Dr. Augustus “Gus” Mazzocca has dedicated his career to studying and fixing tendon, bones, and muscles, whether in astronauts or in his patients at UConn Health in Farmington.
Now a professor of orthopedic surgery, Mazzocca’s interest in medicine started early; a family friend who worked as a urologic surgeon let him scrub up and go into the hospital with him.
“That, of course, was crazily exciting,” Mazzocca says. “The whole idea of the human body and how it reacted to different performance was always interesting to me.”
From Space to UCH
Mazzocca’s resilient path to medical school nearly took him out of this world.
Mazzocca was undeterred by being eliminated from the Denison University pre-med program after receiving a “C” in organic chemistry. He received a BS majoring in biology.
His interest in sports and biology then brought him to Springfield College. While finishing a master’s in physiology, he became the head lacrosse coach at the University of Hartford, which had just made the jump to become a Division I team.
“It was great, but I always knew there was something more,” Mazzocca says.
At Springfield College, Mazzocca studied muscle atrophy. When people lift weights regularly, they gain strength. When they stop working out, they lose that strength. Mazzocca found, however, people could often still lift as much as they could when they were working out regularly, but lost their endurance.
Mazzocca carried this work over to his employment with NASA’s medical operations department. There, he studied muscle atrophy and bone loss on long-term space flights, working with the team that developed exercises and other measures for astronauts to counter these losses.
“They were going to build the space station,” Mazzocca says. “Astronauts would be in zero gravity for long periods of time and would still have to be able to work.”
Mazzocca then attended the UConn School of Medicine.
A self-described “UConn guy,” he grew up in Willimantic. Both his parents attended UConn, and his father, Gus Mazzocca, worked as an art professor at UConn for 42 years until retiring in 2012. His mother, D’Ann Mazzocca, earned her Ph.D. in philosophy at UConn and went on to work at the Connecticut State Capitol as a researcher and then as executive director of legislative management. His wife, Jennifer Mazzocca, earned her master’s in economics at UConn.
In medical school, Mazzocca realized he wanted to focus on orthopedics. He enjoyed how orthopedics focused on anatomy, and how practitioners could get results quickly, rather than the trial-and-error of medication characteristic of other medical fields.
“It either works or it doesn’t,” Mazzocca says. “If it doesn’t work you have to fix it, and if it does work, that’s great.”
Mazzocca has been collaborating with and learning from his partner and mentor at UConn Health, Dr. Robert Arciero, chief of sports medicine, for 20 years. He describes his relationship with Arciero, who served in the army before coming to UConn Health, as akin to a colonel and sergeant. Mazzocca stills runs ideas by Arciero, who provides valuable critical insight. Arciero’s guidance helps balance out Mazzocca’s enthusiastic can-do attitude, as Mazzocca often prefers to jump in with a pilot, see if it works, and address challenges as they arise.
“He’s always a part of what we do,” Mazzocca says.
The Three-Headed Monster
Mazzocca’s research in the Human Soft Tissue Research Laboratory focuses on helping patients with rotator cuff tears. The rotator cuff is a group of muscles and tendons surrounding the shoulder joint. Mazzocca noticed many patients who had surgery to repair rotator cuff tears did not heal as well as they should.
What really motivates us is seeing patients in the office, and how we can improve their care — Gus Mazzocca
Approximately 20-30% of repaired tears do not heal properly. While some of these patients don’t experience any pain or loss of motion, for others, it significantly impacts their quality of life. Additionally, even in the best case, there is a six month-long recovery.
“What really motivates us is seeing patients in the office and how we can improve their care,” Mazzocca says. “If you can even shorten that recovery time by a month, that’s a huge impact on society.”
Mazzocca’s lab is divided into three areas, giving it the nickname “The Three-Headed Monster.” The lab works on cell biology, led by Mary Beth McCarthy, biomechanics, led by Elifho Obopilwe, and clinical outcomes, led by Mark Cote.
By considering all three levels, Mazzocca’s lab tackles everything a surgeon would need to consider with this injury. On the cell biology level, the lab studies how muscle, tendon, and bone cells react to different substances and implants to help those cells heal more successfully. The biomechanics aspect considers how a repaired rotator cuff handles different loads. Finally, they look at clinical outcomes to assess how patients are feeling and moving.
Mazzocca’s primary research focuses on using stem cells to improve outcomes for patients after rotator cuff tear surgery. Mazzocca started looking at connective tissue progenitor cells in bone marrow. Scientists have long known bone marrow contains immature stem cells that can differentiate into any other kind of body cell.
“The idea is if you can get those to differentiate into tendon-healing cells, tendon bone healing cells, then that would take the body’s own natural ability to heal itself and do a better job,” Mazzocca says.
Mazzocca soon found this approach was expensive, time-consuming, and not as effective as he predicted. So he pivoted to look at another kind of cell. A post-doctoral student at UConn Health, Nat Dyment, was working with the paratenon of mice, a thin layer of cells that covers tendons around the knee. Mazzocca theorized he could use cells from the paratenon of the rotator cuff tendons rather than bone marrow to aid rotator cuff healing.
However, when Mazzocca’s team went in looking for the paratenon, they couldn’t find it. What they did find was bursa tissue — and it was filled with stem cells. Bursa tissue was previously something surgeons just slashed through to get to the injured tendons.
“When I first started, I thought the hardest part was going to be getting those cells,” Mazzocca says. “Really, what we found is they’re all over the place. The body has them all over.”
The connective tissue progenitor cells in the bursa proliferated more, grew faster, and migrated more than those in bone marrow. The migratory element of these cells is essential, as it is impossible to target the specific area you want the cells to inhabit.
“If those cells are able to migrate and move, they could move into the area that needed to be healing,” Mazzocca says. “We’re counting on them to know where to go, theoretically. We’re taking the body’s own signals.”
Mazzocca then began developing a fibrin clot composed of these cells to incorporate into standard repair surgeries.
While there is still much more research to do in this area, Mazzocca is committed to working on the problem until he finds the most effective treatment for all patients.
Collaboration Under One Roof
Mazzocca is the director of the UConn Musculoskeletal Institute. The institute was one of the first in New England when it was established in 2003, housing comprehensive spine, orthopedics, rheumatology, and osteoporosis researchers and clinicians under the same roof.
“The idea of the Musculoskeletal Institute is to take all those clinical entities and then all of the clinical researchers associated with that, and plop them all together so they can work together and collaborate,” Mazzocca says. “There’s a natural tendency for people to keep doing the same thing and just be in their own area.”
In his role as director, Mazzocca works to help clinicians and researchers collaborate and support one another’s needs.
“Clinicians identify problems, and then your researchers help solve those problems to advance care for the people of the state of Connecticut,” Mazzocca says.
Mazzocca says the most rewarding part of his work is the collaboration and camaraderie brought by working with students, residents, fellows, faculty, and staff. Mazzocca especially values his role as a mentor for students and residents.
One of the major lessons Mazzocca works to teach others is to be honest with yourself and acknowledge when what you’re doing isn’t working and the need for change.
“That’s where you’re teaching them. You have the potential to have an impact on them, on what they do, and try to impart in them professionalism, best practices and working hard,” Mazzocca says. “It’s easy to be good, but hard to be great. It takes constant dedication to your craft day in and day out to achieve success.”