Joan Reibman, MD

Research in our laboratory is focused on expanding our molecular, environmental, and clinical understanding of urban asthma. Over 18 million adults and 9% of children currently have asthma in the U.S., with urban areas and minorities bearing the greatest burden with the greatest costs incurred by those with severe asthma. There is an unmet need to understand mechanisms of disease and clinical interventions to reduce disease morbidity in these populations. To respond to this need, we have used the NYU/Bellevue Asthma Clinic, and the related HHC World Trade Center Environmental Center to promote the study of airway disease and environmental interactions. Our clinical and research laboratory has focused on three areas:

Airway epithelial cell-dendritic cell interface in the regulation of mucosal innate immunity and the response to environmental insults. Airway epithelial cells are the first targets for most environmental stimuli. Dendritic cells, innate immune cells, rapidly interact with airway epithelial cells. We use translational studies with in vitro studies of human primary cell cultured airway epithelial cells and dendritic cells to study the role of environmental pollutants (ambient particulate matter) on regulation of airway epithelial cell expression of pro-inflammatory molecules (growth factors, chemokines, matrix metalloproteinases) and bronchial epithelial cell-dendritic cell interactions. As such, we have shown that ambient pollutants promote dendritic cells that support Th2 polarization via an indirect effect on airway epithelial cells and elucidated pathways that support this process. Most recently we have developed a technique for in situ evaluation of human cells using sputum for isolation of human airway epithelial and dendritic cells. These studies allow for human in vivo systems analysis of disease mechanisms in response to environmental or therapeutic interventions.

Clinical and genetic studies of asthma in the urban setting. We have developed the Bellevue Hospital Asthma Clinic, a comprehensive asthma program in a public hospital to provide state-of-the-art care to indigent urban patients. Through this program, and as the Principal Investigator of the New York Consortium of the American Lung Association Asthma Clinical Research Centers (ALA ACRC), we participate and design interventional clinical trials to reduce asthma morbidity. We have also created a human gene and protein repository for disease modifying genes in asthma and have described gene and environment interactions for genes involved in the innate immune response.

World Trade Center health impacts. We were the first to study the environmental impact of the destruction of the World Trade Center towers on the respiratory health of the surrounding community. As a result of these studies, we developed a comprehensive medical and mental health treatment program for community members. In addition to ongoing studies to understand the physical and mental health in this population, the program supports clinical studies on early detection of lung injury using physiologic measurements and inflammatory biomarkers.