Updated on Feb 27, 2018 | Featured, Research
A diseased liver with nonalcoholic steatohepatitis (NASH) showing liver cells containing large fat droplets, seen as empty spaces, with clusters of inflammatory cells
A normal liver with even-size liver cells
As the obesity epidemic continues to grow nationwide, so too has the incidence of related diseases such as nonalcoholic fatty liver disease (NAFLD). Estimates suggest that nearly one-third of all Americans have some form of fat in their liver, and as many as one-third of that population has the most worrisome form of NAFLD—nonalcoholic steatohepatitis (NASH), or liver inflammation and damage caused by fat buildup. Left unchecked, the disease may progress to a state of advanced scarring or cirrhosis, and also significantly increase the risk of developing primary liver cancer.
“There are approximately 20 to 35 million Americans who have NASH,” says Scott L. Friedman, MD, Dean for Therapeutic Discovery and the Irene and Dr. Arthur M. Fishberg Professor of Medicine and Liver Diseases at the Icahn School of Medicine at Mount Sinai. “The likelihood is that, within three years, NASH will supplant hepatitis C as the most common indication for liver transplantation.”
Long underappreciated and underdiagnosed, in part because there are often no specific symptoms that indicate liver disease, NASH is emerging as a primary focus of study. Dr. Friedman, who has been at the forefront of those efforts, is launching a new multidisciplinary working group that brings together the considerable resources of the Mount Sinai Health System and those of external stakeholders to advance the understanding, diagnosis, and treatment of NASH.
“This is an effort to link all the strengths of the Health System so we can establish standards for diagnosing and treating NASH,” Dr. Friedman says. “We also want to play a lead role in defining new therapies and offering them to our patients as quickly as possible, either through clinical trials or once they are approved, because there are currently no therapies approved for the treatment of NASH.”
In support of that effort, the Division of Liver Diseases has recruited Amon Asgharpour, MD, and Amreen Dinani, MD, Assistant Professors of Medicine (Liver Diseases), whose goal is to raise awareness about NASH and identify patients to participate in clinical trials.
“For example, I’m currently visiting the Mount Sinai Diabetes Center on Fridays to see patients and risk-stratify them because we know that patients with diabetes are more likely to have NAFLD,” Dr. Asgharpour says. “We have also started screening patients participating in the Weight and Metabolism Management Program at Mount Sinai St. Luke’s for liver disease, and we are providing them with strategies for weight loss. If we can help these patients lose weight, they can reduce the amount of fat and scarring in their liver and thus reduce their risk of developing potential complications from NASH.”
Many other collaborative initiatives are currently being discussed by the working group, ranging from researching the link between pathogenesis and fibrosis in liver adipose tissue, to engaging the Mount Sinai Liver Cancer Clinical Program to better understand the risk of liver cancer among NASH patients. “It’s going to be a very fertile and important time for generating ideas and establishing links across the different disciplines that are concerned about this disease,” Dr. Friedman says.
Updated on Feb 4, 2019 | Featured, Research, Your Health
Ilana B. Katz Sand, MD, with Amit Blushtein, a clinical trial participant, one of 18 multiple sclerosis patients randomized to follow a special dietary plan.
Neurologists have long suspected a link between diet and symptoms of multiple sclerosis (MS), but today, Ilana B. Katz Sand, MD, Assistant Professor of Neurology at the Icahn School of Medicine at Mount Sinai, and Associate Medical Director of the Corinne Goldsmith Dickinson Center for Multiple Sclerosis, is offering fresh insights.
Dr. Katz Sand and a team from the Icahn School of Medicine are currently conducting studies aimed at understanding the role of gut bacteria in inflammation and neurodegeneration. A recent publication of which Dr. Katz Sand is a co-author suggests that gut microbial composition in individuals with MS differs from that in healthy controls. Because gut bacteria communicate heavily with the resident immune system in the gut, as well as secrete molecules that can have distant effects, Dr. Katz Sand and colleagues hypothesize that changes in gut microbiota may contribute to the development of MS and other autoimmune diseases and also may influence disease course once MS is established. If further research confirms this, investigators like Dr. Katz Sand believe it may be possible someday to offer patients microbiome-based therapy to keep the bacteria in check.
One of the biggest drivers of gut microbial composition is diet, and it is this potential mechanistic link that led Dr. Katz Sand to begin studying dietary factors in MS. She says, “We want to better understand the inflammatory process, the neurodegenerative process, and the effect that diet has on MS symptoms. Our findings could be very important in understanding the onset of MS and how to treat it.”
Until recently, developing a methodology to study the possible connection between diet and MS has proved challenging because a double-blind randomized controlled trial doesn’t lend itself to studying diet. Dr. Katz Sand, who has pursued this clinical interest since she was a fellow, designed what she believes is a scientifically sound methodology that may help lay the groundwork for future clinical trials in this area.
She has developed a study to begin evaluating the hypothesis that a modified Mediterranean diet—which includes fresh fish, fruits, vegetables, nuts, whole grains, and avocados, and eliminates meat, dairy, and processed foods—may reduce inflammation characteristic of MS, whereby immune cells attack the myelin insulation that surrounds and insulates nerve fibers, causing problems with vision, balance, muscle control, cognition, and other debilitating symptoms.
She and her team have recruited 36 participants, 18 of whom have been randomized to follow this dietary plan for six months. All participants move through the study in small groups according to their assignment. The dietary-arm participants attend monthly meetings, led by Dr. Katz Sand, a nutritionist, and a research coordinator, that include presentations about various aspects of the diet to keep them motivated—one of the challenges of the study. There, they have the opportunity to discuss their experiences with their restrictive diet and to share tips.
Additionally, they are asked to complete questionnaires at the meetings and through regular emails. Certain markers, including salt, fatty acids, and carotenoids, are tested through lab work at the beginning and end of the study, and participants also are tested for the diet’s effects on body mass index, blood pressure, cholesterol, and glucose. The research team also employs quality-of-life scales that assess fatigue and measure depression, common MS symptoms. “We’ve got a nice group dynamic going,” says Dr. Katz Sand.
The non-dietary intervention participants attend study visits occasionally and also are offered seminars on topics of interest to MS patients. At the end of their study period, if they wish to start the diet, they are offered an opportunity to meet with the study’s nutritionist. The study, funded by the National Multiple Sclerosis Society, began in January 2017, and the last group of participants will finish in April 2018. The challenge for Dr. Katz Sand and her team will be to scale the study to include more participants, which they are planning to do in the near future.
Updated on Feb 21, 2018 | Community, Featured
At the ribbon-cutting, from left: Arthur Klein, MD; Kenneth L. Davis, MD; Peter W. May, Chairman, Boards of Trustees, Mount Sinai Health System; Alicia Gresham, Vice President, Mount Sinai Network Operations; Gonzalo Loveday, MD; and Michael McCloskey, President, FRI Management.
The opening of a multispecialty practice in Florida—Mount Sinai Doctors Palm Beach—was celebrated with a ribbon-cutting on Monday, January 29, signaling a broadened commitment by the Mount Sinai Health System to offer expert health care throughout South Florida.
“This is a significant step in expanding the reach of Mount Sinai New York’s high-quality care in South Florida,” says Kenneth L. Davis, MD, President and Chief Executive Officer of the Mount Sinai Health System. “Residents of Palm Beach County and patients who travel between Florida and New York now have streamlined access to care from Mount Sinai’s outstanding physicians in a broad array of specialties.”
The Palm Beach practice offers primary care, cardiology, gastroenterology, and ophthalmology services, as well as same-day and next-day appointments, and 24-hour on-call access to specialists.
“The staff and clinical leadership at Mount Sinai Doctors Palm Beach have been carefully chosen from a large pool of national applicants,” says Arthur Klein, MD, President of the Mount Sinai Health Network. “We are proud to provide the resources of our nationally and internationally recognized academic health care system to benefit the residents and businesses of Palm Beach County.” The physician staff will be led by prominent cardiovascular specialist Gonzalo Loveday, MD.
This newest practice builds on the success of Mount Sinai Heart New York Palm Beach, and on a partnership between Mount Sinai and the Jupiter Medical Center, both providing high-quality care in cardiology since 2015. Mount Sinai Doctors Palm Beach is located at 625 N. Flagler Drive, Mezzanine Level, West Palm Beach. To schedule an appointment, call 561-268-2000.
Updated on Oct 14, 2019 | Community, Featured, Your Health
Nearly two-thirds of U.S. women ages 40 and older have had a mammogram during the past two years, but significant economic, cultural, and social barriers prevent many in New York City from taking advantage of this important breast cancer detection tool. According to the American Cancer Society and the Avon Foundation, only 47 percent of Latinas and 55 percent of black woman have an annual mammogram, while black women are 43 percent more likely to die of breast cancer than their white counterparts.
The Mount Sinai Health System is determined to improve those numbers through a new mobile mammography program that will provide up to 30 mammograms a day in a specially designed van that will visit women in their communities. The program is part of an early breast cancer awareness and detection initiative that was launched by New York State Governor Andrew Cuomo in 2016, with the goal of increasing by 10 percent the number of women screened by 2020. Mount Sinai won a competitive grant as part of the program and will receive more than $4 million from the state over three years to purchase and operate the mammography van.
“We’re really excited about the prospect of having a big impact on women’s health care by identifying women who can benefit from early breast cancer detection,” says Laurie Margolies, MD, Chief for Breast Imaging at the Mount Sinai Health System, and Medical Director for the mobile mammography screening initiative.
“Our program has a heavy educational component, and we’re gearing up to go to churches, synagogues, mosques, community centers, and other places where we’re invited to talk to women about breast health and how mammography can increase their chances of surviving breast cancer if they are diagnosed with the disease.” At these sessions, held several weeks in advance of the van’s appearance, women will be encouraged to sign up for mammography and assisted in making and keeping their appointments.
Prescheduled visits to health clinics, storefronts, and community and faith-based centers will begin this summer, with a focus on neighborhoods known to have the highest poverty and associated poor health outcomes. Available to women ages 40 and older, the Mount Sinai mobile van will offer digital breast tomosynthesis (3D mammography). According to Dr. Margolies, 3D mammography does not expose patients to higher doses of radiation and has been shown to decrease patient call-back rates by as much as 40 percent.
The specially marked van will leave The Mount Sinai Hospital up to seven days a week and screen women from 9 am to 7 pm. The van will carry mammography technologists and a patient navigator. The driver will also serve as the registrar. All images will be downloaded when the van returns at night, and read over the next 48 hours by one of Mount Sinai’s 13 full-time breast imagers. Women with abnormal mammograms will be called within five days to arrange for appropriate follow-ups, and patients will have free and secure access to their electronic records through Mount Sinai’s MyChart system.
The mobile van staff at Mount Sinai are collaborating with the New York State Cancer Services Program, a statewide program that provides free breast, cervical, and colorectal cancer screening, to enroll eligible women who do not have health insurance or who may be underinsured into the program.
Updated on Feb 21, 2018 | Featured, Research, Your Health
From left: Eric Schadt, PhD; Leena Nasser, Executive Director, Chopra Institute; Deepak Chopra, MD; Dennis S. Charney, MD; Ash Tewari, MBBS, MCh; and David L. Reich, MD.
Can meditation and other forms of alternative medicine be used in conjunction with traditional treatments to improve overall physiological and psychological health and well-being? This was a topic for brainstorming between best-selling author Deepak Chopra, MD, and basic science researchers and physician-scientists who attended a meeting hosted by Ash Tewari, MBBS, MCh, the Kyung Hyun Kim, MD Chair in Urology, Mount Sinai Health System.
The researchers, who were from the Department of Urology at the Icahn School of Medicine at Mount Sinai, joined Dr. Chopra, a pioneer in integrative medicine and co-founder of the Chopra Center for Wellbeing, to discuss their mutual interest in the study of the mind-body connection. Also attending were: 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; David L. Reich, MD, President and Chief Operating Officer, The Mount Sinai Hospital; and Eric Schadt, PhD, Dean for Precision Medicine, and the Jean C. and James W. Crystal Professor of Genomics.
One topic they explored was to study, in a clinical setting, whether mind-body intervention through meditation and other practices such as yoga reduces inflammation and thus prostate cancer progression. In 2016, Dr. Schadt led a study with researchers from the University of California, San Francisco, and Harvard Medical School that assessed the biological impact of meditation. The study, which appeared in Translational Psychiatry and was partially funded by the Chopra Center for Wellbeing, found that meditation could ease stress and benefit the immune system.
Updated on Feb 8, 2018 | Community, Featured
Julie Seltzer receives a check-up from Elizabeth Choi, DO, in the new Stuyvesant Town facility.
The Mount Sinai Health System has opened two new practices, one in Stuyvesant Town-Peter Cooper Village in Manhattan and the other in the Dumbo neighborhood in Brooklyn, both of which will enhance the ability of New Yorkers to access quality health care services
close to where they live and work.
“I like to think of our Mount Sinai Doctors Stuyvesant Town facility as a small-town medical practice within a large urban environment,” says Kelly Cassano, DO, Chief of Ambulatory Care at Mount Sinai Beth Israel. “This is a place where patients of all ages, from infants to the elderly, will find a family doctor who will establish a long-term relationship with them, with the aim of keeping them healthy.”
Stuyvesant Town patient Sushila Patel with Freddie C. Verzosa, MD, MPH, at the new location at 518 East 20th Street.
On Thursday, January 11, a few weeks after the practice opened its doors to patients, community leaders from Stuyvesant Town-Peter Cooper Village gathered with representatives from the Mount Sinai Health System at a ribbon-cutting ceremony. On the same day, the practice held an open house for members of the community, who received free flu shots and snacks, and hosted arts and crafts activities for children.
The practice is a key addition to Mount Sinai’s presence in downtown Manhattan. It will have a full-time staff of family medicine physicians, and offer sessional care in orthopedics, dermatology, podiatry, and other specialties, as well as longitudinal primary care, walk-in care, and specialty care.
“Our goal is to keep people healthy and out of the hospital by providing compassionate, continuous, and coordinated care closer to home,” says Jeremy Boal, MD, Executive Vice President and Chief Clinical Officer, Mount Sinai Health System, and President, Mount Sinai Downtown. “That is the most important premise behind the new Mount Sinai Beth Israel and investment downtown.”
Rick Hayduk, Chief Executive Officer and General Manager at StuyTown Property Services, which manages the residential property, says the facility is a welcome addition to the community. “The opening of this practice means residents can easily access Mount Sinai’s high quality medical care. We are pleased to welcome this quality-of-life improvement for those who live and work in our community.”
Staff at the Dumbo location, from left: Judah Fierstein, MD; Catherine Lopez; Amanda Magli; Ernesto Bodur; and Hillary Moritz. The facility is located at 110 York Street, Second Floor.
At the Mount Sinai Health System’s newest Urgent Care center in Brooklyn’s Dumbo neighborhood—located between the Brooklyn and Manhattan bridges—Mount Sinai leaders joined representatives from local businesses for their ribbon-cutting ceremony on Thursday, January 25. The practice features five exam rooms, onsite X-ray services, and extended hours with no appointment needed.
The Dumbo facility is expected to serve neighborhood residents, and employees who work in many of the start-ups and technology companies that are now located in the area. The new Urgent Care center joins similar Mount Sinai practices in Inwood, the Upper West Side, Union Square, and in nearby Brooklyn Heights.
Judah Fierstein, MD, Assistant Professor of Emergency Medicine and Medical Director of Mount Sinai Doctors Urgent Care, says patients at the Dumbo location will have access to the resources of the Mount Sinai Health System if they need follow-up care. Additionally, Mount Sinai’s practice in Brooklyn Heights, staffed by more than a dozen different specialists, as well as urgent care specialists, is a 15-minute walk from Dumbo.
“The Mount Sinai name stands for compassionate care of the highest order,” says Burton Drayer, MD, Chief Executive Officer of the Mount Sinai Doctors Faculty Practice, Dean for Clinical Affairs, and the Dr. Charles M. and Marilyn Newman Professor of Radiology, and Mount Sinai Health System Chair of the Department of Radiology. “That is exactly what New Yorkers who live or work in the neighborhood will find at the Mount Sinai Urgent Care practice in Dumbo.”
