AFIRM Reduces Scar Formation with their Advances in Regenerative Medicine
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Written for Scars1 by Michelle Alford
Dr. Scott Fish, senior scientist of the army, announced earlier this year that one of the top three priorities for the army, along with armor and power systems, is the advancement of regenerative medicine. Leading that charge is AFIRM—the Armed Forces Institute of Regenerative Medicine. Formed in 2008, AFIRM strives to not just heal injured body parts, but to completely restore them to their original state.
Until recently, skin lost to burns and trauma could only be replaced by skin from other parts of the body or from a donor.
"We started out with the notion that we could potentially have these guys with things blown up or missing and we would be able to promote the body to completely recreate these parts," explains Colonel Stephen Wolf, Chief of Clinical Research for the U.S. Army Institute of Surgical Research. "Early on we discovered that some missing and damaged muscles grew back, so we researched how it happened and how we could augment it to happen faster."
The earliest research studies skin and muscle regrowth, because they're homogeneous, or made entirely of one substance. Heterogeneous body parts, such as fingers, are significantly more complicated to regrow because they include many substances, including skin, muscle, and bone.
Three clinical trials are currently pursuing separate skin regeneration methods. The Lonza engineered skin substitute method is similar to skin grafts in that it takes skin from one area of the body to help another part—however, for this method the patch of skin is no larger than a credit card. The skin is then put in a special solution and sent to a lab where scientists will separate the cells from the skin and grow the cells on a collagen matrix—expanding it to spread over a larger area. Within 40 days, that credit card-sized patch of skin will become the size of two big sheets of paper that can be used to replace burned or missing skin. "The major advantage of this," explains Colonel Robert Hale of the U.S. Army Dental and Trauma Research Detachment, "is that it doesn't require taking excessive amounts of good skin from the few areas of the body that are still left unburned. This reduces the death rate and the length of stay in the hospital."
The second method is primarily for less deep second-degree burns. Again, a small piece of skin is taken off of the patient and dissolved into cells, but this can be done in the operating room instead of in a lab thousands of miles away. The skin cells are put in a solution and sprayed onto the wound. The cells reproduce and spread over the wound, helping it to heal two or three times more rapidly than it normally would and resulting in less severe scarring. According to COL Hale, "This could be especially helpful for critical areas of the body like the hands where scarring would cause a lot of dysfunction."
The third method uses immortal cells from a newborn's foreskin. Unlike normal cells, which have a natural limit on the amount of times they can divide and duplicate, immortal cells can keep duplicating forever unless killed by an outside force. NEKs (normal keratinocytes) cells that are found in the circumcised foreskin of babies, have been found to be immortal and, unlike most donor skin, can be placed on a wound without being rejected by the recipient's body.
If the clinical trials are successful, treatments will be available for public use in about three years—one year of testing, one year of follow-up, and a third year of broader testing.
"I think we'll be able to completely regrow muscle or skin in five to ten years," muses COL Wolf. "Beyond that, we don't know. Changes are going to occur—are going to change people's lives. Will we be able to replace entire limbs? Entire systems? I'm sure we'll be making huge advances in some places we can't predict. We don't really know what's going to happen, but we know that it will."
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Photo: U.S. Army
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