Faculty of Health Sciences, Department of Prosthodontics, School of Dentistry, Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece.
J Endod. 2020 Sep;46(9S):S175-S188. doi: 10.1016/j.joen.2020.06.026.
Regenerative medicine offers innovative approaches to restore damaged tissues on the basis of tissue engineering (TE). Although research on advanced therapy medicinal products (ATMPs) has been very active in recent years, the number of licensed products remains surprisingly low and restricted to the treatment of severe, incurable diseases.
This paper provides a critical review of current literature on the regulatory, clinical, and commercial status of ATMP-based therapies in the EU and worldwide and the hurdles to overcome for their broader application in Regenerative Dentistry.
Competent authorities have focused on developing regulatory pathways to address unmet patient needs. Oncology represents the dominating field, followed by cardiovascular, musculoskeletal, neurodegenerative, immunologic, and inherited diseases. Yet, the status remains in early development, and scientific, regulatory, and cost-effectiveness issues impose considerable hurdles toward marketing authorization, technology adoption, and patient accessibility. In this context, although regenerative dentistry has achieved breakthrough innovations in TE of several dental/oral tissues in preclinical models, it has hardly harnessed research progress to integrate innovative regenerative treatments into clinical practice.
Global demographic changes, which demonstrate a steady increase of the aging population, highlight the societal need for the application of ATMP-based therapies in the treatment of noncommunicable diseases (NCDs). Although oral diseases, as an integral part of NCDs, are not life-threatening and largely preventable, they sustain high prevalence, with severe burden on economy and quality of life. In this perspective, the urgent request to ultimately translate draining research in dental TE conducted during the last decades into innovative treatments brought safely and cost-effectively into society at large still holds the stage. This review provides an overview of the regulatory, clinical, and commercial status of ATMP-based therapies in the European Union and worldwide and the hurdles to overcome for their broader application in regenerative dentistry.
再生医学为基于组织工程(TE)的受损组织修复提供了创新方法。尽管近年来先进治疗药物产品(ATMP)的研究非常活跃,但获得许可的产品数量仍然低得惊人,且仅限于治疗严重的、无法治愈的疾病。
本文对欧盟和全球基于 ATMP 的治疗方法的监管、临床和商业现状以及在再生牙科中更广泛应用所面临的障碍进行了文献综述。
主管部门专注于开发监管途径以满足未满足的患者需求。肿瘤学是主导领域,其次是心血管、肌肉骨骼、神经退行性、免疫和遗传性疾病。然而,现状仍处于早期发展阶段,科学、监管和成本效益问题对营销授权、技术采用和患者可及性构成了相当大的障碍。在这种情况下,尽管再生牙科在 TE 的几种口腔组织的临床前模型中取得了突破性创新,但它几乎没有利用研究进展将创新的再生治疗方法整合到临床实践中。
全球人口结构变化表明,老年人口稳步增加,突出了在治疗非传染性疾病(NCD)中应用基于 ATMP 的治疗方法的社会需求。虽然口腔疾病作为 NCD 的一部分,不会危及生命且在很大程度上可以预防,但它们的患病率很高,对经济和生活质量造成严重负担。从这个角度来看,将过去几十年在牙科 TE 中进行的大量研究转化为安全、经济有效的创新治疗方法并最终应用于整个社会的迫切需求仍然存在。本文综述了欧盟和全球范围内基于 ATMP 的治疗方法的监管、临床和商业现状以及在再生牙科中更广泛应用所面临的障碍。