 The Vale Scientific Summit attracts the greatest minds in regenerative medicine, and this year at the third installment of this event, one of the great minds is Dr. Richard Lieber of Northwestern University. His life work is the study of muscle contracture, and I don't mean like Arnold Schwarzenegger. So my name is Rick Lieber. I'm currently the Chief Scientific Officer at the Shirley Ryan Ability Lab in Chicago, Illinois. I've only been there three years. I was a university professor at the University of California in San Diego in La Jolla for 32 years, where I ran a lab that studied muscle physiology, and most of our applications were clinical problems that patients had, such as inability to move your hands in spinal cord injury, or especially complicated and interesting problem was patients, mostly children, who had wrist flexion contractures because of cerebral palsy. So I'm a guy who, I have a PhD in physiology. I study muscle for a living, and I look at clinical applications to try to understand what the problem is and how to fix them. We have made a lot of progress over the last 20 years. Most of it's been sort of biomechanical. So working with surgeons to figure out what's the best way to suture two tendons together, or working with surgeons to figure out, okay, if this muscle doesn't work, maybe that muscle will replace it, and moving muscles around, we call those tendon transfers. And I'd say, you know, 10 or 20 years of sort of mechanical improvements in surgery has had a huge impact on patients, but we've probably plateaued. Well, yeah, the next issue is what takes us to the next level, and I think most of the new developments and the, well, how do I say it? Most of the new advances are going to be biological. So we understand pretty much how normal muscles work. So I would say our lab over the last 10 years has developed new tools to actually study humans. You probably know that a lot of physiology is studied in rats and mice and other kinds of animals. Some of that applies to humans, some of it doesn't. One area it doesn't apply at all is probably in patients who have injuries to their nervous system, their head or their spinal cord. So we've been taking muscle biopsies from patients, and then taking those muscle samples back to the lab and studying them. And it turns out that human muscle contractures have a dramatic number of really strange differences compared to any animal models. And so one of our take home lessons is just because you study a phenomenon in a rat doesn't mean it's ever going to apply to a human. Yeah, I'm very optimistic because we have seen some changes. Some are really surprising, but some actually lend themselves to therapeutic application. So for example, it turns out, and one of the weirdest findings is I mentioned these kids who have wrist flexion contractures. So if we measure the muscle properties of these kids, one of the things that's changed that was very unexpected is their stem cell population drops by like 70%. And if you know this field, and that's what this group here is talking about, stem cells in tissues keep them sort of happy and allow them to grow and adapt. So if these kids' muscles can't grow, as their bones get longer, their muscles really become like tight rubber bands and pull their joints into a flexed position. So the treatments now for those flexion contractures are things like cutting the tendons or maybe trying to stretch them out, and they honestly don't work that well. So this way, if we can understand why they've lost the stem cells or what are the problems with the stem cells they have, we can actually do biotherapies on these muscles, inject new stem cells, give them pharmaceutical agents that help stem cells to grow and fuse and all that kind of stuff. And I would say those have the capability for much better long term functional outcomes. Yeah, I don't know if this is true, but it seems to me at some level there's some kind of pre-qualification to get here. Because everyone I see here, they're friends from the field. This is not a typical scientific meeting. Typical scientific meetings are pretty dry, and they go on a pretty hardcore schedule. This is more like what we refer to as a Gordon conference, where there's time to present enough material to get the juices flowing and then plenty of time to socialize and talk about that and ask the questions. So I'm a muscle person, but I'm watching people who are doing stem cell work in the bone area, which is not my area. So I'm watching that work and I'm thinking, well, maybe that applies. But in a normal meeting, I don't know enough to ask an intelligent question, but I can go up and say, hey, my name's Rick, I study muscle. I heard you say this and this and this, am I getting this right? So in an atmosphere like this where people are fairly relaxed, where there's plenty of time to talk, it allows us to sort of cross-fertilize among disciplines. It's like professionally we don't get the chance. I hang out with the muscle guys, they hang out with the bone guys. Sometimes we criss-cross at clinical meetings, but it's rare. So this particular meeting allows people plenty of time to cross-fertilize. I'd say unfortunately for the younger people, these are the all-stars. So this is like the all-star game in baseball. The leadership in Vale has selected people in different areas. They're all proven leaders. I would say also they're all pretty much proven to be pretty good collaborators. So there are some superstars that really don't work well with other people and they're not here. It's pretty interesting. There are also some people who are fantastic collaborators but wouldn't be necessarily scientific superstars that are going to be critical to producing progress. I would say probably the unifying theme is people here are excellent in their field and excellent collaborators. So Johnny and I go way back because he studies muscle and we met each other a long time ago and I figured out he's different than me. He's more of a muscle biologist. I'm more of a muscle physiologist. But we cross-fertilize and we hung out at the same orthopedic research society. And we would often talk about, yeah, we need to do this work together. We need to solve these problems together. So I would always learn a lot from him. When he moved here, it signaled to the scientific community that Vale was very serious about doing science in the context of sports medicine. When we all saw his move, we all sort of perked our ears up and said, gee, I wonder what's going to happen. And he has been in the field for 20 plus years. He knows the people. They know him. So when he said, okay, I want to do a regenerative medicine conference in Vale, we all thought, hmm, well, if they're friends of his and we know what kind of person he is, he's a good scientist. He's a good collaborator. I'll bet that's the kind of meeting that would be very interesting to go to. Whereas, if I got, let's say, some super famous surgeon somewhere in the country said, hey, I'm going to put on a sports medicine meeting. Would you come? Honestly, time is really precious. I'm not sure exactly what the value would be. I don't know the person. I don't know the people they know. And so it's really kind of a social cue that Johnny gives this meeting by superimposing his personality on the people. Dr. Huard almost single-handedly within the orthopedic research community invented this muscle-derived stem cell therapy approach to solving problems. Prior to him showing up on the scene, most of orthopedics that related to muscle was, as I mentioned before, surgical reattachments, maybe some fiber type issues, maybe some connective tissues or scarring, but very basic, sort of nuts and bolts orthopedics. Johnny took the approach that he had learned from his advisor, Jacques Tremblay, about the ability of stem cells to differentiate into other tissues and he had a crazy idea. What if I just get some of these stem cells and inject them into a muscle injury? I would say a lot of people would think that was naive. Other people would say that was really brave, but it turned out to work. So Johnny has taken a very pragmatic approach to working on musculoskeletal injuries using his own stem cell populations and then collaborating with people who know a lot more about different aspects than he does. So he's turned out to be sort of an adventuresome scientist who creates functional collaborations that end up making patients better. People ask me how the meeting was. I'm going to say surprising. And the reason I say surprising is I didn't really think I was going to learn that much. I thought I saw the list of people and I know roughly what they do, but I didn't realize how much new material was out there. Science moves quickly. I'm slightly removed from my hardcore scientific roots now that I'm in Chicago, but what I've seen is the progress in this area now relates directly back to me because people are sharing brand new data. Again, a lot of time at scientific meetings, people won't share the newest, hottest stuff because there's so much competition. Here many people have even said, look in the spirit of cooperation and collegiality, I'm showing you this stuff that's brand new. And so it's maybe unprocessed or undigested, but it really gets the thought juices flowing. So I would say after a meeting like this, I probably will have a one to two year period of my professional career now where I'm totally up to date on what's going on. And I would recommend highly that anyone who wants to get up to date come to this kind of meeting.