Reprogramming Retina Cells to Restore Vision

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

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

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

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

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

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

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

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

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

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

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

Lab Discovery Leads to a Remedy

Stuart Sealfon, MD

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

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

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

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

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

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

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

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

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

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

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

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

Mount Sinai Researcher Wins Young Investigator Award

Benjamin D. Greenbaum, PhD

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

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

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

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

Harvard Business Review: How Mount Sinai Health System Fosters Collaboration to Fight Cancer

Samir Parekh, MD

In an article published in the Harvard Business Review, Joel Dudley, PhD, Mount Sinai Professor in Biomedical Data Science at the Icahn School of Medicine at Mount Sinai and Executive Vice President for Precision Health for the Mount Sinai Health System, and Samir Parekh, MD, Associate Professor, Medicine (Hematology and Medical Oncology), and Oncological Sciences, write about the unique partnership between researchers and doctors at Mount Sinai who are using advanced computer analytics to treat blood and bone marrow cancers.

Joel Dudley, PhD

“The Mount Sinai Health System is organized differently from most, as one integrated institution. Doctors from the seven Mount Sinai hospitals work side by side with researchers from the Icahn School of Medicine at Mount Sinai,” the authors write.

“Indeed, many clinicians also have Sinai research labs. If a clinician and a researcher devise a viable idea to solve a medical problem, they are free to join forces and pursue the project. This makes it possible to rapidly bring a finding from the lab bench to the patient bedside.”

Read the full article in the Harvard Business Review

$7.6 Million Grant Awarded for Multifaceted Study of Peanut Allergy

From left: principal investigators Cecilia Berin, PhD; and Scott Sicherer, MD; with Supinda Bunyavanich, MD, MPH, leader of the genomic and data-science arm of the project.

When patients are diagnosed with peanut allergy, they often ask two questions: “How much peanut can I eat before I get sick, and how severe will the reaction be?” says Scott Sicherer, MD, Director, Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai. And physicians have another question, he says: “If I recommend a therapy, is it going to work for this patient?” These questions are at the center of research funded by a five-year, $7.6 million grant from the National Institute of Allergy and Infectious Diseases that was recently awarded to a multidisciplinary team at the Icahn School of Medicine.

The research is divided into three projects, which reflect Mount Sinai’s unique strengths in clinical allergy treatment, basic science, and data-driven medicine. Cecilia Berin, PhD, Deputy Director of the Jaffe Food Allergy Institute, and Professor of Pediatrics, and Dr. Sicherer are principal investigators of the National Institutes of Health grant.

The central project is a clinical trial that will focus on a seldom-studied group—people with “high-threshold” peanut allergy, meaning they react only to larger amounts of peanut. This trial of a dietary allergy immunotherapy will be led by Dr. Sicherer, the Elliot and Roslyn Jaffe Professor of Pediatric Allergy and Immunology, and Chief of Pediatric Allergy; and Anna Nowak-Wegrzyn, MD, PhD, Professor of Pediatrics. “Most studies right now are looking at people who are exquisitely allergic—people who react to a fraction as small as a 50th of a peanut,” Dr. Sicherer says. “But a majority of people with peanut allergy do not react to these tiny amounts, and the treatments so far have not really been directed to them. This study is trying to identify those people and then see if an immunotherapy would help them, possibly to a cure.”

Researchers will conduct “food challenges” of about 200 children ages 4 to 14, giving them small doses of peanut. They plan to identify 98 high-threshold children, who will be divided into two groups. One group will simply avoid peanut, and the other will eat small amounts of peanut butter—carefully measured by parents—starting with about 1/8 teaspoon and progressing to larger servings. The aim is to reduce, or even eliminate, their sensitivity to peanut.

Anna Nowak-Wegrzyn, MD, PhD, gave patient Gabriella Evans a small dose of peanut, a therapy that will be further studied in an upcoming clinical trial.

The other two projects will analyze blood samples from all 200 children. “We have developed advanced tools for studying many parameters of the allergic response to peanut using small amounts of blood,” says Dr. Berin. “In my project, the idea is understanding the immune pathways that affect peanut allergy overall and the immune basis of outgrowing peanut allergy in response to allergen immunotherapy.”

The third project will take a genomic and data-science approach, using Mount Sinai’s high-performance computing resources. It is led by Supinda Bunyavanich, MD, MPH, Associate Director of the Jaffe Food Allergy Institute, and Associate Professor of Genetics and Genomic Sciences, and Pediatrics. “We will sequence blood samples from the children participating in this trial and use data science to identify novel biomarkers for peanut-allergy management,” Dr. Bunyavanich says. “Our goal is to find biomarkers that predict reaction threshold and desensitization potential in peanut-allergic individuals. The project will also further our mechanistic understanding of peanut allergy severity.”

Overall, the objective is to develop more effective, personalized immunotherapies for peanut allergy and to determine which patients are the best candidates before any treatment starts. “Peanut allergy is a very common food allergy—it affects about 2 percent of kids,” Dr. Sicherer says, “and this research will have a big impact on how we treat these patients.”

Postdoctoral Award Supports Innovative Research

Two early-career scientists in the fields of Neuroscience, and Genetics and Genomic Sciences, recently received the 2018 Robin Chemers Neustein Postdoctoral Fellowship Award. The recipients—Lorna Farrelly, PhD, and Sabrina Tamburini, PhD—will each receive an award of $25,000 to further their research.

Dr. Farrelly works in the laboratory of Ian Sutherland Maze, PhD, in the Fishberg Department of Neuroscience. She is investigating susceptibility to psychiatric illness via novel neuroepigenetic brain mechanisms potentially responsible for neural plasticity. “Dr. Farrelly is a truly passionate, talented, and inspiring young scientist who has great potential to one day become a leader in the collective fields of neuroepigenetics and molecular psychiatry,” says Dr. Maze, Assistant Professor of Pharmacological Sciences, and Neuroscience, at the Icahn School of Medicine at Mount Sinai. “Additionally, she is an exceptional mentor to members of my lab and is never afraid to tackle the most difficult of scientific dilemmas.”

Working in the laboratory of Jose Clemente, PhD, Assistant Professor of Genetics and Genomic Sciences, Dr. Tamburini conducts research focused on understanding what constitutes a “healthy” microbiome and how the microbiome is related to overall health and disease. Explains Dr. Clemente: “Dr. Tamburini has developed assays that can distinguish viable bacteria in the human gut, which is crucial because only those bacteria can produce chemical compounds that induce host responses. We are now using this technique to
better understand how microbial transplantation can be used therapeutically in Clostridium difficile and inflammatory bowel
disease patients.”

Intended to encourage and support female research scientists at the Icahn School of Medicine at Mount Sinai, the Fellowship was established in 2010 through a generous gi¦ from Robin Chemers Neustein, JD, MBA, a former member of Mount Sinai’s Boards of Trustees.

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