Joan Von Feldt, MD

University of Pennsylvania, Philadelphia, PA

Clinical Trials Initiative Grant
2002 Biomarkers, Cardiovascular System, Human Lupus Biology

Joan Von Feldt, MDReducing the risk of heart disease is crucial but challenging in people with lupus, not only because the drugs are expensive and have side effects, but because it is difficult to identify who is at risk for developing dangerous deposits of hardened plaques in the coronary arteries.

A non-invasive method, electron beam computed tomography (EBCT), detects plaques on the walls of arteries of the heart by measuring calcium deposits. With her Clinical Trials Initiative Grant from the LRI, Dr. Von Feldt confirmed that EBCT technology is effective in screening lupus patients to determine the presence of atherosclerotic plaques, with one-third of the 150 participants with lupus showing abnormal coronary artery calcification compared to less than 10 percent in age-, gender-, and race-matched controls.

EBCT offers a chance to intervene early, and to reduce treatment testing time, from years to months.

Also notable: in those with lupus, homocysteine was an important marker of atherosclerosis.“We identified that a simple biomarker—homocysteine [measured through blood tests]—could be used as a screening tool in SLE patients to identify patients with subclinical atherosclerosis and at risk of cardiovascular events,” reported Dr. Von Feldt. “We also determined that genetic factors in the homocysteine pathway were not related to high homocysteine levels in patients with SLE and subclinical atherosclerosis.”

“We are still active in SLE research,” reported Dr. Von Feldt in 2010. “We have looked/are looking at insulin resistance in SLE in our original cohort, and more recently are looking at endothelial dysfunction in SLE as a marker of future cardiovascular disease.”

Select publications:

Homocysteine levels and disease duration independently correlate with coronary artery calcification in patients with systemic lupus erythematosus. Von Feldt JM, Scalzi LV, Cucchiara AJ, Morthala S, Kealey C, Flagg SD, Genin A, Van Dyke AL, Nackos E, Chander A, Gehrie E, Cron RQ, Whitehead AS. Arthritis Rheum. 2006 Jul;54(7):2220-7.

Monocyte Chemoattract Protein-1; Plasma Concentrations and the A(-2518)G Promoter Polymorphism of its Gene in Systemic Lupus Erythematosus. Brown NS, Nackos E, Morthala S, Jensen LE, Whitehead AS, Von Feldt JM. J Rheumatol 2007 34: 4.

Neither cell surface nor soluable CD154 levels are associated with coronary artery disease in systemic lupus erythematosus. Von Feldt JM, Latif S, Genin A, Cron RQ. J Rheumatol. 2008 35(2): 359-360.

Functional polymorphisms in folate metabolizing enzymes in relation to homocysteine concentrations in systemic lupus erythematosus patients. Summers CM, Cucchiara AJ, Nackos E, Hammons AL, Mohr E, Whitehead AS, Von Feldt JM. J Rheumatol 2008. 35(11): 2179-86.

Resistin Levels in Lupus and Associations with Disease-specific Measures, Insulin Resistance, and Coronary Calcification. Baker JF, Morales M, Qatanani M, Cucchiara A, Nackos E, Lazar MA, Teff K, Von Feldt JM. J Rheumatol. 2011 Sep 1. [Epub ahead of print]

Rev. September 2011