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

Miloslavsky, EM, Specks, U, Merkel, PA, Seo, P, Spiera, R, Langford, CA, Hoffman, GS, Kallenberg, CGM, St Clair, EW, Tchao, NK, Viviano, L, Ding, L, Sejismundo, LP, Mieras, K, Iklé, D, Jepson, B, Mueller, M, Brunetta, P, Allen, NB, Fervenza, FC, Geetha, D, Keogh, K, Kissin, EY, Monach, PA, Peikert, T, Stegeman, C, Ytterberg, SR, Stone, JH, and Rituximab in ANCA-Associated Vasculitis-Immune Tolerance Network Research Group, . "Clinical outcomes of remission induction therapy for severe antineutrophil cytoplasmic antibody-associated vasculitis." Arthritis Rheum 65, no. 9 (September 2013): 2441-2449.

PMID
23754238
Full Text

Specks, U, Merkel, PA, Seo, P, Spiera, R, Langford, CA, Hoffman, GS, Kallenberg, CGM, St Clair, EW, Fessler, BJ, Ding, L, Viviano, L, Tchao, NK, Phippard, DJ, Asare, AL, Lim, N, Ikle, D, Jepson, B, Brunetta, P, Allen, NB, Fervenza, FC, Geetha, D, Keogh, K, Kissin, EY, Monach, PA, Peikert, T, Stegeman, C, Ytterberg, SR, Mueller, M, Sejismundo, LP, Mieras, K, Stone, JH, and RAVE-ITN Research Group, . "Efficacy of remission-induction regimens for ANCA-associated vasculitis." The New England Journal of Medicine 369, no. 5 (August 2013): 417-427.

PMID
23902481
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Monach, PA, Warner, RL, Tomasson, G, Specks, U, Stone, JH, Ding, L, Fervenza, FC, Fessler, BJ, Hoffman, GS, Iklé, D, Kallenberg, CGM, Krischer, J, Langford, CA, Mueller, M, Seo, P, St Clair, EW, Spiera, R, Tchao, N, Ytterberg, SR, Johnson, KJ, and Merkel, PA. "Serum proteins reflecting inflammation, injury and repair as biomarkers of disease activity in ANCA-associated vasculitis." Ann Rheum Dis 72, no. 8 (August 2013): 1342-1350.

PMID
22975753
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Xie, G, Roshandel, D, Sherva, R, Monach, PA, Lu, EY, Kung, T, Carrington, K, Zhang, SS, Pulit, SL, Ripke, S, Carette, S, Dellaripa, PF, Edberg, JC, Hoffman, GS, Khalidi, N, Langford, CA, Mahr, AD, St Clair, EW, Seo, P, Specks, U, Spiera, RF, Stone, JH, Ytterberg, SR, Raychaudhuri, S, de Bakker, PIW, Farrer, LA, Amos, CI, Merkel, PA, and Siminovitch, KA. "Association of Granulomatosis With Polyangiitis (Wegener's) With HLA-DPB1*04 and SEMA6A Gene Variants: Evidence Grom Genome-Wide Analysis." ARTHRITIS AND RHEUMATISM 65, no. 9 (August 2013): 2457-2468.

PMID
23740775
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St Clair, EW, Levesque, MC, Prak, ETL, Vivino, FB, Alappatt, CJ, Spychala, ME, Wedgwood, J, McNamara, J, Moser Sivils, KL, Fisher, L, Cohen, P, and Autoimmunity Centers of Excellence, . "Rituximab therapy for primary Sjögren's syndrome: an open-label clinical trial and mechanistic analysis." Arthritis Rheum 65, no. 4 (April 2013): 1097-1106.

PMID
23334994
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Hung, EW, Mayes, MD, Sharif, R, Assassi, S, Machicao, VI, Hosing, C, St Clair, EW, Furst, DE, Khanna, D, Forman, S, Mineishi, S, Phillips, K, Seibold, JR, Bredeson, C, Csuka, ME, Nash, RA, Wener, MH, Simms, R, Ballen, K, Leclercq, S, Storek, J, Goldmuntz, E, Welch, B, Keyes-Elstein, L, Castina, S, Crofford, LJ, Mcsweeney, P, and Sullivan, KM. "Gastric antral vascular ectasia and its clinical correlates in patients with early diffuse systemic sclerosis in the SCOT trial." J Rheumatol 40, no. 4 (April 2013): 455-460.

PMID
23418384
Full Text

Kaul, MS, Rao, SV, Shaw, LK, Honeycutt, E, Ardoin, SP, and St Clair, EW. "Association of systemic lupus erythematosus with angiographically defined coronary artery disease: a retrospective cohort study." Arthritis Care Res (Hoboken) 65, no. 2 (February 2013): 266-273.

PMID
22745037
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Monach, PA, Warner, RL, Tomasson, G, Specks, U, Stone, JH, Ding, L, Fervenza, FC, Fessler, BJ, Hoffman, GS, Iklé, D, Kallenberg, CGM, Krischer, J, Langford, CA, Mueller, M, Seo, P, Clair, EWS, Spiera, R, Tchao, N, Ytterberg, SR, Johnson, KJ, and Merkel, PA. "Serum proteins reflecting inflammation, injury and repair as biomarkers of disease activity in ANCA-associated vasculitis." Annals of the Rheumatic Diseases 72, no. 8 (2013): 1342-1350.

Full Text

Chung, SA, Xie, G, Roshandel, D, Sherva, R, Edberg, JC, Kravitz, M, Dellaripa, PF, Hoffman, GS, Mahr, AD, Seo, P, Specks, U, Spiera, RF, St Clair, EW, Stone, JH, Plenge, RM, Siminovitch, KA, Merkel, PA, and Monach, PA. "Meta-analysis of genetic polymorphisms in granulomatosis with polyangiitis (Wegener's) reveals shared susceptibility loci with rheumatoid arthritis." Arthritis Rheum 64, no. 10 (October 2012): 3463-3471.

PMID
22508400
Full Text

Moreland, LW, O'Dell, JR, Paulus, HE, Curtis, JR, Bathon, JM, St Clair, EW, Bridges, SL, Zhang, J, McVie, T, Howard, G, van der Heijde, D, Cofield, SS, and TEAR Investigators, . "A randomized comparative effectiveness study of oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis: the treatment of Early Aggressive Rheumatoid Arthritis Trial." Arthritis Rheum 64, no. 9 (September 2012): 2824-2835.

PMID
22508468
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