The Gillian Reny Stepping Strong Center for Trauma Innovation is pleased to announce the recipients of the 2024 Stepping Strong Innovator Awards.
Each year, the Stepping Strong Innovator Awards support research and innovation across the continuum of trauma care from prevention to treatment and recovery. The following individuals received this year’s awards:
The spleen is one of the most commonly injured organs in blunt abdominal trauma. While nonoperative management is preferred for less severe injuries, more severe injuries often require removing the spleen in a procedure known as a splenectomy. Splenectomies leave patients vulnerable to infections caused by organisms commonly cleared by the spleen. These infections can sometimes lead to overwhelming post-splenectomy infections (OPSI), which have mortality rates as high as 50%. Regardless of the severity, a traumatic injury sustained by the spleen significantly changes the immune system. This immune dysregulation, coupled with reduced immune function following trauma in general, further increases the risk of serious infections. Current preventative measures have limitations and require follow-up, emphasizing the need for new strategies. Two immunologic therapies — CpG-DNA and rapamycin — have shown potential in enhancing immune function and combating infections in trauma patients.
With funding from the Stepping Strong Innovator Award, Alexandria Byskosh, MD, aims to uncover which immune mechanisms contribute to the increased risk of infection in trauma patients with splenic injury and evaluate the efficacy of CpG-DNA and rapamycin treatments. Integrating animal models and human blood samples, Byskosh aims to identify more effective preventive strategies that will reduce the risk of complications and death in post-trauma splenectomy patients.
The Centers for Disease Control and Prevention estimates that there are more than 2 million cases of mild traumatic brain injuries (mTBI) or concussions reported each year. Approximately 12% of these cases occur in high school students after a sports- or recreational-related injury. It is estimated that 30-50% of youths who have experienced a mTBI will have prolonged symptoms, even after only one occurrence. Adolescent and childhood concussions are increasingly associated with a greater risk of depression, anxiety, learning disability, and suicide, especially when the injuries are repeated. Furthermore, early life head injuries are associated with conditions that may appear in adulthood, including increased progression to dementia and, in cases of repetitive injury, chronic traumatic encephalopathy (CTE). Currently, no treatment exists to prevent the short- and long-term outcomes of mTBI in adolescents. Colette Cywes-Bentley, PhD, and her team have found that poly-N-acetyl-glucosamine (PNAG), which is a surface polysaccharide found on microbes, including those in the microbiota, accumulates in the brain after single or repetitive mTBIs in mouse models, as well as individuals diagnosed with CTE after death. The team proposes that long-term progression to dementia is due to chronic, low-grade inflammation — in which uncleared PNAG fragments are a contributing factor— in the brains of mTBI-affected mouse models and humans.
With funding from the Stepping Strong Innovator Award, Cywes-Bentley plans to (1) further understand the role of PNAG inflammation on neurological dysfunction and (2) provide preclinical data to explore the potential for PNAG-specific antibodies to prevent long-term neurological dysfunction in people who have experienced mTBI. This research will deepen the understanding of the role of PNAG in TBI-related injury and will assess whether antibody-mediated clearing of PNAG prevents chronic inflammation after injury. If proven effective, using PNAG-specific antibodies in the form of either a therapeutic or vaccine could be transformative in both the acute and long-term care of adolescents with a history of mTBI.
Trauma centers are specialized hospital units with comprehensive resources to care for the injured. Receiving care from a trauma center within one hour after sustaining an injury can improve outcomes and save lives. Yet, 30 million (mostly rural) patients in the United States cannot be transported to, and treated at, a trauma center within a timely manner, leading to a disproportionately high number of deaths and inefficient care coordination. While building new trauma centers in rural areas can help improve access to care, this process is costly, time-consuming, and has not yielded significant improvements. An alternative solution to accessing trauma care in rural areas is to use telehealth, specifically, teletrauma. Using audio-video links to connect with rural emergency department (ED) patients and their care team, trauma experts can help guide injury management decisions. Though initial results of this approach appear promising, more research is needed to understand how teletrauma is being applied at an individual level across rural EDs to care for injured patients.
With funding from the Stepping Strong Innovator Award, Mohammad Zain Ghani Hashmi, MD, and Carlos Camargo, MD, DrPH, will perform original data collection, data linkage, and geographical analyses to gain a deeper understanding of which EDs are utilizing teletrauma and how these EDs are treating injured patients with this method of care. This new line of research seeks to determine the benefits of using teletrauma and to help guide policies for rural trauma care.
Tissue allotransplantation — the application of donated tissues to an injured recipient — presents a significant clinical reconstructive opportunity for individuals with devastating musculoskeletal trauma or burn injuries. However, subsequent therapies that involve suppressing the immune system to allow the tissue grafts to survive pose a risk of adverse effects, including infection, diabetes, and even the development of tumors. Recognizing this issue, Pratik Koirala, PhD, and his team developed a gene therapy that allows cells to “sense” tissue allotransplantation rejection and produces an immunosuppressant that only impacts the affected skin graft, reducing the likelihood of developing other harmful conditions. This gene therapy has a closed-loop expression system that enables the immunosuppressant to be turned “on” by the cytokines that form during tissue rejection and to be turned “off” when those cytokines are withdrawn. Therefore, this gene therapy, when delivered only to the skin graft, allows the transplanted tissue to regulate threats of rejection and prioritize its survival.
With funding from the Stepping Strong Innovator Award, Koirala will begin a trial study that delivers the gene therapy with the goal of protecting skin grafts from tissue allotransplantation rejection. Using the information gathered during the study, Koirala aims to proceed with further development to bring this therapy closer to human application.
Amid a critical gap in trauma research funding, The Gillian Reny Stepping Strong Center for Trauma Innovation catalyzes multidisciplinary, multi-institutional collaboration to transform care for civilian and military heroes recovering from traumatic injury.
Learn more about the work we fund and stay connected to future Innovator Award opportunities.
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