Updated on Jun 30, 2022 | Featured, Research
Manish Arora, PhD, MPH, is known for his work on biomarkers—using human teeth to reconstruct the timing of exposure to harmful chemicals and essential nutrients.
Manish Arora, PhD, MPH, Vice Chair of the Department of Environmental Medicine and Public Health at the Icahn School of Medicine at Mount Sinai, has been named a recipient of the Presidential Early Career Award for Scientists and Engineers, the highest honor bestowed by the U.S. government on science and engineering professionals in the first 10 years of their independent research careers.
“Dr. Arora’s research is one of those rare paradigm shifts in science,” says Robert O. Wright, MD, MPH, Ethel H. Wise Professor of Community Medicine and Chair, Department of Environmental Medicine and Public Health, and Director, Senator Frank R. Lautenberg Environmental Health Sciences Laboratory at the Icahn School of Medicine. “I first met him 10 years ago when he was a trainee with a big idea. When he explained the concept of using teeth to measure exposure to lead in pregnancy—to assign a date to an event that happened years ago—it felt like science fiction, but he was able to make it happen, which is a testament to both his intellect and perseverance.”
Dr. Arora, an environmental epidemiologist and exposure biologist with a clinical background in dentistry, has long been passionate about the environment and inventing. He earned a PhD analytical chemistry, and nuclear beam methods from the University of Sydney in Australia. He had a joint appointment at that university and at Harvard University’s School of Public Health before being recruited by Dr. Wright to Mount Sinai in 2013. But he credits a source close to home for his current success: his late mother. “She was a big proponent of generating new knowledge,” Dr. Arora says, but as a young girl in India, her education ended in middle school. “So she always valued education, much more than most people do, because it was not easily attainable to many of her generation.”
Dr. Arora focuses his research, which is funded by the National Institute of Environmental Health Sciences, on the effects of prenatal and early childhood chemical exposures on lifelong health. In the same way that trees have growth rings, he says, “we have growth rings in teeth, and because those start forming before you are born, we can actually go back in time and figure out, for example, what you were exposed to in the second or third trimester.”
A baby tooth being prepared for analysis by a laser.
Dr. Arora and his team collect teeth donated by families and dentists all over the world. To study the teeth, they invented novel techniques and equipment, including a robot that cuts, or “micro-dissects,” samples the width of a human hair. The samples are then analyzed for thousands of chemicals the donors may have been exposed to at different times of their development.
“There are two big findings: One is that it’s not just how much you are exposed to, it’s also when you get exposed to it,” Dr. Arora says. “That is what we are finding for diseases like Lou Gehrig’s disease (ALS), in which you become symptomatic at age 50, 60, 70. But the initial exposure—what altered your trajectory—may have occurred early in life. We are also discovering this is true for autism and schizophrenia.” Dr. Arora says the second finding is that a single chemical is not always the key. “What happens when you get exposed to a mixture of chemicals is not the same as when you get any single component. Previously, the technology to study these mixtures of chemicals didn’t exist, but the methods we are developing allow measurement with novel precision. We now have an NIH laboratory hub for this new technology.”
For this work, Dr. Arora received a New Innovator Award in 2014, which included $2.2 million from the NIH. Dr. Arora is now seeing results in the search for metal and organic risk factors. “The next phase will be finding approaches to mitigate the risk, both at a clinical level, with the goal of personalized environmental medicine, and also at a population level, to support public health and policy development,” Dr. Arora says. “The idea is that as clinicians we can treat people one-on-one, but taking broader action like getting rid of lead in gasoline helps all of us.”
Updated on Jun 30, 2022 | Featured, Research
Scott H. Sicherer, MD, left, and Hugh A. Sampson, MD
In a significant departure from past medical practice, new guidelines from the National Institute of Allergy and Infectious Diseases (NIAID) call on parents to introduce peanut containing foods to infants as young as 4 to 6 months as a way to prevent potentially life-threatening peanut allergy. The guidelines, issued in January, were developed by an expert national panel that included two allergist-immunologists from the renowned Elliot and Roslyn Jaffe Food Allergy Institute at the Icahn School of Medicine at Mount Sinai.
“About 4 million babies are born each year in the United States, and we know that two to two-and-a-half percent will develop peanut allergy,” says Hugh A. Sampson, MD, Director of the Jaffe Food Allergy Institute and the Kurt Hirschhorn Professor of Pediatrics. “We are not going to eradicate peanut allergy, but our goal with the new guidelines is to get the number of affected children down to about one percent.” Dr. Sampson was a member of the NIAID panel along with Scott H. Sicherer, MD, the Elliot and Roslyn Jaffe Professor of Pediatrics and Chief of the Division of Pediatric Allergy and Immunology.
Peanut allergy has grown alarmingly in recent years. According to a Mount Sinai study, allergy from peanut affected 1 in 250 children in the United States in 1997. By 2002, the incidence had jumped to 1 in 125 children, and to 1 in 70 children by 2008. The advocacy group Food Allergy Research and Education reports that food allergies result in 200,000 emergency room visits each year. “Peanut allergy tends to be severe, is potentially fatal, and is usually lifelong,” says Dr. Sicherer, “so having a strategy to prevent it, particularly one that is inexpensive to implement, offers tremendous benefits.”
For decades, allergists recommended that high-risk infants avoid exposure to peanuts through the first three years, but a landmark international allergy study, first published in 2015, proved to be a game-changer, showing that early introduction to peanut-containing food among allergy-prone infants reduced their chance of developing a peanut allergy by up to 80 percent.
The new guidelines, which were based largely on these findings, define which infants are at high, moderate, and low risk for developing peanut allergy and recommend to allergists and caregivers how to proceed with the introduction of peanut-containing food based upon risk and age. The guidelines also caution parents not to give whole peanuts to infants, and they offer peanut-containing food suggestions and methods to introduce these foods. To learn more about the guidelines, visit niaid.nih.gov.
Updated on Jun 30, 2022 | Research
The findings by Mount Sinai researchers were published in the January 31, 2017 issue of Nature Cell Biology and featured on the cover.
Updated on Jun 30, 2022 | Featured, Research
In Huffington Post’s new video series “Experimenters,” data scientist Eric Schadt, PhD, founding director of the Icahn Institute for Genomics and Multiscale Biology, discusses his mission to revolutionize health care.
Updated on Jun 30, 2022 | Research, Your Health
If you are like many of my patients, you may be wondering, “Am I getting enough vitamin D?” Shanna R. Levine, MD, Instructor of General Internal Medicine, The Mount Sinai Hospital, explains why this is a valid concern.
Updated on Jun 30, 2022 | Featured, Research
The sarcophagus of a 3,500-year-old mummy was opened at the Egyptian Museum in Cairo.
At the intersection of medicine, archaeology, and the plot of an Indiana Jones movie lies a course of study pursued by Jagat Narula, MD, PhD, MACC.
Dr. Narula’s highly eminent day jobs include serving as the Chief of Cardiology at Mount Sinai St. Luke’s and Mount Sinai West; Director of Cardiovascular Imaging for the Mount Sinai Health System; Philip J. and Harriet L. Goodhart Professor of Medicine, Icahn School of Medicine at Mount Sinai; and Editor-in-Chief of The Journal of the American College of Cardiology: Cardiovascular Imaging. But for more than six years, he has also traveled the world studying mummies with the Horus Group, named for the Egyptian god of the sky and the hunt. The multidisciplinary research group includes cardiologists, radiologists, pathologists, geneticists, basic scientists, anthropologists, and archaeologists. “We call ourselves the paleocardiologists,” Dr. Narula says, “just talking about the old or ancient stuff.” Their studies, which have been published in journals like The Lancet and Global Heart, began with a simple question: Is heart disease—atherosclerosis, or the hardening and narrowing of the arteries—a disease of the modern age and industrialization?
The group has now studied more than 100 Egyptian mummies in Cairo and Berlin using a CT scanner and has found that a third of them showed vascular disease up to 3,500 years ago. The hardening of the arteries was identified by the calcium that had deposited in their arteries. Now that kind of throws you off, as to why mankind suffered from heart disease so long ago,” Dr. Narula says. “But then you start finding out about their lifestyles. These mummies were from the elite of Egypt. These are the people who used to be carried on palanquins; there was no exercise for them.” They consumed meat frequently and feasted on bird e.gs; agriculture was well developed, and food was available all day, every day. In essence, the Egyptian elite lived like modern humans—though riding in sedan chairs, not SUVs—and their cardiovascular health paid the toll.
Jagat Narula, MD, PhD, MACC
Next the group studied the mummies of 70 Peruvians from the Andes foothills who were buried 1,000 years ago and had been naturally preserved. “You are now looking at folks who are not sedentary like the Egyptians; 50 percent of them are vegetarians, and 50 percent of them consume leaner meat, such as alpaca.” In this hardy population, the team still found that one-fifth had atherosclerosis. At first, Dr. Narula says, the researchers wondered, “Does that mean we are doomed to have this disease?” But they noticed mummies with black lungs that resulted from long exposure to the smoke of cooking fires. The team made similar observations in five sets of mummified remains in the Aleutian Islands. People in that society kayaked, hunted, and ate fish and meat, but they lived in subterranean households that were warmed with fires and had minimal ventilation through the ceiling, so they were exposed to “indoor pollution.” He maintains that atherosclerosis, today or thousands of years ago, is a result of risk factors.
In their next project, in March, the Horus Group will study mummified remains in Torino, Italy. “During the day we work, and in the evenings and mornings we sit down and discuss the data,” Dr. Narula says. “It’s a very congenial group of about 15 people.” But the mission is a serious one. Dr. Narula sees the study of mummies as a “very convincing” way to promote global cardiovascular wellness and the awareness of risk factors, including cholesterol, smoking, hypertension, diabetes, obesity, and stress. “Mummy research shows us that the risk factors remain the basis for heart disease,” Dr. Narula says. But heart disease is not inevitable: “Prevention or taking care of risk factors should take care of disease.”
