New directions and advancements for regenerative medicine - Mayo Clinic

People on average are living longer than ever before. In part, this is due to medical advances that have made it possible to save more people from life-threatening diseases, injuries and congenital conditions.

But as people live longer, they're more likely to acquire chronic diseases or develop age-related conditions. Globally, there is an increasing incidence of chronic and degenerative diseases, and nearly 1 in 2 Americans has a chronic medical condition.

After the onset of most chronic diseases or injuries, the damage is there to stay — consider scarring of heart tissue from a heart attack, beta cell dysfunction in diabetes or a spinal cord injury from an accident. Symptoms can be managed, oftentimes with good success, but the underlying tissue or organ damage remains unhealed and can cause complications over time.

To develop new clinical applications that address the unmet needs of these patients, in 2011 Mayo Clinic established the Center for Regenerative Medicine, now called the Center for Regenerative Biotherapeutics.

Mayo Clinic and center leaders believe that regenerative medicine, which makes it possible to actually repair diseased, injured or congenitally defective tissues and organs, will be a vital component of medical and surgical practice in the coming years. By harnessing the potential of regenerative medicine, Mayo Clinic is poised to create new models of health care and transform medicine and surgery.

Regenerative medicine is still a relatively new field of practice, representing a paradigm shift from the traditional focus of health care of fighting disease to rebuilding health. Mayo Clinic's Center for Regenerative Medicine is leveraging its unique expertise, resources and capabilities to create the world’s most advanced and innovative ecosystem for the development, manufacture and delivery of novel regenerative biotherapeutics.

New directions in biomanufacturing

Mayo Clinic is focused on a newly refreshed strategy in regenerative medicine this year — one that emphasizes an enhanced capability for biomanufacturing, with technology platforms supporting the development of new therapeutics known as biologics. Biologics are a new type of "drug" derived from living organisms that have the potential for targeted healing with fewer side effects. Many of these next-generation therapeutics can be scaled and mass produced for patients at Mayo Clinic and around the world. The Center for Regenerative Medicine is leading Mayo’s enterprise biomanufacturing strategy in close collaboration with Research, Practice and Education leaders and key stakeholders, including the Cancer Center, Center for Individualized Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic Ventures, Mayo Clinic Platform, Center for Digital Health and Mayo Clinic International.

In August, Mayo welcomed Julie Allickson, Ph.D., as the Michael S. and Mary Sue Shannon director of Mayo Clinic's Center for Regenerative Medicine and the Otto Bremer Trust director of Biomanufacturing and Product Development in the Center for Regenerative Medicine, and she will lead the execution of Mayo’s biomanufacturing strategy. Dr. Allickson joined Mayo Clinic from the Institute for Regenerative Medicine at Wake Forest School of Medicine in North Carolina.

This is an exciting time in regenerative medicine, a new era with great promise for the impact that these new therapies and procedures can have for patients," says Dr. Allickson. "I am looking forward to working collaboratively with colleagues across the enterprise to position Mayo Clinic as the global leader in scientific discovery and clinical practice advancement in regenerative medicine."

Significant investments in biomanufacturing facilities continued this year with the buildout of current Good Manufacturing Practices facilities on all three Mayo campuses. These facilities meet strict quality controls and regulatory guidelines that are required for manufacturing new biologics. The long-term goal is to have these new types of healing solutions on-site where they can be used immediately for patients with unmet needs. Mayo will focus on biomanufacturing across seven prioritized technology platforms:

• Nonmalignant cellular therapies to replace or repair tissues, including induced pluripotent stem cells, mesenchymal stem cells, MSC/matrix combinations and dendritic cells.
• Malignant cellular therapies, such as chimeric antigen receptor (CAR)- engineered to target malignancies.
• Gene and viral therapies that use genetic engineering and reengineered viruses.
• Tissue engineering — 3D printing, biomaterials, bioengineering for repair and restoration.
• Phage-based therapies — viruses that attack multiple drug-resistant infections.
• Extracellular vesicles — secreted by natural or engineered cells, they can act as drug, protein or gene transporters.
• Synthetic biology — redesigning function of organisms to fit medical needs.

Research that advances the practice

From helping establish common terminology for regenerative medicine to discovering new ways of manufacturing cardiopoietic stem cells with heart healing potential for select patients with advanced heart failure, Mayo Clinic physicians and scientists have made significant advancements in the discovery-translation-application continuum in regenerative medicine. Examples include:

• New potential to heal chronic wounds

Difficult-to-treat, chronic wounds healed with normal scar-free skin in preclinical models after treatment with an acellular product discovered at Mayo Clinic. Derived from platelets, the purified exosomal product, known as PEP, was used to deliver healing messages into cells of animal models of ischemic wounds. In a groundbreaking study published in Theranostics, the Mayo Clinic research team documented restoration of skin integrity, hair follicles, sweat glands, skin oils and normal hydration.

• Early detection of lung cancer

A Mayo Clinic collaborative study documented a remote-controlled bronchoscope functioned like a GPS system, tracking hard-to-find lung masses and accurately biopsying them. This multisite research, published in Annals of Thoracic Surgery, lays the foundation for precisely finding early stage cancer when it is most treatable, and targeting it with regenerative biotherapeutics needed to stimulate healing.

"In the past, we didn't have a reliable way of reaching these nodules in the lungs from within the airway. This is a very small catheter that gets almost anywhere, and is able to access and biopsy lung nodules," says Janani Reisenauer, M.D., first author on the study and a Mayo Clinic thoracic surgeon. "It's very similar to driving a car and having your normal street view with the aid of the GPS in your car telling you in real-time where to turn right and left to arrive at your destination."

• Improving regenerative immunotherapy

Mayo Clinic researchers biomanufactured chimeric antigen receptor-T cell therapy (CAR-T cell therapy) in a new way to track the cells' cancer fighting journey and predict toxic side effects. This Mayo Clinic breakthrough, published in Cancer Immunology Research, could make this immunotherapy easier for patients to tolerate. Perhaps more importantly, it could unravel the mystery of how to expand CAR-T cell therapy to more types of cancers.

This new technology allows us to image CAR-T cells after they are given to patients and study their fate," says Saad Kenderian, M.B., Ch.B., a Mayo Clinic hematologist and researcher, and lead author. "This allows us to investigate strategies that could improve CAR-T cell trafficking and penetration into the tumor cells, and thus can improve tumor killing."

• Applying regenerative medicine to cosmetic and facial surgery

Mayo Clinic is applying regenerative medicine to cosmetic services aimed at resetting the body's clock to a time of more youthful function and appearance. Regenerative procedures, such as platelet-rich plasma to rejuvenate aging skin and stimulate hair growth for people with alopecia or baldness, are offered on all three campuses. Many regenerative services go beyond cosmetics to facial reconstruction after disease, cancer or traumatic injury. For example, The Multidisciplinary Cosmetic Center at Mayo Clinic in Arizona pairs general and facial plastic surgery with dermatologists, gynecologists, vascular surgeons, urologists and aestheticists to deliver services grounded in scientific evidence and the latest regenerative technologies.

Training the emerging regenerative sciences workforce

A well-trained regenerative science workforce is needed to apply the newest discoveries to clinical care. Mayo Clinic has made significant strides this past year in educating future physicians, scientists and allied health staff in regenerative medicine.

• Mayo Clinic launched the inaugural class of regenerative sciences Ph.D. track

Mayo Clinic achieved an important milestone when it admitted its first five students as inaugural scholars in the newly established Regenerative Sciences Track within the Ph.D. program in the Mayo Clinic Graduate School of Biomedical Sciences. The new doctoral program that began this fall fulfills Mayo's objective of providing first-of-its-kind education in the evolving field of regenerative science and medicine

Taught by regenerative science and medicine experts, the curriculum embraces a training paradigm that includes fundamental cellular and molecular science principles, and transdisciplinary education in regulatory issues, quality control, bio-business and entrepreneurial pathways, data science, medical sciences, ethics, and emerging technologies.

• Mayo Clinic held the Symposium on Regenerative Medicine & Surgery 2021

Throughout the four-day symposium, experts at Mayo Clinic and around the world shared regenerative medicine applications to aging, musculoskeletal conditions, lung diseases, organ transplantation and cancer. The symposium featured presentations on promising research, navigating regulatory pathways and seeking opportunities for commercialization.

Peter Marks, M.D., Ph.D.,director of the Food and Drug Administration (FDA) Center for Biologics Evaluation made a virtual presentation where he pledged FDA support for regenerative technologies that offer new solutions for unmet patient needs.

Another promising year in 2022

Mayo Clinic in Arizona is among the first to offer larynx transplantation and is currently evaluating patients for this landmark surgery. In addition, Center for Regenerative Medicine continues to support initiatives, such as expanding of CAR-T therapy and making organ transplantation more available and successful for patients.

New advanced biomanufacturing facilities will be operational in One Discovery Square in Rochester and in the Discovery & Innovation Building in Florida. Biomanufacturing expansion on the Phoenix campus will be strategically assessed as the buildout of Arizona "Bold. Forward" continues. The Center for Regenerative Medicine continues to spur innovation to rapidly advance novel regenerative therapies into the clinic to support Mayo Clinic's 2030 Vision to cure, connect and transform care.

Source: https://regenerativemedicineblog.mayoclinic.org/2021/12/09/a-year-of-new-directions-and-advancements-for-regenerative-medicine/