Teng has been an internist-nephrologist at the LUMC since 2014 and since 2015 head of the outpatient clinic for renal diseases, where the center for Lupus-Vasculitis and Complement-Mediated Systemic Diseases (LuVaCs) was started in 2016. In 2021, this center will be recognized as a national European center of expertise by both the NFU and the EU. The expertise center is an active member of the European Reference Networks RITA and ERKNET.
Development of new treatment strategies
“From the start, my research has focused on the development of new treatment strategies for patients with renal autoimmune disease, including lupus nephritis and ANCA-associated vasculitis. At the same time, we focused on better understanding how new treatments work and benefit the immune system of these patients. To better understand these treatments, we have set up a translational research program in kidney diseases. Here, several crucial aspects of the immune system of these patients are examined in more detail, such as neutrophil extracellular traps, autoreactive B cells, plasma cells and autoantibodies.” Teng indicates that he likes to work precisely at the intersection of clinical research and basic laboratory research. “This has led us within the LuVaCs center of excellence for these renal autoimmune diseases to explore and bring to patients a number of new agents,” said Teng.
Combination treatment Rituximab and Belimumab
A good example of how the LUMC offers an environment for innovation in treatments for these complex autoimmune diseases is the combination treatment of Rituximab and Belimumab, according to Teng. “In lupus nephritis patients, autoantibodies are the cause of an inflammation of the kidneys called glomerulonephritis. Autoantibodies are made by specialized immune cells in our immune system, called plasma cells. These plasma cells arise from activated B cells. Rituximab is a drug capable of removing B cells from the body and was expected to be an effective treatment for patients with lupus nephritis. Several international studies have shown that this is not the case. At the LUMC, we thought that not only removing B cells, but simultaneously inhibiting B cell activation and plasma cells would be much more effective. We have been able to demonstrate the latter and are now investigating it in a randomized study. The combination therapy is currently being investigated in several autoimmune diseases and it is very nice to realize that we from Leiden have been at the cradle of this development.”
Joining forces
Teng sees his chair as a result of successful immunological research at various clinical departments in the LUMC, including nephro-immunology within kidney diseases. He therefore considers it important that this chair provides support to continue and further strengthen this immunological tradition in Leiden. “That means that we will of course continue all of the above research and clinical work in the coming years. I am convinced that we can still make gains at the LUMC by embedding the multidisciplinary collaboration and approach to complex, rare systemic autoimmune diseases even better.” Teng therefore hopes to be able to support the LUMC from a clinical perspective in strengthening collaboration with various (outpatient) clinical departments to enable innovative, groundbreaking treatments for patients with a systemic autoimmune disease. Teng: “This joining of forces is essential for the LUMC to maintain a pioneering role in regional and national expertise networks in this area.”
Pioneering treatments
Teng hopes to be able to conclude in five years’ time that we as LUMC have contributed to state-of-the-art innovative treatment strategies for patients with a renal autoimmune disease and therefore also with a systemic autoimmune disease. He emphasizes that it must be about treatment strategies. “It is not necessarily the case that we as LUMC have to apply the latest (and often most expensive) therapies to patients. On the contrary, with the aforementioned combination treatment, the underlying goal is to stop the immunosuppressants, which suppress the entire immune system, within one year. This is a treatment strategy that is groundbreaking in the history of treating lupus nephritis patients, where those immunosuppressants are usually continued for years. It is equally groundbreaking to investigate a treatment strategy that does not use corticosteroids for patients with ANCA (anti-neutrophil cytoplasmic antibodies) associated vasculitis. Prednisone has been the cornerstone of treatment since its discovery 50 years ago, but it is also well known for its short and long-term side effects.”
In conclusion, Teng says: “If we can determine in five years’ time that the LUMC distinguishes itself in its involvement in regional, national and European expertise networks, making innovative treatments and new treatment strategies accessible to patients, then we will show that the LUMC will continue to support multidisciplinary collaboration and approach to complex, rare systemic autoimmune diseases and thereby improve care for this group of patients.”
