1. AdvancesD I V I S I O N O F R H E U M AT O L O G Y SPRING 2015
2. Table of Contents
A Message from the Director............................................................................................... 3
The Colton Center for Autoimmunity: Prospering Partnerships Between Medicine
and Science............................................................................................................................4
The NYU Psoriatic Arthritis Center: A New Hub for Clinical and Scientific Progress..............7
Philanthropist Q & A with Jim Riley...................................................................................... 9
Accelerating Medicines Partnership: How Knowledge of Abnormal Cellular
Pathways Can Be Translated into New Therapies ................................................................10
Working On A New Toolbox for Rheumatology.......................................................................13
Clinical Faculty Q & A with Brian Golden, MD..........................................................................15
Division & Faculty News..................................................................................................... 16
2015 Seminar in Advanced Rheumatology........................................................................ 18
List of Faculty.................................................................................................................... 19
Philanthropy....................................................................................................................... 19
Research Cures Society Members..................................................................................... 19
Dear Colleagues and Friends,
To flourish, an academic medical center must plant the seeds of success in fertile
soil. Indeed, NYU Langone Medical Center’s Division of Rheumatology has an
outstanding infrastructure of clinicians and scientists dedicated to the common
goal of bringing discoveries to patients. At no greater time that now, has research
been more productive and we are poised to harness this productivity for the
many patients we serve. In addition to success with funding from both the NIH
and advocacy groups, we are grateful to the philanthropy of our longtime donors
who believe in our mission. And of course, the active participation of patients
in partnership with our faculty has facilitated the approval of new treatments
available to others across the nation and the world.
In this issue of Advances, we highlight some of the new initiatives and
longstanding ties that continue to “seed” our success. With the generous backing
of donors Judy and Stewart Colton, for example, we established the Colton Center
for Autoimmunity in the summer of 2014. This comprehensive research program
focuses on the link between the microbiome and autoimmune disease. This new
direction provides a powerful platform upon which we can advance our goal of
developing novel diagnostic, treatment and prevention options for patients.
With the generous support of The Riley Family Foundation and The Beatrice
Snyder Foundation, we also launched our multidisciplinary Psoriatic Arthritis
Center (PAC). The center, a bench-to-bedside integration of rheumatology and
dermatology, will provide an unprecedented opportunity to understand how the
disease progresses both biologically and clinically in patients with psoriasis.
In September 2014, the NIH selected the division to participate in another major
new initiative called the Accelerating Medicines Partnership (AMP). This bold
venture will help researchers uncover the cellular events that cause and perpetuate
lupus nephritis and reveal the effects of race and ethnicity on disease mechanisms
and drug targets.
All three efforts underscore the extraordinary partnerships we’ve formed and
nurtured to advance our focus on fundamental research, state-of-the-art clinical
care, and effective mentoring and education. These efforts comprise the very
reasons why NYU Rheumatology is the perfect fit for researchers such as Johannes
Nowatzky, MD, and clinicians such as Brian Golden, MD, both of whom are
profiled in this issue.
We are honored that U.S. News & World Report recently ranked our Rheumatology
program sixth in the nation, and that the division attracted more than $11 million in
funding from private donations and $3.8 million in federal grants and contracts in
2014. These achievements have propelled visionaries such as the Colton, Riley, and
Snyder families to partner with us in establishing an enduring series of exciting new
programs that we project will yield dividends for years to come.
JILL P. BUYON, MD
Page 3nyulangone.org
A Message from the Director
JILL P. BUYON, MD
Director, Division of Rheumatology,
Department of Medicine
NYU Langone Medical Center
Front cover: An image of a human endothelial cell, part of studies by NYU Rheuma-
tology team and the NYU Antiphospholipid Registry, showing that IgG antibodies
from patients with the antiphospholipid syndrome stimulate the mammalian target of
rapamycin complex (mTORC) an event that is associated with vascular injury.
3. (Specimen and Matched Phenotype
Linked Evaluation), will help solidify
the research infrastructure. To further
clarify the events initiating autoimmu-
nity, Dan Littman, MD, PhD, the Hel-
en L. and Martin S. Kimmel Professor
of Molecular Immunology, and Gregg
Silverman, MD, professor of medicine
and pathology, will lead molecular
studies of the immune system’s T cells
and B cells, respectively.
The center will primarily focus on
specific immune responses to gastro-
intestinal microbes. A link between
chronic inflammation and commensal
(“normal”) or pathogenic (disease-as-
sociated) microbes has long been sus-
pected, particularly in a variety of au-
toimmune diseases. Although inflam-
matory bowel diseases, such as Crohn’s
disease and ulcerative colitis, are most
clearly linked to the composition of
the commensal intestinal microbiota, a
potential connection to other autoim-
mune diseases such RA, SLE, and APS
has not been sufficiently studied. Such
a link has been categorically demon-
strated in mice, however, whether the
intestinal microbiota composition
influences the presence or absence
of autoimmunity in multiple disease
models is less well studied. In models
of RA and multiple sclerosis (MS), for
example, germ-free mice kept in cages
devoid of any microorganisms are
typically resistant to disease.
Dr. Littman’s lab identified the first
commensal bacterium known to se-
lectively induce the differentiation of a
specific subset of the immune system’s
T cells (Cell, 2009). The microorgan-
ism, segmented filamentous bacilli
(SFB), sticks to the epithelial barrier
lining the small intestine of mice and
forms long segmented chains across
the surface of the villi that project
from the intestinal membrane. SFB
colonization prompts naïve CD4+ T
helper cells to differentiate into more
specialized cells that secrete cytokines.
These cytokine molecules play impor-
tant roles in protecting the intestinal
epithelial layer from damage, but also
can strongly promote inflammation.
Because the cells produce a key cyto-
kine called IL-17, this subset of T cells
is known as Th17 cells.
Remarkably, the SFB-induced matu-
ration of naïve T cells into Th17 cells
makes certain mouse strains more
susceptible to developing Th17-de-
pendent arthritis or a form of mouse
MS called experimental autoim-
mune encephalomyelitis (Immunity,
2010). In mouse models, the onset of
arthritis depends upon the produc-
tion of self-reactive autoantibodies,
and Th17 cells appear to facilitate the
production of these antibodies. Th17
cells and autoantibodies are similarly
thought to participate in the patho-
genesis of human autoimmune dis-
eases such as RA and SLE. A greater
understanding of how the microbiota
influence selection of the adaptive B
and T cell immune repertoires may
prove crucial to revealing the first
signs of autoimmunity.
In recently published studies, Dr. Lit-
tman and colleagues characterized
the antigenic specificities of Th17 cells
present in the small intestine of mice
colonized with SFB (Nature, 2014).
Surprisingly, the majority of the Th17
cells reacted with proteins produced by
SFB, while essentially no other T cells
had such reactivity. This research raises
several important questions: Why do
SFB proteins induce only Th17 cells?
Where does this process occur? And
are SFB protein-specific Th17 cells
the only mediators of autoimmune
disease? In humans, researchers have
reported the presence of bacteria bear-
ing SFB-related sequences, but only
in newborns; this finding will need to
be confirmed through further char-
acterization of the human microbiota
with next-generation DNA sequencing
technology. Despite some unanswered
questions, the ongoing studies of how
SFB interacts with the host’s adap-
tive immune system are providing
invaluable insights that will inform the
Colton Center’s approach to studying
human autoimmunity.
Although no one yet knows whether
SFB possesses a similar ability to trigger
autoimmunity in humans, Dr. Scher,
Dr. Littman and Dr. Abramson found
a striking association between newly
diagnosed human RA and another
intestinal commensal bacterium called
Prevotella copri (eLife, 2013). Funded
by a $4 million NIH grant, the NYU
Langone collaborators used advanced
technology not previously applied to
autoimmune disease research: 16S and
shotgun sequencing on stool samples
from 114 rheumatoid arthritis patients
and healthy controls. From the result-
ing data, the study found that the pres-
ence of Prevotella copri in fecal samples
Page 5nyulangone.org
Launched in the summer of 2014, the
Judy and Stewart Colton Center for
Autoimmunity unites research, patient
care, and education around the singu-
lar goal of developing new approaches
for diagnosing, treating and prevent-
ing autoimmune diseases. At the heart
of the center’s work is the growing
realization that for many of these
disorders, specific bacteria within the
human microbiome may provide bio-
markers of a pathogenic process that
tips the scales toward overt disease in
at-risk patients.
To tease apart the connections between
our human microbiota and autoim-
munity, the center’s two-phase plan
is focusing initially on identifying the
earliest events that lead to the develop-
ment of several autoimmune diseases.
A better understanding of these mecha-
nisms, in turn, can help researchers
translate their lab-based findings into
new diagnostic tools and therapeutics
for the clinic. The plan will build upon
recent discoveries by the NYU Langone
team that have already linked certain
microbes to new-onset rheumatoid ar-
thritis (RA), and will capitalize on these
observations to uncover potential mi-
crobial triggers of systemic lupus ery-
thematosus (SLE) and antiphospholipid
syndrome (APS).
Steven Abramson, MD, the Frederick
H. King Professor and chair of the
Department of Medicine, will lead the
center. Dr. Abramson has assembled
a world-class team of physician sci-
entists who will bring unparalleled
interdisciplinary expertise to the
program. Jill Buyon, MD, the newly
appointed director of the Division of
Rheumatology and a world-renowned
SLE researcher, and Jose U. Scher, MD,
director of the NYU Langone Micro-
biome Center for Rheumatology and
Autoimmunity (MiCRA) and the lead
author of recent studies linking the
microbiome to RA, will collaborate in
the investigations. As part of their sci-
entific contributions, both researchers
also will provide access to well-defined
patient populations.
Michael Belmont, MD, associate direc-
tor of clinical affairs for the Division of
Rheumatology, will assist the center’s
efforts by providing clinical expertise
in APS. In addition, a critical division-
wide pipeline of clinical data linked
to biospecimens, known as SAMPLE
Page 4 ADVANCES / SPRING 2015
The Colton Center for Autoimmunity:
Prospering Partnerships Between Medicine and Science
“We now can study these autoimmune diseases
simultaneously at the laboratory and clinical levels, and
share our findings in a continual conversation. This is
the kind of research that drives healthcare forward.”
—Steven B. Abramson, MD
4. strongly correlated with disease in
new-onset untreated rheumatoid ar-
thritis (NORA) patients upon their
initial diagnosis. The researchers did
not observe any similar association in
healthy controls, in treated chronic RA
patients, or in those with psoriatic ar-
thritis. In the NORA patients, increases
in Prevotella abundance correlated
with a reduction in the abundance of
Bacteroides bacteria and with a loss of
reportedly beneficial microbes.
By integrating shotgun sequencing
from the Human Microbiome Project
with the NYU Langone cohort, the
study found that the presence of Pre-
votella genes correlated with disease—
a discovery that may provide a useful
diagnostic tool. Consistent with the
early trends seen in humans so far, the
researchers also found that Prevotella
microbes able to colonize mice went
on to dominate the intestinal microbi-
ota and led to an increased sensitivity
to chemical colitis, an animal model of
inflammatory bowel disease.
The Colton Center will build upon
such pioneering research with an
ambitious two-phase strategy. In its
first phase, the program will integrate
novel fields of science and technology
and expand collaborations between
researchers and clinicians to enable
transformative discoveries about the
environmental triggers and seminal
immunological events that character-
ize the onset of autoimmune disease.
By identifying the earliest events that
drive autoimmunity, this research
could lead to better strategies targeting
both prevention and cure. This phase
will include three overarching goals.
First, the research is geared toward
understanding and comparing the ear-
liest immunological events that initiate
the autoimmune responses in SLE,
RA, and APS. Second, the project will
use advanced technology to identify
microbial triggers of the immune sys-
tem that initiate autoimmune disease
in genetically susceptible individuals.
And third, the collaborative effort
aims to use these discoveries to devel-
op novel strategies to treat and prevent
autoimmune disease.
The subsequent research phase will
be devoted to developing novel diag-
nostics and therapeutics driven by the
program’s basic science discoveries.
This phase also includes three specific
goals. First, the project will aid in the
development of treatment strategies
based upon the identification of dis-
tinct molecular abnormalities of T cell
and B cell activation that promote or
perpetuate autoimmunity. Second, the
program will study novel microbes
and microbial proteins that could be
potentially targeted for disease treat-
ment and prevention. This arm of the
collaborative effort will include strate-
gies to prevent the interaction between
microbial antigens and immune cells,
as well as vaccine strategies to prevent
colonization by microorganisms. Fi-
nally, the Colton Center for Autoim-
munity will identify and validate any
serological or microbial events that
precede disease. These telltale events
can be exploited as prognostic or
diagnostic biomarkers to determine
who is at risk for autoimmune disease.
Eventually, they also may lead to long
awaited breakthroughs in early thera-
peutic intervention.
Page 7nyulangone.org
Up to 7.5 million Americans have
psoriasis, according to the National
Institutes of Health, making it the
most prevalent autoimmune disease in
the United States. Roughly 30 percent
of those patients will develop psoriatic
arthritis (PsA), leading to severe joint
pain, stiffness and swelling. Although
researchers have established a complex
genetic basis for PsA, the susceptibility
genes identified so far are neither nec-
essary nor sufficient for disease onset,
suggesting that environmental factors
such as microbes may play a role.
NYU Langone Medical Center’s Pso-
riatic Arthritis Center (PAC) was
launched in 2014 to provide a better
understanding of the biological and
clinical course of disease. Led by the
Division of Rheumatology in collabo-
ration with the Ronald O. Perelman
Department of Dermatology, the cen-
ter’s integrated network of physicians
and researchers also offers state-of-
the-art care for PsA patients. “The best
psoriatic arthritis care can be achieved
only though an interdisciplinary and
comprehensive approach to patients
with very specific needs,” says Jose U.
Scher, MD, assistant professor of medi-
cine and director of the PAC and the
NYU Microbiome Center for Rheuma-
tology and Autoimmunity (MiCRA).
PAC researchers are focusing on PsA’s
initiating events in patients with pso-
riasis. The resulting discoveries could
form a strong translational base for
developing new diagnostic, treat-
ment and prevention tools. Dr. Scher,
for example, is the lead author of re-
cent studies linking the microbiome
to new-onset rheumatoid arthritis
(eLIFE, 2013) and to PsA (Arthritis
& Rheumatology, 2015). In the latter
study, he and colleagues found that
PsA patients have less diverse com-
mensal bacteria than either healthy
volunteers or patients with psoriasis.
Soumya Reddy, MD, assistant profes-
sor of medicine and dermatology
and the PAC’s co-director, leads its
database and clinical trial efforts. Dr.
Reddy, a rheumatologist with extensive
expertise in PsA clinical trials, is ex-
amining the basis of gender differences
in the disease. Female patients, she has
found, have worse outcomes than male
counterparts despite receiving the
same medication (Arthritis & Rheuma-
tology, 2014).
The PAC will also benefit from the
PsA expertise of senior consultant
Gary Solomon, MD, clinical associate
professor of medicine. Annual pso-
riasis and PsA meetings hosted by the
center, including the NYU Langone
PAC Seminar in Psoriasis and Psori-
atic Arthritis, will give these experts
and their international colleagues a
platform to present cutting-edge ad-
Page 6 ADVANCES / SPRING 2015
The NYU Psoriatic Arthritis Center:
A New Hub for Clinical and Scientific Progress
Enhance
Clinical Cohorts &
Biorepositories
Identify Early
& Preclinical
Disease
Determine
Initiating Microbial
Triggers
Profile Earliest
Autoimmune
Events (T/B Cell)
Select Targets
for
Treatment
JUDITH AND STEWART COLTON
CENTER FOR AUTOIMMUNITY
TRANSLATIONAL
RESEARCH PIPELINE
New Pathways
for Detection,
Treatment & Prevention
of Autoimmune
Diseases
“If we are to truly achieve
targeted, personalized
medicine, we need to
partner the clinician with
the basic scientist”.
—Jill P. Buyon, MD
5. Jim Riley had a fast-paced career that
he loved, until his painful psoriatic
arthritis brought life to a near-stand-
still. A patient of Dr. Steven Abramson
since the mid-‘90s, Riley has benefited
greatly from newer treatment options
such as the blockbuster drug Remi-
cade, initially developed at NYU Lan-
gone. The grateful philanthropist talks
about his longstanding relationship
with the Division of Rheumatology
and his decision to provide a leader-
ship gift that helped launch the Psori-
atic Arthritis Center (PAC).
What has motivated your
long-term support of the Division
of Rheumatology?
I’ve had psoriatic arthritis for over 25
years, and it got to the point where
in the late ‘90s, it was hard to get up
the subway steps. I spent my entire
career at Goldman Sachs and I had to
take a step back from work. I went on
Remicade in 2002 and started to feel
better, and then I went to Enbrel. Five
years after I had retired, I was doing
things that I never thought I’d be able
to do again: I was swimming, I was
cycling, and I set up a family office. I
was also building a relationship with
Dr. Abramson, who had spoken to me
about some of the research. Our family
foundation is always looking for op-
portunities that are leverage-able, and
I think research is the most leverage-
able way in the medical field to help as
many people as possible. That’s how we
got started.
Why is the Psoriatic Arthritis
Center so important to you?
Psoriatic arthritis is a disease that takes
a toll over time. So how do we get out
in front of this? The stars are lining up
for NYU to be the preeminent psori-
atic arthritis center in the country, and
I see how it can leverage the grants it’s
already gotten. It’s not just about what
we’re doing; I believe the opportunity
is there for others to get in on the
ground floor with us to propel the PAC
to do exciting things.
What impact do you hope the
center’s research will have for
patients?
We’ve come so far but we have so much
more to do, because it’s about quality
of life. Are these diseases hereditary or
not? These are the things we’re going to
find out. My own family has had pso-
riasis for many generations, and in one
in three of us, it will turn into psoriatic
arthritis. We just don’t know which
ones, and doing the research ahead of
time to understand what triggers that
can be huge. We’re investing in some-
thing that is personal to our own fam-
ily, and to many millions of others. At
NYU, it feels like everyone’s going to be
working together as a team, and we feel
really good about the chances of posi-
tive things happening.
Page 9nyulangone.orgPage 8 ADVANCES / SPRING 2015
vances in both the clinical and basic
science realms.
Under the guidance of Dr. Scher, Dr.
Reddy and Dr. Solomon and with
generous philanthropic support from
The Riley Family Foundation, the
PAC is focusing on five main clinical
and research strategies:
First, the center will allow NYU Lan-
gone’s PsA clinical program to expand
its considerable reach and integrate
expertise from rheumatology, derma-
tology, radiology, orthopaedics and
other specialties to diagnose and treat
PsA patients. The PAC is part of the
NYU Langone Center for Musculo-
skeletal Care (CMC), the largest free-
standing center of its kind in the U.S.
The PAC at CMC offers clinical man-
agement and complex referrals for
most new PsA patients and is a na-
tional leader in clinical efficacy trials,
longitudinal studies and mechanistic
studies that relate PsA pathogenesis
to therapeutic targets. Clinicians in
the Division of Rheumatology already
treat more than 900 patients every
year, including people from a wide
range of ethnic and genetic back-
grounds. The large and diverse patient
pool provides a unique opportunity to
better define new targets for personal-
ized treatments.
Second, the center will investigate the
natural history of psoriasis to under-
stand the earliest events leading to PsA
and other co-morbidities such as car-
diovascular disease. These efforts will
draw on the expertise of PAC faculty
members such as Andrea Neimann,
MD, assistant professor of dermatol-
ogy, who studies the connections
between psoriasis and cardiovascular
disease and who co-directs NYU Lan-
gone’s psoriasis clinical trials unit.
Third, the center will support an large
roster of NIH-funded research efforts
to identify more effective treatments
and strategies to prevent and cure
psoriasis and PsA. By examining the
basic biology of joint and skin tissues
and their dysregulation in PsA, for ex-
ample, researchers may reveal the basic
disease mechanisms that point toward
novel therapeutics. Toward this end,
the PAC is collaborating with multiple
immunologists at NYU Langone to
investigate the molecular traits of auto-
immunity-promoting T cells and how
they contribute to the pathogenesis of
both psoriasis and PsA.
Fourth, the PAC’s researchers are
examining the role of the human
microbiome in PsA development. As
part of a $4 million NIH grant, NYU
Langone launched MiCRA in 2009 to
study the skin and gut microbiome in
rheumatoid arthritis. In 2013, a sec-
ond $547,000 NIH grant allowed the
center to do the same for PsA. Ongo-
ing efforts are studying the microbial
residents of healthy volunteers and of
patients impacted by rheumatic and
autoimmune diseases. One potential
outcome could be the development
of new therapies such as prebiotics,
probiotics, or other techniques to
repopulate a patient’s intestinal tract
with beneficial flora.
Finally, the PAC will enhance the op-
portunities for academic-industry
partnerships to help discover new PsA
diagnostics, drug targets, and other
NYU Langone’s Center for
Musculoskeletal Care
333 E 38th St,
New York, NY 10016
Fourth floor lobby
The event will include a ribbon
cutting ceremony, tours, and passed
hors d’oeuvres and cocktails
SAVE THE DATE
PSORIATIC
ARTHRITIS CENTER
Opening Reception
Thursday, June 4
6:30 to 8:00pm
therapeutic options. The center pro-
vides a hub for NYU Langone’s Pso-
riatic Arthritis Translational Registry
and Biorepository, established in 2003
to store longitudinal clinical data and
patient biospecimens. The bioreposi-
tory already contains about 400 patient
samples, making it one of the largest
in the country and a key source of data
for multi-center registries like the Pso-
riatic Arthritis Research Consortium.
The PAC’s researchers are also col-
laborating with multiple industry
partners to identify biomarkers such
as blood proteins, cells and molecules
that may predict disease susceptibil-
ity and determine whether or not
patients respond to new therapies or
experience drug toxicity. Simultane-
ously, the PAC is teaming up with
the Seligman Center for Advanced
Therapeutics to help design, develop
and initiate multiple clinical trials
investigating novel compounds and
cutting-edge interventions.
Ultimately, the center’s complemen-
tary efforts may clarify how PsA
progresses in individual patients,
how new therapeutics can be devel-
oped and how those interventions can
be personalized to maximize their
potential benefit.
Profiles in Giving: Jim Riley
6. Page 11nyulangone.orgPage 10 ADVANCES / SPRING 2015
Systemic lupus erythematosus, or SLE,
is strongly associated with racial and
ethnic disparities in disease severity
and overall patient outcomes. In addi-
tion, SLE is often accompanied by kid-
ney inflammation; in extreme cases,
lupus nephritis can lead to end-stage
renal failure. In September 2014, the
National Institutes of Health selected
NYU School of Medicine to participate
in a major new nationwide initiative
that may help researchers uncover the
cellular events that cause and perpetu-
ate lupus nephritis and reveal the ef-
fects of race and ethnicity on disease
pathways and potential drug targets.
This initiative, the Accelerating Medi-
cines Partnership (AMP), is a forward-
thinking and bold venture involving
the NIH, several major medical cen-
ters, biopharmaceutical companies
and non-profit organizations. The goal
is simple but lofty: to transform the
current model of developing SLE diag-
nostics and treatments by jointly iden-
tifying and validating promising bio-
logical targets of disease. The ultimate
aim is to increase the number of new
diagnostic and therapeutic options for
patients and reduce the time and cost
of developing them. The Division of
Rheumatology is honored to have been
selected as one of 11 centers to join
this monumental effort. To maximize
the impact of the clinical and tech-
nological research, the Division has
teamed up with colleagues from Albert
Einstein College of Medicine and The
Rockefeller University.
Jill Buyon, MD, will lead the NYU Lan-
gone team, while Chaim Putterman,
MD, and Thomas Tuschl, PhD, will
head up the Albert Einstein and The
Rockefeller University teams, respec-
tively. On the technological side, Dr.
Tuschl brings extensive expertise and
experience in coding and non-coding
RNA sequencing analysis that can iden-
tify unique patterns of RNA expression
in tissues from lupus patients. This pat-
tern identification, in turn, may lead to
the development of RNA-based diag-
nostics and therapeutics.
On the clinical side, Dr. Buyon and Dr.
Putterman have long focused on SLE
and currently treat more than 1,000
patients combined. For the partner-
ship, they will assemble an ethnically
and racially diverse group of SLE pa-
tients who have nephritis as a major
part of their disease. Under the broad-
er umbrella of the AMP, the medical
researchers will tap the wealth of clini-
cal information contained within a
patient cohort called the Multi-Ethnic
Translational Research Optimization
(METRO) Lupus Consortium. With
this invaluable research tool, the team
will develop, standardize and validate
advanced technologies to identify criti-
cal signaling pathways in patients’ re-
nal and skin tissues, cells and urine.
The NYU Langone-led effort will call
upon two additional clinicians with
extensive expertise in the SLE field.
H. Michael Belmont, MD, professor
of medicine and Associate Director
of Clinical Affairs in the Division of
Rheumatology, directs the Bellevue
Hospital Lupus Clinic, one of the old-
est and largest clinics devoted solely
Accelerating Medicines Partnership:
How Knowledge of Abnormal Cellular Pathways Can
Be Translated into New Therapies
to the care of patients with SLE. Peter
Izmirly, MD, assistant professor of
medicine, directs a project sponsored
by the federal Centers for Disease
Control and Prevention, which aims to
define the incidence and prevalence of
SLE in Asians and Hispanics.
A third researcher, Robert Clancy,
PhD, associate professor of medicine,
will bolster the team’s scientific inves-
tigations with his extensive experience
in endothelial cell biology. Dr. Clancy,
director of the biobank for SAMPLE
(Specimen and Matched Phenotype
Linked Evaluation, a new initiative to
capture clinical and biologic informa-
tion of patients with any rheumatic
disease), will provide guidance in cell
isolation techniques and work closely
with The Rockefeller University.
With its seamless merging of clinical
and technological expertise, the collab-
oration is well positioned to conduct
validation and longitudinal studies of
new technologies and analytics, with
an emphasis on development, re-
sponse, flare and progression of lupus
nephritis.
Because SLE is strongly associated
with racial and ethnic disparities, the
studies will address whether specific
biological pathways and drug targets
are dependent on race or ethnicity.
Accordingly, METRO will include sub-
stantial numbers of Black, Hispanic,
Asian, and White patients drawn
from clinic populations at the NYU
Hospital for Joint Diseases, Bellevue
Hospital Center, NYU Langone Center
for Musculoskeletal Care (CMC), and
Gouverneur Hospital.
The “Multi-Ethnic” component of MET-
RO also refers to the Division of Rheu-
matology’s unique ability to care for
patients of all ethnicities and races. “Our
studies account for health disparities and
facilitate discoveries that are applicable
to people of varied backgrounds and
socioeconomic status,” Dr. Buyon says.
“Few places can match that.”
The AMP-METRO team’s focus on
renal disease is driven by the major
role of lupus nephritis in end-stage
renal failure. Underlying this effort is
the premise that molecular analysis
of gene expression and signaling in
specific subsets of kidney cells may
help predict the subsequent pathologic
processes that lead to organ damage.
Additionally, the research program
may provide insights to deconstruct
the complexity of SLE in general, and
the histologic class of kidney disease
in particular. Furthermore, any finding
that a medically relevant pathway in
renal tissue may be faithfully reflected
in more readily accessible skin tissue,
blood or urine could help link the
disease phenotype to a “biotype” and
pave the way to earlier identification
and treatment options that are critical
to renal survival.
The research initiative, in fact, could
open up an entirely new realm of in-
quiry that addresses the widespread
vascular abnormalities that can de-
velop in patients with SLE. Specifically,
the team plans to evaluate whether
dysfunctional activation of cells lining
the blood vessels in the tubules and
interstitial tissue of the kidney in lupus
nephritis is accompanied by a similar
activation in other vascular locations
“We will be using patient samples such as kidney and
skin biopsies to look for targets and pathways that would
be coverable by new biologics; as with the Colton
Center, it’s ultimately about better therapeutics for
patients living with these diseases.”
—Jill P. Buyon, MD
7. Page 13nyulangone.orgPage 12 ADVANCES / SPRING 2015
such as those in a patient’s unaffected
skin. By also analyzing specific types
of circulating blood cells, the research
should help clinicians determine how
to apply existing and future therapies
to predefined patient populations.
The field needs such clinically relevant
information. Treatment of kidney
nephritis is traditionally considered
a two-phase process: induction and
maintenance. Induction uses high doses
of immunosuppressive or cytotoxic
agents in conjunction with high-dose
glucocorticoids to reverse the immune-
mediated inflammatory processes.
Maintenance therapy consists of lower
and presumably safer levels of immuno-
suppressive medications to assure a last-
ing response and prevent recurrences.
Despite aggressive induction therapy,
however, nearly half of all patients do
not achieve either partial or complete
remission within 6 months. Even if
treatment is continued for 12 months,
the overall response rates are similar.
Although the U.S. Food and Drug
Administration recently approved the
monoclonal antibody belimumab to
treat extrarenal SLE, no new therapies
have been approved for lupus-associated
kidney inflammation in over fifty years.
Approved drugs for SLE – including
aspirin, hydroxychloroquine, and corti-
costeroids – have fallen short of expecta-
tions for the kidney due to their lack of
efficacy or unacceptable side effects.
Researchers have offered several expla-
nations for why the field hasn’t made
more progress in treating nephritis.
First, current drugs are not logically
aligned with the pathogenic stage of
disease. For example eliminating auto-
reactive B cells might have little impact
if the strategy is used during a comple-
ment-mediated acute flare, although
this approach may prevent future
flares. The NYU Langone effort will
address disease stages in the METRO
cohort by conducting comprehensive
clinical and laboratory evaluations ev-
ery 2 months to monitor disease activ-
ity and treatment responses.
Second, the slow progress in drug
development may be due in part to
the absence of a standard definition
of complete response, which can con-
found interpretations of efficacy. The
METRO cohort-based analysis will ac-
count for this wrinkle by recording all
clinical variables and comparing cur-
rent definitions of complete response
to assess how they correlate with iden-
tified biological pathways.
Third, treatment response may be
highly influenced by ethnic and ra-
cial differences. For patients with
proliferative forms of lupus nephritis,
renal survival is worse in Black and
Hispanic patients despite aggressive
treatment with intravenous cyclo-
phosphamide – even after control-
ling for hypertension, initial renal
impairment, and corticosteroid dose.
Socioeconomic features such as in-
come, educational level and access
to health care may contribute to the
poorer prognosis in some of these
populations. In one study, however,
the relative risk of progression to
end-stage renal disease remained high
in Hispanics even after adjusting for
these risk factors. METRO will enroll
ethnically and racially diverse patients
to address possible pathophysiologic
changes that increase the risk of pro-
gression to end-stage renal disease in
minority populations with nephritis.
Finally, a significant limitation of cur-
rent strategies relates to the mantra,
“Time is kidney.” Several studies have
demonstrated that delays in obtaining
a renal biopsy or in initiating treat-
ment can negatively impact patient
outcomes. As part of the new effort,
a longitudinal METRO cohort will
provide a unique opportunity to ad-
dress whether specific gene expression
or signaling pathways in unaffected
skin, circulating blood cells, or cells
shed through urine parallel or even
precede the molecular warning signs
in the kidney. If so, these less invasive
biomarkers may trigger an earlier renal
biopsy and lead to more specific and
potentially lifesaving treatment.
When Johannes Nowatzky came
to NYU, he brought with him an
interest in an unusual disease — Be-
hcet’s. “It’s an inflammatory disease,”
Nowatzky says, that’s rare in the US,
but common to many Middle East-
ern and Asian countries.
Nowatzky, a German native, did his
residency in Israel, where he saw
patients with Behcet’s disease at a na-
tional referral center on a daily basis.
He came to NYU for a Rheumatology
fellowship in 2009 and he has found
New York City has more than its fair
share of Behcet’s, thanks to its diver-
sity of ethnic patient groups.
Now he has a thriving research pro-
gram that seeks to develop a cell-based
immunotherapy for Behcet’s and other
autoimmune diseases. “It’s meant to
alter the immune system in a way that
cures disease — or at least alleviates
disease,” Nowatzky says. He hopes his
work prompts other clinical research-
ers to consider cell-based treatments
for other rheumatological diseases.
“Every cancer specialist knows what
cell-based immunotherapy is and
many people in infectious disease do
as well,” he says. “I want to introduce
the notion of this form of treatment
into our field. That’s the number one
goal of my research.”
Behcet’s disease is an autoimmune
disorder that causes inflammation
and damage to blood vessels in the
body. It is commonly seen in the
interior lining of the eye — the uvea
—which includes structures such as
the colored iris in the front and the
layer immediately beneath the retina
in the back of the eye. Behcet’s almost
always causes mouth ulcers and often
skin rashes. Some patients have life-
threatening disease of large blood ves-
sels, the brain or other organs.
Nowatzky’s research focus is on those
components of the immune system
that have suppressive effects. “With
infection” — the classic immune
response scenario — “the immune
system provides the means to fight,”
he says. “But you also get collateral
damage or have the system shoot into
the wrong direction.” The suppressive
elements of the immune system are
there to curb overly strong, prolonged
or misdirected immune responses and
to bring the fight to cessation.
By manipulating the suppressive side
of the immune system, Nowatzky
thinks he can dampen the autoim-
mune reaction in diseases like Behcet’s.
He says there’s potential for the strat-
egy to be used in other, more common
autoimmune diseases, such as mul-
tiples sclerosis and type-I-diabetes.
Specifically, Nowatzky studies immu-
nosuppressive players known as regu-
latory T cells. “We know these T cells
control the immune system and can
regulate potentially harmful immune
responses,” he says. And this knowl-
edge leads to a number of research
questions. “Are these cells different
in people with autoimmune disease?
Working On A New Toolbox for
Rheumatology
“It’s meant to alter the
immune system in a way that
cures disease — or at least
alleviates disease”.
“The “multi-ethnic” component of the name also
reflects the unique ability of the division to care for
patients of all ethnicities and races. Our studies account
for health disparities and facilitate discoveries
that are applicable to people of varied backgrounds
and socioeconomic status.”
A leader in quality care,
NYU Langone was
ranked number one in
2013 & 2014 for overall
patient safety and
quality among leading
academic medical
centers across the nation
that participated in the
University HealthSystem
Consortium HC) Quality
and Accountability Study
8. Dr. Brian D. Golden, Clinical Associ-
ate Professor in the Department of
Medicine, came to NYU 20 years ago
to do a fellowship at the Hospital for
Joint Disease, and he has stayed ever
since. He says that rheumatologists
are a bit like super internist, because
they tackle a large number of differ-
ent conditions and face patients with
a mix of medical issues, including
chronic and complex conditions. He
doesn’t see many run-of-the-mill
textbook-cases, in other words. For
Golden, this reality is a challenge that
keeps his rheumatology practice both
interesting and rewarding.
Here Golden talks about why NYU
Rheumatology is the perfect fit for
him.
Why did you choose
Rheumatology?
I was influenced by a mentor I had
when I was a medical student at Mt.
Sinai School of Medicine. One of my
attending physicians on the wards
was a well-known rheumatologist
named Harry Spiera. I was very im-
pressed both by him and some of the
cases we saw.
The interesting thing about rheuma-
tology is that you see complex diseas-
es and diagnostic puzzles. You don’t
get much hard data, as from a simple
diagnostic test. Rather you have to put
it all together from the clinical presen-
tation and the patient’s history.
Are those things that drew you to
Rheumatology as a medical stu-
dent still present in your
daily practice?
Yes, absolutely. It’s still why I find it
interesting. It’s a clinically based field,
and also it’s so broadly based that it
overlaps with many other specialties.
We truly have to be the best internists
and understand all the organ systems
well. There are so many different kinds
of clinical presentations, that you have
to be good at thinking through all the
possible diagnoses.
What has changed in the field of
Rheumatology over your career?
There are two things, two realms that
really that didn’t exist back when I
was a medical student.
One is care in osteoporosis. For
many years, this was not on the rheu-
matology radar screen — it usually
was an endocrinologist’s case or a
gynecologist’s case. Each specialty
looks at it from a different perspec-
tive: rheumatologists see it as a skel-
etal disease, a disorder of bone and
skeletal function; endocrinologists
see it as a calcium metabolism prob-
lem, encompassing nutrition and
parathyroid involvement; and gyne-
cologists see it as a common problem
in postmenopausal women.
The fact is that bone is a dynamic tis-
sue. We rheumatologists see the pa-
tient as a whole. We pay attention to
the joints and cartilage and to events
that are upstream from bone turnover
and metabolism.
The second area is muscular skeletal
ultrasound. It’s the same ultrasound
technology that radiologists and gy-
necologists use, but we use it to look
at joints and ligaments and tendons —
those structures inside the body that
we can’t see otherwise. This means
Page 15nyulangone.orgPage 14 ADVANCES / SPRING 2015
Clinical Faculty Q&A with Brian Golden, MDWhat controls the balance between
regulatory and effector T cells? What
are self- and other antigens that these
cells recognize?”
At the end of the list is the big goal:
Can the answers to any of these ques-
tions be translated into a treatment
for patients?
Cell-based therapies typically involve
taking the patients’ own cells and ma-
nipulating them in some way – often
outside of the patient’s body. Then the
cells are injected back into the patient
where they are expected to exert their
new and improved functionality.
Nowatzky is at the beginning stages
of developing his regulatory T cell
therapy. “These cells are relatively few
in the body,” he says. So far his work
has been to develop methods to grow
large numbers of ultra-pure human
regulatory T cells in vitro while main-
taining their functionality. “We exam-
ine their stability, their effectiveness,
and how they function.”
Recently, he has started to test patient-
derived cells in a “humanized” animal
model, to show their safety and effec-
tiveness in a living organism. Nowatz-
ky is using a new model of graft-vs-
host disease in severely immunosup-
pressed mice that can tolerate and
engraft human cells as an in vivo proof
of principle step. Only then can he take
the next step and get approval to test
his cell-based therapy in humans.
Nowatzky finds NYU to be a particu-
larly rich environment for his ambi-
tious and open-ended research pro-
gram, and not only because it’s in one
of the most ethnically diverse cities in
the world. He makes sure to keep up
his clinical practice, serving one full
clinic day each week.
“As a clinical researcher, I find my
work very fulfilling and rich,” he says.
He values the good access to a broad
array of excellent investigators in
the Division of Rheumatology and
beyond, namely the immunologists
working at the Skirball Institute of
Biomolecular Medicine and other
researchers in the Department of
Medicine. He appreciates the admin-
istrative support and the availability
of internal funds to keep his research
program going in between grants.
“The problem with NYU is that it’s
big. The advantage of NYU is that
it’s big.” Nowatzky cites his 20-min
walk from his office to his lab, as a
tiny downside compared to the huge
potential of a place of this size. And
he’s not found any barriers to cross-
ing divisional or departmental lines.
“There are endless opportunities here,
if you’re willing to look for them,” he
says. “And I definitely have the free-
dom to do that.”
“The fact is that bone is a dynamic tissue.
We rheumatologists see the patient as a whole.
We pay attention to the joints and cartilage
and to events that are upstream from
bone turnover and metabolism.”
NYU Langone has
390 physicians named
on Castle Connolly’s
“America’s Top
Doctors” and
New York magazine’s
“Best Doctors”
annual listings
9. Page 17nyulangone.orgPage 16 ADVANCES / SPRING 2015
we can ask more detailed questions.
What’s going on in bursitis? What
activity can we see in inflammatory
rheumatoid arthritis? Is there evi-
dence of early bone erosion? Ultra-
sound also helps with guiding doctors
through procedures, allowing us di-
rect visualization as we place a needle
into a joint, for instance.
Ultrasound methods are increas-
ingly becoming part of the teaching
program here at NYU. Dr. Jonathan
Samuels is leading that effort and
I’m part of the core team who has
experience with the technology and
is currently teaching it as part of the
academic mission of NYU to train
students, interns and fellows in the
latest methods.
What are the strengths of
Rheumatology at NYU?
When I was at Mount Sinai as a medi-
cal student and a resident, I worked
with Dr. Spiera and learned so, so
much. But I wanted to go someplace
else for my fellowship, partly for the
very practical reason of having change
of scene. One big attraction of NYU
was that its program in rheumatology
was much bigger and much broader.
And I have stayed here because the
atmosphere is great — the research
side and the clinical side of rheuma-
tology are well-balanced and there’s
really smart people on both sides of
the equation.
What sort of patients do you see
in your practice?
I’m a general rheumatologist, so I
see it all. I think I’m a good clinician
and diagnostician. I see patients with
osteoarthritis, rheumatoid arthritis,
psoriatic arthritis, lupus, fibromyalgia,
vasculitis, inflammatory muscle dis-
ease, osteoporosis, and gout.
I feel comfortable taking care of every
one of these patients. Also, in the Divi-
sion of Rheumatology at NYU, there
is always a colleague across the hall to
consult with on complex cases. We all
do this all the time. We put our heads
together and find the best solutions for
our patients.
We are proud to report that the
2014-2015 U.S. News & World
Report ranked our Rheumatology
program as #6 nationally, up from #7
in 2013.
Dr. Ashira Blazer, a Second Year
Fellow, was awarded the Rheumatol-
ogy Research Foundation’s Scientist
Development Award for her project
entitled “Arterial dysFunction Re-
lated to INF in Carriers of APOL1”
(AFRICA). With this grant, Dr.
Blazer will study mutations in the
Apolipoprotein L1 (APOL1) gene
which associate with non-diabetic
renal disease—including lupus ne-
phritis, and cardiovascular disease
in homozygous carriers of African
ancestry. This study will leverage
two Systemic Lupus Erythematosus
(SLE) cohorts: one African Ameri-
can and one Ghanaian to address
this inquiry through the develop-
ment of parallel biorepositories.
NYU will consequently cultivate
the first African SLE biorepository,
which will be instrumental in iden-
tifying ethnically determined prog-
nostic factors in lupus.
Dr. Svetlana Krasnokutsky-Sam-
uels was awarded a prestigious,
three-year American College of
Rheumatology/Rheumatology
Research Foundation Investigator
Award. This award will support her
studies on the use of colchicine for
the treatment of osteoarthritis.
Dr. Johannes Nowatzky received a
five-year K08 award from the NIH/
National Eye Institute. This award
is intended to provide an opportu-
nity to promising medical scientists
with demonstrated aptitude to
Division & Faculty News
develop into independent investi-
gators. This funding will support
Dr. Nowatzky’s work on harnessing
monoclonal Treg for the treatment
of autoimmune uveitis.
On Thursday, April 23rd NYU
hosted the Arthritis Foundation
Research Forum. The forum, with
an introduction by Rheumatology
Division Director Dr. Jill Buyon,
featured Arthritis Foundation (AF)
funded “Young Investigators” from
several institutions throughout the
region, presenting their findings in
an effort to facilitate breakthroughs
in arthritis research. NIAMS Direc-
tor Stephen I. Katz gave a special
introduction, and our own Dr. Jose
Scher served as the Keynote Speaker.
Dr. Jill Buyon received a 5 year R01
grant for her ongoing clinical trial
entitled “Preventive Approach to
Congenital Heart Block with Hy-
droxychloroquine” (PATCH). This
study, which was previously funded
by a Lupus Foundation of Min-
nesota research grant, an NIH R03,
and a Lupus Foundation of America
LIFELINE Award, is a first-ever
evaluation of whether hydroxychlo-
roquine, a drug widely used for SLE,
prevents recurrent congenital heart
block. The R01 will fund the second
stage of study enrollment as well as a
second aim that addresses the oph-
thalmologic safety of hydroxychloro-
quine exposure during pregnancy.
Dr. Peter Izmirly was an invited
contributor to the National Public
Health Agenda for Lupus confer-
ence in Washington D.C., spon-
sored by the Lupus Foundation of
America and the National Associa-
tion of Chronic Disease Directors
and funded through a grant from
the Centers for Disease Control and
Prevention (CDC). This was the
first time lupus and public health
experts came together to talk about
the urgent needs of people with
lupus and their families. During the
conference, Agenda contributors
formulated 20 recommendations
and corresponding strategic actions.
The Agenda is currently being
drafted and circulated for comment,
and it is anticipated that it will serve
as a blueprint for action after final
approval by the CDC.
Dr. Jonathan Samuels has been se-
lected as physician chair of the 2015
Arthritis Foundation’s Walk to Cure
Arthritis in NYC. This signature
event of the Foundation unites com-
munities across the country to help
put an end to arthritis. Donations
are used to help patients gain access
to the critical medications necessary
to live full, healthy lives and to fund
research that provides better treat-
ments today and promises a cure for
tomorrow. This year’s walk will be
across the Brooklyn Bridge and take
place on Saturday, May 16th.
Fellowship News After the fall fellow-
ship interview season, the Division
was pleased to have a very successful
match and looks forward to welcom-
ing our new rheumatology fellows this
summer. In addition, thanks in part to
a supplemental grant from the Ameri-
can College of Rheumatology (ACR),
we are increasing the program to 4
fellows per year.
Dr. Michael Pillinger, our Rheuma-
tology Fellowship Program Director,
received the ACR Distinguished
Program Directors Award at the
2014 Annual Meeting in Boston.
Dr. Pillinger is also a member of the
ACR Board of Directors, Chair of
the ACR Curriculum Task Force,
and Chair of the ACR Basic and
Clinical Science Training Curricu-
lum Committee.
Two of our faculty members ob-
tained full professorship. Dr. Michael
Belmont, Professor of Medicine
(Clinical) and Dr. Michael Pillinger,
Professor of Medicine (Clinical) were
honored at the 1st Annual Recogni-
tion Reception for Department of
Medicine Appointments and Promo-
tions, held at the Water Club.
Dr. Adam Mor was awarded an In-
novative Research Grant from the
ACR Rheumatology Research Foun-
dation (RRF). Dr. Mor will be study-
ing the role of PD-1 (Programmed
Death-1) signaling in T cells in Rheu-
matoid Arthritis, using both human
cells and murine models. These stud-
ies may ultimately lead to new immu-
nomodulatory targets, and will shed
light on the current processes leading
to immune activation in RA. He will
be joined in his efforts by Drs. Bruce
Cronstein and Gregg Silverman who
will serve as collaborators. This grant
builds upon a related study currently
funded by the RRF.
Division & Faculty News
NYU Langone is the only hosptal in New York to receive
top 10rankings all three musculoskeletal specialty
areas of orthopaedics, rheumatology, and rehabilitation in
U.S. News & World Report’s Best Hospitals ranking.
10. Shahla Abdollahi-Roodsaz, PhD
Steven Abramson, MD
Mukundun Attur, PhD
Natalie Azar, MD
Bertha Bauer, MD
H. Michael Belmont, MD
Stephen Bernstein, MD
Nina Bhambhani, MD
Lenore Brancato, MD
Jill Buyon, MD
Franco Celada, MD, PhD
Efstathia Chiopelas, MD
Robert Clancy, PhD
Michael Colin, MD
Bruce Cronstein, MD
Mark Eberle, MD
Sari Edelman, MD
Page 19nyulangone.orgPage 18 ADVANCES / SPRING 2015
Philanthropy2015 Seminar in Advanced Rheumatology
Become a member of the Research Cures society and help NYU Langone’s
Division of Rheumatology maintain excellence in patient care, research
and education.
The Division of Rheumatology is filled with talented and devoted faculty mem-
bers who provide exceptional patient care, produce groundbreaking research, and
educate future generations of medical professionals. The partnership and support
of our donors and friends are essential ingredients in assuring our standard of
excellence as we serve the health care and wellness needs of the thousands of lives
we touch each day.
If you would like to make a gift to the Division of Rheumatology, please call Me-
lissa Y. Sosa, Director of Development, and join us as we raise the bar in health care
here and beyond our campus.
To reach Melissa Y. Sosa, call 212-404-3510 or email melissa.sosa@gmail.com.
Avram Goldberg, MD
Brian Golden, MD
Stephen Honig, MD
Peter Izmirly, MD
Philip Kahn, MD
Sara Kramer, MD
Svetlana Krasnokutsky-
Samuels, MD
Sicy Lee, MD
Euna Lee, MD
Kristen Lee, MD
Paula Marchetta, MD
Kavini Mehta, MD
Hal Mitnick, MD
Adam Mor, MD
Johannes Nowatzky, MD
Mark Philips, MD
Michael Pillinger, MD
Andrew Porges, MD
Paula Rackoff, MD
Soumya Reddy, MD
Pamela Rosenthal, MD
Jonathan Samuels, MD
Jose Scher, MD
Harry Shen, MD
Gregg Silverman , MD
Stephen Smiles, MD
Bruce Solitar, MD
Gary Solomon, MD
Chung-E Tseng, MD
Stelios Viennas, MD
Gerald Weissmann, MD
Yusuf Yazici, MD
Gary Zagon, MD
RESEARCH CURES
SOCIETY MEMBERS
LIST TO COME?
Division of Rheumatology Faculty, NYU School of Medicine
BOARD MEMBERS
The annual NYU Seminar in Advanced Rheumatology took place in March 2015 and attracted rheumatologists, orthopedists,
trainees in the rheumatic diseases and internists with a special interest in rheumatology.
