Pharmaceuticals have developed via three manufacturing revolutions. The first arose in the 19th century from the ability to chemically synthesise drugs previously only obtainable from natural sources (aspirin, quinine). Next in the 1970's the biotechnology revolution enabled proteins such as insulin, clotting factors or antibodies to be developed into safe widespread treatments. Currently we are in the midst of the cell therapy revolution where the ability to grow human cells outside the body is being exploited to create cell based treatments. More generally, artificial cell culture is a widespread and rapidly expanding technology with applications in medicine, bioprocessing, crop science, drug development and clinical research. In recent years the idea of cell based therapies has moved from mere possibility to actual treatments for conditions such as leukaemia, stroke, blindness and arthritis. These require not only that cells can be grown outside the body but that they can be multiplied and modified before reintroduction into the patient. In many cases the body's immune system restricts cell therapies to autologous forms where the original cells are obtained from the patient, grown and or modified and then reintroduced. However several allogeneic treatments, where a commercial cell line is used to treat many patients, are also in development for conditions such as stroke or inherited blindness. Much work depends upon growing stem cells which are a "raw material" that can be transformed into a wide range of tissue types for medical applications. Growing sufficient numbers of stem cells to satisfy the needs of various treatments is still a significant challenge. Cells used in research laboratories are often selected for their ability to grow rapidly and indefinitely on plastic surfaces but cells for therapy need life like environments and grow in a highly regulated manner. Currently, cells are cultured on surfaces that largely fall into two groups; low cost, bulk materials, exemplified by plastic dishes, or high cost, low volume biological matrices which recreate the conditions found within the body and are increasingly important as more demanding or fragile cell types are used. This project seeks to use a recently developed and patented industrial process to overturn this product landscape by manufacturing engineered protein polymers with advanced cellular functions at low cost. By bridging the gap between traditional polymer science and protein biochemistry we can create a range of matrices to assist the growth of cells for many downstream applications. The 18 month project, supported by the Cell and Gene Therapy Catapult will start by developing one lead product for use in the rapidly expanding stem cell industry. This uses simple coating of plastic surfaces by our protein polymer and has already shown significant advantages over rival technologies in stem cell culture in our hands. Independent validation will enable us to embark on its commercial exploitation to reduce costs and increase efficiency of the whole cell therapy sector. We then intend to further demonstrate its wider applicability for work on muscle, nerve and cartilage by collaboration with leading research groups in the field and with industry. We will also test its usefulness in recreating even more realistic 3 dimensional environments for cell and tissue culture. Finally by exploiting a recent development by us to include large protein modules within the polymer we will create a matrix which can be decorated with any number of cell modifying molecules which are found in natural extracellular environment. This offers an unprecedented opportunity to create bespoke complex cell growth environments in the "test tube" Using both readily commercialisable products and the new intellectual property we intend to move decisively toward either spin out company or licensing agreement at the end of this project.

The Kings/Royal Free/UCL Gene Therapy Innovation Hub will manufacture clinical-grade gene therapies for the UK academic and clinical community. This will allow promising treatments for a wide range of rare and common diseases to be tested in patients. The results from these early clinical studies may then support larger-scale trials and ultimately new therapies for patients. Provision of suitable quality (GMP) gene therapy product is a key limiting factor for progress in this exciting field. Our Hub will address this directly through a major increase in UK capacity. This will cover the major types of gene therapy used, adeno-associated virus (AAV) and lentivirus, as well as gamma-retrovirus. In addition, we will invest in developing new approaches to increase the amount of gene therapy product that can be made at one time (in one batch). This will mean that each trial needs fewer batches, and that applications needing high doses (for example, administration systemically) become possible. It will also reduce costs of manufacture. We will also work to increase the UK's overall capabilities to manufacture gene therapies, through creation and provision of dedicated training courses, both online and in person, at a variety of levels, to suits varying needs of different groups. In addition to this, we will lend our expertise to other developing Gene Therapy Innovation Hubs, to help them to become operational as quickly as possible. King's, Royal Free and UCL offer unmatched expertise in the UK in gene therapy manufacturing, and we are ideally-placed to contribute to the UK's success in improving therapies for many poorly-treated diseases, and generating sustainable economic benefit for the country.

Cell therapies, which use human cells to restore, maintain, or improve the functioning of human tissues or organs, hold enormous potential for the treatment of a wide range of diseases and conditions, including a variety of cancers. While cell therapies have the potential to improve healthcare for millions of patients worldwide, manufacturing remains a major hurdle for clinical translation. Today's cell therapies manufacturing processes, which include the use of patient's own cells or donor cells to manufacture the therapeutic product, involve manual, labour-intensive and open processes that require highly-skilled personnel. This in turn leads to high process variability, risk of contamination and high manufacturing costs, all of which are major obstacles for cell therapies to realise their full potential and bring about widespread access to the global patient population. New technologies are urgently needed to develop reliable and robust manufacturing processes that ensure quality and consistency of cell therapy products at an economically viable cost. This project will develop an on-demand sensor and monitoring technology that will enable, for the first time, real-time, non-disruptive measurement of key biochemicals in cell culture media. These unprecedented capabilities will be enabled by an innovative microfluidic sensing platform comprising smart, switchable electrode-tethered nanobodies. In contrast with conventional offline analysis, the acquisition of real-time process data will allow immediate response to process variations, thus providing a fine level of process control. This is essential for the consistent production of high-quality therapeutic cells in high yields, independently of the patient's or donor's cells. It will provide an exceptional opportunity to implement fully automated, robust cell therapy culture processes and bring down production costs, ultimately delivering cost-effective and impactful therapeutics to patients in need.

The most significant healthcare challenge facing the UK is the unavoidable transition towards an older, ageing population, resulting in an increased demand for hospital and social care, complex medical interventions, spiralling costs and increased societal burden. The development of new, affordable and effective medicines will therefore be necessary to ensure we maintain and improve the standard of UK and global healthcare. A new type of medicine, advanced cell and gene therapy (CGT), has recently emerged as a promising treatment option for previously incurable conditions. CGTs will form the next-generation of advanced medicines with the potential to improve UK health and wealth. Examples of CGTs include cellular immunotherapies. These are medicines which use genetically-engineered cells to target cancer cells. Chimeric antigen receptor natural killer cell therapies (CAR-NK) are an example of a cellular immunotherapy. Natural killer cells are a key immune cell type that fights infections in our bodies, however, we can genetically-engineer them to express a non-native protein (the CAR) which allows the NK-cells to target and eliminate blood cancer cells, an ability they only possess because of the non-native CAR protein. These gene-modified therapies have demonstrated remarkable clinical success and offer a revolutionary approach to treat patients who have failed every other treatment option (e.g. chemotherapy, bone marrow transplant) and are ultimately destined to die of their disease. However, this new treatment option has resulted in dramatic outcomes, with patients in complete remission for years after receiving the therapy. It has effectively cured patients of their cancer. However, despite their clinical promise, approved immunotherapies suffer from high costs (>$350,000 per dose), poorly defined manufacturing processes and challenging gene engineering approaches involving the use of expensive and complex viruses as vehicles for gene delivery. Without significant manufacturing innovations, the promise of these transformative, curative therapies will not be realised, and they will remain inaccessible to the vast majority of patients that need them. The implications for UK health, wealth and well-being are profound. My Fellowship focuses on establishing a scalable manufacturing process for CAR-NK therapies and demonstrating the first litre-scale production for CAR-NK cells. This will be achieved by creating an innovative and intelligent control strategy to improve the production process and increase the number of cells that can be manufactured. We will use scientific and engineering approaches to understand how the cellular environment can be made more conducive to encourage cell growth, specifically monitoring and controlling the environmental conditions (e.g. gases, nutrients, temperature, pH) to support optimal cell production. We will establish the process conditions and technologies that are required to grow and generate sufficient numbers of cells for clinical applications. We will also develop a new way to engineer the cells using an approach that doesn't require the use of viruses (a non-viral approach) which is based on mechanical and chemical methods. My Fellowship research programme will support the industrial and clinical communities to deliver this next-generation of advanced medicines to treat patients in the UK and ensure these therapies are accessible to the patients that need them at a price that is affordable for the UK health system to bear. This will also support the development of the growing cell and gene therapy manufacturing industry in the UK and support economic activity in the high-growth biomanufacturing sector.

We will establish a technology platform that changes the way we diagnose and treat patients. It involves detecting and producing nano-sized biological particles that act as communication machinery in nature. These particles are called exosomes and with significant investment in the engineering required to accurately capture and profile them, it will be possible to create a new class of diagnostics that can detect disease earlier than is currently possible, based on the release and detection of specific exosomes. It will also be possible to distinguish between different stages of disease, which will help to tailor the right treatment to an individual patient. The diagnostics platform will also form the basis for manufacturing analytics that will enable cell and gene therapies to be carefully monitoring during manufacture. Cell and gene therapies currently cost in the order of £100,000 to £1,000,000 per dose and is related to the fact that bioprocesses (the manufacturing approaches used to create them) are sub-optimal. A radical advance in manufacturing analytics will help to better monitor and control manufacturing, which will lead to improved product consistency and ultimately drive down cost of manufacturing, which will catalyse the routine adoption of cell and gene therapies in the NHS. Finally, by producing exosomes using industrial bioprocesses it will be possible to create new drugs based on exosomes, exploiting their communication machinery to target therapies to sites of disease. This will involve a combination of engineering exosomes to have increased potency, or loading them with powerful drugs and targeting them directly at the diseased tissue. Ultimately, this will radically advance personalised medicine across diagnostics, analytics and drug delivery. In 30 years' time this technology platform will be widely used in healthcare to diagnose and treat disease with high fidelity using bespoke formulations. In order to advance this vision, phase 1 feasibility studies will address engineering challenges in sensor development to detect exosomes at different orders of sensitivity. It will also address the consistent production of exosomes at pilot scale in order to advance the exosome therapeutic platform.