Research For A Cure: Update from The National Institute of Health

Research For A Cure: Update from The National Institute of Health

I recently attended a lecture by Dr. John O’Shea, Chief of the Molecular Immunology and Inflammation Branch and Scientific Director of the National Institute of Health (NIH) and Director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Dr. O’Shea gave us an update on the current research being performed by these national institutes to search for treatments and, more importantly, a cure for arthritis.

As it turns out, it was the second President of the United States, John Adams, who originally recognized the need for our government to support biomedical research. Today the NIH is our nation’s official medical research agency, with a mission to seek fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to enhance health, lengthen life, and reduce illness and disability.  NIAMS works specifically to support research into the causes, treatments, and prevention of arthritis and musculoskeletal and skin diseases.

Dr. O’Shea started by giving us some historical context, explaining how the molecular biology revolution of the 1970s culminated in the Human Genome Project, which was completed in 2003. The Human Genome Project let to the discovery of monoclonal antibody technology, which led to the discovery of hundreds of cytokines, a term used for a large and diverse family of molecules that relay signals within our immune systems. One of the purposes of cytokines is to regulate the body’s inflammatory response by communicating with other cells, so understanding how these molecules work is very useful for figuring out how to treat (and eventually cure!) RA and other autoimmune diseases.

In patients with RA, an oversupply of several types of cytokines can end up increasing inflammation and triggering joint damage. Among others, these cytokines include tumor necrosis factor (TNF), interleukin-1 (IL-1), and interleukin-6 (IL-6). The identification of these specific cytokines let to the development of biologic response modifiers, or medications we know simply as “biologics.” These medications are made up of genetically engineered proteins, derived from human genes, which work to inhibit the communication of particular cytokines that play pivotal roles in inflammation (for example, you may have heard the terms TNF-blocker or IL-1 inhibitor). There are now at least 25 different targeted therapies that have been approved to treat autoimmune diseases like RA. These biologic medications have completely revolutionized the treatment of arthritis.

The most recent arthritis research at the NIH has been on the topic of janus kinase inhibitors, or JAK inhibitors. While JAK inhibitors work similarly to biologics, by working to inhibit or block communication by particular cytokines, JAK inhibitors have some benefits over biologics. First, while biologics must be administered either by injection or infusion, JAK inhibitors can be taken orally, either once or twice daily. Secondly, while biologics are produced from live organisms, JAK inhibitors do not require as complex of a manufacturing process which means that they are likely to cost significantly less than biologics.

As scientists learn more about the specific ways our immune systems function they are then able to help create more specific treatments. As Dr. O’Shea put it, scientists are working to discover how “switches” within our immune system can be used to treat different conditions. As an example, if you wanted to turn off a light in a room you don’t need to destroy the light bulb – you just need to find the appropriate switch in the room to make the light turn off. Likewise in our bodies identifying which “switches” trigger certain immune responses can help us develop treatments for diseases like RA and other autoimmune diseases.

While these discoveries present significant new treatment options for people living with RA, there are still future research challenges to be faced. Unfortunately, scientists still don’t know why some drugs work for some people with RA but not for others – and we still don’t understand why people get autoimmune diseases in the first place. And while we have every reason to be optimistic about progress over the next 15 years, we still need dedication, commitment, and additional research funding to have any chance of finding a cure.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The RheumatoidArthritis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

View Comments (7)
  • Karmel
    5 years ago

    I have suffered 32 yrs. of Rheumatoid mine is hereditary.
    Been on all the DMARDS and a first line med. which has nearly killed me by supressing my immune system and let in Aspergillus fungus which ate my lungs and lost half a lung.
    Rheumatologist was going to put me on Orencia however I tried a supplement called SAMe methionine which is a medication on prescription in Spain, Italy Germany & Russia for arthritis. In 6 weeks (600mgs daily) it has bought my CRP & ESR down to within normal range. Rh factor is still 902 but down from 1675. CCP Abs is also down(half what it was) but not yet within normal range.

    SAMe does not Suppress the immune system it Modulates it meaning balances it. I feel much better too I guess not being immune suppressed. I feel it totally wrong to be suppressing the immune system and I got all manner of pneumonia, golden staff infections, fungus etc.

  • Mariah Z. Leach moderator author
    5 years ago

    Hi Karmel – So glad you and your rheumatologist were able to find a solution that works for you!

  • Janet Lemay
    5 years ago

    Thanks Mariah!
    Your article offers facts & hope… I have not heard of JAK meds but would like to hear feedback on the accuracy of Crescendo Bioscience’s Vectra test. I have tested four times over 2 yrs & was told last week that my medication Actemera reads falsely on the Vectra test. I depended on it to measure my RA activity, and that’s how we identified the IL-6 protein as the culprit. Your knowledge or thoughts? Anyone?
    Janet

  • Andrew Lumpe, PhD moderator
    5 years ago

    Hi Janet, I’ll try to respond to your questions. Kinase inhibitors are one of the recent targets for RA drug development. You can read more about them at this post (http://livingwithra.wordpress.com/2010/08/10/kinase-inhibitors-new-potential-disease-modifying-drugs-for-ra/).

    Here’s a recent post I wrote about diagnostic tests including Vectra DA (http://rheumatoidarthritis.net/living/better-diagnostic-and-individualized-tests-for-ra-needed/). I’m not sure what is meant by Actemra reading falsely on the test. Actemra is an IL-6 inhibitor and you know that IL-6 is a protein tested for by the Vectra DA test. Maybe what your doctor meant was that your IL-6 levels were still high in spite of taking Actemra. That could mean that Actemra is not working but that would also be based on other clinical diagnostic factors like joint pain, swelling, etc.

    Here’s another post I wrote about IL-6 inhibitors.
    http://livingwithra.wordpress.com/2013/08/23/interleukin-6-inhibitors-the-next-big-target-for-ra-treatment-after-tnf-alpha-inhibitors/

    Hope this helps or maybe it’s just information overload! 🙂
    Andrew

  • Mariah Z. Leach moderator author
    5 years ago

    Hi Janet~ Crescendo Bioscience’s Vectra test is actually not something that I am familiar with. I don’t have a science background myself (in fact, I have a law degree!) I just attended a great lecture on science in this case and shared what I learned!! But I can certainly look into it and one of our other moderators does have a science background so I can ask him if he has more specific thoughts on this issue!

  • Norreen Clark
    5 years ago

    Interesting, thanks for the information. JAK inhibitors are a cost of thousands of dollars. I called the company a while back and I believe it was between $23000.00 and 36000.00 a year. Do you have Dr. O’Shea’s email address? I myself would love to talk to him. Maybe I can find it on line.

  • Mariah Z. Leach moderator author
    5 years ago

    Hi Norreen – The information about JAK inhibitors potentially costing less than biologics was not something Dr. O’Shea said in his lecture but rather a fact that my own research turned up. Of course these advanced treatments are still going to be expensive – my research just showed that JAK inhibitors had the POTENTIAL to be less costly than most of the other biologics. And what each person would pay out of pocket would obviously depend on the type of medication and their particular insurance coverage.

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