Dr. Mohammad Saeed
Founder & CEO
Consultant Rheumatology and Immunogenetics

Rheumatology Clinic: Mon to Thu and Sat
Timings: 10 am to 5 pm
Appointments: +92 308 282 2712

Dr. Mohammad Saeed, M.D.
Consultant Rheumatology and Immunogenetics
Fellowships (USA): Rheumatology, Musculoskeletal Ultrasound, Genomics, Immunology

Dr. Mohammad Saeed graduated from Aga Khan University Medical College and has Fellowships in Genomics from Northwestern University, Chicago, and Immunology from the University of Arkansas for Medical Sciences (UAMS). He trained in Internal Medicine and Rheumatology at UAMS and has further specialization in Musculoskeletal Ultrasound from Boston University (USSONAR program). He has been faculty at UAMS and Staff Scientist at Nephropath, USA.

.

He is an active researcher working on the genetics of lupus and other autoimmune disorders and has previously contributed substantially to Neurogenetics. He has several publications in international journals and has been a member of professional organizations including the American College of Rheumatology, European Lupus Society (SLEuro) and American Society of Human Genetics. He is a member of the Pakistan Society for Rheumatology and Health Research Advisory Board, Pakistan.

Rheumatology deals with inflammation anywhere in the body (kidneys, lungs, brain, and nerves, or even eyes) as well as disorders of joints and bones. These conditions are often difficult to diagnose due to the variety of symptoms they produce in different organ systems. Dr. Saeed has a special interest in patients who have not had a diagnosis despite visiting several doctors. Other common Rheumatologic diseases Dr. Saeed manages, include Osteoporosis and Osteoarthritis, Rheumatoid arthritis, Gout, Systemic lupus erythematosus, Myositis, Reactive arthritis, Psoriasis, and Vasculitis. These conditions can vary from mild to severe disease but have good treatments available especially if diagnosed early.

Research Publications

Curriculum vitae

.

Pakistan Society for Rheumatology (PSR) Conference 2019 was held in Karachi. Dr. Mohammad Saeed gave a plenary talk on “Lupus Nephritis” and reviewed the pathogenesis and treatment of the disease. This presentation is available for download using the link below. The presentation included kidney biopsy findings. the role of antibodies, mechanism of disease induction and propagation and how the various lupus drugs act, as well the latest genetic findings including APOL1 in Collapsing lupus glomerulopathy and PLA2R1 in Membranous glomerulonpehritis (MGN) and its interaction with lupus. These major genetic discoveries are co-authored by Dr. Mohammad Saeed.

ImmunoCure now offers PLA2R antibody test for MGN which may help in obviating the need for kidney biopsy in these patients and may be decisive in choosing a therapeutic regimen.

Dr. Mohammad Saeed Lupus Nephritis PDF

#PakistanSocietyRheumatology

# LupusNephritis

Dr. Mohammad Saeed was invited to talk on the “Multiple Sclerosis Pathogenesis” at the Aga Khan University (AKU). The event was organized by the Multiple Sclerosis Research and Education Forum at AKU led by Professor Mohammad Wasay (Neurologist). The day-long Multiple Sclerosis (MS) workshop was part of a nation-wide effort to train medical and paramedical staff in MS care. The presentation by Dr. Mohammad Saeed is attached below.

Early diagnosis and treatment is key to preventing neurological damage to patients. At ImmunoCure Laboratory rapid and efficient tests of the highest quality are available for a vast array of autoimmune diseases, including those affecting the nervous system. For demyelinating diseases such as Multiple Sclerosis, Neuromyelitis optica (NMO) and NMO spectrum disorders (NMOSD) ImmunoCure offers Immunoflourescence based testing for Aquaporin-4 (AQP4) antibody and myelin oligodendrocyte glycoprotein (MOG) antibody. AQP4-Ab is present in 80% of NMO while MOG-Ab is present in ~ 30% of NMOSD negative for AQP4-Ab. MOG-Ab is also present in 30-40% of acute disseminated encephalomyelitis (ADEM) and 5% of MS patients (1). These novel tests are helping Neurologists across Pakistan in making accurate and early diagnosis of autoimmune neurological diseases. Early diagnosis followed by rapid treatment, often with the latest biologic medications, has a major impact on reducing complications of these devastating diseases which were formerly thought to be incurable.

1. Peschl et al. (2017). Front Immunol. PMID: 28533781

Dr. Mohammad Saeed Multiple Sclerosis Presentation

Academic Debate: Ocrevus vs Rituximab for Multiple sclerosis Treatment

Home Blood Draw / Sample collection: 0334-2121-232

Membranous Glomerulopathy (MG) MG is a morphologic pattern of glomerulonephritis in which immune complexes deposit along the subepithelial aspect of the glomerular basement membrane. The molecular etiology of MG was recently discovered to be Podocyte Phospholipase A2 receptor (PLA2R) and its genetic susceptibility mutation was identified by Dr. Mohammad Saeed and colleagues (Saeed et al. 2014).

Antibodies against PLA2R are detected in 70-80% of patients with primary MG (Larsen et al. 2014). These findings are a major advance in the study of MG pathology, and has since then led to consequent developments in diagnosis and treatment of the disease.

Previously, diagnosis of autoimmune MG could only be made by kidney biopsy, histological examination or electron microscopy of the kidney tissue. These procedures were invasive, time consuming and costly. PLA2R antibody testing on blood samples using the sensitive IIFT method is safe and effective.

Ref:

Saeed M et al. (2014). Genes Immun. PMID: 25187357.

Larsen CP, et al. (2014). Am J Kidney Dis. PMID: 24731740.

Many patients have vague joint pains for prolonged durations which only temporarily resolve with anti-inflammatory medications. Such patients are often classified as having Fibromyalgia. However, these patients may actually be suffering from an inflammatory arthritis which needs more focused Rheumatologic treatment (Ref). Recent studies show that patients visit their doctors for joint and body aches and pains (musculoskeletal complaints) more frequently 1 to 2 years prior to the diagnosis of inflammatory arthritis (Ref).

At ImmunoCure, Dr. Mohammad Saeed conducts ‘Early Arthritis Clinic’ which includes the general medical screening of such patients in a detailed manner and ordering of appropriate tests which are performed rapidly at the ImmunoCure Laboratory. All test results are made available within 1 hour except antibody testing, results for which are also provided within 24 to 48 hours. ImmunoCure offers the special Musculoskeletal Ultrasound facility which helps readily diagnose early arthritis. This Clinic helps to to accurately diagnose these patients suffering from chronic pain rapidly in a single clinic visit.

Dr. Mohammad Saeed

Full Text Article

The talk is about inflammation and the immune system in general with special focus on the interaction of the immune system with the nervous system. It discusses neurological diseases such as Multiple sclerosis and Autoimmune Encephalitis, their diagnosis with special immunological tests and treatment. Neuroimmunology is the field where Rheumatologists and Neurologists interact together for the betterment of the patients.

Note: Talk is most in Urdu (for the benefit of the general public)

Anti-nuclear antigen. It is a test done to screen for inflammatory diseases such as lupus. 95% patients with lupus have ANA positive. It does not mean that if you have ANA positive you have lupus. This test can be positive in old age or if you have a close relative with an ‘autoimmune’ or inflammatory disease such as lupus, rheumatoid arthritis or thyroid disease. In any case the international protocol is for Rheumatologists to follow people with ANA positive for 2-years every 6-months to monitor for development of any autoimmune (inflammatory) disease.

ANA Subsets: These include antibodies to DNA (dsDNA), SS-A (Ro), SSB (La), RNP, Smith (Sm), Scl70, Jo-1.

These are all molecules in the cells against which antibodies develop because a hyperactive immune system is inappropriately exposed to them. This usually happens when the natural cell death, called apoptosis, does not execute properly.

E.g. Mutations in the gene TREX1, a major intracellular DNAse causing single-stranded DNA cleavage during apoptosis, lead to lupus (SLE) likely by inappropriately cleaving DNA and also resulting in dsDNA antibody formation.

General associations:

SLE (Lupus) is positive for ANA in 95% of cases
The remaining 4% is SSA positive
1% of lupus may be negative for all antibodies

SSA is associated with SLE and Sjogren’s
SSB is associated with Sjogren’s
RNP is present in MCTD (Mixed Connective Tissue Disease), SLE
Smith is associated with SLE and its kidney involvement
DNA is also associated with SLE and kidney involvement
Scl70 is associated with Scleroderma, SLE
JO-1 is associated with aggressive polymyositis

Again these are only associations. Presence of certain antibodies does not mean the patient has that disease, though it does make it somewhat more likely. Diagnosis is a clinical Rheumatology decision.

One of the most common antibodies tested for. This is present in ~ 70-80% Rheumatoid arthritis (RA) but is also present in other diseases such as hepatitis, chronic liver disease, thyroid disease, certain infections, and other autoimmune diseases like lupus, Sjogren’s etc. Therefore the diagnosis of RA should not be based on a positive RF. Moreover RA can be ‘Sero-negative’ i.e. the patient can have RA but the RF test is negative. This is equally aggressive disease and can be confirmed using MSKUS (Musculoskeletal Ultrasound).

RF together with anti-CCP has a 95% sensitivity for RA. If RA is suspected both antibodies should be tested simultaneously (unless there are financial issues – then test RF first). If positive a Rheumatologist opinion must be sought.

Antibodies can be present a decade (10-years) prior to the development of the disease. So treatment decisions are very much clinical and should remain within the domain of the Rheumatologist.

Antibodies circulating in the blood are markers of disease, i.e. they indicate that the person has or will develop in the future an autoimmune disease. This is not necessarily true. Some people have antibodies positive on a blood test simply because they are relatives of people with autoimmune disease. Antibodies also develop with aging. The immune system clearance mechanisms decrease in efficiency as we age and this allows antibodies to develop and circulate in the blood.

Antibody tests are generally done once in a lifetime (if positive). They do not usually vary with disease activity except for some tests.

Antibodies can be present a decade (10-years) prior to the development of the disease. So treatment decisions are very much clinical and should remain within the domain of the Rheumatologist.