Institute for Health Equity Research Holds Inaugural Symposium to Exchange Ideas and Propel Research

Updated on Dec 19, 2023 | Community, Diversity and Inclusion, Featured

Carol Horowitz, MD, MPH, left, and Lynne D. Richardson, MD, directors of the Institute for Health Equity Research, at its inaugural symposium.

As part of its mission to elevate the science of heath equity, the Institute for Health Equity Research (IHER) held its inaugural symposium, one of the first major milestones in a new partnership between IHER and Royalty Pharma, established in 2022, to build an infrastructure to exchange ideas and propel research collaboration.

“We founded IHER to elevate the science of health equity to the same level as other important areas of science that are studied here at the Icahn School of Medicine at Mount Sinai. We are very pleased to partner with Royalty Pharma as we engage other leaders in the field to bring this conversation to the forefront,” says IHER Co-Director Lynne D. Richardson, MD, Professor of Emergency Medicine, and Population Health Science and Policy, Icahn Mount Sinai.

“We designed the symposium to explore two main areas of priority: collecting strong data to transform clinical care and building partnerships for cross-sector engagement,” says IHER Director Carol Horowitz, MD, MPH, Professor, Population Health Science and Policy, and Medicine, and Dean for Gender Equity in Science and Medicine.

The symposium, titled “From Inquiry to Action,” was held Friday, December 1, at Icahn Mount Sinai. The Institute was founded in 2020.

“To help us craft solutions that will really make a difference, we need community-based organizations to help us understand the lived experiences within the community,” says Dr. Horowitz. “We can’t come into a community without understanding the social determinants of health at a local level: Do members of the community have access to nutritious food, do they live in safe housing, how clean is the air?  Our institute is looking at all these different influences and working hand-in-hand with people from local communities to develop programs that tangibly improve their health.”

Dr. Horowitz moderated a panel of experts from community-based organizations, academia, and the public sector. The panelists described the challenges and possibilities of community-engaged equity initiatives.

“The use of data, both from health care organizations and from other sectors, is key to addressing structural inequities and achieving health equity,” says Dr. Richardson.

Dr. Richardson moderated a diverse panel that included leaders from health care, payors, and industry who described how cross sector data on health status and health care utilization can be linked to individual data on social risks and needs and to neighborhood data on physical and social exposures that threaten health. The panelists presented examples of how data can be harnessed to inform organizational strategies to promote equity and discussed the considerable challenges of using data in ethical and unbiased ways that do not adversely impact minoritized populations.

Through many voices and viewpoints, a familiar pattern emerged: a sobering story of a broken system that continues to fail its most vulnerable patients.

The keynote speaker, former New York State Health Commissioner, Mary T. Bassett, MD, MPH, FXB Professor of the Practice of Health and Human Rights, Harvard T. H. Chan School of Public Health, described the unequal landscape of medicine over time and across the country.  At one point, she reminded the audience that it was only 15 years ago that the American Medical Association, the voice of organized medicine in the United States, acknowledged that it had wrongly allowed, even endorsed, policies that prohibited Black physicians from practicing in hospitals.

“That Black individuals disproportionately suffer from kidney failure is one of many manifestations of unequal care that has its seed in a very long list of inequities,” says Dinushika Mohottige, MD, MPH.

Two members of the IHER faculty presented their research, beginning with Dinushika Mohottige, MD, MPH, Assistant Professor, Population Science and Policy, and Medicine (Nephrology). Dr. Mohottige, who specializes in kidney health equity, led her presentation with a startling statistic: While 13 percent of the U.S. population is Black, Black Americans make up 35 percent of individuals receiving dialysis care.

“That Black individuals disproportionately suffer from kidney failure is one of many manifestations of unequal care that has its seed in a very long list of inequities from underinsurance, limited access to doctors, and a wide spectrum of unequal social determinants working against them. Kidney patients, specifically, also experience the lingering challenges resulting from a race-based algorithm that has been phased out but which previously limited the possibilities for transplantation for Black patients,” says Dr. Mohottige.

Dr. Mohottige has found partners to leverage equity data to reform transplant roadblocks. To address the eGFR algorithm, a race-based correction that had the effect of overestimating a Black patient’s kidney function, she has worked with colleagues to help implement restorative policies to require unbiased, race neutral estimates of kidney health that began in January 2023.

She discussed cascading barriers to transplantation that begin with challenges to transplant referral and evaluation.

“These challenges can include trauma, discrimination, financial or employment instability, mental health or substance abuse, underinsurance, food insecurity or transportation barriers. If you are an individual with any of these challenges, imagine how hard it is to take even the simplest of steps in this long journey,” says Dr. Mohottige. “A fundamental part of change is simply making sure providers know that any of these obstacles can be an impediment, and we know from the data that clinicians are not always aware of these roadblocks.  To address this, we are working with multiple partners to build training programs to fill some of the education gaps among providers who treat these vulnerable populations.”

“Faith-based organizations are a natural place to integrate mental health supports,” says Sidney Hankerson, MD, MBA.

Sidney Hankerson, MD, MBA, Associate Professor, Population Health Science Policy, and Psychiatry, and a Mount Sinai Biomedical Laureate, described several initiatives designed to address mental health inequities in New York City. African Americans and Mexican Americans, he told his listeners, have the lowest rates of depression treatment in the United States. Dr. Hankerson is working to address this problem through partnerships he has developed with faith-based organizations throughout the NYC area and Westchester County.

Through the First Corinthians Baptist Church in Central Harlem, he has collaborated with church leadership to develop free mental health care embedded in their HOPE (Healing on Purpose and Evolving) Center. With a new grant from the Mother Cabrini Health Foundation, he is expanding the program by training psychiatry residents at Mount Sinai in the principles of community engagement and supervising residents who provide direct clinical services at the HOPE Center.

Through the TRIUMPH (TRansformIng yoUr Mental health through Prayer and Healing (Triumph Together), he has developed an eight- week training program to teach motivational interviewing in churches in the five boroughs and Westchester. TRIUMPH aims to address racial and gender disparities that affect Blacks and other communities of color by promoting mental health equity, increasing mental health literacy, reducing stigma, and improving access to care for depression, anxiety, prolonged grief, and drug use.

“More people initially seek help for depression from clergy than from psychiatrists.  So, faith-based organizations are a natural place to integrate mental health supports,” says Dr. Hankerson.

Through grant funding from the Scarlett Feather Foundation, Dr. Hankerson is now launching “Brothers Connect,” a suicide prevention program aimed at black youth ages 13-19. The program will roll out in YMCA’s across the city to reach boys participating in basketball leagues.

“All of these programs have one thing in common: They are all created as community-based networks of care to reach vulnerable populations where they are,” says Dr. Hankerson. “Our churches and local Y’s are safe havens where we can have the greatest impact. These programs underline how important it is for an institution like Mount Sinai to find partners in the community to reach patients who aren’t likely to walk through our doors and ask for help.”

Learn more about the Institute for Health Equity Research

Annual Gala Benefits the Louis Armstrong Center for Music and Medicine

Updated on Dec 14, 2023 | Community, Featured, Patient Stories

Samara Joy, multi-Grammy Award-winning vocalist, singing “What a Wonderful World” at the annual “Wonderful World” gala benefiting the Louis Armstrong Center for Music and Medicine.

The 18th annual “Wonderful World” gala benefiting the Louis Armstrong Center for Music and Medicine, was a festive evening of jazz and expressions of gratitude to three honorees for making the world more wonderful through their contributions to music and music therapy.

The event, held Monday, October 23 at the Angel Orensanz Foundation and hosted by the Wonderful World Friends of Music Therapy Inc., honors the legacy of the Louis Armstrong Department of Music Therapy and the Department’s commitment to music therapy at Mount Sinai hospitals.

The evening recognizes a dynamic group of individuals chosen from a variety of fields including music and medicine, in addition to patients who have benefitted from receiving music therapy at Mount Sinai hospitals.

From left: Honorees Zoë Brecher, Manjeet Chadha MD, and Samara Joy.

This year’s honorees were Manjeet Chadha, MD, Director, Department of Radiation Oncology, Mount Sinai Downtown; Samara Joy, the multi-Grammy Award-winning vocalist, who was presented the Phoebe Jacobs Award by renowned jazz trumpeter Jon Faddis; and patient Zoë Brecher, a patient of the Louis Armstrong Center who is the drummer of Bruce Springsteen’s ‘Nightshift’ band.

The gala was hosted by Mercedes Ellington, dancer, choreographer, and granddaughter of Duke Ellington, and Bill Daughtry, the retired radio and TV host. The co-chairs were Robert Lande, President and Director at FXCM and Chief Financial Officer of Forex Capital Markets, and Kim Polson, from the Louis Armstrong Center for Music and Medicine’s Steering Committee.

The event featured an opening performance by Aneesa Folds from the Broadway production of Freestyle Love Supreme, with Dizzy Senze, Anabelle Luke, and David Bradshaw. Jazz ensued throughout the evening with saxophonist Erik Lawrence, Matthew Munisteri, jazz guitarist, and bass player Russell Hall who accompanied Samara Joy. Her voice, recalling the memory of Ella Fitzgerald, enraptured the more than 200 attendees with her rendition of Louis Armstrong’s “What a Wonderful World.”

Joanne V. Loewy, left, and Samara Joy.

Ricky Riccardi, archivist from the Louis Armstrong House Museum in Queens, shared Louis Armstrong  memorabilia. There was also Pop’s Food Court and a silent auction.

“This event highlights our commitment to music therapy, as the doctors, musicians, and patients who attend enjoy hearing about Louis’ love of music and people from all walks of life. This gala supports our care of patients and research—from neonatal care to oncology, Alzheimer’s disease, and psychiatry,” said Joanne V. Loewy, DA, LCAT, MT-BC, Founder and Director of the Louis Armstrong Center for Music and Medicine, which offers music therapy services throughout the Mount Sinai Health System.

This year Dr. Loewy and the Loewy Lab received funding from the National Institute of Health for her study of how music therapy addresses chronic stress in Black pregnant women through metabolomic pathways, and she received additional funding from the National Endowment for the Arts to study how music influences depression across several disease cohorts.

The Department of Music Therapy, with support from the Louis Armstrong Educational Foundation and other grants, provides a range of clinical services for infants, children, and adults, and day treatment at the Mount Sinai-Union Square clinic and within the community. Its music therapists are licensed and board certified to provide care that complements medical treatment, assisting with sedation, pain management, and neurologic and respiratory function.

Learn more about the Louis Armstrong Center for Music and Medicine
Listen to the Road to Resilience Podcast episode about music therapy and the Louis Armstrong Center for Music and Medicine

Second Book Celebrates Cancer Patients’ Prose During Pandemic

Updated on Dec 13, 2023 | Cancer, Community, Featured

Alison Snow, PhD, LCSW-R (left), Emily Rubin, and Manjeet Chadha, MD

Cancer patients had much to express during the COVID-19 pandemic, and their heartfelt stories can now be read in a new book, The Write Treatment Anthology Volume 2: The Pandemic Years (Write Treatment Anthology Series). The book includes essays, short stories, and poems from 15 cancer patients, survivors, and caregivers—all members of the Write Treatment Workshops for Mount Sinai Hospitals.

“During the pandemic, in the spring of 2021, I found this loving and supportive group while they met on Zoom,” writes workshop member Liz York in an excerpt from the anthology. “It was difficult to meet people who understood the emotional challenges of cancer, so the group immediately became important to me.”

The sentiment is shared by novelist Emily Rubin, workshop founder and cancer survivor who spoke to a large audience of fellow patients, their families, and caregivers at a recent book launch for the anthology on Wednesday, November 15, held at Mount Sinai-Union Square. She was introduced by Manjeet Chadha, MD, Director, Department of Radiation Oncology, Mount Sinai Downtown, and Professor, Radiation Oncology, Icahn School of Medicine at Mount Sinai, who described her as a “guiding light and a huge resource in helping many of our patients find an outlet through their writing.”

As Ms. Rubin took the microphone, she told the packed auditorium that running the workshops has helped her to “connect through the creative act of writing with so many who, like me, have been participants in these workshops, come and stay with a yearning to tell stories and hear those of others. Together we have built a supportive, creative community of writers.”

The Write Treatment Workshops: Evolution and Founding

Emily Rubin, novelist and workshop co-founder

Emily Rubin, novelist and workshop co-founder

A co-editor of the anthology, Ms. Rubin founded one of the workshops in 2011 after she completed breast cancer treatment at Mount Sinai Beth Israel. The other workshop was started by Susan Ribner, an author who was treated for ovarian cancer at Mount Sinai West. While the two coincidentally formed the workshops around the same time, they had met years before at an Aikido dojo, a type of martial arts gym, in Chelsea. They collaborated on workshops and book readings, and after Ms. Ribner went into hospice care, Ms. Rubin took over both groups. Ms. Ribner died in 2014.

Before the pandemic, the workshops were held in-person at the Blavatnik Family Chelsea Medical Center and at Mount Sinai West but moved to Zoom during the pandemic. While the workshops continue to be held virtually, they stick to the same routine they have always followed since their origins: Ms. Rubin emails prompts, such as quotes, cards, or photographs, to participants to spur their imaginations. Each participant then writes for about a half-hour, aiming to create a short, finished product. About 600 people now take part in the workshops regularly—a number that has doubled since the workshops began.

The book, published on Amazon.com through grants and crowdfunding, includes an in-memoriam section with writings from those who have died. In one excerpt, Susan Masaad, MD (1938-2021), writes of a virtual visit with her gastrointestinal oncologist of whom she was very fond: “I have come to appreciate his wonkiness, encyclopedic knowledge of all the ways we can slash and burn the cancer, as well as his absolutely exquisite taste in clothing…”

In another excerpt, patient Norman Ford (1935-2021) offers words of encouragement: “To you my cancer-laden brothers and sisters I have a message. This is not a chore. In the thoughts and feelings on display you expressed courage, anger, uncertainty, and more…”

Copies of the The Write Treatment Anthology Volume 2: The Pandemic Years (Write Treatment Anthology Series)

The Write Treatment Anthology Volume 2: The Pandemic Years (Write Treatment Anthology Series) follows Volume 1, published in 2022, which includes essays, short stories, and poems from 23 workshop participants. During the recent book launch, Alison Snow, PhD, LCSW-R, Director, Cancer Center Supportive Services at Mount Sinai Downtown Cancer Centers, called the second anthology’s publication “an extraordinary accomplishment” for the hundreds of Mount Sinai patients who continue to live—and write—with cancer.

Learn more about Mount Sinai's Cancer Support and Wellness Programs and Events

A “Profound Honor”: Mount Sinai Partnership Expands Health Care to Thousands in Guyana

Dec 6, 2023 | AIGH, Community, Diversity and Inclusion, Featured

Rachel Vreeman, MD, MS, speaks with Frank Anthony, MD, MPH, Minister of Health, Guyana (right)

The Icahn School of Medicine at Mount Sinai is seizing “an amazing opportunity” in global public health in a three-year initiative that is expanding health care to Guyana’s more than 800,000 citizens. Launched in 2022, the initiative is a partnership among Mount Sinai, the Hess Corporation, and the government of Guyana, and it is already bringing crucial health screenings to roughly half the nation’s eligible children.

“It is a profound honor to serve the people of Guyana in this mission to give everyone the best opportunity for a healthy and long life,” says Jeremy Boal, MD, Chief Clinical Officer of the Mount Sinai Health System, who is overseeing Mount Sinai’s efforts under the initiative.

Guyana is a racially and ethnically diverse nation at the northern edge of South America, with strong historic and cultural ties with nearby Caribbean nations. The nation entered a transformative era in 2015, when nearly 11 billion barrels of crude oil reserves were discovered offshore and its government began making plans to invest in much-needed infrastructure in many areas, including health care. Guyana’s National Healthcare Initiative was launched after John Hess, Chief Executive Officer of Hess and a member of Mount Sinai’s Boards of Trustees, approached Mount Sinai about partnering with Guyana’s government and Hess to expand health care in the country. The collaboration will make health care more accessible even to its most vulnerable citizens, including pregnant people and adults living with diabetes or cancer.

Working closely with Guyana’s government, a 40-member project team of experts from the Mount Sinai Health System are providing thought partnership to the country’s leadership to implement a range of improvements to the national health infrastructure of Guyana. These teams are led by the Mount Sinai’s Arnhold Institute of Global Health and Mount Sinai International, organizations dedicated to advancing Mount Sinai’s mission of delivering innovative, high-quality health care around the globe.

Initial steps: Increasing access to children’s health care, primary care for diabetics, and a “world class” pathology lab

Already underway is a national child and youth health initiative, the first primary care program for children in Guyana. Launched in August 2023, the program provides comprehensive health exams for all nursery school students in Guyana, children aged three to five years old. Within its first month the program conducted health screenings—including vision, hearing, and dental evaluation—on 50 percent of the eligible children in Guyana, and the program is now reaching every region of the country, including remote regions accessible only by boat or plane.

“We’re really proud to move this bold children’s health initiative forward with the Guyana Ministry of Health and Ministry of Education,” says Rachel Vreeman, MD, MS, Director of the Arnhold Institute for Global Health, which is guiding the program. “It provides the critical steps toward implementing a primary care system and more universal health coverage. We’re providing screenings that let us identify children’s health issues early and connect families and communities and schools with the health centers in a new way.”

Comprehensive school health screening in the indigenous community of Karasabai in Region 9, Guyana

The next step is to enhance the national primary care program for adults, which will initially focus on diabetes screenings. After developing new national guidelines on diabetes in partnership with Guyana’s Ministry of Health, Mount Sinai experts trained Guyanese health professionals to implement high quality screening and care for diabetes at every level of the health system. Under the program, which also supplies medication and equipment, the Guyanese providers will, in turn, travel across the country to train health professionals in their local communities.

“The diabetes care platform is a model for other ‘train the trainer’ programs and primary care efforts, which will expand to provide screening and care for health challenges across Guyana, including high blood pressure, cancer screening, mental health screening, and other chronic diseases,” Dr. Vreeman says. The diabetes training is accompanied by efforts to build an infrastructure of expertise, supplies, and referral pathways, explains Dr. Vreeman, noting that expanding primary care services throughout the country will prevent patients from having to travel long distances for care. The Arnhold Institute is also guiding the country in building a more robust health care workforce, as well as the eventual rollout of a national electronic health records system and national health information system strategy.

The health care initiative will also expand specialty and tertiary health care at both public and private health care facilities throughout the country, particularly in cancer and cardiovascular care. Under the partnership, Mount Sinai International is working with Guyana’s government to develop a strategic plan that will determine how and where these services will be implemented, and how they will be funded and staffed. While most of these services are still in the planning stages, a telepathology lab is expected to be in operation by January 2024. Using advanced remote technology, the lab will allow doctors in Georgetown, the nation’s capital, to work with Mount Sinai pathologists in New York to diagnose patients in Guyana.

“The technology will decrease the wait time in Guyana for high-quality pathology readings from two to three months to few days,” says Szabi Dorotovics, MD, MBA, President, Mount Sinai International, who is overseeing these efforts. “I don’t think I have to tell you how much of a difference that can make, especially in cancer care. The quality of the readings will be world class.”

Guiding quality improvements at Guyana’s largest hospital

Under the initiative, Mount Sinai is also consulting on quality and operational improvements with leaders from Georgetown Public Hospital Corporation in Georgetown, Guyana’s largest hospital, where roughly half of patients are women seeking maternity care. These include enhancements to its neonatal intensive care unit; accident and emergency services; fire and life safety procedures; information technology; pharmacy services; supplies, equipment, and technology; minor renovations to the hospital campus, and more. A major challenge faced by hospital leaders in rolling out these improvements is a lack of resources, including a shortage of nurses and equipment.

“What we have to do is work with them, given the constraints, and figure out what can we do,” says Art Gianelli, MBA, MPH, FACHE, Chief Transformation Officer for the Mount Sinai Health System, who is leading these efforts with the Mount Sinai International Group. “Maybe we can’t do what is ideal, but we can take practical steps to improve all of the areas.”

Most of these improvements involve process changes that make up the foundation of good care, explains Mr. Gianelli, some of which are already underway. “The next step is to build on this foundational work and start to drive changes in outcomes, but you have to start at the beginning.”

Hospital leaders have already made a number of quality improvements, such as installing soap dispensers throughout the building to help reduce the spread of hospital-acquired infections, and deploying hospital administrator “safety huddles” to improve awareness of potential safety issues. For Guyana’s largest and busiest hospital, where many patients travel long distances to obtain care, these changes are sure to have a positive “ripple effect” across the country, Mr. Gianelli says.

While Guyana’s health care initiative is still in its early phases, it is providing valuable insight into how to target, at a national level, social determinants of disease. This will allow the country to address problems early and provide community-based prevention strategies, according to Dr. Vreeman.

“Our teams feel really privileged to be serving as this partner for Guyana’s Ministry of Health,” says Dr. Vreeman, Chair of Global Health and Health System Design at the Icahn School of Medicine at Mount Sinai. “It’s an amazing opportunity to be able to bring up to scale some of the most evidence-based practices for what works in global settings. Through this initiative, Guyana is improving access to care, especially for marginalized and vulnerable children, and for people living in remote communities who have often experienced systemic inequities.”

Learn more about the Arnhold Institute for Global Health

Transforming the Face of Pharmacy by Training Knowledgeable, Efficient Techs

Nov 30, 2023 | Community, Diversity and Inclusion, Featured

The first cohort of six students graduated from the Mount Sinai Health System Pharmacy Technician Training Program. The students holding certificates are, from left: Christian Cuatlal-Zempoalteca, Jacqueline Pierce, Millagros Verdejo, and Ekelly Huntley. They are joined by, from left, Irina Usherenko, PharmD MBA; Elone Winston, MPH, CPhT; Susan Mashni, PharmD, BCPS; John Ugbogbo, MS, RPh; and Brian Radbill, MD. Students Oprah Reid and Aishatou Coulibaly are not shown.

Pharmacy technicians serve as crucial team members who work alongside pharmacists to maximize the pharmacist’s scope and efficiency.

As technology and training have evolved, technicians have taken a more significant leadership role in hospital pharmacy operations. However, there is a severe shortage of qualified pharmacy technicians across the country.

To address the issue, the Mount Sinai Health System Pharmacy Technician Training Program launched earlier this year with support from Susan Mashni, PharmD, BCPS, Senior Vice President and Chief Pharmacy Officer, Mount Sinai Health System.

The program was begun under the leadership of Irina Usherenko, PharmD, MBA, Vice President, Pharmacy, Mount Sinai Morningside and Mount Sinai West, and Elone V. Winston, MPH, CPhT, Project Manager II, Mount Sinai Health System.

“We want to fill the pharmacy tech vacancies from within the Health System while providing career advancement opportunities to our Mount Sinai colleagues. Our goal is to fill those vacancies with the best trained, most qualified personnel,” said Dr. Usherenko. “Specifically, we need certified pharmacy techs who are registered and licensed in New York State and have hospital-based training or experience.”

To do that, they decided to create a comprehensive training program that would be accredited by the American Society of Health-System Pharmacists (ASHP).

“There are only four other ASHP-accredited programs in New York State,” said Mr. Winston. “We designed a program with didactic, simulation, and onsite rotations. It is what is necessary so that pharmacy technicians are prepared to work in a complex environment that operates 24/7.”

The first cohort of six students graduated in September. Students were recruited from Strive NYC and the Manhattan Educational Opportunity Center (MEOC)—organizations focused on providing pathways to life-changing careers that provide financial empowerment and stability.

Each student completed more than 400 hours of intense study that includes online classroom work, time in a simulation lab, and hands-on experience in the Mount Sinai Morningside pharmacy. The online topics included basic anatomy and physiology and pharmaceutical terminology. In the simulation lab, students learned about dispensing and filling prescriptions, sterile compounding, and hazardous medications. They also gained experience working in retail and hospital pharmacies.

The students must pass a certification exam before applying for licensure and registration. Once that is achieved, the technicians are ready to work in a hospital environment with a starting salary of close to $70,000 per year.

The training for the first cohort was provided tuition free, and the students were given a small stipend during their experiential phase of the training.

The next group of students is being recruited from existing hospital staff including Environmental Services, Throughput, Patient Accounts, and the Emergency Department. The 1199 Training Fund will support these students and they will continue to work part-time during the training program. There were more than 400 applicants for 15 spots.

To learn more, contact PharmTechTraining@mountsinai.org.

Miriam Merad, MD, PhD: Overcoming Doubt and Redefining Immunology

Nov 30, 2023 | Featured, Research

Miriam Merad, MD, PhD: Overcoming Doubt and Redefining Immunology

About 17 years ago, when Miriam Merad, MD, PhD, had barely started her lab at the Icahn School of Medicine at Mount Sinai to research macrophage lineages, she was having trouble attracting grants from the National Institutes of Health (NIH).

Macrophages are a group of immune cells found in all organs, constantly surveying for potential threats and ensuring elimination of damaged cells and dead cells. During her fellowship at Stanford University, Dr. Merad discovered that in contrast to the dominant understanding that macrophages are recruited from blood circulation, some macrophages are independently renewed locally in tissues. She hypothesized that these self-renewing macrophages played a key role for the maintenance of tissue integrity.

But knowledge and awareness of the topic were too nascent at the time, and there weren’t sufficient experts on the grant committees who recognized the value of the research, said Dr. Merad, who is now the Mount Sinai Professor in Cancer Immunology, Chair of the Department of Immunology and Immunotherapy, and Director of the Marc and Jennifer Lipschultz Precision Immunology Institute at Icahn Mount Sinai. For years, it was difficult to convince scientists of the importance of this cell lineage and secure funding. “While I was projecting confidence, I was doubting, too, whether I was on the right path,” said Dr. Merad.

Fast forward to October 2023, and that perseverance paid off: Dr. Merad was elected to the National Academy of Medicine (NAM), making her one of the few scientists at Mount Sinai to hold dual membership with the National Academy of Sciences, which she was elected to in 2020. The appointments were for her discovery of this new lineage, and that body of work has ignited research around the world on revealing the key role of macrophages in many key physiological processes, including preserving the vascular tone, promoting neuronal function, and contributing to tissue regeneration and repair via stem cell niches.

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“Miriam Merad is one of the most renowned immunologist of her generation and has made seminal discoveries in our understanding of the embryonic origin of tissue-resident macrophages and the crucial contribution of these and related cells to the tumor microenvironment,” said Eric Nestler, MD, PhD, Dean for Academic Affairs of Icahn Mount Sinai and Chief Scientific Officer of the Mount Sinai Health System.

“These advances are now driving highly novel clinical trials for lung and other cancers. Mount Sinai is enormously proud of her accomplishments and the leadership role that she serves on campus,” said Dr. Nestler.

Switching Tracks

Early in her medical career, in France during the late 90s, Dr. Merad trained in allogeneic bone marrow transplants and saw how they essentially cured leukemia for some patients. As she moved onto the subject of solid tumors, she noted that the treatment landscape was bleak—especially for metastatic patients, for whom chemotherapy and radiation therapy had limited effect.

As she was studying tumor stains of her patients, Dr. Merad realized that in some tumor lesions, there were more immune cells than cancer cells, which led her to conclude that solid tumors could also be targeted by immune cells. Having come from the hematological oncology field, where immunotherapy had seen success, she saw the potential of tapping the immune system in tackling solid tumor cancers. And so Dr. Merad pursued a PhD at Stanford University to deepen her understanding of immunology, and began a research career in cancer vaccines.

At the time, researchers knew that dendritic cells—responsible for initiating all antigen-specific immune responses—could mount a response against cancer cells, but not enough was known about dendritic cells to harness them. Nor was there great interest in the related lineage of macrophages.

“I thought if we wanted to be serious in harnessing dendritic cells and macrophages to destroy tumor cells, we had to understand everything about these cells, including where they came from and why they accumulated in cancer tissues,” Dr. Merad said.

Persevering Through a Rocky Start

Dr. Merad’s research brought her to Icahn Mount Sinai, where she established a lab to study the lineages of tissue-resident macrophages. That journey had a rough start.

“I managed to produce some nice papers with my seed funding from Mount Sinai, but I had no money otherwise, and I needed more funding to carry out these big experiments that were needed,” she said.

The next step—obtaining formal proof that macrophages had a lineage independent of circulating immune cells existed—required a gene tracing experiment that traces the origin of the cells in the embryo. “It’s very technical research that requires the building of many new expensive tools and experimental models. I was spending a lot of money and I was not getting any grants,” Dr. Merad said.

In order to keep her lab aloft, Dr. Merad had to lay off two people in her group. “I was extremely saddened,” she said. “These people stuck with me through my research, and I kept saying what a fantastic job they were doing. And somehow I let them down.”

Thankfully, about a month later, the group had a big paper published in a leading scientific journal, and that recognition attracted two NIH grants, turning Dr. Merad’s lab around.

What kept Dr. Merad pushing forward was the belief in her research. “I knew the data was reproducible and would have an impact for sure. But new discoveries are always faced with some skepticism by the scientific community. I realized that I needed more successes to convince the community of the clinical relevance of the new discovery,” she said. Dr. Merad then examined the distribution and contribution of these new macrophages to different disease conditions, which gained traction, and now, nearly 15 years after the initial discovery, textbooks have been rewritten and graduate students are now taught about this lineage.

“But new discoveries are always faced with some skepticism by the scientific community. I realized that I needed more successes to convince the community of the clinical relevance of the new discovery.”

—Dr. Merad

“It had been an anxious three years of starting my journey. Despite all the anxiety and the doubts, I always felt strongly supported at Mount Sinai,” said Dr. Merad. In addition to the intellectual engagement she has received from her peers and lab group, she appreciated the support of Dennis Charney, MD, the Anne and Joel Ehrenkranz Dean of Icahn Mount Sinai, who emboldened her belief in her niche line of research.

“We’re from different fields,” she said of Dr. Charney, a psychiatrist, “and when I engaged him to explain my field and my research, he encouraged me to explore further.” Most deans usually don’t want to rock the boat, but Dr. Charney pushed me to find a way to bring the discovery to the clinic, Dr. Merad added.

That encouragement to keep probing despite uncertainty and doubt was why Dr. Merad stayed at Icahn Mount Sinai, even after her research took off, she said. “I came into science because I wanted to change medicine. Mount Sinai is exactly the environment that enables you to do so, aim big despite the uncertainty, and accomplish your dreams.”

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A closer look at Dr. Merad's work

Brian Brown, PhD

Brian Brown, PhD, Professor of Genetics and Genomic Sciences, and Dermatology, and Associate Director of the Marc and Jennifer Lipschultz Precision Immunology Institute, explains why Dr. Merad’s body of work in immunology is so impactful.

“Dr. Merad’s work has transformed our understanding of an entire branch of the immune system, which is made up of cells called macrophages and dendritic cells,” said Dr. Brown.

These cells are found in all tissues of the body and influence virtually every disease. Macrophage and dendritic cells used to be thought of as having no variations, but Dr. Merad led the way in showing otherwise—they differ developmentally, reside in healthy and diseased tissues differently, and have different molecule programs, which also means they have different physiological functions.

Uncovering the diversity in these cells, especially at the molecular level, has had a profound impact in our thinking about what these cells do, including how they help fight infections, control tumor growth, or contribute to inflammation, Dr. Brown said. “She helped rewrite our textbook understanding of these cells and really about the immune system itself.”

Prominent papers from Dr. Merad include a 2010 Science study which revealed that adult microglia—primary immune cells of the central nervous system—derive from primitive macrophages, and the paper was cited nearly 3,000 times, according to the journal. Another 2010 Science paper on the development of monocytes, macrophages, and dendritic cells was cited nearly 2,000 times. Dr. Merad has published more than 250 articles, and her works have been cited over 82,000 times, according to Google Scholar.

Dr. Merad’s work on dendritic cells and macrophages has very broad implications for the treatment of many diseases, said Dr. Brown. In cancer, her work is helping therapies to be developed that can enhance immune responses in patient tumors, and clinical trials are running based on concepts and specific molecular pathways she has identified as being important. Similarly, in inflammatory diseases, Dr. Merad has been pioneering the use of single-cell analysis technologies to study disease, and this work has led to new ways to classify disease lesions and predict what types of drugs a patient might respond to, Dr. Brown noted.

The National Academy of Medicine (NAM) only admits 100 individuals each year, and membership is one of the highest honors for a scientist in health and medicine. NAM has more than 2,400 members, and Dr. Merad’s appointment brings Mount Sinai’s membership in this organization to 26 current and emeritus faculty members. Dr. Merad also holds joint membership in the National Academy of Sciences, which she was elected to in 2020.

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