Plasmin Therapy to Prevent Post-Traumatic Heterotopic Ossification in the Upper Extremity After Severe Injury
Abstract
The Fiscal Year 2017 Peer Reviewed Orthopaedic Research Program Focus Area to be addressed by this work is the prevention of Heterotopic Ossification in the upper extremity. Background: Because of improvements in medicine, Soldiers now survive injuries that they used to die from. While being fortunate to survive, these Soldiers are now faced with problems coming from their bodies’ response to such severe injuries. One of the most common problems is a delay or failure of wounds to heal. This can lead to loss of function and even death from infection of non-healing wounds. Not only is this a painful and frustrating process for the patient, but it costs the patients and the military and United States healthcare system a great deal. One of the greatest mysteries, and problems, is why these severely injured patients often develop bone in areas of muscle injuries. This is called heterotopic ossification and is a big problem in the military as it has inflected more the 60% of severe injuries during the Afghanistan and Iraqi conflicts. When heterotopic ossification occurs in the arm, it is particularly debilitating as it leads to the inability to use the arm for daily activities such as feeding and bathing, not to mention the inability to work. As such, heterotopic ossification formation not only affects Service members, but also greatly impacts the lives of the family members caring for them. It is well known that that plasmin, a protein capable of breaking up other proteins, is very important in muscle and bone healing. We have recently discovered that it also is important in preventing heterotopic ossification, and that in cases of severe injury, it is used up. We therefore tested the idea that we could prevent heterotopic ossification from forming if we used drugs to restore this protein. Supporting this idea, we have found that our new treatments do prevent heterotopic ossification if we give them right at the time of injury in an animal model. However, most often we cannot give medicine right at the time of injury in a battlefield. For these reasons, before we try this new therapy in Soldiers, we want to make sure we know the exact time we can give this new therapy after injury and it still be effective in our animal models. Therefore, we will test each of the two new drugs, separately and together, to determine how far away from injury that we can give them and still be effective at preventing heterotopic ossification in the elbow of animals. We hope that we will find that we have around a 3-day window that we can start this new treatment, as this would be practical in the wartime setting. If so, we would move quickly to starting clinical trials in Soldiers, and similar civilian injuries, to improve the lives and decrease pain and dysfunction in these patients.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1810536
Entities
People
- Jonathan G. Schoenecker
Organizations
- United States Army
- Vanderbilt University