Possible New Treatment for Soft Tissue Bone Formation in Burn Victims May Hold Promise for Blast Injured

Newswise — Bethesda, MD – A possible new treatment for stopping bone growth in soft tissue following third-degree burns may also prove to be beneficial to combat troops suffering high energy orthopaedic trauma or blast injuries, according to an article to appear in Science Translational Medicine, Sept. 24, 2014. Navy Cmdr. (Dr.) Jonathan Forsberg, associate professor of Surgery at the F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences (USU), and head, Department of Regenerative Medicine at the Naval Medical Research Center, and his co-authors Dr. Tom Davis, scientific director, Department of Regenerative Medicine, Naval Medical Research Center; Dr. Eric Elster, professor and Chair, Norman M. Rich Department of Surgery at USU; and Dr. Jeffrey M. Gimble, Center for Stem Cell Research and Regenerative Medicine, Tulane University School of Medicine, suggest that findings by a team of scientists led by Dr. Benjamin Levi at the University of Michigan, also reported in the same issue of Science Translational Medicine, could pave the way for improved methods to prevent heterotopic ossification (HO), or bone formation in soft tissues, a significant complication in battlefield wounds.

Third-degree burns, like combat injuries, can cause bone to form in soft tissues where it normally does not appear, creating major problems for patients and their surgeons. Levi’s team developed a mouse model to replicate the abnormal bone growth. The scientists then added a protein over the surface of the burn that removes energy molecules from the environment. The body’s cells normally release this energy molecule when exposed to trauma like a burn. The presence of the molecule outside the cell signals the cell to turn on its bone-forming machinery. By removing this energy molecule from the environment, Levi’s team has shown that the cell’s bone-forming machinery is turned off and bone formation is substantially reduced. Forsberg and his co-authors believe the process could be applied to military orthopaedic trauma patients, and suggest further exploration using a blast injury model that Forsberg’s lab has recently developed.

The frequency of HO formation from injuries sustained by improvised explosive devices and rocket propelled grenades in Operation Enduring Freedom and Operation Iraqi Freedom have been reported as high as 63 percent in the wounded warfighters.

"Combat-related HO represents a key clinical problem that's emerged during the present conflicts, afflicting a higher percentage of combat-injured personnel than either traumatic brain injury or post-traumatic stress disorder. For many patients, combat-related HO represents a critical barrier; limiting return to duty or regaining functional independence,” Forsberg said. “The work by Dr. Levi's research team and ours in the Regenerative Medicine Department at NMRC is designed to address these gaps through multi-faceted, multi-investigator, and multi-institutional collaborations."

“What impresses me about this study by Dr. Levi’s group,” said Gimble, “is how well findings based on civilian injuries and trauma can help the military address combat casualty care and vice versa. This just reinforces my growing appreciation of how well civilian and military medicine and surgery can complement each other!”