Feb 25, 2020 | Featured, Global Health
Keynote speaker Karenna Gore with conference host Robert Wright, MD, MPH.
Global warming is having an increasingly profound effect upon human health, making it harder to breathe, giving rise to more infectious diseases, and even lowering nutritional levels in our food supply.
These were among the many consequences cited on Friday, January 24, when the Institute for Exposomic Research at the Icahn School of Medicine at Mount Sinai hosted its second annual Clinical Climate Change Conference at the New York Academy of Medicine. The event drew more than 150 clinicians and other members of the U.S. medical community.
“Health care professionals are on the front lines of this planetary health problem,” which is having a disproportionate effect on “the poor, the marginalized, the elderly and infirm, and nonhuman life,” said Karenna Gore, the Conference’s keynote speaker, and the founder and Director of the Center for Earth Ethics at Union Theological Seminary.
She told the audience, “This is no ordinary time and we are together in not knowing how it will turn out. We need you to warn, and we need you to heal.” Ms. Gore is the daughter of former U.S. Vice President Al Gore, who received the 2007 Nobel Peace Prize for his work on climate change.
Robert Wright, MD, MPH, the Ethel H. Wise Chair of the Department of Environmental Medicine and Public Health, Director of the Institute for Exposomic Research, and Professor of Pediatrics at the Icahn School of Medicine at Mount Sinai, said exposomics—a new field of science that uses technology to measure an individual’s total environmental exposures over their lifetime—could help physicians understand the effects of global warming.
Satellites, for example, are used to help measure a person’s external exposure to air pollution, whereas mass spectrometry is used to measure an individual’s internal chemical exposures. As the field matures, Dr. Wright said, exposomic data will be used more widely to determine cause and effect and monitor the success of interventions.
Dr. Wright shared information from the U.S. Centers for Disease Control and Prevention (CDC), which highlighted the negative impact of extreme heat and air pollution on cardiovascular health and asthma and showed that warmer weather would lead to an increase in tick-and-mosquito-borne illnesses such as Lyme disease and the Zika virus, since insects could live and breed in more places.
Conference attendees gathered at the New York Academy of Medicine in New York City.
As a point of reference, Dr. Wright cited the European heat wave of 2003, which led to tens of thousands of deaths. France, he said, had the highest temperatures and the most deaths. Another example, he said, was chronic kidney disease of unknown origin, a progressive loss of kidney function that has killed more than 20,000 people in Central America over the past 10 years, most of whom were agricultural workers.
“The leading theory of the cause,” he said, “is a combination of dehydration and pesticide exposure. With climate change and higher temperatures, workers may be dehydrated for longer periods of time.”
Lewis Ziska, PhD, Associate Professor of Environmental Health Sciences at the Columbia University Mailman School of Public Health, and a former plant physiologist at the U.S. Agricultural Service, said increasing levels of carbon dioxide in the atmosphere were creating an imbalance in many plant species that people consume. Rice, wheat, potatoes, and barley, he said, were all showing a decline in protein, nitrogen, sulfur, zinc, and iron. Extreme weather-related events that take place in one part of the continent also affect the health of people living thousands of miles away.
Allan C. Just, PhD, Assistant Professor of Environmental Medicine and Public Health at the Icahn School of Medicine, discussed the unprecedented Canadian wildfires of 2015, which followed a hot, dry spring. The forest fires burned millions of acres and displaced thousands of people, mainly in Saskatchewan. Airborne particles from the fires spread to the Eastern United States, he said, and led to unsafe levels of air pollution in cities as far away as Baltimore.
In her closing remarks, Ms. Gore reminded the audience of the earth’s interconnectedness. “The climate crisis is a force that will ultimately spare no one,” she said. “Solving it should be a unifying cause.”
Updated on Feb 26, 2020 | Cardiology, Community, Featured
Health fairs were held throughout the Mount Sinai Health System to raise awareness of women’s risk for disease. Above, the fair at The Mount Sinai Hospital.
Eat healthy, get plenty of exercise, manage stress, and know your numbers. This was some of the crucial advice dispensed at health fairs held throughout the Mount Sinai Health System in honor of Go Red for Women Day® on Friday, February 7. The fairs, which were spearheaded by the nurses of Mount Sinai Heart, also provided nutritious snacks and free health screenings. Go Red is an initiative of the American Heart Association with the goal of increasing the awareness that heart disease is the No. 1 cause of death for women. Says Beth Oliver, DNP, RN, Senior Vice President, Cardiac Services, Mount Sinai Health System: “We want all women to understand the importance of knowing their numbers—their cholesterol levels, weight, blood sugar, and blood pressure—and to understand the risks of stress, smoking, and a sedentary lifestyle.”
Updated on Mar 5, 2020 | Featured, Global Health
Pathology technicians at work in the new laboratory at John F. Kennedy Medical Center in Monrovia, Liberia.
The only pathology laboratory in Liberia recently opened, thanks to a collaboration led by Ann Marie Beddoe, MD, MPH, Director of Global Women’s Health and Associate Professor of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai. The laboratory, which became operational in October 2019, is a crucial step in rebuilding the health infrastructure in Liberia after years of civil war. “The impetus for founding this laboratory was our mission to improve women’s health,” Dr. Beddoe says. “But this is not just for women or for cancer. This is something that will benefit the entire country.”
In an event attended by President George Weah of Liberia, the 4,000-square-foot laboratory at the John F. Kennedy Medical Center in Monrovia, Liberia, was dedicated in July 2019, along with an imaging center donated by the National Institutes of Health and an infectious disease center donated by the United States Agency for International Development. The new facilities are part of an overarching mission to provide evidence-based care in Liberia, which was wracked by civil wars for more than a decade. Around 2006, Ellen Johnson Sirleaf, then president of Liberia, noted that only 50 physicians were left in the nation of more than 4 million people, and she sent out a call for volunteers to help restore health care. In 2008, Dr. Beddoe was part of a group from Mount Sinai who answered that call, led by Jeffrey S. Freed, MD, Clinical Professor of Surgery, Icahn School of Medicine at Mount Sinai; and Eileen Solomon, Senior Director, Special Events, Mount Sinai Health System. “Our early teams recognized the need for gynecologic oncology services, and Dr. Beddoe had the courage and fortitude to make it happen,” says Dr. Freed, who has made many trips to Liberia to care for patients there.
From the beginning, Dr. Beddoe was struck by the prevalence of cervical cancer in Liberia. “Women would walk to the clinic, or come in strapped to motorbikes, and when we examined them, we found they were dying of cervical cancer,” she says. “I couldn’t walk away from this.” Low-income nations bear most of the burden of cervical cancer because industrialized nations benefit from widespread prevention, screening, and early treatment. For example, among more than 500,000 new cases of cervical cancer each year, only 14,000 are in the United States, Dr. Beddoe says. In addition, cancer carries a stigma in Liberia. “We couldn’t really treat these patients,” she says. “Nobody even acknowledged that they had cancer.”
Over the years, she has returned to Liberia every few months to work with physicians there to improve the diagnosis and treatment of cancer. The first step in securing any health care funding from the Liberian government is building a registry to document the nation’s cancer burden, Dr. Beddoe says. The creation of the pathology laboratory, where diseases can be diagnosed through the analysis of body fluids and tissues, is integral to this effort.
Ann Marie Beddoe, MD, MPH, at the dedication of the laboratory with Jerry Brown, MD, Chief Executive Officer of the John F. Kennedy Medical Center.
The $250,000 facility was built in a suite of storage rooms at JFK Medical Center and funded partly by The Women Global Cancer Initiative, a nonprofit led by Dr. Beddoe. Sakura Finetek USA, a pathology supply company, donated equipment, including a tissue processor and slide stainer, and Mount Sinai donated computers and printers, and a year’s worth of “consumable” supplies, such as reagents, alcohol, blades, and gloves.
Staffing the laboratory presented a challenge. Licensed clinical laboratory technicians—known as histotechnicians—are crucial to a pathology laboratory, and there were none in Liberia. So in 2019, four Liberians were trained by the American Society of Clinical Pathology, a crucial partner in the project. JFK Medical Center hired two physicians specializing in pathology, and other physicians at the hospital are being trained in handling and labeling specimens and in the discipline of evidence-based medicine.
“I am 99 percent sure that when I see a cervical cancer, it’s a cervical cancer, but that is not the way to introduce cancer care to a country that is trying to do things right,” Dr. Beddoe says. “Having pathology, and good diagnoses, will start generating more research, which is what you need to provide good medicine.”
Mount Sinai’s Division of Global Women’s Health focuses on the long term in its overall mission to improve research and clinical care. “We try to do a lot of capacity building—training people, and focusing on ongoing, sustainable projects,” Dr. Beddoe says. Her years of dedication were acknowledged at the ceremony in July, when the pathology laboratory was dedicated in her name.
Updated on Jun 30, 2022 | Asthma, Featured, Patient Stories
2019 Heisman Trophy winner Joe Burrow met with pediatric patients, including Ryan Diaz.
Patients and families at the Child Life Zone at Mount Sinai Kravis Children’s Hospital received a special visit on Sunday, December 15, from Joe Burrow, just a day after he was named the 2019 Heisman Trophy winner. The Louisiana State University quarterback hosted a special trivia-themed episode on KidZone TV, answered questions, opened up about his personal life and adversity, and provided inspiration to patients and their families in an appearance made possible through the Companions in Courage Foundation.
Mr. Burrow also signed football keepsakes for the patients, much to the delight of one 13-year-old patient, Ryan Diaz, an aspiring football player himself. Ryan already has helped his Harlem Jets youth football team win two championships—no easy feat for this offensive guard and center who happens to have severe asthma.
“He has had asthma since he was a baby, and he has been in and out of the hospital,” recalled his mother, Christina Ortiz. “He would miss up to 18 days a year of school.” Added Ryan: “It was really hard. I would miss so many things because I couldn’t control my asthma. I struggled so much from something I didn’t cause.”
“We have many, many patients like Ryan with severe asthma,” said Alfin G. Vicencio, MD, Vice Chair for Clinical Affairs and Strategy, and Division Chief for Pediatric Pulmonology at Kravis Children’s Hospital, who started treating Ryan in September 2018. “He has multiple triggers, and it’s hard to isolate one thing, so what is your recourse, stay inside a bubble?”
Ryan Diaz with Alfin G. Vicencio, MD
Dr. Vicencio is primarily treating Ryan with an injection of omalizumab, a monoclonal antibody, every two weeks. “This medication targets very specific molecules that are important in the asthma-inflammation cascade,” said Dr. Vicencio. The treatment acts to decrease the number of sudden episodes of wheezing, shortness of breath, and trouble breathing in individuals whose symptoms are not controlled with inhaled steroids.
“Mount Sinai has a very active program for the diagnosis and treatment of children with severe asthma,” said Dr. Vicencio. “This includes some important research initiatives that are starting to identify new subtypes of asthma, some of which may be driven by unsuspected infections.”
Other components of the research program, he added, are starting to identify new genes in the airway that may contribute to severity. This is part of a collaborative project with Supinda Bunyavanich, MD, MPH, MPhil, Professor of Pediatrics, and Genetics and Genomic Sciences, aimed at finding new therapeutic targets for patients with severe disease.
Following this protocol has allowed Ryan to keep active—except for when he was sidelined for two weeks in February with the flu and pneumonia. He is now able to resume his strenuous four-hour weekend football workouts and continue his participation in a dance and theater program.
Throughout it all, he has excelled in middle school, which has earned him an academic scholarship to Archbishop Stepinac High School in White Plains, New York, a football powerhouse.
“I just love football,” said Ryan, whose father, Juan Diaz, a registrar in Mount Sinai’s Institute for Advanced Medicine, played football for George Washington High School in New York City and has been a coach for the Harlem Jets since 2013. “It is a bond,” said Ryan.
Mr. Burrow is now certainly part of this bond, too. “It was really inspiring to speak with someone of that caliber,” said Ryan. “We talked about football, staying in school, and doing your best. One thing that made me proud—he signed my football jersey, and I gave him a signed Ryan Diaz #74 Harlem Jets hat, which he wore for the entire event.”
As for the football that Mr. Burrow signed, Ryan said he no longer has it. “We decided to give it to Dr. Vicencio because he has done so much for me. He let me lead a normal life. He really likes football, and I felt he really deserved that,” said Ryan. “I felt very, very touched,” said Dr. Vicencio. “I told Ryan that when he is in the National Football League, I will ask for one of these signed by him.”
Updated on Jun 30, 2022 | Cancer, Featured, Research
From left: Thomas Marron, MD, PhD; Adeeb Rahman, PhD, Associate Professor, Genetics and Genomic Sciences; and Miriam Merad, MD, PhD
Using a collection of sophisticated single-cell technologies, scientists at the Mount Sinai Health System have launched an early-stage clinical trial that examines the effects of immunotherapy on hepatocellular carcinoma, non-small-cell lung cancer, and head and neck squamous cell carcinoma.
Four to six weeks before a tumor is resected, the researchers administer a neoadjuvant immunotherapy, cemiplimab, and study its effects. As soon as the tumor is removed, they continue to analyze the fresh tissue for a month or more to observe mechanisms of resistance and response. The Phase 1 trial is sponsored by Regeneron Pharmaceuticals, Inc.
“With the technologies available to us at The Tisch Cancer Institute and Mount Sinai’s Human Immune Monitoring Center, we are able to investigate at an unprecedented depth how these immune therapies are changing the microenvironment within the tumor,” says Thomas Marron, MD, PhD, Assistant Professor of Medicine (Hematology and Medical Oncology), Icahn School of Medicine at Mount Sinai, and Principal Investigator of the study. “This trial enables us to analyze fresh tissue immediately after resection—instead of the preserved tissue typically obtained in trials—to observe the dynamic changes that occurred.”
The study is enrolling multiple small cohorts of 21 patients. One goal is to determine which cancer patients will benefit from cemiplimab, and, more specifically, how cemiplimab can be more effective by combining it with chemotherapy and/or other novel immunotherapies. Cemiplimab was previously studied at Mount Sinai in liver and lung cancer patients and has been approved by the U.S. Food and Drug Administration for patients with metastatic cutaneous squamous cell carcinoma. The compound works by inhibiting the interaction between PD-L1, a protein on the surface of tumor cells, and PD-1, the protein on the surface of T cells, and restoring the immune system’s ability to recognize and kill cancer cells.
Another goal of the study is to identify biomarkers in human tissue and blood that will be able to predict who will respond to immunotherapy, since so many patients do not respond to anti-PD-1 therapy. “We really need to find the ideal patients to treat so we don’t unnecessarily expose those who won’t respond to the toxicity of immune therapies,” says Dr. Marron, who is also Assistant Director of Early Phase and Immunotherapy Clinical Trials at Mount Sinai. “There’s also a financial issue at stake for patients and society in general in using expensive drugs that are not improving outcomes.”
Dr. Marron and his team are using several powerful new technologies to help them with their work. These include immune mapping and monitoring technologies such as mass cytometry (CyTOF), a flow-cytometry-like technology that allows them to see up to 50 proteins on each cell so they can identify the cell type and classify the maturation and activation status of the cell, along with some of the regulatory “on/off” checkpoints.
CITE-Seq (Cellular Indexing of Transcriptomes and Epitopes by Sequencing) is another platform that provides an even higher resolution view of each individual cell within the tumor. This technology combines the capabilities of CyTOF and single-cell RNA sequencing to characterize both the RNA and protein in each cell.
A third technology is known as Multiple Ion Beam Imaging (MIBI), a unique form of immunohistochemistry that allows scientists, for the first time, to unravel the spatial architecture of tumors in order to better understand the mechanisms through which the immune system is infiltrating the tumor and is being hijacked by the tumor.
“For 10 years, we’ve been building the Human Immune Monitoring Center into one of the leading platforms in the world for investigating the role of the immune system in human disease, and using that knowledge to design novel, immune-based therapies,” says Miriam Merad, MD, PhD, Director of the Center, and Professor of Oncological Sciences, and Medicine, Icahn School of Medicine at Mount Sinai.
Drawing on a highly specialized team of clinicians, immunologists, mathematicians, physicists, and surgeons, the Human Immune Monitoring Center is currently involved in more than 45 federal- and foundation-funded research programs in fields such as cancer, autoimmune disease, inflammatory bowel disease, allergies, and neurodegenerative disease.
Updated on Jun 30, 2022 | Featured, Research
Denise Cai, PhD
Denise Cai, PhD, Assistant Professor of Neuroscience, Icahn School of Medicine at Mount Sinai, is the recipient of a 2019 National Institutes of Health New Innovator Award to continue her novel research into the brain and memory.
The Award was established to accelerate the pace of biomedical, behavioral, and social science discoveries by supporting exceptionally creative early-career scientists with high-impact ideas. It provides Dr. Cai with $2.5 million in funding over five years.
Dr. Cai’s research is driven by two perplexing questions: How, precisely, does the brain optimize its capacity and efficiency to store memories? And, how do these processes change over time? She and her research team will use a number of innovative approaches to further explore these concepts.
The effort includes the recording of neural activity in the brains of both younger and older study mice as they learn new spatial locations through a novel, wire-free miniature microscope known as the Miniscope system, which was co-developed with colleagues at the University of California, Los Angeles, and the Icahn School of Medicine. Using this new technology, the mice will wear tiny, head-mounted, wire-free microscopes as they enter a variety of different environments, enabling researchers to record and analyze thousands of neurons over the course of time.
“We will use a variety of techniques to observe and manipulate these populations of neurons to determine how the neural activity in the brain controls the animals’ behavior,” explains Dr. Cai. “Ultimately, we aim to learn how the brain optimizes its capacity to store information across a lifetime. I am tremendously grateful to have received the New Innovator Award, which will enable our lab to explore some fundamental, yet very complex, biological questions in the field of memory and cognition.”
