cell therapy - definitions and classifications
TRANSCRIPT
Alexey Bersenev, MD, PhDAdvanced Cell Therapy Laboratory,Yale-New Haven Hospital, Yale University www.celltrials.info
8th the BioProcessing Summit, Boston, Aug. 15, 2016
CELL THERAPY – Definitions, Classifications and Trends
2011 2012 2013 2014 20150
50
100
150
200
250
300
56 58
85
117
133
111
179
243259
293
industry academia
Total number of cell therapy trials: academic vs. industry
• Cell therapy – administration of cells to the body with therapeutic purpose
• Regenerative medicine - replaces or regenerates human cells, tissues or organs, to restore or establish normal function
• Cellular immunotherapy – using immune or other types of cells for modulation of host immune system or direct elimination of pathogen/ tumor
Definitions:
What if cell is just a vehicle for therapeutic agent?
Is irradiated cancer cell line a cellular therapy?
Is manipulation of cell in vivo (cells are not administered) a cell therapy?
Is cell-based therapy better term?
Problem with definitions - Cell (cellular) Therapy
cells
tissue engineering
Scaffold (matrix)
genes
small molecules
Regenerative Medicine as generic term
RegenerativeMedicinebio-
molecules device
RM is not equal to cellular immunotherapy. Equation is confusing!
Tissue engineering was rebranded as RM
RM and Cell Therapy may have different challenges and obstacles (example: EPO as regenerative)
Organizations successfully exploit RM brand to attract public trust, money, and lobby politicians (CIRM, ARM)
Problem with definitions - Regenerative Medicine
• Immunocellular
• Regenerative
Classification based onmechanism of action
2011 2012 2013 2014 20150%
20%
40%
60%
80%
100%
46 62
137 156 174
121 175
191 220 252
Immuno- Regenerative-
Trend: Immunocellular therapy vs. cell-based regenerative medicine
• Autologous
• Allogeneic
• Auto + Allo
• Xenogeneic
Classification based on donor cell origin
Industry is not in favor of allo- model
Total number of registered clinical trials
2011 2012 2013 2014 20150
20
40
60
80
100
120
140
31 26
48
707924 29
34
45
54
alloauto
Trend: Allo- vs. auto- commercial trials
Origin:
• Somatic cell therapy• Germline cell modifications
Differentiation:
• Stem cells• Progenitor cells• Mature (differentiated) cells
Cell types classifications
2011 2012 2013 2014 20150
20
40
60
80
100
120
140
52
80
90
116
140
22
42
60
81
96
3825
13
2226
3 38
11
41
32
17
MSC total
T-cells
BM MNC
HSPC
adipose SVF
ESC
DC
NK cells
Trend: Interest to major cell types
2011 2012 2013 2014 20150
20
40
60
80
100
23 2419
28
4031
58
71
89
100
industry academic
Cell therapy trials: cell type – mesenchymal stem cells
2011 2012 2013 2014 20150%
20%
40%
60%
80%
100%
5 9
13 2226
6 13
10 1837
Fresh SVF Adipose SC expanded
Trend: Interest to adipose tissue-derived cells
Based on:
• Degree of cell manipulation• Homology• Risks to recipient
Disregard:
• Cell biology, cell type and origin• Therapeutic intention
Regulatory classifications
Cell Therapy (somatic cell, including stem
cells)
Gene Therapy Devices related to cells
351 HCT/P (drug, biologic or device) 361 HCT/P (tissues)
cartilage, bone, tendon, skin, ocular tissue, reproductive cells
and tissues…
HCT/P
Regulatory classification: USA
Cells & Tissues but not HCT/Ps:(blood and blood components, minimally manipulated bone marrow for
homologous use, xenogenic cells/ tissue…)
Regulatory classification: EU
Cell-based/ gene therapy
Biologic - ATMP (EMA – CAT)
Somatic Cell
(including stem cells)
Gene Therapy
Transplants/
Transfusions
Tissue Engineering
Regulatory classification: Japan
Class I (iPS/ ES cells,
gene-modified cells, allo-)
Class II(auto- somatic cells
– cultured/ nonhomologous
use)
Class III(auto- somatic cells – homologous use,Processed somatic
cells)
Regenerative Medical Product Blood Transfusions
HPC transplantationAssisted Reproduction(no gene modification, not derived
from stem cells)
Processed cells (manufacturing) Not processed orSpecific processed cells
Cell Therapy Gene Therapy Tissue Engineering
Biologics (medicinal product) Human Tissue
cartilage, bone, ligament, tendon, skin, heart valves, blood vessel,
fascia, amnion
MFDS (former KFDA)
Regulatory classification: South Korea
Cell Therapy as medical practice (minimally manipulated auto- or allo- cells)
Some products hard to fit in definitions (ATMP or 361/351). To avoid confusions, contact regulators as early as possible
Not always clear difference between ”product” and “medical procedure” / “tissue for transplantation”
Autologous not gene-modified cells freshly used at point-of-care is not easy to fit in definitions of “regulated product” Immunocellular therapy called “regenerative medical product” (Japan)
No definitions for ”stem cell product”
Confusions about regulatory definitions