title: Meeting the need for regenerative therapies: translation-focused analysis of U.S. regenerative medicine opportunities in cardiovascular and peripheral vascular medicine using detailed incidence data.
abstract: Cardiac and vascular diseases represent one of the most substantial medical areas for the applications of regenerative medicine. Despite advances in endovascular repair, surgical intervention, and disease management, atherosclerosis and heart failure continue to be prominent health problems. This report analyzes the regenerative medicine treatment opportunities in both cardiovascular and peripheral vascular repair, examining the treatment opportunities for tissue-engineered vascular grafts as well as cell-based therapies. U.S. hospital discharge data were used to generate a detailed estimate of the relative target populations for cardiac and vascular disease. Gap analyses were performed for vascular access, small caliber vascular grafts, and cell-based therapies for revascularization and heart failure. The analysis compared current alternatives, gaps in medical need, and what a tissue-engineered or regenerative alternative should achieve for optimum medical and commercial feasibility. Although the number of coronary bypass grafts vastly outnumbered peripheral grafts, a detailed consideration of re-grafts and the success of first grafts combined with gap analysis (GAP) leads us to conclude that peripheral vascular disease is the more commercially feasible and attractive target opportunity for engineered small caliber grafts for the foreseeable future. Cardiac bypass would need substantial long-term clinical experience, which could be a significant hurdle. Vascular access, often regarded as a first-in-man indication, is an excellent opportunity for an engineered graft as an alternative to arteriovenous fistula that could overcome complications associated with a prosthetic graft. The GAP also suggests that for heart failure, cellular therapies should link near-term changes in repair, such as improvement in cardiac output and reduced scarring with limiting progression of the disease, reducing the need for complex pharmacologic management, and reducing rates of hospitalization. Naturally, researchers must determine where their technology and know-how can be applied most effectively, but it is clear from our analysis that an astute strategy in the use of science and technology will be important to successful translation in this space.
authors.affiliation: The McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Tillman
authors.forename: Janet
authors.initials: J
authors.lastname: Hardin-Young
authors.forename: William
authors.initials: W
authors.lastname: Shannon
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Russell
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Parenteau
mesh_terms: D001807:Blood Vessel Prosthesis; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D015994:Incidence; D015995:Prevalence; D044968:Regenerative Medicine; D057170:Translational Research, Biomedical; D014481:United States / Q000453:epidemiology; D014945:Wound Healing