Emily Littlejohn, D.O., M.P.H.
2019 Career Development Awardee
Study: Longitudinal Antinuclear Antibodies Titers from Pre-Clinical to Clinical SLE
Mentors: Emily Somers, Ph.D, ScM & Jinoos Yazdany, M.D., M.P.H.
About the Researcher
Emily Littlejohn completed her undergraduate education at Georgetown University, where she received a bachelor’s in human science. After undergraduate, she received a master’s in public health, focusing on epidemiology, from Boston University of Public Health.
Littlejohn then attended Western University’s College of Osteopathic Medicine of the Pacific (COMP) where she was awarded a research fellowship in the college’s department of biotechnology. She went on to complete her internal medicine residency at Loyola University Medical Center in Chicago, where she became interested in Rheumatology. While attending Loyola University, Littlejohn performed research in a disease called giant cell arteritis and presented an abstract on clinical symptoms and biomarkers of the disease in patients who have undergone a temporal artery biopsy. This abstract went on the win first place at the Loyola Research Symposium.
She completed a rheumatology fellowship at the University of Michigan, where she worked closely with lupus patients and became interested in lupus disease activity measures. At this time, she performed meaningful research studying the ratio of certain biomarkers to distinguish infection from a lupus flare in patients presenting with fever. Additionally, Littlejohn was able to compare different types of lupus disease measurements, such as a validated tool using blood work versus a patient self-reported tool.
Since starting at the Cleveland Clinic, Littlejohn has taken over the Cleveland Clinic Lupus Cohort (CCLC), a longitudinal bio repository that banks blood and urine of lupus patients. Within this cohort she has plans to explore measurements of blood markers over time in hopes of finding the best measures of early lupus activity. She has a distinct interest in laboratory medicine and elucidating how positive blood tests in lupus patients can change or increase over time. Her vision is to identify early markers of lupus that may prompt early treatment to prevent the onset or progression of this devastating disease.
The overarching goal of this project is to acquire the expertise necessary to lead a clinical research program devoted to systemic lupus erythematosus (SLE) that will leverage advances in electronic health records and bioinformatics. Within this framework we will investigate trends of antinuclear antibodies.
SLE is an autoimmune disease with vast and potentially life threatening consequences if it is not detected and treated early. Autoantigens to cellular antigens, commonly referred to as antinuclear antibodies (ANAs), are a hallmark of SLE, with greater than 95% of SLE patients testing positive for ANA (Somers). Further, ANA positivity has been found in 13.8% of the general adult population (Satoh). Understanding which of these ANA positive individuals are at greatest risk of developing a clinical autoimmune phenotype for lupus would be a goal of precision medicine. An important first step is to understand trajectories of ANA titers within individuals over time, and the factors associated with these changes.
The aim of this project is to first apply electronic health record (EHR) phenotyping techniques of noisy labeling to construct a patient population that will be the substrate for longitudinal lupus research. From this cohort, authors plan to characterize longitudinal trends of ANA titers throughout the course of disease, both in patients with lupus and those who have “incomplete lupus” or are at risk for the disease. Authors will then investigate if the use of hydroxychloroquine is associated with changes in ANA positivity or strength over time. In addressing these aims, the authors hope to elucidate the utility of serial ANA testing in lupus patients and provide data to guide decision making related to ANA ordering.
For more information on Lupus Foundation on America’s granted research, please contact Ashley Marion at [email protected]