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Factors Driving Wear and Implant Failure in Total Shoulder Arthroplasty

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NIAMS - National Institute of Arthritis and Musculoskeletal and Skin Diseases

Polyethylene (PE) wear and implant-related failure remain leading causes of revision in total shoulder arthroplasty (TSA), a procedure which now surpasses the growth rate of hip and knee arthroplasty. Both anatomic (aTSA) and reverse (rTSA) TSA outcomes are heavily influenced by complex interactions between rotator cuff function, scapular motion, implant design, and patient-specific loading—factors not adequately captured in current preclinical implant testing standards. Emerging evidence suggests that PE wear progression in TSA is highly dependent on shoulder kinematics, joint loading, implant positioning, and individual patient factors. Nonetheless, data on in vivo motion and load profiles remain sparse, and few tools exist to link these profiles to clinically relevant wear patterns or associated periprosthetic inflammatory tissue responses. Accordingly, the primary objective of this project is to develop validated, patient-specific models that predict PE wear in TSA and identify modifiable surgical, design, and rehabilitation targets to improve implant longevity and restore patient mobility. Additionally, we will establish histopathological hallmarks that indicate TSA failure caused by PE wear debris. Our central hypothesis is that specific shoulder kinematics and joint loading drive distinct PE wear patterns in TSA associated with mechanical failure or inflammatory-mediated osteolysis, depending on implant design and positioning. To achieve the overall objective of this work, shoulder motions and muscle excitations across 25 activities of daily living will be collected at pre-op and post-op (>6 months) in both aTSA and rTSA patients, with long-term follow-up of patient-reported outcomes via validated surveys (5 years). Unsupervised machine learning will categorize patients into movement-based phenotypes, which will then inform a multi-scale modeling framework to estimate in vivo shoulder joint loads and implant wear across the varying movement strategies. Predicted wear patterns will be validated using state-of-the-art preclinical wear simulators. Simultaneously, we will quantify how patient, surgical, and implant factors contribute to wear in retrieved TSA components (>400 samples), correlating imaging-based wear patterns with clinical outcomes, patient-reported function, inflammatory tissue responses, and radiographic indications of loosening. For that purpose, we will establish benchmarks of TSA wear rates and introduce a new histopathological approach augmented by infrared spectroscopic imaging. This work is innovative because we are linking patient-specific movement patterns following TSA with multi-scale computational models to predict PE wear, breaking the current approaches of using generic motions and loads in existing testing standards. This work will produce the first integrated, publicly available database of TSA kinematics, joint loading, and PE wear patterns and rates, along with validated computational tools to inform implant design, surgical planning, rehabilitation strategies, and personalized risk assessment. Ultimately, these advances will improve functional outcomes and long-term success for TSA patients and enable better preclinical testing methods and standards.

Up to $643K
2031-04-30
health research

Free to search & build · $99 one-time to unlock the application pack · No subscription

FOXE3 in Creating Lens Chromatin Architecture and Transcriptional Identity

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NEI - National Eye Institute

The ocular lens serves as an excellent model for studying cell fate determination, as it consists of two distinct cell types derived from the surface ectoderm: lens epithelial and fiber cells. Lens development requires suppression of pro-neurogenic pathways, distinguishing it from other anterior placodes, such as the olfactory placode, which gives rise to neurons. Mutations in key transcription factors (TFs), including AP-2α, FOXE3, and PAX6, lead to overlapping developmental defects such as aphakia, incomplete lens separation, and fiber cell abnormalities, suggesting shared transcriptional targets and regulatory mechanisms. However, a major gap remains in understanding how FOXE3 functions as a transcriptional regulator and how its activity influences chromatin architecture to suppress pro-neurogenic gene expression during lens formation. Preliminary studies using CUT&RUN identified a de novo FOXE3-binding motif, with strong similarity to FOXD3, and revealed that FOXE3 is required to repress neurogenic gene expression in early lens cells. Additionally, RNA-seq analyses of Foxe3 mutant lenses demonstrated significant differential gene expression linked to pro-neurogenic pathways. This led to the hypothesis that FOXE3 functions as both a transcriptional activator and repressor, coordinating chromatin remodeling to establish and maintain lens cell identity. To test this, state-of-the-art chromatin and transcriptomic technologies, including single- nucleus multiomics (ATAC-seq + RNA-seq), CUT&RUN, and functional assays in chick embryos, to dissect FOXE3’s molecular mechanisms will be conducted. Aim 1 will identify FOXE3 transcriptional targets and determine how chromatin accessibility (DARs) and FOXE3-bound enhancers and promoters are altered in Foxe3 mutant lenses. This will be accomplished through the integration of single-nucleus multiomics and CUT&RUN data to map the FOXE3-dependent regulatory landscape. Aim 2 will determine the functional role of FOXE3 in cell fate decisions by (1) gain and loss of function assays in chick lens cells, (2) testing its ability to suppress neurogenesis in the developing chick retina, and (3) identifying FOXE3-interacting proteins via immunoprecipitation and mass spectrometry. The completion of these aims will provide mechanistic insights into FOXE3’s role in lens development, establish a FOXE3 DNA-binding motif, and identify targets of FOXE3 regulation. These studies aim to reveal how FOXE3 mutations contribute to congenital eye disorders such as aphakia, cataracts, microphthalmia, coloboma, and Peters anomaly. By elucidating the chromatin regulatory mechanisms underlying lens cell identity, this work has the potential to inform therapeutic strategies for human eye diseases linked to transcriptional dysregulation.

Up to $468K
2031-03-31
health research

Free to search & build · $99 one-time to unlock the application pack · No subscription

Fulfilling the potential of next generation brain PET imaging systems

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NIBIB - National Institute of Biomedical Imaging and Bioengineering

Applications of brain Positron Emission Tomography (PET) have been in place for over 40 years. The combination of quantitative PET systems with novel radiotracers has led to numerous imaging paradigms for understanding normal and pathological brain physiology and pharmacology. Brain-dedicated PET systems offer important advantages over currently available PET systems in terms of sensitivity and resolution. Funded by a BRAIN Initiative grant, we developed the NeuroEXPLORER (NX), an ultra-high performance brain PET system. To date, human results have produced exceptional image quality and the delineation of small brain nuclei. The system's performance derives from its long axial field of view, small crystal elements, depth of interaction measurement, and excellent time-of-flight resolution. This proposal takes the next steps to optimize system performance including accuracy and precision, expand on the capabilities for dynamic PET with tracer kinetic modeling, and demonstrate the real-world performance with a wide range of PET radiopharmaceuticals. The proposal includes the following Aims. Specific Aim 1: Optimize key aspects of the system performance and reconstruction methodology to maximize image quality and minimize noise. We will further optimize and improve rigid and non-rigid motion correction, investigate impact of detector crosstalk and corrections, and develop reconstruction methods with practical computation times. Specific Aim 2: Develop and extend the capabilities of the NX for dynamic analysis using tracer kinetic modeling. Our initial assessment of extracting image-derived input functions from the carotid arteries has been very successful, and we will further validate this approach against arterial blood samples with a large cohort study using multiple radiopharmaceuticals that are commonly used in research and have potential clinical impact. We will also develop and validate methods to estimate the radiopharmaceutical metabolite corrections using population modeling and kinetic analysis strategies. In addition, the ultra-high resolution and sensitivity of the NX allows the reassessment of optimal modeling methods, which will be explored for tracers with challenging spatiotemporal distributions. Specific Aim 3: Real-world performance of human brain scans. We will further develop our 3D printing methods to generate a full-brain phantom and use it to compare to other PET systems. We will facilitate access of this phantom to other sites with novel brain PET systems. To truly optimize NX human imaging, we will perform test/retest studies with multiple radiopharmaceuticals and compare NX images to those of a current state-of- the-art whole-body system (Siemens Vision). This work will demonstrate the significance of the NX's performance characteristics and enable harmonization with conventional PET/CT scanners. In addition, we will perform brain activation studies using functional PET in a paradigm targeting the olfactory system, which is highly relevant in the early manifestations of neurodegenerative disorders.

Up to $664K
2030-02-28
health research

Free to search & build · $99 one-time to unlock the application pack · No subscription

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