Advances in trauma care as a result of past campaigns in Iraq and Afghanistan have seen an increase in survival rates from blast and ballistic injuries. Traditionally, treatment for these types of injury sought to stop the spread of damage. However, with the emergence of regenerative medicine clinical staff now have the capacity to re-grow, repair or replace damaged or diseased cells, organs and tissues.
Clearly, the potential for this technology is significant, and will revolutionise the treatment given to people injured as a result of conflict or other hostile act.
The Defence and Security Accelerator (DASA) is keen to embrace this breakthrough. Last year it launched the Regenerative Medicine at the Front Line competition, seeking proposals for regenerative technologies to be delivered at the earliest possible stage following severe injuries.
The nature of future British military operations could lead to longer casualty evacuation timelines and medical care being delivered in more austere environments. This creates a challenge for the delivery of life-saving interventions and in the ongoing medical management of the casualty; not just to survive, but to also maximise functional recovery.
It is this early application of treatment that marks a step change in intervention, moving away from the normal practice of treating wounds away from the battlefield. Many current procedures in trauma care can only be administered at a hospital facility in the UK.
The scoping study, undertaken by the Defence Science and Technology Laboratory (Dstl) and the Royal Centre for Defence Medicine (RCDM), identified various areas of research in tissue engineering and regenerative medicine which could be exploited as early interventions that could potentially further revolutionise frontline trauma care.
It is envisaged that shifting the focus of tissue regeneration to earlier in the care pathway could maximise the success of later functional recovery.
Unsurprisingly, the battlefield provides an incredibly challenging environment for the development and delivery of regenerative medicine technologies. This means various factors must be considered in the development of such approaches including the type and severity of the injury, the battlefield environment itself and the logistical context.
Given these obstacles, the Ministry of Defence is keen to explore technologies that will help those injured on the front line and reduce the burden on later care supplied by both the Department and the National Health Service.
A DASA Innovation Network event was held in Bristol last year, as the competition sought new technologies and approaches that bring the principles of regenerative medicine to the front line and provide a truly disruptive capability for Defence.
The competition has two challenge areas – bioengineered blood and blood components; and the preservation and regeneration of soft tissue using biophysical approaches. For both, proposed technologies must take into account the particular difficulties of delivering trauma care in challenging environments.
The first challenge explores how tissue engineering and regenerative medicine are likely to hold the key to the logistical challenges of using blood products in future conflicts, and how these products could be optimised.
The production of blood components in vitro would remove the requirement for blood donation. Above and beyond this, however, it is envisaged that this could lead to further innovation – using the principles of tissue engineering to produce blood components with reduced immunogenicity, improved storage profiles or augmented functionality, for example.
In recent combat operations, red cells and platelets have been the only ‘cellular therapy’ used in theatre as replacements for blood lost during haemorrhage. In this challenge, DASA is looking for proposals that push at the boundaries of what these high-value assets are able to do.
The second challenge focuses on finding solutions to be used early after wounding following high-energy transfer from ballistics and blast to encourage the regeneration of soft tissue and mitigate the ensuing progressive tissue loss.
The repair and regeneration of severe tissue damage involves a complex set of biological processes that need to occur with the right balance, at the right time and in the right sequence for a tissue to repair, regenerate and/or undergo successful reconstructive procedures.
Early intervention often leads to more successful outcomes and a variety of biological approaches are under investigation for the manipulation of wound healing and regeneration after significant soft tissue damage.
Many of these approaches present logistical difficulties at the front line or during casualty evacuation, which could be quite protracted in future operations, with extended time to the delivery of definitive care also likely to negatively impact progressive tissue loss.
Physical approaches can be used to encourage the repair and regeneration of a variety of tissues and are likely to be less of a logistical burden than biological solutions. They may be a useful way to halt the progressive deterioration of tissue during transit and switch tissues to a regenerative trajectory. The competition encourages submissions that develop the use of cellular approaches for the preservation and regeneration of soft tissues.
Dr Abigail Spear, Principal Scientist at Dstl and Technical Lead for the DASA funding competition, said: “This dedicated focus on regenerative medicine research has been, and continues to be, an extremely fruitful collaboration between Dstl and the Academic Department for Military Surgery and Trauma at the Royal Centre for Defence Medicine. In this way we have brought together scientific, clinical and operational expertise to form an evidence-based strategy for MOD’s engagement in regenerative medicine research.
“This DASA funding competition forms a first step in implementation of our strategy to provide disruptive solutions for frontline trauma care in the future. We are excited to see these projects develop and welcome continued engagement from inside and outside of Defence as we move forward.”
DASA recently invited those with an interest in regenerative medicine, particularly for the treatment of traumatic injury, to a demonstration and discussion event.
Representatives from Dstl and RCDM were also present at the event, which allowed suppliers funded at Phase 1 of the Regenerative Medicine at the Front Line competition to showcase their projects and attendees to hear plans for Phase 2, as well as receiving an update on the wider regenerative medicine strategy and seeing how to get involved.
The demonstrations were led by DASA’s funded suppliers the Universities of Nottingham, Bristol and Birmingham and Plasticell Ltd, with three projects showcased in the area of bioengineered blood components and two in technologies to potentiate soft tissue regeneration early after wounding.
The event also saw Dr Matthias Pumberger from the regenerative medicine programme at Charité, Berlin deliver the keynote speech. Charité is one of the largest teaching hospitals in Europe and its regenerative medicine programme brings together experts from the fields of medicine, biology and engineering to deliver novel therapies including in the area of musculoskeletal injury.
Those looking to find out more information about the Regenerative Medicine at the Front Line competition and strategy should visit www.gov.uk/government/organisations/defence-and-security-accelerator.
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