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

Silva, F, Seo, P, Schroeder, DR, Stone, JH, Merkel, PA, Hoffman, GS, Spiera, R, Sebastian, JK, Davis, JC, St Clair, EW, Allen, NB, McCune, WJ, Ytterberg, SR, Specks, U, and Wegener's Granulomatosis Etanercept Trial Research Group, . "Solid malignancies among etanercept-treated patients with granulomatosis with polyangiitis (Wegener's): long-term followup of a multicenter longitudinal cohort." Arthritis Rheum 63, no. 8 (August 2011): 2495-2503.

PMID
21484770
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Tomasson, G, Lavalley, M, Tanriverdi, K, Finkielman, JD, Davis, JC, Hoffman, GS, McCune, WJ, St Clair, EW, Specks, U, Spiera, R, Stone, JH, Freedman, JE, Merkel, PA, and Wegener's Granulomatosis Etanercept Trial (WGET) Research Group, . "Relationship between markers of platelet activation and inflammation with disease activity in Wegener's granulomatosis." J Rheumatol 38, no. 6 (June 2011): 1048-1054.

PMID
21411717
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Nepom, GT, St Clair, EW, and Turka, LA. "Challenges in the pursuit of immune tolerance." Immunol Rev 241, no. 1 (May 2011): 49-62. (Review)

PMID
21488889
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Suppiah, R, Judge, A, Batra, R, Flossmann, O, Harper, L, Höglund, P, Javaid, MK, Jayne, D, Mukhtyar, C, Westman, K, Davis, JC, Hoffman, GS, McCune, WJ, Merkel, PA, St Clair, EW, Seo, P, Spiera, R, Stone, JH, and Luqmani, R. "A model to predict cardiovascular events in patients with newly diagnosed Wegener's granulomatosis and microscopic polyangiitis." Arthritis Care Res (Hoboken) 63, no. 4 (April 2011): 588-596.

PMID
21452269
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Iwata, Y, Matsushita, T, Horikawa, M, Dilillo, DJ, Yanaba, K, Venturi, GM, Szabolcs, PM, Bernstein, SH, Magro, CM, Williams, AD, Hall, RP, St Clair, EW, and Tedder, TF. "Characterization of a rare IL-10-competent B-cell subset in humans that parallels mouse regulatory B10 cells." Blood 117, no. 2 (January 13, 2011): 530-541.

PMID
20962324
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Specks, U, Merkel, PA, Hoffman, GS, Langford, CA, Spiera, R, Seo, P, Kallenberg, CGM, Clair, EWS, Ding, L, Webber, L, Mokhtarani, M, Tchao, NK, Sayre, P, Seyfert-Margolis, V, Ikle, D, Brunetta, PP, Zhang, D, Sejismundo, L, Mueller, M, and Stone, JH. "Design of the Rituximab in ANCA-Associated Vasculitis (RAVE) Trial." Open Arthritis Journal 4, no. 1 (2011): 1-18.

Scholars@Duke

Mahr, AD, Edberg, JC, Stone, JH, Hoffman, GS, St Clair, EW, Specks, U, Dellaripa, PF, Seo, P, Spiera, RF, Rouhani, FN, Brantly, ML, and Merkel, PA. "Alpha₁-antitrypsin deficiency-related alleles Z and S and the risk of Wegener's granulomatosis." Arthritis Rheum 62, no. 12 (December 2010): 3760-3767.

PMID
20827781
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Desjardins, C, St Clair, EW, and Ehrenberg, RG. "Analysis of the workforce and workplace for rheumatology and the research activities of rheumatologists early in their careers." Arthritis Rheum 62, no. 12 (December 2010): 3528-3536.

PMID
20737466
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Bluestone, JA, Auchincloss, H, Nepom, GT, Rotrosen, D, St Clair, EW, and Turka, LA. "The Immune Tolerance Network at 10 years: tolerance research at the bedside." Nat Rev Immunol 10, no. 11 (November 2010): 797-803. (Review)

PMID
20972473
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Stone, JH, Merkel, PA, Spiera, R, Seo, P, Langford, CA, Hoffman, GS, Kallenberg, CGM, St Clair, EW, Turkiewicz, A, Tchao, NK, Webber, L, Ding, L, Sejismundo, LP, Mieras, K, Weitzenkamp, D, Ikle, D, Seyfert-Margolis, V, Mueller, M, Brunetta, P, Allen, NB, Fervenza, FC, Geetha, D, Keogh, KA, Kissin, EY, Monach, PA, Peikert, T, Stegeman, C, Ytterberg, SR, Specks, U, and RAVE-ITN Research Group, . "Rituximab versus cyclophosphamide for ANCA-associated vasculitis." N Engl J Med 363, no. 3 (July 15, 2010): 221-232.

PMID
20647199
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