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Dolores Benedicta Njoku, M.D.
Program Director, Pediatric Anesthesiology
Associate Professor of Anesthesiology and Critical Care Medicine
Expertise: Anesthesiology, Critical Care Medicine
Research Interests: Mechanisms of immune-mediated, drug-induced liver injury; Effects of occuptaional exposures to volatile anesthetics; Myocarditis; Autoimmunity; DILI; Hepatitis; Drug haptens; Care of pediatric patients undergoing complicated orthopedic procedures; Drug-induced liver injury ...read more
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Dr. Dolores Benedicta Njoku is an associate professor of anesthesiology and critical care medicine, pathology and pediatrics at the Johns Hopkins University School of Medicine.
In 2005, Dr. Njoku opened the door for understanding the pathways in the liver-injury process when she published results of her work with a mouse model that mimicked the drug reaction in the liver.
She serves as the director of the Pediatric Anesthesiology Fellowship program.
Dr. Njoku received her undergraduate degree in biochemistry from the University of Dallas. She earned her M.D. from the University of Mississippi. She completed her residency at Rainbow Babies and Children’s Hospital in Cleveland, Ohio, and performed a five-year training fellowship in the combined pediatric anesthesiology/pediatric critical care program at Johns Hopkins. Dr. Njoku joined the Johns Hopkins faculty in 1995.
From 1998 to 2005, Dr. Njoku was an adjunct investigator at the Laboratory of Molecular Immunology for the National Institutes of Health''s National Heart, Lung and Blood Institute.
Her areas of interests include multidisciplinary translational research investigating drug-induced liver injury in adult and pediatric patients and the care of pediatric patients undergoing complicated orthopedic procedures.
Dr. Njoku is the founder and director of PEDI-20, a novel pediatric anesthesiology educational/training program at Johns Hopkins. She received the William F. Rienhoff Jr. M.D. Scholar Award for 2011-2013 from Johns Hopkins. She is a member of several professional organizations, including the American Academy of Pediatrics and the American Society of Anesthesiology.
- Program Director, Pediatric Anesthesiology
- Director, Pediatric Anesthesiology Fellowship
- Associate Professor of Anesthesiology and Critical Care Medicine
- Assistant Professor of Pediatrics
- Associate Professor of Pathology
Departments / Divisions
- MD; Medicine, University of Mississippi School of Medicine (1987)
- Johns Hopkins University School of Medicine / Anesthesiology and Critical Care Medicine (1993)
- Johns Hopkins University School of Medicine / Anesthesiology and Critical Care Medicine (1994)
- American Board of Anesthesiology / Anesthesiology (1995)
- American Board of Anesthesiology / Pediatric Anesthesiology (2013)
Research & Publications
Dr. Njoku studies how drugs, including antibiotics and anti-seizure medications, can cause immune-mediated liver injury. As an anesthesiologist, Dr. Njoku became interested in this field because some patients who had undergone anesthesia for surgical procedures, as well as some physicians who were chronically exposed to halogenated anesthetic, became ill following these seemingly different types of exposures. With her animal model of sensitization to proteins that are affected by anesthetics, Dr. Njoku has begun to better understand the pathways involved in the injury process and recognizes that this model can also uncover pathways involved with other drugs that cause similar liver injury.
During the metabolic process, some drugs produce haptens, which can bind to and alter proteins in the liver. This alteration can result in those proteins no longer being identified by the body as “self,” and consequently, an immune reaction develops. As part of her research, Dr. Njoku analyzes a bank of serum samples from patients to look for protein-specific autoantibodies. From this investigation, she began to suspect that immunoglobulin G4 (IgG4) might be involved in the injury process. By testing this hypothesis, she found that mice that lacked the IgG4 pathway did not develop the anesthetic-induced liver disease.
In future work, Dr. Njoku hopes to uncover the immunogenic epitopes, or pieces, of the proteins that trigger the autoimmune reaction and identify the key regulatory pathways involved. The goal is to study and characterize the pathway further so that new drugs can be developed that do not trigger the disease process. One final aim would be to determine why women are more prone to develop this drug-induced, immune-mediated liver injury than are men.
- Njoku D. Kliegman R. Atypical Extrapulmonary Presentations of Severe Respiratory Syncytial Virus Infections Requiring Intensive Care. Clinical Pediatrics 32:155-160, 1993.
- Njoku DB, Laster MJ, Gong DH, Eger EI, Reed GF, Martin JL. Biotransformation of Halothane, Enflurane, Isoflurane and Desflurane to Trifluoroacetylated Liver Proteins: Association between Protein Acylation and Hepatic Injury. Anesthesia and Analgesia. 84:173-178, 1997.
- Njoku DB, Shrestha S, Lon J, Soloway R, Duray PR, Tsokos M, Abu-Asab MS, Pohl LR, West AB. Subcellular Localization of Trifluoroacetylated Liver Proteins in Association with Hepatitis Following Isoflurane. Anesthesiology 96:757-761, 2002.
- Njoku DB, Greenberg RS, Bourdi M, Dake B, Martin JL, Pohl LR. Autoantibodies Associated with Inhalational Anesthetic Hepatitis Found in the Sera of a Large Cohort of Pediatric Anesthesiologists. Anesthesia and Analgesia 94:243-249, 2002.
- Fairweather D, Frisancho-Kiss S, Gatewood S, Njoku D, Steele R, Barrett M, Rose NR. Mast cells and innate cytokines are associated with susceptibility to autoimmune heart disease following Coxsackievirus B3 infection. Autoimmunity 37:131-145, 2004
- Fairweather D, Frisancho-Kiss S, Yusung SA, Barrett MA, Davis SE, Gatewood SJ, Njoku DB and Rose NR. Interferon-γ protects against chronic viral myocarditis by reducing mast cell degranulation, figrosis, and the profibrotic cytokines transforming growth factor-β1, Interleukin-1β and interleukin-4 in the heart. Am J Pathol 165:1883-1894 2004.
- Njoku DB, Talor MV, Fairweather D, Frisancho-Kiss S, Odumade OA and Rose NR. A Novel Model of Drug Hapten- Induced Hepatitis with Increased Mast Cells in the BALB/c Mouse. Exp Mol Pathol. 78:87- 100, 2005.
- Njoku DB, Mellerson JL, Talor MV, Kerr, D R, Faraday NR, Outschoorn I and Rose NR. Role of CYP2E1 Immunoglobulin G4 Subclass Antibodies and Complement in the Pathogenesis of Idiosyncratic, Drug-Induced Hepatitis. Clin Vaccine Immunol. 2006 Feb;13(2):258-65.
- Fairweather D, Frisancho-Kiss S, Njoku DB, Nyland JF. Kaya Z, Yusung SA, Davis SE, Frisancho A, Barrett M and Rose NR. Complement receptor 1 and 2 deficiency increases coxsackievirus B3-induced mycarditis, dilated cardiomyopathy and heart failure by increasing macrophages, Il-2beta and immune complex deposition in the heart. J Immunol 176(6): 3516 - 24, 2006.
- Frisancho-Kiss S, Nyland JF, Davis SE, Barrett MA, Gatewood SJ, Njoku DB, Cihakova D, Silbergeld EK, Rose NR and Fairweather D. Cutting Edge: Tim-3 reduces inflammatory heart disease by increasing CTLA-4 during innate immunity. J Immunology, 176(11): 6411 -15, 2006.
- Anderson JS, Rose NR, Martin JL, Eger EI and Njoku DB. Desflurane hepatitis associated with hapten and autoantigen-specific IgG4 antibodies. Anesthesia and Analgesia, 104 (6): 1452, 2007.
- Chin MW, Njoku DB, MacQuillan G, Cheng WS, Kontorinis N. "Desflurane-induced acute liver failure." Med J Aust. 2008 Sep 1;189(5):293-4. No abstract available.
- Nguyen C, Rose NR and Njoku DB. Trifluoroacetylated IgG4 antibodies in a child with Idiosyncratic acute liver failure following first exposure to halothane. Journal of Pediatric Gastroenterology and Nutrition 47(2):199 -202, 2008.
- Njoku DB, Li Z, Mellerson JL , Sharma R, Talor MV, Barat N and Rose NR. IP-10 protects while MIP-2 promotes experimental drug hapten hepatitis. J Autoimmun. Feb;32(1):52-59, 2009.
- Njoku DB, Li Z, Washington ND, Mellerson JL, Talor MV, Sharma R, Rose NR. "Suppressive and pro-inflammatory roles for IL-4 in the pathogenesis of experimental drug-induced liver injury." Eur J Immunol. 2009 Jun;39(6):1652-63. doi: 10.1002/eji.200838135.
- Cho J, Kim L, Li Z, Rose NR, Talor MV, Njoku DB. "Sex bias in experimental immune-mediated, drug-induced liver injury in BALB/c mice: suggested roles for Tregs, estrogen, and IL-6." PLoS One. 2013;8(4):e61186. doi: 10.1371/journal.pone.0061186. Epub 2013 Apr 5.
- Molleston JP, Mellman W, Narkewicz MR, Balistreri WF, Gonzalez-Peralta RP, Jonas MM, Lobritto SJ, Mohan P, Murray KF, Njoku D, Rosenthal P, Barton BA, Talor MV, Cheng I, Schwarz KB, Haber BA; PEDS-C Clinical Research Network. "Autoantibodies and autoimmune disease during treatment of children with chronic hepatitis C." J Pediatr Gastroenterol Nutr. 2013 Mar;56(3):304-10. doi: 10.1097/MPG.0b013e3182774cae.
- Martin JL and Njoku DB Understanding the Metabolism and Toxicity of Modern Inhaled Anesthetics. In: Anesthesia. 5th Edition. Ed: Miller RD. Churchill Livingstone, Philadelphia, PA , 2004.
- Sharma R, Burek CL, Cihakova D, Njoku DB and Rose NR. Environmental Factors in Autoimmune Endocrinopathies. Editor: A P Weetman, Humana Press, Inc. in press, 2007.
- Njoku D. Branchial Cleft Cyst. In: Anesthesia for Strategies in Pediatric Anesthesia for the Palm Pilot. Ed.: RS Litman. Pocketmedicine.com, New York, NY, 2007.
- Kaufman S and Njoku D. Craniotomy for CNS Tumor Excision. In: Anesthesia for Strategies in Pediatric Anesthesia for the Palm Pilot. Ed.: RS Litman. Pocketmedicine.com, New York, NY, 2007.
- Ajuba-Iwuji C and Njoku DB. Rashes. In PocketICUMedicine. Ed: M Wall. Pocketmedicine.com, New York, NY, 2008.
- Ajuba-Iwuji C and Njoku DB. Traumatic Brain Injury in Hand book of Neuroanesthesia. Ed: J Kirsch and A Brambrink. In press, 2009.
Activities & Honors
- William F. Rienhoff Jr. M.D. Scholar Award, 2011 - 2013
- Research Day Award for Pulmonary Medicine - Inflammation and Immunity, Johns Hopkins School of Medicine, 2011
- Best Abstract of Meeting, American Autoimmune Related Diseases Association, 2007
- Best Scientific Abstract of Meeting, International Anesthesia Research Society, 1999
- Young Investigator Award, Society of Pediatric Anesthesiology, 1998
- Young Investigator Award, Foundation for Anesthesia Education and Research, 2000 - 2002
- American Academy of Pediatrics
- American Association of Immunologists
- American Board of Anesthesiology
- American Society of Anesthesiology
- Association of University Anesthesiologists
- Society for Education in Anesthesiology
- The Society for Pediatric Anesthesia
- Anesthesiology Leader, The Johns Hopkins Hospital, 1998
Pediatric Orthopedic Operating Room Triad
- Founder and Director, Johns Hopkins University School of Medicine, 2005
- Joint Council on In, American Society of Anesthesiologists, 2002
- Junior Oral Board Examiner, American Board of Anesthesiology, 2007
- Lead Investigator, Johns Hopkins University School of Medicine, WHO Center for Autoimmune Disease Research, 2002
Drug-Induced Autoimmune Liver Diseases
Videos & Media
Lectures and Presentations
Preventing Injury from Commonly Used Medications