For most Americans, watching the heart wrenching films, Saving Private Ryan or Full Metal Jacket is the closest we will ever get to war. We won’t hear the screams or be witness to the terror felt by a young man or woman who has been hit by an IED in the sands of Iraq…who looks down and sees that his leg is ripped open and his arm isn’t much better…who lies there with a thousand thoughts flying through his mind: “Am I going to die? Will I ever see my family again? If I make it, will I lose my leg?”
Six thousand miles away, a cadre of dedicated engineers—a brain trust, really—work in labs around the U.S. to help ensure that when soldiers ask those questions, they have the kind of answers that any of us would want.
Susan Lephart, Ph.D., is the president of the Airlift Research Foundation, a public charity formed in 2008 by The Aircast Foundation to improve the care of wounded warriors. “At the outset, Aircast provided grants to young investigators to foster their careers; the foundation invested $3.6 million and the researchers managed to bring in $39 million in additional extramural funding.”
Explains Dr. Lephart, “Aircast was impressed by the outside support and wanted to build on that to make a more significant impact. They initially considered focusing the research to improve the care of amputees coming from Iraq and Afghanistan, but then learned that 82% of those returning suffered from significant extremity trauma, while only 6% were amputees. It became clear that the injuries created by IEDs were so significant that we were dealing with a different type of trauma. While modern body armor has greatly improved the survival rate of our troops, it still leaves the extremities vulnerable.
LT (RET) Edwin Salau is on the left and
Sgt. (RET) Andrew Butterworth is on the right.
In 2008 the Aircast Foundation put all of these ideas into a new, non profit entity–the Airlift Research Foundation. Dr. Lephart: “The goal of Airlift is to fund research that is specific to extremity trauma so that we could hopefully have a larger reach. It was obvious that while the government was doing its best, there was just not enough money to fund the amount and type of research that is needed. The Airlift mission is threefold: fund orthopedic research, increase public awareness of traumatic war injuries, and work with other groups whose goals are similar to our own.”
So who are the dedicated recipients of the Airlift foundation grants? They are the late night, goggle wearing young investigators…they are the ones who bring hope to those in pain whose minds are churning with a thousand questions. Dr. Lephart: “Each year, Airlift provides two $200, 000 grants for young investigators (either young as in just beginning their careers or as in just beginning a specific research agenda) to embark on proof of concept work that will ideally be funded by NIH [National Institutes of Health] or the Department of Defense (DOD) at a later date. When selecting the grantees, our bottom line is that the project should be able to be translational and have the potential to improve clinical care by exhibiting some marketability within five years. Thus far we have had two grant cycles; I’m excited to say that one of those projects may be approved by the FDA next year, while another two have led to patents.”
Dr. Christopher Born, the chief of Orthopedic Trauma at Brown University, is one of the research grantees. According to Dr. Lephart; “Dr. Born developed an intramedullary nail (IM) that has a special coating to fight infection. This is especially helpful in Iraq and Afghanistan where soldiers who have lost a significant portion of a femur can have an IM nail that will likely not result in what so often happens, i.e., the nail is rejected or the patient requires several follow on surgeries because of infection. The texture of the coating that Dr. Born uses is also revolutionary, and appears to increase healing. They are now looking at expanded ways of using the coating and other ways to manufacture the nail so that it may be used in lesser developed countries. The reach is just huge, and we hope they will receive FDA approval in the foreseeable future.”
Down at the University of Texas Health Science Center, another Airlift grantee, Peter Yang, Ph.D., developed something with so much potential that the DOD has opened its arms. Dr. Lephart explains, “Dr. Yang has created scaffolds that are weight bearing, which is significant because that makes quite a difference with large bone defects. There are patents on his work, and he has garnered close to $4 million in additional funding from the DOD and NIH. Fortunately, this work will benefit our troops as well as the general populace.”
With scaffolds occupying such an important place in the healing process, it’s not surprising that another Airlift grant recipient is pursuing excellence in this arena. “Yufeng Dong, M.D., Ph.D. of the University of Rochester Medical Center, is working with skeletal stem cells that are harvested from the injured patient. He is making a scaffold for large segmental bone loss, something that is novel because most times scaffolds are made using synthetic grafts or stem cells from outside the body. This work is so new and so applicable to the types of bone defects we are seeing in Iraq and Afghanistan that he will likely receive follow on funding.”
According to Dr. Lephart, the race to market just might be won by a young investigator at Harvard. “Tianhong Dai, Ph.D., has created a fascinating product. He is using light-based therapy—UV-C light—which is highly antibacterial, with the goal of putting it into a portable format. This ‘flashlight’ device could be carried by paramedics who need to treat a wound quickly and cut down on the bacteria. On the battlefield and in regular life, we are seeing that because of the overuse of antibiotics so many patients are resistant to these drugs…it is really the time for something noninvasive.”
So how do the stewards of the Airlift Foundation ensure that its precious resources go only to the most promising research? “We have a preliminary application deadline of July 1, something that enables us to determine if a project is in line with our mission and has scientific merit. This is also best for the applicants as we don’t want them to go through the rigors of a full application without knowing that they are fundable. Full applications are then due September 1, with the review process beginning in October.”
The reviewers and scientific board members engage in rigorous discussions and take significant time with each application. Whether or not someone is granted funding, they will receive substantial constructive feedback.
As for what those guarding the funds look for, Dr. Lephart states, “It is important that applicants have had the appropriate type of mentoring. While the science and clinical translatability are the most important aspects of the project, we also look at the institution and how much support they are willing to provide. Also, we want to know if the researcher has the right team in place. Finally, we assess the relevancy of the work to the task of assisting military personnel.”
Highlighting the organization’s unusual position, Dr. Lephart notes, “We have a unique opportunity because as a public charity we can function differently than the government or a for-profit organization.”
“Airlift can be more nimble, for example, being in more direct communication with the applicants and grantees. And our review process is both arduous and pure, which is challenging because orthopedics is a small community. We have to work hard to keep the process unbiased, but we feel that we have been able to do it.”
Aside from the financial elephant in the room—the need for funding—what are the organization’s growth pains? “Building our board has been a little slow because the members are very well respected individuals who are quite active outside of Airlift. But our board members are not just names on a letterhead…they have significant responsibilities to help us raise funds and national awareness.”
“In five years I would like us to be a sustainable organization with our percentages as low as possible relative to operations and programming. I would like to be able to provide more grants and add a second program that will fund senior investigators pursuing a new line of research.”
The fact that Airlift is raising that awareness among the general public is key to improved treatments for soldiers and civilians alike.”
Salau continues; “It is personal for me because my fellow service members need the scientific, medical improvements each grant recipient promises. Airlift is its own quietest cheerleader. America needs to know what our young researchers are accomplishing.”
Bernard Morrey, M.D., emeritus chairman and professor of the Department of Orthopedics of Mayo Clinic/Mayo Foundation, is chair of the Scientific Advisory Board for Airlift, adds, “Airlift fills a void in the research world, and provides for the rapid translation of important work to real life. The review process has a proven track record that can ably handle conflicts of interest and other hurdles that might impede this important work.”
Dr. Morrey, a former president of the American Academy of Orthopaedic Surgeons summed up the Airlift Foundation story best when he said, “I believe that we need to reach outside of the orthopedic community as well. So often, it seems that there are misunderstandings within our field about various groups that appear to be doing the same type of work. In sum, I am proud to offer my experience to help these very deserving wounded soldiers and young investigators.”
If any of our readers would like to receive more information about the Airlift Foundation please visit their website: www.airliftrf.org or email Dr. Susan Lephart: SLephart@airliftrf.org.
