All procedures that restore missing tissue in patients require some type of replacement structure for the area of defect or injury. This form of therapy accounts for a large part of health-care resources (table). These devices have traditionally been totally artificial substitutes (joints), non-living processed tissue (heart valves), or tissue taken from another site from the patients themselves or from other patients (transplantation).1 Now a new alternative, tissue engineering, is becoming available to clinicians: the replacement of living tissue with living tissue that is designed and constructed to meet the needs of each individual patient. Tissue engineering is an interdisciplinary field which applies the principles of engineering and the life sciences toward the development of biological substitutes that restore, maintain, or improve tissue function, z Examples of tissue engineering can be found as early as 1933 when Bisceglie 3 encased mouse tumour cells in a polymer membrane and inserted them into the abdominal cavity of a pig. 3 The cells lived long enough to show that they were not killed by the immune system. In 1975, Chick and colleagues 4 reported their results of encapsulating pancreatic-islet cells in semipermeable membranes to aid glucose control in patients with diabetes mellitus. Replacement of the skin with cells in collagen gels, or collagen-glycosaminoglycan composites to guide regeneration, was attempted by the early 1980s and these techniques are now in clinical use. 5'6 The next major advance came with the recognition that thicker three-dimensional systems could organise implanted cells to form vascularised tissue in vivo. Synthetic degradable polymers were used as templates for cells to form permanent new tissues. 7 Systems were designed with highly porous structures to meet the needs for the mass transfer of large numbers of cells. Angiogenesis after implantation produced permanent vascularised new tissue. With the demonstration of experimental success in many different tissues, and the engineering flexibility that synthetic materials provided, tissue engineering has now gained wide attention. 2'8 A recent survey of tissue engineering as an emerging industry found that the total capital value of companies in the industry exceeded US$3.5 billion, that the industry growth rate was 22.5% per year, and that it employed over 2500 scientists with an annual expenditure of $450 million3 It has been estimated that the total market potential of tissue-engineered products in the USA alone is $80 billion annually (Business Week, July 27, 1998, p 61).
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