By April Dudash
This is the future of military medicine: Muscle engineered in laboratories. Ears grown in petri dishes. New skin that can be sprayed on wounds, in the field.
But research from the Wake Forest Institute for Regenerative Medicine is already helping soldiers, including a patient at Fort Sam Houston whose scars are being "remodeled" thanks to a procedure that injects a person's own fat and stem cells into affected skin.
"It will remodel their face to make it like they didn't have the injury," says Terry Irgens, director of the Armed Forces Institute of Regenerative Medicine and a pharmacist with 27 years of experience in the Navy. "What's being developed at Wake Forest and other institutions is designed to help all humanity, not just the military."
When AFIRM, a group of 30 universities and other research institutions, began its work in 2008, the goal was to get one product into a clinical trial after five years. Regenerative medicine takes patience; the average time from lab to market is 14 years. But after only three years of research, AFIRM is running 10 clinical trials for 10 different products.
Right now, in a Wake Forest University lab, a printer that looks like an office model on steroids is being used to "print" new skin and even organs. Cartridges that once held ink now contain human cells that are sprayed onto the body to grow new skin. The same technology has been used to make miniature kidneys; the next step is to increase the organ size.
Dr. Anthony Atala is director of the Wake Forest institute. "You have a device, more like an X-ray machine, but instead of an X-ray, it scans a picture of the wound and then it tells you what the defect is. Then it goes over and prints skin onto the wound."
It's possible that soldiers will someday use the printer in field hospitals overseas. For now, the bioprinter has been used to heal small, square wounds on pigs.
"That reduces the morbidity with such wounds," said Wake Forest associate professor John Jackson. "Once you get it covered with skin, you have less infections associated with it. You have less fluid loss."
Bringing new skin and organs, plus other projects, to patients will take years. Wake Forest researchers want to stretch skin for grafts, create an injectable oxygen-producing gel to keep tissue alive, engineer muscle and grow limbs in the lab.
But they are already growing replacement ears, a solution to the problem of ear implants that erode, become dislodged or poke through the skin. Cartilage is engineered over the implant, creating a safe barrier between the skin and implant. The ears have already been transplanted under the skin of mice and rabbits.
And Wake Forest's ReCell project has already reached patients - 35 people as of June were enrolled and treated at six clinical sites, where their harvested regenerative cells are sprayed onto their burn wounds. Taking parts of a patient's body, modifying it and putting it back is a practice known as personalized medicine. Rejection and other issues are avoided with that practice, Atala said. Over the next two years, researchers plan to expand the trial to 106 people.
"That project is actually licensed in seven different countries already but not licensed yet by the FDA," Irgens said.
AFIRM funds clinical trials in the early stages, but it's relying on commercial industry to pick up the final stage of clinical testing, which tackles product licensing and approval by the U.S. Food and Drug Administration.
"We're actually hoping we get some products licensed so they're on the shelf, ready to be used," Irgens said.
All of these ideas are first passed through the Department of Defense, which has set aside $300 million in federal money and matching funds over five years to research burn repair, wound healing without scarring, craniofacial reconstruction, limb construction, regeneration or transplantation, and compartment syndrome, a condition related to inflammation after surgery. The hope is that the research will eventually translate into methods capable of treating large volumes of wounds to soldiers' extremities, a critical need in the wars in Iraq and Afghanistan where dismounted soldiers have been vulnerable to attacks from improvised explosive devices.
"The body armor protects the trunk of the individual right now," Jackson said, "but there are a lot of injuries to the extremities."
Clinical trials are already being held throughout the military's medical centers, and Fort Bragg may at some point be chosen as a participating site. Most of the resulting technology would be kept at military hospitals.
In the meantime, AFIRM is looking toward the next innovation.
"You have to get that clock ticking sooner so you can finish sooner," Atala said, "to be able to get that technology to as many people as you can."