Melanie Coathup, PhD, professor and expert in Orthopedic and Musculoskeletal Science at the University of Central Florida College of Medicine talks about new developments in prosthetics.
Interview conducted by Ivanhoe Broadcast News in July 2018.
I would like to start by asking you about your research and your interest in Orthopedics and Prosthetics. How did that get started?
Dr. Coathup: I kind of fell into it a little bit. I do remember when I was younger, maybe about eleven or twelve; there was this picture of a skeleton and all the different parts that had been replaced with metal. That included the shoulders, the knees, the hips and plates on the skull; I found it absolutely amazing. There was talk about how this was somewhat a novelty and how they were working on it to rebuild the skeleton as well as construct the bionic skeleton. That’s when I really started to gain interest in it.
Tell me a little bit more about smart prosthetics.
Dr. Coathup: Historically, the medical industry has had so many medical devices that have been put in to the human body that have worked very well and have essentially transformed lives. Cataracts, cardiovascular stents, hip replacements, knee replacements, etc. Back then it was a case of using a material to replace the tissue or replace the function of the tissue. However, now when we talk about smart implants we want to try to make these materials interact with the body in some way; we want them to do more. In constructing these replacements and prosthetics we want to ask ourselves: can we sense things within the body? Can we interact within the body a little bit more? Can we deliver drugs perhaps? We just want them to be smarter in that respect -to help with the normal function of the body.
How do you go about making them smarter, what part of them is smarter?
Dr. Coathup: That is the big question. There are different answers for different aspects of this. To make orthopedic implants smarter we would want to modify the surface by having a coating on the surface of the replacement; we would do this to make proteins attach, to make cells attach or to make bone attach. In some circumstances you may want to insert implants in the vascular system for example and in this instance you may not want proteins and cells from the body to attach to the surface. Smart implants that specifically are made to only attract specific responses could help improve their function. Also, if we want to attract specifics and measure the concentrations of specific markers such as biochemicals, enzymes or hormones for example then smart sensors may help to monitor and even react to conditions within the body. The ways in which we can make the prosthetics smarter varies and the idea is to work to understand the clinical problems and the challenges that we have. Then specifically tailor the implant to the problem that we’re trying to address.
Are there specific areas of the body that you are focusing on? If so, can you tell me a little bit more about that?
Dr. Coathup: Sure. My work is focusing on orthopedic implant fixation. Looking at hip replacements, knee replacements and looking at ways to further improve that fixation. So when you put an implant in they do very well; but we can make that even better. We’ve got a growing aging population and Surgeons are even noticing now that the implants are doing well enough to put them into younger and younger patients and so there are more of them that need to be produced. We want to make sure that they work and they last for a long time within our body. Looking at different surface modifications, coatings, designs, may be novel materials that we can produce that will help them to last a little longer. And then there’s also the case of tissue, bone tissue that may have been lost due to trauma or due to disease. This can also happen sometimes due to the implant not working so well and looking at ways of regenerating bone tissue around that using stem cells and synthetic bio-materials.
You were talking about these coatings and materials; can you explain what kind of materials you’re looking at specifically?
Dr. Coathup: Well the materials and the coatings that we use—well the coatings I’ve been involved in mainly have been calcium phosphate coatings. The inorganic component of a bone is made up of something called hydroxyapatite which is mainly composed of calcium and phosphate. So what has happened in the past is we’ve developed synthetic coatings that are calcium phosphate based. And there’s a variety of different ones and you can spray these on to the implant surfaces of hip replacements or knee replacements and they will encourage bone to attach. So the bone is wonderful in the sense that it responds to its mechanical environment. A lot of orthopedic research is involved in trying to understand that mechanical environment. For example, if you go in to space and you don’t load your bone, you lose your bone. If you over stress your bone you can fracture your bone. So, it’s trying to understand the mechanical environment and trying to get good distribution of loads from the bone into the materials as well as understanding the biological environment. So it’s kind of a multifactorial vision I guess of the best implant.
You were talking to me about infection being a problem with some of these implants. In what ways are you researching and how are you researching ways of either avoiding or helping rid the body of these infections?
Dr. Coathup: Okay. So implant infection and other tissue infections are becoming more and more of an issue and the development of resistant bacteria is one of the huge concerns. When you have an implant in the body it provides a place where bacteria can attach and can colonize in some cases. And it’s something we don’t know so much about it, we don’t know what triggers the bacteria to sit on the surface and what encourages it to proliferate, to grow. They sometimes can form what we call a Biofilm which is a kind of slimy matrix they secret to hide in to and we don’t know too much about these mechanisms either. So I think there’s still a lot of work that’s being done here and around the world trying to understand the mechanisms and understand the communities of bacteria that are often associated with implant infection. There are some studies that are looking at heating implants which is a more novel approach that I came across a few weeks ago. Other ways are looking into perhaps coatings, doping the surfaces of the implants with various antibacterial agents. They’re have been studies looking at polymers that are being used in hip replacements for example and doping these materials with antibacterial clusters that are proving to be effective. We are interested in looking at these, we’re interested in looking at seeing if we can understand the bacteria a little bit more. I’m looking at -potentially looking at, beneficial bacteria as well to see how they may interact with the pathogenic problem causing bacteria.
One of the questions I asked your colleague, who is also in research, is that we like to take our viewers through the bench to see the science inside when we can see it in patients. Along those lines are several steps before there would be a manufacturing process, could you just walk me through the steps?
Dr. Coathup: Yes. So that actually is the prime purpose of the cluster is to work with the clinicians and to work with engineers, material scientists, myself as biologist and come together with the purpose of developing new technologies, techniques, therapies that will go in to the patient. So we’re at that translational edge. We will carry out a little bit of basic science to develop ideas and the goal for us is to work those ideas with clinicians, with the hospitals within the area, with medical device companies and small business to try to get new technologies across in to patients; there are many stages to do that. We have lab based studies, computer modeling based studies and clinical studies as well.
How close are you to anything that you are working on that would move to that clinical trial step? That first step in humans?
- Coathup: removed the sentence here as it didn’t make too much sense!
So the time within?
Dr. Coathup: We are working with a synthetic bone product and we’re looking to further develop it and if it’s successful then we will be able to do some tests that we hope will translate across. We’re looking into a commercially available product to see whether or not we can add another nano coating to its surface to see whether we can further improve bone healing.
I always ask time frame.
Dr. Coathup: Yeah and you know I was actually saying the other day that things that you think are going to work- you do these experiments and they don’t work and then experiments that you think there’s no point in doing – they actually work and you get results that help to move things forward. So you can never tell. As far as time frame I would hope within a couple of years.
Is there anything I didn’t ask you about this particular work that you’re doing that you would want people to know?
Dr. Coathup: I don’t think so.
If you could just tell me a little bit more about the cluster, the people that you’re working with and different areas that they’re looking at.
Dr. Coathup: So the prosthetic inspector cluster is new. It is part of a university wide cluster initiative which I think is amazing. I think it is amazing because the concept is to bring interdisciplinary people together. So you have people working in different disciplines that come together to solve problems. They have skills, expertise and experience in different areas. By bringing the different ways of thinking, different ways of targeting problems, different problem solving ways together and combined we can try to solve challenging problems. So with the prosthetic interface cluster we have engineers, we have material scientists and biologists working with clinicians. The goal is that interdisciplinary groups will hopefully solve some of the challenges that we have presently. The clinicians are a huge part because they will tell us what the problems are, what are the current unmet clinical needs and what challenges we need to solve. And then we come together, we focus and try to develop new technologies, new therapies, new techniques; or we try to improve existing technologies and therapies and techniques to try to solve those problems. The goal is to not only work together within the cluster but to develop interdisciplinary collaborations and team up with colleagues within UCF. And as I mentioned before to work with companies, medical device companies and the hospitals so we together find the solutions we need
END OF INTERVIEW
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