Scaffold engineering: a bridge to where?

A significant amount of federal research funding (over $4 billion) has gone into tissue engineering over the last 20 years. This has led to an exponential increase in research productivity as evidenced by the number of published papers referencing 'tissue engineering' and 'scaffold'. However, the number of tissue engineering products resulting from this research remains a paltry few, of which true tissue engineering products can be counted using the fingers of two hands. The fundamental question remains 'Why does such a gap exist between research and translation?'. This paper argues that such a gap exists in part due to the research paradigms followed in tissue engineering, in which a linear model is followed that assumed individual technical discovery can be bundled into model tissue engineering systems, followed by manufacturing scale up and regulatory approval. As such, most research funding follows this linear model with the vast majority of research spent on the discovery phase. This includes funding on both cell therapy and scaffold materials and engineering. It is assumed that therapy systems can readily be constructed by combining disparate technologies derived in different laboratories and that these therapies can readily achieve regulatory approval. Yet, most tissue engineering technologies fail to make it to clinical application because they simply have not been engineered for these specific applications or cannot be scaled to clinical level production. This paper argues that a different research paradigm is needed, essentially that of Pasteur's Quadrant proposed by Donald Stokes in the book of the same name. In this paradigm, research is pursued from the twin perspective of end use and the need for fundamental understanding. From this perspective, more funding emphasis should be placed on scalable manufacturing of systems that are designed for specific clinical applications that can attain regulatory approval. Funding of such scaffold/cell manufacturing technologies would not only enable greater translation of technology to clinical application, but would also enable a richer investigation of basic science issues. For example, the investigation of stem cell biology and differentiation in controlled 3D environments instead of 2D culture dishes. In this sense, a concentration of scaffold manufacturing would enable a quicker bridge across the 'Valley of Death' by providing for faster regulatory approval as stand alone products that would pave the way to combination products. At the same time, such manufacturing capabilities would broaden the scientific horizons in cell therapy.