The research program of Peter C. Amadio, M.D., focuses on the role of fibrosis in human health and disease. Dr. Amadio's current research addresses the causes and prevention of fibrosis in two tissues: flexor tendons, where post-traumatic fibrosis impairs tendon function, and degenerative tendinopathy is also common; and the synovium within the carpal tunnel, where fibrosis leads to the most common hand surgery condition, carpal tunnel syndrome.
- Wolff's law of soft tissue. Wolff's law of soft tissue addresses the effect of loading on wound healing and soft tissue material properties. In tendon, this especially affects the nature of the rehabilitation protocol, timing of initiation of motion, and timing and gradation of loading of the repair.
- Tendon gliding beneath pulleys. Dr. Amadio looks at the effects of tendon repair and lubrication on tendon gliding. This factor interacts with the effects of Wolff's law of soft tissue, as the ease of gliding will dictate how well the tendon moves under loading and how much loading is needed to initiate motion. At the same time, the amount of loading needed to initiate motion will affect the strength requirements of the tendon repair.
Tissue engineering. Dr. Amadio's laboratory is currently investigating the effect of tissue engineering strategies on tendon healing and the reduction of adhesions. To accomplish this, he and his team are incorporating a bone marrow stromal cell-seeded and cytokine-augmented collagen patch into the repair site of their animal model in vitro. The team is also investigating the effects of a tendon patch with surface modification on tendon repair in vivo.
Such therapies also have an effect on other tendon-associated pathologies where impaired tendon gliding appears to be a factor, such as carpal tunnel syndrome, and adhesions complicating tendon grafting procedures. Therefore, Dr. Amadio's group is also pursuing similar strategies to address these other clinical problems. Finally, his team is investigating the use of ultrasound for the early diagnosis of tendon adhesions and carpal tunnel syndrome.
Carpal tunnel syndrome. The novel animal model developed in Dr. Amadio's laboratory investigates the etiology of carpal tunnel syndrome and enables the lab to look at the role of subsynovial connective tissue in carpal tunnel syndrome. He and his colleagues then compare, biologically and biomechanically, clinical results with their unique carpal tunnel syndrome animal model.
Research by Dr. Amadio and his team will identify and characterize the initiating mechanism underlying carpal tunnel syndrome development and then generate novel, mechanism-based interventions that will prevent, detect and treat carpal tunnel syndrome. The group is are also investigating the hypothesis that subsynovial connective tissue fibrosis in carpal tunnel syndrome is mediated by TGF-b and if TGF-b activation is blocked, subsynovial connective tissue fibrosis in their animal model will be reduced.
Significance to patient care
Therapies to improve rehabilitation and the strength of tendon repair developed in Dr. Amadio's laboratory have already changed the clinical practice of tendon surgery. The next goal is to translate the successful in vivo animal results into a product that can be used clinically.
The carpal tunnel syndrome model developed in Dr. Amadio's laboratory will allow his team to identify novel anti-fibrotic therapies, as well as biomarkers that can be used to guide therapy.
- Board of directors, Orthopaedic Research Society, 2006-2008, 2014-2016
- Board of directors, Mayo Clinic Alumni Association, 2010-2016
- Chair, Integrated Physician Practice Section, American Medical Association, 2012-2014
- CORR ORS Richard A. Brand Award for Outstanding Orthopaedic Research, The Association of Bone and Joint Surgeons and the Orthopaedic Research Society, 2014
- Alumni Achievement Award, Jefferson Medical College, Thomas Jefferson University, 2013