Rutgers University Leadership Paves Way for Breakthrough Medical Research Including Cleveland Clinic’s First Total Face Transplant

Dr. Joachim Kohn, Board of Governors Professor, Department of Chemistry and Chemical Biology, Rutgers University-New Brunswick, and Director, New Jersey Center for BiomaterialsNEW BRUNSWICK, NJ — Less than a decade ago, the U.S. Department of Defense established the Armed Forces Institute of Regenerative Medicine I (AFIRM I) with a multimillion dollar grant to focus research centered on regenerative medicine for the treatment of battlefield injuries and selected Rutgers University-New Brunswick to lead the civilian research program. Under the leadership of Dr. Joachim Kohn, Rutgers University-New Brunswick Board of Governors Professor in the Chemistry and Chemical Biology department at the School of Arts and Sciences, and director of the New Jersey Center for Biomaterials, the program has made great strides in breakthrough scientific research. One of the most dramatic outcomes is a series of face transplants at the Cleveland Clinic that culminated in a total face transplant in May 2017.

“Before 2008, facial transplants were a novel idea,” said Dr. Kohn, who heads the Rutgers-Cleveland Clinic Consortium (RCCC) within AFIRM and is the Principal Investigator of the Department of Defense contract which made the face transplants possible. “France was the first country to perform the groundbreaking face transplant operation in 2005, and if it hadn’t been for the Department of Defense’s investment, the United States would be far behind the world.”

The Rutgers-Cleveland Clinic Consortium (RCCC) is an integrated network of 20 dedicated partners based in premier academic institutions and medical centers developing promising biomaterials, cell-based and combined regenerative medicine technologies to restore lost tissue and lost function. In an effort to advance the commercialization of many of the new products and therapies emerging from the RCCC’s research and development, the consortium has forged collaborations with industrial partners and health care companies to one day bring the innovations not only to wounded warriors but also to civilian trauma and burn victims.

Under the AFIRM I grant, which totals over $56.4 million in funds from 2008 to date, the Cleveland Clinic performed two face transplants, including its first total face transplant in May on a 21-year-old female who suffered severe facial trauma and other complications from a gunshot wound as a teenager. The 31-hour surgery, performed by 11 surgeons and multiple specialists, included transplantation of the scalp, forehead, upper and lower eyelids, eye sockets, nose, upper cheeks, upper jaw and half of the lower jaw, upper and lower teeth, partial facial nerves, facial muscles, and skin, effectively replacing 100 percent of the patient’s facial tissue.

“Face transplants are always associated with great tragedy but also great courage. And while this grant enabled the Cleveland Clinic to perform a total of three transplant surgeries, the implications of the research and this investment go far beyond the transformation of an individual’s face,” added Dr. Kohn. “The breakthroughs and innovations we unravel today will help heal the most seriously injured among us, and will give them back quality of life.”

Frank Papay, M.D., (center) directs Cleveland Clinic’s third face transplant. (DPSI Medical Photography)

Cleveland Clinic is one of six U.S. institutions that has conducted face transplants. Fewer than three dozen face transplants have been performed worldwide.

“Thanks to the support of the AFIRM I grant, the technical capability to perform a face transplant is becoming state-of-the-art; it’s no longer considered experimental,” said Frank Papay, M.D., chairman of Cleveland Clinic’s Dermatology and Plastic Surgery Institute. “The experimental part of this life-changing surgery includes the ethical considerations and side effects of lifelong immunosuppression. Research and innovation needs to occur on the tolerance of allograft tissues. We still have to improve the pharmacology of immunosuppression, which appears to be greater than the technical risk.  If we can figure that out, it would open up a whole new world for face transplantation.”

The five major research program areas under the AFIRM grant include: limb and digit salvage; craniofacial reconstruction, of which face transplant is a culminating and seminal step; scarless wound healing; and burn repair. The projects under each program category addressed: repair and regeneration of bone and soft tissue; composite tissue injury repair; cartilage regeneration; epimorphic regeneration; control of wound environment; therapeutic delivery to wounds; attenuation of wound inflammatory response; intravenous and topical treatment of burn injury; wound healing and scar prevention; skin products/substitutes; cellular therapy; and clinical trials.

“As a biomaterials scientist, I am driven by the desire to improve health care and quality of life by developing advanced biomedical products that can be translated from the laboratory to clinical use,” said Dr. Kohn. “Giving someone a new face is transformative, but it is not without challenges. A multitude of factors play an important role in the success or failure of such a complex, life-changing surgery. The most important challenge is the prevention of immune rejection of the newly transplanted tissue. Similar to organ transplants, face transplants require lifelong immune suppression therapy. But the progress we make today will help heal wounded soldiers and alleviate the pain and suffering of patients throughout the world.”

AFIRM is a multi-institutional, interdisciplinary network of universities, military laboratories and investigators under the framework of a cooperative agreement designed to promote a seamless integration of development, from basic science research through translational and clinical research, as the best means of bringing regenerative medicine therapies to practice. 

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About Rutgers, The State University of New Jersey

Rutgers, The State University of New Jersey, is a leading national research university and the state of New Jersey’s preeminent, comprehensive public institution of higher education. Established in 1766, the university is the eighth oldest higher education institution in the United States. Nearly 69,000 students and 22,000 full- and part-time faculty and staff learn, work, and serve the public at Rutgers locations across New Jersey and around the world. The university belongs to the Big Ten Academic Alliance, comprised of 14 world-class research universities, and is among the top 20 public U.S. universities for total R&D funding. Rutgers University–New Brunswick is the state’s only public institution in the prestigious Association of American Universities.

As the premier public research university in the state, Rutgers is dedicated to teaching that meets the highest standards of excellence, to conducting cutting-edge research that breaks new ground and aids the state’s economy, businesses, and industries, and to providing services, solutions, and clinical care that help individuals and the local, national, and global communities where they live. ored.rutgers.edu

About the New Jersey Center for Biomaterials (NJCBM)

Founded in 1997 at Rutgers, The State University of New Jersey, the New Jersey Center for Biomaterials Center works to improve health care and quality of life by developing advanced biomedical products for tissue repair and replacement as well as the delivery of pharmaceutical agents. Staffed by biomaterial scientists, NJCBM spans academia, industry, and government, and its technologies have been translated into clinical and pre-clinical products including surgical meshes, cardiovascular stents, bone regeneration scaffolds, and ocular drug delivery systems. www.njbiomaterials.org

About Cleveland Clinic

Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. U.S. News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey. Among Cleveland Clinic’s 51,000 employees are more than 3,500 full-time salaried physicians and researchers and 14,000 nurses, representing 140 medical specialties and subspecialties. Cleveland Clinic’s health system includes a 165-acre main campus near downtown Cleveland, 10 regional hospitals, more than 150 northern Ohio outpatient locations – including 18 full-service family health centers and three health and wellness centers – and locations in Weston, Fla.; Las Vegas, Nev.; Toronto, Canada; Abu Dhabi, UAE; and London, England. In 2016, there were 7.1 million outpatient visits, 161,674 hospital admissions and 207,610 surgical cases throughout Cleveland Clinic’s health system. Patients came for treatment from every state and 185 countries. clevelandclinic.org