Breakthroughs in Restoration - Part 1

By Ashleigh Bryant

In 2009, retired Army Master Sgt. Todd Nelson underwent the last of some 47 surgeries to repair the damage inflicted on his body by a suicide bomber in Afghanistan. He had finally grown accustomed to and accepted his new, post-recovery appearance, but he also realized there was little else that could be done.

“The fact is they can’t really do anything for me except replace a scar with a scar,” said Nelson. “So I’m cool with it. I’m used to it by now.”

Nelson, who helps ill and injured veterans find employment, also serves on a regenerative medical advisory committee in San Antonio, Texas, which helps to guide research through the Armed Forces Institute of Regenerative Medicine (AFIRM). The Defense Department launched the AFIRM in 2008, bringing together experts and researchers in the field of regenerative medicine to help accelerate the development of treatments and therapies for service members. In particular, the AFIRM’s research zeroes in on the types of wounds most common to the wars in Iraq and Afghanistan.

“In modern warfare, some of the most feared wounds are those caused by burns,” said John Bushby, a Navy pilot who flew 67 combat missions over North Vietnam. He now works as part of the AFIRM team as the chief operating officer for the New Jersey Center for Biomaterials at Rutgers University. “There’s this very distorted view of possible injury. That Hollywood depiction of the clean bullet wound, a neat drilling of the body with no concurrent loss of bone and tissue, is what the combatant expects.”

We know, of course, this is far from the truth and so does Nelson. For him, the reality was a car packed with explosives. A suicide driver detonating the bomb along a roadside. Smashed cheekbones, a shattered forehead and chin. Shrapnel tearing away skin, muscle and bone. Fire searing the flesh of Nelson’s nose, ears and eyelids. The reality of impending death, with only the slimmest chance of survival. Excruciating recovery, countless surgeries, futures changed and lives irreversibly altered. That was his new reality.

The procedures Nelson has undergone to repair the damage were based mainly on older Vietnam-era technologies: flesh taken from one body part to salvage another. The breakthroughs the AFIRM has made in limb salvage, burns, facial reconstruction and scarless healing may never serve Nelson directly, but he considers it his mission to share his story and make sure research continues for these procedures to advance.

“I basically represent our country’s battle for freedom and democracy. People look at me, or people like me, and what do they see? They see we’re not winning this fight,” said Nelson. “As long as our enemies are able to do this to us and we’re not able to recover, basically we’re putting people on the street who are walking billboards saying they’re kicking our tail. That’s the reason we need to continue this. Until we’re able to restore people back to their original conditions, the enemy is winning.”

Collaborating to Meet Challenges

The AFIRM is the joining of many minds and a shrug to the traditionally competitive nature of biomaterials research. Researchers at Rutgers and the Cleveland Clinic lead a network of 15 institutions, and teams at Wake Forest and the University of Pittsburgh head a second network of 16 institutions. Synergy has become status quo, and it’s yielding tremendous breakthroughs as the AFIRM researchers are no longer competing for the same grant funding. Rather, they are a team working toward a shared goal.

Washington Headquarters Executive Director Barry Jesinoski was invited to visit the Rutgers laboratories to see first hand the types of treatments now in development.

“It was extraordinary to see and hear about some of the advances they are making within the AFIRM,” said Jesinoski. “The researchers are developing some unbelievable treatments that will no doubt change the way our wounded service members and veterans receive care. They are on a course to helping restore quality of life for a lot of men and women who have been injured in service.”

Lauren Macri, the acting chief operating officer for the Rutgers-Cleveland group, explained they currently have the ability to take a small skin sample and manufacture entire sheets of a patient’s own skin. “The second-generation product also includes pigmented cells, so if you’re a person of color, you can have skin that actually matches your natural tone, and beyond that adding all the essential components to skin like hair follicles and sweat glands. All that is coming.”

Also coming is a sprayable cell treatment, wherein a small amount of donor skin will be able to more efficiently cover large surface burn areas. This treatment, similar to a breath spray, is now in clinical trials and is likely to become the first product to reach the market thanks to the work of the AFIRM.

The research efforts have also yielded a scar remediation therapy in which fat generated from liposuction procedures is purified and specific cells are injected under scar tissue. In many cases, the scar remodels, becomes pliable and results in a more cosmetically appealing surface. Researchers are currently looking at how old scar tissue responds to the treatment, which could aid patients whose scar tissue formed long ago.

In the area of bone regeneration, materials previously used were not only dangerous, but the protein needed to promote growth was also incredibly expensive. If the protein leached during treatment it could lead to bone growth within the muscle tissue and possibly sterility. But the AFIRM has developed bone regeneration scaffolds that use significantly less protein. “You get about 30 to 40 percent more bone formation at a quarter of the price and with a quarter of the risk,” said Dr. Joachim Kohn, director of the Rutgers-Cleveland group.

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