Improve the Detection of Neuro-Musculoskeletal Disease

This focus includes the development of novel imaging techniques (present and future), body fluid biomarkers, and molecular monitoring. The uses of these early diagnostic techniques include a) evaluation of the pathogenesis of musculoskeletal disease, b) early detection of disease processes, and c) monitoring of therapy, with the long-term goal of preventing severe osteoarthritis, failure of joints, tendons, ligaments and menisci, and catastrophic injury. Work in biomarkers has progressed into imaging biomarkers with particular emphasis on the use of ultrasonography, MRI, and computed tomography (CT) in diagnosing early disease change in the limb. Considerable work has also been accomplished using subject-specific finite element modeling of the equine metacarpal phalangeal joint which helps us better understand the stresses that play a role in injury of this critical joint.

3a. Access to imaging modalities and strategies

We have two board-certified radiologists (Drs. Kurt Selberg and Myra Barrett) and board-certified surgeons, Drs. Chris Kawcak and Brad Nelson along with several graduate students that have led significant efforts in developing our imaging equipment and protocols. This is one of the fastest growing areas that is rapidly changing our ability to detect subchondral bone disease prior to catastrophic injury. Detection of early injury through these mechanisms will change the landscape of diagnosing repetitive injuries in our athletes.

3b. Correlation between imaging findings and clinical signs

Detection of imaging findings and correlation to clinical signs will be important for practitioners in the field. Without this, clinical use and recommendations to actually “order” the correct imaging modality will not result in clinical impact. This correlation is crucial to bringing the clinical implications to practice.

3c. Predicting disease before it manifests clinically through biomarkers

Fluid biomarkers have been studied at the Orthopaedic Research Center for 25 years in work led by Drs. David Frisbie and Wayne McIlwraith, with critical contributions from experts of human osteoarthritis biomarkers. We have published multiple publication on detection of early disease and developed a combination of ELISA and biochemical techniques that could predict musculoskeletal injury 6 weeks to 6 months before musculoskeletal injury but were thwarted in developing an affordable commercial panel. Armed with proof of principle, work demonstrating strong value using metabolomics, Drs. Wayne McIlwraith and David Frisbie have combined forces with Dr. John Belisle’s group to pursue the development of a metabolomic platform that can be used to diagnose pre-osteoarthritis changes as well as identify horses at risk for musculoskeletal injury (including catastrophic injury). This concomitantly involves establishment of a core facility in metabolomics at the Translational Medicine Institute with the instillation of two mass spectrometers funded by two significant donors to our program.

3d. Validating novel diagnostic techniques

Novel diagnostics such as the lameness locator, force plate analysis, and the computer software developed to better interpret lameness and subtle lameness are being intensively developed within the Orthopaedic Research Center. Even more novel is wearable technology that detects, in real time, how a horse’s movement and parameters (heart rate and respiratory rate) may change in response to the beginning of an injury. This research is being led by Dr. Chris Kawcak and is involving multiple collaborations. We hope to decrease the subjectivity from lameness examinations and instead develop more diagnostic techniques to detect and quantify pain/lameness in our athletes.