J. Medical Research
Table E.III-9 summarizes international capabilities in medical research. Basic research efforts in the medical sciences related to military missions address four areas: infectious diseases; combat casualty care; Army operational medicine; and medical biological defense. The first relates to protection/prophylaxis of personnel deployed to a mission area from indigenous organisms or to biological (B) agents; the second to care of personnel following acute injury; the third to enhancers/sustainers of performance in the field; the fourth to treatment and care of persons following exposure to B agents. These areas of investigation are dual use and impact on general health care delivery, although the military aspects often differ from civilian concerns in several critical instances. For example, deployed military personnel may be more susceptible than indigenous populations to infectious agents because of lack or prior exposure. Also, developing novel means useful in delaying onset of clinical disease in the face of the physically and mentally demanding nature of combat is of critical importance, as incapacitating military forces for short periods may have profound effects on the outcome of operations.
The Human Genome effort has identified those gene profiles that render specific populations more susceptible to disease than other populations. The Human Genome project is a multinational effort spearheaded by the US, nations of EC, and Japan; the information is freely available on the Internet. Novel combinatorial chemistry strategies have allowed the synthesis of non-peptide molecules that bind gene fragments, receptors, or cell proteins and thereby offer the potential of protection against threat agents. These same materials also may provide utility in multi-array sensors used for the detection of B agents. Combinatorial chemistry strategies are being pursued in many developed nations through the pharmaceutical sector. Switzerland, Sweden, the Netherlands, and Israel have expertise in these areas, as do the above mentioned nations.
Foreign efforts in medical chemical defense closely parallel those in medical biological defense. For the most part, countries that are engaged in one are also active in the other. The one exception for countries listed is the Netherlands. The Dutch effort in medical chemical defense is not as extensive as in medical biological defense. All countries listed have world leading capabilities but none are expected to pull ahead of the others.
The critical areas of care for combat casualties in the next decade include treatment for fluid loss and accompanying shock, management of impact injury on the nervous system including the spinal cord, increased susceptibility to infection at points of projectile entry because of stress related events, and prevention of B agent dissemination by friendly forces exposed to agents. Biocompatible materials that bind oxygen and have utility as blood expanding agents are in development in the US, EC, and Japan. Cellular growth factors, acting on neural tissues, have been found to stimulate the repair of transected spinal cord and other CNS regions. Macromolecular growth factors, acting on tissues other than the nervous system have been shown to enhance the rate of wound healing and to increase resistance to disease. This research is actively explored in the US, Canada, Germany, UK, France, Japan, Israel, and Sweden.
Table E.III-9. Medical Science
|MEDICAL SCIENCE||UNITED KINGDOM||FRANCE||GERMANY||OTHER COUNTRIES||JAPAN||PACIFIC RIM||FSU|
|| a-e Switzerland
|Combat Casualty Care||a,b,c
|Army Operational Medicine||a,b,c
|Medical Biological Defense||a,b,c,d
Diseases - a: Human genome and Desease Susceptibility; b:
non-peptide antivirals; c: rapid diagnosis; d: vaccines; e:
delivery of vaccines post exposure
Combat Casualty Care - a: manage acute trauma shock ( blood loss, CNS change and perfusion); b: pharmacology of wound healing and CNS injury repair; c: containment of personnel and equipment after exposure (containment pods and telemedicare)
Army Operational Medicine - a: biomarkers for toxicant exposure (GST, P450, acute phase proteins); b: nutrient additives; c: countermeasure to intense noise
Medical Biological Defense - a; immune response enhancers (interferon, interlukin); b: intracellular transport molecules (M protein); c: block viral docking and replication; d: enhance uptake of drugs to cells (Botox)
Biomarkers for toxicant exposure in humans and animals have been identified; these materials are body catalysts and enzymes that serve to detoxify chemicals. The absence of some of these normally occurring enzymes in specific persons has been shown to increase susceptibility to disease. It is now possible to screen blood and urine samples and determine the concentration of these biomarkers in select persons. It is likely that biomarker profiles will have utility in selection of persons resistant to toxicants (for special operations) and for reviewing fitness for duty. The Human Genome project is likely to increase the number of biomolecules that can serve as biomarkers for exposure. The US, Canada, EC, and Japan have expertise in this area.
Normally occurring biomolecules have now been identified that enhance or degrade the immune response of persons to infectious material or to toxins. These materials are called biological response modifiers (BRM). Treatment, with novel BRMs, of military forces who may have been exposed to pathogenic agents as a consequence of deployment or through B agent attack, may enhance the survival or sustain the performance of the affected personnel. In the past few years, it has been shown that transport of infectious materials across cell membranes is a critical element in viral replication and maturation. Chemical treatment that interferes with the ability of a virus to bind to a target cell or with intracellular transport, can impede viral multiplication and infectivity; such treatments may sustain performance of affected personnel for long periods after exposure to such agents. The US, Japan, France, UK, Germany, Sweden, and Netherlands are leaders in this area.