Military Medicine: Marching Ideas into Action

Soldiers in the military push their bodies to the limit as part of their every day jobs. The injuries these soldiers sustain in battle also push medicine to its limits as doctors search for new devices and procedures to quickly and effectively treat soldiers in the field. But the path from an idea to an approved, usable device can often feel long and tedious. Even the most carefully conceived medical invention can stop short of growing into fruition. So how can military soldiers and their physicians get the new devices they need to treat the strains of a new kind of warfare? It takes a solid team effort.

The Georgia Tech Center for Advanced Bioengineering for Soldier Survivability aims to speed up the long process of turning an idea into a reality by bringing doctors, engineers, and industry together. The director of this center, Dr. Barbara Boyan, who we recently featured in OTW’s “Picture of Success” series, says,

 “Our goal is to convert these ideas into actual, tangible products so that they are engineered to go into humans within three years. I thought if we could take the full capacity [of Georgia Tech] and really focus it on just a few technologies that we could in fact convert them into usable products. And it looks like that is what is happening. Everything we do is with the idea, ‘What do we have to do to make it work?’”

Dr. Boyan started asking the government that very question about a year and a half ago. The initial pool of money to fund the center came from Congress in 2007. Now the center, based in Georgia Tech’s engineering school, is partly funded through the Orthopedic Trauma Research Program, partly funded through the Armed Forces Institute of Regenerative Medicine, and partly funded directly through the Department of Defense.

A Team Effort

Everything about the center, from its diverse sources of funding to the physical layout of its offices, is geared towards collaboration. “The newest building was just finished a year ago, and it has all been built since I came in 2002, ” says Dr. Boyan. “It's gorgeous, and the setup of all the interdisciplinary buildings is really amazing. I don't even have to leave the campus. I just walk across the courtyard, and there is an incubator facility with all the companies. That's one reason why our work is possible here. It’s the perfect environment in which to manage everyone...it's just magical.”

Making devices that work, however, requires more than magic; these doctors and engineers need smart science and the motivation to get the work done. “What really drives us, ” says Dr. Boyan,

“is the fact that, often in medical school, great ideas happen, and everybody agrees that we can study something and understand it better, but the actual converting of it into a technology that will be used by a surgeon requires engineering.

I think the process usually does take a lot longer than three years, and this is the nature of the beast. I'm not saying our devices will be commercial in three years, but the technology we’re developing will be ready in three years, we hope, to be tested in humans.”

Dr. Boyan thrived in her own medical training, but she admits that there are difficulties with trying to create new medical devices in a purely academic setting:

“In general, in academics, what happens is that a laboratory makes an invention. They study it and try to understand it, and if they are a laboratory that is motivated towards commercialization, they may file an invention disclosure describing what they think is the invention.

Then the university tries to figure out whether or not the invention has a path to commercialization that is worth pursuing. Many times these inventions become lost in the technology licensing office while the university tries to put some value on it. It's usually so early-stage that they don't always even know what companies might be interested in picking it up. Another problem is that the invention may be a wonderful idea, but it may not be formatted in a way that the physician can actually use it."

Companies may not have a university’s concentrated pool of laboratory inventors, but they do operate in a commercial world that can move faster than an academic community. “Companies can license from other companies, and they can buy other companies that may take an invention much further down the development path instead of putting all that time and energy into early-stage development. Universities can really only get to this early-stage. And that’s the missing piece where a company needs to become a partner in the process. But you also need a surgeon as a partner. And what we have done is brought the surgeon together with the engineer together with the company to move the technology forward.”

New Stem Cell Technologies

So what exactly are these technologies that Dr. Boyan and her researchers are working so hard to develop? The details may still be top secret, but one major area of development now is a device to more efficiently use adult stem cells. Dr. Boyan started with the question: “You could study stem cells, but we want them to be useful, so how do you make them useful in a reasonably short period of time?”

Adult stem cells show great promise in orthopedic treatments to help the body re-grow damaged bone and cartilage, speeding up recovery time by using the patient’s own cells. But researchers are still trying to figure out how to best use stem cells efficiently. “Stem cells tend not to remain at the site for very long, ” says Dr. Boyan. “Nobody really knows what the best amount of time is for them to be there, but it would make sense to me that we want more of them there and for a longer period of time. With the way that stem cells are now being used, they don't stay in the damaged area for very long in part because they aren't alive when we put them there, and they are also quickly removed from the scene, especially if they aren't the patient's own stem cells (allograft stem cells).”

The center is, however, developing stem cell technologies that would use the soldier’s own fat-derived stem cells, because, as Dr. Boyan points out, “even the thinnest of young men out there on the battle field has subcutaneous fat.”

After settling on the source of their stem cells, Dr. Boyan and her researchers went to work on turning those cells into efficient healers. “We came up with the idea that the series of technologies that we could develop relatively quickly would be ways of placing stem cells exactly where we want them and then keeping them at that site long enough to reasonably do their job. We have developed technologies for concentrating subclasses of stem cells, and then for delivering them percutaneously so we can treat focal legions that way. We had to come up with a novel shaped syringe that will allow this kind of particle to be delivered smoothly without clumping. And we had to be able to identify a flowable carrier that wouldn't negatively impact the ability of the stem cells to do their job.

“From an orthopedic point of view, we are also taking these same ideas and using them on scaffolding to place the stem cells precisely where we want them. The concept we have is that once healing starts there is potential in these very large orthopedic defects for nonunion to occur, but if we can place stem cells at that site to jumpstart the healing process, we could prevent nonunion from happening.”

In the midst of developing this technology, collaboration again is the key.

 “Without having the surgeon input, we might have made the syringe a less desirable shape, or given it less effective handling properties, ” says Dr. Boyan. “Or we might not have made a syringe at all!”

Gains and Strains of Collaboration

Although it may sound like these collaborations happen smoothly and easily, there can be definite challenges to getting surgeons, engineers, and companies to work together. “The surgeons have time constraints because of the need to see patients when the patients need to be seen, ” says Dr. Boyan. “And that can impact the way a study is done. You can have everything set up to go, and then there is an emergency, and the human comes first. There has to be a really good partnership between the surgeon and the scientist, and even for a clinician scientist, if they are in fact taking care of people, they need to treat their patients first.

“There needs to be a team, and the pure scientist part of the team needs to understand what some of the constraints of the surgeons are. But the surgeons also need to understand the constraints of the scientist. There's always funding issues, and most scientists are every bit as busy as most surgeons. Sometimes even more busy. So there has to be mutual respect.”

In her own experience, Dr. Boyan has a great respect for collaborative efforts with industry: “I think it's the best. I have really nice relationships with the companies that I work with. I ask them to be part of the team as well, and I really like it when their scientists are active members. It just makes everything go more smoothly.”

Plans for the Future

The team effort at Georgia Tech also allows for a long pipeline of projects in addition to stem cell technologies. The next top secret devices involve using nanotechnology to develop wound dressings and guided nerve regeneration. “We're also developing some ways of linking bone fragments together to preserve them, to have the greatest opportunity for the patient to heal with their own body parts. And we're developing hemostasis products, ” adds Dr. Boyan.

The center also has a growing head and neck program at the request of the military. “At the start of the conflict, most of the injuries were to the extremities, but as the conflict has gone on, a greater percentage of injuries are happening to the head and neck, particularly to the face, ” explains Dr. Boyan. “More than 25% of the injuries are actually to the head and neck, so how great would it be if we could adapt some of our orthopedic technologies to treat these cases as well?”

All these new potential technologies certainly give the Georgia Tech Center for Advanced Bioengineering for Soldier Survivability a “magical” feel, as Dr. Boyan puts it. But this is not a secret James Bond gadget lab–these new devices will hopefully, in three years, help treat real soldiers in the field. They put their lives in danger to keep others safe, and it only seems fair to push the limits of medical technology in order to keep the soldiers safe as well. And then, thanks to the quick, collaborative efforts of these surgeons, engineers and companies, the general public could also see stem cell injections and nanotechnology band aids sooner than one might think.