The field of Tissue Engineering and Regenerative Medicine exists because there are medical problems for which there are either no solutions or poor solutions, such as stroke, esophageal cancer, loss of extremities, and severe burns. Traditional research approaches to these types of maladies rarely result in quantum leaps with regard to treatment, but rather incremental advances. The ability to create new functional tissue to replace injured or missing tissue and organs would obviously represent a major advancement. With the increased recognition of the possibilities that exist in the interdisciplinary approaches of regenerative medicine, there is the very real possibility of changing the default mechanisms of wound healing in patients with previously “untreatable” conditions. The convergence of stem cell biology, biomedical engineering, developmental biology and regenerative medicine has already resulted in early evidence of dramatic advancements.
The replacement of damaged upper airway segments in patients in Spain and Sweden, the replacement of large segments of esophageal mucosa for the treatment of esophageal cancer in the United States, the replacement of corneas in France, and the transplantation of custom grown urinary bladders in children with congenital abnormalities of the lower urinary tract represent examples of therapies considered impossible only a few short years ago.
The boundaries between the traditional triad of cell based, scaffold based and bioactive molecule based approaches to regenerative medicine are becoming increasingly blurred as investigators combine these concepts into experimental approaches to reconstruction of the central nervous system, the retina, damaged myocardium and even whole organs such as liver, lung and kidney. If even a small percentage of these efforts are successful, it will result in dramatic changes in the practice of medicine. There are now more than 3,500 members of the Tissue Engineering Regenerative Medicine International Society (TERMIS); a statement to the excitement and energy that exists in the biomedical research community with regard to this approach to long standing pathologies.
Although the future of the scientific advancements that are imminent from the work in the regenerative medicine field, it will be a challenge for regulatory agencies, cost reimbursement agencies, and surgeon community to keep pace. Traditional concepts and practices are not easy to change but if the patient population is to receive maximum benefit from such advancements, the infrastructure that supports the practice of medicine is going to have to be nimble, open minded and forward looking.
This is an exciting time for the field of tissue engineering and regenerative medicine. Optimism is high and expectations are realistic. If the investment of recent years in regenerative medicine R&D continues, there is every reason to believe that cures for some of the disease conditions mentioned above with be realized.
Stephen Badylak, MD, PhD, DVM, Professor in the Dept. of Surgery, a deputy director of the McGowan Institute for Regenerative Medicine (MIRM), and Director of the Center for Pre-Clinical Tissue Engineering, University of Pittsburgh, USA