Sometime this year, at the Army Institute of Surgical Research on Fort Sam in Houston, more severely burned service members will benefit directly from the emerging science of cell regeneration.
In a new clinical trial, doctors will remove a small patch of a patient's undamaged skin. The patch, no bigger than a small Post-it note, will be dipped in a special enzyme and protein solution to disperse individual cells.
As surgeons debride the wound of burned or dead skin, the dispersed cells will be loaded into a special syringe that has a nozzle instead of a needle. The contents then will be sprayed evenly over the wound bed, spreading cells like seeds across warm, welcoming soil.
"Those skin cells genetically have all the information needed to reproduce. So when you put them in the right environment they do what they are genetically programmed to do," said Dr. Anthony Atala.
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Atala is director of the Institute for Regenerative Medicine at Wake Forest University Baptist Medical Center. If all goes as planned, he said, second-degree burns will be covered with new skin in four to six weeks.
Because the new skin will be engineered from the soldier's own cells, a lot of problems go away. Burn victims typically have to undergo multiple operations, needing temporary skin grafts from a cadaver, which, in time, immune systems reject. Donor grafts won't be needed for these patients. Nor will permanent grafts using a patient's own undamaged skin, thus avoiding more operations and the added risk of infection at graft sites.
Also, the new skin will be flexible, restoring more functionality so a burn patient can live a relatively normal life, said Lt. Col. Brian Moore, deputy director of the Armed Forces Institute of Regenerative Medicine at Fort Detrick, Md.
"The biggest problem a lot of burn patients have is they can't move because of constriction of their skin. They can't move their arms or neck or they can't swallow or get normal blink reflex," Moore said.
The "re-celling" technique Atala and his staff already have tested on civilian patients at Wake Forest is one of 84 projects involving regenerative medicine being funded, at least in part, by AFIRM in its effort to advance the treatment and recovery of wounded service members.
The projects nearest to gaining FDA approval, and therefore wider use, all involve skin replacement, Moore said. But other work continues on regenerated cells to restore shattered bones, muscle tissue and other organs, including ears and noses.
Cell regeneration was viewed two decades as science fiction, Atala said. At the time he was a young pediatric urologist and surgeon at Harvard who, with colleagues, began studying the possibility of building arteries and even bladders using patients' own cells. It took almost nine years to do it.
Atala said he first was approached by the Department of Defense in 2006 on whether research at his institute at Wake Forest could help in the treatment of wounded service members. By 2008, Department of Defense had established AFIRM to oversee development of a host of cell regeneration strategies.
AFIRM is a virtual institute. Research is conducted by two consortiums of universities and research facilities tasked to study five areas for cell regeneration: limb and digit salvage; craniofacial repair; burn repair; scar-less wound healing; and compartment syndrome.
Wake Forest and the University of Pittsburgh lead one team; Rutgers University and Cleveland Clinic lead the other. A total of 31 universities have so far received most of the $100 million in AFIRM's five-year budget.
At Wake Forest, to treat deeper burn wounds, Atala's team is testing another technique that uses a computer scanner and printer to apply not ink but rather an appropriate concentration of cell lines directly onto wounds.
They also are building organs including bladders, ears and noses. First they build a scaffold of the organ from biological material. Then they layer on to the structures proper types of a patient's own cells. The engineered organs are placed in oven-like devices for cell growth under conditions that duplicate a human body: 95 percent oxygen, 5 percent carbon dioxide and 37 degrees Celsius. In four to six weeks, they are ready to transplant.
Over time, Atala said, the body will invigorate engineered organs with blood vessels and nerves. The science is still in its infancy, but progress on regenerative medicine is being made in labs across the country.