MINNESOTA HEALTH CARE ROUNDTABLE
TH 48 SESSION
REGENERATIVE MEDICINE Efficacy, Economics, and Evolution It is fair to say that regenerative medicine is a lot like the Wild West. Things are happening fast, laws are sometimes hard to find, and sometimes things are made up on the fly. It is a field that is evolving so quickly that it is not widely understood, though this is quickly changing. Let’s start by defining regenerative medicine. DAVID BROWN: Rarely do two people agree on what constitutes regenerative
Minnesota Physician Publishing’s 48th Minnesota Health Care Roundtable focused on the topic of Regenerative Medicine: Efficacy, Economics, and Evolution. Seven panelists and our moderator, Minnesota Physician Publisher Mike Starnes, met on December 12, 2017, to discuss this topic.
medicine. Last October, a combined group of the National Academies of Sciences, Engineering, and Medicine got together at a workshop exploring the state and science of regenerative medicine. The workshop introduced it as technology with the potential to create living functional cells and tissues that can be used to repair or replace those that have been irreparably damaged due to specific diseases, age, trauma, genetic, or congenital defects. They then looked at four targeted therapies in the areas of cell therapies, gene therapies, tissue engineering, and non-biologic constructs such as signal models and scaffolding. The operating paradigm for this was identifying the right cell to the right target with the right function to the right patient.
certain connotations—but autologous [patient-derived] biocellular treatment using a pool of regenerative cells contained within the patient’s own body.
BLAKE JOHNSON: We are looking at not just replacement, but also rejuvenation
MERI FIRPO: In the laboratory we can use regenerative medicine to identify
of tissue, restoring tissue and organs to their original function when they have been injured or undergone degeneration. We are simply facilitating the innate ability of the body to do that, rather than using pharmacology or surgery as our primary modalities. Instead, we harness the body’s own ability to perform those functions, concentrating them, and serving as both a catalyst and an accelerator for the body’s natural processes.
drugs, for example. We use stem cells all the time as a model system to understand diseases, and we can make stem cells from people who have diseases and do comparative studies. We can model through these degenerative diseases in the laboratory and even come up with novel drug therapies, and I would still call that regenerative medicine. I think it is the approach of looking at these cellular processes in a way of trying to work within the cellular functions to heal the body.
RON HANSON: It is a little broader than that. It is all of the things that
change the issues within the body and the body’s ability to heal on its own— not just the procedural, not just the cellular aspects, but what is the diet, what is the exercise, what is the sleep, what is the mindset of the individual, and doing this from a very broad approach rather than just what is the cell, what is the area that you are putting it into? ROGER HOGUE: Regenerative medicine has a very large scope. As a physician
that performs regenerative medicine, I view myself as a mere catalyst. I look at being able to take a patient’s regenerative capabilities, whether it comes from their bone marrow, their blood, or their fat, and, as a catalyst, allowing them to be able to repair and rejuvenate and replace what is ailed. If you replete regenerative cells that have been depleted, the body has the capability to heal itself. We don’t call these stem cell treatments—because “stem cell” has
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FEBRUARY 2018 MINNESOTA PHYSICIAN
The next roundtable on April 26, 2018, will address The Opioid Epidemic: Complex Problems, Complex Solutions.
Does that touch on the concept of the difference between the structure and function of regenerative medicine? DAVID BROWN: To me, regenerative medicine is enhancing or reintroducing
where a particular biologic expression has been incapacitated. It focuses on the normal mechanisms the body uses, biochemically or genetically, to carry out these functions. Whether it is by drug, whether by cell, or whether by genome editing, we simply facilitate that normal biologic expression. I would look more at the phenotypes that result from those underlying processes in terms of either healing disease or improving the status of the individual as what you referred to as the structural component. I was discussing the functional first, and those phenotypic expressions would be the structural component.