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Andrew Freiberg, MD
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Fourth Session
Moderator: Andrew Freiberg, MD
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| Reuben Gobezie, MD |
Thomas S. Thornhill, MD |
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Proteomics Applications to the Study of Osteoarthritis-the identification of new protein biomarkers for osteoarthritis
Reuben Gobezie, MD
Advisor: Peter J. Millett, MD
Discussor: Thomas S. Thornhill, MD
Proteomics is the use of various assay methods to find the collection of proteins that are expressed in a disease state. Osteoarthritis (OA) is the most prevalent musculoskeletal disease in the US, yet there are no good serum or cellular markers heralding its onset. In Dr. Gobezie’s work, a method of analyzing
synovial tissue from a patient for early markers of OA using proteomic methods is proposed. In this study, samples from 20 patients each with no OA, early OA and late OA were compared with one another to find cellular biomarkers that were different in those with OA versus those with normal knees. Ultimately it is hoped that markers will be found that can help the clinician in determining the presence of OA in a patient.
Dr. Thornill complemented Dr. Gobezie for his leadership role in taking on such a large multi-disciplinary study. He asked Dr. Gobezie to discuss some of the difficulties he encountered in taking on such a large project encompassing so many fields. Dr. Gobezie answered that the challenge in such a project was remembering that no one investigator can be responsible for everything – not everyone can run or understand every aspect of the experiments, the project truly was a collaborative effort.
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| Patrick McCulloch, MD |
Mark A. Randolph, PhD |
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Microfracture in a Non-human Primate Model
Patrick McCulloch, MD
Advisor: Thomas Gill, MD
Discussor: Mark A. Randolph, PhD
Microfracture is a commonly used technique in the treatment of chondral injuries. It is known that it has good results in patient outcome. However, little is known about the optimal time and course of postoperative immobilization and rehabilitation. Some work has been done with both horses and rabbits, but each suffers from its limitations, most notably that neither correctly represents the milieu seen in human bone after microfracture.
In this work, Dr. McCulloch proposes the use of a non-human primate model to assess microfracture technique and ultimate healing. He uses macaque monkey knees as a proxy for human chondral injuries on the premise that these more closely mimic human knees. By comparing the gross and histological appearance of the microfracture sites at six and twelve week intervals it was shown that incomplete healing had taken place at 6 weeks, while at 12 weeks there was good integration of the fibrocartilage. It was recommended that patients remain non-weight bearing at least twelve weeks postop from a microfracture.
Dr. Randolph commended Dr. McCulloch on his work on a difficult project
with a difficult subject. He inquired as to what tissue types were filling the defect after microfracture. He suggested changes to the experimental method that could account for different tissue types. Dr. McCulloch answered that based on the stains used in the histology part of the report, mostly type I and II collagen was present in the microfracture site.
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| John A. Abraham, MD |
John Ready, MD |
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The MGH Experience with Angiosarcoma: Survival Analysis
John A. Abraham, MD
Advisor: Sam Yoon, MD
Discussor: John Ready, MD
Angiosarcoma is an exceedingly rare disease with only approximately 60 new cases every year in the US. Nonetheless it is a devastating disease with abysmal survival data. However, given the small numbers of patients who present with the disease it is difficult to forward hard, fast numbers on survivorship.
In this study, Dr. Abraham analyzed the MGH experience with angiosarcoma
over the past three decades. He found 38 cases of angiosarcoma in that time period. He analyzed factors thought to be important in survival and ultimately found that tumor margins had a statistically significant effect on survivorship with a roughly ten-fold increased survivorship for negative margins. Tumor size, stage and grade all trended toward significant effects on survivorship. Patient age and tumor location did not seem to affect survivorship.
Ultimately it was found that angiosarcoma still had overall survival of 20-35% at five years.
Dr. Ready thanked Dr. Abraham for taking on such a daunting task and providing new analysis on a rare disease. He proposed that there be a citywide
tumor registry to pool data so that rare tumors could be more easily analyzed. Dr. Abraham agreed that this was a good idea – in fact, he had already begun work on the registry and is awaiting IRB approval.
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