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

O'Dell, JR, Smolen, JS, Aletaha, D, Robinson, DR, and St Clair, EW. "Rheumatoid arthritis." (December 1, 2009): 1-13. (Chapter)

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St Clair, EW. "Novel targeted therapies for autoimmunity." Curr Opin Immunol 21, no. 6 (December 2009): 648-657. (Review)

PMID
19828300
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Smolen, JS, van der Heijde, DM, Aletaha, D, Xu, S, Han, J, Baker, D, and St Clair, EW. "Progression of radiographic joint damage in rheumatoid arthritis: independence of erosions and joint space narrowing." Ann Rheum Dis 68, no. 10 (October 2009): 1535-1540.

PMID
18957487
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Vastesaeger, N, Xu, S, Aletaha, D, St Clair, EW, and Smolen, JS. "A pilot risk model for the prediction of rapid radiographic progression in rheumatoid arthritis." Rheumatology (Oxford) 48, no. 9 (September 2009): 1114-1121. (Review)

PMID
19589891
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Shah, A, Diehl, LF, and St Clair, EW. "T cell large granular lymphocyte leukemia associated with rheumatoid arthritis and neutropenia." Clin Immunol 132, no. 2 (August 2009): 145-152.

PMID
19394280
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Smolen, JS, Han, C, van der Heijde, DMFM, Emery, P, Bathon, JM, Keystone, E, Maini, RN, Kalden, JR, Aletaha, D, Baker, D, Han, J, Bala, M, St Clair, EW, and Active-Controlled Study of Patients Receiving Infliximab for the Treatment of Rheumatoid Arthritis of Early Onset (ASPIRE) Study Group, . "Radiographic changes in rheumatoid arthritis patients attaining different disease activity states with methotrexate monotherapy and infliximab plus methotrexate: the impacts of remission and tumour necrosis factor blockade." Ann Rheum Dis 68, no. 6 (June 2009): 823-827.

PMID
18593759
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Finkielman, JD, Merkel, PA, Schroeder, D, Hoffman, GS, Spiera, R, St Clair, EW, Davis, JC, McCune, WJ, Lears, A, Ytterberg, SR, Hummel, AM, Viss, MA, Peikert, T, Stone, JH, Specks, U, and WGET Research Group, . "Glycosylation of proteinase 3 (PR3) is not required for its reactivity with antineutrophil cytoplasmic antibodies (ANCA) in Wegener's granulomatosis." Clin Exp Rheumatol 27, no. 1 Suppl 52 (January 2009): S45-S52.

PMID
19646346
Scholars@Duke

Finkielman, JD, Merkel, PA, Schroeder, D, Hoffman, GS, Spiera, R, Clair, EWS, Jr, JCD, McCune, WJ, Lears, A, Ytterberg, SR, Hummel, AM, Viss, MA, Peikert, T, Stone, JH, and Specks, U. "Glycosylation of proteinase 3 (PR3) is not required for its reactivity with antineutrophil cytoplasmic antibodies (ANCA) in Wegener's granulomatosis." Clinical and Experimental Rheumatology 27, no. 1 SUPPL. 52 (2009): S45-S52.

Scholars@Duke

Meyer, CG, and Clair, EWS. "Promising Biologic Agents and Small Chemical Compounds." Rheumatoid Arthritis (2009): 372-378.

Full Text

Oliver, AM, and St Clair, EW. "Rheumatoid arthritis C. treatment and assessments." (December 1, 2008): 133-141. (Chapter)

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