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Tissue Engineering: An Introduction


An emerging biology-based industry that will produce the next generation of medical ... Appligraf (Organogenesis/1997) Dermagraft (ATS/2001) Orcel (Ortec/2001) ... – PowerPoint PPT presentation

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Title: Tissue Engineering: An Introduction

Tissue Engineering An Introduction
  • Robert M. Nerem

Tissue Engineering
  • Biological substitutes/therapies to repair,
    replace, or enhance tissue function
  • An emerging biology-based industry that will
    produce the next generation of medical implants
  • At the interface of the biological revolution and
    the traditional medical implant industry
  • An industry where the engineering will be
    revolutionized by advances in biology

Regenerative Medicine
  • The replacement, repair, and/or regeneration of
  • Tissue engineering term coined in 1987
  • Regenerative medicine term began to be used in
    mid 1990s
  • Many use these terms interchangeably

Historical Perspective
  • Prior to 1950 references to the concept of tissue
    engineering may be found in the literature
  • In the 1970s and 1980s research on what we now
    call tissue engineering emerges
  • In 1987 the term tissue engineering is coined
  • In 1988 the first meeting called tissue
    engineering is held at Lake Tahoe
  • In the 1990s research accelerates and an industry
    begins to emerge

(No Transcript)
Ive thought a lot about this Charlie, and I
believe that when Historians look back at the
twentieth century the greatest scientific
achievement will not be space travel or
computers but will be in the fields of tissue
engineering and genetic medicine Dr Michael
Guillen, ABC Science Correspondent 29 September
Tissue Engineered Skin Substitutes
  • Initial tissue engineering products have been for
    the most part skin substitutes
  • Not just a covering, but a wound-healing agent
  • Have not been as successful commercially as hoped
  • Have provided insight, however, into what some of
    the critical issues are

Tissue Engineered Products on the U.S. Market
  • Carticel (Genzyme/1997)
  • Transcyte (ATS/1997)
  • Appligraf (Organogenesis/1997)
  • Dermagraft (ATS/2001)
  • Orcel (Ortec/2001)

DERMAGRAFT on Traumatic Wounds
Cartilage Repair
  • Genzymes Carticel is on the market, works for
    focal defects
  • Autologous cells are expanded and then implanted
  • Next step is a chondrocyte-seeded scaffold
  • Everyone thought that after skin this would be a
    slamdunk it is not

Issues for Cartilage Replacement
  • Cell source and phenotype, scaffold
  • Osteo-chondral integration
  • Mechanical properties

Critical Issues
  • Addressing issues of cell sourcing
  • Controlling cell function
  • Developing interactive biomaterials
  • Engineering 3D constructs/healing responses
  • Scaling up manufacturing processes
  • Preserving manufactured products
  • Controlling in vivo biological responses
  • Engineering immune acceptance
  • Assessing post-implantation viability

Georgia Tech / Emory Center for the Engineering
of Living Tissues (GTEC)
  • NSF Engineering Research Center
  • Established in 1998
  • Built on the 1993 Whitaker Award
  • 32 faculty principal investigators 16 from
    Georgia Tech, 12 from Emory, one from the
    University of Georgia, and three from Morehouse
    School of Medicine
  • 19 industrial partners
  • Focus on core, enabling technologies

Industrial Educational Partners
  • Aderans Research Institute, Inc.
  • Allograft Solutions
  • AtheroGenics
  • Battelle Memorial Institute
  • Boston Scientific Corporation
  • BresaGen
  • Cell Dynamics
  • Cook Biotech
  • Edwards Life Sciences
  • EnduraTEC Systems
  • Genzyme Corporation
  • Guidant Corporation
  • Johnson and Johnson
  • Medtronic
  • Organ Recovery Systems
  • OrthoLogic Corporation
  • Smith and Nephew
  • St. Jude Medical
  • Serologicals

GTECs Matrix Strategy for the Enabling Core
Integration into Living Systems
Clinical Application
Construct Technology
Cell Technology
Blood Vessels Heart Valves Myocardial
Patches Diabetes Liver Failure Bone
and Cartilage Defects Neural Tissues Neural
Cardiovascular Substitutes
The tools made available by the
biological revolution
Metabolic, Secretory Organs
Orthopaedic Tissue Engineering
Neural Tissue Engineering
Cell Technology
  • Cell Source
  • Autologous cells
  • Allogeneic, xenogeneic cells
  • Stem cells/progenitor cells
  • Manipulation of cell function
  • Extracellular environment
  • Genetic engineering

Stem Cell Technology Beyond the Science
  • Cell expansion/bioreactor technology
  • Process quality control
  • Delivery systems/incorporation into constructs

Construct Technology
  • Construct engineering
  • 3D architecture
  • Functionality
  • Manufacturing technology
  • Process scaleup
  • Product preservation

Integrating Cells into Scaffolds
  • A multi-cellular system is needed to mimic native
  • A three-dimensional architecture can be provided
    by a scaffold into/onto which cells are seeded
  • The scaffold could be biological, made of a
    synthetic material, e.g. a polymer, or be a
  • Cells in three dimensions are very different from
    cells in monolayer culture

Biological Responses and Their Control
  • Immune acceptance/rejection
  • Remodeling
  • Thrombotic responses

The Transplantation Crisis
  • A record 75,131 Americans await single- and
    multiple-organ transplants
  • Of those on the waiting list, 15 die each day
  • There is an ever increasing patient need, but not
    much of an increase in donor organs
  • Tissue engineering has the potential to confront
    this crisis

Transplantation Crisis
People on List Days to Wait
  • Heart
  • Liver
  • Kidney
  • Pancreas

4,121 12,070 38,270 725
206 517 1,099 179
Transplantation Crisis Liver
1990 1,237 43
1998 12,070 512
  • People on Waiting List
  • Days to Wait

Some Tissue Engineering Applications
  • Blood Vessels
  • Heart Valves
  • Myocardial Patches
  • Heart
  • Bioartificial Pancreas
  • Kidney
  • Liver
  • Severe Burns
  • Skin ulcers
  • Facial reconstruction
  • Cartilage
  • Tendons
  • Ligaments
  • Bone

Cardiovascular Tissue Engineering
  • Small Diameter Blood Vessels
  • Heart Valves
  • Myocardial Patches
  • Basic Components of the Heart

Cardiovascular Tissue Engineering
  • Myocardial repair cell implantation in clinical
  • Myocardial patches technology under development,
    at least five years away
  • Small diameter blood vessel substitutes a number
    of different concepts being pursued, but clinical
    trials at least five years away and FDA approval
    10 years
  • Heart valves may be the biggest challenge, more
    than a decade away

Bioartificial Pancreas
  • Sourcing of functional cells
  • Materials
  • Architecture for construct function and
  • Immune acceptance
  • Monitoring for in vivo function

Cell technology
Construct technology
Technologies for integration into living systems
Liver Tissue Engineering
  • Liver is a very complex organ, has the ability to
  • Extracorporeal systems under development
  • An implantable bioartificial liver is decades away

Functional Tissue Engineering
  • What functional characteristics are essential?
  • How do we engineer in functionality?
  • How do we assess functional properties?
  • What are the standards used to measure success?

Tissue Engineering Industry 2001
  • 66 Companies
  • 3100 employees
  • 580 million annual investment
  • 16 annual growth rate

Tissue Engineering Industry 2003
  • 99 companies
  • 3400 employees
  • 675 million annual investment
  • 14 annual growth rate

Source M.J. Lysaght (2002)
Key Trends Since 2001
  • 26 firms increased in size
  • 21 firms decreased in size
  • 4 have gone out of business
  • 3 no longer have tissue engineered products
  • 70 of new firms are in stem cells
  • 40 of new firms located outside of the U.S.

2003 Product Scorecard
Tissue Engineering 2003
  • Lack luster sales of approved products
  • A high failure rate of mandated clinical trials
  • A threadbare pipeline of products in clinical

Bringing a Product to Market
  • Even for a simple product a 150-250 million
  • Compared to early expectations, it has been more
    complicated, more costly, and more time consuming
  • This is a pharmaceutical size investment, with
    the return on investment of a device size

A Challenge for Tissue Engineering
The introduction of a tissue-engineered product
into the clinical arena requires major changes in
treatment, in the financial management of the
treatment, and in the reimbursement process.
Tissue Engineering Industry 2003
  • A fledgling industry, combined sales in 2001 less
    than 50 million
  • None of the current clinical trials suggest
    products that will be blockbusters
  • Over 200 million has been invested in the
    bioartificial pancreas to date without a real
    product on the horizon
  • Even so, tissue engineering has tremendous long
    term potential
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