The US Food and Drug Administration (FDA) has introduced a new avenue for advancing gene therapies that experts say could become transformative if widely implemented, though the full scope of the initiative remains uncertain. In an article published in the New England Journal of Medicine, FDA Commissioner Martin Makary and Center for Biologics Evaluation and Research (CBER) Director Vinay Prasad outlined how this pathway may speed up the development of personalised treatments while allowing certain regulatory steps to be bypassed.
The framework was inspired by the case of Baby KJ, a newborn boy diagnosed with a severe form of carbamoyl-phosphate synthetase 1 (CPS1) deficiency a rare inherited disorder that prevents the body from properly metabolising protein. After the FDA processed a single-patient expanded-access investigational new drug (IND) application within one week, clinicians were able to create and administer a tailor-made CRISPR-based gene-editing treatment that corrected the underlying mutation. In May 2025, KJ became the first individual worldwide to receive a customised CRISPR therapy.
To qualify for this pathway, a therapy must address a clearly defined molecular or cellular defect rather than a broadly characterised condition, and it must act directly on the biological root of the disease. Although this approach could eliminate the requirement for a traditional clinical trial before FDA authorisation, the agency will still demand preclinical safety evidence prior to patient dosing.
While aspects of the pathway have been clarified, questions persist regarding which therapies may ultimately qualify. Terry Pirovolakis, CEO of Elpida Therapeutics a rare-disease biotechnology company that acquires discontinued gene therapy programmes noted that if the framework is applied broadly, it could have a major impact on the cell and gene therapy field.
Interview Highlights
How might this pathway influence gene therapy development?
Pirovolakis explained that although the publication is not official guidance, it serves as an important reference when preparing submissions for rare disease programmes. He hopes it will prompt regulatory changes tailored to ultra-rare conditions, which often affect between one and 5,000 patients and currently lack dedicated pathways.
Which types of programmes may benefit?
He noted that the Baby KJ case involved an extremely small patient population but believes the proposed framework could extend to conditions impacting dozens or even thousands of patients, where unmet medical need remains high. He emphasised that similar flexibility should apply to gene replacement therapies, antisense oligonucleotides (ASOs), and other modalities.
Could this reshape how biotech and pharmaceutical companies assess viability?
According to Pirovolakis, commercial challenges not regulatory obstacles are the main reason many programmes are abandoned. The absence of a priority review voucher (PRV) and the cost of commercialisation remain unresolved, meaning the new pathway alone may not revive discontinued projects. Still, it could make it easier for therapies to reach clinical testing.
Will companies save money during development?
He said savings may be possible if developers follow the exact same pathway design, but differences in promoters or capsids could diminish that advantage. Acceptance of varied capsids by the FDA would significantly improve feasibility.
Is the pathway limited in scope?
Pirovolakis believes the FDA has already shown flexibility but highlighted that the new article is vague about how broadly the pathway can be applied. Key questions remain about whether capsids or promoters will form the basis of eligibility.
Does this signal greater international alignment?
He noted that while the UKs Medicines and Healthcare products Regulatory Agency (MHRA) recently introduced a similar mechanism, it is unclear whether the agencies coordinated. Even before this development, he said, the FDA has been highly supportive of rare-disease submissions.
Does gene therapy development need more initiatives like this?
Pirovolakis argued that additional programmes aimed at supporting commercialisation are essential. A larger number of approved therapies would reduce manufacturing costs and encourage broader regulatory support, potentially reshaping the entire industry.
Originally published by Pharmaceutical Technology, a GlobalData brand.
