December 2, 2021

Cell and gene therapy: In vivo and Ex vivo in comparison

Reading time: 5 minutes

Cell and gene therapy (CGT in short) is a new and promising type of immunotherapy for patients suffering from certain types of cancer and lymphoma/leukemia. It is among the treatments of Advanced Therapy Medicinal Products, in short ATMP.

Any ex-vivo type of cell & gene therapy works by utilizing the patient’s own blood cells, respectively genetic material: DNA is extracted to be genetically modified ex vivo. It is then re-infused in the patient’s system to target cancer cells. An in-vivo gene therapy on the other hand is administered directly, with the targeted cells remaining in the body.

Clinical trials have shown breakthroughs for both in-vivo and ex-vivo gene and cell therapy. However, while there are success stories, the full potential of such therapies – both cell and gene therapy – is yet to be explored and realized by biotech experts. 

Find out more about the differences between cell and gene therapies as well as in-vivo and ex-vivo and read about genome and gene editing in the following article.

What is gene therapy?

While we have already mentioned that there are two types of gene delivery – in vivo and ex vivo – the question is: What exactly is gene therapy? 

Generally speaking, gene therapy is a technique that modifies a person’s genes to treat or cure disease. It works on the basis of altering (that is introducing, removing, or changing) the content of a person’s genetic code: The alteration of the genetic material by means of genome or gene editing creates mutated genes. The new gene type changes how a single protein or group of proteins is produced by the cell, and is thus an intrinsic part of any gene therapy. Mutated gene material can be used to 

  • reduce levels of a disease-causing version of a protein
  • increase production of disease-fighting proteins
  • produce new/modified proteins 

In short: The altered new gene type can be seen as therapeutic genes, and there is a variety of gene therapy products available. Those include viral vectors, bacterial vectors, human gene therapy and patient-derived cellular gene products. As already mentioned, there is a difference between cell and gene therapy: Gene therapies are not to be confused with cell therapy products, all of which involve the transfer of cells rather than genetic material.  

What is cell therapy?

While cell & gene therapy fall under the same umbrella term of regenerative medicine, they use different approaches. 

As opposed to gene therapy, cellular therapy is a type of regenerative medicine that works by using human cells. Stem cells are either taken from the patient or from a suitable donor to be modified so as to target cancer cells and certain genetic diseases. After alteration, viable cells are injected or otherwise transplanted into the patient, in a process called immunotherapy. 

One of the most prominent examples for cell therapies is the CAR T-cell therapy (CAR being short for chimeric antigen receptor). CAR T-cell therapy is a novel treatment promising breakthroughs for patients suffering from certain types of leukemia/lymphoma who are not responding to more traditional approaches (for instance bone marrow transplantation). 

There are currently 5 FDA approved therapies. Healthcare organizations worldwide hope for rapid expansion for the benefit of the people.

The 5 FDA approved CAR T-cell therapies

Ex Vivo and In Vivo Approaches

Leaving cell therapies aside and returning to gene therapy, there are two different approaches, namely ex vivo and in vivo. For gene therapy to work, the mutated human gene first needs to get inside the cells of the person affected by the disease. There are two ways to achieve this:

  • In vivo: genetic material is delivered to target affected cells (cancer cells or other) that remain inside a person’s body.
  • Ex vivo: mutated genes are delivered to a person’s body after the cells have been extracted and exposed to genome or gene editing.

Read on to find out what exactly sets these two types of gene therapy apart.

Ex Vivo and In Vivo Approaches in cell gene therapy

In Vivo delivery

The term “in vivo” refers to the direct delivery of genetic material to the patient. This transplantation of genetic material can happen in one of two ways, either intravenously or locally. 

As clinical trials have shown, the in-vivo approach proves to be successful in various areas (oncology), with biotech companies conducting ongoing research and development and exploring further fields of application in fields such as oncology but also in case of immunodeficiency.

This being said, before any genetic material can be delivered to the patient, it needs to be frozen for safe and protected shipping and storage. Human genes and cells are a sensitive matter, which is why the production of gene therapy products is an elaborate process.

In-vivo cell or gene therapy requires processes and technologies that are customized to meet the needs of the highly sensitive and valuable human cells and genes. Single-use has proven to be the technology of choice as it allows for flexible and scalable platforms and solutions.

Ex Vivo gene transfer

As opposed to in vivo, ex vivo refers to a gene editing process: Specific cells are removed from a person to genetically alter and reintroduce them to the patient. This transplantation replaces target cells with manipulated stem cells. This process is most frequently used for 

  • genetic diseases that affect tissues and organs that can be reached by blood cells
  • diseases that affect the blood and immune system.

As is the case with in-vivo, any altered genetic material needs to be protected, be it from potential contamination or loss of quality. All cell & gene material is highly sensitive and can be contaminated relatively easily if not treated with the utmost care and handled in sterile/aseptic environments, especially when it comes to ex-vivo genome and gene editing.

CGT or CAR-T logistic solution "RoSS KSET" - Protect your cell & gene therapy (CGT) bags

Challenges & Opportunities in cell and gene therapy

There is general progress in the field of genome and gene editing, and generally regarding cell & gene therapy. Based on results from clinical trials, the US National Cancer Institute is projecting an apparent increase in the number of cancer survivors. Advances in immunotherapy as well as mutated gene and cellular therapy are going hand in hand with significant breakthroughs on the one hand and new challenges for the biotech industry on the other hand.

Personalized CGTs (short for cell & gene therapies) and the involved cell and gene delivery are an extremely cost-intensive approach: Despite the high costs, the yields of genetic material manipulated for cell & gene therapies are low – and supply chains are complex. However, CGT can only be successful if the material modified by genome and gene editing is safely and reliably delivered to the patient. 

This is why, once CGTs have passed the phase of clinical trials, the overall aim is a standardization of processes. While there is definitely room for improvement, there have been developments that are already pushing the bar. With single-use technology taking the lead, the goal of standardization – even in the relatively new field of cell & gene therapy, seems to be in closer reach than it ever has been. 

In order to achieve this goal, the team at Single Use Support are rethinking existing processes and pioneering innovations around single-use technologies. With their game-changing sterile consumables, platform systems and process solutions for cell and gene therapies, they aim to optimize the entire biotech industry by building upon existing and established technology.

Cell and gene therapy: In vivo and Ex vivo in comparison

Michael Eder

Business Development / Marketing Manager


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