Thomas Clemens is no stranger to translational research. “I’ve spent my entire career in clinical departments working with physicians on translational research projects,” says the vice chair for research in the Johns Hopkins Department of Orthopaedic Surgery. “What struck me when I joined Hopkins was that the surgeons and residents were so busy, they simply had no time to collaborate with us on research projects. We may as well have been on different planets.” This separation, popularly known as the “bench-to-bedside gap,” severely impedes the translation of new discoveries into clinical practice.
Today, however, Clemens has a powerful new mechanism for closing the bench-to-bedside gap: a National Institutes of Health-sponsored training program called TOTS, short for Training in Orthopaedic Team Science.
Clemens believes that the key to developing meaningful translational research studies is to create multidisciplinary teams. “I took a page from what industry does,” he says. “They form big teams that comprise people from very different backgrounds. Here, we’re consolidating the entire program, bringing surgical faculty, residents and Ph.D. basic scientists together on projects.”
Because residents are key to its success, the TOTS program sponsors a dedicated research year for an orthopaedic resident to collaborate with clinical faculty and a basic science team to address an important question related to diagnosis or treatment of a musculoskeletal disorder.
The first TOTS-sponsored project joins faculty from several Johns Hopkins departments, including dermatology, orthopaedic surgery and radiology, to study infection in bone via a mouse model in which they can monitor the bacterial burden with fluorescent bacteria. The aim is to apply their research to treating infection after orthopaedic implant surgery, with the goal of avoiding costly revisions.
Clemens believes this project exemplifies how effective the team approach can be in developing translational research. “You can’t expect busy surgeons to make a genetically altered mouse or to work in a wet lab culturing cells. That’s our bailiwick,” he says. “Conversely, I wouldn’t know how to deliver biologic molecules during surgery, but I can learn the basics from my surgical colleagues. It’s all about teamwork: the surgeons to provide input on the most pressing clinical questions and the researchers to develop the methods to study them.
“The applied nature of orthopaedic science is ideal for translational approaches,” he continues. “The great diversity of problems that affect the musculoskeletal system provides unique opportunities for training in a wide range of fields, including basic cell biology, genetics, bioengineering, biomechanics, regenerative medicine and public health.” With the support of the T32 grant, the Hopkins Orthopaedic Department is poised to take a lead role in developing the next generation of therapies that will greatly benefit patients with disorders of the musculoskeletal system, such as osteoporosis and arthritis.