We held our first symposium, Autoimmune Encephalopathy of Infectious Etiology: Assessing the Current State of Knowledge, Clinical Treatments and Research Directions, on June 14 and 15, 2019 at Georgetown University in Washington D.C. The program was jointly sponsored by The Center for Innovation and Leadership in Education (CENTILE) at Georgetown University, The Foundation of Total Recovery, and The Kaplan Center for Integrative Medicine.
Attendees at our one-and-a-half-day symposium, included invited guests from multiple medical disciplines including, Pediatricians, Immunologists, Neurologists, Pain Specialists, Family Physicians, and Lyme Specialists. The event was closed to the public and media in order attempt to create a collegial atmosphere conducive to open and honest discussions about the state of the disease and the controversy surrounding the diagnosis and treatment of “Autoimmune Encephalopathy of Infectious Etiologies” as a unique entity.
The symposium was held at the Georgetown University Hotel and Conference Center. Georgetown University Hotel and Conference Center.
In the United States, over 70 million Americans suffer with debilitating diseases for which the diagnosis and treatment are highly controversial and/or largely ineffective (CDC Report, 2016). These diseases are generally classified under the broad term of “Chronic Pain.” Increasing evidence suggests that the disease process in a number of controversial conditions like PANDAS/PANS, POTS, Post Lyme Syndrome, ME/CFS, as well as in more accepted chronic pain diagnoses such as Fibromyalgia, CRPS, and psychiatric conditions are all driven by immunologic mechanisms. Indeed, it is common for many of these diseases to be comorbid, further suggesting a common pathophysiologic process. There is early evidence of involvement of both the innate as well as the acquired immune systems in all of these conditions. There is also increasing correlative, if not causative, evidence of infectious agents as the initiators of immunologic processes that play a role in these diseases. Two of the proposed mechanisms by which infectious agents may cause autoimmunity include epigenetic mechanisms in the case of EBV and molecular mimicry in conditions such as Strep bacteria and Lyme Disease.
For clinicians, the challenge is trying to find solutions for patients suffering with an array of symptoms for which the diagnosis and treatments are generally controversial and/or ineffective, and treatments that might prove useful, are denied to many patients because of economic constraints.
Too often, clinicians and researchers are siloed in their approach to these diseases. Clinicians, especially in academia, may only see patients who have been so pre-selected with conditions such as ME/CFS, that they do not see patients with comorbidities such as Fibromyalgia or Depression. Consequently, the correlations among these disease conditions may be missed. While pediatricians are beginning to accept the diagnosis of PANDAS, other infections such as EBV and Lyme as etiologic agents of the condition called PANS, remain highly controversial. According to the NIH, PANDAS rarely occurs in children older than 12. Is this in fact true, or does the presentation of the disease differ as the brain matures?
- What is known of the role of the innate and acquired immune system in POTS, PANDAS/PANS, and chronic pain conditions such as Fibromyalgia, CRPS, ME/CFS, Chronic/Post Lyme Syndrome, and Psychiatric illness (Mono and Bipolar depression)?
- Is there a legitimate argument for an immune-mediated pathophysiology for some or all of these conditions? If so, what are the possible mechanisms through which the immune system is activated?
- What are the known comorbidities of these conditions and their rates of occurrence?
- Are there subpopulations within these various diagnostic groups, where for some patients, the autoimmune process is the pathophysiology of the disease, but for others, it is not?
- In the case of Lyme Disease, there is question about when we should consider Lyme “cured”? When can treatment for the primary disease end, and treatment focus on the immune issues, or must the two be addressed concurrently. These same questions apply to the PANDAS/PANS population and possibly to many of these conditions. (role for T&A)
- How do you diagnose Autoimmune Encephalopathy? Clinical S/S. What tests might be helpful?
- What treatments have been used to treat Autoimmune Encephalopathies? What is the available evidence of what has worked and not worked and in what conditions? (IgG, plasmapheresis, Rituxan)
- What new ways might we consider in studying these populations?
- Is there a role for an Omics approach to research in this area?
SYMPOSIUM ADVISORY COMMITTEE
Program Chair: Dr. Gary Kaplan D.O., DABFM, DABPM, FAAMA
President of the Foundation for Total Recovery. Founder and Medical Director of the Kaplan Center for Integrative Medicine. Author of <u>Total Recovery: A Revolutionary New Approach to Breaking the Cycle of Pain and Depression</u> (Rodale, 2014).
A Clinical Associate Professor in the Department of Community and Family Medicine at Georgetown University School of Medicine, Dr. Kaplan is one of only 19 physicians in the country to be board-certified in both Family Medicine and Pain Medicine. Also board-certified in Medical Acupuncture, he has studied and practiced Osteopathic Manipulative Medicine, Emergency Medicine, and Interventional Medicine, including Prolotherapy.
In response to growing numbers of patients presenting with heavy metal toxicity, Dr. Kaplan received certification in the science and practice of chelation therapy from The American College for Advancement in Medicine (ACAM). In 2013, Dr. Kaplan was appointed by U.S. Secretary of Health and Human Services (HHS), Kathleen Sebelius, to the Chronic Fatigue Syndrome Advisory Committee (CFSAC), where he served until 2017.
Co-Chair: Aviad Haramati, Ph.D.
Professor of Integrative Physiology of the Department of Biochemistry, Molecular & Cellular Biology and the Department of Medicine (Nephrology) at Georgetown University School of Medicine. A graduate of Brooklyn College, he received a Ph.D. in Physiology (University of Cincinnati) and came to Georgetown in 1985 after spending five years at Mayo Clinic. For over 25 years, Dr. Haramati’s research focus was on regulation of kidney and electrolyte physiology during growth and in states such as heart failure.
For the past decade, his activities have centered on medical education and rethinking how health professionals are trained. In April 2013, he was named the Inaugural Director of the Center for Innovation and Leadership in Education (CENTILE) at Georgetown University Medical Center (GUMC). Dr. Haramati led a broad NIH-funded educational initiative aimed at incorporating complementary, alternative (CAM) and integrative medicine into the medical curriculum at Georgetown, and currently co-directs the Physiology-CAM graduate program.
Robert C. Bransfield, M.D., DLFAPA
Clinical Associate Professor Robert Wood Johnson UMDNJ Medical School and President International Lyme and Associated Diseases Educational Foundation. Board certified by the American Board of Psychiatry and Neurology in Psychiatry, is certified in Clinical Psychopharmacology by the American Society of Clinical Psychopharmacology and is Distinguished Life Fellow of the American Psychiatric Association.
Dr. Bransfield’s primary activity is an office based private practice of psychiatry. In addition, Dr. Bransfield is the Associate Director of Psychiatry and Chairman of Psychiatric Quality Assurance at Riverview Medical Center in Red Bank, NJ. He has served as the Past Immediate President of the International Lyme and Associated Diseases Society, and Immediate President of the New Jersey Psychiatric Association. He has held a number of administrative positions for various organizations involved with a number of health, mental health and community related activities.
Michael D Lumpkin, Ph.D.
Dr. Lumpkin is a member of the Georgetown School of Medicine faculty. Dr. Lumpkin’s physiology laboratory primarily conducts studies examining the regulatory relationships between the brain, endocrine glands, and the immune cells of the body. Lumpkin’s research examines how stress or stressors such as infectious agents (HIV), neuropeptides, stress hormones, and emotional trauma disrupt the brain hormone systems that govern sexuality, growth, metabolism, and immunity, thereby causing chronic disease. Specifically, his research has revealed why stress and HIV infection cause failures of growth, puberty, and growth hormone production in pediatric AIDS patients, body wasting and sexual dysfunction in adult AIDS patients, and exacerbation of immune systems failure in HIV/AIDS.
He has extended these scientific investigations into understanding how certain complementary medications and mind-body techniques (relaxation/biofeedback) reduce stress and improve the hormonal and immune status of the body. Lumpkin also discovered and patented the use of a peptide hormone receptor binding compound to block the damaging effects of the HIV/AIDS virus on nerve cells in the hypothalamus of the brain and on cells of the pituitary gland, thereby restoring normal brain hormone function that leads to improvements in chronic illnesses. Dr. Lumpkin teaches both medical students and lay audiences about all aspects of neuroendicronology, neuroimmunology, stress and their associated disease states.
Joseph A. Bellanti, M.D.
Soon after arriving at Georgetown in 1963, Dr. Bellanti realized that his goal of generating new knowledge in immunology and translating it to clinical use would require adopting a multidisciplinary, translational approach to immunology that would involve a horizontal matrix including both basic and clinical investigators, allied health professionals, statisticians, and health educators and the public. Accordingly, in 1975 he established and became the Director of the International Center for Interdisciplinary Studies of Immunology at Georgetown University Medical Center and later Director of the Division of Allergy-Immunology, Department of Pediatrics and the Division of Virology and Immunology in the Department of Laboratory Medicine of Georgetown University Hospital.
Dr. Bellanti has focused a major investigative effort on antimicrobial research, evaluation of new vaccine strategies and developmental immunology. With other investigators, he has studied antibody and phagocytic cell function in the newborn human and in experimental model systems. He and his colleagues described the antiviral activity of the secretory IgA system in respiratory secretions and later cellular responses to viral infections following immunization or natural infection. Dr. Bellanti’s academic career has been nurtured by his previous research that has focused on the immunopathogenesis of infectious diseases, and the allergic and autoimmune disorders. His experience as a GUMC clinical investigator was established by a track record of successfully directing major R01, Center and Program Project awards as well as training grants. In addition to teaching medical students and residents, he directed a postgraduate training program in developmental immunology from 1968-1996 and a clinical residency program in allergy and immunology from 1978 -1992. The ICISI has trained over 300 postdoctoral candidates in basic and clinical immunology who come to the Center from the US as well as from countries throughout the world. Dr. Bellanti draws upon his pioneering experience as an established clinical investigator in the field of translational research in immunology.
Hakima Amri, Ph.D.
A Professor in the Department of Biochemistry and Cellular and Molecular Biology and the Division of Integrative Physiology at Georgetown University School of Medicine, Dr. Amri holds a master and doctoral degree in reproductive physiology and steroid biochemistry from Pierre and Marie Curie University, Paris, France. As the co-founder of the Comprehensive and Alternative Medicine (CAM) educational initiative at Georgetown’s School of Medicine, Dr. Amri has led the CAM graduate program since its launch in 2003. Her line of research is the introduction of a novel, systems biology-based paradigm to cancer diagnosis, prognosis, treatment assessment, and biomarkers discovery using genomics, proteomics, and metabolomics data and parsimony phylogenetics.
Dr. Amri’s research has attracted funding from both NIH and the private sector. She has published a significant number of scientific papers, reviews, and book chapters. Her her latest publication is a book on Greco-Arabic medicine, linking 21st century biomedicine to Hippocrates and Avicenna.
Charles Ray Jones, M.D.
Dr. Jones has been practicing medicine for more than 40 years and has treated over 15,000 children and adolescents with Lyme Disease and other tick-borne diseases. He is the world’s leading pediatric specialist on Lyme Disease. Dr. Jones graduated from New York Medical College in 1962. He interned in pediatrics at St. Luke’s Medical Center in Manhattan, where he served as Chief Resident. He went on to become attending physician at Memorial Sloan-Kettering Cancer Center. Dr. Jones moved to Connecticut to practice pediatrics in the late 1960’s. Within a few months of arriving, he noticed that clusters of patients, who had been diagnosed with Juvenile Rheumatoid Arthritis, actually had Lyme Disease. Since then, Dr. Jones has dedicated his practice to serving children and youth from around the world, who are suffering from tick-borne diseases.
Nour Amri, M.S., C.N.S, L.D.N.
Symposium Manager: In addition to organizing this symposium, Nour serves clients as a Licensed Integrative Nutritionist and a Certified Nutrition Specialist at the Kaplan Center for Integrative Medicine. After earning her Master’s degree from Maryland University of Integrative Health, she received her certification as a Mind-Body-Medicine Facilitator at Georgetown University School of Medicine. In her approach to nutritional well-being Nour applies the principles of Integrative and Functional Nutrition, emphasizing healthy eating in accordance with an individual patient’s unique genetics, lifestyle, and health concerns. In 2016 Nour did a poster presentation at the International Congress of Integrative Medicine and Health (ICIMH), in Las Vegas, Nevada, titled “Conventional Treatment for Ulcerative Colitis: An Attempt to Treat or Aggravate the Disease.” More recently, Nour has worked extensively alongside Dr. Kaplan on a project that studied the human-gut microbiome and its role in the pathophysiology of chronic pain and depression. She is now working to develop dietary plans for patients of the Kaplan Clinic who are suffering from a variety of neuroinflammatory and autoimmune conditions.
2022 Conference Information
February 9-12th, 2022
Autoimmune Encephalopathy Secondary to Infectious Disease: A New Perspective on the Pathogenetic Interaction of the Immune system, Infection, Stress and Chronic Disease
This program is being jointly sponsored by the International Center for Interdisciplinary Studies of Immunology (ICISI) at Georgetown University Medical Center, The Foundation for Total Recovery and The Kaplan Center for Integrative Medicine.