Care transition and systems immunology experts join advisory committee

IDF’s Medical Advisory Committee (MAC) is excited to welcome two new members, Dr. Aisha Ahmed of Northwestern University Feinberg School of Medicine, and Dr. Elena Hsieh of the University of Colorado School of Medicine. The MAC is an important part of IDF’s volunteer leadership structure that enables the organization to provide the highest quality scientific and clinical information on primary immunodeficiency (PI) to patients, caregivers, and healthcare professionals. The MAC also advises IDF on key clinical, research, and health policy issues. 

Aisha Ahmed, MD, is an assistant professor at Northwestern University Feinberg School of Medicine and sees young adults at Lurie Children’s Hospital of Chicago. She earned her medical degree from the University of Illinois, then began a residency in internal medicine/pediatrics at the Medical College of Wisconsin. Halfway through, she transferred to an adult internal medicine residency at the University of Texas Southwestern Medical Center. She then completed a fellowship in allergy and immunology at the University of California, San Francisco (UCSF), where she developed an interest in PI, also known as inborn errors of immunity (IEI).

“During my fellowship at UCSF, I had the opportunity to work with physicians like Dr. [Jennifer] Puck and Dr. [Morna] Dorsey, and with them I was able to see a lot of really rare IEI,” said Ahmed. “I really appreciated the longitudinal relationship we developed with the patients but also families, because multiple siblings might be affected or even multiple generations might be affected in a family.”

At UCSF, Ahmed participated in research evaluating how to transition adults with PI who were still being seen by pediatric providers to the adult immunology clinic. At Lurie, she continues to take advantage of her board certification in internal medicine and experience in pediatrics and is developing a transition program. She likes “being able to take care of patients across the spectrum of age ranges and being able to understand what the specific needs are at different stages of life.”

Ahmed also values interdisciplinary care and has started both immunology-hematology and immunology-rheumatology clinics within her practice. She collaborates closely with gastroenterology colleagues as well. As a result, every patient diagnosed with very early onset inflammatory bowel disease (VEO-IBD) at Lurie gets an immunology workup to see if a PI diagnosis can explain their symptoms.

“We've developed a lot of cross-specialty relationships,” Ahmed explained, “It’s been really nice to have this multidisciplinary approach so we can identify these patients early and help provide targeted therapeutic options.”

As part of the MAC, Ahmed hopes to continue her focus on transition of care, multidisciplinary care, and addressing barriers patients experience in getting diagnosed and treated in a timely manner.

Elena Hsieh, MD, is an associate professor at the University of Colorado School of Medicine, Children’s Hospital Colorado. She was born in Taiwan, grew up in Spain, and then came to the U.S. as a college student with an already developed interest in immunology. 

“In Europe, we tend to narrow our academic interest early on,” said Hsieh. “In high school in Spain, we had advanced calculus, organic chemistry, and our first introduction to genetics and immunology. I was very drawn to genetics and immunology. Both disciplines exist in medicine and they span every specialty.”

Hsieh completed her medical degree at UCSF, then moved to the University of California, Los Angeles for her pediatric residency. Although she initially wanted to specialize in oncology and transplant medicine, she realized during residency that it didn’t quite fit her interests. A conversation with Dr. Sean McGhee, who became a mentor, steered her toward a fellowship in allergy and immunology at Stanford University instead. Hsieh said she was drawn to “the concept that I get to be a generalist, but a specialist at the same time, because the immune system, you know, it's involved in every organ.”

These days, Hsieh spends the majority of her time doing research on common autoimmune diseases, like lupus and type I diabetes, and PIs that can cause autoimmune diseases. In people with the ‘common’ form of an autoimmune condition, there is no one gene variant that explains their symptoms. Both genetic variants and environmental triggers like infections likely play a role. In PI though, there usually is a single gene variant that explains all of the person’s symptoms, including any autoimmunity. By coming at autoimmune conditions from both directions, Hsieh hopes to untangle the biological pathways involved.

Hsieh explained, “If I'm able to understand how that [IEI gene variant] results in type one diabetes, it's important. But then it also tells me that this pathway is important for type one diabetes in general, right?”

To look holistically across the immune system, Hsieh’s lab uses what she calls “high-dimensional, single-cell techniques,” such as mass cytometry or multiplexed ion beam imaging, that allow researchers to separate out and look at very specific cell populations and compare these populations across people with or without autoimmune conditions and with or without PI.

“The way I see these technologies applied to medicine is that you can look at all these parameters and then you can narrow down to maybe 8 or 10 and that becomes something that you could actually implement at the clinical level,” she said about using these techniques to monitor patients or predict symptoms or complications.

As part of the MAC, Hsieh hopes to raise awareness and provide clinician education on PI to clinicians in countries outside of the U.S. and Europe, where people with PI are even more likely to remain undiagnosed and untreated.