In Conversation: Dr. Kari Nadeau
Since her fellowship in 2003, Dr. Kari Nadeau has worked tirelessly on finding a cure for allergies. She was the driving force behind the formation of an allergy center at Stanford University. Her mission and vision was further strengthened in December 2014 by the generous contribution of $24 million by philanthropist Sean N. Parker. Recently, the Center was incorporated into the Division of Pulmonary and Critical Care Medicine (PCCM). We recently sat down with Dr. Nadeau, now the director of the Sean N. Parker Center for Allergy and Asthma Research at Stanford University, to speak about the mission of the Center and the tremendous progress that has been made in recent years.
In Summer 2015, the Sean N. Parker Center for Allergy and Asthma Research joined PCCM. What changes can we expect from this partnership?
Dr. Nadeau: We are extremely excited to have the Center incorporated within PCCM, which is led by Division Chief Dr. Mark Nicolls. As part of PCCM, the Center now embraces asthma research in tandem with allergy research. The Center is now poised to become a center of excellence in asthma and allergic disease.
The Center has made great strides in food allergy research. Why not just focus on food allergies? Why incorporate asthma into the Center’s research focus?
Dr. Nadeau: The Center developed the first rapid multi-allergen immunotherapy protocol, making Stanford the first to treat patients with multiple food allergies. This is now in active Phase 2 trials. Under this protocol, patients are pretreated with omalizumab, a drug first approved by the FDA in 2003 for the treatment of severe, persistent allergic asthma. Our Center found that pretreating patients with omalizumab makes it possible to quickly escalate the dose of multiple food allergens and desensitize patients faster than using conventional immunotherapy. In both food allergies and allergic asthma — seemingly different diseases affecting different organ systems — excessive amount of an antibody, called IgE, is produced. Omalizumab is an anti-IgE molecule, which blocks the action of IgE. Similar increases in IgE are also observed in hay fever and eczema. It is important to recognize that research on one disease may further our understanding of other allergic diseases or asthma. At our Center, we found that a drug developed for asthma is effective as pretreatment for immunotherapy in patients with food allergies. We hope that by creating collaborations with experts in multiple disciplines from national and international institutions, while closely working with world–renowned experts on lung disease within PCCM, we can accelerate our understanding of allergic diseases and asthma.
What is the overall mission of the Center? What steps are being taken to support this?
Dr. Nadeau: The mission of the Center is to determine the causes and cures for asthma and allergy and to offer personalized care. Our goal is to transform the knowledge we obtain through robust scientific research into action. Collaborations with scientists and community in an interdependent and integrated manner is key to accelerating the science behind a personalized cure for patients with allergies and asthma. As mentioned earlier, allergies can affect many organ systems, and patients may need to be seen by different specialists. We are planning to have this occur in an integrated and comprehensive manner through ambulatory clinics. We also need to make certain that the findings of our research are disseminated through education and training and that the findings from other clinics and centers are collected through digital databases and comprehensively analyzed. Community support is also vitally important. To achieve our mission, the Center has combined six integrated and interdependent disciplines into its fold: Research Science, Inpatient Research, Ambulatory Wellness Research, Training and Education, Community Outreach and Community Building, and Computation Research. The incorporation of a broad range of disciplines within the Center permits a structured means of transforming knowledge gained from research into personalized comprehensive care for patients in centers throughout the United States and worldwide.
To date, what are some of the key accomplishments of the Center?
Dr. Nadeau: As mentioned earlier, we developed the first rapid multi-allergen immunotherapy protocol, making Stanford the first to treat patients with multiple food allergies. Having completed Phase I trials, we are now conducting Phase 2 trials in 7 satellite centers (Chicago, Cincinnati, Los Angeles, New York, Philadelphia, Seattle, and Stanford) across the United States. We developed a new way to predict severity of reaction to food allergens and to test a person’s DNA to determine if they are responding to immunotherapy. We developed a blood test that can provide 95% accuracy in simultaneously diagnosing allergies to multiple allergens in patients of all ages, even infants. These methods are being further investigated. We patented a new infant/toddler formula to prevent food allergies. We have treated more than 700 patients and screened more than 1500 patients for clinical trials in allergy. We have also shared clinical protocols and trained more than 60 health care professionals from around the world on how to run food allergy clinical trials and treat patients; helped pass legislation in California for injectable epinephrine to be provided in schools; presented at the United Nations and the National Academy of Sciences as well as numerous other national and international meetings to teach about food allergies and immune monitoring; published more than 115 articles in peer-reviewed journals; identified new potential molecular targets that may help develop therapies for curing allergies; and created more than 60 jobs at Stanford and across the United States.
It is important to recognize that our success has been largely dependent on the deep philanthropic support that the Center has received. Ninety-four percent of our funding comes from private philanthropy. We actively engage and update the community on current research at our Center. We listen to the needs of the community and have expanded care to the California Pacific Medical Center in San Francisco. For those interested in comprehensive care without being a participant in a clinical trial, we now provide adult and pediatric allergy and asthma care at Stanford. We have added a therapist to our staff to provide ongoing psychological support for patients and families in our clinical studies. We are the only Center in the world that is working in allergy and asthma to have an active Community Council and National Advisory Board. The support of the community is vital for propelling the Center forward to achieve its goals. It is the collective will of scientists, administrators, clinicians, and the community that can propel the Center towards finding a cure for allergies and asthma.
What is your vision for the Center for the next 2-10 years?
Dr. Nadeau: Over the last few years, we’ve gained some significant insights into the molecular mechanisms underlying allergy and asthma. These discoveries need to be translated into use in patients and laboratories. The methods we have discovered need to be tested rigorously and thoroughly to make them robust so they can be used by laboratories across the globe. We need to push the boundaries of our knowledge. Within 2 years, our goal is to have strong methods that can accurately distinguish those patients who will achieve long-term desensitization with immunotherapy from those who will not. This will require a follow-up of patients after discontinuation of therapy to identify patients who do and do not develop long-term desensitization and investigate molecular differences between the two groups. We plan to continue development and testing of more accurate and sensitive markers that can help diagnose allergies and predict those who are likely to have severe reactions to allergens. We are hoping to start clinical studies to determine the safety and effectiveness of our patented infant/toddler supplement for preventing allergies. Another priority is to make sure that our treatments are accessible by all and that patients can obtain reimbursements from insurance companies for the use of omalizumab as pretreatment before start of immunotherapy. Beginning trials for patients with eosinophilic esophagitis, an emerging allergic/immune condition, is also part of our vision. Our infrastructure is also an important piece of our vision. Our current lab space is slated to be torn down in 2016, so plans for new lab space is in the works. And we are working towards establishing and sustaining a data sharing system between all the sites under the Center umbrella. Within 10 years, we hope to make transformative changes in the field of allergy by uncovering its root causes and developing a long-lasting cure.
Interview by Vanitha Sampath
Vanitha Sampath received her PhD in Nutrition from the University of California at Davis. At the Sean N. Parker Center for Allergy and Asthma Research, as a medical writer and content manager, she enjoys being in the midst of groundbreaking research in asthma and allergy and is committed to communicating the scientific advances of the Center and spreading awareness of its mission and vision.