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El Fiky A, Ibenana L, Anderson R, Hare JM, Khan A, Gee AP, Rooney C, McKenna DH, Gold J, Kelley L, Lundberg MS, Welniak LA, Lindblad R. The National Heart, Lung, and Blood Institute-funded Production Assistance for Cellular Therapies (PACT) program: Eighteen years of cell therapy. Clin Transl Sci 2021; 14:2099-2110. [PMID: 34286927 PMCID: PMC8604220 DOI: 10.1111/cts.13102] [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: 02/09/2021] [Revised: 04/08/2021] [Accepted: 05/24/2021] [Indexed: 11/29/2022] Open
Abstract
The Production Assistance for Cellular Therapies (PACT) Program, is funded and supported by the US Department of Health and Human Services’ National Institutes of Health (NIH) National Heart Lung and Blood Institute (NHLBI) to advance development of somatic cell and genetically modified cell therapeutics in the areas of heart, lung, and blood diseases. The program began in 2003, continued under two competitive renewals, and ended June 2021. PACT has supported cell therapy product manufacturing, investigational new drug enabling preclinical studies, and translational services, and has provided regulatory assistance for candidate cell therapy products that may aid in the repair and regeneration of damaged/diseased cells, tissues, and organs. PACT currently supports the development of novel cell therapies through five cell processing facilities. These facilities offer manufacturing processes, analytical development, technology transfer, process scale‐up, and preclinical development expertise necessary to produce cell therapy products that are compliant with Good Laboratory Practices, current Good Manufacturing Practices, and current Good Tissue Practices regulations. The Emmes Company, LLC, serves as the Coordinating Center and assists with the management and coordination of PACT and its application submission and review process. This paper discusses the impact and accomplishments of the PACT program on the cell therapy field and its evolution over the duration of the program. It highlights the work that has been accomplished and provides a foundation to build future programs with similar goals to advance cellular therapeutics in a coordinated and centralized programmatic manner to support unmet medical needs within NHLBI purview.
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Affiliation(s)
| | | | | | - Joshua M Hare
- Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Aisha Khan
- Interdisciplinary Stem Cell Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Adrian P Gee
- Center For Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas, USA
| | - Cliona Rooney
- Center For Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas, USA
| | - David H McKenna
- Molecular and Cellular Therapeutics, University of Minnesota, Saint Paul, Minnesota, USA
| | - Joseph Gold
- Center for Biomedicine and Genetics, City of Hope, Duarte, California, USA
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Khan A, Bellio MA, Schulman IH, Levi AD, Longsomboon B, Brooks A, Valasaki K, DiFede DL, Pujol MV, Yavagal DR, Bates KE, Si MS, Kaushal S, Green BA, Anderson KD, Guest JD, Burks SS, Silvera R, Santamaria AJ, Lalwani A, Dietrich WD, Hare JM. The Interdisciplinary Stem Cell Institute's Use of Food and Drug Administration-Expanded Access Guidelines to Provide Experimental Cell Therapy to Patients With Rare Serious Diseases. Front Cell Dev Biol 2021; 9:675738. [PMID: 34169074 PMCID: PMC8217825 DOI: 10.3389/fcell.2021.675738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/04/2021] [Indexed: 11/15/2022] Open
Abstract
The U.S. Food and Drug Administration (FDA) provides guidance for expanded access to experimental therapies, which in turn plays an important role in the Twenty-first Century Cures Act mandate to advance cell-based therapy. In cases of incurable diseases where there is a lack of alternative treatment options, many patients seek access to cell-based therapies for the possibility of treatment responses demonstrated in clinical trials. Here, we describe the use of the FDA’s expanded access to investigational new drug (IND) to address rare and emergency conditions that include stiff-person syndrome, spinal cord injury, traumatic brain stem injury, complex congenital heart disease, ischemic stroke, and peripheral nerve injury. We have administered both allogeneic bone marrow-derived mesenchymal stem cell (MSC) and autologous Schwann cell (SC) therapy to patients upon emergency request using Single Patient Expanded Access (SPEA) INDs approved by the FDA. In this report, we present our experience with 10 completed SPEA protocols.
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Affiliation(s)
- Aisha Khan
- Leonard M. Miller School of Medicine, The Interdisciplinary Stem Cell Institute, University of Miami, Miami, FL, United States.,The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Michael A Bellio
- Leonard M. Miller School of Medicine, The Interdisciplinary Stem Cell Institute, University of Miami, Miami, FL, United States
| | - Ivonne H Schulman
- Leonard M. Miller School of Medicine, The Interdisciplinary Stem Cell Institute, University of Miami, Miami, FL, United States.,Katz Family Division of Nephrology and Hypertension, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Allan D Levi
- The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States.,The Department of Neurological Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Bangon Longsomboon
- Leonard M. Miller School of Medicine, The Interdisciplinary Stem Cell Institute, University of Miami, Miami, FL, United States
| | - Adriana Brooks
- Leonard M. Miller School of Medicine, The Interdisciplinary Stem Cell Institute, University of Miami, Miami, FL, United States.,The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Krystalenia Valasaki
- Leonard M. Miller School of Medicine, The Interdisciplinary Stem Cell Institute, University of Miami, Miami, FL, United States
| | - Darcy L DiFede
- Leonard M. Miller School of Medicine, The Interdisciplinary Stem Cell Institute, University of Miami, Miami, FL, United States
| | - Marietsy V Pujol
- Leonard M. Miller School of Medicine, The Interdisciplinary Stem Cell Institute, University of Miami, Miami, FL, United States
| | - Dileep R Yavagal
- Leonard M. Miller School of Medicine, The Interdisciplinary Stem Cell Institute, University of Miami, Miami, FL, United States.,The Department of Clinical Neurology and Neurosurgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Karen E Bates
- The Department of Clinical Neurology and Neurosurgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Ming-Sing Si
- Section of Pediatric Cardiovascular Surgery, Department of Cardiac Surgery, Michigan Medicine, C.S. Mott Children's Hospital, Ann Arbor, MI, United States
| | - Sunjay Kaushal
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Barth A Green
- The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States.,The Department of Neurological Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | | | - James D Guest
- The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States.,The Department of Neurological Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Stephen Shelby Burks
- The Department of Neurological Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Risset Silvera
- Leonard M. Miller School of Medicine, The Interdisciplinary Stem Cell Institute, University of Miami, Miami, FL, United States.,The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Andrea J Santamaria
- The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Anil Lalwani
- Medtronic ST Neurosurgery, Louisville, CO, United States
| | - W Dalton Dietrich
- The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States.,The Department of Neurological Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Joshua M Hare
- Leonard M. Miller School of Medicine, The Interdisciplinary Stem Cell Institute, University of Miami, Miami, FL, United States.,Division of Cardiology, Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
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Saltzman RG, Jayaweera DT, Caceres LV, Tovar JA, Vidro-Casiano M, Karakeshishyan V, Soto J, Khan A, Mitrani RD, Schulman IH, Hare JM. Demographic representation in clinical trials for cell-based therapy. Contemp Clin Trials Commun 2021; 21:100702. [PMID: 33511300 PMCID: PMC7817424 DOI: 10.1016/j.conctc.2021.100702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/09/2020] [Accepted: 01/01/2021] [Indexed: 01/22/2023] Open
Abstract
Inclusion of women and minorities in clinical research is critical to fully assess the safety and efficacy of innovative therapies. With inadequate representation of demography, generalizability is impaired since pharmacokinetics and pharmacodynamics differ in these patient populations. This study was designed to analyze the voluntary participation rates of different demographic groups in cell-based therapy clinical trials conducted by the Interdisciplinary Stem Cell Institute (ISCI) at the University of Miami, Miller School of Medicine. ISCI conducted eight clinical trials between 2007 and 2017. The trials enrolled patients with ischemic and non-ischemic cardiomyopathy, idiopathic pulmonary fibrosis (IPF), aging-frailty, and Type-2 Diabetes. Participants received cell-based therapy (n = 218) or placebo (n = 33). Among the 251 participants, 29.5% were Hispanic and 20% were women. The proportion of individuals participating in each trial was compared to that of the respective disease populations attending University of Miami Health System clinics to calculate the participation to prevalence ratio (PPR). Distribution of women accurately reflected the population attending the University of Miami Health System in trials for dilated cardiomyopathy (DCM) and aging-frailty but was under-represented in others. Similarly, Hispanics and whites were accurately represented in three of the five disease fields, with Hispanics under-represented in frailty and diabetes, and whites over-represented in DCM and IPF. Black patients were accurately represented in the diabetes trial but were under-represented in all others. This study provides insight into challenges of achieving representative inclusion in research. Novel community engagement strategies are necessary to improve inclusion of women and under-represented minorities in clinical research of cell-based therapy.
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Affiliation(s)
- Russell G Saltzman
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dushyantha T Jayaweera
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lina V Caceres
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jairo A Tovar
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mayra Vidro-Casiano
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Vela Karakeshishyan
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jeanette Soto
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Aisha Khan
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Raul D Mitrani
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ivonne H Schulman
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joshua M Hare
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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