Looking to solve ALL the lupus puzzles

By Emily Gillespie, Ph.D., Board of Directors

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At the Renaissance Festival last fall, my family tried an escape room for the first time. If you’re not familiar with the concept, these are themed rooms filled with challenges – usually a variety of puzzles or riddles – that need to be solved within a certain amount of time in order for the participants to unlock the room and escape. Because there are multiple challenges and time is of the essence, teams usually split up and try to solve the different puzzles simultaneously. Solving just one puzzle won’t cut it; if the team hopes to escape, they must identify and solve all of the puzzles, working in tandem.

For many patients, successful treatment of their lupus may require a similar strategy. Lupus (like many other autoimmune diseases) doesn’t result from a single problem within the immune system; instead, multiple aspects of the immune system have gone awry, leading to the systemic features of the disease. It’s very possible that treatments that focus on just one of these underlying problems won’t be sufficient to control the disease. Identifying and solving all of the puzzles, in tandem, might be required.  

Let’s look at an example. The Federal Drug Administration’s approval of belimumab (also known as Benlysta) in 2011 was met with great excitement. While this new treatment option was a major advance, it doesn’t work for everyone. Belimumab works by targeting one particular aspect of the immune system that is malfunctioning. Could it be that, when used together with another drug that targets a different facet of the disease, the combination could be more effective and could benefit more patients? 

The manufacturer of belimumab recently began a clinical trial of belimumab combined with rituximab, a drug not yet approved for Systemic Lupus Erythematosus that has a different but potentially complementary mechanism of action. The main goal of the study is to determine whether giving the two drugs together enhances the efficacy of belimumab, but it will also be important to determine whether there are any safety concerns with combining the two treatments.

At the same time, scientists continue to work on identifying drug targets, and developing and testing new treatments. A quick search of the National Institutes of Health’s register of clinical trials reveals that there are currently 79 lupus trials (including 52 interventional trials) that are actively recruiting patients in the United States. If you want to learn more, try searching Antidote, a portal for clinical trial information that aims to provide patient-friendly descriptions of clinical trials, helping connect patients with studies in which they might be eligible to participate. 

In real life, escape rooms are a fun challenge, and participants enter willingly. However, in the analogy that I’m attempting to weave here – in which the need to simultaneously solve diverse puzzles represents the challenge of identifying and treating the variety of problems underlying autoimmune disease – it would be far better if one was never locked in the room in the first place. 

This is reflected in new research that aims to identify people who are most at risk of developing lupus, in the hopes of being able to offer them a treatment that might prevent them from ever developing the disease. Researchers across multiple institutions have launched a clinical study aiming to do just that. (Barbara Schillo’s article in this newsletter dives a little deeper.) 

The field of lupus research is filled with very accomplished puzzle solvers, dedicated to attacking the problems of autoimmune disease from every angle. With your help, Lupus Link Minnesota is pleased to support today’s researchers through our research grant program, and the researchers of tomorrow through our summer fellowship program.

You too are a part of our escape room puzzle-solving team. Continue to help us unlock the door.