WAR CAN TAKE A HORRIFIC TOLL ON THE HUMAN BODY — bullets destroy organs, explosions render limbs nonfunctional, and burns maim. Doctors often are limited in what they can do to repair wounded warriors, but there’s a promising new tool on the horizon.
“Regenerative medicine is the science of using a patient’s own cells together with other bio-materials to repair or replace damaged tissue and organs,” explains Dr. Anthony Atala, director of the Wake Forest Institute for Regenerative Medicine at Wake Forest Baptist Medical Center in Winston-Salem, N.C., and co-director of the Armed Forces Institute for Regenerative Medicine (AFIRM). “It has tremendous potential.”
The concept is not new. As far back as the 1970s, researchers were examining the myriad medical possibilities held by stem cells, which can be stimulated to create almost any type of human cell or tissue, says Air Force Reserve Brig. Gen. Dr. Michael Yaszemski, professor of orthopedics and bioengineering at the Mayo Clinic in Rochester, Minn., and director of the Tissue Engineering and Biomaterials Laboratory.
The 1980s and ’90s saw promising breakthroughs in the field of tissue engineering, which led to the creation of skin and cartilage in the laboratory and the development of biomatrices — scaffolding on which cells could be placed to create tissue and, theoretically, even whole organs. Today’s researchers are building on these and other early concepts to take regenerative medicine in some fascinating directions, many of which have huge implications for wounded warriors.
No limit to benefits
“I believe there is no limit to the severe injuries and pathology that can potentially be treated with regenerative medicine,” says Dr. Stephen Badylak, deputy director of the McGowan Institute for Regenerative Medicine at the University of Pittsburgh, one of several facilities that currently receive funding from AFIRM.
Research fields relevant to wounded warriors include:
Volumetric muscle loss (VML): Explosions and other types of trauma can result in the loss of large chunks of muscle and other tissue. Amputation of the traumatized limb often is the only recourse, and in those rare cases where a limb can be saved, function usually is limited. However, regenerative medicine might make VML a thing of the past by promoting the reformation of functional, vascularized new muscle tissue.
“A biologic scaffold material is used to hold things together in the injured muscle while simultaneously releasing signaling molecules, which recruit the body’s own stem cells to the injury site to rebuild the tissue,” says Badylak. “The result is functional contractile muscle tissue instead of scar tissue. The potential benefits to wounded warriors are tremendous; it can change quality of life.”
Eye injuries: Research is ongoing at the McGowan Institute and elsewhere to address the most common types of traumatic eye injuries, including severed optic nerves, torn retinas, and damage to the cornea and ocular globe. “We’re even exploring the ability to recreate eyelids for patients who suffer severe burns,” Badylak says. “You can imagine the complications that occur in the globe itself when you don’t have an eyelid.”
Tissue engineering to create whole organs: This form of regenerative medicine, which involves using cells and biomaterials, already is being tested in humans through clinical trials. Engineered bladders, urethras, blood vessels, and tracheas have been implanted in human patients, and research teams are working to expand the number of organs that can be engineered. While they’re probably years away from providing commercial availability, researchers hope one day to be able to replace almost any damaged organ with a new one created with a patient’s own cells, an advance that would make immunosuppression a nonissue.
Bone regeneration: Bones constantly undergo a tissue-replacement process known as remodeling, Yaszemski says. Bone engineering would tap that natural process to heal specific defects such as large gaps in bone resulting from traumatic injury. “Using synthetic or natural scaffolds, we can stimulate the growth of bone and exactly match the size and shape of the piece that is missing,” Yaszemski says.
76 MILITARY OFFICER JANUARY 2014
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