In the not too distant future, one of the most important pieces of equipment for treating injured soldiers at a combat hospital could be a printer. Doctors may someday wheel a portable “bioprinter” over to a soldier’s bed, line it up, and print new layers of skin directly onto a severe wound or burn.
That’s the kind of high-tech medical salvation for traumatically injured service members that military officials were hoping for when they began funding the Armed Forces Institute of Regenerative Medicine (AFIRM) in 2008. At the time, the U.S. military was struggling to cope with more than 51,000 soldiers wounded in recent conflicts in Iraq and Afghanistan. Many of them were hurt by IEDs—improvised explosive devices—and concussive blasts that were so powerful that the soldiers would have died if not for body armor and advanced emergency treatments.
Now the Army’s vision of better treatments is coming closer to reality. Researchers funded by AFIRM have successfully “printed” skin cells onto mice and pigs, cutting normal healing time by more than half in pigs. They have launched 10 different clinical trials in such areas as nerve repair and the remodeling of damaged faces. AFIRM also supported the continuing work of Johns Hopkins surgeons who performed a double arm transplant in 2012 on a soldier who had lost all four limbs in Iraq. The progress has prompted the Army to begin a second five-year phase, called AFIRM-II, with $75 million more in military funding.
Anthony Atala, director of the Wake Forest Institute for Regenerative Medicine in Winston-Salem, NC, has held key leadership roles in the Army project since its inception. Atala (pictured above) says the work so far has well exceeded the modest goal set by the military at the beginning of AFIRM. “They asked that one patient be ready to be treated within five years,” Atala says.
Wake Forest is now bioengineering muscle and other specialized tissues that may help replace missing structures of the bladder, urethra, and penis.
Reconstructing shattered limbs or restoring damaged organs might have seemed like a science-fiction fantasy to battlefield doctors as the Afghanistan and Iraq wars began in the early 2000s. But scientists like Atala were already anticipating what might be possible. In 2005, Atala gave a talk to combat casualty researchers, who were persuaded that some of the benefits of regenerative medicine were within reach, according to the AFIRM institute’s account of its founding.
The Army responded by setting up AFIRM, and picked Atala to be the co-leader of the first phase of the institute’s work. Atala co-led one of two independent civilian research consortia working with the U.S. Army Institute of Surgical Research (USAISR) at Fort Sam Houston, Texas. The second consortium was led by Rutgers, the State University of New Jersey, and the Cleveland Clinic.
All told, funding for AFIRM’s first phase added up to more than $300 million, with contributions not only from the U.S. Army, Navy, and other Department of Defense units, but also from the National Institutes of Health, the U.S. Department of Veterans Affairs, state governments, and other entities, including university research institutes that pitched in matching funds. About $22 million went to Wake Forest and other research institutes in North Carolina.
The military funding catalyzed the formation of a sweeping nationwide consortium of university research centers, military and civilian hospitals, and more than 40 biomedical companies, including medical device giant Medtronic. The initiative has provided one of the largest single U.S. sources of funding for regenerative medicine research, Atala says.
Because military officials wanted new treatments to be available to veterans as soon as possible, AFIRM also created opportunities for commercial enterprises to test their experimental products. For example, a preparation of human-derived structural proteins called keratins developed by Winston-Salem, NC-based biomaterials company KeraNetics has undergone preclinical testing at Wake Forest University School of Medicine as an early therapy to minimize continuing damage to tissues due to serious burns.
Atala says the new treatments being studied under the AFIRM umbrella, if successful, are as likely to benefit civilians as they are to treat soldiers.
“In reality, anything we’ve seen among military personnel we’re also seeing in [civilian] patients,” Atala says. While soldiers suffer catastrophic wounds due to hidden explosives and arms fire, the most common causes of similarly severe injuries at home are
