Alfred Kim

The old version and the new (Powerpoint-friendly, content edits by @alhkim.bsky.social ) version of the lupus overview graphic ~

#MedSky #RheumSky (do we still use hashtags here? i feel old 👵)

Oh please keep the “verbiage” so this keeps an NC-17 rating. I can tell my dad that I’m still doing good stuff with my career.

Recording an episode of @freelyfiltered.bsky.social with @kidneyboy.bsky.social and @jenniejlin.bsky.social with special guests @alhkim.bsky.social Koyal Jain and Brad Rovin
No surprises on what recent #NephJC study we are discussing 👑

NIH indirects case update:

Hearing ongoing now, and I'll try to live tweet some notable exchanges.

Prior to more detailed arguments, Judge Kelley starts off with a few point questions to both sides:

(I'm paraphrasing here)

COMING UP at 10am, the preliminary injunction hearing in the consolidated Boston cases against NIH (Mass v., AAU v., AAMC v.).

Oral argument time is divided thus:

🆕 #Obinutuzumab (Obi) in Lupus Nephritis: the REGENCY Trial

Phase 3 RCT: Obi vs PBO
🫘 Pts w/ SLE nephritis Class III/IV ± 5
🎲 Randomized 1:1 to OBI v PBO (+MMF/steroids)
📊 Obi: ⇡rate of renal response and improved renal outcomes

#LupusNephritis #RheumSky #NephSky #MedSky #Lupus

This will kill science in the US. This is how China wins. Why is this not on the news? Why are people not more upset about this?

grants.nih.gov/grants/guide...

On changes to #NIH indirect rates, there is a law in place that prohibits NIH from making such changes without the approval of Congress. See Division D, Title II Section 224 of The Further Consolidated Appropriations Act, 2024 (Public Law No: 118-47) grants.nih.gov/grants/guide...

This is a massive hit to academic medical centers - probably unilaterally cuts their NIH dollars by 20%. Lots of folks are going to lose their jobs:

Last year 90% of members of the US Air Force didn’t even fly planes! MaSIvE GOverNMeNt wAsTE!! Or - they do all the other essential things to keep the mission running, including really boring things like cutting paychecks, cooking, and even being pediatricians to airmen/women’s kids

Similar to how the medical world realized how over-reliant they’ve been on elective procedures for generating revenue, academic institutions similarly got lazy. How they innovate around this will be interesting, and way above my pay grade.

I don’t buy that federal grants are better because they are longer and have higher direct cost caps: these grants still do not cover the true costs for the research funded anyway.

Hmmm.

Part of this is the fault of academic institutions IMO: the financial reliance on governmental indirect costs led to the strong link to get federal grants for faculty promotion. No matter how many grants you get from private foundations, lack of governmental funding is a strike against you.

Holy shit…ALL indirect rates for NIH grants slashed to 15% (if I’m reading this correctly?)

grants.nih.gov/grants/guide...

I’ve seen this film before.

@alhkim.bsky.social @jeffsparks.bsky.social @kristenyoung.bsky.social @situationrheum.bsky.social

Researchers rush to preserve federal health databases before they disappear from government websites Journalists have long relied on federal health data for their reporting. We include several tips that they can use to help researchers preserve the data.

“A group of researchers and students at the Harvard T.H. Chan School of Public Health is gathered today for a data preservation marathon, scraping and downloading data related to health equity from U.S. government agency websites before they disappear.”

This is a big deal, y'all. Federal health websites are being stripped of content or removed in their entirety. Stick with this thread for a look at what's disappeared so far! 1/x

Our hospital system (Barnes-Jewish) uses the Mayo Clinic Labs “CRY-S” (www.mayocliniclabs.com/test-catalog...) test, which is cryocrit-based with a reflex immunofixation. What is this Ig quant test, never heard of it!

I feel that the antigen will always be there, and coupled with any memory responses, there could be persistent activation of these B cells.

What pediatric rheumatology workshop would adult rheumatologists find most useful at a conference?

So RTX does not deplete B cells from lymph nodes & likely inflamed organs.

Curious in the non-responders what the C3 nephritic factor levels are. If high, they are coming from long-lived plasma cells (I’d hypothesize). If they drop, then it argues that tissue B cells are contributing to pathology.

Distinct Effector B Cells Induced by Unregulated Toll-like Receptor 7 Contribute to Pathogenic Responses in Systemic Lupus Erythematosus - PubMed Systemic Lupus Erythematosus (SLE) is characterized by B cells lacking IgD and CD27 (double negative; DN). We show that DN cell expansions reflected a subset of CXCR5^- CD11c⁺ cel...

Good question: depends if it is coming from plasmablast or plasma cells. Most SLE autoAbs come from extrafollicular activated B cells that differentiate into “pre-plasma cells,” which are plasmablast precursors. They are indirectly depleted with RTX.

pubmed.ncbi.nlm.nih.gov/30314758/

Sounds like we need to look, and yes, @anujajava.bsky.social has asked me before. We have ~400 patients with classified lupus we could query.

🎆4 years in the making! Thrilled to share the 1st spatial single cell aging clock ⏰ www.nature.com/articles/s41...

We use #AI + spatial transcriptomics to discover what makes some cells age faster/slower in the brain 🧠

Led by Eric Sun and awesome collaboration w/ @brunetlab.bsky.social🧵

Look who’s migrated over to @bsky.app: @zahitouma.bsky.social!! You better give him a follow.

If you want to understand why healthcare pricing is horrific, the first thing to know is that our system puts 100% of the credit risk for deductibles, copays and co-insurance on hospitals and doctors. That's insane.

We have turned them into Sub Prime Lenders 🧵

Andrea continues to delve deeply into the utility of urinary biomarkers for lupus nephritis. We both provide deeper insight into this massive unmet need in lupus nephritis on @medpagetoday.bsky.social: nam10.safelinks.protection.outlook.com?url=https%3A...

franklypenn.com/wp-content/u...

CAS ‘96

Surprise case of immunotactoid glomerulopathy in a biopsy for longstanding proteinuria thought to be due to chronic HTN. ~30nm microtubular structures. IgG2-kappa restricted. MGRS lesions, often associated with lymphoma bit.ly/3NNpwVd. #renalpath #pathsky #nephsky