Dr Jennifer Paxton on her work on musculoskeletal tissue engineering

Dr Jennifer Paxton is a Lecturer in Anatomy at the University of Edinburgh. Her lab focusses on musculoskeletal tissue engineering, in particular, methods to engineer bone tissue, tendon tissue and the bone-tendon interface.

Why have you chosen to work in this subject area?

The connection between the hard, rigid tissue of bone and the soft, stretchy tissue of tendon is very cleverly formed. Instead of a simple join between two parts, the connection, known as the enthesis, has a unique structure that allows the force of muscle movement to travel to the bone smoothly, reducing injury during activity. Although this works well normally, when tendons are injured and need surgical reattachment to the bone, the enthesis does not fix itself well and patients can suffer more pain and lack of movements that can really affect their day-to-day living. Tissue engineered models serve as an exciting and cost-effective way to study the unique structure of the enthesis in the laboratory to investigate ways to repair the connection between bone and tendon. It also may lead to the production of a new enthesis in the laboratory that could be implanted into patients following injury.

What problem are you trying to solve?

Hand tendon injuries are a major cause of pain and reduced ability to perform everyday tasks. Indeed, it is estimated that they result in over 1.5 million days lost from work each year. The poor healing seen when tendons are injured, especially their inability to reattach to bone, can significantly delay return to normal activities. Here, we propose to improve a model system to allow studying of repair approaches, and indeed, design new tissue-engineered implants to improve surgical reattachment of tendons-to-bone. These would shorten patient recovery times and improve pain-free movements of the fingers and hand. Also, this study will help the whole field of tendon repair, as other sites also display poor tendon-to-bone healing (e.g Achilles tendon near the ankle joint). Developing model systems to study the formation and repair of tendon-bone attachments are crucial to advancing the treatment options for difficult injuries and ultimately to benefit patient outcome.

How will your research impact on people with musculoskeletal conditions?

This research aims to develop a realistic model of the tendon-to-bone site in the laboratory that will lead to fundamental research activities into useful repair strategies for improving tendon-to-bone repair. For example, the influence of drugs could be trialled in the laboratory without the need for expensive and controversial animal models. Also, the effect of the drugs would be investigated within a system made from human cells and so will be more relevant to the human situation than the effect observed in, for example, a mouse or rat. In addition, taking the work from this study to develop patient-specific implants would be a major step forward in providing a new repair option for tendon-to-bone repair. Both of these avenues will permit a better functional outcome for those patients experiencing a musculoskeletal injury, improving their quality of life and reducing the overall burden of their injury on their own life and society. Furthermore, adaptations of this technology into other anatomical sites, such as the ligaments in the knee joint or the tendons at the shoulder joint, will help prevent the onset of further musculoskeletal conditions such as osteoarthritis, which is a common complication of poor tendon-to-bone healing following injury. Ultimately, we predict that this research will pave the way for exciting and impactful work into treatment for a variety of musculoskeletal conditions and injuries where tendon and/or ligament damage is prevalent. These will reduce patient rehabilitation times following injury, improve patient satisfaction and quality of life, and contribute to an overall benefit to society.