Three scientists left the room. At a large oval table straight out of “The West Wing,” their colleagues, along with the family of a Boston Marathon bombing survivor, weighed their proposals — and took a gamble on whose idea would transform trauma care.
The winner, plastic surgeon Dr. E.J. Caterson, aims to bring to market a gel that would disinfect and seal wounds instantaneously.
That scene took place one recent evening in a grand boardroom inside Boston’s Brigham and Women’s Hospital. Their votes would determine the latest recipient of a $100,000 Stepping Strong Innovator Award, a trauma-related research grant for Brigham-based researchers paid for by the Gillian Reny Stepping Strong Fund. Gillian Reny was one of the bystanders badly injured in the terrorist attack at the 2013 marathon; her family launched the fund after Brigham doctors saved her mangled leg.
Reny wasn’t at the boardroom event: Her health improved enough that she has gone off to college and is now studying abroad in South Africa. But the event was a reunion of sorts, bringing Reny’s family together with some of the Brigham doctors who treated her. In a pre-vote reception, doctors and hospital bigwigs schmoozed with her family over glasses of white wine and plates of ravioli.
The finalists in the competition roamed the room, posing for copious photographs. They had a tough task ahead: Presenting an idea with enough detail to sway experts in the field, but in plain enough terms that a lay audience could grasp. Some on the 28-person voting committee — a mix of donors, Brigham staff, and Reny family and friends — had no medical background.
Dr. Reza Abdi, a transplant nephrologist, took the stage first. He pitched a new way of helping severe burn patients who don’t have any skin left to graft onto their wounds. These patients go through some of the worst pain imaginable, he said. Skin from a cadaver can be a “lifesaver,” he said — but the body often rejects the graft, and the patients can’t be put on immunosuppressants. Abdi proposed placing skin from a cadaver atop a scaffold laced with stem cells, which would suppress immune reaction locally, allowing the skin graft to be accepted.
Caterson, medical director of craniofacial surgery at the Brigham, took a personal approach to his pitch: He led with a photo of a doctor friend who was nearly killed by an improvised explosive device, and talked about his time working with wounded veterans at the Walter Reed military hospital. He aims to study a thermoplastic gel patented by Ashim Mitra, a professor at the University of Missouri-Kansas City School of Pharmacy. The gel would flood the area with antibiotics and firm up when warmed to body temperature, creating a clear Band-Aid. If a doctor or nurse needed to tend to the wound, they could wash off the dressing with cold water.
The final presenters, bioengineers Ali Khademhosseini and Nasim Annabi, pitched creating a sprayable skin that would form an elastic layer, sealing a wound. A few lay listeners in the back of the audience traded puzzled glances: Amid all the technical jargon, they had little idea what the scientists had said.
After the finalists left the room, doctors translated the presentations into everyday speech and offered frank critiques.
Abdi’s skin graft is “still limited by how much skin is available” from cadavers, said Dr. Matthew Carty, a transplant surgeon at the Brigham. You couldn’t just pick it up in a can on the side of a battlefield, he noted. Others objected that the skin graft wouldn’t last very long.
Dr. George Dyer, an orthopedic surgeon at the Brigham, raised concerns that the spray-on skin would create a sticky mess, trapping dirt inside a wound.
“It’s a nightmare when you get a dirty, closed wound,” Dyer said.
Caterson was a finalist last year but had apparently confounded his audience: “He presented something so bewilderingly complex that no one got it,” Dyer said.
This time, his simpler approach succeeded: Caterson won the vote by secret ballot, announced by Reny’s grandparents.
He plans to use the award money to study whether the gel can be used to prevent the common problem of hospital-acquired infections.
In his comments as he accepted the award, Caterson said the survivors of the marathon bombing have made a remarkable effort to support each other. He said he recently attended the wedding of one of his patients who had to have an amputation after the bombing. At the next table, he said, there were seven people with amputations from the same incident.
He thanked the Reny family for continuing “to look out and make others better.”
Audrey Epstein Reny, Gillian’s mother, said the Gillian Reny Stepping Strong Fund has raised $4.6 million so far; she plans to create an endowment to continue supporting trauma research for years to come.