Osteoarthritis, a ‘wear and tear’ degenerative condition of articular joints, is the most common cause of chronic disability in older adults: in fact, according to research published in Clinics in Geriatric Medicine, between 30 and 50% of adults over age 65 in the United States suffer from the condition. What’s worse, traditional treatment options for osteoarthritis are invasive and do not provide long-term solutions – but regenerative medicine offers an exciting new approach. By encouraging tissues and organs to regenerate themselves, regenerative medicine helps the body to heal itself, with massive benefits for patients. Vannary Tieng, CEO and founder of Vanarix, spoke to us about her company’s work in articular cartilage regeneration.

Can you briefly explain Vanarix’s technology? How did you come up with it?

I was previously involved in stem cell research, using mini grafts of brain tissue that produce dopamine to treat Parkinson’s disease. From there, I was inspired to develop a treatment for cartilage damage – which is a serious problem, as, once damaged, cartilage doesn’t repair itself. That’s how Vanarix was born.

Vanarix has developed Cartibeads™, which are bio-implants for knee cartilage regeneration. They are produced either from the cells of the patient (autologous) or from a donor (allogenic). The production is inspired by stem cell culture methods. We amplify cartilage cells – causing them to lose their original characteristics – and then we re-differentiate them to produce cartilage tissue again. The cartilage cells are then transformed in clusters, sized between 1.5 and 2 mm, called Cartibeads, that are injected into the knee lesion to merge with the host cartilage.

How competitive is this field? What are the clinical advantages/disadvantages of your technology compared to other solutions on the market?

As things stand, the gold standard regenerative treatment for traumatic cartilage damage is called ‘microfracture’, which consists of perforating the subchondral bone (the layer of bone just underneath the cartilage) to induce bleeding, allowing stem cells from the bone marrow to leak out. In time, this leads to the formation of fibrocartilage – a sort of scar tissue – but this is naturally of lower quality and durability than the original cartilage. So, this treatment only offers short-term relief. After three to five years, according to our research, patients generally experience advanced degeneration and have to resort to a complete knee replacement. This is an invasive procedure with a long and complex recovery, and it still doesn’t solve the problem in the long term, as it must be replaced every 15 to 20 years, which is obviously not ideal for patients under 60.

When it comes to more innovative approaches in the field of regenerative knee repair, there is significant competition, but in my eyes, many of the options are fundamentally flawed. This is because most other competitors only use the autologous approach (where cells come from the patient), which has significant drawbacks, as patients must undergo two surgeries – one to extract their cells and one to re-implant them. And above all, it’s wildly expensive. As such, this autologous cell therapy is only available to a limited number of patients in the United States.

This is where Vanarix can come in: with our allogenic product (where cells come from donors), we can manufacture bio-implants from a cell bank, meaning patients undergo just one surgery within a much shorter timeframe. The product could feasibly be ready to implant in less than two weeks. The allogenic approach is particularly exciting, as it should allow us to keep production costs down and treat a wide range of people – cells from one donor could serve millions of patients.

What’s more, according to feedback from the 20 patients that we’ve treated thus far, the recovery trajectory is very positive. The patient can walk out of the treatment centre on the day of their procedure and then, between five and six weeks after transplantation, they can return to doing intensive physical activity.

When developing the Cartibeads technology, did you try out different approaches? What are the challenges you’ve encountered so far?

I did what everyone else has been doing for the past 30 years, which is to cultivate cartilage cells in the laboratory with growth factors. However, not only are cartilage cells not amplifiable ad infinitum, they also quickly lose their original properties. That’s why my patented technique is crucial: I’ve found a way to mass amplify the cells but then make them re-differentiate – ‘recover their memory’ so to speak – to become cartilage cells again.

Today, the main challenge we’re facing is the same one that affects the whole cell therapy industry: cost of production. At the moment, we’re working with a manual production process, which is inherently costly and difficult to scale up. Furthermore, there are stringent regulatory requirements to consider when working in this field, which can also raise costs, as we have to work in a specialised lab with state-of-the-art equipment.

We now need to forge the right partnerships to build a sophisticated master cell bank and automate our process, so that we can make an affordable, accessible solution. It doesn’t make sense to produce a treatment that’s only available to a tiny proportion of wealthy patients.

Does Vanarix aim to reach other markets with this solution?

 We’re currently focusing on knee cartilage, but in theory, our technology could target damage in the ankle, hip and elbow, among other applications – that’s why it’s so powerful. Millions of patients could be targeted in the future, and that’s only considering humans. 

We have also made a first foray into the veterinary market, treating horses’ knees in a separate clinical study. There are about 7 million horses in the United States (and about the same number in Europe), of which 1 million are athletes and therefore prone to developing traumatic lesions, so there’s definitely scope to position our solution in this market. Notably, there is also some demand for camel treatments, as camel racing is popular in certain countries. And honestly, we could translate our technology to any animal – cats, dogs, etc. But for now, we’re a small team and the regulation for each market is complex, so we’ve decided to focus on humans and horses for now.

Having raised CHF 4m last July, what are your aspirations for Vanarix in the next couple of years? What are the next steps?

We’re obviously delighted to have raised CHF 4m, but we would like to raise CHF 35m by the end of 2025 to prepare for Phase IIb/III clinical trials in humans that will set us up for market entry in the USA and Europe. We’re aiming for a 2028 market entry, all being well!

I’m feeling optimistic, because there’s a huge amount of demand. I’ve even had prospective patients contact me through the Vanarix website, as they want to try out the Cartibeads. Unfortunately, at the moment, I have to turn them down, explaining that we’re still in the clinical stage. That’s why I really want to push and get the technology out into the world as quickly as possible, so it can help as many people as possible.

After that, who knows! When I was a university researcher, I was working on mini organoid brain models, which was a dauntingly complicated and expensive field. In the end, we didn’t have enough funding to continue the project. If I had the time in the future, I would go back to this technology, drawing on everything I’ve learned through developing the Cartibeads. The sky’s the limit!