How can diet and the gut microbiome influence the onset of autoimmune conditions like multiple sclerosis? And could these findings connect to other diseases, like COVID-19?
Esther Melamed, M.D., Ph.D., assistant professor in Dell Medical School’s Department of Neurology, is set on answering this question, among others. Her research focuses on the origins of neurological autoimmune diseases — conditions characterized by a person’s immune system attacking healthy brain and nerve cells — with the goal of improving prevention and treatment for patients.
Esther Melamed, M.D., Ph.D.
Q&A
What’s the focus of your research, and what brought you to this point in your work?
As a resident in neurology, I became fascinated with autoimmune diseases of the nervous system, such as multiple sclerosis and neuromyelitis optica spectrum disorder, and why women were affected more commonly with autoimmune diseases while men developed more severe presentation of these diseases.
I was also drawn to the amazing patients who were affected by autoimmune diseases, and impressed by patients’ perseverance in looking for answers to get better. It was the patients‘ search for answers that inspired me to study autoimmune diseases of the nervous system and to understand how genetic and environmental factors play a role in disease onset and disease progression.
Over the last couple of years, my students and I have focused on studying the interplay between diet, alcohol and gut microbiome and how these environmental factors interact with an individual’s sex and genes to drive the course of neurological autoimmune diseases.
How will your research play a role in impacting the lives of those with autoimmune conditions?
There is a growing appreciation that immune dysregulation plays a key role not only in recognized autoimmune diseases, such as multiple sclerosis, but that there are other nervous system disorders such as epilepsy, neuropathy — and now COVID-19, where the immune system is attacking the body and leading to autoimmunity.
Often, patients cannot get immunotherapies for some of these conditions because insurance companies may not recognize diseases like epilepsy as autoimmune. Our lab is studying how different parts of the immune system, such as antibodies, T cells and cytokines may be contributing to autoimmunity in diseases like multiple sclerosis, neuromyelitis optica spectrum disorder, epilepsy, neuropathy and COVID-19 in an effort to decipher immune underpinnings of both traditionally recognized and under-recognized autoimmune diseases of the nervous system.
What makes you positioned to solve this problem?
I am tremendously grateful for Dell Med and the Department of Neurology’s support in helping to get our studies started. I am also truly honored to work with outstanding students in my lab and with amazing Dell Med and UT Austin colleagues.
What I love most about being at Dell Med and UT Austin is the spirit of innovation and collaboration that truly permeates students, staff and faculty who are lucky to be at our institution. I would say that it is the support of Dell Med and the neurology department — and the highly collaborative environment at the medical school and UT Austin — that allows for innovative and interdisciplinary research progress!
The New York Times asks readers to tell their “Tiny Love Stories” in just 100 words. What’s yours?
My inspiration for studying neuroimmune diseases always starts with my patients and leads to exciting discussions with my students to come up with way(s) to answer scientific questions related to the patients’ clinical autoimmune conundrums.
As an example, I have recently taken care of a patient with refractory epilepsy, who was in status epilepticus (sustained seizures) for days, and his seizures got significantly better with steroid treatment. Seeing his seizures disappear made me realize that taming the immune system helped this patient to get over the electrical storm in his brain and led to a new project in our lab to understand immune system mechanisms in epilepsy.
My students and I are now in the process of making connections between diseases like multiple sclerosis and neuromyelitis optica spectrum disorder to better understand refractory epilepsy, neuropathy and COVID-19 with the knowledge that we have gained from studying the breadth of known neurological autoimmune diseases.
This news feature is part of Dell Med’s Voices, a series of profiles that highlight the people of Dell Med as they work to improve health with a unique focus on our community.