Top Ten Regenerative Medicine Applications for Improving Health in Developing Countries
An international panel of 44 experts, including researchers in disciplines contributing to regenerative medicine and clinicians working in fields that will be at the forefront of applying regenerative medicine therapies, participated in a technology foresight study to identify the ten most promising applications of regenerative medicine for improving health in developing countries (Table S1). We made a conscious effort to balance specialty areas within regenerative medicine, geographic distribution (see Figure 1), and gender representation on the expert panel. Seventy-seven percent of the panellists lived in developing countries as defined in the United Nations Human Development Report 2005.[15]
Figure 1.
Countries Represented on the Expert Panel potentially provide more affordable treatments than corneal grafts and could address current shortages of donor material.
A modified Delphi method, as described in two previous studies,[16,17] was used to build consensus among the experts through a series of three rounds. Communication with the panellists occurred primarily via e-mail, while phone and fax served as supporting and alternative means of contact. In the first round, panellists were asked the open-ended question, "What do you think are the clinical applications of regenerative medicine that are the most likely to improve the health of people in developing countries within the next ten years?" We provided the definition of regenerative medicine that is shown in the sidebar.
This definition was developed based on a previously published definition,[6] which was modified and validated based on input from regenerative medicine experts external to the panel. In response to the open-ended question, panellists proposed applications and provided comments to support their suggestions. Results were analyzed and grouped according to common themes, while suggestions that did not fit within the definition of regenerative medicine were omitted. The resulting list was reviewed for face validity by two experts in regenerative medicine external to the panel.
In the second round, panellists were asked to rank their top ten choices from the list of 29 applications derived from the first round. The rankings of each panellist were added together to provide a cumulative score for each application. In order to provide an increased number of choices and more accurate results, the top 14 applications were chosen to redistribute to the panellists for the third round along with a brief summary of the panellists' reasons supporting each choice. Consensus was consolidated as panellists were asked to either agree with the ranking or to re-rank their top ten choices from the list of 14. In addition, concrete examples were gathered from the panellists in the third round. The panellists' comments were used to identify six criteria that informed their choices ( Box 1 ).
Figure 2 contains the list of the ten regenerative medicine applications considered by the panellists to be the most promising for improving health in developing countries. There was a high degree of consensus with regard to the top five applications: all panellists except one ranked at least three of the top five applications in their own top five responses. The number one ranked application, "Novel methods of insulin replacement and pancreatic islet cell regeneration for diabetes" received 415 points out of a possible maximum of 440 (44 × 10), and was ranked in first position by 35 of the 44 panellists. Due to space restrictions, only the top three applications are discussed in further detail below.
Figure 2.
Top Ten Regenerative Medicine Applications for Improving Health in Developing Countries aThe maximum total score an application could receive was 440.
Top-Ranked Application: Novel Methods of Insulin Replacement and Pancreatic Islet Cell Regeneration for Diabetes
The first-ranked application was frequently supported by reference to the high prevalence of diabetes in developing countries and the major health, social, and economic burden that results. Panellists emphasized that controlling diabetes would in turn reduce the incidence of complications such as blindness, heart disease, chronic kidney disease, and diabetic ulcers. The panellists noted that repeated insulin treatments are costly and inaccessible to many patients in developing countries. They felt that regenerative medicine therapies, such as bone marrow stem cell transplantation or microencapsulated islet cells using novel biomaterials, could increase accessibility by providing a permanent solution and reducing the financial burden caused by the purchase of insulin.
Second-Ranked Application: Autologous Cells for the Regeneration of Heart Muscle After Myocardial Infarction and Cardiomyopathies
Dramatically increasing rates of cardiovascular diseases in developing countries were cited by panellists in support of the second-ranked application. Panellists noted that such therapy shows promising early results, and is being tested in clinical trials in a number of countries. Panellists believed that in addition to saving lives, such therapies could potentially reduce the cost of treating heart failure. Autologous cells, potentially injected directly into damaged regions of the heart or used in regenerative myocardial patches, were emphasized by the panellists due to their advantage of avoiding immune rejection and, hence, costly immunosuppressive regimens.
Third-Ranked Application: Immune System Enhancement by Engineered Immune Cells and Novel Vaccination Strategies for Infectious Disease
In support of this application, panellists referred to the devastating burden of infectious diseases in developing countries, particularly on the young. According to the panellists, the regeneration or enhancement of the immune system by engineered immune cells and novel vaccination strategies could improve an individual's ability to fight infections and to combat new strains of common diseases. Panellists made specific reference to the importance of addressing HIV/AIDS, tuberculosis, hepatitis, and malaria.
PLoS Med. 2006;3(9) © 2006 Tang et al. licensee Public Library of Science
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Cite this: Regenerative Medicine and the Developing World - Medscape - Sep 01, 2006.
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