Microbiome & Novel Modalities

Some Products Arrive Before Their Pathway Does.

Regulatory strategy for the frontier — live biotherapeutics, gene editing, phage — where the pathway isn't drawn yet and you help write it.

Ahead of the guidance

When There Is No Precedent, the Strategy Is the Precedent.

The microbiome gave us the first approved live biotherapeutic products for recurrent C. difficile. RNA, in vivo gene editing, radioligand therapy, bacteriophage, and xenotransplantation are each writing their own regulatory history in real time. For these, there is no worn path — no template protocol, no settled CMC framework, sometimes not even a clear reviewing office.

That is exactly where regulatory strategy matters most. The sponsors who succeed engage the agency early through INTERACT and pre-IND meetings, propose the framework rather than wait for it, and build the evidence the FDA will need to say yes to something it has never seen. We help you write the pathway, not just follow it.

A scientist at the frontier of a novel therapeutic modality
First of its kind

A modality with no predecessor has no template — the regulatory framework has to be proposed, negotiated, and built.

Where does it even get reviewed?

The First Question for a Novel Modality Is Which Door It Walks Through.

Before endpoints or CMC, a novel product needs a regulatory home — the center and office that will review it. Getting that assignment right, early, shapes everything that follows.

Live Biotherapeutic Products

Microbiome consortia and defined-strain products for C. difficile and beyond.

CBERReviewed as biologics, with living-product CMC.

RNA & Oligonucleotides

siRNA, antisense, and mRNA therapeutics beyond vaccines.

CDERReviewed as drugs, with modality-specific expectations.

In Vivo Gene Editing

CRISPR and base editing delivered directly to the patient.

CBER · OTPOffice of Therapeutic Products, with long-term follow-up.

Radiopharmaceuticals

Radioligand therapy and theranostic diagnostic–therapeutic pairs.

CDER + radiationDrug review plus radiation safety and dosimetry.

Phage & Xenotransplantation

Bacteriophage therapy and engineered animal-source organs and cells.

CBERBiologics review, often case-by-case and first-of-kind.
Six frontiers

The Modalities Rewriting What a Medicine Can Be.

Each of these is early, each is different, and each rewards a sponsor who brings a regulatory framework rather than waiting for one.

CBER · living

Microbiome & LBPs

Live biotherapeutic products where the medicine is a community of organisms — with the first approvals now setting precedent for the field.

CDER · sequence

RNA & Oligonucleotides

siRNA, antisense, and mRNA platforms where a programmable sequence and a maturing but modality-specific CMC define the pathway.

CBER · OTP

In Vivo Gene Editing

Editing delivered directly to the patient, where off-target, durability, and lifelong follow-up questions have no long precedent yet.

CDER + radiation

Radiopharmaceuticals

Radioligand therapy and theranostics, where a drug pathway meets radiation dosimetry, supply logistics, and a diagnostic pair.

CBER · case-by-case

Bacteriophage Therapy

Phage against resistant infection, where personalized and cocktail approaches strain the standard product and trial paradigm.

CBER · first-of-kind

Xenotransplantation

Gene-edited animal organs and cells, where a genuinely novel product class meets transplant, infection, and ethical review.

Microscopic characterization of a living biotherapeutic product
The process is the product

You cannot fully characterize a community of living organisms — so the manufacturing process becomes the definition.

CMC for products you can't fully define

Novel Modalities Break the Assumptions CMC Was Built On.

Conventional CMC assumes a well-defined molecule. A live biotherapeutic is a consortium of organisms; a phage cocktail changes with the pathogen; a radiopharmaceutical decays on a clock. Potency, identity, and comparability have to be reimagined for products defined as much by their process and their living behavior as by a structure.

We build the control strategy the FDA will accept for a product it has rarely or never seen — potency assays that reflect mechanism, characterization that acknowledges complexity, and a comparability plan that survives the inevitable process changes on the way to commercial scale.

Writing the pathway with the agency

First-of-Kind Is a Regulatory Strategy, Not a Marketing Line.

When your product has no precedent, the way you engage the FDA is the difference between defining the category and being defined out of it. Early, structured dialogue is the whole game.

INTERACT

The FDA's earliest formal meeting exists for exactly this — novel products seeking guidance before a pre-IND. Use it to shape the framework, not just ask questions.

OTP

The Office of Therapeutic Products is the home for cell, gene, and many novel modalities — building the relationship early pays off across the program.

Precedent

Every first-of-kind approval becomes the template the next one uses — the evidence and framework you build outlive your own program.

Where novel-modality programs stall

Six Failure Modes We Are Brought In to Prevent.

On the frontier, the failures are almost never the science alone — they are the framework around it.

1

Waiting for guidance that isn't coming

Assuming the FDA will hand over a template for a novel modality instead of proposing the framework and negotiating it early.

2

The wrong regulatory home

Entering through the wrong center or office and losing time re-routing — or building to the wrong center's expectations entirely.

3

Conventional CMC on an unconventional product

Forcing a live, decaying, or evolving product into a small-molecule control strategy that cannot capture what defines it.

4

Skipping INTERACT and early dialogue

Arriving at pre-IND with a fixed plan the division was never consulted on — and discovering the framework doesn't hold.

5

Long-term follow-up underscoped

Underestimating the durability, off-target, and safety follow-up that editing, xeno, and living products demand for years.

6

No comparability plan for a moving product

A control and comparability strategy that can't survive the process changes a first-of-kind product inevitably goes through.

People who have filed the firsts

Regulatory Leadership for Products the Agency Has Never Seen.

Our novel-modality leads have engaged the FDA on living products, RNA, editing, and radioligand therapy — proposing frameworks, building living-product CMC, and taking first-of-kind programs through review.

Regulatory scientists working on a novel-modality program

"When there is no precedent, the regulatory strategy is the precedent. The best novel-modality teams don't wait for a pathway — they propose one the FDA can say yes to, and build the evidence to back it."

The discipline we bring across microbiome, RNA, in vivo editing, radiopharmaceuticals, phage, and xenotransplantation.

Live biotherapeutic products RNA & oligonucleotides In vivo gene editing Radioligand therapy INTERACT & OTP engagement Novel-product CMC

Building Something the FDA Has Never Seen? Bring the Framework With You.

Bring senior novel-modality regulatory leadership in early — while the regulatory home, CMC framework, and agency strategy are still open to shape.

Senior-led. Embedded in your team. No junior hand-offs.