Bispecific antibody research and development among China, the United States and Europe

Bispecific antibody research and development among China, the United States and Europe | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 21 August 2025 V1 Latest version Share on Bispecific antibody research and development among China, the United States and Europe Authors : Yuxuan Gong , Zetong Wu 0009-0002-9672-6043 , Jinglan Huang , Xiaotong Yang , Dan Wang , and Sirong He [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.175576332.25254096/v1 405 views 186 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Bispecific antibodies (BiAbs), which can simultaneously bind two distinct antigens, have emerged as a promising therapeutic strategy for treating cancer, autoimmune disorders, and metabolic diseases. The United States, China, and Europe are the leading regions in BiAb research, each demonstrating unique strengths. The United States dominates the field with a mature research ecosystem and balanced progression across all stages of development. China excels in early-stage innovation but continues to face challenges in late-stage clinical trials and commercialization. Europe emphasizes high-quality foundational research, although its overall output remains limited. Key research targets include PD-1 x CTLA-4 and CD3-based combinations, underscoring BiAbs pivotal role in immunotherapy. The BiAb research reveals significant disparities in regional priorities, technological capabilities, and developmental progress, which collectively shape innovation and translational outcomes in this field. These variations highlight differences in research intensity, infrastructure quality, and regulatory frameworks that critically influence the advancement and outcomes of BiAb development globally. Introduction Bispecific antibodies(BiAbs) are engineered immunoglobulins with two distinct antigen-binding sites capable of recognizing different antigens or two separate epitopes on the same antigen. While natural antibodies are predominantly monospecific, IgG4 stands as a notable exception due to its ability to undergo Fab-arm exchange, albeit with limited stability. The antigen-binding site is formed by the variable domains of the light chain (VL) and heavy chain (VH) within the Fab arm. Without precise intervention, the random assembly of VLs and VHs can theoretically produce 16 configurations, only one of which is bispecific (1). Therefore, achieving a stable and functional BiAbs requires deliberate pairing of light and heavy chains to ensure correct antigen-binding site assembly. BiAbs can simultaneously target two distinct antigens, enhancing therapeutic efficacy by directing immune cells to attack tumors, blocking dual escape pathways, and overcoming drug resistance. Compared to monospecific antibodies, BiAbs provide greater targeting flexibility and synergistic effects. However, their development is more complex, and they pose a higher risk of potential toxicity. Despite these challenges, BiAbs represent a promising approach to addressing the limitations of traditional antibody therapies, particularly in the treatment of cancer and autoimmune diseases. BiAbs, capable of simultaneously binding to two distinct antigens or epitopes, have emerged as a promising class of biotherapeutics. The concept of BiAbs was first proposed in the 1960s, and significant progress has since been made in their development.(2, 3). Initially, BiAbs were developed to overcome the limitations of monoclonal antibodies, including single-target drug resistance and safety concerns(4, 5). In 1986, Staerz and Bevan employed BiAbs to direct cytotoxic T lymphocytes in cancer cell lysis experiments, establishing the foundation for subsequent applications(6). The first therapeutic BiAb, Catumaxomab, was approved in 2009 for the treatment of malignant ascites(7, 8) . Research on BiAbs has expanded beyond solid tumors to include autoimmune, metabolic, and neurological diseases, with tumor-related research remaining dominant (9). The United States, Europe, and China are leading the global development of BiAbs, with the approval of Blinatumomab in 2014 marking a significant milestone. Approved by both the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA), Blinatumomab significantly accelerated global BiAb development efforts (10). In 2022, China introduced Cadonilimab for the clinical treatment of cervical cancer (11), marking its formal entry into the field of BiAb manufacturing. Since then, the United States, China, and Europe have emerged as the leading regions driving the development of BiAbs. The number and areas of BiAb research and development (R&D) vary slightly across different regions globally ( Fig 1 ). In terms of the number of studies, the United States, China, and Europe account for over 90% of the global total. Therefore, the following discussion primarily explores the differences in BiAb R&D among the United States, China, and Europe. Regional differences in global BiAb target combinations The analysis of global BiAb target combinations demonstrates clear regional differences in research priorities and activity levels. The heatmap shows that the combination of PD-1 X CTLA-4 is the most studied target combination worldwide, with a total of 62 trials, reflecting the fact that this combination may play a key role in immune checkpoint regulation for cancer therapy( Fig 2) . The second and third most studied target combinations were CD3 X CD20 (46 trials) and CD3 X CD19 (41 trials), which are mainly associated with hematological malignancies and indicate the continued interest in the involvement of CD3-related targets in T-cell-mediated cytotoxicity. However, the remaining combinations, such as HER2-EC204 X CD3, showed moderate research activity, while most combinations were relatively underrepresented, as shown by the lighter areas on the heatmap. The bar chart on the right further illustrates the geographical differences between the five most studied BiAb combinations (CD3 X CD20, CD3 X BCMA, CD3 X EpCAM, PD-1 X CTLA-4, and CD3 X CD19). (Figure 2.) What is clear is that China is leading the way in PD-1 X CTLA-4 research, with a total of 46 trials that could be tracked, underscoring its leading role in the advancement of immune checkpoint blockade therapies. At the same time, the data show that USA is a clear leader in CD3 X CD20 research with 23 trials, significantly more than Europe (n=9) and China (n=8). For the CD3 X BCMA combination, the USA dominated with 25 trials, well ahead of China (n=2) and Europe (n=1). In combining CD3 X EpCAM and CD3 X CD9 in the target，it can be seen that the number of trials in China is zero. In the first case, the number of trials in Europe (n=5) is four times higher than in the USA (n=1), while in the second case, the number of trials in the USA (n=23) is three times higher than in Europe (n=7), which is the dominant position. Combining the two charts shows that the China maintains a dominant position in immune checkpoint-related BiAb research, particularly PD-1 X CTLA-4, reflecting its leadership in immunotherapy innovation(12). In contrast, the USA’s strategy focuses on CD3-related target combinations such as CD3 X CD20 and CD3 X BCMA, possibly due to their therapeutic potential in hematological and solid tumors(13). However, while Europe may struggle to achieve large research volumes and play a major role in the global BiAb research landscape due to lower funding and smaller populations, this does not mean that European BiAb development is poor(14). The distribution characteristics of BiAb target combinations across different research fields and regions. From the perspective of research fields, solid tumors and metabolic diseases represent the core areas of BiAb research, with targets such as PD-1×CTLA-4 offering significant research advantages in this field( Fig 3 ).This highlights the wide potential for dual antibodies in tumor immunotherapy, particularly those targeting HER2 and PD-1, whose efficacy has been validated in clinical practice. Furthermore, the field of hematological tumors and autoimmune diseases also occupies an important position, with the target combination of CD3×CD19 and PD-1×CTLA-4 representing a significant area of investigation( Fig 3 ). It is noteworthy that the combination of PD-1×CTLA-4 has a broad scope, with numerous studies conducted in various disease fields, making it one of the most extensively investigated target combinations currently. The number of research on nervous system diseases is relatively limited, suggesting that research on BiAb in this field is still in its early stages and holds significant potential for future development( Fig 3 ). From the perspective of geographical distribution, the USA occupies a leading position in the field of BiAb research, with research activities spanning almost all target combinations, particularly in the areas of immune checkpoint inhibitors (such as PD-1×CTLA-4) and cytokine targets (such as OX40×OX40L)( Fig 3 ). This reflects the rapid rise of China in the field of tumor immunotherapy in recent years and the priority layout of innovative targets (15). Furthermore, China’s research output in the field of oncology and metabolic disorders is particularly prolific, reflecting the high level of focus on targets with translational potential (16). European research is more balanced in terms of their focus, but the overall number is relatively small, particularly in the field of neurological diseases( Fig 3) . Indeed, the proportion of target research in this area is relatively low (17). This may be attributable to the comparatively lower levels of research and development investment, coupled with the smaller scale of pharmaceutical companies and scientific research institutions (18). The China-USA-Europe BiAb research platform leverages panoramic insights into differences Through in-depth analysis of the research focus and target combination of different regions, we have gained insight into the significant differences between regions, which are reflected not only in the preference of research directions but also in the quantity and quality of research results(7). In the macro framework of BiAb research, the distribution of research platforms is an indispensable key link. Exploring the differences in research platforms in different regions is conducive to understanding the BiAb-related technologies mastered in each region and to predicting the future development direction of each region(7). As shown in the figure 4 , China, the USA and Europe have significant differences in the distribution of research platforms for BiAb. China has a significant lead in the scale of research on multiple platforms, such as Tetrabody, CRIB and Triomab platforms, and the number of research in China is significantly higher than those in the USA and Europe, especially the distribution of Tetrabody in China has reached the highest value, indicating that China has invested a lot of resources in the field of BiAb research and development in recent years and has achieved rapid development (12). In contrast, research in the USA is more broadly distributed and balanced, with strong performance across multiple platforms such as BiTE, DART and XmAb, and the BiTE platform, where the USA leads in the number of research, demonstrating its strengths in technical diversity and innovation capabilities (19). European research is relatively concentrated on a few platforms such as dock-and-lock, Removab® and BiTE, demonstrating a deep accumulation and specialization in some specific technology areas. Interestingly, BiTE, as a lower-cost technology platform, has been focused on in the USA and Europe, but is less developed in China, which may to some extent reflect the difference in market demand(20). Overall, China pays more attention to large-scale development and concentrates resources to promote the rapid development of specific platforms (12). The USA embodies a diversification strategy, maintaining balanced development in a wide range of technological fields and possessing significant innovation (21); Europe, on the other hand, focuses on detailed research in specific fields and achieves specialization and differentiated development with less capital and human resources (5). In the field of global BiAb research, the scale advantage of China, the technical diversity of the USA and the fine technology of Europe have formed a unique competitive pattern among the three. Participation of BiAb research institutions in China, the USA and Europe and in-depth analysis of stage distribution BiAb research is a complex, systematic project involving numerous participants and multiple stages of development. The diversity and complexity of global BiAb research is reflected in the differences in institutional participation and research phase distribution in different regions. The participation degree and type distribution of institutions, as the core promoters of scientific research activities, directly affect the depth and breadth of research. The distribution of research stages reflects the evolution track of scientific research results from germination to maturity (22). There are significant differences between China, the USA and Europe in terms of institutional participation in BiAb research and the distribution of research stages, which are reflected in the distribution characteristics of the number of research projects, types of institutions and research stages( Fig 5 ). In terms of total research, the USA has the highest number of BiAb research and development projects with 274 in total, accounting for the largest proportion of global research, indicating its significant leadership in BiAb research. China came in second with 212 projects, demonstrating rapid growth in R&D capacity. Europe lagged with 71 studies, reflecting the low volume of BiAb studies in the region compared to the top two countries. In terms of institutional involvement, the USA is dominated by large multinational pharmaceutical companies such as Regeneron, Amgen and Pfizer, whose strong financial backing and R&D capabilities not only allow them to perform well in the early stages of research but also give them significant advantages in the late clinical and commercialization phases. This balanced distribution of projects reflects the mature capabilities of the entire industry chain in the USA in BiAb. In contrast, R&D in China is more focused on local biotech companies and medium-sized pharmaceutical companies, such as Hengrui Pharmaceutical, Cinda Bio and Beigene. The research focus of Chinese companies is mainly on preclinical and phase I clinical trials. Although some projects have entered stage III clinical trials and even commercialization, but the total number of listed products is still insufficient. Compared to China and the USA, BiAb research in Europe is dominated by small and medium-sized biotechnology companies such as Genmab and Roche. Research is mainly focused on preclinical and stage I trials, demonstrating its traditional advantages in innovative research and development. However, this may be due to its small region, less capital, insufficient human resources and small market (23). As a result, it lacks the capacity for large-scale follow-on development and commercialization. From the perspective of research stage distribution, projects in the USA encompass the entire research and development cycle, from the initial stages of basic research to the final stages of marketization. The number of research in stage III, which encompasses clinical trials and marketing, is significantly higher in the USA than in Central Europe. This is indicative of the USA’s more mature regulatory environment and market demand-driven approach. China’s research stage presents an evident ”pyramid” shape, with a considerable number of basic research and preclinical stage projects, but the number of subsequent projects is gradually declining. This phenomenon may be attributed to the fact that China still requires the strengthening of its technology accumulation, industrialization experience and international market access (12). The distribution of research stages in Europe is more concentrated in the early stage, with a paucity of stage III clinical and marketing projects. This may be attributed to the limited size and volume of the domestic market, as well as the absence of a discernible technology transformation trajectory (23). It is evident that the USA occupies an unparalleled position in the research of BiAb, which is distinguished by a multitude of research institutions, comprehensive stage coverage, and extensive marketisation (24). China demonstrates considerable potential for accelerated development, particularly in the initial stages of research, where there is a notable surge in activity(12). However, the subsequent stages and marketisation capabilities still require enhancement. Europe is primarily concentrated on early-stage innovation, and despite its considerable investment in fundamental research, there are deficiencies in the commercialization capabilities and industrial chain support (25). BiAb research stage in China, America and Europe competition and regional diversification The disparities in the distribution of institutional participation and research stages across different regions have already yielded a heterogeneous picture of global BiAb research, which has a significant impact on the research process and the efficacy of results translation in this field(26). Furthermore, the BiAb research in different regions and its corresponding stage also serve as a reflection of a region’s technical capacity and research intensity in BiAb research (26). The Sankey map serves to illustrate the competitive and regional diversity of BiAb research( Fig 6 ). In terms of research volume and industry leadership, the USA is the dominant player. China, meanwhile, has demonstrated significant growth and diversification, while Europe has maintained a steady, quality-focused contribution. China is distinguished by the strength of its pipeline of BiAb candidates, particularly in preclinical and early-stage clinical trials (Stages 1 and 2). BiAb products such as AK104, PM8002 and KN046 are prominent in this research landscape, reflecting China’s growing investment in innovative treatments and commitment to advancing early-stage clinical research. Nevertheless, the relatively limited number of late-stage trials indicates that, while China has made considerable headway in early-stage innovation, it has yet to fully translate this progress into advanced clinical development and regulatory success. In contrast, the USA demonstrates a more balanced distribution across all stages of development, including preclinical studies and late-stage clinical trials (Stages 3 and 4). The USA is particularly dominant in late-stage studies, with BiAbs such as blinatumomab and emicizumab dominating stage 3 and 4 studies. This strength reflects the USA’s well-established research infrastructure, mature biotechnology ecosystem, and expertise to transition BiAb drug candidates from early-stage trials to commercialization. The USA’s capacity to successfully develop and bring BiAb therapies to market serves to reinforce its position as a global leader in immunotherapy research. Due to the constraints of regional size, financial resources and human capital, Europe accounts for a relatively minor share of global BiAb research. The continent is home to a smaller number of BiAb projects at various stages of development, with many contributions concentrated in stage 2 clinical trials, including BiAb such as Mosunetuzumab and Glofitamab. The limited representation of Europe in preclinical and late-stage trials suggests a deficiency in early-stage innovation and advanced clinical development, when compared to China and the USA. China is emerging as a leader in early-stage innovation, with a focus on developing a robust pipeline of novel BiAb drug candidates(12). Conversely, the USA, China’s principal competitor, has exhibited an impressive capacity to transform research outcomes into clinical and commercial triumphs, sustaining a dominant position in the advancement and approval of BiAb therapies (19). The figure illustrates that the number of European research is only slightly below that of China and the USA, and the precise circumstances must be considered in conjunction with other data analysis. The Regional Dynamics and Comparative Strategies in BiAb Research The United States dominates the global BiAb research landscape, characterized by a well-balanced distribution across all development stages, supported by cutting-edge research infrastructure, regulatory efficiency, and strong financial systems. (27, 28) Prominent hubs, including California (n=114), New York (n=25) and Maryland (n=20), host numerous late-stage clinical trials, underscoring the nation’s capacity to advance BiAb candidates from early research to market-ready therapies( Table 1 ). This success is attributed to a well-integrated industrial ecosystem, university-industry collaborations, and the streamlined drug approval process of the FDA. These factors empower the United States to lead the commercialization of BiAb therapies, as exemplified by the approval of drugs such as blinatumomab and emicizumab, which serve as benchmarks in late-stage BiAb development.(27) China, though a relatively recent entrant in the field, has quickly established itself as a leader in early-stage BiAb innovation. Clinical activities related to BiAbs are primarily concentrated in economically advantaged coastal regions, particularly Shanghai (n=67) and Guangdong (n=46). ( Table 1 ). These regions, supported by favorable policies, advanced infrastructure, and substantial financial backing, have emerged as hotspots for innovation and development. This concentration reflects the alignment of China’s BiAb research with the country’s economic and industrial priorities. Shanghai and Guangzhou are key areas for BiAbs development due to several factors. Both cities have strong biomedical foundations, with Shanghai leading the Yangtze River Delta Biological R&D cluster and attracting global pharmaceutical companies and investment(29). Guangzhou, in the Pearl River Delta Economic Zone, began biopharmaceutical development early and has a strong manufacturing base (29); Both cities benefit from China’s mixed innovation model(30), combining government support with foreign collaboration, driving growth in biotechnology and pharmaceuticals. Policy support, such as the ”Healthy China 2030” initiative, has accelerated BiAbs development(29, 31), while the national talent introduction program has strengthened the human capital pool(32). Europe contributes a consistent, though comparatively smaller, share to global BiAb research, prioritizing quality-focused advancements over volume. European BiAb research is primarily concentrated in Germany (n=23), the United Kingdom (n=14), and Switzerland (n=12) ( Table 1 ). These regions host leading biotech companies and prestigious academic institutions, benefiting from industrial infrastructures, supportive government policies, and highly skilled talent pools. This combination of factors positions them as hubs for innovation and development in the field of BiAbs. Germany and Switzerland play a key role in providing technical support for BiAb research due to their advanced biopharmaceutical and chemical industries. In Germany, where manufacturing represents 80% of export value(33), a well-established industrial chain supports BiAb innovation. Similarly, the UK has become a significant R&D center, driven by growing life sciences clusters (34). European regulators, such as EMA, support the efficient approval of novel biologics like BiAbs (35), while countries like Germany and the UK offer tax incentives to foster biotechnology growth(36). Additionally, Germany and the UK have strong clinical trial networks with excellent medical resources and patient recruitment capabilities(37-39), making them attractive locations for clinical research and supporting the rapid development of BiAbs in Europe. Other regions, including Canada, South Korea, Japan, and India, also play crucial roles in diversifying global BiAb research. Institutions and biopharmaceutical companies in these countries are making significant contributions to innovative drug discovery, thus supporting the global development of BiAb. Canada has invested heavily in BiAb research, with institutions such as the University of Toronto leading the way(40). South Korea, supported by its strong biotechnology sector, has made notable progress in this area(41, 42). Japan, particularly through companies like Daiichi Sankyo, has played a leading role in the advancement of novel bioantigen therapies for cancer treatment(43). India, with its rapidly growing biopharmaceutical industry, is contributing to bioantigen research through collaborations and partnerships with global pharmaceutical companies(44, 45). Although their research scale is smaller than that of the USA, China, and Europe, their contributions enrich the global BiAb landscape and create opportunities for collaboration. Overall, the USA’s dominance in translating research into commercial success contrasts with China’s emphasis on early-stage innovation and Europe’s quality-driven, yet limited output. These regional disparities highlight how distinct approaches and resources shape the competitive and collaborative dynamics of global BiAb research. Conclusion Globally, the United States possesses a mature BiAbs development system and efficient translational capabilities; however, high R&D costs remain a significant constraint. Europe demonstrates strong innovative potential in BiAbs R&D; however, its limited commercial capacity hampers large-scale experimental efforts. As a latecomer, China exhibits significant activity in early-stage R&D and benefits from stable government support. Nevertheless, it faces challenges such as a lack of late-stage clinical trials and an underdeveloped market-oriented system. The advancement of worldwide BiAb research can be facilitated by shared R&D technologies and cross-regional clinical trial collaboration. However, it necessitates harmonized international safety and regulatory standards to address existing constraints. In the future of BiAbs R&D, alongside prioritizing the innovation of new platforms and target combinations to drive technological advancement, a deeper exploration of optimizing antibody screening and design processes is essential to enhance efficacy and specificity(46), eventually leading to the clinical application of BiAbs. As biopharmaceutical technologies advance, new platforms present increased potential for the design and application of BiAbs. Simultaneously, the selection of target combinations will increasingly prioritize personalized therapies, with target design tailored to disease types, patient subgroups, and clinical needs, enhancing therapeutic precision and efficacy. For countries seeking to establish a mature BiAbs system, in addition to optimizing clinical trial designs and minimizing adverse reactions, strengthening the sharing of clinical data and technologies across institutions is crucial(47). This will facilitate cross-border and cross-regional trials, enabling effective resource and data integration and improving R&D efficiency. Ultimately, the marketization of BiAbs is not only a technological breakthrough, but also requires synergistic support from multiple facets, including policy, regulation, and funding. Countries and regions should develop strategies tailored to their industrial base and policy environment to accelerate the development and commercialization of BiAbs at various stages. Given the varied distribution of resources across countries and regions, global BiAbs R&D and application should be achieved through balanced and synergistic development. International collaboration will play a crucial role in resource sharing, technology exchange, and standardization, helping overcome bottlenecks in single-country R&D and promoting the global dissemination of BiAbs technology. Acknowledgements: Not applicable. Authors’ contributions: Yuxuan Gong, Zetong Wu, Xiaotong Yang, Jinglan Huang, Dan Wang and Sirong He collected and analyzed the data; Yuxuan Gong, Zetong Wu, Xiaotong Yang and Sirong He wrote the paper. All authors read and approved the final manuscript. Funding: This work was sponsored by the Program of National Natural Science Foundation of China(No.32370985), Natural Science Foundation of Chongqing, China (No. CSTB2023NSCQ-MSX0257 and cstc2021jcyj-msxmX0151), the Science and Technology Research Program of Chongqing Municipal Education Commission (No. KJQN202200436), the CQMU Program for Youth Innovation in Future Medicine (No.W0100), the Youth Practical Research Project for Respiratory Diseases of the China International Medical Foundation (No. Z-2017-24-2301), Cultivation Fund of The First Affiliated Hospital of Chongqing Medical University, China (No.PYJJ2020-03), Postdoctoral Cultivation Fund of The First Affiliated Hospital of Chongqing Medical University, China (No.CYYY-BSHPYXM-202215). Competing interests: all authors declare no competing interests Reference 1. Brinkmann U, Kontermann RE. The making of bispecific antibodies. MAbs. 2017;9(2):182-212.2. Nisonoff A, Rivers MM. 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On Optimal Designs for Clinical Trials: An Updated Review. Journal of Statistical Theory and Practice. 2019;14(1):10.47. Yang J, Kang H, Lyu L, Xiong W, Hu Y. A target map of clinical combination therapies in oncology: an analysis of clinicaltrials.gov. Discover Oncology. 2023;14(1):151. Table 1. Amount of BiAb research in different regions Region City/State/Country Amount of institution China Shanghai 67 Guangdong 46 Beijing 29 Jiangsu 14 Zhejiang 13 Other 63 USA California 114 New York 25 Maryland 20 New Jersey 18 Massachusetts 17 Other 113 Europe Germany 23 United Kingdom 14 Switzerland 12 Netherlands 6 Denmark 4 Other 26 This table presents the distribution of BiAb research across three regions: China, the United States, and Europe. It provides a quantitative overview of the number of research in each city for China and the United States, and in each country for Europe. The data highlights the geographic concentration of BiAb research, facilitating regional comparisons and analysis. Figure 1. This figure shows the number of BiAb in each country around the world, with different colours indicating the staging of each study. Figure 2. This figure illustrates the popularity of target combinations (left: heatmap) and a comparison of the research frequency for the top five target combinations (r ight: bar chart) across different regions: China, the USA, and Europe. b） Figure 3. This circular bar chart illustrates the research distribution of various target combinations across three regions (China, USA, and Europe) and six disease areas (Solid tumors, Hematological system tumors, Autoimmune Disease, Metabolic disorders, and Nervous system disease). Figure 4. This figure highlights the differences in the utilization of various research platforms across different regions: China, the USA, and Europe, as indicated by the distribution of research frequency for each platform. Figure 5. This Sankey diagram illustrates the distribution of research stages (Preclinical, Stage 1, Stage 2, Stage 3, and Stage 4) among various research institutions located in three regions: China, the USA, and Europe. The width of the lines connecting the research institutions to the stages represents the number of research projects at each stage. Figure 6. This Sankey diagram illustrates the distribution of research stages for Bispecific Antibodies (BiAbs) across three regions: China, the USA, and Europe. Supplementary Material File (fig.docx) Download 1.36 MB Information & Authors Information Version history V1 Version 1 21 August 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords cell therapy immunotherapy tumour immunology Authors Affiliations Yuxuan Gong University of Leicester Joint Institute View all articles by this author Zetong Wu 0009-0002-9672-6043 University of Leicester Joint Institute View all articles by this author Jinglan Huang Chongqing Medical University View all articles by this author Xiaotong Yang University of Leicester Joint Institute View all articles by this author Dan Wang Affiliated Hospital of Chongqing Medical University View all articles by this author Sirong He [email protected] Chongqing Medical University View all articles by this author Metrics & Citations Metrics Article Usage 405 views 186 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Yuxuan Gong, Zetong Wu, Jinglan Huang, et al. Bispecific antibody research and development among China, the United States and Europe. Authorea . 21 August 2025. 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