Message from Asthma, Allergy & Immunology Division Chief, Michael Nelson, MD, PhD
I can’t believe a year has passed since my return to the University of Virginia as Division Chief during the last academic year. In that time, every one of my expectations has been exceeded, and I couldn’t be prouder of this Division that continues to shine no matter the challenge.
Looking back, I am impressed with the resilience of our personnel in overcoming unprecedented clinic nursing and access staff turnover, space challenges, compensation, and pandemic-related barriers to our normal clinical and research activities. I am humbled to be surrounded by such a talented and productive team that is so selflessly dedicated to advancing the specialty and each other.
Highlights of the past year are many. Perhaps none more significant than the 60th Annual Swineford Meeting and celebration at Boar’s Head last month on April 8th and 9th. Course Director Dr. Thomas Platts-Mills and the planning committee outdid themselves with an incredible lineup of distinguished national and international speakers in a forum unlike any other. The Swineford meeting remains the longest-running CME program at UVA. Last Fall, the Division conducted an informative and inspiring research retreat with collaborators across the School of Medicine at Morven Farms. The event enhanced awareness of Division research excellence and has spurred new collaborations already leading to new research initiatives, funding opportunities, publications, and monthly multi-specialty research meetings. Dr. Tim Kyin, Dr. Anna Smith, and I initiated a hypersensitivity high-risk COVID-19 vaccine clinic for our community’s team members and members. This dedicated clinic was well received and deeply appreciated by the hundreds of patients that overcame their hesitancy for a vaccination with our assistance. In addition, our fellows, graduate students, and post-docs had a stellar year garnering multiple awards and high-profile clinical and scholarly accomplishments in alpha-Gal allergy, eosinophilic disorders, vaccine immune response, and asthma pathogenesis, and COVID-19 vaccine immune response.
This was also a big year for a long-overdue recognition of the Asthma, Allergy, and Immunology Division leaders. Dr. Monica Lawrence was selected as the incoming Vice-Chair of the national Allergy-Immunology Fellowship Program Directors Assembly. Dr. Larry Borish was chosen as the American College of Physicians Virginia Teacher of the Year. Dr. Judith Woodfolk and her COVID19 biorepository team were awarded the UVA Dean of the School of Medicine Team Science Award. Second-year fellow Dr. Ryan Eid was awarded 2nd place in the 2021 American College of Asthma, Allergy, and Immunology prestigious Clemons von Pirquet fellow research competition. For their scientific abstracts, Dr. Lindsey Muehling and Dr. Glenda Canderan were both honored at the 2022 American Academy of Asthma, Allergy, and Immunology meeting. Dr. Jeff Wilson and collaborators demonstrating differences in the immune response to mRNA COVID-19 vaccines have attracted national media attention with each publication.
For hails and farewells, we were saddened by the departure of Carol King, RN, who had over 35 years of dedicated service to UVA and our Northridge clinic, Julie Negri from the Borish Lab, Amani Al-Hazaymeh from the McGowan Lab, and Nathan Richards from the Platts-Mills and Wilson Labs. With every goodbye, we are most fortunate to welcome Emily Noonan to the McGowan Lab, Sam Ailsworth to the Platts-Mills and Wilson Labs, Paul Dell to the Woodfolk Lab, and Martha Joy Spano Lindsay Somerville to the Borish Lab. We are also grateful for Rebecca Wade, RN as our new Clinic Manager, assembling a stellar new team of access and nursing support after critical losses over the past year. And, as you will read in our Fellow Spotlight, we were excited to welcome baby Liam, whose mother is one of our first-year fellows, Kelly Boyd, MD.
~Michael Nelson, MD, PhD
The 60th Annual Swineford Conference Held April 2022
By Thomas Platts-Mills
The second week of April 2022 culminated with the 60th Annual Swineford Allergy Conference and a triumphant return to an in-person educational event. This is the longest-running, academic Allergy meeting in the United States for those keeping score. Our Division has held this conference as a scientific gathering dedicated to educating physicians involved in caring for patients with allergic disorders and for the scientists who work with them developing novel understanding of and treatments for allergic diseases.
Being an in-person meeting, we were very excited to welcome to the University of Virginia and Charlottesville several stars in our field as Conference Faculty. Our visitors hailed from California (Seema Aceves, MD from the University of California, San Diego), Michigan (James Baker, MD from the University of Michigan), Wisconsin (Dan Jackson, MD from the University of Wisconsin), New York (Cecilia Berin, PhD from Mount Sinai), and Maryland (Thomas Fleisher, MD from the National Institue of Health). We also hosted Dr. Stephen Durham from the National Heart and Lung Institute from the Imperial College, London. In keeping with the traditions of this meeting, there were excellent discussions on multiple topics, including different forms of immunotherapy, Eosinophilic Esophagitis, and the relevance of nanoparticles to allergic disease.
Not to be outdone by our external Conference Faculty, UVA was well represented by those giving talks which are our internal colleagues: Jonathan Hemler, MD from PEDS Pulmonary and Allergy, Alexandra Kadl, MD from Pulmonary and Critical Care Medicine, and Sean Moore, MD from PEDS Gastroenterology. In keeping with a long-standing tradition, we had thee presentations by our trainees: Ryan Eid, MD, and Jaimin Patel, DO, who are both Allergy Fellows, and Jonathan Medernach, MD, who is a PEDS resident.
We have already started to plan for next year’s edition, our 61st Swineford. Be on the lookout for the information in the Fall!
The Larry Borish, MD laboratory’s primary focus remains the role of rhinovirus in precipitating asthma exacerbations. These NIH-funded studies include a UO1 grant designed to define the role of innate immune responses, including anti-viral and T2-promoting immune responses, by infected airway epithelial cells as they might distinguish the consequences of rhinovirus (RV) infections in asthmatics and healthy control subjects. These studies are further supported by an R21 grant that investigates evidence for nascent type 2 inflammation in the lungs of pre-school children with problematic wheeze undergoing clinically-indicated bronchoscopies in whom RV infection is identified. The Borish lab recently received an R56 grant to generate preliminary data supporting the concept that RV infections produce long-term remodeling in the airway, including expanded populations of IL-25-producing chemosensory cells. In addition, for the next 2½ years, the Borish laboratory will be the co-lead sponsor of a Regeneron-funded investigator-initiated study entitled “Viral infection in asthma (VIA) Study: A randomized, placebo-controlled study to assess cellular and molecular markers related to experimental rhinovirus infection in mild asthmatics, and the effect of dupilumab in this investigational model.” The goal of this study will be to assess the molecular and cellular basis by which dupilumab prevents the development of an RV-induced asthma exacerbation. Unrelated to the RV studies, the Borish lab collaborates closely with Dr. Gerry Teague in pediatrics as co-PI for the UVA commitment to the NHLBI-funded PreCISE Asthma Network Clinical Centers. These studies will enroll severe treatment-resistant asthmatics and investigate novel therapeutics in this refractory population. We also have several investigator-initiated pharmaceutical studies. We are currently enrolling patients in a Regeneron-sponsored study to demonstrate the ability of dupilumab to attenuate staphylococcus aureus infection in chronic sinusitis and ameliorate the dysbiotic state, including with restoration of a healthier antimicrobial state. Finally, we have recently completed a GSK-sponsored study to investigate type 2 inflammation in COPD and, more specifically, the expression of IL-5 receptors on airway neutrophils.
In collaboration with Dr. Larry Borish, Dr. Monica Lawrence is working with Dr. W. Gerald Teague in Pediatrics to continue studies on severe treatment-refractory asthma in children. She also continues as head of the Rhinovirus core laboratory and is working with Dr. Borish and Dr. Judith Woodfolk in ongoing investigations of rhinovirus-induced asthma exacerbations. She and Dr. Borish have collaborated with Dr. Malpass and Dr. Barros in Pulmonary to evaluate the expression of the IL-5 receptor on lung neutrophils in patients with COPD. Along with Dr. Borish and Allergy/Immunology fellow Dr. Thomas Makin, she is also continuing to research the role of a low IgE as a sentinel biomarker for evolving humoral immunodeficiency (research sponsored by the Jeffrey Modell Foundation and CSL Behring).
Dr. McGowan’s group continues to expand their research on an emerging form of food allergy, eosinophilic esophagitis (EoE). Through her NIH/NIAID K23 Award, Dr. McGowan established the University of Virginia EoE Cohort with her collaborators, Drs. Bryan Sauer (Adult Gastroenterology) and Barrett Barnes (Pediatric Gastroenterology). This cohort longitudinally follows over 300 patients, and it was designed to examine the environmental, nutritional, and immunologic drivers of this disease. In addition, Dr. McGowan and her colleagues are investigating the mechanisms by which food drives this disease, including the role of non-IgE mediated activation of mast cells via food-derived peptides and the role of IgG4 in activating local immune cells. Dr. McGowan’s group is also interested in whether EoE is underdiagnosed in patients with allergic diseases. They are investigating this further using a novel minimally-invasive device called the Cytosponge. Finally, the University of Virginia participated in the international, multi-center Phase III trial of Dupilumab in treating Eosinophilic Esophagitis (R668-EE-1774).
The Woodfolk lab studies adaptive immunity to respiratory viruses and allergens in man and how this goes awry in patients with chronic respiratory and allergic diseases. The lab uses an inter-disciplinary approach to collect and analyze large cell datasets to gain insight into the immune response and its relation to clinical disease. Ongoing significant initiatives include: (1) Analyzing the evolution of T cell responses to SARS-CoV-2 in recovered patients to identify biomarkers of post-acute pulmonary complications; (2) Assessing the effects of type 2 cytokine blockade on the immune response to rhinovirus in patients with allergic asthma; and (3) Studying protective and pathogenic immune responses to food and inhalant allergens in human systems.
The Platts-Mills lab has a long-standing interest in understanding environmental and immunologic contributions to allergic disease. Historically, a significant focus of the lab is related to understanding how dust mite and cat allergen were causally related to asthma and respiratory allergies. More recently, the lab has been a leader in studying two unusual forms of food allergy – eosinophilic esophagitis (EoE) and the tick-acquired mammalian meat allergy (aka – the α-Gal syndrome). The recruitment of patients has facilitated these studies from the Allergy Clinics at UVA and close collaborations with several outside investigators, including the Boston-based Viva birth cohort, Phil Cooper’s studies on children in rural Ecuador, and Elizabeth Erwin’s studies on children with EoE in Columbus, OH. The lab recently published on the epidemiology of the α-Gal syndrome in the USA and about connections between helminth infections and striking rates of alpha-gal sensitization observed in rural Ecuador and Africa. A primary ongoing analysis of the Viva cohort suggests that changes in the living environment over the past 20 years may have led to decreases in asthma and changes in pollen allergy patterns. Dr. Platts-Mills is funded by an NIH R-37 Merit award for his work in asthma, EoE, and the α-Gal syndrome. He continues to serve as the Division’s most senior research mentor, fostering and supporting the professional development of independent physician-scientists and basic science investigators.
Dr. Jeffrey Wilson has a major clinical and research focus on the α-Gal syndrome. Over the past two years, has been studying antibody responses to SARS-CoV-2 in response to natural infection and vaccination. Working with Dr. Platts-Mills and colleagues, Dr. Wilson has been involved in studies to characterize the prevalence of alpha-gal sensitization in the community. He also investigates different ways that α-Gal syndrome can manifest – e.g., traditional allergic symptoms (e.g., hives or anaphylaxis), isolated abdominal pain, or tolerance of mammalian meat despite making IgE antibodies to α-Gal.
This work involves DoD-funded research collaborating with Cade Nylund, PhD at the Uniformed Services University of the Health Sciences, to assess sensitization incidence among military recruits. Dr. Wilson is also the PI of a UVA employee COVID-19 vaccine study and an IRB-approved study that will assess in vivo immunologic responses to α-Gal in patients challenged with traditional pork vs. genetically modified pork that lacks α-Gal (GalSafe pork, Revivicor Inc.). Dr. Wilson is the recipient of an AAAAI Faculty Development Award honoring his collaboration with Coleen McNamara, MD, and Angela Taylor, MD, MPH in cardiology, which studies the putative association between α-Gal sensitization and coronary artery disease. Dr. Wilson is also the recipient of the 2021 McCausland Fellowship, which supports his ongoing research interests.
The Division of Asthma, Allergy, and Immunology’s long-standing fellowship program, led by Monica Lawrence, MD (Program Director) and Anna R. Smith, MD (Associate Program Director), continues to celebrate the many achievements of our fellows-in-training. In July of 2021, we welcomed two new fellows into the program: Dr. Kelly Boyd (University of Texas Southwestern, Pediatrics) and Dr. Thomas Makin (University of Virginia, Internal Medicine). We congratulate our 2022 graduating fellows, Dr. Ryan Eid, who will be entering an academically-affiliated private practice in Boston, Massachusetts, and Dr. Jaimin Patel, who will be entering private practice in Richmond, Virginia.
We also completed a very successful virtual recruitment season and are excited to welcome two new incoming fellows in July 2022: Dr. Charlene Dunaway Altamirano (Cleveland Clinic, Internal Medicine) and Dr. Marc Breidenbaugh (University of Virginia, Pediatrics).
Our fellows have stayed very busy despite the challenges of the COVID pandemic and have continued to actively participate in research projects on alpha-gal allergy (Dr. Patel; mentors Dr. Wilson and Dr. Platts-Mills); eosinophilic esophagitis (Dr. Eid, mentor Dr. McGowan); selective IgE deficiency (Dr. Makin; mentors Dr. Borish, Dr. Lawrence and Dr. Wilson); and preschool asthma (Dr. Boyd; mentors Dr. Borish and Dr. Teague). They have presented their work at the American Academy of Asthma Allergy & Immunology (AAAAI) and American College of Asthma Allergy & Immunology (ACAAI) national meetings, as well as the recent 60th Annual Swineford Allergy Conference held on Grounds in April 2022. Dr. Eid was recognized for his outstanding meeting abstract with the Clemens von Pirquet award second place at this year’s ACAAI meeting.
This past year, Dr. Monica Lawrence was elected to serve as the Vice-Chair of the AAAAI/ACAAI Program Director’s Assembly in recognition of her leadership, dedication, and passion for medical education.