NYU THE MAGAZINE OF NEW YORK UNIVEPHRSITY SCHOOL OF MEDYICINE SICIASPRING 2013N volume 64 • No. 3 THE COURAGE TO CUT A Journey Into the Hearts and Minds of NYU Langone’s Neurosurgeons PLUS Dr. Glenn Saxe on Sandy Hook Earning an MD How Molecular Autopsies Can and Childhood Trauma in Three Years Help Solve Mysterious Deaths Help Us Make Dreams Come True EVERY ASPIRING PHYSICIAN DREAMS OF THE DAY SOMEONE WILL MAKE A GIFT ONLINE CALL HIM OR HER “DOCTOR” FOR THE FIRST TIME. But getting there Please visit www.nyu.edu/alumni. takes a lot more than hard work and dedication—it takes resources. By contributing to the NYU School of Medicine Alumni Campaign, you help To discuss special ensure that our next generation of physicians will have access to the best giving opportunities, teaching and research, along with a competitive financial assistance package. call Anthony J. Grieco, MD, Associate Dean for Alumni Relations, When you make a gift, you help us guarantee that all of our students will at 212.263.5390. have the means to complete our rigorous education. One day, you may even have the privilege of addressing them yourself as “Doctor.” Thank you for your generosity. THE MAGAZINE OF NEW YORK UNIVERSITY SCHOOL OF MEDICINE SPRING 2013 VOLUME 64 NO. NYUPHYSICIAN 3 New York University Martin Lipton, Esq. Chairman, DEPARTMENTS Board of Trustees COVER STORIES John Sexton The Courage to Cut 02 Message from the Dean President A journey into the hearts and minds of Because It Is Brain Surgery 08 NYU Langone’s neurosurgeons. Robert Berne 03 News from Medicine Executive Vice President Missed Connections for Health • When Leukemia Rebounds • An emerging theory of autism links social • A Strategy to Drive Leukemia Cells NYU Langone 16 isolation to faulty circuits in the brain. Out of Hiding Medical Center • One Access Point for Two Deadly Diseases A Matter of Degrees Kenneth G. Langone • Every Breath You Take A new option to earn an MD in three Chairman, • A Chemical Clue to Aging Board of Trustees 18 years aims to help some students save time and money. Robert I. Grossman, MD 14 Faculty Conversation Dean and Chief The Heart of the Matter Dr. Glenn Saxe on Sandy Hook and Executive Offi cer childhood trauma. • How molecular autopsies are solving 20 mysterious deaths— and saving lives. NYU PHYSICIAN 24 Tools of the Trade Steven B. Abramson, MD In praise of the stethoscope. Anthony J. Grieco, MD Editors, Science 26 Faculty News and Medicine • Dr. Vilcek Honored at White House Marjorie Shaffer Awards Ceremony Editor • Dr. Littman Receives Inaugural Ross Prize from Molecular Medicine Nicole Dyer • NYU Langone’s Nurses Honored for Contributing Editor Their Heroism during Hurricane Sandy Sherry Zucker Print Production 28 End Page Coordinator Dr. Abramson to Chair Medicine Segal Savad Design Art Direction Nancy E. Sherman Copy Editor Molecular autopsies can • help medical examiners ON THE COVER: ILLUSTRATION BY pinpoint the cause of a GREGORY MANCHESS mysterious death, identify lethal mutations that might run in families, and 2(S)A F C03 Fragment base #6 Base 108 even solve crimes. ILLUSTRATION: GETTY IMAGES ILLUSTRATION: NYU PHYSICIAN SPRING 2013 1 MESSAGEFROMTHEDEAN&CEO Because It Is Brain Surgery LONG BEFORE I BECAME DEAN & CEO OF NYU LANGONE MEDICAL CENTER, I began a residency in neurosurgery. Though I eventually changed course, deciding on the field of radiology, I never lost my fascination, my respect, my awe, for the mysteries and marvels of the human brain. Indeed, that passion for neuroscience steered me toward neuroradiology as a subspecialty. So while I try not to play favorites, I must admit that neurosurgery and neurosurgeons, whom I’ve consulted with closely for many years, hold a special place in my heart. I’m immensely proud of our Department of Neurosurgery, which has a long and distinguished history, and I’m delighted to see it featured in this issue. It’s a well deserved tribute to a remarkable team of surgeons. Fifty years ago, the late Joseph Ransohoff, MD, chair of our Department of Neurosurgery from 1962 to 1992, served as medical consultant to the pioneering TV series Ben Casey, whose title character was loosely modeled after the brash, brooding surgeon. For several consecutive years, U.S. News & World Report’s Best Hospital Rankings has placed our program in neurosurgery among the top 10 in America. In the last two years, the Department has become even stronger, recruiting several outstanding neurosurgeons, some of them world-renowned for their expertise in certain subspecialties. What heartens me most about these master surgeons is their compassion and can-do attitude. As one of them puts it: “Many patients are told that their tumor is ‘inoperable,’ but then they come here and they survive.” I think you’ll enjoy this inspirational journey into their hearts and minds. • DEAN & CEO ROBERT I. GROSSMAN, MD NYU PHYSICIAN PHOTOGRAPH BY 2 SPRING 2013 JOHN ABBOTT NEWSFROMMEDICINE When Leukemia Rebounds Genetic mutations linked to relapse in common childhood cancer point the way to new treatments. Julia Meyer EVERY YEAR in the United William Carroll States, roughly 6,000 patients are diagnosed with acute lymphoblastic leukemia (ALL), a disease in which the body’s bone marrow produces a glut relapse,” he says. mutations that of lymphocytes, or white blood In the new study, led by Dr. changed the genetic cells. Improved chemotherapy Carroll and graduate student code over the course and other treatments have Julia Meyer and published of the disease. dramatically boosted the cure in the March issue of Nature Intriguingly, two rate of ALL, the most common Genetics, researchers analyzed patients harbored type of childhood cancer, to bone marrow samples from a mutation in the about 80 percent. For the 10 pediatric ALL patients for same gene, NT5C2, unfortunate 20 percent of telltale clues to the disease’s which encodes an children who relapse after a progression. After receiving enzyme that regulates some bout with the aggressive blood- samples from the Children’s DNA building blocks but can A micrograph of a white borne disease, however, the Oncology Group, the medical also degrade an important class blood cell. In acute prognosis remains dire. researchers painstakingly of drugs used in ALL therapy. lymphoblastic leukemia, white blood cells turn “There has been no progress pieced together a complete When the researchers fully malignant and flood the in curing children who relapse, sequence of ribonucleic acid, sequenced the NT5C2 gene in 61 bone marrow. in spite of giving them very or RNA, extracted from each other cases in which pediatric high doses of chemotherapy patient’s bone marrow—or ALL patients had relapsed, and bone marrow about 100 billion letters of they found five more mutations transplantation,” says William RNA in all. “It took years of that had altered the gene. therapeutics at the Dana- L. Carroll, MD, director of NYU effort analyzing samples from Experiments suggested that Farber/Children’s Hospital Langone Medical Center’s the same patient at diagnosis these seven NT5C2 mutations Cancer Center in Boston, Cancer Institute and the and relapse,” Dr. Carroll says. all made the cancer cells more says the discovery may help Julie and Edward J. Minskoff RNA is an essential resistant to chemotherapy. clinicians create personalized Professor of Pediatrics. intermediary in the cellular By identifying a specific treatment strategies. CE Dr. Carroll’s team may now process that uses DNA disease mechanism, the “This paper identifies an R be closer to changing that grim blueprints to assemble finding may help doctors abnormal enzyme that could reality with the discovery of proteins, meaning that a detect the early emergence be specifically targeted and CE SOU IEN 20 genetic mutations linked complete RNA sequence can of chemotherapy-resistant exploited in some patients with to relapse, including one that give researchers a view of all leukemia cells and adjust their relapsed leukemia,” Dr. Place / SC ER may allow ALL to reemerge active genes within a patient’s strategy before the disease can says. Inhibiting the enzyme months or years after the leukemia cells. By comparing fully reassert itself. Andrew may also prove useful in initial initial diagnosis. “For the the sequences at the moment Place, MD, PhD, an instructor ALL therapies, he says, helping CHMEISSN S first time, we have pinpointed of diagnosis and upon relapse, in pediatrics at Harvard doctors prevent those relapses genetic mutations that lead to the team found that most Medical School and associate in their pediatric leukemia chemotherapy resistance and patients had acquired multiple director of developmental patients. —BRYN NELSON STEVE G • NYU PHYSICIAN SPRING 2013 3 NEWSFROMMEDICINE A Strategy to Drive Leukemia Cells Out of Hiding Tim Cardozo Eliminating a mutated protein points the way to new Iannis Aifantis cancer therapies. IANNIS AIFANTIS, PHD, to fight off infections and bleed blood cells. “Blood stem cells Fbw7—that is, by releasing the had been studying leukemia too easily. In about 25 percent activate only occasionally, when clamp on hematopoietic stem for years when, in 2007, he hit of cases, patients die due to we need them, like during an cells and letting them divide upon a discovery that would take irreparable damage to vital accident when we’ve lost blood,” and grow unchecked—he his research in an unexpected organs and the central nervous Dr. Aifantis explains. When hypothesized that he could direction. At the time, Dr. system. Fbw7 is mutated or removed drive leukemia-inducing stem Aifantis, professor of pathology It was while studying blood altogether, he found, the throttle cells out of dormancy and into at NYU Langone Medical Center samples from T-ALL patients is prematurely released and the crosshairs of the medication.