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AP IMPACT: Surprising methods heal wounded troops
Question of the Day
Her lab thinks it’s found the solution. Using a computer model of a patient’s remaining ear, scientists craft a titanium framework covered in collagen, the stuff that gives skin elasticity and strength.
They take a snip of cartilage from inside the nose or between the ribs and seed the scaffold with these cells. This is incubated for about two weeks in a lab dish to grow more cartilage. When it’s ready to implant, a skin graft is taken from the patient to cover the cartilage and the ear is stitched into place.
Scientists in her lab have maintained lab-grown sheep ears on those animals for 20 weeks, proving it can be done successfully and last long-term. They also have grown anatomically correct human ears from cells. These have been implanted on the backs of lab rats to keep them nourished and allow further research. But that wouldn’t happen with ears destined for patients _ they would just be grown in a lab dish until they’re ready to implant.
“We’ve solved all the technical problems,” Sundback said, and now they are ready to seek approval from the Food and Drug Administration to implant these into patients _ probably in about a year. “It’s amazing how much progress we’ve made with the AFIRM funding.”
Bioengineering muscles, bone and skin
A soldier lucky enough to keep his arms and legs after a bomb blast still might lose so much of a key muscle, like biceps or quadriceps, that the limb can’t be used properly. In some cases, “the patient has lost so much muscle that there’s nothing left for the surgeon to sew together,” said Dr. Stephen Badylak, a regenerative medicine specialist at the University of Pittsburgh.
He is testing implants of “extracellular matrix” _ connective tissue that holds cells together _ to boost muscle mass. The matrix is thought to release chemical signals that promote regrowth of healthy tissue instead of scar tissue.
“It changes the body from thinking, `I need to respond to injured tissue,’ to `I need to rebuild this tissue,’” Badylak said.
The material is supplied by a private company _ ACell Inc. of Columbia, Md. _ and comes from pigs. The immune system tolerates it because it doesn’t contain cells. It comes in multi-layered sheets like slightly stiff gauze and can be cut or molded to fit the needed shape.
Strang, who lost half of a thigh muscle, is among the five patients treated so far in an 80-patient study. Doctors wait at least six months after an injury to make sure all natural healing has occurred, and put patients through intensive physical therapy before implanting the matrix.
“We want to be able to say after the surgery that they were as good as they could be” and that the matrix accounted for any improvement, Badylak explained.
In early testing, “They’ve shown up to 10 to 20 percent improvement” in strength of the muscle after treatment, said Irgens, the director of AFIRM, which funded some of the early work. The Department of Defense is sponsoring the study under way now, which includes non-military patients as well as former troops. The new study is measuring changes in strength and muscle volume, and doctors are aiming for the kind of quality-of-life improvement Strang has enjoyed.
In other efforts, Pittsburgh and Rice University scientists are working on growing bone to fix jawbone and other facial defects. Researchers at Massachusetts General and Rutgers University are trying to grow eyelid muscles. Blindness can result from not being able to close an eyelid.
Doctors also are testing various ways to make skin. In one method, doctors take a postage stamp-sized piece of a patient’s skin, process it in the lab and spray these cells onto a burn or other wound. The sprayer device that is used for this treatment is already licensed in seven countries, and AFIRM is sponsoring a study aimed at winning U.S. approval so the treatment can be offered here.
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