DOD REPORTS ON PREVENTING SKIN TRANSPLANT REJECTION USING STEM CELLS

FROM:  U.S. DEFENSE DEPARTMENT 
Research Team Finds Promising Way to Prevent Skin Transplant Rejection
Story Number: NNS141203-03Release Date: 12/3/2014 10:02:00 AM   Email this story to a friend    Print this story
By Doris Ryan, Naval Medical Research Center Public Affairs

SILVER SPRING, Md. (NNS) -- A team of Navy researchers and collaborators working at the Naval Medical Research Center may have found a way to stop skin tissue rejection and published their results in the latest issue of STEM CELL Translational Medicine.

The research team developed and tested a laboratory skin transplantation treatment strategy model that supports the indefinite survival of donor transplanted skin grafts without use of long-term immunosuppression drug therapy.

This novel approach entails the intravenous injection of a small number of donor bone marrow cells and human stem cells.

"We demonstrated in the laboratory that a single infusion of adipose-derived stromal cells (ASC), stem cells taken from human body fat in a minimally invasive procedure, from an unmatched donor combined with an extremely low dose of bone marrow cells resulted in stable long-term tolerance of the skin graft without rejection for 200 days after the initial graft," said Thomas Davis, Ph.D., lead author on the paper and a contractor from the Henry M. Jackson Foundation. Davis is working at the Naval Medical Research Center's Regenerative Medicine Department.

Researchers still have a lot of work to do. From these preliminary studies, the next step is to test this strategy in preclinical studies to determine safety and efficacy. With promising results, this research will provide important knowledge about new ways to prevent rejection of transplanted organs.

"As we move forward, we are cautiously optimistic, appreciating that the transition from a laboratory model to proof-of-principle preclinical studies is challenging and not straightforward. If successful, this technology has diverse therapeutic applications in clinical transplantation in both military and civilian settings," Davis said.

Capt. Eric A. Elster, professor and chairman at Norman M. Rich Department of Surgery, Uniformed Services University of the Health Sciences, helped lead the study.

"ASC constitutively produced high levels of anti-inflammatory immunoregulatory factors," Elster said. "While further work is needed to validate this approach in other laboratory models before clinical trials can begin, the ability to use ASC, which are non-donor specific and clinically feasible, to induce tolerance opens a new horizon in transplantation."

Traumatically injured warfighters often undergo complex tissue and limb reconstruction that includes procedures involving skin, muscle, bone, joint, cartilage and nerve. Preservation and reconstruction is critical to long-term rehabilitation related to daily activities such as walking, eating, bathing and dressing. Doctors are using reconstructive surgery to treat devastating combat wounds and burns and that includes tissue transplantation combined with long-term immune-suppression medications. Rejection of transplanted tissue from an unmatched donor can lead to critical complications.

ONE MEMBER JOINT DOD TEAM BRINGS EXPERIENCE OF TREATING EBOLA PATIENTS

FROM:  U.S. DEFENSE DEPARTMENT

Right:  Navy Cmdr. (Dr.) James Lawler, center, an infectious disease physician, talks to team members during a training event at the San Antonio Military Medical Center on Joint Base San Antonio-Fort Sam Houston, Texas, Oct. 25, 2014. The group is part of a 30-member DoD team that could be called on to respond to new cases of Ebola in the United States. DoD photo by Army Sgt. 1st Class Tyrone C. Marshall Jr.  

Navy Physician Provides Ebola Treatment Expertise to DoD Team
By Army Sgt. 1st Class Tyrone C. Marshall Jr.
DoD News, Defense Media Activity

JOINT BASE SAN ANTONIO-FORT SAM HOUSTON, Texas, Oct. 27, 2014 – The Defense Department’s unprecedented mission of establishing a 30-member team to rapidly and effectively respond to any potential Ebola virus outbreak in the U.S. has brought some of the U.S. military health system’s best medical professionals together.

One member of the joint team brings real-world experience treating Ebola patients to the DoD training course that will assist in advancing the group’s proficiency. Navy Cmdr. (Dr.) James Lawler, chief of the clinical research department of the bio-defense research directorate, Naval Medical Research Center, Fort Detrick, Maryland, discussed his role on the DoD team serving as a subject-matter expert on Ebola treatment.

“I’ve had the opportunity to work in a couple of isolation treatment units in sub-Saharan Africa,” he said, “and recently, in May, I was at the Ebola treatment unit in Conakry, Guinea, as a consultant for the World Health Organization. He also worked with the local health ministry and with Doctors Without Borders, which runs the Ebola treatment unit in Conakry.

Advances in Ebola treatment

Lawler, an 18-year Navy veteran, said he thinks the treatment of Ebola has “evolved significantly” due to the outbreak in West Africa.

“We’re really rewriting the textbook on Ebola virus disease, because we’ve seen so many more cases in this outbreak,” he said. “I think we’ve tried to capture a lot of the lessons that have been learned from West Africa, and also from the repatriated patients who have been treated here in the United States. We’ve learned a lot about effective treatment and how important aggressive supportive care can be, and we’ve tried to impart those lessons to the team here.”

One characteristic of Ebola, he said, has been recognized more widely now for contributing to the mortality and morbidity of the disease: diarrhea and the incredible amount of fluid loss and associated electrolyte abnormalities that come with the disease.

“I think being more aggressive in treating those features of the disease has been an advance that this outbreak has precipitated,” Lawler said. “And I think that there’s a better appreciation that aggressive supportive care can make a significant difference in outcome.”

Training focused on infection prevention

During the DoD training the 30-member team has undergone, Lawler said, the focus has centered on appropriate infection prevention and control in isolation units -- how to set up an isolation unit appropriately, how to use the personal protective equipment, and how to integrate the appropriate infection control procedures into daily clinical practice.

Team diversity

The team’s make-up — 10 critical care nurses; 10 noncritical care in-patient nurses; five physicians with infectious disease, internal medicine and critical care experience; and five members trained in infection control specialties — is essential to its success, Lawler said. “Their complex patients require a significant amount of care,” he added, “and as part of the team we have a core of critical care nurses who are really the most important part of the team.”

That intensive nursing, Lawler said, makes the biggest difference in patient outcome, and all of those disciplines are important to managing patients.
“We also have some other folks who specialize in things like industrial hygiene and environmental health [who] can help with some of the other aspects of setting up a patient care unit that are important,” he said.

The infection prevention control practices the team is training on will work if they’re done effectively, Lawler said.

“It’s important to really rely on your training and to remain focused and deliberate when you’re working in a unit,” he said. “Errors usually come when people get sloppy; when they get tired [and] careless. We really focus on preventing that.”

Additionally, Lawler said, there is “absolutely” a benefit to having a team available for any infectious disease contingency, because Ebola is not the only worry.

“There’s [Middle East respiratory syndrome] Coronavirus that’s out there in the Middle East right now,” Lawler explained. “We’ve already had experience with [severe acute respiratory syndrome] [and] with pandemic influenza, so the threat of emerging disease and pandemic disease is always out there.”
Confidence in DoD team

Lawler expressed confidence in the team’s training and said he believes it’s ready to “deliver good care, and to do it safely.”

“I feel very comfortable that our training has prepared the team to deliver care effectively and safely,” he said. “If the event ever happens [where] the team gets called up, hopefully, other people [outside DoD] have the same confidence that I do that the team is ready to go.”

Lawler said the nation always turns to the military in difficult times, and it is up to the DoD team to ensure it lives up to that trust.

“I think, in general, doing good patient care in difficult situations is what the military medical system always does,” he said. “That mission is not unfamiliar to us, and we’re ready to go if the call comes around for this particular instance.”