This is a reality for millions of Americans who live with psoriatic arthritis (PsA), an incurable autoimmune disease in which the immune system mistakenly attacks a person’s skin and joints.
And while there are several effective medications on the market to help manage the disease, not all patients respond to treatment in the same way, leaving some looking for other options that would enable them to do everyday activities with less pain.
Now, there is an additional treatment option: The U.S. Food & Drug Administration just approved a new indication for a treatment for adults with active PsA.
For Daniel Cua, Ph.D., Vice President, Immunology, Pathway Biology Lead, Janssen Pharmaceutical Companies of Johnson & Johnson, this approval is a culmination of years of groundbreaking research he’s been conducting to better understand how the immune system works and how to help combat the damaging inflammation patients with autoimmune diseases like active PsA experience.
We asked Dr. Cua to discuss the integral role he’s played in helping advance treatments for those battling active PsA, what makes him so passionate about his work and what it feels like to see the research he started 20 years ago come to fruition.
Q:
What are some of the challenges of managing psoriatic arthritis?
A:
For one, it’s a multifaceted disease. Since the skin and the joints are both involved, we need different groups of doctors—dermatologists and rheumatologists—to co-manage patients, so there needs to be communication between the two, which can be a challenge.
In the last decade or so there have been several biologic therapies approved for the treatment of active PsA, which target specific parts of the immune system that trigger inflammation—these approvals are providing treatment options to physicians in these groups about how to treat the condition.
Not so long ago, in the 1990s, we were still learning how the immune system itself works. We were still gathering information, like that there are different types of white blood cells that play specific roles in fighting infection and repairing damaged tissues.
Today we know a lot more about how the symptoms of PsA respond to biologics. And we now understand more about what is driving inflammation in the joints.
My team discovered a type of cytokine that turned out to be a driver of autoimmune inflammation.
Q:
You helped lay the groundwork for this approval many years ago. What discoveries did you make that led to this?
A:
It began in the early 2000s. At that time, I was working at a small biotech firm that had identified several cytokines, which are proteins that play a role in activating inflammation in the body. We wanted to identify molecules that targeted them, with the hope that they could potentially work to modify the body’s immune response.
My team then discovered a type of cytokine that turned out to be a driver of autoimmune inflammation.
When we conducted experiments in which we eliminated this type of cytokine in mice, we found that they became resistant to autoimmune disease models we tested on them. Of course, there are many steps between applying great findings in mice to humans, but this was very exciting, because it raised the possibility that we could develop ways to pharmacologically impact different autoimmune diseases.
This research enabled companies to begin developing biologic medications that blocked this cytokine.
Q:
And now, years later, you’re at Janssen, working on a treatment that wouldn’t exist without your research. Is this a thrilling moment in your career?
A:
To take research I conducted back then and apply it in today’s clinical studies … I can’t even explain how cool that is.
When Janssen approached me last spring about applying for a position here, they were actively hiring for their immunology therapy area and wanted to put together the best team they could to further drive their science.
It’s so energizing to be part of this wonderful group and I’m having a lot of fun.
We have a team that is working on identifying biomarkers for PsA and similar conditions that can be used to help doctors predict patients’ response to particular types of medication.
Q:
You’re a bit of a celebrity in the world of immunology, correct?
A:
I don’t know that I would say “celebrity!” Years ago, I was referred to as “the father” of the cytokine pathway that I discovered by a professor at Harvard, although he joked that I was too young to actually be a father. Needless to say I’m not too young now!
My papers are also among some of the most cited—some of the early ones I published have been cited over 4,000 times. Thankfully, immunologists around the world have really embraced my team’s ideas.
But I honestly never expected to have this kind of impact in my field. I feel very privileged and lucky.
Q:
What’s next in terms of your team’s research?
A:
We’re exploring every possible way of treating several types of autoimmune diseases. We also have a team that is working on identifying biomarkers—genes, proteins and other indicators of a disease—for PsA and similar conditions that can be used to help doctors predict patients’ response to particular types of medication.
When you understand what patients endure, you really appreciate how even the little things that you do as a researcher might make a difference.
It goes back to grad school, when we students would have meetings with patients and patient advocates who had PsA and other types of autoimmune conditions. They would talk to us about how their symptoms felt and what it was like living with these diseases, which in many cases are very challenging.
There was one young man with PsA who struggled to do so many simple things we take for granted, like tie his shoes and button a shirt. On top of that, he had huge psoriatic skin lesions that he felt he needed to cover every time he left the house.
You’re forever changed from these experiences. You become determined to never give up in your pursuit of new ways to help treat these conditions.
