The reality of war is as grim today as it ever was: soldiers put themselves in harm’s way with predictable results. What’s changed is, the predictions are better than they used to be. So thanks to advances in emergency, in-theater medicine, the U.S. Armed Forces’ wounded-to-fatality ratio went from 2:1 in World War II to 8:1 in the Iraq/Afghanistan conflicts, according to the Philanthropy Roundtable publication, Serving Those Who Served.
The inevitable result is that a large number of service members and veterans are living with challenging injuries and disabilities. It’s a reality that underscores the timely importance of the research being done right now at the Georgia Institute of Technology and its partner institutions, who came together recently for the first Military and Veterans Healthcare Technologies Symposium.
About 90 scientists, engineers, students, and representatives from the Department of Defense gathered recently at the Parker H. Petit Institute for Bioengineering and Bioscience, where they shared leading-edge research that addresses the health challenges facing military personnel. Because, while the reality of war may be as grim as ever, soldiers are surviving injuries in greater numbers, which demands better therapeutic and rehabilitative options.
“The symposium really exceeded my expectations in every way,” says Robert Guldberg, executive director of the Petit Institute and professor in the George W. Woodruff School of Mechanical Engineering. “The purpose was to highlight military health-related research at Georgia Tech, Emory, and the University of Georgia (UGA). We have established very strong collaborations among the three institutions in areas like regenerative medicine, neuro-engineering, and prosthetics and orthotics.”
It took a collaborative effort on all fronts to produce the symposium. The event was co-sponsored by the Center for Advanced Bioengineering and Soldier Survivability (CABSS) at Georgia Tech, a U.S. Army funded research grant coming to a close this year, and the Center for Regenerative Engineering and Medicine (REM). REM is a collaborative center led by co-directors Steve Stice (UGA), Ned Waller (Emory), and Johnna Temenoff (Georgia Tech). The symposium was organized by Tom Barker, Petit Faculty Fellow and associate professor in the Wallace H. Coulter Department of Biomedical Engineering (BME), and Martha Willis, program manager in the Woodruff School.
Research in technologies addressing a wide range of clinical challenges in the military and veteran’s population were presented throughout the day, and a poster session to highlight additional projects and research efforts encouraged symposium participants to network and look for areas of common interests and focus.
Post traumatic osteoarthritis (OA), a debilitating and extremely painful condition characterized by gradual but progressive degradation of the cartilage surrounding the joints is often the result of battlefield injuries and it plagues wounded soldiers and veterans at rates higher than that of the general population. Effective pain relief for OA is limited and, remarkably, no disease modifying OA drugs are currently approved. Researchers at Georgia Tech are developing therapies and strategies for intra-articular delivery of micronized human amnion membrane that have shown promise in preventing the development of osteoarthritis following knee trauma in animal studies, and have gone on to show that they can regenerate regions of degraded cartilage in already arthritic joints.
ImmunoEngineering, or the application of engineering tools and principles to quantitatively study the immune system in health and disease, allows researchers to develop new and improved therapies by precisely controlling and modulating a patient’s immune response. Researchers at Georgia Tech’s Center for ImmunoEngineering discussed “Immuno-Engineering Soldier Health: From Sepsis and Trauma to Rehabilitation and Regeneration.” Krishnendu Roy, the center director described his center as a collaboration of engineers, chemists, physicist, computational scientists, and immunologists, focused on a broad range of diseases. He emphasized that correcting the long term immune-imbalance that causes chronic inflammation and suppresses many of the body’s natural healing mechanisms is critical for the success of any regenerative and rehabilitative therapies in our wounded warriors.
Other researchers at Georgia Tech and the Atlanta Veterans Affairs Medical Center outlined work conducted in their laboratories and facilities in regenerative engineering strategies for tendon overuse, extremity trauma and complex, multi-tissue injuries that simultaneously effect bone, muscle, vasculature and neural anatomy. Existing injury models tend to address individual components, but composite defect models and methods are bringing these technologies to the point of translation to human trials and actual clinical application. At UGA, researchers highlighted regenerative medicine efforts in bone fracture healing and nerve repair following traumatic brain injury.
Novel engineering approaches to hemostasis, scar formation and contracture as well as infection fighting materials that could be brought to bear on battlefield injuries were discussed, and researchers from Emory addressed neuromuscular control as well as some of the clinical complications associated with extremity amputation. Reminding us of the long-term reality of our military veterans living with amputations, one of the final presentations addressed the challenges of improving the technology behind prosthetic sockets, as researchers attempt to find solutions that improve comfort and function.
The symposium wrapped up with a presentation by one of the invited military guests, Brian Pfister from the U.S. Army’s Clinical and Rehabilitative Medicine Research Program (CRMR), entitled “DoD Priorities and Opportunities for Regenerative and Rehabilitative Technologies.” Following his presentation, a long line of symposium participants waited to pick Pfister’s brain. This was expected and one of the main reasons for the symposium, which organizers saw as a chance to become better acquainted with Department of Defense goals and funding priorities. They also saw it as a community-building event where researchers could explore new synergies and begin developing multi-investigator grant opportunities.
“At the end of the day, I felt incredibly energized by the research progress presented and the potential these technologies have to impact critical health issues experienced by our military personnel in very significant ways,” says Guldberg. “Our faculty and their students are clearly on the front lines of the latest advancements, whether we are talking about new approaches for treating acute problems like extremity trauma, bleeding, or infections, or the longer-term challenges associated with traumatic brain injury, post-traumatic osteoarthritis, or optimizing the functional mobility of amputees.”
In addition to Pfister, military guests at the symposium included Eva Lai of the Congressionally Directed Medical Research Programs (CDMRP), Bob Christy of the Army Institute of Surgical Research (AISR), and Susan Taylor and Mike Leggier of the Armed Forces Institute for Regenerative Medicine (AFIRM). Their presence, the nature of the research that was on display (including the stark images of soldiers’ injuries), and Pfister’s explanation of priority areas (extremity regeneration in the areas of muscle, nerve, and vascular) emphasized the ultimate purpose of the symposium, and the challenges facing researchers in this field.
“We have to keep in mind that this is not research as usual, but really focused on developing and translating healthcare technologies that help put back together our military personnel injured during service to our country,” Guldberg says. “This symposium served as a small but important step in that direction by bringing together like-minded members of our community and connecting with key program leaders at the Department of Defense.”
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