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Chan WW, Le QB, Naing MW, Choudhury D. Commercialization of skin substitutes for third-degree burn wounds. Trends Biotechnol 2024; 42:385-388. [PMID: 37949776 DOI: 10.1016/j.tibtech.2023.10.005] [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: 09/08/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 11/12/2023]
Abstract
Technological advances have increasingly provided more and better treatment options for patients with severe burns. Here, we provide a bird's-eye view of the product development process for third-degree burn wounds with considerations of the critical interaction with regulatory bodies, existing technological gaps, and future directions for skin substitutes.
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Affiliation(s)
- Weng Wan Chan
- Biomanufacturing Technology, Bioprocessing Technology Institute (BTI), Agency for Science, Technology, and Research (A*STAR), 20 Biopolis Way, Singapore 138668, Singapore
| | - Quang Bach Le
- Biomanufacturing Technology, Bioprocessing Technology Institute (BTI), Agency for Science, Technology, and Research (A*STAR), 20 Biopolis Way, Singapore 138668, Singapore
| | - May Win Naing
- Singapore Institute of Manufacturing Technology (SIMTech), Agency for Science, Technology and Research (A*STAR), 2 Fusionopolis Way, Innovis, Singapore 138634, Singapore
| | - Deepak Choudhury
- Biomanufacturing Technology, Bioprocessing Technology Institute (BTI), Agency for Science, Technology, and Research (A*STAR), 20 Biopolis Way, Singapore 138668, Singapore.
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2
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Arato T, Nomura K. Cell and gene therapy approvals in Japan and the need for international harmonization. Nat Biotechnol 2024; 42:13-17. [PMID: 38191662 DOI: 10.1038/s41587-023-02053-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Affiliation(s)
- Teruyo Arato
- Hokkaido University Hospital, Clinical Research and Medical Innovation Center, Sapporo, Japan.
- Hokkaido University Graduate School of Medicine, Department of Regulatory Science, Sapporo, Japan.
| | - Kaori Nomura
- Teikyo Heisei University, Faculty of Pharmaceutical Sciences, Tokyo, Japan
- Fukushima Medical University, Advanced Clinical Research Center, Fukushima, Japan
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Forrestal DP, Allenby MC, Simpson B, Klein TJ, Woodruff MA. Personalized Volumetric Tissue Generation by Enhancing Multiscale Mass Transport through 3D Printed Scaffolds in Perfused Bioreactors. Adv Healthc Mater 2022; 11:e2200454. [PMID: 35765715 DOI: 10.1002/adhm.202200454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/06/2022] [Indexed: 01/28/2023]
Abstract
Engineered tissues provide an alternative to graft material, circumventing the use of donor tissue such as autografts or allografts and non-physiological synthetic implants. However, their lack of vasculature limits the growth of volumetric tissue more than several millimeters thick which limits their success post-implantation. Perfused bioreactors enhance nutrient mass transport inside lab-grown tissue but remain poorly customizable to support the culture of personalized implants. Here, a multiscale framework of computational fluid dynamics (CFD), additive manufacturing, and a perfusion bioreactor system are presented to engineer personalized volumetric tissue in the laboratory. First, microscale 3D printed scaffold pore geometries are designed and 3D printed to characterize media perfusion through CFD and experimental fluid testing rigs. Then, perfusion bioreactors are custom-designed to combine 3D printed scaffolds with flow-focusing inserts in patient-specific shapes as simulated using macroscale CFD. Finally, these computationally optimized bioreactor-scaffold assemblies are additively manufactured and cultured with pre-osteoblast cells for 7, 20, and 24 days to achieve tissue growth in the shape of human calcaneus bones of 13 mL volume and 1 cm thickness. This framework enables an intelligent model-based design of 3D printed scaffolds and perfusion bioreactors which enhances nutrient transport for long-term volumetric tissue growth in personalized implant shapes. The novel methods described here are readily applicable for use with different cell types, biomaterials, and scaffold microstructures to research therapeutic solutions for a wide range of tissues.
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Affiliation(s)
- David P Forrestal
- Centre for Biomedical Technologies, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland, 4059, Australia.,Herston Biofabrication Institute, Metro North Hospital and Health Service, 7 Butterfield St, Herston, Queensland, 4029, Australia.,School of Mechanical and Mining Engineering, The University of Queensland, Staff House Rd, St Lucia, Queensland, 4072, Australia
| | - Mark C Allenby
- Centre for Biomedical Technologies, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland, 4059, Australia.,School of Chemical Engineering, University of Queensland, Staff House Rd, St Lucia, Queensland, 4072, Australia
| | - Benjamin Simpson
- School of Science and Technology, Nottingham Trent University, Clifton Campus Rd, Nottingham, NG11 8NF, UK
| | - Travis J Klein
- Centre for Biomedical Technologies, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland, 4059, Australia
| | - Maria A Woodruff
- Centre for Biomedical Technologies, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland, 4059, Australia
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Beheshtizadeh N, Gharibshahian M, Pazhouhnia Z, Rostami M, Zangi AR, Maleki R, Azar HK, Zalouli V, Rajavand H, Farzin A, Lotfibakhshaiesh N, Sefat F, Azami M, Webster TJ, Rezaei N. Commercialization and regulation of regenerative medicine products: Promises, advances and challenges. Biomed Pharmacother 2022; 153:113431. [DOI: 10.1016/j.biopha.2022.113431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/04/2022] [Accepted: 07/14/2022] [Indexed: 11/02/2022] Open
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Approach of resource expenditure estimation toward mechanization in the manufacturing of cell-based products. Regen Ther 2022; 20:9-17. [PMID: 35350420 PMCID: PMC8920920 DOI: 10.1016/j.reth.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/11/2022] [Accepted: 02/23/2022] [Indexed: 11/23/2022] Open
Abstract
Recent developments for the manufacturing of cell-based products have focused on the advancement of products to clinical trials or commercialization, with awareness of the importance of cost-based effectiveness in cell manufacturing. The mechanization of cell-processing operations is advantageous for the reproducibility and stability of product quality and is thought to reduce the cost-of-goods through the life cycle of the product in a scale-up system; however, few cases of the implementation exist. This study developed an estimation method for the resource expenditure of cell-processing operations in the manufacturing of cell-based products. To estimate resource expenditures, we evaluated the manufacturing processes by operations involving entering into the surrounding area of cell processing zone, materials loading, cell-processing operation, cleaning, and leaving from the surrounding area. The cell-processing operation is applicable to manual or robotic cell manufacturing system in a biosafety cabinet or an isolator system. In cases of low annual batch numbers of manufacturing (batch number <33), the resource expenditure of cell-processing operations in a robotic operation system installed in the isolator system is estimated to be higher compared with a manual operation system in the isolator system due to additional initial costs for design and fabrication of the robotic operation system containing robot arms. With increasing numbers of annual batches, the resource expenditure decreases for robotic operating system, leading to an advantageous juncture where the resource expenditure of a robotic operation system is equivalent to that of a manually operated system, whereby the labor cost for cell-processing operations rises. In addition, the expertise of operations required for cell manufacturing is suggested to foster potential risks associated with the operation skills or turnover of operators, and the cost of education and training increases due to the necessity of persistent human resource development. Collectively, revealing the approach for installation of robotic operation system in cell manufacturing.
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6
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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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7
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Allenby MC, Woodruff MA. Image analyses for engineering advanced tissue biomanufacturing processes. Biomaterials 2022; 284:121514. [DOI: 10.1016/j.biomaterials.2022.121514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 11/02/2022]
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Orozco-Solares TE, León-Moreno LC, Rojas-Rizo A, Manguart-Paez K, Caplan AI. Allogeneic Mesenchymal Stem Cell-based treatments legislation in Latin America: The need for standardization in a medical tourism context. Stem Cells Dev 2022; 31:143-162. [PMID: 35216516 DOI: 10.1089/scd.2022.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Medicinal Signaling Cells (MSCs) secrete bioactive molecules with paracrine effects. These cells are widely used in basic and clinical research to treat several human diseases and medically relevant conditions. Although there are promising results, only a few treatments are approved of its administration, and clinicians should not underestimate the potential risks of its application without proper authorization. However, some treatments advertised mainly through the internet are not supported by solid or rigorous scientific evidence, legal consent, or the assurance of safety and efficacy, especially in the cell therapy tourism space. This practice allows patients to travel from stringently regulated countries to less restricted ones and increases the flourishing of non-endorsed therapies in these regions. Clinical applications of MSC-based treatments are subject to health legislation, and regulatory agencies are responsible for supervising their manufacture, quality control, and marketing approval. Consensus is needed to homologize and strengthen health legislation regarding those therapies, particularly in regions where medical tourism is frequent. Latin America and the Caribbean, an overlooked region with very heterogeneous legislation regarding cell therapy, is a popular medical tourism destination. Brazil and Argentina created regulations to supervise cell-based treatments manufacture, quality, and marketing. While Mexico, considered the second-largest drug market in Latin America, does not recognize nor authorize any cells as therapy. Also, some regulatory bodies miss the importance of several critical GMP processes to ensure reproducible, reliable, safe, and potentially more favorable results and do not consider them in their legislation. These inconsistencies make the region vulnerable to unproven or unethical treatments, potentially becoming a public health problem involving people from countries worldwide. This review attempts to generate awareness for the legal status of cell therapies in Latin America and the need for standardization as this region is a significant medical tourism destination.
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Affiliation(s)
| | - Lilia Carolina León-Moreno
- Universidad de Guadalajara, 27802, Guadalajara, Jalisco, Mexico.,Provida Salud Integral, Research and Development, Guadalajara, Jalisco, Mexico;
| | - Andrea Rojas-Rizo
- Provida Salud Integral, Mesenchymal Stem Cell Bank, Guadalajara, Jalisco, Mexico;
| | - Karen Manguart-Paez
- Provida Salud Integral, Mesenchymal Stem Cell Bank, Guadalajara, Jalisco, Mexico;
| | - Arnold I Caplan
- Case Western Reserve University, 2546, Department of Biology, Cleveland, Ohio, United States;
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Qiu T, Liang S, Wang Y, Dussart C, Borissov B, Toumi M. Reinforcing Collaboration and Harmonization to Unlock the Potentials of Advanced Therapy Medical Products: Future Efforts Are Awaited From Manufacturers and Decision-Makers. Front Public Health 2021; 9:754482. [PMID: 34900902 PMCID: PMC8655837 DOI: 10.3389/fpubh.2021.754482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/22/2021] [Indexed: 11/29/2022] Open
Abstract
Some advanced therapy medicinal products (ATMPs) hold great promises for life-threatening diseases with high unmet needs. However, ATMPs are also associated with significant challenges in market access, which necessitates the joint efforts between all relevant stakeholders to navigate. In this review, we will elaborate on the importance of collaborations and harmonization across different stakeholders, to expedite the market access of promising ATMPs. Manufacturers of ATMPs should proactively establish collaborations with other stakeholders throughout the whole lifecycle of ATMPs, from early research to post-market activities. This covered engagements with (1) external developers (i.e., not-for-profit organizations and commercial players) to obtain complementary knowledge, technology, or infrastructures, (2) patient groups and healthcare providers to highlight their roles as active contributors, and (3) decision-makers, such as regulators, health technology assessment (HTA) agencies, and payers, to communicate the uncertainties in evidence package, where parallel consultation will be a powerful strategy. Harmonization between decision-makers is desired at (1) regulatory level, in terms of strengthening the international standardization of regulatory framework to minimize discrepancies in evidence requirements for market authorization, and (2) HTA level, in terms of enhancing alignments between regional and national HTA agencies to narrow inequity in patient access, and cross-border HTA cooperation to improve the quality and efficiency of HTA process. In conclusion, manufacturers and decision-makers shared the common goals to safeguard timely patient access to ATMPs. Collaboration and harmonization will be increasingly leveraged to enable the value delivery of ATMPs to all stakeholders.
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Affiliation(s)
- Tingting Qiu
- Département de Santé Publique, Aix-Marseille Université, Marseille, France
| | - Shuyao Liang
- Département de Santé Publique, Aix-Marseille Université, Marseille, France
| | - Yitong Wang
- Département de Santé Publique, Aix-Marseille Université, Marseille, France
| | - Claude Dussart
- Faculté de Pharmacie, Université Claude Bernard Lyon 1, Lyon, France
| | | | - Mondher Toumi
- Département de Santé Publique, Aix-Marseille Université, Marseille, France
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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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Local Treatment of Burns with Cell-Based Therapies Tested in Clinical Studies. J Clin Med 2021; 10:jcm10030396. [PMID: 33494318 PMCID: PMC7864524 DOI: 10.3390/jcm10030396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/08/2021] [Accepted: 01/18/2021] [Indexed: 12/30/2022] Open
Abstract
Effective wound management is an important determinant of the survival and prognosis of patients with severe burns. Thus, novel techniques for timely and full closure of full-thickness burn wounds are urgently needed. The purpose of this review is to present the current state of knowledge on the local treatment of burn wounds (distinguishing radiation injury from other types of burns) with the application of cellular therapies conducted in clinical studies. PubMed search engine and ClinicalTrials.gov were used to analyze the available data. The analysis covered 49 articles, assessing the use of keratinocytes (30), keratinocytes and fibroblasts (6), fibroblasts (2), bone marrow-derived cells (8), and adipose tissue cells (3). Studies on the cell-based products that are commercially available (Epicel®, Keraheal™, ReCell®, JACE, Biobrane®) were also included, with the majority of reports found on autologous and allogeneic keratinocytes. Promising data demonstrate the effectiveness of various cell-based therapies; however, there are still scientific and technical issues that need to be solved before cell therapies become standard of care. Further evidence is required to demonstrate the clinical efficacy and safety of cell-based therapies in burns. In particular, comparative studies with long-term follow-up are critical.
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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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Angelis A, Naci H, Hackshaw A. Recalibrating Health Technology Assessment Methods for Cell and Gene Therapies. PHARMACOECONOMICS 2020; 38:1297-1308. [PMID: 32960434 DOI: 10.1007/s40273-020-00956-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Recently licensed cell and gene therapies have promising but highly uncertain clinical benefits. They are entering the market at very high prices, with the latest entrants costing hundreds of thousands of dollars. The significant long-term uncertainty posed by these therapies has already complicated the use of conventional economic evaluation approaches such as cost-effectiveness and cost-utility analyses, which are widely used for assessing the value of new health interventions. Cell and gene therapies also risk jeopardising healthcare systems' financial sustainability. As a result, there is a need to recalibrate the current health technology assessment methods used to measure and compensate their value. In this paper, we outline a set of technical adaptations and methodological refinements to address key challenges in the appraisal of cell and gene therapies' value, including the assessment of efficiency and affordability. We also discuss the potential role of alternative financing mechanisms. Ultimately, uncertainties associated with cell and gene therapies can only be meaningfully addressed by improving the evidence base supporting their approval and adoption in healthcare systems.
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Affiliation(s)
- Aris Angelis
- Department of Health Policy, London School of Economics and Political Science, Cowdray House, Portugal Street, London, UK.
| | - Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, Cowdray House, Portugal Street, London, UK
| | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK
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Cuende N, Álvarez-Márquez AJ, Díaz-Aunión C, Castro P, Huet J, Pérez-Villares JM. Promoting the ethical use of safe and effective cell-based products: the Andalusian plan on regenerative medicine. Cytotherapy 2020; 22:712-717. [PMID: 32878735 PMCID: PMC7456586 DOI: 10.1016/j.jcyt.2020.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/04/2020] [Accepted: 07/15/2020] [Indexed: 10/25/2022]
Abstract
With regard to regenerative medicine, the expectations generated over the last two decades and the time involved in developing this type of therapies, together with the availability of devices that allow point-of-care treatments through the rapid isolation of cellular or plasma products from patients in the operating theater, represent the perfect breeding ground for the offering of unproven or unregulated therapies on a global scale. A multidisciplinary approach-one based on the collaboration of institutions that, from the perspective of their area of competence, can contribute to reversing this worrying situation-to this problem is essential. It is a priority for local health authorities to take measures that are adapted to the particular situation and regulatory framework of their respective territory. In this article, the authors present the regenerative medicine action plan promoted by the Andalusian Transplant Coordination (i.e., the action plan for the largest region in Spain), highlighting the aspects the authors believe are fundamental to its success. The authors describe, in summary form, the methodology, phases of the plan, actions designed, key collaborators, important milestones achieved and main lessons they have drawn from their experience so that this can serve as an example for other institutions interested in promoting the ethical use of this type of therapy.
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Affiliation(s)
- Natividad Cuende
- Coordinación Autonómica de Trasplantes de Andalucía, Servicio Andaluz de Salud, Sevilla, Spain.
| | | | - Concepción Díaz-Aunión
- Coordinación Autonómica de Trasplantes de Andalucía, Servicio Andaluz de Salud, Sevilla, Spain
| | - Pablo Castro
- Coordinación Autonómica de Trasplantes de Andalucía, Servicio Andaluz de Salud, Sevilla, Spain
| | - Jesús Huet
- Coordinación Autonómica de Trasplantes de Andalucía, Servicio Andaluz de Salud, Sevilla, Spain
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Smith D, Heathman TRJ, Klarer A, LeBlon C, Tada Y, Hampson B. Towards Automated Manufacturing for Cell Therapies. Curr Hematol Malig Rep 2020; 14:278-285. [PMID: 31254154 DOI: 10.1007/s11899-019-00522-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW Many cell therapy products are beginning to reach the commercial finish line and a rapidly escalating pipeline of products are in clinical development. The need to develop manufacturing capability that will support a successful commercial business model has become a top priority as many cell therapy developers look to secure long-term visions to enable both funding and treatment success. RECENT FINDINGS Manufacturing automation is both highly compelling and very challenging at the same time as a key tactic to address quality, cost of goods, scale, and sustainability that are fundamental drivers for commercially viable manufacturing. This paper presents an overview and strategic drivers for application of automation to cell therapy manufacturing. It also explores unique automation considerations for patient-specific cell therapy (PSCT) where each full-scale lot is for one patient vs off-the-shelf cell therapy (OTSCT) where a full-scale lot will treat many patients, and finally some practical considerations for implementing automation.
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Affiliation(s)
- David Smith
- Hitachi Chemical Advanced Therapeutics Solutions LLC, Allendale, NJ, USA.
| | | | - Alex Klarer
- Hitachi Chemical Advanced Therapeutics Solutions LLC, Allendale, NJ, USA
| | - Courtney LeBlon
- Hitachi Chemical Advanced Therapeutics Solutions LLC, Allendale, NJ, USA
| | | | - Brian Hampson
- Hitachi Chemical Advanced Therapeutics Solutions LLC, Allendale, NJ, USA
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16
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Eder C, Wild C. Technology forecast: advanced therapies in late clinical research, EMA approval or clinical application via hospital exemption. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2019; 7:1600939. [PMID: 31069029 PMCID: PMC6493298 DOI: 10.1080/20016689.2019.1600939] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/10/2019] [Accepted: 03/18/2019] [Indexed: 06/09/2023]
Abstract
Background: The umbrella term ATMPs (Advanced Therapy Medicinal Products) comprises cell therapies, gene therapeutics and tissue engineered products. After implementation of the Regulation 1394/2007, only a couple of products have obtained a centralized European marketing authorisation. Objectives: The aim of the presented study is to give an overview on ATMPs available within the European Union either via centralized marketing authorisation or via national Hospital exemption. Additionally, a forecast on innovative ATMPs in the process of EMA approval as well as in phase III and IV clinical trial is provided. Methods: Systematic literature search including 'grey literature' and database reviews as well as manual search following pre-defined search terms. Results: 8 ATMPs are currently available via centralized marketing authorisation. 6 new product launches are expected before 2020. At least 32 additional ATMPs are available in individual European Union member states via Hospital exemption. Another 31 potential ATMP candidates could be identified in industry-driven phase III research projects. Conclusion: Advanced therapeutic medicinal therapies are still in their early days, but constantly evolving. By 2020, innovative therapies targeting retinal dystrophy, ß-thalassemia, scleroderma, sickle-cell anaemia, adrenoleukodystrophy and leukaemia shall be available on the market.
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Affiliation(s)
- Claudia Eder
- Ludwig Boltzmann Institute for Health Technology Assessment, Vienna, Austria
| | - Claudia Wild
- Ludwig Boltzmann Institute for Health Technology Assessment, Vienna, Austria
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17
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Yano K, Speidel AT, Yamato M. Four Food and Drug Administration draft guidance documents and the REGROW Act: A litmus test for future changes in human cell- and tissue-based products regulatory policy in the United States? J Tissue Eng Regen Med 2018; 12:1579-1593. [PMID: 29702746 PMCID: PMC6055862 DOI: 10.1002/term.2683] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 04/08/2018] [Accepted: 04/16/2018] [Indexed: 11/08/2022]
Abstract
Modern regenerative medicine research has expanded well past the development of traditional drugs and medical devices with many promising new therapies encompassing an increasingly diverse range of substances, notably cell-based therapies. These substantial recent developments and the progress in the health care and therapeutics fields necessitate a new regulatory framework agile enough to accommodate these unique therapies and acknowledge their differences with traditional pharmaceuticals. In the United States, recent proposed changes in the regulatory framework for autologous human cells, tissues, and cellular and tissue-based products (HCT/Ps) and their perceived risk-benefit analysis for patients remain controversial in the scientific field. To provide perspective on of the current status of the most recent attempts to redefine and conceptualize these changes in the United States, we will examine 4 draft guidance documents implemented by the Food and Drug Administration in interpreting relevant concepts and terminology pertaining to HCT/Ps: the Bipartisan Policy Center think tank report, "Advancing Regenerative Cellular Therapy: Medical Innovation for Healthier Americans," the proposed REGROW Act for HCT/Ps, and the current 24 Food and Drug Administration-approved HCT/Ps and related products in the United States.
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Affiliation(s)
- Kazuo Yano
- Institute of Advanced Biomedical Engineering and ScienceTokyo Women's Medical UniversityTokyoJapan
- Research Institute for Science and EngineeringWaseda UniversityTokyoJapan
- Cooperative Major in Advanced Biomedical SciencesJoint Graduate School of Tokyo Women's Medical University and Waseda UniversityTokyoJapan
| | - Alessondra T. Speidel
- Institute of Advanced Biomedical Engineering and ScienceTokyo Women's Medical UniversityTokyoJapan
| | - Masayuki Yamato
- Institute of Advanced Biomedical Engineering and ScienceTokyo Women's Medical UniversityTokyoJapan
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18
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McBlane JW, Phul P, Sharpe M. Preclinical Development of Cell-Based Products: a European Regulatory Science Perspective. Pharm Res 2018; 35:165. [PMID: 29943208 PMCID: PMC6156759 DOI: 10.1007/s11095-018-2437-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/01/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE This article describes preclinical development of cell-based medicinal products for European markets and discusses European regulatory mechanisms open to developers to aid successful product development. Cell-based medicinal products are diverse, including cells that are autologous or allogeneic, have been genetically modified, or not, or expanded ex vivo, and applied systemically or to an anatomical site different to that of their origin; comments applicable to one product may not be applicable to others, so bespoke development is needed, for all elements - quality, preclinical and clinical. METHODS After establishing how the product is produced, proof of potential for therapeutic efficacy, and then safety, of the product need to be determined. This includes understanding biodistribution, persistence and toxicity, including potential for malignant transformation. These elements need to be considered in the context of the intended clinical development. RESULTS This article describes regulatory mechanisms available to developers to support product development that aim to resolve scientific issues prior to marketing authorization application, to enable patients to have faster access to the product than would otherwise be the case. CONCLUSIONS Developers are encouraged to be aware of both the scientific issues and regulatory mechanisms to ensure patients can be supplied with these products.
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Affiliation(s)
- James W McBlane
- Licensing Division, Medicines & Healthcare Products Regulatory Agency, 10 South Colonnade, Canary Wharf, London, E14 4PU, UK.
| | - Parvinder Phul
- Licensing Division, Medicines & Healthcare Products Regulatory Agency, 10 South Colonnade, Canary Wharf, London, E14 4PU, UK
| | - Michaela Sharpe
- Nonclinical Safety, Cell and Gene Therapy Catapult, Guy's Hospital, 12th Floor, Tower Wing B, London, SE1 9RT, UK
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19
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Bedford P, Jy J, Collins L, Keizer S. Considering Cell Therapy Product "Good Manufacturing Practice" Status. Front Med (Lausanne) 2018; 5:118. [PMID: 29761103 PMCID: PMC5936751 DOI: 10.3389/fmed.2018.00118] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/09/2018] [Indexed: 11/17/2022] Open
Affiliation(s)
- Patrick Bedford
- Centre for Commercialization of Regenerative Medicine (CCRM), Toronto, ON, Canada
| | - Juliana Jy
- Centre for Commercialization of Regenerative Medicine (CCRM), Toronto, ON, Canada
| | - Lucas Collins
- Centre for Commercialization of Regenerative Medicine (CCRM), Toronto, ON, Canada
| | - Steven Keizer
- Centre for Commercialization of Regenerative Medicine (CCRM), Toronto, ON, Canada
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20
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Halioua-Haubold CL, Peyer JG, Smith JA, Arshad Z, Scholz M, Brindley DA, MacLaren RE. Regulatory Considerations for Gene Therapy Products in the US, EU, and Japan. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2017; 90:683-693. [PMID: 29259533 PMCID: PMC5733859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Developers of gene therapy products (GTPs) must adhere to additional regulation beyond that of traditional small-molecule therapeutics, due to the unique mechanism-of-action of GTPs and the subsequent novel risks arisen. We have provided herein a summary of the regulatory structure under which GTPs fall in the United States, the European Union, and Japan, and a comprehensive overview of the regulatory guidance applicable to the developer of GTP. Understanding the regulatory requirements for seeking GTP market approval in these major jurisdictions is crucial for an effective and expedient path to market. The novel challenges facing GTP developers is highlighted by a case study of alipogene tiparvovec (Glybera).
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Affiliation(s)
- Celine-Lea Halioua-Haubold
- Department of Paediatrics, University of Oxford, Oxford, UK,Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford, UK,To whom all correspondence should be addressed:
Celine-Lea Halioua-Haubold, Nuffield Laboratory and Department of Paediatrics, University of Oxford and Oxford University Hospitals NHS Foundation Trust NIHR Biomedical Research Centre, Oxford, UK;
| | | | - James A. Smith
- Nuffield Departments of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK,Oxford-UCL Center for the Advancement of Sustainable Medical Innovation, University of Oxford, Oxford, UK
| | - Zeeshaan Arshad
- School of Clinical Medicine, University of Cambridge, Cambridge, UK,Oxford-UCL Center for the Advancement of Sustainable Medical Innovation, University of Oxford, Oxford, UK
| | | | - David A. Brindley
- Department of Paediatrics, University of Oxford, Oxford, UK,Oxford-UCL Center for the Advancement of Sustainable Medical Innovation, University of Oxford, Oxford, UK
| | - Robert E. MacLaren
- Moorfields Eye Hospital, London, UK,Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford, UK,Oxford University Hospitals National Health Service Foundation Trust, Oxford, UK
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21
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Dwarshuis NJ, Parratt K, Santiago-Miranda A, Roy K. Cells as advanced therapeutics: State-of-the-art, challenges, and opportunities in large scale biomanufacturing of high-quality cells for adoptive immunotherapies. Adv Drug Deliv Rev 2017. [PMID: 28625827 DOI: 10.1016/j.addr.2017.06.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Therapeutic cells hold tremendous promise in treating currently incurable, chronic diseases since they perform multiple, integrated, complex functions in vivo compared to traditional small-molecule drugs or biologics. However, they also pose significant challenges as therapeutic products because (a) their complex mechanisms of actions are difficult to understand and (b) low-cost bioprocesses for large-scale, reproducible manufacturing of cells have yet to be developed. Immunotherapies using T cells and dendritic cells (DCs) have already shown great promise in treating several types of cancers, and human mesenchymal stromal cells (hMSCs) are now extensively being evaluated in clinical trials as immune-modulatory cells. Despite these exciting developments, the full potential of cell-based therapeutics cannot be realized unless new engineering technologies enable cost-effective, consistent manufacturing of high-quality therapeutic cells at large-scale. Here we review cell-based immunotherapy concepts focused on the state-of-the-art in manufacturing processes including cell sourcing, isolation, expansion, modification, quality control (QC), and culture media requirements. We also offer insights into how current technologies could be significantly improved and augmented by new technologies, and how disciplines must converge to meet the long-term needs for large-scale production of cell-based immunotherapies.
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Affiliation(s)
- Nate J Dwarshuis
- The Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University, Atlanta, GA 30332-0313, United States; The Parker H. Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, GA 30332, United States.
| | - Kirsten Parratt
- The Parker H. Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, GA 30332, United States; Department of Material Science and Engineering, Georgia Institute of Technology, Atlanta, GA 30332, United States.
| | - Adriana Santiago-Miranda
- The Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University, Atlanta, GA 30332-0313, United States; The Parker H. Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, GA 30332, United States.
| | - Krishnendu Roy
- The Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University, Atlanta, GA 30332-0313, United States; The Parker H. Petit Institute for Bioengineering and Biosciences, Georgia Institute of Technology, Atlanta, GA 30332, United States.
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22
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Inokuma Y. Pharmacovigilance of Regenerative Medicine Under the Amended Pharmaceutical Affairs Act in Japan. Drug Saf 2017; 40:475-482. [DOI: 10.1007/s40264-017-0517-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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23
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Emmert MY, Fioretta ES, Hoerstrup SP. Translational Challenges in Cardiovascular Tissue Engineering. J Cardiovasc Transl Res 2017; 10:139-149. [PMID: 28281240 DOI: 10.1007/s12265-017-9728-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/03/2017] [Indexed: 01/23/2023]
Abstract
Valvular heart disease and congenital heart defects represent a major cause of death around the globe. Although current therapy strategies have rapidly evolved over the decades and are nowadays safe, effective, and applicable to many affected patients, the currently used artificial prostheses are still suboptimal. They do not promote regeneration, physiological remodeling, or growth (particularly important aspects for children) as their native counterparts. This results in the continuous degeneration and subsequent failure of these prostheses which is often associated with an increased morbidity and mortality as well as the need for multiple re-interventions. To overcome this problem, the concept of tissue engineering (TE) has been repeatedly suggested as a potential technology to enable native-like cardiovascular replacements with regenerative and growth capacities, suitable for young adults and children. However, despite promising data from pre-clinical and first clinical pilot trials, the translation and clinical relevance of such TE technologies is still very limited. The reasons that currently limit broad clinical adoption are multifaceted and comprise of scientific, clinical, logistical, technical, and regulatory challenges which need to be overcome. The aim of this review is to provide an overview about the translational problems and challenges in current TE approaches. It further suggests directions and potential solutions on how these issues may be efficiently addressed in the future to accelerate clinical translation. In addition, a particular focus is put on the current regulatory guidelines and the associated challenges for these promising TE technologies.
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Affiliation(s)
- Maximilian Y Emmert
- Institute for Regenerative Medicine (IREM), University of Zurich, Moussonstrasse 13, 8091, Zurich, Switzerland.,Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland.,Wyss Translational Center Zurich, Zurich, Switzerland
| | - Emanuela S Fioretta
- Institute for Regenerative Medicine (IREM), University of Zurich, Moussonstrasse 13, 8091, Zurich, Switzerland
| | - Simon P Hoerstrup
- Institute for Regenerative Medicine (IREM), University of Zurich, Moussonstrasse 13, 8091, Zurich, Switzerland. .,Wyss Translational Center Zurich, Zurich, Switzerland.
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24
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Riff AJ, Yanke AB, Cole BJ. Getting Products to Market: Understanding and Navigating the Regulatory Pathway. OPER TECHN SPORT MED 2017. [DOI: 10.1053/j.otsm.2016.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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25
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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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26
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Eco matters; In & Out. J Stem Cells Regen Med 2016; 12:52-53. [PMID: 28096628 PMCID: PMC5227103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
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27
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Bagherifard S. Mediating bone regeneration by means of drug eluting implants: From passive to smart strategies. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 71:1241-1252. [PMID: 27987680 DOI: 10.1016/j.msec.2016.11.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/06/2016] [Accepted: 11/02/2016] [Indexed: 02/03/2023]
Abstract
In addition to excellent biocompatibility and mechanical performance, the new generation of bone and craniofacial implants are expected to proactively contribute to the regeneration process and dynamically interact with the host tissue. To this end, integration and sustained delivery of therapeutic agents has become a rapidly expanding area. The incorporated active molecules can offer supplementary features including promoting oteoconduction and angiogenesis, impeding bacterial infection and modulating host body reaction. Major limitations of the current practices consist of low drug stability overtime, poor control of release profile and kinetics as well as complexity of finding clinically appropriate drug dosage. In consideration of the multifaceted cascade of bone regeneration process, this research is moving towards dual/multiple drug delivery, where precise control on simultaneous or sequential delivery, considering the possible synergetic interaction of the incorporated bioactive factors is of utmost importance. Herein, recent advancements in fabrication of synthetic load bearing implants equipped with various drug delivery systems are reviewed. Smart drug delivery solutions, newly developed to provide higher tempo-spatial control on the delivery of the pharmaceutical agents for targeted and stimuli responsive delivery are highlighted. The future trend of implants with bone drug delivery mechanisms and the most common challenges hindering commercialization and the bench to bedside progress of the developed technologies are covered.
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Affiliation(s)
- Sara Bagherifard
- Politecnico di Milano, Department of Mechanical Engineering, Milan, Italy.
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28
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Raftery RM, Walsh DP, Castaño IM, Heise A, Duffy GP, Cryan SA, O'Brien FJ. Delivering Nucleic-Acid Based Nanomedicines on Biomaterial Scaffolds for Orthopedic Tissue Repair: Challenges, Progress and Future Perspectives. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2016; 28:5447-5469. [PMID: 26840618 DOI: 10.1002/adma.201505088] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 11/27/2015] [Indexed: 06/05/2023]
Abstract
As well as acting to fill defects and allow for cell infiltration and proliferation in regenerative medicine, biomaterial scaffolds can also act as carriers for therapeutics, further enhancing their efficacy. Drug and protein delivery on scaffolds have shown potential, however, supraphysiological quantities of therapeutic are often released at the defect site, causing off-target side effects and cytotoxicity. Gene therapy involves the introduction of foreign genes into a cell in order to exert an effect; either replacing a missing gene or modulating expression of a protein. State of the art gene therapy also encompasses manipulation of the transcriptome by harnessing RNA interference (RNAi) therapy. The delivery of nucleic acid nanomedicines on biomaterial scaffolds - gene-activated scaffolds -has shown potential for use in a variety of tissue engineering applications, but as of yet, have not reached clinical use. The current state of the art in terms of biomaterial scaffolds and delivery vector materials for gene therapy is reviewed, and the limitations of current procedures discussed. Future directions in the clinical translation of gene-activated scaffolds are also considered, with a particular focus on bone and cartilage tissue regeneration.
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Affiliation(s)
- Rosanne M Raftery
- Tissue Engineering Research Group (TERG), Dept. of Anatomy, Royal College of Surgeons in Ireland (RCSI), 123, St. Stephens Green, Dublin 2, Dublin, Ireland
- Trinity Centre for Bioengineering (TCBE), Trinity College Dublin, Dublin 2, Dublin, Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
- Drug Delivery and Advanced Materials Research Team, School of Pharmacy, Royal College of Surgeons in Ireland, 123, St. Stephens Green, Dublin 2, Dublin, Ireland
- Centre for Research in Medical Devices (CÚRAM), National University of Ireland Galway, Galway, Ireland
| | - David P Walsh
- Tissue Engineering Research Group (TERG), Dept. of Anatomy, Royal College of Surgeons in Ireland (RCSI), 123, St. Stephens Green, Dublin 2, Dublin, Ireland
- Trinity Centre for Bioengineering (TCBE), Trinity College Dublin, Dublin 2, Dublin, Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
- Drug Delivery and Advanced Materials Research Team, School of Pharmacy, Royal College of Surgeons in Ireland, 123, St. Stephens Green, Dublin 2, Dublin, Ireland
- Centre for Research in Medical Devices (CÚRAM), National University of Ireland Galway, Galway, Ireland
| | - Irene Mencía Castaño
- Tissue Engineering Research Group (TERG), Dept. of Anatomy, Royal College of Surgeons in Ireland (RCSI), 123, St. Stephens Green, Dublin 2, Dublin, Ireland
- Trinity Centre for Bioengineering (TCBE), Trinity College Dublin, Dublin 2, Dublin, Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
| | - Andreas Heise
- Tissue Engineering Research Group (TERG), Dept. of Anatomy, Royal College of Surgeons in Ireland (RCSI), 123, St. Stephens Green, Dublin 2, Dublin, Ireland
| | - Garry P Duffy
- Tissue Engineering Research Group (TERG), Dept. of Anatomy, Royal College of Surgeons in Ireland (RCSI), 123, St. Stephens Green, Dublin 2, Dublin, Ireland
- Trinity Centre for Bioengineering (TCBE), Trinity College Dublin, Dublin 2, Dublin, Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
| | - Sally-Ann Cryan
- Tissue Engineering Research Group (TERG), Dept. of Anatomy, Royal College of Surgeons in Ireland (RCSI), 123, St. Stephens Green, Dublin 2, Dublin, Ireland
- Trinity Centre for Bioengineering (TCBE), Trinity College Dublin, Dublin 2, Dublin, Ireland
- Drug Delivery and Advanced Materials Research Team, School of Pharmacy, Royal College of Surgeons in Ireland, 123, St. Stephens Green, Dublin 2, Dublin, Ireland
- Centre for Research in Medical Devices (CÚRAM), National University of Ireland Galway, Galway, Ireland
| | - Fergal J O'Brien
- Tissue Engineering Research Group (TERG), Dept. of Anatomy, Royal College of Surgeons in Ireland (RCSI), 123, St. Stephens Green, Dublin 2, Dublin, Ireland
- Trinity Centre for Bioengineering (TCBE), Trinity College Dublin, Dublin 2, Dublin, Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
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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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Report of the international conference on regulatory endeavors towards the sound development of human cell therapy products. Biologicals 2015; 43:283-97. [DOI: 10.1016/j.biologicals.2015.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 07/30/2015] [Indexed: 12/31/2022] Open
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Ikawa T, Yano K, Watanabe N, Masamune K, Yamato M. Non-clinical assessment design of autologous chondrocyte implantation products. Regen Ther 2015; 1:98-108. [PMID: 31245449 PMCID: PMC6581806 DOI: 10.1016/j.reth.2015.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 06/22/2015] [Accepted: 06/23/2015] [Indexed: 10/26/2022] Open
Abstract
The aims of this study were to investigate the premarket assessment of autologous chondrocyte implantation (ACI) products especially regarding the non-clinical assessment by surveying the guidelines and review reports of authorized ACI products in detail and to provide information regarding the non-clinical assessment of the safety and efficacy for the future development of regenerative medicine products to design effective premarket assessment. The non-clinical assessment plays a role in justifying the testing of investigational products in humans. Effective non-clinical assessments minimize the risk of clinical trials and achieve prompt product development. In this study, we focused on authorized ACI products that remain in the body of patients for a long time and often contain extrinsic components such as animal tissue-derived collagen. We summarized the details of the characteristics of each ACI product, non-clinical assessment design and related guidelines. To design effective non-clinical assessments, we discussed the evaluation method (particularly the validation of clinical assessment and mechanical property testing), the employed animal models, and the differences in the assessment of the safety and efficacy of the products. Based on these investigations, we provide the details of satisfactory non-clinical assessment of ACI products and indicate the possibility of more effective non-clinical assessment of ACI products and other future regenerative medicine products.
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Affiliation(s)
- Taisuke Ikawa
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Tokyo, Japan
| | - Kazuo Yano
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Tokyo, Japan
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University (TWIns), Tokyo, 162-8666, Japan
- Research Institute for Science and Engineering, Waseda University, Tokyo, 169-8555, Japan
| | - Natsumi Watanabe
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Tokyo, Japan
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University (TWIns), Tokyo, 162-8666, Japan
| | - Ken Masamune
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Tokyo, Japan
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University (TWIns), Tokyo, 162-8666, Japan
| | - Masayuki Yamato
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Tokyo, Japan
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University (TWIns), Tokyo, 162-8666, Japan
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