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Under Attack
Advances in the treatment of autoimmune disorders aim to combat symptoms head-on — and are being made right here in Milwaukee.


BY JEN KENT

Jan. 2019



An autoimmune disease is, at its most basic level, one in which the body’s immune system attacks its own healthy cells.

Different variations target, and ultimately damage, different parts of the body, from tissues (lupus) and joints (rheumatoid arthritis) to the protective covering surrounding nerve fibers (multiple sclerosis). Perhaps the most frustrating aspect of such diseases is just how difficult they are to manage, and that healthy habits such as eating right and exercising may not always improve symptoms.

“I always tell people, ‘Beer and chicken-wing night is a decision; it’s not a disease,’” says Dr. James Kwiatt of GI Associates. “... If you’re managing your stress, if you’re not smoking, if you’re exercising, if you’re trying to eat right — those things are good for your general health, which then can only benefit you if you have a chronic illness. The hard thing with some of these autoimmune conditions is that someone can be doing all those things and they’re still sick. And that’s not their fault.”

Kwiatt is both personally and professionally invested in the treatment of autoimmune disorders. His wife suffers from celiac disease, wherein the ingestion of gluten damages the small intestine, and GI Associates is currently a study sponsor for phase two of a clinical trial that involves a “desensitization to gluten,” Kwiatt explains. “... When you try to think about how to treat any kind of disease and coming up with a medication for it, you need to figure out, ‘What’s causing the problem? And where are areas that I can potentially prevent it?’ So if gluten’s the problem, don’t eat gluten. There’s your solution. What if we could make it so when someone eats gluten, they don’t have that reaction? ... [With this clinical trial,] what happens is that the patient is slowly exposed to very minute amounts of gluten to try to trick their immune system into tolerating it.”

Phase two of the clinical trial will last several years, he notes, and a third and final phase is required before the drug hits the market.

Advances in the treatment of other autoimmune conditions, including multiple sclerosis (MS), are being made locally too. Dr. Staley Brod of Froedtert & the Medical College of Wisconsin is currently developing a bone marrow transplant program to treat individuals with MS who have eye problems. The program, he adds, won’t debut until the middle of the year, but a patient with neuromyelitis optica spectrum disorder — a disease of the central nervous system that Brod says likens itself to MS — recently received a bone marrow transplant to treat her condition and is experiencing a “remarkable recovery.”

“That highlights a unique opportunity we have here,” explains Brod. “... [The program] does provide that opportunity to be given a treatment and have no additional therapy done for many years down the road.”

Brod and his team are also utilizing innovative imaging technology to better diagnose and treat MS, specifically the 7-Tesla MRI scanner, which captures high-quality scans of lesions and, according to Brod, is one of only 58 such magnets in the world.

Explains Brod, “We’re about to embark on a trial where we will take individuals who have MS and do serial scanning — MR (magnetic resonance) scanning — of their brains on our 7-Tesla magnet and, at the same time, get blood and spinal fluid, and we will follow changes in their brain imaging studies and try to make linkages between changes in certain important biochemicals in the blood or spinal fluid that very well may be responsible for repair. ... In other words, as a new lesion pops up, maybe a particular molecule or molecules goes down. Or, more importantly, when lesions go away, these molecules will increase. So we will see a natural synchronicity between reparative molecules and the rising or the disappearance of lesions in [a disease like] MS.” The findings, he adds, could lead to using said molecules as a form of therapeutic intervention.

Both Kwiatt and Brod say that successful trial or program methodologies may be used in the treatment of other autoimmune disorders.

“There’s a lot of crossover between celiac (disease) and type 1 diabetes, and how the immune system works,” says Kwiatt. “The hope is that some of these treatments would also apply to type 1 diabetes, and vice versa.” Brod is involved with additional MS research that may also prove beneficial in the treatment of diseases like rheumatoid arthritis and psoriasis. “Once you show that a therapy works in one [autoimmune disease],” he adds, “you may be able to test it in another.”
 

UW Researcher to Speak on Implementation Science and More

“Increasing longevity [of life] and reducing health disparities are the main angles of my program,” says Dr. Christie Bartels, a rheumatologist and health science researcher with the University of Wisconsin (UW) School of Medicine and Public Health. Bartels has spent the last 10 years collaborating with Dr. Ann K. Rosenthal of the Medical College of Wisconsin, and their research focuses primarily on lupus and implementation science.

“Implementation science is the study of methods to promote the adoption and integration of evidence-based practices, interventions and policies into routine health care and public health settings,” explains Bartels. “... The idea is basically getting evidence into practice and making sure it’s routinely delivered.”

One of their current studies concentrates on cardiac disease prevention and tobacco cessation in individuals with lupus. “Women with lupus in middle age actually have 50 times higher rates of heart attacks than their peers,” notes Bartels. Nurses in four rheumatology clinics throughout the state are trained to follow the routine “Do you smoke?” question with, “Have you thought about cutting back or quitting in the next 30 days?” “Here at UW, about one in three people say ‘Yes,’” says Bartels. The nurse then offers to make a quitline referral, adds Bartels, and more than half accept the offer. “We’ve seen a 26-fold increase in the rate of referral for tobacco cessation,” she says.

Bartels will address these findings and more on Jan. 4 at the Medical College of Wisconsin’s Ground Rounds, a program recommended for physicians and health care professionals. Visit www.mcw.edu for more information.







 

This story ran in the Jan. 2019 issue of: