Photo of Dr Eve Smith

Dr Eve Smith PhD, MBCHB, BSC

NIHR Academic Clinical Lecturer Women's & Children's Health


Personal Statement

Dr Eve Smith undertook her undergraduate training at the University of Edinburgh, graduating in 2005. Her postgraduate training in paediatrics commenced in Newcastle-upon Tyne. In 2013 she moved to Liverpool to undertake a PhD supervised by Professor Michael Beresford focused on ‘Developing a Lupus Nephritis (LN) urinary biomarker panel in children for use in a clinical trial’, working as part of the UK's only Experimental Arthritis Treatment Centre for Children (EATC4Children). During her PhD she developed a panel of biomarkers for identification of active LN identification and validated these results in two independent international cohorts (from Albert Einstein College of Medicine, US, and the University of Cape Town, South Africa). A subsequent longitudinal study identified one of the urinary biomarkers (AGP) to be predictive of flare, and another (Ceruloplasmin) to predict LN remission. In 2014, Eve was awarded the Merck Millipore 2014 MAGPIX Grant program, receiving a MAGPIX Luminex Multiplex Instrument, and associated magnetic bead-based biomarker assays. An MRC Confidence in Concept grant facilitated collaborative development and validation of a custom multiplex assay, with industry partner Merck Millipore. The multiplex assay streamlined the process of biomarker quantification, and is more accurate than the original ELISA based methods for biomarker quantification. See Video Summary of Dr Eve Smiths PhD. This assay has recently been used as part of a collaboration with the BILAG-BR and MRC MASTERPLANS Consortium, demonstrating that these biomarkers can also identify active LN in adult SLE, and help predict response to rituximab treatment. This research is leading use of cSLE urine biomarkers, demonstrating real potential for future translation and impact for patients through development of a non-invasive test for LN.

As an NIHR ACL, Dr Eve Smith's main focus has been on developing the TARGET LUPUS research programme (Targeting disease, Agreeing Recommendations, and reducing Glucocorticoids through Effective Treatment, in LUPUS), which ultimately aims to develop T2T approach for cSLE. With T2T, treatment is intensified until a certain pre-determined ‘target’ is reached, and re-intensified again if the target is lost. CSLE patients have been shown to be more severely affected than adults with SLE (aSLE), with a higher disease activity and medication burden, more severe organ manifestations, and higher standardised mortality rates. CSLE patients are also at high risk of accruing permanent organ damage, and suffer from significantly lower health-related quality of life than healthy children. T2T is now part of routine clinical care in many areas of medicine (e.g. rheumatoid arthritis, hypertension, diabetes), and there is increasing interest in use of T2T in cSLE and aSLE, as a means to aggressively control disease activity early, preventing organ damage, and improving quality of life.

Dr Smith has recently published two important studies which help to lay the foundation for the T2T approach in cSLE:

- Smith EMD, Tharmaratnam K, Al-Abadi E, Armon K, Bailey K, Brennan M, et al. Attainment of Low Disease Activity and Remission Targets reduces the risk of severe flare and new damage in Childhood Lupus. Rheumatology (Oxford). 2021.

- Smith EMD, Gorst SL, Al-Abadi E, Hawley DP, Leone V, Pilkington C, et al. 'It is good to have a target in mind': qualitative views of patients and parents informing a treat to target clinical trial in juvenile-onset systemic lupus erythematosus. Rheumatology (Oxford). 2021;60(12):5630-41.

With significant interest in T2T for cSLE across the world, Dr Smith has led in developing a 'International cSLE T2T Task Force', supported by the TARGET LUPUS Public and Patient Involvement group. Dr Smith is particularly interested in undertaking patient-centric research, in rare autoimmune paediatric diseases.

Dr Smith is a keen collaborator, recognising that this is crucial for producing impactful research. She currently co-leads the Research Section of the Paediatric Rheumatology European Society (PReS) SLE Working Party, supporting development of International cSLE studies and collaborations. She also co-leads the UK JSLE Topic Specific Group, running and supporting a range of clinical and epidemiological studies involving the UK JSLE Cohort Study. She is co-PI on a PReS/CARRA funded study ‘Identifying Cross-Registry Commonalities to Facilitate International Pediatric Lupus Research’ which aims to bring together three of the biggest cSLE International Cohorts to facilitate larger, and more impactful cSLE studies. She supervises a range of local, national and international students, both at undergraduate and postgraduate level. Previously she has been the UK Paediatric Rheumatology Clinical Studies Group (CSG) Trainee Representative (2013-21), the PReS Trainee Representative (2013-19) and the PReS EMERGE (Emerging Paediatric Rheumatologists and Researchers Chair, 2017-19), and has been on the steering committee for a British Paediatric Surveillance Unit (BPSU) study investigating the incidence and prevalence of cSLE across the UK and Republic of Ireland.

Dr Smith also works very closely with the European Network for Children with Arthritis (ENCA) in the development and on-going organisation of WORD day (World young Rheumatic Diseases day), an international campaign that takes place on the 18th of March each year. The ultimate aim of WORD Day is to raise the awareness and knowledge level of parents, doctors, primary practitioners, teachers, and the general public to help first and foremost in early diagnosis, and quick referral to specialised paediatric rheumatology services. The hope is that awareness will have a ripple effect on all levels of practitioners who come in contact with these children, improving the level of treatment they receive and their prognosis worldwide.

Yona Egert, Tsipi Egert, Wendy Costello, Berent J Prakken, Eve M D Smith, Nico M Wulffraat,
Children and young people get rheumatic disease too. The Lancet Child & Adolescent Health 2019,
3 (1): 8-9,