The efforts of McGowan Institute for Regenerative Medicine
faculty members Michael Boninger, MD (pictured top left), chair and professor of the University of Pittsburgh’s Physical Medicine and Rehabilitation Department, Anthony Delitto, PhD (pictured top right), professor and chair of physical therapy in Pitt’s School of Health and Rehabilitation Sciences, Fabrisia Ambrosio, PhD (pictured bottom left), assistant professor of physical medicine and rehabilitation, physical therapy, and orthopaedic surgery in Pitt’s Department of Physical Medicine and Rehabilitation, and Andrew Schwartz, PhD (pictured bottom right), professor of neurobiology at the University of Pittsburgh, were recently highlighted in the PittMed article “The ‘Now What?’ Field of Medicine.” Author Reid Frazier described how these and other rehabilitation doctors work with the biologic underpinnings of injury and recovery—the gray area between sickness and health—where rehab docs live. They study the molecular mechanisms behind recovery, new technologies, and biologic therapies that could restore tissue and increase function.
Dr. Boninger, described as a wheelchair evangelist, feels his mission is to give the imperfect and impaired body increased function. As a physiatrist, Dr. Boninger makes the best of impaired bodies where no real “cure” yet exists. He has authored pioneering studies in repetitive stress injuries for wheelchair users. “In physical medicine, the only outcome we look at is function,” says Dr. Boninger. “Are we getting less pain and more function?”
Dr. Delitto collaborates with others on biological research into the role exercise plays in reducing inflammation. Estimates put the health care cost of lower-back pain at around $32 billion per year, making it the most expensive nonlife-threatening condition. Still, little is known about the mechanisms that cause it or remedy it. Exercise is good for the back, but how much and what kind? The question of dosage in exercise is very much unresolved, according to Dr. Delitto.
“We’re flying blind as far as dose is concerned,” says Dr. Delitto, who has studied the enormous health costs lower-back pain incurs. “We want to be a little more enlightened about dose. We could be underdosing, for all we know. At the same time, we have a patient sitting in a chair in front of us, and she wants to be treated.”
Dr. Ambrosio and her collaborators at Pitt explore the possibility that electrical stimulation and exercise—two standard physical therapy interventions—can help improve the performance of transplanted adult stem cells. Dr. Ambrosio says that even when an adult stem cell from a younger donor is injected into the body of an older person, the grafted cells tend to behave like the cells in their new environment. With “e-stim” and exercise, transplanted stem cells in mice reproduce more quickly and don’t die or form scar tissue as quickly as those in a control group. Both of these therapies increase blood supply to the affected area. Dr. Ambrosio thinks this could be a factor in improving the vitality of grafted stem cells. “I think that exposing the stem cells to either nutrients they need or growth factors they need—or even contact to stem cells in other locations—is what’s allowing them to behave better.”
The work of Dr. Schwartz is the foundation of the basic research underlying neural prosthetics. Researchers are trying to map the neural network involved in proprioception—the body’s understanding of where its different parts are in relationship to one another. Their focus is neural prosthetics—the cybernetic science that could one day help an amputee move a robotic arm just by thinking. To do this, neuroengineers must map how the limbs report to the brain sensations like how heavy an object is and whether it’s hot or smooth.
In 1993 the then department of orthopaedic surgery had zero NIH dollars. Today, the Physical Medicine and Rehabilitation Department’s 36 faculty brim with grants from the NIH (ranking number one for departments of its kind), the Department of Defense, and other big-league funders. These grants permit the researchers to continue exploring better ways to deal with, slow, or reverse the inevitable destruction of the body—whether destroyed through disease, bullets, stress, trauma, or time.
Illustration: McGowan Institute for Regenerative Medicine.
Bio: Dr. Michael Boninger
Bio: Dr. Anthony Delitto
Bio: Dr. Fabrisia Ambrosio
Bio: Dr. Andrew Schwartz, PhD