Research The Division of Rheumatology at Albert Einstein College of Medicine has a long and distinguished history of accomplishments that helped elucidate our current understanding of rheumatologic disease. From some of the earliest studies on impaired immunity in systemic lupus erythematosus (SLE) and the establishment of one of the first immunodiagnostic laboratories in the nation, to innovative studies on the pathophysiology of neuropsychiatric lupus, to risks and benefits of hydroxychloroquine in lupus, and psychosocial factors affecting patients with rheumatologic disease. Our diverse patient population with its broad spectrum of diseases motivate us to continue to search for answers in the laboratory, clinic and the community. Research Faculty Clinical Trials and Registries Putterman Lab Highlighted Publications Stock AD, Der E, Gelb S, Huang M, Weidenheim K, Ben-Zvi A, Putterman C. Tertiary lymphoid structures in the choroid plexus in neuropsychiatric lupus. Journal of Clinical Investigation Insight 2019; 4(11):e124203. https://doi.org/10.1172/jci.insight.124203. Ariel Stock, PhD, and Chaim Putterman, MD, demonstrate the formation of tertiary lymphoid structures in the choroid plexus of lupus mice models. This is the first description of a novel brain-immune interface that can explain the transfer of autoreactive leukocytes and neuropathic autoantibodies to the central nervous system of lupus patients with neuropsychiatric manifestations. Der E, Suryawanshi H, Morozov P, Kustagi M, Goilav B, Ranabothu S, Izmirly P, Clancy R, Belmont HM, Koenigsberg M, Mokrzycki M, Rominieki H, Graham JA, Rocca JP, Bornkamp N, Jordan N, Schulte E, Wu M, Pullman J, Slowikowski K, Raychaudhuri S, Guthridge J, James J, Buyon J, Tuschl T, Putterman C, Accelerating Medicines Partnership Rheumatoid Arthritis and Systemic Lupus Erythematosus (AMP RA/SLE) Consortium. Tubular cell and keratinocyte single-cell transcriptomics applied to lupus nephritis reveal type I IFN and fibrosis relevant pathways. Nature Immunology 2019; 20(7):915-927. doi: 10.1038/s41590-019-0386-1. Evan Der, PhD, and Chaim Putterman, MD, together with the Accelerating Medicines Partnership, use single-cell RNA sequencing to evaluate kidney biopsies from lupus patients, and compare with healthy controls. The use of such a sensitive analytical technique allows for the potential deconstructing of the heterogeneity of lupus nephritis, in order to identify new targets for personalized approach to therapy. In this publication, the authors identify differential expression of type-I interferon and fibrosis pathways in tubular cells among different histological classes of lupus nephritis. Broder A, Mowrey WB, Khan HN, Jovanovic B, Londono-Jimenez A, Izmirly P, Putterman C. Tubulointerstitial damage predicts end stage renal disease in lupus nephritis with preserved to moderately impaired renal function: A retrospective cohort study. Seminars in Arthritis and Rheumatism 2018; 47: 545-551. In this important paper, Anna Broder, MD, MSc, demonstrates that tubulointerstitial damage is predictive of progression of lupus nephritis to end-stage renal disease, even without advanced kidney disease at the time of presentation. This finding seems to support a role for early intervention in patients with tubulointerstitial damage on biopsy, and provides a potential target for therapy. Blanco I, Barjaktarovic N, Gonzalez, CM. Addressing health disparities in medical education and clinical practice. 2020; 46(1):179-191. doi: 10.1016/j.rdc.2019.09.012. Advocating for the under-resourced and marginalized patients throughout all of the medical fields is an imperative, and needs to start with effective education. Here, Irene Blanco, MD, provides a review of health disparities education strategies specifically for rheumatology that should be implemented in training programs throughout the country, to increase providers’ knowledge of the issues and provide more culturally competent care. Schwartz N, Stock AD, Putterman C. Neuropsychiatric lupus: new mechanistic insights and future treatment directions. Nature Reviews Rheumatology 2019; 15(3):137-152. doi: 10.1038/s41584-018-0156-8. Drs. Schwartz, Stock and Putterman present a comprehensive review of neuropsychiatric lupus, including its varied presentations, possible pathogenic pathways, and current and potential diagnostic and treatment strategies.
