Regenerative medicine and war: a front-line focus for UK defence

Abstract

The recent prolonged conflicts in Iraq and Afghanistan saw the advancement of deployed trauma care to a point never before seen in war. The rapid translation of lessons from combat casualty care research, facilitated by an appetite for risk, contributed to year-on-year improvements in care of the injured. These paradigms, however, can only ever halt the progression of damage. Regenerative medicine approaches, in contrast, hold a truly disruptive potential to go beyond the cessation of damage from blast or ballistic trauma, to stimulate its reversal, and to do so from a very early point following injury. The internationally distributed and, in parts austere environments in which operational medical care is delivered provide an almost unique challenge to the development and translation of regenerative medicine technologies. In parallel, however, an inherent appetite for risk means that Defence will always be an early adopter. In focusing our operational priorities for regenerative medicine, the authors conducted a review of the current research landscape in the UK and abroad and sought wide clinical opinion. Our priorities are all applicable very far forward in the patient care pathway, and are focused on three broad and currently under-researched areas, namely: (a) blood, as an engineered tissue; (b) the mechanobiology of deep tissue loss and mechanobiological approaches to regeneration, and; (c) modification of the endogenous response. In focusing on these areas, we hope to engender the development of regenerative solutions for improved functional recovery from injuries sustained in conflict.

Fig. 1

Diagram detailing injury types and prevalence from the most recent conflict in Afghanistan. Data from ‘Types of Injuries Sustained by UK Service Personnel on Op HERRICK in Afghanistan’ produced by the UK Ministry of Defence: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/502888/20160223_Afghanistan_Types_of_Injuries_Official_Statistic_Final_OS.pdf

Fig. 2

Diagram detailing an illustrative clinical case from the most recent conflict in Afghanistan with associated representation of the Operational Patient Care Pathway (OPCP) for that patient. Diagram drawn and assembled by John Skinner (Dstl Imagery) and authors. Further details on the nature of complex, multifaceted blast injury can be found in the comprehensive review by Cannon et al. including representative photographs of injuries

Fig. 3

Depiction of possible future scenarios for the Operational Patient Care Pathway (OPCP), derived from the Allied Joint Doctrine on Medical Management and future operational analysis. The OPCP has been split into four broad sections: the supply of medical capability (logistics), far-forward care at the point of primary injury, a period of potential secondary injury within Deployed Medical Treatment Facilities, either iatrogenic in nature (e.g. wound debridement) or a feature of the endogenous response to trauma (e.g. apoptotic cell death), and finally, reconstruction, recovery and rehabilitation in the Firm Base. Diagram drawn and assembled by John Skinner (Dstl Imagery) and authors