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Wadmann S, Johansen AB, Born AP, Kessel L. Infrastructuring precision medicine: Making gene therapies for rare diseases workable in practice. Soc Sci Med 2024; 351:116966. [PMID: 38759386 DOI: 10.1016/j.socscimed.2024.116966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/27/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024]
Abstract
Long viewed by social scientists as a future imaginary, precision medicine is now materializing in many healthcare systems in the form of new diagnostic practices and novel treatment modalities, such as gene therapies. Based on an ethnographic study of the introduction of the first two clinically available in-vivo gene therapies in the Danish healthcare system, we investigate what it takes to make these therapies workable in practice. Drawing on social science literature on infrastructuring, we describe the many forms of mundane work required to fit these therapies into regulatory frameworks, political processes and daily work practices in the healthcare system. Further, we observe how the processes of infrastructuring required to introduce the gene therapies into clinical practice had transformative implications as they redistributed roles and responsibilities among clinicians, pharmacists, procurement agencies and pharmaceutical manufacturers.
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Affiliation(s)
- Sarah Wadmann
- The Danish Center for Social Science Research - VIVE, Herluf Trolles Gade 11, DK-1052 Copenhagen, Denmark.
| | - Anna Brueckner Johansen
- The Danish Center for Social Science Research - VIVE, Herluf Trolles Gade 11, DK-1052 Copenhagen, Denmark
| | - Alfred Peter Born
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Line Kessel
- Department of Ophthalmology, Copenhagen University Hospital - Rigshospitalet, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
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2
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Abukhder M, Tarassoli S, Hassan R, Onions E, Nasri Elmi S, Whelan R. Exploring Aesthetic Outcomes and Complications in Auricular Reconstruction Utilising Autologous Cartilage: A Systematic Review and Narrative Synthesis. Cureus 2024; 16:e56345. [PMID: 38633940 PMCID: PMC11021216 DOI: 10.7759/cureus.56345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 04/19/2024] Open
Abstract
Auricular reconstruction remains a challenging procedure, requiring a high degree of manual dexterity and attention to detail in order to reconstruct the complex three-dimensional geometry of the ear successfully. Most techniques will rely on autologous cartilage for auricular framework fabrication, carrying a risk of donor and recipient site morbidity. The aim of this report is to investigate the complications and aesthetic outcomes associated with autologous cartilage harvest in auricular reconstruction. A systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) and reported in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses. Comprehensive electronic search strategies for four databases were developed. Studies were screened according to the inclusion and exclusion criteria by two independent reviewers. The literature search identified 7171 articles. Filtering for relevance and duplication reduced the number of articles to 52. A total of 12,215 patients underwent auricular reconstruction utilising autologous cartilage. Indications included 11,696 patients due to microtia, 334 patients due to burns or trauma, 70 patients due to constricted ears, and 115 patients due to prominent ears. The most commonly reported donor site complications included chest wall deformities (n = 159). The most commonly reported recipient site complications included hypertrophic or keloid scars (n = 279), haematoma (n = 155), tissue expander exposure (n = 111), cartilage or framework exposure (n = 122), and cartilage framework deformation or resorption (n = 50). Although a challenging procedure, auricular reconstruction utilising autologous cartilage is possible. Exceptional aesthetic results can be achieved when performed by a skilled surgeon on appropriately selected individuals. However, the potential risks and complications associated with the procedure should be discussed with the patient and family beforehand.
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Affiliation(s)
- Munir Abukhder
- Oral and Maxillofacial Surgery, Northwick Park Hospital, London, GBR
| | | | - Ridwanul Hassan
- Burns and Plastic Surgery, Queen Elizabeth Hospital Birmingham (QEHB), Birmingham, GBR
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3
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Lee MK, Seyedmousavi S, Auvity S, Pourroy B, Elleboode V, Kachaner I, Jansen C, Lilliu H. Forecasting the potential impact of cell and gene therapies in France: projecting product launches and patients treated. Front Med (Lausanne) 2024; 11:1324602. [PMID: 38439899 PMCID: PMC10910012 DOI: 10.3389/fmed.2024.1324602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/02/2024] [Indexed: 03/06/2024] Open
Abstract
Objective To evaluate the potential impact of cell and gene therapies (CGTs) in France by forecasting the number of patients that will be treated with CGTs over the period 2023-2030 by therapeutic area and region. Methods A review of CGTs in clinical development and related disease epidemiology was conducted to forecast the number of CGT launches and patient population between 2023 and 2030. The number of expected launches was identified by filtering the clinical development pipeline with estimated time to launch and probability of success values from Project ALPHA. Disease prevalence and incidence in France were combined with projected adoption rates derived from historical data to forecast the patient population to be treated. Results Up to 44 new CGTs are forecasted to launch in France in the period 2023-2030, which translates into more than 69,400 newly treated patients in 2030. Leading indications in terms of newly treated patients per year include cardiovascular disease, hematological cancers and solid tumors with 27,300, 15,200 and 13,000 newly treated patients in 2030, respectively. Discussion The forecast suggests that the future landscape of CGTs will undergo a shift, moving from CGTs targeting (ultra) rare diseases to more prevalent diseases. In France, this will likely pose organizational challenges hindering patient access to these transformative therapies. Further research and planning around network organization and patient distribution are needed to assess and improve the readiness of the French healthcare system for ensuring access for this growing number of patients to be treated with CGTs.
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Affiliation(s)
| | | | - Sylvain Auvity
- Université Paris Cité, INSERM, UMRS-1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France
- Service de Pharmacie, AP-HP, Hôpital Necker, Paris, France
| | - Bertrand Pourroy
- Oncopharma Unit, Pharmacy Department, University Teaching Hospital la Timone, Marseille, France
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4
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Abukhder M, Onions E, Flaherty E, Tarassoli S, Hassan MR, Whelan R. A systematic literature review and narrative synthesis on the use of autologous cartilage in the repair of orbital fractures. Ann Med Surg (Lond) 2024; 86:968-974. [PMID: 38333240 PMCID: PMC10849358 DOI: 10.1097/ms9.0000000000001598] [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: 08/22/2023] [Accepted: 11/27/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction Fractures of the orbit are common injuries within the maxillofacial skeleton, and can often result in restrictions to ocular movement, diplopia, and enophthalmous if herniation of globe content occurs. Various studies have demonstrated the use of autologous cartilage grafts in the reconstruction of orbital fractures. Methods A systematic review protocol was registered with PROSPERO, and reported in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses. Comprehensive electronic search strategies of four databases were developed. Studies were screened according to the inclusion and exclusion criteria by two independent reviewers. Results Seven thousand one hundred seventy-one articles were identified following a comprehensive literature search. These articles were filtered for relevance and duplication, which reduced the number of articles to 16. A total of 259 patients underwent orbital reconstruction with the use of autologous cartilage. Conchal cartilage was harvested in 148 patients, auricular cartilage in 22 patients, nasoseptal cartilage in 72 patients, and costal cartilage in 17 patients. Thirty, seven, twelve, and four complications were observed in patients where cartilage was harvested from the concha, auricle, nasoseptum and rib, respectively. Most common complications included diplopia (n=23), infra-orbital para/anaesthesia (n=27), and enophthalmos (n=7). No failure of graft or donor site morbidity were observed in the studies. Conclusion Autogenous materials such as cartilage can be used as an alternative for orbital reconstruction. Cartilage was considered by the authors to provide adequate structural support to the orbital contents, and that it was easy to harvest, shape, and position.
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Affiliation(s)
| | | | - Erin Flaherty
- School of Medicine, Cardiff University, Neuadd Meirionnydd, Cardiff
| | - Sam Tarassoli
- Morriston Hospital, Heol Maes Eglwys, Morriston, Cwmrhydyceirw, Swansea
| | | | - Rhys Whelan
- Morriston Hospital, Heol Maes Eglwys, Morriston, Cwmrhydyceirw, Swansea
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Johanna I, Daudeij A, Devina F, Nijenhuis C, Nuijen B, Romberg B, de Haar C, Haanen J, Dolstra H, Bremer E, Sebestyen Z, Straetemans T, Jedema I, Kuball J. Basics of advanced therapy medicinal product development in academic pharma and the role of a GMP simulation unit. IMMUNO-ONCOLOGY TECHNOLOGY 2023; 20:100411. [PMID: 38192616 PMCID: PMC10772236 DOI: 10.1016/j.iotech.2023.100411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Following successes of authorized chimeric antigen receptor T-cell products being commercially marketed in the United States and European Union, product development of T-cell-based cancer immunotherapy consisting of cell-based advanced therapy medicinal products (ATMPs) has gained further momentum. Due to their complex characteristics, pharmacological properties of living cell products are, in contrast to classical biological drugs such as small molecules, more difficult to define. Despite the availability of many new advanced technologies that facilitate ATMP manufacturing, translation from research-grade to clinical-grade manufacturing in accordance with Good Manufacturing Practices (cGMP) needs a thorough product development process in order to maintain the same product characteristics and activity of the therapeutic product after full-scale clinical GMP production as originally developed within a research setting. The same holds true for transferring a fully developed GMP-grade production process between different GMP facilities. Such product development from the research to GMP-grade manufacturing and technology transfer processes of established GMP-compliant procedures between facilities are challenging. In this review, we highlight some of the main obstacles related to the product development, manufacturing process, and product analysis, as well as how these hinder rapid access to ATMPs. We elaborate on the role of academia, also referred to as 'academic pharma', and the added value of GMP production and GMP simulation facilities to keep innovation moving by reducing the development time and to keep final production costs reasonable.
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Affiliation(s)
- I. Johanna
- Department of Hematology, University Medical Center Utrecht, Utrecht
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht
| | - A. Daudeij
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht
| | - F. Devina
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht
| | - C. Nijenhuis
- Department of Pharmacy & Pharmacology, Netherlands Cancer Institute, Amsterdam
| | - B. Nuijen
- Department of Pharmacy & Pharmacology, Netherlands Cancer Institute, Amsterdam
| | - B. Romberg
- Department of Pharmacy, University Medical Center Utrecht, Utrecht
| | - C. de Haar
- Department of Pharmacy, University Medical Center Utrecht, Utrecht
| | - J. Haanen
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam
- Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam
| | - H. Dolstra
- Laboratory of Hematology, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen
| | - E. Bremer
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Z. Sebestyen
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht
| | - T. Straetemans
- Department of Hematology, University Medical Center Utrecht, Utrecht
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht
| | - I. Jedema
- Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam
| | - J. Kuball
- Department of Hematology, University Medical Center Utrecht, Utrecht
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht
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6
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Frederix GW, Ham RMT. Gene therapies, uncertainty, and decision-making: thinking about the last mile at the first step. Expert Rev Pharmacoecon Outcomes Res 2023; 23:853-856. [PMID: 37539711 DOI: 10.1080/14737167.2023.2245138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/02/2023] [Indexed: 08/05/2023]
Affiliation(s)
- Gerardus Wj Frederix
- University Medical Centre Utrecht, Julius Centre for Health Sciences and Primary Care, Department of Epidemiology & Health Economics, Utrecht, The Netherlands
| | - Renske Mt Ten Ham
- University Medical Centre Utrecht, Julius Centre for Health Sciences and Primary Care, Department of Epidemiology & Health Economics, Utrecht, The Netherlands
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Gardner J, Herron D, McNally N, Williams B. Advancing the digital and computational capabilities of healthcare providers: A qualitative study of a hospital organisation in the NHS. Digit Health 2023; 9:20552076231186513. [PMID: 37456124 PMCID: PMC10345922 DOI: 10.1177/20552076231186513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
Objective Healthcare systems require transformation to meet societal challenges and projected health demands. Digital and computational tools and approaches are fundamental to this transformation, and hospitals have a key role to play in their development and implementation. This paper reports on a study with the objective of exploring the challenges encountered by hospital leaders and innovators as they implement a strategy to become a data-driven hospital organisation. In doing so, this paper provides guidance to future leaders and innovators seeking to build computational and digital capabilities in complex clinical settings. Methods Interviews were undertaken with 42 participants associated with a large public hospital organisation within England's National Health Service. Using the concept of institutional readiness as an analytical framework, the paper explores participants' perspectives on the organisation's capacity to support the development of, and benefit from, digital and computational approaches. Results Participants' accounts reveal a range of specific institutional readiness criteria relating to organisational vision, technical capability, organisational agility, and talent and skills that, when met, enhance the organisations' capacity to support the development and implementation of digital and computational tools. Participant accounts also reveal challenges relating to these criteria, such as unrealistic expectations and the necessary prioritisation of clinical work in resource-constrained settings. Conclusions The paper identifies a general set of institutional readiness criteria that can guide future hospital leaders and innovators aiming to improve their organisation's digital and computational capability. The paper also illustrates the challenges of pursuing digital and computational innovation in resource-constrained hospital environments.
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Affiliation(s)
- John Gardner
- School of Social Sciences, Monash University, Melbourne, Australia
| | | | | | - Bryan Williams
- Institute of Cardiovascular Sciences, University College London, London, UK
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8
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Bicudo E, Brass I. Institutional and infrastructure challenges for hospitals producing advanced therapies in the UK: the concept of 'point-of-care manufacturing readiness'. Regen Med 2022; 17:719-737. [PMID: 36065826 DOI: 10.2217/rme-2022-0064] [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] Open
Abstract
Aim: To propose the concept of point-of-care manufacturing readiness for analyzing the capacity that a country, a health system or an institution has developed to manufacture therapies in clinical settings (point-of-care manufacture). The focus is on advanced therapies (cell, gene and tissue engineering therapies) in the UK. Materials & methods: Literature review, analysis of quantitative data, and qualitative interviews with professionals and practitioners developing and administering advanced therapies. Results: Three components of point-of-care manufacturing readiness are analyzed staff and institutional procedures, infrastructure, and relations between hospitals and service providers. Conclusion: The technical and regulatory experience that has been gained through manufacturing advanced therapies at small scale in hospitals qualifies the UK for more complex and larger-scale production of therapies in the future.
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Affiliation(s)
- Edison Bicudo
- Department of Science, Technology, Engineering, & Public Policy, University College London, Shropshire House (4th Floor), 11-20 Capper Street, London, WC1E 6JA, UK
| | - Irina Brass
- Department of Science, Technology, Engineering, & Public Policy, University College London, Shropshire House (4th Floor), 11-20 Capper Street, London, WC1E 6JA, UK
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9
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Whitaker M. The Advanced Therapies Treatment Centres and their Network: a Model for the Accelerated Adoption of Advanced Therapies. Hum Gene Ther 2022; 33:857-864. [PMID: 36070453 DOI: 10.1089/hum.2022.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Emerging advanced therapies that include cell and gene therapies and tissue-engineered products offer substantial therapeutic benefits. They also present challenges for health services in their modes of delivery to patients. Funding was made available in the UK to establish three Advanced Therapies Treatment Centres (ATTCs) and a network to coordinate their activities, supported by the Cell and Gene Therapy Catapult (CGTC). The aim of this initiative was to grow the advanced therapies sector in the UK by enhancing access to the NHS for patients and industry through close collaboration between advanced therapy companies and publicly funded services and regulators. Here, we describe the initiative's antecedents, its collaborative structures and management and its activities. A guiding concept in shaping and assessing progress has been the idea of institutional readiness, an idea developed in the context of social sciences that defines and so can measure movement towards an organisation's full competence in delivering new technologies and approaches. We also report the initiative's outcomes and impacts as assessed by ourselves and by third parties. As the initiative has progressed it has excited increasing interest from advanced therapy companies who were not aware of or engaged in it at the outset and from healthcare systems that wished to learn from its practices. It is to further that end that we present our work.
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10
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McKelvey M, Saemundsson RJ. Developing innovation governance readiness in regenerative medicine: lessons learned from the Macchiarini crisis. Regen Med 2021; 16:283-294. [PMID: 33834842 DOI: 10.2217/rme-2020-0173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The generation and clinical adoption of workable therapies in regenerative medicine has been slow, despite its alleged potential to relieve suffering and improve health outcomes. This has been explained by a fundamental difference between advanced cell and gene therapies and conventional drug- and device-based therapies, raising questions about how the readiness of existing healthcare systems to adopt such therapies can be evaluated and improved. In this paper, we use the lessons learned from the Macchiarini crisis at the Karolinska Institute in Sweden to take the first step in formulating the concept of innovation governance readiness. We propose it as a tool to help evaluate and improve the ability of private, public and civil society actors to work together to build and put into practice therapies based on emerging medical technologies such as regenerative medicine.
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Affiliation(s)
- Maureen McKelvey
- Unit of Innovation & Entrepreneurship, Department of Economy & Society, School of Business, Economics & Law, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Rögnvaldur J Saemundsson
- Unit of Innovation & Entrepreneurship, Department of Economy & Society, School of Business, Economics & Law, University of Gothenburg, 405 30 Gothenburg, Sweden.,Department of Innovation Management, Halmstad University, 301 18 Halmstad, Sweden.,Department of Industrial Engineering, University of Iceland, 102 Reykjavik, Iceland
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11
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Halamka J, Cerrato P. Understanding the role of digital platforms in technology readiness. Regen Med 2021; 16:207-213. [PMID: 33820473 DOI: 10.2217/rme-2020-0135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
State-of-the-art digital tools that take advantage of machine learning-derived algorithms and advanced data analytics have the potential to transform regenerative medicine by enabling investigators and clinicians to extract intelligence and actionable insights from published studies, electronic health records, pathology images and a variety of other sources. Used in isolation, however, these tools are not as effective as they can be integrated into a comprehensive strategy - a platform. We discuss the value of a platform strategy by summarizing several initiatives that have been launched at Mayo Clinic, including a clinical data analytics platform, a remote diagnostics and management platform and a virtual care system.
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Affiliation(s)
- John Halamka
- Mayo Clinic, President of Platform, 55905 Rochester, MN, USA
| | - Paul Cerrato
- Mayo Clinic, Senior Research Analyst & Communications Specialist, 55905 Rochester, MN, USA
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12
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Affiliation(s)
- Andrew Webster
- Science & Technology Studies Unit, University of York, York, YO10 5DD, UK
| | - Andre Terzic
- Mayo Clinic, Center for Regenerative Medicine, 200 First Street SW, Rochester, 55905-0002 MN , USA
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13
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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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14
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Medcalf N. Re-engineering the innovator-clinic interface for adoption of advanced therapies. Regen Med 2021; 16:295-308. [PMID: 33764156 DOI: 10.2217/rme-2020-0149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The relationship between regenerative medicine innovators and the clinics that will use their inventions continues to evolve. In the UK, the Advanced Therapy Treatment Centres exemplify this. The agents in the value chain are becoming collaborators in a shared innovation process. This paper proposes a larger role for systems engineering in this change and a cost-based representation of institutional readiness in designing suitable operational models for clinical adoption. The proposed approach places this value in a whole-lifetime cost framework. The current value for the adoption process can then be estimated for comparison with the sum of the adoption costs, the costs of operating at steady state and, if need be, replacement costs at end of life of the innovation.
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15
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Wotherspoon L, Buchan R, Morrison E, Amatt G. Evaluation of institutional readiness at sites within the UK NHS using a novel advanced therapy medicinal product assessment tool. Regen Med 2021; 16:253-268. [PMID: 33724873 DOI: 10.2217/rme-2020-0140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Aim: This paper reports on a study to assess institutional readiness (IR) of UK National Health Service sites that form part of the Northern Alliance Advanced Therapy Treatment Centre to deliver advanced therapy medicinal products (ATMPs). The paper discusses the development of an assessment tool to support self-assessment of IR in healthcare institutions. Methods: The tool utilized criteria developed by clinicians to self-assess IR to deliver four classes of ATMP over a series of time points. Each assessment was independently analyzed and validated by independent expert groups. Results & conclusion: The collated results indicated an overall trend toward IR for all classes of ATMP. The study highlighted areas where IR is evidenced, areas where work is ongoing and areas where further work is required to achieve IR. The study also facilitated validation of the IR assessment tool.
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Affiliation(s)
- Lisa Wotherspoon
- Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, EH16 4UU, UK
| | - Ruaridh Buchan
- Pharmacy, NHS Lothian, Western General Hospital, Edinburgh, EH4 2XU, UK
| | - Ewan Morrison
- Clinical Directorate, NHS National Services Scotland, Edinburgh, EH12 9EB, UK
| | - Greg Amatt
- Special Care and Rare Diseases, Chiesi Ltd, Manchester Green, Manchester, M22 5LG, UK
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16
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Yamada S, Behfar A, Terzic A. Regenerative medicine clinical readiness. Regen Med 2021; 16:309-322. [PMID: 33622049 PMCID: PMC8050983 DOI: 10.2217/rme-2020-0178] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/05/2021] [Indexed: 02/06/2023] Open
Abstract
Regenerative medicine, poised to transform 21st century healthcare, has aspired to enrich care options by bringing cures to patients in need. Science-driven responsible and regulated translation of innovative technology has enabled the launch of previously unimaginable care pathways adopted prudently for select serious diseases and disabilities. The collective resolve to advance the design, manufacture and validity of affordable regenerative solutions aims to democratize such health benefits for all. The objective of this Review is to outline the framework and prerequisites that underpin clinical readiness of regenerative care. Integrated research and development, specialized workforce education and accessible evidence-based practice implementation are at the core of realizing an equitable regenerative medicine vision.
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Affiliation(s)
- Satsuki Yamada
- Center for Regenerative Medicine, Marriott Heart Disease Research Program, Van Cleve Cardiac Regenerative Medicine Program, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, 55905 MN, USA
- Division of Geriatric Medicine & Gerontology, Department of Medicine, Mayo Clinic, Rochester, 55905 MN, USA
| | - Atta Behfar
- Center for Regenerative Medicine, Marriott Heart Disease Research Program, Van Cleve Cardiac Regenerative Medicine Program, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, 55905 MN, USA
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, 55905 MN, USA
| | - Andre Terzic
- Center for Regenerative Medicine, Marriott Heart Disease Research Program, Van Cleve Cardiac Regenerative Medicine Program, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, 55905 MN, USA
- Department of Molecular Pharmacology & Experimental Therapeutics, Department of Clinical Genomics, Mayo Clinic, Rochester, 55905 MN, USA
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17
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Wyles SP, Monie DD, Paradise CR, Meyer FB, Hayden RE, Terzic A. Emerging workforce readiness in regenerative healthcare. Regen Med 2021; 16:197-206. [PMID: 33622054 PMCID: PMC8656339 DOI: 10.2217/rme-2020-0137] [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] [Indexed: 01/06/2023] Open
Abstract
The biology of regenerative medicine has steadily matured, providing the foundation for randomized clinical trials and translation into validated applications. Today, the growing regenerative armamentarium is poised to impact disease management, yet a gap in training next-generation healthcare providers, equipped to adopt and deliver regenerative options, has been exposed. This special report highlights a multiyear experience in developing and deploying a comprehensive regenerative curriculum for medical trainees. For academicians and institutions invested in establishing a formalized regenerative medicine syllabus, the Regenerative Medicine and Surgery course provides a patient-focused prototype for next-generation learners, offering a dedicated educational experience that encompasses discovery, development and delivery of regenerative solutions. Built with the vision of an evolving regenerative care model, this transdisciplinary endeavor could serve as an adoptable education portal to advance the readiness of the emergent regenerative healthcare workforce globally.
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Affiliation(s)
- Saranya P Wyles
- Center for Regenerative Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Dermatology, Mayo Clinic, Rochester, MN 55905, USA.,Department of Molecular Pharmacology & Experimental Therapeutics, Rochester, MN 55905, USA
| | - Dileep D Monie
- Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA
| | | | - Fredric B Meyer
- Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA.,Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Richard E Hayden
- Center for Regenerative Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Otolaryngology, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Andre Terzic
- Center for Regenerative Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Molecular Pharmacology & Experimental Therapeutics, Rochester, MN 55905, USA.,Department of Cardiovascular Medicine, Rochester, MN 55905, USA.,Department of Clinical Genomics, Mayo Clinic, Rochester, MN 55905, USA
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18
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Liokaftos D. Sociological investigations of human enhancement drugs: The case of microdosing psychedelics. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 95:103099. [PMID: 33518382 DOI: 10.1016/j.drugpo.2020.103099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/22/2020] [Accepted: 12/28/2020] [Indexed: 12/15/2022]
Abstract
Microdosing psychedelics is the regular use of sub-perceptive threshold doses of substances such as lysergic acid diethylamide (LSD) and psilocybin ('magic') mushrooms. The phenomenon has attracted increasing public and scientific attention in numerous countries in recent years. This commentary looks at microdosing psychedelics as an emerging facet of human enhancement through drugs. After presenting a narrative based on a multidisciplinary body of literature on human enhancement drugs and microdosing, the commentary maps out directions for further sociological studies of the phenomenon as well as outlining the different fields such research can contribute to.
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19
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Master Z, Crowley AP, Smith C, Wigle D, Terzic A, Sharp RR. Stem cell preservation for regenerative therapies: ethical and governance considerations for the health care sector. NPJ Regen Med 2020; 5:23. [PMID: 33298936 PMCID: PMC7708480 DOI: 10.1038/s41536-020-00108-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 10/23/2020] [Indexed: 12/18/2022] Open
Abstract
The stem cell preservation industry has grown substantially with private businesses, public hospitals, and academic medical centers considering preserving induced pluripotent stem cells, mesenchymal stem cells, and other cell types of patients and the public in order to potentially use them for stem cell therapy should such an intervention exist in the future. Despite this growth and interest among private firms and academic centers, no study has yet considered the bioethical issues of such platforms. In this article, we explore several ethical and social issues related to the biopreservation of stem cells for future regenerative therapies. We analyze a range of bioethical considerations that public and private institutions should bear in mind as they develop stem cell preservation platforms. These include medical validation of regenerative interventions and their influence on the public understanding of stem cell therapies, the impact of public trust of organizations creating a private, for-profit venture of stem cell preservation, and logistical issues in the governance of the collection including ownership and dispositional authority, informed consent and access, and withdrawal and non-payment. These considerations should be incorporated into current and future stem cell preservation platforms in order to promote the responsible translation of regenerative medicine.
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Affiliation(s)
- Zubin Master
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, 55905, USA.
- Center for Regenerative Medicine, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Aidan P Crowley
- College of Science, Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Cambray Smith
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, 55905, USA
- School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Dennis Wigle
- Center for Regenerative Medicine, Mayo Clinic, Rochester, MN, 55905, USA
- Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Andre Terzic
- Center for Regenerative Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Richard R Sharp
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, 55905, USA
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20
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Jovic TH, Combellack EJ, Jessop ZM, Whitaker IS. 3D Bioprinting and the Future of Surgery. Front Surg 2020; 7:609836. [PMID: 33330613 PMCID: PMC7728666 DOI: 10.3389/fsurg.2020.609836] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/06/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction: The disciplines of 3D bioprinting and surgery have witnessed incremental transformations over the last century. 3D bioprinting is a convergence of biology and engineering technologies, mirroring the clinical need to produce viable biological tissue through advancements in printing, regenerative medicine and materials science. To outline the current and future challenges of 3D bioprinting technology in surgery. Methods: A comprehensive literature search was undertaken using the MEDLINE, EMBASE and Google Scholar databases between 2000 and 2019. A narrative synthesis of the resulting literature was produced to discuss 3D bioprinting, current and future challenges, the role in personalized medicine and transplantation surgery and the global 3D bioprinting market. Results: The next 20 years will see the advent of bioprinted implants for surgical use, however the path to clinical incorporation will be fraught with an array of ethical, regulatory and technical challenges of which each must be surmounted. Previous clinical cases where regulatory processes have been bypassed have led to poor outcomes and controversy. Speculated roles of 3D bioprinting in surgery include the production of de novo organs for transplantation and use of autologous cellular material for personalized medicine. The promise of these technologies has sparked an industrial revolution, leading to an exponential growth of the 3D bioprinting market worth billions of dollars. Conclusion: Effective translation requires the input of scientists, engineers, clinicians, and regulatory bodies: there is a need for a collaborative effort to translate this impactful technology into a real-world healthcare setting and potentially transform the future of surgery.
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Affiliation(s)
- Thomas H Jovic
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University, Swansea, United Kingdom.,Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Emman J Combellack
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University, Swansea, United Kingdom.,Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Zita M Jessop
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University, Swansea, United Kingdom.,Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Iain S Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University, Swansea, United Kingdom.,Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
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21
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Coppens DG, Gardarsdottir H, Bruin MLD, Meij P, Gm Leufkens H, Hoekman J. Regulating advanced therapy medicinal products through the Hospital Exemption: an analysis of regulatory approaches in nine EU countries. Regen Med 2020; 15:2015-2028. [PMID: 33151792 DOI: 10.2217/rme-2020-0008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aim: To study regulatory approaches for the implementation and utilization of the Hospital Exemption (HE) in nine EU countries. Materials & methods: Using public regulatory documentation and interviews with authorities we characterized the national implementation process of the HE, including national implementation characteristics and two outcomes: national licensing provisions and the amount of license holders. Results: National licensing provisions vary substantially among selected countries as a result of different regulatory considerations that relate to unmet medical needs, benefit/risk balance, and innovation. The amount of license holders per country is moderate (0-11). Conclusion: The HE facilitates HE utilization in clinical practice in some countries, yet safeguarding of public health and incentivizing commercial development is challenging.
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Affiliation(s)
- Delphi Gm Coppens
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Department of Clinical Pharmacy, Division Laboratories, Pharmacy & Biomedical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marie L De Bruin
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Copenhagen Centre for Regulatory Science, University of Copenhagen, Copenhagen, Denmark
| | - Pauline Meij
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hubert Gm Leufkens
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Jarno Hoekman
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Innovation Studies Group, Faculty of Geosciences, Utrecht University, Utrecht, The Netherlands
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22
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Sharpe M, Barry J, Kefalas P. Clinical Adoption of Advanced Therapies: Challenges and Opportunities. J Pharm Sci 2020; 110:1877-1884. [PMID: 32918916 DOI: 10.1016/j.xphs.2020.08.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 12/11/2022]
Abstract
As the cell and gene therapy field matures the powerful therapeutic potential of these innovative therapies is starting to be shown, particularly in the fields of oncology and childhood immune deficiency diseases. However, as more therapies enter late stage clinical trials, advances and innovation are required in manufacturing, logistics, regulation, reimbursement and the healthcare setting to ensure that systems are in place to support wider clinical adoption of these promising treatments. A window of opportunity exists to implement new methodologies for best practice in both the ability to manufacture products reproducibly at scale, as well as ensuring healthcare systems are not overwhelmed by the variety and complexity of these new therapies and the additional burden they will place on already stretched facilities. If all interested parties work together it will be possible for the sector to develop the necessary processes, skilled staff and infrastructure needed as more treatments move from clinical trial to marketed products.
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Affiliation(s)
- Michaela Sharpe
- Moare Solutions Ltd, 99 Canterbury Road, Whitstable, Kent CT5 4HG, UK.
| | - Jacqueline Barry
- Cell and Gene Therapy Catapult, Guys Hospital, 12th Floor Tower Wing, Great Maze Pond, London SE1 9RT, UK
| | - Panos Kefalas
- Cell and Gene Therapy Catapult, Guys Hospital, 12th Floor Tower Wing, Great Maze Pond, London SE1 9RT, UK
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23
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What does cell therapy manufacturing cost? A framework and methodology to facilitate academic and other small-scale cell therapy manufacturing costings. Cytotherapy 2020; 22:388-397. [DOI: 10.1016/j.jcyt.2020.03.432] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 12/26/2022]
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24
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Advanced therapy medicinal product manufacturing under the hospital exemption and other exemption pathways in seven European Union countries. Cytotherapy 2020; 22:592-600. [PMID: 32563611 DOI: 10.1016/j.jcyt.2020.04.092] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/01/2020] [Accepted: 04/17/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AIMS As part of the advanced therapy medicinal product (ATMP) regulation, the hospital exemption (HE) was enacted to accommodate manufacturing of custom-made ATMPs for treatment purposes in the European Union (EU). However, how the HE pathway has been used in practice is largely unknown. METHODS Using a survey and interviews, we provide the product characteristics, scale and motivation for ATMP manufacturing under HE and other, non-ATMP-specific exemption pathways in seven European countries. RESULTS Results show that ATMPs were manufactured under HE by public facilities located in Finland, Germany, Italy and the Netherlands, which enabled availability of a modest number of ATMPs (n = 12) between 2009 and 2017. These ATMPs were shown to have close proximity to clinical practice, and manufacturing was primarily motivated by clinical needs and clinical experience. Public facilities used HE when patients could not obtain treatment in ongoing or future trials. Regulatory aspects motivated (Finland, Italy, the Netherlands) or limited (Belgium, Germany) HE utilization, whereas financial resources generally limited HE utilization by public facilities. Public facilities manufactured other ATMPs (n = 11) under named patient use (NPU) between 2015 and 2017 and used NPU in a similar fashion as HE. The scale of manufacturing under HE over 9 years was shown to be rather limited in comparison to manufacturing under NPU over 3 years. In Germany, ATMPs were mainly manufactured by facilities of private companies under HE. CONCLUSIONS The HE enables availability of ATMPs with close proximity to clinical practice. Yet in some countries, HE provisions limit utilization, whereas commercial developments could be undermined by private HE licenses in Germany. Transparency through a public EU-wide registry and guidance for distinguishing between ATMPs that are or are not commercially viable as well as public-private engagements are needed to optimize the use of the HE pathway and regulatory pathways for commercial development in a complementary fashion.
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25
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Kang HK, Kim KH, Ahn JS, Kim HB, Yi JH, Kim HS. A simple segmentation and quantification method for numerical quantitative analysis of cells and tissues. Technol Health Care 2020; 28:401-410. [PMID: 32364173 PMCID: PMC7369084 DOI: 10.3233/thc-209041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Microscopic image analysis based on image processing is required for quantitative evaluation of decellularization. Existing methods are not widely used because of expensive commercial software, and machine learning-based techniques lack generality for decellularization because many high-resolution image data has to be processed. OBJECTIVE In this study, we developed an image processing algorithm for quantitative analysis of tissues and cells in a general microscopic image. METHODS The proposed method extracts the color images obtained by the microscope into reference images consisting of grayscale, red (R), green (G), and blue (B) information and transforms each into a binary image. The transformed images were extracted by separating the cells and tissues through outlier noise elimination, logical multiplication and labeling. In order to verify the method, decellularization of porcine arotic valve was performed by the electrical method. Slice samples were obtained by time and the proposed method was applied. RESULTS The experimental results show that the segmentation of cells and tissues, and quantitative analysis of the number of cells and changes in tissue area during the decellularization process was possible. CONCLUSIONS The proposed method shows that cell and tissue extraction and quantitative numerical analysis were possible in different brightness of microscopic images.
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Affiliation(s)
- Hyun-Kyu Kang
- Department of Software Technology, College of Science and Technology, Konkuk University, Chungju, Korea
| | - Ki-Han Kim
- Department of Biomedical Engineering, BK21+ Research Institute of Biomedical Engineering, College of Science and Technology, Konkuk University, Chungju, Korea
| | - Jin-Su Ahn
- Department of Biomedical Engineering, BK21+ Research Institute of Biomedical Engineering, College of Science and Technology, Konkuk University, Chungju, Korea
| | - Hong-Bae Kim
- Department of Biosystems and Biomaterials Science and Engineering, Seoul National University, Seoul, Korea
| | - Jeong-Han Yi
- Department of Biomedical Engineering, BK21+ Research Institute of Biomedical Engineering, College of Science and Technology, Konkuk University, Chungju, Korea
| | - Hyung-Sik Kim
- Department of Biomedical Engineering, BK21+ Research Institute of Biomedical Engineering, College of Science and Technology, Konkuk University, Chungju, Korea
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26
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Jørgensen J, Hanna E, Kefalas P. Outcomes-based reimbursement for gene therapies in practice: the experience of recently launched CAR-T cell therapies in major European countries. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2020; 8:1715536. [PMID: 32082514 PMCID: PMC7006635 DOI: 10.1080/20016689.2020.1715536] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 05/05/2023]
Abstract
Background: The experience of Kymriah® and Yescarta® provides real-world examples of how health-care systems approach and manage the reimbursement of one-off, high-cost, cell, and gene therapies, and the decision uncertainty and affordability challenges they present. Objective: To provide an overview of the reimbursement schemes used for Kymriah® and Yescarta® in France, Germany, Italy, Spain, and the UK (EU5) as per the final quarter of 2019; to identify challenges and derive learnings for future product launches. Methodology: Secondary research, complemented by primary research with key market access stakeholders. Findings: Kymriah® and Yescarta® have relatively uniform list prices across the EU5, and are reimbursed according to their marketing authorisations. In France and the UK, reimbursement is on the condition of collecting additional data (at the cohort level) and subject to future reassessments; elsewhere, rebates (Germany) or staged payments (Italy and Spain) are linked to individual patient outcomes. Conclusions: The experience of Kymriah® and Yescarta® shows an increased appetite for outcomes-based reimbursement (OBR) in the EU5, with notably novel approaches applied in Italy and Spain (outcomes-based staged payments). Thus, real-world evidence (RWE) has become an increasingly powerful lever for demonstrating the value of health benefits in the clinical setting.
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Affiliation(s)
- Jesper Jørgensen
- Health Economics and Market Access, Cell and Gene Therapy Catapult, London, UK
| | - Eve Hanna
- Pricing and Market Access, Creativ-Ceutical, Paris, France
| | - Panos Kefalas
- Health Economics and Market Access, Cell and Gene Therapy Catapult, London, UK
- CONTACT Panos Kefalas Health Economics and Market Access, Cell and Gene Therapy Catapult, 5th Floor Uncommon, 1 Long Lane, LondonSE1 4PG, UK
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27
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Cicha I, Chauvierre C, Texier I, Cabella C, Metselaar JM, Szebeni J, Dézsi L, Alexiou C, Rouzet F, Storm G, Stroes E, Bruce D, MacRitchie N, Maffia P, Letourneur D. From design to the clinic: practical guidelines for translating cardiovascular nanomedicine. Cardiovasc Res 2019; 114:1714-1727. [PMID: 30165574 DOI: 10.1093/cvr/cvy219] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/23/2018] [Indexed: 12/20/2022] Open
Abstract
Cardiovascular diseases (CVD) account for nearly half of all deaths in Europe and almost 30% of global deaths. Despite the improved clinical management, cardiovascular mortality is predicted to rise in the next decades due to the increasing impact of aging, obesity, and diabetes. The goal of emerging cardiovascular nanomedicine is to reduce the burden of CVD using nanoscale medical products and devices. However, the development of novel multicomponent nano-sized products poses multiple technical, ethical, and regulatory challenges, which often obstruct their road to successful approval and use in clinical practice. This review discusses the rational design of nanoparticles, including safety considerations and regulatory issues, and highlights the steps needed to achieve efficient clinical translation of promising nanomedicinal products for cardiovascular applications.
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Affiliation(s)
- Iwona Cicha
- Cardiovascular Nanomedicine Unit, Section of Experimental Oncology und Nanomedicine (SEON), ENT-Department, University Hospital Erlangen, Glückstr. 10a, Erlangen, Germany
| | - Cédric Chauvierre
- INSERM U1148, LVTS, Paris Diderot University, Paris 13 University, X. Bichat Hospital, 46 rue H. Huchard, Paris, France
| | | | - Claudia Cabella
- Centro Ricerche Bracco, Bracco Imaging Spa, Colleretto Giacosa, Italy
| | - Josbert M Metselaar
- Department of Experimental Molecular Imaging, University Clinic and Helmholtz Institute for Biomedical Engineering, RWTH-Aachen University, Aachen, Germany
| | - János Szebeni
- Nanomedicine Research and Education Center, Department of Pathophysiology, Semmelweis University, Budapest, Hungary
| | - László Dézsi
- Nanomedicine Research and Education Center, Department of Pathophysiology, Semmelweis University, Budapest, Hungary
| | - Christoph Alexiou
- Cardiovascular Nanomedicine Unit, Section of Experimental Oncology und Nanomedicine (SEON), ENT-Department, University Hospital Erlangen, Glückstr. 10a, Erlangen, Germany
| | - François Rouzet
- INSERM U1148, LVTS, Paris Diderot University, Paris 13 University, X. Bichat Hospital, 46 rue H. Huchard, Paris, France.,Department of Nuclear Medicine, X. Bichat Hospital, Paris, France
| | - Gert Storm
- Department of Pharmaceutics, University of Utrecht, Utrecht, The Netherlands.,Department of Biomaterials Science and Technology, University of Twente, Enschede, The Netherlands
| | - Erik Stroes
- Department of Vascular Medicine, Amsterdam Medical Center, Amsterdam, The Netherlands
| | | | - Neil MacRitchie
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Pasquale Maffia
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.,Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.,Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Didier Letourneur
- INSERM U1148, LVTS, Paris Diderot University, Paris 13 University, X. Bichat Hospital, 46 rue H. Huchard, Paris, France
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28
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Gardner J, Carter A, O'Brien K, Seear K. Psychedelic-assisted therapies: The past, and the need to move forward responsibly. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 70:94-98. [PMID: 31136924 DOI: 10.1016/j.drugpo.2019.05.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/06/2019] [Accepted: 05/20/2019] [Indexed: 12/17/2022]
Abstract
Recent clinical studies illustrate that psychedelics such as LSD and psilocybin may represent much-needed new treatment options for mood disorders and alcohol and other drug use disorders. More clinical studies are required to confirm the safety and efficacy of psychedelic-assisted therapies, but the cultural stigma that has surrounded psychedelics since the 1960s has hindered research. This problem is amplified in Australia. There has been a complete absence of research into psychedelic therapies, and Australian-based research advocates claim to have encountered a number of barriers. In this commentary, we provide a brief account of the historical stigma associated with psychedelics, and an overview of the contemporary context of research into psychedelic-assisted therapies, including the purported barriers to research in Australia. In light of the complex history of psychedelics, we identify a number of pressing questions relating to the social and legal context that need to be addressed so that clinical studies can proceed. Research is needed to address such questions so that the nature and extent of purported barriers to clinical studies with psychedelics can be properly elucidated, and strategies developed - with practitioners, patients, families and other stakeholders - to responsibly address these barriers. This is important because it will enable Australian researchers to contribute robust evidence about the possible efficacy and safety of psychedelic therapies, and to facilitate local expertise needed to implement psychedelic-assisted therapies, should they prove efficacious.
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Affiliation(s)
- John Gardner
- School of Social Sciences, Faculty of Arts, Monash University, Melbourne, Australia; W414 Menzies Building, 20 Chancellors Walk, Clayton, VIC, 3800, Australia.
| | - Adrian Carter
- School of Psychological Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia.
| | - Kerry O'Brien
- School of Social Sciences, Faculty of Arts, Monash University, Melbourne, Australia.
| | - Kate Seear
- Faculty of Law, Monash University, Melbourne, Australia.
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29
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Webster A. Accelerating Innovation: Complexity, Regulation, and Temporality. FRONTIERS IN SOCIOLOGY 2019; 4:13. [PMID: 33869340 PMCID: PMC8022755 DOI: 10.3389/fsoc.2019.00013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 02/08/2019] [Indexed: 05/05/2023]
Abstract
This Perspective paper explores recent moves seen in many countries toward accelerating the speed at which biomedical innovation can be delivered to the clinic. It discusses the drivers behind this and the rationale for it, illustrating this briefly in the field of regenerative medicine. It argues that the process reconfigures present/future relations, especially in terms of the relationship between different forms of evidence and risk calculations. The regulatory/innovation relationship is, as a result, being rewritten. Paradoxically, the moves toward acceleration are less to do with the arrival of a more streamlined evaluation system that selects for scientifically robust technologies ready for "the market." In contrast, it reflects the growing complexity of innovation itself: whereas Latour (1987) had argued that "science-in the-making" was backstage in contrast to "ready-made science," the former is now very visible. This in turn has generated two other parallel processes-"regulation-in-the-making" and "risk-in-the-making." Such shifts can be seen in the field of regenerative medicine. The paper asks how best to engage with the move toward acceleration and thereby the future oversight of innovation.
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30
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van Haasteren J, Hyde SC, Gill DR. Lessons learned from lung and liver in-vivo gene therapy: implications for the future. Expert Opin Biol Ther 2018; 18:959-972. [PMID: 30067117 PMCID: PMC6134476 DOI: 10.1080/14712598.2018.1506761] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 07/27/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Ex-vivo gene therapy has had significant clinical impact over the last couple of years and in-vivo gene therapy products are being approved for clinical use. Gene therapy and gene editing approaches have huge potential to treat genetic disease and chronic illness. AREAS COVERED This article provides a review of in-vivo approaches for gene therapy in the lung and liver, exploiting non-viral and viral vectors with varying serotypes and pseudotypes to target-specific cells. Antibody responses inhibiting viral vectors continue to constrain effective repeat administration. Lessons learned from ex-vivo gene therapy and genome editing are also discussed. EXPERT OPINION The fields of lung and liver in-vivo gene therapy are thriving and a comparison highlights obstacles and opportunities for both. Overcoming immunological issues associated with repeated administration of viral vectors remains a key challenge. The addition of targeted small molecules in combination with viral vectors may offer one solution. A substantial bottleneck to the widespread adoption of in-vivo gene therapy is how to ensure sufficient capacity for clinical-grade vector production. In the future, the exploitation of gene editing approaches for in-vivo disease treatment may facilitate the resurgence of non-viral gene transfer approaches, which tend to be eclipsed by more efficient viral vectors.
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Affiliation(s)
- Joost van Haasteren
- Gene Medicine Group, Nuffield Division of Clinical Laboratory Science, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Stephen C. Hyde
- Gene Medicine Group, Nuffield Division of Clinical Laboratory Science, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Deborah R. Gill
- Gene Medicine Group, Nuffield Division of Clinical Laboratory Science, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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