New Funding Aims to Accelerate Treatments for Lupus, an Autoimmune Disease with Many Faces

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It’s not clear how many people worldwide suffer from the autoimmune disease lupus — estimates say about 1.5 million Americans have some form of the condition, and about 5 million people worldwide. That uncertainty may be partly due to the heterogeneity of lupus: That is, the disease can manifest in completely different ways in different people. Lupus causes the immune system to misfire, creating antibodies that may target the kidneys, brain, heart, lungs, blood, skin and joints. As a result, patients can go undiagnosed or misdiagnosed for years — about two-thirds of Americans with lupus are initially misdiagnosed, according to experts — experiencing difficult symptoms while the disease progresses and causes irreparable damage.

For decades, a limited range of available lupus treatments included steroids and other drugs (such as hydroxychloroquine, which was hyped and quickly debunked as a COVID treatment), used to broadly tamp down the misdirected immune system response that causes the damage. But in recent years, researchers and people affected by lupus have drawn hope from new drugs, such as anifrolumab, which work in a more targeted manner than the older generation of therapies.

Enter the Lupus Research Alliance (LRA) — the country’s largest philanthropic funder of lupus research at currently about $15 million in annual grantmaking — which is redoubling its efforts to speed the development of medicines that more precisely target the underlying disease and its various manifestations.

The LRA recently announced awards totaling $9 million to three international research teams across four continents. The backing for the awards came from a longtime LRA supporter, Bloomberg Philanthropies. The focus of these awards is not so much on the basic science of the disease, but rather on developing treatments that can benefit lupus patients as soon as possible.

Through these Global Team Science Grants, the LRA is providing $3 million to each multidisciplinary team over three years. Like a growing number of biomedical research efforts, the funds will support research that crosses disciplines, including collaborative projects to accelerate personalized lupus treatments. The areas of study that the teams will delve into include: heterogeneity in immune cell behavior and cognitive function in patients; identifying gut microbes that trigger lupus via leaky gut; and identifying ancestry-specific lupus molecular profiles that could uncover genetic causes of lupus.

The LRA has been granting the Global Team Science Awards since 2020 — along with its other research grants — but the newly announced awards represent a substantial jump in giving, said Teodora Staeva, the LRA’s chief scientific officer.

“Traditionally, we have given grants that not only are much smaller, but usually directed to single investigators working on an idea,” Staeva said. “We’ll continue to support individual researchers, but [for the Global Team Science Awards], we came up with some key criteria that we really wanted to be achieved through this mechanism. That included bringing teams of investigators that are working across domains of science, and across countries, to come up with a solution that was central to human lupus research.”

To date, few philanthropies have foregrounded lupus in their giving. In a couple of respects, this may be an issue of equity. For one, the disease disproportionately affects women, who make up 90% of lupus patients. Historically, doctors and researchers have not always taken women’s health seriously, nor focused on health challenges primarily affecting women on par with those primarily affecting men — though this disparity is increasingly being called out and, one hopes, corrected. At the same time, lupus is also much more likely to affect people of color. In the U.S., people of color, including Blacks, Latinos, Asian Americans and Native Americans, face two to three times greater risk of lupus than white people.

It’s also worth noting that research into lupus and the development of lupus treatments may have benefits that reach far beyond lupus patients, applying to the much larger category of autoimmune conditions. Estimates of the number of people with autoimmune diseases vary, but recent calculations put the number at about 50 million people worldwide. “Lupus is often thought of as the prototypic systemic autoimmune disease. And because it affects so many different parts of the body, the research that is being done to address it could have application to a number of other autoimmune diseases,” Staeva said.

In fact, the LRA has ongoing collaborations with two other organizations tackling autoimmune disorders: the Juvenile Diabetes Research Society and the National Multiple Sclerosis Society. In addition, said Staeva, research into a number of other related autoimmune diseases may also benefit from lupus research, including rheumatoid arthritis, psoriasis and Sjogren’s syndrome.

Addressing the heterogeneity of lupus is key in the development of new, targeted therapies: not only do different patients have different symptoms and medical issues, but in some patients, the disease can present in different ways at different times. “So one of the challenges of heterogeneity is that up to now, all lupus patients have tended to be lumped together despite the wide variability in their symptoms and in the underlying mechanisms of their disease,” Staeva said. “They’ve been treated with the same drugs and experimental treatments, and unfortunately, most of the Phase 3 trials in lupus have failed.”

Bloomberg Philanthropies had the financial resources to enable LRA to follow through on its vision to generate research results that could impact patients sooner rather than later. In that sense, Bloomberg’s lupus funding reflects some of the advantages focused philanthropic funding can bring to the medical research field — speed and teamwork. With the pace of biomedical research and drug development typically measured in decades, patients are bound to cheer on any strategy to speed therapies into the clinic, and to patients. “We felt it was important to create this additional team science mechanism to accelerate our mission,” Staeva said.