Left to right: Ali Salim, MD, Audrey Epstein Reny, Jessica Lehoczky, PhD, Jennifer Galloway, PhD, Nish Acharya, Matthew Carty, MD

In 2014, the Reny and Epstein families established the Gillian Reny Stepping Strong Fund to honor the Brigham team that cared for their daughter, Gillian Reny, who was injured in the Boston Marathon bombings. Five years later, much has evolved. Seed money for trauma research has been leveraged into larger federal funding. Brigham-led research and emergency preparedness efforts have created national waves and long-lasting impact. What began as a small group of family and friends has grown into a global community of scientists, runners and philanthropists. But a dedication to transforming outcomes for trauma patients remains unwavering.

Stepping into Innovation

The fund was initially established to provide much-needed funding to support trauma research. Despite the high morbidity and mortality of traumatic injury, trauma research remains underfunded and often overlooked.

In 2017, the Brigham celebrated the opening of The Gillian Reny Stepping Strong Center for Trauma Innovation — a physical hub with cutting-edge laboratories dedicated to promoting cross-disciplinary collaboration in trauma research.

“Traumatic injury is a leading cause of death in America, and there was no center in the country that was focused on traumatic injury across departments in this way,” said Nish Acharya, MPA, program director at the Stepping Strong Center. “The innovation center is building an infrastructure around the research to help it reach patients more effectively and rapidly.”

Strength in Research

Bohdan Pomahac

One of the strengths of the center is its unique approach in funding diverse and multidisciplinary projects. Every year, its leaders distribute several Stepping Strong Innovator Awards — $100,000 seed grants to catalyze novel and groundbreaking initiatives in trauma research. The award supports projects in basic, translational and clinical research across the fields of orthopaedics, plastic surgery, trauma surgery, bioengineering, wound healing and emergency medicine.

Among the innovative projects funded is an initiative to build a portable device to rescue limbs. Bohdan Pomahac, MD, director of Plastic Surgery Transplantation, and two-time winner of the Stepping Strong Innovator Award, is spearheading this effort.

“Typically, when limbs are traumatically amputated, there is only a four-to-six-hour window during which the limbs remain alive and can be replanted,” said Pomahac. “This is often not enough time to stabilize the victim and carry out the challenging replantation operation.”

Accordingly, Pomahac and colleagues have been developing a portable system which extends the period of viability. By perfusing the limb with oxygen and basic nutrients, they have extended the window from six hours to up to 24 hours.

Pomahac explains that while not all limbs will be re-attachable, this device would allow for surgeons to use “spare parts,” such as muscle, tendon, bone, and skin, to close wounds or provide functional reconstruction.

“We have been successful in large animal studies and we’re in the process of developing the device,” said Pomahac. “Stepping Strong has been integral in both obtaining the data and now developing this actual machine.”

The Stepping Strong Innovator Award has enabled Pomahac to collaborate with an Australian company to design a prototype of the device. The next stage is to secure additional funding to build these prototypes for further testing in animal models, and eventually, in clinical trials.

If successful, this device could be used in versatile settings, ranging from military field hospitals to first-line trauma centers. Importantly, the portable device would allow for transportation and stabilization of the patient while prolonging the possibility for replantation.

Propelling Research Through Basic Discovery

Jessica Lehoczky (right) and her co-principal investigator Jennifer Galloway

In addition to funding lab-to-market medical innovations, the Stepping Strong Center consistently supports initiatives in basic science research.

One such researcher is Jessica Lehoczky, PhD, Department of Orthopaedic Surgery. She recently received the 2018 Innovator Award alongside Jenna Galloway, PhD, Massachusetts General Hospital, for their project titled “Identifying Drugs to Expedite the Healing of Orthopaedic Injuries.”

In traumatic injury, there is often extensive damage to bone, as well as soft tissue, such as cartilage and tendon. These tissues may fail to regenerate or fully heal, leading to scarring, proneness to reinjury and loss of function.

In this initiative, Lehoczky and Galloway are seeking to identify molecules capable of expediting healing by targeting a specific cell group: mesenchymal stem cells.

“Mesenchymal stem cells are progenitor cells that participate in healing orthopedic injuries — tendon, cartilage, bone,” said Lehoczky. “If we can find drugs that coerce these cells to go down very specific paths, it could lead to therapies benefitting patients with orthopaedic trauma.”

Galloway’s lab has previously screened thousands of candidate molecules for those that can direct mesenchymal stem cells towards becoming tendons, ligaments or cartilage in zebrafish. Of these, 69 chemicals showed promising results. Their current project focuses on testing those 69 chemicals in mouse models.

“Our goal with the Stepping Strong project is to determine which of these molecules have a conserved function in mice,” said Lehoczky. “Then, we can move onto the next phase and begin testing in human cells.”

Lehoczky lights up as she talks about potential therapeutic application of her newly-funded project.

“The long-term vision here is to ultimately affect patient outcomes, but we are still at the basic discovery phase,” Lehoczky remarked “It’s not a quick process, but we’re fortunate because Stepping Strong sees that and they’re willing to invest in the early stages.”

Stepping Forward: Trauma Prevention, Intervention and Advocacy

In addition to furthering research initiatives, the Stepping Strong Center has introduced a new program to promote injury prevention and effective intervention through hospital- and community-based initiatives. This program aims to prevent traumatic injuries occurring as a result of distracted driving, gun violence, falls, and other incidents, as well as promote better outcomes.

Ali Salim, MD, medical co-director of the Stepping Strong Center and chief of the division of Trauma, Burns, and Surgical Critical Care, is leading this work.

“Traumatic injury remains the leading cause of death for children and young adults in this country,” said Salim. “The goal of our Injury Prevention and Intervention program is to help decrease the number of patients who are injured in the first place.”

Last November, the Stepping Strong Center held its inaugural research symposium to unite past and present grantees. The Center is also looking to further expand its research community and form new connections.

“We’re trying to launch more programs around connecting researchers to industry leaders, and to initiatives going on outside the building,” said Acharya. “We’re constantly trying to expand our portfolio and are actively thinking about what programs could benefit our grantees and larger community.”

What initially began as a community comprised of one family expressing gratitude for a Brigham care team has since evolved to a community including 21 research teams, 110 Stepping Strong Center-affiliated faculty and 18,000 local supporters.

“The greatest strength of the Stepping Strong Center is the fact it’s been this all-inclusive, multidisciplinary body,” said Salim. “Our biggest achievement is bringing people together to help trauma patients, which I think is extraordinary.”

For more information about the Stepping Strong Center and supported projects, visit their website.