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Riau AK, Look Z, Yam GHF, Boote C, Ma Q, Han EJY, Binte M Yusoff NZ, Ong HS, Goh TW, Binte Halim NSH, Mehta JS. Impact of keratocyte differentiation on corneal opacity resolution and visual function recovery in male rats. Nat Commun 2024; 15:4959. [PMID: 38862465 PMCID: PMC11166667 DOI: 10.1038/s41467-024-49008-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 05/17/2024] [Indexed: 06/13/2024] Open
Abstract
Intrastromal cell therapy utilizing quiescent corneal stromal keratocytes (qCSKs) from human donor corneas emerges as a promising treatment for corneal opacities, aiming to overcome limitations of traditional surgeries by reducing procedural complexity and donor dependency. This investigation demonstrates the therapeutic efficacy of qCSKs in a male rat model of corneal stromal opacity, underscoring the significance of cell-delivery quality and keratocyte differentiation in mediating corneal opacity resolution and visual function recovery. Quiescent CSKs-treated rats display improvements in escape latency and efficiency compared to wounded, non-treated rats in a Morris water maze, demonstrating improved visual acuity, while stromal fibroblasts-treated rats do not. Advanced imaging, including multiphoton microscopy, small-angle X-ray scattering, and transmission electron microscopy, revealed that qCSK therapy replicates the native cornea's collagen fibril morphometry, matrix order, and ultrastructural architecture. These findings, supported by the expression of keratan sulfate proteoglycans, validate qCSKs as a potential therapeutic solution for corneal opacities.
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Affiliation(s)
- Andri K Riau
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, 169856, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore, 169857, Singapore
| | - Zhuojian Look
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, 169856, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore, 169857, Singapore
| | - Gary H F Yam
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, 169856, Singapore
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Craig Boote
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, CF24 4HQ, UK
| | - Qian Ma
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, CF24 4HQ, UK
| | - Evelina J Y Han
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, 169856, Singapore
| | - Nur Zahirah Binte M Yusoff
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, 169856, Singapore
| | - Hon Shing Ong
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, 169856, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore, 169857, Singapore
- Corneal and External Eye Disease Department, Singapore National Eye Centre, Singapore, 168751, Singapore
| | - Tze-Wei Goh
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, 169856, Singapore
| | | | - Jodhbir S Mehta
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, 169856, Singapore.
- Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore, 169857, Singapore.
- Corneal and External Eye Disease Department, Singapore National Eye Centre, Singapore, 168751, Singapore.
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2
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Olry de Labry-Lima A, Ponce-Polo A, García-Mochón L, Ortega-Ortega M, Pérez-Troncoso D, Epstein D. Challenges for Economic Evaluations of Advanced Therapy Medicinal Products: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:138-150. [PMID: 36031480 DOI: 10.1016/j.jval.2022.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/20/2022] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Advanced therapy medicinal products (ATMPs) are drugs for human use for the treatment of chronic, degenerative, or life-threatening diseases that are based on genes, tissues, or cells. This article aimed to identify and critically review published economic analyses of ATMPs. METHODS A systematic review of economic analyses of ATMPs was undertaken. Study characteristics, design, sources of data, resources and unit costs, modeling and extrapolation methods, study results, and sensitivity analyses were assessed. RESULTS A total of 46 economic analyses of ATMP (from 45 articles) were included; 4 were cell therapy medicinal products, 33 gene therapy medicinal products, and 9 tissue-engineered products. 30 therapies had commercial marketing approval; 39 studies were cost-utility analysis, 5 were cost-effectiveness analysis, and 2 were cost only studies. Four studies predicted that the ATMP offered a step change in the management of the condition and 10 studies estimated that the ATMP would offer a lower mean cost. CONCLUSIONS Comparison with historical controls, pooling of data, and use of techniques such as mixture cure fraction models should be used cautiously. Sensitivity analyses should be used across a plausible range of prices. Clinical studies need to be designed to align with health technology assessment requirements, including generic quality of life, and payers should aim for clarity of criteria. Regulators and national payers should aim for compatibility of registers to allow interchange of data. Given the increasing reliance on industry-funded economic analyses, careful critical review is recommended.
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Affiliation(s)
- Antonio Olry de Labry-Lima
- Escuela Andaluza de Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria Ibs, Granada, Spain; CIBER en Epidemiología and Salud Pública (CIBERESP), Spain
| | - Angela Ponce-Polo
- Andalusian Network for the Design & Translation of Advanced Therapies, Sevilla, Spain.
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3
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Starr NC, Creel L, Harryman C, Gupta N. Cost Utility Analysis of Costal Cartilage Autografts and Human Cadaveric Allografts in Rhinoplasty. Ann Otol Rhinol Laryngol 2021; 131:1123-1129. [PMID: 34779266 DOI: 10.1177/00034894211058115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Human cadaveric allograft (HCA) and costal cartilage autograft (CCA) have been described for reconstruction during rhinoplasty. Neither are ideal due to infection, resorption, and donor site morbidity. The clear superiority of 1 graft over the other has not yet been demonstrated. This study assesses comparative costs associated with current grafting materials to better explore the cost ceiling for a theoretical tissue engineered implant. MATERIALS AND METHODS A cost utility analysis was performed. Initial procedure costs include physician fees (CPT 30420), hospital outpatient prospective payments, ambulatory surgical center payments, and fees for the following: rib graft (CPT 20910), hospital observation, and DRG (155) for inpatient admission. Additional costs for revision procedure, included the following fees: physician (CPT 30345), rib graft, hospital outpatient prospective payment, and ambulatory surgical center payments. Total costs under each scenario were calculated with and without the revision procedure. Comparison of total costs for each potential outcome to the estimated health utility value allowed for comparison across rhinoplasty subgroups. RESULTS The mean cost of primary outpatient rhinoplasty using HCA and CCA were $8075 and $8342 respectively. Revision outpatient rhinoplasty averaged $7447 and increased to $8228 if costal cartilage harvest was required. Hospital admission increased the cost of primary rhinoplasty with CCA to $8609 for observational admission and to $13653 for 1 day inpatient admission. Revision CCA rhinoplasty with an inpatient admission complicated by pneumothorax increased costs to $21 099. CONCLUSION Cost of rhinoplasty without hospitalization was similar between HCA and CCA and this cost represents the lower limit of a practical cost for an engineered graft. Considering complications such as need for revision or for admission after CCA due to surgical morbidity, the upper limit of cost for an engineered implant would approximately double.
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Affiliation(s)
- Nicole C Starr
- Department of Otolaryngology Head and Neck Surgery, University of Kentucky, Lexington, KY, USA
| | - Liza Creel
- School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA
| | - Christopher Harryman
- Department of Otolaryngology Head and Neck Surgery, University of Kentucky, Lexington, KY, USA
| | - Nikita Gupta
- Department of Otolaryngology Head and Neck Surgery, University of Kentucky, Lexington, KY, USA
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4
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Poudel BK, Robert MC, Simpson FC, Malhotra K, Jacques L, LaBarre P, Griffith M. In situ Tissue Regeneration in the Cornea from Bench to Bedside. Cells Tissues Organs 2021; 211:506-526. [PMID: 34380144 DOI: 10.1159/000514690] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/22/2021] [Indexed: 11/19/2022] Open
Abstract
Corneal blindness accounts for 5.1% of visual deficiency and is the fourth leading cause of blindness globally. An additional 1.5-2 million people develop corneal blindness each year, including many children born with or who later develop corneal infections. Over 90% of corneal blind people globally live in low- and middle-income regions (LMIRs), where corneal ulcers are approximately 10-fold higher compared to high-income countries. While corneal transplantation is an effective option for patients in high-income countries, there is a considerable global shortage of corneal graft tissue and limited corneal transplant programs in many LMIRs. In situ tissue regeneration aims to restore diseases or damaged tissues by inducing organ regeneration. This can be achieved in the cornea using biomaterials based on extracellular matrix (ECM) components like collagen, hyaluronic acid, and silk. Solid corneal implants based on recombinant human collagen type III were successfully implanted into patients resulting in regeneration of the corneal epithelium, stroma, and sub-basal nerve plexus. As ECM crosslinking and manufacturing methods improve, the focus of biomaterial development has shifted to injectable, in situ gelling formulations. Collagen, collagen-mimetic, and gelatin-based in situ gelling formulas have shown the ability to repair corneal wounds, surgical incisions, and perforations in in-vivo models. Biomaterial approaches may not be sufficient to treat inflammatory conditions, so other cell-free therapies such as treatment with tolerogenic exosomes and extracellular vesicles may improve treatment outcomes. Overall, many of the technologies described here show promise as future medical devices or combination products with cell or drug-based therapies. In situ tissue regeneration, particularly with liquid formulas, offers the ability to triage and treat corneal injuries and disease with a single regenerative solution, providing alternatives to organ transplantation and improving patient outcomes.
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Affiliation(s)
- Bijay K Poudel
- Département d'Ophtalmologie, Université de Montréal, Montréal, Québec, Canada.,Centre de Recherche, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
| | - Marie-Claude Robert
- Département d'Ophtalmologie, Université de Montréal, Montréal, Québec, Canada.,Centre de Recherche, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada.,Département d'Opthalmologie, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Fiona C Simpson
- Département d'Ophtalmologie, Université de Montréal, Montréal, Québec, Canada.,Centre de Recherche, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada.,Département d'Opthalmologie, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Institut du Génie Biomédicale, Université de Montréal, Montréal, Québec, Canada
| | - Kamal Malhotra
- Département d'Ophtalmologie, Université de Montréal, Montréal, Québec, Canada.,Centre de Recherche, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada.,Département d'Opthalmologie, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Ludovic Jacques
- Département d'Ophtalmologie, Université de Montréal, Montréal, Québec, Canada.,Centre de Recherche, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
| | | | - May Griffith
- Département d'Ophtalmologie, Université de Montréal, Montréal, Québec, Canada.,Centre de Recherche, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada.,Département d'Opthalmologie, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada.,Institut du Génie Biomédicale, Université de Montréal, Montréal, Québec, Canada
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5
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Ting DSJ, Peh GSL, Adnan K, Mehta JS. Translational and Regulatory Challenges of Corneal Endothelial Cell Therapy: A Global Perspective. TISSUE ENGINEERING PART B-REVIEWS 2021; 28:52-62. [PMID: 33267724 DOI: 10.1089/ten.teb.2020.0319] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cell therapies are emerging as a unique class of clinical therapeutics in medicine. In 2015, Holoclar (ex vivo expanded autologous human corneal epithelial cells containing stem cells) gained the regulatory approval for treating limbal stem cell deficiency after chemical eye burn. This has set a precedent in ophthalmology and in medicine, reinforcing the therapeutic promise of cell therapy. However, to generalize and commercialize cell therapies on a global scale, stringent translational and regulatory requirements need to be fulfilled at both local and international levels. Over the past decade, the Singapore group has taken significant steps in developing human corneal endothelial cell (HCEnC) therapy for treating corneal endothelial diseases, which are currently the leading indication for corneal transplantation in many countries. Successful development of HCEnC therapy may serve as a novel solution to the current global shortage of donor corneas. Based on the experience in Singapore, this review aims to provide a global perspective on the translational and regulatory challenges for bench-to-bedside translation of cell therapy. Specifically, we discussed about the characterization of the critical quality attributes (CQA), the challenges that can affect the CQA, and the variations in the regulatory framework embedded within different regions, including Singapore, Europe, and the United States. Impact statement Functional corneal endothelium is critical to normal vision. Corneal endothelial disease-secondary to trauma, surgery, or pathology-represents an important cause of visual impairment and blindness in both developed and developing countries. Currently, corneal transplantation serves as the current gold standard for treating visually significant corneal endothelial diseases, although limited by the shortage of donor corneas. Over the past decade, human corneal endothelial cell therapy has emerged as a promising treatment option for treating corneal endothelial diseases. To allow widespread application of this therapy, significant regulatory challenges will need to be systematically overcome.
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Affiliation(s)
- Darren Shu Jeng Ting
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Department of Ophthalmology, Queen's Medical Centre, Nottingham, United Kingdom.,Singapore Eye Research Institute, Singapore, Singapore
| | - Gary S L Peh
- Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore, Singapore
| | | | - Jodhbir S Mehta
- Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore, Singapore.,Schools of Material Science and Engineering, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
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6
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Huygens SA, Ramos IC, Bouten CVC, Kluin J, Chiu ST, Grunkemeier GL, Takkenberg JJM, Rutten-van Mölken MPMH. Early cost-utility analysis of tissue-engineered heart valves compared to bioprostheses in the aortic position in elderly patients. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:557-572. [PMID: 31982976 PMCID: PMC7214484 DOI: 10.1007/s10198-020-01159-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 01/07/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Aortic valve disease is the most frequent indication for heart valve replacement with the highest prevalence in elderly. Tissue-engineered heart valves (TEHV) are foreseen to have important advantages over currently used bioprosthetic heart valve substitutes, most importantly reducing valve degeneration with subsequent reduction of re-intervention. We performed early Health Technology Assessment of hypothetical TEHV in elderly patients (≥ 70 years) requiring surgical (SAVR) or transcatheter aortic valve implantation (TAVI) to assess the potential of TEHV and to inform future development decisions. METHODS Using a patient-level simulation model, the potential cost-effectiveness of TEHV compared with bioprostheses was predicted from a societal perspective. Anticipated, but currently hypothetical improvements in performance of TEHV, divided in durability, thrombogenicity, and infection resistance, were explored in scenario analyses to estimate quality-adjusted life-year (QALY) gain, cost reduction, headroom, and budget impact. RESULTS Durability of TEHV had the highest impact on QALY gain and costs, followed by infection resistance. Improved TEHV performance (- 50% prosthetic valve-related events) resulted in lifetime QALY gains of 0.131 and 0.043, lifetime cost reductions of €639 and €368, translating to headrooms of €3255 and €2498 per hypothetical TEHV compared to SAVR and TAVI, respectively. National savings in the first decade after implementation varied between €2.8 and €11.2 million (SAVR) and €3.2-€12.8 million (TAVI) for TEHV substitution rates of 25-100%. CONCLUSIONS Despite the relatively short life expectancy of elderly patients undergoing SAVR/TAVI, hypothetical TEHV are predicted to be cost-effective compared to bioprostheses, commercially viable and result in national cost savings when biomedical engineers succeed in realising improved durability and/or infection resistance of TEHV.
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Affiliation(s)
- Simone A Huygens
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
- Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.
| | - Isaac Corro Ramos
- Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands
| | - Carlijn V C Bouten
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Jolanda Kluin
- Department of Cardio-Thoracic Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - Shih Ting Chiu
- Medical Data Research Centre, Providence Health and Service, Portland, OR, USA
| | - Gary L Grunkemeier
- Medical Data Research Centre, Providence Health and Service, Portland, OR, USA
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Maureen P M H Rutten-van Mölken
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
- Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands
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7
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Wahlig S, Peh GSL, Adnan K, Ang HP, Lwin CN, Morales-Wong F, Ong HS, Lovatt M, Mehta JS. Optimisation of Storage and Transportation Conditions of Cultured Corneal Endothelial Cells for Cell Replacement Therapy. Sci Rep 2020; 10:1681. [PMID: 32015414 PMCID: PMC6997453 DOI: 10.1038/s41598-020-58700-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/20/2020] [Indexed: 12/29/2022] Open
Abstract
As the cornea is one of the most transplanted tissues in the body it has placed a burden on the provision of corneas from cadaveric donors. Corneal endothelial dysfunction is the leading indication for cornea transplant. Therefore, tissue engineering is emerging as an alternative approach to overcome the global shortage of transplant-grade corneas. The propagation and expansion of corneal endothelial cells has been widely reported. However, one obstacle to overcome is the transport and storage of corneal endothelial cells. In this study we investigated whether tissue engineered corneal endothelial cells can be preserved in hypothermic conditions. Human corneal endothelial cells (HCEnCs) were exposed to various temperatures (4 °C, 23 °C, and 37 °C) in both adherent and suspension storage models. Optimal storage media and storage duration was tested along with post-storage viability. Following storage and subsequent recovery at 37 °C, cell phenotype was assessed by immunofluorescence, gene and protein expression, and proliferative capacity analysis. Functionality was also assessed within a rabbit model of bullous keratopathy. Our data support our hypothesis that functional HCEnCs can be preserved in hypothermic conditions.
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Affiliation(s)
- Stephen Wahlig
- Duke University School of Medicine, Durham, NC, USA.,Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Gary S L Peh
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Khadijah Adnan
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Heng-Pei Ang
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Chan N Lwin
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore
| | - F Morales-Wong
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore.,Singapore National Eye Centre, Singapore, Singapore.,Autonomous University of Nuevo Leon (UANL), University Hospital, Monterrey, Mexico
| | - Hon Shing Ong
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore, Singapore.,Singapore National Eye Centre, Singapore, Singapore
| | - Matthew Lovatt
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore. .,Duke-NUS Graduate Medical School, Singapore, Singapore.
| | - Jodhbir S Mehta
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore. .,Duke-NUS Graduate Medical School, Singapore, Singapore. .,Singapore National Eye Centre, Singapore, Singapore. .,School of Material Science and Engineering, Nanyang Technological University, Singapore, Singapore.
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8
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Peh GSL, Ong HS, Adnan K, Ang HP, Lwin CN, Seah XY, Lin SJ, Mehta JS. Functional Evaluation of Two Corneal Endothelial Cell-Based Therapies: Tissue-Engineered Construct and Cell Injection. Sci Rep 2019; 9:6087. [PMID: 30988373 PMCID: PMC6465252 DOI: 10.1038/s41598-019-42493-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 04/02/2019] [Indexed: 12/26/2022] Open
Abstract
Restoration of vision due to corneal blindness from corneal endothelial dysfunction can be achieved via a corneal transplantation. However, global shortage of donor tissues has driven the development cell-based therapeutics. With the capacity to propagate regulatory compliant human corneal endothelial cells (CEnCs), this study evaluated the functionality of propagated CEnCs delivered via tissue-engineered endothelial keratoplasty (TE-EK) or corneal endothelial cell injection (CE-CI) within a rabbit model of bullous keratopathy. For animals with TE-EK grafts, central corneal thickness (CCT) increased to >1000 μm post-operatively. Gradual thinning with improvements in corneal clarity was observed from week 1. CCT at week 3 was 484.3 ± 73.7 μm. In rabbits with CE-CI, corneal clarity was maintained throughout, and CCT at week 3 was 582.5 ± 171.5 μm. Control corneas remained significantly edematous throughout the study period compared to their respective experimental groups (p < 0.05). Characterization of excised corneas showed a monolayer with heterogeneously shaped CEnCs in both TE-EK and CE-CI groups. Immunohistochemistry demonstrated reactivity to anti-human specific nuclei antibody attributing corneal recovery to the functional human CEnCs. This study showed that regulatory compliant cell-based therapy for corneal endothelial dysfunction can be delivered by both TE-EK and CE-CI, and holds great promise as an alternative to traditional corneal transplantation.
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Affiliation(s)
- Gary S L Peh
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore. .,Duke-NUS Graduate Medical School, Singapore, Singapore.
| | - Hon Shing Ong
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore.,Singapore National Eye Centre, Singapore, Singapore
| | - Khadijah Adnan
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Heng-Pei Ang
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Chan N Lwin
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Xin-Yi Seah
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Shu-Jun Lin
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Jodhbir S Mehta
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore. .,Duke-NUS Graduate Medical School, Singapore, Singapore. .,Singapore National Eye Centre, Singapore, Singapore. .,School of Material Science and Engineering, Nanyang Technological University, Singapore, Singapore.
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9
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Ng KS, Smith JA, McAteer MP, Mead BE, Ware J, Jackson FO, Carter A, Ferreira L, Bure K, Rowley JA, Reeve B, Brindley DA, Karp JM. Bioprocess decision support tool for scalable manufacture of extracellular vesicles. Biotechnol Bioeng 2018; 116:307-319. [PMID: 30063243 PMCID: PMC6322973 DOI: 10.1002/bit.26809] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 07/22/2018] [Accepted: 07/26/2018] [Indexed: 12/28/2022]
Abstract
Newly recognized as natural nanocarriers that deliver biological information between cells, extracellular vesicles (EVs), including exosomes and microvesicles, provide unprecedented therapeutic opportunities. Large-scale and cost-effective manufacturing is imperative for EV products to meet commercial and clinical demands; successful translation requires careful decisions that minimize financial and technological risks. Here, we develop a decision support tool (DST) that computes the most cost-effective technologies for manufacturing EVs at different scales, by examining the costs of goods associated with using published protocols. The DST identifies costs of labor and consumables during EV harvest as key cost drivers, substantiating a need for larger-scale, higher-throughput, and automated technologies for harvesting EVs. Importantly, we highlight a lack of appropriate technologies for meeting clinical demands, and propose a potentially cost-effective solution. This DST can facilitate decision-making very early on in development and be used to predict, and better manage, the risk of process changes when commercializing EV products.
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Affiliation(s)
- Kelvin S Ng
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts.,Division of Engineering in Medicine, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA.,Harvard Stem Cell Institute, Cambridge, Massachusetts.,RoosterBio, Frederick, Maryland
| | - James A Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,The Oxford-UCL Centre for the Advancement of Sustainable Medical Innovation, University of Oxford, Oxford, UK
| | - Matthew P McAteer
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts
| | - Benjamin E Mead
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts.,Division of Engineering in Medicine, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA.,Harvard Stem Cell Institute, Cambridge, Massachusetts.,Broad Institute of Harvard and MIT, Cambridge, Massachusetts.,Koch Institute for Integrative Cancer Research, MIT, Cambridge, Massachusetts
| | - Jamie Ware
- The Oxford-UCL Centre for the Advancement of Sustainable Medical Innovation, University of Oxford, Oxford, UK
| | - Felix O Jackson
- The Oxford-UCL Centre for the Advancement of Sustainable Medical Innovation, University of Oxford, Oxford, UK
| | - Alison Carter
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Lino Ferreira
- University of Coimbra, Center for Neuroscience and Cell Biology, Portugal
| | - Kim Bure
- The Oxford-UCL Centre for the Advancement of Sustainable Medical Innovation, University of Oxford, Oxford, UK
| | | | - Brock Reeve
- Harvard Stem Cell Institute, Cambridge, Massachusetts
| | - David A Brindley
- Harvard Stem Cell Institute, Cambridge, Massachusetts.,The Oxford-UCL Centre for the Advancement of Sustainable Medical Innovation, University of Oxford, Oxford, UK.,Department of Paediatrics, University of Oxford, Oxford, UK.,Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, London, UK.,UCSF-Stanford Center of Excellence in Regulatory Science and Innovation, San Francisco, California
| | - Jeffrey M Karp
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts.,Division of Engineering in Medicine, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA.,Harvard Stem Cell Institute, Cambridge, Massachusetts.,Broad Institute of Harvard and MIT, Cambridge, Massachusetts
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10
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Abstract
Human-induced pluripotent stem cells (hiPSCs) provide a personalized approach to study conditions and diseases including those of the eye that lack appropriate animal models to facilitate the development of novel therapeutics. Corneal disease is one of the most common causes of blindness. Hence, significant efforts are made to develop novel therapeutic approaches including stem cell-derived strategies to replace the diseased or damaged corneal tissues, thus restoring the vision. The use of adult limbal stem cells in the management of corneal conditions has been clinically successful. However, its limited availability and phenotypic plasticity necessitate the need for alternative stem cell sources to manage corneal conditions. Mesenchymal and embryonic stem cell-based approaches are being explored; nevertheless, their limited differentiation potential and ethical concerns have posed a significant hurdle in its clinical use. hiPSCs have emerged to fill these technical and ethical gaps to render clinical utility. In this review, we discuss and summarize protocols that have been devised so far to direct differentiation of human pluripotent stem cells (hPSCs) to different corneal cell phenotypes. With the summarization, our review intends to facilitate an understanding which would allow developing efficient and robust protocols to obtain specific corneal cell phenotype from hPSCs for corneal disease modeling and for the clinics to treat corneal diseases and injury.
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Affiliation(s)
| | - Rohit Shetty
- Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, India
| | - Arkasubhra Ghosh
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bengaluru, India
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Brunette I, Roberts CJ, Vidal F, Harissi-Dagher M, Lachaine J, Sheardown H, Durr GM, Proulx S, Griffith M. Alternatives to eye bank native tissue for corneal stromal replacement. Prog Retin Eye Res 2017; 59:97-130. [DOI: 10.1016/j.preteyeres.2017.04.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 04/15/2017] [Accepted: 04/21/2017] [Indexed: 12/13/2022]
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Bostan C, Thériault M, Forget KJ, Doyon C, Cameron JD, Proulx S, Brunette I. In Vivo Functionality of a Corneal Endothelium Transplanted by Cell-Injection Therapy in a Feline Model. Invest Ophthalmol Vis Sci 2016; 57:1620-34. [PMID: 27046125 PMCID: PMC4824382 DOI: 10.1167/iovs.15-17625] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To evaluate the functionality of a corneal endothelium reconstituted by injection of corneal endothelial cells (CEC) in the anterior chamber of a feline model. METHODS We operated the right eyes of 16 animals. Eight underwent central endothelial scraping and injection with 2 × 10(5) (n = 4) or 1 × 10(6) (n = 4) feline CEC supplemented with Y-27632 and labeled with 3,3'-Dioctadecyl-5,5'-Di(4-Sulfophenyl)Oxacarbocyanine (SP-DiOC18[3] or DiOC). After total endothelial scraping, two eyes were injected with 1 × 10(6) labeled CEC and Y-27632. The central (n = 3) or entire (n = 3) endothelium was scraped in six eyes followed by Y-27632 injection without CEC. Subjects were positioned eyes down for 3 hours. Outcomes included graft transparency, pachymetry, CEC morphometry, histology, electron microscopy, and function and wound healing-related protein immunostaining. RESULTS Postoperatively, corneas grafted with 2 × 10(5) CEC and centrally scraped controls displayed the best transparency and pachymetry. Corneas grafted with 1 × 10(6) CEC yielded intermediate results. Entirely scraped controls remained hazy and thick. Histopathology revealed a confluent endothelial monolayer expressing sodium-potassium adenosine triphosphatase (Na(+)/K(+)-ATPase) and zonula occludens-1 (ZO-1) in corneas grafted with 2 × 10(5) CEC and centrally scraped controls, a nonuniform endothelial multilayer without expression of functional proteins in centrally scraped corneas grafted with 1 × 10(6) CEC, and a nonfunctional fibrotic endothelium in entirely scraped grafts and controls. Expression of DiOC in grafts was scarce. CONCLUSIONS Injected CEC contributed little to the incompletely functional endothelium of grafted corneas. Y-27632 injection without CEC following scraping reconstituted the healthiest endothelium. Further studies investigating the therapeutic effect of Y-27632 alone are needed to validate these conclusions.
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Affiliation(s)
- Cristina Bostan
- Maisonneuve-Rosemont Hospital Research Center, Montreal, Quebec, Canada 2Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
| | - Mathieu Thériault
- Centre d'organogénèse expérimentale de l'Université Laval/LOEX, Québec City, Quebec, Canada, and Centre de recherche du CHU de Québec-UL, Axe Médecine régénératrice, Québec City, Quebec, Canada
| | - Karolyn J Forget
- Maisonneuve-Rosemont Hospital Research Center, Montreal, Quebec, Canada
| | - Christelle Doyon
- Maisonneuve-Rosemont Hospital Research Center, Montreal, Quebec, Canada 2Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
| | - J Douglas Cameron
- Ophthalmology and Visual Neurosciences and Laboratory Medicine and Pathology, University of Minnesota School of Medicine, Minneapolis, Minnesota, United States
| | - Stéphanie Proulx
- Centre d'organogénèse expérimentale de l'Université Laval/LOEX, Québec City, Quebec, Canada, and Centre de recherche du CHU de Québec-UL, Axe Médecine régénératrice, Québec City, Quebec, Canada 5Department of Ophthalmology and ENT-Head and Neck Surgery, U
| | - Isabelle Brunette
- Maisonneuve-Rosemont Hospital Research Center, Montreal, Quebec, Canada 2Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
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Soh YQ, Peh GSL, Mehta JS. Translational issues for human corneal endothelial tissue engineering. J Tissue Eng Regen Med 2016; 11:2425-2442. [DOI: 10.1002/term.2131] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/19/2015] [Accepted: 12/10/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Yu Qiang Soh
- Tissue Engineering and Stem Cell Group; Singapore Eye Research Institute; Singapore
- Singapore National Eye Centre; Singapore
| | - Gary S. L. Peh
- Tissue Engineering and Stem Cell Group; Singapore Eye Research Institute; Singapore
- Ophthalmology Academic Clinical Programme; Duke-NUS Graduate Medical School; Singapore
| | - Jodhbir S. Mehta
- Tissue Engineering and Stem Cell Group; Singapore Eye Research Institute; Singapore
- Singapore National Eye Centre; Singapore
- Ophthalmology Academic Clinical Programme; Duke-NUS Graduate Medical School; Singapore
- Department of Clinical Sciences; Duke-NUS Graduate Medical School; Singapore
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Nowakowski A, Walczak P, Janowski M, Lukomska B. Genetic Engineering of Mesenchymal Stem Cells for Regenerative Medicine. Stem Cells Dev 2015; 24:2219-42. [PMID: 26140302 DOI: 10.1089/scd.2015.0062] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Mesenchymal stem cells (MSCs), which can be obtained from various organs and easily propagated in vitro, are one of the most extensively used types of stem cells and have been shown to be efficacious in a broad set of diseases. The unique and highly desirable properties of MSCs include high migratory capacities toward injured areas, immunomodulatory features, and the natural ability to differentiate into connective tissue phenotypes. These phenotypes include bone and cartilage, and these properties predispose MSCs to be therapeutically useful. In addition, MSCs elicit their therapeutic effects by paracrine actions, in which the metabolism of target tissues is modulated. Genetic engineering methods can greatly amplify these properties and broaden the therapeutic capabilities of MSCs, including transdifferentiation toward diverse cell lineages. However, cell engineering can also affect safety and increase the cost of therapy based on MSCs; thus, the advantages and disadvantages of these procedures should be discussed. In this review, the latest applications of genetic engineering methods for MSCs with regenerative medicine purposes are presented.
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Affiliation(s)
- Adam Nowakowski
- 1 NeuroRepair Department, Mossakowski Medical Research Centre, Polish Academy of Sciences , Warsaw, Poland
| | - Piotr Walczak
- 2 Division of Magnetic Resonance Research, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine , Baltimore, Maryland.,3 Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering, The Johns Hopkins University School of Medicine , Baltimore, Maryland.,4 Department of Radiology, Faculty of Medical Sciences, University of Warmia and Mazury , Olsztyn, Poland
| | - Miroslaw Janowski
- 1 NeuroRepair Department, Mossakowski Medical Research Centre, Polish Academy of Sciences , Warsaw, Poland .,2 Division of Magnetic Resonance Research, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine , Baltimore, Maryland.,3 Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Barbara Lukomska
- 1 NeuroRepair Department, Mossakowski Medical Research Centre, Polish Academy of Sciences , Warsaw, Poland
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Muhammad R, Peh GS, Adnan K, Law JB, Mehta JS, Yim EK. Micro- and nano-topography to enhance proliferation and sustain functional markers of donor-derived primary human corneal endothelial cells. Acta Biomater 2015; 19:138-48. [PMID: 25796353 DOI: 10.1016/j.actbio.2015.03.016] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 02/10/2015] [Accepted: 03/12/2015] [Indexed: 12/13/2022]
Abstract
One of the most common indications for corneal transplantation is corneal endothelium dysfunction, which can lead to corneal blindness. Due to a worldwide donor cornea shortage, alternative treatments are needed, but the development of new treatment strategies relies on the successful in vitro culture of primary human corneal endothelial cells (HCECs) because transformed cell lines and animal-derived corneal endothelial cells are not desirable for therapeutic applications. Primary HCECs are non-proliferative in vivo and challenging to expand in vitro while maintaining their characteristic cell morphology and critical markers. Biochemical cues such as growth factors and small molecules have been investigated to enhance the expansion of HCECs with a limited increase in proliferation. In this study, patterned tissue culture polystyrene (TCPS) was shown to significantly enhance the expansion of HCECs. The proliferation of HCECs increased up to 2.9-fold, and the expression amount and localization of cell-cell tight junction protein Zona Occludens-1 (ZO-1) was significantly enhanced when grown on 1 μm TCPS pillars. 250 nm pillars induced an optimal hexagonal morphology of HCEC cells. Furthermore, we demonstrated that the topographical effect on tight-junction expression and cell morphology could be maintained throughout each passage, and was effectively 'remembered' by the cells. Higher amount of tight-junction protein expression was maintained at cell junctions when topographic cues were removed in the successive seeding. This topographic memory suggested topography-exposed/induced cells would maintain the enhanced functional markers, which would be useful in cell-therapy based approaches to enable the in situ endothelial cell monolayer formation upon delivery. The development of patterned TCPS culture platforms could significantly benefit those researching human corneal endothelial cell cultivation for cell therapy, and tissue engineering applications.
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The effects of Rho-associated kinase inhibitor Y-27632 on primary human corneal endothelial cells propagated using a dual media approach. Sci Rep 2015; 5:9167. [PMID: 25823914 PMCID: PMC4387913 DOI: 10.1038/srep09167] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 02/23/2015] [Indexed: 12/13/2022] Open
Abstract
The global shortage of donor corneas has garnered extensive interest in the development of graft alternatives suitable for endothelial keratoplasty using cultivated primary human corneal endothelial cells (CECs). We have recently described a dual media approach for the propagation of human CECs. In this work, we characterize the effects of a Rho-kinase inhibitor Y-27632 on the cultivation of CECs propagated using the dual media culture system. Seventy donor corneas deemed unsuitable for transplantation were procured for this study. We assessed the use of Y-27632 for its effect at each stage of the cell culture process, specifically for cell attachment, cell proliferation, and during both regular passaging and cryopreservation. Lastly, comparison of donor-matched CEC-cultures expanded with or without Y-27632 was also performed. Our results showed that Y-27632 significantly improved the attachment and proliferation of primary CECs. A non-significant pro-survival effect was detected during regular cellular passage when CECs were pre-treated with Y-27632, an effect that became more evident during cryopreservation. Our study showed that the inclusion of Y-27632 was beneficial for the propagation of primary CECs expanded via the dual media approach, and was able to increase overall cell yield by between 1.96 to 3.36 fold.
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Tan TE, Peh GSL, Finkelstein EA, Mehta JS. A practical model for economic evaluation of tissue-engineered therapies. WILEY INTERDISCIPLINARY REVIEWS-SYSTEMS BIOLOGY AND MEDICINE 2015; 7:91-100. [PMID: 25689271 DOI: 10.1002/wsbm.1292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 12/28/2014] [Accepted: 01/05/2015] [Indexed: 11/06/2022]
Abstract
UNLABELLED Tissue-engineered therapies are being developed across virtually all fields of medicine. Some of these therapies are already in clinical use, while others are still in clinical trials or the experimental phase. Most initial studies in the evaluation of new therapies focus on demonstration of clinical efficacy. However, cost considerations or economic viability are just as important. Many tissue-engineered therapies have failed to be impactful because of shortcomings in economic competitiveness, rather than clinical efficacy. Furthermore, such economic viability studies should be performed early in the process of development, before significant investment has been made. Cost-minimization analysis combined with sensitivity analysis is a useful model for the economic evaluation of new tissue-engineered therapies. The analysis can be performed early in the development process, and can provide valuable information to guide further investment and research. The utility of the model is illustrated with the practical real-world example of tissue-engineered constructs for corneal endothelial transplantation. CONFLICT OF INTEREST The authors have declared no conflicts of interest for this article.
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Affiliation(s)
- Tien-En Tan
- Singapore National Eye Centre, Singapore, Singapore
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