From stem cells to genomics, HSS research plays a critical role in the field of musculoskeletal medicine. Our physicians and scientists made many breakthrough discoveries over the past year. All are aimed at improving patients’ quality of life.
With a new year upon us, Lionel Ivashkiv, MD, HSS Chief Scientific Officer, and his team of researchers share the latest on current research and what lies ahead for the long-term advancement of musculoskeletal medicine.
Purpose: heal injured tendons, improving outcomes for patients undergoing repairs of the rotator cuff, quadriceps tendon and Achilles tendon
When the study began: 2015
In Sports Medicine, Scott Rodeo, MD, Attending Orthopaedic Surgeon, is making progress in understanding how tendons can be repaired. What his team has been able to uncover recently is that intrinsic stem cells—which are probably involved in early tissue formation—may help heal injured tendon tissue. When these cells are stimulated, new blood vessels form, cells proliferate and the tissue becomes stronger. Now HSS researchers are investigating whether intrinsic stem cells could play a role in meniscus and cartilage repair. “It is a totally novel approach to cell-based therapies,” says Dr. Rodeo. “We are the first to use these cells in any musculoskeletal tissue.”
Upcoming Milestones: HSS will test whether specialized stem cells taken from a person’s muscle instead of tendon can be used to promote tendon healing. We will also test allogeneic cells, which are taken from a donor and would enable the use of “off-the-shelf” cells. HSS researchers are also investigating whether intrinsic stem cells could play a role in meniscus and cartilage repair.
Preventing Periprosthetic Joint Infections
Purpose: understand how infections develop and how to prevent infections that can develop after joint replacement surgery
When the study began: 2015
Another area of groundbreaking research is our understanding and treatment of periprosthetic joint infections, which can develop after joint replacement surgery. HSS Orthopaedic Surgeons Mathias Bostrom, MD, Geoffrey Westrich, MD, and Michael Cross, MD; HSS infectious disease specialists; and scientist Laura Donlin, PhD, of the Precision Medicine Laboratory, are investigating how these infections develop—and how to best treat them. Dr. Bostrom is developing a model of periprosthetic infections to better understand what causes this challenging—and devastating—clinical problem, while Drs. Cross and Westrich are investigating the diagnosis and treatment of such infections, as well as the risk factors. “I’m excited about our ability to have an impact on periprosthetic infections,” says Dr. Ivashkiv. “This is an area that really needs some breakthroughs because implant infections are very difficult to treat and are debilitating for patients.”
Upcoming Milestones: access new treatment protocols with novel antibiotics
Increasing Patient Satisfaction with Knee Replacement
Purpose: prevent pain and dissatisfaction associated with knee replacement
When the study began: We anticipate the first patients will be recruited this month
The Precision Medicine Laboratory (PML), which was expanded to include Orthopaedics in the summer of 2016, is involved in several research projects, including one in which researchers are trying to understand the problems some patients have after total knee replacement. “The idea is to take precision medicine, genomics approaches, and be among the first—if not the first—to apply them in orthopaedic research,” said Dr. Ivashkiv. A multidisciplinary team led by Timothy Wright, PhD, Hollis Potter, MD, Douglas Padgett, MD, Matthew Koff, PhD, Alessandra Pernis, MD, and Ed Purdue, PhD, is investigating ways to prevent the dissatisfaction and pain that occur in as many as 20 percent of knee replacement patients nationwide. “If we can identify the risk factors for these problems, we can intervene early,” says Dr. Ivashkiv.
Upcoming Milestones: Coordination of data from imaging, biomechanical and biological studies will be the initial focus. A multidisciplinary team of researchers will discuss each case to explore relationships between patient, implant, surgical and clinical factors.
Predicting a Patient’s Risk of Osteoarthritis
Purpose: predict a patient’s risk of developing osteoarthritis after a meniscal surgery
When the study began: 2013
Great strides are being made in understanding the mechanical factors that can contribute to the development of osteoarthritis. Scientists and clinicians in Biomechanics, Imaging and Sports Medicine are collaborating on research to determine why some patients develop osteoarthritis after removal of the meniscus following meniscal injury. Team members include Dr. Rodeo, Dr. Potter, Dr. Koff and Suzanne Maher, PhD, Associate Scientist and Associate Director of the Department of Biomechanics. In a recent pilot study, HSS researchers, led by Dr. Maher, determined that patients with areas of high contact stresses in the knee joint will most likely experience tissue degeneration later. The goal is to predict a patient’s risk of osteoarthritis using computer-based models and MRI scans. Eventually, a surgeon might be able to treat not only the site of injury but also the areas that are at risk of developing osteoarthritis.
Upcoming Milestones: We will perform two-year follow-up scans to assess cartilage health.
Healing Spinal Disc Degeneration
Purpose: develop a therapy to regenerate spinal discs
When the study began: 2014
Chitra Dahia, PhD, Assistant Scientist, is studying the key developmental pathways involved in the formation and development of spinal discs, thanks to a $1.9 million National Institutes of Health (NIH) grant. She hopes to create a biological therapy that could reawaken the aged or degenerated discs’ own (dormant) cells to regenerate them. So far, she has created genetic models that will help illuminate the cellular, molecular and biomechanical changes associated with disc degeneration, as well as the mechanisms associated with regenerating the disc.
Upcoming Milestones: Dr. Dahia is trying to determine how levels of Shh—a developmental cell-signaling pathway—change in the disc as a person ages; the mechanism by which Shh maintains the disc; and how progressive loss of Shh signaling as a person ages leads to disc aging.