New Trends in Autoimmunity for Patients, Researchers and ...

New Trends in Autoimmunity for Patients, Researchers and the American Public

Highlights from "The State of Autoimmune Disease:

A National Summit"

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About American Autoimmune Related Diseases Association

Founded in 1991, American Autoimmune Related Diseases Association (AARDA) is the nation's only non-profit organization dedicated to bringing a national focus to autoimmunity as a category of disease and a major women's health issue, and promoting a collaborative research effort in order to find better treatments and a cure for all autoimmune diseases. AARDA's mission is the eradication of autoimmune diseases and the alleviation of the suffering and socioeconomic impact of autoimmunity through initiating, fostering, and facilitating collaboration in research, advocacy, patient education and public education in an effective, ethical, and efficient manner.

Research Highlights, include:

providing nearly five million dollars in funds for peer reviewed basic autoimmune research and donor directed specific disease research/fellowships.

"AARDA has been effective. And I can tell you that they have

founding of the Center for Autoimmune Disease Research at John Hopkins University Medical Center with a major grant for start-up funding continues to support today. AARDA also sponsors an annual

made an impact on the field. They're deeply appreciated."

"Autoimmunity Day" program at Johns Hopkins that brings together researchers from many different disciplines who are involved in

- Dr. Robert Carter

autoimmune research.

organizing and/or sponsoring numerous national and international scientific symposia and colloquia as well as

cosponsoring several scientific meetings with the National Institutes of Health, American College of

Rheumatology, and Clinical Immunology Society.

working in collaboration with five National Institutes of Health, the U.S. Department of Health and Human

Services and other research universities in the U.S. and around the world.

Patient Education Highlights, include: handling more than 400,000 inquiries per year via phone, email, mail and the internet and developing over 80

patient education information pamphlets. hosting 4-5 Autoimmune Public Forums annually in different cities around the country.

creating the Autoimmune Walk: Linking Together for a Cure annual campaign, allowing patients to band together to meet, share experiences and help raise money for research. Walks have been held in Washington, DC, New York City, Chicago, Detroit and Atlanta, among others.

Advocacy Highlights, including: initiating, supporting and facilitating the National Coalition of Autoimmune Patient Groups (NCAPG), a coalition

of 38 national voluntary health agencies which represent specific autoimmune diseases. sponsoring annual Congressional Briefing on Autoimmune Diseases and hosting every several years National

Summits on Autoimmune Disease to focus on current and emerging trends. successfully advocating for the creation of and/or passage of: - NIH Autoimmune Disease Coordinating Committee - Legislative language included in the Children's Health Act that required NIH to develop a national strategic plan for autoimmune disease research.

Public Education Highlights, including: working with longtime AARDA celebrity spokesperson Kellie Martin who stars in public service and social media

campaigns, speaks at patient forums and advocacy events and participates in media interviews. creating the "Walk Through Autoimmunity" Curriculum for Grades 3-8 and providing it free to U.S. elementary

and middle school teachers to supplement their in-class science lessons. conducting ongoing research projects with patients and physicians to better understand autoimmune disease

diagnosis, treatment and daily life.

For more information, please visit or follow AARDA on social media including:

Facebook (Autoimmunity) Twitter (@AARDATweets) YouTube (AARDATube)

Introduction

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Table of Contents Introduction Featured Panelists and Speakers Autoimmune Research: An Overview Autoimmune Disease and Fatigue: What's the Connection? Autoimmunity and the Environment Advocating for Autoimmunity Patient Perspective: Getting an Autoimmune Disease Diagnosis Patients on Autoimmune Disease, Chronic Illness and the Gender Issue Paths for the Future

Introduction

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NOTE: By summarizing the ideas from our recent National Summit on Autoimmune Disease, American Autoimmune Related Diseases Association wishes to provide important information and updates to patients, physicians, researchers and those who oversee and set U.S. health and health care policy. We invite anyone with an interested in autoimmune diseases to utilize this report, including the media. It may be reproduced, either in whole or in part, with proper credit given to American Autoimmune Related Diseases Association.

Introduction

Autoimmune disease affects some 50 million Americans and their families. The physical,

emotional and economic toll of these diseases is enormous. Autoimmune disease is one of

the top 10 leading causes of death of women under the age of 65. It encompasses more than

100 diseases, including psoriasis, Graves' disease, Sjogren's syndrome, multiple sclerosis,

rheumatoid arthritis, Crohn's disease and lupus. It is responsible for more than $100 billion in

direct health care costs annually.

Since American Autoimmune Related Diseases Association (AARDA) was founded in 1991, autoimmunity has come a long way in terms of being recognized as a major disease category, like cancer and heart disease.

However, there is still much work to be done.

Every March, AARDA and the National Coalition of Autoimmune Patient Groups (NCAPG) celebrate National Autoimmune Diseases Awareness Month to bring much need attention to this major disease category.

"It seems to me that as our knowledge of the actual science behind these conditions increases -- the

kind of knowledge on view here today -- the tendency to psychologize and dismiss patients will diminish as well. After all, we don't really think of cancer as being a disease of repression. We don't tell someone who has tuberculosis they're too soulful. We give them antibiotics. I don't want to sound like a Pollyanna, but even with the limited knowledge we have, I think I and many other autoimmune patients are living healthier and more capacious lives than we once did. It's very illuminating to read

Henrietta Aladjem's memoir. You realize how hard it was once and how much better it is today. That's

thanks to the work of organizations like AARDA and all of you here."

-- Meghan O'Rourke, journalist, author, poet and autoimmune patient

This past March, we co-hosted the fourth National Summit on Autoimmune Disease which brought together leading experts to advance knowledge and understanding by sharing the most current trends in autoimmune disease research, advocacy and patient issues.

AARDA and NCAPG would like to thank the dozens of experts who participated and the hundreds of autoimmune patients, advocates, policymakers, pharmaceutical industry representatives and others who attended.

The following report synthesizes the key issues that emerged during the daylong summit. We encourage you to read and share the report with your colleagues and partners. A PDF version will be available for downloading on AARDA's web site at .

Introduction

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Featured Panelists and Speakers The Doctors/Researchers

Dr. Robert Carter, Deputy Director, National Institute of Arthritis and Musculoskeletal and Skin Diseases

Dr. Anne Davidson, Investigator, Feinstein Institute for Medical Research Dr. Michael Holers, Head, Division of Rheumatology, University of Colorado Dr. William Harvey, Clinical Director of the Arthritis Treatment Center, Tufts University School of Medicine and Chair, Government Affairs Committee, American College of Rheumatology Dr. Abid Khan, MidMichigan Health, University of Michigan Health System Dr. Frederick Miller, Deputy Chief, Clinical Research Branch, and Head, Environmental Autoimmunity Group, National Institute of Environmental Health Sciences Dr. Jennifer Nyland, Assistant Professor, University of South Carolina Dr. Noel Rose, Director, Center for Autoimmune Disease Research, Johns Hopkins University

The Patients Tracy Evans, Patient Beth Harkavy, Patient Meghan O'Rourke, Journalist, Author, Poet and Autoimmune Disease Patient Tiffany Westrich-Robertson, Patient

The Advocates Dr. Dennis Cryer, Chief Medical Officer, CryerHealth Stephanie P. Hales, Associate, Sidley Austin LLP Virginia T. Ladd, Executive Director, AARDA Kellie Martin, Emmy Award-nominated Actress and AARDA Spokesperson Georgine Paltzer, ARNet: The Autoimmune Disease Patient Registry Michael Reilly, Executive Director, Alliance for Safe Biological Medicines Steven Taylor, Chief Executive Officer, Sjogren's Syndrome Foundation

Featured Panelists and Speakers

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Autoimmune Research: An Overview

Environmental Factor

Genetic Predisposition

Autoimmune Disease

Endocrine

=

Effect

Graphic Credit: Dr. Noel R. Rose

It's All in the Genes Autoimmune diseases have a genetic precursor, meaning individuals have an inherited

predisposition to developing them and it involves a multitude of genes.

Considerable research has found there are two major types of genes involved in the

development of autoimmune disease. The first type is a complicated system called a

histocompatibility complex, a genetic family that determines what the lymphocytes or immune

cells detect and how they respond. The other is a

multitude of smaller genes that together help regulate the immune system and determine what lymphocytes will do once triggered.

Autoimmune Diseases Develop in Stages With rare exceptions, autoimmune diseases are not

"Trying to understand, even in individuals who don't have an autoimmune disease, how these things are different provides important insights into how genes work together."

pure genetic diseases. Instead, they are diseases that

-- Dr. Michael Holers

need a necessary trigger in order to manifest.

Autoimmune diseases develop in stages based on genetic risk and predictive biomarkers which include antibodies present in a person's system even though there are no signs or symptoms yet.

Autoimmune Research: An Overview

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The Environment Plays a Key Role Too

These diseases evolve over time through a combination of genetics and environmental factors. Understanding, on a molecular basis, how and why these genes act the way they do is key. Equally important is understanding the influence external environmental factors have on disease development.

Today innovative human studies are advancing knowledge by looking at a particular gene in different individuals to determine if differences exist in the expression of that same gene in different individuals and its impact of that difference on the immune response, as well as how outside influences on the genes impact their behavior.

Gender Role in Autoimmune Disease

Another key to understanding autoimmune disease is how

One of our major problems in

genes express themselves, particularly those related to the

research is the decrease in

body's endocrine system. Since these diseases predominantly budget that's happened over

impact women in the childbearing years, better understanding the last 10 years. In real terms,

of the role played by sex-related properties, genes and

a more than 25% decrease in

hormones, in disease development is fundamental.

funding to the National Insti-

tutes of Health has been voted

National Institutes of Health Approaches to Autoimmune Disease Research

in by two Presidents and I don't know how many Congresses, because of political

issues. An understanding of

Patient-Reported Outcomes Measurement Information System how these [diseases] happen

Launched 10 years ago, the Patient-Reported Outcomes

can't progress without

Measurement Information System (PROMIS) offers a more

research. Keep that at the

meaningful portrait by allowing researchers to bring patient

forefront of an agenda ? not

voices and experiences into the outcomes of clinical trials and only patient advocacy, but

other types of research.

advocacy at the level of

research funding.

Accelerating Medicines Partnership

-- Dr. Anne Davidson

Because many drugs fail in late stage development due to lack

of efficacy, NIH created the Accelerating Medicines Partnership

(AMP). AMP brings NIH's research community together with the pharmaceutical industry and

patient groups. Working collaboratively, they identify targets for drug development that have a

high probability for success. Although originally established around drugs for rheumatoid

arthritis and lupus, the concept from the outset has been to create a model applicable broadly

to all autoimmune diseases and even other disease categories.

Autoimmune Centers of Excellence The National Institute of Allergy and Infectious Diseases (NIAID) has created the Autoimmunity Centers of Excellence (ACEs) to encourage and enable collaborative research across scientific disciplines and medical specialties, and between basic and clinical scientists.

Autoimmune Research: An Overview

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Cosponsored by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the NIH Office of Research on Women's Health (ORWH), ACEs support an integrated basic and clinical research program that focuses on treatment or prevention approaches that induce immune tolerance or modulate the immune system. ACEs investigators also explore the immune mechanisms underlying the agents evaluated in these trials ? research that commonly is not included in other clinical trial programs.

Cooperative Study Group for Autoimmune Disease Prevention Established in 2001, the Cooperative Study Group for Autoimmune Disease Prevention's mission is to focus on the prevention of autoimmune disease. The initiative consists of a group of investigators across multiple public and private research institutions focused on advancing understanding of the natural history of autoimmune diseases and the various features they share including genetics, pathways of disease and treatment.

Autoimmune Disease and the Pharmaceutical Pipeline Drug development in common autoimmune diseases is fairly robust. Even for the more rare

autoimmune diseases, the market is slowly improving.

There is a growing shift expensive biological to large, complex, molecules.

Due to genetic analysis biomarkers, biological tailored specifically to more effective and the and the advent of therapies can be patients, fostering efficient treatments.

"Credit Suisse sees some solid upside in big pharma in the coming years... The brokerage firm updated its autoimmune market model and it sees implications for all large cap U.S. pharmaceutical companies in its coverage. Based on multiple conversations with physician experts and companies active in the space, Credit Suisse sees the U.S. autoimmune market growing to $30 billion by 2025, up from $20 billion in 2014."

? Chris Lange, 24/ June 8, 2015

Autoimmune Research: An Overview

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