Approximately 8% of the U.S. population is living with an autoimmune disease, and nearly 80% of those with an autoimmune disease are women.[1] The category of autoimmune diseases includes between 80 and 150 conditions (depending on the source) that are chronic and in many cases debilitating—with no known cures.[2] These diseases can affect almost every organ in the body and can occur at any point across the lifespan.[3] Despite the large burden of disease, many autoimmune diseases are understudied, and treatment options are limited.
To accelerate progress in this area, in 2022, the U.S. Congress directed NIH to establish an Office of Autoimmune Disease Research within ORWH.
As described in the Consolidated Appropriations Acts, 2023 (Public Law 117-328) for the departments of Labor, Health and Human Services, and Education, and related agencies, the Office of Autoimmune Disease Research (OADR-ORWH) will:
- Coordinate development of a multi–institute and center (IC) strategic research plan;
- Identify emerging areas of innovation and research opportunity;
- Coordinate and foster collaborative research across ICs;
- Annually evaluate the NIH autoimmune disease research (ADR) portfolio;
- Provide resources to support planning, collaboration, and innovation; and
- Develop a publicly accessible central repository for ADR.
These directives—along with the findings of the National Academies of Sciences, Engineering, and Medicine (NASEM) report titled Enhancing NIH Research on Autoimmune Disease—guide the establishment of the office.
Currently, ADR expertise is housed across various NIH institutes, centers, and offices (ICOs) in alignment with their mission areas. Establishing OADR-ORWH within the NIH Office of the Director (OD) positions it well to amplify and integrate individual ICO efforts and create opportunities for collective innovation.
The mission of OADR-ORWH is to support high priority autoimmune disease research, identify emerging areas of innovation, and foster collaboration across NIH ICOs.
Learn More
Dr. Shanmugam is an experienced physician-scientist, rheumatologist, and academic leader. She graduated from Oxford University with a B.A. in physiology and completed her medical degree at Imperial College School of Medicine in London, graduating with honors in medicine. She is a member of the Royal College of Physicians in London. Dr. Shanmugam completed the Internal Medicine Residency and Rheumatology Fellowship at Georgetown University and joined the faculty of Georgetown University School of Medicine in 2007. She previously served as Director of Rheumatology at the George Washington University. Learn more about Dr. Shanmugam’s extensive experience in the field of autoimmune diseases here.
Want to learn more about OADR and the OADR Team?
- Join Dr. Shanmugam quarterly for virtual Updates on OADR-ORWH sessions. Learn more here. To find a record of past events, please visit Autoimmune Disease Research News and Updates.
- Read Dr. Shanmugam’s guest editorial in ORWH’s publication, In Focus.
Autoimmune diseases occur when the body’s immune system malfunctions and mistakenly attacks the body’s healthy cells, tissues, and organs.
Autoimmune diseases include at least 80 acute and chronic illnesses that are often disabling, such as Sjögren’s disease, systemic lupus erythematosus (SLE), antiphospholipid syndrome, rheumatoid arthritis, psoriasis, inflammatory bowel disease (IBD), celiac disease, primary biliary cholangitis, multiple sclerosis, type 1 diabetes, and autoimmune thyroid disease. For more information, refer to the 2022 NASEM report Enhancing NIH Research on Autoimmune Disease .
Sex- and gender-specific differences in the prevalence and expression of autoimmune diseases underscore the critical importance of recognizing sex and gender as factors in health and disease at every stage of the research process.
The reasons underlying the higher prevalence of autoimmune diseases in women are not yet understood.[4] In addition, not all autoimmune diseases act the same; some autoimmune diseases are many times more prevalent in women, and some affect men and women at similar rates. These diseases also affect males and females differently.
Though the complex factors underlying these differences are not yet clear, a growing body of research has documented significant sex differences in the immune system which contribute to the sex differences observed in the symptoms, expression, treatment response, and prevalence of autoimmune diseases. For example, women tend to have a more robust immune response than men, which may contribute to improved outcomes in infectious diseases and greater vulnerability to autoimmune diseases.[5] Psychosocial and cultural factors, as well as environmental exposures, may also contribute to the risk of developing autoimmune diseases. More research is needed to understand how these factors contribute to autoimmune disease development.
Recognizing sex and gender as factors in health and disease at every stage of the research process is a critical part of ORWH’s mission.
Learn more about the influences of sex and gender in health and disease.
Learn more about sex differences in immunology with Module 1 of ORWH’s Bench to Bedside course. (Registration is free and open to the public.)
References
4 Fairweather D, Frisancho-Kiss S, Rose NR. Sex differences in autoimmune disease from a pathological perspective. Am J Pathol. 2008 Sep;173(3):600-9. doi: 10.2353/ajpath.2008.071008. Epub 2008 Aug 7. PMID: 18688037; PMCID: PMC2527069.
5 Vom Steeg, L. G., & Klein, S. L. (2016). SeXX matters in infectious disease pathogenesis. PLOS Pathogens, 12(2), e1005374. https://doi.org/10.1371/journal.ppat.1005374
Chen, N., Zhou, M., Dong, X., Qu, J., Gong, F., Han, Y., et al. (2020). Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. The Lancet, 395(10223), 507–513. https://doi.org/10.1016/s0140-6736(20)30211-7
Ngo, S. T., Steyn, F. J., & McCombe, P. A. (2014). Gender differences in autoimmune disease. Frontiers in Neuroendocrinology, 35(3), 347–369. https://doi.org/10.1016/j.yfrne.2014.04.004
The direction to establish OADR-ORWH stemmed from recommendations from the NASEM report Enhancing NIH Research on Autoimmune Disease, which identified a need for greater coordination across NIH regarding autoimmune disease research. The report recommended that an Office of Autoimmune Disease Research be established within OD, and Congress selected ORWH to establish this office in because autoimmune diseases disproportionately affect women.
As one of the 14 cross-cutting offices in OD’s Division of Program Coordination, Planning, and Strategic Initiatives, ORWH is experienced and skilled at coordinating across NIH to create pathways for collaboration, foster collective innovation, and mobilize multidisciplinary efforts to advance the health of women. As a part of ORWH, OADR-ORWH will be able to leverage this existing expertise, infrastructure, and position to inform and amplify its efforts.
The Office of Autoimmune Disease Research (OADR-ORWH) is currently advancing several initiatives that will lay the foundation for high-priority autoimmune disease research (ADR) at NIH.
OADR-ORWH is evaluating NIH’s ADR portfolio, which includes more than 140 diseases. In partnership with key subject matter experts, the office is curating and analyzing research funded by NIH within the past 5 years to generate a baseline landscape analysis of the portfolio. Understanding the NIH ADR portfolio is critical to identifying opportunities to advance research and assess progress moving forward. This portfolio analysis will inform the inaugural NIH-wide strategic plan for ADR.
The strategic plan, which will guide future OADR-ORWH activities, aims to amplify institute, center and office efforts and advance opportunities for innovation. For more information on strategic planning for ADR, please visit Strategic Planning for ADR at NIH.
To learn more about current OADR-ORWH activities, please visit our Events page to join us at the next virtual Updates on OADR-ORWH session.
For more information on these efforts, please visit Autoimmune Disease Research Across NIH.
NIH supports a broad range of basic to clinical research on autoimmunity and autoimmune diseases. OADR-ORWH is conducting a baseline landscape analysis of NIH’s autoimmune disease research (ADR) portfolio. For the purposes of this analysis, more than 140 diseases and conditions included in the National Academies of Science, Engineering and Medicine report, Enhancing NIH Research on Autoimmune Disease, and considered to be either autoimmune or that co-exist with other autoimmune diseases will be reviewed. For more information on ADR across NIH and updates on the ongoing portfolio analysis, please visit the ADR Across NIH page.
Future OADR-ORWH-supported research will most likely investigate genetics, environmental exposures, biomarkers, sex influences, co-occurring autoimmune diseases, mechanistic pathways as therapeutic targets, animal models, systems biology, and translational research as they relate to various autoimmune diseases.
NIH investment in autoimmune disease research has increased over the past 5 years, reaching nearly $1 billion ($946,356,182) in fiscal year (FY) 2021.
In FY 2021 and FY 2022, 1,443 new research and administrative supplement grants listed "autoimmune disease” as the spending category. However, it is important to note that progress in our understanding of autoimmune disease research may not necessarily arise from research categorized as such. At NIH, we recognize that disease does not occur in a vacuum; disease-focused research often aligns with multiple ICO mission areas, allowing for a multidisciplinary approach.
For questions about OADR-ORWH, please reach out to OADRInfo@nih.gov. To receive updates directly to your inbox, please provide your email in the “Subscribe to Our Communications” box at the bottom of the page. When prompted, opt in to receive news and announcements from The Office of Autoimmune Disease Research (OADR-ORWH).
To learn more and sign up for the next virtual Updates on OADR-ORWH session, please visit the OADR-ORWH Events page.
For media inquiries, please use orwhinfo@nih.gov.