Q&A with Cleveland Clinic’s New Endowed Chair of Translational Functional Medicine Research

Meet M. Elaine Husni, MD, MPH, Vice Chair of Rheumatology, Director of the Arthritis and Musculoskeletal Center at Cleveland Clinic – and the new chair of Translational Functional Medicine Research at Cleveland Clinic

In July, Dr. Husni was called on to lead collaborative research between Cleveland Clinic’s Department of Rheumatic and Immunologic Disease and the Cleveland Clinic Center for Functional Medicine when she was named Endowed Chair of Translational Functional Medicine Research. Dr. Husni is a clinician-scientist with grounding and accomplishments in both traditional and complementary medicine. In this new chair role, she will bring a new dimension of expertise to the field.

This collaboration aims to bring scientific study to functional medicine modalities for autoimmune diseases. Consult QD recently sat down with her to learn what drives her passion and to learn about research plans in her new chair role.

Why was this academic chair created?

The field of functional medicine has raised many hopes for improving health, and Mark Hyman, MD, who leads the Cleveland Clinic Center for Functional Medicine, has shown us how these modalities can be successfully used in clinical practice. We are partnering to do rigorous, evidence-based translational work looking at chronic autoimmune diseases and functional medicine modalities. This new chair will provide the needed resources to allow critical appraisal and help define, through rigorous scientific investigation, the utility and safety of functional medicine interventions and their role in improving health and health care.

What is your area of specialty?
As a clinician scientist, I have pursued an interdisciplinary collaborative approach focusing on the epidemiology and health outcomes of musculoskeletal and rheumatic diseases, specifically psoriatic diseases, rheumatoid arthritis and osteoarthritis.

My research program focuses on three unique areas. They are one, clinical therapeutics through conducting large multicenter clinical trials, and most recently serving on the executive committee of the PRECISION trial. Two, rheumatic disease comorbidities unraveling the complex mechanisms linking atherosclerosis and rheumatic diseases by identification of clinically applicable biomarkers of subclinical atherosclerosis. And three, development of innovative patient reported outcomes and screening tools for investigating the epidemiology, natural history and health outcomes in large psoriatic disease clinical cohorts.

Over the past 10 years, I’ve had the privilege of helping our rheumatology department expand its research infrastructure. I also have a translational research lab in the Lerner Research Institute, which focuses on the understanding of cellular responses and signaling events initiated by inflammatory cytokines, in particular TNF-alpha, in chronic inflammatory diseases.

What will the focus of your new research be?

We have two early stage projects, one is studying the health outcomes of patients with inflammatory arthritis such as psoriatic arthritis. Psoriasis and psoriatic arthritis are immune-mediated diseases that involve the skin and joints. We will focus on the biological effects and mechanisms of action underlying functional medicine approaches that may be adjunctive to currently available disease modifying treatments.

The other project involves studying the impact of functional medicine on the human microbiome, which plays an important role in the development and maintenance of the host immune system. As more studies support the growing evidence of the microbiome as a potential contributor to certain immune mediated diseases, we are interested in studying the impact of the gut microbiome on arthritis and autoimmune diseases. This raises the possibility of new treatments based on expanding knowledge of this microbial microenvironment.

How will you carry this out?

Since there are unique challenges inherent in developing and testing functional medicine interventions, a tiered approached is most helpful. There will be a focus on providing a conceptual framework for functional medicine in clinical research and the pathway for studying the effects of these techniques in human subjects. The importance of early clinical studies to develop and refine functional medicine interventions prior to launching efficacy or effectiveness studies will be emphasized. There will be support for other investigators to align their research interests, questions and approach with the appropriate stage of development.

Our longer term goal is to build a state-of-the-art clinical biorepository programs, clinical data collection, and linked with patient reported outcomes. I have led disease specific rheumatology biorepository program with well annotated clinical and biologic samples, and now I want to establish a biorepository to follow functional medicine patients — to see if there are differences to those who do and those who don’t respond to this treatment. We also want to understand the bigger connections between autoimmune health and lifestyle choices.

What draws you to functional medicine?

This work allows me to continue my passion for interdisciplinary care. While at Harvard Medical School, I started a dermatology rheumatology clinic at Brigham and Women’s Hospital and that is when I first saw how interdisciplinary care improves outcomes. The same holds true here at Cleveland Clinic where I am the director of the arthritis and musculoskeletal center. We have a team of rheumatologists, office-based orthopaedists and physiatrists work together to make the best treatment decisions. I believe there are places in which functional medicine approaches can offer great promise, and I look forward to exploring the possibilities in the years ahead.

What will this do for Functional Medicine?

There is a critical need to apply standard principles of evidence-based medicine to integrate conventional science to this exciting and promising area. The overarching goal is to propel the evidence-based conventional practices into the broad spectrum of functional medicine approaches, with the goal of infusing scientific discoveries that will inform clinical decision-making by healthcare providers and health policymakers. This work can help to generate high impact peer-reviewed publications in frontline journals to make functional medicine more transparent and known to the entire medical community.

My hope is that this partnership will enhance the ability of Functional Medicine to obtain grant funding, publish in high-impact journals, and most importantly, provide a voice in the scientific community of how functional medicine can provide sustainable change in health and disease.