Eugene William St. Clair, MD

Professor of Medicine
W. Lester Brooks, Jr. Professor of Medicine
Chief, Division of Rheumatology and Immunology
Professor in Immunology
Campus mail 34229 Hosp South, Durham, NC 27710
Phone (919) 684-4499
Email address stcla003@mc.duke.edu

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

Education and Training

  • Chief Resident, Medicine, Duke University, 1984 - 1985
  • Fellow in Rheumatology, Medicine, Duke University, 1983 - 1985
  • Medical Resident, Medicine, Duke University, 1980 - 1983
  • M.D., West Virginia University, 1980

Publications

Barnett, ML, Kremer, JM, St Clair, EW, Clegg, DO, Furst, D, Weisman, M, Fletcher, MJ, Chasan-Taber, S, Finger, E, Morales, A, Le, CH, and Trentham, DE. "Treatment of rheumatoid arthritis with oral type II collagen. Results of a multicenter, double-blind, placebo-controlled trial." Arthritis and Rheumatism 41, no. 2 (February 1998): 290-297.

PMID
9485087
Full Text

Kremer, JM, Alarcón, GS, Weinblatt, ME, Kaymakcian, MV, Macaluso, M, Cannon, GW, Palmer, WR, Sundy, JS, St Clair, EW, Alexander, RW, Smith, GJ, and Axiotis, CA. "Clinical, laboratory, radiographic, and histopathologic features of methotrexate-associated lung injury in patients with rheumatoid arthritis: a multicenter study with literature review." Arthritis and Rheumatism 40, no. 10 (October 1997): 1829-1837. (Review)

PMID
9336418
Full Text

Alarcón, GS, Kremer, JM, Macaluso, M, Weinblatt, ME, Cannon, GW, Palmer, WR, St. Clair, EW, Sundy, JS, Alexander, RW, Smith, GJW, and Axiotis, CA. "Risk factors for methotrexate-induced lung injury in patients with rheumatoid arthritis: A multicenter, case-control study." Annals of Internal Medicine 127, no. 5 (September 1, 1997): 356-364.

Full Text

Alarcón, GS, Kremer, JM, Macaluso, M, Weinblatt, ME, Cannon, GW, Palmer, WR, St Clair, EW, Sundy, JS, Alexander, RW, Smith, GJ, and Axiotis, CA. "Risk factors for methotrexate-induced lung injury in patients with rheumatoid arthritis. A multicenter, case-control study. Methotrexate-Lung Study Group." Annals of Internal Medicine 127, no. 5 (September 1997): 356-364.

PMID
9273826
Full Text

Pisetsky, DS, Gilkeson, G, and St Clair, EW. "Systemic lupus erythematosus. Diagnosis and treatment." Med Clin North Am 81, no. 1 (January 1997): 113-128. (Review)

PMID
9012757
Scholars@Duke

Conlon, PJ, Fischer, CA, Levesque, MC, Smith, SR, St Clair, EW, Allen, NB, Fleming, JA, and Howell, DN. "Clinical, biochemical and pathological predictors of poor response to intravenous cyclophosphamide in patients with proliferative lupus nephritis." Clin Nephrol 46, no. 3 (September 1996): 170-175.

PMID
8879851
Scholars@Duke

St Clair, EW, Wilkinson, WE, Lang, T, Sanders, L, Misukonis, MA, Gilkeson, GS, Pisetsky, DS, Granger, DI, and Weinberg, JB. "Increased expression of blood mononuclear cell nitric oxide synthase type 2 in rheumatoid arthritis patients." The Journal of Experimental Medicine 184, no. 3 (September 1996): 1173-1178.

PMID
9064335
Full Text

Olsen, NJ, Brooks, RH, Cush, JJ, Lipsky, PE, St Clair, EW, Matteson, EL, Gold, KN, Cannon, GW, Jackson, CG, McCune, WJ, Fox, DA, Nelson, B, Lorenz, T, and Strand, V. "A double-blind, placebo-controlled study of anti-CD5 immunoconjugate in patients with rheumatoid arthritis. The Xoma RA Investigator Group." Arthritis and Rheumatism 39, no. 7 (July 1996): 1102-1108.

PMID
8670317
Full Text

St Clair, EW, and Burch, JA. "In vitro RNA selection of an autoimmune epitope on stem-loop II of U1 RNA." Clin Immunol Immunopathol 79, no. 1 (April 1996): 60-70.

PMID
8612352
Scholars@Duke

Isaacs, JD, Manna, VK, Rapson, N, Bulpitt, KJ, Hazleman, BL, Matteson, EL, St Clair, EW, Schnitzer, TJ, and Johnston, JM. "CAMPATH-1H in rheumatoid arthritis--an intravenous dose-ranging study." Br J Rheumatol 35, no. 3 (March 1996): 231-240.

PMID
8620297
Scholars@Duke

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