Rheumatology, Immunology and Allergy Move Under One Roof

Rheumatology, Immunology and Allergy Move Under One Roof
Pei Tong, PhD, and Colby Devereaux of the Wesemann lab in the Division of Rheumatology, Immunology and Allergy

This story was originally published in BWH Clinical and Research News.

Walking has unexpectedly become an essential part of how the Division of Rheumatology, Immunology and Allergy get their work done.

That’s because the division’s clinicians and researchers are scattered throughout multiple locations: the main hospital, 221 Longwood Ave., Dana-Farber Cancer Institute’s Smith Building and 850 Boylston St. Consequently, they spend a considerable amount of time trekking around Longwood not only to work with each other, but also with the many other specialties they team up with at BWH.

Although the staff gets together about once a month to informally catch up and share ideas, this distributed setup has made day-to-day logistics and collaboration challenging. Daniel Solomon, MD, MPH, a rheumatologist and epidemiologist, and his research team are currently recruiting Cardiovascular Medicine patients for a clinical trial to assess how various rheumatoid arthritis treatments affect their risk of cardiovascular disease. That means physically hurrying over to the Shapiro Center from their offices at 221 Longwood whenever there’s a patient who might be interested in enrolling in the trial.

And that’s just one example of the hurdles they face. It’s neither an efficient nor a sustainable arrangement, especially given how much the division has grown over the years in terms of patients, staff and research studies.

Fortunately, however, it’s not a situation Rheumatology, Immunology and Allergy staff will be living with much longer, as they will be among the teams moving into the Brigham Building for the Future this fall—bringing most of the division under one roof for the first time.

The benefits extend beyond logistics. Clinicians and researchers in the division anticipate moving into the BBF will produce tangible results for patients—namely, the accelerated development of advanced therapies and improved patient outcomes.

“We’re going to co-house the division’s basic science, translational science and clinical science for the first time. That is going to substantially enhance our ability to move things, literally, from bench to bedside in a way that we’ve never been able to do before,” said Joshua Boyce, MD, associate chief of Rheumatology, Immunology and Allergy at BWH.

Bringing the Pieces Together

As Rheumatology, Immunology and Allergy grew over the years, its offices and labs popped up wherever there was available space, resulting in the division’s current setup. Its clinicians and researchers say coming together in the BBF will provide fertile ground for innovation and more robust collaboration among themselves—the importance of which cannot be overstated.

“If you’re working elbow to elbow and walking by people several times a day, there is a much greater chance to run ideas by colleagues,” said Solomon who is also chief of the division’s Section of Clinical Services and the Matthew H. Liang distinguished chair in Arthritis and Population Health. “Clinicians feel more in touch with researchers, and the researchers feel more in touch with the clinical work.”

The division’s Allergy and Clinical Immunology ambulatory practice will remain at 850 Boylston St. and continue to give patients routine care, such as allergy shots or treatment for hay fever.

That enables the clinicians and researchers to focus their work at the BBF on more complex disorders, where active investigations being led by BWH researchers in the new building could eventually result in a ground-breaking clinical trial for patients being seen on the next floor.

One potential candidate for this is the division’s AERD Center, Boyce says. Aspirin-exacerbated respiratory disease (AERD) has been recognized for almost a century, but its underlying cause is still unclear. It can appear suddenly in healthy adults, who seemingly overnight develop chronic sinus disease, nasal polyps and acute asthma. Medications such as aspirin and ibuprofen trigger or worsen patients’ symptoms; current treatments aim at desensitizing patients to these medications.

Researchers at the Brigham’s AERD Center—one of only a few like it in the country—are currently conducting three clinical trials, with a fourth expected to begin soon. Mouse models have enabled BWH investigators to test hypotheses about what causes AERD and identify potential therapeutic targets. It’s no surprise that the several hundred patients seen at the center “are anxious to participate in clinical research,” Boyce says.

“The tools, resources and expertise we need to move insights from preclinical models into clinical research settings is here, but it’s really scattered. This is an ideal example of the kind of research that will become easier when everything is under one roof,” Boyce says. “Patients will be able to come in to the clinical research lab to enroll and have their blood drawn, and then go to the clinical space downstairs to receive their treatment.”

Duane Wesemann, MD, PhD, is an allergist and immunologist who also runs a lab at BWH, where he studies B cells and how environmental factors may influence their behavior. What’s more exciting to him than a so-called trickledown effect—research coming down to patients for clinical trials—is what he calls a “trickle upward” from patients to the lab. Having close proximity to patients will help researchers gain a better understanding about the most pressing clinical needs. But in either scenario, “patients will win,” Wesemann says.

“It’s impossible to have one person solve all problems,” he said. “One of the frustrating things in medicine is that most of the things people suffer from are complex problems that we do not fully understand. The BBF will allow us to do the best science possible in order to generate innovative new therapies and expand our ability to offer improved care.”

Opportunities for Collaboration Across Divisions and Centers

Bringing the division together is just one part of what excites Rheumatology, Immunology and Allergy clinicians and researchers about moving to the BBF. Many also see an opportunity to collaborate with other divisions that will be their neighbors in the new building.

It’s a concept that’s very familiar to Patrick Brennan, MD, PhD, who splits his time between seeing asthma and allergy patients at 850 Boylston and studying T cells in patients with severe asthma in his lab at the Smith Building. Brennan is conducting his research with BWH’s Human Immunology Center, a flow cytometry lab for clinicians and researchers interested in studying the human immune response across multiple translational research areas. Brennan collaborates with investigators in the Division of Genetics to use its technologies to sort immune cells and analyze their different gene expression profiles.

Brennan anticipates that moving to the BBF will spark similar partnerships with other divisions and centers in the building.

“Some of the best science happens when you’re in the hallway or getting coffee,” he says. “Some of the things I’m doing now were really triggered by collaborations that grew from friendly conversations.”

In terms of specific collaborations, Rheumatology’s Solomon sees a lot of potential for work with Orthopaedics in the BBF, noting that the two are very closely aligned in terms of clinical and research topics.

Solomon also sees overlap in the BBF with Neurology, as many BWH rheumatologists already work with neuroscientists to study pain mechanisms. There are also benefits to having access to the new MRI technologies coming into the building.

On the Allergy and Immunology side, clinicians and researchers see similar opportunities to work with Neurology as well as various members of the research community using technologies in the Human Immunology Center.

“As you cohabitate a space and start to attend one another’s talks, there’s always a lot of commonality when you’re talking about basic research. There might be someone studying the same molecule as you except in a different disease model, or somebody might have a piece of equipment you could really use,” Boyce said. “It’s always better when they’re right there and you can form a collaboration.”