Regeneration and Enhanced Recovery of Injured Skeletal Muscles Using External, Noninvasive, Passive Mechanical Stimulation
Abstract
Objectives and Rationale: Today, there is no therapy able to induce muscle regeneration in patients. Cell therapies and bio-engineering offer hopes for the future but their availability remains far from clinical application: physical therapy (PT) is the standard of care for musculoskeletal injuries. Despite partial effectiveness, PT is limited by delays in delivered therapy, limited application in acutely ill patients, dependence on patient cooperation, need for trained personnel and specific equipment, and difficulties accessing dedicated rehabilitation facilities. Our muscles physiologically grow and regenerate in response to mechanical stimulation (such as weight loading during gym training). These biological properties can used to design novel, safe, non-invasive, and cost-effective therapies. Passive mechanical stimulation of muscles was shown to induce tissue growth, improve muscle blood flow, and recruit stem cells to promote regeneration. This study aims to define in a preclinical translational model the exact parameters of passive mechanical stimulation (pressure, kinetics, duration) that maximize the regenerative capacity of injured muscles. Our outcomes will provide the biological knowledge required for subsequent adoption of the treatment in a preliminary clinical trial. The External Mechanical Muscle Enhancement (EMME) therapy will use non-invasive external compression to induce muscle recovery and regeneration after injury. EMME therapy is suitable for deployment in far-forward medical facilities to facilitate muscle regeneration immediately after injury and prevent the onset of further damage, and for implementation in post-acute rehabilitative care regimens to accelerate rehabilitation of patients. Applicability and Impact: Skeletal muscle injury is common in military and civilian (motor vehicle accidents, workplace injuries, and mass casualties) trauma. Trauma care for these patients does not end with the treatment of acute life-threatening injuries, but rather continues through a long path of rehabilitation. Functional disability after injury relates the inability of muscles to effectively regenerate. Instead, muscle injuries heal by scarring and fibrosis, leading to long-term loss of strength and enduring disability. The increased number of wounded Warriors over the last decade of military conflicts has exposed the need for novel therapies that induce immediate and delayed functional regeneration of muscles. Target Patient Population: Muscle injuries and the associated disability broadly affect Service members, Veterans, and civilians. The novel therapy developed under this award will be benefit all traumatic volumetric muscle loss (VML) injuries, including acute injuries and residual disability related to prior VML trauma. Potential Clinical Applications, Benefits, and Risks: This project will optimize a technique for immediate mitigation of acute damage, prevention of long-term disability, and improved rehabilitation of muscle after VML injuries in Service members and Veterans. We will define optimal parameters (dose, timing, frequency, duration, and setting) of treatment and design the therapy for improved patient interaction and usability. Once clinically available, we believe that EMME therapy will be provided in combination with PT to every Service member and Veteran with a VML injury as standard-of-care. Injured military members will obtain better functional recovery, sustain shorter rehabilitation regimens, and experience a substantial reduction in overall long-term disability. The meaningful impact of EMME therapy translates to a more rapid return of our Service members to duty at the same level of pre-injury performance, and a better quality of life for Veterans. Projected Timeline: This study will lay the ground for a subsequent preliminary clinical trial that we plan to conduct in collaboration with Department of Defense and Department of Veterans Affairs inst
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1810109
Entities
People
- Giorgio Giatsidis
Organizations
- United States Army