Tracey Koehlmoos: Regenerative medicine—where miracles and science overlap

traceykoehlmoosRegenerative medicine. I did not know it existed until I began working with the Marine Corps. Even writing “regenerative medicine” reminds me that I am not in Bangladesh anymore, trying to produce miracles by scaling up a 20 cent zinc intervention aimed at every child under the age of 5 with diarrhea, or figuring out the best way to get the simplest forms of primary care to the urban homeless, or strengthening access to vaccines. For a health systems scientist, it is a bit of a leap of faith to go into a laboratory that works on the discovery end of the research continuum.

In the last year, I have travelled around the US meeting with research leaders, and touring the laboratories of several members of the Armed Forces Institute of Regenerative Medicine: Warrior Restoration Consortium (AFIRM). Now on its second iteration, AFIRM II is led by Tony Atala, of Wake Forest University School of Medicine, in partnership with Rocky Tuan, of the University of Pittsburgh’s McGowan Institute of Regenerative Medicine. Although I met with Atala and Tuan at different times and at different locations, I was struck by their common sense of urgency and compassion, their extraordinary vision, and the radiant air of hope and possibility about them. Both times it was like meeting the Pope or Mother Teresa.

The enormous consortium under AFIRM II is funded through a cooperative agreement with the US Army Medical Research and Materiel Command, the Office of Naval Research, the Air Force Medical Service, the Office of Research and Development: Department of Veterans Affairs, the National Institutes of Health, and the Office of the Assistant Secretary of Defense for Health Affairs. AFIRM II is the follow up to AFIRM I, which produced awe-inspiring achievements like spray on skin for scar-less burn healing and a double arm transplant. AFIRM II will focus on five main areas: extremity regeneration, craniomaxillofacial regeneration, skin regeneration, composite tissue allotransplantation and immunomodulation, and genitourinary/lower abdomen reconstruction.

In early June, I had the privilege of attending a State of the Science symposium on regenerative medicine for wounded, injured, and ill veterans, which took place at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. The event was part of an ongoing series of symposiums sponsored by Rory Cooper, department chair of rehabilitation science and technology at the University of Pittsburgh, and brought together regenerative medicine leaders and researchers from the civilian and military sectors.

In the morning, a myriad of scientists from across the US talked about their experimental work. The audience of scientists, providers, and potential patients were rapt from the “playing around with growing nerves in the lab” presentation on neural tissue engineering—delivered by the New Jersey Institute of Technology—to the University of Pittsburgh’s overview of an in progress human trial on regenerative implanted muscle, which aims to improve healing and functional recovery.

Also, there was a global view of the state of osseointegrated implants (and what needs to be perfected), and a study of extra cellular electrical stimulation for bladder control after spinal cord injury. The latter generated a buzz from potential beneficiaries, who were seated in the front row of the symposium. The audience gave an audible sigh of disappointment on learning that the science has so far only advanced to working on cats.

The afternoon was reserved for an overarching look at the work being conducted by a variety of civilian and military institutions that participate in AFIRM II. It framed the broader challenges of managing a single, visionary project across a nation when more than 40 institutions and hundreds of scientists are involved, as well as emphasizing the work being done by the US military.

However, system and policy challenges already exist as we grapple with how best to move wounded warriors and others in need toward these new, potentially beneficial services and studies—and the reverse direction of moving services and scientists toward potential subjects. For people like the friendly man in the wheelchair in the row in front of me, these promising technologies and restorative practices cannot move into human trials or general practice soon enough. Cats? Spinal cord injury survivors want and need these innovations today. Is it blasphemy to want to hurry along a miracle?

Tracey Pérez Koehlmoos is the special assistant to the assistant commandant of the Marine Corps, and senior program liaison for community health integration for the US Marine Corps.

The opinions expressed in this article are her own and in no way reflect the opinions of the US Marine Corps, the Department of Defense, or any other agency.