Interim Division Chief

Department / Division:
Medicine / Rheumatology and Immunology

Address:
DUMC 3874
Durham, NC 27710

Appointment Telephone:
919-668-7630

Office Telephone:
919-684-4499

Fax Telephone:
919-684-8358

• MD, West Virginia University School of Medicine, 1980

• Rheumatology, Duke University Medical Center, 1980-1983, 1983-1985

Clinical Interests:
Rheumatoid arthritis, Sjogren's syndrome, scleroderma, systemic lupus erythematosus, vasculitis

Research Interests:
    The main focus of my research is the pathogenesis and treatment of rheumatoid arthritis (RA).  This work has been conducted using patient-oriented research methodologies in collaboration with basic scientists and other clinical investigators.  A major area of interest has been the development of novel therapies for RA, which has primarily included studies of novel biologics.  Another important area of investigation has been the possible role of nitric oxide in the pathogenesis of RA.

    My research is conducted in our Clinical Trials Unit which is built around a staff of three clinical research coordinators and a collaborative relationship with Dr. William E. Wilkinson, a Ph.D. biostatistician.  Our group has been involved in numerous clinical trials sponsored by the pharmaceutical industry.  Another important project has been a study of doxycycline therapy in RA, which has been supported by the National Institutes of Health (NIH).  Recently, we have
begun an epidemiologic study of SLE in collaboration with Glinda Cooper, an epidemiologist from the National Institutes of Environmental Health Services in the Research Triangle Park. The General Clinical Research Center, an NIH-supported facility, has frequently served as the site for our research.
 
    The current biologic therapies under investigation in patients with RA include a peptide vaccine, IL-4, IL-10, and anti-tumor necrosis factor-à chimeric monoclonal antibody (anti-TNF).  The peptide vaccine consists of a "shared HLA-DRB1 epitope", a short amino acid sequence common to the  -chain of those HLA-DR molecules associated with RA.  IL-4 and IL-10 are inhibitory cytokines that ameliorate arthritis in experimental animal models and are in the early stages of development as a possible treatment for human disease.  The most promising of the novel biologics are those agents inhibiting TNF.  Our center is now involved in a phase III clinical trial of anti-TNF in patients with RA, a study involving over 20 other sites in the United States and Europe.  I am also principal investigator of an NIH-sponsored study investigating the treatment efficacy of doxycycline in RA and the ability of this antibiotic to suppress collagenase activity in vivo.  The work involving nitric oxide has been supported by a Specialized Center for Research in RA (Barton F. Haynes, M. D., Principal Investigator).  Other current studies include a clinical trial of DHEA in SLE, and the epidemiologic study of SLE, which is based in North and South Carolina and will examine the relationship between environmental exposures and the incidence of disease.

    I have been a consultant for several pharmaceutical companies who are developing new therapies for RA.  In addition, I have served as a consultant on NIH study sections for applications related to clinical trials of new anti-rheumatic therapies.  I have also organized a Sjogren's Syndrome Clinic at Duke that attracts referrals from the southeastern part of the United States.  I have also spoken at the Annual Scientific Meeting of the American College of
Rheumatology on subjects related to my research and clinical interests, including Sjogren's Syndrome, vasculitis, and autoantibodies.  Finally, I am developing an investigator's network in the southeastern United States, which should provide the patient base and infrastructure to conduct large clinical trials in rheumatology.

Key words: rheumatoid arthritis, biologics, clinical trials, Sjogren's syndrome, systemic lupus erythematosus, nitric oxide

Representative Publications:
St.Clair EW, Wilkinson WE, Lang T, Sanders L, Misukonis MA, Gilkeson GS, Pisetsky DS, Granger DL, Weinberg JB: Increased expression of blood mononuclear cell nitric oxide synthase type 2 in rheumatoid arthritis patients. J Exp Med 1996; 184:1173-1178. (1996)

St.Clair EW, Burch JA Jr: In vitro selection of an autoimmune epitope on stem-loop II of U1 RNA. Clin Immunol Immunopathol 1996;60-70, 1996. (1996)

Olsen NJ, Brooks RH, Cush JJ, Lipsky PE, St.Clair EW, Matteson E, Cannon GW, Jackson CG, McCune WJ, Fox DA, Nelson B, Lorenz T, Strand V: A double-blind, placebo-controlled study of an anti-CD5 immunoconjugate in patients with rheumatoid arthritis. Arthritis Rheum 1996;39:1102-1108. (1996)

St.Clair EW: Vasculitis, Treatment of the Rheumatic Diseases. Edited by MJ Weisman and ME Weinblatt. Philadelphia, WB Saunders Co., 1995. (1995)

Matteson EL, Yocum D, St.Clair EW, Jacobs MR, Achkar AA, Johnston J: Treatment of active refractory rheumatoid arthritis with humanized monoclonal antibody CAMPATH-1H administered by daily subcutaneous injection. Arthritis Rheum 38:1187-1193, 1995. (1995)

St. Clair EW, Angelillo JC, Singer KH: Expression of cell adhesion molecules in the salivary gland microenvironment of Sjogren's syndrome. Arthritis Rheum 1992;35:62-66. (1992)

St. Clair EW, Burch JA Jr, Ward MM, Keene JD, Pisetsky DS: Temporal correlation of antibody responses to different epitopes of the human La autoantigen. J Clin Invest 1990;85:515-521. (1990)

St. Clair EW, Pisetsky DS, Reich CF, Keene JD: Analysis of autoantibody binding to different regions of the human La antigen expressed in recombinant fusion proteins. J Immunol 1988;141:4173-4180. (1988)