The discovery of anti-neutrophil cytoplasmic autoantibodies (ANCAs) revolutionized the understanding, diagnosis, and treatment of small vessel vasculitis associated with these autoantibodies.
Attendees of the Rheumatology Research Foundation Philip Hench, MD, Memorial Lecture: ANCA-Associated Vasculitis Diagnosis & Treatmentwill hear a unique perspective on the discovery of ANCA and subsequent research on the subject. This clinical science session will take place from 7:30 – 8:30 am on Tuesday in Room 20 A.
J. Charles Jennette, MD, the Kenneth M. Brinkhous Distinguished Professor and Chair of the Department of Pathology and Laboratory Medicine at the University of North Carolina School of Medicine in Chapel Hill, said he wants to give rheumatologists a deeper understanding of disease caused by ANCA, which, in turn, will improve the diagnosis and care of patients with these conditions.
“Timely and accurate diagnosis and rapid initiation of the most effective and least toxic therapy are extremely important for optimizing the outcome of patients with ANCA disease,” said Dr. Jennette, who is also Chief of Pathology and Laboratory Medicine Services at UNC Hospitals. “ANCA-associated disease is the most common form of aggressive acute vasculitis and glomerulonephritis in adults, especially older adults.”
Dr. Jennette said he took inspiration from the lecture’s namesake in planning his remarks. The lecture was originally established by the Hench Society at the Mayo Clinic in memory of the Nobel laureate, who described the use of glucocorticoids in rheumatoid arthritis. The Rheumatology Research Foundation now manages the lectureship, and each year a lecturer who has made significant contributions to the field of rheumatology is designated to receive this honor.
“Dr. Hench discovered cortisone and was a pioneer in using corticosteroids as immunomodulatory therapy for diseases caused by inflammatory and immunologic mechanisms, including autoimmune diseases,” Dr. Jennette said. “Since his discovery, there have been tremendous advances in developing more effective and less toxic regimens and pharmacologic agents to threat autoimmune disease. A major goal of my presentation is to provide an understanding of the basis for current therapy for ANCA-associated disease, including trials currently underway to identify more precise, more targeted, and less toxic therapies.
“One example of a promising new approach is to target a pathway that is required for complement-mediated neutrophil activation. Recent and ongoing trials from Europe and North America have shown that a C5a receptor inhibitor called Avacopan can effectively substitute for high-dose glucocorticoids in treating ANCA-associated vasculitis.”
During the lecture, Dr. Jennette will also describe how a serendipitous evaluation of a patient seen at the University of North Carolina in 1985 led to the discovery of MPO-ANCA and subsequently to the elucidation of the broad spectrum of ANCA disease, the development of a useful animal model of ANCA disease, and advances in therapeutic strategies for ANCA disease, including the possible value of C5a receptor inhibitors.
“This is a classic tale of bedside-to-bench-and-back-again research,” he said.
Dr. Jennette has contributed extensive research directed at understanding the causes of kidney diseases, particularly those caused by inflammatory or immunologic mechanisms. His current research focuses on inflammatory vascular disease, including investigation of the role of epitope specificity in the pathogenicity of ANCA and studies to elucidate the pathogenesis of ANCA-induced necrotizing pulmonary granulomatosis.