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Rochester Physician Helps Lead Approach Against Lupus

Tuesday, April 24, 2007

A Rochester physician is helping to coordinate the national response against lupus.

Iñaki Sanz, M.D., professor of Medicine, Microbiology and Immunology, has been named chair of the research committee of the Lupus Foundation of America. Sanz will help the group determine priorities for research into new ways to treat and prevent the disease.

Currently the University is known as the home of one of the nation’s strongest lupus research and treatment efforts, thanks to the work of Sanz and his colleagues. Sanz and R. John Looney, M.D., and Jennifer Anolik, M.D., Ph.D., discovered that the drug rituximab, approved to treat lymphoma, appears to be effective at treating lupus. In a small study, the team virtually wiped out symptoms of lupus in several people who had suffered from the condition for years. Now the team is coordinating a larger national study to see if the results hold true for a larger group of patients as well.

The research with rituximab is some of the most exciting research going on in lupus, which affects roughly 1 million people in the United States. Women are about 10 times as likely as men to get lupus, an autoimmune disease that can affect a person’s joints, skin, blood, kidneys, and even organs like the lungs and brain. Fatigue, arthritic joints, and infections are among the most common symptoms. Many patients live a normal life while taking medicine and working with a doctor to keep tabs on the disease, perhaps feeling some joint pain or having a rash occasionally, while others are debilitated by the illness that can even include kidney failure or stroke.

A new treatment like rituximab would offer an alternative to current treatments, most of which are laden with severe side effects that can include serious infections, infertility, tumors, and osteoporosis. The idea to test the drug in lupus patients came about because of the team’s strong grounding in the basic biology of cells known as B cells, which are a crucial part of the immune system, making antibodies that flag down and kill microbes and other invaders in the body.

The team has learned a great deal about how errant B cells in lupus patients behave, not responding to some threats while over-reacting to others. Two years ago Sanz identified a key cellular checkpoint that is somehow bypassed in lupus patients, where harmful B cells that normally are squelched by the body are mistakenly granted access. It’s the constant warring between the wayward cells and healthy tissue that leaves patients constantly open to dangerous infections.

“The body’s immune system has tremendous power. It’s wonderfully adapted to protect us against many, many types of threats, but that protection comes with a price,” said Sanz, a rheumatologist who is chief of the Division of Allergy/Immunology and Rheumatology. “Sometimes our immune system is too reactive and even starts attacking its own tissues. That’s what happens with lupus. Fortunately there is exciting research that is a real cause for hope for lupus patients.”

At Rochester the expertise in the laboratory has progressed quickly to patients. Along with his colleagues, Sanz three years ago founded a new clinic at Strong Memorial Hospital focusing on patients with lupus. The clinic brings together in one place the treatment of more than 400 lupus patients and makes research efforts easier to coordinate. Its patients have access to experimental treatments through the nationwide Lupus Clinical Trials Consortium, which Looney leads in Rochester; through the network, doctors scrutinize potential new treatments in patients.

Currently doctors at the clinic are conducting three lupus studies in patients, and several more are planned. Doctors and nurses at the clinic are putting together a registry to lupus patients – the goal is to include 1,000 lupus patients, a large enough number to make large, systematic studies possible for doctors evaluating new treatments.

Besides his work treating patients and conducting research on lupus, Sanz heads two large research efforts at the University. He leads the Autoimmunity Center of Excellence, funded by the National Institutes of Health. There, two dozen University scientists and physicians work together to seek better treatments or cures for patients with lupus, multiple sclerosis, rheumatoid arthritis, and diabetes. Sanz also directs the Rochester Center for Biodefense of Immunocompromised Populations, where scientists are looking for ways to help people most vulnerable to bioterrorist attacks – such as people with compromised immune systems, like those with lupus – survive despite having weaker immune systems.

Sanz earned his bachelor’s degree in biology from San Agustin College in Santander, Spain, and his medical degree from the University of Santander before moving to Southwestern Medical School in Dallas to specialize in molecular immunology. He joined the University of Rochester in 1996.

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