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Dr Francesco Dell'Accio

DellaccioDr Francesco Dell'Accio is an Arthritis Research UK clinician scientist in the department of rheumatology at King's College, London.

What does your work involve?

We're trying to understand the mechanisms by which the joint surface repairs itself after injury. In young, healthy individuals this can happen, for instance, after sports injuries. When the repair mechanisms fail, joint surface damage persists and may cause osteoarthritis. Our final aim is to restore the regeneration capacity by targeting stem cells that normally reside within the joint. I also anticipate that our investigations will be instrumental to trigger and enhance joint tissue regeneration in inflammatory conditions such as rheumatoid arthritis, once the inflammation is under control.

How long has Arthritis Research UK been funding you?

Twenty months.

What's the most important thing you have found out in the past 12 months? Why?

Together with my long-standing collaborator, Dr Cosimo De Bari (another rheumatologist and clinician scientist), in the past few years we've discovered that stem cells are present in several joint tissues including the articular cartilage, the synovial membrane which cover the inner side of the joint capsule, and the periosteum, a membrane that covers the bones. These cells are capable of extensive proliferation and can contribute to the formation of several tissues, including bone and cartilage. They persist within their niches into adulthood, even in elderly individuals, and are believed to contribute to reparative processes. I was very thrilled when I discovered that, when injured, the articular cartilage sends out potent molecular signals that activate stem cells within the joint. We're currently 'decoding' these signals and expect in the future to use this 'molecular language' to stimulate joint tissue regeneration without taking the cells out of the body. This would be a major advantage over current technologies that utilise stem cells isolated and expanded in the laboratory because, by eliminating the manipulations of the cells outside the body, we hope to make these technologies less invasive, less expensive, more reproducible and especially safer.

What do you hope or expect to achieve as a result of your Arthritis Research UK funding?

I expect that we'll complete the screening for all human genes regulated in human cartilage in response to injury. We'll then have a list of all signalling molecules that are released by the injured cartilage, some with a known function and some others with a function that will need to be investigated, within the joint. At this point we'll need additional funding to pursue two lines of research. First, in a translational research programme, we'll explore the use of the identified signalling molecules with a known function for possible clinical applications. Second, we'll continue the basic research to understand the function of individual signalling molecules in the context of joint tissue repair and the way different signals interact with each other.

What do you do in a typical day?

I use the quiet, early hours for the most difficult experiments, reading the scientific literature and thinking. Later, I supervise and teach students, plan experiments, write articles and perform experiments myself. Mondays are fully dedicated to the clinical work; in the morning I see patients in the rheumatology outpatient clinic and in the afternoon I read the clinical literature.

What's your greatest research achievement?

The identification of markers that predict the efficacy of cell preparations for cartilage repair using autologous chondrocyte implantation.

Why did you choose to do this work?

I trained as a clinical rheumatologist and I felt a tremendous frustration because of our helplessness with patients with joint tissue destruction. Take patients with osteoarthritis: we do relatively little more than managing pain until they need surgery for joint replacement. Take patients with rheumatoid arthritis: a lot has been done to achieve control on disease progression, and biological therapies have recently made an impressive impact on the quality of life of these patients. However, patients who have disability from extensive joint destruction remain with their disability. This is why I felt that it'd be important and exciting to enhance tissue repair.

Do you ever think about how your work can help people with arthritis?

I think of it every Monday, while doing the clinical work and facing clinical problems that would need enhancement of repair mechanisms, and every day of the week, when our experiments suggest that this may be possible.

What would you do if you weren't a GP/researcher?

I always liked humanities and I love the eagerness in the way young people learn. I think I could have been a good teacher.

About Francesco

Most of my time off work is dedicated to my family and in particular to my five-year-old daughter. However, one of the benefits of commuting is that it allows some time for listening to music and reading a good book.

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