examples from Approved Therapies. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1420:139-149. [PMID: 37258788 DOI: 10.1007/978-3-031-30040-0_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Advanced therapy medicinal products (ATMP) encompass a new type of drugs resulting from the manipulation of genes, cells, and tissues to generate innovative medicinal entities with tailored pharmaceutical activity. Definition of suitable potency tests for product release are challenging in this context, in which the active ingredient is composed of living cells and the mechanism of action often is poorly understood. In this chapter, we present and discuss actual potency assays used for the release of representative commercial ATMP from each category of products (namely, KYMRIAH® (tisagenlecleucel), Holoclar® (limbal epithelial stem cells), and PROCHYMAL®/RYONCIL™ (remestemcel-L)). We also examine concerns related to the biological relevance of selected potency assays and challenges ahead for harmonization and broader implementation in compliance with current quality standards and regulatory guidelines.
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Affiliation(s)
- Sílvia Torrents
- Banc de Sang i Teixits, Edifici Dr. Frederic Duran i Jordà, Barcelona, Spain
- Transfusion Medicine group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Grau-Vorster
- Banc de Sang i Teixits, Edifici Dr. Frederic Duran i Jordà, Barcelona, Spain
- Transfusion Medicine group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquim Vives
- Banc de Sang i Teixits, Edifici Dr. Frederic Duran i Jordà, Barcelona, Spain.
- Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
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5
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Lopez-Navas L, Torrents S, Sánchez-Pernaute R, Vives J. Compliance in Non-Clinical Development of Cell-, Gene-, and Tissue-Based Medicines: Good Practice for Better Therapies. Stem Cells Transl Med 2022; 11:805-813. [PMID: 35830540 PMCID: PMC9397649 DOI: 10.1093/stcltm/szac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/20/2022] [Indexed: 11/14/2022] Open
Abstract
The development of cell-, gene- and tissue engineering (CGT)-based therapies must adhere to strict pharmaceutical quality management standards, as for any other biological or small-molecule drug. However, early developments often failed to fully comply with good laboratory practices (GLP) in non-clinical safety studies. Despite an upward trend of positive opinions in marketing authorization applications, evidence of adherence to the principles of GLP is not openly reported; therefore, their relative impact on the overall quality of the product development program is unknown. Herein we investigated the actual degree of GLP implementation and the underlying factors impeding full compliance in non-clinical developments of CGT-based marketed medicines in the EU and USA, including (i) the co-existence of diverse quality management systems of more strategic value for small organizations, particularly current Good Manufacturing Practices n(GMP); (ii) lack of regulatory pressure to pursue GLP certification; and (iii) the involvement of public institutions lacking a pharmaceutical mindset and resources. As a final reflection, we propose conformity to good research practice criteria not as a doctrinaire impediment to scientific work, but as a facilitator of efficient clinical translation of more effective and safer innovative therapies.
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Affiliation(s)
- Luis Lopez-Navas
- Andalusian Network for the Design and Translation of Advanced Therapies, Andalusian Health Ministry, Sevilla, Spain
| | | | - Rosario Sánchez-Pernaute
- Andalusian Network for the Design and Translation of Advanced Therapies, Andalusian Health Ministry, Sevilla, Spain
| | - Joaquim Vives
- Banc de Sang i Teixits, Barcelona, Spain.,Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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6
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Optical Behavior of Human Skin Substitutes: Absorbance in the 200-400 nm UV Range. Biomedicines 2022; 10:biomedicines10071640. [PMID: 35884945 PMCID: PMC9313464 DOI: 10.3390/biomedicines10071640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 11/25/2022] Open
Abstract
The most recent generation of bioengineered human skin allows for the efficient treatment of patients with severe skin defects. Despite UV sunlight can seriously affect human skin, the optical behavior in the UV range of skin models is still unexplored. In the present study, absorbance and transmittance of the UGRSKIN bioartificial skin substitute generated with human skin cells combined with fibrin-agarose biomaterials were evaluated for: UV-C (200−280 nm), -B (280−315 nm), and -A (315−400 nm) spectral range after 7, 14, 21 and 28 days of ex vivo development. The epidermis of the bioartificial skin substitute was able to mature and differentiate in a time-dependent manner, expressing relevant molecules able to absorb most of the incoming UV radiation. Absorbance spectral behavior of the skin substitutes showed similar patterns to control native skin (VAF > 99.4%), with values 0.85−0.90 times lower than control values at 7 and 14- days and 1.05−1.10 times the control values at 21- and 28-days. UV absorbance increased, and UV transmission decreased with culture time, and comparable results to the control were found at 21 and 28 days. These findings support the use of samples corresponding to 21 or 28 days of development for clinical purposes due to their higher histological similarities with native skin, but also because of their absorbance of UV radiation.
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7
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Patient access to and ethical considerations of the application of the European Union hospital exemption rule for advanced therapy medicinal products. Cytotherapy 2022; 24:686-690. [DOI: 10.1016/j.jcyt.2022.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/17/2022] [Accepted: 03/20/2022] [Indexed: 11/21/2022]
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8
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Kidpun P, Ruanglertboon W, Chalongsuk R. State-of-the-art knowledge on the regulation of advanced therapy medicinal products. Per Med 2022; 19:251-261. [PMID: 35293224 DOI: 10.2217/pme-2021-0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
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.
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Affiliation(s)
- Patcharaphun Kidpun
- Department of Community Pharmacy, Faculty of Pharmacy, Silpakorn University, Sanam Chandra Palace Campus, Nakhon Pathom, Thailand
| | - Warit Ruanglertboon
- Discipline of Pharmacology, Division of Health and Applied Sciences, Faculty of Science, Prince of Songkla University, Songkhla, Thailand
| | - Rapeepun Chalongsuk
- Department of Community Pharmacy, Faculty of Pharmacy, Silpakorn University, Sanam Chandra Palace Campus, Nakhon Pathom, Thailand
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9
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Trias E, Juan M, Urbano-Ispizua A, Calvo G. The hospital exemption pathway for the approval of advanced therapy medicinal products: an underused opportunity? The case of the CAR-T ARI-0001. Bone Marrow Transplant 2022; 57:156-159. [PMID: 35046545 PMCID: PMC8821008 DOI: 10.1038/s41409-021-01463-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/24/2021] [Accepted: 09/03/2021] [Indexed: 11/25/2022]
Abstract
In February 2021, the ‘Advanced Therapy Medicinal Product’ (ATMP) ARI-0001 (CART19-BE-01), developed at Hospital Clínic de Barcelona (Spain), received authorization from the Spanish Agency of Medicines and Medical Devices (AEMPS) under the ‘hospital exemption’ (HE) approval pathway for the treatment of patients aged >25 years with relapsed/refractory (RR) acute lymphoblastic leukemia (ALL). The HE pathway foreseen by the European Regulation establishing the legal framework for ATMPs intended to be placed on the market in the EU, allows access to ATMPs prepared on a non-routine basis, according to quality standards, like a custom-made product for an individual patient. Its use is limited to the same Member State where it was developed, in a hospital under the responsibility of a medical practitioner. HE-ATMPs must comply with national traceability and pharmacovigilance requirements and specific quality standards. HE offers an opportunity to develop ATMPs in close contact with clinical practice, with the quality and rapid access needed by patients and at a lower cost compared to regular market authorization. However, many barriers need to be overcome. Here we discuss relevant aspects of the development and authorization of ARI-0001 in the context of the heterogeneous frame of the European Regulation implementation across the Member States.
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10
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Benvenuti S, Wang CM, Borroni S. Perspectives, Expectations, and Concerns of European Patient Advocates on Advanced Therapy Medicinal Products. Front Med (Lausanne) 2021; 8:728529. [PMID: 34888320 PMCID: PMC8649896 DOI: 10.3389/fmed.2021.728529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/01/2021] [Indexed: 12/15/2022] Open
Abstract
This paper presents the results of a qualitative study based on semi-structured interviews of 10 expert patient advocates on several different issues around Advanced Therapy Medicinal Products (ATMPs). The interviews were conducted between February and May 2020 based on a guideline with a list of 8 topics that covered concerns about safety and ethics, access problems and limitations, pricing of ATMPs and educational needs for patient communities. Overall, the interviewees expressed a high degree of convergence of opinions on most of the topics and especially on the identification of the reasons for concern. Conversely, when asked about possible solutions, quite a wide range of solutions were proposed, although with many common points. However, it highlights that the debate is still in its infancy and that there are not yet consolidated positions across the whole community. A general concern emerging from all the interviews is the potential limitation of access to approved ATMPs, both due to the high prices and to the geographical concentration of treatment centers. However, patients recognize the value of a model with a limited number of specialized clinical centers administering these therapies. On the ethical side, patients do not show particular concern as long as ATMPs and the underlying technology is used to treat severe diseases. Finally, patients are asking for both more education on ATMPs as well as for a more continuous involvement of patient representatives in the whole “life-cycle” of a new ATMP, from the development phase to the authorization, from the definition of the reimbursement scheme to the collection of Real Word Data on safety and long-term efficacy of the treatment.
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Affiliation(s)
| | | | - Simona Borroni
- Fondazione Telethon, Milan, Italy.,Gruppo Famiglie DRAVET, Milan, Italy
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11
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Chemali M, Laurent A, Scaletta C, Waselle L, Simon JP, Michetti M, Brunet JF, Flahaut M, Hirt-Burri N, Raffoul W, Applegate LA, de Buys Roessingh AS, Abdel-Sayed P. Burn Center Organization and Cellular Therapy Integration: Managing Risks and Costs. J Burn Care Res 2021; 42:911-924. [PMID: 33970273 PMCID: PMC8483250 DOI: 10.1093/jbcr/irab080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The complex management of severe burn victims requires an integrative collaboration of multidisciplinary specialists in order to ensure quality and excellence in healthcare. This multidisciplinary care has quickly led to the integration of cell therapies in clinical care of burn patients. Specific advances in cellular therapy together with medical care have allowed for rapid treatment, shorter residence in hospitals and intensive care units, shorter durations of mechanical ventilation, lower complications and surgery interventions, and decreasing mortality rates. However, naturally fluctuating patient admission rates increase pressure toward optimized resource utilization. Besides, European translational developments of cellular therapies currently face potentially jeopardizing challenges on the policy front. The aim of the present work is to provide key considerations in burn care with focus on architectural and organizational aspects of burn centers, management of cellular therapy products, and guidelines in evolving restrictive regulations relative to standardized cell therapies. Thus, based on our experience, we present herein integrated management of risks and costs for preserving and optimizing clinical care and cellular therapies for patients in dire need.
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Affiliation(s)
- Michèle Chemali
- Department of Musculoskeletal Medicine, Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, Switzerland
- Department of Interdisciplinary Centers, Lausanne Burn Center, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Alexis Laurent
- Department of Musculoskeletal Medicine, Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Corinne Scaletta
- Department of Musculoskeletal Medicine, Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Laurent Waselle
- Department of Interdisciplinary Centers, Cell Production Center, Service of Pharmacy, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Jeanne-Pascale Simon
- DIrectorate Department, Unit of Legal Affairs, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Murielle Michetti
- Department of Musculoskeletal Medicine, Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Jean-François Brunet
- Department of Interdisciplinary Centers, Cell Production Center, Service of Pharmacy, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Marjorie Flahaut
- Department of Musculoskeletal Medicine, Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Nathalie Hirt-Burri
- Department of Musculoskeletal Medicine, Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Wassim Raffoul
- Department of Musculoskeletal Medicine, Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, Switzerland
- Department of Interdisciplinary Centers, Lausanne Burn Center, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Lee Ann Applegate
- Department of Musculoskeletal Medicine, Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, Switzerland
- Department of Interdisciplinary Centers, Lausanne Burn Center, Lausanne University Hospital, University of Lausanne, Switzerland
- Oxford Suzhou Center for Advanced Research, Science and Technology Co. Ltd., Oxford University, Suzhou, PR China
- Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Switzerland
| | - Anthony S de Buys Roessingh
- Department of Interdisciplinary Centers, Lausanne Burn Center, Lausanne University Hospital, University of Lausanne, Switzerland
- Women-Mother-Child Department, Children and Adolescent Surgery Service, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Philippe Abdel-Sayed
- Department of Musculoskeletal Medicine, Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, Switzerland
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12
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Juan M, Delgado J, Calvo G, Trias E, Urbano-Ispizua Á. Is Hospital Exemption an Alternative or a Bridge to European Medicines Agency for Developing Academic Chimeric Antigen Receptor T-Cell in Europe? Our Experience with ARI-0001. Hum Gene Ther 2021; 32:1004-1007. [PMID: 34476985 DOI: 10.1089/hum.2021.168] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The hospital exemption (HE) allows for the use of advanced therapy medicinal products (ATMPs) next to marketing authorization (MA), but under special conditions. The HE is only applicable to individual patients treated in the hospital setting and it is limited to member states of the European Union (EU); HE is mainly conceded to the academic centers that developed the ATMP, being granted by the national competent authority (NCA), which, in the case of Spain, is the Spanish Agency of Medicines and Medical Devices (AEMPS). The HE follows strict standards of traceability, pharmacovigilance, and quality. In February 2021, our ATMP ARI-0001, a new autologous chimeric antigen receptor (CAR) targeting CD19, was approved by AEMPS under HE for patients >25 years with relapsed or refractory CD19+ acute lymphoblastic leukemia. This authorization was a first step in the development of, and access to, academic CAR T cell products in the EU. The fact that HE is limited to a specific country and hospital, the need of continuous evaluation by the NCA, and the potential future overlap with other centrally approved ATMPs, suggest that the HE could be used as an intermediate step before obtaining a centralized MA by the European Medicines Agency.
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Affiliation(s)
- Manel Juan
- Inmunology Service.,Advanced Therapies Unit.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS).,Hospital Clínic de Barcelona.,Universitat de Barcelona
| | - Julio Delgado
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS).,Hospital Clínic de Barcelona.,Universitat de Barcelona.,Hematology Service
| | - Gonzalo Calvo
- Advanced Therapies Unit.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS).,Hospital Clínic de Barcelona.,Clinic Pharmacology, Barcelona, Spain
| | - Esteve Trias
- Advanced Therapies Unit.,Hospital Clínic de Barcelona
| | - Álvaro Urbano-Ispizua
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS).,Hospital Clínic de Barcelona.,Universitat de Barcelona.,Hematology Service
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13
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Optimized Manufacture of Lyophilized Dermal Fibroblasts for Next-Generation Off-the-Shelf Progenitor Biological Bandages in Topical Post-Burn Regenerative Medicine. Biomedicines 2021; 9:biomedicines9081072. [PMID: 34440276 PMCID: PMC8394413 DOI: 10.3390/biomedicines9081072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 12/13/2022] Open
Abstract
Cultured fibroblast progenitor cells (FPC) have been studied in Swiss translational regenerative medicine for over two decades, wherein clinical experience was gathered for safely managing burns and refractory cutaneous ulcers. Inherent FPC advantages include high robustness, optimal adaptability to industrial manufacture, and potential for effective repair stimulation of wounded tissues. Major technical bottlenecks in cell therapy development comprise sustainability, stability, and logistics of biological material sources. Herein, we report stringently optimized and up-scaled processing (i.e., cell biobanking and stabilization by lyophilization) of dermal FPCs, with the objective of addressing potential cell source sustainability and stability issues with regard to active substance manufacturing in cutaneous regenerative medicine. Firstly, multi-tiered FPC banking was optimized in terms of overall quality and efficiency by benchmarking key reagents (e.g., medium supplement source, dissociation reagent), consumables (e.g., culture vessels), and technical specifications. Therein, fetal bovine serum batch identity and culture vessel surface were confirmed, among other parameters, to largely impact harvest cell yields. Secondly, FPC stabilization by lyophilization was undertaken and shown to maintain critical functions for devitalized cells in vitro, potentially enabling high logistical gains. Overall, this study provides the technical basis for the elaboration of next-generation off-the-shelf topical regenerative medicine therapeutic products for wound healing and post-burn care.
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14
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Hug K. Bringing Advanced Therapies for Parkinson's Disease to the Clinic: An Analysis of Ethical Issues. JOURNAL OF PARKINSONS DISEASE 2021; 11:S147-S155. [PMID: 34092655 PMCID: PMC8543290 DOI: 10.3233/jpd-212639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Advanced therapies for Parkinson’s disease (PD) constitute a broad range of treatments, each presenting specific ethical challenges. Some of these therapies are established and in clinical use, like device-aided therapies, and others, based on advanced therapeutic medicinal products (ATMPs), are still in early stage of clinical trials. This paper focuses on some common ethical issues arising in these two categories of advanced therapies, especially challenges arising when advanced therapies are proposed to PD patients in the form of advanced care, under a clinical trial, or, in case of ATMPs, under the “hospital exemption” rule. The ethical issues covered here relate mainly to ensuring informed consent in these different contexts, to the stakeholder role of patient’s non-professional caretakers, such as family, and to patient safety in treatments under “hospital exemption”. To illustrate the points discussed in connection with “hospital exemption” rule, the example of the EU has been chosen. This paper does not claim completeness of ethical issues raised by bringing advanced therapies for PD to the clinic, but rather presents examples of ethical challenges in this context.
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Affiliation(s)
- Kristina Hug
- Department of Clinical Sciences, Medical Ethics, Faculty of Medicine, Lund University, Lund, Sweden
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15
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García-Muñoz E, Vives J. Towards the standardization of methods of tissue processing for the isolation of mesenchymal stromal cells for clinical use. Cytotechnology 2021; 73:513-522. [PMID: 33994662 PMCID: PMC8109215 DOI: 10.1007/s10616-021-00474-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/04/2021] [Indexed: 12/11/2022] Open
Abstract
Multipotent mesenchymal stromal cells (MSCs) are currently the most extensively studied type of adult stem cells in advanced stages of development in the field of regenerative medicine. The biological properties of MSCs have generated great hope for their therapeutic use in degenerative and autoimmune conditions that, at present, lack effective treatment options. Over the last decades, MSCs have been typically obtained from adult bone marrow, but the extraction process is highly invasive and the quality and numbers of isolated cells is drastically influenced by patient age, medication and associated comorbidities. Therefore, there is currently an open discussion on the convenience of allogeneic over autologous treatments, despite potential disadvantages such as rejection by the host. This shift to the allogeneic setting entails the need for high production of MSCs to ensure availability of sufficient cell numbers for transplantation, and therefore making the search for alternative tissue sources of highly proliferative MSC cultures with low levels of senescence occurrence, which is one of the greatest current challenges in the scale up of therapeutic cell bioprocessing. Herein we (i) present the main isolation protocols of MSCs from bone marrow, adipose tissue and Wharton’s jelly of the umbilical cord; and (ii) compare their qualities from a bioprocess standpoint, addressing both quality and regulatory aspects, in view of their anticipated clinical use.
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Affiliation(s)
- Elisabeth García-Muñoz
- Banc de Sang iTeixits, Edifici Dr. Frederic Duran i Jordà, Passeig Taulat, 116, 08005 Barcelona, Spain
| | - Joaquim Vives
- Banc de Sang iTeixits, Edifici Dr. Frederic Duran i Jordà, Passeig Taulat, 116, 08005 Barcelona, Spain.,Musculoskeletal Tissue Engineering Group, Vall D'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 129-139, 08035 Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 129-139, 08035 Barcelona, Spain
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16
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Al-Dourobi K, Laurent A, Deghayli L, Flahaut M, Abdel-Sayed P, Scaletta C, Michetti M, Waselle L, Simon JP, El Ezzi O, Raffoul W, Applegate LA, Hirt-Burri N, Roessingh ASDB. Retrospective Evaluation of Progenitor Biological Bandage Use: A Complementary and Safe Therapeutic Management Option for Prevention of Hypertrophic Scarring in Pediatric Burn Care. Pharmaceuticals (Basel) 2021; 14:ph14030201. [PMID: 33671009 PMCID: PMC7997469 DOI: 10.3390/ph14030201] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/11/2022] Open
Abstract
Progenitor Biological Bandages (PBB) have been continuously applied clinically in the Lausanne Burn Center for over two decades. Vast translational experience and hindsight have been gathered, specifically for cutaneous healing promotion of donor-site grafts and second-degree pediatric burns. PBBs constitute combined Advanced Therapy Medicinal Products, containing viable cultured allogeneic fetal dermal progenitor fibroblasts. Such constructs may partly favor repair and regeneration of functional cutaneous tissues by releasing cytokines and growth factors, potentially negating the need for subsequent skin grafting, while reducing the formation of hypertrophic scar tissues. This retrospective case-control study (2010-2018) of pediatric second-degree burn patients comprehensively compared two initial wound treatment options (i.e., PBBs versus Aquacel® Ag, applied during ten to twelve days post-trauma). Results confirmed clinical safety of PBBs with regard to morbidity, mortality, and overall complications. No difference was detected between groups for length of hospitalization or initial relative burn surface decreasing rates. Nevertheless, a trend was observed in younger patients treated with PBBs, requiring fewer corrective interventions or subsequent skin grafting. Importantly, significant improvements were observed in the PBB group regarding hypertrophic scarring (i.e., reduced number of scar complications and related corrective interventions). Such results establish evidence of clinical benefits yielded by the Swiss fetal progenitor cell transplantation program and favor further implementation of specific cell therapies in highly specialized regenerative medicine.
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Affiliation(s)
- Karim Al-Dourobi
- Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland; (K.A.-D.); (A.L.); (L.D.); (M.F.); (P.A.-S.); (C.S.); (M.M.); (W.R.); (L.A.A.); (N.H.-B.)
- Lausanne Burn Center, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland;
| | - Alexis Laurent
- Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland; (K.A.-D.); (A.L.); (L.D.); (M.F.); (P.A.-S.); (C.S.); (M.M.); (W.R.); (L.A.A.); (N.H.-B.)
- Regenerative Therapy Unit, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland
| | - Lina Deghayli
- Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland; (K.A.-D.); (A.L.); (L.D.); (M.F.); (P.A.-S.); (C.S.); (M.M.); (W.R.); (L.A.A.); (N.H.-B.)
- Lausanne Burn Center, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland;
| | - Marjorie Flahaut
- Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland; (K.A.-D.); (A.L.); (L.D.); (M.F.); (P.A.-S.); (C.S.); (M.M.); (W.R.); (L.A.A.); (N.H.-B.)
- Regenerative Therapy Unit, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland
| | - Philippe Abdel-Sayed
- Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland; (K.A.-D.); (A.L.); (L.D.); (M.F.); (P.A.-S.); (C.S.); (M.M.); (W.R.); (L.A.A.); (N.H.-B.)
- Regenerative Therapy Unit, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland
| | - Corinne Scaletta
- Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland; (K.A.-D.); (A.L.); (L.D.); (M.F.); (P.A.-S.); (C.S.); (M.M.); (W.R.); (L.A.A.); (N.H.-B.)
- Regenerative Therapy Unit, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland
| | - Murielle Michetti
- Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland; (K.A.-D.); (A.L.); (L.D.); (M.F.); (P.A.-S.); (C.S.); (M.M.); (W.R.); (L.A.A.); (N.H.-B.)
- Regenerative Therapy Unit, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland
| | - Laurent Waselle
- Cell Production Center, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland;
| | - Jeanne-Pascale Simon
- Unit of Legal Affairs, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland;
| | - Oumama El Ezzi
- Lausanne Burn Center, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland;
- Children and Adolescent Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Wassim Raffoul
- Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland; (K.A.-D.); (A.L.); (L.D.); (M.F.); (P.A.-S.); (C.S.); (M.M.); (W.R.); (L.A.A.); (N.H.-B.)
- Lausanne Burn Center, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland;
| | - Lee Ann Applegate
- Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland; (K.A.-D.); (A.L.); (L.D.); (M.F.); (P.A.-S.); (C.S.); (M.M.); (W.R.); (L.A.A.); (N.H.-B.)
- Lausanne Burn Center, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland;
- Regenerative Therapy Unit, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland
- Oxford Suzhou Center for Advanced Research, Science and Technology Co., Ltd., Oxford University, Suzhou 215000, China
- Center for Applied Biotechnology and Molecular Medicine, University of Zurich, CH-8057 Zurich, Switzerland
| | - Nathalie Hirt-Burri
- Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland; (K.A.-D.); (A.L.); (L.D.); (M.F.); (P.A.-S.); (C.S.); (M.M.); (W.R.); (L.A.A.); (N.H.-B.)
- Regenerative Therapy Unit, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland
| | - Anthony S de Buys Roessingh
- Lausanne Burn Center, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland;
- Children and Adolescent Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland
- Correspondence: ; Tel.: +41-79-556-37-67; Fax: +41-21-314-31-02
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17
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Stanco D, Urbán P, Tirendi S, Ciardelli G, Barrero J. 3D bioprinting for orthopaedic applications: Current advances, challenges and regulatory considerations. BIOPRINTING (AMSTERDAM, NETHERLANDS) 2020; 20:None. [PMID: 34853818 PMCID: PMC8609155 DOI: 10.1016/j.bprint.2020.e00103] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 02/07/2023]
Abstract
In the era of personalised medicine, novel therapeutic approaches raise increasing hopes to address currently unmet medical needs by developing patient-customised treatments. Three-dimensional (3D) bioprinting is rapidly evolving and has the potential to obtain personalised tissue constructs and overcome some limitations of standard tissue engineering approaches. Bioprinting could support a wide range of biomedical applications, such as drug testing, tissue repair or organ transplantation. There is a growing interest for 3D bioprinting in the orthopaedic field, with remarkable scientific and technical advances. However, the full exploitation of 3D bioprinting in medical applications still requires efforts to anticipate the upcoming challenges in translating bioprinted products from bench to bedside. In this review we summarised current trends, advances and challenges in the application of 3D bioprinting for bone and cartilage tissue engineering. Moreover, we provided a detailed analysis of the applicable regulations through the 3D bioprinting process and an overview of available standards covering bioprinting and additive manufacturing.
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Affiliation(s)
- D. Stanco
- European Commission, Joint Research Centre (JRC), Ispra, Italy
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Turin, Italy
| | - P. Urbán
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - S. Tirendi
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - G. Ciardelli
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Turin, Italy
| | - J. Barrero
- European Commission, Joint Research Centre (JRC), Ispra, Italy
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18
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Coppens DG, Gardarsdottir H, Bruin MLD, Meij P, Gm Leufkens H, Hoekman J. Regulating advanced therapy medicinal products through the Hospital Exemption: an analysis of regulatory approaches in nine EU countries. Regen Med 2020; 15:2015-2028. [PMID: 33151792 DOI: 10.2217/rme-2020-0008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aim: To study regulatory approaches for the implementation and utilization of the Hospital Exemption (HE) in nine EU countries. Materials & methods: Using public regulatory documentation and interviews with authorities we characterized the national implementation process of the HE, including national implementation characteristics and two outcomes: national licensing provisions and the amount of license holders. Results: National licensing provisions vary substantially among selected countries as a result of different regulatory considerations that relate to unmet medical needs, benefit/risk balance, and innovation. The amount of license holders per country is moderate (0-11). Conclusion: The HE facilitates HE utilization in clinical practice in some countries, yet safeguarding of public health and incentivizing commercial development is challenging.
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Affiliation(s)
- Delphi Gm Coppens
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Department of Clinical Pharmacy, Division Laboratories, Pharmacy & Biomedical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marie L De Bruin
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Copenhagen Centre for Regulatory Science, University of Copenhagen, Copenhagen, Denmark
| | - Pauline Meij
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hubert Gm Leufkens
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Jarno Hoekman
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Innovation Studies Group, Faculty of Geosciences, Utrecht University, Utrecht, The Netherlands
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19
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Laurent A, Hirt-Burri N, Scaletta C, Michetti M, de Buys Roessingh AS, Raffoul W, Applegate LA. Holistic Approach of Swiss Fetal Progenitor Cell Banking: Optimizing Safe and Sustainable Substrates for Regenerative Medicine and Biotechnology. Front Bioeng Biotechnol 2020; 8:557758. [PMID: 33195124 PMCID: PMC7644790 DOI: 10.3389/fbioe.2020.557758] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/21/2020] [Indexed: 12/17/2022] Open
Abstract
Safety, quality, and regulatory-driven iterative optimization of therapeutic cell source selection has constituted the core developmental bedrock for primary fetal progenitor cell (FPC) therapy in Switzerland throughout three decades. Customized Fetal Transplantation Programs were pragmatically devised as straightforward workflows for tissue procurement, traceability maximization, safety, consistency, and robustness of cultured progeny cellular materials. Whole-cell bioprocessing standardization has provided plethoric insights into the adequate conjugation of modern biotechnological advances with current restraining legislative, ethical, and regulatory frameworks. Pioneer translational advances in cutaneous and musculoskeletal regenerative medicine continuously demonstrate the therapeutic potential of FPCs. Extensive technical and clinical hindsight was gathered by managing pediatric burns and geriatric ulcers in Switzerland. Concomitant industrial transposition of dermal FPC banking, following good manufacturing practices, demonstrated the extensive potential of their therapeutic value. Furthermore, in extenso, exponential revalorization of Swiss FPC technology may be achieved via the renewal of integrative model frameworks. Consideration of both longitudinal and transversal aspects of simultaneous fetal tissue differential processing allows for a better understanding of the quasi-infinite expansion potential within multi-tiered primary FPC banking. Multiple fetal tissues (e.g., skin, cartilage, tendon, muscle, bone, lung) may be simultaneously harvested and processed for adherent cell cultures, establishing a unique model for sustainable therapeutic cellular material supply chains. Here, we integrated fundamental, preclinical, clinical, and industrial developments embodying the scientific advances supported by Swiss FPC banking and we focused on advances made to date for FPCs that may be derived from a single organ donation. A renewed model of single organ donation bioprocessing is proposed, achieving sustained standards and potential production of billions of affordable and efficient therapeutic doses. Thereby, the aim is to validate the core therapeutic value proposition, to increase awareness and use of standardized protocols for translational regenerative medicine, potentially impacting millions of patients suffering from cutaneous and musculoskeletal diseases. Alternative applications of FPC banking include biopharmaceutical therapeutic product manufacturing, thereby indirectly and synergistically enhancing the power of modern therapeutic armamentariums. It is hypothesized that a single qualifying fetal organ donation is sufficient to sustain decades of scientific, medical, and industrial developments, as technological optimization and standardization enable high efficiency.
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Affiliation(s)
- Alexis Laurent
- Regenerative Therapy Unit, Lausanne University Hospital, University of Lausanne, Épalinges, Switzerland
- Tec-Pharma SA, Bercher, Switzerland
- LAM Biotechnologies SA, Épalinges, Switzerland
| | - Nathalie Hirt-Burri
- Regenerative Therapy Unit, Lausanne University Hospital, University of Lausanne, Épalinges, Switzerland
| | - Corinne Scaletta
- Regenerative Therapy Unit, Lausanne University Hospital, University of Lausanne, Épalinges, Switzerland
| | - Murielle Michetti
- Regenerative Therapy Unit, Lausanne University Hospital, University of Lausanne, Épalinges, Switzerland
| | - Anthony S. de Buys Roessingh
- Children and Adolescent Surgery Service, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Wassim Raffoul
- Plastic, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Lee Ann Applegate
- Regenerative Therapy Unit, Lausanne University Hospital, University of Lausanne, Épalinges, Switzerland
- Oxford Suzhou Center for Advanced Research, Science and Technology Co., Ltd., Oxford University, Suzhou, China
- Competence Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, Switzerland
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20
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Hills A, Awigena-Cook J, Genenz K, Ostertag M, Butler S, Eggimann AV, Hubert A. An assessment of the hospital exemption landscape across European Member States: regulatory frameworks, use and impact. Cytotherapy 2020; 22:772-779.e1. [PMID: 33046395 DOI: 10.1016/j.jcyt.2020.08.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 11/17/2022]
Abstract
The hospital exemption (HE) (Article 28(2) of Regulation (EC) No 1394/2007; the "ATMP Regulation") rule allows the invaluable opportunity to provide patients with access to innovative, potentially life-saving treatments in situations of unmet clinical need. Unlicensed, developmental advanced therapy medicinal products (ATMPs) - cell-, gene- or tissue-based therapies - can be used to treat patients under certain conditions. Such products should be produced on a non-routine basis, custom-made for an individual patient under the responsibility of the requesting physician, for use in a hospital setting within the same Member State in which they are manufactured. The HE rule, and the specific requirements permitting its use, is further regulated at the Member State level, which has led to divergence in the implementation of HE across the European Union (EU). As a result, HE use varies significantly across Member States depending on their respective national legal implementation, policy makers' interpretation of HE, clarity of guidance at the national level, reimbursement opportunities and level of ATMP research and development activities carried out by academic and commercial organizations. With important variations in how quality, safety and efficacy standards are implemented and controlled across EU Member States for ATMPs provided via the HE rule and a lack of transparency around its use, the HE rule draws concern around its potential impact on public health. In this article, the authors report results of a legal analysis of the implementation of HE across the UK, France, Germany, Italy, Spain, Poland and the Netherlands and research findings on its current utilization, highlighting divergences across countries as well as gaps in legislation and control in these countries. The significance of these divergences and the differing levels of enforcement are discussed as well as their associated impact on patients, industry and health care professionals.
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Affiliation(s)
| | | | | | | | | | | | - Annie Hubert
- Alliance for Regenerative Medicine, Brussels, Belgium.
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21
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Advanced therapy medicinal product manufacturing under the hospital exemption and other exemption pathways in seven European Union countries. Cytotherapy 2020; 22:592-600. [PMID: 32563611 DOI: 10.1016/j.jcyt.2020.04.092] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/01/2020] [Accepted: 04/17/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AIMS As part of the advanced therapy medicinal product (ATMP) regulation, the hospital exemption (HE) was enacted to accommodate manufacturing of custom-made ATMPs for treatment purposes in the European Union (EU). However, how the HE pathway has been used in practice is largely unknown. METHODS Using a survey and interviews, we provide the product characteristics, scale and motivation for ATMP manufacturing under HE and other, non-ATMP-specific exemption pathways in seven European countries. RESULTS Results show that ATMPs were manufactured under HE by public facilities located in Finland, Germany, Italy and the Netherlands, which enabled availability of a modest number of ATMPs (n = 12) between 2009 and 2017. These ATMPs were shown to have close proximity to clinical practice, and manufacturing was primarily motivated by clinical needs and clinical experience. Public facilities used HE when patients could not obtain treatment in ongoing or future trials. Regulatory aspects motivated (Finland, Italy, the Netherlands) or limited (Belgium, Germany) HE utilization, whereas financial resources generally limited HE utilization by public facilities. Public facilities manufactured other ATMPs (n = 11) under named patient use (NPU) between 2015 and 2017 and used NPU in a similar fashion as HE. The scale of manufacturing under HE over 9 years was shown to be rather limited in comparison to manufacturing under NPU over 3 years. In Germany, ATMPs were mainly manufactured by facilities of private companies under HE. CONCLUSIONS The HE enables availability of ATMPs with close proximity to clinical practice. Yet in some countries, HE provisions limit utilization, whereas commercial developments could be undermined by private HE licenses in Germany. Transparency through a public EU-wide registry and guidance for distinguishing between ATMPs that are or are not commercially viable as well as public-private engagements are needed to optimize the use of the HE pathway and regulatory pathways for commercial development in a complementary fashion.
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22
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Vilsbøll AW, Mouritsen JM, Jensen LP, Bødker N, Holst AW, Pennisi CP, Ehlers L. Cell-based therapy for the treatment of female stress urinary incontinence: an early cost-effectiveness analysis. Regen Med 2018; 13:321-330. [PMID: 29715070 DOI: 10.2217/rme-2017-0124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To perform an early cost-effectiveness analysis of in vitro expanded myoblasts (IVM) and minced myofibers versus midurethral slings (MUS) for surgical treatment of female stress urinary incontinence. METHODS Cost-effectiveness and sensitivity analyses were performed using a decision tree comprising previously published data and expert opinions. RESULTS & CONCLUSION In the base case scenario, MUS was the cost-effective strategy with a negative incremental cost-effectiveness ratio compared with IVM and a positive incremental cost-effectiveness ratio compared with minced myofibers. However, the sensitivity analysis indicates that IVM may become an alternative providing greater effect at a higher cost. With the possibility of becoming more effective, IVM treatment would be advantageous over MUS given its reduced invasiveness and lower risks of complications.
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Affiliation(s)
- Andreas West Vilsbøll
- Department of Health Science & Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Jakob Munk Mouritsen
- Department of Health Science & Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Line Park Jensen
- Department of Health Science & Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Nikolaj Bødker
- Department of Health Science & Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | | | - Cristian P Pennisi
- Department of Health Science & Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Lars Ehlers
- Danish Center for Healthcare Improvements, Aalborg University, Aalborg, Denmark
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23
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Harrison RP, Ruck S, Rafiq QA, Medcalf N. Decentralised manufacturing of cell and gene therapy products: Learning from other healthcare sectors. Biotechnol Adv 2017; 36:345-357. [PMID: 29278756 DOI: 10.1016/j.biotechadv.2017.12.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 12/13/2022]
Abstract
Decentralised or 'redistributed' manufacturing represents an attractive choice for production of some cell and gene therapies (CGTs), in particular personalised therapies. Decentralised manufacturing splits production into various locations or regions and in doing so, imposes organisational changes on the structure of a company. This confers a significant advantage by democratising supply, creating jobs without geographical restriction to the central hub and allowing a more flexible response to external pressures and demands. This comes with challenges that need to be addressed including, a reduction in oversight, decision making and control by central management which can be critical in maintaining quality in healthcare product manufacturing. The unwitting adoption of poor business strategies at an early stage in development has the potential to undermine the market success of otherwise promising products. To maximise the probability of realising the benefits that decentralised manufacturing of CGTs has to offer, it is important to examine alternative operational paradigms to learn from their successes and to avoid their failures. Whilst no other situation is quite the same as CGTs, some illustrative examples of established manufacturing paradigms are described. Each of these shares a unique attribute with CGTs which aids understanding of how decentralised manufacturing might be implemented for CGTs in a similar manner. In this paper we present a collection of paradigms that can be drawn on in formulating a roadmap to success for decentralised production of CGTs.
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Affiliation(s)
- Richard P Harrison
- Centre for Biological Engineering, Holywell Park, Loughborough University, Loughborough LE11 3TU, UK.
| | - Steven Ruck
- Centre for Biological Engineering, Holywell Park, Loughborough University, Loughborough LE11 3TU, UK
| | - Qasim A Rafiq
- Department of Biochemical Engineering, Faculty of Engineering Science, University College London, Gower Street, London, WC1E 6BT, UK
| | - Nicholas Medcalf
- Centre for Biological Engineering, Holywell Park, Loughborough University, Loughborough LE11 3TU, UK
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Roura S, Gálvez-Montón C, Mirabel C, Vives J, Bayes-Genis A. Mesenchymal stem cells for cardiac repair: are the actors ready for the clinical scenario? Stem Cell Res Ther 2017; 8:238. [PMID: 29078809 PMCID: PMC5658929 DOI: 10.1186/s13287-017-0695-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
For years, sufficient progress has been made in treating heart failure following myocardial infarction; however, the social and economic burdens and the costs to world health systems remain high. Moreover, treatment advances have not resolved the underlying problem of functional heart tissue loss. In this field of research, for years we have actively explored innovative biotherapies for cardiac repair. Here, we present a general, critical overview of our experience in using mesenchymal stem cells, derived from cardiac adipose tissue and umbilical cord blood, in a variety of cell therapy and tissue engineering approaches. We also include the latest advances and future challenges, including good manufacturing practice and regulatory issues. Finally, we evaluate whether recent approaches hold potential for reliable translation to clinical trials.
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Affiliation(s)
- Santiago Roura
- ICREC Research Program, Germans Trias i Pujol Health Research Institute, Badalona, Spain. .,Center of Regenerative Medicine in Barcelona, Barcelona, Spain. .,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain. .,ICREC (Heart Failure and Cardiac Regeneration) Research Programme, Health Sciences Research Institute Germans Trias i Pujol (IGTP), Carretera de Can Ruti, Camí de les Escoles s/n, 08916, Badalona, Barcelona, Spain.
| | - Carolina Gálvez-Montón
- ICREC Research Program, Germans Trias i Pujol Health Research Institute, Badalona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Clémentine Mirabel
- Servei de Teràpia Cel∙lular, Banc de Sang i Teixits, Edifici Dr. Frederic Duran i Jordà, Passeig Taulat, 116, 08005, Barcelona, Spain.,Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 129-139, 08035, Barcelona, Spain
| | - Joaquim Vives
- Servei de Teràpia Cel∙lular, Banc de Sang i Teixits, Edifici Dr. Frederic Duran i Jordà, Passeig Taulat, 116, 08005, Barcelona, Spain.,Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 129-139, 08035, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antoni Bayes-Genis
- ICREC Research Program, Germans Trias i Pujol Health Research Institute, Badalona, Spain. .,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain. .,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain. .,Cardiology Service, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. .,Heart Institute, Hospital Universitari Germans Trias i Pujol University Hospital, Carretera de Canyet s/n, 08916, Badalona, Barcelona, Spain.
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25
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Viganò M, Giordano R, Lazzari L. Challenges of running a GMP facility for regenerative medicine in a public hospital. Regen Med 2017; 12:803-813. [DOI: 10.2217/rme-2017-0051] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Advanced therapy medicinal products represent a new generation of medicinal products for regenerative medicine. Since the implementation of the EU regulation for this innovative class of drugs, the academic and hospital institutions have played a central role in their development and manufacture. For these institutions that are not familiar with the industrial context, being in compliance with the pharmaceutical standards is extremely challenging. This report describes how we dealt with some specific issues during our hospital-based GMP experience. Furthermore, we identify as a future perspective the consistent stimulating contribution that a public entity can ensure for advanced therapy medicinal product development and licensing.
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Affiliation(s)
- Mariele Viganò
- Cell Factory, Laboratory of Regenerative Medicine, Department of Services & Preventive Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Rosaria Giordano
- Cell Factory, Laboratory of Regenerative Medicine, Department of Services & Preventive Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Lorenza Lazzari
- Cell Factory, Laboratory of Regenerative Medicine, Department of Services & Preventive Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
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26
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Elsanhoury A, Sanzenbacher R, Reinke P, Abou-El-Enein M. Accelerating Patients' Access to Advanced Therapies in the EU. MOLECULAR THERAPY-METHODS & CLINICAL DEVELOPMENT 2017; 7:15-19. [PMID: 28971109 PMCID: PMC5609878 DOI: 10.1016/j.omtm.2017.08.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ahmed Elsanhoury
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Germany
| | - Ralf Sanzenbacher
- Division of Medical Biotechnology, Paul-Ehrlich-Institut-Federal Institute for Vaccines and Biomedicines, Paul-Ehrlich-Straße 51-59, Langen, 63225, Germany
| | - Petra Reinke
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Germany.,Department of Nephrology and Internal Intensive Care, Charité - Universitätsmedizin Berlin, Germany
| | - Mohamed Abou-El-Enein
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Germany.,Department of Nephrology and Internal Intensive Care, Charité - Universitätsmedizin Berlin, Germany
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27
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von Tigerstrom B. New Regulatory Pathways for Stem Cell-Based Therapies: Comparison and Critique of Potential Models. STEM CELLS IN CLINICAL APPLICATIONS 2017. [DOI: 10.1007/978-3-319-59165-0_7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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28
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Abou-El-Enein M, Bauer G, Medcalf N, Volk HD, Reinke P. Putting a price tag on novel autologous cellular therapies. Cytotherapy 2016; 18:1056-1061. [PMID: 27288308 DOI: 10.1016/j.jcyt.2016.05.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/05/2016] [Accepted: 05/09/2016] [Indexed: 12/24/2022]
Abstract
Cell therapies, especially autologous therapies, pose significant challenges to researchers who wish to move from small, probably academic, methods of manufacture to full commercial scale. There is a dearth of reliable information about the costs of operation, and this makes it difficult to predict with confidence the investment needed to translate the innovations to the clinic, other than as small-scale, clinician-led prescriptions. Here, we provide an example of the results of a cost model that takes into account the fixed and variable costs of manufacture of one such therapy. We also highlight the different factors that influence the product final pricing strategy. Our findings illustrate the need for cooperative and collective action by the research community in pre-competitive research to generate the operational models that are much needed to increase confidence in process development for these advanced products.
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Affiliation(s)
- Mohamed Abou-El-Enein
- Berlin-Brandenburg Center for Regenerative Therapies, Charité University Medicine, Campus Virchow, Berlin, Germany; Department of Nephrology and Internal Intensive Care, Charité-University Medicine, Campus Virchow, Berlin, Germany.
| | - Gerhard Bauer
- Institute for Regenerative Cures, University of California Davis, Sacramento, CA, USA
| | - Nicholas Medcalf
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough, UK
| | - Hans-Dieter Volk
- Berlin-Brandenburg Center for Regenerative Therapies, Charité University Medicine, Campus Virchow, Berlin, Germany; Institute of Medical Immunology, Charité University Medicine, Campus Virchow, Berlin, Germany
| | - Petra Reinke
- Berlin-Brandenburg Center for Regenerative Therapies, Charité University Medicine, Campus Virchow, Berlin, Germany; Department of Nephrology and Internal Intensive Care, Charité-University Medicine, Campus Virchow, Berlin, Germany
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29
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Azuma K, Yamanaka S. Recent policies that support clinical application of induced pluripotent stem cell-based regenerative therapies. Regen Ther 2016; 4:36-47. [PMID: 31245486 PMCID: PMC6581825 DOI: 10.1016/j.reth.2016.01.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 01/07/2016] [Accepted: 01/28/2016] [Indexed: 02/04/2023] Open
Abstract
In Japan, a research center network consisting of Kyoto University to provide clinical-grade induced Pluripotent Stem Cells (iPSC) and several major research centers to develop iPSC-based regenerative therapies was formed for the clinical application of iPSCs. This network is under the supervision of a newly formed funding agency, the Japan Agency for Medical Research and Development. In parallel, regulatory authorities of Japan, including the Ministry of Health, Labour and Welfare, and Pharmaceuticals and Medical Devices Agency, are trying to accelerate the development process of regenerative medicine products (RMPs) by several initiatives: 1) introduction of a conditional and time-limited approval scheme only applicable to RMPs under the revised Pharmaceuticals and Medical Devices Act, 2) expansion of a consultation program at the early stage of development, 3) establishment of guidelines to support efficient development and review and 4) enhancement of post-market safety measures such as introduction of patient registries and setting user requirements with cooperation from relevant academic societies and experts. Ultimately, the establishment of a global network among iPSC banks that derives clinical-grade iPSCs from human leukocyte antigens homozygous donors has been proposed. In order to share clinical-grade iPSCs globally and to facilitate global development of iPSC-based RMPs, it will be necessary to promote regulatory harmonization and to establish common standards related to iPSCs and differentiated cells based on scientific evidence.
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Key Words
- AMED, Japan Agency for Medical Research and Development
- BLA, Biological License Approval
- CFR, Code of Federal Regulations
- CiRA, Center for iPS Cell Research and Application
- DMF, Drug Master File
- ESC, embryonic stem cell
- FDA, Food and Drug Administration
- FY, fiscal year
- GAiT, Global Alliance for iPS Cell Therapies
- GCTP, Good Gene, Cell, Cellular and Tissue-based Products Manufacturing Practice
- GMP, good manufacturing practice
- HLA, human leukocyte antigen
- Haplobank
- IBRI, Institution of Biomedical Research and Innovation
- ICH, The International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use
- IND, Investigational New Drug
- INTERMACS, Interagency Registry for Mechanically Assisted Circulatory Support
- IRB, Institutional Review Board
- J-MACS, Japanese Registry for Mechanically Assisted Circulatory Support
- JST, Japan Science and Technology Agency
- Japan
- LVAD, left ventricular assist device
- METI, Ministry of Economy, Trade and Industry
- MEXT, Ministry of Education, Culture, Sports, Science and Technology
- MHLW, Ministry of Health, Labour and Welfare
- NEDO, New Energy and Industrial Technology Development Organization
- NIBIO, National Institute of Biomedical Innovation
- NIHS, National Institute of Health Science
- PAL, Pharmaceutical Affairs Law
- PIC/S, The Pharmaceutical Inspection Convention and Pharmaceutical Inspection Co-operation Scheme
- PMD Act, Pharmaceuticals and Medical Devices Act
- PMDA, Pharmaceuticals and Medical Devices Agency
- Policy
- R&D, research and development
- RM Act, the Act on the Safety of Regenerative Medicine
- RMP, regenerative medicine product
- Regenerative medicine
- Regulation
- Riken CDB, Riken Center for Developmental Biology
- U.S., United States
- WHO, World Health Organization
- iPS cells
- iPSC, induced pluripotent stem cell
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Affiliation(s)
- Kentaro Azuma
- Center for iPS Cell Research and Application, Kyoto University, Kyoto 606-8507, Japan
| | - Shinya Yamanaka
- Center for iPS Cell Research and Application, Kyoto University, Kyoto 606-8507, Japan
- Gladstone Institute of Cardiovascular Disease, San Francisco, California 94158, USA
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30
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Hurdles in clinical implementation of academic advanced therapy medicinal products: A national evaluation. Cytotherapy 2016; 18:797-805. [DOI: 10.1016/j.jcyt.2016.02.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 02/16/2016] [Accepted: 02/22/2016] [Indexed: 11/17/2022]
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31
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Izeta A, Herrera C, Mata R, Astori G, Giordano R, Hernández C, Leyva L, Arias S, Oyonarte S, Carmona G, Cuende N. Cell-based product classification procedure: What can be done differently to improve decisions on borderline products? Cytotherapy 2016; 18:809-15. [PMID: 27209278 DOI: 10.1016/j.jcyt.2016.03.292] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 03/18/2016] [Indexed: 10/21/2022]
Abstract
In June 2015, European Medicines Agency/Committee for Advanced Therapies (CAT) released the new version of the reflection paper on classification of advanced therapy medicinal products (ATMPs) established to address questions of borderline cases in which classification of a product based on genes, cells or tissues is unclear. The paper shows CAT's understanding of substantial manipulation and essential function(s) criteria that define the legal scope of cell-based medicinal products. This article aims to define the authors' viewpoint on the reflection paper. ATMP classification has intrinsic weaknesses derived from the lack of clarity of the evolving concepts of substantial manipulation and essential function(s) as stated in the EU Regulation, leading to the risk of differing interpretations and misclassification. This might result in the broadening of ATMP scope at the expense of other products such as cell/tissue transplants and blood products, or even putting some present and future clinical practice at risk of being classified as ATMP. Because of the major organizational, economic and regulatory implications of product classification, we advocate for increased interaction between CAT and competent authorities (CAs) for medicines, blood and blood components and tissues and cells or for the creation of working groups including representatives of all parties as recently suggested by several CAs.
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Affiliation(s)
- Ander Izeta
- Tissue Engineering Laboratory, Bioengineering Area, Instituto Biodonostia, Hospital Universitario Donostia, San Sebastián, Spain
| | - Concha Herrera
- Cell and Gene Therapy Unit, Hospital Universitario Reina Sofía, IMIBIC, Universidad de Córdoba, GMP Network of the Andalusian Initiative for Advanced Therapies, Córdoba, Spain
| | - Rosario Mata
- Andalusian Initiative for Advanced Therapies, Junta de Andalucía, Sevilla, Spain
| | - Giuseppe Astori
- Advanced Cellular Therapy Laboratory, Department of Cellular Therapy and Hematology, San Bortolo Hospital, Vicenza, Italy
| | - Rosaria Giordano
- Cell Factory, Unit of Cell Therapy and Cryobiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Carmen Hernández
- Cell Therapy Unit, Blood Bank of Malaga, Servicio Andaluz de Salud, GMP Network of the Andalusian Initiative for Advanced Therapies, Málaga, Spain
| | - Laura Leyva
- Cell Therapy Unit, Hospital Universitario Regional de Málaga, IBIMA, GMP Network of the Andalusian Initiative for Advanced Therapies, Málaga, Spain
| | - Salvador Arias
- Cell Therapy and Tissue Engineering Unit, Complejo Hospitalario de Granada, GMP Network of the Andalusian Initiative for Advanced Therapies, Granada, Spain
| | - Salvador Oyonarte
- Cell Therapy Unit, Blood Bank of Seville, Servicio Andaluz de Salud, GMP Network of the Andalusian Initiative for Advanced Therapies, Sevilla, Spain
| | - Gloria Carmona
- Andalusian Initiative for Advanced Therapies, Junta de Andalucía, Sevilla, Spain; Cell Therapy and Cell Reprogramming Unit, Consejería de Salud, GMP Network of the Andalusian Initiative for Advanced Therapies, Seville, Spain
| | - Natividad Cuende
- Andalusian Initiative for Advanced Therapies, Junta de Andalucía, Sevilla, Spain; Andalusian Transplant Coordination, Servicio Andaluz de Salud, Sevilla, Spain.
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32
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Development of advanced therapies in Italy: Management models and sustainability in six Italian cell factories. Cytotherapy 2016; 18:481-6. [DOI: 10.1016/j.jcyt.2016.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 12/20/2015] [Accepted: 01/03/2016] [Indexed: 11/22/2022]
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33
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Nichols K, Janssen W, Wall D, Cuende N, Griffin D. Part 4: Interaction between unproven cellular therapies and global medicinal product approval regulatory frameworks. Cytotherapy 2016; 18:127-37. [DOI: 10.1016/j.jcyt.2015.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/03/2015] [Indexed: 11/29/2022]
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34
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Oliver-Vila I, van Deusen AL, Palau R, Vives J. Quality compliance in the development of cell-based medicines in non-pharma environments. BMC Proc 2015. [PMCID: PMC4685435 DOI: 10.1186/1753-6561-9-s9-p29] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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