Regenerative Medicine

On March 4th, 2009, a scientific steering committee (SSC) for regenerative medicine research met to identify and prioritize capability gaps and the research needed to provide the definitive and rehabilitative care innovations required to reset wounded warriors in terms of duty performance and quality of life, and provide input into recommendations for Defense Health Program (DHP) funding for fiscal year 2010 (FY10). Through a brainstorm process, the SSC identified potential capability gaps, sub-gaps and research needs. The SSC identified the six major gaps and associated sub-gaps listed below.

Treatment of Extremity Injury

Composite Tissue regeneration (muscle, bone, adipose, skin)
Vascular Repair/Revascularization
Inability to regenerate Nerve Defects >3 cm with >90% reliability
Inability to regenerate bone defects over 3 cm or bone non-unions with sufficient reliability
Muscle Protection/Regeneration
Cartilage/Joint Regeneration
Ability to optimize immune system to optimize CTA for extremity transplantation
Wound Management/Tissue Preservation/Infection Control
Limited ability to control immuno-modulation to promote healing and limit injury
Tendon/Muscle Unit Regeneration
Amputated Limb/Digit Regeneration
Inability to adequately prevent heterotopic bone formation
Ligament Regeneration
Limited availability of evidence based criteria for treatment

Treatment of Craniofacial Injury

Inability to repair functional nerve deficits
Inability to restore complete functionality and aesthetics of face
Need to use regenerative medicine and tissue engineering to replace missing or damaged composite facial features
Inability to repair/replace neuromuscular tissue units of the face
Inadequate ability to modulate the immune system to optimize CTA
Lack of implantable vascular scaffold
Limited ability to control immuno-modulation to promote healing and limit injury
Limited availability of evidence based criteria for treatment
Inability to modulate heterotopic bone formation
Inability to use imaging and anatomical characterization of CMF injuries and defects for quantitative surgical planning and donor selection
Inability to characterize and categorize craniofacial battle-injuries for epidemiology research and medical planning

Treatment of Skin Injury (burns and scars)

Inability to close burn wounds of greater than 40% at a single operation using autologous skin
Inability to control scar formation during the first 1-2 years postburn
Techniques applicable to burn patients re: eyelid, lips, nose, etc
Functional integration of epidermis and dermis
Better immunosuppressive therapies that avoid toxicity and possibly have the potential to be modified in case of infection to other complication
Matching elasticity pigmentation to normal skin
Inability to predict or prevent graft failure and ultimately wound failure in patients with massive injuries
Inability to provide definitive wound closure of large burns in the combat zone
Excessive duration of healing (one day per percent burn minimum inpatient hospitalization; prolonged inpatient and outpatient rehabilitation; multiple reconstructive surgeries)
Limited availability of evidence based criteria for treatment
Integration of sweat glands into skin to regulate heat
Inability to predict Pharmo-kinetic response in burn patients
Limited availability to control immuno-modulation to promote healing and limit injury
Failure to maintain lean body mass and activities of daily living during prolonged healing periods

Treatment of Spine Injuries

Limited availability to control immuno-modulation to promote healing and limit injury
Long term success of implant is problematic (poor integration leading to material failure)

Treatment of Abdomen and Pelvic Injury

Limited ability to repair, functionally augment, or replace abdominal and pelvic neuro-vascular tissues and organs
Limited ability to control immuno-modulation to promote healing and limit injury
Limited ability to repair, functionally augment, or replace abdominal and pelvic support and structural tissues (bone, cartilage, muscle, abdominal wall)
Limited ability to repair, functionally augment, or replace pancreatic tissues and organs
Limited ability to repair, functionally augment, or replace gastrointestinal tissues and organs
Limited ability to repair, functionally augment, or replace bladder and urethral tissues and organs
Limited ability to repair, functionally augment, or replace renal tissues and organs
Limited ability to repair, functionally augment, or replace reproductive and genital tissues and organs
Limited ability to repair, functionally augment, or replace hepatic tissues and organs
Limited availability of evidence based criteria for treatment

Treatment of Chest Injury

Limited availability to treat glottic injuries
Inability to repair/regenerated Chest wall incompetence (e.g. s/p sternal excision)
Healing of airway injuries following inhalation of smoke or toxic industrial chemicals
Limited ability to treat tracheal and bronchial injuries
Limited availability of evidence based criteria for treatment
Limited ability to control immuno-modulation to promote healing and limit injury