War on Wounds
Why the military is backing the cool new field of regenerative
medicine.
By Anne Underwood | NEWSWEEK
May 19, 2008 Issue
To visit Wake Forest University's institute for Regenerative
Medicine is to enter a surreal world where scientists create living
organs—hearts, bladders and even kidneys—that function like the real
thing. Skin, bone, cartilage, blood vessels, nerves: nothing seems
too ambitious for director Anthony Atala and his staff of 150 to
craft. And while none of their creations are available from your
doctor yet—most are still being tested in animals—there have been
enough small-scale successes in humans that the U.S. military is
suddenly very interested.
War may be hell, but it has a way of accelerating medical research.
World War I brought methods for collecting and preserving blood for
transfusions. World War II saw the introduction of penicillin into
medical practice. One day, medical historians may remember Iraq and
Afghanistan for spurring regenerative medicine, a grab bag of
techniques that share the same end—to repair human bodies by helping
them regenerate living tissue, rather than relying on artificial
parts. Last month Lt. Gen. Eric Schoomaker, the Army surgeon general,
announced $85 million in government funding to create a new Armed
Forces Institute of Regenerative Medicine (AFIRM). The effort, which
involves researchers at two dozen institutions, is codirected by
Atala at Wake Forest, together with colleagues at the University of
Pittsburgh, Rutgers and the Cleveland Clinic. As the general put
it, "We're embarking on a new generation of research that's going to
redefine Army and military medicine as we know it today." And likely
transform civilian medicine, too.
The military's need is enormous. Thanks to improved medical care, 90
percent of soldiers who are injured in Iraq and Afghanistan are
surviving. But many of them come home with multiple traumatic
injuries to the face, head and limbs that will take years to treat
and will result in lifelong impairment. Even state-of-the-
treatments can leave burn victims with disfiguring scars, say
doctors. Such injuries can be emotionally devastating. "Soldiers
who've lost their faces have the highest suicide rate of severely
wounded war victims," says Joachim Kohn of Rutgers, codirector of
AFIRM. Currently, soldiers with burns covering 40 percent or more of
their bodies have to undergo dozens of operations as surgeons harvest
healthy skin from, say, their thighs, and transplant it onto damaged
areas. The doctors must then wait several weeks for new, healthy skin
to grow back on the thighs so they can repeat the process. But Dr.
Jörg Gerlach at the University of Pittsburgh's McGowan Institute for
Regenerative Medicine is isolating patients' own skin stem cells from
a small patch of healthy skin. Then, using a specially developed skin-
cell gun, he sprays them onto the wounded area in a fine mist. Over a
period of two to six weeks, the cells grow into functional skin,
including dermis, epidermis and blood vessels. There is little
scarring, and because Gerlach includes the patient's own pigment
cells in the mix, the new skin looks natural. In one pilot study, he
treated eight patients in Germany with good results.
Researchers are also looking for ways to restore body parts. Doctors
cannot make these parts regrow all by themselves—at least not yet.
(The Defense Advanced Research Projects Agency is funding very-early-
stage research on regenerating fingers, the way a salamander regrows
lost limbs.) But regenerative medicine will do the next best thing.
Robert Langer at MIT and Joseph Vacanti at Harvard, for example, want
to help soldiers who have lost noses and ears. To build a nose, they
will create a nose-shaped scaffold, made of biocompatible,
biodegradable materials, then seed it with the patient's own cells
and nurture it in a chamber called a bioreactor that mimics
conditions in the body. Weeks later, when cells have multiplied to
form tissues, the nose will be surgically implanted; over the ensuing
months, the scaffold will dissolve and be resorbed into the body.
Using these same basic techniques, Atala has created organs,
including small kidneys that filter liquid and produce urine in the
lab. When implanted in animals, the kidneys grow to full size and
continue to work. "We start, and the body takes over," he says.
The full array of potential regenerative therapies being developed by
AFIRM is astonishing. Newell Washburn at Carnegie Mellon University
is working on special gels to help tamp down inflammation at the site
of a deep wound, allowing skin to regenerate without scarring. Dr.
Charles Sfeir at the McGowan Institute is developing a powder
containing bone proteins, growth factors and biodegradable cement
that can be mixed with water in the operating room and molded to the
shape of missing bone. Atala has created nerves that conduct impulses—
at least in mice. "There isn't a tissue you could name that someone
isn't working on," says Alan Russell of the McGowan Institute,
codirector of AFIRM. And one day, that will benefit us all.
© 2008
http://www.newsweek
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StemCells subscribers may also be interested in these sites:
Children's Neurobiological Solutions
http://www.CNSfoundation.org/
Cord Blood Registry
http://www.CordBlood.com/at.cgi?a=150123
The CNS Healing Group
http://groups.yahoo.com/group/CNS_Healing
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