Standards for Tissue Engineered Medical Products (TEMPs) January 22, 2014 TISSUE ENGINEERING Volume 11, Number 9/10, 2005 © Mary Ann Liebert, Inc. Editorial Standardized Experimental Procedures in Tissue Engineering: Cure or Curse? Professor Alan J. Russell What Is a Standard? “A standard is a common language that promotes the flow of goods between buyer and seller and protects the general welfare.” ASTM Examples: • Medical & Surgical Materials & Devices • Anesthetic & Respiratory Equipment • Environment Site Assessment • Jet Fuel Why Are Standards Important? • AID in design, manufacturing, performance, operation and maintenance • ADVANCE safety, health, quality • INCREASE public interest, product certainty, and information availability • TRANSFER technology to the marketplace via standards, handbooks, manuals, and training • PASSPORTS to the global market How Are Standards Used? • Developed voluntarily and used voluntarily • Means of communication and quality assurance • Government agencies reference them in codes, certification, regulations, and laws • Over 3,400 ASTM International standards are used as the basis for national standards by reference in regulation in over 75 countries • Used by thousands of individuals/companies/agencies globally to declare conformance/compliance (design and marketing), coordinate research, coordinate product TEMPs Challenges • TEMPs = tissue engineered medical products • Complex emerging field • Priority for standards within the field of tissue engineering and regenerative medicine is not established • Global coordination remains uncertain Standards Organizations • • • • • • ASTM International ISO (International Organization for Standardization) IEC (International Electrotechnical Commission) ITU (International Telecommunication Union) ANSI (American National Standards Institute) IEEE (Institution of Electrical Engineers) ASTM International • ASTM provides the structure, resources, forum and technical expertise required to develop standards • ASTM provides the organization required to publish and disseminate standards • ASTM – Previously American Standards for Testing and Materials • Organized as a set of ‘Technical Committees’ covering all broad topics of interest (140) • A Technical Committee may have ‘Divisions’ containing a cluster of sub-committees covering a topic area • A Technical Committee may have several – many ‘Subcommittees’ – focused on a particular broad topic • Each Sub-committee has task groups, each being responsible for developing a particular standard ASTM F04 Division IV – Tissue Engineered Medical Products • Objective –Establish standards and guides for use in tissue engineered medical products. –Consensus based approach, involving Industry, Academia, Federal groups –Involvement of international regulatory interests • Meetings two times per year (May and November) TEMPs Standards Characteristics • Assured patient safety • Function related • Provide reproducible results • Realistic assessment(s) • Requirements should be consistent between different products with similar objectives • Develop through consensus TEMPs Opportunities for Standards • Increased efficiency for Research and Product Development • Reduced costs of product development and manufacture • Increased manufacturing efficiency • Improved clinical effectiveness • Reduced regulatory hurdles and timelines 6 Types of ASTM Standards Documents Type of Standard Definition Active An organized collection of information or series of options that does not recommend a specific course of action 23 A definitive procedure that produces a test result 7 A set of instructions for performing one or more specific operations that does not produce a test result 0 Specification An explicit set of requirements to be satisfied by a material, product, system or service 0 Terminology A document composed of terms, definitions of terms, descriptions of terms, nomenclature, and explanations of abbreviations, acronyms & symbols 0 Systematic arrangement or division of materials, products, systems, or services into groups based on similar characteristics such as origin, composition, properties, or use 0 Guide Test Method Practice Classification Total 30 ASTM F4.04 Tissue Engineered Medical Products 6 Subcommittees with 30 published standards • F4.41 Classification & Terminology for TEMPs (2) • F4.42 Biomaterials & Biomolecules for TEMPs (16) • F4.43 Cells & Tissue Engineered Constructs (6) • F4.44 Assessment of TEMPs (5) • F4.45 Adventitious Agents Safety (1) • F4.46 Cell Signaling (0) Approved TEMPs Standards: F04.41 Classification & Terminology for TEMPs 1. F2311-08 Standard Guide for Classification of Therapeutic Skin Substitutes 2. F2312-11 Standard Terminology Relating to Tissue Engineered Medical Products Approved TEMPs Standards: F04.42 Biomaterials and Biomolecules for TEMPs 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. F2027-08 Standard Guide for Characterization and Testing of Raw or Starting Biomaterials for Tissue-Engineered Medical Products F2064-00(2006)e1 Standard Guide for Characterization and Testing of Alginates as Starting Materials Intended for Use in Biomedical and Tissue-Engineered Medical Product Applications F2103-11 Standard Guide for Characterization and Testing of Chitosan Salts as Starting Materials Intended for Use in Biomedical and Tissue-Engineered Medical Product Applications F2131-02(2012) Standard Test Method for In Vitro Biological Activity of Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2) Using the W-20 Mouse Stromal Cell Line F2150-13 Standard Guide for Characterization and Testing of Biomaterial Scaffolds Used in Tissue-Engineered Medical Products F2212-11 Standard Guide for Characterization of Type I Collagen as Starting Material for Surgical Implants and Substrates for Tissue Engineered Medical Products (TEMPs) F2259-10(2012)e1 Standard Test Method for Determining the Chemical Composition and Sequence in Alginate by Proton Nuclear Magnetic Resonance (1H NMR) Spectroscopy F2260-03(2012)e1 Standard Test Method for Determining Degree of Deacetylation in Chitosan Salts by Proton Nuclear Magnetic Resonance (1H NMR) Spectroscopy F2347-11 Standard Guide for Characterization and Testing of Hyaluronan as Starting Materials Intended for Use in Biomedical and Tissue Engineered Medical Product Applications F2450-10 Standard Guide for Assessing Microstructure of Polymeric Scaffolds for Use in Tissue Engineered Medical Products F2602-13 Standard Test Method for Determining the Molar Mass of Chitosan and Chitosan Salts by Size Exclusion Chromatography with Multi-angle Light Scattering Detection (SEC-MALS) F2603-06(2012) Standard Guide for Interpreting Images of Polymeric Tissue Scaffolds F2605-08e1 Standard Test Method for Determining the Molar Mass of Sodium Alginate by Size Exclusion Chromatography with Multi-angle Light Scattering Detection (SEC-MALS) F2791-09 Standard Guide for Assessment of Surface Texture of Non-Porous Biomaterials in Two Dimensions F2883-11 Standard Guide for Characterization of Ceramic and Mineral Based Scaffolds Used for Tissue-Engineered Medical Products (TEMPs) and as Devices for Surgical Implant Applications F2900-11 Standard Guide for Characterization of Hydrogels used in Regenerative Medicine Approved TEMPs Standards: F04.43 Cells and TE Constructs 1. F2149-01(2007) Standard Test Method for Automated Analyses of Cells-the Electrical Sensing Zone Method of Enumerating and Sizing Single Cell Suspensions 2. F2210-02(2010) Standard Guide for Processing Cells, Tissues, and Organs for Use in Tissue Engineered Medical Products 3. F2315-11 Standard Guide for Immobilization or Encapsulation of Living Cells or Tissue in Alginate Gels 4. F2664-11 Standard Guide for Assessing the Attachment of Cells to Biomaterial Surfaces by Physical Methods 5. F2739-08 Standard Guide for Quantitating Cell Viability Within Biomaterial Scaffolds 6. F2944-12 Standard Test Method for Automated Colony Forming Unit (CFU) Assays— Image Acquisition and Analysis Method for Enumerating and Characterizing Cells and Colonies in Culture Approved TEMPs Standards: F04.44 Assessment for TEMPs 1. 2. 3. 4. 5. F2451-05(2010) Standard Guide for In Vivo Assessment of Implantable Devices Intended to Repair or Regenerate Articular Cartilage F2529-13 Standard Guide for In Vivo Evaluation of Osteoinductive Potential for Materials Containing Demineralized Bone (DBM) F2721-09 Standard Guide for Pre-clinical In Vivo Evaluation in Critical Size Segmental Bone Defects F2884-12 Standard Guide for Pre-clinical In Vivo Evaluation of Spinal Fusion F2903-11 Standard Guide for Tissue Engineered Medical Products (TEMPs) for Reinforcement of Tendon and Ligament Surgical Repair Approved TEMPs Standards: F04.45 Adventitious Agents Safety 1. F2383-11 Standard Guide for Assessment of Adventitious Agents in Tissue Engineered Medical Products (TEMPs) Approved TEMPs Standards: F04.46 Cell Signaling This is a new subcommittee and does not have any published standards yet. TEMPS Standards Used in a 510K Submission to FDA - A Living Example X-Repair (Synthasome): • Woven, degradable mesh (poly-L-lactic acid) • Augments surgical repair of tendons & soft tissues • Received 510k clearance in 2009 Standards Used in 510k Application: • ASTM D3786 Standard Test Method for Bursting Strength of Textile Fabrics - Diaphragm Bursting Strength Tester Method • ASTM D5035 Standard Test Method for Breaking Force & Elongation of Textile Fabrics (Strip Method) • ASTM D5587 Standard Test Method for Tearing Strength of Fabrics by Trapezoid Procedure • ASTM F1635-11 Standard Test Method for in vitro Degradation Testing of Hydrolytically Degradable Polymer Resins and Fabricated Forms for Surgical Implants • ASTM F2211 Standard Classification for Tissue Engineered Medical Products (TEMPs) • ASTM F2312 Standard Terminology Relating to TEMPs • ASTM F2027 Standard Guide for Characterization and Testing of Raw or Starting Biomaterials for Tissue-Engineered Medical Products • ASTM F2150 Standard Guide for Characterization of Biomaterial Scaffolds Used in TEMPs • ISO 10993 Biological Evaluation of Medical Devices • ISO 11135 Sterilization of Health Care Products F2451 - 05 (2010) Standard Guide for in vivo Assessment of Implantable Devices Intended to Repair or Regenerate Articular Cartilage • Consensus document developed over two years with input from academics, companies, clinicians, and FDA • Approved in 2005 • Used in applications to the FDA • Key document referenced in FDA guidance document for articular cartilage repair: – “Guidance for Industry: Preparation of IDEs and INDs for Products Intended to Repair or Replace Knee Cartilage” Standards Opportunities for Animal Models • Standard guides for pre clinical in-vivo evaluation of cranio-facial defects – Cranial – Facial – Neurological • Standardization of surgical procedures • Standard guide for assessing scarring, healing & regeneration of the skin – Surgical incisions – Open wound defects – Burns – Skin regeneration • Wound infection • Rapid screening model for cartilage repair • Tendon (mobility, lack of scarring, scaffold materials) • Ligament (focus on strength) • Muscle (focus on function and mass, fibrosis) • Soft tissue augmentation • Standard practice/guide for nerve repair Standards Opportunities for Clinical Studies • Assessment of clinical outcomes – Measurement of patient-reported outcomes – Measurement of clinically relevant biomechanical functions • Identification and coding of clinical conditions • Current standards of care for managing various conditions Standards Opportunities for Cells & Tissue Engineered Constructs • Standard guide to normal versus dystrophic mineralization • Standard guide for cellular alkaline phosphatase activity • Standard guide for characterization of osteoblasts and other lineages • Standard guide for characterization of progenitor populations (proliferation, differentiation, purity, viability) • Standard for apoptosis • Standardize terminology regarding MSCs/progenitors (what is it now, what can it become, and what does it do) Standards Opportunities for Biomaterials • • • • • • • • • • • • Standard guide to host response Cell attachment Mechanical properties Porosity Loading Cell-mediated degradation Cell and scaffold tracking in vivo Vascular supply Innervation Assessing sensory and autonomic function Biointegration Biomaterial behavior in a contaminated/infected environment (Performance standards for biofilm formation) Standards Opportunities for Adventitious Agents & Safety • Exuberant inflammatory responses • Tumorgenicity • Toxicity for cell based constructs – Assessing cell viability – Biodistribution of cells after implantation Standards Opportunities for Cell Signaling • Apoptosis mechanism • Cell signaling mechanism-based assays for stress/cytotoxicity – Greater predictive capability compared to live/dead • Controlled extracellular matrix preparations for systematic studies – Expected physical and chemical properties of protocols and response from cells • Criteria for evaluating cells after storage – Integrity with genetics, response to environment, ‘health’ • Quantitative methods for cell area determination – Robust benchmarking protocol for fixing, staining and analyzing morphologies of cells in a population • Criteria for qualifying a cell-based assay – What criteria are required for assuring a robust, reproducible, and valid biomarker assay(s) relevant to biological interpretation • Fluorescent labels Future Plans for TEMPs • • • • Continue standards development Increase involvement by individuals and groups Continue and encourage international cooperation Prioritize standard developments for pre-clinical and clinical assessment • Spur selective safety document development • Refine strategy • Continue coordination with ISO/international partners Summary • TEMPs are already on the market addressing previously unmet clinical needs • New TEMPs will continue to be developed for use • Commerce needs to gain approval by multiple regulatory agencies globally • The need for International Standards will increase • Consensus standards are being developed • TEMPs standards are being used • Standards are an integral component of all industries • Standard development is an active and ongoing process within TERM • Standards are a valuable and necessary component of applications to the FDA • Standards enhance efficiency of research, product development & manufacturing • Risk: If you don’t develop (or participate in) the standard, someone else will Additional Resources • www.astm.org • www.iso.org • www.nist.gov/srm • Plant AL, Horowitz E. Symposium on metrology and standards for cell signaling: impact on tissue engineering, National Institute for Standards and Technology, October 14-15, 2003. Tissue Engineering, 2005, 11, 985-90. • Russell AJ. Standardized experimental procedures in tissue engineering: cure or curse. Tissue Engineering, 2005, 11, vii-vix. • Messenger MP, Tomlins PE. Regenerative medicine: a snapshot of the current regulatory environment and standards. Advanced Healthcare Materials, 2011, 23, H10-H17. • Leitner E, Bischoff P. Setting standards for technologies in regenerative medicine. Biomedical Technology (Berlin), 2012, 57, 1051-1054. • Yokoi M, Hattori K, Narikawa K et al. Feasibility and limitations of the round robin test for assessment of in vitro chondrogenesis evaluation protocol in a tissue-engineered medical product. Journal of Tissue Engineering and Regenerative Medicine, 2012, 6, 550-8. • American Academy of Orthopaedic Surgeons. Position Statement: Consensus Standards for Medical Devices. Rosemont, IL, 2013. • U.S. Food & Drug Administration. Guidance for Industry and FDA Staff: Frequently Asked Questions on Recognition of Consensus Standards. White Oak, MD: 2007.