Research Highlights from 13th International Congress on Lupus
By Joan T. Merrill, M.D., Lupus Foundation of America Chief Advisor, Clinical Development
This was an exciting Congress, reporting on the latest advances in treatment development and progress in understanding the causes and types of lupus at a deep- down molecular level. Data from recent clinical trials was reviewed. Although some of this has already been reported in the past year or two at larger rheumatology conferences, the way this meeting was organized facilitated discussions among smaller groups of focused lupus researchers to dissect what the data can teach us.
The findings of several new treatments in development were presented at the conference and are different than any potential treatments that have come before. For example, Xencor has a new biologic treatment that attaches to a special protein on B Cells, which are central actors in lupus flares. This singular protein, (called Fc-gamma-RIIb) can be mobilized to dampen down B Cell hyper-activity without killing the cells the way some other B Cell-directed treatments do. This is important because a healthy immune response requires healthy components. In lupus, some of the immune response has gotten out of hand, but killing the cells is not always the best solution since they are needed to protect us from infections and other diseases.
Additional reports of new treatments that involve fine-tuning of immune response included Janssen’s ustekinumab, which dampens signaling that causes hyperactivity of a specialized type of T cell. Another medication, baracitinib, moderates signals going through immune cells. A report on low dose IL2 illustrates an immune paradox in which a little IL2 is therapeutic, but a lot could set off too much of an immune response.
Optimal treatment of lupus in the future will require a comprehensive understanding of how to rebalance the immune system rather than combat it. There was also an update on the interferon kinoid, as well as a novel vaccine against a major inflammatory stimulator in lupus, interferon alpha, which is being developed by Immunpharma. Here, the patient’s own immune system is being mobilized to counteract elements that may have become disordered.
All of these agents have shown some evidence of promise, but all may have pros and cons and must be studied further to finally determine what role they can play in lupus. In line with this, there was much discussion during the conference about how patients can become more pro-active in clinical trial design and participation. There are several ongoing projects to create pathways for hearing the patient’s voice, including work at GlaxoSmithKline that was reported at the conference, and two large collaborative programs from the Lupus Foundation of America and the Oklahoma Medical Research Foundation. You can learn more about these educational programs on this page, or visiting https://empower.crisalisllc.com.
Meanwhile, the conference also provided up-to-the-minute updates on the work that is going on in large multi-institutional groups who are working together to characterize exactly how lupus works at the molecular level. The Accelerating Medicines Partnership (AMP) is a collaboration of biotechnology companies, the government, voluntary organizations such as the Lupus Foundation of America, and academic scientists working together to understand, for the first time in microscopic detail, how lupus operates in the organs that become inflamed, such as the kidney. The work reported at the Congress was very exciting because the techniques being developed using all of this talent are unprecedented in their sophistication and their potential to define unique aspects of the disease in individual patients.
There is more work going on using blood samples from lupus patients or samples from the bacteria that operate in the gut, examining patterns of genes that are being activated to make proteins as well as emerging patterns in the proteins themselves that regulate the immune system. The question of how the gut may impact lupus is fascinating and may shed some light on ways in which our environment can influence disease.
Work using blood samples from lupus patients is beginning to reduce the mysterious complexity of lupus into predictable patterns that may improve how we choose and dose treatments in the near future. In turn, all of this research into the mechanics of lupus should lead to more, better new targets for illuminating the design of new treatments.
Attending this conference provided convincing evidence that there is a great amount of hope on the horizon. However, we must not forget how long it has taken to get to here, and how long it might be to reach fully adequate control over lupus for all individuals. Much is left to do, and, as a community of researchers, clinicians, voluntary organizations, and people with lupus, that hope dangling out there underscores the importance of renewing our activism.