The California Institute for Regenerative Medicine was created by the voters of California in 2004 to accelerate stem cell treatments to patients with unmet medical needs. By the end of its first 10 years, the agency was funding ten projects in clinical trials, including work in heart disease and cancer, HIV/AIDS and Type 1 diabetes. The goal now is to significantly increase that number, adding another 50 clinical trial projects funded by California Institute for Regenerative Medicine over the next 5 years. How we get there may be the biggest challenge the agency has ever faced.