AFIP Partners With Walter Reed

AFIP Partners With Walter Reed to Help Advance Combat Wound Initiative Program

For many years the mission of the Armed Forces Institute of Pathology’s (AFIP) division of microbiology has been detection and developing therapeutics for biowarfare agents. Since the Institute’s work with biological select agents and toxins has become limited to inactivated agents, the staff wasted no time in applying their 15 years of biodefense knowledge to support research in the area of combat wounded soldiers. And today, the research scientists and technical staff from AFIP’s former microbiology division are collaborating with Walter Reed Army Medical Center in support of this new mission. This has resulted in a partnership between the Combat Wound Initiative Program (CWIP) and the AFIP for the establishment and hosting of the CWIP Complex Wound Biospecimen Network Program. As part of this, the microbiology division has been reorganized and renamed the division of wound biology and translational research.

“Our collaborator on this major initiative is the director of the CWIP, Army Col. Alexander Stojadinovic, M.D., who is a surgeon at Walter Reed Army Medical Center,” said Dr. Mina Izadjoo, chief of the newly formed division. “This joint effort will lead to developing therapeutics and major treatment decision support tools directed to improving outcomes for wounded soldiers.”

“We started discussions over a year ago with the AFIP and slowly built a partnership that I think is meaningful and will clearly advance the program,” Stojadinovic said. “We are very passionate about what we view is an unmet need in complex wound care, so we partnered to address this need based on knowledge we have already acquired for specific fields of interest and training.”

With operations in Iraq now in their sixth year and Afghanistan operations now in their eighth, doctors at WRAMC see some of the most severely injured soldiers, many of whom have multiple wound injuries caused by improvised explosive devices and intense firefights.

“We felt there was an unmet need within the National Capital area, if not within the DoD, to have truly an inter-service partnership as well as a private-public partnership in order to provide not only advanced complex wound care, but complex wound translational research/medicine,” Stojadinovic said.

In wound treatment it’s not uncommon for military personnel who have suffered combat injuries to receive several surgeries, so that doctors can prepare the wound to be closed for healing purposes.

“The treatment approach is predicated on aggressive surgical measures. That means multiple take-backs to the OR (operating room) to prepare the wound bed to reduce the bacterial load and ensure there is sufficient nutrient blood flood, so the wound can be closed or covered in a durable non-complicated way,” said Stojadinovic. “The way that we do that is to keep returning to the operating room, washing out bacteria, debriding the wound and changing dressings … getting the wound bed prepared for coverage, with the ultimate goal of preventing wound-related complications and limb loss.”

The biorepository for this program is being maintained by AFIP’s division of wound biology and translational research. The former microbiology division has newly renovated laboratories, administrative space, and state of the art equipment in AFIP’s headquarters for this collaborative effort. In addition, the division, under the leadership of Izadjoo, is providing the Combat Wound Initiative Program with scientific expertise in wound bioburden analysis, molecular diagnostics and therapeutics, using cutting edge instrumentation and techniques.

In support of this effort the division is establishing a “Combat Wound Microbial Culture Collection” and “Combat Wound Genomic Repository.” Izadjoo explained that these will provide significant resources in conducting research in the area of combat related infections and genetic characterization of microbial agents isolated from wounds. Also, extracted metal fragments, foreign bodies and biospecimens are being submitted to AFIP’s division of biophysical toxicology for biotoxicity studies under the leadership of Dr. Jose Centeno. He will analyze metal fragments, tissues and related wound biospecimens as part of the Depleted Uranium and Embedded Metal Fragments Registries. Centeno explained that his role in program involves “analyzing the contents in the fragments and analysis of all biospecimens in the repository, biospecimen tissue, body fluids, fluids used to clean the wound and other related tissue involved.”

Izadjoo is particularly excited about the translational research component of the program.

“We have made translational research a priority in an attempt to fill current gaps in the care of combat wounded soldiers,” Izadjoo said. “Our initiative for establishing this division is the first of its kind in DoD. Our research findings will be translated into a new knowledge for the clinical application of the combat wounded soldiers. This initiative in our institute is intended to provide significant support in driving the DoD’s clinical research engine in the 21st Century. Our scientists at AFIP will provide clinicians with new tools for use in patients.”

Izadjoo explained that translation research is the fundamental basis for translational medicine, including the manner which leads from evidence-based medicine to practical solutions for public health difficulties. Doctors using translational research identify needs; develop possible treatments through laboratory research; perform safety tests; evaluate the capacity to produce a desired effect; and conduct controlled clinical trials. Essentially, it takes scientific discoveries in laboratories and translates them into effective clinical applications, resulting in specialized and individualized care.

Former U.S. soldier and current AFIP logistics technician Adonnis Anderson knows only too well about the need for such an initiative. Anderson suffered severe injuries in 2003 while serving in Iraq. Iraqi insurgents threw an IED into the windshield of the Humvee that Anderson and three others rode in as they crossed underneath a bridge. He had a compound fracture, as well as muscle, tissue, and artery damage to his left arm. He spent nearly a year and a half involved in constant medical treatment, including emergency surgeries in Mosul, Kuwait, Landstuhl, Germany and Walter Reed.

“I had to endure four surgeries to save my arm,” said Anderson as he pushed up his sleeve and revealed the deep scars that ran half the length of his arm. “During my round of surgeries an infection started in my thumb and moved to three other fingers in my left hand. Then the top part of my thumb rotted away. I have limited movement in my arm. But I am one of the lucky ones who made it.”

Anderson spent a year and a half in physical therapy at WRAMC.

“The first five or six months were very painful, but after a while I got used to the pain,” said Anderson, who declined to have plastic surgery to help cover his wound on his arm, instead deciding to live with his battle scar.

After the wounds on his arm, as well as severe damage to his leg, healed, Anderson was granted a medical discharge. However, he said he will never forget the multiple surgeries he had to endure and the physical limitations due to his war wounds.