The Center for Advanced Medical Simulation at Mount Sinai West Hosts Annual Tristate Regional Simulation Symposium May 17

Mar 20, 2024 | Community, Research

The Center for Advanced Medical Simulation (CAMS) at Mount Sinai West is hosting its pioneering annual Tristate Regional Simulation Symposium. The symposium is scheduled for Friday, May 17, from 11 am to 2 pm, using a live online format.

The theme for this eighth annual symposium is “Embracing Change: How Artificial Intelligence (AI) Can Influence Health Care Simulation.” The symposium will include plenary talks, data-driven presentations, and panel discussions.

“Together, we will explore AI possibilities to enhance patient safety, team performance, and outcomes in simulation-based education and powerfully affirm everything that is most striking about simulation that we do at our institutions and worldwide,” said Priscilla V. Loanzon, EdD, RN, CHSE, Director of Simulation Education, Center for Advanced Medical Simulation, and Assistant Professor of Medicine (Pulmonary, Critical Care, and Sleep Medicine) at the Icahn School of Medicine at Mount Sinai.

Since the pandemic, the format for the symposium has changed from a full-day onsite and in-person conference to a three-hour live online. The target audience has expanded over the years from regional to national and international. Attendees can earn credits for continuing medical education and continuing education units.

CAMS is one of the Mount Sinai Health System’s outstanding simulation centers, all dedicated to improving patient safety, communication, and medical education. It provides health care training opportunities to professionals in the safe learning environment of a lab setting, offering courses that include case-based simulation, in-situ simulation, and procedural training such as point of care ultrasonography, central line training, blood culture competency, medical code response, managing mechanically ventilated patients, and advanced airway management. The Center includes three simulation laboratories, a virtual-reality training arcade, and two conference rooms. All areas of CAMS are equipped with audiovisual and video-recording equipment to facilitate education, training, debriefing, and research and quality improvement projects.

The Center, accredited by the Society for Simulation in Healthcare (SSH), is working with the Continuing Medical Education Department, Mount Sinai’s Office of Corporate Compliance and Office of Development.

To learn more about the symposium, contact Dr. Loanzon at priscilla.loanzon@mountsinai.org or call 212-523-8698.

The Society for Simulation in Healthcare declared September 11-15, 2017, as an inaugural simulation week with a focus on celebrating the professionals who work in health care simulation to improve the safety, effectiveness, and efficiency of health care.

“CAMS invited the simulation centers in the tristate area to a joint celebration through a symposium,” said Dr. Loanzon. “This inaugural celebration was intended to powerfully affirm the tristate region’s successes, opportunities, and myriad possibilities to be the best in what we do so well individually and collectively.”

Learn more about the Center for Advanced Medical Simulation

AI Spotlight: Predicting Risk of Death in Dementia Patients

Updated on Mar 22, 2024 | Featured, Research

Kuan-lin Huang, PhD, Assistant Professor of Genetics and Genomic Sciences at the Icahn School of Medicine at Mount Sinai

Dementia is a neurodegenerative disorder, commonly known to affect cognitive function—including memory and reasoning. It is also a factor contributing to death. According to the Centers for Disease Control and Prevention, dementia is currently the seventh leading cause of death in the United States. Alzheimer’s disease is the most common form of dementia, accounting for approximately 70 percent of cases.

Researchers have used artificial intelligence and machine learning to help diagnose and classify dementia. But less effort has been put into understanding mortality among patients with dementia.

A group of researchers at the Icahn School of Medicine at Mount Sinai seeks to tackle this problem by developing a machine learning model to predict risks of death for a patient within 1-, 3-, 5-, and 10-year thresholds of a dementia diagnosis.

“We really want to call attention to how Alzheimer’s disease is actually a major cause of death,” says Kuan-lin Huang, PhD, Assistant Professor of Genetics and Genomic Sciences and Principal Investigator of the Precision Omics Lab at Icahn Mount Sinai.

“When people think of dementia, they think of patients losing their memory, as opposed to when people think about cardiovascular disease or cancer, they think about mortality,” says Dr. Huang. “As someone who has a family member who unfortunately passed away from Alzheimer’s disease, I’ve seen how the late stage of the disease—because you lose certain bodily functions—can become quite lethal.” In late-stage dementia, the disease destroys neurons and other brain cells, which could inhibit swallowing, breathing, or heart rate regulation, or cause deadly associated complications such as urinary tract infections or falls.

In the study, the team focused on this question: Given a person’s age, specific type of dementia, and other factors, what will be the risk the person will end up passing within a certain number of years?

For its model, the team used XGBoost, a machine learning algorithm that utilizes “gradient boosting.” This algorithm is based on the use of many decision trees—“if-this, then-that”-type reasoning. It learns from errors made by previous simple trees and collectively can make strong predictions.

Here’s how the study’s lead authors, Jimmy Zhang and Luo Song in Dr. Huang’s research team, leveraged machine learning to shed light on mortality in dementia.

The study used data from more than 40,000 unique patients from the National Alzheimer’s Coordinating Center, a database spanning about 40 Alzheimer’s disease centers across the United States. The model achieved an area under the receiver operating characteristic curve (AUC-ROC) score of more than 0.82 across the 1-, 3-, 5-, and 10-year thresholds. Compared to an AUC-ROC of 0.5, which amounts to a random guess that correctly predicts 50 percent of the time, the model performed reasonably well in predicting a dementia patient’s mortality, but still has room for improvement. By conducting stratified analyses within each dementia type, the researchers also identified distinct predictors of mortality across eight dementia types.

Findings were published in Communications Medicine on February 28.

In this Q&A, Dr. Huang discusses the team’s research.

What was the motivation for your study?

We wanted to address the challenges in dementia care: namely, to identify patients with dementia at high risk of near-term mortality, and to understand the factors contributing to mortality risk across different types of dementia.

What are the implications?

Clinically, it supports the early identification of high-risk patients, enabling targeted care strategies and personalized care. On a research level, it underscores the value of machine learning in understanding complex diseases like dementia and paves the way for future studies to explore predictive modeling in other aspects of dementia care.

What are the limitations of the study?

While our study includes nationwide data, to make the model more generalizable, it still needs to be adapted to different research and clinical settings.

How might these findings be put to use?

These findings could enhance the care of dementia patients by identifying those at high risk of mortality for more personalized management strategies. On a broader scale, the study’s methodologies and insights could influence future research in predictive modeling for dementia, potentially leading to improved patient outcomes and more efficient health care systems.

What is your plan for following up on this study?

We plan to refine our dementia models by including treatment effects and genetic data, and exploring advanced deep learning techniques for more accurate predictions.

Learn more about how Mount Sinai researchers and clinicians are leveraging machine learning to improve patient lives

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First Gene Therapies Approved for Sickle Cell Disease: What Do They Spell for Patients?

Updated on Mar 1, 2024 | Featured, Research, Your Health

In December 2023, the U.S. Food and Drug Administration announced its approval of two gene therapies for sickle cell disease—the first of their kind for the condition.

Casgevy™ (exagamglogene autotemcel), a cell-based gene therapy developed by CRISPR Therapeutics using its CRISPR/Cas9 genome editing technology, was approved for use in patients 12 years and older with recurrent vaso-occlusive crises (VOCs). Lyfgenia™ (lovotibeglogene autotemcel), also a cell-based gene therapy by bluebird bio, was similarly approved for treating patients 12 and up with a history of VOCs; it uses a lentiviral vector for genetic modifications.

“This is absolutely a development that physicians treating sickle cell disease are excited about,” says Jeffrey Glassberg, MD, Professor of Emergency Medicine, and Medicine (Hematology and Medical Oncology), at the Icahn School of Medicine at Mount Sinai, and Director of the Mount Sinai Center for Sickle Cell Disease.

For a long time, sickle cell disease could only be cured with a bone marrow transplant, but that procedure involves challenges, starting with finding a match and also including the potential for complications, Dr. Glassberg says. “With these gene therapies, we’re taking stem cells from your own blood and taking it to a manufacturing facility to edit the DNA. When we give the stem cells back, you begin making new blood that’s yours without sickle cell disease,” he says. “This resolves a lot of the limitations of a bone marrow transplant.”

How do Casgevy and Lyfgenia work in curing sickle cell disease, and how do they differ from bone marrow transplants? Dr. Glassberg explains in this Q&A.

What goes on in a bone marrow transplant?

So with bone marrow transplant, you need a match. You need somebody to donate the bone marrow. While it’s unlike an organ transplant—where you’re waiting for an organ to become available either through a donation or after someone dies—there is a registry where people are willing to donate. However, finding a 100 percent match is tricky. If you’re lucky, you might have a sibling where their marrow matches perfectly. If not, it’s a rigorous search through this registry.

We can do bone marrow transplants with only half-matches, but those don’t work as well. And even for well-matched transplants, there remains the risk of developing a complication called graft-versus-host disease (GvHD). That is a condition where the donor immune cells recognize the host as foreign and attack the recipient’s body cells. GvHD can be pretty common—occurring in about 50 percent of cases—but only a small percentage turn into catastrophic GvHD.

Jeffrey Glassberg, MD, Director of the Mount Sinai Center for Sickle Cell Disease

What is sickle cell disease?

Sickle cell disease is a group of inherited blood disorders, where a mutation in hemoglobin—a protein in red blood cells that delivers oxygen to tissues—causes the red blood cells to develop a sickle shape. These sickled cells can restrict blood flow in blood vessels and deliver oxygen inefficiently, which can cause pain or organ damage—also known as vaso-occlusive crises. This condition affects approximately 100,000 people in the United States and is most common in Black people. Even with good management, the life expectancy of a person with sickle cell disease is around 50 years

How do the gene therapies avoid these issues?

With the gene therapies, the patient is essentially still going through a bone marrow transplant. The individual still receives a large amount of toxic chemotherapy to kill off existing stem cells, and receives new cells. However, the difference is that it is your own stem cells taken out and fixed. You are donating marrow to yourself, so it will always be a 100 percent match when reintroduced to your body and would not attack the host.

What are the technology differences behind the two gene therapies?

Casgevy uses CRISPR/Cas9, which is basically a protein discovered from bacteria that can cut tiny pieces out of your DNA. The therapy uses CRISPR to turn down a gene called BCL11A, which suppresses the production of fetal hemoglobin after babies are born and activates beta hemoglobin, which is affected by the sickle-cell mutation. By turning down that gene, the patient stops making adult hemoglobin and switches to making fetal hemoglobin.

Lyfgenia uses a lentivirus to create a so-called transgene. The lentivirus drops in a whole gene which contains instructions for producing functional hemoglobin. This approach produces a type of hemoglobin called HbAT87Q, which works even better than regular adult hemoglobin and can be identified with a lab test. The differentiation is helpful in telling exactly how well the gene therapy is working by the amount of HbAT87Q.

In a way, for both fetal hemoglobin and HbAT87Q, they work slightly better than regular hemoglobin for adults with sickle cell disease. Both have similar or slightly better oxygen-binding affinity, and each possesses “anti-sickling” globins that limit or inhibit hemoglobin S levels, which are tied to the sickling of red blood cells.

Are these gene therapies available at Mount Sinai?

Yes, we’ll be doing the therapies starting in late February. We’ve got four patients approved already, and have a list of dozens of people who are being evaluated. You can make an appointment at the Mount Sinai Sickle Cell Disease Center.

To call Mount Sinai Sickle Cell Disease Center
212-241-3650

What goes into the process of receiving these therapies?

It’s a long road. It starts with a visit at a sickle cell disease center. If the physicians have not identified any big reasons why you should not be a candidate, you’ll be referred to a gene therapy team—these doctors also work with bone marrow transplants. They will ensure any medical issues before and after the therapy are accounted for.

Administrative and finance teams will work with you to ensure these therapies are covered. These are expensive products—about $2 million or so—and each gene therapy is an individual negotiation and contract between the insurance company and drug company.

If everything is approved, you’ll make an appointment to come into the hospital for a procedure called apheresis. It’s almost like dialysis, where you’re hooked up to a machine. Your blood is pulled into the machine where stem cells are extracted over a period of about six hours. The stem cells are sent off to a manufacturing facility where the drug company does the gene therapy. This could take up to six months.

When the product is ready, you’ll check into the hospital again. You’ll be given chemotherapy to kill off all the stem cells in your body that make blood. Once all the stem cells are gone, a bag containing the gene therapy gets transfused into you, and the modified cells find their way back into the bones and start making blood that doesn’t have sickle cell disease.

Similar to a bone marrow transplant, you’ll be in the hospital for four to six weeks, because you have no immune system following the transfusion, and the product takes about a month to get into your body. This would be the biggest danger period of the whole process. But after that, you leave the hospital pretty much cured of sickle cell disease, though you might have to come back for several checkups.

What are some risks associated with the gene therapies?

Like in bone marrow transplant, the involvement of chemotherapy does carry a small risk of death. And there is a small risk of secondary cancers from the chemotherapy. It is very likely a person opting for this therapy might not be able to have children afterward unless you preserve your eggs or sperm. After the therapy, you would have to be careful for a while because your immune system is still reconstituting itself, and a simple case of influenza can make you much sicker than it normally would.

Who might be ideal for this sort of therapy?

The sickest of patients would be too frail to undergo chemotherapy, and a patient with mild disease wouldn’t find the risk-benefit attractive. It would essentially be someone with severe disease who isn’t responding well to current available drugs, but is strong enough to undertake the risk of chemotherapy to not have sickle cell disease anymore.

In adult medicine, we have moved away from paternalism, so our approach is: if you have sickle cell disease, and you understand the procedure, risks, and alternatives, and you still want to opt for the gene therapy, we will support you and do our best to help you succeed. It’s a shared decision-making process with the patient to make sure they understand what they’re getting themselves into.

In children for whom this therapy is appropriate, it’s a different approach. It’s more a medicine-based approach, where you only reach for the extreme care when you’ve exhausted all other options and you can say with relative certainty that the child would otherwise be certain to experience bad outcomes. An example would be if a child had had a stroke after maximal treatment and continued to have another stroke, then a transplant or gene therapy could be considered.

There might be many who would not opt for this, given that there are many good treatments that could help manage the condition, as well as more drugs in development. But these gene therapies open up options for a tremendous number of people. They are a cure for sickle cell disease as much as a bone marrow transplant is considered a cure. We know from bone marrow transplant patients who have lived decades after the procedure that the benefit continues to be a durable effect for the rest of their life. While we can’t predict how patients will fare decades down the road, since the first patients for these gene therapies got them in 2014, we are hopeful they will see similar durable benefit as well.

Learn more about the Mount Sinai Center for Sickle Cell Disease

Mount Sinai Hosts Landmark Symposium on Urologic Oncology

Updated on Dec 14, 2023 | Community, Featured, Research

James Tisch, left, Co-Chairman of the Boards of Trustees of the Mount Sinai Health System, and Ash Tewari, MBBS, MCh, Chair of the Milton and Carroll Petrie Department of Urology.

The Department of Urology at the Icahn School of Medicine at Mount Sinai recently took center stage in the global medical community by hosting the Fifth International Prostate Cancer Symposium and World Congress of Urologic Oncology.

The event, held Friday, December 8, to Sunday, December 10, is considered a cornerstone in prostate, kidney, and bladder cancer. The event drew more than 500 registrants, including 90 of the world’s most renowned experts from more than 20 countries, and showcased groundbreaking research and clinical practices poised to redefine cancer care and impact patient outcomes worldwide.

A significant highlight was the presentation of the first Golden Robot Surgical Award for Excellence in Surgical Innovations for Cancer Patients to Ash Tewari, MBBS, MCh, Chair of the Milton and Carroll Petrie Department of Urology at Icahn Mount Sinai. This award was presented by Merryl and James Tisch, Co-Chairman of the Boards of Trustees of the Mount Sinai Health System, during a gala at the Pierre Hotel. The award recognizes a significant leap in medical innovation and patient care. Also attending were Brendan Carr, MD, MA, MS, whose appointment as Chief Executive of the Mount Sinai Health System is effective early next year, who opened the gala event, and Margaret Pastuszko, President and Chief Operating Officer.  Click here to watch a video shown at the gala titled “A Decade of Excellence: Dr. Ash Tewari’s 10-Year Voyage at the Department of Urology.”

Participants included 90 of the world’s most renowned experts from more than 20 countries.

Three Mount Sinai leaders opened the symposium: Dr. Tewari, Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean of Icahn Mount Sinai, and David Reich, MD, President,The Mount Sinai Hospital and Mount Sinai Queens. Their insightful opening remarks set the tone for what was to be an intensive three-day exploration of the latest advancements and challenges in urologic cancer care.

One of the symposium’s highlights was an engaging presentation by best-selling author Deepak Chopra, MD, a pioneer in integrative medicine and a prolific writer titled “Major Breakthroughs in the Science of Healing.” Dr. Chopra’s talk focused on integrating AI with the holistic interplay of mind, body, and spirit in medical science.

The event also highlighted technological innovation in medical communication and education, featuring state-of-the-art holographic presentations by Declan Murphy, MB, BCh, BaO, Consultant Urologist, Peter MacCallum Cancer Centre, Melbourne, Australia, and Alberto Breda, MD, PHD, Chief, Uro-Oncology Unit and Kidney Transplant Surgical Program at Fundació Puigvert in Barcelona.

Additionally, a stimulating debate between Mount Sinai radiation oncologist Richard Stock, MD, and robotic surgery pioneer Mani Menon, MD, Professor and Chief of Strategy and Innovation at the Department of Urology, offered contrasting perspectives on treating intermediate-risk prostate cancer.

Ketan Badani, MD, the Department’s Vice Chair and Director of Robotic Operations, and other renowned speakers enriched the symposium with their expertise on modern surgical techniques in kidney cancer, fostering a collaborative learning culture.

The symposium’s final day, led by Peter Wiklund, MD, PhD, Professor and Director of the Bladder Cancer Program, showcased advanced surgical procedures and a panel discussion with Reza Mehrazin, MD, Associate Professor, and John Sfakianos, MD, Assistant Professor, providing deeper insights into bladder cancer management.

Interactive sessions, including live surgical demonstrations, 3D video presentations, and hands-on experiences in simulation laboratories, underscored the event’s commitment to innovative and experiential learning.

Reflecting on the symposium’s impact, Dr. Tewari noted, “This gathering served as a dynamic platform for exploring the various facets of urology and robotic surgery. The exchange of ideas and insights among our peers underscores our collective capacity to shape the future of urologic oncology significantly.”

 

Watch a slideshow of photos from the event:

Learn more about Urology at Mount Sinai

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.

“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.”

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.

Mount Sinai Researchers Share Thoughts on the Promise of mRNA Technology, a Nobel Prize-Winning Science

Updated on Oct 27, 2023 | Cancer, Featured, Research, Vaccines

Miriam Merad, MD, PhD, the Mount Sinai Professor in Cancer Immunology (left), and Nina Bhardwaj, MD, PhD, Ward-Coleman Chair in Cancer Research (right), lead some of the most cutting edge research in mRNA technology at the Icahn School of Medicine at Mount Sinai.

The 2023 Nobel Prize in Medicine was awarded jointly to two researchers, Katalin Karikó, PhD, and Drew Weissman, MD, PhD, for their decades-long work on messenger RNA (mRNA), which ultimately led to the successful development of COVID-19 vaccines that made a huge difference during the pandemic.

The concept of using mRNA to deliver genetic instructions was met with a lot of skepticism in the beginning, says Nina Bhardwaj, MD, PhD, Ward-Coleman Chair in Cancer Research at the Icahn School of Medicine at Mount Sinai. Because these molecules were rapidly degraded by the immune system, they were thought to be too transient to be used to express anything therapeutic, such as antigens or other molecules in immune cells, she added.

“It’s really through the two researchers’ sheer hard work and determination and validation, both in the lab and in the clinic, that this became a technology that can be harnessed for patient benefit,” says Dr. Bhardwaj, who is also Director of Immunotherapy and Medical Director of the Vaccine and Cell Therapy Laboratory.

The validation of mRNA as a delivery mechanism has opened the doors to vaccines in many other diseases, including cancer, says Miriam Merad, MD, PhD, the Mount Sinai Professor in Cancer Immunology, and Director of the Marc and Jennifer Lipschultz Precision Immunology Institute (PrIISM) at Icahn Mount Sinai.

“We’ve been quite interested in the mRNA for some time—not only this type but also another called the micro RNA,” says Dr. Merad. Even prior to COVID-19, Mount Sinai researchers have recognized the potential of various RNA for use in vaccines, such as for cancer, she adds.

Read more from Drs. Bhardwaj and Merad on their thoughts on mRNA technology, and learn how Mount Sinai is leading this field with its research.

Katalin Karikó, PhD (left), and Drew Weissman, MD, PhD, were the joint winners of the 2023 Nobel Prize in Medicine. Dr. Karikó, a Hungarian-American biochemist who worked at the University of Pennsylvania, continues her research as a professor at the University of Szeged in Hungary. Dr. Weissman, an immunologist, advances vaccine work at his laboratory at the Perelman School of Medicine at UPenn.

What’s the history of mRNA technology development been like?

Dr. Bhardwaj: There was a lot of skepticism in the beginning about how exogenously-delivered RNA—which we usually think of as these transient molecules that are rapidly degraded—can be utilized to express antigens and other molecules in immune cells. So the concept that could happen was not well accepted initially.

Dr. Merad: Also, much of the early focus was on cancer, and researchers were not obtaining fantastic results. Cancer vaccines are still yielding anecdotal responses, and it might not have anything to do with the technology.

What do you feel was a turning point for that skepticism?

Dr. Bhardwaj: I think, in especially the last decade, this technology was being used a good deal at the National Institutes of Health’s Vaccine Research Center as a platform for developing vaccines against other infectious agents, not COVID-19 at the time. What had been generated from the platform showed promise, in preclinical models.

When the COVID-19 pandemic came along, there were highly immunogenic modified “cassettes” generated wherein one could just plug in antigens—such as the spike protein of the COVID-19 virus—which could be rapidly formulated into vaccines and tested.

But even prior to that, there were ongoing efforts to use this technology as platforms for cancer vaccines, which are now being tested in the clinic with encouraging preliminary results in randomized studies in melanoma.

Dr. Merad: I think the big two were the lipid nanoparticle (LNP) as a delivery mechanism, and of course, a disease that somehow was the perfect case to try this new therapeutic strategy.

Drs. Karikó and Weissman were able to change up the RNA prior to the injections so that the molecules persisted longer. They were making clear advances in the way the proteins were being made. But, still, the real fixes started when they learned to encapsulate the mRNA in nanoparticles.

In fact, Dr. Karikó went to BioNTech (which partnered with Pfizer to produce the COVID-19 vaccine) and Moderna also licensed mRNA technology, and what happened was that two companies developed a way of delivering mRNA. This extra component—the delivery mechanism—was what made therapeutics possible.

Also, the pandemic is kind of a boost for mRNA technology. Because, first, of the number of patients available, and second, we are in a bit of a risk-taking mode. These vaccines were already developed against pathogens, so they just had to be pivoted to COVID-19.

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One solution that companies like Pfizer/BioNTech and Moderna used to protect the mRNA instructions in their vaccines from being degraded by the immune system was loading them into tiny fat particles known as lipid nanoparticles (LNPs). These delivery vehicles are also able to find the targeted cells, which mRNA molecules alone cannot achieve. Icahn School of Medicine at Mount Sinai honored the efforts of the BioNTech executives during its 54th Commencement in May 2023, conferring upon them honorary Doctor of Science degrees.

Learn more about LNPs and mRNA technology in a Q&A with BioNTech executives

What research is Mount Sinai doing with mRNA?

Dr. Bhardwaj: One exciting line of research includes work from Yizhou Dong, PhD, Professor of Oncological Sciences at Icahn Mount Sinai, who works with the Icahn Genomics Institute and PrIISM. He is one of our newly recruited faculty members, who has been working in this space for quite a while. He has demonstrated that RNA can be used as a platform to introduce various kinds of immune modulators into cells, including dendritic cells, a key cellular potentiator of the immune system.

Dr. Dong uses RNA-LNPs to introduce various types of immune modulators into immune cells and even cancer cells to enhance antitumor immunity. My team is using RNA-LNPs to encode newly identified antigens, such as neoantigens, which arise from mutations in cancer cells, and then use those within vaccine constructs.

In preclinical models, we have shown that such RNA-lipid constructs, developed in-house in The Tisch Cancer Institute, are immunogenic and can have therapeutic benefit in treating cancers. Our goal is to take that to the next level: develop our own vaccine constructs and deliver them into humans.

Dr. Merad: We’ve been interested in exploiting mRNA to translate into specific proteins. We have been very much interested in using mRNA to change the immunosuppressive environment of tumors, where we use mRNA to go into the tumor and start making it look like an infection to induce an antitumor immune response. There is a lot of effort in using mRNA to transform cancer lesions—which can suppress and evade the immune system—into something very inflamed that can be recognized by the immune system and lead to tumor clearance.

One of my colleagues, Brian Brown, PhD, Director of the Icahn Genomics Institute, and Professor of Genetics and Genomic Sciences at Icahn Mount Sinai, is quite interested in using mRNA in different types of disease settings. My lab is mostly looking at inflaming regions in cancer, or reducing inflammation in inflammatory diseases—in this case we use mRNA as cargo to deliver proteins that will dampen inflammation and enable inflammatory lesions to heal.

What do you see as the future of mRNA technology?

Dr. Bhardwaj: I think the breadth is enormous. We can add many different types of immune-enhancing modulators into these particles—not just antigens—including homing receptors and cytokines. RNA platforms have been given intramuscularly and intravenously, and it’s possible you may be able to deliver it intranasally and into the skin, as well as directly into tumors.

The scope of what we can do, what we can encode and add, and the potential combinations with other immunomodulatory agents is vast. I think the field is moving really fast, especially with new companies coming into the field and startups accelerating rapidly.

Dr. Merad: Right now, the big conundrum that we have is: how can we raise an immune response against cancer that is beneficial, without inducing a harmful response against other tissue? I think the answer is delivery.

With mRNA, it provides all the instruction needed for therapeutic effect, but what we are still working on is enhancing that cell-specific delivery system. If we were allowed to bring that instruction to the right compartment, then we can afford to do so much more.

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