Advancing the Study of Dizziness and Imbalance

Joanna C. Jen, MD, PhD, a physician-scientist with a special interest in the genetic and physiological basis of neurological disorders affecting eye movement control, balance, and coordination, recently joined the Icahn School of Medicine at Mount Sinai as Chief of the Division of Neuro-otology and Neurogenetics in the Department of Neurology.

She was named the Dr. Morris B. Bender Professor of Neurology, and Professor of Neurosurgery, and Otolaryngology, and will build upon the groundbreaking work of her predecessors—the late Morris B. Bender, MD, a pioneer in the neurology of the ocular motor system and a former Chair of Neurology at Mount Sinai, and Bernard Cohen, MD. An internationally renowned scientist and clinician, Dr.  Cohen considerably advanced understanding of the functions of the vestibular system, helping to discover a mechanism in the brainstem that is an essential part of the neural basis for balance that aligns the body with gravity.

In one research project that began in the 1980s—which was recently documented in the Smithsonian Institution Online Virtual Archives Dr. Cohen was asked by NASA to test the neuro-optical response of primates when orbiting the Earth in microgravity. The Cosmos Primate Rotator Chair, which was built to specifications provided by Dr. Cohen and a Russian Academy of Medicine scientist, allowed the researchers to study eye movement responses in monkeys in an upright position and at various angles of tilt, before and after spaceflight. They demonstrated for the first time that exposure to microgravity had dramatically altered an essential reflex that is part of normal eye movements, both in humans and monkeys.

Dr. Cohen with the Cosmos Primate Rotator Chair.

The laboratory established by Dr. Cohen also developed the first effective treatment for mal de débarquement syndrome (MdDS), which has since treated more than 400 patients who have sensations of continuous rocking, swaying, and bobbing after cruises on the sea. Dr. Cohen, who served as the inaugural Dr. Morris B. Bender Professor of Neurology and continues his research as Professor Emeritus, recently provided generous funding for the first fellow in neuro-otology and for research on the pathophysiologic mechanisms underlying MdDS.

In her new role, Dr. Jen aims to create a comprehensive multidisciplinary clinical care and research program that spans the population health approach, from front-line evaluation and management of dizziness and imbalance, to precision medicine-based diagnosis and treatment for rare disorders of cerebellar maldevelopment and degeneration.

Computational Model Leads to Discovery of Gene-Activation Pathway Associated With Atherosclerosis

 Jun Zhu, PhD

A computational model of cells that line blood vessels in the human heart, developed at the Icahn School of Medicine at Mount Sinai, has led to the discovery of a gene-activation pathway caused by lipids associated with coronary artery disease. The findings appear in the June 12, 2018, issue of Nature Communications.

The new pathway, discovered by researchers in Mount Sinai’s Department of Genetics and Genomic Sciences, and at Goethe University in Frankfurt, Germany, could help identify new directions in research and drug development.

Atherosclerosis is caused by the buildup of a complex mixture of components, commonly referred to as plaque, within the inner lining of arteries. Oxidized phospholipids are abundant in this arterial plaque and are thought to promote atherosclerosis progression. However, the specific cellular processes caused by these lipids on the arterial surface are still not well understood. The cells composing the inner surface of blood vessels, called endothelial cells, are at the forefront of the atherosclerotic process and, therefore, are a major focus of research into coronary artery disease.

“Computational biological models such as the one we used in this study are allowing us to uncover a wealth of knowledge about complex diseases that we never could before,” says Jun Zhu, PhD, Professor of Genetics and Genomic Sciences at the Icahn School of Medicine at Mount Sinai; Head of Data Science at Sema4, a patient-centered predictive health company that is a Mount Sinai venture; and co-senior author of the study. “Endothelial cell response to lipids has been studied extensively over the years, but it was still unknown that MTHFD2 was even functional in these cells.”

The researchers from Mount Sinai and Goethe University predicted and validated in follow-up experiments that the MTHFD2 gene plays a key role in endothelial cell response to oxidized phospholipids. They found that MTHFD2 was also activated in endothelial cells in response to other factors, such as inflammation or a change in amino acid concentration. This underscores the many factors involved in the development of atherosclerosis that must be understood and taken into consideration when approaching disease therapies.

“Our study showed that when the MTHFD2 gene is activated in endothelial cells in response to oxidized lipids, it sends out molecular ‘danger signals’ promoting inflammation and stimulating the atherosclerotic process,” says Ralf Brandes, MD, Director of the Institute for Cardiovascular Physiology and Professor of Physiology at Goethe University. “These findings suggest that MTHFD2 could be a novel target to disrupt development and progression of atherosclerosis.”

While the role of MTHFD2 in the vascular system was unknown before this study, the gene is known to be consistently activated in cancer, making it a promising target for cancer therapies. In clinical trials, MTHFD2 inhibitors are already in use as anticancer therapies. “It’s possible that these therapies could also help prevent coronary artery disease, but more research into the specific role of MTHFD2 in atherosclerosis is needed first, before proposing it as a target for potential therapy,” according to Dr. Zhu.

Wholeness of Life Awards for Compassionate Care

The Mount Sinai staff members honored were, from left, Raymond V. Wedderburn, MD; Lindsay Condrat, RN, MSN, ACNP-BC; and Junior Corniel.

Three Mount Sinai Health System employees received 2018 Wholeness of Life Awards from the HealthCare Chaplaincy Network™ for their commitment to providing compassionate and respectful care to patients. The staff members, all nominated by their colleagues, received their awards in November at the HealthCare Chaplaincy Network’s annual gala at the Lotte New York Palace.

Raymond V. Wedderburn, MD, FACS, Chief of Trauma and Critical Care at Mount Sinai St. Luke’s and Mount Sinai West, and Assistant Professor of Surgery, Icahn School of Medicine at Mount Sinai, was honored for being a gifted teacher and healer whose care for patients integrates mind, body, and spirit.

Lindsay Condrat, RN, MSN, ACNP-BC,Associate Director of Nursing, Mount Sinai Heart, was recognized for her personalized and holistic approach, especially in caring for patients who are far from home and families who are going through a difficult time.

Junior Corniel, an X-ray technician at Mount Sinai Beth Israel, was honored as an exceptionally empathic worker whose “love for his job and patients alike shines through every day.”

The HealthCare Chaplaincy Network is a global, nonprofit organization that offers spiritual care-related information and resources to hospitals and health care institutions.

STAT Online: Virtual Repurposing Can Speed the Discovery of New Uses for Existing Drugs

Inga Peter, PhD

In an essay in STAT, a leading online publication covering the life science industry, Inga Peter, PhD, Professor, Genetics and Genomic Sciences, at the Icahn School of Medicine at Mount Sinai, writes about a new approach to drug discovery—sometimes called virtual repurposing—that offers a way to discover unknown connections between “unconnected” diseases that may lead to new treatments.

Dr. Peter is a genetic epidemiologist with extensive experience designing studies aimed at identifying  genetic risk factors associated with complex diseases such as type 2 diabetes, obesity, cardiovascular disease, and Crohn’s disease.

Read the essay in STAT online

Learn more about the Peter Laboratory at the Icahn School of Medicine

Two Studies Point to the Quality of Neoantigens in Determining Long-Term Cancer Survival

Benjamin Greenbaum, PhD

The quality, not quantity, of tumor neoantigens may best predict a patient’s response to cancer immunotherapy and his or her chance of long-term survival. That finding was based on two groundbreaking studies co-authored by Benjamin Greenbaum, PhD, Assistant Professor, Medicine (Hematology and Medical Oncology), and Pathology, Icahn School of Medicine at Mount Sinai. Now, it is being further explored by Dr. Greenbaum and Vinod Balachandran, MD, Memorial Sloan Kettering Cancer Center, through a Stand Up to Cancer Convergence 2.0 Grant and funding from the Lustgarten Foundation.

Their goal is to understand the underpinnings of pancreatic cancer survivorship, and their team is one of seven research groups that comprise Stand Up to Cancer’s broad $11 million initiative that was announced in January 2018. Neoantigens, or peptides found on the surface of cancer cells, are considered promising targets for cancer immunotherapy.

“Previous research has shown that T cell immunity is linked to exceptional outcomes for the few long-term survivors of pancreatic cancer, but it wasn’t clear if neoantigens played a role,” says Dr. Greenbaum. “Our newest research shows there are particular neoantigens that seem to be driving this long-term response in patients with pancreatic cancer, and further suggests that targeting those neoantigens might be a viable therapeutic strategy.”

According to Dr. Greenbaum, who was trained as a physicist and quantitative biologist, “One of the most exciting aspects of our work is collaborating with academic teams that can combine the tools and knowledge from diverse fields like theoretical physics, structural biology, mathematics, computer science, and translational genomics. We never lose sight of the fact that our combined efforts could one day result in clinical breakthroughs that benefit countless numbers of people.”

Earlier research formed the basis of the team’s efforts. In the first of two back-to-back studies published in Nature (November 2017), researchers described a mathematical model they developed—the first of its kind—to predict how a cancer patient would benefit from certain immunotherapies. Dr. Greenbaum was the senior author on this work with first author Marta Luksza, PhD, Assistant Professor of Oncological Sciences, Icahn School of Medicine at Mount Sinai.

By capturing aspects of a tumor’s evolution and ways in which it interacted with the underlying immune system, the new model appeared to offer an approach beyond previous biomarkers. Going forward, it also has the potential to uncover new therapeutic targets within the immune system, and help in the design of vaccines for patients who do not respond to immunotherapy.

The second study, whose first author was Dr. Balachandran, applied the modeling framework in order to better understand immune response in patients with pancreatic cancer and, more specifically, the unique role of neoantigens.

As part of the broad initiative, the Mount Sinai researchers are focused on better understanding what makes a neoantigen a good immune target, and the role of the microbiome in neoantigen recognition. By advancing the core science behind developing a vaccine for pancreatic cancer, the research could eventually improve treatment prospects for patients with this deadly form of the disease.

As they investigate the immune system’s response to cancers, the Convergence 2.0 team will be encouraged to draw upon the knowledge of Microsoft Research experts in machine learning and artificial intelligence. In addition to Dr. Luksza, the research team includes Nina Bhardwaj, MD, PhD, from the Icahn School of Medicine at Mount Sinai; and Eileen M. O’Reilly, MD; Taha Merghoub, PhD; and Jedd D. Wolchok, MD, PhD, from Memorial Sloan Kettering Cancer Center.

Mount Sinai Doctors Long Island Celebrates New Location

From left: Kenneth L. Davis, MD; patient Elly Arabadjief with her mother, Tracy; father, Justin; and sister, Abigail; and Alicia Gresham, Vice President of Operations, Mount Sinai Health Network.

Mount Sinai Doctors Long Island is expanding its reach with the opening of a new health complex in Greenlawn to better serve the northwestern communities of Suffolk County. The modern and spacious 80,000-square-foot location, at 5 Cuba Hill Road, offers primary care, 20 medical and surgical specialties, a comprehensive Women’s Center, and an infusion center, as well as onsite radiology and laboratory services. The facility consolidates the Mount Sinai Doctors Long Island practices from three separate locations in Huntington.

A ribbon-cutting for the $22 million facility, developed in conjunction with Simone Healthcare Development Group, was held on Thursday, October 18, and was attended by about 100 guests, among them Mount Sinai executives and Long Island elected officials, including Hempstead Town Supervisor Chad Lupinacci, as well as physicians and managers from several Mount Sinai Doctors Long Island locations.

Patient Elly Arabadjief, with pediatric hepatologist Jaime Chu, MD.

“Residents of Long Island deserve high-quality, convenient care close to home, and Mount Sinai is meeting that need,” said Kenneth L. Davis, MD, President and Chief Executive Officer of the Mount Sinai Health System. “With an expanded primary and specialty care network and a Long Island footprint that includes 200 physicians and other experts at 11 multidisciplinary practice locations, Mount Sinai is transforming care in this area. Our goal is to keep patients and communities healthy by providing health care excellence close to home and work.”

At the new Cuba Hill Road facility, 70 board certified physicians working with nurses and other medical staff are providing primary care, as well as specialty care in allergy, asthma, and immunology; cardiology; dermatology; endocrinology; gastroenterology; hematology/oncology; nephrology; neurology; obstetrics and gynecology; ophthalmology; orthopedics; pain management; general pediatrics; pediatric gastroenterology; podiatry; pulmonology; rheumatology; surgery; and urology. For patients’ convenience, the office offers extended hours, ample parking, and comfortable waiting areas.

“Mount Sinai Doctors Long Island is expanding access to specialty care with a local state-of-the-art facility that will serve as a medical hub for this community,” said Arthur A. Klein, MD, President of the Mount Sinai Health Network. “Our physician partners will work collaboratively and tirelessly to provide personalized care for each patient. We are proud to bring the renowned services of Mount Sinai to serve the residents of Suffolk County and beyond.”

Guests gathered in the main waiting area of the new Mount Sinai Doctors Long Island location at 5 Cuba Hill Road in Greenlawn for the ribbon-cutting celebration.

A very special guest at the event was 8-year-old patient Elly Arabadjief. She and her family were honored for their efforts to raise awareness for Wilson disease, a rare inherited disorder that was diagnosed in Elly in August 2017 by her Mount Sinai Doctors Long Island pediatrician, Steven J. Brunner, MD. Elly’s father, Justin Arabadjief, gave an emotional speech as he expressed the family’s profound gratitude for Dr. Brunner’s astute diagnosis and credited him with saving his daughter’s life. Individuals with Wilson disease lack an enzyme, which causes copper to accumulate in the liver and other vital organs. The disease can be fatal if not discovered early.

Recalling the Wilson Disease Association conference he attended in 2018, Mr. Arabadjief said he met patients of all ages, at varying stages of their illness. “We heard horror stories of missed diagnoses, but we only met a small handful like Elly, who were lucky enough to have had this disease discovered early enough to have every chance at a long, happy, healthy life.”

Dr. Brunner said, “I always say pediatrics is not just about colds, coughs, and sore throats. There’s always that needle in the haystack that you have to be on the lookout for, and this case was definitely a needle in the haystack.”

It was Dr. Brunner who immediately referred Elly to Joanne Lai, MD, Assistant Professor of Pediatrics (Pediatric Gastroenterology), who is based in Manhattan and practices at Mount Sinai Doctors Long Island on a sessional basis, and to Jaime Chu, MD, Assistant Professor of Pediatrics (Pediatric Hepatology), who practices at Mount Sinai Kravis Children’s Hospital in Manhattan.

“We were fast-tracked with several specialists to review Elly’s symptoms and help with the diagnosis,” said Mr. Arabadjief. “We are thankful for all of the kind, compassionate people at various Mount Sinai locations we have met along the way to help get us through one of the scariest things that can happen to a family.”

 

From left: Jeffrey Vacirca, MD, Chief Executive Officer, New York Cancer & Blood Specialists; Kenneth L. Davis, MD; Arthur A. Klein, MD; Luis Isola, MD, Medical Director, Mount Sinai Cancer Network; and Benjamin Kornitzer, MD, Chief Medical Officer and Vice President, Mount Sinai Health Network.

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