Ferguson Lab Trainee Spotlight: Julia Chagas, MD, International Postdoctoral Fellow

Julia Chagas, MD, is a trained orthopaedic spine surgeon from Brazil who came to the University of Pittsburgh in early 2025 to begin a two-year postdoctoral fellowship in the Ferguson Laboratory for Orthopaedic and Spine Research.

Dr. Chagas completed her medical degree in Brazil at the UNIFASCISA in Campina Grande, and orthopaedic residency and research fellowship at Hospital Israelita Albert Einstein in São Paulo, where she developed a clinical focus in spine surgery and was later invited to participate in a research fellowship investigating exosome-based therapies for intravertebral disc degeneration.

That research experience, which was her first exposure to basic science lab work, introduced her to cellular and molecular techniques and created a deeper interest in conducting orthopaedic research. Through mentorship connections with a former Ferguson Lab trainee, Pedro Pohl, MD, PhD, Dr. Chagas was introduced to Ferguson Lab Co-Directors Nam Vo, PhD, and Gwendolyn Sowa, MD, PhD, and was subsequently invited to join the lab and continue her scientific training as a postdoctoral research fellow where she is now working to understand the biological mechanisms that may underlie chronic back pain in aging women, an area of basic science research that remains underexplored despite its high clinical relevance.

“Research is not very common in orthopaedic surgery in Brazil, and basic science research even less so,” says Dr. Chagas. “But I had the opportunity to learn how to isolate exosomes, culture cells, and perform assays. I realized how much I enjoyed the scientific process.”

Exploring the Hormonal Effects on Intravertebral Discs, Degeneration, and Pain

Dr. Chagas’s primary research project in the Ferguson Lab is studying how hormone replacement therapy (HRT), specifically estrogen and progesterone supplementation, may affect intervertebral disc degeneration and the experience of pain in women as they age. Using both animal models and human cell cultures, Dr. Chagas is testing estrogen alone versus combined estrogen–progesterone while also assessing the roles of luteinizing hormone (LH) and follicle-stimulating hormone (FSH).

Her project builds on prior studies showing that estrogen replacement can reverse damage in articular chondrocytes. Dr. Chagas is extending this work to the spine, examining whether similar regenerative or protective effects might be achievable in intravertebral disc cells. Dr. Chaga’s research uses in vitro analyses using human disc cells, as well as animal studies designed to test different hormone formulations and combinations.

In reviewing the literature for a menopause and low back pain review, Dr. Chagas found a long gap in publications after early work on the subject was conducted in the 1960s and 1970s, followed by renewed interest that has begun to examine associations between menopause and low back pain independent of osteoporosis.

“The literature shows that women tend to experience and feel greater levels of pain than men, in general, but also as they age,” Dr. Chagas says. “One of the causes may be hormonal imbalance during perimenopause and menopause.”

While the clinical use of HRT in managing gynecologic symptoms of menopause is well established in the literature, much less is known about its possible effects on spinal health or intervertebral disc-related pain. In surveying the literature to support a planned review manuscript, Dr. Chagas identified a sizeable gap.

“There were a handful of studies from the 1960s and 1970s, but then almost two decades passed with little research in this area. It is only more recently that the field is beginning to recognize again this connection and what it may mean clinically.”

Collaborative Research and Mentorship Roles

In addition to her primary research project, Dr. Chagas also is contributing to the lab’s LB3P (Low Back Pain: Biological, Biomechanical, Behavioral Phenotyping)* clinical research consortium, which is a multi-year, multicenter National Institutes of Health-funded effort studying the nature of, causes, and phenotypes of low back pain. One area of current exploration involves the use of heart rate variability as an easily accessible biomarker (collected from wearable devices or monitors as a potential predictor of pain risk or autonomic dysregulation in certain patient subgroups.

“We are trying to understand whether measuring heart rate variability in patients with and without low back pain could help us detect early signs or triggers of pain,” Dr. Chagas says. “We want to know if those physiological changes are correlated with how pain develops or progresses.”

Beyond her clinical lab work, Dr. Chagas is mentored a visiting medical student from Italy through a summer research experience.

“When you teach someone, you also learn,” Dr. Chagas says. “It completes the cycle of learning — first you see it done by someone, then you do it yourself, and then you teach it. That’s how it becomes part of you.”

Working in Pittsburgh and Future Career Plans

Adjusting to life in Pittsburgh after living in São Paulo, Brazil, a city of more than 20 million people, was its own learning experience. When Dr. Chagas arrived in Pittsburgh it was winter, and it was the first time she had seen and experienced snow. Despite the cold, the city, the university, and the Ferguson Lab gave her a warm welcome.

“I feel like Pittsburgh hugged me when I got here,” Dr. Chagas says. “I am incredibly appreciative of the opportunity and the trust that Dr. Vo and Dr. Sowa have showed me. The lab is such a collaborative place, and everyone has been generous and supportive. It’s been a very different, meaningful time in my life so far and I’m looking forward to my second year of fellowship.”

Dr. Chagas’s goal is to build a career that combines clinical practice, research, and teaching.

“I no longer see myself solely as a physician. I want to be a physician-scientist, and a professor someday. My dream is to stay here in the United States, but I also know that sometimes you have to go where the opportunity takes you,” Dr. Chagas says.

Her time in the Ferguson Lab so far has expanded her scientific expertise and helped her reimagine what a career in medicine can look like.

“I never imagined I would be here doing this work. But now that I am, I know I am doing what fulfills me the most.”

*The University of Pittsburgh Low Back Pain: Biological, Biomechanical, Behavioral Phenotypes (LB3P) Mechanistic Center of the Back Pain Consortium Research Program (BACPAC), part of the National Institutes of Health Helping to End Addiction Long-term Initiative administered by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) of the National Institutes of Health (NIH)