ELAD is an investigational human cell-based bio-artificial liver support system that operates outside the body, or extracorporeal, and is designed with the proposed intent to allow the patient’s own liver to regenerate to a healthy state, or to stabilize the patient until liver transplant. ELAD incorporates our human liver-derived C3A cells combined with a reusable ancillary delivery system and single-use disposables. Data from ELAD clinical studies has shown trends that may indicate a potential for ELAD to increase survival rates in patients with acute liver failure. ELAD has received orphan designation in the United States and Europe for the treatment of acute liver failure.
ELAD Design and Operation
During ELAD therapy, blood is drawn from the patient via a central venous line and then passes into the ancillary delivery system where plasma ultrafiltrate is isolated by an ultrafiltrate generator. The patient’s plasma ultrafiltrate then passes into the four ELAD cartridges where it contacts our C3A cells after passing through fibers which allow appropriate two-way transfer of toxins, metabolites and nutrients, mimicking liver function. The fibers, made of a semi-permeable membrane, permit passage from our C3A cells to the patient’s plasma ultrafiltrate of macromolecules. At the same time, these fibers permit the passage of toxins such as bilirubin, and nutrients such as glucose, from the plasma ultrafiltrate to our C3A cells. Heparin, a widely-available anti-coagulant drug, is administered during ELAD therapy in some patients to prevent blood-clotting in the ultrafiltrate cartridge.
Treated plasma ultrafiltrate is then filtered, reconstituted with blood cells and returned to the patient via the central venous catheter. Meanwhile, the ancillary delivery system monitors temperature, pH, and oxygen concentrations in the plasma ultrafiltrate in order to maintain the cells’ viability. Therapy is expected to consist of a single session of continuous treatment lasting between three and ten days, as determined by the treating physician.
Our Proprietary C3A Cell Bank
The key to the performance of ELAD is our proprietary C3A cell bank. The bank contains immortal human liver cells that can be stored and shipped worldwide. It is proposed that the immortal C3A cells may mimic certain functions of human liver cells, and it has been shown in nonclinical studies that these cells retain many of the specific metabolic processes and pathways of hepatocytes (ELAD® Cellular and System Performance Improvements (Brotherton, et al, AASLD, November 5, 2007)). These functions include an active P450 enzyme system as well as the production of liver specific proteins such as albumin, anti-thrombin III, alpha-fetoprotein, C3 complement, Factor V, transferrin, alpha-1-antichymotrypsin and alpha-1-antitrypsin.
The C3A cell line has been studied by independent investigators who have confirmed its hepatocyte properties, such as the presence of a functional cytochrome P450 toxin-processing enzyme system and the production of many liver-specific proteins. However, the C3A cell line does not entirely mimic the behavior of primary hepatocytes. For instance, it has not been shown to process ammonia as primary hepatocytes do and C3A produces large amounts of alpha-fetoprotein, or AFP. We believe these issues are manageable since excess ammonia can be removed by dialysis, if needed, and AFP is a non-toxic fetal analogue of albumin.
We have customized the now-publicly available C3A cell line, which we originally acquired from Baylor University, to create a proprietary C3A cell bank for use in ELAD, which we culture and expand through proprietary techniques. This cell bank represents a well-characterized stock of original cells that have been subjected to rigorous testing for viruses, pathogens and other contaminants in order to allow them to be used in humans. This bank contains enough cells to enable our clinical development and commercialization. VTI owns this C3A cell bank exclusively and on a royalty-free basis. In addition, we have developed proprietary methods for growing, storing and optimizing the function of these cells.
ELAD therapy is not patient specific and our C3A cells, which are derived from a single source, are used to treat all patients. This process is known as allogeneic cellular therapy. In contrast, autologous cellular therapy uses a patient’s own cells, which are manipulated in individual production batches, and is a costly and complex process. As a result, the production and logistics of treatment with our C3A cells does not face the challenges commonly associated with autologous cellular therapies.
Our proprietary C3A cell bank is stored in three separate locations around the world for security purposes and is used as the basis for growing approximately one pound of cells needed for each patient at our production facility in San Diego, CA.
Differentiating Factors of ELAD
Unlike other potential therapies developed for acute liver failure in the past, we believe ELAD holds a unique combination of attributes:
• Biologically active. ELAD is a biologically active system that is designed to replicate many liver functions. The functional unit of the liver, the hepatocyte, is thought to be responsible for 500 or more biologic processes necessary for human life. Moreover, many processes of the liver occur at ever-fluctuating rates in continuing response to the liver’s constantly changing biologic environment. As a result, we believe that an acellular solution to liver failure is unlikely to effectively replace lost liver function. We believe that a cellular approach, capable of replicating key biologic processes performed by a human hepatocyte, is best able to provide the requisite flexibility and breadth of function to sufficiently supplement liver function and improve survival in patients with acute liver failure.
• Human cellular therapy. ELAD is based on human cells which confer a considerable advantage over animal cell therapies. Given the widespread availability of animal tissues, much work has been done on the use of animal liver cells, often derived from pigs, to treat humans with liver failure. While immunological risk is always present in cellular therapy, the use of non-human animal tissues presents greater immunological risk compared to human cellular therapy. Humans possess naturally occurring antibodies that react with antigens on porcine cell surfaces. These antibodies can mount an immediate attack in the presence of porcine cells, causing these cells to rapidly lose function and die. Moreover, repeated treatments with a porcine cell may cause subsequent immune responses to become increasingly severe. The infusion of porcine enzymes into a patient’s blood stream also poses immunologic risk. We are not aware of any FDA-approved non-human animal-based cellular therapy for use in patients.
• Immortal C3A cells. Our C3A cells used in ELAD are derived from a human hepatoblastoma and are immortal. They can be expanded and can survive a session up to ten days of ELAD therapy, often without needing to be replaced during treatment. Hepatocytes are the main cell in the liver and deteriorate rapidly when removed from the body. Hepatocytes cannot be grown outside the body as they de-differentiate and die in a short period of time. The inability to expand makes hepatocytes unsuitable for a liver assist system, which requires large amounts of hepatocytes.
• Commercially scalable. We have developed a process to grow our C3A cell line in our facility in San Diego that is designed for scalable production. Each patient set of four cartridges contains a total of about one pound of cells and is grown in a production process that takes about six weeks. The process is carefully controlled and is performed under aseptic conditions to avoid contamination in our cGMP compliant production plant. The process is scalable by modular units, to accommodate demand upon commercialization.
• Minimal manipulation needed by site. Prior to shipment, ELAD cartridges are put into a dormant state and have up to 60 hours to be administered. When the hospital receives the cartridges, they are unpacked by our ELAD Specialists on site, placed on the bedside unit, flushed with saline and are ready to be used for patient therapy. Since our C3A cells are immortal, they can remain alive for the duration of anticipated patient therapy. ELAD cartridges rarely require replacement, thus enhancing ease-of-use and reducing the cost-of goods.