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Kirthiga Devi SS, Joga R, Srivastava S, Nagpal K, Dhamija I, Grover P, Kumar S. Regulatory landscape and challenges in CAR-T cell therapy development in the US, EU, Japan, and India. Eur J Pharm Biopharm 2024:114361. [PMID: 38871092 DOI: 10.1016/j.ejpb.2024.114361] [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: 01/30/2024] [Revised: 06/02/2024] [Accepted: 06/10/2024] [Indexed: 06/15/2024]
Abstract
Chimeric Antigen Receptor-T cell (CAR-T) therapy has evolved as a revolutionary cancer treatment modality, offering remarkable clinical responses by harnessing the power of a patient's immune system to target and eliminate cancer cells. However, the development and commercialization of CAR-T cell therapies are accompanied by complex regulatory requirements and challenges. This therapy falls under the regulatory category of advanced therapy medicinal products. The regulatory framework and approval tools of regenerative medicine, especially CAR-T cell therapies, vary globally. The present work comprehensively analyses the regulatory landscape and challenges in CAR-T cell therapy development in four key regions: the United States, the European Union, Japan, and India. This work explores the unique requirements and considerations for preclinical studies, clinical trial design, manufacturing standards, safety evaluation, and post-marketing surveillance in each jurisdiction. Due to their complex nature, developers and manufacturers face several challenges. In India, despite advancements in treatment protocols and government-sponsorships, there are still several difficulties regarding access to treatment for the increasing number of cancer patients. However, India's first indigenously developed CAR-T cell therapy, NexCAR19, for B-cell lymphoma or leukemia, approved and available at a low cost compared to other available CAR-T therapies, raises great hope in the battle against cancer. Several strategies are proposed to address the identified hurdles from global and Indian perspectives. It discusses the benefits of aligning regulatory requirements across regions, eventually facilitating international development and enabling access to this transformative therapy.
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Affiliation(s)
- S S Kirthiga Devi
- Department of Regulatory Affairs, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana 500037, India
| | - Ramesh Joga
- Department of Regulatory Affairs, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana 500037, India
| | - Saurabh Srivastava
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, Telangana 500037, India
| | - Kalpana Nagpal
- Amity Institute of Pharmacy, Amity University, Noida, Uttar Pradesh 201303, India
| | - Isha Dhamija
- Department of Pharmacology, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, Telangana 500037, India
| | - Parul Grover
- KIET School of Pharmacy, KIET Group of Institutions, Delhi-NCR, Ghaziabad 201206, India
| | - Sandeep Kumar
- Department of Pharmaceutics, NIMS Institute of Pharmacy, NIMS University Rajasthan, Jaipur, Rajasthan 303121, India.
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Okumura N, Nishikawa T, Imafuku C, Matsuoka Y, Miyawaki Y, Kadowaki S, Nakahara M, Matsuoka Y, Koizumi N. U-Net Convolutional Neural Network for Real-Time Prediction of the Number of Cultured Corneal Endothelial Cells for Cellular Therapy. Bioengineering (Basel) 2024; 11:71. [PMID: 38247948 PMCID: PMC10813389 DOI: 10.3390/bioengineering11010071] [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: 12/29/2023] [Accepted: 01/08/2024] [Indexed: 01/23/2024] Open
Abstract
Corneal endothelial decompensation is treated by the corneal transplantation of donor corneas, but donor shortages and other problems associated with corneal transplantation have prompted investigations into tissue engineering therapies. For clinical use, cells used in tissue engineering must undergo strict quality control to ensure their safety and efficacy. In addition, efficient cell manufacturing processes are needed to make cell therapy a sustainable standard procedure with an acceptable economic burden. In this study, we obtained 3098 phase contrast images of cultured human corneal endothelial cells (HCECs). We labeled the images using semi-supervised learning and then trained a model that predicted the cell centers with a precision of 95.1%, a recall of 92.3%, and an F-value of 93.4%. The cell density calculated by the model showed a very strong correlation with the ground truth (Pearson's correlation coefficient = 0.97, p value = 8.10 × 10-52). The total cell numbers calculated by our model based on phase contrast images were close to the numbers calculated using a hemocytometer through passages 1 to 4. Our findings confirm the feasibility of using artificial intelligence-assisted quality control assessments in the field of regenerative medicine.
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Affiliation(s)
- Naoki Okumura
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, 1-3 Miyakodani, Tatara, Kyotanabe-City 610-0394, Kyoto, Japan; (T.N.); (Y.M.); (Y.M.); (S.K.); (N.K.)
| | - Takeru Nishikawa
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, 1-3 Miyakodani, Tatara, Kyotanabe-City 610-0394, Kyoto, Japan; (T.N.); (Y.M.); (Y.M.); (S.K.); (N.K.)
| | - Chiaki Imafuku
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, 1-3 Miyakodani, Tatara, Kyotanabe-City 610-0394, Kyoto, Japan; (T.N.); (Y.M.); (Y.M.); (S.K.); (N.K.)
| | - Yuki Matsuoka
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, 1-3 Miyakodani, Tatara, Kyotanabe-City 610-0394, Kyoto, Japan; (T.N.); (Y.M.); (Y.M.); (S.K.); (N.K.)
| | - Yuna Miyawaki
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, 1-3 Miyakodani, Tatara, Kyotanabe-City 610-0394, Kyoto, Japan; (T.N.); (Y.M.); (Y.M.); (S.K.); (N.K.)
| | - Shinichi Kadowaki
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, 1-3 Miyakodani, Tatara, Kyotanabe-City 610-0394, Kyoto, Japan; (T.N.); (Y.M.); (Y.M.); (S.K.); (N.K.)
| | - Makiko Nakahara
- ActualEyes Inc., D-egg, 1 Jizodani, Koudo, Kyotanabe-City 610-0332, Kyoto, Japan; (M.N.); (Y.M.)
| | - Yasushi Matsuoka
- ActualEyes Inc., D-egg, 1 Jizodani, Koudo, Kyotanabe-City 610-0332, Kyoto, Japan; (M.N.); (Y.M.)
| | - Noriko Koizumi
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, 1-3 Miyakodani, Tatara, Kyotanabe-City 610-0394, Kyoto, Japan; (T.N.); (Y.M.); (Y.M.); (S.K.); (N.K.)
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3
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Hernández-Melchor D, López-Bayghen E, Padilla-Viveros A. The patent landscape in the field of stem cell therapy: closing the gap between research and clinic. F1000Res 2023; 11:997. [PMID: 38481536 PMCID: PMC10933573 DOI: 10.12688/f1000research.123799.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 03/28/2024] Open
Abstract
Stem cell technology is a powerful tool ready to respond to the needs of modern medicine that is experiencing rapid technological development. Given its potential in therapeutic applications, intellectual property rights (IPR) as a protection resource of knowledge are a relevant topic. Patent eligibility of stem cells has been controversial as restrictions to access the fundamental technologies open a gap between research and clinic. Therefore, we depicted the current patent landscape in the field to discuss if this approach moves forward in closing this breach by examining patent activity over the last decade from a transdisciplinary perspective. Stem cell therapeutic applications is an area of continuous growth where patent filing through the PCT is the preferred strategy. Patenting activity is concentrated in the USA, European Union, and Australia; this accumulation in a few key players leads to governance, regulation, and inequality concerns. To boost wealthiness and welfare in society - stem cell therapies' ultimate goal - while at post-pandemic recovery, critical elements in the field of IPR rise to overcome current limitations: to promote bridge builders able to connect the research and business worlds, regulatory updates, novel financing models, new vehicles (startups, spinouts, and spin-offs), and alternative figures of intellectual property.
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Affiliation(s)
- Dinorah Hernández-Melchor
- Science, Technology and Society Program, . Centro de Investigación y de Estudios Avanzados del Instituto Politecnico Nacional, Mexico City, 07360, Mexico
- Departamento de Toxicología, Centro de Investigacion y de Estudios Avanzados del Instituto Politecnico Nacional, Mexico City, 07360, Mexico
| | - Esther López-Bayghen
- Departamento de Toxicología, Centro de Investigacion y de Estudios Avanzados del Instituto Politecnico Nacional, Mexico City, 07360, Mexico
| | - América Padilla-Viveros
- Science, Technology and Society Program, . Centro de Investigación y de Estudios Avanzados del Instituto Politecnico Nacional, Mexico City, 07360, Mexico
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Fernández-Colino A, Kiessling F, Slabu I, De Laporte L, Akhyari P, Nagel SK, Stingl J, Reese S, Jockenhoevel S. Lifelike Transformative Materials for Biohybrid Implants: Inspired by Nature, Driven by Technology. Adv Healthc Mater 2023; 12:e2300991. [PMID: 37290055 DOI: 10.1002/adhm.202300991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/25/2023] [Indexed: 06/10/2023]
Abstract
Today's living world is enriched with a myriad of natural biological designs, shaped by billions of years of evolution. Unraveling the construction rules of living organisms offers the potential to create new materials and systems for biomedicine. From the close examination of living organisms, several concepts emerge: hierarchy, pattern repetition, adaptation, and irreducible complexity. All these aspects must be tackled to develop transformative materials with lifelike behavior. This perspective article highlights recent progress in the development of transformative biohybrid systems for applications in the fields of tissue regeneration and biomedicine. Advances in computational simulations and data-driven predictions are also discussed. These tools enable the virtual high-throughput screening of implant design and performance before committing to fabrication, thus reducing the development time and cost of biomimetic and biohybrid constructs. The ongoing progress of imaging methods also constitutes an essential part of this matter in order to validate the computation models and enable longitudinal monitoring. Finally, the current challenges of lifelike biohybrid materials, including reproducibility, ethical considerations, and translation, are discussed. Advances in the development of lifelike materials will open new biomedical horizons, where perhaps what is currently envisioned as science fiction will become a science-driven reality in the future.
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Affiliation(s)
- Alicia Fernández-Colino
- Department of Biohybrid & Medical Textiles (BioTex), AME-Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Forckenbeckstraße 55, 52074, Aachen, Germany
| | - Fabian Kiessling
- Institute for Experimental Molecular Imaging, Faculty of Medicine, RWTH Aachen University, Forckenbeckstraße 55, 52074, Aachen, Germany
| | - Ioana Slabu
- Institute of Applied Medical Engineering, Helmholtz Institute, Medical Faculty, RWTH Aachen University, Pauwelsstraße 20, 52074, Aachen, Germany
| | - Laura De Laporte
- DWI - Leibniz-Institute for Interactive Materials, Forckenbeckstraße 50, 52074, Aachen, Germany
- Institute of Technical and Macromolecular Chemistry (ITMC), RWTH Aachen University, Worringerweg 2, 52074, Aachen, Germany
- Advanced Materials for Biomedicine (AMB), Institute of Applied Medical Engineering (AME), University Hospital RWTH Aachen, Center for Biohybrid Medical Systems (CMBS), Forckenbeckstraße 55, 52074, Aachen, Germany
| | - Payam Akhyari
- Clinic for Cardiac Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Saskia K Nagel
- Applied Ethics Group, RWTH Aachen University, Theaterplatz 14, 52062, Aachen, Germany
| | - Julia Stingl
- Institute of Clinical Pharmacology, University Hospital RWTH Aachen, Wendlingweg 2, 52074, Aachen, Germany
| | - Stefanie Reese
- Institute of Applied Mechanics, RWTH Aachen University, Mies-van-der-Rohe-Str. 1, 52074, Aachen, Germany
| | - Stefan Jockenhoevel
- Department of Biohybrid & Medical Textiles (BioTex), AME-Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Forckenbeckstraße 55, 52074, Aachen, Germany
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5
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Das M, Sloan AJ. Stem cell sources from human biological waste material: a role for the umbilical cord and dental pulp stem cells for regenerative medicine. Hum Cell 2023:10.1007/s13577-023-00922-6. [PMID: 37273175 DOI: 10.1007/s13577-023-00922-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 05/18/2023] [Indexed: 06/06/2023]
Abstract
Stem cell research with biological waste material is an area that holds promise to revolutionize treatment modalities and clinical practice. The interest in surgical remnants is increasing with time as research on human embryonic stem cells remains controversial due to legal and ethical issues. Perhaps, these restrictions are the motivation for the use of alternative mesenchymal stem cell (MSC) sources in the regenerative field. Stem cells (SCs) of Umbilical Cord (UC) and Dental Pulp (DP) have almost similar biological characteristics to other MSCs and can differentiate into a number of cell lineages with enormous potential future prospects. A concise critical observation of UC-MSCs and DP-MSCs is presented here reviewing articles from the last two decades along with other stem cell sources from different biological waste materials.
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Affiliation(s)
- Monalisa Das
- Department of Pedodontics & Preventive Dentistry, Dr. R. Ahmed Dental College and Hospital, Kolkata, India.
- , No. 2 Durganagar, Sripally, Chakdaha, Nadia, West Bengal, 741222, India.
| | - Alastair J Sloan
- Melbourne Dental School, Level 4, 720 Swanston Street, Melbourne, VIC, 3010, Australia
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Shimizu Y, Ntege EH, Sunami H. Current regenerative medicine-based approaches for skin regeneration: A review of literature and a report on clinical applications in Japan. Regen Ther 2022; 21:73-80. [PMID: 35785041 PMCID: PMC9213559 DOI: 10.1016/j.reth.2022.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/11/2022] [Accepted: 05/25/2022] [Indexed: 11/18/2022] Open
Abstract
Current trends indicate a growing interest among healthcare specialists and the public in the use of regenerative medicine-based approaches for skin regeneration. The approaches are categorised in either cell-based or cell-free therapies and are reportedly safe and effective. Cell-based therapies include mesenchymal stem cells (MSCs), tissue induced pluripotent stem cells (iPSCs), fibroblast-based products, and blood-derived therapies, such as those employing platelet-rich plasma (PRP) products. Cell-free therapies primarily involve the use of MSC-derived extracellular vesicles/exosomes. MSCs are isolated from various tissues, such as fat, bone marrow, umbilical cord, menstrual blood, and foetal skin, and expanded ex vivo before transplantation. In cell-free therapies, MSC exosomes, MSC-derived cultured media, and MSC-derived extracellular vesicles are collected from MSC-conditioned media or supernatant. In this review, a literature search of the Cochrane Library, MEDLINE (PubMed), EMBASE, and Scopus was conducted using several combinations of terms, such as ‘stem’, ‘cell’, ‘aging’, ‘wrinkles’, ‘nasolabial folds’, ‘therapy’, ‘mesenchymal stem cells’, and ‘skin’, to identify relevant articles providing a comprehensive update on the different regenerative medicine-based therapies and their application to skin regeneration. In addition, the regulatory perspectives on the clinical application of some of these therapies in Japan are highlighted. The use of regenerative medicine-based therapy for skin rejuvenation is expanding. Therapies can be categorised as either cell-based or cell-free therapies. MSCs can be isolated from various tissues for cosmetic applications. MSC-derived exosomes increase skin cell proliferation and migration. In Japan, most cell-based treatments carry class II/III regenerative medicine risks.
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Affiliation(s)
- Yusuke Shimizu
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Nakagami, 903-0215 Okinawa, Japan
- Corresponding author. Department of Plastic and Reconstructive Surgery Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Edward Hosea Ntege
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Nakagami, 903-0215 Okinawa, Japan
| | - Hiroshi Sunami
- Center for Advanced Medical Research, School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Nakagami, 903-0215 Okinawa, Japan
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Louis F, Sowa Y, Irie S, Higuchi Y, Kitano S, Mazda O, Matsusaki M. Injectable Prevascularized Mature Adipose Tissues (iPAT) to Achieve Long-Term Survival in Soft Tissue Regeneration. Adv Healthc Mater 2022; 11:e2201440. [PMID: 36103662 DOI: 10.1002/adhm.202201440] [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: 10/04/2021] [Revised: 09/01/2022] [Indexed: 01/28/2023]
Abstract
Soft tissue regeneration remains a challenge in reconstructive surgery. So far, both autologous fat implantations and artificial implants methods used in clinical applications lead to various disadvantages and limited lifespan. To overcome these limitations and improve the graft volume maintenance, reproducing a mature adipose tissue already including vasculature structure before implantation can be the solution. Therefore, injectable prevascularized adipose tissues (iPAT) are made from physiological collagen microfibers mixed with human mature adipocytes, adipose-derived stem cells, and human umbilical vein endothelial cells, embedded in fibrin gel. Following murine subcutaneous implantation, the iPAT show a higher cell survival (84% ± 6% viability) and volume maintenance after 3 months (up to twice heavier) when compared to non-prevascularized balls and liposuctioned fat implanted controls. This higher survival can be explained by the greater amount of blood vessels found (up to 1.6-fold increase), with balanced host anastomosis (51% ± 1% of human/mouse lumens), also involving infiltration by the lymphatic and neural vasculature networks. Furthermore, with the cryopreservation possibility enabling their later reinjection, the iPAT technology has the merit to allow noninvasive soft tissue regeneration for long-term outcomes.
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Affiliation(s)
- Fiona Louis
- Joint Research Laboratory (TOPPAN) for Advanced Cell Regulatory Chemistry, Graduate School of Engineering, Osaka University, Suita, 565-0871, Japan
| | - Yoshihiro Sowa
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan.,Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, 606-8501, Japan
| | - Shinji Irie
- Joint Research Laboratory (TOPPAN) for Advanced Cell Regulatory Chemistry, Graduate School of Engineering, Osaka University, Suita, 565-0871, Japan.,TOPPAN INC, Taito, Tokyo, 110-0016, Japan
| | - Yuriko Higuchi
- Department of Drug Delivery Research, Graduate School of Pharmaceutical Sciences, Kyoto University, Kyoto, 606-8501, Japan
| | - Shiro Kitano
- Joint Research Laboratory (TOPPAN) for Advanced Cell Regulatory Chemistry, Graduate School of Engineering, Osaka University, Suita, 565-0871, Japan.,TOPPAN INC, Taito, Tokyo, 110-0016, Japan
| | - Osam Mazda
- Department of Immunology, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
| | - Michiya Matsusaki
- Joint Research Laboratory (TOPPAN) for Advanced Cell Regulatory Chemistry, Graduate School of Engineering, Osaka University, Suita, 565-0871, Japan.,Department of Applied Chemistry, Graduate School of Engineering, Osaka University, Suita, 565-0871, Japan
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Kim DS, Bae S. Impact and challenges of enactment for advanced regenerative medicine in South Korea. Front Bioeng Biotechnol 2022; 10:972865. [PMID: 36312539 PMCID: PMC9597240 DOI: 10.3389/fbioe.2022.972865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022] Open
Abstract
The Korean government has enacted the Act on Advanced Regenerative Medicine and Advanced Biological products (ARMAB) in August 2019, and it has been implemented in 2020. We reviewed the changes made by ARMAB compared to the existing Pharmaceutical Affairs Act and discussed future challenges to accelerate regenerative medicine while ensuring safety and efficacy. This act and regulations focused on the key elements of act as follows: the definition of advanced regenerative medicine (RM), the licensing of related facilities, safety management such as long-term follow-up, clinical research review committee, and establishment of a roadmap. Our study shows that Korea has achieved the second highest number of first approvals for regenerative medicine indications worldwide through expedited approvals encouraging innovation, while maintaining patient safety by mandating long-term follow-up. Additionally, the establishment of an interactive system for retrieval of patients' data and reporting of safety information by manufacturers electronically demonstrates Korea’s commitment to innovation for Advanced RM and patient safety.
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Affiliation(s)
- Dong-Sook Kim
- Department of Research, Health Insurance Review and Assessment Service, Wonju, South Korea
- *Correspondence: Dong-Sook Kim, ; SeungJin Bae,
| | - SeungJin Bae
- College of Pharmacy, Ewha Womans University, Seoul, South Korea
- *Correspondence: Dong-Sook Kim, ; SeungJin Bae,
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Carolina IL, Antònia A, Mercè O, Antonio V. Regulatory and clinical development to support the approval of advanced therapies medicinal products in Japan. Expert Opin Biol Ther 2022; 22:831-842. [PMID: 35762253 DOI: 10.1080/14712598.2022.2093637] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION : A new category of products, i.e., regenerative medicine products (RPs), has been defined for advanced therapies medicinal products in Japan, as well as a legislative and regulatory framework to promote their clinical development. AREAS COVERED : This review analyses the most relevant features of the regulatory strategies and clinical development that led RPs to their approval in Japan. EXPERT OPINION : As of 31st September 2021, a total of 14 RPs were approved for 16 indications. From a regulatory standpoint, the available designations allow attractive benefit packages that promote the development of innovative products in Japan and is one of the key points to consider when the global regulatory strategy for the product is being developed. RPs regulations in Japan allow adaptive licensing and constitute shortcut through the clinical development to the approval. RPs have been mainly approved so far based on small studies with inconclusive and limited evidence of efficacy and safety, prioritizing the unmet medical needs of the target diseases, and therefore, the early access for patients. This review also compares the regulatory and clinical development for the current approved RPs in Japan with the development trends in the European Union and United States of America.
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Affiliation(s)
- Iglesias-Lopez Carolina
- Department of Pharmacology, Therapeutics and Toxicology. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Agustí Antònia
- Department of Pharmacology, Therapeutics and Toxicology. Universitat Autònoma de Barcelona, Barcelona, Spain.,Clinical Pharmacology Service. Vall d'Hebron University Hospital, Barcelona, Spain
| | - Obach Mercè
- Medicines Department. Catalan Healthcare Service, Barcelona, Spain
| | - Vallano Antonio
- Department of Pharmacology, Therapeutics and Toxicology. Universitat Autònoma de Barcelona, Barcelona, Spain.,Medicines Department. Catalan Healthcare Service, Barcelona, Spain
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Kim J, Park J, Song SY, Kim E. Advanced Therapy medicinal products for autologous chondrocytes and comparison of regulatory systems in target countries. Regen Ther 2022; 20:126-137. [PMID: 35582708 PMCID: PMC9079100 DOI: 10.1016/j.reth.2022.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/27/2022] [Accepted: 04/14/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Autologous chondrocytes (ACs) are Human cell/tissue-based products used for the treatment of joint cartilage defects. Regulatory agencies have established regulations related to ACs to ensure their safety and efficacy. This study investigated the status and characteristics of ACs approved worldwide. Furthermore, the AC-related regulations were compared by country to provide reference materials for the development of product approval procedures. Methods This study reviewed the current status of global AC products over the past 20 years by referring to the AC approval list provided on the International Society for Cell & Gene Therapy (ISCT) website. Based on the review report provided by the regulatory agencies that approved the products, major nonclinical/clinical data and product characteristics were reviewed; and the classification and definition of ACs and the approval review procedures were compared through the regulatory agencies’ websites. The development status of ACs was also analyzed using a clinical trial registration site. Results Eight ACs were approved during the study period in Europe, the US, Japan, Australia, and Korea. Two products were withdrawn owing to marketability problems. Human cell/tissue-based products in each country are classified and defined distinguished from biopharmaceuticals, but the approval process for both products is the same. The approval period differs by country, with an average of 282.4 days and the shortest being in Korea (115 days). On Clinical Trials.gov, we screened 46 clinical trials related to ACs, which were conducted in Europe (41%), Korea (20%), and the US (17%). The knee accounted for the largest portion of the indication (37/46, 80%), followed by the ankle or hip joints. Measurements of improvements in function and pain were the main endpoints used to evaluate the efficacy of ACs. Observational studies were conducted to confirm the long-term safety of these products. Conclusions This is the first study comparing the current status and characteristics of globally approved AC products, as well as their classification and definition by country. In the past two decades, clinical trials have been conducted on the application of ACs in tissue engineering to treat joint cartilage defects. ACs are expected to be used for the treatment of cartilage defect diseases. This is the first study that compared AC products that are currently approved globally per country. AC products are classified distinguished from biopharmaceuticals. Regulatory agencies implement systems to ensure long-term safety and efficacy of ACs.
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Affiliation(s)
- Jiwon Kim
- Department of Pharmaceutical Industry, Chung-Ang University, Seoul, 06974, Republic of Korea
- Data Science, Evidence-Based Clinical Research Laboratory, Departments of Health Science & Clinical Pharmacy, College of Pharmacy, Chung-Ang University, Seoul, 06974, Republic of Korea
| | - Jaehong Park
- Department of Pharmaceutical Industry, Chung-Ang University, Seoul, 06974, Republic of Korea
- Data Science, Evidence-Based Clinical Research Laboratory, Departments of Health Science & Clinical Pharmacy, College of Pharmacy, Chung-Ang University, Seoul, 06974, Republic of Korea
| | - Seung-Yeon Song
- Data Science, Evidence-Based Clinical Research Laboratory, Departments of Health Science & Clinical Pharmacy, College of Pharmacy, Chung-Ang University, Seoul, 06974, Republic of Korea
| | - Eunyoung Kim
- Department of Pharmaceutical Industry, Chung-Ang University, Seoul, 06974, Republic of Korea
- Data Science, Evidence-Based Clinical Research Laboratory, Departments of Health Science & Clinical Pharmacy, College of Pharmacy, Chung-Ang University, Seoul, 06974, Republic of Korea
- Corresponding author. Division of Licensing of Medicines and Regulatory Science, The Graduate School of Pharmaceutical Management, Chung-Ang University, 84 Heukseok-Ro, Dangjak-gu, Seoul, 06974, Republic of Korea. Tel: +82-2-820-5791, Fax: +82-2-816-7338.
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11
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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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Muthu S, Jeyaraman M, Kotner MB, Jeyaraman N, Rajendran RL, Sharma S, Khanna M, Rajendran SNS, Oh JM, Gangadaran P, Ahn BC. Evolution of Mesenchymal Stem Cell Therapy as an Advanced Therapeutic Medicinal Product (ATMP)-An Indian Perspective. Bioengineering (Basel) 2022; 9:bioengineering9030111. [PMID: 35324800 PMCID: PMC8945480 DOI: 10.3390/bioengineering9030111] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 02/05/2023] Open
Abstract
Stem cells can be defined as the cells that have the capacity to both self-renew and give rise to differentiated cells. Under the right conditions and signals, depending on their origin and bio-plasticity, stem cells can differentiate into multiple cell lineages and develop into various mature cells. Stem cell therapy is a fast-developing branch of medicine that includes the most innovative regenerative therapies for the restoration of cell and tissue function in individuals with severe diseases. Stem cell research has resulted in the emergence of cell-based therapies for disorders that are resistant to conventional drugs and therapies, and they are considered under the category of an Advanced Therapeutic Medicinal Product (ATMP). The FDA and the European Medicines Agency (EMA) devised a new strategy in 2017 with the aim of unifying the standards for development of ATMPs such that it is easy to exchange information at the international level. In this review, we discuss the evolution of mesenchymal stem cell-based therapy as an ATMP in the global and Indian scenarios, along with the guidelines governing their usage and clinical application of these therapeutics.
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Affiliation(s)
- Sathish Muthu
- Department of Orthopaedics, Government Medical College and Hospital, Dindigul 624001, India;
- Indian Stem Cell Study Group, Lucknow 226010, India; (M.B.K.); (N.J.); (M.K.)
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida 201310, India
| | - Madhan Jeyaraman
- Indian Stem Cell Study Group, Lucknow 226010, India; (M.B.K.); (N.J.); (M.K.)
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida 201310, India
- Department of Orthopaedics, Faculty of Medicine-Sri Lalithambigai Medical College and Hospital, Dr. MGR Educational and Research Institute University, Chennai 600095, India
- Correspondence: (M.J.); (P.G.); (B.-C.A.)
| | - Moinuddin Basha Kotner
- Indian Stem Cell Study Group, Lucknow 226010, India; (M.B.K.); (N.J.); (M.K.)
- Fellow in Orthopaedic Rheumatology, Dr. Ram Manohar Lohiya National Law University, Lucknow 226012, India
| | - Naveen Jeyaraman
- Indian Stem Cell Study Group, Lucknow 226010, India; (M.B.K.); (N.J.); (M.K.)
- Fellow in Orthopaedic Rheumatology, Dr. Ram Manohar Lohiya National Law University, Lucknow 226012, India
- Fellow in Joint Replacement, Atlas Hospitals, The Tamil Nadu Dr. MGR Medical University, Tiruchirappalli 620002, India
| | - Ramya Lakshmi Rajendran
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (R.L.R.); (J.M.O.)
| | - Shilpa Sharma
- Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi 110029, India;
| | - Manish Khanna
- Indian Stem Cell Study Group, Lucknow 226010, India; (M.B.K.); (N.J.); (M.K.)
| | - Sree Naga Sowndary Rajendran
- Department of Medicine, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry 605107, India;
| | - Ji Min Oh
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (R.L.R.); (J.M.O.)
| | - Prakash Gangadaran
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (R.L.R.); (J.M.O.)
- BK21 FOUR KNU Convergence Educational Program of Biomedical Sciences for Creative Future Talents, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Korea
- Correspondence: (M.J.); (P.G.); (B.-C.A.)
| | - Byeong-Cheol Ahn
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (R.L.R.); (J.M.O.)
- BK21 FOUR KNU Convergence Educational Program of Biomedical Sciences for Creative Future Talents, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Korea
- Correspondence: (M.J.); (P.G.); (B.-C.A.)
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Gomes KLG, da Silva RE, Silva Junior JBD, Novaes MRCG. Comparison of new Brazilian legislation for the approval of advanced therapy medicinal products with existing systems in the USA, European Union and Japan. Cytotherapy 2022; 24:557-566. [DOI: 10.1016/j.jcyt.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/13/2021] [Accepted: 10/17/2021] [Indexed: 11/03/2022]
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Zocchi ML, Facchin F, Pagani A, Bonino C, Sbarbati A, Conti G, Vindigni V, Bassetto F. New perspectives in regenerative medicine and surgery: the bioactive composite therapies (BACTs). EUROPEAN JOURNAL OF PLASTIC SURGERY 2021; 45:1-25. [PMID: 34728900 PMCID: PMC8554210 DOI: 10.1007/s00238-021-01874-6] [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: 07/14/2021] [Accepted: 08/06/2021] [Indexed: 12/26/2022]
Abstract
Regenerative medicine and surgery is a rapidly expanding branch of translational research in tissue engineering, cellular and molecular biology. To date, the methods to improve cell intake, survival, and isolation need to comply with a complex and still unclear regulatory frame, becoming everyday more restrictive and often limiting the effectiveness and outcome of the therapeutic choices. Thus, the authors developed a novel 360° regenerative strategy based on the synergic action of several new components called the bioactive composite therapies (BACTs) to improve grafted cells intake, and survival in total compliance with the legal and ethical limits of the current regulatory frame. The rationale at the origin of this new technology is based on the evidence that cells need supportive substrate to survive in vitro and this observation, applying the concept of translational medicine, is true also in vivo. Bioactive composite mixtures (BACMs) are tailor-made bioactive mixtures containing several bioactive components that support cells' survival and induce a regenerative response in vivo by stimulating the recipient site to act as an in situ real bioreactor. Many different tissues have been used in the past for the isolation of cells, molecules, and growth factors, but the adipose tissue and its stromal vascular fraction (SVF) remains the most valuable, abundant, safe, and reliable source of regenerative components and particularly of adipose-derived stems cells (ADSCs). The role of plastic surgeons as the historical experts in all the most advanced techniques for harvesting, manipulating, and grafting adipose tissue is fundamental in this constant process of expansion of regenerative procedures. In this article, we analyze the main causes of cell death and the strategies for preventing it, and we present all the technical steps for preparing the main components of BACMs and the different mixing modalities to obtain the most efficient regenerative action on different clinical and pathological conditions. The second section of this work is dedicated to the logical and sequential evolution from simple bioactive composite grafts (BACGs) that distinguished our initial approach to regenerative medicine, to BACTs where many other fundamental technical steps are analyzed and integrated for supporting and enhancing the most efficient regenerative activity. Level of Evidence: Not gradable.
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Affiliation(s)
- Michele L Zocchi
- Plastic and Reconstructive Surgery Unit, University of Padua, Padua, Italy.,Remix Institute for Regenerative Surgery, Turin, Italy
| | - Federico Facchin
- Plastic and Reconstructive Surgery Unit, University of Padua, Padua, Italy
| | - Andrea Pagani
- Department of Plastic and Hand Surgery, Technical University of Munich, Munich, Germany
| | - Claudia Bonino
- Department of Rheumatology and Immune Diseases, Humanitas Gradenigo Hospital, Turin, Italy
| | - Andrea Sbarbati
- Institute of Human Anatomy, University of Verona, Verona, Italy
| | - Giamaica Conti
- Institute of Human Anatomy, University of Verona, Verona, Italy
| | - Vincenzo Vindigni
- Plastic and Reconstructive Surgery Unit, University of Padua, Padua, Italy
| | - Franco Bassetto
- Plastic and Reconstructive Surgery Unit, University of Padua, Padua, Italy
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15
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Regulatory and intellectual property conundrums surrounding xenotransplantation. Nat Biotechnol 2021; 39:796-798. [PMID: 34234315 DOI: 10.1038/s41587-021-00976-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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New Visualization Models of Designation Pathway and Group Categorization of Cell-Device and Protein-Device Combination Products in the United States. Ther Innov Regul Sci 2021; 55:1199-1213. [PMID: 34152563 DOI: 10.1007/s43441-021-00307-7] [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: 01/17/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The developer and sponsor of new cell-device and protein-device combination products in the United States needs to forecast which classification and designation to the regulatory scheme of biological products or devices would be required for the new products by the Food and Drug Administration (FDA). To improve the predictability and acceptability of the designation of new cell-device and protein-device combination products for innovators, developers, and sponsors, and to encourage the development and early access of new combination products, we proposed new visualization models of the designation pathway and group categorization. METHODS We searched the website of the FDA and the Alliance for Regenerative Medicine (ARM) on May 3, 2021 to identify the regulatory scheme of the FDA's capsular decision cases of cell-device and protein-device combination products, and of the tissue-engineered products approved by the FDA. RESULTS By introducing a new definition of the primary intended use (PIU) of developers and sponsors extracted from the classification factors of primary mode of action (PMOA), as well as drug-device and biologic-device combination products, we developed new visualization models of the designation pathway and the two-dimensional model of group categorization, and proposed a new group categorization of cell-device and protein-device combination products, focusing on the device component function. DISCUSSION The new visualization models and the group categorization proposed in this study may increase the predictability and acceptability of the classification of newly developed cell-device and protein-device combination products to regulatory schemes in the US for innovators, developers, and sponsors.
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Takashima K, Morrison M, Minari J. Reflection on the enactment and impact of safety laws for regenerative medicine in Japan. Stem Cell Reports 2021; 16:1425-1434. [PMID: 34019814 PMCID: PMC8190593 DOI: 10.1016/j.stemcr.2021.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 02/07/2023] Open
Abstract
Japan's Act on the Safety of Regenerative Medicine (ASRM) created an innovative regulatory framework intended to safely promote the clinical development of stem cell-based interventions (SCBIs) while subjecting commercialized unproven SCBIs to greater scrutiny and accountability. This article reviews ASRM's origins, explains its unprecedented scope, and assesses how it envisions the regulation of SCBIs. This analysis is used to highlight three key insights that are pertinent to the current revision of the ASRM: clarifying how the concept of safety should be defined and assessed in research and clinical care settings; revisiting risk criteria for review of SCBIs; and taking stronger measures to support the transition from unproven interventions to evidence-based therapies. Finally, the article reflects on lessons drawn from Japanese experiences in dealing with unproven SCBIs for international endeavors to regulate SCBIs.
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Affiliation(s)
- Kayo Takashima
- Uehiro Research Division of iPS Cell Ethics, Center for iPS Cell Research and Application, Kyoto University, Kyoto 606-8507, Japan; Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Chiba 277-856, Japan
| | - Michael Morrison
- Centre for Health, Law and Emerging Technologies (HeLEX), Faculty of Law, University of Oxford, Oxford OX2 7DD, UK; Institute for Science, Innovation and Society, School of Anthropology and Museum Ethnography, University of Oxford, Oxford OX2 6PN, UK.
| | - Jusaku Minari
- Uehiro Research Division of iPS Cell Ethics, Center for iPS Cell Research and Application, Kyoto University, Kyoto 606-8507, Japan.
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18
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Umemura M, Morrison M. Comparative lessons in regenerative medicine readiness: learning from the UK and Japanese experience. Regen Med 2021; 16:269-282. [PMID: 33781099 DOI: 10.2217/rme-2020-0136] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
This paper explores how 'regenerative readiness' varies between different national research and healthcare systems. Here, 'readiness' refers to both the readiness of a given technology and the ability of a given setting to adopt a new technology. We compare two settings that have taken active yet dissonant approaches to improve readiness: the UK and Japan. Existing scholarship observes that disruptive technologies such as regenerative medicine require many adaptations to become useable and function along the principles of their design. We incorporate the sociotechnical systems framework to consider the range of adaptive measures taken across elements of the sociotechnical system for novel technological adoption. Building upon existing works on technology readiness and institutional readiness, we also expand the conceptualization of readiness toward system-wide readiness.
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Affiliation(s)
- Maki Umemura
- Senior Lecturer in International Business, Cardiff Business School, Cardiff University, Aberconway Building, Colum Drive, Cardiff, CF10 3EU, UK
| | - Michael Morrison
- Senior Researcher in Social Science, Centre for Health, Law & Emerging Technologies, Faculty of Law, University of Oxford, Ewert House, Banbury Road, Oxford, OX2 7DD, UK.,Research Affiliate, Institution for Science Innovation & Society, School of Anthropology & Museum Ethnography, University of Oxford, 51/53 Banbury Road, Oxford, OX2 6PE, UK
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Advanced Therapy Medicinal Products for the Eye: Definitions and Regulatory Framework. Pharmaceutics 2021; 13:pharmaceutics13030347. [PMID: 33800934 PMCID: PMC8000705 DOI: 10.3390/pharmaceutics13030347] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 01/12/2023] Open
Abstract
Advanced therapy medicinal products (ATMPs) are a group of innovative and complex biological products for human use that comprises somatic cell therapy medicinal products, tissue engineered products, gene therapy medicinal products, and the so-called combined ATMPs that consist of one of the previous three categories combined with one or more medical devices. During the last few years, the development of ATMPs for the treatment of eye diseases has become a fast-growing field as it offers the potential to find novel therapeutic approaches for treating pathologies that today have no cure or are just subjected to symptomatic treatments. Therefore, it is important for all professionals working in this field to be familiar with the regulatory principles associated with these types of innovative products. In this review, we outline the legal framework that regulates the development of ATMPs in the European Union and other international jurisdictions, and the criteria that each type of ATMP must meet to be classified as such. To illustrate each legal definition, ATMPs that have already completed the research and development stages and that are currently used for the treatment of eye diseases are presented as examples.
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20
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Sekar MP, Budharaju H, Zennifer A, Sethuraman S, Vermeulen N, Sundaramurthi D, Kalaskar DM. Current standards and ethical landscape of engineered tissues-3D bioprinting perspective. J Tissue Eng 2021; 12:20417314211027677. [PMID: 34377431 PMCID: PMC8330463 DOI: 10.1177/20417314211027677] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/08/2021] [Indexed: 01/17/2023] Open
Abstract
Tissue engineering is an evolving multi-disciplinary field with cutting-edge technologies and innovative scientific perceptions that promise functional regeneration of damaged tissues/organs. Tissue engineered medical products (TEMPs) are biomaterial-cell products or a cell-drug combination which is injected, implanted or topically applied in the course of a therapeutic or diagnostic procedure. Current tissue engineering strategies aim at 3D printing/bioprinting that uses cells and polymers to construct living tissues/organs in a layer-by-layer fashion with high 3D precision. However, unlike conventional drugs or therapeutics, TEMPs and 3D bioprinted tissues are novel therapeutics and need different regulatory protocols for clinical trials and commercialization processes. Therefore, it is essential to understand the complexity of raw materials, cellular components, and manufacturing procedures to establish standards that can help to translate these products from bench to bedside. These complexities are reflected in the regulations and standards that are globally in practice to prevent any compromise or undue risks to patients. This review comprehensively describes the current legislations, standards for TEMPs with a special emphasis on 3D bioprinted tissues. Based on these overviews, challenges in the clinical translation of TEMPs & 3D bioprinted tissues/organs along with their ethical concerns and future perspectives are discussed.
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Affiliation(s)
- Muthu Parkkavi Sekar
- Tissue Engineering & Additive Manufacturing Lab, Centre for Nanotechnology & Advanced Biomaterials, ABCDE Innovation Centre, School of Chemical & Biotechnology, SASTRA Deemed University, Thanjavur, Tamil Nadu, India
| | - Harshavardhan Budharaju
- Tissue Engineering & Additive Manufacturing Lab, Centre for Nanotechnology & Advanced Biomaterials, ABCDE Innovation Centre, School of Chemical & Biotechnology, SASTRA Deemed University, Thanjavur, Tamil Nadu, India
| | - Allen Zennifer
- Tissue Engineering & Additive Manufacturing Lab, Centre for Nanotechnology & Advanced Biomaterials, ABCDE Innovation Centre, School of Chemical & Biotechnology, SASTRA Deemed University, Thanjavur, Tamil Nadu, India
| | - Swaminathan Sethuraman
- Tissue Engineering & Additive Manufacturing Lab, Centre for Nanotechnology & Advanced Biomaterials, ABCDE Innovation Centre, School of Chemical & Biotechnology, SASTRA Deemed University, Thanjavur, Tamil Nadu, India
| | - Niki Vermeulen
- Department of Science, Technology and Innovation Studies, School of Social and Political Science, University of Edinburgh, High School Yards, Edinburgh, UK
| | - Dhakshinamoorthy Sundaramurthi
- Tissue Engineering & Additive Manufacturing Lab, Centre for Nanotechnology & Advanced Biomaterials, ABCDE Innovation Centre, School of Chemical & Biotechnology, SASTRA Deemed University, Thanjavur, Tamil Nadu, India
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Ntege EH, Sunami H, Shimizu Y. Advances in regenerative therapy: A review of the literature and future directions. Regen Ther 2020; 14:136-153. [PMID: 32110683 PMCID: PMC7033303 DOI: 10.1016/j.reth.2020.01.004] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/14/2020] [Accepted: 01/26/2020] [Indexed: 12/14/2022] Open
Abstract
There is enormous global anticipation for stem cell-based therapies that are safe and effective. Numerous pre-clinical studies present encouraging results on the therapeutic potential of different cell types including tissue derived stem cells. Emerging evidences in different fields of research suggest several cell types are safe, whereas their therapeutic application and effectiveness remain challenged. Multiple factors that influence treatment outcomes are proposed including immunocompatibility and potency, owing to variations in tissue origin, ex-vivo methodologies for preparation and handling of the cells. This communication gives an overview of literature data on the different types of cells that are potentially promising for regenerative therapy. As a case in point, the recent trends in research and development of the mesenchymal stem cells (MSCs) for cell therapy are considered in detail. MSCs can be isolated from a variety of tissues and organs in the human body including bone marrow, adipose, synovium, and perinatal tissues. However, MSC products from the different tissue sources exhibit unique or varied levels of regenerative abilities. The review finally focuses on adipose tissue-derived MSCs (ASCs), with the unique properties such as easier accessibility and abundance, excellent proliferation and differentiation capacities, low immunogenicity, immunomodulatory and many other trophic properties. The suitability and application of the ASCs, and strategies to improve the innate regenerative capacities of stem cells in general are highlighted among others.
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Affiliation(s)
- Edward H. Ntege
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of the Ryukyus, Japan
- Research Center for Regenerative Medicine, School of Medicine, University of the Ryukyus, Japan
| | - Hiroshi Sunami
- Research Center for Regenerative Medicine, School of Medicine, University of the Ryukyus, Japan
| | - Yusuke Shimizu
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of the Ryukyus, Japan
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Regenerative medicine regulatory policies: A systematic review and international comparison. Health Policy 2020; 124:701-713. [PMID: 32499078 DOI: 10.1016/j.healthpol.2020.05.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 04/24/2020] [Accepted: 05/03/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND A small number of regenerative medicines (RMs) have received market authorization (MA) worldwide, relative to the large number of clinical trials currently being conducted. Regulatory issues constitute one major challenge for the MA of RMs. OBJECTIVE This study aimed to systematically review the regulation of RMs internationally, to identify the regulatory pathways for approved RMs, and to detail expedited programs to stimulate MA process. METHODS Official websites of regulatory authorities in 9 countries (United States (US), Japan, South Korea, Australia, Canada, New Zealand, Singapore, China, and India) and the European Union (EU) were systematically browsed, and was complemented by a systematic literature review in Medline and Embase database. RESULTS Specific RM legislation/frameworks were available in the EU, US, Japan, South Korea and Australia. A risk-based approach exempting eligible RMs from MA regulations were adopted in the EU and 6 countries. All investigated regions have established accelerated review or approval programs to facilitate the MA of RMs. 55 RMs have received MA in 9 countries and the EU. Twenty-three RMs received Priority Medicine designation, 32 RMs received Regenerative Medicine Advanced Therapy designation, and 11 RMs received SAKIGAKE (fore-runner initiative) designation. CONCLUSION Regulators have adopted proactive strategies to facilitate RM approval. However, addressing the discrepancies in regulatory requirements internationally remains challenging.
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Oberweis CV, Marchal JA, López-Ruiz E, Gálvez-Martín P. A Worldwide Overview of Regulatory Frameworks for Tissue-Based Products. TISSUE ENGINEERING PART B-REVIEWS 2020; 26:181-196. [DOI: 10.1089/ten.teb.2019.0315] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Caroline Veronique Oberweis
- Biosanitary Research Institute of Granada (ibs.GRANADA), University Hospitals of Granada—University of Granada, Granada, Spain
| | - Juan Antonio Marchal
- Biosanitary Research Institute of Granada (ibs.GRANADA), University Hospitals of Granada—University of Granada, Granada, Spain
- Biopathology and Regenerative Medicine Institute (IBIMER), Centre for Biomedical Research (CIBM), University of Granada, Granada, Spain
- Department of Human Anatomy and Embryology, Faculty of Medicine, University of Granada, Granada, Spain
- Excellence Research Unit “Modeling Nature” (MNat), University of Granada, Granada, Spain
| | - Elena López-Ruiz
- Biosanitary Research Institute of Granada (ibs.GRANADA), University Hospitals of Granada—University of Granada, Granada, Spain
- Biopathology and Regenerative Medicine Institute (IBIMER), Centre for Biomedical Research (CIBM), University of Granada, Granada, Spain
- Excellence Research Unit “Modeling Nature” (MNat), University of Granada, Granada, Spain
- Department of Health Sciences, University of Jaén, Jaén, Spain
| | - Patricia Gálvez-Martín
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Granada, Granada, Spain
- R&D Human Health, Bioibérica S.A.U., Barcelona, Spain
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Riau AK, Liu YC, Yam GH, Mehta JS. Stromal keratophakia: Corneal inlay implantation. Prog Retin Eye Res 2020; 75:100780. [DOI: 10.1016/j.preteyeres.2019.100780] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/28/2019] [Accepted: 09/02/2019] [Indexed: 12/31/2022]
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Embryonic Stem Cells in Clinical Trials: Current Overview of Developments and Challenges. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1312:19-37. [PMID: 33159303 DOI: 10.1007/5584_2020_592] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The first isolation of human embryonic stem cells (hESC) reported in the late 90s opened a new window to promising possibilities in the fields of human developmental biology and regenerative medicine. Subsequently, the differentiation of hESC lines into different precursor cells showed their potential in treating different incurable diseases. However, this promising field has consistently had remarkable ethical and experimental limitations. This paper is a review of clinical trial studies dealing with hESC and their advantages, limitations, and other specific concerns. Some of the hESC limitations have been solved, and several clinical trial studies are ongoing so that recent clinical trials have strived to improve the clinical applications of hESC, especially in macular degeneration and neurodegenerative diseases. However, regarding hESC-based therapy, several important issues need more research and discussion. Despite considerable studies to Date, hESC-based therapy is not available for conventional clinical applications, and more studies and data are needed to overcome current clinical and ethical limitations. When all the limitations of Embryonic stem cells (ESC) are wholly resolved, perhaps hESC can become superior to the existing stem cell sources. This overview will be beneficial for understanding the standard and promising applications of cell and tissue-based therapeutic approaches and for developing novel therapeutic applications of hESC.
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Transplantation of human embryonic stem cell-derived retinal pigment epithelial cells (MA09-hRPE) in macular degeneration. NPJ Regen Med 2019; 4:19. [PMID: 31482011 PMCID: PMC6712006 DOI: 10.1038/s41536-019-0081-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 07/26/2019] [Indexed: 12/15/2022] Open
Abstract
The use of human embryonic stem cell (hESC)-derived Retinal Pigment Epithelium (RPE) transplants has advanced dramatically in different forms for clinical application in macular degeneration. This review focuses on the first generation of hESC-RPE cell line, named as “MA09-hRPE” by Astellas Institute of Regenerative Medicine (AIRM), and its therapeutic application in human, which evaluated the safety and efficacy of MA09-hRPE cell line transplanted in patients with macular degeneration. This project marks the first milestone in overcoming ethical hurdles and oncogenic safety concerns associated with the use of an embryonic stem cell-derived line. Through in-depth, evidence-based analysis of the MA09-hRPE cell line, along with other hESC-RPE cell lines, this review aims to draw attention to the key technical challenges pertinent to the generation of a biologically competent hESC-RPE cell line and distill the four key prognostic factors residing in the host retina, which concurrently determine the outcomes of clinical efficacy and visual benefits. Given that the technology is still at its infancy for human use, a new clinical regulatory path could aid in cell line validation through small cohort, adaptive clinical trials to accelerate product development toward commercialization. These strategic insights will be invaluable to help both academia and industry, collaboratively shorten the steep learning curve, and reduce large development expenditures spent on unnecessary lengthy clinical trials.
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Sleeboom-Faulkner M. Regulatory brokerage: Competitive advantage and regulation in the field of regenerative medicine. SOCIAL STUDIES OF SCIENCE 2019; 49:355-380. [PMID: 31185876 PMCID: PMC6566457 DOI: 10.1177/0306312719850628] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This article concerns the roles of entrepreneurial scientists in the co-production of life science research and regulation. Regulatory brokerage, defined as a mode of strategic planning and as the negotiation of regulation based on comparative advantage and competition, is expressed in scientific activities that take advantage of regulatory difference. This article is based on social science research in Japan, Thailand, India and the UK. Using five cases related to Japan's international activities in the field of regenerative medicine, I argue that, driven by competitive advantage, regulatory brokerage at lower levels of managerial organization and governance is emulated at higher levels. In addition, as regulatory brokerage affects the creation of regulation at national, bilateral and global levels, new regulation may be based on competition in regulatory advantage rather than on ethical and scientific values. I argue that regulatory brokerage as the basis for regulatory reform bypasses issues that need to be decided by a broader public. More space is needed for international and political debate about the socio-political consequences of the global diversity of regulation in the field of the life sciences.
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LYSAGHT TAMRA, MUNSIE MEGAN, CASTRICUM ADAM, HUI JAMESH, OKADA KYOSHI, SATO YOJI, SAWA YOSHIKI, STEWART CAMERON, TAN LIPKUN, TAN LYNNH, SUGII SHIGEKI. A roundtable on responsible innovation with autologous stem cells in Australia, Japan and Singapore. Cytotherapy 2018; 20:1103-1109. [DOI: 10.1016/j.jcyt.2018.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/13/2018] [Accepted: 06/15/2018] [Indexed: 01/22/2023]
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A decade of marketing approval of gene and cell-based therapies in the United States, European Union and Japan: An evaluation of regulatory decision-making. Cytotherapy 2018; 20:769-778. [PMID: 29730080 DOI: 10.1016/j.jcyt.2018.03.038] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/29/2018] [Accepted: 03/29/2018] [Indexed: 02/06/2023]
Abstract
There is a widely held expectation of clinical advance with the development of gene and cell-based therapies (GCTs). Yet, establishing benefits and risks is highly uncertain. We examine differences in decision-making for GCT approval between jurisdictions by comparing regulatory assessment procedures in the United States (US), European Union (EU) and Japan. A cohort of 18 assessment procedures was analyzed by comparing product characteristics, evidentiary and non-evidentiary factors considered for approval and post-marketing risk management. Product characteristics are very heterogeneous and only three products are marketed in multiple jurisdictions. Almost half of all approved GCTs received an orphan designation. Overall, confirmatory evidence or indications of clinical benefit were evident in US and EU applications, whereas in Japan approval was solely granted based on non-confirmatory evidence. Due to scientific uncertainties and safety risks, substantial post-marketing risk management activities were requested in the EU and Japan. EU and Japanese authorities often took unmet medical needs into consideration in decision-making for approval. These observations underline the effects of implemented legislation in these two jurisdictions that facilitate an adaptive approach to licensing. In the US, the recent assessments of two chimeric antigen receptor-T cell (CAR-T) products are suggestive of a trend toward a more permissive approach for GCT approval under recent reforms, in contrast to a more binary decision-making approach for previous approvals. It indicates that all three regulatory agencies are currently willing to take risks by approving GCTs with scientific uncertainties and safety risks, urging them to pay accurate attention to post-marketing risk management.
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Riley MF. A RAT by Another Name: 21 st Century Cures Act and Stem Cell Therapies. AMERICAN JOURNAL OF LAW & MEDICINE 2018; 44:291-308. [PMID: 30106653 DOI: 10.1177/0098858818789427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Regenerative medicine (“RM”) is a 21st century technology whose regulation has badly needed a 21st century cure. It is not clear that the 21st Century Cures Act (“Cures Act”) is that cure, but it has not been a poison. For some months prior to the passage of the Cures Act it seemed that it might be a catalyst for really endangering the field by allowing a flood of untested therapies to continue to enter the market. That, fortunately, did not happen. Thus far, the Cures Act has been a useful tonic; its effect on RM has been largely symbolic. But it has allowed the Food and Drug Administration (“FDA”) to redirect resources, and it demanded the quick adoption of guidance. That has allowed the Agency to finalize a regulatory framework that has been sorely needed. The evidentiary flexibility within the Cures Act is extremely important for the development of technologies that do not fit easily into the traditional approval rubric.
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Affiliation(s)
- Margaret F Riley
- Professor Riley is a professor at the University of Virginia's Law School, has a secondary appointment at the Medical School, and has an affiliation with the Batten School of Public Policy
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Munsie M, Lysaght T, Hendl T, Tan HYL, Kerridge I, Stewart C. Open for business: a comparative study of websites selling autologous stem cells in Australia and Japan. Regen Med 2017; 12:777-790. [PMID: 29125016 DOI: 10.2217/rme-2017-0070] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Aim: This article examines online marketing practices of Japanese and Australian clinics offering putative autologous stem cell treatments. Materials & methods: We conducted google searches for keywords related to stem cell therapy and stem cell clinics in English and Japanese. Results: We identified websites promoting 88 point-of-sale clinics in Japan and 70 in Australia. Conclusion: Our findings provide further evidence of the rapid global growth in clinics offering unproven stem cell interventions. We also show that these clinics adopt strategies to promote their services as though they are consistent with evidentiary and ethical standards of science, research and medicine. Unless addressed, these practices risk harming not only vulnerable patients but also undermining public trust in science and medicine.
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Affiliation(s)
- Megan Munsie
- Centre for Stem Cell Systems, School of Biomedical Sciences, The University of Melbourne, Parkville, Australia
| | - Tamra Lysaght
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, 119228, Singapore
| | - Tereza Hendl
- Center for Values, Ethics & the Law in Medicine, University of Sydney, Australia
| | - Hui-Yin Lynn Tan
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, 119228, Singapore
| | - Ian Kerridge
- Center for Values, Ethics & the Law in Medicine, University of Sydney, Australia.,Hematology Department, Royal North Shore Hospital, St Leonards, Sydney, Australia
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Coppens DG, De Bruin ML, Leufkens HG, Hoekman J. Global Regulatory Differences for Gene- and Cell-Based Therapies: Consequences and Implications for Patient Access and Therapeutic Innovation. Clin Pharmacol Ther 2017; 103:120-127. [DOI: 10.1002/cpt.894] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/12/2017] [Accepted: 10/01/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Delphi G.M. Coppens
- Utrecht/WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Utrecht Institute for Pharmaceutical Sciences; Utrecht University; Utrecht The Netherlands
| | - Marie L. De Bruin
- Utrecht/WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Utrecht Institute for Pharmaceutical Sciences; Utrecht University; Utrecht The Netherlands
- Copenhagen Centre for Regulatory Science (CORS), Department of Pharmacy; University of Copenhagen; Copenhagen Denmark
| | - Hubert G.M. Leufkens
- Utrecht/WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Utrecht Institute for Pharmaceutical Sciences; Utrecht University; Utrecht The Netherlands
| | - Jarno Hoekman
- Utrecht/WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Utrecht Institute for Pharmaceutical Sciences; Utrecht University; Utrecht The Netherlands
- Innovation Studies Group, Copernicus Institute for Sustainable Development; Utrecht University; Utrecht The Netherlands
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Lysaght T. Accelerating regenerative medicine: the Japanese experiment in ethics and regulation. Regen Med 2017; 12:657-668. [DOI: 10.2217/rme-2017-0038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
In 2014, the Japanese National Diet introduced new laws aimed at promoting the clinical translation of stem cells and regenerative medicine. The basic action of these laws is to allow the early introduction of regenerative medicine products into the Japanese market through an accelerated approval process, while providing patients with access to certain types of stem cell and cell-based therapies in the context of private clinical practice. While this framework appears to offer enormous opportunities for the translation of stem cell science, it raises ethical challenges that have not yet been fully explored. This paper critically analyzes this framework with respect to the prioritization of safety over clinical benefit, distributive justice and public trust in science and medicine. It is argued that the framework unfairly burdens patients and strained healthcare systems without any clear benefits, and may undermine the credibility of the regenerative medicine field as it emerges.
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Affiliation(s)
- Tamra Lysaght
- Centre for Biomedical Ethics, Yong LooLin School of Medicine, National University of Singapore, 119228, Singapore
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Lysaght T, Kerridge IH, Sipp D, Porter G, Capps BJ. Ethical and Regulatory Challenges with Autologous Adult Stem Cells: A Comparative Review of International Regulations. JOURNAL OF BIOETHICAL INQUIRY 2017; 14:261-273. [PMID: 28247202 DOI: 10.1007/s11673-017-9776-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 10/24/2016] [Indexed: 06/06/2023]
Abstract
Cell and tissue-based products, such as autologous adult stem cells, are being prescribed by physicians across the world for diseases and illnesses that they have neither been approved for or been demonstrated as safe and effective in formal clinical trials. These doctors often form part of informal transnational networks that exploit differences and similarities in the regulatory systems across geographical contexts. In this paper, we examine the regulatory infrastructure of five geographically diverse but socio-economically comparable countries with the aim of identifying similarities and differences in how these products are regulated and governed within clinical contexts. We find that while there are many subtle technical differences in how these regulations are implemented, they are sufficiently similar that it is difficult to explain why these practices appear more prevalent in some countries and not in others. We conclude with suggestions for how international governance frameworks might be improved to discourage the exploitation of vulnerable patient populations while enabling innovation in the clinical application of cellular therapies.
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Affiliation(s)
- Tamra Lysaght
- Centre for Biomedical Ethics, National University of Singapore, Level 2 Block MD11, Clinical Research Centre, 10 Medical Drive, 117576, Singapore, Singapore.
| | - Ian H Kerridge
- Centre for Values, Ethics and the Law in Medicine, University of Sydney, Medical Foundations Building K25, Sydney, NSW, 2006, Australia
| | - Douglas Sipp
- RIKEN Centre for Developmental Biology, 2-2-3 Minatojima-minamimachi Chuou-ku, Kobe, 650-004, Japan
| | - Gerard Porter
- School of Law, Edinburgh University, Old College, South Bridge, Edinburgh, EH8 9YL, Scotland
| | - Benjamin J Capps
- Department of Bioethics, Dalhousie University, 5849 University Avenue, Room C-315, CRC Bldg, PO Box 15000, Halifax, NS, B3H 4R2, Canada
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Jokura Y, Yano K, Watanabe N, Yamato M. Bayesian statistics and clinical trial designs for human cells and tissue products for regulatory approval. Regen Ther 2016; 5:86-95. [PMID: 31245506 PMCID: PMC6581844 DOI: 10.1016/j.reth.2016.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 08/31/2016] [Accepted: 09/02/2016] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION In order to obtain premarket approval for medical products derived from human cells or tissues in the United States (US), the European Union (EU), and Japan, data from clinical trials are typically required to evaluate product efficacy and safety. Clinical investigators or study sponsors often face challenges when designing clinical trials on human cells and tissue products with the goal of obtaining premarket approval owing to the unique characteristics of products in this category. The methods used to administer, infuse and transplant these products vary more widely than the methods used for pharmaceuticals. In addition, final product quality may vary depending on the product source, i.e., patients or donors. These products are generally intended to treat intractable and rare diseases or injuries; therefore, it may not be possible to collect a sufficient number of cases and enrollment may be a long process. Moreover, since the technology for product development in this category is relatively new, knowledge and experience from previous studies are limited. METHODS The key elements for the design of clinical trials to determine product efficacy were identified by examining clinical trial designs for approving products. Review reports for approved products from regulatory authorities in the US and Japan as well as the European public assessment reports in the EU were analyzed. RESULTS For one product approved in the US, Dermagraft®, Bayesian statistics were used to evaluate product efficacy, instead of traditional (frequentist) statistics. Based on the statistical guidance for clinical trials recently issued by the US Food and Drug Administration, statistical analyses including Bayesian statistics are key elements in the design of clinical trials for products based on human cells and tissues. New regulations regarding human cells and tissue products have recently been implemented in Japan, including conditional and time-limited approval for regenerative medicine products. In these cases, Bayesian statistics are a promising alternative approach to support product development. CONCLUSIONS Our results emphasize the benefit of considering cogitating statistical methods, such as Bayesian statistics, when designing clinical trials for regulatory purposes.
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Affiliation(s)
- Yoji Jokura
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Kazuo Yano
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University (TWIns), 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
- Research Institute for Science and Engineering, Waseda University, Wakamatsu-cho, Shinjuku-ku, Tokyo 162-8489, Japan
| | - Natsumi Watanabe
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University (TWIns), 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Masayuki Yamato
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University (TWIns), 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
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Rosemann A, Bortz G, Vasen F, Sleeboom-Faulkner M. Global regulatory developments for clinical stem cell research: diversification and challenges to collaborations. Regen Med 2016; 11:647-57. [DOI: 10.2217/rme-2016-0072] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In this article, we explore regulatory developments in stem cell medicine in seven jurisdictions: Japan, China, India, Argentina, Brazil, the USA and the EU. We will show that the research methods, ethical standards and approval procedures for the market use of clinical stem cell interventions are undergoing an important process of global diversification. We will discuss the implications of this process for international harmonization and the conduct of multicountry clinical research collaborations. It will become clear that the increasing heterogeneity of research standards and regulations in the stem cell field presents a significant challenge to international clinical trial partnerships, especially with countries that diverge from the regulatory models that have been developed in the USA and the EU.
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Affiliation(s)
- Achim Rosemann
- Centre for Education Studies, Faculty of Social Sciences, University of Warwick, Coventry, CV4 7AL, UK
- Centre for Bionetworking, School of Global Studies, University of Sussex, Brighton, BN1 9SJ, UK
| | - Gabriela Bortz
- Institute of Science & Technology Studies, National University of Quilmes (IESCT-UNQ), Roque S. Peña 352, (1876) Bernal, Buenos Aires, Argentina
- National Council of Scientific & Technical Research (CONICET), Godoy Cruz 2290, C1425FQB Buenos Aires, Argentina
| | - Federico Vasen
- Institute of Science & Technology Studies, National University of Quilmes (IESCT-UNQ), Roque S. Peña 352, (1876) Bernal, Buenos Aires, Argentina
- Institute of Social Research, National Autonomous University of Mexico, Circuito Mario de la Cueva s/n, Ciudad Universitaria, Coyoacán, 04510 Ciudad de México, México
| | - Margaret Sleeboom-Faulkner
- Centre for Bionetworking, School of Global Studies, University of Sussex, Brighton, BN1 9SJ, UK
- Department of Anthropology, University of Sussex, Arts C 206, Brighton, BN1 9SJ, UK
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The Social Framework Surrounding the Development of Regenerative Medicine in Japan. Camb Q Healthc Ethics 2016; 25:466-71. [PMID: 27348830 DOI: 10.1017/s0963180116000104] [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: 11/07/2022]
Abstract
In 2014, the Japanese government amended the laws concerning regenerative medicine. This reform aimed to contribute to the appropriate promotion of regenerative medicine and new drug discovery for intractable diseases using stem cells. It also helped restrict stem cell tourism, that is, provision of stem cell therapy of unclear efficacy and safety to tourists from abroad, and its relaxed regulations may even lead to the resolution of the drug lag problem. Stem cell medicine is positioned as a part of a national growth strategy that requires cooperation among the industry, government, healthcare field, and academia. It can be characterized as a "mesoscopic strategy," in that it aims to achieve high-level technological developments that would allow results from human-induced pluripotent stem cell and traditional stem cell research to contribute to regenerative medicine and drug development for intractable diseases, while attempting to strike a balance with commercialization and improved access of citizens to cutting-edge medical care.
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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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Comparison of international guidelines for regenerative medicine: Knee cartilage repair and replacement using human-derived cells and tissues. Biologicals 2016; 44:267-270. [PMID: 27156144 DOI: 10.1016/j.biologicals.2016.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 04/01/2016] [Accepted: 04/11/2016] [Indexed: 11/23/2022] Open
Abstract
Regenerative medicine (RM) is an emerging field using human-derived cells and tissues (HCT). Due to the complexity and diversity of HCT products, each country has its own regulations for authorization and no common method has been applied to date. Individual regulations were previously clarified at the level of statutes but no direct comparison has been reported at the level of guidelines. Here, we generated a new analytical framework that allows comparison of guidelines independent from local definitions of RM, using 2 indicators, product type and information type. The guidelines for products for repair and replacement of knee cartilage in Japan, the United States of America, and Europe were compared and differences were detected in both product type and information type by the proposed analytical framework. Those findings will be critical not only for the product developers to determine the region to initiate the clinical trials but also for the regulators to assess and build their regulations. This analytical framework is potentially expandable to other RM guidelines to identify gaps, leading to trigger discussion of global harmonization in RM regulations.
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Lysaght T, Sugii S. Uncertain Oversight of Regenerative Medicines in Japan under the ASRM. Cell Stem Cell 2016; 18:438-9. [DOI: 10.1016/j.stem.2016.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Comparing national home-keeping and the regulation of translational stem cell applications: An international perspective. Soc Sci Med 2016; 153:240-9. [PMID: 26921839 DOI: 10.1016/j.socscimed.2016.01.047] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 01/23/2016] [Accepted: 01/25/2016] [Indexed: 11/21/2022]
Abstract
A very large grey area exists between translational stem cell research and applications that comply with the ideals of randomised control trials and good laboratory and clinical practice and what is often referred to as snake-oil trade. We identify a discrepancy between international research and ethics regulation and the ways in which regulatory instruments in the stem cell field are developed in practice. We examine this discrepancy using the notion of 'national home-keeping', referring to the way governments articulate international standards and regulation with conflicting demands on local players at home. Identifying particular dimensions of regulatory tools - authority, permissions, space and acceleration - as crucial to national home-keeping in Asia, Europe and the USA, we show how local regulation works to enable development of the field, notwithstanding international (i.e. principally 'western') regulation. Triangulating regulation with empirical data and archival research between 2012 and 2015 has helped us to shed light on how countries and organisations adapt and resist internationally dominant regulation through the manipulation of regulatory tools (contingent upon country size, the state's ability to accumulate resources, healthcare demands, established traditions of scientific governance, and economic and scientific ambitions).
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43
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Rosemann A, Sleeboom-Faulkner M. New regulation for clinical stem cell research in China: expected impact and challenges for implementation. Regen Med 2015; 11:5-9. [PMID: 26680327 DOI: 10.2217/rme.15.80] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Achim Rosemann
- Department of Social Sciences, Centre for Education Studies, University of Warwick, Coventry CV4 7AL, UK.,Centre for Bionetworking, School of Global Studies, University of Sussex, Brighton, BN1 9SJ, UK
| | - Margaret Sleeboom-Faulkner
- Centre for Bionetworking, School of Global Studies, University of Sussex, Brighton, BN1 9SJ, UK.,Department of Anthropology, University of Sussex, Arts C 206, Brighton, BN1 9SJ, UK
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Rafiq QA, Ortega I, Jenkins SI, Wilson SL, Patel AK, Barnes AL, Adams CF, Delcassian D, Smith D. The early career researcher's toolkit: translating tissue engineering, regenerative medicine and cell therapy products. Regen Med 2015; 10:989-1003. [PMID: 26628407 DOI: 10.2217/rme.15.56] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Although the importance of translation for the development of tissue engineering, regenerative medicine and cell-based therapies is widely recognized, the process of translation is less well understood. This is particularly the case among some early career researchers who may not appreciate the intricacies of translational research or make decisions early in development which later hinders effective translation. Based on our own research and experiences as early career researchers involved in tissue engineering and regenerative medicine translation, we discuss common pitfalls associated with translational research, providing practical solutions and important considerations which will aid process and product development. Suggestions range from effective project management, consideration of key manufacturing, clinical and regulatory matters and means of exploiting research for successful commercialization.
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Affiliation(s)
- Qasim A Rafiq
- Centre for Biological Engineering, Wolfson School of Mechanical & Manufacturing Engineering, Loughborough University, Leicestershire, LE11 3TU, UK.,Aston Medical Research Institute, School of Life & Health Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET, UK
| | - Ilida Ortega
- Bioengineering & Health Technologies Group, The School of Clinical Dentistry, University of Sheffield, S10 2TA, UK
| | - Stuart I Jenkins
- Institute for Science & Technology in Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Samantha L Wilson
- Academic Ophthalmology, Division of Clincial Neuroscience, Queen's Medical Centre Campus, University of Nottingham, NG7 2UH, UK
| | - Asha K Patel
- Wolfson Centre for Stem Cells, Tissue Engineering & Modeling, University of Nottingham, Nottingham, NG7 2RD, UK.,David H Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | | | - Christopher F Adams
- Institute for Science & Technology in Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Derfogail Delcassian
- Department of Materials, Imperial College London, Exhibition Road, London SW7 2AZ, UK.,Wolfson Centre for Stem Cells, Centre for Biological Sciences, School of Pharmacy, University of Nottingham, NG7 2RD, UK
| | - David Smith
- Centre for Biological Engineering, Wolfson School of Mechanical & Manufacturing Engineering, Loughborough University, Leicestershire, LE11 3TU, UK.,PCT, a Caladrius company, 4 Pearl Court, Suite C, Allendale, NJ 07401, USA
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Van Bokkelen G, Morsy M, Kobayashi TH. Demographic Transition, Health Care Challenges, and the Impact of Emerging International Regulatory Trends With Relevance to Regenerative Medicine. CURRENT STEM CELL REPORTS 2015. [DOI: 10.1007/s40778-015-0013-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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