Viral vector gene therapies (approximately seven scheduled or possible regulatory decisions in 2024 per approved reporting mechanism (ARM))
The pioneering viral vector gene therapies focused on gene addition to address ultra-rare monogenic diseases (e.g., Luxturna, Zolgensma). Recent approvals continue to leverage the gene addition manifold and apply the solution toward addressing larger (but still rare) indications such as hemophilia A (BioMarin’s Roctavian). The next wave of pipeline therapies continues to explore gene addition in larger indications, including looking beyond rare diseases (e.g., Bayer and congestive heart failure, Candel Therapeutics’ viral-based immunotherapies) and potentially in polygenic diseases (e.g., wet age-related macular degeneration, Parkinson’s disease, frontotemporal dementia), where adeno-associated viruses can deliver a gene to express a therapeutic protein.
As the addressable indications scale, developers continue to seek solutions to selectively deliver vectors to target organs safely and reduce cost of goods. In a previous piece, we outlined these key viral vector workflow needs and reviewed the emerging potential bioprocessing solutions.
Gene-edited cell therapies (approximately four scheduled or possible regulatory decisions in 2024 per ARM)
The first approved gene-edited cell therapies addressed hematologic cancers with autologous chimeric antigen receptor (CAR-T) cell therapy approaches. These six FDA-approved CAR-T therapies continue to scale, including by winning approval in earlier lines of therapy and through clinical trials or compassionate use programs. The next wave of cell therapies includes expanded application of autologous CAR-T as well as both new approaches and new indications. Solid tumors remain a significant area of focus, with developers exploring a range of other autologous approaches (e.g., Iovance’s recently approved tumor-infiltrating lymphocyte therapy for melanoma, Adaptimmune’s T-cell receptor therapy for synovial sarcoma).
Nucleic acid therapies (approximately three expected potential regulatory decisions in 2024 per Biomedtracker)
While early efforts in nucleic acid therapies focused on antisense oligonucleotides (ASO) and RNA-mediated interference (RNAi) approaches to knock down the expression of gene targets in rare disease (e.g., Alnylam’s Onpattro), the COVID-19 pandemic saw mRNA medicines leap to the forefront through vaccine efforts from Moderna and Pfizer/BioNTech (BNT). Now, the next wave of mRNA medicines is targeting further respiratory infectious diseases (e.g., mRNA-1083 for COVID-19 and flu) as well as expanding to explore oncology with personalized cancer immunotherapies (e.g., mRNA-4157 for melanoma, BNT122 for pancreatic cancer), where a patient-specific combination of neoantigens is expressed via mRNA to modulate immune response to checkpoint inhibitors. mRNA is also being explored to deliver therapeutic proteins (e.g., mRNA-3927 for propionic acidemia) and for in vivo delivery of gene-editing nucleases such as CRISPR-Cas9 (e.g., Verve’s PCSK9-targeted base editor).
Evolving needs in mRNA include improved tools for in silico screening and sequence optimization, discovery and process support for novel mRNA types (e.g., circular RNA, self-amplifying RNA), and an expanded tool kit of drug delivery solutions to enable selective mRNA delivery to more organ types. Beyond mRNA, the ASO and RNAi pipelines continue to scale and address larger indications, as evidenced by approval of Novartis’ Leqvio for low-density lipoprotein cholesterol reduction in patients with an increased risk of heart disease. Key needs as the oligonucleotide therapeutics space targets larger indications include improved scalability, reduced cost and organic solvent use, and improved yield and synthetic efficiency for longer (e.g., more than 50 base pairs) oligonucleotide sequences.
Conclusion
Despite near-term life sciences research tools and diagnostics market uncertainty owing to macro conditions, the scientific promise and transformational potential of precision medicine and advanced therapies continue to substantiate the core investment thesis for the space. Today’s golden age of biotechnology continues to catalyze the engineering of novel advanced research tools and the concomitant development of high-value research and clinical applications. It is still early in the life cycle for many innovative companies that formed during the COVID-19-era funding boom, and moving forward this next wave of companies is anticipated to mature commercially and achieve scale, which may set the stage for future strategic business development activity into 2025 and beyond as consolidators seek to leverage M&A to drive topline growth and inorganically accelerate entry into emerging high-growth areas.
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