Rutgers University leadership creates great strides in breakthrough scientific research

Less than a decade ago, the U.S. Department of Defense established the Armed Forces Institute of Regenerative Medicine I (AFIRM I) with a multimillion dollar grant to focus research centered on regenerative medicine for the treatment of battlefield injuries and selected Rutgers University-New Brunswick to lead the civilian research program. Under the leadership of Dr. Joachim Kohn, Rutgers University-New Brunswick Board of Governors Professor in the Chemistry and Chemical Biology department at the School of Arts and Sciences, and director of the New Jersey Center for Biomaterials, the program has made great strides in breakthrough scientific research. One of the most dramatic outcomes is a series of face transplants at the Cleveland Clinic that culminated in a total face transplant in May 2017.

"Before 2008, facial transplants were a novel idea," said Dr. Kohn, who heads the Rutgers-Cleveland Clinic Consortium (RCCC) within AFIRM and is the Principal Investigator of the Department of Defense contract which made the face transplants possible. "France was the first country to perform the groundbreaking face transplant operation in 2005, and if it hadn't been for the Department of Defense's investment, the United States would be far behind the world."

The Rutgers-Cleveland Clinic Consortium (RCCC) is an integrated network of 20 dedicated partners based in premier academic institutions and medical centers developing promising biomaterials, cell-based and combined regenerative medicine technologies to restore lost tissue and lost function. In an effort to advance the commercialization of many of the new products and therapies emerging from the RCCC's research and development, the consortium has forged collaborations with industrial partners and health care companies to one day bring the innovations not only to wounded warriors but also to civilian trauma and burn victims.

Under the AFIRM I grant, which totals over $56.4 million in funds from 2008 to date, the Cleveland Clinic performed two face transplants, including its first total face transplant in May on a 21-year-old female who suffered severe facial trauma and other complications from a gunshot wound as a teenager. The 31-hour surgery, performed by 11 surgeons and multiple specialists, included transplantation of the scalp, forehead, upper and lower eyelids, eye sockets, nose, upper cheeks, upper jaw and half of the lower jaw, upper and lower teeth, partial facial nerves, facial muscles, and skin, effectively replacing 100 percent of the patient's facial tissue.

"Face transplants are always associated with great tragedy but also great courage. And while this grant enabled the Cleveland Clinic to perform a total of three transplant surgeries, the implications of the research and this investment go far beyond the transformation of an individual's face," added Dr. Kohn. "The breakthroughs and innovations we unravel today will help heal the most seriously injured among us, and will give them back quality of life."

Cleveland Clinic is one of six U.S. institutions that has conducted face transplants. Fewer than three dozen face transplants have been performed worldwide.

"Thanks to the support of the AFIRM I grant, the technical capability to perform a face transplant is becoming state-of-the-art; it's no longer considered experimental," said Frank Papay, M.D., chairman of Cleveland Clinic's Dermatology and Plastic Surgery Institute. "The experimental part of this life-changing surgery includes the ethical considerations and side effects of lifelong immunosuppression. Research and innovation needs to occur on the tolerance of allograft tissues. We still have to improve the pharmacology of immunosuppression, which appears to be greater than the technical risk. If we can figure that out, it would open up a whole new world for face transplantation."

The five major research program areas under the AFIRM grant include: limb and digit salvage; craniofacial reconstruction, of which face transplant is a culminating and seminal step; scarless wound healing; and burn repair. The projects under each program category addressed: repair and regeneration of bone and soft tissue; composite tissue injury repair; cartilage regeneration; epimorphic regeneration; control of wound environment; therapeutic delivery to wounds; attenuation of wound inflammatory response; intravenous and topical treatment of burn injury; wound healing and scar prevention; skin products/substitutes; cellular therapy; and clinical trials.

"As a biomaterials scientist, I am driven by the desire to improve health care and quality of life by developing advanced biomedical products that can be translated from the laboratory to clinical use," said Dr. Kohn. "Giving someone a new face is transformative, but it is not without challenges. A multitude of factors play an important role in the success or failure of such a complex, life-changing surgery. The most important challenge is the prevention of immune rejection of the newly transplanted tissue. Similar to organ transplants, face transplants require lifelong immune suppression therapy. But the progress we make today will help heal wounded soldiers and alleviate the pain and suffering of patients throughout the world."

AFIRM is a multi-institutional, interdisciplinary network of universities, military laboratories and investigators under the framework of a cooperative agreement designed to promote a seamless integration of development, from basic science research through translational and clinical research, as the best means of bringing regenerative medicine therapies to practice.

Source: https://ored.rutgers.edu/content/rutgers-university-leadership-paves-way-breakthrough-medical-research-including-cleveland