The Scoop: A Publication of the University of Texas Medical School at Houston

Scientists discover critical piece to puzzling form of arthritis of the spine

Dr. John Reveille

Dr. John Reveille

When a person starts complaining of acute back or pelvic pain, his or her doctor will sometimes order a blood test tied to a form of inflammatory arthritis called ankylosing spondylitis (AS). If the test comes back positive for the human leukocyte antigen B27 (HLA-B27), the patient’s likelihood of having AS increases. But, no one seems to know exactly why.

An international team of researchers from the Medical School and other institutions believe they may be on the road to solving this mystery. Findings of their new genetic study are online ahead of the August print issue of Nature Genetics.

“We have evidence of a gene-gene interaction that gives us a potential mechanism by which HLA-B27 may cause ankylosing spondylitis,” said Dr. John Reveille, study co-author and director of the Division of Rheumatology and Clinical Immunogenetics.

Ankylosing spondylitis and its related diseases afflict up to 2.4 million people in the United States. The disease triggers inflammation in joints, particularly the spine and pelvis. In severe cases, it creates a forward-stooped posture. The late Pope John Paul II is widely thought to have had ankylosing spondylitis as is Pharaoh Ramses II, Reveille said.

The Spondylitis Association of America reports that more than 95 percent of Caucasians with AS have HLA-B27. But, people do not have to be HLA-B27 positive to have AS, and the majority of those with HLA-B27 do not develop the disease. The link between AS and HLA-B27 varies between ethnic groups.

The study led by Reveille and Dr. Matthew Brown of the University of Queensland reported a link between a gene producing protein, ERAP1, and HLA-B27. ERAP1 was associated with ankylosing spondylitis in HLA-B27 positive patients; whereas, there was no association between ERAP1 and AS in HLA-B27 negative patients.

Stephen Haskew, who has AS and is a co-leader of a support group that meets at the Medical School, called the discovery a “significant finding.” He said that learning more about the mechanisms involved in the disease could aid in the development of new treatments.

The HLA-B27 protein is found on the surface of white blood cells and can impact the ability of the immune system to fight off infections. Both HLA-B27 and ERAP1 work together inside cells to combat infection.

Other indications of AS include a history of AS in the family and frequent gastrointestinal issues. While physicians can manage patients’ symptoms, there is currently no cure for ankylosing spondylitis.

Findings were based on an analysis of the DNA of almost 7,000 people with ankylosing spondylitis. The analysis also led to a genetic variant that could aid in the development of a less expensive blood test for HLA-B27.

“If you could reduce the cost of the test, you may be able to increase the number of people getting tested, which would lead to an earlier diagnosis,” Haskew added.

The genetic analysis also led to the identification of three genetic variants strongly associated with the disease.

Reveille said genetic research is helping efforts to find a cure. As an example of a current treatment tied to genetic research, he pointed to biologic medications, also known as Tumor-Necrosis-Factor alpha (TNF-a) blockers, that can potentially slow or halt disease progression in some people. Research on TNF-a was done at the Medical School and Memorial Hermann-Texas Medical Center.

The most recent study involved the Australo-Anglo-American Spondyloarthritis Consortium, which is led by Reveille in collaboration with the Wellcome Trust Case Control Consortium 2. Findings were replicated in an independent cohort from Australia, Great Britain, and The Spondyloarthritis Research Consortium of Canada.

The study is titled “Interaction between ERAP1 and HLA-B27 in ankylosing spondylitis implicates peptide handling in the mechanism for HLA-B27 in disease susceptibility.”

Reveille is a professor of medicine, Linda and Ronny Finger Foundation Distinguished Chair in Neuroimmunologic Disorders, the George S. Bruce, Jr. Professor in Arthritis & Other Rheumatic Diseases, as well as chief of rheumatology at Memorial Hermann-TMC. He is the director of The Frank C. Arnett M.D., Center for Autoimmunity and Immunobiology in the UT Professional Building, 6410 Fannin, Suite 450, 713.486.3100.

— Robert Cahill, Office of Advancement, Media Relations

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Goldschmidt honored with lecture series

Dr. Millicent Goldschmidt

Dr. Millicent Goldschmidt

The Rice University-Texas Medical Center Chapter of Sigma Xi, the Scientific Research Society, has created a fund and lecture series in honor of Dr. Millicent Goldschmidt, professor of microbiology and molecular genetics.

The Millicent Goldschmidt Lecture Series had its inaugural event June 30 at the Chevron BAX Auditorium in Bellaire, featuring scholarly presentations by two high school Sigma Xi Award winners of Houston’s 2010 and 2011 Science and Engineering Fair.

The board voted to honor Goldschmidt for all she has done for science, including working with high school students, science fairs, presenting science workshops throughout the country, in addition to her achievements in microbiology.

Goldschmidt also is a faculty member of the UT School of Dentistry.

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Student retreat registration deadline Aug. 5

Retreat games

The Annual Henry Strobel Retreat for first-year Medical School students will be held Aug. 12–13 at Camp Allen.

Registration is available online and is open to all students, faculty, and alumni. The deadline to register is Friday, Aug. 5. For details, visit the website, or contact Mark Gold, second-year class president.

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New TMC METRO Q rules in place Aug. 1

UT Shuttle

Beginning Aug. 1, TMC METRO Q® Card holders must tap their card, or risk receiving a citation for fare evasion. Currently, not all individuals are tapping their cards before boarding, which leads other riders to think they do not need to tap in order to pay.

Remember to tap your TMC® METRO Q® Fare Card when riding the Red, White and Blue TMC Shuttles or boarding at any of the following rail stations: Memorial Hermann/Houston Zoo, TMC Transit Center, Dryden/TMC, or Smith Lands.

TMC Metro Q-Cards are issued to remote parking contract holders when a parking contract is purchased. The only other way to ride the Red, White, or Blue shuttles is to purchase a standard METRO Q-Card.

Note that the TMC METRO Q® Fare Card is valid only in the TMC on the rail line. Travel outside of the TMC requires the use of a separate METRO Q® Fare Card.

For more information or assistance with your card, call the METROLine at 713.635.4000 or visit RideMETRO.org.

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El Paso connection

State Rep. Dee Margo, left, meets Cristian Dominguez, a fourth-year medical student, during a tour of the Medical School July 28. Dominguez is from Margo's district in El Paso.

State Rep. Dee Margo, left, meets Cristian Dominguez, a fourth-year medical student, during a tour of the Medical School July 28. Dominguez is from Margo's district in El Paso.

— Dwight C. Andrews, Office of Communications, Medical School

 

 

 

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Events to know

August 10

Family & Community Medicine Grand Rounds: Dr. Ebony Beaudoin, assistant professor of pediatrics, presents, “Newborn Jaundice.”
1–2 p.m., MSB 2.135.

August 11

Department of Ophthalmology Webinar: Dr. Robert Feldman, chair of the Richard S. Ruiz, M.D. Department of Ophthalmology and the director of glaucoma services at the Cizik Eye Clinic, presents, “Preventing and Treating Glaucoma.”
Noon–1 p.m., Sign in here.
In association with Memorial Hermann-Texas Medical Center.

August 17

Family & Community Medicine Grand Rounds: Dr. Kenya Parks, assistant professor of pediatrics, presents, “Childhood Obesity.”
1–2 p.m., MSB 2.135.

August 18

Webinar: Dr. Art Day, professor of The Vivian L. Smith Department of Neurosurgery, presents, “Pituitary Tumors.”
Noon–1 p.m., Sign in here.

August 19

The University of Texas at Houston – Memorial Hermann Center for Healthcare Quality and Safety Seminar: Dr. Josh Peterson (Vanderbilt) presents, “Personalizing Evidence-Based Medicine with Advanced Clinical Decision Support.”
Noon–1 p.m., UTPB 1100.55.

August 24

Center for Clinical Research Lecture: Drs. Jon Tyson and Kathleen Kennedy present, “Introduction to Clinical Research.”
4 p.m., MSB 2.103.

Center for Clinical Research Lecture: Dr. George Stancel presents, “The NIH Grant Submission and Review Pathway.”
5–6:30 p.m., MSB 2.135.

August 25

The Texas Bus Rounds, presented by MD Anderson Cancer Center.
8 a.m.–noon.
For details, email here.

August 26

Harris County Medical Society First Year Medical Student Mixer.
5–7 p.m., HAM-TMC Library lawn.
For details, email here.

August 31

Family & Community Medicine Grand Rounds: Dr. Michelle Barratt, professor of pediatrics, presents, “Adolescent Issues.”
1–2 p.m., MSB 2.135.

UTMost

Dr. Eric Thomas, associate dean for healthcare quality, will moderate a panel at the UT System Clinical Safety and Effectiveness conference, “Building the Bridge: Excellence through Innovation, Education and Financial Stewardship,” Oct. 27–28 in San Antonio.

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