Grants We Funded

Abstract
Trapeziometacarpal Osteoarthritis (TMOA) is a prevalent, painful condition for which there is no cure(1). Non-surgical treatment has only shown minor short-term benefits. End-stage TMOA is treated by surgical intervention and often has a lengthy recovery period(2-5). To find a cure for TMOA we need a better understanding of the disease and ability to evaluate it. Radiographic disease severity is often discordant with pain illustrating the need for objective markers to diagnose the disease earlier, predict patients who will rapidly deteriorate, and evaluate treatment efficacy. Biomarkers are objective, measurable indicators of normal and pathophysiology, or response to treatment. Currently there are no validated biomarkers for TMOA(6). To address this pertinent issue, our group has created one of the world's first TMOA biobanks with patient tissue, and longitudinal blood samples that have matched clinical, imaging and functional data. We have also commenced studies investigating biomarker identification within this cohort. Our preliminary data show there is a group of inflammatory cytokines capable of characterizing subsets of TMOA patients. Our overall objectives are to discover which cytokines can stratify disease, predict severity and progression, and are capable of evaluating response to treatment. We hypothesize that cytokine panel screening of plasma paired with clinical outcomes will identify a unique subset of markers with the above-mentioned capabilities. Aim 1: Biomarker identification through plasma cytokine screening of TMOA patients. Disease changes at the local joint level are reflected in systemic changes in plasma(7, 8). Characterization of cytokines could describe early disease mechanisms, and phenotypes that could be targeted for prevention of joint degeneration. To investigate whether there is a molecular identity or subset of cytokines unique to TMOA patients we will screen these patients for markers of inflammation, bone and cartilage remodeling, metabolism and pain. Aim 2: Evaluation of cytokine correlation to pain, function and severity. By longitudinally examining how cytokines correlate with pain, function, and radiographic severity we will be able to determine which cytokines are capable of predicting disease progression to surgical status, and create a risk score that can be applied to clinical evaluation. Additionally, post-surgical follow-up data will yield information about efficacy of intervention.

Biography
Dr. Heather Baltzer completed both her undergraduate medical training and residency training in Plastic Surgery from the University of Toronto. Prior to her medical training, Heather completed an MSc in the Department of Medical Biophysics at the University of Toronto. Following residency, she spent a year obtaining subspecialty fellowship training at the Mayo Clinic in Rochester, MN in hand and wrist surgery. She is an Assistant Professor in the Department of Surgery and Department of Laboratory Medicine and Pathobiology at the University of Toronto and is a research collaborator in the Department of Surgery at Mayo Clinic. Dr. Baltzer’s clinical practice focuses primarily on hand and wrist surgery. A large proportion of her patients suffer from osteoarthritis and post-traumatic arthritis of the small joints of hand and the wrist. Acute traumatic hand injuries are also a large part of her patient population. Both acute and chronic hand pathology have significant functional implications for patients. Dr. Baltzer presents her research at international hand surgery meetings and has published several articles in leading hand surgery and plastic surgery journals. She has joined a team of researchers with specific expertise in cartilage biology that have established an arthritis tissue bank and biomarker research facility, enabling groundbreaking work to be conducted in the areas of osteoarthritis.