Defence medicine research at the NCSEM-EM

The NCSEM and Loughborough University are carrying out high-quality research, design and development of innovative rehabilitation technologies to advance musculoskeletal injury prevention, rehabilitation and return (to work) across military and civilian populations.

Research expertise covers assistive technologies, additive manufacturing, regenerative medicine, wearable technologies, tissue engineering, design, prototyping and sport and exercise medicine.

Examples of our research in this area

Prevention of Musculoskeletal Injury in the Military Environment (PRIME)

Musculoskeletal injury is one of the major drains on human capital and military capability, costing the military £1.02bn over the last 15 years. The PRIME study seeks to gain a better understanding of the different factors involved in musculoskeletal injury in military personnel.

Dr Paul Sanderson and Dr Andrew Kingsnorth from the School of Sport, Exercise and Health Sciences at Loughborough University are carrying out a stakeholder engagement project with individuals across all ranks to identify what they believe are the factors causing injury among army personnel.

One hundred and sixty participants from colonel through to private soldier have been surveyed to gain an understanding of what they think is causing injury, what can be changed to reduce this, the impact of making the changes and how readily the current military systems could adapt to those changes.

This is the second stage of the of PRIME study, with the outcomes of the first phase already helping to re-shape defence policy in MSKI prevention.

Next Generation Prosthetics mini-CDT

This was the pioneering mini-CDT at Loughborough University involving an interdisciplinary team of PhD students and academics from the Schools of Sport, Exercise & Health Sciences, Mechanical, Electrical & Manufacturing Engineering, Science, and Design & Creative Arts. Four PhD students addressed topics including biology, materials, mechanical simulation and computer aided design working towards a vision of a fully integrated prostheses enabled by biological feedback via a tissue engineered conduit between the artificial prosthetic and remaining muscle and nerves.

The work produced four successful PhD theses and underpinned the Engineering and Physical Sciences Research Council (EPSRC) funded project “Towards Bespoke Bio-Hybrid Prosthesis – Manufacturing bio-inductive interfaces in 3D to research into smart prosthetics”. Work is continuing in this exciting and challenging line of research.

Troy Bodkin – Specifying a hybrid, multiple material CAD system for next-generation prosthetic design
Maria Pardo-Figueres – Designing neuronal networks with chemically modified substrates: an improved approach to conventional in vitro neural systems
Lorenzo Zani – Biomechanical characterisation of soft tissue for transtibial prosthetics
Laura Jinks – The biocompatibility and adhesive properties of polymer–clay nanocomposite hydrogels

Biomechanical Associations and Efficacy of Injectable Therapies in Tendinopathy (BEFIT)

Loughborough University academics are collaborating with Stanford Hall’s Academic Department of Military Rehabilitation (ADMR) on a major project that could help UK military personnel with tendon problems.

The BEFIT study brings together university academics and Ministry of Defence (MOD) collaborators to investigate risk factors and treatment of tendon pain in the regular armed forces. It is led by Squadron Leader Robert Barker-Davies and supervised by Loughborough academics, Dr Daniel Fong, Professor Mark Lewis and Dr Patrick Wheeler.

The main focus of the project is a randomised controlled trial investigating the effect of high volume injection therapy in Achilles and patellar tendinopathy.

Defence mini CDT (Centre for Doctoral Training)

Loughborough University and Defence Medical Services became research partners in 2016, combining their expertise to make advancements in the medical care of the UK’s service men and women. This led to the establishment of the Defence Mini CDT at Loughborough, with projects looking at areas including:

How wearable technology can help prevent injury
Cellular level models of wound repair
Implications of age for those with very serious injury in the military

Work funded through the defence mini-CDT has seen the development of a 3D primary human cell-based culture model of wound healing, which is capable of mimicking complex musculoskeletal biology, that is relevant to human muscle wound healing biology, allows temporal analysis of the model state to investigate the distinct phases of wounding, and is amenable to pharmacological and genetic manipulation. This has culminated in the development of the thesis entitled “Development of an in vitro model of skeletal muscle wound healing” by Jacob Fleming, as well as resulting in the following publications.

Fleming JW , Capel AJ, Rimington RP, Player DJ, Baker LA, Turner MC, Jones JM, Martin NRW, Ferguson RA, Mudera VC & Lewis MP (2019) Scalable 3D Printed Molds for Human Tissue Engineered Skeletal Muscle. Front. Bioeng. Biotechnol. 7: 20
Fleming JW, Capel AJ, Rimington RP, Player DJ, Stolzing A & Lewis MP (2019) Functional regeneration of tissue engineered skeletal muscle in vitro is dependent on the inclusion of basement membrane proteins. Cytoskeleton 76: 371–82
Fleming JW, Capel AJ, Rimington RP, Wheeler P, Leonard AN, Bishop NC, Davies OG & Lewis MP (2020) Bioengineered human skeletal muscle capable of functional regeneration. BMC Biol. 18: 1–16

CDT in Regenerative Medicine

Following on from the success of the Defence mini-CDT, further projects were established and funded through the Centre for Doctoral Training in Regenerative Medicine investigating in vitro 3D bioengineered models of musculoskeletal injury and rehabilitation.

Specifically, this has included the successful completion of a thesis entitled “Molecular and phenotypic responses to mechanical loading in tissue-engineered skeletal muscle” by Kathryn Aguilar-Agon. This thesis investigated the methodology required to optimise, scale and utilise an in vitro model of skeletal muscle in order to establish a hypertrophic loading regime of engineered muscle, thereafter, characterising the molecular mechanisms following mechanical load and application of this regime. This work provided the methodology, hardware and software required to mechanically load lab grown musculoskeletal tissues, recreating exercise, injury and rehabilitation, allowing high-throughput investigation of the cellular and molecular mechanisms that underpin musculoskeletal trauma. as well as resulting in the following publications and thesis.

K.W. Aguilar-Agon, A.J.Capel, N.R.W.Martin, D.J.Player. M.P.Lewis (2019) ‘Mechanical loading stimulates hypertrophy in tissue-engineered skeletal muscle: Molecular and phenotypic responses’ Journal of Cellular Physiology. DOI: 10.1002/jcp.28923 4.
K.W. Aguilar-Agon, A.J.Capel, J.W. Fleming, D.J.Player, N.R.W.Martin, M.P.Lewis (2020) ‘Mechanical loading of tissue engineered skeletal muscle prevents dexamethasone induced myotube atrophy’ Journal of Muscle Research and Cell Motility. DOI: 10.1007/s10974-020-09589-0
https://repository.lboro.ac.uk/articles/thesis/Molecular_and_phenotypic_responses_to_mechanical_loading_in_tissue-engineered_skeletal_muscle/13146323

Ongoing research in this area has continued, again through research funded through the Centre for Doctoral Training in Regenerative Medicine with the following PhD project.

Jess Judd – “A Mechanically Induced Injury Model of Tissue Engineered Skeletal Muscle”

The success of the research funded through the mini-CDTs and DTCs has culminated in a successful grant award (£93k, Prof. Mark Lewis, Dr. Andrew Capel, Dr. Rowan Rimington) through the National Centre for the Replacement, Refinement and Reduction of Animals in Research (NC3Rs) CRACK IT Challenges (Challenge 37 STRATIS). This 6-month project will develop an in vitro bioengineered skeletal muscle tissue platform, that is amenable to multiple pathology-relevant injurious mechanisms and facilitates the screening of pro-regenerative therapeutics in high throughput and will commence in 2021.