Applying to Battlefield Injuries Anthony Atala, Karen Richardson

Due to advances in body armor, battlefield evacuation, clinical study of a new treatment for wounded warriors. and medical care, more US service members survive seri- Instead, there were more than 10 clinical studies of poten- ous injuries now than ever before. However, many of these tial new therapies, including trials of face transplanta- wounded warriors subsequently face daunting challenges tion, minimally invasive surgery for craniofacial injuries, overcoming severe limb, head, face, and burn wounds a lower-dose antirejection regimen for use after kidney caused by the use of improvised explosive devices. With transplantation, scar reduction treatments, fat grafting for the goal of applying the science of regenerative medicine reconstructive surgery, and new treatments for burns. to these wounds, the Department of Defense established The program’s success is due to its focus on clini- the Armed Forces Institute of Regenerative Medicine cal impact as the ultimate goal as well as the degree of (AFIRM) in 2008. collaboration among the laboratories. Now in its second Regenerative medicine is a science that takes advan- 5 years, AFIRM-II, led by the Wake Forest Institute for tage of the body’s natural healing powers to restore or Regenerative Medicine (WFIRM), includes researchers replace damaged tissues and organs. A multi-institutional, from more than 30 academic institutions and industries, interdisciplinary network of scientists, AFIRM has a mis- and it has $75 million in government support from the sion to accelerate the development of new regenerative US Army Medical Research and Materiel Command, the medicine–based products and therapies to treat severe Office of Naval Research, the Air Force Medical Service, injuries suffered by US service members. the Office of Research and Development - Department of AFIRM is a results-focused program that not only funds Veterans Affairs, the National Institutes of Health, and the scientific research but requires that discoveries be tested Office of the Assistant Secretary of Defense for Health and compared so that the most promising therapies can Affairs. With this funding, the AFIRM-II team is focusing be brought to clinical trials. Therapies that come out of on developing clinical therapies in several areas: restor- this effort can help not only our wounded warriors but also ing function to severely traumatized limbs; reconstruction patients in hospitals across and the world. for facial and skull injuries through tissue regeneration; To date, AFIRM has exceeded the US Army’s expec- skin regeneration for burn injuries; new treatments to tations regarding the speed of translating new therapies prevent rejection of “composite” transplants such as face from the research laboratory into clinical trials. During and hands; and reconstruction of the genital and urinary the program’s first 5 years, researchers were charged organs and lower abdomen including the bladder, anal with having at least 1 patient ready to be entered into a sphincter, and external genitalia.

324 NCMJ vol. 76, no. 5 ncmedicaljournal.com AFIRM-II encompasses 60 different projects, with Johns Hopkins University; Livionex, Inc.; Massachusetts almost one-quarter of them based in North Carolina. General Hospital; Mayo Clinic; New York University School Examples of research underway at WFIRM include engi- of Medicine; Northwestern University; Oregon Health and neering blood vessels in the lab for limb reconstruction Science University; Radboud University Medical Center; and developing cell therapies to improve recovery after Research Foundation of SUNY; Rice University; Stanford compartment syndrome, a severe consequence of blast University School of Medicine; Rutgers; Southwest injuries that can result in amputation. In the area of facial Research Institute; Stratatech Corporation; The Ohio injuries, the Wake Forest team is working to engineer State University College of Medicine; Tufts University; replacement muscle tissue in the lab and is using 3D print- University of California, Los Angeles; University of ers to print facial components such as bone, cartilage, and Cincinnati; University of Connecticut; University of muscle for reconstructive surgeries. Florida; School of Medicine; During the first few days after a burn injury, the wound University of Maryland School of Medicine; University can expand in size and increase in severity. Over the long of Michigan; University of Pittsburgh; University of term, burn progression results in increased scarring, Washington Medicine; Vanderbilt University Medical increased contraction, and reduced function. WFIRM has Center; and School of Medicine developed a skin cell printer and is evaluating the poten- (Wake Forest Baptist Medical Center). tial of using stem cells found in the amnion for enhanced Anthony Atala, MD director, Wake Forest Institute for Regenerative wound healing. Medicine, Winston–Salem, North Carolina. Another unmet need for wounded warriors is advanced Karen Richardson, BA communications manager, Wake Forest treatments for severe genitourinary and pelvic injuries Institute for Regenerative Medicine and Department of Urology, Winston–Salem, North Carolina. that occur due to improvised explosive devices. These injuries can result in permanent urinary and fecal inconti- Acknowledgments nence, loss of sexual function, infertility, the need for tes- Potential conflicts of interest. A.A. and K.R. have no relevant con- flicts of interest. tosterone replacement, and colostomy. WFIRM’s projects in this area include engineering bladder, penile, testicular, urethral, and anal sphincter tissue, as well as developing Electronically published November 13, 2015. a cell therapy to restore function to penile erectile tissue. Address correspondence to Dr. Anthony Atala, Wake Forest Baptist Members of the AFIRM-II team, known as the Warrior Medical Center, Medical Center Blvd, Winston–Salem, NC 27157 Restoration Consortium, are Brigham and Women’s ([email protected]). N C Med J. 2015;76(5):324-325. ©2015 by the North Carolina Hospital; Case Western Reserve University; Cleveland Institute of Medicine and The Duke Endowment. All rights reserved. Clinic; Georgia Institute of Technology; Jewish Hospital; 0029-2559/2015/76513

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