Carolina Munoz Grajales MD PhD

Toronto Western Hospital
Title of Project: Elucidating the Risk Factors and Trajectories of Cognitive Impairment in Systemic Lupus Erythematosus
Mentor: Zahi Touma, MD

About the Researcher

Carolina Munoz Grajales, MD, PhD, completed her medical training (2005) and an internal medicine residency (2009) at Universidad Pontificia Bolivariana in Medellin, Colombia. Following residency, she completed a rheumatology fellowship at Universidad de Antioquia in Medellin, Colombia (2010-2012).

Dr. Munoz Grajales’ thesis work during her rheumatology fellowship was directed at understanding gender differences in disease activity and clinical features in newly diagnosed SLE patients. This work was later published in the journal Lupus.

From 2012 to August 2017, Dr. Munoz Grajales worked as staff of the rheumatology department at Hospital Pablo Tobon Uribe in Medellin. There she participated in clinical research focused
mainly on SLE. While working as a rheumatologist she was encouraged to pursue a PhD in immunology in the hopes of gaining a stronger understanding of rheumatology. 

Dr. Munoz Grajales started her Ph.D. in fundamental immunology at University of Toronto in 2017 and expects to complete the program in the Fall of 2021. At the University of Toronto, she focuses upon identification of the immune changes that promote development of systemic autoimmune rheumatic diseases such as lupus. She has presented her work at various rheumatology conferences such as the American College of Rheumatology and the Canadian Rheumatology Association. Dr. Munoz Grajales hopes to integrate the knowledge gained from her Ph.D. with her previous work as a rheumatologist to become an effective clinician scientist in systematic lupus erythematosus.

Project Summary

Systemic lupus erythematosus or SLE is a chronic rheumatic autoimmune disease in which the immune system attacks the body's own tissues. It can affect various organs or systems of the body, including the central nervous system (CNS). The compromise of the CNS by SLE produces neurological and psychiatric manifestations known as neuropsychiatric lupus (NPSLE). With a prevalence of 33-43%, cognitive impairment (CI) is one of the most common manifestations of NPSLE. Symptoms of CI include decline in memory, thinking speed, attention, and planning abilities. Even though CI can be associated with significant reduction of lupus patient’s quality of life and employment potential, it is often overlooked in the clinical practice. Because the risk factors are unknown currently it is not possible to identify those SLE patients at risk of developing CI. Similarly, the different patterns of CI in SLE, or subtypes, are unrecognized.

Using novel data analyses techniques such as machine learning analyses and data modeling, our study aims to: 1) identify clinical subtypes of CI among SLE patients; and 2) predict which patients are at risk for CI, identify what factors increase risk of persistent CI, and predict the trajectory of cognitive function over time.

Given the high prevalence of CI in SLE, our research initiative will impact a large number of patients. Identifying patients with a high risk of CI and those who are likely to have severe CI over time will enhance the management of the disease and its progression. Ultimately, our project can help alleviate the burden of disease due to CI and improve the overall health related quality of life among patients.