How Digital Orchestration Is Redefining Regulatory Infrastructure for Cell and Gene Therapy

The rapid growth of cell and gene therapies is exposing structural limitations in how traditional biopharmaceutical systems were designed. Unlike batch-based manufacturing models, these therapies are patient-specific, requiring tightly coordinated execution across clinical, manufacturing, and quality domains.

In this environment, maintaining chain-of-identity and chain-of-custody is not simply a regulatory requirement, but a foundational design constraint. As programs move from early clinical development into global commercialization, gaps in system-level orchestration can translate directly into compliance and operational risk.

These pressures are driving renewed attention toward how digital infrastructure is architected in regulated life sciences, particularly around validation, traceability, and cross-system integration.

Monika Birdi, global product strategy leader for SAP’s Cell and Gene Therapy Orchestration (CGTO) platform, has spent more than two decades working on regulated enterprise systems across industries, with a recent focus on advanced therapy manufacturing and supply chains. In this interview with GEN, Birdi discusses SAP CGTO’s architecture, regulatory design in SAP Batch Release Hub (BRH) and Intelligent Clinical Supply Management (ICSM), and digital frameworks for inspection readiness, jurisdictional control, and chain-of-identity enforcement. She also shares insights on balancing innovation with GxP validation and building digital infrastructure for global commercialization of patient-specific therapies.

GEN: What foundational lessons about compliance architecture, data integrity, and large-scale system design most influenced your transition into life sciences and cell and gene therapy?

MB: The biggest shift I experienced after moving to life sciences was in perspective and significance. During the many years I worked building large-scale regulated systems in diverse industries, a failure of data integrity meant financial loss or reputational damage. However, when I moved into the pharma and biotech life science sectors, I realized that in this domain, there was zero margin for error. If the chain-identity breaks anywhere in that journey, there is no fallback.

Monika Birdi
Monika Birdi

This reality puts compliance at the heart of architecture. Controls need to be built from the start and cannot be retrofitted later. We must stop treating compliance and scalability as competing priorities, because when you architect them together, one enables the other.

 

 

GEN: When you began working in advanced therapies, what operational or digital fragilities did you observe in early-stage programs that signaled a structural gap in how regulated supply chains were being architected?

MB: The first thing we need to understand is that advanced therapies are completely different from traditional small molecule manufacturing. Hence, for organizations that have been in the pharma business, shifting to manufacture advanced therapies is different from both scientific and architectural perspectives. The same tools that worked for small molecules will not serve the end-to-end business for advanced therapies.

The common structural gaps I observed were around chain of identity and chain of custody tracking. Since these are typically not part of the native system design, every single process runs via piles of papers that are difficult to organize and trace. In these cases, there was no orchestration layer and all the systems—such as clinical, manufacturing, quality—were running in silos.

GEN: You have led the design and commercialization of SAP CGTO. What operational failures or regulatory risks did you observe in early-stage CGT programs that convinced you digital orchestration had to be architected differently from traditional pharma systems?

MB: Traditional pharma systems are built around batch manufacturing, where thousands of units are manufactured in one batch. Even if one batch fails the compliance, the next batch can be used by discarding the non-compliant batch. Chain-of-identity is being maintained through a combination of spreadsheets. This is what convinced me to rethink orchestration. You can’t take a traditional batch management system and configure your way into CGT compliance.

The right therapy needs to reach the right patient. So, with CGTO, the design question was never “how do we adapt existing functionality” to make a compliant solution. Our approach was to ask, “if we are building this from scratch for one patient and one batch, what should the process actually look like?”

GEN: Autologous cell and gene therapy manufacturing is patient-specific and tightly synchronized. How did you architect SAP CGTO to enforce chain-of-identity and chain-of-custody controls at every transition point rather than relying on retrospective reconciliation?

MB: Personalized advanced therapies operate under a unique manufacturing cycle, which makes conventional post-production reconciliation processes ineffective. We needed an architecture that shifts the control point from “detect and correct” to “prevent and confirm” for every transaction.

With SAP CGTO, every transition point, from receipt at the plant, disposition, manufacturing start, and allocation to final shipment, is within an order and includes validations to make sure the right patient gets the right therapy. The system won’t let you proceed with a mismatched identity. These validations ensure that the process is stopped immediately, instead of alerting the user at a later point in time.

GEN: In your work on SAP BRH, you focused on jurisdiction control and regulatory components. How do digital release architectures need to evolve to support multi-country regulatory environments while preserving data integrity and inspection readiness?

MB: Most organizations use local Standard Operating Procedures (SOPs) and spreadsheets, utilized by people who have been around long enough to manage the regulatory requirements. This system will likely fail if a critical employee leaves, or if you are entering a new market under pressure, or when an inspector asks you to reconstruct a release decision from two years ago.

Jurisdictional controls should be part of the solution. Once validations are embedded directly into workflows, compliance becomes part of the business process. The audit trails are thus automatically created as a natural result of doing the job.

GEN: You believe designing infrastructure before scale exposes operational gaps. What are the most common digital fragilities you see when sponsors defer enterprise architecture decisions until Phase III or Phase IV?

MB: In cell and gene therapy, many sponsors treat digital infrastructure like office furniture: something to worry about later. The largest problems tend to be in two areas: traceability and coordination.

gene therapy
Credit: Metamorworks/Getty Images

In terms of traceability, it’s common for programs to track materials in whatever way is convenient at that time, such as spreadsheets, half-set-up software, or systems that don’t talk to one another. But for a hundred patients across many sites, it becomes nearly impossible to track it all correctly, especially when the FDA starts asking questions.

But as trials get bigger, it becomes difficult to manage all of it through those means—and in fact, it can become dangerous. Then, as the trial advances, scale your investment in alignment with emerging trial results.

GEN: Across CGTO, BRH, and ICSM, you have helped define regulatory-ready digital architectures for emerging therapy models. What measurable operational or compliance outcomes have resulted from these implementations, and how do they demonstrate advancement in the field’s digital maturity?

MB: The actual benefit of digitalization in advanced therapies shows up in audits and inspections. By ensuring that digital systems are properly implemented from the beginning and integrated with quality and batch record systems, decisions regarding the release of batches are much faster and more accurate.

In the area of clinical trials, integrated systems enable teams to predict and prevent problems rather than simply reacting to them. This results in fewer delays, and the benefits are easy to demonstrate and prove to the authorities.

GEN:  What principles guide your approach to building compliant cloud-native platforms that remain modular, secure, and extensible?

MB: I believe modularity itself is a compliance strategy. Highly integrated platforms introduce hidden risk, because every regulatory change or market requirement can trigger system‑wide retesting.

I design security and extensibility together, with clear separation between what is validated, configurable, and subject to formal change control. That clarity allows teams to move faster without compromising compliance.

Commercialization teaches you that adoption depends on validation of reality. A platform can be technically strong, but if it is difficult to validate and operate in a regulated environment, it will not be scaled. The most successful products do not transfer the customer’s validation burden.

GEN: As advanced therapy pipelines expand and manufacturing networks become more geographically distributed, which architectural capabilities will determine whether organizations can sustain compliant commercialization without repeated remediation cycles?

MB: We need to start building compliance as the core of architecture instead of treating it as per each unique market need. Once the foundation has been set, market regulations can be adjusted accordingly. A few capabilities in which I would invest early include real-time chain-of-identity enforcement, jurisdictional logic embedded in workflows rather than documented beside them, and audit structures that generate inspection-ready data as a natural output, as opposed to a reconstruction exercise. What really matters most is the flexibility of architecture. Regulations evolve, new markets pop up, and manufacturing networks constantly adapt and relocate. This requires organizations to build adaptable and modular architecture that can evolve with growth.

 

The post How Digital Orchestration Is Redefining Regulatory Infrastructure for Cell and Gene Therapy appeared first on GEN – Genetic Engineering and Biotechnology News.

Medical Marijuana Initiation and Simulated Driving Performance Among Mid-to-Late-Life Adults With Chronic Pain: Prospective Observational Feasibility Cohort Study With Matched Controls

Background: Marijuana initiation among adults aged 50 years and older has increased substantially. Although acute tetrahydrocannabinol exposure can impair psychomotor function, less is known about how real-world medical marijuana initiation relates to functional tasks such as driving in mid-to-late life. Objective: The objective of our study was to evaluate the feasibility of recruiting and retaining adults aged 50 years and older, who are newly registered for medical marijuana, and matched non–marijuana-using controls, into a longitudinal high-fidelity driving simulator protocol, and to explore preliminary associations between medical marijuana initiation and simulated driving performance. Methods: This prospective, nonrandomized feasibility cohort study enrolled adults aged 50 years and older who are newly registered in the Florida Medical Marijuana Use Registry, along with age-, race-, and sex-matched controls. Assessments occurred at baseline (T1; preinitiation) and at 1 month (T2). Primary feasibility outcomes included recruitment, retention, simulator completion and tolerance, and exposure verification. Exploratory outcomes included reaction time and divided attention (DA) performance, which are measured using an immersive, high-fidelity driving simulator. Results: Recruitment and exposure verification procedures were feasible, but simulator sickness contributed to substantial missing data. Exploratory analyses suggested group differences in select DA outcomes at T2. At T2, reaction time to DA situation 3 (DA3) was significantly shorter in the medical marijuana group (n=14, mean 2.57, SD 1.63) than in the control group (n=7, mean 5.79, SD 4.32; =−2.50, =.02, =−1.11, 95% CI −2.04 to −0.16). These findings should be interpreted cautiously, given the small sample size, missing data, and multiple comparisons. Conclusions: A prospective protocol examining medical marijuana initiation and simulated driving among mid-to-late-life adults is feasible, but future studies should incorporate design and analytic refinements to address simulator sickness and missing data and to better characterize exposure timing and patterns. Trial Registration: ClinicalTrials.gov NCT04629716; https://clinicaltrials.gov/study/NCT04629716
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Two-year longitudinal neuropsychological monitoring after unilateral and staged bilateral subthalamic nucleus deep brain stimulation

IntroductionDeep brain stimulation (DBS) is an increasingly popular therapeutic method for treating motor symptoms in Parkinson’s disease, but its impact on non-motor symptoms in long-term follow-up remains debated.MethodThe primary objective of this study was to monitor the cognitive functioning, mood, and quality of life in 2 years of unilateral and staged bilateral subthalamic nucleus DBS. A cohort of 30 patients was evaluated at three intervals: before DBS surgery, at 6 months, and 24 months post-surgery. The time points of neuropsychological assessments were set to control the impact of unilateral and bilateral DBS throughout the treatment. Two selected groups, unilateral and bilateral DBS, were also analyzed. The study employed a combination of computerized and paper-based tests to assess cognitive functions, alongside questionnaires to gauge emotional state and quality of life. The cognitive evaluation focused on three domains critical for daily activities: attention and processing speed, learning and episodic memory, and executive functions, including working memory and cognitive flexibility.ResultsAnalysis of the entire cohort from baseline through the two follow-up assessments revealed no decline in cognitive function, mood, or quality of life, alongside significant motor improvement. Additional analyses of the two subgroups—unilateral DBS and staged bilateral DBS—also showed no overall decline in any assessed domain over the 2-year follow-up period. However, comparison of cognitive outcomes with normative data indicated a higher proportion of patients meeting criteria for cognitive decline at the 24-month follow-up in the staged bilateral DBS group compared with the unilateral DBS group.ConclusionThe findings support the long-term overall stability of cognitive function, mood, and quality of life following unilateral and staged bilateral subthalamic DBS. Subgroup analyses did not reveal any significant decline in cognitive measures over time. Nevertheless, individual comparisons with normative data showed a higher proportion of patients with memory deficits in the staged bilateral DBS group after the two-year follow-up.

A multichannel MEG time–frequency analysis framework for detecting stage -specific effects of spatial distraction in visual-spatial working memory

IntroductionSpatial distraction can disrupt visual-spatial working memory (VSWM), but its stage-dependent effects on multichannel neural dynamics remain insufficiently characterized. This study presents a multichannel magnetoencephalography (MEG) time—frequency analysis framework to detect stage-specific oscillatory responses to spatial distraction during a VSWM task.MethodsMEG signals were recorded from healthy participants under Distractor and No-distractor conditions and analyzed across encoding, maintenance, and retrieval/decision epochs. Time–frequency power was estimated in the delta, theta, alpha, beta, and gamma bands, and condition differences were evaluated using sensor-level spatiotemporal cluster-based permutation testing and Bonferroni correction within each predefined epoch.ResultsThe proposed analysis revealed a clear stage-specific pattern, with the most prominent modulation occurring during maintenance. Specifically, distraction induced robust and sustained increases in theta-, alpha-, and beta-band power during the retention interval (all cluster-level p < 0.01). Theta activity increased rapidly after maintenance onset and remained elevated throughout the full maintenance period over bilateral temporal, and widespread parieto-occipital sensors, while alpha and beta enhancements also showed temporally continuous and spatially stable patterns across widespread sensor networks.DiscussionThese findings highlight sustained large-scale oscillatory modulation as a key neural signature of distraction during mnemonic maintenance. The study provides an interpretable multichannel signal-analysis perspective on distraction effects in working memory and offers a practical framework for stage-resolved analysis of brain dynamics in cognitive tasks.

Can exercise combined with transcranial direct current stimulation improve cognitive function in older adults? A systematic review and meta-analysis

ObjectiveThis study investigated whether combining exercise with transcranial direct current stimulation (tDCS) improves overall cognition, memory, and executive function in older adults.MethodsFollowing PRISMA guidelines, we systematically searched databases including PubMed, Web of Science, CNKI, and Wan Fang for randomized controlled trials (RCTs) examining the combined effect of exercise and tDCS on cognitive function in older adults. Used RStudio (version 4.2.0) to merge effect sizes and represent them as SMD with a 95% confidence interval (CI). The main effects are synthesized using a random effects model, and heterogeneity sources are explored through subgroup regression and sensitivity analysis.ResultsThe combined exercise and tDCS intervention significantly improved global cognitive function in older adults (SMD = 0.62, 95% CI: 0.36 to 0.89, p < 0.0001). Significant enhancements were observed in executive function (SMD = 0.54, 95% CI: 0.16 to 0.92, p = 0.005) and general cognitive ability (SMD = 0.75, 95% CI: 0.21 to 1.30, p = 0.006), while memory showed a non-significant improvement (SMD = 0.58, 95% CI: −0.03 to 1.19, p = 0.063). Both interventions lasting less than 6 weeks (SMD = 0.94, 95% CI: 0.60 to 1.27, p < 0.0001) and those lasting 6 weeks or longer (SMD = 0.24, 95% CI: 0.10 to 0.37, p = 0.0006) positively impacted cognitive function. However, the effect size was larger for cognitively healthy older adults (SMD = 0.69, 95% CI: 0.20 to 1.18, p = 0.006) compared to those with cognitive impairment (SMD = 0.60, 95% CI: 0.29 to 0.92, p = 0.0002). The combination of tDCS and integrated exercise produced the largest effect size (SMD = 1.74), despite high heterogeneity, while the combination of tDCS and Tai Chi produced the smallest but most robust effect (SMD = 0.25, I 2 = 0%), indicating that exercise type significantly regulates the intervention effect of tDCS (p = 0.0015). Regression analysis shows that tDCS stimulation time has a significant positive regulatory effect on cognitive function in elderly people (p = 0.0002), while the combined intervention period (p = 0.030) and single exercise time (p = 0.034) both have a significant negative regulatory effect.ConclusionBased on limited evidence, we found that a combined intervention of exercise and tDCS is a potentially effective means of improving cognitive function in older adults. However, the extent of improvement varies with the cognitive domain, baseline performance level, and intervention plan.

Virtual reality-based inhibition training influences food-related responses: no additional effects of repetitive transcranial magnetic stimulation

Combining cognitive inhibition training with brain stimulation techniques has received increasing attention as a potential approach to modulating maladaptive food craving and food intake. Building on previous work in this line of research, the current study examined whether virtual reality (VR)-based no-go inhibition training paired with repetitive transcranial magnetic stimulation (rTMS) modulates implicit food-related attitudes, craving and food-choice behaviors. Healthy women with high trait food cravings and a preference for high-calorie foods were assigned to one of four groups in a 2 (rTMS: active vs. sham) × 2 (training: no-go vs. neutral) between-subjects design. High-frequency rTMS was applied over the left dorsolateral prefrontal cortex (DLPFC), and no-go training was implemented in a VR environment using food stimuli tailored to participants’ self-reported preferences. Implicit attitudes and food craving were assessed before and after the intervention, while food choice was measured post-intervention only. Following training, the no-go group showed reduced positive implicit attitudes toward high-calorie foods and increased craving for low-calorie foods compared to pre-training levels, whereas no such changes were observed in the neutral group. Moreover, compared to the neutral group, the no-go group made healthier food choices. No-go training effects on food choice were more pronounced among individuals with low-to-moderate baseline preferences for high-calorie foods. In contrast, no significant main effects or additive effects of rTMS were observed. The present study demonstrates that VR-based no-go training can effectively regulate food-related responses and extends earlier work by demonstrating robust inhibition training effects across implicit and explicit measures, while highlighting the importance of considering individual differences in future research.

Impact of a Prototype Combining Recommender Functionality With Structured Documentation on Operator Performance in Calls to Medical Communication Centers: Quasi-Experimental Feasibility Study

<strong>Background:</strong> Management of contacts to medical communication centers relies heavily on clinical judgment, contextual understanding, and communication skills. Decision support systems, intended to complement medical expertise, may, due to their rigidity, impede effective caller interaction and may, together with the obligatory documentation of calls, contribute to a workflow that draws attention away from the communication. Recommender systems have demonstrated potential in supporting decision-making across various domains by nudging individuals toward better choices without undermining autonomy. We built a prototype that combined artificial intelligence–based question recommendations with structured documentation (hereafter: the prototype) and conducted a feasibility study to test its influence on operators’ performance. <strong>Objective:</strong> This study aimed to examine whether the prototype influenced the operators’ performance during telephone triage. We hypothesized that the prototype would affect medical quality without affecting communication quality. <strong>Methods:</strong> A quasi-experimental pre- and posttest feasibility study was conducted in a simulated setting. Twenty-five operators were voluntarily recruited from 5 Norwegian medical communication centers, in which 22 operators contributed to both the pretest (before the prototype) and the posttest (with the prototype). The operators handled the same 15 medical cases presented by simulated callers, with a 5-month interval between the 2 sessions. The question recommender was trained on other data and then fine-tuned on the 15 scenarios used. Audio recordings of the calls were rated using the tool Assessment of Quality in Telephone Triage. Pre- and posttest values were compared, with overall medical and communication quality as the primary outcomes. Secondary outcomes included specific items related to medical content and communication, accuracy of triage, patient safety, call duration, and efficiency. <strong>Results:</strong> A total of 320 paired calls were analyzed. Overall medical quality improved significantly with use of the prototype, from a mean of 6.83 points pretest to 7.16 points posttest rated on a 10-point scale (difference 0.34, 95% CI 0.11-0.57; <i>P</i>=.004). The effect size was small (Cohen <i>dz</i>=0.16). No significant change was observed in overall communication quality, with a mean of 7.06 points pretest and 6.97 points posttest (difference –0.09 points, 95% CI –0.28 to 0.10; <i>P</i>=.35). A significant decrease from pre‑ to posttest was observed in the specific items “Collects information about the patient’s location” (<i>P</i>&lt;.001) and “Ensures that the triage decision is understandable and feasible” (<i>P</i>=.002). None of the remaining secondary outcomes showed significant changes. <strong>Conclusions:</strong> The prototype yielded a modest improvement in medical quality within the scenario‑based test environment. Although overall communication quality remained unchanged, aspects of the interaction were negatively affected. Artificial intelligence–based question recommendations combined with structured documentation may serve as useful functionalities within a decision support system, but each functionality requires further testing and development before such technology can be implemented in the triage of unselected, real‑world calls. <strong>Trial Registration:</strong>

Key takeaways from WHO briefing on hantavirus cruise ship outbreak

The MV Hondius, the cruise ship that has garnered global attention because of an apparent outbreak of person-to-person spread hantavirus infections, is on the move. At the request of Tedros Adhanom Ghebreyesus, the World Health Organization’s director-general, Spain has agreed to let the ship dock off Tenerife, in the Canary Islands. The ship is expected to arrive on Sunday.

This outbreak — the first time hantavirus has been suspected of transmitting on a cruise ship — is an evolving situation. It’s also one that is going to take weeks to resolve, because of the long incubation period of hantaviruses. And it could be months before scientists piece together how the virus got on the boat and whether all the subsequent cases were people infected through contact with other people or whether rodents — which are known to carry hantaviruses — that were on board played any part.

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Amyloid-β clearance: an astrocytic perspective

Alzheimer’s disease (AD) represents a major global public health challenge in the 21st century, recognized as the neurodegenerative disorder with the highest mortality rate and socioeconomic burden. The core pathological feature of AD is an imbalance in Aβ production and clearance, leading to conformational changes and pathological aggregation of Aβ peptides. This imbalance triggers neurodegenerative cascades 20–30 years before clinical symptoms appear. Therapeutic approaches targeting Aβ production, including β-secretase and γ-secretase inhibitors, have thus far shown limited clinical benefit in late-stage trials and have been further constrained by safety and tolerability concerns. As a result, early interventions aimed at enhancing Aβ clearance have attracted increasing attention. While microglia-mediated phagocytosis of Aβ has been extensively studied, the multifaceted roles of astrocytes in this process remain underexplored. This review synthesizes recent findings to elucidate the molecular mechanisms of astrocyte-mediated Aβ clearance, focusing on endocytic uptake and intracellular degradation, maintenance of the blood–brain barrier, and aquaporin-4 (AQP4)-dependent glymphatic drainage. Additionally, this review dissects key regulatory nodes, including the dynamic modulation of Aβ clearance capacity through astrocyte phenotypic transitions and functional decline associated with pathology. These insights offer a theoretical foundation and translational perspective for the development of astrocyte-targeted interventions in early-stage AD.

Official leading CDC’s cruise ship program retires

WASHINGTON — The top U.S. official responsible for public health on cruise ships is stepping down, according to an internal Centers for Disease Control and Prevention announcement obtained by STAT.

The retirement of Luis Rodríguez, who has been part of the Vessel Sanitation Program since 2010 and served as its chief since 2023, was announced internally at the CDC on Wednesday.

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