Presentations at the 4th annual ACR/Arthritis Foundation (AF) Rheumatology Research Workshop—held May 4–5, 2012, in Denver—juxtaposed overarching themes of emerging science and career development. The research workshop is intended to support budding rheumatologists and scientific investigators, said Bruce Cronstein, MD, Paul R. Esserman professor of medicine, director of NYU-HHC Clinical and Translational Science Institute in New York City. The workshop “is oriented to science, but more so to career development,” he explained. “This is a unique group—many are recipients of early career development assistance. They are our future leaders and will be leading rheumatology in 15 to 20 years.”
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“The workshop is especially relevant to research fellows and junior faculty members,” said Elana J. Bernstein, MD, a rheumatology fellow at the Hospital for Special Surgery and New York Presbyterian Hospital, New York, N.Y. “[The workshop] teaches you about starting a career in academic rheumatology and gives an overview of grant funding and exposure to research in different areas of rheumatology.”
Scientific presentations at the workshop covered hot topics such as stem cell research, ultrasound technology, and how the changing shape of the healthcare system affects patients with rheumatic disease. Career-focused presentations included grant funding—what’s out there and how to get it—landing a job, and time management.
Possibilities for Mesenchymal Stem Cells in OA
The work being done with adult mesenchymal stem cells (MSCs) has exciting therapeutic possibilities for osteoarthritis (OA), said Rocky Tuan, PhD, director of the Center for Cellular and Molecular Engineering and professor at the departments of orthopaedic surgery and bioengineering at the University of Pittsburgh. MSCs possess both tissue-building and tissue-regenerating properties. It is, therefore, theoretically possible to remake the entire joint structure—cartilage, ligament/tendon, bone, muscle, nerves, etc.—using MSCs, which are multipotent, Dr. Tuan said. “They can become, with some coaxing, all of these things.”
Dr. Tuan and his team are using MSCs to create cartilage and help regrow it in an animal model of posttraumatic OA. Using a bioreactor consisting of a vessel that spins on a central axis, they were able to grow cartilage with medium change and growth-factor supplementation. “At the end of the day, we got this 1.5-cm version 1.0 cartilage piece,” he said.
To test its clinical application, they used a mini-pig model and drilled out an 8-mm defect in the knee cartilage. After implanting a xenograft with human MSCs seeded within a nanofibrous scaffold, they saw significant cartilage repair at six months postimplantation. The team has since developed a supraphysiological impact-mediated cartilage-degeneration model to induce posttraumatic OA, and is in the process of testing the therapeutic value of the MSC constructs to repair this type of cartilage defect.
Using Ultrasound for Diagnosis
Advances in ultrasound technology now allow for an assessment of joint effusion, the extent of synovial proliferation, and cartilage changes in knee OA, said Anthony Reginato, PhD, MD, assistant professor of medicine in the division of rheumatology at The Alpert School of Medicine at Brown University in Providence, R.I. Ultrasound gives rheumatologists real-time information about tissue structure and damage, including joint inflammation, which can assist in developing treatment options, he said. A trend of the future is fusion imaging, in which ultrasound images are superimposed on CT and MRI images, and more recently, the application of elastography, for example.