BOSTON – Scientists are growing ears, bone and skin in the lab, and doctors are planning more face transplants and other extreme plastic surgeries.
Around the country, the most advanced medical tools that exist are now being deployed to help Americas newest veterans and wounded troops.
In Los Angeles, surgeons used part of Michael Mills forehead to rebuild his nose after a bomb disfigured him in Iraq.
In Pittsburgh, doctors used an experimental therapy from pig tissue to help regrow part of a thigh muscle that Ron Strang lost in a blast in Afghanistan.
In Boston, scientists are making plans for the first implants of lab-grown ears for wounded troops after successful experiments in sheep and rats.
In San Antonio and other cities, doctors are testing sprayed-on skin cells and lab-made sheets of skin to heal burns and other wounds. The ingenuity is impressive: One product was developed from foreskin left over from circumcisions.
Much of this comes from taxpayer-funded research. Four years ago, the federal government created AFIRM, the Armed Forces Institute of Regenerative Medicine, a network of top hospitals and universities, and gave $300 million in grants to spur new treatments using cell science and advanced plastic surgery.
The whole idea is to bring all these researchers together to develop these great technologies that were in early science to eventually be ready for the troops, said AFIRMs recently retired director, Terry Irgens.
Now those who served are coming home, and projects that once had been languishing in labs are making strides and moving into clinics.
Strang is among those benefiting. The 28-year-old Marine sergeant from Pittsburgh lost half of a thigh muscle to shrapnel, leaving too little to stabilize his gait.
My knee would buckle and Id fall over, he said.
Now, after an experimental treatment at the University of Pittsburgh Medical Center, Im able to run a little bit and play a light football game with friends, he said. Its been a huge improvement.
Its one example of the new medicine in the works for troops.
Growing new ears
Up to 1,000 troops might need an ear, and prosthetics are not a great solution. A rod or other fastener is required to attach them to the head. They dont look or feel natural and they wear out every couple of years. A matching ear grown from a patients own cells would be a huge improvement.
People have been working on this for 20 years but havent been able to overcome obstacles to making it practical, said Cathryn Sundback, director of the tissue engineering lab at Massachusetts General Hospital.
Her lab thinks its found the solution. Using a computer model of a patients 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 its 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.
Muscles, bone, skin
A soldier lucky enough to keep his arms and legs after a bomb blast still might lose so much of a key muscle, such as biceps or quadriceps, that the limb cant be used properly.
In some cases, the patient has lost so much muscle that theres 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.
The material is supplied by a private company – ACell Inc. of Columbia, Md. – and comes from pigs. The immune system tolerates it because it doesnt 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.
In early testing, Theyve 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.
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 patients 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.
The second approach uses sheets of skin developed from cells in the lab that originally came from foreskin after circumcisions.
Thats in clinical trials now and theyre having tremendous results, Irgens said.