Gertjan Wolbink has been appointed as Professor of Rheumatology, specializing in precision medicine for rheumatic diseases, effective April 1, 2024. This professorship is within the Department of Rheumatology and Clinical Immunology, Division 1 of Amsterdam UMC, and is affiliated with the Amsterdam Institute for Immunology and Infectious Diseases (AII). Following his appointment, we conducted an interview with Prof. Wolbink.
Prof. Wolbink's journey into rheumatology began during his medical studies in Groningen, where he developed a fascination for immunology. His interest deepened while conducting research on Lymphokine-Activated Killer Cells. After his studies, he seized the opportunity to work at the CLB (Centraal laboratorium van de bloedtransfusiedienst), which is currently known as Sanquin, in Amsterdam under the guidance of Erik Hack, focusing on the side effects of IL-2 therapy in cancer treatment. Witnessing the translation of immunological knowledge into meaningful advancements for patients inspired Prof. Wolbink to pursue rheumatology. Reflecting on his career, Prof. Wolbink states: ‘Throughout my career, I have remained committed to understanding the intricate mechanisms underlying rheumatic diseases and its treatments to improve patient outcomes’.
Navigating the Intersection of Rheumatology and Precision Medicine
Rheumatic diseases encompass a diverse group of conditions affecting the musculoskeletal system, particularly joints, muscles, and bones. These conditions include inflammatory diseases like rheumatoid arthritis and systemic lupus erythematosus (SLE), as well as non-inflammatory conditions such as osteoarthritis.
Precision medicine in rheumatology involves tailoring treatment approaches to individual patients based on their unique characteristics, including genetic makeup and environmental factors. This approach employs advanced technologies like genetic testing and biomarker analysis to predict treatment responses and adverse reactions, ultimately leading to more effective and personalized care.
Researching precision medicine for rheumatic diseases is crucial to comprehend treatment response diversity among patients. Prof. Wolbink shares: ‘By pinpointing factors affecting treatment efficacy and safety, our goal is to refine therapy for improved outcomes with minimal adverse effects. Precision medicine allows us to customize treatment strategies based on individual patient traits, such as genetic predispositions and disease mechanisms, leading to more precise and personalized care’. This approach holds promise in revolutionizing rheumatological practice by enhancing treatment effectiveness, mitigating treatment-related issues, and elevating patients' quality of life.
Moreover, the integration of theory and practice is crucial, particularly in precision medicine, as practical application allows for the assessment of theoretical validity. Professor Wolbink recounts his experience as a rheumatology assistant at Slotervaart Hospital, where patients were treated with anti-TNF (Tumor Necrosis Factor). TNF is pivotal in both normal inflammation and the inflammation seen in various rheumatic diseases. Anti-TNF therapy suppresses this process by inhibiting TNF action. While effective for most patients, some experienced reduced efficacy due to allergic reactions. Reflecting on these observations, Prof. Wolbink returned to the lab, collaborating with colleagues to uncover the significance of antibody responses to agents like anti-TNF in rheumatoid arthritis. This insight, born from the synergy of lab research and clinical application, underscores the necessity and efficacy of this combined approach.
Research Focus
Prof. Wolbink's research group aims to optimize biological therapy through personalized dosing using Therapeutic Drug Monitoring, exploring pharmacogenomics in treatment response, and identifying novel biomarkers and therapeutic targets. Prof. Wolbink: ‘By integrating cutting-edge technologies into our research, we hope to advance precision medicine in rheumatology and improve treatment outcomes for patients worldwide’.
Prof. Wolbink provides a practical illustration: "Currently, rheumatoid arthritis patients can conveniently collect blood samples at home using a finger prick. This enables us to monitor their medication's concentration in the bloodstream. Through PK modeling, which combines pharmacokinetic and pharmacodynamic components into mathematical expressions, we offer dosage recommendations that ensure the blood concentration effectively blocks the disease without exceeding necessary levels. This method reduces the need for frequent finger pricks for patients while maintaining optimal blood concentration levels. Additionally, it presents cost-saving advantages for healthcare providers compared to traditional dosing regimens."
Exploring Innovations in Rheumatology
Looking ahead, Prof. Wolbink expresses a desire to explore innovative treatments such as Car-T cell therapy to reset inflammatory rheumatic diseases. This approach involves genetically modifying a patient's own T cells to target and eliminate diseased cells, offering a promising new avenue for treating autoimmune and inflammatory conditions. Prof. Wolbink: ‘By harnessing the power of the immune system to selectively target and destroy pathological cells, Car-T cell therapy holds the potential to induce long-term remission and even cure rheumatic diseases in some patients’. Further research is needed to understand and optimize this approach, identify suitable patient populations, and address potential safety concerns before it can be widely implemented in clinical practice. Prof. Wolbink’s colleague Prof. Tas is currently researching this topic within Amsterdam UMC.
Milestones and insights
A significant milestone in Prof. Wolbink's career was uncovering the role of antibody formation against biologicals in rheumatology patients, leading to insights into treatment efficacy and pharmacokinetics. Additionally, collaborative efforts during the pandemic, such as the ARC-Covid study, underscore the impact of multidisciplinary research in addressing clinical challenges.
Prof. Wolbink reflects: "In early 2020, as the pandemic loomed, it prompted the question: what implications does this have for us? We swiftly established a prospective controlled study, monitoring thousands of patients and a control group via a digital platform. Alongside this, we integrated data from the serological finger-prick test for Covid-19 antibodies, developed by Theo Rispens at Sanquin. This allowed us to promptly address queries from both patients and healthcare providers. What set our platform apart was the direct communication of Covid-19 antibody results to patients, bypassing the need for a microbiologist or doctor. Subsequently, direct feedback via the platform became standard practice for numerous studies and tests.
"We are now transitioning our research platform strategy to address broader questions. Initially, it was dedicated solely to Covid-19 and entirely digital, proving highly efficient. Patients complete questionnaires and play an active role in the process. Finger-prick samples travel from patients to the lab, facilitating straightforward scalability. We're discovering its applicability to diverse research inquiries."
Effective communication with the patient population is pivotal in digital research. Prof. Wolbink emphasizes: "We engage with patients, acknowledging their concerns and priorities. For the ARC-Covid study, we hosted scientific discussions accessible to research participants, underscoring the importance of their commitment."
"The ARC-Covid study was a collaborative effort with partners like Target to B, yielding extensive publications, notably in The Lancet Rheumatology. Dr. Laura Boekel recently graduated with honors based on this research."
Learn more about the ARC-Covid study:
Accelerated innovation driven by COVID-19 in rheumatoid arthritis research (August 2022)
Ensuring access to rheumatological care
Ensuring accessibility to rheumatological care while efficiently allocating resources remains a significant challenge, according to Prof. Wolbink. Limited healthcare resources and disparities in access to care can hinder timely diagnosis and treatment, leading to poorer outcomes for patients with rheumatic diseases.
Prof. Wolbink shares: ‘Addressing these challenges requires a concerted effort from healthcare providers, policymakers, and stakeholders to prioritize rheumatological care, improve healthcare infrastructure, and implement strategies to reduce disparities in access to care. By working together, we can overcome these challenges and ensure that all patients receive the quality care they need and deserve’.
An illustrative example is our collaboration with genetics. Prof. Wolbink explains: 'Utilizing our digital platform designed for the ARC-COVID study, we seek to understand our patients' attitudes towards genetics. Subsequently, we aim to evaluate the concept of pharmacogenetics for various well-established genes and extend it to encompass biologicals and pertinent genetics for rheumatoid arthritis patients. Moreover, our goal is to empower rheumatoid arthritis patients to increasingly self-manage their care remotely, thereby enhancing the accessibility of rheumatological services. Many patients achieve remission with medication, often identifiable through questionnaires. We are exploring the potential of patient-taken photos as an additional tool, especially in conjunction with AI. Additionally, we're strategizing the transition of current hospital-based blood tests to a finger-prick format. Successful implementation of these measures promises a more efficient resource utilization and greater flexibility for patients as needed.'
Nurture your passion and dedication
Prof. Wolbink advises young researchers to follow their passion, find inspiring mentors and environments, and remain dedicated to improving patient care.
Prof. Wolbink: ‘As a researcher in rheumatology, you have the opportunity to make a significant impact on the lives of patients with rheumatic diseases and contribute to advancing our understanding and treatment of these complex conditions. Embrace challenges, stay curious, and never stop learning. Your dedication and perseverance will be rewarded with meaningful discoveries and advancements that benefit patients and the scientific community alike’.
Reflecting on recent experiences, Prof. Wolbink mentored medical student Mischa Pier during his research internship, alongside Dr. Laura Boekel. Their focus was on a literature review of herpes zoster, a prevalent concern among individuals with immune suppression. Their findings have been published in The Lancet Rheumatology, and they aim to advance this research using the ARC-COVID platform. Prof. Wolbink shares: ‘Mentoring and offering opportunities to others energizes me. I also value the continuity in rheumatology, finding fulfillment in passing on knowledge. Despite our achievements in the past, there is still much to explore in the field’.
Beyond academia
Alongside his clinical practice in rheumatology at Reade OLVG and Amsterdam UMC, Prof. Wobink’s research pursuits at Sanquin Immunopathology and Reade/AmsterdamUMC encompass the immunogenicity of therapeutic proteins, therapeutic drug monitoring, and investigations related to COVID-19. In addition to his clinical and research work, Prof. Wolbink enjoys gardening at Sloterland and cycling on his Pinarello F8. He has a keen interest in sports such as athletics (AAC), rowing (Okeanos), and soccer (Ajax).
Text: Esmée Vesseur