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Calabrese: Rheumatologists Must be Prepared for Immune-mediated Diseases
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NEW YORK — While immune-mediated diseases cannot be prevented, rheumatologists must be ready to prepare for the critical decision-making that lies ahead, according to a presentation by Leonard H. Calabrese, DO, at the Interdisciplinary Autoimmune Summit.
“I think there is enough heat in the area to invest in biobehavioral approaches right now in the clinic,” Calabrese said. “And this is prime time for immunotherapy.”
In his presentation, Calabrese discussed how genetic predispositions to disease can be observed in asymptomatic autoimmune patients and what rheumatologists can do to prevent symptomatic disease in these patients. He cited a genome-wide association study published in the New England Journal of Medicine in which investigators found human leukocyte antigen (HLA) and non-HLA genes were linked in patients who were anti-citrullinated protein antibody (ACPA)-positive.
“This is one of the most famous studies in rheumatoid arthritis,” Calabrese said. “In people who have ACPA, they have distinct disease. It is more severe, more extra-articular manifestations, it has a poorer prognosis. This is the molecular taxonomy of our disease.”
Calabrese talked about interventions a rheumatologist can utilize to prevent rheumatoid arthritis, which include mind-body stress reduction, pharmacologic drugs, immunotherapy and changes in diet and exercise. He cited a study conducted in animal models and published in the Journal of Clinical Investigations in 2013 in which investigators found immunoregulatory dendritic cells suppressed inflammation in an antigen-specific manner. In a study conducted in Science and Translational Medicine in 2015, investigators noted dendritic cells could reduce effector T-cells by more than 25%, as well as reduce levels of interleukin (IL)-15 and IL-29. In addition, Calabrese mentioned a study published in Science in 2016 that demonstrated artificial T-cell receptors can target B-cell receptors toward specific antigens.
“Our T-cells are here to stay,” Calabrese said. “This is moving at a furious pace in oncology, and we need to keep our eyes open right now.” – by Will Offit
Reference:
Calabrese LH. Advances in basic and clinical immunology 2017: Can we prevent immune-mediated diseases?. Presented at: Interdisciplinary Autoimmune Summit; March 24-26, 2017; New York City.
Disclosure: Calabrese reports he is a consultant for Genentech, Pfizer, Bristol-Myers Squibb, GlaxoSmithKline, Sanofi, Jansen and AbbVie; and is on the speakers bureau for Genentech, AbbVie and Bristol-Myers Squibb and Crescendo Bioscience.