Background & Aim Executives at the Food and Drug Administration (FDA) state that by the year 2025, there will be 10 to 20 cell and gene therapy (GT) product approvals per year. Current infrastructure is not sufficient to accommodate the spike in GT at most healthcare facilities. Furthermore, few healthcare providers (HCP) are trained to assess the risk of GT, or to implement safe handling strategies. Containment of GT, from entry to exit, requires a customized approach dictated by the construct of the vector. The risk of hazardous exposure to a novel therapy is amplified when containment procedures are undefined. Uncertainty regarding GT handling is due to a lack of relevant contemporary information and training. The outdated guidance's are drafted for pre-clinical laboratories, and many HCP are forced to extrapolate them to alternate settings. Recent papers have attempted to bridge the gap, but there is much work to be done with GT risk level identification, infrastructure establishment, and policy development. This presentation aims to describe a decision tree that sends the HCP on a rational path toward safe handling, by taking precautions that match the risk level of the GT vector. Methods, Results & Conclusion The method to eliminate vector exposure is by careful consideration of its replication status, integration ability, carcinogenicity, and toxicity. Vectors that are replication deficient, do not integrate into the host genome, and are otherwise not hazardous, are routed toward minimal handling precautions on the decision tree. However, if any of these factors, or a combination of them are present in a vector, the routing process dictates a more cautious approach. Importantly, influences such as capsid size and seroconversion are being added to the current body of knowledge to form the decision tree. Escalated handling precautions involves moving from Biosafety Level 1 (BSL1) to Biosafety Level 2 (BSL2) or 3. Two vectors, one using Adeno-associated virus (AAV), and the other incorporating the Herpes Simplex Virus (HSV-1) are routed through the decision tree. Because AAV is non-replicating, does not integrate into the host genome, and is non-toxic, it is reasonable to infer that handling can be performed in a BSL1 environment. However, since HSV-1 is replication competent and integrates into the host genome, BSL2 is a prudent recommendation. The decision tree provides a safety tool for HCP tasked with GT handling. Its application depends on modern infrastructure, focused training, and clear policy.
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