A few pig cells, a single surgery and a rigorous daily workout: They're the three ingredients that patients will need to re-grow fresh, functional slabs of their own muscle, courtesy of Pentagon-backed science that's already being used to rebuild parts of people.

The research team behind the project, based out of the University of Pittsburgh, has made remarkably swift progress: Mere months after starting their first-ever clinical trial, they've already operated on four soldiers and are now training groups of surgeons from across the country in perfecting the approach. If progress continues at this pace, the trial will wrap in 24 months and the technique will become "a standard of care for orthopedists and trauma surgeons," according to Dr. Stephen Badylak, head of the initiative.

It isn't quite salamander territory, but it's astonishingly close. The Pittsburgh team's research means that, within this decade, the thousands of soldiers who've suffered major muscle loss during this decade's wars can overcome devastating impairment – a life sentence of chronic pain, disability and no viable treatment short of amputation – and experience at least a 25 percent improvement in physical function. For civilians, the impact would incalculable. The kinds of trauma and health problems that now cause amputation, from car accidents and fires to cancer or diabetic peripheral vascular disease, would no longer cause irreparable damage.

Badylak and colleagues at the University of Pittsburgh's McGowan Institute for Regenerative Medicine are only one of several groups leading far-out research projects that are part of the Pentagon's Armed Forces Institute of Regenerative Medicine (AFIRM), a massive, $250 million undertaking meant to quickly usher regenerative medicine into the mainstream. Already, military brass have fast-tracked clinical trials for "bone cement" to replace metal screws and plates and accelerated the sophistication of face and hand transplants – a handful of which have now been conducted in the United States.

The tantalizing prospect of regrowing tissue using Badylak's technique first made headlines in 2007, when he announced the successful regrowth of a small portion of fingertip using a concoction based on cells derived from a pig's bladder. His approach with muscle tissue is similar: Surgeons start by implanting what's called an extracellular matrix, a sort of "cellular glue," whose key components are growth factor proteins from pig bladders. Those proteins trigger the body's own stem cells to flock to the area and initiate the process of tissue growth and wound repair – which adult muscles normally wouldn't do. Combined with an intensive rehab program to essentially "exercise" the nascent muscle, the body is able to restore not only basic muscle tissue, but the tendons and nerves that are necessary for function.

"The patient needs to do their part, and that involves a lot of work – we aren't just putting a cast on the leg and waiting," Badylak said. "But these soldiers coming in with 60, 70 percent muscle loss, they'll do anything to get their lives back."

Now, only four years after Badylak's fingertip achievement suggested his technique could restore lost tissue, his team is celebrating a notable milestone: The first patient enrolled in their trial, a veteran who lost the majority of the anterior tibial muscle in his lower leg during an IED attack, has today graduated from the requisite six-month rehabilitation program that follows surgery. "He's doing great," Badylak says of the unnamed patient, who has yet to be identified. "What would have been an amputation is now somebody with a limb that works much, much better than it did after the injury."

And if this patient's results are anything like those of Marine Corporal Isaias Hernandez, a U.S. soldier who served as Badylak's veritable guinea pig in 2008, after he returned from deployment missing 70 percent of his right quadriceps, the procedure is no doubt poised to transform medicine.

"I've been losing weight and playing sports," Hernandez said earlier this year, adding that he expected to re-enlist and deploy again. "It feels pretty good."

More will soon have the chance to undergo the treatment: The Institute is still recruiting soldiers and veterans missing at least 25 percent of the muscle mass in a given area – described as "a massive loss" by researchers – or qualify for limb amputation. Given that more than 50 percent of injuries in Iraq and Afghanistan have resulted in this kind of devastating tissue damage, they should have no shortage of eager volunteers.

"From what we're seeing, it works," Badylak said of the technique. "And there's a huge need here. So of course, we're being as aggressive rolling it out as we can."

*Photo: courtesy of McGowan Institute for Regenerative Medicine

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