Jefferson Investigates: Scar Tissue, Asthma Control, and Adherence to Diabetes Medication

Breaking Down the “Brick Wall” of Scar Tissue

Doctors in the U.S. perform nearly 800,000 total knee replacements every year, but some estimates indicate that up to 10% of patients may emerge from surgery with a new problem: arthrofibrosis, or excessive scarring that limits mobility.

“Scar formation is a natural process of wound healing,” says connective tissue researcher Andrzej Fertala, PhD. “However, when too much scar tissue is formed around a joint, it can stop us from moving as we’d like to.”

Few treatments currently exist for arthrofibrosis, but Dr. Fertala is working to change that. The most recent step in his research, published in the journal Gels, provides preliminary support for a technique that locally delivers antibody therapy to the knee.

After injury, cells release collagen molecules. Just as bricks are stacked and mortared to form a stable wall, these collagen molecules naturally aggregate into a sturdy scaffold to patch damaged tissue, Dr. Fertala explains. However, when excessive scar tissue forms after surgery or traumatic injury, the scaffold of collagen molecules becomes an impenetrable wall that prevents movement.

To stop that “wall” from being built, his technique employs an anti-collagen antibody — a specialized protein that latches onto collagen, disrupting the geometry that helps it stack. The antibody is delivered using a gel that shrinks at body temperature, keeping it concentrated and allowing its slow release at the knee joint.

This technique aided recovery in an animal model of injury, helping a damaged nerve near the knee joint grow back rather than being impinged by scar tissue. Without the antibody treatment, the nerve remained encased by scar tissue, preventing normal movement. Dr. Fertala says more tests need to be conducted to translate the therapy to humans, but the initial results are highly promising.

“Currently, apart from costly and painful surgical interventions and aggressive physical therapies, patients lack viable options to mitigate excessive scar formation,” says research associate and study co-author Andrzej Steplewski, PhD, “If successful, our method can potentially advance treating these debilitating conditions.”

By Marilyn Perkins

Improving Asthma Control in Young Adults

Here’s a surprising statistic: Nearly 50% of people with asthma do not take their medications as prescribed. That means they risk a flare-up of symptoms or a visit to the emergency room. Asthma researchers have studied medication adherence in children and adults to improve patient education, but rarely the population that bridges those groups: young adults.

“According to past studies, young adults are no longer adolescents but don’t think of themselves as adults,” says pharmacy researcher Ruth Jeminiwa, PhD. Once they leave home, they are new to disease self-management. In addition, Dr. Jeminiwa says, “Research suggests that young adults are very optimistic and may underestimate the risk of medication non-adherence.”

In a new study published in Pharmacy, Dr. Jeminiwa and her collaborators studied a text-messaging intervention in college students between the ages of 18 and 29 with moderate to severe persistent asthma. Three times a week, the 43 participants received a text message that outlined a consequence of using, or failing to use, their daily inhaler. Messages were framed either positively or negatively. For example:

• Taking your daily inhaled medications as prescribed DECREASES breathlessness.
• Failing to take your daily inhaled medications as prescribed INCREASES breathlessness.

The participants responded to questionnaires before and after eight weeks of receiving these messages. The researchers found that participants’ intentions to use their inhalers had improved and their asthma was better controlled compared to baseline scores, regardless of whether the message was framed positively or negatively. Dr.Jeminiwa says: “This text-message intervention actually has the potential to improve asthma outcomes.”

In addition, the intervention proved to be feasible and heeded — no participants dropped out of the study and they responded to 85% of the text messages.

There’s more to learn, Dr. Jeminiwa says. She’d like to test her text-messaging intervention in a larger sample, and include a control group that doesn’t receive texts.

By Jill Adams

Discussions May Improve Adherence to Diabetes Medication

Not taking medications exactly as prescribed  is a major barrier to the treatment of diabetes and has been shown to be more common in African American patients than their white counterparts. Researchers have examined the role of two related factors — depressive symptoms and concerns about medication — among middle-aged and older African Americans. Their results, described in the Community Mental Health Journal, add to growing evidence that physicians should take a broader approach to care, rather than simply writing prescriptions.

Eric Sah, a medical student at Thomas Jefferson University and study author, used data collected as part of a larger clinical trial, testing an education effort to reduce the need for emergency department visits by African American patients with diabetes. He analyzed patients’ responses to questions about their beliefs about their condition and their medication, as well as depressive symptoms they experienced. He also included measures of their hemoglobin A1c, a long-term indication of blood glucose control. His research expanded on an earlier analysis of similar data, published in The American Journal of Geriatric Psychiatry.

Sah’s analysis showed that the more signs of depression someone reported, the more likely they were to negatively view their medications’ side effects and the barriers to taking medications as prescribed. Meanwhile, the worse patients’ blood glucose control was, the more they perceived barriers to taking their medication properly. Worse control was also linked to symptoms of depression, but to a lesser degree. These results echo those of the earlier analysis, which uncovered a similar pattern.

Findings from both studies suggest that doctors should ask patients about their beliefs about medications and directly address them, according to Barry Rovner, MD, senior researcher on all three studies. “A physician should ask, ‘What do you think about these medications?’” Dr. Rovner says. “Because if a physician wants the patient to take the medication, that’s going to be more effective than saying, ‘You have diabetes? You need to take this pill.’”

By Wynne Parry