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August 26, 2019

Aiming for Better Lupus Treatments

A few months before Toni Grimes was set to deploy to Iraq in 2007, she went out on the town with her cousin. The following morning, the Army major woke up short of breath and barely able to talk.

“I couldn’t get up,” she says, “I had to text my cousin, who was just three bedrooms away, to rush me to the hospital.” 

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Toni had been diagnosed with lupus a few weeks earlier, but her symptoms had been mild. Now the disease had caused so much fluid to build up around her lung that it collapsed.

“The day I went into surgery, my unit deployed to Iraq,” she says. 

Toni was cleared to go to Afghanistan five months later. But her lupus got worse, ultimately causing her to retire from the military after more than 19 years. 

Toni isn’t alone. Veterans and military members, especially women of color, are more likely to have lupus than the general public — possibly because they’re exposed to toxic chemicals, stress and PTSD. That’s why the U.S. Department of Defense (DOD) funds lupus research — and why it awarded grants to BRI’s Karen Cerosaletti, PhD, and Adam Lacy-Hulbert, PhD, in 2018. The researchers are studying genes that play a role in lupus and are gaining insights that could improve treatment. 

“We’re learning more about how and why lupus starts,” Dr. Cerosaletti says. “This will help us know who is most likely to get it, so we can diagnose it sooner and develop better treatments.”

Featured Karen Cerosaletti Adam Lacy-Hulbert

Blocking Genes 

Dr. Lacy-Hulbert thinks that a gene called ATG5 is a promising target for new lupus therapies.

Immune cells protect us by hunting down bacteria and viruses. Dr. Lacy-Hulbert’s team found that cells that lack ATG5 never stop attacking. Eventually, they aim at healthy cells and cause lupus. 

Dr. Lacy-Hulbert thinks it might be possible to stop these attacks by using medications to reactivate ATG5 and other genes. This could switch off overactive immune cells. 

“This is helping us understand the mechanisms that cause lupus and moving us toward better, more personalized treatments,” he says.

New Therapies 

Dr. Cerosaletti has identified a different gene involved in lupus: BANK1. This gene plays a role in immune cells called B cells. Many B cells make tiny proteins called antibodies, and some of these antibodies attack healthy cells, causing lupus. 

Dr. Cerosaletti has shown that BANK1 may increase the number of B cells that make antibodies, especially in people with lupus who have a particular BANK1 variant.  She is using her DOD grant to study how BANK1 spurs B-cell growth — planning to eventually test drugs that could block this process, to slow or even prevent lupus.

“There’s only one drug that was developed specifically for lupus,” Dr. Cerosaletti says. “This research could open the door to more treatments that help more people.”

Hope for a Cure

Toni is all too aware that there’s only one drug developed for lupus, because it doesn't work for her. That’s why her new mission is helping others who have the disease. 

“In the military, you always have a purpose,” she says. “Now lupus is my purpose.” 

Toni leads a lupus support group in Arizona, advocates for research funding and sits on the DOD’s Peer Review Panel for lupus research. 

“The people developing these drugs might not think about how a drug that causes hair loss would impact a 20-year-old, or that a medication that causes weight gain might cause a middle schooler to get bullied,” she says. “The panel lets patients like me voice these concerns.” 

The DOD-fueled research gives Toni hope.

“I’m excited that there will be better treatments in my lifetime,” she says, “and maybe even a cure.”

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