Cellular Therapies in Trauma and Critical Care Medicine: Forging New Frontiers.

"The authors report no conflicts of interest."

"Funding To date, obtaining funding for research and clinical trials investigating stem cell therapies has been challenging. The majority of clinical trials in cellular therapies have either been funded by entities such as small biotech companies, the DoD, or the NIH. The NHBLI developed the Production Assistance for Cell Therapy (PACT) program to advance the development and production of clinical grade cellular therapies to treat ALI, left ventricular failure, and hematologic diseases (142); however, this funding has ceased, and the direction PACT funding is taking now is to support research-grade cell production facilities that will support preclinical research. Lack of funding is a major barrier in translation for trauma care as well as for cellular therapies in general. The majority of clinical trial runs in trauma in civilian populations have been conducted at Level 1 trauma centers, and few large multicenter trials have been conducted to date. The DoD has strongly supported efforts in the area of trauma research and also regenerative medicine through entities such as USAMRMC, Congressionally Directed Medical Research Program, and AFIRM. However, there is currently no true “home” or institute to support trauma research or highly translational cellular therapy efforts, hence compounding the truly challenging prospects for advancement in both fields. Strong support from federal and state governments, private foundations, the general public, and industry are needed to make significant advances in this field. The interest and capability from all of these involved parties is growing, but will require accelerated action from all sides. Another problem is the conceptual barrier that trauma is not a disease in itself and, although it is one of the leading causes of death worldwide, has yet to receive the interest and support that other diseases such as cancer, HIV, and cardiovascular disease have received (143, 144). This would need to change for major advances to be made in a field with strong potential to offer novel therapies that can significantly alter outcomes for gravely ill patients."