LSU Integrated Musculoskeletal Biobank (LIMB)

Location

Clinical Sciences Research Building, Room 518
533 Bolivar Street
New Orleans, LA 70112

Overview

LIMB Leadership Team: Vinod Dasa, MD; Luis Marrero, PhD; Jessica Rivera, MD, PhD; and Jennifer Simkin, PhD

The Department of Orthopaedic Surgery at Louisiana State University (LSU) Health - New Orleans is dedicated to providing exceptional patient care, facilitating high-quality training of residents and medical students, and engaging in innovative research. Our team includes clinical and research faculty, residents, and students who are interested in finding answers to today's most pressing questions on orthopaedic diseases, refining the standard of care, and improving the outcomes of intervention strategies that combat health care disparities. We are constantly searching for novel approaches to better understand a broad range of orthopaedic conditions, therapies, and outcomes across the care continuum of our patient populations concurrent with implementation of individualized medical assessments. Considering the diversity of patients in our immediate region, one of the main goals of our research strategy is to investigate factors that fuel disparities in the outcome of both orthopaedic diseases and their treatment. For example, in November 2015, we initiated a prospective study that gathers demographic and patient reported outcome survey data from candidates for total knee arthroplasty (TKA) to store in an encrypted database (REDCap) for further study. Preliminary analyses of these data showed that women of black and white races constituted the majority of over 200 TKA consented patients. Statistics on this patient sample showed that black patients were significantly younger and had a higher body-mass index (BMI) than white patients. Interestingly, black patients reported significantly worse severity of knee problems in most Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales: 1) symptoms, 2) pain, 3) activities of daily life, and 4) quality of life. These differences persisted even after adjusting for sex, age, and BMI. Therefore, to conduct more in-depth analyses integrating demographic, clinical, social, and biological variables that may account for disparities in osteoarthritis symptomology, we developed the LSU Integrated Musculoskeletal Biobank (LIMB).

The LIMB is a repository that has been approved by the LSU Health Institutional Review Board to harvest biological samples with clinical data sets from 1000 consented patients undergoing TKA of which over 300 have already been secured. The LIMB implements standardized procedures for perioperative collection, preservation, and banking of synovial fluid and knee tissues from matching anatomical locations between patients, including synovium, medial and lateral femoral condyles, tibial plateau and metaphysis, femoral cortex and periosteum, meniscus, and intra-articular muscle. Blood is also drawn prior to TKA and at the three month TKA follow-up for isolation of serum, plasma, and peripheral blood mononucleated cells. Representative portions of all samples are banked in liquid nitrogen at vapor phase and most tissues are also preserved in formalin for histopathological analyses and scoring for disease severity based on the Osteoarthritis Cartilage Histopathology Assessment System established by the Osteoarthritis Research Society International. Moreover, the LIMB performs isolation of primary cell lines from patient synovium, articular cartilage, and periosteum for functional in vitro experiments in addition to transcriptional and protein assays performed in-house.

Coded biological sample sets from each patient are linked to basic demographics (i.e. age, sex, self-reported race), socioeconomic status, and insurance type. Clinical data are also integrated with each sample set, which can be categorized into medical records, clinical metrics, and surveys. Examples of medical record information include BMI, pre-operative history of prescribed pharmaceuticals and treatment with injectable medications and biologicals. Clinical measures encompass factors such as knee deformity type, laboratory test values (e.g. CRP, ESR, triglycerides), radiographic assessment, range of motion, and co-morbidity indices. Answers to various patient-administered surveys are also entered into the LIMB database, from validated questionnaires on nutrition, alcohol and drug use, and patient-reported outcome (PRO) measures such as the KOOS, Patient-Reported Outcomes Measurement Information System (PROMIS), and Western Ontario and McMaster Universities Arthritis Index (WOMAC). Of note is that all samples and clinical data are routinely collected by the same fellowship-trained arthroplasty surgeon at the same location. Although the LIMB is currently limited to banked sets from TKA of patients with osteoarthritis, its logistics and standard operating procedures will serve as a platform to bank from patients with other congenital, chronic, and traumatic orthopaedic conditions. The resources found at the LIMB can answer many health questions, beyond those specific to the diseased knee joint, and accounting for the many medical and socioeconomic variables among a diverse patient cohort.

Research Team

Medical Students

-Past: Linus Igbokwe, Jacob Davis, Jonathan Schuon, Michael Langley, Lauren Saunee
-Present: Sydney Hodgeson, John Valentino, Mallory Crawford, Jose Cruz Ayala, Zohaib Lakhami, Lauren Guillot

Nursing Students

-Past: Kaylea Reeves
-Present: TBD

Graduate Students: Tierra Strange

Undergraduate Students:

-Past: Kathryn Jordan, Sarah O'Brien, Nathaniel Beech, Jose Cruz Ayala
-Present: Christina McCarthy, Elena Plakotaris, Maria Tovar

Collaborating labs: