29-10-2009, 12:42 AM
DARPA: Transforming Soldiers One Cell at a Time
Katie Drummond
27 October 2009
World Politics Review
If you ask Spc. Daniel McBroom of the Army National Guard, the hardest part of war was the wind. "Physically and mentally, the wind was the worst," he recalls. "This endless hot wind, like 100-degree fans turned toward your body." But McBroom, 23, who returned in June after serving a year in Iraq, says that the toll of war will be different for everyone. "There's no doubt it will mark you, change your body. But I don't think anyone can predict what that change will be."
McBroom is one of nearly 1.5 million Americans enlisted in the U.S. armed forces, all of whom see different sides of war. For those involved in combat -- some 200,000 in Iraq and Afghanistan right now -- the same three phases will shape their experience: training, deployment and reintegration.
After having arrived at pre-deployment mobilization camp, where enlistees spend several months before overseas departure, every man and woman of the American military will be transformed. Physically, their bodies will be examined and immunized -- this year, against H1N1 and anthrax -- and then molded into a robust battlefield warrior. Mentally, they will undergo interactive video training and group counseling, meant to bolster them against the inevitable trauma they'll experience on the ground.
Then the war-zone transformation begins. In Iraq and Afghanistan, troops endure 110-degree heat, wind storms and torrential rain, along with ongoing threats of roadside bombings or engagement with hidden pockets of insurgency. The military's technological prowess has evolved remarkably from earlier wars, and the improvements go beyond just deadlier, more efficient weaponry. They also have implications for our own soldiers' survival. Only 10 percent of wounded troops now die from their injuries, compared to 25 percent during the Korean War.
Today, the United States is fighting a new kind of war, on a battlefield populated by unmanned drones, biological threats and an enemy in civilian dress. Yet an impersonal war is still a deadly one, and with more troops living to recover from injury and relive the battle, their bodies and minds will inevitably bear trauma.
Inevitably, that is, for now.
Enter DARPA
That's the popular acronym for the Defense Department's Advanced Research Projects Agency, responsible for the most "out there" Pentagon programs, from turning trash into electricity to turning primates into telepathic seers. Since 1958, DARPA has been the outlet for the military's wildest innovation dreams, but the agency didn't take a dedicated interest in human health until the 21st century. In 2001, when Tony Tether took DARPA's reins, his open-mindedness about ethically murky human studies, along with the burgeoning threat of biological weapons, led to a focus on troops: how to make them fitter, stronger and more resilient.
In 2002, DARPA was granted a $75 million annual bonus from Congress to boost human research projects, on the grounds that troops had become "the weakest link" in the military armor. Since then, DARPA has continued to churn out unconventional ideas by harnessing recent developments in biotechnology, neuroscience and genetics. Of course, they don't always succeed: Since the 1970s, DARPA has thrown millions of dollars into dozens of failed efforts, including telepathic troop communication. More recently, the agency has shifted away from prioritizing human advancement. More of their mega-million dollar budget is now going to eco-innovations, like turning carbon and hydrogen from water into electricity, and robotics, which might one day replace the imperfect human warrior altogether.
But DARPA still has several ongoing soldier-enhancement programs, and another handful of proposals for future ones, which offer funding to keen researchers with atypical ideas for fortifying the human mind and body. And despite the often-outlandish ideas, DARPA-funded research sometimes gets it right: Some of the agency's theoretical oddities are becoming legitimate scientific possibilities. From training to combat to recovery, today's inevitable health implications of war could one day be solved by a handful of pills and a quick trip to the body-parts bank.
Better, Stronger, Sooner
Before deployment, troops prepare with months of training, from kicking down doors to counseling a traumatized colleague. And though nothing can adequately prepare a body for the rigors of war, tomorrow's troops will leave home stronger and sturdier, in part because of the power lurking in their own cells.
At least, that's the hope of Dr. Asish Chaudhuri, a biochemist at the University of Texas Health Science Center, who's been working on enhancing soldiers at the cellular level for eight years, with $1.6 million in funding from DARPA and Veterans Affairs. He was the first to demonstrate how oxidative stress, which causes cell degeneration, aging and neurological diseases, can be mitigated by a process already at work in the body. It takes place in the mitochondria, proteins in our cells that convert energy to glucose, and, as a byproduct, also produce oxidative reactions that degenerate cells. The more energy a body requires, the more oxidative stress it incurs, and the more a cell degenerates.
Last year, the Defense Department launched Mitochondrial Energetics, requesting proposals that would tinker with troop's energy-production abilities. That same year, Dr. Chaudhuri concluded that mole rats, who can live up to 28 years, have a particularly efficient mitochondrial cleanup system. Even when exposed to high levels of stress, the mole rats sustained their impressive lifespan. Now he's trying to boost the mitochondrial efficiency of primates, with a process that's part pharmaceutical and part diet. Anti-oxidants, often touted as a benefit of nutritious food, are the enzymes that eliminate byproducts of mitochondrial processes. DARPA wants those anti-oxidants condensed into a tablet, which Dr. Chaudhuri anticipates would be dozens of times more concentrated than a serving of greens. But caloric intake matters too: The byproducts of digestion cause cellular stress. So Dr. Chaudhuri expects that tomorrow's troops will also survive on a calorie-restricted diet, which, combined with anti-oxidant supplementation, will actually boost their bodies' efficiency.
"The armed forces are exposed to more stress, and more environmental toxins, than most," he says. "If we boost their mitochondrial efficiency, and curb the oxidative reaction of digestion, we're mitigating that stress before it happens."
Not only might troops increase their physical resistance to stress and toxins, they'd also minimize their risk of neurological diseases like MS and ALS, which have stricken vast numbers of Gulf War vets exposed to nerve gas and other chemical agents. "Within 10 years, I'd predict we have a supplement available," Dr. Chaudhuri says. "And neurological diseases? All but eradicated."
Mitigating existing stress is one thing, but DARPA also wants to eliminate cognitive awareness of stress altogether. This year, they launched another program, this one geared towards mental, rather than physical, stamina. The program, Enabling Stress Resistance, hopes to use advances in molecular biology and neuroscience to short-circuit how we interpret and internalize stressful situations -- long before oxidative stress enters the fray.
This kind of tactical pharmacology isn't new to the military, which started doling out amphetamines to troops in World War II, and have been criticized for continuing to do so as recently as 2003, when Air Force pilots accidentally bombed a Canadian training force while charged up on Dexedrine.
But DARPA isn't looking for a quick fix. They're asking for a team of academics, including molecular biologists and neuroscientists, to first identify how stress targets the brain, and then demonstrate a pharmaceutical intervention that can reduce stress reactions by at least 75 percent in test animals. From there, DARPA wants to "inoculate warfighters" against the cognitive and emotional impact of the high-stress inevitabilties in war zones, including limited sleep, emotional disturbance and physical exertion.
Of course, an appropriate dose of stress can also be a powerful catalyst. That's why Dr. Amy Krause, the Defense Department program manager in charge of the initiative, writes that she wants a method to "identify the breaking point" at which stress turns from motivational to harmful. By mapping cognitive stress response, and then meting out a pharmaceutical intervention that can short-circuit the feedback loop before stress even happens, DARPA hopes to boost troop bravado and performance, while limiting the long-term impact of wartime trauma, which is being linked to the unprecedented number of vets struggling with symptoms of post-traumatic stress.
Infallible on the Field
Making stress a thing of the past is one part of DARPA's ongoing soldier enhancement initiative. Undoing wounds incurred on the battlefield is another. In 2006, DARPA launched the Restorative Injury Repair Program, with the lofty goal of reinventing wound-healing. Rather than leaving soldiers bearing scar tissue or chronic pain, DARPA hopes to completely restore bone, nerve, tissue and skin. The program is one of their most ambitious, but it's already reached a significant milestone. In March, researchers at Tulane University used adult skin cells to develop the equivalent of blastema -- undifferentiated cells, found in amphibians, that can be used to regenerate lost body parts.
According to Dr. Jon Mogford, the program's director, Restorative Injury Repair is targeted at the multi-tissue injuries that are often sustained in combat. "A troop with a torso trauma might have layers of skin, muscle, nerve, bone, even fat, to restore, " he says. "We want to heal any injury, anywhere."
Estimates suggest that 85 percent of wartime injuries involve multi-tissue trauma to the extremities and face, which usually means multiple surgeries, rehabilitation and permanent disability. Skin grafts and muscle scaffolding yield acceptable results, but Mogford has higher hopes. "I'm after an approach that simulates natural healing -- as if every injury were just scraped skin."
Phase two, turning the blastema cells into actual muscle, and then other tissues, is already well underway. Biologists led by the Tulane University team are using a $570,000 grant from DARPA to regrow muscle tissue, and hope to do so within a year. Of course, muscles are naturally capable of withstanding and repairing damage. After all, that's how we strengthen them. But too much trauma, like an injury sustained in a war-zone, leads to permanent scarring instead of growth and improvement. A fresh muscle transplant, however, would offer an injured soldier a fresh start.
Muscle is the first target, but functional organs, nerves and bone aren't far behind. Mogford anticipates human trials within five to 10 years, assuming that the regenerative mechanism of amphibians can effectively be scaled to human size.
Of course, tissue and organ transplants are a ways off. Even once researchers yield the specific tissue cells, they'll need to learn how to use them within the body, and how to prevent rejection. Already, though, DARPA is on the verge of unveiling another battlefield health tactic that will be available in war zones within three years: lab-cultivated red blood cells generated using stem cells.
Last year, DARPA spent $1.95 billion on their blood pharming project, which uses adult stem cells to create vast quantities of red blood cells, the most transfused blood product on the battlefield. Because naturally derived red blood cells last for less than five days, the military doesn't store them in combat zones. Instead, traumatic injuries require transportation to triage or a medical center for treatment. To manage time-sensitive blood loss, DARPA wants a portable red blood cell bioreactor -- a machine, operating on electricity and water, that quickly produces vast quantities of red blood cells for immediate tranfusion.
DARPA only started funding blood pharming in 2007, but progress has been quick. Last year, scientists at bio-firm Advanced Cell Technology produced 100 billion red blood cells from a single sample of human embryonic stem cells. The achievement was remarkable, but not quite good enough. One unit of blood contains over 1.2 trillion red blood cells, and a standard combat-related trauma requires six units of blood within the first few days of injury. According to Mogford, the bioreactor and the technology are there. The challenge is to find the right balance of inputs to yield efficient, untainted cells in vast supply. "This is a question of recipe," says Mogford. "But on paper, we're slated for clinical trials within three years. So we'll get the recipe right."
Reintegration
Wartime injuries can't be undone yet, but war-zones have become less fatal, and that means more troops returning home to face another, longer battle: reintegrating into day-to-day life. For those returning from Iraq and Afghanistan, the process hasn't been easy. In July, the New York Times reported that veteran suicides were at an all-time high, and the Department of Veteran's Affairs estimates that 40 percent of today's troops will suffer from post-traumatic stress symptoms.
In 2008, the military started screening all returning troops for mental health symptoms. But a psych evaluation can't spot symptons if they don't show up until months or years later, and a 2007 report (.pdf) by an Army task force estimates that thousands of affected troops are going undetected. Until DARPA's pharmaceutical stress-resistance solution becomes a reality, the agency is also trying to make diagnosing post-traumatic stress and other post-war injuries easier, cheaper and more convenient.
Among the programs DARPA is backing are an at-home neuro-imaging device to diagnose changes in brain waves, and software that can detect changes in speech patterns associated with burgeoning mental health problems. But the thrust of their funding is going towards PREVENT: Preventing Violent Explosive Neurological Trauma. Launched in 2006, the program aims to detect brain trauma resulting from exposure to explosive devices. The phenomenon, called TBI (traumatic brain injury), often leads to symptoms that are similar to those associated with post-traumatic stress -- including confusion, anxiety, and depression, among others. So far, research hasn't determined why a soldier exposed to a blast can seem injury-free, but still suffer from long-term brain trauma. "We needed to go back to square one," says Mogford, "and determine the actual mechanism causing the damage."
Dr. Ibolja Cernak, an applied physicist at Johns Hopkins, was the first to study the injuries, which are undetectable even on sensitive MRI screenings. She theorizes that a blast can send a spike of energy through blood vessels, squeezing brain cells and changing how they transmit information. It's a domino effect that snowballs slowly, showing up over months or years.
DARPA is also evaluating the role of electromagnetic pulse, light and noise, and physical jolting, in causing TBI. Already, PREVENT has funded human studies on marines-in-training, who were exposed to small blasts and then examined for gradual neurological impairment. Unlike a concussion, which can heal, Cernak hypothesizes that TBI occurs at a molecular level. By determining the tipping point -- how many blast exposures are too many -- the military could rotate out troops who've been overexposed, until the ill effects can be prevented.
Prevention of post-traumatic stress, and a solution for traumatic brain injury, are likely decades away, but better diagnosis and improved prevention is around the corner. The same goes for prosthetic devices. Thanks to DARPA-funded research, they'll be more intuitive and life-like by next year, and indistinguishable from human limbs within a decade.
Ironically, the research might never have happened were it not for the better medical care available on the ground, says Fred Downs, the head of prosthetic devices at the VA's Veteran's Health Administration. Downs, who lost his arm in the Vietnam War, says that before the Gulf War, upper limbs accounted for fewer than 3 percent of amputations. In 2008, they accounted for nearly a quarter, because troops who would have died from their injuries 30 years ago are coming home alive. Unfortunately, most are receiving prosthetic devices that are the same now as they were after World War II.
That's where DARPA comes in. They've launched a $100 million program, Revolutionizing Prosthetic Devices, to finally bring artificial limbs into the 21st century. The thrust of the program is the DEKA arm, which took three years and a team of 30 researchers to develop, and shrinks 25 circuit boards and 10 motors into a device no bigger than the average human arm. Downs, who is one of 10 at-home testers of the limb, says it offers so much control that he's able to pick up small objects, like bottle caps, for the first time in 40 years. "I've got buttons inserted into my cowboy boots, and I push on those to move the arm," he explains. Different button combinations, triggered by Downs' feet, send wireless signals to the arm, causing unique movement patterns.
Downs anticipates that the arm will be available within a year for veterans and civilians, but DARPA already has plans for the next phase of prosthetic devices, which will harness neuroscience to create prosthetic arms that are indistinguishable from real limbs. The first step, being tinkered with by biochemists at the University of Michigan, is to attach severed nerves to a bioengineered scaffold, which then grafts onto the arm's muscle. As with a real human limb, thought would yield movement, and the neuromuscular connection could also relay sensory perceptions. "It's sci-fi stuff, Star Wars stuff, but it's going to work," predicts Downs. "We'll keep making improvements until it's like these traumas never happened."
Troops with endless energy, resistance to bio-threats and protection from injuries that once meant a lifetime of rehabilitation and suffering: What sounds like science fiction is exactly where DARPA is headed.
But not everyone wants to join them there. Spc. McBroom, who plans to redeploy next year despite a knee injury and recurring flashbacks, likely won't benefit from any of the new possibilities. And that's fine by him. "A world where you throw a pill at anything is not where I want to be," he says. "We train, we go, and we hope to come back. That's what I signed on for, and that's just how it's always been."
Katie Drummond is a journalist and editor in New York who specializes in unconventional and alternative approaches to health and medicine. She contributes military medical coverage to Danger Room at Wired.com and writes a column, The Extreme Self, at True/Slant Online.
Photo: DARPA'S non-invasively controlled advanced prosthetic developed under the Revolutionizing Prosthetics 2007 program.(DARPA/DEKA Photo).
http://www.worldpoliticsreview.com/article.aspx?id=4497
Katie Drummond
27 October 2009
World Politics Review
If you ask Spc. Daniel McBroom of the Army National Guard, the hardest part of war was the wind. "Physically and mentally, the wind was the worst," he recalls. "This endless hot wind, like 100-degree fans turned toward your body." But McBroom, 23, who returned in June after serving a year in Iraq, says that the toll of war will be different for everyone. "There's no doubt it will mark you, change your body. But I don't think anyone can predict what that change will be."
McBroom is one of nearly 1.5 million Americans enlisted in the U.S. armed forces, all of whom see different sides of war. For those involved in combat -- some 200,000 in Iraq and Afghanistan right now -- the same three phases will shape their experience: training, deployment and reintegration.
After having arrived at pre-deployment mobilization camp, where enlistees spend several months before overseas departure, every man and woman of the American military will be transformed. Physically, their bodies will be examined and immunized -- this year, against H1N1 and anthrax -- and then molded into a robust battlefield warrior. Mentally, they will undergo interactive video training and group counseling, meant to bolster them against the inevitable trauma they'll experience on the ground.
Then the war-zone transformation begins. In Iraq and Afghanistan, troops endure 110-degree heat, wind storms and torrential rain, along with ongoing threats of roadside bombings or engagement with hidden pockets of insurgency. The military's technological prowess has evolved remarkably from earlier wars, and the improvements go beyond just deadlier, more efficient weaponry. They also have implications for our own soldiers' survival. Only 10 percent of wounded troops now die from their injuries, compared to 25 percent during the Korean War.
Today, the United States is fighting a new kind of war, on a battlefield populated by unmanned drones, biological threats and an enemy in civilian dress. Yet an impersonal war is still a deadly one, and with more troops living to recover from injury and relive the battle, their bodies and minds will inevitably bear trauma.
Inevitably, that is, for now.
Enter DARPA
That's the popular acronym for the Defense Department's Advanced Research Projects Agency, responsible for the most "out there" Pentagon programs, from turning trash into electricity to turning primates into telepathic seers. Since 1958, DARPA has been the outlet for the military's wildest innovation dreams, but the agency didn't take a dedicated interest in human health until the 21st century. In 2001, when Tony Tether took DARPA's reins, his open-mindedness about ethically murky human studies, along with the burgeoning threat of biological weapons, led to a focus on troops: how to make them fitter, stronger and more resilient.
In 2002, DARPA was granted a $75 million annual bonus from Congress to boost human research projects, on the grounds that troops had become "the weakest link" in the military armor. Since then, DARPA has continued to churn out unconventional ideas by harnessing recent developments in biotechnology, neuroscience and genetics. Of course, they don't always succeed: Since the 1970s, DARPA has thrown millions of dollars into dozens of failed efforts, including telepathic troop communication. More recently, the agency has shifted away from prioritizing human advancement. More of their mega-million dollar budget is now going to eco-innovations, like turning carbon and hydrogen from water into electricity, and robotics, which might one day replace the imperfect human warrior altogether.
But DARPA still has several ongoing soldier-enhancement programs, and another handful of proposals for future ones, which offer funding to keen researchers with atypical ideas for fortifying the human mind and body. And despite the often-outlandish ideas, DARPA-funded research sometimes gets it right: Some of the agency's theoretical oddities are becoming legitimate scientific possibilities. From training to combat to recovery, today's inevitable health implications of war could one day be solved by a handful of pills and a quick trip to the body-parts bank.
Better, Stronger, Sooner
Before deployment, troops prepare with months of training, from kicking down doors to counseling a traumatized colleague. And though nothing can adequately prepare a body for the rigors of war, tomorrow's troops will leave home stronger and sturdier, in part because of the power lurking in their own cells.
At least, that's the hope of Dr. Asish Chaudhuri, a biochemist at the University of Texas Health Science Center, who's been working on enhancing soldiers at the cellular level for eight years, with $1.6 million in funding from DARPA and Veterans Affairs. He was the first to demonstrate how oxidative stress, which causes cell degeneration, aging and neurological diseases, can be mitigated by a process already at work in the body. It takes place in the mitochondria, proteins in our cells that convert energy to glucose, and, as a byproduct, also produce oxidative reactions that degenerate cells. The more energy a body requires, the more oxidative stress it incurs, and the more a cell degenerates.
Last year, the Defense Department launched Mitochondrial Energetics, requesting proposals that would tinker with troop's energy-production abilities. That same year, Dr. Chaudhuri concluded that mole rats, who can live up to 28 years, have a particularly efficient mitochondrial cleanup system. Even when exposed to high levels of stress, the mole rats sustained their impressive lifespan. Now he's trying to boost the mitochondrial efficiency of primates, with a process that's part pharmaceutical and part diet. Anti-oxidants, often touted as a benefit of nutritious food, are the enzymes that eliminate byproducts of mitochondrial processes. DARPA wants those anti-oxidants condensed into a tablet, which Dr. Chaudhuri anticipates would be dozens of times more concentrated than a serving of greens. But caloric intake matters too: The byproducts of digestion cause cellular stress. So Dr. Chaudhuri expects that tomorrow's troops will also survive on a calorie-restricted diet, which, combined with anti-oxidant supplementation, will actually boost their bodies' efficiency.
"The armed forces are exposed to more stress, and more environmental toxins, than most," he says. "If we boost their mitochondrial efficiency, and curb the oxidative reaction of digestion, we're mitigating that stress before it happens."
Not only might troops increase their physical resistance to stress and toxins, they'd also minimize their risk of neurological diseases like MS and ALS, which have stricken vast numbers of Gulf War vets exposed to nerve gas and other chemical agents. "Within 10 years, I'd predict we have a supplement available," Dr. Chaudhuri says. "And neurological diseases? All but eradicated."
Mitigating existing stress is one thing, but DARPA also wants to eliminate cognitive awareness of stress altogether. This year, they launched another program, this one geared towards mental, rather than physical, stamina. The program, Enabling Stress Resistance, hopes to use advances in molecular biology and neuroscience to short-circuit how we interpret and internalize stressful situations -- long before oxidative stress enters the fray.
This kind of tactical pharmacology isn't new to the military, which started doling out amphetamines to troops in World War II, and have been criticized for continuing to do so as recently as 2003, when Air Force pilots accidentally bombed a Canadian training force while charged up on Dexedrine.
But DARPA isn't looking for a quick fix. They're asking for a team of academics, including molecular biologists and neuroscientists, to first identify how stress targets the brain, and then demonstrate a pharmaceutical intervention that can reduce stress reactions by at least 75 percent in test animals. From there, DARPA wants to "inoculate warfighters" against the cognitive and emotional impact of the high-stress inevitabilties in war zones, including limited sleep, emotional disturbance and physical exertion.
Of course, an appropriate dose of stress can also be a powerful catalyst. That's why Dr. Amy Krause, the Defense Department program manager in charge of the initiative, writes that she wants a method to "identify the breaking point" at which stress turns from motivational to harmful. By mapping cognitive stress response, and then meting out a pharmaceutical intervention that can short-circuit the feedback loop before stress even happens, DARPA hopes to boost troop bravado and performance, while limiting the long-term impact of wartime trauma, which is being linked to the unprecedented number of vets struggling with symptoms of post-traumatic stress.
Infallible on the Field
Making stress a thing of the past is one part of DARPA's ongoing soldier enhancement initiative. Undoing wounds incurred on the battlefield is another. In 2006, DARPA launched the Restorative Injury Repair Program, with the lofty goal of reinventing wound-healing. Rather than leaving soldiers bearing scar tissue or chronic pain, DARPA hopes to completely restore bone, nerve, tissue and skin. The program is one of their most ambitious, but it's already reached a significant milestone. In March, researchers at Tulane University used adult skin cells to develop the equivalent of blastema -- undifferentiated cells, found in amphibians, that can be used to regenerate lost body parts.
According to Dr. Jon Mogford, the program's director, Restorative Injury Repair is targeted at the multi-tissue injuries that are often sustained in combat. "A troop with a torso trauma might have layers of skin, muscle, nerve, bone, even fat, to restore, " he says. "We want to heal any injury, anywhere."
Estimates suggest that 85 percent of wartime injuries involve multi-tissue trauma to the extremities and face, which usually means multiple surgeries, rehabilitation and permanent disability. Skin grafts and muscle scaffolding yield acceptable results, but Mogford has higher hopes. "I'm after an approach that simulates natural healing -- as if every injury were just scraped skin."
Phase two, turning the blastema cells into actual muscle, and then other tissues, is already well underway. Biologists led by the Tulane University team are using a $570,000 grant from DARPA to regrow muscle tissue, and hope to do so within a year. Of course, muscles are naturally capable of withstanding and repairing damage. After all, that's how we strengthen them. But too much trauma, like an injury sustained in a war-zone, leads to permanent scarring instead of growth and improvement. A fresh muscle transplant, however, would offer an injured soldier a fresh start.
Muscle is the first target, but functional organs, nerves and bone aren't far behind. Mogford anticipates human trials within five to 10 years, assuming that the regenerative mechanism of amphibians can effectively be scaled to human size.
Of course, tissue and organ transplants are a ways off. Even once researchers yield the specific tissue cells, they'll need to learn how to use them within the body, and how to prevent rejection. Already, though, DARPA is on the verge of unveiling another battlefield health tactic that will be available in war zones within three years: lab-cultivated red blood cells generated using stem cells.
Last year, DARPA spent $1.95 billion on their blood pharming project, which uses adult stem cells to create vast quantities of red blood cells, the most transfused blood product on the battlefield. Because naturally derived red blood cells last for less than five days, the military doesn't store them in combat zones. Instead, traumatic injuries require transportation to triage or a medical center for treatment. To manage time-sensitive blood loss, DARPA wants a portable red blood cell bioreactor -- a machine, operating on electricity and water, that quickly produces vast quantities of red blood cells for immediate tranfusion.
DARPA only started funding blood pharming in 2007, but progress has been quick. Last year, scientists at bio-firm Advanced Cell Technology produced 100 billion red blood cells from a single sample of human embryonic stem cells. The achievement was remarkable, but not quite good enough. One unit of blood contains over 1.2 trillion red blood cells, and a standard combat-related trauma requires six units of blood within the first few days of injury. According to Mogford, the bioreactor and the technology are there. The challenge is to find the right balance of inputs to yield efficient, untainted cells in vast supply. "This is a question of recipe," says Mogford. "But on paper, we're slated for clinical trials within three years. So we'll get the recipe right."
Reintegration
Wartime injuries can't be undone yet, but war-zones have become less fatal, and that means more troops returning home to face another, longer battle: reintegrating into day-to-day life. For those returning from Iraq and Afghanistan, the process hasn't been easy. In July, the New York Times reported that veteran suicides were at an all-time high, and the Department of Veteran's Affairs estimates that 40 percent of today's troops will suffer from post-traumatic stress symptoms.
In 2008, the military started screening all returning troops for mental health symptoms. But a psych evaluation can't spot symptons if they don't show up until months or years later, and a 2007 report (.pdf) by an Army task force estimates that thousands of affected troops are going undetected. Until DARPA's pharmaceutical stress-resistance solution becomes a reality, the agency is also trying to make diagnosing post-traumatic stress and other post-war injuries easier, cheaper and more convenient.
Among the programs DARPA is backing are an at-home neuro-imaging device to diagnose changes in brain waves, and software that can detect changes in speech patterns associated with burgeoning mental health problems. But the thrust of their funding is going towards PREVENT: Preventing Violent Explosive Neurological Trauma. Launched in 2006, the program aims to detect brain trauma resulting from exposure to explosive devices. The phenomenon, called TBI (traumatic brain injury), often leads to symptoms that are similar to those associated with post-traumatic stress -- including confusion, anxiety, and depression, among others. So far, research hasn't determined why a soldier exposed to a blast can seem injury-free, but still suffer from long-term brain trauma. "We needed to go back to square one," says Mogford, "and determine the actual mechanism causing the damage."
Dr. Ibolja Cernak, an applied physicist at Johns Hopkins, was the first to study the injuries, which are undetectable even on sensitive MRI screenings. She theorizes that a blast can send a spike of energy through blood vessels, squeezing brain cells and changing how they transmit information. It's a domino effect that snowballs slowly, showing up over months or years.
DARPA is also evaluating the role of electromagnetic pulse, light and noise, and physical jolting, in causing TBI. Already, PREVENT has funded human studies on marines-in-training, who were exposed to small blasts and then examined for gradual neurological impairment. Unlike a concussion, which can heal, Cernak hypothesizes that TBI occurs at a molecular level. By determining the tipping point -- how many blast exposures are too many -- the military could rotate out troops who've been overexposed, until the ill effects can be prevented.
Prevention of post-traumatic stress, and a solution for traumatic brain injury, are likely decades away, but better diagnosis and improved prevention is around the corner. The same goes for prosthetic devices. Thanks to DARPA-funded research, they'll be more intuitive and life-like by next year, and indistinguishable from human limbs within a decade.
Ironically, the research might never have happened were it not for the better medical care available on the ground, says Fred Downs, the head of prosthetic devices at the VA's Veteran's Health Administration. Downs, who lost his arm in the Vietnam War, says that before the Gulf War, upper limbs accounted for fewer than 3 percent of amputations. In 2008, they accounted for nearly a quarter, because troops who would have died from their injuries 30 years ago are coming home alive. Unfortunately, most are receiving prosthetic devices that are the same now as they were after World War II.
That's where DARPA comes in. They've launched a $100 million program, Revolutionizing Prosthetic Devices, to finally bring artificial limbs into the 21st century. The thrust of the program is the DEKA arm, which took three years and a team of 30 researchers to develop, and shrinks 25 circuit boards and 10 motors into a device no bigger than the average human arm. Downs, who is one of 10 at-home testers of the limb, says it offers so much control that he's able to pick up small objects, like bottle caps, for the first time in 40 years. "I've got buttons inserted into my cowboy boots, and I push on those to move the arm," he explains. Different button combinations, triggered by Downs' feet, send wireless signals to the arm, causing unique movement patterns.
Downs anticipates that the arm will be available within a year for veterans and civilians, but DARPA already has plans for the next phase of prosthetic devices, which will harness neuroscience to create prosthetic arms that are indistinguishable from real limbs. The first step, being tinkered with by biochemists at the University of Michigan, is to attach severed nerves to a bioengineered scaffold, which then grafts onto the arm's muscle. As with a real human limb, thought would yield movement, and the neuromuscular connection could also relay sensory perceptions. "It's sci-fi stuff, Star Wars stuff, but it's going to work," predicts Downs. "We'll keep making improvements until it's like these traumas never happened."
Troops with endless energy, resistance to bio-threats and protection from injuries that once meant a lifetime of rehabilitation and suffering: What sounds like science fiction is exactly where DARPA is headed.
But not everyone wants to join them there. Spc. McBroom, who plans to redeploy next year despite a knee injury and recurring flashbacks, likely won't benefit from any of the new possibilities. And that's fine by him. "A world where you throw a pill at anything is not where I want to be," he says. "We train, we go, and we hope to come back. That's what I signed on for, and that's just how it's always been."
Katie Drummond is a journalist and editor in New York who specializes in unconventional and alternative approaches to health and medicine. She contributes military medical coverage to Danger Room at Wired.com and writes a column, The Extreme Self, at True/Slant Online.
Photo: DARPA'S non-invasively controlled advanced prosthetic developed under the Revolutionizing Prosthetics 2007 program.(DARPA/DEKA Photo).
http://www.worldpoliticsreview.com/article.aspx?id=4497
"Where is the intersection between the world's deep hunger and your deep gladness?"