Walking Tall After a Paralyzing Car Accident

Peter Schreiner, walking to the finish line, with Eberardo Burgos, left, and Michael Elliott, both assistant trainers at the James J. Peters VA Medical Center. Click here to watch the Mount Sinai Future You video.

For months, New York City resident Peter Schreiner trained extensively for the New Balance 5th Avenue Mile, determined to win. With friends, family, and new fans cheering him on, he triumphantly crossed the finish line, first among his co-competitors.

But this was no ordinary race: Mr. Schreiner is paralyzed below the chest, and he accomplished this feat in 44:19 minutes—nearly four minutes faster than the goal he had set for himself—with the help of an exoskeleton, a robotic device that enables him to stand and walk. The event, held on Sunday, September 9, marked the first time that an entire heat was dedicated to paralyzed athletes using exoskeletons.

In September 2017, the 27-year-old former scuba instructor from the Upper East Side fractured his T5 vertebra in a car accident that occurred while he was coming home from a friend’s funeral in Florida, sustaining a spinal cord injury (SCI). He had no sensation or motor function below his upper chest, and until he came to The Mount Sinai Hospital five weeks after the injury to begin a comprehensive multidisciplinary SCI rehabilitation program, he was unable to sit up, talk, eat by mouth, or even drink water.

After the race, Peter Schreiner got a congratulatory hug from his mother, Mary Kate Wold.

His treatment involved rehabilitation nursing, physical therapy—including locomotor training with the exoskeleton—occupational, speech, respiratory, and recreation therapy, counseling, nutrition, and community reintegration. “At the time, this seemed so permanent,” recalls Mr. Schreiner.

“It has been amazing to see Peter’s progress,” says Thomas N. Bryce, MD, Professor of Rehabilitation and Human Performance, and Medical Director of Mount Sinai’s Spinal Cord Injury Program. “When he was an inpatient here, we tried to get him up to use the exoskeleton, and it was very slow. He needed a lot of assistance, but very soon he was racing around here very quickly.”

Finishing the race right behind Mr. Schreiner were two other Mount Sinai patients, Richard “Woody” Woods and Robert Woo, and Heather Miner (U.S. Navy Ret.), a patient at the Veterans Administration (VA) Medical Center in Dallas. All four—in T-shirts identifying them as “Team Bionic Athletes”—wore an  exoskeleton device placed on their legs, hips, and torso, and weighing 50 pounds, a weight not felt by the user wearing it.

Among its many components, the powered exoskeleton has motors at the hips and knees, a tilt sensor for detecting body position, a computer in the pelvic band to control the motors, and two batteries, all of which are brought together to provide coordinated leg movement into a somewhat natural gait. Arm crutches help users maintain their balance.

“When you’re sitting in a wheelchair, you are literally looking up at the world, and the world is literally looking down at you,” says Angela Riccobono, PhD, Senior Clinical Psychologist, Rehabilitation and Human Performance, who was part of Mr. Schreiner’s care team. “I cannot overstate the significance of being able to stand up and look at someone eye to eye. It is beyond powerful.”

Ann M. Spungen, EdD, Vice Chair of Research for the Department of Rehabilitation and Human Performance at the Icahn School of Medicine at Mount Sinai, is one of the nation’s top exoskeleton researchers for patients with disabilities caused by SCI. Dr. Spungen is also the Associate Director of the VA Rehabilitation Research & Development (RR&D) National Center for the Medical Consequences of Spinal Cord Injury at the James J. Peters VA Medical Center in the Bronx—with which Mount Sinai has an affiliation.

Dr. Spungen has been studying many aspects of SCI, including paralysis, medical complications, mobility, and quality of life for nearly three decades. In addition to lack of mobility, paralysis causes adverse body composition changes, bowel and bladder dysfunction, and cardiovascular problems. Her research has shown that four to six hours per week of exoskeleton-assisted walking leads to improved bowel and bladder function, reduced fat mass, less fatigue, improved sleep and mood, better pain management, and improved overall well-being.

Before the race, Pierre Asselin, MS, Senior Biomedical Engineer, James J. Peters VA Medical Center, and Assistant Clinical Professor, Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, ensured the exoskeleton device was a proper fit for Peter Schreiner.

Mount Sinai’s Abilities Research Center is expanding the outpatient exoskeleton program, focusing on technologies such as neuromodulation, upper extremity robotics, and lower extremity robotics. This initiative will be overseen by Maria del Mar Cortes, MD, Assistant Professor of Rehabilitation and Human Performance, who specializes in robotic technology and noninvasive brain and spinal stimulation techniques to understand the mechanisms of motor dysfunction and improve motor control. Her team will collaborate closely with Dr. Spungen’s program at the VA Medical Center.

Mr. Schreiner recently completed a Department of Defense-sponsored clinical trial at the VA Medical Center in which he participated in exoskeletal-assisted walking three times a week to determine the effects of exoskeletal use in those with SCI. Says Mr. Schreiner: “Mentally, just being on my feet and moving my legs makes me feel whole again.”

For someone who achieved—and surpassed—one early and significant milestone of competing in the race, Mr. Schreiner continues to set new expectations. “I believe I will be doing all the things that I want to do completely independently, and I am very excited about that,” he says. “Even though I have had setbacks, I am not giving up hope.”

 

Reprogramming Retina Cells to Restore Vision

From left: Postdoctoral Fellows Xinzheng Guo, PhD, and Ye Xie, PhD, with Bo Chen, PhD.

A team of researchers, led by Bo Chen, PhD, Associate Professor of Ophthalmology, Icahn School of Medicine at Mount Sinai, has reversed congenital blindness in mice by changing the supportive Müller glia cells in the retina into functional rod photoreceptors—light-sensitive cells in the retina that signal the brain when activated.

The breakthrough research, published online in the August 15, 2018, issue of Nature, is expected to advance efforts toward retinal regeneration for diseases of the eye, such as age-related macular degeneration, degenerative glaucoma, and retinitis pigmentosa.

Funded in part by the National Eye Institute (NEI), an arm of the National Institutes of Health, the study drew praise from NEI Program Director Thomas N. Greenwell, PhD. “This is the first report of scientists reprogramming Müller glia to become functional rod photoreceptors in the mammalian retina,” says Dr. Greenwell. “Rods allow us to see in low light, but they may also help preserve cone photoreceptors, which are important for color vision and high visual acuity. Cones tend to die in later-stage eye diseases.  If rods can be regenerated from inside the eye, this might be a strategy for treating diseases of the eye that affect photoreceptors.”

Macro view of retinal stem cells in the process of division.

Scientists have long studied the regenerative potential of Müller glia cells because in species such as zebrafish, they divide in response to injury and can turn into photoreceptors and other retinal neurons. In the lab, scientists have coaxed mammalian Müller glia to behave as they do in the fish, but not without injuring the tissue. Since injured tissue is counterproductive to restoring vision, Dr. Chen’s lab was able to achieve an effective method of achieving both goals, something others could not.

In pursuing this novel gene-transfer therapy, Dr. Chen, who is also Director of the Ocular Stem Cell Program at the Icahn School of Medicine at Mount Sinai, and his investigators followed a two-stage process. First, they demonstrated that Müller glia cells could be spurred to divide in mice by injecting their eyes with a gene to turn on a protein called beta-catenin. Then, weeks later, the mice were injected with transcription factors Otx2, Crx, and Nrl that encouraged the newly divided cells to develop into rod photoreceptors.

The investigators were encouraged to find that the newly formed cells looked structurally no different from real photoreceptors, and that synaptic structures that allow the rods to communicate with other types of neurons within the retina had also formed.

When the researchers took another step forward by testing the treatment in congenitally blind mice that were born without functional rod photoreceptors, the results were positive once again. The light responses recorded from retinal ganglion cells—neurons that carry signals from photoreceptors to the brain—and measurements of brain activity confirmed that the newly formed rods were integrating into the visual pathway circuitry, from the retina to the primary visual cortex in the brain.

“Our findings underscore that we are closer than ever to developing new therapies for people with severe degenerative eye disease,” says Dr. Chen. “Mice that were blind from birth were now able to see light for the first time following treatment.”

Dr. Chen says his next step will be determining whether the technique works on cultured human retinal tissue. In addition to receiving NIH funding, Dr. Chen’s research was supported by a $2 million grant from the McGraw Family Foundation.

Lab Coat Ceremony Kicks Off PhD Training

Members of the matriculating PhD class celebrated after receiving their lab coats.

The Graduate School of Biomedical Sciences at the Icahn School of Medicine at Mount Sinai recently held its inaugural PhD Lab Coat Ceremony—becoming the only institution in New York City, and one of the few in the country, to honor its matriculating class of PhD students in this fashion. The event, symbolizing the start of their graduate training, recognized 53 new students enrolled in Mount Sinai’s PhD programs in Biomedical Sciences, Neuroscience, and the MD/PhD Medical Scientist Training Program.

The ceremony, held Monday, September 17, in Goldwurm Auditorium, was a jubilant event for the students who received their lab coats, as well as for their families and friends, and Icahn School of Medicine at Mount Sinai leadership and faculty. The Graduate School separately presented honorary plaques to 40 PhD and MD/PhD students who have officially joined a lab and confirmed their PhD candidature by passing their thesis proposal exams.

Front row: Matthew O’Connell, PhD, and Marta Filizola, PhD, with PhD students who received an honorary plaque as they officially joined a Mount Sinai laboratory and confirmed their PhD candidature, back row from left: Denise Jurczyszak, Emma Mcgregor, and Nivedita Saxena.

“We value the innovation and creativity that drive transformative scientific discoveries at Mount Sinai, but we also love the symbolism of the white lab coat, which embodies scientific rigor, objectivity, and professionalism,” said Marta Filizola, PhD, Dean of the Graduate School of Biomedical Sciences, the Sharon and Frederick Klingenstein/Nathan Kase, MD Professor, and Professor of Pharmacological Sciences, and Neuroscience.

During the ceremony, the students recited an oath for doctoral candidates—a set of guiding principles—written by Matthew O’Connell, PhD, Senior Associate Dean for Curriculum, Recruitment, and Admissions.

“I willingly pledge to uphold the highest levels of integrity, professionalism, scholarship, and honor,” they each read, as they affirmed to conduct their research and professional endeavors with honesty and objectivity.

Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean, Icahn School of Medicine at Mount Sinai, and President for Academic Affairs, Mount Sinai Health System, welcomed the incoming students and spotlighted their strong academic credentials and their significant research experience.

Eric J. Nestler, MD, PhD, Dean for Academic and Scientific Affairs, reminded guests: “Although science today is under attack from extremists of many political stripes, science still represents promise for the future: economic advancement, improved health, and better lives. So, as we put on that lab coat—figuratively or literally—we accept several obligations to carry out research that is rigorous, reproducible, robust, and responsible.” Dr. Nestler is also Director of The Friedman Brain Institute and Nash Family Professor of Neuroscience.

World-renowned microbiologist Peter Palese, PhD, Chair of the Department of Microbiology and the Horace W. Goldsmith Professor of Medicine, introduced keynote speaker Vincent Racaniello, PhD, Higgins Professor of Microbiology and Immunology at Columbia University’s Vagelos College of Physicians and Surgeons. Dr. Racaniello, a noted virologist who focuses on the molecular biology of picornavirus replication and pathogenesis, earned his doctorate from Mount Sinai in 1980 and was the first PhD graduate mentored by Dr. Palese.

“Forty-three years ago this month, I was in the same place as you are now,” Dr. Racaniello said, addressing the students. “Looking back, I now realize I was completely clueless, but four decades in science have taught me many important lessons. The one worth telling you is that science is not about you: It is not about building a big lab, scoring many research grants, publishing papers in prominent journals, or even winning a Nobel Prize. It is about discovery.”

Members of the matriculating PhD class celebrated after receiving their lab coats.

Lab Discovery Leads to a Remedy

Stuart Sealfon, MD

A drug that recently received approval from the U.S. Food and Drug Administration (FDA) for the treatment of pain associated with the gynecological disorder endometriosis had its genesis two decades ago in the laboratory of Stuart Sealfon, MD, at the Icahn School of Medicine at Mount Sinai.

The drug, Orilissa™, approved by the FDA in July, is the first oral regimen that specifically helps to ease the moderate to severe pain that accompanies endometriosis, a condition where the tissue that forms in the lining of the uterus continues to grow outside the uterus.

The disorder, which affects roughly one in ten women of reproductive age, negatively impacts quality of life, since the excess tissue growth is often accompanied by pain during menstruation, intercourse, or urination.

“Orilissa is a drug that resulted from the basic research we conducted at Mount Sinai, and it will help millions of women,” says Dr. Sealfon, Sarah B. and Seth M. Glickenhaus Professor and Chair Emeritus of the Department of Neurology. “At Mount Sinai, we discovered how to clone the drug target that was needed to develop this new drug.”

Indeed, as a young researcher more than two decades ago, Dr. Sealfon led the Mount Sinai team that cloned the gonadotropin-releasing hormone receptor (GnRHR) and genetically engineered host cells that express GnRHR. Gonadotropin-releasing hormone (GnRH), which is secreted by the hypothalamus, plays a key role in controlling reproduction, and acts via its receptor GnRHR.

The cloning procedure and primary structure of the receptor were described in two studies authored by Dr. Sealfon in 1992 and 1993, which were published in Molecular Endocrinology and Molecular and Cellular Endocrinology, respectively. The research provided a better understanding of the complex interplay of hypothalamic, pituitary, and gonadal hormones, which underlie pharmacotherapy and the reproductive system.

At the time, Dr. Sealfon says, a career-development grant provided him with the funding he needed to conduct his research. Two U.S. patents, in 1998 and 1999, assigned these inventions to Mount Sinai.

The oral application of Orilissa—also known by its generic name, elagolix—enables women to dial down the reproductive system. The dose-dependent drug suppresses the luteinizing hormone and the follicle-stimulating hormone, which leads to decreased blood concentrations of estradiol and progesterone. This reduces the growth of excess tissue, or lesions that form on the ovaries, fallopian tubes, or areas near the uterus, including the bowel and bladder that characterize endometriosis and cause pain.

The 20 years it took for elagolix to move from Dr. Sealfon’s laboratory to the marketplace demonstrates the length of time it can take for basic scientific discoveries to bear fruit, experts say. The drug was released by AbbVie, a global pharmaceutical company, in cooperation with Neurocrine Biosciences, Inc.

Endometriosis is considered one of the most common gynecologic disorders in the United States, but women can sometimes go years before having the laparoscopic procedure needed to render a proper diagnosis. In addition to the use of oral contraceptives, treatments have included nonsteroidal anti-inflammatory drugs, and opioids. In more extensive cases, women may undergo surgical procedures, including a hysterectomy.

In two Phase 3 clinical trials, Orilissa has been shown to be helpful in the treatment of uterine fibroids, as well. Fibroids are a common benign tumor that causes bleeding or pain in millions of women, and for which there are, currently, limited nonsurgical treatment options.

In the years since his initial discovery, Dr. Sealfon’s lab has continued to study GnRH receptor-mediated gonadotropin regulation and help guide future work in the field.

Mount Sinai Receives Award from VNSNY CHOICE SelectHealth

From left: Matthew Baney with Michael Mullen, MD, Director, Institute for Advanced Medicine, Mount Sinai Health System; Thomas Dwyer, Senior Vice President, Visiting Nurse Service of New York; and Edward Lucy, Chief Administrative and Contracting Officer, Mount Sinai Health System.

VNSNY CHOICE SelectHealth, a New York State Department of Health Special Needs Plan for Medicaid-eligible New Yorkers living with HIV, recently awarded the Mount Sinai Health System $360,000 for its efforts at successfully improving the overall health status of its members.

Mount Sinai’s Institute for Advanced Medicine, which directs all of the Mount Sinai Health System’s HIV prevention and treatment programs, serves more than 1,100 HIV-positive VNSNY CHOICE SelectHealth members annually. The award will be used to support Mount Sinai’s quality initiatives that serve this population.

“VNSNY CHOICE SelectHealth shares with our Mount Sinai provider partners the conviction that HIV infection is now a readily treatable condition from which no New Yorker needs to suffer or die,” says Jay Dobkin, MD, Medical Director for VNSNY CHOICE SelectHealth. “We are gratified that our efforts in support of the Mount Sinai program have been so successful, and hope to build even more effective collaborations in the future.”

Matthew Baney, Senior Director of the Institute for Advanced Medicine, says, “We have been successful in starting and maintaining our patients on medications to keep them healthier. All of our sites have initiated outreach efforts and care coordination activities directed at finding patients who fall out of care and getting them back into treatment. We also have a fair amount of patients in the Mount Sinai Health Home Program, which is a free service that integrates and coordinates health care for people on Medicaid—and that has a significant impact on suppression rates.”

Mount Sinai Researcher Wins Young Investigator Award

Benjamin D. Greenbaum, PhD

Immunotherapy has been a game changer in treating some cancers, but it does not work for every patient. Building mathematical models that might predict a patient’s response is central to the work of Benjamin D. Greenbaum, PhD, Assistant Professor of Medicine (Hematology and Medical Oncology), Oncological Sciences, and Pathology, at The Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai. For his efforts, he recently won the Pershing Square Sohn Prize for Young Investigators in Cancer Research.

Dr. Greenbaum, a computational biologist, was among seven researchers to receive the award from the Pershing Square Sohn Cancer Research Alliance, a program of The Pershing Square Foundation. His laboratory will receive $200,000 yearly for the next three years. In a novel partnership, The Mark Foundation for Cancer Research will fully fund Dr. Greenbaum’s award, and has named him a Pershing Square Sohn Mark Foundation Fellow.

Dr. Greenbaum’s work “will be instrumental in understanding what types of T cells are required for generating effective anti-tumor immunity and how to design immune therapies that selectively induce their development,” says a longtime colleague and mentor, Nina Bhardwaj, MD, PhD, the Ward-Coleman Chair in Cancer Research, and Director of Cancer Immunotherapy, at The Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai.

Dr. Greenbaum began his career studying the evolution of viruses and later became interested in checkpoint blockade inhibitor immunotherapies, which help the body recognize and kill cancer cells, and for which the Nobel Prize was recently awarded. He led a group that created the first predictive mathematical model demonstrating how a set of melanoma and lung cancer patients would respond to certain immunotherapies, a finding described in November 2017 in the journal Nature. To further improve such models, “we work with clinicians, oncologists, immunologists, geneticists, and others to try to round out the full picture of how the immune system interacts with cancer,” Dr. Greenbaum says. “This is a very vibrant time in cancer immunotherapy.”

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