function and prevent further degenera- tion during injury healing. Examples of products being developed by academia and industry include nerve growth fac- tors, bioengineered scaffolds and tools to prevent degeneration.


KEY TARGET: MUSCLE REPAIR Major muscle tissue loss following combat-related trauma is complicated by infection or damage to the surrounding bone, nerves or blood vessels. Unfor- tunately, little can be done to combat volumetric muscle loss as muscle regener- ates poorly and there are limited options for surgical repair.


Current treatment of volumetric muscle loss


is geared toward rehabilitation to preserve the patient’s remaining muscle


CURRENT TISSUE


Skin/burn wounds


Blood vessels


Nerves Bones Muscles


DEVELOPMENT STAGE


Phase 2/3 clinical trials in patients


Phase 2/3 clinical trials in patients


Early human studies


Early human studies


Large animal studies


MEASURING UP


The TIRM PMO collaborates with industry, academia and government to accelerate the development of new medical products for commercial and military applications. In 2008, USAMRMC launched the Armed Forces Institute of Regenerative Medicine, which translates scientific research into clinical outcomes. Several projects, including permanent vascular grafts and skin substitutes, are moving through the acquisition process. (SOURCE: USAMMDA)


function. In certain cases, surgeons can use muscle from elsewhere in the body (known as a muscle flap transfer) to repair more critical areas such as the hand or face. However,


these procedures are


plagued by complications and poor out- comes, with little academic or industrial research being conducted because of a very small potential commercial market. As a result, DOD-targeted investments in volumetric muscle loss treatment are likely to have the greatest overall impact as compared to the other areas.


BONE AND CONNECTIVE TISSUE REPAIR While bone normally repairs spontane- ously after a fracture, munition blasts can create complex fragmented injuries that do not heal, as it is much like trying


to reassemble shattered glass. In such cases, our immediate focus is on prod- ucts that stabilize complex bone injuries using materials that are integrated into the body, prevent infection and promote healing.


Long-range targets will support preven- tion and treatment of post-traumatic osteoarthritis, which causes damage to joints following severe injuries, similar to deterioration experienced in old age.


MILITARY EMPHASIS


Burns, trauma


Trauma Trauma Trauma Trauma CIVILIAN INDICATIONS


Burns, chronic wounds (diabetes)


Heart attack, stroke, kid- ney dialysis


Carpal tunnel syn- drome, neuroma


Arthritis, bone fractures


Rare conditions, e.g., muscular dystrophy


COMMERCIAL MARKET


Medium Large Medium Large Almost none


FROM BENCH TO BATTLEFIELD Te TIRM PMO works with a broad network of collaborators in industry, aca- demia and government to accelerate the development of new medical products, specifically regenerative medicine tech- nologies. Te overriding goal is to rapidly acquire emerging technologies to make wounded service members whole again by restoring form, function and appear- ance. Because trauma is


relatively rare


compared with chronic diseases such as cancer and diabetes, the challenge for DOD has been selecting commercially viable candidates to meet a military need among a rapidly growing field of cutting- edge technologies.


DOD has invested in regenerative medi- cine through different mechanisms because of new scientific breakthroughs in the field, which emerged in the early 1990s and allow scientists to better har- ness the body’s own healing powers through the use of stem cells and tis- sue engineering. Regenerative medicine is about growing specific cell types and directing these cells toward a final out- come such as new skin, blood vessels or muscle.


Tis technology advancement led to the 2008 launch of the Armed Forces Institute of Regenerative Medicine by


ASC.ARMY.MIL 53


SCIENCE & TECHNOLOGY


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