Trailblazing New Connections in Medicine

(bright upbeat music) - This is "Lab Medicine Rounds," a curated podcast for physicians, laboratory professionals, and students. I'm your host, Justin Kreuter, a Transfusion Medicine Pathologist and Assistant Professor of Laboratory Medicine and Pathology at Mayo Clinic. Today, we're rounding with Dr. Shannon Strader, a fellow in cellular therapy at Mayo Clinic here in Rochester, Minnesota, talking about trailblazing new connections in medicine. Thanks for joining us today, Dr. Strader.

- Thank you so much for having me on. - So we're talking about trailblazing and we're talking about connections. I introduced you as our cellular therapy fellow. What I didn't put in the introduction is that you completed your residency training in physical medicine and rehabilitation. Maybe to kick off this podcast, can you kind of share your story with our listeners

of how you connected the dots between physical medicine and rehab and cellular therapy? - That's just a wonderful question. So I think to start, I'll start by describing PM&R, and then what a physiatrist or PM&R doctor does. To make it more complicated, in PM&R, we have so many different names that we call ourselves, but physical medicine rehabilitation is a specialty dedicated solely to maximizing functional abilities and quality of life for those with any type of neurological or MSK disorder.

So we care for a wide range of individuals. Sometimes we call ourselves the zebra finder, but we do focus on stroke, spinal cord injury, brain injury, cerebral palsy, spina bifida, muscular dystrophy, amputee medicine, and then sports and pain medicine.

Because PM&R is fairly new and a unique specialty, I often get the question on how I even found the specialty in interviews for PM&R, whether it's attending interview or residency interview, that's a common, common question, and I always say it has all to do with my twin sister. My twin sister passed from complications of cerebral palsy. And so I truly don't remember a time in my life where I wasn't exposed to both the positive and negatives of medicine.

And so I became a physiatrist or PM&R doctor because of my twin sister. However, connecting the dots to cell therapy, there's so much unmet need in treating these patients. There's not a lot of options, and oftentimes, the procedures and medications we can offer are just maybe a temporary solution with a lot of side effects. So this led me to being very interested in novel cell therapeutics. Down my path, as I grew up and in high school and in college, I found Dr. James Thompson.

He is the father of stem cells. He derived the first embryonic stem cell, and then later created induced pluripotent stem cells alongside Dr. Yamanaka. And so I emailed him when I was in high school saying, "Thank you for your work," and he offered a job as an undergrad researcher at the time. And so I'm forever thankful for that. And working in his lab, I just developed even more passion for discovering innovation and novel cell therapeutics.

And so I did have to put that kind of passion of cellular therapy and stem cell research on the back burner as I completed medical school and residency, there's so much I needed to learn clinically, of course. And then during my training, it was during the pandemic, so we were just trying not to drown in clinical work at the time. So now I'm very thankful to be in my cell therapy fellowships where I can connect all my dots together, including PM&R and cell therapy.

I would say that I guess the common conception is that, or common thought is that cell therapy relates mostly to oncology. And I think that's true, especially for the focus on CAR-T therapies currently, there's a lot of promise there and so many new discoveries in that arena. But I do think cell therapy was made as a home to innovate procedures and therapeutics for patients that don't otherwise have any options. And so as a PM&R physician, I think I fit perfectly in that realm.

- I really appreciate you kind of highlighting that aspect that you're coming at cellular therapy. Yeah, so even coming at cellular therapy in really a new way, you know, there certainly are some people that might be interested, but a lot of focus has been on that neoplastic or oncology background, as you say. And so I really appreciate that you're kind of bringing it into a new area. What's been those challenges and joys of kind of working in the lab medicine world now?

You've been a couple months into your fellowship, and it also sounds like you have some prior lab experience, but this might be the first time actually in terms of clinically working in the laboratory. How have you found it? - Well, I think it's so fascinating. It's so stimulating. Every day, there's just a new adventure and the possibilities are endless. There's a lot of hope in this arena, which I love.

It's been wonderful to learn how to create cellular products from both a diagnostic standpoint and a therapeutic standpoint. And then, I guess the dream goal is to biomanufacture and make it on a scalable level so that all facilities and clinician scientists could use such a product.

Interesting, I feel that I can be more creative while I'm in this fellowship and in laboratory medicine, even though laboratory medicine is much more black and white than I'd say a clinic or inpatient setting, there's a lot more gray. I do feel like there's so much more time to be able to think about how you're going to analyze a certain product or procedure. And so it's very interesting to see the different ways of thinking and approaching solutions versus clinic and lab medicine.

The challenge I would say is educating the clinical world on what's actually being performed in the lab and the innovation that is changing the potential future treatments and pathways. I think we do, as clinicians, get so tied up in kind of the daily pressures, rightly so, of taking care of patients in front of us and also providing the standard of care that we have at this moment.

And then also the pressures of documentation, getting orders into the pharmacy, and talking with insurance companies. So we kind of sometimes aren't able to use that creative part of our brain, and think what could potentially we change in the standard of care and the processes that are happening. And then another challenge I'm learning is biomanufacturing a product can be very difficult and have its challenges in itself, but that's the ultimate goal.

So everybody in potentially the world has easy access to these products. - Something you said earlier in your answer, you're talking about kind of things being black and white in laboratory medicine, that's something that I find interesting, 'cause we often talk, we sometimes get residents applying, and when you talk to 'em about why they chose pathology, they a lot of times, will talk about appreciating that it's black and white.

And what's funny is, for practicing pathologists, I think most of us would sort of say, "Oh, there is so much gray."

- So much gray. I can imagine. - You know. - Totally, yeah. - Like, yes, we put it in this diagnostic box, but you know, these cases could be challenging. But to your point though, where I certainly will concede the point when you're talking about manufacturing a process, or, sorry, not a process, when you're manufacturing a product, you know, that often does have a lot more of that black and white contrast because of the manufacturing requirements.

- Exactly, like, all the regulatory processes being very strict with the standard of practice and your SOPs are so vital in that. - When you're talking about your creativity, is that something that you've been able to kind of tap into throughout your life?

Is that something that as you were doing your physical medicine rehabilitation training, like, because of your kind of strengths in that area, you were able to kinda continue to think about cellular therapies, as opposed to, I think, for a lot of people, as you're saying, you get busy with things and people probably just think about, "Okay, let me go and start working, "hang up my shingles as as a physiatrist." - 100%, yeah.

I think it also, it started with my twin, especially, is wanting to have more options, have more answers, and there just wasn't. And then unfortunately, 20 years plus, and fast forward in my residency,

I realized a lot of things haven't changed in the standard of care, and that made me very frustrated. And so as much as I would go throughout my day-to-day and offer potential treatments or procedures that are considered the standard of care and what we do have to provide to the patient population I was working with, there is still that big part of myself that was like, "Ugh, I hate this. "I want to provide more, I want there to be more options."

I want there at least to be clinical trials that I'm aware of that's going on that I could direct my patients to. And so I think I've never lost that, I guess, creative thought process, but definitely had to put that on the back burner to focus on what I can do in that day while that patient was potentially hurting or suffering or needing a different kind of direction of medication and treatment.

- What's been your experience for the level of knowledge of cellular therapies in the physical medicine and rehab world? Is this something that people are aware of, but are thinking about it like, well, that's cancer treatment, or like, is it something like, you know, how could this construct help us in physical medicine? What's that like? What's your experience been? - Yeah, it's very interesting you say that, because I do think there's kind of a clouded version of what cell therapy even is.

But in PM&R, we use orthobiologics daily for our patients. And that's probably a conversation in itself of what that even entails, but you could say that is a cell therapy version, because you are taking cells from a patient and essentially injecting it back into the patient.

I do think there needs to be a lot more studies on orthobiologics and a lot more regulatory processes, which also is why I wanted to complete this fellowship so that I could bring back that knowledge to the PM&R world and say, "Hey guys, I think we can do this better." But also, I think because PM&R is, I guess, more focused on calling it orthobiologics, they don't even consider it a type of cell therapy.

And I think the education in saying that this is a cell, that these are cells that we are injecting and understanding them better is probably gonna help our field a lot more. I will say, as far as like, MSC type cells, that has been- - When you say MSC, I'm sorry to interrupt, but- - Yeah. - What does that mean for our listeners?

- Oh, yeah, mesenchymal or stromal cells or stem cells, there's a debate on whether you should call them stromal or stem cells, but they're finding more and more these types of cells

help with anti-inflammatory mechanisms, help with potentially proteins and growth factors and signaling for certain cells to help with injury or disease. And so the MSCs in PM&R world have been used for, I think over a decade now in certain clinical trials. There's some promise there still, but I think that has been challenging to translate it as a standard of care of treatment for our patients. But that has been a constant conversation, I think, in the PM&R world.

- You know, I'm always looking for the tagline for this podcast, is, you know, encouraging people to continue to connect lab medicine in the clinical practice. And you know, I'm kind of struck by, as I hear you, as you've connected these dots, how, you know, really, it's been disparate expertise, right? We have some people that are expert in cellular therapies, we have some people that are expert in physical medicine rehabilitation.

And because those are two different knowledge sets, like, the physiatrists don't even know what's possible, necessarily, on the cell therapy side. Cell therapy people probably don't even know there's a maybe a clinical need or an application. - Oh, for sure. Yeah.

- And so this connection, thinking about this connection, knowing that, you know, you're somebody who enjoys laboratory medicine and working in these areas now, but you've certainly have worked in the clinical practice for a number of years. Everyone's super busy. What ways can, you know, laboratory professionals reach out and build relationships with clinical colleagues? A lot of times when I have clinicians on, I kind of tell them they should definitely pick up the phone and call the lab.

How can lab reach out to the clinical colleagues?

- Well, I think you're doing a wonderful job, first off, by creating and leading this podcast. I think social media, for better or for worse, is kind of the future for young trainees to learn in a lot of different ways. And so using social media tools, I definitely think help and will help, continue to help close that communication gap. I do think laboratory professionals are kind of the unicorns of medicine.

You guys have the 360 view of what's going on and streamlining processes to even get to a patient. And most of what you guys are developing as far as products to be used for patients are lifesaving. And so you guys kinda have this overview of both clinically and what's going on in the laboratory, which I think is so vital to promote to the clinicians that may not truly understand what's going on in that world.

I do feel like when somebody is talking about bone marrow transplant or CAR-T therapy, which is the most common types of cell therapies that I think are being discussed out in the world, they think more about administrating it to the patient and potentially curing or treating that patient, which is very exciting, but personally, I think the coolest part is actually creating the product itself, which is what you guys do and perform.

And then without creating that product, there'd be absolutely no treatment or option. And so getting the word out about that is, I think, just as is important as as these treatments

and the patients benefiting from them. - Wow, that's a perfect lead-in to my final question, which is, now you're talking about getting these products out. What does the future of PM&R look like with cellular therapies in the toolbox? - Yeah, well, I hope I can recruit some other PM&R docs to be excited about cell therapy and want to be educated and understand it more.

But there are thousands of both cell and gene therapies being produced in clinical trials at this time, and over half are not for cancer-related disorders at this time, most of which are MSK or neuro-related. And so I think that the next biggest hurdle is addressing these treatments that are coming in the pipeline for education and training in residencies and fellows, and who takes ownership of that as a clinician and understanding these.

And then my dream is for PM&R to combine forces with neurology and cellular therapy to create more of a holistic approach in streamlining these novel therapeutics. I don't think we can do this alone or isolated from each other. I think these therapies are very complex and they require a lot of different expertise and education. And so I hope that we all kind of get together as a team in our expertise.

But my personal goal is to investigate cellular products related to abnormal muscular pathology for both diagnostic and therapeutic reasons. Most recently, I've become very obsessed with nanoparticles and nanomedicine for delivery of therapy. So we'll see if I can make something happen in these next couple years. - We've been rounding with Dr. Shannon Strader, talking about creating new connections in medicine. Thanks for taking the time to talk about this with us.

- Thank you so much for having me, I really appreciate it. - And to all of our listeners, thank you for joining us today. We invite you to share your thoughts and suggestions via email to [email protected]. If you've enjoyed this podcast, please subscribe, and until our next rounds together, we encourage you to continue to connect lab medicine in the clinical practice through educational conversations. (bright upbeat music)