<?xml version="1.0" encoding="UTF-8"?>
<!DOCTYPE article PUBLIC "-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" "journalpublishing.dtd">
<article article-type="review-article" dtd-version="2.3" xml:lang="EN" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">
<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Bioeng. Biotechnol.</journal-id>
<journal-title>Frontiers in Bioengineering and Biotechnology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Bioeng. Biotechnol.</abbrev-journal-title>
<issn pub-type="epub">2296-4185</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="publisher-id">841420</article-id>
<article-id pub-id-type="doi">10.3389/fbioe.2022.841420</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Bioengineering and Biotechnology</subject>
<subj-group>
<subject>Mini Review</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>CDMOs Play a Critical Role in the Biopharmaceutical Ecosystem</article-title>
<alt-title alt-title-type="left-running-head">Kurata et&#x20;al.</alt-title>
<alt-title alt-title-type="right-running-head">CDMO in Biopharmaceutical Ecosystem</alt-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Kurata</surname>
<given-names>Hideyuki</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1609106/overview"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Ishino</surname>
<given-names>Tetsuya</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1607073/overview"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Ohshima</surname>
<given-names>Yasuhiro</given-names>
</name>
<xref ref-type="aff" rid="aff4">
<sup>4</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1688150/overview"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Yohda</surname>
<given-names>Masafumi</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="corresp" rid="c001">&#x2a;</xref>
<uri xlink:href="https://loop.frontiersin.org/people/464282/overview"/>
</contrib>
</contrib-group>
<aff id="aff1">
<sup>1</sup>
<institution>Technology General Division</institution>, <institution>AGC Inc.</institution>, <addr-line>Tokyo</addr-line>, <country>Japan</country>
</aff>
<aff id="aff2">
<sup>2</sup>
<institution>Institute of Engineering</institution>, <institution>Tokyo University of Agriculture and Technology</institution>, <addr-line>Tokyo</addr-line>, <country>Japan</country>
</aff>
<aff id="aff3">
<sup>3</sup>
<institution>AGC Biologics</institution>, <addr-line>Bothell</addr-line>, <addr-line>WA</addr-line>, <country>United&#x20;States</country>
</aff>
<aff id="aff4">
<sup>4</sup>
<institution>Business Development Division</institution>, <institution>AGC Inc.</institution>, <addr-line>Tokyo</addr-line>, <country>Japan</country>
</aff>
<author-notes>
<fn fn-type="edited-by">
<p>
<bold>Edited by:</bold> <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/46832/overview">Susana Rodriguez-Couto</ext-link>, LUT University, Finland</p>
</fn>
<fn fn-type="edited-by">
<p>
<bold>Reviewed by:</bold> <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/60315/overview">Roberto Pisano</ext-link>, Politecnico di Torino, Italy</p>
<p>
<ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/465023/overview">Harir Mohammed</ext-link>, Oran University 1 Ahmed Ben Bella, Algeria</p>
</fn>
<corresp id="c001">&#x2a;Correspondence: Masafumi Yohda, <email>yohda@cc.tuat.ac.jp</email>
</corresp>
<fn fn-type="other">
<p>This article was submitted to Industrial Biotechnology, a section of the journal Frontiers in Bioengineering and Biotechnology</p>
</fn>
</author-notes>
<pub-date pub-type="epub">
<day>21</day>
<month>03</month>
<year>2022</year>
</pub-date>
<pub-date pub-type="collection">
<year>2022</year>
</pub-date>
<volume>10</volume>
<elocation-id>841420</elocation-id>
<history>
<date date-type="received">
<day>22</day>
<month>12</month>
<year>2021</year>
</date>
<date date-type="accepted">
<day>07</day>
<month>03</month>
<year>2022</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2022 Kurata, Ishino, Ohshima and Yohda.</copyright-statement>
<copyright-year>2022</copyright-year>
<copyright-holder>Kurata, Ishino, Ohshima and Yohda</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these&#x20;terms.</p>
</license>
</permissions>
<abstract>
<p>Biopharmaceutical industries have advanced significantly after the millennium. Novel biopharmaceuticals have been developed one after another, and blockbuster drugs have been produced. Accompanying the increase in the demand for biopharmaceuticals, a business model called &#x201c;contract development manufacturing organization (CDMO)&#x201d; has emerged. A CDMO is entrusted with the development and manufacturing of production processes from pharmaceutical companies. In this review, we identify the success factors of the biopharmaceutical CDMO by analyzing the foundry business for the semiconductor industry. Furthermore, we also review monoclonal antibody production platforms and new technologies that are critical aspects of differentiation strategies in the biopharmaceutical&#x20;CDMO.</p>
</abstract>
<kwd-group>
<kwd>CDMO</kwd>
<kwd>biologics</kwd>
<kwd>bioprocess</kwd>
<kwd>monoclonal antibody</kwd>
<kwd>semiconductor</kwd>
<kwd>foundry</kwd>
</kwd-group>
</article-meta>
</front>
<body>
<sec id="s1">
<title>Introduction</title>
<p>Biopharmaceutical drugs or biologics is a general term for drugs manufactured using biotechnology. Unlike small-molecule drugs that are chemically manufactured, biologics are complex molecules, such as proteins, or cells that are used as medicinal ingredients. Protein therapeutics was a niche market in the 20th century, but it has dramatically changed with the advent of antibody drugs in the 21st century. Eventually, protein therapeutics dominated the sales of new drugs in the pharmaceutical industry, resulting in paradigm shift (<xref ref-type="bibr" rid="B10">Ecker et&#x20;al., 2015</xref>). The share of biologics in the total sales of the top 100 drugs was more than 16% in 2012 and expected to reach 55% by 2026. Global sales of biologics in prescription medicines continue to grow rapidly with an annual average growth rate of 9.6% from 2019 to 2026 (<xref ref-type="bibr" rid="B12">Evaluate Pharma World Preview 2020, 2021</xref>). Furthermore, new modalities, such as gene therapy drugs, have been developed to treat unmet medical&#x20;needs.</p>
<p>While the biopharmaceutical industry has made remarkable progress, the contract manufacturing and development organization (CDMO), which performs the development and manufacturing of drug substances in contract with biopharmaceutical companies, has grown simultaneously (<xref ref-type="bibr" rid="B28">Lakshmikanthan, 2007</xref>). <xref ref-type="fig" rid="F1">Figure&#x20;1</xref> shows an ecosystem of the pharmaceutical industry that is a horizontal division model of drug discovery by biotech and pharmaceutical companies as well as drug manufacture by CDMOs. The market size of the biopharmaceutical CDMO industry exceeded 10 billion US dollars in 2018. In addition to the continuous development of antibody drugs, various new biologics have emerged, expanding the biopharmaceutical CDMO market. The average annual growth rate is expected to be 10.2% from 2020 to 2025, which is higher than the small molecule drug market (8.0%) (<xref ref-type="bibr" rid="B5">BCC Research, 2020</xref>).</p>
<fig id="F1" position="float">
<label>FIGURE 1</label>
<caption>
<p>Horizontal division of roles in the pharmaceutical industry.</p>
</caption>
<graphic xlink:href="fbioe-10-841420-g001.tif"/>
</fig>
<p>Prior to the biopharmaceutical industry, the semiconductor industry established a horizontal division model in the 1980s. There are three divisions in the semiconductor ecosystem as follows: fabless, foundries that manufacture microchips for other companies, and integrated device manufacturers (IDMs) (<xref ref-type="bibr" rid="B2">Anzenbacher and Wagner, 2020</xref>). <xref ref-type="fig" rid="F2">Figure&#x20;2</xref> shows a comparison of the horizontal business model between the pharmaceutical industry and the semiconductor industry. In this model, the positions of the design department of semiconductor companies and fabless companies correspond to the drug discovery department of pharmaceutical companies and drug discovery startups, respectively. Although each industry&#x2019;s product is distinct, both industries suffer from the burdens of increasing costs of R&#x26;D for new products and manufacturing technology. The history of the development and technology platform of the semiconductor industry provides insights into the key success factors for the biopharmaceutical CDMO industry.</p>
<fig id="F2" position="float">
<label>FIGURE 2</label>
<caption>
<p>Comparison of semiconductor and pharmaceutical industries.</p>
</caption>
<graphic xlink:href="fbioe-10-841420-g002.tif"/>
</fig>
</sec>
<sec id="s2">
<title>Background of Semiconductor Foundry Growth</title>
<p>The historical background of the semiconductor industry has a significant influence on the growth of foundries. Before the rise of the foundry, fabless companies outsourced manufacturing to IDM. However, the growth of fabless was restricted by the manufacturing capacity and the lack of necessary manufacturing technologies for IDM. In the 1980s, many fabless companies started to enter the semiconductor business with the establishment of foundry companies. These fabless companies made a significant contribution to the innovation of semiconductor chips (<xref ref-type="bibr" rid="B39">Shalf, 2020</xref>). In the 2000s, fabless companies and other companies, such as Google and Amazon, started to design dedicated chips and outsourced manufacturing the chips at foundries. Due to the increasing demand for semiconductor manufacturing, the foundry market became 73.6 billion US dollars in 2018 and will be 151.2 billion US dollars in 2022. The compound annual growth rate is expected to be 11.6% by 2025 (<xref ref-type="bibr" rid="B20">IC Insights, 2021</xref>).</p>
</sec>
<sec id="s3">
<title>Success Factors for Semiconductor Foundries</title>
<p>One of the key success factors of the foundry is to secure the supply of high-quality and high-performance semiconductor products in a timely manner. As the semiconductor market grows, foundries need great investments to ensure their manufacturing capacity. Nonetheless, IDM also requires significant capital investment for manufacturing equipment, but the operating ratio of the equipment depends on the sales of its new products. Therefore, a decrease in the operating ratio can be a management risk. In contrast, because foundries can receive orders of contracted manufacturing from both IDM and fabless companies, they can maintain the high operation ratio of the manufacturing equipment. Therefore, fabless companies can focus on design, and foundries can concentrate on securing manufacturing process capabilities (<xref ref-type="bibr" rid="B30">Liu, 2021</xref>). Currently, several strong foundries are leading the semiconductor industry. However, the coexistence of IDM, fabless, and foundries will be necessary for the advancement of the semiconductor industry (<xref ref-type="bibr" rid="B19">Hung et&#x20;al., 2017</xref>).</p>
<p>Access to new technologies is another success factor for foundries. Microfabrication is one of the most critical technologies in the semiconductor manufacturing process. In the semiconductor industry, miniaturization of the devices proceeds according to Moore&#x2019;s law (semiconductor integration rate doubles in 18&#x2013;24 months). This evolution of microfabrication makes it possible to increase the number of transistors per unit area, significantly contributing to the increase in operating speed and reducing power consumption (<xref ref-type="bibr" rid="B9">Dennard et&#x20;al., 1974</xref>). Advanced process technologies, such as extreme ultraviolet (EUV) light, have been invented to overcome microfabrication limits by conventional exposure equipment using ultraviolet light (<xref ref-type="bibr" rid="B42">Turkot et&#x20;al., 2017</xref>; <xref ref-type="bibr" rid="B39">Shalf, 2020</xref>). In recent years, top-class foundries have quickly introduced these microfabrication technologies and developed chip manufacturing capabilities based on the latest design rules. As a result, the dependence on foundries with high manufacturing technology is increasing.</p>
</sec>
<sec id="s4">
<title>Background of Growth of Biologics Contract Development Manufacturing Organizations</title>
<p>Pharmaceutical companies are also required to concentrate their investment and resources for new drug discovery (<xref ref-type="bibr" rid="B7">Blanco and Gardinier, 2020</xref>). The total R&#x26;D cost at mega-pharma (2006&#x2013;2014) was in the range of 10&#x2013;90 billion US dollars, and the number of new drugs launched tends to increase in proportion to the R&#x26;D cost (<xref ref-type="bibr" rid="B38">Schuhmacher et&#x20;al., 2016</xref>). As a result, it is becoming difficult for pharmaceutical companies (equivalent to IDM in the semiconductor industry) to invest in process development and manufacturing as well as start to depend on CDMOs (equivalent to the foundry in the semiconductor industry) (<xref ref-type="bibr" rid="B28">Lakshmikanthan, 2007</xref>). Furthermore, due to the evolution of biotechnology, many innovative modalities for various rare diseases have been developed by drug discovery biotech (equivalent to fabless in the semiconductor industry) (<xref ref-type="bibr" rid="B33">O&#x2019;Neil, 2014</xref>). Biotech as well as small and medium-sized pharmaceutical companies increasingly outsource manufacturing to avoid the risk of investing in production facilities.</p>
</sec>
<sec id="s5">
<title>Success Factors for Biologics Contract Development Manufacturing Organizations</title>
<p>By comparing the semiconductor foundries and the biologics contract business, we found several important common factors for their success as follows:<list list-type="simple">
<list-item>
<p>1) Secure production technology using advanced technology.</p>
</list-item>
<list-item>
<p>2) Secure timely equipment capacity.</p>
</list-item>
<list-item>
<p>3) Appropriate service according to customer request.</p>
</list-item>
</list>
</p>
<p>In the semiconductor industry, manufacturing technology has been standardized with the development of manufacturing equipment, making it possible to outsource semiconductor manufacturing. Thus, fabless companies have grown in collaboration with foundries. In addition, semiconductor manufacturing technology has advanced significantly with microfabrication technology, making it difficult to create a product only by purchasing equipment. Foundries have advanced manufacturing technology by the combination of complicated processes and operating know-how. In the biopharmaceutical industry, manufacturing biologics, especially antibody drugs, have been well standardized. This standardization has made it easier to outsource the manufacture of biopharmaceutical drugs to CDMOs. In this context, the further development of biopharmaceutical CDMOs will depend on the advancement of their manufacturing technologies. In the following section, we review the production technology trends in antibody drugs, which are the mainstream biologics. We will also discuss the potential of next-generation manufacturing systems for biologics.</p>
</sec>
<sec id="s6">
<title>Standardized Technology of Antibody Drug Production Boosts the Biopharmaceutical Contract Development Manufacturing Organization Business</title>
<p>An antibody is a protein used by the immune system to identify and neutralize foreign objects called antigens. Using the ability to bind various target molecules, many antibody drugs have been developed and put on the market (<xref ref-type="bibr" rid="B31">Lu et&#x20;al., 2020</xref>). Antibodies consist of two polypeptide chains, a heavy (H) and a light (L) chain, each of which is composed of two regions, a constant region (C) and a variable region (V). The complementarity-determining region (CDR) of the variable region is essential to the ability of the antibody to bind to its intended target. Most antibody drugs are humanized antibodies that are constructed by transplanting the CDR from mouse monoclonal antibodies into human antibodies, indicating that antibody drugs share almost the same physical and chemical properties. Therefore, it is possible to standardize the manufacturing process of antibody drugs. The general flow of antibody drug manufacturing platforms is composed of upstream and downstream processes. The upstream process is comprised of processes of producing a cell line and culturing the cell line in a bioreactor, and the downstream process is comprised of processes of purifying the produced antibody component from culture media, inactivating the virus, and filling it as a pharmaceutical substance (<xref ref-type="bibr" rid="B18">Gronemeyer et&#x20;al., 2014</xref>). Most of the processes are batch-type and are controlled by good manufacturing practice (GMP) production processes at pharmaceutical manufacturing sites. Because the antibody manufacturing process is standardized, it results in the standardization of manufacturing equipment, peripheral auxiliary materials, and raw material systems. The standardization of antibody manufacture has made it easier for biopharmaceutical companies to outsource their manufacturing to biopharmaceutical CDMOs (<xref ref-type="bibr" rid="B26">Lakhdar et&#x20;al., 2007</xref>).</p>
<p>As mentioned in the previous chapter, the foundries of the semiconductor industry have established the position in which semiconductor manufacturing technology is equal to or better than the IDM by acquiring novel technology and accumulating proven track records of the manufacture of semiconductor devices. We believe that biopharmaceutical CDMOs can provide manufacturing technology of the same quality as pharmaceutical companies. To establish a similar position to the foundry in the semiconductor industry, it will be important for biopharmaceutical CDMOs to acquire and develop distinctive manufacturing technologies. In the following chapters, we will review recent trends in the production technology of antibody drugs while showing examples of advanced technology development at biopharmaceutical CDMOs.</p>
</sec>
<sec id="s7">
<title>Cell Line Development Process</title>
<p>Various cell lines have been used to produce antibody drugs, but the most frequently used cell lines today are Chinese hamster ovary (CHO) cells. Although CHO cells have been used to produce various protein therapeutics in addition to antibody drugs, they are the most compatible production cells for antibody drugs in terms of high productivity, quality of glycosylation, and safety (<xref ref-type="bibr" rid="B25">Kunert and Reinhart, 2016</xref>). Examples of research and development on CHO cells performed by CDMOs are described&#x20;below.</p>
<p>For the large-scale production of therapeutic proteins, including monoclonal antibodies (mAbs), recombinant Chinese hamster ovary (rCHO) cells are established using dihydrofolate reductase (DHFR)-based methotrexate (MTX) selection. However, it requires a multiround of MTX selection for stepwise gene amplification, resulting in a longer timeline for cell line generation (<xref ref-type="bibr" rid="B35">Porter et&#x20;al., 2010</xref>). LONZA (Switzerland) has developed a CHO-GS (glutathione synthetase) system to resolve this problem. In the CHO-GS system, the selection of top-producing cell lines is based on controlling the balance between the expression level of GS and the concentration of its specific inhibitor, <sc>l</sc>-methionine sulfoximine (MSX). The CHO-GS system has attracted a wide range of customers from venture companies to major pharmaceutical companies because it requires only a single round of MSX selection. Recently, LONZA developed a method to introduce antibody genes site-specifically by homologous recombination in collaboration with Pfizer (<xref ref-type="bibr" rid="B13">Feary et&#x20;al., 2021</xref>). Compared to the conventional method in which antibody genes are randomly inserted in the genome, the cells prepared by this method provide stable antibody expression levels. AGC Biologics (United&#x20;States) also developed a CHEF1 system that significantly improves the productivity of recombinant proteins using the EF-1 alpha promoter (<xref ref-type="bibr" rid="B37">Running Deer and Allison, 2004</xref>). AGC Biologics further developed a system with higher antibody productivity, in which the DNA codon of the selection marker (dihydrofolate reductase) gene is modified to suppress the expression to amplify the introduced plasmid genes in the cell (<xref ref-type="bibr" rid="B44">Westwood et&#x20;al., 2010</xref>).</p>
<p>As a recent trend, it is noteworthy that comprehensive analysis of metabolic pathways by omics analysis becomes essential for cell line development (<xref ref-type="bibr" rid="B46">Yusufi et&#x20;al., 2017</xref>). For example, systematic analysis of typical CHO cell parent strains (CHO-K1, CHO-DXB11, and CHO-DG44) has shown that the sugar chain structure difference of the antibody is due to the difference in the expression levels of various genes involved (<xref ref-type="bibr" rid="B27">Lakshmanan et&#x20;al., 2019</xref>). Omics analysis is also a powerful tool for optimizing media components. <xref ref-type="bibr" rid="B1">Ali et&#x20;al. (2020)</xref> elucidated how the lack of cysteine in the medium reduces antibody productivity. Analysis of the transcriptome and proteome has led to the elucidation of the mechanism by which various factors, such as endoplasmic reticulum stress, affect antibody production. The omics analysis method is an effective method for improving production stocks. In addition, trials to enhance CHO cell antibody productivity by genome editing technologies, such as CRISPR/Cas9, are increasing (<xref ref-type="bibr" rid="B36">Ronda et&#x20;al., 2014</xref>; <xref ref-type="bibr" rid="B17">Grav et&#x20;al., 2017</xref>; <xref ref-type="bibr" rid="B29">Ley et&#x20;al., 2019</xref>).</p>
</sec>
<sec id="s8">
<title>Culture and Purification Process</title>
<p>Mass production of blockbuster marketed drugs was mainstream in the biopharmaceutical CDMO industry in the early 2000s. In recent years, however, the pipelines of biologics, such as rare diseases, have increased (<xref ref-type="bibr" rid="B31">Lu et&#x20;al., 2020</xref>), which favors production schemes with a wider variety and smaller quantity. As a result, the demand for highly flexible single-use reactors has been increased (<xref ref-type="bibr" rid="B22">Jacquemart et&#x20;al., 2016</xref>). Single-use equipment is disposable equipment made from plastic and is mainly used for the upstream process of biological production. Because each lot of production is prepared with new single-use equipment, cleaning and the accompanying validation are not required. Thus, production can be started faster than in stainless bioreactors. It has been demonstrated that there is no difference in product quality between single-use and stainless-steel reactors (<xref ref-type="bibr" rid="B6">Beck et&#x20;al., 2020</xref>).</p>
<p>High-density culture or continuous culture methods have attracted attention as another technology in the upstream process to reduce capital costs and improve productivity (<xref ref-type="bibr" rid="B23">Jyothilekshmi and Jayaprakash, 2021</xref>). Continuous production allows for large quantities of culture in small facilities. Moreover, by continuous medium replacement, the concentrations of metabolites, such as lactic acid or ammonia, are kept low, increasing the lifetime of cells. Continuous culture may improve product quality. The perfusion process produces significantly lower bispecific antibody aggregates compared to the fed-batch process (<xref ref-type="bibr" rid="B40">Sinharoy et&#x20;al., 2020</xref>).</p>
<p>By cell engineering and the optimization of the culture process, antibody productivity has significantly increased up to approximately 10&#xa0;g/L culture. Accordingly, the downstream process has been optimized (<xref ref-type="bibr" rid="B8">Chahar et&#x20;al., 2020</xref>). The general first step in antibody purification is affinity chromatography using resin-conjugating protein A, which binds to the antibody&#x2019;s constant region. This step requires a large amount of the expensive protein A resin, raising production costs (<xref ref-type="bibr" rid="B45">Xenopoulos, 2015</xref>). The continuous chromatography method has attracted attention to solve this problem. <xref ref-type="bibr" rid="B14">Fedorenko et&#x20;al. (2020)</xref> developed continuous countercurrent tangential chromatography (CCTC), which efficiently purifies antibodies with a smaller amount of column resin. In this method, protein A resin is circulated to continuously adsorb and desorb antibodies; therefore, the necessary resin amount is approximately 3&#x20;times smaller than that of the batch method, while the product quality (HCP, DNA, and single molecular weight fraction) of the antibody purified by the CCTC method is equivalent to that of the batch method. Although the development of alternative resins has been reported (<xref ref-type="bibr" rid="B16">Ghose et&#x20;al., 2006</xref>; <xref ref-type="bibr" rid="B21">Ishihara et&#x20;al., 2018</xref>), it is still uncertain whether they can replace protein A resin in the manufacture of antibody&#x20;drugs.</p>
</sec>
<sec id="s9">
<title>Next-Generation Manufacturing Process</title>
<p>The end-to-end continuous manufacturing process draws attention as a favorable biologics manufacturing system in the future. <xref ref-type="fig" rid="F3">Figure&#x20;3</xref> depicts an example of continuous process of therapeutic antibody production with (I) perfusion bioreactor, (II) multiple column chromatography capture, (III) virus inactivation, (IV) membrane chromatography polishing, (V) concentration/buffer exchange, and (VI) preservation processes. The continuous process does not require the extraction of products for each process, which could reduce the total time of manufacturing and the number of operators as well as the risk of human error and contamination (<xref ref-type="bibr" rid="B24">Khanal and Lenhoff, 2021</xref>). Furthermore, highly reliable quality assurance may be achieved by monitoring the quality in real time (<xref ref-type="bibr" rid="B43">Walther et&#x20;al., 2015</xref>). Some cost simulations show that the manufacturing cost of antibody drugs will be reduced by continuous production (<xref ref-type="bibr" rid="B34">Pollock et&#x20;al., 2017</xref>; <xref ref-type="bibr" rid="B3">Arnold et&#x20;al., 2019</xref>). Although continuous manufacturing processes produce various small molecule drugs, the continuous production of biologics is still under development. A complete continuous production process of antibody drugs on the laboratory scale has been reported (<xref ref-type="bibr" rid="B41">Steinebach et&#x20;al., 2017</xref>). Using this method, continuous culture was successfully performed for 18&#x20;days and the product quality was acceptable compared to the batch method.</p>
<fig id="F3" position="float">
<label>FIGURE 3</label>
<caption>
<p>Schematic drawing of an example of end-to-end continuous manufacturing process for therapeutic monoclonal antibody.</p>
</caption>
<graphic xlink:href="fbioe-10-841420-g003.tif"/>
</fig>
<p>Despite the advantages as discussed above, progress to date in implementing continuous manufacturing appears to be slower than anticipated. This is mainly because development and implementation of continuous processes require long period of time to recoup an initial investment. Badman et&#x20;al. have proposed some interesting idea, for instance such as tax and regulatory incentives, to promote the transition from batch to continuous systems (<xref ref-type="bibr" rid="B4">Badman et&#x20;al., 2019</xref>). Use of the continuous production method is also limited due to the high complexity of the system. Although digital technologies, such as supervisory control and data acquisition (SCADA), have also been developed (<xref ref-type="bibr" rid="B15">Feidl et&#x20;al., 2020</xref>), there will be room for improvement to achieve the end-to-end continuous manufacturing of biologics in actual settings. Process analytical technologies (PAT) has been developed in batch or fed-batch operations (<xref ref-type="bibr" rid="B32">Maruthamuthu et&#x20;al., 2020</xref>). We believe that further development of PAT combined with digital data management systems will also help transition to the continuous production in biopharmaceutical industries (<xref ref-type="bibr" rid="B11">Eifert et&#x20;al., 2020</xref>).</p>
</sec>
<sec sec-type="conclusion" id="s10">
<title>Conclusion</title>
<p>In the biopharmaceutical industry, many technological innovations have occurred both in drug discovery and the manufacturing process. At the same time, the horizontal division model in the pharmaceutical industry has become essential; biopharmaceutical companies (and biotech companies) focus more on drug discovery and development, while CDMOs focus more on process development and manufacture. Biopharmaceutical CDMOs could learn from the semiconductor industry, in which the foundries established a technical status similar to that of the IDM. It will be more critical for CDMOs to invest more in technological development and acquire new technology to maintain a competitive edge. We believe that CDMOs will contribute significantly to a healthy life by continuous support to the biopharmaceutical industry in producing biopharmaceuticals for more diseases.</p>
</sec>
</body>
<back>
<sec id="s11">
<title>Author Contributions</title>
<p>MY and HK designed the concept of this review and provided guidance for composition; TI and YO performed the investigation of biologics CDMO and semiconductor industries, respectively. HK analyzed the data in the references and wrote the most of manuscript.</p>
</sec>
<sec sec-type="COI-statement" id="s12">
<title>Conflict of Interest</title>
<p>HK, TI and YO were employed by the company AGC Inc. TI was employed by the copmany AGC Biologics.</p>
<p>The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec sec-type="disclaimer" id="s13">
<title>Publisher&#x2019;s Note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
<ref-list>
<title>References</title>
<ref id="B1">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ali</surname>
<given-names>A. S.</given-names>
</name>
<name>
<surname>Chen</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>Raju</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>Kshirsagar</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>Gilbert</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Zang</surname>
<given-names>L.</given-names>
</name>
<etal/>
</person-group> (<year>2020</year>). <article-title>Multi-Omics Reveals Impact of Cysteine Feed Concentration and Resulting Redox Imbalance on Cellular Energy Metabolism and Specific Productivity in CHO Cell Bioprocessing</article-title>. <source>Biotechnol. J.</source> <volume>15</volume>, <fpage>1900565</fpage>. <pub-id pub-id-type="doi">10.1002/biot.201900565</pub-id> </citation>
</ref>
<ref id="B2">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Anzenbacher</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Wagner</surname>
<given-names>M.</given-names>
</name>
</person-group> (<year>2020</year>). <article-title>The Role of Exploration and Exploitation for Innovation success: Effects of Business Models on Organizational Ambidexterity in the Semiconductor Industry</article-title>. <source>Int. Entrep. Manag. J.</source> <volume>16</volume>, <fpage>571</fpage>&#x2013;<lpage>594</lpage>. <pub-id pub-id-type="doi">10.1007/s11365-019-00604-6</pub-id> </citation>
</ref>
<ref id="B3">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Arnold</surname>
<given-names>L.</given-names>
</name>
<name>
<surname>Lee</surname>
<given-names>K.</given-names>
</name>
<name>
<surname>Rucker-Pezzini</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Lee</surname>
<given-names>J.&#x20;H.</given-names>
</name>
</person-group> (<year>2019</year>). <article-title>Implementation of Fully Integrated Continuous Antibody Processing: Effects on Productivity and COGm</article-title>. <source>Biotechnol. J.</source> <volume>14</volume>, <fpage>1800061</fpage>. <pub-id pub-id-type="doi">10.1002/biot.201800061</pub-id> </citation>
</ref>
<ref id="B4">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Badman</surname>
<given-names>C.</given-names>
</name>
<name>
<surname>Cooney</surname>
<given-names>C. L.</given-names>
</name>
<name>
<surname>Florence</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Konstantinov</surname>
<given-names>K.</given-names>
</name>
<name>
<surname>Krumme</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Mascia</surname>
<given-names>S.</given-names>
</name>
<etal/>
</person-group> (<year>2019</year>). <article-title>Why We Need Continuous Pharmaceutical Manufacturing and How to Make it Happen</article-title>. <source>J.&#x20;Pharm. Sci.</source> <volume>108</volume>, <fpage>3521</fpage>&#x2013;<lpage>3523</lpage>. <pub-id pub-id-type="doi">10.1016/j.xphs.2019.07.016</pub-id> </citation>
</ref>
<ref id="B5">
<citation citation-type="book">
<collab>BCC Research</collab> (<year>2020</year>). <source>Global Market Opportunities and Competitive Landscape for CDMO</source>. <publisher-loc>Wellesley</publisher-loc>: <publisher-name>BCC Research LLC</publisher-name>. </citation>
</ref>
<ref id="B6">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Beck</surname>
<given-names>C.</given-names>
</name>
<name>
<surname>Werz</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Herrmann</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Meiringer</surname>
<given-names>C. T. A.</given-names>
</name>
</person-group> (<year>2020</year>). <article-title>Comparative Study for the Production of Monoclonal Antibodies in Single-Use vs Stainless Steel Bioreactors Based on Product Quality and Stress Factor</article-title>. <source>Eng. Rep.</source> <volume>2</volume>, <fpage>e12197</fpage>. <pub-id pub-id-type="doi">10.1002/eng2.12197</pub-id> </citation>
</ref>
<ref id="B7">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Blanco</surname>
<given-names>M.-J.</given-names>
</name>
<name>
<surname>Gardinier</surname>
<given-names>K. M.</given-names>
</name>
</person-group> (<year>2020</year>). <article-title>New Chemical Modalities and Strategic Thinking in Early Drug Discovery</article-title>. <source>ACS Med. Chem. Lett.</source> <volume>11</volume>, <fpage>228</fpage>&#x2013;<lpage>231</lpage>. <pub-id pub-id-type="doi">10.1021/acsmedchemlett.9b00582</pub-id> </citation>
</ref>
<ref id="B8">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Chahar</surname>
<given-names>D. S.</given-names>
</name>
<name>
<surname>Ravindran</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Pisal</surname>
<given-names>S. S.</given-names>
</name>
</person-group> (<year>2020</year>). <article-title>Monoclonal Antibody Purification and its Progression to Commercial Scale</article-title>. <source>Biologicals</source> <volume>63</volume>, <fpage>1</fpage>&#x2013;<lpage>13</lpage>. <pub-id pub-id-type="doi">10.1016/j.biologicals.2019.09.007</pub-id> </citation>
</ref>
<ref id="B9">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Dennard</surname>
<given-names>R. H.</given-names>
</name>
<name>
<surname>Gaensslen</surname>
<given-names>F. H.</given-names>
</name>
<name>
<surname>Yu</surname>
<given-names>H.-N.</given-names>
</name>
<name>
<surname>Rideout</surname>
<given-names>V. L.</given-names>
</name>
<name>
<surname>Bassous</surname>
<given-names>E.</given-names>
</name>
<name>
<surname>LeBlanc</surname>
<given-names>A. R.</given-names>
</name>
</person-group> (<year>1974</year>). <article-title>Design of Ion-Implanted MOSFET&#x27;s with Very Small Physical Dimensions</article-title>. <source>IEEE J.&#x20;Solid-state Circuits</source> <volume>9</volume>, <fpage>256</fpage>&#x2013;<lpage>268</lpage>. <pub-id pub-id-type="doi">10.1109/JSSC.1974.1050511</pub-id> </citation>
</ref>
<ref id="B10">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ecker</surname>
<given-names>D. M.</given-names>
</name>
<name>
<surname>Jones</surname>
<given-names>S. D.</given-names>
</name>
<name>
<surname>Levine</surname>
<given-names>H. L.</given-names>
</name>
</person-group> (<year>2015</year>). <article-title>The Therapeutic Monoclonal Antibody Market</article-title>. <source>MAbs</source> <volume>7</volume>, <fpage>9</fpage>&#x2013;<lpage>14</lpage>. <pub-id pub-id-type="doi">10.4161/19420862.2015.989042</pub-id> </citation>
</ref>
<ref id="B11">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Eifert</surname>
<given-names>T.</given-names>
</name>
<name>
<surname>Eisen</surname>
<given-names>K.</given-names>
</name>
<name>
<surname>Maiwald</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Herwig</surname>
<given-names>C.</given-names>
</name>
</person-group> (<year>2020</year>). <article-title>Current and Future Requirements to Industrial Analytical Infrastructure-Part 2: Smart Sensors</article-title>. <source>Anal. Bioanal. Chem.</source> <volume>412</volume>, <fpage>2037</fpage>&#x2013;<lpage>2045</lpage>. <pub-id pub-id-type="doi">10.1007/s00216-020-02421-1</pub-id> </citation>
</ref>
<ref id="B12">
<citation citation-type="book">
<collab>Evaluate Pharma World Preview 2020</collab> (<year>2021</year>). <source>Outlook to 2026</source>. <comment>Available from: <ext-link ext-link-type="uri" xlink:href="https://www.evaluate.com/thought-leadership/pharma/evaluatepharma-world-preview-2020-outlook-2026%20">https://www.evaluate.com/thought-leadership/pharma/evaluatepharma-world-preview-2020-outlook-2026</ext-link> (Accessed November 26, 2021)</comment>. </citation>
</ref>
<ref id="B13">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Feary</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Moffat</surname>
<given-names>M. A.</given-names>
</name>
<name>
<surname>Casperson</surname>
<given-names>G. F.</given-names>
</name>
<name>
<surname>Allen</surname>
<given-names>M. J.</given-names>
</name>
<name>
<surname>Young</surname>
<given-names>R. J.</given-names>
</name>
</person-group> (<year>2021</year>). <article-title>CHOK1SV GS-KO SSI Expression System: A Combination of the Fer1L4 Locus and Glutamine Synthetase Selection</article-title>. <source>Biotechnol. Prog.</source> <volume>37</volume>, <fpage>e3137</fpage>. <pub-id pub-id-type="doi">10.1002/btpr.3137</pub-id> </citation>
</ref>
<ref id="B14">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Fedorenko</surname>
<given-names>D.</given-names>
</name>
<name>
<surname>Dutta</surname>
<given-names>A. K.</given-names>
</name>
<name>
<surname>Tan</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Walko</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Brower</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Pinto</surname>
<given-names>N. D. S.</given-names>
</name>
<etal/>
</person-group> (<year>2020</year>). <article-title>Improved Protein A Resin for Antibody Capture in a Continuous Countercurrent Tangential Chromatography System</article-title>. <source>Biotechnol. Bioeng.</source> <volume>117</volume>, <fpage>646</fpage>&#x2013;<lpage>653</lpage>. <pub-id pub-id-type="doi">10.1002/bit.27232</pub-id> </citation>
</ref>
<ref id="B15">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Feidl</surname>
<given-names>F.</given-names>
</name>
<name>
<surname>Vogg</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Wolf</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Podobnik</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Ruggeri</surname>
<given-names>C.</given-names>
</name>
<name>
<surname>Ulmer</surname>
<given-names>N.</given-names>
</name>
<etal/>
</person-group> (<year>2020</year>). <article-title>Process-wide Control and Automation of an Integrated Continuous Manufacturing Platform for Antibodies</article-title>. <source>Biotechnol. Bioeng.</source> <volume>117</volume>, <fpage>1367</fpage>&#x2013;<lpage>1380</lpage>. <pub-id pub-id-type="doi">10.1002/bit.27296</pub-id> </citation>
</ref>
<ref id="B16">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ghose</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Hubbard</surname>
<given-names>B.</given-names>
</name>
<name>
<surname>Cramer</surname>
<given-names>S. M.</given-names>
</name>
</person-group> (<year>2006</year>). <article-title>Evaluation and Comparison of Alternatives to Protein A Chromatography</article-title>. <source>J.&#x20;Chromatogr. A</source> <volume>1122</volume>, <fpage>144</fpage>&#x2013;<lpage>152</lpage>. <pub-id pub-id-type="doi">10.1016/j.chroma.2006.04.083</pub-id> </citation>
</ref>
<ref id="B17">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Grav</surname>
<given-names>L. M.</given-names>
</name>
<name>
<surname>la Cour Karottki</surname>
<given-names>K. J.</given-names>
</name>
<name>
<surname>Lee</surname>
<given-names>J.&#x20;S.</given-names>
</name>
<name>
<surname>Kildegaard</surname>
<given-names>H. F.</given-names>
</name>
</person-group> (<year>2017</year>). <article-title>Application of CRISPR/Cas9 Genome Editing to Improve Recombinant Protein Production in CHO Cells</article-title>. <source>Methods Mol. Biol.</source> <volume>1603</volume>, <fpage>101</fpage>&#x2013;<lpage>118</lpage>. <pub-id pub-id-type="doi">10.1007/978-1-4939-6972-2_7</pub-id> </citation>
</ref>
<ref id="B18">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Gronemeyer</surname>
<given-names>P.</given-names>
</name>
<name>
<surname>Ditz</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>Strube</surname>
<given-names>J.</given-names>
</name>
</person-group> (<year>2014</year>). <article-title>Trends in Upstream and Downstream Process Development for Antibody Manufacturing</article-title>. <source>Bioengineering</source> <volume>1</volume>, <fpage>188</fpage>&#x2013;<lpage>212</lpage>. <pub-id pub-id-type="doi">10.3390/bioengineering1040188</pub-id> </citation>
</ref>
<ref id="B19">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Hung</surname>
<given-names>H.-C.</given-names>
</name>
<name>
<surname>Chiu</surname>
<given-names>Y.-C.</given-names>
</name>
<name>
<surname>Wu</surname>
<given-names>M.-C.</given-names>
</name>
</person-group> (<year>2017</year>). <article-title>Analysis of Competition between IDM and Fabless-Foundry Business Models in the Semiconductor Industry</article-title>. <source>IEEE Trans. Semicond. Manufact.</source> <volume>30</volume>, <fpage>254</fpage>&#x2013;<lpage>260</lpage>. <pub-id pub-id-type="doi">10.1109/TSM.2017.2699739</pub-id> </citation>
</ref>
<ref id="B20">
<citation citation-type="book">
<collab>IC Insights</collab> (<year>2021</year>). <source>Foundry Market Tracking toward Record-Tying 23% Growth in 2021</source>. <publisher-loc>Scottsdale, Arizona USA</publisher-loc>: <publisher-name>IC Insights Research Bulletin</publisher-name>. </citation>
</ref>
<ref id="B21">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ishihara</surname>
<given-names>T.</given-names>
</name>
<name>
<surname>Miyahara</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Yamamoto</surname>
<given-names>K.</given-names>
</name>
</person-group> (<year>2018</year>). <article-title>Monoclonal Antibody Purification Using Activated Carbon as a Replacement for Protein A Affinity Chromatography</article-title>. <source>J.&#x20;Chromatogr. B</source> <volume>1102-1103</volume>, <fpage>1</fpage>&#x2013;<lpage>7</lpage>. <pub-id pub-id-type="doi">10.1016/j.jchromb.2018.10.004</pub-id> </citation>
</ref>
<ref id="B22">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Jacquemart</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>Vandersluis</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Zhao</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Sukhija</surname>
<given-names>K.</given-names>
</name>
<name>
<surname>Sidhu</surname>
<given-names>N.</given-names>
</name>
<name>
<surname>Stout</surname>
<given-names>J.</given-names>
</name>
</person-group> (<year>2016</year>). <article-title>A Single-Use Strategy to Enable Manufacturing of Affordable Biologics</article-title>. <source>Comput. Struct. Biotechnol. J.</source> <volume>14</volume>, <fpage>309</fpage>&#x2013;<lpage>318</lpage>. <pub-id pub-id-type="doi">10.1016/j.csbj.2016.06.007</pub-id> </citation>
</ref>
<ref id="B23">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Jyothilekshmi</surname>
<given-names>I.</given-names>
</name>
<name>
<surname>Jayaprakash</surname>
<given-names>N. S.</given-names>
</name>
</person-group> (<year>2021</year>). <article-title>Trends in Monoclonal Antibody Production Using Various Bioreactor Syst</article-title>. <source>J.&#x20;Microbiol. Biotechnol.</source> <volume>31</volume>, <fpage>349</fpage>&#x2013;<lpage>357</lpage>. <pub-id pub-id-type="doi">10.4014/jmb.1911.11066</pub-id> </citation>
</ref>
<ref id="B24">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Khanal</surname>
<given-names>O.</given-names>
</name>
<name>
<surname>Lenhoff</surname>
<given-names>A. M.</given-names>
</name>
</person-group> (<year>2021</year>). <article-title>Developments and Opportunities in Continuous Biopharmaceutical Manufacturing</article-title>. <source>MAbs</source> <volume>13</volume>, <fpage>1903664</fpage>. <pub-id pub-id-type="doi">10.1080/19420862.2021.1903664</pub-id> </citation>
</ref>
<ref id="B25">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kunert</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>Reinhart</surname>
<given-names>D.</given-names>
</name>
</person-group> (<year>2016</year>). <article-title>Advances in Recombinant Antibody Manufacturing</article-title>. <source>Appl. Microbiol. Biotechnol.</source> <volume>100</volume>, <fpage>3451</fpage>&#x2013;<lpage>3461</lpage>. <pub-id pub-id-type="doi">10.1007/s00253-016-7388-9</pub-id> </citation>
</ref>
<ref id="B26">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lakhdar</surname>
<given-names>K.</given-names>
</name>
<name>
<surname>Savery</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Papageorgiou</surname>
<given-names>L. G.</given-names>
</name>
<name>
<surname>Farid</surname>
<given-names>S. S.</given-names>
</name>
</person-group> (<year>2007</year>). <article-title>Multiobjective Long-Term Planning of Biopharmaceutical Manufacturing Facilities</article-title>. <source>Biotechnol. Prog.</source> <volume>23</volume>, <fpage>1383</fpage>&#x2013;<lpage>1393</lpage>. <pub-id pub-id-type="doi">10.1021/bp0701362</pub-id> </citation>
</ref>
<ref id="B27">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lakshmanan</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Kok</surname>
<given-names>Y. J.</given-names>
</name>
<name>
<surname>Lee</surname>
<given-names>A. P.</given-names>
</name>
<name>
<surname>Kyriakopoulos</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Lim</surname>
<given-names>H. L.</given-names>
</name>
<name>
<surname>Teo</surname>
<given-names>G.</given-names>
</name>
<etal/>
</person-group> (<year>2019</year>). <article-title>Multi-omics Profiling of CHO Parental Hosts Reveals Cell Line-specific Variations in Bioprocessing Traits</article-title>. <source>Biotechnol. Bioeng.</source> <volume>116</volume>, <fpage>2117</fpage>&#x2013;<lpage>2129</lpage>. <pub-id pub-id-type="doi">10.1002/bit.27014</pub-id> </citation>
</ref>
<ref id="B28">
<citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname>Lakshmikanthan</surname>
<given-names>J.</given-names>
</name>
</person-group> (<year>2007</year>). <source>Outsourcing: Biologics Manufacturing: The CMO Advantage</source>. <comment>Available from: <ext-link ext-link-type="uri" xlink:href="https://www.biopharminternational.com/view/outsourcing-biologics-manufacturing-cmo-advantage">https://www.biopharminternational.com/view/outsourcing-biologics-manufacturing-cmo-advantage</ext-link> (Accessed December 17, 2021)</comment>. </citation>
</ref>
<ref id="B29">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ley</surname>
<given-names>D.</given-names>
</name>
<name>
<surname>Pereira</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Pedersen</surname>
<given-names>L. E.</given-names>
</name>
<name>
<surname>Arnsdorf</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Hefzi</surname>
<given-names>H.</given-names>
</name>
<name>
<surname>Davy</surname>
<given-names>A. M.</given-names>
</name>
<etal/>
</person-group> (<year>2019</year>). <article-title>Reprogramming AA Catabolism in CHO Cells with CRISPR/Cas9 Genome Editing Improves Cell Growth and Reduces Byproduct Secretion</article-title>. <source>Metab. Eng.</source> <volume>56</volume>, <fpage>120</fpage>&#x2013;<lpage>129</lpage>. <pub-id pub-id-type="doi">10.1016/j.ymben.2019.09.005</pub-id> </citation>
</ref>
<ref id="B30">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Liu</surname>
<given-names>M.</given-names>
</name>
</person-group> (<year>2021</year>). <article-title>Taiwan and the Foundry Model</article-title>. <source>Nat. Electron.</source> <volume>4</volume>, <fpage>318</fpage>&#x2013;<lpage>320</lpage>. <pub-id pub-id-type="doi">10.1038/s41928-021-00576-y</pub-id> </citation>
</ref>
<ref id="B31">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lu</surname>
<given-names>R.-M.</given-names>
</name>
<name>
<surname>Hwang</surname>
<given-names>Y.-C.</given-names>
</name>
<name>
<surname>Liu</surname>
<given-names>I.-J.</given-names>
</name>
<name>
<surname>Lee</surname>
<given-names>C.-C.</given-names>
</name>
<name>
<surname>Tsai</surname>
<given-names>H.-Z.</given-names>
</name>
<name>
<surname>Li</surname>
<given-names>H.-J.</given-names>
</name>
<etal/>
</person-group> (<year>2020</year>). <article-title>Development of Therapeutic Antibodies for the Treatment of Diseases</article-title>. <source>J.&#x20;Biomed. Sci.</source> <volume>27</volume>, <fpage>1</fpage>&#x2013;<lpage>30</lpage>. <pub-id pub-id-type="doi">10.1186/s12929-019-0592-z</pub-id> </citation>
</ref>
<ref id="B32">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Maruthamuthu</surname>
<given-names>M. K.</given-names>
</name>
<name>
<surname>Rudge</surname>
<given-names>S. R.</given-names>
</name>
<name>
<surname>Ardekani</surname>
<given-names>A. M.</given-names>
</name>
<name>
<surname>Ladisch</surname>
<given-names>M. R.</given-names>
</name>
<name>
<surname>Verma</surname>
<given-names>M. S.</given-names>
</name>
</person-group> (<year>2020</year>). <article-title>Process Analytical Technologies and Data Analytics for the Manufacture of Monoclonal Antibodies</article-title>. <source>Trends Biotechnol.</source> <volume>38</volume>, <fpage>1169</fpage>&#x2013;<lpage>1186</lpage>. <pub-id pub-id-type="doi">10.1016/j.tibtech.2020.07.004</pub-id> </citation>
</ref>
<ref id="B33">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>O&#x2019;Neil</surname>
<given-names>D. A.</given-names>
</name>
</person-group> (<year>2014</year>). <article-title>A Better Fit? Biotech versus Big Pharma in Orphan/rare Disease Drug Research</article-title>. <source>Expert Opin. Orphan Drugs</source> <volume>2</volume>, <fpage>317</fpage>&#x2013;<lpage>319</lpage>. <pub-id pub-id-type="doi">10.1517/21678707.2014.900433</pub-id> </citation>
</ref>
<ref id="B34">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Pollock</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Coffman</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Ho</surname>
<given-names>S. V.</given-names>
</name>
<name>
<surname>Farid</surname>
<given-names>S. S.</given-names>
</name>
</person-group> (<year>2017</year>). <article-title>Integrated Continuous Bioprocessing: Economic, Operational, and Environmental Feasibility for Clinical and Commercial Antibody Manufacture</article-title>. <source>Biotechnol. Prog.</source> <volume>33</volume>, <fpage>854</fpage>&#x2013;<lpage>866</lpage>. <pub-id pub-id-type="doi">10.1002/btpr.2492</pub-id> </citation>
</ref>
<ref id="B35">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Porter</surname>
<given-names>A. J.</given-names>
</name>
<name>
<surname>Dickson</surname>
<given-names>A. J.</given-names>
</name>
<name>
<surname>Racher</surname>
<given-names>A. J.</given-names>
</name>
</person-group> (<year>2010</year>). <article-title>Strategies for Selecting Recombinant CHO Cell Lines for cGMP Manufacturing: Realizing the Potential in Bioreactors</article-title>. <source>Biotechnol. Prog.</source> <volume>26</volume>, <fpage>1446</fpage>&#x2013;<lpage>1454</lpage>. <pub-id pub-id-type="doi">10.1002/btpr.442</pub-id> </citation>
</ref>
<ref id="B36">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ronda</surname>
<given-names>C.</given-names>
</name>
<name>
<surname>Pedersen</surname>
<given-names>L. E.</given-names>
</name>
<name>
<surname>Hansen</surname>
<given-names>H. G.</given-names>
</name>
<name>
<surname>Kallehauge</surname>
<given-names>T. B.</given-names>
</name>
<name>
<surname>Betenbaugh</surname>
<given-names>M. J.</given-names>
</name>
<name>
<surname>Nielsen</surname>
<given-names>A. T.</given-names>
</name>
<etal/>
</person-group> (<year>2014</year>). <article-title>Accelerating Genome Editing in CHO Cells Using CRISPR Cas9 and CRISPy, a Web-Based Target Finding Tool</article-title>. <source>Biotechnol. Bioeng.</source> <volume>111</volume>, <fpage>1604</fpage>&#x2013;<lpage>1616</lpage>. <pub-id pub-id-type="doi">10.1002/bit.25233</pub-id> </citation>
</ref>
<ref id="B37">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>RunningDeer</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Allison</surname>
<given-names>D. S.</given-names>
</name>
</person-group> (<year>2004</year>). <article-title>High-Level Expression of Proteins in Mammalian Cells Using Transcription Regulatory Sequences from the Chinese Hamster EF-1&#x3b1; Gene</article-title>. <source>Biotechnol. Prog.</source> <volume>20</volume>, <fpage>880</fpage>&#x2013;<lpage>889</lpage>. <pub-id pub-id-type="doi">10.1021/bp034383r</pub-id> </citation>
</ref>
<ref id="B38">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Schuhmacher</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Gassmann</surname>
<given-names>O.</given-names>
</name>
<name>
<surname>Hinder</surname>
<given-names>M.</given-names>
</name>
</person-group> (<year>2016</year>). <article-title>Changing R&#x26;D Models in Research-Based Pharmaceutical Companies</article-title>. <source>J.&#x20;Transl. Med.</source> <volume>14</volume>, <fpage>105</fpage>&#x2013;<lpage>116</lpage>. <pub-id pub-id-type="doi">10.1186/s12967-016-0838-4</pub-id> </citation>
</ref>
<ref id="B39">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Shalf</surname>
<given-names>J.</given-names>
</name>
</person-group> (<year>2020</year>). <article-title>The Future of Computing beyond Moore&#x27;s Law</article-title>. <source>Phil. Trans. R. Soc. A.</source> <volume>378</volume>, <fpage>20190061</fpage>. <pub-id pub-id-type="doi">10.1098/rsta.2019.0061</pub-id> </citation>
</ref>
<ref id="B40">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Sinharoy</surname>
<given-names>P.</given-names>
</name>
<name>
<surname>Aziz</surname>
<given-names>A. H.</given-names>
</name>
<name>
<surname>Majewska</surname>
<given-names>N. I.</given-names>
</name>
<name>
<surname>Ahuja</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Handlogten</surname>
<given-names>M. W.</given-names>
</name>
</person-group> (<year>2020</year>). <article-title>Perfusion Reduces Bispecific Antibody Aggregation via Mitigating Mitochondrial Dysfunction-Induced Glutathione Oxidation and ER Stress in CHO Cells</article-title>. <source>Sci. Rep.</source> <volume>10</volume>, <fpage>16620</fpage>. <pub-id pub-id-type="doi">10.1038/s41598-020-73573-4</pub-id> </citation>
</ref>
<ref id="B41">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Steinebach</surname>
<given-names>F.</given-names>
</name>
<name>
<surname>Ulmer</surname>
<given-names>N.</given-names>
</name>
<name>
<surname>Wolf</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Decker</surname>
<given-names>L.</given-names>
</name>
<name>
<surname>Schneider</surname>
<given-names>V.</given-names>
</name>
<name>
<surname>W&#xe4;lchli</surname>
<given-names>R.</given-names>
</name>
<etal/>
</person-group> (<year>2017</year>). <article-title>Design and Operation of a Continuous Integrated Monoclonal Antibody Production Process</article-title>. <source>Biotechnol. Prog.</source> <volume>33</volume>, <fpage>1303</fpage>&#x2013;<lpage>1313</lpage>. <pub-id pub-id-type="doi">10.1002/btpr.2522</pub-id> </citation>
</ref>
<ref id="B42">
<citation citation-type="confproc">
<person-group person-group-type="author">
<name>
<surname>Turkot</surname>
<given-names>B.</given-names>
</name>
<name>
<surname>Carson</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Lio</surname>
<given-names>A.</given-names>
</name>
</person-group> (<year>2017</year>). &#x201c;<article-title>Continuing Moore&#x27;s Law with EUV Lithography</article-title>,&#x201d; in <conf-name>Proceeding of the 2017 IEEE International Electron Devices Meeting (IEDM)</conf-name>, <conf-loc>San Francisco, CA, USA</conf-loc>, <conf-date>Dec. 2017</conf-date> (<publisher-name>IEEE</publisher-name>), <fpage>1441</fpage>&#x2013;<lpage>1443</lpage>. <pub-id pub-id-type="doi">10.1109/iedm.2017.8268390</pub-id> </citation>
</ref>
<ref id="B43">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Walther</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Godawat</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>Hwang</surname>
<given-names>C.</given-names>
</name>
<name>
<surname>Abe</surname>
<given-names>Y.</given-names>
</name>
<name>
<surname>Sinclair</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Konstantinov</surname>
<given-names>K.</given-names>
</name>
</person-group> (<year>2015</year>). <article-title>The Business Impact of an Integrated Continuous Biomanufacturing Platform for Recombinant Protein Production</article-title>. <source>J.&#x20;Biotechnol.</source> <volume>213</volume>, <fpage>3</fpage>&#x2013;<lpage>12</lpage>. <pub-id pub-id-type="doi">10.1016/j.jbiotec.2015.05.010</pub-id> </citation>
</ref>
<ref id="B44">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Westwood</surname>
<given-names>A. D.</given-names>
</name>
<name>
<surname>Rowe</surname>
<given-names>D. A.</given-names>
</name>
<name>
<surname>Clarke</surname>
<given-names>H. R. G.</given-names>
</name>
</person-group> (<year>2010</year>). <article-title>Improved Recombinant Protein Yield Using a Codon Deoptimized DHFR Selectable Marker in a CHEF1 Expression Plasmid</article-title>. <source>Biotechnol. Prog.</source> <volume>26</volume>, <fpage>1558</fpage>&#x2013;<lpage>1566</lpage>. <pub-id pub-id-type="doi">10.1002/btpr.491</pub-id> </citation>
</ref>
<ref id="B45">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Xenopoulos</surname>
<given-names>A.</given-names>
</name>
</person-group> (<year>2015</year>). <article-title>A New, Integrated, Continuous Purification Process Template for Monoclonal Antibodies: Process Modeling and Cost of Goods Studies</article-title>. <source>J.&#x20;Biotechnol.</source> <volume>213</volume>, <fpage>42</fpage>&#x2013;<lpage>53</lpage>. <pub-id pub-id-type="doi">10.1016/j.jbiotec.2015.04.020</pub-id> </citation>
</ref>
<ref id="B46">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Yusufi</surname>
<given-names>F. N. K.</given-names>
</name>
<name>
<surname>Lakshmanan</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Ho</surname>
<given-names>Y. S.</given-names>
</name>
<name>
<surname>Loo</surname>
<given-names>B. L. W.</given-names>
</name>
<name>
<surname>Ariyaratne</surname>
<given-names>P.</given-names>
</name>
<name>
<surname>Yang</surname>
<given-names>Y.</given-names>
</name>
<etal/>
</person-group> (<year>2017</year>). <article-title>Mammalian Systems Biotechnology Reveals Global Cellular Adaptations in a Recombinant CHO Cell Line</article-title>. <source>Cel Syst.</source> <volume>4</volume>, <fpage>530</fpage>&#x2013;<lpage>542</lpage>. <comment>e6</comment>. <pub-id pub-id-type="doi">10.1016/j.cels.2017.04.009</pub-id> </citation>
</ref>
</ref-list>
</back>
</article>