Researcher Aims to Help Prevent Osteoarthritis

 

Matthew Tao, MD, is part of the research team at the University of Nebraska Medical Center participating in the PIKASO trial (Preventing Injured Knees from Osteoarthritis: Severity Outcomes), the first Arthritis Foundation-directed clinical trial aimed at preventing post-traumatic osteoarthritis (PTOA). The trial brings together top scientists from nine institutions across the country to examine the use of the drug Metformin in people with knee injury who are at high-risk for developing PTOA in the knee after anterior cruciate ligament (ACL) reconstruction. Dr. Tao is an Associate Professor in the Department of Orthopaedic Surgery and the Medical Director for the Sports Medicine program.

Q: Tell us about your background.
I was always fairly active, although I’d love to lie and tell you I was a great athlete! But the mental and physical importance of activity was imprinted on me at a young age and continues to be a big part of life for me personally and as a parent of little kids. Clinically, I specialize in knee preservation, so my goal is to help people stay healthy and active whether they’re kids or aging adults. As such, I see a lot of younger folks with an ACL tear and older patients with arthritis, so it has given me some perspective on the spectrum of disease over time.

I did my undergraduate studies at a small liberal arts school, Calvin University, in Michigan, and then transitioned to medical school in Chicago at Northwestern University. My orthopedic training was at Duke University, and then I spent a year specializing in Sports Medicine at Hospital for Special Surgery in New York City. 

Q: What drew you to science and research, and arthritis research in particular? And what do you hope to accomplish professionally?
Most of my time day-to-day is spent as a clinician where I see patients and do surgery, which I absolutely love. It allows me to build a relationship with people and walk with them through their recoveries and get them back to activity. Without question, that interpersonal aspect is the most rewarding part of the job. But I also recognize that my impact on people is on a relatively small scale and is limited to the patients I meet directly. 

The beautiful thing about research is that you have the potential for a much more dramatic effect on a much larger population. That’s particularly true as it relates to ACL tears — they are such a common injury these days. And while there is always room for improvement in surgical technique and return-to-sport, these are relatively short-term outcomes. What I worry about more is the long-term effect ACL injuries have on these young people in the years ahead. 

Our team, led by Dr. Liz Wellsandt, has a keen interest in better understanding the mechanisms of post-traumatic arthritis and also trying to mitigate that effect. Ultimately, if we are able to alter the progression of degenerative changes, that offers a tremendous benefit to patients individually and to society as a whole.

Q: Could you describe what you do, especially with PIKASO?
Our team is thrilled to be a part of PIKASO, as it aligns so well with the focus of our research. We will be one of the research sites where patients enroll in the trial and then follow with us postoperatively for further testing and imaging. We have several surgical partners who are very engaged in our research team, and Dr. Wellsandt runs an amazing lab that has particular expertise in both the biomechanical and imaging side of post-ACL injuries. 

Q: Do you expect PIKASO to affect patients directly or indirectly? How so?
My hope is that PIKASO affects our patients both directly and indirectly. Metformin is a fascinating medication because it has been around for a long time and is safe and generally well tolerated. And while it's used primarily for diabetes management, there is a whole subculture of interest in it as a 'lifestyle' medication. It seems to have anti-inflammatory and other metabolic properties that extend well beyond blood-sugar control. 

As it relates to post-ACL injury, we don’t know what effect it will have on the progression to arthritis, but it’s a very exciting medication to study. Obviously, I hope that we find a significant and direct benefit to those who receive it in terms of decreasing the degenerative changes seen in their knees. But there is an indirect benefit as well with research like this, where these patients are helping to further an important cause and help us gain a better understanding of long-term treatment options.

Q: What are you excited about in OA?  What should patients be excited about?
OA is just so prevalent in society that it affects the mobility and quality of life of a huge number of people. From an orthopedic standpoint, we have a great treatment option for end-stage arthritis in knee replacements. But both as a patient and a surgeon, I want to wait for that operation until it’s needed. So if we can discover a way to delay the progression of OA, whether it’s Metformin or something else down the road, that will be really exciting for the medical community and so beneficial to our patients.

Q: What else would you like to share about your involvement with arthritis research?
Sometimes research on things like cancer or heart disease feels more important or pressing to the general public due to the life-threatening nature of those problems. And without question, those are critical issues that warrant the attention and funding they receive. 

But arthritis is actually much more of an issue than people often imagine. Particularly when you look at quality of life and physical activity, the effect arthritis has on patients’ lives is substantial. Although OA is not life-threatening, helping patients with it is certainly life-changing. I am grateful that we have good nonoperative and surgical options available, but if we are able to help reduce the rate and impact of arthritis before it becomes problematic, that is something the whole medical community and general public should be able to get behind in a big way.