Twin Siblings Specializing in Vasculitis Are Working Together at KUMC

Kelly Liang, MD, and her twin sister, Kimberly Liang, MD, both joined the University of Kansas Medical Center (KUMC) in December 2021. Kelly is currently Associate Professor of Medicine in KUMC’s Division of Nephrology and Hypertension, and Kimberly is Associate Professor of Medicine in the Division of Allergy, Clinical Immunology and Rheumatology. The doctors hope to collaborate on both the care of vasculitis patients and clinical research, while contributing together toward recruitment for vasculitis trials.

Kelly became interested in vasculitis through her care of patients with anti-neutrophil cytoplasmic antibody-associated vasculitis during her residency and fellowship training at Mayo Clinic in Rochester, Minnesota, and as attending physician at the University of Pittsburgh Medical Center (UPMC). “The longitudinal care of patients with vasculitis at the UPMC Lupus Center of Excellence and Vasculitis Center spurred my interest in vasculitis further, particularly since I co-managed several patients with my sister, Kimberly,” she explained. At UPMC’s Vasculitis Center, Kelly served as the primary nephrology consultant for vasculitis patients who also had renal involvement. In addition, she was a co-investigator on vasculitis studies that included renal vasculitis subjects in the PEXIVAS, RITAZAREM, BREVAS and TAPIR trials, and was responsible for screening and recruiting patients.

During her rheumatology fellowship training at Mayo Clinic in Minnesota, Kimberly saw many interesting cases of vasculitis and worked with some renowned vasculitis experts including Eric Matteson, MD, and Kenneth Warrington, MD. “This encouraged my interest in vasculitis,” she said. “But what drew me to rheumatology as a field was the importance of understanding multi-system disease and following patients over the long term to provide tailored treatment and improve lives,” Kimberly added. She was Assistant Professor of Medicine in the Division of Rheumatology and Clinical Immunology at UPMC from 2008-2021, and worked primarily in the Vasculitis Center and Lupus Center of Excellence, seeing patients referred for all types of vasculitis, lupus, and other connective tissue diseases. She also cared for patients with other rheumatic diseases, but her specific focus clinically was on patients with vasculitis and lupus. Kimberly was the site principal investigator for various studies in vasculitis, such as DCVAS and MANDARA for eosinophilic granulomatosis with polyangiitis, co-investigator on multiple Vasculitis Clinical Research Consortium studies, and helped recruit patients and collect study data for the PEXIVAS, AGATA, RITAZAREM and TAPIR, among others.

At KUMC, Kelly will be seeing patients with vasculitis who have kidney disease. She will provide full consultative and treatment services, and follow-up as needed for patients who are referred to her for confirmed or suspected kidney involvement. “I will also see vasculitis patients who have any other reason for nephrology referral, even if it’s not renal vasculitis (e.g., control of hypertension or edema), and will co-manage kidney-related conditions with their rheumatologist and/or primary care physician,” Kelly said. Clinical research will be a component in which she will be the primary nephrologist, acting as co-investigator on vasculitis studies. She will help with screening and recruitment of patients seen in the hospital and/or clinic for ongoing vasculitis trials.

Kimberly will also see patients with vasculitis at KUMC and hopes to provide subspecialized care to all types of vasculitis patients and coordinate multidisciplinary specialty care (nephrology, pulmonology, dermatology), if needed. “I anticipate providing the highest quality care to meet the needs of individual patients with vasculitis,” she said. “This includes using the latest treatments available.” She plans to assist in carrying out clinical trials in vasculitis too. “The MANDARA study is already in progress at KUMC and I plan to serve as a sub-investigator.” What’s more, she intends to serve as an investigator for a study looking at a therapeutic clinical trial in giant cell arteritis, which is also underway at KUMC, and assist in recruiting subjects for various other studies in vasculitis.

“We have a uniquely close relationship that allows us to care for patients very easily together, as we are able to communicate readily on cases and formulate plans that we mutually agree are in the patients’ best interests,” Kelly said. “We may also be able to see patients we refer to each other more quickly, so they may not need to wait as long as they would otherwise.”

Given that many patients with vasculitis need both a rheumatologist and a nephrologist, the doctors’ goal is to build a stronger referral center at KUMC for difficult cases of vasculitis and join forces with the Division Chief, Mehrdad Maz, MD, at KUMC Rheumatology Vasculitis Clinic. Dr. Maz noted that he has known Kelly and Kimberly since their training years at Mayo Clinic where he trained and practiced. He has followed their academic trajectory with enthusiasm and is excited that they joined KUMC to enhance, expand and build on the success of the Vasculitis Center.

To schedule an appointment with Kelly, patients can call her appointment office number at 913-588-6074 (general line) or 913-588-6048 (direct line to her appointment secretary).

For appointments with Kimberly, patients can have their referring office or primary care provider fax a referral to 913-588-5785. Once her office has all the records, they will contact the patient to schedule.

Rheumatology:
https://www.kansashealthsystem.com/care/specialties/rheumatology

Nephrology:
https://www.kansashealthsystem.com/care/specialties/nephrology

Study Results: “Microbubble Contrast-Enhanced Vascular Ultrasonography: A Novel Method of Detecting Large Vessel Vasculitis.”

Monitoring disease activity is crucial for effective patient care and better outcomes, yet a key unmet need is the ability to differentiate active vasculitic disease activity from vessel damage in patients with large vessel vasculitides (LVV), like giant cell arteritis and Takayasu arteritis. In LVV, the inflammatory process appears to begin at the outer layer of the vessel’s blood supply, with inflammation and new vessel formation occurring.

Kimberly’s team used microbubble-contrast-enhanced carotid ultrasonography (CU), a novel non-invasive imaging technique, to detect new vessel formation in the outer vessel layer, to determine if CU could help distinguish between active vasculitis and damage in patients with LVV. Blood biomarkers of vessel inflammation were also measured. Kimberly’s research looked at LVV patients with clinically active and inactive disease, and compared them to patients with rheumatoid arthritis (RA) and people with no history of autoimmune disease.

The average value for the measure of new vessel formation in the outer vessel layer in active patients (n=2) was 0.58, whereas it was 0.50 in the inactive patients (n=5). This was not statistically significant, though the higher level in the active patients supported the hypothesis that those with active disease may have more new vessel formation due to inflammation starting in the outer layer. There was no significant difference in this measure when compared to RA patients or controls.

No positive correlations were found between disease activity and any of the vascular and inflammatory biomarkers (E-selectin, ICAM-1, VCAM-1, CD40L, MMP-9, MPO, hsCRP, ESR), but sample sizes were small and these biomarkers’ variability was wide. The results, however, could support future research studies using carotid artery imaging to follow disease activity in LVV patients.

The study was funded by the VF from 2014-2020. A manuscript for potential publication is in progress.