Cell & Gene Therapy

Novel therapies to reboot cells and organs

Overview

The human body is a remarkable structure composed of countless minuscule cells—the basic building blocks of life. Like bricks used to build a house, the intricate organization of these cells forms the complex structure of the body. However, like any structure, the body is not invulnerable and can suffer from structural damage and dysfunction like injuries, diseases, and wear and tear. Cell and gene therapies (CGTs) provide groundbreaking approaches to repairing or replacing dysfunctional cells and enabling the smooth functioning of the human body.

Although still in their early days, these therapies could change the way we tackle previously untreatable diseases. There is no better illustration of their potential than in the recent case of a 19-month-old baby girl in the UK diagnosed with a rare genetic disorder (metachromatic leukodystrophy [MLD]), who showed no signs of it after being treated with a gene therapy called Libmeldy developed by Orchard Therapeutics. The treatment involved extracting stem cells from the child, replacing the faulty gene with a healthy one capable of producing a crucial enzyme, and administering the modified cells back into the body. 

As of August 2023, more than 30 CGTs have been approved by the US FDA, with several other therapies awaiting approvals as of the same date. The number of clinical trials being conducted for CGTs totaled 1,600+ across the North American, European, and Asia-Pacific regions.

Industry Updates

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Market Sizing

The US Cell Therapy market could reach USD 2.4 billion–3.5 billion by 2027

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Use cases


CGT is a branch of genomic therapeutics that applies to the healthcare industry with focus on the biotechnology and life sciences subsegments. 

Examples of CGT comprise therapeutic developers that offer their platforms primarily to pharmaceutical companies to facilitate use cases such as research, product development, and commercialization of CGT candidates across areas such as regenerative medicine and therapeutics based on vectors such as ribonucleic acid (RNA), adeno-associated viruses (AAVs), and T cells. Furthermore, these platforms are used in pre-clinical testing of drug candidates. 

We have identified key CGT use cases below:

Market Mapping


Disruptors and incumbents in this space develop CGTs or materials to assist with the development of either type of therapeutic. 

Industry players are segregated based on the type of therapy offered, with cell therapies being further broken down based on the type of therapy being developed: 1) chimeric antigen receptor T-cell (CAR-T) therapy, 2) stem cell therapy, and 3) other approaches of cell therapies.

As of September 2023, startups in the gene therapy segment had raised ~USD 7 billion in funding; the highest funds raised by a single segment, indicating the investment-heavy nature of developing gene therapies. Across cell therapy, startups developing CAR-T had raised nearly USD 3 billion as of September 2023, accounting for over half of funds raised by all cell therapy players.

Major global pharmaceutical giants such as Bayer, Pfizer, Novartis, and Johnson & Johnson are among the incumbents active in this space, with partnerships and product collaborations being the most common growth strategy employed by these players, along with some big-ticket acquisitions to accelerate the product portfolio.

The Disruptors


The CGT developers identified are primarily classified as early-/seed-stage disruptors, as most have their lead candidates in development or testing. Given the nature of the industry as an emerging field of study, therapeutics typically take a considerable amount of time to go from the research and ideation phases to commercialization. 

Given this time to market, most disruptors will also test lead cell and gene therapeutic candidates in multiple related applications to optimize their commercialization process. 

Disruptors in the industry typically choose to raise funds through public offerings, with several disruptors, such as Sarepta Therapeutics, Catalent Pharma Solutions, Vericel Corporation, and Sana Biotechnology being valued in excess of USD 1 billion in public markets.

Funding History

Competitive Analysis


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Incumbents


Major global pharmaceutical giants such as Bayer, Pfizer, Novartis, and Johnson & Johnson are among the incumbents active in CGT, with the most common growth strategy being partnerships and product collaborations with startups and other incumbents in the field. Many of the incumbents’ own in-house activities are focused on gene therapy, with most incumbents having multiple therapies in their pipelines for various diseases.

Roche’s acquisition of Genentech more than a decade ago for nearly USD 47 billion remains the largest acquisition in the space to date. The largest deal in more recent times was Novartis’ acquisition of AveXis for nearly USD 9 billion in 2018 to absorb the latter’s gene therapy portfolio for spinal muscular atrophy (SMA) and Astellas Pharma’s acquisition of Iveric Bio in 2023 for nearly USD 6 billion in a bid to expand the former’s eye disease pipeline.

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Notable Investors


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Market sizing

The TAM for the cell therapy market in the US is estimated at USD 21.8 billion

The total addressable market (TAM) refers to the total revenue opportunity available for a product or service, while the actual market is the market size based on revenue projections. 
To arrive at the TAM for cell therapies, we looked at chimeric antigen receptor T-cell (CAR T) therapy and stem-cell therapies—two of the most common types of cell therapies today—and the types of blood cancer these therapies have been approved for and which are making progress in treating. These include the following:
  • CAR T therapy: Non-Hodgkin lymphoma (NHL) and multiple myeloma (MM)
  • Stem-cell therapy: Acute lymphocytic leukemia (ALL)
These cancers were mainly chosen based on the availability of therapies in the market that address the diseases while also considering their prevalence, low survival potential, and limited availability of alternative treatments.
Genetic diseases, such as Duchenne muscular dystrophy, are among the key disease targets in the US; however, the high cost of such treatments (up to USD 3.2 million) against an insurance market structure that is not designed to handle high-value treatments alike so is likely to make scalable adoption of these therapies challenging. As such, the TAM for this segment has not been estimated. However, there is a potential upside for this segment in the future, as specific insurance/reinsurance products and novel payment mechanisms become more widespread to address the high upfront costs of gene therapies.
The aggregate TAM for cell therapies in the US is estimated to be ~USD 21.8 billion. CAR-T therapies account for 95.3% of this TAM, while stem-cell therapies account for the remaining 4.7%. There is additional upside to the TAM as the scope of cell therapies expands, resulting in the expansion of the addressable patient pool. Several startups are already developing treatments to address other therapeutic areas, such as blood disorders and neuromuscular diseases, with the potential to extend to other areas like cardiovascular and neurological diseases.
The actual market size for cell therapies was estimated to be USD 1.4 billion in 2022 and is expected to grow at a CAGR of 16.3% to reach USD 2.9 billion by 2027, with a penetration of 13.4%. 
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