All fellows are required to participate in clinical or basic research that is included in the program with appropriate protected time. There are multiple research opportunities available including NIH-funded basic science and clinical research. The fellows can also choose to tailor their research to their interests.

The aims of the research experience is for the fellow to learn learn sound methodology in designing and performing research studies, and the correct interpretation and synthesis of research data in applying it to patient care. Fellows also acquire knowledge of how to design and interpret research studies, the responsible use of informed consent, proper research methodologies and interpretation of data with their involvement in actual projects.

Research Setting

We are a NIH-Funded research lab that focuses on the advancement of biomarkers to help with diagnosis, prognostication, and selection of treatment modalities for Rheumatological disorders. We also work with a diverse patient population needs from three different hospital settings. The variety of patient demographics provides a large pool source material for clinical research in both common and rare Rheumatological disorders.

Research Timeline in Training

First Year Fellow:

• Fellows explore current research projects to help to formulate which projects they would like to pursue in their second year.
• Fellows are encouraged to research interesing clinical cases and present them at the Rheumatology Grand Rounds and Lab conference.
• Felllows participate in acquiring and entering patients in various studies, and may elect to spend up to a month on a specific project.
• Fellows receive CITI research of ethics and conflict of interest training for human research subjects and attend a mini-course on the aspects of research studies.

Second Year Fellow:

• Fellows are encourage to complete a majority of their electives by the end of the first year so they can dedicate more time to resarch in their second year.
• Fellows are expected to prepare their research activities for presentation and publication. They are also expected to publish at least one scientific paper, book chapter, abstract, case reports in a peer-reviewed journal, peer-reviewed performance improvement and/or present a peer-reviewed funding or a peer-reviewed abstract at regional, state, or a national specialty meeting during the course of their fellowship.

Third Year Fellow:

• An optional third year is available for those that are interested in pursing intensive research.
• A specific project will be tailored to the fellow’s interest, usually depending upon their experience and progress in a related to a similar project during their first two years.
• Eighty-five percent time is protected for research; 15% of their time is devoted to clinical duties, including a continuity ambulatory care experience of ½-day clinic per week, one month of inpatient consult year, and attendance at the Laboratory Conference/Journal clubs and weekly Rheumatology Conference

A MAJORITY OF FELLOWS HAVE SERVED AS CO-AUTHORS IN PEER-REVIEWED PUBLICATIONS

Publications from Former Fellows

Liu, Y, Yu J, Oaks Z, Marchena-Mendez I, Francis L, Bonilla E, Aleksiejuk P, Patel J, Banki K, Landas SK, Perl A. (2015) Liver injury correlates with biomarkers of autoimmunity and disease activity and represents an organ system involvement in patients with Systemic Lupus Erythematosus. Clin Immunology. 160(2):319-327. PMID:26160213

Lai, ZW, Marchena-Mendez I, Perl A. (2015) Oxidative stress and Treg depletion in lupus patients with anti-phospholipid syndrome. Clin Immunology. 158(2):148-52. PIMD:25862984

Lai, ZW, Borsuk, R., Shadakshari, A., Yu, J., Dawood, M., Garcia, R., Francis, F., Tily, H., Bartos, A., Faraone, S.V., Phillips, P.E. and Perl. A. (2013). mTOR activation triggers IL-4 production and necrotic death of double-negative T cells in patients with systemic lupus eryhthematosus. J. Immunol. 191: 2236-2246. doi: 10.4049/jimmunol.1301005

Garcia, R.J., Francis, L., Dawood, M, Lai, Z-W., Faraone, S.V., and Perl, A. (2013) Attention Deficit and Hyperactivity Disorder Scores are Elevated and Respond to NAC treatment in patients with SLE. Arth. Rheum. 65: 1313-1318. PMID: 23400548

Lai, Z-W, Hanczko, R., Bonilla, E, Caza, T.N., Clair, B., Bartos, A., Miklossy, G, Jimah, J., Doherty, E, Tily, H., Francis, L, Garcia, R., Dawood, M., Yu, J., Ramos, I., Coman, I., Faraone, S.V., Phillips, P.E. and Perl, A. (2012). N-acetylcysteine reduces disease activity by blocking mTOR in T cells of lupus patients. Arth. Rheum. 64: 2937-2946. PMID:22549432

Tily, H., Banki, K., Hoffman, G.S. and Perl. A. (2010) Detection of lupus anti-coagulant and successful anti-coagulation in familial Sneddon syndrome. Ann. Rheum. Dis. 69: 775-776.

Francis, L. and Perl. A. (2010) Infection in systemic lupus erythematosus: friend or foe? Int. J. Clin. Rheumatol. 5:59-74.

Soforo, E., Baumgartner, M., Francis, L., Allam, F., Phillips, P.E., and Perl, A. (2010) Induction of systemic lupus erythematosus with TNF blockers. J. Rheumatol. 37:204-205.

Tily, HI and Perl, A. (2009) Lymphedema: a paradoxical effect of tumor necrosis factor inhibitors – case report and review of literature. BMJ Case Reports [doi:10.1136/bcr.07.2008.0520]

Perl, A., Fernandez, D., Telarico, T., Francis, L. and Phillips, P.E. (2009) T- and B-cell signaling biomarkers and treatment targets in lupus. Curr. Opin. Rheumatol. 21: 454-464.

Francis, L. and Perl. A. (2009) Pharmacotherapy of SLE. Expert. Opin. Pharmacother. 10: 1481-1494.

Fernandez, D.R. Telarico, T., Bonilla, E., Li, Q., Banerjee, S., Middleton, F.A., Phillips, P.E.,  Crow, M.K., Oess, S., Muller-Esterl, W., and Perl, A. (2009) Activation of mTOR controls the loss of TCRζ in lupus T cells through HRES-1/Rab4-regulated lysosomal degradation. J. Immunol. 182: 2063-2073.

Perl, A., Nagy, G.,  Koncz, A., Gergely, P., Fernandez, D., Doherty, E., Telarico, T., Bonilla, E. and Phillips, P.E. (2008) Molecular mimicry and immunomodulation by the HRES-1 endogenous retrovirus in SLE. Autoimmunity, 41:287-297.

 Vyshkina, T., Sylvester, A., Sadiq, S., Bonilla, E., Canter, J., Perl, A. and Kalman, B.(2008) Association of Common Mitochondrial DNA Variants with Multiple Sclerosis and Systemic Lupus Erythematosus. Clin. Immunol. 129:31-35.

Vyshkina, T., Sylvester, A., Sadiq, S., Bonilla, E., Perl, A. and Kalman, B.(2008) CCL genes in multiple sclerosis and systemic lupus erythematosus. J. Neuroimmunol. 200:145-152.

Pullmann, R. Jr., Bonilla, E., Phillips, P.E., Middleton, F.A. and Perl, A. (2008) Haplotypes of the HRES-1 endogenous retrovirus are associated with development and disease manifestations of systemic lupus erythematosus. Arth. Rheum. 58: 532-540.

Francis L, Bonilla E, Soforo E, Neupane H, Nakhla H, Fuller C, and Perl A. (2008) Fatal toxic myopathy attributed to propofol, methylprednisolone, and cyclosporine after prior exposure to colchicine and simvastatin. Clin. Rheumatol. 27:129-31.

Bonilla, E., Francis, L., Allam, F., Ogrinc, M., Neupane, H., Phillips, P.E., and Perl, A. (2007) Immunofluorescence microscopy is superior to fluorescent beads for detection of antinuclear antibody reactivity in systemic lupus erythematosus patients. Clin. Immunol. 124:18-21

Bonilla, E., Lee, Y.Y., Phillips, P.E., and Perl, A. (2007) Hypoglycaemia after initiation of etanercept treatment in a patient with type 2 diabetes mellitus. Ann. Rheum. Dis. 66:1688.

Quintero M, Mirza N, Chang H, Perl A. (2006) Antiphospholipid antibody syndrome associated with primary angiitis of the central nervous system: report of two biopsy-proven cases. Ann. Rheum. Dis. 65 :408‑9

Fernandez, D., Bonilla, E., Mirza, N, Niland, B. and Perl, A. (2006) Rapamycin reduces disease activity and normalizes T-cell activation-induced calcium fluxing in patients with systemic lupus erythematosus. Arth. Rheum. 54: 2983-2988.

Fernandez, D., Bonilla, E., Phillips, P.E. and Perl, A. (2006)  Signaling abnormalities in systemic lupus erythematosus as potential drug targets. Endocrin, Metabolic & Immune Disorders - Drug Targets. 6:305-311

Mukhopadhyay, S., Mousa, S., George, B.R. and Perl, A. (2004) Palpable purpura, polyarthritis, and abdominal pain. Med. J. Aust. 180:121-122.