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Mount Sinai and Sema4 Launch Groundbreaking Asthma Study With Global Pharmaceutical Company

Updated on Jun 30, 2022 | Featured, Patient Stories, Research

Andrew Kasarskis, PhD, left, and Linda Rogers, MD, are part of the asthma study team.

Asthma, a chronic disease of the airways of the lungs, is a growing public health problem that now affects 350 million people and results in about 400,000 deaths worldwide each year. Its diagnosis and treatment remain challenging, however, and debilitating symptoms, such as coughing and shortness of breath, are a major cause behind rising health care costs, missed school for children, and loss of productivity and early disability in adults.

Recently, the Mount Sinai Health System and Sema4—a patient-centered predictive health company and a venture of Mount Sinai—joined with Sanofi, one of the world’s largest pharmaceutical companies, to follow 1,200 Mount Sinai patients to gain unprecedented insights into the biological mechanisms and environmental factors implicated in this condition.

The five-year study—the first of its kind—will collect traditional clinical data, such as electronic medical records and clinical samples, including blood samples and nasal brushings, from patients during their doctor appointments. The data will be analyzed for genomic and transcriptomic information and combined with other data collected using the patient’s mobile phone—environmental data, like air quality and pollen counts, data from the patient’s asthma inhaler, and data from home monitoring of activity and sleep. One of the unique elements of this study is that the research will be incorporated into actual clinical practice, and real-world data using remote devices will be integrated with molecular data.

“Despite advances in recent years, we still see many patients struggling with asthma, so there is a tremendous need for innovation to reduce the burden of this disease,” says Linda Rogers, MD, Associate Professor of Medicine (Pulmonary, Critical Care and Sleep Medicine) and Clinical Director of the Adult Asthma Program at the Mount Sinai – National Jewish Health Respiratory Institute. Dr. Rogers is the clinical principal investigator of the study, which is a collaboration among the Respiratory Institute, the Icahn Institute of Genomics and Multiscale Biology, Sema4, and Sanofi.

The Respiratory Institute is uniquely positioned to undertake this research. In addition to the large number of asthma patients that the program treats, the Mount Sinai and Sema4 study team have unparalleled capabilities in specimen analysis, data science, and multiscale biological modeling, allowing researchers to gather large amounts of data more rapidly than using more traditional research methods.

Clinical research teams will deploy advanced analytics on this information to better understand how the disease functions, including what triggers asthma attacks and which patient segments are most likely to respond to certain therapies. “This collection of large amounts of multiple types of data is needed to fully understand asthma—a condition researchers now believe is far more complex than was previously understood—and how best to treat patients,” says Tom Neyarapally, Sema4’s Chief Commercial Officer.

Significantly, gathering and analyzing these kinds of data from patients will demonstrate at the molecular level how their bodies are responding to asthma, says Andrew Kasarskis, PhD, Executive Vice President and Chief Data Officer for the Mount Sinai Health System and a co-principal investigator of the study. For example, analysis of a blood sample will show changes in the cellular activity, such as which proteins are being produced, and a nasal swab may reveal important clues about one’s immune response and what is happening in the lungs.

“We will define asthma subtypes clinically, then understand the molecular basis of disease in each subtype in order to discover new therapies and better manage asthma in all our patients,” says Dr. Kasarskis.

Ultimately, adds Erik Lium, PhD, Executive Vice President of Mount Sinai Innovation Partners, “this collaboration may lead to the identification of novel drug targets and the development of groundbreaking therapies to benefit all patients with asthma.”

Symposium Showcases Neurosurgery Technology

Updated on Jun 30, 2022 | Featured

Fedor E. Panov, MD, center, Assistant Professor of Neurosurgery, Icahn School of Medicine at Mount Sinai, explained the use of a robotic guidance device in epilepsy surgery to Cameron McIntyre, PhD, Tilles-Weidenthal Professor, Biomedical Engineering, Case Western Reserve School of Medicine, left, and Kelly Nicol, MS, medical student at the Philadelphia College of Osteopathic Medicine.

More than 100 physicians, medical and graduate students, residents, advanced practice providers, and other medical professionals attended the Icahn School of Medicine at Mount Sinai Department of Neurosurgery’s Digital Neuro Symposium held at the Hess Center for Science and Medicine on Friday, December 7, and Saturday, December 8. The symposium leaders included Mount Sinai physicians and researchers, joined by 20 academic and clinical experts from across the country, who advanced discussion of the technology revolution taking place in the neurosurgery arena. Topic areas included artificial intelligence, preoperative simulation and navigation tools, the expanding number of digital technologies used in the operating room, next-generation brain circuit therapeutics, and medical device development and entrepreneurship.

The event was co-directed by Joshua B. Bederson, MD, Professor and Chair of Neurosurgery, Mount Sinai Health System, and Clinical Director of the Neurosurgery Simulation Core; and Anthony B. Costa, PhD, Assistant Professor of Neurosurgery, Director of Sinai BioDesign, and Scientific Director of the Neurosurgery Simulation Core. The symposium also included world leaders in the medical technology industry who provided hands-on demonstrations that focused on patient-specific, 3D-printed brain models integrated directly into mock operating rooms.

The Department of Neurosurgery has long been a leader in the use of advanced digital technologies. In 2018, Mount Sinai became one of the first health systems to debut a next-generation microscope, which when integrated with other novel simulation and navigation tools, gives neurosurgeons an unprecedented real-time look into the brain’s vasculature. “Our Department of Neurosurgery is committed to advancing neurosurgical care and helping to educate other medical professionals about the tools and insights they need to improve outcomes for their patients,” says Dr. Costa.

Fedor E. Panov, MD, receives compensation as a consultant and lecturer from Zimmer, manufacturer of the ROSA Robot.

New Pathway to Treating Rheumatoid Arthritis Identified

Updated on Jun 30, 2022 | Featured, Research, Your Health

Pércio S. Gulko, MD, center, with team members Teresina Laragione, PhD, Assistant Professor of Medicine (Rheumatology), left, and Carolyn Harris, Senior Associate Researcher.

A new gene associated with disease severity in rheumatoid arthritis (RA) has been identified by researchers at the Icahn School of Medicine at Mount Sinai. This finding could provide a new pathway for treatment and a way to measure the prognosis of patients diagnosed with this autoimmune condition.

Through a series of experiments, Pércio S. Gulko, MD, Chief of the Division of Rheumatology, and the Lillian and Henry M. Stratton Professor of Medicine (Rheumatology), and his colleagues showed that Huntingtin-interacting protein 1 (HIP1) is a driver in inflammatory arthritis severity. The findings were published in July 2018 in the Annals of the Rheumatic Diseases. “It is known that this gene is expressed in some cancers, but precisely how it contributed to cancer was not known, and it has never been implicated in inflammation or arthritis. So this new discovery, that it regulates cell invasion, is completely novel,” says Dr. Gulko, senior author of the paper.

Rheumatoid arthritis is a chronic disease affecting more than 1.3 million Americans. The disease causes pain, swelling, and sometimes deformation of joints and affects about 1 percent of the world’s population. In the last 20 years, there have been major advances in the treatment of RA, but the existing treatments immunosuppress patients, increasing the risk for infections.

Dr. Gulko with images of synovial fibroblasts, cells in the joints that are central to his team’s study of rheumatoid arthritis.

“At my laboratory, we have been looking for alternative strategies,” Dr. Gulko says. “We have focused on understanding the regulation of disease severity and joint damage, and this led us to the synovial tissue and the fibroblasts.” These cells are present in all joints and produce the fluid that lubricates and nourishes the cartilage, but in patients with RA, they grow out of control, invading and destroying cartilage and bone.

Dr. Gulko’s team started with rodent models of arthritis, studying animals that were highly susceptible to RA and those that were resistant. Using a technique called positional cloning, the researchers identified gene variants that control arthritis severity and the behavior of the synovial fibroblasts, finding that HIP1 made the cells highly invasive. Next, the team studied synovial fibroblasts from patients with RA and found that HIP1 was strongly expressed in those cells. To test the finding further, the team used a molecular biology technique to “knock down,” or remove, HIP1 from the cells of RA patients, and found that this significantly reduced the cells’ ability to invade.

The team unexpectedly found further evidence implicating HIP1 while collaborating in a study of RA and epigenetics, the environmental influence on genetics. The study, which was published in May 2018 in Nature Communications, compared the synovial fibroblasts of patients with RA with those from patients with osteoarthritis, which is not considered an inflammatory disease. The researchers were looking for dysregulated genes and pathways that differentiated the two groups of patients.

“One key pathway found to be epigenomically dysregulated was the Huntington protein pathway, including HIP1,” Dr. Gulko says.

Going forward, Dr. Gulko has several goals: improving the understanding of how HIP1 regulates disease; finding a way to quantify HIP1 levels in the blood or synovial fluid cells with the aim of creating a predictor of disease prognosis; and developing a drug that would target the HIP1 gene. The ultimate goal is to achieve remission for RA patients.

“I treat many patients with rheumatoid arthritis,” Dr. Gulko says, “and all the work that we have done throughout my career has been centered on trying to bring a benefit to these patients.”

The Mount Sinai AppLab Forges an Academic Home for Evidence-Based Digital Medicine

Updated on Jun 30, 2022 | Featured

Members of the AppLab and Rx.Health team, from left, Andy Pfau, JD; Sonya Makhni, MD, MBA; Ashish Atreja, MD, MPH, FACP; Shrawan Patel, MBBS; Jason Rogers; Shashank Garg; Saurabh Gupta; Sarah Zweifach; Sarthak Kakkar; and Farah Fasihuddin, MPH.

As the field of digital medicine rapidly produces novel innovations for a wide patient population, the Mount Sinai Health System’s AppLab is creating applications that provide meaningful benefits to both patients and health care providers.

Led by Ashish Atreja, MD, MPH, FACP, Associate Professor, Medicine (Gastroenterology), and Chief Innovation and Engagement Officer, Icahn School of Medicine at Mount Sinai, the AppLab comprises data scientists, software developers, and population health coordinators whose digital solutions for clinical and research objectives adhere to the stringent, evidence-based safeguards of traditional medicine.

To date, the AppLab has built and validated apps and other digital medicine solutions for numerous diseases and use cases. In 2017, the group launched RxUniverse, a software platform that curates clinically validated health apps. This led to the launch of Rx.Health, a Mount Sinai spinout company focused on seamlessly integrating evidence-based digital tools into health care systems. Commercialization of Rx.Health was led by Mount Sinai Innovation Partners, which facilitates the real-world application of Health System innovations as early as product ideation.

The AppLab has created a dozen stand-alone apps, developed various micro apps on the RxUniverse platform, and participated in more than 25 funded projects. In the past year, it has conducted a project at The Mount Sinai Hospital that monitors recently discharged heart failure patients through an app and connected Bluetooth devices. Through the RxUniverse platform, the AppLab also provides pertinent information and preparatory support for patients prior to colonoscopy procedures. Pfizer Inc. has provided the AppLab with a grant to study ways to improve vaccinations in inflammatory bowel disease patients. Additionally, the AppLab participates in a project with the New York State Department of Health AIDS Institute to improve care among young adults with HIV.

“The proliferation of apps and new technologies makes it difficult to determine what truly has evidence,” says Jason Rogers, Program Manager, Mount Sinai AppLab. “We try to build software solutions that meet the challenge and build a community to share knowledge.”

The AppLab leads one of the many efforts at Mount Sinai to implement digital health solutions. Open-MIC (Mount Sinai Innovation Champions) is a monthly, collaborative group where individuals meet to share their success stories and what they have learned. Additionally, a Mobile Application Executive Committee was recently formed to develop guidelines for app implementation and branding.

Dawn Irish, Head of Digital Experience and Brand at biopharmaceutical maker Shire, discussed balancing automation and physician-patient engagement at the NODE.Health conference.

NODE.Health, a nonprofit founded and chaired by Dr. Atreja, fosters a wider community of digital medicine leaders throughout the country and held its second annual Digital Medicine Conference in December. During the three-day event held at the Microsoft Conference Center in Times Square, more than 30 health systems were on hand to share their projects, learn from their colleagues, and build collaborations. The conference held seminars, hosted a pitch competition, and featured roundtable discussions on topics such as “Bridging the Evidence Gap in Digital Medicine.”

Dr. Atreja says he is encouraged by advances in apps such as MyChart and those within the RxUniverse that allow patients to access their own medical records. “In the next few years, we will see the prescription of apps become mainstream,” he adds. But it is essential that they are rigorously tested to prevent potentially harmful technologies from reaching patients. “We have touched tens of thousands of patients’ lives and feel we can increase that,” says the AppLab’s Program Manager, Mr. Rogers. “It is about building out use cases for particular care pathways and scaling up the engagement so we can help more patients.”

Those interested in launching a mobile app are requested to reach out to Rebecca Lingner, Director, Branding, Mount Sinai Health System (rebecca.lingner@mountsinai.org). Additionally, the AppLab provides free ‘AppChat’ consults through the Clinical and Translational Science Awards (CTSA) program. Contact sinaiapplab@gmail.com to schedule a meeting.

Ninth Episode of Mount Sinai Future You Features Stories Celebrating Heart Month

Updated on Jun 30, 2022 | Featured, Future You

Episode 9 of Mount Sinai Future You features stories celebrating heart month, including a young girl who was diagnosed with two heart conditions. Following treatment with Barry Love, MD, Director of the Catheterization Laboratory and Pediatric Electrophysiology Programs at the Children’s Heart Center, she’s enjoying life in Colorado with her family.

A New Waiting Room that Supports Men’s Health

Updated on Jun 30, 2022 | Featured, Patient Stories, Your Health

The idea that men often take better care of their cars than their own health led to the recent opening of a sports-themed waiting room at the Milton and Carroll Petrie Department of Urology’s midtown office at 625 Madison Avenue. The special space was designed to serve as a refuge for male patients waiting for a doctor’s appointment or looking for
educational resources on prostate health or men’s health.

Amid the mounted football jerseys belonging to former Super Bowl winners and other framed sports memorabilia featured in the room, male patients can find information on medical services, holistic treatments, or emotional support when dealing with a critical prostate diagnosis.

Ash Tewari, MBBS, MCh, left, and Tom Milana Jr. celebrated the opening of the waiting room with a ribbon-cutting.

The new space was donated by Man Cave Health, Inc., a nonprofit led by philanthropist and Mount Sinai Health System patient Tom Milana Jr., a prostate cancer survivor who recognized the need to raise awareness about the disease and men’s health as he was recovering from his 2016 diagnosis.

At the official ribbon-cutting ceremony in January, Mr. Milana said, “This is a place where men can get educated, screened, and treated for prostate cancer in a welcoming environment. Our goal is to get more men to go to the doctor for their annual screening, which will lead to fewer prostate cancer deaths in this country.”

Mr. Milana’s physician at Mount Sinai, Ash Tewari, MBBS, MCh, the Kyung Hyun Kim, MD Chair in Urology, said, “Men avoid going to the doctor. I think this room makes a difference. They can come here and relax.”

The inspirational message, he added, is about winning at sports and winning the fight against cancer.

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