Suzanne Farid (EPSRC Centre for Innovative Manufacturing, UCL) www.ucl.ac.uk/epsrccim www.ucl.ac.uk/biochemeng/industry/vision EPSRC CIM - UCL VISION Event 2 Dec 2013 www.ucl.ac.uk/epsrccim “Connectivity is our strength” The VISION Programme aims to be the nexus for the leaders of the biological sciences industry to hear and debate the latest technological and business developments in the sector. Contact Dr Karen Smith, Director of Bioprocess Leadership on +44 (0)20 7679 4411 or email karen.smith@ucl.ac.uk www.ucl.ac.uk/biochemeng/industry/vision EPSRC CIM - UCL VISION Event 2 Dec 2013 Chairman’s Introduction Neil Weir (UCB Pharma) EPSRC CIM - UCL VISION Event 2 Dec 2013 Proposed Session Format 17.00 Registration & Refreshments Posters and guided tours of UCL’s Biochemical Engineering facilities 18.00 Welcome and Introduction Suzanne Farid (UCL) 18.10 Chairman’s Introduction Neil Weir (UCB Pharma) 18.25 Implementing QbD in a Large Company Graham McCartney (Eli Lilly) 18.45 Implementing QbD in a Contract Manufacturing Organisation Graham McCreath (Fujifilm Diosynth Biotechnologies) 19.05 Open Forum Discussion with Industrial Panel Richard Francis (Francis Biopharma) Graham McCartney (Eli Lilly) Graham McCreath (Fujifilm Diosynth Biotechnologies) Stephen Ward (Cell Therapy Catapult) Chairman: Neil Weir (UCB Pharma) 19.30 21.00 Networking Reception Close EPSRC CIM - UCL VISION Event 2 Dec 2013 QbD – ‘Cycle of Life’ EPSRC CIM - UCL VISION Event 2 Dec 2013 7 QbD in Discovery vs Empiricism • • • • • • • • Therapeutic concept Chemical / Biologic starting point Potency Selectivity Pharmacokinetics and distribution Relative optimization Pharmaceutical properties Therapeutic concept in vitro, in vivo , in patients EPSRC CIM - UCL VISION Event 2 Dec 2013 Implementing QbD in a Large Company Graham McCartney (Eli Lilly) EPSRC CIM - UCL VISION Event 2 Dec 2013 Eli Lilly Kinsale We Make Medicine. Implementation of QbD in a “Large” Pharma Company R. Graham McCartney PhD Technical Lead Biotechnology Eli Lilly Kinsale Ireland UCL Pre-Conference QbD Workshop Introduction Eli Lilly has recently constructed and qualified a commercial cell culture biologics manufacturing facility in Kinsale, Ireland. Presentation uses the first molecules validated in this facility to illustrate: Approach taken to integrate QbD principles into robust Control Strategy development. Practical Translation of “concepts” into outcomes: a successful Process Validation start-up “There are many paths up the mountain”...this is but one path . Kinsale Ireland: Biotech Infrastructure IE28 Analytical, TS/MS, Micro capabilities and infrastructure. Testing, mfg support, late stage R&D IE43 (2016) 4 x 11,000L bioreactors 1 purification train 65lots/annum. Expandable IE42 3 x 5,000L bioreactors 1 purification train 44lots / annum. Multi product IE30 Platforms, SM fixed LM disposable. Roll in – out equip Capable of both NS0 + CHO platforms and adaptable to longer term Lilly pipeline molecules . Elements to Consider Eli Lilly’s Approach to QbD for Biotech Products Quality Target Product Profile Critical Quality Attributes Risk Assessments and Tools Attribute Driven Process Optimization Characterization via DOE Multivariate Analysis Robust Control Strategy Development Validation and Continuous Monitoring . Drug Product Profile Product Attribute Target Profile Active Pharmaceutical Ingredient IgGx Indication To be considered Dosage Form Single Use Sterile Parenteral Solution Dosage Strength Two dosage forms Fixed volume with 2 concentrations Container closure system glass prefilled syringe Shelf life X months @ 2 to 8 oC Administration Route Consider injection route Injection volume NMT X mL Acceptable needle Patient self administration with auto-injector and manual syringe Short term unrefrigerated in-use stability Formulation Delivery . Molecule Attributes: Orthogonal Analytical Method Strategy Required Site(s) Modification N-terminus Modification Fc Met and Fc Trp Oxidation Asn in Fc Domain Reduced RP-HPLC SEC Nonreduced CESDS CZE ThioGLo1 CE-LIF Reduced CE-SDS LC-MS X X X X Deamidation X X Asp in Fc Domain Isomerization X X Fc Domain Des Asn Glycosylation Cys-Cys Free Sulfhydryl Multiple Sites Glycation Aggregation X X X X X X X X X X X . Overall Risk Formula RPN = Severity x Occurrence x Detectability . CQA Risk Ranking & Filtering Tool A Continuum of Criticality Assess relative safety and efficacy risks using two factors: – Impact and Uncertainty used to rank risks Impact = impact on safety or efficacy, i.e. consequences – Determined by available knowledge for attribute in question (prior, clinical, etc) – More severe impact = higher score Impact on biological activity, PK/PD, immunogenicity, adverse effects Uncertainty = uncertainty that attribute has expected impact – Determined by relevance of knowledge for each attribute – High uncertainty = high score (no information with variant or published literature only) – Low uncertainty = low score (data from material used in clinical trials) Severity = Impact x Uncertainty Severity = risk that attribute impacts safety or efficacy . Severity Assessment: Knowledge Source Basis for Impact Assessment No data available Literature / Expert Opinion Platform knowledge Molecule-specific in vitro or non-clinical data Description No information is available to assess impact of quality attribute (e.g., new variant or no relevant literature data available on impact of quality attribute). Impact assessment based upon published external literature for the quality attribute in a related molecule. Literature must be from representative molecule(s) (e.g., similar MOA to assess impact of quality attribute on efficacy, similar clearance mechanism to assess impact of quality attribute on PK) with a similar level of the quality attribute. Impact assessment is based upon internal data (in vitro, non-clinical or clinical) from a similar class of molecule (i.e., platform knowledge). Platform knowledge must be from appropriate molecule(s) (e.g., similar MOA to assess impact of quality attribute on efficacy) and similar level of the quality attribute. Impact assessment is based upon in vitro or non-clinical data for the specific quality attribute and the specific molecule (e.g., in vitro potency testing for enriched fractions to assess impact on potency, correlating PK/PD data in relevant animal data to presence/level of quality attribute to assess impact on PK/PD, toxicology “margins of safety” for quality attribute to assess impact of quality attribute on toxicity). Impact assessment is based upon clinical data for the specific quality attribute and the specific molecule (e.g., correlating clinical immunogenicity data to presence/level of quality attribute to assess impact on immunogenicity, observation that clinical exposure of the quality attribute at relevant levels yields good safety profile to assess impact of the quality attribute on Safety as low). Molecule-specific clinical data Note –Based upon the range of quality attributes of the batches utilized in clinical studies as well as the design of the clinical studies, it is often not possible to ascribe specific clinical results to specific quality attributes of the molecule. Therefore, caution is needed when utilizing clinical data to assign impact scores to specific quality attributes (e.g., the observation of adverse events should not be utilized to assign a high impact Safety rating to a specific quality attribute unless the adverse events can be specifically attributed or correlated to the presence/level of the quality attribute). . Severity: Overall Scoring Knowledge Source Moleculespecific in vitro or nonclinical data Moleculespecific clinical data No data available Literature Platform knowledge 9 (CQA) 9 (CQA) 9 (CQA) 9 (CQA) 9 (CQA) Moderate Impact 9 (CQA) 9 (CQA) 3 (CQA) 3 (CQA) Low Impact 1 1 1 1 High Impact . Overall Risk Formula RPN = Severity x Occurrence x Detectability . Occurrence Assessment • Potential sources for assessment: – Experimental data/design space: • Univariate ranging study • Multivariate DOEs • Challenge studies – Historical data from lab, demo and GMP campaigns – Phase appropriate risk assessments – Scientific judgment, external literature/experience – Platform knowledge (in-house experience) – Parameter ranges intended at commercial scale/site Holistic assessment based on the overall body of data/scientific judgment . Risk Assessment Tool Fishbone – Production Bioreactor . Process - Risk Assessment IdentifyOptimization interactions to include in DOE studies: Example Cell Culture Development Mitigation: - None - DOE (parameter) - Linkage in study Assess >>>> Prioritize >>>>>Mitigate (Actions) Process Bone Aggregation N-Terminal Modification Isomerisation Deamidation AA Oxidation Formation of Single Chain Host Cell Proteins DNA 6 6 6 6 10 6 2 2 Analytical Method SEC CZE CZE LC-MS/ CZE ELISA PiPicogre en Facilities: Scale Effect 0 0 0 0 0 0 0 Operations: Culture Duration 0 9 9 0 9 0 Operations: Temp control 0 9 0 0 9 Operations: Temp shift 0 0 0 0 Operations: DO control 0 9 0 Operations: pH control 0 3 Operations: pCO2 control 0 0 Process Sub-Bone Relative Rank Production Bioreactor Operation Score Mitigation 0 0 None 0 0 252 Time Course Study, Operational Procedures 0 0 0 198 DOE Study, Control Strategy 0 0 0 0 0 Operational Procedures 0 9 0 0 0 198 DOE Study, Control Strategy 9 0 9 0 0 0 180 DOE Study, Control Strategy 0 0 3 0 0 0 30 DOE Study, Operational Procedures . CESDS 1 Block Early Gen 33.5 Temp 36 N-1 Temp 4.5 Inoc Age . 6.8 pH 6.8 N-1 pH 2.5 [Media] 0.2 Curv 98.289 Mean CO2 90 70 50 160 30 120 80 1.25 40 .75 .25 -0.25 2.7 2.5 2.3 6.95 6.85 6.75 6.95 6.65 6.85 6.75 5 6.65 4.75 4.5 4.25 37 4 36.5 36 35.5 34.5 35 34 33.5 33 32.5 Late Early 2 1 d14 Lac ±19.07497 30.96819 ±0.1229 1.705595 D14 titer ±0.946038 7.815795 Oxy % Trp(25) ±1.72782 ±0.124822 0.94337 Pho 15.16178 % Pyruvylation % Ser(46) Critical Quality Attributes ±0.25605 2.768565 % des H/HG DOE Studies to Define Design Space Bringing Together Process and Product Attributes Example – Production Bioreactor Prediction Profiler 5 4 3 1.75 2 1.25 0.75 0.25 20 17.5 15 12.5 10 7.5 12 10 8 6 2.5 4 1.5 2 100 1 60 -20 20 58.813 Mean Nova DO (D3-D14) DOE Study to Characterize CQA Impact of pCPP’s - Central Composite Design Execute the corner points of the design space - to confirm with data the model predictions of acceptability. • Multivariate (interaction) confirmation. Execute the Axial points to expand the information around the variation of a single variable. • Univariate (main effects) confirmation . Range Comparison Knowledge Space • The space explored by experimentation and may include areas of failures. Design Space • The multidimensional combination and interaction of input variables (e.g., material attributes) and process parameters that have been demonstrated to provide assurance of quality. (ICH Q8) Normal Operating Range (BR Range) • Region within the design space that define the operational limits (for process parameters and input variables) used in routine manufacturing. (A-Mab :a case Study) . Control Parameter (Input) Criticality Decision Tree Complete Following Characterization DOEs Process Parameter Risk Assessment Probable Risk to CQAs? No – do not evaluate in empirical study Yes - evaluate in empirical study Statistical Significance? No Yes Critical (CPP/CIPC) Yes Practical Significance? . No Not Critical (OPP/IPC) Control Parameter Criticality Assessment Assuring Significance and Relationship to CT Lots Link to clinical manufacturing experience: • Approach considers variability in development data (5 L to 500 L) compared to clinical scale experience (5000 L in this example) Impact on CQA consists of: • Is the effect of the parameter on a CQA statistically sig (P<0.05) • If yes, a comparison is then made between lab DOE CQA data and large scale CT lot CQA data, to assess whether the prospective manufacturing ranges yield CQA performance that exceeds clinical experience. If so, then CPP. If not, then OPP. Approach is reliant on/limited by requirement for a reasonable amount of clinical manufacturing experience . Documented Summary of Key Outcomes: Integrated Control Strategy (ICS) Analytical • Origin of critical quality attributes • Batch release specifications • In process testing for process validation (PVAC) Parametric •Control parameters for drug substance manufacturing •Rationale for criticality assessment • Why are specific parameters critical, and why are others noncritical? Microbiological •Risk assessment and evaluation •Selection of control points and limits based on facility Environmental monitoring history ICS – the foundation for Process Monitoring and Process Validation . Developing Process Validation Acceptance Criteria Parametric Control Strategy (CPPs Maintained in Range) Analytical Control Strategy (Demonstrate Unit Operation Functional Claims) Drug Substance Specifications Impurity Profile In Process Microbiological/Viral Specifications . Summary and Commentary (1) • Possible to translate QbD “concepts” into a Robust Control Strategy that leads to successful Process Validation and (hopefully) fewer process issues through the lifecycle (20+ year investment) • Potential Benefits of the approach 1. Increased confidence in validation success (PV complete on 4 processes/molecules) 2. Reduced numbers of deviations in PV (number and severity) 3. Foundation for Post PV process monitoring plan (lifecycle approach) . Summary and Commentary (2) • QbD is just they way you do process development and technology transfer and validation in the 21st century....increasing expectation to see “elements of QbD” in BLA/MAA • QbD focus is not “regulatory relief” focus is a systemic approach that leads top greater process/product understanding and robustness for the long term • We have not called out our submissions as “QbD” to date and have not clamed “design space” • Regulatory Agencies...where is their head at? . Acknowledgements Ciaran Brady Matthew Osborne Sarah Demmon Kristi Griffiths Steve Galvin Pete Lambooy Tom Black Graham Tulloch Marie Murphy Mark Milford Bryan Harmon . Implementing QbD in a CMO Graham McCreath (Fujifilm Diosynth Biotechnologies) EPSRC CIM - UCL VISION Event 2 Dec 2013 Implementing QbD in a Contract Manufacturing Organisation ESPRC Annual Research Meeting Monday 2nd December 2013, UCL Graham McCreath, PhD Head of Process Design …alternatively…… Adventures in Time and (Design) Space ESPRC Annual Research Meeting Monday 2nd December 2013, UCL Graham McCreath, PhD Head of Process Design Presentation Outline ► ► ► ► ► ► Brief introduction to Fujifilm Diosynth Biotechnologies (FDB) Brief introduction to Quality by Design (QbD) and components employed at FDB Some challenges and benefits of QbD development programs How does FDB as a CMO equip itself to deliver critical components of QbD Tools and considerations for QbD components Conclusions Fujifilm Diosynth Biotechnologies Billingham, UK (FDBK) MERCK / MSD Combining >25 years of Biologics CMO experience and track record Acquired April 2011 by Fujifilm Corp (80%) Mitsubishi Corp (20%) RTP, North Carolina, USA (FDBU) Fujifilm Diosynth Biotechnologies EU and USA operations ► >160 development products and processes ► 5 Commercial Products (4 Microbial, 1 MCC/BV) ► 900 Staff ► Billingham, UK Manufacturing & Process Development ► RTP, NC, USA Manufacturing & Process Development Inspection history: ICH Q8 introduced the concept of “Quality by Design, (QbD)” for pharmaceuticals QbD definition (ICHQ8) is: A systematic approach to development, that begins with predefined objectives and emphasizes product and process understanding and process control based on sound science and quality risk management • Scientific, risk-based, holistic and proactive approach to pharmaceutical development • Deliberate design effort from product conception through commercialisation • Full understanding of how product attributes and process relate to product performance In other words…. DESIGN UNDERSTAND CONTROL QbD Elements Employed at FDB Quality Target Product Profile (QTPP) To address patient requirements such as: Patient Safety, Efficacy, Dosage and route of administration The multidimensional combination and interaction of input variables and process parameters that have been demonstrated to provide an assurance of quality –ICHQ8 “Process Validation: General Principles and Practices” 2011, FDA. Critical Quality Attribute (CQA) Risk Assessment Defines desired product performance (CQA and KPA) Identify potential sources of variability affecting the CQAs (e.g. Process steps, Raw Materials) –ICHQ9 Design Space Control Strategy Continuous Improvement Control manufacturing processes to produce consistent product quality over time –ICHQ10 Lifecycle approach to continuously monitor and evaluate the process –ICHQ10 What challenges do CMOs face with the application of QbD ► ► Varies with customer – generally large pharma / large biotech expect QbD elements to be included in development programs Small to medium sized customers can be less aware of QbD and therefore require education; particular concerns around • Time – perception that QbD adds significant time into a development program (requires a rational staged approach to avoid!). • Many small / virtual biotechs have a horizon that stretches only as far as the next clinical or financial milestone. • Expectation that costs and resource requirements are high. • Unaware or unconvinced of the benefits including regulatory flexibility. ► CMOs require a flexible approach to deliver critical elements of QbD What are the benefits of a QbD directed development program ? ► There can be substantial business benefits to both small and large customers • Process understanding allows the most appropriate control strategy to be developed • Lower manufacturing costs, higher efficiency, right-first-time, etc ► QbD development programs reduce the risk of failure in process performance qualification (PPQ) campaigns and commercial manufacturing - drug shortages are a concern to FDA. ► Additional data with which to assess deviations and RCAs. ► Can increase value to the development and product package especially if subsequently licensed onto big pharma / biotech who often have QbD expectation. ► There can also be regulatory benefits • Ability to meet increased expectations of regulators • Lest post approval updates – Recent citations by regulators o Unacceptable levels of process understanding o Un-indentified factors causing process/product variability • Regulatory “flexibility” may not always be considered a primary benefit QbD = sound science based PD Does science beat stainless (and plastic)….? ► If it is becoming recognised that investing in good manufacturing science is as important as investing in fixed or disposable assets then what does this mean to us and our clients….? ► How can we offer the best possible science to recognise the benefits of a QbD development program…..? ► QbD Tools & Support areas Accuracy Range Repeatability Intermediate Precision Assay Qualification Linearity 1.8 Specificity 1.6 1.4 1.0 0.8 0.6 0.4 0.2 TEMP A IR F L pH PO 2 In le t_ O 2 E x tr a O 2 G ly c e r o l f RQ In le t_ C O 2 OUR S T IR R CER E x it_ O 2 E x it_ C O 2 0.0 M e th a n o l f V IP [7 ] 1.2 LOQ QbD Tools & Support area Edge of Failure Design of Experiments (DOE) Normal Operating Range Design Space Centre Face RSM Design Mapping 1.5 B7 B6 B5 B8 0.5 t[2 ] Multivariate Data Analysis (MVDA) 1.0 Batch Trajectory Scale Down Model Qualification B7 B8 B6 B5 B8 B6 B6 B5 B6 B7 B5 B8 B5 BB8 6 B7 B5B8 B5 B7 B8B6 B7 B6 B8 B5 B8 B7 B7 B6 B5 B8 B5 B6 B5 B8 B6 B5 B7 B6 B7B7B5 B5 B7 B5 B6 B8 B5 B8B8 B5 B6 B8 B7 B7 B6 B6 B7BB6 B5 8 B8B6 B8 B7B7B6 B5 B6B5B6 B8B8 B5 B7 B7 B8 B6 B7 B7 B8B6B7 0.0 -0.5 -1.0 () 99% Hotelling’s T2 limit -1.5 B8 -2.0 -6 -5 -4 -3 -2 -1 0 1 2 t[1] Statistical Process Control (SPC) 3 4 5 6 (▲) Laboratory scale data (prediction set) (▲) Manufacturing scale data (model set) Mechanistic Models Fujifilmdb Control Charts Slide No: 47 Training for Project Teams (and customers..!) ► Master class in QbD – QbD origins and execution ►Statistics for Technical Professional – Statistical theory, Outlier detection, Statistical comparison, ►Introduction to Design of Experiments (DOE) – Advantage of DoE, How applied in FDB ►Master class in Design of Experiments (DOE) – Details on design and analysis of different type of designs – DX-8® and JMP® focused ►Statistical Process Control – SPC theory and application in FDB manufacturing – Minitab® focused ►FMEA parameter assembly and scoring – Process parameter identification – Scoring system for S, O, D – RAPTA focused Slide No: 48 Training for Project Teams (and customers..!) ►Statistical Process Control – SPC theory and application in FDB manufacturing – Minitab® focused ►FMEA parameter assembly and scoring – Process parameter identification – Scoring system for S, O, D – RAPTA focused ►Identifying and classifying product quality attributes – SOP and in-house tools ►Development and validation activities leading to product commercialisation. – SOP and White papers 49 Where do we see most QbD approaches being applied for our clients ? Technology Transfer Process Creation Phase I Tox Strong use of DoE / Risk assessment in development … CQA mostly DS specification Sample retention……………. CQA Confirmation Phase II Process FMEA Phase III PPQ Assay Process Qualification Characterisation Control Strategy Critical Quality Attributes ► A critical quality attribute (CQA) is a physical, chemical, biological or microbiological property or characteristic that should be within an appropriate limit, range or distribution to ensure the desired product quality. ► CQAs typically include those properties or characteristics that affect the safety and efficacy of a product. ► Identifying CQAs is important for biopharmaceuticals and is becoming a regulatory expectation for market submission. ► The identified CQAs are also used in assessment of process parameters during risk assessments ahead of process characterisation studies therefore early identification is useful. ► FDB have tools and guidance's that assist clients in CQA identification Risk Assessments ► ► A systematic process for the assessment, control, communication and review of risk to the quality of the drug product across the product lifecycle (ICH Q9) Risk assessment tools allow you to distil down, assess, rationalise and prioritise what important in complex manufacturing processes ► ► ► ► ► Identify parameters & material attributes most likely to affect product quality & process performance Highlight which steps & RMs impact one or more CQAs Link parameters & RM attributes to CQAs Steers product and process development Informs design space & control strategy emphasis Risk Assessment Tools High RPN or Severity score: Parameter for further evaluation and characterization through formal process ranging High Occurrence/Detection Score: Mitigation through control strategy, facility/equipment improvements, PAT Risk Assessment planning Attribute Impact Assessment Risk Scoring Risk Scoring dictates Mitigation Strategy Risk Mitigation Strategy Initial RPN scores may change in accordance with mitigation E.g.: Failure Mode Effects Analysis (FMEA) for a process step Process FMEA tool – RAPTA Risk Assessment Process Template Application • Inbuilt lists of unit variables based on previous experiences in process characterisation and Manufacturing • Automated visual plots (heat maps, sorted score plots) • Emphasis on impact of each individual parameter on CQA’s: • Impact, Detection and Occurrence within the unit operation. • Links the various options of Mitigation Strategy relevant to process and our manufacturing facilities 54 Design Space Development: Using Statistical Design of Experiments (DOE) Tool Design Options ► There are always a number of options available for experimental design. ► DoE is one option but sometime single factor studies are also appropriate. ► When DoE is employed, it is important that clients recognise that high resolution options, whilst providing greater levels of understanding also take more time, generate more materials for analytical testing and require more feedstock. ► FDB always produce a range of options to clients outlining risks and benefits of each approach. Discussion on DoE options Slide No: 57 DOE: Process Characterisation Example Several design options proposed for the study Parameters for design derived from FMEA Blocking ensures variation due to different AKTA &/or Analyst is taken into account Risk Assessment (FMEA) output • 25-1=16 Run RV design with 3 centre points per block design option adopted for Stage-1 Screening study • Centre points will help to account and analyse the variability due to Process (i.e. batch to batch variation) • Centre points also help to identify curvature (nonlinearity) Similar design option proposed for different steps in the process Summary from JMP® Response with 95% Confidence interval at centre point conditions of factors Factors at centre point conditions Slide No: 59 B D G Monte-Carlo Design Space Simulation Specification of Peak 1 area<15% Respective failure rates Slide No: 61 Control strategy evolution (high level) Development trajectory pCQA identification Process development CQA vs process steps Design space Analytical development FMEA Product characterisation CQA vs process parameters Method validation FMEA FMEA Specifications Raw materials Draft control strategy Updated control strategy (several iterations) PPQ control strategy Conclusions - What do you get from a QbD development program ? ► A robust well controlled process ► Risk assessments as an iterative description and repository of process knowledge. ► Documented description and justification for small scale process models. ► Proven acceptable ranges for high risk input parameters and raw materials. ► Comprehensive description of process and analytical controls. ► A control strategy specifically designed constructed to minimise risk to product and process CQAs. ► QbD is a continuum not a step function – Many traditional pharmaceutical development approaches are consistent with QbD; all applications have some aspects of science and risk based approaches Thanks to ► ► ► ► Simon Hanslip Mahesh Shivhare Somi Mohammadi Carol Fisher PANEL DISCUSSION: Graham McCartney, Graham McCreath, Richard Francis, Stephen Ward Chair: Neil Weir EPSRC CIM - UCL VISION Event 2 Dec 2013