The US Defense Advanced Research Projects Agency (DARPA) is known for conducting high-level scientific research in the field of advanced military technologies. However, the Directorate is increasingly focusing its attention on the most important, but sometimes underestimated area - medical support of personnel.
DARPA's work in the field of military medicine is mostly carried out with the participation of the latest component in its overall structure - the Biological Technologies Office (WTO). As its director Brad Ringeisen noted, "our office is working on a wide range of tasks that can be grouped into three broad categories." First, it is neuroscience, such as using brain signals to make limb prostheses work. The second area is genetic engineering or synthetic biology. The third area of research focuses on technologies that can outpace infectious diseases and is a priority area of research for DARPA.
According to Colonel Mat Hepburn, head of several programs at the WTO, there are a number of reasons that bring the fight against infectious diseases to the fore. For example, the US military or its allies could be deployed to help a region or country affected by a specific pandemic, such as Ebola. "We are a globally deployable military force and we are going to send our people to the areas that we need to protect from disease."
Developing technologies and treatments to prevent infectious outbreaks can also enhance national security. For example, therapies developed for the military can be used to prevent or treat major civilian pandemics. However, all this is also true at lower levels, down to a single individual.
“A simple, yet extremely revealing example is the flu on a ship,” Hepburn explained. "Infected personnel are less efficient and this may affect the performance of the entire task." As another example, Hepburn cited the danger of a member of the group contracting malaria or dengue, “which is quite common in the places where we work. It could of course actually ruin the entire mission if you don't think about medical evacuation and precautions for this person."
As Hepburn noted, there are two broad categories when it comes to dealing with infectious diseases. First, it is diagnostics: to find out whether a person is sick or not. Second, what to do if someone is sick, that is, develop a course of treatment or countermeasures, such as a vaccine.
However, the main focus of DARPA is still on predicting whether a healthy-looking person will become sick. In addition, the FDA wants to know not only the likelihood that the patient may get sick, but also whether he is contagious or not. “Will he become a distributor of infection? Will we be able to suppress an outbreak in a specific community?"
Hepburn also talked about the Prometheus program. According to DARPA, its goal is to search for "a set of biological signals in a newly infected person that can indicate within 24 hours whether that person will become infectious," allowing early treatment and action to prevent transmission of the disease to others.
The Prometheus program currently focuses on acute respiratory diseases, which are selected for proof of concept, although the technology may be applicable to other infectious diseases.
“Let's say we have 10 people infected, we could test them and say that these three people will be the most infectious and will become carriers of the disease. We will then treat these people in order to prevent the spread of the infection,”Hepburn explained.
The Prometheus project aims to create "biomarkers" that show a person's susceptibility to disease and their potential level of infectiousness. “These markers are difficult to create,” Hepburn said. “Another challenge is to read these markers in the field and at the point of care. It may be necessary to develop a battery-powered device that can do the job."
“I think their military use is pretty obvious,” Hepburn continued. - Imagine a barracks or a ship or a submarine. The ability to identify who is going to get sick and stop an outbreak in these cramped conditions would be extremely beneficial for our military.”
In the area of prevention, DARPA does a great job of preventing disease. The main emphasis is on developing so-called “near-immediate” solutions to neutralize an infectious outbreak that will work much faster than the traditional vaccine.
“If I give you the vaccine, it may take two or three doses within six months before you reach the level of immunity you need,” Hepburn said.
In this regard, DARPA has begun work on a new program called the Pandemic Prevention Platform (Pandemic Prevention Platform), which aims to develop an “almost immediate” solution that can complement vaccines. The vaccine works by forcing the body to produce antibodies, and if they circulate in the blood in sufficient quantities, then the person is protected from a particular infectious disease. DARPA intends to dramatically accelerate this process through the implementation of the P3 program.
“What if we could just give antibodies that fight infection or protect you? In fact, if a person could just inject the right antibodies, then he would immediately receive protection, - said Hepburn. “The problem is that it takes months and years to get enough of these antibodies in a factory. This is a complex and costly process."
Instead of the traditional process of making antibodies and injecting them into a human vein, DARPA is working to create an injectable injection that contains DNA and RNA for antibodies so that the body can create the antibodies it needs. When the genetic code is injected into the body, "within 72 hours you will already have enough antibodies to protect you." Hepburn believes that this can be achieved within four years, by the end of the P3 program.
Ringeisen is leading another prevention program, Microphysiological Systems or Organs on a Chip, which will create artificial models of various systems in the human body on inkjet chips or chips. They can be used in a variety of ways, such as testing vaccines or administering a biological pathogen. The goal is ambitious - to simulate the processes of the human body in a laboratory setting.
“The significance of this is enormous,” added Ringeisen. "You can test literally thousands of drug candidates for efficacy and toxicity without the current cumbersome and expensive processes going through."
The current development model involves several very expensive processes, including animal and clinical trials. Animal studies are very expensive and do not always accurately reflect the effects of a drug or vaccine on the human body. Clinical trials are even more expensive, and the vast majority of tests fail.
“It's even more difficult with the job for the Department of Defense, as many of the medical protective measures it needs are designed to combat biological and chemical agents,” he added. "You can't take a group of people and try anthrax or Ebola on them."
Organs on a Chip technology is revolutionizing drug development for the military and civilian communities. The project, led by teams from Harvard University and the Massachusetts Institute of Technology, is currently nearing completion.
Ringeisen also noted the Elect-Rx (Electrical Prescriptions) program, which aims to develop technologies that could artificially stimulate the peripheral nervous system using its ability to heal itself quickly and effectively.
“This will improve the immune system, give the body more resistance to infections or inflammatory diseases,” explained Ringeisen.
Hepburn believes that in the future, military medicine will be able to "predict the disease much better at the earliest stages, and then all that remains is to take appropriate measures in a specialized institution."
“Everything is like preventive maintenance of your car. A sensor in it signals, for example, that the engine may break down or that you need to fill in oil. We want to do the same with the human body."
In the body, these sensors can be combined with other technologies to automatically initiate the required action, such as monitoring the glucose level of a diabetic patient. “We haven’t achieved it yet, but in 10 years it will become a common reality.”
Military medicine - especially with an emphasis on therapies and preventive measures - can provide real benefits in a number of other areas. It is clear that the priority is to ensure that personnel are protected from infection, but preventing such outbreaks on a larger scale, such as dealing with pandemics, also has a direct impact on the level of security. As a consequence, military medicine must meet the needs of not only the individual soldier, not only the Armed Forces, but society as a whole.
