Where will medicine be in 2035?

An important determinant of “where medicine will be” in 2035 is the set of dynamics and forces behind healthcare delivery systems, including primarily the payment method, especially regarding reimbursement. It is clear that some form of reform in healthcare will result in a consolidation of the infrastructure paying for and managing patient populations. The infrastructure is bloated and expensive, unnecessarily adding to costs that neither the federal government nor individuals can sustain. This is not to say that I predict movement to a single payer system — that is just one perceived solution to the problem. There are far too many costs in healthcare that offer no benefits in terms of quality; indeed, such costs are a true impediment to quality. Funds that go to infrastructure (insurance companies and other intermediaries) and the demands they put on healthcare delivery work directly against quality of care. So, in the U.S., whether Obamacare persists (most likely) or is replaced with a single payer system, state administered healthcare (exchanges) or some other as-yet-unidentified form, there will be change in how healthcare is delivered from a cost/management perspective. 

From the clinical practice and technology side, there will be enormous changes to healthcare. Here are examples of what I see from tracking trends in clinical practice and medical technology development:

  • Cancer 5 year survival rates will, for many cancers, be well over 90%. Cancer will largely be transformed in most cases to chronic disease that can be effectively managed by surgery, immunology, chemotherapy and other interventions. Cancer and genomics, in particular, has been a lucrative study (see The Cancer Genome Atlas). Immunotherapy developments are also expected to be part of many oncology solutions. Cancer has been a tenacious foe, and remains one we will be fighting for a long time, but the fight will have changed from virtually incapacitating the patient to following protocols that keep cancer in check, if not cure/prevent it. 
  • Diabetes Type 1 (juvenile onset) will be managed in most patients by an “artificial pancreas”, a closed loop glucometer and insulin pump that will self-regulate blood glucose levels. OR, stem cell or other cell therapies may well achieve success in restoring normal insulin production and glucose metabolism in Type 1 patients. The odds are better that a practical, affordable artificial pancreas will developed than stem or other cell therapy, but both technologies are moving aggressively and will gain dramatic successes within 20 years.

Developments in the field of the “artificial pancreas” have recently gathered considerable pace, such that, by 2035, type 1 blood glucose management may be no more onerous than a house thermostat due to the sophistication and ease-of-use made possible with the closed loop, biofeedback capabilities of the integrated glucometer, insulin pump and the algorithms that drive it, but that will not be the end of the development of better options for type 1 diabetics. Cell therapy for type 1 diabetes, which may be readily achieved by one or more of a wide variety of cellular approaches and product forms (including cell/device hybrids) may well have progressed by 2035 to become another viable alternative for type 1 diabetics.

  • Diabetes Type 2 (adult onset) will be a significant problem governed by different dynamics than Type 1. A large body of evidence will exist that shows dramatically reduced incidence of Type 2 associated with obesity management (gastric bypass, satiety drugs, etc.) that will mitigate the growing prevalence of Type 2, but research into pharmacologic or other therapies may at best achieve only modest advances. The problem will reside in the complexity of different Type 2 manifestation, the late onset of the condition in patients who are resistant to the necessary changes in lifestyle and the global epidemic that will challenge dissemination of new technologies and clinical practices to third world populations.

Despite increasing levels of attention being raised to the burden of type 2 worldwide, including all its sequellae (vascular, retinal, kidney and other diseases), the pace of growth globally in type 2 is still such that it will represent a problem and target for pharma, biotech, medical device, and other disciplines.

  • Cell therapy and tissue engineering will offer an enormous number of solutions for conditions currently treated inadequately, if at all. Below is an illustration of the range of applications currently available or in development, a list that will expand (along with successes in each) over the next 20 years.

    Cell therapy will have deeply penetrated virtually every medical specialty by 2035. Most advanced will be those that target less complex tissues: bone, muscle, skin, and select internal organ tissues (e.g., bioengineered bladder, others). However, development will have also followed the money. Currently, development and use of conventional technologies in areas like cardiology, vascular, and neurology entails high expenditure that creates enormous investment incentive that will drive steady development of cell therapy and tissue engineering over the next 20 years, with the goal of better, long-term and/or less costly solutions.
  • Gene therapy will be an option for a majority of genetically-based diseases (especially inherited diseases) and will offer clinical options for non-inherited conditions. Advances in the analysis of inheritance and expression of genes will also enable advanced interventions to either ameliorate or actually preempt the onset of genetic disease.

    As the human genome is the engineering plans for the human body, it is a potential mother lode for the future of medicine, but it remains a complex set of plans to elucidate and exploit for the development of therapies. While genetically-based diseases may readily be addressed by gene therapies in 2035, the host of other diseases that do not have obvious genetic components will resist giving up easy gene therapy solutions. Then again, within 20 years a number of reasonable advances in understanding and intervention could open the gate to widespread “gene therapy” (in some sense) for a breadth of diseases and conditions –> Case in point, the recent emergence of the gene-editing technology, CRISPR, has set the stage for practical applications to correct genetically-based conditions.
  • Drug development will be dramatically more sophisticated, reducing the development time and cost while resulting in drugs that are far more clinically effective (and less prone to side effects). This arises from drug candidates being evaluated via distributed processing systems (or quantum computer systems) that can predict efficacy and side effect without need of expensive and exhaustive animal or human testing.The development of effective drugs will have been accelerated by both modeling systems and increases in our understanding of disease and trauma, including pharmacogenomics to predict drug response. It may not as readily follow that the costs will be reduced, something that may only happen as a result of policy decisions.
  • Most surgical procedures will achieve the ability to be virtually non-invasive. Natural orifice transluminal endoscopic surgery (NOTES) will enable highly sophisticated surgery without ever making an abdominal or other (external) incision. Technologies like “gamma knife” and similar will have the ability to destroy tumors or ablate pathological tissue via completely external, energy-based systems.

    By 2035, technologies such as these will measurably reduce inpatient stays, on a per capita basis, since a significant reason for overnight stays is the trauma requiring recovery, and eliminating trauma is a major goal and advantage of minimally invasive technologies (e.g., especially the NOTES technology platform). A wide range of other technologies (e.g., gamma knife, minimally invasive surgery/intervention, etc.) across multiple categories (device, biotech, pharma) will also have emerged and succeeded in the market by producing therapeutic benefit while minimizing or eliminating collateral damage.

Information technology will radically improve patient management. Very sophisticated electronic patient records will dramatically improve patient care via reduction of contraindications, predictive systems to proactively manage disease and disease risk, and greatly improve the decision-making of physicians tasked with diagnosing and treating patients.There are few technical hurdles to the advancement of information technology in medicine, but even in 2035, infotech is very likely to still be facing real hurdles in its use as a result of the reluctance in healthcare to give up legacy systems and the inertia against change, despite the benefits.

  • Personalized medicine. Perfect matches between a condition and its treatment are the goal of personalized medicine, since patient-to-patient variation can reduce the efficacy of off-the-shelf treatment. The thinking behind gender-specific joint replacement has led to custom-printed 3D implants. The use of personalized medicine will also be manifested by testing to reveal potential emerging diseases or conditions, whose symptoms may be ameliorated or prevented by intervention before onset.
  • Systems biology will underlie the biology of most future medical advances in the next 20 years. Systems biology is a discipline focused on an integrated understanding of cell biology, physiology, genetics, chemistry, and a wide range of other individual medical and scientific disciplines. It represents an implicit recognition of an organism as an embodiment of multiple, interdependent organ systems and its processes, such that both pathology and wellness are understood from the perspective of the sum total of both the problem and the impact of possible solutions.This orientation will be intrinsic to the development of medical technologies, and will increasingly be represented by clinical trials that throw a much wider and longer-term net around relevant data, staff expertise encompassing more medical/scientific disciplines, and unforeseen solutions that present themselves as a result of this approach.Other technologies being developed aggressively now will have an impact over the next twenty years, including medical/surgical robots (or even biobots), neurotechnologies to diagnose, monitor, and treat a wide range of conditions (e.g., spinal cord injury, Alzheimer’s, Parkinson’s etc.).

The breadth and depth of advances in medicine over the next 20 years will be extraordinary, since many doors have been recently opened as a result of advances in genetics, cell biology, materials science, systems biology and others — with the collective advances further stimulating both learning and new product development. 


See the 2016 report #290, “Worldwide Markets for Medical and Surgical Sealants, Glues, and Hemostats, 2015-2022.”

Medtech fundings in April 2015

Fundings for medical technologies in April 2015 reached $615 million, led by the huge $225 million funding of Intarcia Therapeutics.

Below are the top fundings for the month.

Company, fundingProduct/technology
Intarcia Therapeutics has raised $225 million in a round of funding according to the companySubcutaneous, osmotic pump for drug delivery in type 2 diabetes
Mesoblast has raised $58.5 million in a round of funding by Celgene Corp.Precursor and stem cells for cell therapy
MyoKardia, Inc., has raised $46 million in a round of funding according to a regulatory filingGenetically based treatments for cardiomyopathies
Scanadu has raised $35 million in a Series B round of funding according to press reportsDevice that enables patients to scan and upload diagnostic information
Neuronetics, Inc., has completed a $34.3 million Series F funding round, according to the companyTranscranial magnetic stimulation for the treatment of depression
Lombard Medical, Inc., has raised $26 million in financing from Oxford Finance, LLCStent grafts for treatment of abdominal aortic aneurysm
EBR Systems, Inc., has raised $20 million in a round of funding according to the companyWireless cardiac pacing

For the complete list of medtech fundings in April 2015, see link.

For a historical list of the individual fundings in medtech, by month, since 2009, see link.

Tissue Engineering and Cell Therapy Market Outlook

The market for tissue engineering and cell therapy products is set to grow to nearly $32 billion by 2018. This figure includes bioengineered products that are themselves cells or are actively stimulating cell growth or regeneration, products that often represent a combination of biotechnology, medical device and pharmaceutical technologies. The largest segment in the overall market for regenerative medicine technologies and products comprises orthopedic applications. Other key sectors are cardiac and vascular disease, neurological diseases, diabetes, inflammatory diseases and dental decay and injury.

An overview (map) of the spectrum of clinical applications in tissue engineering and cell therapy is shown below:

Source: Report #S520

Cell therapy is defined as a process whereby new cells are introduced into tissue as a method of treating disease; the process may or may not include gene therapy. Forms of cell therapy can include: transplantation of autologous (from the patient) or allogeneic (from a donor) stem cells , transplantation of mature, functional cells, application of modified human cells used to produce a needed substance, xenotransplantation of non-human cells used to produce a needed substance, and transplantation of transdifferentiated cells derived from the patient’s differentiated cells.

Once considered a segment of biomaterial technologies, tissue engineering has evolved into its own category and now comprises a combination of cells, engineering and suitable biochemical and physiochemical factors to improve or replace biological functions. These include ways to repair or replace human tissue with applications in nearly every medical specialty. Regenerative medicine is often synonymous with tissue engineering but usually focuses on the use of stem cells.

Tissue engineering and cell therapy may be considered comprised of bioengineered products that are themselves cells or are actively stimulating cell growth or regeneration. These often comprise a combination of biotechnology, medical device and pharmaceutical technologies.

Researchers have been examining tissue engineering and cell therapy for roughly 30 years. While some products in some specialties (such as wound care) have reached market, many others are still in research and development stages. In recent years, large pharmaceutical and medical device companies have provided funding for smaller biotech companies in the hopes that some of these products and therapies will achieve a highly profitable, commercial status. In addition, some companies have been acquired by larger medical device and pharmaceutical companies looking to bring these technologies under their corporate umbrellas. Many of the remaining smaller companies received millions of privately funded dollars per year in research and development. In many cases it takes at least ten years to bring a product to the point where human clinical trials may be conducted. Because of the large amounts of capital to achieve this, several companies have presented promising technologies only to close their doors and/or sell the technology to a larger company due to lack of funds.

The goal of stem cell research is to develop therapies to treat human disease through methods other than medication. Key aspects of this research are to examine basic mechanisms of the cell cycle (including the expression of genes during the formation of embryos) as well as specialization and differentiation into human tissue, how and when the differentiation takes place and how differentiated cells may be coaxed to differentiate into a specific type of cell. In the differentiation process, stem cells are signaled to become a specific, specialized type of cell when internal signals controlled by a cell’s genes are interspersed across long strands of DNA and carry coded instructions for all the structures and functions of a cell. In addition, cell differentiation may be caused externally by use of chemicals secreted by other cells, physical contact with neighboring cells and certain molecules in the microenvironment.

The end goal of stem cell research is to develop therapies that will allow the repair or reversal of diseases that previously were largely untreatable or incurable.. These therapies include treatment of neurological conditions such as Alzheimer’s and Parkinson’s, repair or replacement of damaged organs such as the heart or liver, the growth of implants from autologous cells, and even regeneration of lost digits or limbs.

In a developing human embryo, a specific layer of cells normally become precursor cells to cells found only in the central nervous system or the digestive system or the skin, depending on the cell layer and the elements of the embryo that direct cell differentiation. Once differentiated, many of these cells can only become one kind of cell. However, researchers have discovered that adult body cells exist that are either stem cells or can be coaxed to become stem cells that have the ability to become virtually any type of human cell, thus paving the way to engineer adult stem cell that can bring about repair or regeneration of tissues or the reversal of previously incurable diseases.

Another unique characteristic of stem cells is that they are capable of self-division and self-renewal over long periods of time. Unlike muscle, blood or nerve cells, stem cells can proliferate many times. When exposed to ideal conditions in the laboratory, a relatively small sample of stem cells can eventually yield millions of cells.

There are five primary types of stem cells: totipotent early embryonic cells (which can differentiate into any kind of human cell); pluripotent blastocyst embryonic stem cells, which are found in an embryo seven days after fertilization and can become almost any kind of cell in the body; fetal stem cells, which appear after the eighth week of development; multipotent umbilical cord stem cells, which can only differentiate into a limited number of cell types; and unspecialized adult stem cells, which exist in already developed tissue (commonly nerves, blood, skin, bone and muscle) of any person after birth.

tissue-cell-2012-2018

Source: MedMarket Diligence, LLC; Report #S520, “Tissue Engineering & Cell Therapy Worldwide 2009-2018.”

Developmental Timescales

Tissue engineering and cellular therapy products take years of research and many millions of dollars (averaging about $300 million, according to some reports) before they make it over the hurdles of clinical trials and into actual market launch. More than one small biotech company has burned through its money too quickly and been unable to attract enough investment to keep the doors open. The large pharmaceutical and medical device companies are watching development carefully, and have frequently made deals or entered into alliances with the biotechs, but they have learned to be cautious about footing the bill for development of a product that, in the end, may never sell.

For many of the products in development, product launch is likely to occur within five years. Exceptions include skin and certain bone and cartilage products, which are already on the market. Other products are likely to appear on the European market before launch in the United States, due to the presence of (so far) less stringent product review and approval laws in the European Union.

Even when the products are launched, take-up will be far from 100% of all patients with that particular condition. Initially, tissue engineering and cell therapy products will go to patients suffering from cancers and other life-threatening conditions, who, for example, are unable to wait any longer for a donor organ. Patients who seem to be near the end of their natural lives likely will not receive these treatments. Insurance coverage will certainly play a key role as well in the decision about who receives which treatments and when. But most importantly, physicians will be selecting who among their patients will be treated; the physicians learn about the treatments by using them, by observing the patient’s reactions, and by discussing their experiences with colleagues. In other words, the application of tissue engineering and cellular therapy will progress in a manner similar to the introduction of any new technology: through generally conservative usage by skilled, highly trained physicians dedicated to providing their patients with the best possible treatment without causing them additional harm.

 

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Applications, global markets in tissue engineering and cell therapy

Screen Shot 2014-04-17 at 7.37.44 AMThe market for tissue engineering and cell therapy products is set to grow from a respectable $8.3 billion in 2010 to nearly $32 billion by 2018. This figure includes bioengineered products that are themselves cells or are actively stimulating cell growth or regeneration, products that often represent a combination of biotechnology, medical device and pharmaceutical technologies. The largest segment in the overall market for regenerative medicine technologies and products comprises orthopedic applications. Other key sectors are cardiac and vascular disease, neurological diseases, diabetes, inflammatory diseases and dental decay and injury.

Cell-tissue-applications

Factors that are expected to influence this market and its explosive growth include political forces, government funding, clinical trial results, industry investments (or lack thereof), and an increasing awareness among both physicians and the general public of the accessibility of cell therapies for medical applications. Changes in the U.S. government’s federal funding of embryonic stem cell research has given a potentially critical mass of researchers increased access to additional lines of embryonic stem cells. This is expected to result in an increase in the number of research projects being conducted and thus possibly hasten the commercialization of certain products.

regional-forecast

Source: Report #S520, “Tissue Engineering, Cell Therapy and Transplantation: Products, Technologies & Market Opportunities, Worldwide, 2009-2018.”

Another factor that has influenced the advancement of regenerative technologies is found in China, where the Chinese government has encouraged and sponsored cutting-edge (and some have complained ethically questionable) research. While China’s Ministry of Health has since (in May 2009) established a policy requiring proof of safety and efficacy studies for all gene and stem cell therapies, the fact remains that this research in China has spurred the advancement of (or at least awareness of) newer applications and capabilities of gene and stem cell therapy in medicine.

Meanwhile, stricter regulations in other areas of Asia (particularly Japan) will serve to temper the overall growth of commercialized tissue and cell therapy–based products in that region. Nonetheless, the growth rate in the Asia/Pacific region is expected to be a very robust 20% annually.


MedMarket Diligence’s Report #S520 remains the most comprehensive and credible study of the current and project market for products and technologies in cell therapy and tissue engineering.

Tissue engineering and cell therapy market

Stem cell therapy has the potential to treat a broad range of acute and chronic degenerative diseases. These applications include: hematopoietic cells for blood diseases and cancer, myocardial and endothelial vascular tissue for cardiovascular disease, congestive heart failure, myocardial infarction and other cardiovascular disease skin cells for dermatological conditions, retinal pigment epithelium cells as treatment for macular degeneration and retinal pigmentosis, neural cells for spinal cord injury, Parkinson's disease and other neurodegenerative diseases, pancreatic islet ß cells for diabetes, liver cells for hepatitis and cirrhosis, cartilage cells for arthritis, and lung cells for a variety of pulmonary diseases. As populations age in developed countries, the need to treat increasing numbers of people with these disorders is likewise increasing.

With increased attention being paid to the need for these technologies, researchers have been reporting promising results in several areas.

In results reported in 2009, scientists from MIT found that stem cells can improve stem cells’ ability to regenerate vascular tissue by equipping them with genes that produce extra growth factors. These results were produced in mice; specially developed nanoparticles were used to deliver vascular endothelial growth factor to stem cells removed from the mouses’ bone marrow. The enhanced stem cells were then implanted into damaged tissue, where they regenerated blood vessles near the injury, thus allowing the damaged tissue to survive.

Other results reported in 2009 (Proceedings of the National Academy of Sciences, September 2009) showed researchers have had some success in engineering human tissue patches for cardiovascular repair. These clinicians (from the University of Washington, led by Dr. Charles Murry) created disk-shaped patches measuring less than a millimeter up to a half-inch in diameter decided to examine the possibility of creating new tissue with supply lines for oxygen and nutrients needed by living cells. Previously, heart tissue patches composed of only heart muscle cells could not grow big enough or survive long enough to adhere to the heart once implanted. Researchers added to the heart muscle cell mixture two other types of cells similar to those inside blood vessels and cells that provide vascular muscular support. All of the heart muscle cells were derived from embryonic stem cells or a variety of more mature sources such as umbilical cord blood. The result was seen in the formation of tissue containing tiny blood vessels.

On the orthopedic front, adult stem cells were used to regrow a 14-year-old boy’s missing cheekbones at the Cincinnati Children’s Hospital Medical Center. The technique used reengineered autologous stem cells.

In another example, scientists at the University of Bristol developed new scaffolds that can be used to grow such tissues as skin, nerves and cartilage. They built the scaffolds by using proteins from alpha helices to create long fibers (hydrogelating self-assembling fibers or hydrogels).

Unmet Clinical Needs

Allotransplantation (the transplanting of donated organs or tissues from a cadaver or a living donor) works effectively but has a couple of significant drawbacks. First, the number of organs available for donation is always far smaller than the number of organs and tissues needed by patients. According to the U.S. Department of Health and Human Services, there were more than 102,000 people in the United States alone waiting for donated organs in 2007; many of those on the waiting list die before a suitable organ or tissue becomes available. Secondly, even when an organ becomes available, organ transplant is a very expensive procedure. In addition, if the procedure is successful, the transplant recipient may often need to take immunosuppressive drugs, sometimes for life. Yet another factor in the equation is the cost of keeping patients alive while awaiting a donor, or caring for them until they die if no donor is found.  

One solution to this would be to use genetically designed pigs, animals whose organs would present minimal immunologic reaction to the host. Such animals (the pig is often cited because most of its internal organs are similar to human organs) could potentially present an unlimited supply of organs for donation to and implantation in humans. 

Designing a genetically engineered pig that is capable of carrying human immune proteins has been the focus of select researchers at the Shanghai Institute of Biochemistry and Cell Biology. Results published in 2009 in the Journal of Molecular Cell Biology showed how the scientists successfully reprogrammed pig skin and bone marrow cells into an embryo-like state with the potential to form every type of body tissue. The successful creation of pig pluripotent stem cells would enable engineering of transgenic animals for organ transplantation purposes. The embryonic or induced stem cellscould be used to modify the immune-related genes in the pig to make the pig’s organs compatible to the human immune system, thus allowing the pigs to be used as organ donors without triggering an adverse reaction from the patient’s own immune system.

Another solution would be, of course, tissue engineering and cell therapy. There are hundreds of companies working in the field of tissue engineering, expanding the procedures, devices, cell-based products, biomaterial-based products and other products for the repair and regeneration of damaged tissues.

See the current (2011) market for tissue engineering and cell therapy by area of clinical focus.

Source: MedMarket Diligence, LLC; Report #S520, "Tissue Engineering, Cell Therapy and Transplantation: Products, Technologies & Market Opportunities, Worldwide, 2009-2018."

 

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Cell Matrices in Tissue Engineering

The search for synthetic-based biocompatible materials has posed particular problems for researchers in that no synthetic material is completely accepted and integrated by the body. Therefore, the goal has been to create a replacement tissue that closely mimics natural tissue and will activate normal body healing and tissue reconstruction, and eventually be resorbed harmlessly into the body after normal healing has begun.

Scaffolds used to grow the tissue must be biocompatible, biodegradable, and bioabsorbable and must have a surface chemistry that promotes cell adhesion and growth. They also must have a specific porosity and pore size dependent upon the type of tissue to be grown and be able to degrade within the desired time frame. It must have the capability to be molded into a variety of desired shapes.

[Inset. Source: 3DM, Inc.]

The goal in bone tissue engineering is to have a composite with surface and microstructural attributes that promote good cell adhesion and vascularization, that have the necessary transport channels for good cell activity, that has the right three-dimensional network to serve as a substitute for bone under both static and dynamic, weight-bearing conditions, and will be resorbed at an appropriate rate—neither too fast nor too slowly. Even titanium, currently considered virtually the gold standard for implant materials (such as replacement hip joints) is not ideal, and eventually shows failure.

A range of bioceramic and polymer scaffold materials developed so far for bone tissue applications include: coralline hydroxyapatite, calcium carbonate, poly(lactic acid) (PLA), poly(glycolic acid) (PGA) and copolymers of PLA and PGA, as well as new polymer systems like poly(propylene fumarate) and polyarylates. Composites have been used to compensate for the fact that no single material has fulfilled all the necessary functions.

Neuronal tissue is notoriously difficult to replace; even when autologous nerves are used, function is at best about 50% of normal. Again various synthetic materials are being investigated for use as scaffolds, including PLLA poly (L-Lactic Acid) and PLGA poly (DL-glycoloic acid). The ideal scaffold will probably be a combination of synthetic and natural materials.


(The above is an excerpt from Report #S520, "Tissue Engineering, Cell Therapy and Transplantation: Products, Technologies & Market Opportunities, Worldwide, 2009-2018.")

Cell Therapy and Cardiovascular Disease

Cell therapy is defined as a process whereby new cells are introduced into tissue as a method of treating disease; the process may or may not include gene therapy. Forms of cell therapy can include: transplantation of autologous (from the patient) or allogeneic (from a donor) stem cells , transplantation of mature, functional cells, application of modified human cells used to produce a needed substance, xenotransplantation of non-human cells used to produce a needed substance, and transplantation of transdifferentiated cells derived from the patient’s differentiated cells.

Once considered a segment of biomaterial technologies, tissue engineering has evolved into its own category and now comprises a combination of cells, engineering and suitable biochemical and physiochemical factors to improve or replace biological functions. These include ways to repair or replace human tissue with applications in nearly every medical specialty. Regenerative medicine is often synonymous with tissue engineering but usually focuses on the use of stem cells.

Tissue engineering and cell therapy may be considered as comprising bioengineered products that are themselves cells or are actively stimulating cell growth or regeneration. These often comprise a combination of biotechnology, medical device and pharmaceutical technologies.

Researchers have been examining tissue engineering and cell therapy for roughly 30 years. While some products in some specialties (such as wound care) have reached market, many others are still in research and development stages. In recent years, large pharmaceutical and medical device companies have provided funding for smaller biotech companies in the hopes that some of these products and therapies will achieve a highly profitable, commercial status. In addition, some companies have been acquired by larger medical device and pharmaceutical companies looking to bring these technologies under their corporate umbrellas. Many of the remaining smaller companies received millions of privately funded dollars per year in research and development. In many cases it takes at least ten years to bring a product to the point where human clinical trials may be conducted. Because of the large amounts of capital to achieve this, several companies have presented promising technologies only to close their doors and/or sell the technology to a larger company due to lack of funds.

The goal of stem cell research is to develop therapies to treat human disease through methods other than medication. Key aspects of this research are to examine basic mechanisms of the cell cycle (including the expression of genes during the formation of embryos) as well as specialization and differentiation into human tissue, how and when the differentiation takes place and how differentiated cells may be coaxed to differentiate into a specific type of cell. In the differentiation process, stem cells are signaled to become a specific, specialized type of cell when internal signals controlled by a cell’s genes are interspersed across long strands of DNA and carry coded instructions for all the structures and functions of a cell. In addition, cell differentiation may be caused externally by use of chemicals secreted by other cells, physical contact with neighboring cells and certain molecules in the microenvironment.

The end goal of stem cell research is to develop therapies that will allow the repair or reversal of diseases that previously were largely untreatable or incurable. These therapies include treatment of neurological conditions such as Alzheimer’s and Parkinson’s, repair or replacement of damaged organs such as the heart or liver, the growth of implants from autologous cells, and even regeneration of lost digits or limbs.

In a developing human embryo, a specific layer of cells normally become precursor cells to cells found only in the central nervous system or the digestive system or the skin, depending on the cell layer and the elements of the embryo that direct cell differentiation. Once differentiated, many of these cells can only become one kind of cell. However, researchers have discovered that adult body cells exist that are either stem cells or can be coaxed to become stem cells that have the ability to become virtually any type of human cell, thus paving the way to engineer adult stem cell that can bring about repair or regeneration of tissues or the reversal of previously incurable diseases.

Another unique characteristic of stem cells is that they are capable of self-division and self-renewal over long periods of time. Unlike muscle, blood or nerve cells, stem cells can proliferate many times. When exposed to ideal conditions in the laboratory, a relatively small sample of stem cells can eventually yield millions of cells.

There are five primary types of stem cells: totipotent early embryonic cells (which can differentiate into any kind of human cell); pluripotent blastocyst embryonic stem cells, which are found in an embryo seven days after fertilization and can become almost any kind of cell in the body; fetal stem cells, which appear after the eighth week of development; multipotent umbilical cord stem cells, which can only differentiate into a limited number of cell types; and unspecialized adult stem cells, which exist in already developed tissue (commonly nerves, blood, skin, bone and muscle) of any person after birth.

One of the key methods by which to evaluate the potential market opportunities in the early stages of an industry such as tissue engineering and cellular therapy is to look at the number of current procedures that could possibly be augmented or replaced by the new technologies. In the sections that follow, we review the major areas of transplantation and estimate the clinical caseloads that reflect potential uses of tissue engineering. It should be kept in mind that it is highly unlikely that tissue engineering will replace 100% of these particular procedures, even after years of clinical usage. There will always be patients for whom certain procedures are inappropriate; other procedures may not be fully covered by insurance and hence will only be used by those patients who can afford them. Transplant of cadaver organs is likely to continue as long as these organs are available and free of disease, and the cost of transplantation is equal to or less than the cost of tissue engineering. The latter, of course, reflects a key pricing strategy for tissue engineering and cellular therapy. The clinical caseloads for the conditions addressed are enormous, hence, even with the caveats, the potential markets for TE and cell therapy are extremely significant. The competition within the infant industry is fierce, with reason.

Cell Therapy in Cardiovascular Disease

The term “cardiovascular disease” encompasses as large number of diseases of the heart and vasculature. There are an estimated 70 million Americans who could benefit from cell-based therapies for cardiovascular applications. The prevalence and incidence of cardiovascular disease in the United States are shown in the following exhibits.

Source: MedMarket Diligence Report #S520: Tissue Engineering, Cell Therapy and Transplantation: Products, Technologies & Market Opportunities, Worldwide, 2009-2018

Revenues in Cell Therapy and Tissue Engineering Exceeding Expectations

The number of companies with approved products and measurable revenues in the field of cell therapy and tissue engineering has exceeded the expectation of many (though not all) in the industry.

Markets such as cell/tissue are often characterized by overestimated evaluations of commercial potential and underestimated consideration of the actual challenges. Indeed many technology challenges remain to be overcome if any significant portion of the purported potential of tissue engineering or cell therapy (in particular) is to be realized. Nonetheless, our estimate of only a few years ago (which were considered optimistic by some and conservative by others) has been eclipsed by the reality of substantial market growth, with 2009 revenues in cell therapy and tissue engineering at nearly $7 billion.

Source:  In process (draft) projections by MedMarket Diligence, LLC; Report #S520.

Commercial success in tissue engineering, cell therapy and transplantation

Tissue engineering involves taking either autologous, allogeneic or xenogeneic cells and redirecting those cells to carry out fundamental processes. Often the researcher will use a biomaterial matrix and seed the cells into this matrix. The redirection may take the form of stimulating the cells to become stem cells or precursor cells, or it may mean genetic modification of those cells. The processes which may be carried out seem almost infinite in variety: from regenerating heart muscle cells (myocytes) damaged from a heart attack, to regrowing islet cells to answer the body’s need for insulin and glucose regulation, to regrowing a thumb, including bone, cartilage, vasculature and skin. According to current industry and academic research, the potential exists to cure neurological and immunological disorders such as Parkinson’s, multiple sclerosis, and many cancers; to regrow most or all of an organ that has been damaged through disease or trauma, including the kidney, liver, intestine, bone, skin and pancreas; to take a cell sample from a patient and grow it into a new tooth bud which can be transplanted into the patient’s jaw to replace a missing tooth; and to grow blood vessels for use in coronary artery bypass graft, thereby avoiding the surgical process and pain inherent in harvesting the saphenous vein. It seems that tissue engineering and cell therapy may find applications in every system in the body.

At least 250 companies in the US, Europe and the Far East are working in tissue engineering and regenerative medicine. The larger pharmaceutical and medical device companies have initially been cautious about investing in and/or developing tissue engineering therapeutics, but a consensus recognizes that a full consideration of the device or drug industry's competitive landscape is incomplete if not factoring the possibilities of tissue engineered or cell therapy solutions.

tissue-pieThe US alone spends nearly $35 billion annually to care for patients with end stage organ failure. The alternatives are basically organ transplant, living on indefinite hold with an organ substitute such as kidney dialysis, if such a substitute exists, or death. According to the United Network for Organ Sharing (UNOS), at any one time in the US there are some 80,000 people waiting for donated organs, many of whom die before a suitable organ or tissue becomes available. If a suitable organ can be procured, the transplant procedure itself is very expensive, and not always successful. If it succeeds and the organ functions as intended, then the patient usually must take expensive immuno-suppressive drugs for life. Physicians and researchers have long sought other means to treat these patients, and tissue engineering is one avenue of significant promise.

The major areas of clinical need for alternative treatments are generally also those areas most attractive to companies, which must ultimately recoup their heavy research and development investments. These areas include cardiology, neurology, orthopedics, urology, skin, dental and organ replacement and regeneration.

Research and development in tissue engineering and cell therapy have been accelerating, which has led to a steady stream of commercial developments, including product launches.  The existing market therefore already stands at over $500 million and the growth curve on the markets for these technologies does not appear to be leveling soon, with compound annual growth rates for the aggregate of tissue/cell therapy markets exceeding 20%.


The global market for tissue engineering, cell therapy and tissue/organ transplantation is the subject of pending report #S520, from MedMarket Diligence.

Tissue Engineering, Cell Therapy and Transplantation: Products, Technologies & Market Opportunities, Worldwide, 2009-2018

Publishing a new report in December 2009:  Tissue Engineering, Cell Therapy and Transplantation:


Tissue Engineering, Cell Therapy and Transplantation: Products, Technologies & Market Opportunities, Worldwide, 2009-2018.

This report examines the status of technologies, applications and markets for tissue engineering, cell therapy and tissue/cell transplantation. The report reviews therapeutic tissue engineering, tissue reconstruction, cell therapies, tissue/organ transplantation and related technologies under various stages of development at over 150 companies. The report details the technology development, projected market introduction dates and/or current and forecast market size and competitor shares for products being developed to address major causes of death and disease spanning applications in cardiovascular, neurological, orthopaedic, urological, skin, dental, ophthalmological, gastroointestinal, organ transplant, cancer and others. The report details the status of product development and assesses the current and forecast worldwide market for tissue engineering, cell therapy and transplantation.

The report provides market size and share data, with forecast market data to 2018, for the U.S., Europe, Asia/Pacific and Rest of World.

The report establishes the current worldwide market size for major technology segments as a baseline for and projecting growth in the market over a ten-year forecast and assesses and projects the composition of the market as technologies gain or lose relative market performance over this period. 

The report is described, with preliminary table of contents, at link.