Regenerative medicine in China: demands, capacity, and regulation

Regenerative medicine (RM) is an emerging interdisciplinary field of research. Its clinical application focuses on the repair, replacement, and regeneration of cells, tissues, and organs by approaches including cell reprogramming, stem cell transplantation, tissue engineering, activating factors, and clone treatment. RM has become a hot point of research in China and other countries. China’s main and local governments have attached great importance to RM and given strong support in relevant policies and funding. About 3.5 billion RMB has been invested in this field. Since 1999, China has established about 30 RM centers and cooperates with many advanced countries in RM research and benefits from their cooperation. However, China needs to develop standards, regulations, and management practices suitable for the healthy development of RM. In this review, we focus on its great demand, capacity, and relative regulations.


Background
Annually, about 100 million Chinese patients will receive treatment by tissue repair and regeneration technologies because of the sharp increase in various injuries, accidents, and diseases of aging. However, the current paradigm of "healing by scar tissue replacement," regardless of superficial tissues or visceral organs, is stagnating and is far away from the ultimate goal of "regenerating the impaired organ." Regenerative medicine (RM) is gradually being used to restore the intrinsic repair ability with stem cell transplantation, tissue engineering, activating factors, cell reprogramming, and genetic treatments. RM holds sound promise of restoring organ function that is impaired because of congenital disorders, acquired disease, trauma, and aging by replacing or regenerating cells, tissues, and even organs. RM is expected to transcend traditional organ transplantation and replacement. Stem cell technology and tissue engineering have an outstanding role in RM. RM will become one of the most promising areas of life science in the twenty-first century [1,2].
In the past 20 years, the RM market has continued to grow in China and other countries such as the USA, Europe, Japan, and Singapore. As the largest developing country, China has impressed the world with its findings in stem cells, tissue engineering, active molecules, and gene therapy as well as its national strategies and regulation of RM. These achievements may benefit China in both disease treatment and society development [3].

Funding support and resources
Multiple sources are funding RM studies and translational application. After 1999, the MST approved the National Program on Key Basic Research Project (973 Program) related to tissue engineering, and the stem cell field had the largest number of "973 Program" projects. Research into the clinical transformation and application of stem cell therapy was established in the biotechnology and medical technology field of the "863 Program." The National Natural Science Foundation (NNSF) funded about 200 million RMB for this study, including 5627 items (Fig. 1a, b). Up to now, about 3 billion RMB from the MST, CAS, and NNSF has been invested in this field. Both the amount of funding and number of projects are increasing annually. Other funding for RM from companies is about

Production in academic fields
Publication of valued scientific papers is one of the very important indicators to evaluate investment and production in academic fields. The total number of scientific papers dealing with RM has increased quickly in China, as has the number published in leading scientific journals in China and internationally (Fig. 2). Since the 1960s, the USA has published 599 articles about stem cells in Cell and its subjournals   [47,48]. Also, the use of theories and skills of RM in military medicine is one of the important fields in the future [49].

Conclusions
Great demands in RM are not only in China but also in the world. Their theories and key skills or products are used not only in peacetime but also in military field [49]. The Chinese government attaches great importance to this field, and vigorous investments from the government and companies may accelerate the progress in basic research and translational application. Innovation and international cooperation will be emphasized in future studies. Other sound administrative system, laws, technical specifications, and guidelines are very important in pushing their healthy and orderly development.