Promoting excellence

AO Trauma CPP Bone Infection is shaping the future of patient care

12 May 2020

Launched in 2012 with the aim of achieving a better understanding of bone infection, providing solutions for the most pressing clinical problems, and positively impacting patient care, the AO Trauma Clinical Priority Program (CPP) Bone Infection is shaping the future of patient care and inspiring a new generation of researchers. 

Led by Prof Stephen Kates and Prof Edward Schwarz, the CPP Bone Infection is poised to change the way clinicians think about bone infection, with projects aimed specifically at prevention, diagnosis, treatment, documentation, and education. More than 30 researchers from around the world have been involved in the CPP since its inception.

“We are really trying to get at the fundamental reasons people get an infection and that relates not only to the organism of infection but also to the patient’s immune system,” explained Kates, Virginia Commonwealth University, Virginia, United States. “We have put an immense amount of effort into understanding immunity and the response of the bone itself.”

Fundamental discovers

Through its work in those two areas—understanding immune system and how the bone itself responds to infection—the CPP’s work has yielded fundamental discoveries in just eight years.

“We’ve gained a fundamental understanding of why some people will die with their infection because the immune system is tricked by the bacteria and the bacteria win the battle,” he said, adding that a patient’s ability to fight an infection is likely either genetically determined or related to how his or her immune system developed during childhood. “We can actually measure this now in the research lab to advance our understanding and possibly come up with a therapy for a patient with a critical low level of antibodies and provide the antibodies as a supplemental medicine. That is a game changer.”

In fact, two such treatments have been patented: one by Kates and Schwarz and another by Schwarz.

“We’ve tried it in animals—sheep at the AO Research Institute Davos (ARI)—but have not yet tested it in first-in-human trials. We expect to do that within two years,” said Kates.

Another CPP Bone Infection breakthrough was finding an explanation for why one Staphylococcus aureus (S. aureus) vaccine associated with a higher mortality rate than placebo in patients who later developed postoperative S. aureus infections. The answer? It’s because the bacteria actually grows up the bone canaliculi and can deform itself down to 0.25 micron in size. Those findings have been submitted for publication and Kates expects them to be published later this year.

Stephen Kates
“The projects within the CPP have been expansive and ambitious from the outset. Trauma’s CPP has the potential to change the way clinicians think about bone infection, with projects aimed specifically at prevention, diagnosis, treatment, documentation, and education.”

Stephen Kates, Virginia Commonwealth University, Richmond, USA

Major strides in just a decade

While breakthroughs like these can be decades in the making, Schwarz said the CPP Bone Infection has made major strides in less than one decade.

“What makes this CPP so unique is its integration of both surgeons and scientists. The lab’s job is to create the tools for discovery, and the surgeons job is to help determine meaning and how we go forward with prevention, diagnosis, and treatment,” said Schwarz, University of Rochester, New York, United States. “For example, we have developed an in vitro system that models the canaliculi to identify the genes staph uses to invade, and made antibiotics against them. We really are desperate for a new class of antibiotics.”

Inspiring a new generation

Beyond that remarkable progress is understanding and treating bone infection, the CPP continues to inspire a new generation of researchers, Schwarz added.

“What this team, including fellows at ARI and our postdocs in Rochester and Richmond, has been able to accomplish is truly remarkable. I think the key is that everyone involved in this CPP has put egos aside and worked together as a team with the goal of solving problems,” he said. “The AO really fostered this and made these achievements possible.”

Edward M. Schwarz
“What makes makes this CPP so unique is its integration of both surgeons and scientists. The lab’s job is to create the tools for discovery, and the surgeons job is to help determine meaning and how we go forward with prevention, diagnosis, and treatment.”

Edward Schwarz, University of Rochester, New York, USA

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