Interview with Regenerative Medicine Leaders: Part III

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Daniel Youngstrom, PhD

Daniel Youngstrom, PhD

Continuing our series of talking with researchers within the field of Regenerative Medicine, I had the pleasure of interviewing Daniel Youngstrom, PhD.  He has recently finished a doctorate at Virginia Tech and plans on pursuing a post-doc position in a lab studying mesenchymal precursor cells within tendons.  Below is an excerpt of an interview he gave for the CORE newsletter, for which I am the editor:

 

Tell us about your research project and what you have learned from it.

 

I am interested in the mechanobiology of stem cell fate decisions, including how stem cells interpret mechanical stimulation to direct their differentiation. Cells within musculoskeletal tissues experience loading patterns, and it turns out that how cells experience exercise may play a significant role in damage propagation and repair. My research project involves culturing adult mesenchymal stem cells in a bioreactor: a device that applies tuned physical and chemical stimuli to mimic the in vivo environment. By doing so, we can observe changes in gene expression associated with tendon differentiation, and measure changes in tissue biomechanics resulting from cell-mediated anabolism. In this system we have learned that stem cells optimally respond to a certain window of strain magnitude, and over- or under-stimulation decreases the efficacy of tenogenic differentiation in our model. This provides valuable clues necessary for preconditioning cells prior to transplantation, for growing graft material in the lab, or for designing rehabilitation protocols with an ideal level of stimulation.

 

What was your most exciting discovery while working in this lab?

 

Generally, I think the discovery that adult stem cells can regenerate tendon is incredible. There are no effective pharmacological treatments for tendinopathies, so the prospect of using cells as medicine was exciting and novel for me when I entered this field. Discoveries in our lab are helping to optimize cell culture conditions to further improve tendon healing. Specifically, one of our studies, recently published in the Journal of Orthopaedic Research, demonstrated the dependency of stem cell differentiation on strain magnitude. I am delighted to be a part of the engine that is improving cell therapy.

 

What has been your most difficult barrier in this field of research?

 

The field of tendon research is small relative to many other tissues, and there are important fundamental questions that are still unanswered. This means that there are many opportunities in the field for new investigators, but it also means that we don’t have a large toolkit available to tackle big issues: like developing effective treatments for tendinopathies. Musculoskeletal function is essential to maintaining high quality of life, so I’d love to see more talent and money dedicated to increasing tendon healthspan.

 

How has your experience at the benchtop affected your perspective on orthopedic medicine?

 

Working at the benchtop is exciting. I enjoy making connections between cell biology, tissue mechanics and musculoskeletal function, and I find this holistic view to help keep things in perspective. However, an even better question for me would be: how has my experience working with orthopedic surgeons affected my perspective as a scientist? Working alongside practicing clinicians has greatly changed my views about what the

important questions are, and shifted my focus toward translational technologies. I think it would be valuable for all researchers in biotechnology-related fields to have some level of exposure to the clinic, if for nothing else than to see how their work has the potential to impact real people and animals.

 

How do you envision your research impacting clinical practice and what direction do you see your research continuing to evolve into?

I hope that my current research will improve the efficacy of stem-cell based medicine, and provide more options to individuals suffering from acute or chronic tendinopathies. In veterinary medicine, stem cell therapy is becoming increasingly widespread. It is only a matter of time until off-the-shelf regenerative medicine products are readily available for humans in the US. Our increasing knowledge of the cell biology of adult stem cell-mediated regeneration will continue to inform the development of future therapies.

 

Our young physicians would love some advice on how they can become active in translational research: from the benchtop to the clinic. What advice would you give them?

 

Collaborate. Regenerative medicine is highly interdisciplinary, and collaborations between researchers and clinicians are essential for generating new ideas and assembling teams with the expertise necessary to impact lives. Attend scientific meetings and search for opportunities to work with researchers in the academic sector. It is to the advantage of both parties – and the patients who will ultimately benefit – for scientists and clinicians to work together.

Interview with Regenerative Medicine Leaders: Part II

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Regenerative Medicine holds the promise of revolutionary changes in the way we treat many medical conditions, from heart problems to brain injury.  Stem cell technology is quickly expanding in the area of musculoskeletal conditions.  As physiatrists, we routinely treat musculoskeletal injuries and are therefore, perfectly aligned to be leaders in this new realm of medicine.

In this edition, we meet Dr. Centeno who is involved in stem cell research and clinical application, as well,  has the largest body of clinical data for the use of therapeutic stem cells for Orthopedic conditions, in the United States.  Also, he is active in the education of other Rehab Physicians through the AAPMR’s Regenerative Medicine course.

This is an excerpt from the full length article in the AAPMR CORE newsletter, for which I am editor.  In this section, Dr Centeno discusses his experience over the years with research and development of stem cells for musculoskeletal conditions.

centenoChristopher J Centeno, MD

Co-medical Director of Centeno-Schultz Clinic   Boulder, CO

 

“‘The Centeno-Schultz clinic (CSC) has a research lab that looks like it should be sitting in a university. You can find PCR for cell RNA and DNA analysis, a fluorescence activated cell sorter for purifying various cell populations, flow cytometry for identifying cell types, fluorescent microscopy, etc…  This remarkably is all sitting in a private medical practice for one reason-to improve the lab bench to bedside clinical translation process. While a basic science research idea in a university may take decades to reach patients, here at CSC small tweaks in lab processing can quickly yield big clinical results.’

‘Centeno’s most exciting discovery while researching this topic was first failing and then succeeding in intervertebral disc regenerative medicine. CSC first began using same day stem cells for severe degenerative disc disease in 2005, but without much success. Cultured mesenchymal stem cells were then tried, replicating successful animal models of disc regeneration, but there was also little clinical success. Finally, extensive changes were made to the clinical procedure and culturing process to better target one condition (disc protrusion) and mimic the environment inside the degenerating disc in the lab. This ultimately lead to the successful remediation of disc bulges through a precise injection of specially cultured mesenchymal stem cells. This procedure and protocol is now the subject of an FDA clinical trial that begins this year.’

‘Centeno states that a current area of clinical research he’s excited about is measuring the micro-environment with stem cell treatment of osteoarthritis. He says that a good farmer would never plant seeds before knowing about the soil conditions and supplementing them accordingly. He believes that one of the reasons that animal models of orthopedic stem cell therapy don’t often directly correlate with human research is that the animals are all young, healthy, with acute artificially created acute injuries that are meant to be surrogates for middle aged Americans with OA. Those real patients don’t have the same micro environment conditions as the animal models. His goal is to quantify and find ways to maximize the local OA micro-environment (the soil) to maximize stem cell therapy outcome (planting the seeds).’

‘Dr. Centeno believes that the best advice that he can give young PMR residents who want to practice Regenerative Medicine is to find a high quality Regenerative Medicine fellowship. He believes that PMR is ideally positioned to launch a new medical specialty that he calls, Interventional Orthopedics. This new field will meld both interventional spine with sports medicine’s knowledge of peripheral joints and focus on an expanding array or biologic therapies and new tools to implant cells. He believes that the fellowship should have both lab and clinical research components so that fellows can learn from the ground up. Finally, he thinks that there is simply too much to learn to come out of residency and begin practicing regen med at a high level.'”

 

I had the pleasure of listening to Dr Centeno’s breakthrough research at my annual Academy meeting as well as at a recent Regenerative Medicine course, put on by my Academy.  Through great teachers and leaders, like Dr Centeno, I am confident that physiatrists will be at the forefront of using stem cells for many musculoskeletal conditions.

 

Good Luck,

Dr Ethan Colliver

 

 

 

Interview with Regenerative Medicine Leaders: Part 1

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Mouse_embryonic_stem_cells

 

 

 

 

 

 

 

Regenerative Medicine

 

Regenerative Medicine is an exciting, expanding field of medicine.  Stem cell technology is quickly expanding in the area of musculoskeletal conditions.  As physiatrists, we routinely treat musculoskeletal injuries and are therefore, perfectly aligned to be leaders in this new realm of medicine.

 

In this edition, we meet Dr. Malanga who is involved in stem cell research and clinical application, as well as active in the education of other Rehab Physicians through the AAPMR’s Regenerative Medicine course.

 

This is an excerpt from the full length article in the AAPMR CORE newsletter, for which I am editor.  In this section, Dr Malanga discusses the research and efficacy behind platelet rich plasma and stem cell technology.


Dr. Malanga

 

 

 

 

 

 

 

Gerard A. Malanga, MD

Founder and Partner; New Jersey Sports Medicine and New Jersey Regenerative Institute Cedar Knolls, NJ

Clinical Professor, PMR, Rutgers University- New Jersey Medical School

Chair, AAPM&R Regenerative Medicine Task Force   .

 

“I believe that PRP (platelet rich plasma) is effective for treating many musculoskeletal conditions.  I have personally been able to publish review articles on the topic and feel that the literature is supportive of PRP.  Also, I was fortunate to be part of a multi-center study, along with Dr. Kenneth Mautner of Emory University, looking at PRP in the treatment of tendinopathy1.   Several factors affect the efficacy of PRP: the absence of red blood cells, the concentration of PRP relative to serum concentrations, and the presence/absence of leukocytes.

 

Other than tendinopathies, the other area that many clinicians have found difficult to manage is a diagnosis of degenerative arthritis, such as in the knee, particularly in those under the age of 60.  This is an ever increasing common problem with very few treatment options.  Many patients have tried and failed a variety of nonoperative treatment measures that include: medications, strengthening and physical therapy, various injections and yet remain limited by pain.  Many are offered a total knee arthroplasty, a procedure that often requires a reduction of activity level after surgery.  It is this population, I believe, that may be better treated with mesenchymal stem cell therapies.

 

Several years ago, I researched and developed expertise in the use of bone marrow stem cell therapies in the treatment of various cartilage and osteoarthritic conditions as well as for meniscal tears.  This involved a great deal of review of various journal articles in journals that I had never before read.  I have been fortunate to learn from and exchange experiences with many other physicians around the country who are pioneers in this area.

 

Thus far, the results from stem cell therapies are promising and each year the techniques and experiences continue to improve.  There continues to be a great deal of more work to be done in this area to solidify the scientific evidence for these Orthbiologic treatments and I am excited to be working with physicians across the country who share interest in this area of medicine.”

 

 Dr Malanga is leading an upcoming review of the literature for both techniques in the medical journal PMR; and is leading the task force on Regenerative Medicine for the medical society, American Academy of Physical Medicine & Rehabilitation.  Dr Malanga has been a leader for years in the field of musculoskeletal care and I feel quite fortunate to learn from him over the years and I look forward to learning more about this very exciting therapy.

 

Good Luck!

References:

  1. Outcomes after ultrasound-guided platelet-rich plasma injections for chronic tendinopathy: a multicenter, retrospective review.

http://www.pmrjournal.org/article/S1934-1482(13)00003-8/pdf

 

 

Causes of Knee Pain You Had No Idea Existed

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Not all knee pain is created equally. Knee pain can be a symptom of a problem in another part of the body. Valley Sports and Spine finds the cause of the pain.

People complain of knee pain every day. In fact, knee pain is one of the most common complaints among active adults over the age of 30. While most people chalk up their discomfort to ‘getting old,’ it can actually be a symptom of a problem in the ankle or hip joints. If untreated, the ankle, hip, and knee can all suffer long-term damage that may require surgical repair, but if diagnosed and treated by an osteopathic physician early on, surgery can be completely avoided.

Common Causes

All of the joints on the leg work together, starting at the ankle and reaching all the way to the hip. This system of movement is designed to support one another to promote a smooth action, like walking. Unfortunately, due to a culture of poor body mechanics, it is becoming commonplace to see stiffening in hip and ankle joints. This stiffening can often be attributed to prolonged periods of sitting or inactivity as well as footwear that promotes poor alignment of the spine.

Knee pain is often a late symptom of limited range of motion in the hip or ankle joints. When considering a runner, as the runner attempts to stride, if the ankle is stiff, the knee is forced to bend at a greater angle. As a result the hip is unable to fully rotate which causes a shorter stride and harder impact on the knee. While the runner is feeling the hard impact on the knee, the real problem is the stiff ankle.

Treatment

Rehabilitative medicine is ideal for treating knee pain that may not have an obvious cause. Rehabilitative physicians, more commonly referred to as physiatrists, do more than examine the aching knee, they examine your body mechanics. With consideration for the systems of the body all working together, physiatrists evaluate the whole person and then investigate possible causes for atypical pain. Once the cause of the pain has been identified, a personalized treatment plan is created to fit the patient’s needs. Under most circumstances, a regiment of exercises that focus on stretching and strengthening specific muscles groups, while lubricating the joints, can correct the problem in no time.

For more information about knee pain, please visit our website at http://valleysportsandspine.com and learn how Valley Sports & Spine Clinic can get you moving!

What Your Hip Pain is Trying to Tell You

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running1

Pain in your hip can be a symptom of an injury in another location of the body. The kinetic chain links the joints of the body together to keep the body moving.  

 

 

Are you suffering with hip pain? Does your hip ache day and night for no apparent reason? Do you remember a specific activity that initially brought on the pain, or did it seem to come out of nowhere? The truth is that the pain you are feeling in your hip may not signify that anything is actually wrong with your hip. What you may be experiencing is something called referred pain, and you can blame the kinetic chain. Referred pain is pain felt in one area of the body that has actually originated in a completely different area of the body. You may not feel pain, or any symptoms at all, in the point of origin, but your hip sure feels something!

What is the kinetic chain?

The simplest way to describe the kinetic chain is to think about the division of responsibility. If you have a job to do and four workers to do it, the job will get done efficiently as everyone knows their role and works together. If you take away one of these people and now only have three people to complete the task, the job will still get done but not as quickly and with a greater burden placed on each worker. Now let’s put that in terms of the body. The joints are an interconnected system that all work together to allow the body to move. If one joint suffers a set-back such as stiffness or injury, the other joints will absorb the extra stress in order to keep the body moving.

How does pain relate to the kinetic chain?

When speaking in terms of the kinetic chain and your pain, try imagining a pebble dropped into a pool of water. Think of how the ripples in the water are larger where the pebble hit the water and smaller the further away they get until they disappear. This is what many physiatrists, or function specialists, call the kinetic chain ripple effect. The body spreads out the stress that it endures as it compensates for the area actually experiencing complications.

What this means for you?

The next time that you go to see your physiatrist do not expect the examination to be focused solely on your hip. You can expect your provider to ask you several questions about your daily activities and what aggravates the pain or makes it better. You can also expect radiological imaging of your hip as well as your entire back and possibly a knee.  Through the use of x-ray, your doctor can identify any underlying stressors or injuries along the kinetic chain.

It’s hip to be informed.

For more information about the kinetic chain and how it relates to your pain, please see our webpage at www.valleysportsandspine.com.  Asking questions and getting involved in your care are great ways to get your pain under control because knowing what causes your pain can also help you prevent it.

Good Luck!

Dr Ethan Colliver

 

Sitting is Bad for Your Health

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coupleWalkingSM

A new meta-analysis shows that sitting too much increases your risk of early death from any cause.  The other important finding is that this increases your risk even if you exercise.  Further, the study showed that the less active you were, the more likely you were to die prematurely.

Previous studies have also showed that you should get get up 35 times a day or get up about every 15 minutes throughout the day.

For many of our patients in the Christiansburg, Radford, and Blacksburg area, the struggle after successfully completing physical therapy has been finding a way to continue to exercise and keep moving afterwards.  Valley Sports & Spine Clinic and Valley Active are committed to finding a personal exercise plan to keep you regularly moving for a healthy lifestyle.

 

Good Luck!

 

Dr Ethan Colliver

Why Finding an Osteopathic “Function Expert” Might Be the Best Way To Treat Your Pain

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150px-Muybridge_human_male_walking_animatedThe physicians at Valley Sports and Spine specialize in Physical Medicine & Rehabilitation. Their proven methods identify the root of your pain and prevent further injury.  

 

Are you struggling with pain in your neck, back, or knees? Have you been back and forth to your regular practitioner but still have no idea what is causing the discomfort? Have you considered being evaluated by a function expert? You may be surprised to find that osteopathic medicine can offer you the relief you have been looking for and so much more.

What is a Function Expert?

Physiatrists, also called function experts, specialize in the nerve, muscle, and bone functions of the body. Another way of stating this is to say that they are experts in how the body moves. While a general practitioner may be looking specifically at your aching knee, a function expert will be looking at your back, hips, and ankles simultaneously and watching how they are all working together in support of your knee.

Why Movement Matters

The body is a machine with many working parts that all have a job to do. Like a machine, if one part starts to get worn out and stiff, it can cause a chain reaction of stress throughout the system. The bones, muscles, nerves, joints, and connective tissue are all an interconnected system that work together to produce movement. If a specific area begins to have trouble the body will naturally compensate and attempt to shift the stress to another area. An example of this is a runner with knee pain. Once evaluated by a function expert it is identified that the runner is actually suffering from a stiff ankle. The ankle’s limited motion when running is putting extra stress on the knee. Once identified, specific exercises can be very effective at restoring the ankle’s mobility and eliminating the knee pain.olderStretchers

Why Choose Rehabilitative Medicine?

Rehabilitative medicine is about more than just your specific injury. Physiatrists evaluate each patient as an individual. Diagnosis and treatment of an ailment involve learning about the patient’s lifestyle and hobbies and understanding how their life is being affected by their current limitations. Understanding a patient’s daily activities can help the practitioner find clues to the greater cause of the ailment. Additionally, this type of consideration helps to create a treatment plan that can accommodate the patient’s lifestyle and hopefully allow them to continue conducting their favorite activities. Patients get the satisfaction of knowing that not only is their chief complaint being addressed but that they also are reducing their risk for further injuries.

For more information about function experts, please visit our website at http://valleysportsandspine.com and find out what Valley Sports & Spine Clinic can do for you!

Introducing our newest team member, Shannon

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IMG_4074I love my staff. We have had many of the same faces at Valley Sports & Spine since the beginning. Their dedication and knowledge are an integral function of the clinic and I am finally getting around to writing about them on the blog.

A recent addition to our Medical Assistant position is Shannon. Shannon recently graduated from VT and is now in a Masters Program with an ultimate goal of Public Health work. She has a passion for Africa and desires to work in West Africa where the Ebola outbreak is exploding.

She recently completed the Eagle Man triatholon with three generations of her family, her mother and grandmother in a team named TriGenerational.  Their team placed 2nd in the relay division.  Her mother swam for 1.2 miles, her grandmother biked for 56 miles, and Shannon finished with a 13.1 mile run.  Shannon called the experience “Awesome!” and looks forward to more races with her family.

Her family has always been into competing and exercise.  Shannon’s grandmother, who was born in 1939, has competed in the Iron Man triathlon at least 5 times and stars in her own Spinning training videos.  Shannon has been a competitive swimmer since 5 years of age and participated in District and Regional swimming competitions in high school.  She admits she likes the competition more than the practice, and always try to beat her best time in any given sport.

Shannon has an upcoming 1/2 marathon and continues to swim and run regularly. She wants to master bicycling next so she can compete in triathlons, like her grandmother.

Good Luck, Shannon!

Student Reflection – Shadowing Dr Colliver

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Shadowing a physician can be a wonderful opportunity for students, such as myself, who are interested in a career in medicine.  With consent from patients, one may attend visits alongside the physician.  This experience can give great insight into what a physician’s typical day may be like.

I am currently a graduate student at Virginia Tech studying to earn a master’s degree in Human Nutrition, Foods, and Exercise.  After having a hard time finding a local physician to shadow, I consulted two friends who are medical students at VCOM for suggestions.  They both recommended that I reach out to Dr. Colliver who has a strong passion for teaching students.  After contacting his office, I was pleased to learn that he would be able to accommodate me.

My week-long shadowing opportunity provided me with invaluable clinical exposure to patient care.  During patient visits, I was able to stand back and observe Dr. Colliver. The first thing that I noticed right away was his impeccable bedside manner.  Of all my previous clinical experiences with volunteering and shadowing, Dr Colliver has by far the best doctor-patient relationship.  He introduced himself to all his new patients and created a welcoming environment by taking his time with all his patients.  Dr. Colliver addressed and reassured his patients’ concerns as well as ensured that patients did not leave with any unanswered questions.  I feel that such etiquette-based communication is very important and that every healthcare professional should model themselves after this behavior.

With 14 years of training, Dr Colliver truly is an expert in pain management.  I was amazed at how effortlessly he was able to evaluate and diagnose patients, analyze imaging, and perform nerve conduction testing.  I was able to observe a few procedures that were performed at the clinic as well. The ultrasound-guided injections and electromyography were fascinating to witness.

Something that I especially appreciated was his incorporation of Osteopathic Manipulative Treatment (OMT) in his practice.  It was satisfying to hear patients stating that they instantly felt lower levels of pain after Dr. Colliver performed OMT. Observing OMT in interesting and made me appreciated the vast amount of training involved.

While Dr. Colliver filled out paperwork in between patient visits, I would observe his staff.  Dr. Colliver selected a great tem of healthcare professionals for his practice.  All the members of his staff were very knowledgeable, friendly, and also practiced excellent bedside manners.

At the end of each day, I was able to ask Dr. Colliver questions that had developed throughout the day. My questions ranged from his experiences in medical school and residency to how he believes medicine is changing.  I was very pleased to learn that he and the Physician Assistant, Holly, participated in a scientific journal club.  My graduated program stresses the importance of translational research, the
“bench to bedside” transition of scientific discovery to clinical application.  Those who conduct health-related research, including myself, ultimately seek to fulfill the purpose of finding new discoveries and ways to improve health. When that research is published, we rely on the front-line professionals, the health providers, to engage in evidence-based practice.  It is reassuring to know that Dr. Colliver and Holly keep up-to-date with current research and new findings that may be useful for his practice.

In addition to being informative, this shadowing experience was also quite humbling. I observed patients that suffer from debilitating pain caused by accidents, injuries, and non-injuries. I saw how drastically the pain had changed people’s lives, from loss of work productivity to decreased physical activity.  I witnessed Dr. Colliver’s passion for patient care put to work as he helped patients after patient regain control of his or her life and provide relief.  Follow-up patients that praised him for their pain relief and improvements with their range of motion were inspiring and satisfying.  This experience only served to strengthen my decision to pursue a career in medicine.

 

Thank you Valley Sports & Spine Clinic for providing me with an excellent clinical experience!

Tamima Hossain