As the chair of the Department of Orthopaedic Surgery, James Kang, MD, has an expansive view of the research projects and clinical initiatives currently underway and a contagious optimism about the future of the department. But he is also aware of a key constraint on his department’s ability to innovate and share ideas.
“We have incredibly smart people doing work in clinical medicine, basic science and clinical outcomes research – but right now, they are siloed because of physical space,” said Kang. “Brilliant ideas generally don’t come to you when you’re sitting in a lab trying to think of a solution – instead, those ideas come about when people from different disciplines run into each other in a hallway or at a lunch table and start talking.”
Many entities that will be moving into or taking shape for the first time in the new building will foster these sorts of collisions of collaboration and give structural support to collaborative teams. In particular, the Brigham Building for the Future (BBF) will be home to the Orthopaedics and Arthritis Center, which will be led by the Department of Orthopaedics and the Division of Rheumatology – two groups that have worked in synergy for many decades at Brigham and Women’s Hospital. When Kang pictures the Orthopaedics and Arthritis Center in the Brigham Building for the Future, he sees a space where basic researchers, molecular biologists, biomechanical engineers, neurosurgeons, rheumatologists and others are in close enough proximity that they will be able to share their perspectives and solutions with one another.
“Researchers will be able to go down one floor to where patients are being seen every day,” said Kang. “Both our research and clinical initiatives will get a big boost.”
When the building opens in the fall of 2016, more than a dozen investigators who specialize in orthopaedics will be moving in, along with colleagues working in rheumatology, neurology, neurosurgery and other fields. The new building will also mean a physical space for new centers and initiatives. Researchers working on projects that span the gamut of musculoskeletal sciences – from biomechanics to stem cells to cartilage research – will be neighbors and, Kang and others expect, close collaborators.
Research Collaborations, New and Old
For Jessica Whited, PhD, moving her lab from its current location across the river in Cambridge to her new space in the BBF will be a bit of a homecoming. “I’m excited to go back to the Longwood area and about being closer to collaborators at Boston Children’s Hospital and HMS Systems Biology, and to strengthen or rekindle our ties to HMS Genetics,” said Whited, who completed her postdoc at Harvard Medical School in the lab of Cliff Tabin, PhD, chair of the Department of Genetics at HMS.
“The most important aspect of returning to the Longwood area, for me, is the proximity to the other researchers and to seminars,” she added. “Right now, if we want to go to a seminar, we lose a lot of time in traveling from Cambridge to Longwood and back. The activation energy for attending seminars will be much lower. The people in my lab will have many more sources of advice in troubleshooting experiments than they have here. Even though e-mail exists, it’s still way better to pick someone’s brain in person.”
Whited, who studies limb regeneration in salamanders, is looking forward to following up on some early leads in human tissue samples from the operating room in orthopaedic surgery and in increasing the visibility of her research as it relates to medical students.
“We have lots of ideas for projects that delve into the human realm, but the people who are training to be clinical scientists are the ones who are more likely to pursue those projects,” she said.
The Department of Orthopaedic Surgery recently hired one of Whited’s long-time collaborators, Jessica Lehoczky, PhD, who works on mouse digit tip regeneration, and the groups are looking forward to collaborating.
“Our research has some natural parallels, so I’m definitely excited about starting to collaborate more closely on some projects,” said Lehoczky, who will join the department on June 1. “More than anything, I’m excited about starting my lab in an established, yet growing department; and I think the open layout of our space in the BBF is going to be a great way for all of our groups to interact and collaborate.”
In addition to the newly added faculty in regenerative medicine, the department will also move the already well-established musculoskeletal research programs in bone biology (Julie Glowacki, PhD), stem cell biology (Shuanhu Zhou, PhD), physicochemical mechanobiology of cartilage and intervertebral disc (Shuichi Mizuno, PhD) and orthopaedic material sciences (Anuj Bellare, PhD) into the BBF to maximize the basic science footprint. Collectively, the scope of musculoskeletal and orthopaedic research that will be done at the new BBF will hopefully lead to many novel innovations that will have a major impact on clinical care.
The practice of orthopedic medicine spans – quite literally – from head to toe. In the course of caring for patients with pain or injury to their upper extremities, lower extremities, back, foot, ankle and more, clinicians face challenging decisions on a daily basis. Ideally, a physician will make a clinical recommendation based on strong evidence and data from clinical trials. But in reality, they often find that the questions they most seek the answers for, do not have published evidence-based solution in the medical or scientific literature yet. Often, these unanswered questions relate to patient outcomes and value of specific orthopedic procedures.
With the opening of the BBF, clinicians will be physically closer to two centers that focus on those challenges: PIVOT (Policy and Innovation eValuation in Orthopaedic Treatments), a newly launched program led by Elena Losina, PhD, and OrACORe (Orthopaedic and Arthritis Center for Outcomes Research), led by Jeffrey Katz, MD. PIVOT and OrACORe faculty work together closely to identify and then pursue evidence and to establish the value of orthopedic treatments.
PIVOT investigators work with physicians to identify questions that urgently need to be answered and provides guidance on policy decisions based on high quality care for patients. The work of the PIVOT center also informs the research agenda for the OrACORe regarding most influential data uncertainties. Based on this, the OrACORe investigators can design and then undertake studies focused on these areas. PIVOT investigators then help to generalize results of the studies conducted by OrACORe by using computer simulation policy modeling and cost effectiveness analyses to ensure that BWH physicians derive value-based care.
“We believe that the most interesting questions arise when PIVOT and OrACORe faculty shadow physicians, observe surgery and hear from clinicians directly about the care-related questions they need answered. Seeing what happens in the clinic helps to shed light on how to conduct studies and recruit study participants in the most efficient way,” said Losina. She and Katz also hope that in the new space, more clinicians will be able to join them for meetings when they have short breaks in between seeing patients.
“A lot of interesting ideas get generated during conversations and spontaneous interactions,” Losina said.
Future Directions and New Centers
In April of 2013, Mitchel B. Harris, MD, chief of orthopaedic trauma, played a pivotal role in responding to the Boston Marathon bombings, working collaboratively to save and treat those who had been injured, including Gillian Reny. Since then, the Gillian Reny Stepping Strong Fund has funded scholars, fellows and innovators pursuing advances in limb reconstruction, limb transplant, orthopaedic and plastic surgery and more. In January, Harris was named Stepping Strong Distinguished Chair of Orthopedic Trauma and the director of the Stepping Strong Trauma Center, which aims to accelerate promising multidisciplinary trauma research and clinical care for civilians and wounded warriors impacted by traumatic injuries. When the Brigham Building for the Future opens, the Stepping Strong Trauma Center will reside on its fifth floor, with laboratories, conference rooms, research bays and suites.
“Our overarching goal is to bring together individual scientists and clinicians with a common interest in trauma to help streamline research,” said Harris. “By uniting everyone under one roof, we hope to encourage more collaboration and ultimately obtain bigger grants that will fund ongoing research in this important field.”
Kang describes the Stepping Strong Trauma Center as aligning perfectly with Orthopaedic Surgery’s goals and its efforts to recruit scientists who are doing basic research in muscle biology and regeneration – including muscle biologist Ron Neppl, PhD who is also a new faculty recruit– to understand the underpinnings of muscle trauma. “This program is an example of how the BBF will fuel integrated clinical care as well as stimulate translational research in a specific discipline that is in need of such focus,” said Kang.
The Orthopaedics and Arthritis Center will also provide integrated clinical space for Orthopaedics and Rheumatology. With Radiology, Rheumatology and Orthopaedics clinical space in close proximity, physicians will be able to more easily consult with each other and provide seamless patient care. Under the umbrella of the center, Orthopaedics and Rheumatology will develop specialized programs, like the Stepping Strong Trauma Center, with a specific focus on important clinical needs.
Kang also envisions other cross-disciplinary collaborations emerging through the sports medicine initiative that he will be spearheading. Kang intends to grow the hospital’s sports concussion program, and plans to collaborate closely with leaders in the neurosciences – many of whom will also have space in the new building.
“We are poised to leverage our resources and expertise to develop a program focused on understanding concussion and traumatic injury within the larger context of sports medicine,” said Kang. “The opening of this beautiful new building will help us to make that vision as well as many others related to orthopaedics into a reality.”