Perelman School of Medicine at the University of Pennsylvania

McKay Orthopaedic Research Laboratory

Smith/Malhotra Laboratory

Ongoing Research Projects

1. Bioactive Injectable Therapeutics for Intervertebral Disc Degeneration

Degeneration of the lumbar spine intervertebral discs is widespread and strongly implicated as a cause of low back pain amongst the adult population. Current treatment options for symptomatic disc degeneration are limited, and focused on alleviating pain without preserving biomechanical function of the intervertebral joint. The goals of our research are to develop synergistic, minimally invasive therapeutics that incorporate a structural implant to normalize mechanics, anti-inflammatory agents to prevent further degeneration, and stem cells to potentiate tissue regeneration. This work spans from in vitro laboratory studies, through to preclinical large animal studies.

GoatGoat 2

2. Pathogenesis and Treatment of Spine Disease in Mucopolysaccharidosis Disorders

The mucopolysaccharidoses (MPS) are genetic, lysosomal storage disorders that affect children, and which are characterized by deficient activity of enzymes that degrade glycosaminoglycans. Musculoskeletal disease manifestations are severe, and in the spine include vertebral dysplasia, odontoid hypoplasia, accelerated disc degeneration and kyphoscoliotic deformity, leading to spinal cord compression and airway obstruction. The goals of our research are to understand the molecular mechanisms underlying spine disease in MPS, and develop new therapeutic strategies. This work spans from in vitro laboratory studies, to preclinical animal studies, through to human clinical studies.

Healthy Spine   MPS VII Spine

3. Developing novel clinical tools for integrating surgery patient outcome data with basic and translational research.

Two million patients per year are evaluated and treated in the UPenn health system, consistently one of the patient’s top 10 hospitals. Clinical care, if carefully observed and analyzed, can be leveraged in order to enhance individual patient care and population quality-of-life.  A mechanism for comprehensive, low cost, patient level data collection is needed. Embedding data acquisition into normal workflow provides the opportunity to accomplish such a goal. In this arm of our lab research we have constructed, integrated, and tested a sustainable, IRB approved, clinical information acquisition system (objective and patient reported) within the electronic medical record (EMR). The Neurosurgery Quality improvement initiative EpiLog tool collects critical patient data and outcomes information. Beta testing has demonstrated success in supporting precision medicine, QI, clinical and translational research and the ability to generate data pools for clinical research queries. In ongoing work we are integrating this novel clinical tool with our IRB approved surgical tissue collection banks for intervertebral disc tissue and stem cells. This will enable us to directly and uniquely couple basic research findings to the clinical presentation, symptoms and treatment outcomes of patients. In an adjacent project, by coupling Clinical information and patient reported outcome measures we are studying the impact various surgical results, and patient’s satisfaction, on overall outcome and return to functional status for a broad array of neurosurgical disorders.