Nations around the world are preparing for Remembrance Day and Veterans Day, during which we recognize the contributions of the men and women who serve their armed forces and consider how best to give back.

The ISSCR is proud of the role stem cell research is playing in advancing the field of regenerative medicine, which stands to benefit wounded servicemen and women.

Dr. Anthony Atala, director of Wake Forest Institute for Regenerative Medicine, North Carolina, U.S.A., leads the consortium of researchers that make up the Armed Forces Institute of Regenerative Medicine (AFIRM). We spoke with him about the organization, which is working to develop advanced treatment options.


Q: What is the Armed Forces Institute of Regenerative Medicine (AFIRM)?

A: AFIRM is a federally funded program that works to apply regenerative medicine to battlefield injuries. It involves a consortium of more than 30 academic institutions and industry partners. The first phase of AFIRM began in 2008 and resulted in clinical studies of face transplantation, minimally invasive surgery for craniofacial injuries, scar reduction treatments, fat grafting for reconstructive surgery and new treatments for burns. The second five-year phase of AFIRM began in 2013.

AFIRM is results-focused, not only funding scientific research, but requiring that discoveries be tested and compared so that the most promising therapies can be brought to clinical trials. The AFIRM-I teams were charged with conducting at least one clinical study of a new treatment for wounded warriors. Instead, due to the teams’ expertise, collaborative spirit and dedication to the mission, there were 10 clinical studies of potential new therapies.

Q: Why did you choose to become involved with AFIRM?

A: Our team at the Wake Forest Institute for Regenerative Medicine has been involved in regenerative medicine since the early 1990s. When we learned about plans by the U.S. Department of Defense and other government agencies to focus on new treatments for our wounded warriors, we saw it as an opportunity to give back to those who put themselves in harm’s way while serving our country. Our researchers who work on this project say that they are driven by the needs of wounded warriors for new and better treatments. But, it’s important to note that most of the treatments developed through this program will also benefit the civilian population.

Q: What injuries does AFIRM focus on and why?

A: The AFIRM-II team is dedicated to developing clinical therapies over the next five years focusing on:

• Restoring function to severely traumatized limbs
• Reconstruction for facial and skull injuries through tissue regeneration
• Skin regeneration for burn injuries
• New treatments to prevent rejection of “composite” transplants such as face and hands
• Reconstruction of the genital and urinary organs and lower abdomen including the bladder, anal sphincter and external genitalia

These areas were identified by the military based on the wounds most in need of improved treatments.

Q: Can you share an example of how you are using stem cells to understand and treat these injuries?

A: Stem cells are used in almost every project under way at our institute. For example, in our work to develop new treatments for burns as part of AFIRM, we are evaluating the stem cells found in amniotic fluid and placenta (afterbirth) for enhanced wound healing. New treatments for burns are needed because the loss of the skin barrier results in fluid and heat loss and the risk of infection. Traditional treatments to surgically move healthy skin to the site of the wound won’t work for extensive burns. Other projects that use stem cells include the development of cell therapies to improve functional recovery after compartment syndrome, a condition associated with blast injuries that can cause tissue death and amputation. Stem cells are also used in our AFIRM-related work to 3D-print replacement bone, muscle, nerve and cartilage for reconstructive surgeries.

Q: What research are you particularly excited about at the moment?

A: To be honest, I am excited about all of our projects, which I suppose explains why I’m in this field! But, I am particularly excited by the precision of 3D printing and the potential to accelerate the development of new therapies. It is devastating to both the patient and doctor when a patient needs replacement tissue for reconstruction and there isn’t a good option. There is generally a Plan B, such as taking tissue from other organs, but it is almost never ideal. I am excited by the ability of regenerative medicine to provide replacement tissue made from a patient’s own cells and what it can mean to the patient’s recovery and long-term health.