The Icahn School of Medicine at Mount Sinai is establishing the Institute for Exposomic Research under the leadership of Robert O. Wright, MD, MPH, and Rosalind J. Wright, MD, MPH, two international leaders in environmental health. The Institute, the first in the world focused on exposomics, will study the effects of environmental exposures on health and will translate these findings into new strategies for prevention and treatment.
“The exposome is a new research field and is analogous to genomics,” says Dr. Robert Wright, Ethel H. Wise Professor and Chair, Department of Environmental Medicine and Public Health, and Director, Senator Frank R. Lautenberg Environmental Health Sciences Laboratory. “While genomics concerns all the genetic factors that predict health, the exposome encompasses all the environmental factors that affect your health, including nutrition, social factors, chemicals, and the physical environment, from the time you are conceived until the time you die. To understand health, you must understand both fields.” He is Director of the Institute, and its Co-Director is Dr. Rosalind Wright, Horace W. Goldsmith Professor in Children’s Health Research and Dean of Translational Biomedical Sciences at the Icahn School of Medicine.
Robert O. Wright, MD, MPH
The Institute will build upon the expertise of the Lautenberg Laboratory to develop new technologies and methodologies in exposomics. Mount Sinai’s recent investment in the field has already led to significant funding from the National Institutes of Health (NIH), including a $9 million grant in December for Environmental influences on Child Health Outcomes (ECHO), to investigate the effects of a broad range of environmental exposures on children’s long-term health, and two additional $10 million NIH grants for the Children’s Health Exposure Analysis Resource (CHEAR) program. CHEAR provides laboratory resources to measure environmental chemicals, metabolites, hormones, and other factors representing components of the human exposome. The CHEAR grants also fund a Data Repository, Analysis, and Science Center, led by Susan L. Teitelbaum, PhD, Professor of Environmental Medicine and Public Health, that specializes in analyzing exposomic big data.
A major part of the CHEAR facilities’ mission will be analyzing the samples collected by ECHO, a seven-year study of 50,000 children followed longitudinally across the United States. Mount Sinai is part of a consortium that includes programs in Boston and Virginia and will recruit 5,000 of these subjects. The Wrights are part of the committees now setting up protocols for the national ECHO study.
The doctors have been collaborating for more than 20 years. They first met in medical school at the University of Michigan. Rosalind Wright specialized in critical care and adult pulmonary medicine and Robert Wright in medical toxicology and pediatric emergency medicine. Over the years their interests converged, in large part because they were both concerned by the environmental issues that brought their patients to the hospital. “For me it became an issue of prevention,” Dr. Rosalind Wright says. “Taking care of someone with very advanced, end-stage lung disease, I could adjust medications so the patient could walk a little farther or sleep a little better. But I thought, ‘Where do we start so that we can give people a healthier life overall, as well as help them live longer?’ Getting them to stop smoking, for example, has a small effect. But if we go back to the root of the unhealthy trends, we can have a huge impact. For example, I was struck by the data showing that if a mother smokes during pregnancy or she experiences high stress in pregnancy, the child will have decreased lung function by age 6 or 7, and that lower lung function will track over their life and make them more likely to develop chronic lung disease.”
The new Institute will expand exposomics into research programs in disciplines across campus, including personalized medicine, cancer, women’s health, aging, immunology, and clinical trials. “Intuitively, we all know that our environment plays the major role in shaping our health, but until recently the tools to measure environment on an ‘omic’ scale didn’t exist. That’s the future, and it aligns with the changes happening in health care,” Dr. Robert Wright says. “As Mount Sinai’s leadership says, population health, not fee for service, is the future, and that means prevention. Investing in understanding exposomics will give us the tools for prevention.”
Peter Palese, PhD, chair of the department of microbiology at the Icahn School of Medicine at Mount Sinai, discusses the microbiology of flu vaccination and his work on a universal flu vaccine.
“In the U.S. alone every year, estimates are that between 30,000 and 50,000 people die of influenza despite the availability of the vaccine. The ideal vaccine would be one which is given once in a lifetime, and it would provide protection against all influenza strains. We hope that we will achieve the same with our universal influenza vaccine, which we are developing at Mount Sinai.”
From left: Rosalind J. Wright, MD, MPH; Manish Arora, PhD, MPH; the two moderators, Shevon Skinner, RN, MSN, MPH, Director of Patient Services, LSA Family Health Service in East Harlem, and Maida Galvez, MD, MPH, Associate Professor, Environmental Medicine and Public Health; David Bellinger, PhD; and Avi Reichenberg, PhD.
“The Decade of the Developing Brain,” a symposium held in honor of the tenth anniversary of the Department of Environmental Medicine and Public Health’s Children’s Environmental Health Center, could arguably be summed up by these three points: “Our environment is complex and constantly changing. Prenatal and early postnatal life are critical periods that can affect lifelong health,” said Manish Arora, PhD, MPH, Vice Chair of the Department of Environmental Medicine and Public Health at the Icahn School of Medicine at Mount Sinai. And finally, “Save your teeth.”
At the half-day symposium, held at the New York Academy of Medicine on Friday, February 24, a keynote speech by David Bellinger, PhD, Harvard T.H. Chan School of Public Health, Boston Children’s Hospital, outlined the population-level effects of environmental chemicals on neurodevelopment. Avi Reichenberg, PhD, Professor of Psychiatry, and Environmental Medicine and Public Health, addressing the complexity of autism risk, said multiple published studies have concluded that “there is no association between vaccination and the risk for autism. Yet unfortunately this comes up again and again.”
Rosalind J. Wright, MD, MPH, Horace W. Goldsmith Professor in Children’s Health Research and Dean of Translational Biomedical Sciences at the Icahn School of Medicine, discussed the relationship between a mother’s physical response to stress and fetal development. “When you are living with chronic financial strain, violence, and discrimination, it can have effects on the developing baby, starting in pregnancy with particular implications on the developing brain,” she said. On the positive side, she also showed evidence indicating that good nutrition and “sensitive, responsive, supportive care” can buffer young children from the effects of stress.
Dr. Arora called the study of the developing brain a “relay race” in which bench scientists like him supply packets of information that clinicians and researchers in the field can act upon. One of his major contributions is developing new techniques to study human teeth, which have growth rings that each day capture information about chemical exposure and nutrition—a hard drive of biologic information. Dr. Arora advised attendees not to throw away the teeth they shed, saying, “They are more valuable than you think.”
Children who have older siblings or frequent interaction with grandparents are diagnosed with autism spectrum disorders (ASD) earlier than those who do not, according to new research conducted at The Seaver Autism Center for Research and Treatment at Mount Sinai, and published in the journal Autism. This study is the first to ask not only parents, but also friends and family members who had contact with the child, about their early observations of the child.
“About half of the family and friends who reported being concerned about a child were reluctant to share their concerns,” says Joseph D. Buxbaum, PhD, Director of The Seaver Autism Center for Research and Treatment at Mount Sinai and co-author of the paper. “Our work shows the important role that family members and friends can play in the timing of a child’s initial diagnosis of autism. Since early detection of ASD is critical to effective treatment interventions, we hope the study will serve as a call-to-action to encourage family and friends to share concerns early on.”
Scientists from the Icahn School of Medicine at Mount Sinai published results from a pioneering study of asthma patients in the U.S. conducted entirely via iPhone using the Apple ResearchKit framework and the Asthma Health app developed at Mount Sinai with collaborating organizations. The results demonstrated that this approach was successful for large-scale participant enrollment across the country, secure bi-directional data exchange between study investigators and app users, and collection of other useful information such as geolocation, air quality, and device data. The publication appears in Nature Biotechnology.
“The Asthma Mobile Health study represents the coming together of academia and industry to benefit from the ubiquity of smartphones and harness the power of citizen-science to modernize the clinical research process,” said Eric Schadt, PhD, senior author on the paper and the Jean C. and James W. Crystal Professor of Genomics at the Icahn School of Medicine at Mount Sinai, and Founding Director of the Icahn Institute for Genomics and Multiscale Biology. “We now have the ability to capture rich research data from thousands of individuals to better characterize ‘real world’ patterns of disease, wellness, and behavior. This approach provides a more comprehensive and accurate view of our patients that was not feasible in the past due to logistical limitations and prohibitive costs.”
Diane Meier, MD, director of the Center to Advance Palliative Care at The Mount Sinai Hospital, talks with STAT News about her pioneering work in palliative medicine, which seeks to optimize patients’ quality of life by preventing or reducing their suffering. “The people we’re trying to serve have serious illnesses, and they’re trying to live as well as they can for as long as they can. This notion that somehow you’re braver or smarter or wiser if you confront your death and accept it and plan for it-this is not what most patients and families are seeking. It’s not what most people care about. And it actually can get in the way of people having a good life,” she said.