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The American Shoulder and Elbow Surgeons association has awarded a team of London researchers the 2017 Charles S. Neer Award for Clinical Science, one of the most prestigious awards in the areas of shoulder and elbow surgical research in North America.

The award recognizes the scientists’ development of the PCR-RFLP (polymerase chain reaction restriction fragment length polymorphism) assay, a test that can accurately identify Propionibacterium acnes (P acnes) infection of the shoulder within 24 hours. Current methods take an average of six or more days, and are prone to sample contamination and false-positive results.

“We are incredibly honoured to receive this award,” says Dr. David O’Gorman, Lawson scientist, Co-Director of Molecular and Cellular Research at the Roth McFarlane Hand and Upper Limb Centre (HULC) at St. Joseph’s Health Care London, and senior author of the publication. “We believe it illustrates the high quality of research being done at Lawson and marks the beginning of another clinically relevant research program at HULC.”

P acnes is a type of bacteria typically found deep in the hair follicles and sebaceous pores of the skin. A P acnes infection of the shoulder is a common and serious complication that occurs after arthroplasty (surgery to replace a damaged joint, most commonly with artificial material). It can cause pain in the shoulder joint and often loosens the implant. In most cases, the patient requires additional surgery to remove the infection and replace the implant.

It can be difficult to diagnose a P acnes infection as it often presents without symptoms that would be characteristic of an infection, such as pain, skin reddening or wound drainage. The prevalence of P acnes in the deeper layers of the skin also increases the chance of sample contamination and false-positive results making it hard to isolate and identify in a pathology lab.

Currently P acnes infection is identified by administering a tissue swab for anaerobic culture, which takes an average of six or more days but could take up to three weeks. This technique also carries substantial risk of contamination from the adjacent skin and other sites where P acnes is present.

The PCR-RFLP assay can identify P acnes in tissue from a shoulder biopsy within a 24-hour period. The extremely sensitive technology also has the ability to detect fewer than ten P acnes cells in the sample, which may decrease the false-positive rate in cultures caused by swab contamination.

“The accuracy of this test and the shorter period of time needed for identification can help with treatment decision making, targeted antibiotic therapy, and monitoring to minimize implant failure and revision surgery,” explains Dr. O’Gorman, who is also an Assistant Professor in the Departments of Surgery and Biochemistry at Western University’s Schulich School of Medicine & Dentistry. “We hope that the test can be further developed into a ‘point of case’ assay that can detect P acnes in tissue samples in real time while the patient is undergoing shoulder surgery.”

Since the PCR and RFLP mapping used for the assay are techniques routinely performed in many clinical microbiology and pathology labs, the test would be a cost-efficient approach not restricted to highly specialized research labs.

Other scientists who were part of the study include Dr. George Athwal and Dr. Kenneth Faber, HULC orthopaedic surgeons, Lawson scientists and Schulich professors; Ana Pena Diaz, research technician for the HULC Molecular and Cellular Biology Research Lab; and Scott Holmes, a medical student and Schulich Research Opportunities Program participant who was primarily responsible for designing and optimizing the assay.

Both Dr. O’Gorman and Dr. Faber are also members of Western’s Bone and Joint Institute.

“A rapid method for detecting Propionibacterium acnes in surgical biopsy specimens from the shoulder” was published in the Journal of Shoulder and Elbow Surgery (JSES). 

When cases of COVID-19 began spreading in the London region, Lawson Health Research Institute (Lawson) had to rapidly adjust to a new environment.

As a hospital based research institute, Lawson is uniquely positioned to address the medical questions posed by a new virus. The expertise and infrastructure to begin these investigations was already in place. The global shortage of supplies, as well as physical distancing measures, forced many research projects to be put on hold. Other areas, however, were ramping up their work to support the scientists and physicians eager to figure out how we can better prevent, detect, and treat patients with COVID-19.

Lawson Clinical Research Services (LCRS) and the Center for Clinical Investigation and Therapeutics (CCIT) got to work immediately. The teams responded rapidly to research requests, getting new studies up and running within days.

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Dr. Douglas Fraser, Lawson Scientist and Paediatric Critical Care Physician at London Health Sciences Centre (LHSC), initiated a study to examine the immune response in patients with COVID-19. Reports from other parts of the world identified a heightened immune response in more severe cases of the infection, also labeled the ‘cytokine storm’. Laboratories at Lawson were ready to handle this type of research, as close proximity to patients and sample collection is essential.

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“Our world changed almost overnight,” adds Tereschyn. “We had to pivot on a dime and change the entire way we do business. Our staff have really risen to the challenge.”

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The LCRS and CCIT teams are supporting essential research in other ways as well, including logistics and administrative support, and supply sharing.

“We’ve developed many new partnerships throughout this pandemic, and figured out in very short order how to work efficiently together,” says Tereschyn. “While COVID-19 has presented us with many challenges, it has also been a great opportunity for us to support one another in ways that I don’t believe would have transpired otherwise.”

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Researchers first in world to profile the body’s immune response to COVID-19

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Study suggests that surgery may be superior treatment for chronic sciatica

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Researchers unravel two mysteries of COVID-19

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Gut microbiome may influence how cancer patients respond to oral therapies, study suggests

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Assessing the pandemic's impact on Canadian Veterans and their spouses

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