Medicine COVID-19 and RACISM

Columbia 2019–2020 ANNUAL REPORT Medicine Columbia University Vagelos College of Physicians & Surgeons

FIGHTING TWO VIRUSES: COVID-19 AND RACISM Features:

4 12 20 At a Crossroads: All Hands on Deck The Bioethics of Medicine and Genomics and Justice the Movement Pivot was the action verb that describes how VP&S clinicians, A new ethics division is Work toward health equality researchers, and students expanding VP&S scholarship has begun at VP&S and all confronted COVID-19 when the into the ethical, legal, and of academic medicine as early virus arrived in New York City. social implications of precision summer protests revealed From redeploying clinicians to medicine. The 360-degree the health disparities in areas outside their specialty to perspective includes “studying medicine in general and graduating fourth-year students the studies” as researchers especially in COVID-19 cases. early, VP&S helped “bend the continue to unleash the Students and faculty share curve” at the epicenter of the power to treat, prevent, and their own perspectives on nation’s pandemic. cure disease. The effort also the intersection of COVID-19 provides an opportunity to and Black Lives Matter. bring social science to bear on bioethical questions.

On the Cover Steven McDonald, MD, a 2014 VP&S graduate, is one of five faculty members and medical students who share their perspectives on the Black Lives Matter movement. Read about the five and the VP&S plans to promote racial justice, Page 4.

Photograph by Jörg Meyer ColumbiaMedicine | 2019–2020 Annual Report Issue Columbia University Vagelos College of Physicians & Surgeons Departments:

2 Dean’s Message

24 Philanthropy News

28 2020 Year in Highlights · Research highlights · Patient care highlights · Education highlights · Community highlights · COVID-19 research highlights

54 About VP&S · Trustees Committee on the Health Sciences · CUIMC Administration · CUIMC Board of Advisors · CUIMC Advisory Group Chairs · VP&S Administration · Executive Committee of the Faculty Council · VP&S Department Chairs · Institutes, Centers, and VP&S Schoolwide Initiatives and Their Directors · Affiliated Hospitals · Facts and Statistics 29

2019–2020 VP&S Annual Report Office of the Interim Executive Vice President and Editor: Bonita Eaton Enochs Dean of the Faculties of Health Sciences and Medicine Columbia University Irving Medical Center Principal Writer: Sharon Tregaskis 630 W. 168th St. Contributing Writers: Barbara Brody, Kristin Bundy, New York, NY 10032 Julia Hickey, Brittany King, and Christine Yu Communications Office Art Director: Eson Chan Vagelos College of Physicians & Surgeons Produced by the Communications 701 W. 168th St., Box 153 Office at Columbia University New York, NY 10032 Vagelos College of Physicians & Surgeons Phone: 212-305-3900 Christopher DiFrancesco, Fax: 212-305-4521 Chief Communications Officer Office of Development Printed in November 2020 Columbia University Irving Medical Center 630 W. 168th St., P&S 2-421 New York, NY 10032 http://ps.columbia.edu/ Phone: 212-342-0088 • DEAN’S MESSAGE

A YEAR LIKE NO OTHER

s people all over the country watched, New We paused most research during the height of the York City became the epicenter of the U.S. pandemic—with the exception of COVID-19 research, ACOVID-19 pandemic and all eyes were on our research that could be performed remotely, and clinical faculty, students, and staff, as well as our colleagues at research that could directly benefit the patients being our partner, NewYork-Presbyterian. Our commitment studied—but an impressive amount of research had been to simultaneously treat patients, test best practices for published before the first COVID-19 patient appeared. helping those patients, and research the science of the Highlights of research projects, clinical advances, edu- virus was on view even beyond our national borders cational milestones, and community engagement fill and illustrated the strength of our great school’s part- several pages of this report, and a special section of nership with an equally great hospital. highlights is devoted to COVID-19 research. A pandemic alone would have been enough to define Several research highlights show the power of cryo- BARBARA ALPER BARBARA the 2020 fiscal year described in this annual report, electron microscopy (cryo-EM), a scientific advance which covers the year that began July 1, 2019, and ended for which Joachim Frank, PhD, shared the Nobel Prize June 30, 2020. But as we started to feel some relief from in Chemistry in 2017. The research made good use of fighting the virus, Black Lives Matter protests reminded the new Cryo-electron Microscopy Center that opened us of the health disparities revealed by COVID-19 and in the lower level of the Hammer Health Sciences Cen- other persistent structural racism in academic medicine ter. The center trains researchers and provides access and throughout society, unfortunately. to the advanced instrumentation, data collection These two history-changing phenomena converged capacity, and processing support required to incorpo- just as the Vagelos College of Physicians and Surgeons rate cryo-EM into their studies at the medical center, at (VP&S) and the greater Columbia University Irving Columbia’s Zuckerman Institute, and at the New York Medical Center were transitioning to new leadership. Structural Biology Center campuses. As Lee Goldman, MD, prepared to step down as chief Although the final figures from the NIH are not yet executive of the medical center and dean of VP&S at available for the 2020 federal fiscal year, early indica- the end of Fiscal 2020, I was appointed by President tions show government support of our research remains Lee Bollinger as interim EVP and dean. Dr. Goldman strong, with VP&S receiving a substantial increase in was a good teacher during the transition and continues NIH funding this year. If the early figures are confirmed, to advise me on important matters. The last months of his tenure were unlike any other four-month period of The Aaron Diamond AIDS Research Center at Columbia, his 14 years as dean, but he was generous with his time led by David Ho, is one of the teams trying to identify potential antiviral drugs and antibodies for use against the in preparing me for the transition. new coronavirus. Pictured is Kenia De Los Santos, a senior Inside this annual report, you can read about the technician in Dr. Ho’s lab. impact of the pandemic on research, patient care, and education and the impact of the Black Lives Matter movement on five members of our community as illus- trative. A taskforce was commissioned by me with

multiple working groups across the medical center in O’ROURKEJENNIFER July 2020, and a full report should be available for the Fall/Winter 2020 issue of Columbia Medicine. I will welcome your feedback on the steps we will take to strengthen our commitment to an inclusive workplace, our pledge to eliminate health disparities, and our efforts to educate and train a generation of health care professionals who will make equality a hallmark of health care for all.

2 Vagelos College of Physicians and Surgeons JENNIFER O’ROURKE we will move in NIH funding rankings from #9 in 2019 Preparing the next generation of physicians and to #5 in 2020. Another measure of our research excel- scientists will always be at the core of our mission, The Department of Emergency Medicine lence is Nature Index, an annual calculation of research and this year’s accomplishments in education were not has been on the front citations. In the 2019 index, Columbia University Irving dimmed by the changes put in place to respond to the lines of the pandemic Medical Center was No. 1 in the health care sector. We pandemic. Even though the way we taught students since the first patients were admitted in have ranked either No. 1 or No. 2 over the past five shifted, it was a momentary course change and we March. Wearing full years. Among medical schools ranked by the U.S. News hope to have all students back on campus next year, personal protective equipment are two & World Report, VP&S tied for sixth place this year, recognizing that many CUIMC students are on cam- emergency medicine our highest ranking in recent years. pus already. In addition to adjusting to online learning faculty: Angela Mills, As research advanced at VP&S during the year, so early in the pandemic, students stepped up to support department chair, and Penelope Lema. too did patient care. Most notable is the growth of our missions in new ways, whether collecting data for primary care. The recruitment of David Buchholz, research teams, taking on service-learning projects to MD, as senior founding medical director for primary support front-line workers, performing music to pro- care at ColumbiaDoctors and NewYork-Presbyterian vide respite for colleagues, or bringing together stu- has expanded our strategy to provide patients greater dents from around the world to collaborate virtually. access to primary care services across the New York I want to emphasize our deep partnership with metropolitan area. Plans are moving forward on new NewYork-Presbyterian in multiple domains related to primary care practice sites on the Upper West Side, clinical care, graduate medical education, and commu- in Midtown, and in Westchester. The Washington nity programs under the leadership of Dr. Steve Cor- Heights and Morningside campuses have primary care win, president and CEO. practices, part of the strategy to add 50 to 70 primary Every year we publish an annual report to document care doctors in the next five years in partnership with measurements of growth, and VP&S during the 2020 NewYork-Presbyterian. fiscal year showed growth, adaptation, and resiliency Confident that in-person outpatient care will always in abundance. While the year will best be remembered be an option—and for some patient care a necessity— for what changed us, it must also motivate the growth we are nonetheless heartened to see how quickly our that will strengthen us in the years ahead. patients have taken to telemedicine. Credit goes to our physicians and also to the leadership of NewYork- Sincerely yours, Presbyterian and ColumbiaDoctors who rolled out a new electronic health record—EPIC—just before the height of the pandemic. EPIC’s rollout included plans for telemedicine, but no one could have foreseen how Anil K. Rustgi, MD quickly our faculty, staff and patients would need to Interim Executive Vice President and Dean of pivot to this technology and would do so in large num- the Faculties of Health Sciences and Medicine bers. The technology is here to stay. [email protected]

2019–2020 Annual Report | ColumbiaMedicine 3 n early June, Columbia University Irving Medical Center held a vigil featuring nine minutes of silence—one for each minute that George Floyd’s life ebbed as a police officer kneeled on his neck in Minneapolis. The employees who gathered in front of university and hospital buildings—and others who paused in their work across campus or at their remote work locations—to stand or kneel were joining forces with Itens of thousands of protesters who peacefully assembled across the United States and around the world to call for police reform and an end to systemic racism. Like medical schools everywhere, VP&S felt the weight of responding—acknowledging the role of structural racism in health disparities and in patient care, education, research, and workplace environments. In the months since, VP&S and other medical schools have worked to find solutions unique to their missions: augmenting a diverse and inclusive environment for students, faculty, staff, and patients; conducting research that improves AT A CROSSROADS: MEDICINE AND THE MOVEMENT REFLECTING ON MEDICINE AMIDST A GLOBAL HEALTH CRISIS AND A RACIAL RECKONING

By Brittany King and Sharon Tregaskis // Photographs by Jörg Meyer AT A CROSSROADS: Lisa Mellman Jonathan Amiel

‘The protests are the necessary medicine for both ills.’

health care; combating health disparities; expanding community the way we care for patients, and how our research can improve programs; and strengthening education and training. A task force health outcomes.” with multiple working groups across Columbia University Irving At VP&S, 13% of students in the entering Class of 2024 are Medical Center was formed in the summer. Black (an additional 9% are Latino with a combined total of 22% The institutional reflection sparked by the summer protests for underrepresented students, above the national average), com- coincided with the greatest public health crisis in modern history pared with 7% nationally. (Slightly more than 5% of all U.S. phy- and heightened white Americans’ awareness of race-based health sicians are Black.) disparities. As COVID-19 affected Black Americans at more than Students are actively involved in the work toward change. “Our twice the rate of white Americans, the social faults that give rise to VP&S students, led by our Black student leaders, brown students, disparities stood out in stark relief. Suddenly, the deaths of Black and white allies and supported by faculty and administration, have Americans—either at the hands of police or through a virus no one catalyzed a process for effecting long overdue change,” says Lisa knew existed a few months earlier—collided, and for many pro- Mellman, MD, interim co-vice dean for education. “We are proud testers, the hazard of coronavirus infection paled in comparison of our students, united in our commitment, and grateful to col- to the brutal consequences of systemic racism. “As a Black phy- laborate across the school, the campus, and with the community.” sician,” wrote emergency medicine physician Steven McDonald, Adds Jonathan Amiel, MD, interim co-vice dean for education: MD, in a New York Times opinion piece, “I understand that the “Our responsibility to improving health care for all begins here at protests are the necessary medicine for both ills.” VP&S. We must enhance equity and justice within our own academic “The statistics of illness and death from the pandemic make medical center and ensure that our training programs equip health clear that the virus and racial injustice are interwoven into the care providers to advocate for equity and justice in their work. Our fabric of this part of our history,” says Anil K. Rustgi, now interim staff and faculty share this commitment with our students and are EVP and Dean of the Faculties of Health Sciences and Medicine. already hard at work moving ahead with curricular innovations.” “Just as we have learned much about COVID-19 this year, we As VP&S redoubled its efforts to promote racial justice, a few also have acknowledged that we are in a unique position to have Black medical students and physicians at VP&S shared their an impact on health care disparities. We can work toward health thoughts on navigating this historical moment—what one calls a equality by examining the education of health care professionals, “perfect storm.”

6 Vagelos College of Physicians and Surgeons “As an adviser for Hilda Hutcherson, MD students of color, Senior Associate Dean for Diversity and Multicultural Affairs I have heard,

hen Dr. Hutcherson arrived at that our current leadership, with Dean firsthand, the W VP&S, she became the first Black Rustgi at the helm, will make lasting pain and anguish woman resident in the Department of systemic change that will make VP&S a of implicit bias Obstetrics & Gynecology. “Those early place where everyone feels comfortable days were really difficult because there and supported.” and racism.” were so few Black people among the residents or faculty; it was very isolating. Discussions about race, racism, equity, and inclusion didn’t take place. As a minority physician, you learned to put your head down and forge ahead.” In the years that Dr. Hutcherson has led the Office of Diversity and Multi- cultural Affairs, the representation of students underrepresented in medicine has increased. For more than 10 years, Black, Hispanic, and Native American students have ranged from 20% to 24% of each entering class. “Increasing the diversity of the health care workforce is an important first step to decrease health disparities in minority communities. “The combination of the COVID-19 pandemic and the murder of George Floyd and other African Americans by police caused us all to look squarely in the face of racism in our society and how our institution may have contributed to this social ill. As an adviser for students of color, I have heard, firsthand, the pain and anguish of implicit bias and racism. We are working hard to extinguish systemic racism at our institution and the community at large.” Structural change often comes slowly, says Dr. Hutcherson, and depends on the synergy of collective action and strong leadership. “You need a critical mass of people getting together—where all of us, putting our energy together, say ‘The status quo is no longer acceptable. There is a need for change.’ And you have to have a leader who says, ‘This is important,’ who takes those recommendations Hilda Hutcherson and makes them happen. I am confident

2019–2020 Annual Report | ColumbiaMedicine 7 Steven McDonald, MD 2014 VP&S Graduate and Assistant Professor

s the son of a physician and a nursing Marathon in 2013, the year a bomb went A school dean, Steven McDonald, MD, off at the finish line. He rushed to the assistant professor of emergency medicine, scene to help. “I wasn’t needed,” says Dr. has long believed that working in medi- McDonald, “but that experience made me cine was a way to be on the “good side” wish I knew a bit of emergency practice, of injustice. He was running the Boston so I went back and did a round of emergency medicine.” The training altered his professional trajectory; today in addition to teaching at VP&S, he treats patients in three New York City emergency departments. “Emer- gency medicine is social justice—a majority of the patients we serve are Black and Latinx,” he says. “People who are left dis- enfranchised by the system are ultimately cared for by emergency medicine.” Since the pandemic began, Dr. McDonald has expanded his focus. “As COVID started to ramp up, I felt that I needed to amplify my voice as much as possible to communicate what I was seeing.” He began speaking to the press about the intersection of his experiences as a Black man and a doctor and “To the extent penned opinion that medicine is pieces for the New York Times and lifelong learning, Atlantic magazine. my white peers At protests, are seeing that it Dr. McDonald has noticed more includes learning of his non-Black about anti-racism.” colleagues present, including his former educators. “There’s been a real societal shift since the death of George Floyd,” he notes. “I can’t tell you why it took his death over Trayvon Martin’s or Michael Brown’s, but there’s a real change in public support for the Black Lives Matter movement. To the extent that medicine is lifelong learning, my white peers are seeing that it includes Steven McDonald learning about anti-racism.”

8 Vagelos College of Physicians and Surgeons Taiwo Peter Alonge

Taiwo Peter Alonge’21 hen fifth-year medical student Mr. Alonge says much of the work it “I hate that it took this W Taiwo Alonge becomes a doctor, takes to truly understand health dispari- he plans to serve Black and brown com- ties starts when students enter medical awful perfect storm munities. “When Trayvon Martin was school. For a long time, he was skeptical for it to happen, but murdered while I was in high school, I whether the changes he wanted to see in knew that if I was going to be a doctor, I his field would happen. this change could needed to serve people who looked like “I think every medical institution is try- dramatically impact me,” he says. ing to figure out how to have these conver- what it’s like to be Since then, he has worked to under- sations, especially now. There’s this feeling stand our current health care system, that something has to shift,” he says. “But a person of color in especially the disparities between com- if students are going to be involved in lec- America, even outside munities of color and white communi- ture conversations about race, potentially of medicine.” ties. Studying both medicine and public re-traumatizing themselves to try and edu- health (in the Mailman School MPH cate other people, there needs to be some program) has allowed him to understand sort of compensation. Because of what how to treat issues that plague Black and we’ve seen happen with George Floyd, brown communities, while also working Breonna Taylor, and Tony McDade—on to find solutions that promote preventive top of being forced to stay inside for three care. “Oftentimes, issues like hyperten- months—future doctors will have the sion and diabetes add up in patients,” opportunity to learn about systemic rac- he explains. “But if we could treat those ism in their coursework. I hate that it took smaller things before they get too big, this awful perfect storm for it to happen, we can make health care better and our but this change could dramatically impact patients healthier. To me, that’s a doc- what it’s like to be a person of color in tor’s job.” America, even outside of medicine.”

2019–2020 Annual Report | ColumbiaMedicine 9 Ogoegbunam Brian Okolo’23

hen asked what it feels like to be of a few Black med students here, I’m W Black in his program at Colum- continuously reminded of the exclusivity bia, Mr. Okolo recounts a particular associated with highly academic spaces,” struggle at the intersection of his racial he says. Born into a Nigerian immigrant and professional identity. “It is truly a family, Mr. Okolo aspires to uplift and privilege to be at Columbia, but as one advocate for Black and brown communities as a health care provider. Mr. Okolo chose to study at VP&S because of the sense of support he felt when visiting, especially within the BALSO (Black and Latino Student Organization) community. “It is hard to imagine navigating medical school without the support of BALSO. It has been particularly valuable to me now, amidst the widespread anti- Black racism that we continue to face.” When he first heard about the murder of George Floyd, the news sat with him in a way he knew it did not for his white peers. “The weight of realizing that could be me and having to grapple with that reality, while trying to study for an exam to main-

“As one of a few Black med students here, I’m continuously reminded of the exclusivity associated with highly academic spaces.”

tain my status as a medical student was something I was really struggling with,” he recalls. “The very next day, I had to go to class as if everything was normal. It was difficult for me to balance my identity as a Black student and a med student in a space where the guise of ‘professionalism’ leaves little room for these important conversations to happen. It is vital for medical institutions to critically examine the practices that contribute to racial injustice that has Ogoegbunam Brian Okolo been invisibilized for far too long.”

10 Vagelos College of Physicians and Surgeons Keyanna Jackson’23

eyanna Jackson grew up in Wilson, KNorth Carolina, a small town where local medical care was substandard. Her family drove to a hospital 30 minutes away, one with a better reputation. But that didn’t always mean better care. “My grandfather had an older white doctor who was dismissive,” she explains. “He had hypertension and the doctor would speak about it as if it were normal.” Eventually the family switched doctors. The new doctor, a woman, was attentive, explained complex issues, and even allowed Ms. Jackson to shadow her throughout high school. “Having a woman pour so much into me and my family allowed me to see what was possible,” says Ms. Jackson. At VP&S, Ms. Jackson facilitates mutual support among fellow Black medical students. As president of the Black and Latino Student Organization (BALSO), the Columbia chapter of the Student National Medical Association, and the Latino Medical Student Asso- ciation, she works to connect her peers and faculty to one another for academic support and mentorship. BALSO also partners with local schools to encourage Keyanna Jackson children to pursue a career in medicine. Yet Ms. Jackson laments that more robust structures were not already in place through VP&S to facilitate this content. Ms. Jackson says that’s a start, work. “There needs to be a better under- and she would like to see more done “It can be hard to navigate standing of what the invisible labor looks within the curriculum to ensure that white spaces, or sit in like for Black faculty and students to Black students alone are not forced to class and hear about how show up as mentors, or explain health explain anti-racist concepts to their non- disparities in our communities to our Black peers in discussions of race and certain diseases affect my white peers,” she says. “It can be hard to medicine. “People can do the reading community without much navigate white spaces, or sit in class and and take what they want from it. There context or explanation on hear about how certain diseases affect should be opportunities to have these my community without much context or types of conversations about race,” she why that might be.” explanation on why that might be.” says. “Maybe tap on those outside of the In recent years, VP&S has revamped medical field to facilitate this. Students its curriculum to include more anti-racist have been asking for it.” v

2019–2020 Annual Report | ColumbiaMedicine 11 ALL HANDS ON DECK BY KRISTIN BUNDY HOW COLUMBIA FACULTY CHANGED COURSE TO NAVIGATE COVID-19

PORTRAITS BY JÖRG MEYER ISTOCK t the end of March, George Hripcsak, MD, had expected to attend a symposium in England for a global interdisciplinary research collaborative whose coordinating center operates out of AVP&S. Instead, on March 26, Dr. Hripcsak and fellow members of the leadership committee of the Observational Health Data Sciences and Informat- ics (or OHDSI, pronounced “Odyssey”) launched an 88-hour virtual study-a-thon with more than 300 investigators from dozens of countries in attendance. “This is how we shifted our efforts to COVID,” says Dr. Hripcsak, co-PI of the international OHDSI, “an around-the-clock, four-day meeting of researchers from North America, Europe, and Asia, coming together to kick off our COVID study.” George Hripcsak Since 2014, Dr. Hripcsak and other volunteer members of OHDSI have amassed a database of electronic health records and claims data on nearly 600 mil- chloroquine was ineffective at mitigating the risk of lion patients worldwide. That dataset put them in a intubation and death among patients with COVID-19. unique position to combine efforts against the new Dr. Hripcsak was one of dozens of VP&S faculty disease. With real-world data at their fingertips, they who leveraged ongoing work to briskly and substan- developed an observational study designed to answer tively address clinical and investigative challenges that questions about this novel illness, for example, Who is emerged as New York City became the epicenter of the getting the disease more often? Which therapies work? pandemic starting in March 2020. What are the myriad risks for complications? At the Center for Radiological Research, director “There wasn’t a lot of sleep during those 88 hours,” David Brenner, PhD, had been working on a particu- says Dr. Hripcsak, but those sleepless nights yielded lar wavelength region of UV light (far-UVC, 222 nm) quick results. By early April, the use of hydroxychlo- which he had shown was efficient at killing airborne roquine alone or in combination with azithromycin influenza virus but, unlike conventional germicidal was under consideration as prophylaxis for health UVC light, was safe for direct human exposure. He care workers. Dr. Hripcsak and colleagues alerted the quickly pivoted his focus to SARS-CoV-2, the coro- U.S. Food and Drug Administration and its European navirus that causes COVID-19. In a paper published counterpart—the European Medicines Agency—that in June, Dr. Brenner showed that far-UVC light, used the OHDSI database shows a number of sudden within current regulatory safety limits, inactivated deaths were associated with short-course hydroxy- 90% of airborne coronaviruses in eight minutes and chloroquine/azithromycin among patients without 99.9% within about 25 minutes. COVID-19. Ultimately, government officials did not “Based on our results, far-UVC light from overhead recommend this form of prophylaxis. lights could be safely used to markedly reduce the In parallel with the OHDSI work, Dr. Hripcsak ambient level of SARS-CoV-2 virus in occupied indoor published other COVID-related papers between April spaces,” says Dr. Brenner. Unlike conventional germi- and June, including a study run by VP&S medical stu- cidal UVC light, far-UVC light is safe for human expo- dents and published in the British Medical Journal that sure and has the potential to become as necessary as characterized the course of disease of the first 1,000 other precautions people take indoors. “Far-UVC light COVID-19 patients admitted to NewYork-Presbyterian has great potential as a third approach, in addition to Hospital and a study published in the New England face masks and social distancing, to limit the trans- Journal of Medicine, written with Joshua Geleris, MD, mission of SARS-CoV-2 and other viruses in occupied and Neil Schluger, MD, demonstrating that hydroxy- indoor spaces.” COVID-19

Eric Greene, PhD, professor of biochemistry & is working on COVID-19-related topics and specify molecular biophysics, found a way to support the pan- what it is they do, just as a way to communicate with demic response after suddenly finding himself working one another,” Dr. Greene says. from home, writing papers and grants that were already In the early phases, Dr. Greene gathered names ad in the pipeline. The Greene Lab was shut down in mid- hoc, then learned that Andrea Califano, PhD, chair March as Columbia and New York sought to “flatten of the Department of Systems Biology, was doing the the curve,” but Dr. Greene wanted to help, especially same. They collated their lists and the database was with so many of his Columbia colleagues on the front taken over by the CRAC team, led by postdoc Haotian lines. “The worst thing in the world is to have a scientist “Howie” Wu, PhD. stuck at home with nothing to do,” says Dr. Greene. “I This effort led to a bigger, more far-reaching proj- started asking folks how I could help and found many ect: the COVID-19 Virtual Symposia, a live, weekly people who were trying to figure out the same thing. online lecture series featuring eight to 10 presenters Quickly—within the first week—we coalesced. That’s each week from Columbia and around the globe, who what really made things work.” relay the most current science on COVID-19. “It was Through the VP&S grapevine, Dr. Greene learned a way to bring people together at the university,” says about an emerging grassroots effort among VP&S Dr. Greene, “and keep everyone up to date on the latest researchers. Dubbed CRAC—Columbia Research- understanding of the disease.” The Virtual Symposia ers Against COVID-19—the collective enterprise was series is hosted by Dr. Greene; Dr. Califano; Andrew launched by postdocs who realigned their research Marks, MD, the Clyde’56 and Helen Wu Professor of goals toward the pandemic after their labs were shut Molecular Cardiology and chair of the Department of down. Dr. Greene and Kenneth Olive, PhD, associate Physiology & Cellular Biophysics; and Stephen Goff, professor of medicine who conducts pancreatic can- PhD, the Higgins Professor of Microbiology & Immu- cer research, became CRAC faculty advisers. “I sug- nology and Biochemistry & Molecular Biophysics. gested that one of the things we should do is build “The symposium,” Dr. Greene adds, “would not have a Columbia-wide database, listing everybody who been possible without the truly amazing efforts of the CRAC team volunteers like postdocs Ester Cynn, Jessie Brown, and many others who run all of the behind the scenes operations. I really cannot overstate the impor- tance of these volunteers to the overall effort.” The inaugural symposium on Zoom was held April 1 with more than 700 Columbia scientists and clinicians in attendance. During the series, speakers reported on knowledge gleaned from the front lines in Italy, China, and Spain; others provided the latest on vaccine development and treatments; others offered commentary on evolving social issues related to the disease. Dr. Greene says much of the information was generously presented before publication. “People were very will- ing to share data,” he says. “It was amazing to see.” Within the first three months, VP&S hosted 13 ses- sions of the COVID-19 Virtual Symposia, with about 200 attendees per session. A month into the pandemic, as the virtual symposia launched, clinicians at NYP-Morgan Stanley Chil- dren’s Hospital noticed a cluster of previously healthy children presenting with multiple and sometimes critical symptoms; the condition would come to be known as multisystem inflammatory syndrome in children, or MIS-C. “We had to rapidly recognize, investigate, and treat a whole new syndrome affecting children related to COVID-19 that very few people in the world knew anything about,” says pediatric critical care physician Eric Greene and cardiologist Eva Cheung, MD.

14 Vagelos College of Physicians and Surgeons Although MIS-C shared many features with Kawa- saki’s disease (KD) and toxic shock syndrome (TSS), Dr. Cheung says, these novel cases were occurring at a higher rate than expected, so doctors suspected something new was emerging. “On average, we see a child with KD or TSS every several months, or even less. Since we were admitting one child after another—and, at the peak of MIS-C, many children a day—it just didn’t align with those two diseases,” Dr. Cheung says. “We had a suspicion this was connected to COVID-19.” Dr. Cheung characterized MIS-C in a case series published in JAMA in June. She reported that the main sign of the syndrome was fever accompanied by other symptoms, such as gastrointestinal upset, nausea, vomiting, rash, and abnormal chest X-rays. Together, Dr. Cheung says, these complications illustrated that something about exposure to COVID-19 triggered an inflammatory reaction that made children sick. Researchers believe MIS-C is rare; among the thousands of children receiving care at NYP, MIS-C was diagnosed in just 60, all of whom were treated at the hospital and have Eva Cheung since gone home. Dr. Cheung continues her research, prospectively monitoring this cohort for long-term effects of MIS-C. She also leads an ongoing study on the ing the Office for Research, joined forces to launch an MIS-C treatment given at NYP, compared with other institutional biobank sooner than planned and with institutions during the surge, to help pinpoint the opti- a changed focus. “We were planning on going live, mal protocol for managing the syndrome. enrolling all patients who consented at CUIMC as of Like their colleagues in adult medicine, Dr. Cheung April 1 then proactively collecting samples,” says Dr, and her fellow MIS-C investigators were simultane- Reilly. “But when COVID happened, we quickly piv- ously responding to and documenting strategies to oted our focus to enroll patients who tested positive treat COVID-19 and its complications while also adjusting to abrupt transformations in where and how they saw patients. Pediatric cases in the NYP health “I don’t think there was a clinician in this care system—COVID and otherwise—were central- institution who didn’t have to find a different ized at Morgan Stanley Children’s Hospital, where many pediatric specialists were also redeployed to role during the pandemic.” care for adults. “Because children were less affected by COVID-19, we had capacity to take care of our city’s for COVID at NYP/Columbia and preserve residual children and also open our doors to adult patients samples once the clinical laboratory had finished with with COVID,” she explains. Other pediatric special- the samples.” The most common sample collected was ists were transferred to adult hospitals to contribute serum, but others were also collected: plasma, nasal to critical care efforts there. “I don’t think there was pharyngeal swabs, urine, feces, cerebral spinal fluid, a clinician in this institution who didn’t have to find a and the concentrated white blood cell product known different role during the pandemic.” as “buffy coats,” which is used for DNA extraction. Reimagination was a common theme running “Patients were very interested in contributing and through VP&S research programs during the pandem- participating in this effort,” says Jennifer Williamson, ic’s peak in New York City. Led by Muredach Reilly, MS, MPH, associate vice dean for research policy and MBBCh, director of the Irving Institute for Clinical scientific strategy, who worked with Dr. Reilly and and Translational Research, researchers pivoted and other faculty to launch the biobank and oversee out- accelerated a years-long project. Researchers in the reach to patients. The willingness of patients to help Irving Institute, the Institute for Genomic Medicine, immediately made the biobank useful for COVID-19 and the Department of Pathology & Cell Biology with and MIS-C research. “While other institutions said it multiple other partners at the medical center, includ- could take up to five years before a newly established

2019–2020 Annual Report | ColumbiaMedicine 15 COVID-19

biorepository would make an impact, researchers Insights from the front lines of patient care have were using our samples just four months after the bio- informed other areas of research, including women’s bank began,” Ms. Williamson adds. health. Cynthia Gyamfi-Bannerman, MD, a mater- By the end of June, about 7,000 current and former nal-fetal medicine specialist, co-authored a research patients with COVID had agreed to the use of their letter published in JAMA that revealed social deter- samples—approximately 70,000 total samples had minants associated with an increased risk of infec- been collected, including one of the largest sets of lon- tion—namely, a higher number of people living in a gitudinal MIS-C samples in the country—in research. household, a more crowded household, and a lower Almost 2,000 other patients have consented to ongo- socioeconomic status—among pregnant women deliv- ing involvement in the biobank and agreed to be con- ering at two NYP hospitals between mid-March and tacted for other research studies. mid-April. “One may think that because New York “With samples from the biobank and electronic City is so dense, there’s little that can slow the spread health records, we can provide patients with ongoing of the virus, but our study suggests the risk of infec- follow-up while also trying to answer important question is related to household, rather than urban, den- tions such as why some people get very sick and some sity,” says Dr. Gyamfi-Bannerman. don’t and why some people respond to some treat- Jeremy Beitler, MD, a pulmonary intensivist and ments and others don’t,” says Dr. Reilly. director of clinical research for the Center for Acute Respiratory Failure, developed, implemented, and published a ventilator-sharing protocol as a public health preparedness tactic to mitigate anticipated ventilator shortages at the height of the epidemic. Through thor- Who’s Who ough review and pairing of compatible patients, these · Jeremy Beitler, MD, assistant professor of medicine and director of breathing machines were successfully used to support clinical research for the Center for Acute Respiratory Failure two people at the same time for two days. Results from

· David Brenner, PhD, the Higgins Professor of Radiation Biophysics (in the initial series of patients were published in the Amer- Radiation Oncology) and director of the Center for Radiological Research ican Journal of Respiratory and Critical Care Medicine, and the protocol has been adopted by hospitals around · Andrea Califano, PhD, the Clyde‘56 and Helen Wu Professor of Chemical Biology (in Systems Biology), professor of biomedical informatics, professor the globe. “We’re doing something that hasn’t really of biochemistry & molecular biophysics, and professor of medicine in the ever been done before, but now is the time to do it,” Dr. Institute for Cancer Genetics Beitler told the New York Times. The successful pivot to COVID-19 research during · Eva Cheung, MD, assistant professor of pediatrics in the Division of Critical Care and Hospital Medicine and the Division of Cardiology and the height of the pandemic was borne out of a shared medical director of the pediatric ECMO program sense of purpose and unity across departments, say researchers. “We have learned to work with our col- · Eric Greene, PhD, professor of biochemistry & molecular biophysics leagues in a way that we really didn’t ever need to in · Stephen Goff, PhD, the Higgins Professor of Microbiology & Immunology the past,” says Dr. Cheung. “Health care for adults and and Biochemistry & Molecular Biophysics and Investigator, Howard Hughes children are very separate—separate buildings, separate Medical Institute hospitals. But everyone adjusted their practice and cared · Cynthia Gyamfi-Bannerman, MD,the Ellen Jacobson Levine and for so many patients in so many different locations. It Eugene Jacobson Professor of Women’s Health in the Department of was an incredible demonstration of teamwork.” Obstetrics & Gynecology Dr. Greene shares the same sentiment from the · George Hripcsak, MD, the Vivian Beaumont Allen Professor of Biomedical bench. “It has been remarkable to see how many Informatics and chair of the Department of Biomedical Informatics labs have coalesced to attack the problem—both at · Andrew Marks, MD, the Clyde’56 and Helen Wu Professor of Molecular Columbia and worldwide. I’ve gotten to know so Cardiology and chair of the Department of Physiology & Cellular Biophysics many people I would have never had the opportunity · Muredach Reilly, MBBCh, the Florence and Herbert Irving Endowed to interact with before, which has been valuable.” Professor of Medicine, director of the Irving Institute for Clinical and The collaborations formed through a shared com- Translational Research, and VP&S associate dean for clinical and mitment to fighting COVID-19 are likely to endure translational research beyond the end of the pandemic. As Ms. Williamson · Jennifer Williamson, MS, MPH, VP&S associate vice dean for research policy puts it: “Whenever you’re working on something that and scientific strategy is so important, everyone clearly knows the mission and focuses on making it work, it is incredibly reward- ing. It’s the best part of Columbia.”

16 Vagelos College of Physicians and Surgeons New York City in April. ColumbiaDoctors conducted nearly 40,000 virtual visits that month. The psychiatry department, which was the pilot practice for ColumbiaDoctors’ transition to Epic, has relied especially heavily on telehealth. Many surgeons also transitioned to telehealth for postoperative checkups to A WHOLE assess range of motion or examine incision sites. “Patients have embraced this more than I would have predicted,” says George “Jack” Cioffi, MD, president of Columbia NEW WORLD: Doctors and VP&S vice dean for clinical affairs. Because Epic is a secure, private network, few patients have expressed concerns about privacy. The bigger challenge has been getting older, less tech-savvy PATIENT CARE patients on board; in some cases, family members or caregivers facilitate remote appointments. Occasion- ally, providers host telephone-only appointments. THROUGH As the number of COVID-19 cases in New York began to wane and physicians welcomed patients back for in- person appointments, virtual visits naturally started to SCREENS drop off. Yet telehealth usage is unlikely to ever return to pre-pandemic levels. As of July, ColumbiaDoctors was still virtually seeing about 1,600 patients per day, says Before the coronavirus pandemic, few New York- Ms. Long. “We certainly want to continue to provide Virtual ers could have imagined getting most of their medical virtual visits and grow it as appropriate to the level of Consults care via their computer, tablet, or smartphone. Until care that the patient needs.” Sustain 2019, ColumbiaDoctors had merely dipped a toe into Among the patients who like it are patients who pre- the field of telehealth. And then, in March 2020, “the viously traveled from the suburbs or outer boroughs to Continuity world changed,” says Rosalie Long, RN, MBA, chief see their providers. “It doesn’t require anyone to cross During operating officer of ColumbiaDoctors. a bridge, park a car in a garage, or wait in a waiting Between July 2019 and January 2020, ColumbiaDoc- room,” says Ms. Long. Pandemic tors conducted an average of 300 telemedicine visits per Of course, not every specialty is well-suited for tele- —and month, Ms. Long estimates. In February, when the fac- medicine, notes Dr. Cioffi, who is chair of ophthalmol- ulty practice launched Epic, a digital platform that inte- ogy, one of the specialties better suited for in-person Beyond grates electronic health recordkeeping with scheduling visits because of the equipment involved. Ditto for and billing software and a patient portal, the plan was any appointments that require hands-on examination, BY BARBARA to “slowly optimize and bring more people into the new blood work, or imaging tests. BRODY system, using the patient portal to expand virtual visits.” Even when a fully remote appointment is not possible, When the COVID-19 pandemic hit New York, however, telehealth can play an important role: Patients plans for a gradual transition were quickly scrapped. can complete standard intake forms online via the Epic With a focus on flattening the curve by minimizing portal. A nurse can call a patient the day before an in-person interactions, doctors quickly embraced tele- appointment to discuss allergies, medications, and current health—as did patients who needed to discuss coro- health concerns. Lab and imaging tests can be pre-ordered navirus concerns with their primary care providers, and patients can have tests completed at a location most people with chronic health issues who were eager to convenient to them. Results can be reviewed by the pro- stay in touch with specialists, pregnant people seeking viders before patients arrive for their in-person visits. prenatal care, and many, many others. “Now when you get into the office, everything is “In the entire month of February, we had 222 vir- aligned and pre-charted,” says Dr. Cioffi. “You’re not tual visits. During the last two weeks of March, we sitting in the waiting room filling out forms, which is had nearly 14,000,” says Ms. Long. “It was an amaz- safer for you and the staff. You’re not spending 20 min- ing pickup. The providers were very engaged and very utes with a nurse; the nurse just checks your blood pres- determined, and the patients were also very inter- sure and asks if anything has changed since your phone ested.” The highest use of virtual visits, not surpris- conversation. You see the doctor for half an hour and ingly, coincided with the peak of COVID-19 cases in you’re out the door.”

2019–2020 Annual Report | ColumbiaMedicine 17 COVID-19 EMBRACING

CHANGE BY BARBARA BRODY Despite Interruptions to Classes and Clerkships, VP&S Students Didn’t Let a In March 2020, Tyler Wen’22 had just finished morn- Pandemic Slow Them Down ing rounds at Harlem Hospital Center when he got the news. “I received an email along the lines of ‘Every student who is in a clinical setting should immediately not be in a clinical setting,’” he recalls. About 15 minutes later, during which he made a hasty apology to other residents, the in-hospital experience of Mr. Wen’s pediatrics clerkship was over. Mr. Wen—who intends to specialize in emergency medicine—was disappointed that he would have to temporarily stop interfacing with patients, though he understood why it was necessary to suspend clerkships during the height of the pandemic in New York. He just needed to decide what to do in the meantime. With the city scrambling to mobilize a vast army of health care workers, VP&S graduated the Class of 2020 a month early, so the brand-new doctors could immediately be of service. But other students got a forced timeout: They could participate in remote elec- tives, do research, complete service-learning projects to support health systems, or study for exams. Unwilling to sit back while the pandemic crashed down on the city, Sarah Soo-Hoo (who will graduate in 2021 with a joint MD/MBA degree) and fifth-year medical student David Edelman quickly teamed up to create the COVID-19 Student Service Corps to provide support during the COVID-19 crisis. By early April, volunteers were fielding 1,600 hotline calls a day from New Yorkers desperate for information about the new virus. Mr. Wen and Nick Morley’22 spent more than a month answering hotline calls. “The community hotline was initially staffed by physician assistants, but they were overwhelmed by mid-March,” says Mr. Morley. “Students took four-hour shifts. We provided Tyler Wen information about coronavirus, where to go to receive

18 Vagelos College of Physicians and Surgeons care, CDC guidelines about what constituted as symptom, and so on.” Mr. Wen further disseminated information about COVID-19 by lending his social media skills to Craig Spencer, MD, director of global health in emergency medicine. “Dr. Spencer, who became especially well- known after he contracted Ebola in 2014, was being inundated by COVID questions on Twitter,” says Mr. Nick Morley Wen. “He wanted to create an educational campaign that would address the top questions in a simplified Q&A format.” Despite the clear value of these interim projects, Mr. Mr. Wen and his classmate, Saurabh Sudesh’22, sorted Morley, Mr. Wen, and their classmates were eager to through the incoming questions and obtained the most get back to their formal medical training. Clerkships up-to-date information. “Then Dr. Spencer would share for third-year students resumed in late June, and rota- the answers using his unique, approachable internet tions have been compressed slightly so the students presence,” says Mr. Wen. “It was a huge team effort.” can stay on track to graduate in May 2022. Mr. Wen also joined forces with David Van, MD, fac- This summer, Mr. Morley turned his attention to his ulty supervisor for the VP&S student emergency medi- psychiatry clerkship at the Bronx VA, participating in cine interest group, to write a case report on the impact both outpatient and inpatient care. Most outpatient of psychosocial stressors in COVID-19 patients. care in psychiatry is done virtually, which he describes Mr. Morley, who plans to specialize in family medi- as challenging but more convenient and safer for cine or infectious diseases, spent a good chunk of the patients during the coronavirus. Providing inpatient spring working with Magda Sobieszczyk, MD, an HIV care after months of isolation has been “incredible,” expert who is conducting a study on whether PrEP says Mr. Morley. “Hands-on experience is as impor- users who receive regular text messages and short sur- tant—and as much of a gift—as it ever was.” v veys are more apt to adhere to their preventive drug regimen. While Dr. Sobieszczyk, chief of the Depart- ment of Medicine’s Division of Infectious Diseases, focused on coordinating COVID-19 clinical trials at Additional reading on COVID-19: VP&S, Mr. Morley spent months building a new data- · SPRING/SUMMER 2020 COLUMBIA MEDICINE: base that automated the process of sending out text http://columbiamedicinemagazine.org/features/spring-2020/ messages to PrEP participants based on their response first-60-plus-days-epicenter-covid-19 to the surveys. “We no longer have to have someone · CUIMC NEWSROOM: manually sending out the appropriate responses, which https://www.cuimc.columbia.edu/news/topics/infectious-diseases/covid-19 was pretty effort-intensive,” says Mr. Morley. “Now it’s easier, so we can reach and recruit more participants.”

2019–2020 Annual Report | ColumbiaMedicine 19

THE BIOETHICSOF GENOMICSAND JUSTICE NEW DIVISION OF ETHICS EXPLORES THE IMPLICATIONS OF PRECISION MEDICINE

BY CHRISTINE YU ILLUSTRATIONS BY DAVIDE BONAZZI hen the Human Genome Project Such discrepancies can produce skewed results launched in 1990, the international that aren’t relevant to most of the world’s popula- collaboration to sequence and map tion. “I can tell you unequivocally that my patients every gene in a single human being of Latino ancestry or Black ancestry don’t get as Wushered in a new era of scientific and medical much out of genetic evaluations,” says Dr. Chung, research and laid the groundwork for precision “because I cannot as readily interpret the data to medicine. But in unraveling the map of our genes, help them make important decisions about manag- researchers unearthed more than a collection of ing risk for cancer or heart disease or what medica- As, Ts, Gs, and Cs. Along with groundbreaking tion might be safest for them.” knowledge came a host of sticky philosophical and Yet solving biomedical research’s diversity prob- ethical questions. “Genomic technology allows lem involves more than just recruiting historically us to do many different things—and the ethics is underrepresented groups to provide samples. It What should we do?” says Wendy Chung, MD, requires examining what Dr. Lee calls “upstream the Kennedy Professor of Pediatrics (in Medicine). decisions”—how individuals and groups are “That’s a discussion we have to have in the public defined, measured, and compared; how practices square, not just as doctors and scientists. Entire to recruit, engage, and retain research partici- societies need to think about it because it affects pants promote or compromise goals of diversity everything from the criminal justice system to our and inclusion; and how researchers, themselves, legal system to our health system.” engage communities in a long-term research Thirty years later, precision medicine has arrived relationship. She’s particularly interested in trac- at a crossroads. With such projects as the NIH’s ing the cascading effects of early decisions about “All of Us,” researchers continue how populations are defined and how researchers to unleash the power to treat, pre- make comparisons among populations. vent, and cure disease. As the field Consider, for example, the downstream effects accelerates, though, so too does the of how samples are collected and categorized imperative to grapple with the social in terms of race and ethnicity. “As we’re build- and ethical dimensions of emerging infrastructure for a biobank, for example, ing technology and the associated where the samples are already identified using research infrastructure, so as not to racial categories, it’s easy then to just continue perpetuate or create new inequities. using those categories as a stand-in for genetics,” Engaging the ethical, legal, says Dr. Lee. “The downstream effects could be and social implications—ELSI— that researchers use race as a biological variable of precision medicine requires a instead of looking at the socio-cultural aspects of 360-degree perspective. In 2019, those categories.” VP&S reinforced its leadership in Dr. Lee’s work often involves “studying the Sandra Soo-Jin Lee the ELSI field with the appoint- studies” to better understand the ELSI of preci- ment of Sandra Soo-Jin Lee, PhD, sion medicine research. In her National Human as founding chief of a new Division Genome Research Institute-funded study, “The of Ethics in the Department of Medical Humani- Ethics of Inclusion: Diversity in Precision Medi- ties & Ethics. Trained as a medical anthropolo- cine Research,” Dr. Lee and her team observe and gist, Dr. Lee has long investigated the intersection interview investigators, funders, and participants of race, identity, and emerging technology articu- and examine research materials. Through this lated in such questions as, “How does genetics ethnographic research and analysis, the teams impact how we identify as humans and what evaluate how those upstream decisions affect such counts as difference?” downstream outcomes as engagement, retention, Dr. Chung has long wrestled with such questions and participation. Ultimately, she hopes to pro- in her clinical work as chief of the Division of Clin- duce a set of recommendations and guidance for ical Genetics in the Department of Pediatrics. Chief precision medicine research going forward. among the challenges is the lack of diversity in pre- “For many years, there have been people like cision medicine data: Roughly 80% of genetic sam- Sandra who have made issues related to fair rep- ples are derived from people of European ancestry, resentation in genomics part of their research who comprise just 20% of the world’s population. agenda, but there’s no question it’s become more

22 Vagelos College of Physicians and Surgeons salient since the inception of ‘All of Us’ under ELSI-related research, study instruments, policies President Obama,” says Paul Appelbaum, MD, and guidance, and a directory of ELSI research- “HOW DOES who chaired the search committee for the new ers intended to promote collaboration. Columbia GENETICS division chief. While Columbia has hubs of ELSI was set to host the fifth ELSI Congress meeting in IMPACT HOW scholarship, including the Department of Psychia- June, but the event was postponed until June 2022 try’s Center for Research on the ELSI of Psychiat- because of the COVID-19 pandemic. Instead, Dr. WE IDENTIFY ric, Neurologic, and Behavioral Genetics founded Lee, who co-directs the Biennial ELSI Congress, AS HUMANS by Dr. Appelbaum, those efforts have been scat- hosted an abbreviated virtual forum with more tered across departments. “There was no single than 1,000 registrants from 46 countries. The dis- AND WHAT locus around which it coalesced. We wanted some- cussion ranged from new models for the implemen- COUNTS AS one who could bring people together, who had the tation of artificial intelligence in precision medicine skills to be a builder and a leader, and who brought to use of DNA databases by law enforcement and DIFFERENCE?” research skills that would augment the growing frameworks for research collaboration with indig- focus at Columbia on precision medicine,” he says. enous communities. He sees Dr. Lee as a catalyst for interdisciplinary Dr. Lee says she was drawn to Columbia’s collaboration and scholarship across the University institutional commitment to ethics and humani- and around the world. ties, particularly within a medical school setting. Already, Dr. Lee has begun to nourish a broader “Support for dialogue across the humanities and ELSI community. In September 2019, she launched social sciences is unique,” she says. Equally impor- the Center for ELSI Resources and Analysis tant, says Dr. Lee, is the focus on social justice. (CERA), a multi-institutional partnership among “This was an opportunity to build a program that Stanford University, the Hastings Center, and Har- addresses issues of structural racism and inequities vard University, funded by a $7.1 million grant and to bring social science to bear on bioethical from the National Human Genome Research questions in ways that could be creative, genera- Institute. It’s the first international center to house tive, and ultimately impactful.” v

2019–2020 Annual Report | ColumbiaMedicine 23  PHILANTHROPY NEWS HELP FROM OUR FRIENDS

Then, months later, the start of 2020 brought extraordinary, unprecedented, and unexpected change—at VP&S and around the world—as we responded to the COVID-19 pandemic. Despite daily, sometimes hourly, changes on our campus, one thing remained constant: the generosity of our philanthropic partners. The

Roy Vagelos and VP&S scholarship students

AS WE REFLECT on this past the dedication of the newly completed year, we remain more grateful than Cryo-Electron Microscopy Center to ever for the support and leadership events that celebrated our faculty From left: Roy Vagelos, Diana Vagelos, Cheryl Milstein, and Philip Milstein of our friends and partners. The year accomplishments. Additionally, build- began with multiple celebrations and ing on the support of Roy and Diana exciting programmatic activities, from Vagelos, we continued to focus on the tremendous outpouring of support precision medicine initiative and the for COVID-19 research and programs implementation of our robust, first- has funded our world-leading efforts in-the-nation loan-free scholarship to advance knowledge of the novel program. Fall 2019 also saw more than coronavirus and develop more effec- 1,000 riders, volunteers, and supporters tive tests and treatments. gather to celebrate Velocity: Columbia’s In a year where we started out Ride to End Cancer. This third annual together but ended apart, your peer-to-peer fundraising event raised vital philanthropy has allowed us to more than $1.5 million to support continue advancing our shared goal cancer research and patient care at of educating the next generation of Columbia’s Herbert Irving Comprehen- doctors, scientists, and teachers,

From left: Terry Moore, Roy Vagelos, Joachim sive Cancer Center, building upon the while also improving the lives of our Frank, and Michael Purdy at the opening of vision and initiatives supported by the patients, communities, and popula- the Cryo-Electron Microscopy Center late Herbert and Florence Irving. tions. For that, we are grateful.

24 Vagelos College of Physicians and Surgeons Response to COVID-19 As we began our response to COVID-19, friends and supporters from around the world immediately asked how they could help. From donations of PPE and food for our front-line heroes to support for clinical care and research efforts, our friends rallied around us. Donors helped us pivot nimbly to respond to emerging needs and priorities. These priorities included outfitting additional research spaces to allow our scientists to work safely with the live virus, identifying new drug treatments and therapeutics, initiating a clinical trial on convalescent anti-viral compounds. They also are work- financial assistance fund for students in the plasma, building a biobank of samples from ing to develop more effective tests. doctor of physical therapy program. They patients with the virus, providing wellness Other supporters of Dr. Ho’s work also provided vital support for our Depart- resources for our physicians, and conduct- included Panda Cares Foundation, the phil- ment of Emergency Medicine and the ing research to prevent burnout. Supporters anthropic arm of Panda Express, the largest COVID-19 patient care response. also aided our medical students who moved Asian dining concept in the United States. The response we received was far reach- to the front lines as part of our COVID-19 Along with the generous contribution of ing and compelling, involving alumni Student Service Corps. the popular restaurant brand’s co-founders, around the world. In one example, the We extend our gratitude to this large Andrew and Peggy Cherng, Panda Cares’ Asian Columbia Alumni Association har- donor community, with special recognition funding advanced Dr. Ho’s research of nessed the power of the alumni commu- for the significant and generous funding monoclonal antibodies as a treatment or nity across Asia and New York to collect from Shoshana Shendelman’05 PhD and prophylactic against COVID-19. Addi- PPE and raise $2.1 million in cash and her husband, Vlad. Dr. Shendelman is tional funding for Dr. Ho’s research proj- in-kind contributions from more than 300 a member of the Board of Advisors and ects was provided by Carol Ludwig’74 donors. Thomas E. Lo’08, VP&S Alumni founder and CEO of Applied Therapeutics. and the Ludwig Family Foundation, which Association president, and June Wu’96, a This support allowed Columbia to invest contributed toward research on monoclo- faculty member, were among the leaders in critical infrastructure and equipment to nal antibodies and anti-viral compounds of this successful networking and fund- launch a major COVID-19 antibody test- called protease inhibitors. raising effort. ing program for employees and patients. Drs. Roger and David Wu also provided Our friends also gave through innovative The JPB Foundation, Jack Ma Founda- significant funding for Dr. Ho’s research on efforts, including a food donation program tion, Tencent Charity Foundation, and COVID-19. In addition, the brothers estab- to support our front-line heroes, as well as Kwang Hua Educational Foundation were lished a fund for critical research and labo- a crowdfunding campaign for the Center among other funders who also quickly ratory activities led by Michael Yin, MD, for Radiological Research, which advanced responded to support the work of luminary in the VP&S Division of Infectious Dis- cutting-edge research of a new UV light scientist David Ho, MD, director of the eases. The goal of this work is to improve technology to kill airborne viruses. In addi- Aaron Diamond AIDS Research Center at rapid diagnostics for the SARS-CoV-2 virus tion, celebrities such as Stephen Colbert, Columbia. Dr. Ho and his team are leading and improve understanding of the health Kerry Washington, Lin-Manuel Miranda, an effort, in collaboration with researchers effects of the immune response to infection. and others gave their thanks to our front- across campuses and around the world, Support for students was also essential, line heroes through social media. to identify new therapies for COVID-19, with donors such as Drs. Sara M. Zion and We remain grateful for this tremendous including new antibody treatments and Tushar Shah, who established a COVID-19 outpouring of vital support.

2019–2020 Annual Report | ColumbiaMedicine 25  PHILANTHROPY NEWS

Louis and Gloria Flanzer the program, bringing its total contribu- support of programs that focus on women’s Philanthropic Trust Honored tion to the program to $10 million. The cardiovascular health provide an enduring at Crown Awards program has supported cutting-edge tribute to his foresight and generosity. investigations across several clinical areas, At the 10th anniversary Crown Awards including cardiovascular disease, oncology, gala, VP&S honored the Louis and Glo- obstetrics and gynecology, otolaryngology, ria Flanzer Philanthropic Trust for its Estelle P. Bender, MD pediatrics, cerebrovascular disorders such generous gift of $32.5 million to name A gift from Estelle P. Bender’68 established as stroke, and chronic conditions such as the Estelle P. Bender, MD VP&S ’68 and asthma and childhood obesity. To date, 52 T. Richard Fishbein Scholars Fund in the early-career investigators have been named Division of Child and Adolescent Psychia- Gerstner Scholars and six have received try in the VP&S Department of Psychiatry. the Gerstner Merit Award, designed to The fund provides awards to assistant or recognize an outstanding third-year associate professors with preference for Gerstner Scholar. Over the past 12 years, those whose area of study includes research Gerstner Scholars have received more on youth suicide or child and adolescent than $166 million in additional funding. mental health in underserved or minority communities. The first scholar is Claudia Lugo-Candelas, PhD, assistant professor of Andrew Sabin clinical medical psychology (in psychiatry). The Andrew Sabin Family Foundation Dr. Bender serves on the Columbia Psy- has committed $2.5 million to establish chiatry Board of Advisors, the Council for the Andrew Sabin Family Foundation the Advancement of Global Mental Health From left: Eric Kaplan, R. Dean Hautamaki, and Allan Schwartz Cardiovascular Research Laboratory Fund Research, and the Women’s Health Care to support research in the Department Council. She is also a lecturer in psychiatry of Surgery. The gift was matched by at the Columbia University Center for Psy- and endow the Seymour, Paul and Gloria NewYork-Presbyterian Hospital. choanalytic Training and Research. Milstein Division of Cardiology at VP&S. The trust’s support provides clinicians, researchers, and educators with substantial Charles Adler Jim Ovia resources dedicated to advancing the field During his lifetime, Charles Adler was A $2.5 million gift from the Jim Ovia of cardiac medicine. Committed philan- a generous supporter of VP&S, making Foundation has established the Jim Ovia thropists, Gloria and Louis Flanzer cared impactful gifts to the Department of Neu- Professorship of Cardiology. The gift hon- deeply about improving the lives of oth- rology, the Taub Institute for Research on ors Christopher Irobunda, MD, PhD, the ers. Their visionary investment will help Alzheimer’s Disease and the Aging Brain, inaugural Ovia Professor. Dr. Irobunda Allan Schwartz, MD, chief of the division, and the cardiology division. Upon his death has dedicated himself to patient care and and his team advance critical research in in 2019, his estate gave VP&S gifts of education of medical students, residents, cardiovascular disease. Co-trustees of the $4.6 million to support the Department of Trust, Eric Kaplan and R. Dean Hauta- Neurology and $5.4 million for the Taub maki, MD, accepted the award. Columbia Institute. Mr. Adler made several large will continue to partner with Mr. Kaplan contributions during his lifetime, including and Dr. Hautamaki to realize the vision of a gift to establish the Adler Assistant Pro- Gloria and Louis Flanzer. fessorship of Neurological Sciences, held by Elizabeth Bradshaw, PhD. Mr. Adler also gave $2 million to support the recruit- Gerstner Family Foundation ment of a leading physician-scientist in the The Gerstner Family Foundation contin- Department of Neurology. During his life ued to advance the Louis V. Gerstner Jr. and following his death, Mr. Adler’s total Scholars Program at VP&S, after launch- philanthropy to VP&S was more than ing the program in 2008 and providing $15 million. His commitment to the From left: Christopher Irobunda, Marjorie Irobunda, Kay Ovia, and Jim Ovia additional support to sustain and expand research of neurodegenerative diseases and

26 Vagelos College of Physicians and Surgeons Anil K. Rustgi, director of the Herbert Irving Comprehensive Cancer Center (and now interim EVP and dean of the Faculties of Health Sciences and Medicine), welcomes riders at a 2019 Velocity start area.

Doubling the Impact The Crimson Lion/Lavine Family Foundation created a matching gift challenge to help Velocity participants double their impact. Velocity is Columbia’s annual event to raise funds to support cancer care and research. Pictured from left at Velocity 2019 are Columbia University Trustees Co-Chair Jonathan Lavine, Jeannie Lavine, Lee Goldman, Nathan Rosin, and Emily Lavine.

and cardiology trainees. The support from mother, Sharon Golub, who earned a BS pediatric oncology, significant support for Jim Ovia and his family will allow Dr. from Columbia University in 1959 and an pediatric cancer research, monies for the Irobunda to continue his work in cardio- MA in psychology from Teachers College pediatric COVID-19 emergency response, vascular medicine while passing on his at Columbia University in 1966. Sharon and general support for pediatric oncol- skill and knowledge to the next generation Golub was a professor of psychology at the ogy. Under the leadership of board presi- of physicians. College of New Rochelle and a long-time dent Robert Kapito and executive director editor of the journal Women & Health. Mr. Bob Bomersbach, Hope & Heroes has Golub is chief executive officer of Golub built a formidable philanthropic legacy The NVLD Project Capital and a member of the CUIMC at Columbia. Previous Hope & Heroes The NVLD Project, led by Laura Lemle, Board of Advisors. His gift establishes an initiatives include survivorship and psy- PhD, founder and chair, has given a endowment that will support research and cho-social support programs for patients $1 million gift to support work in non-ver- postdoctoral fellowship training in the and families and a pioneering integrative bal learning disability (NVLD). NVLD is laboratory of Anne Moscona, MD, therapies program that offers patients a neurodevelopmental disorder character- VP&S professor of pediatrics, of microbiol- evidence-based complementary care, such ized by deficits in visual-spatial reasoning, ogy & immunology, and of physiology & as nutrition therapy and acupuncture. which has recently been renamed devel- cellular biophysics, director of the Center Hope & Heroes’ generosity this year opmental visual spatial disorder (DVSD). for Host-Pathogen Interaction, and vice will strengthen its legacy and help keep This funding will allow Amy Margolis, chair of basic science research in pediatrics. Columbia’s clinical and research efforts PhD, director of the Environment, Brain, Dr. Moscona and her team are known for in childhood cancer and blood disorders and Behavior Lab for Developmental research on respiratory viruses, including among the best in the country. Visual-Spatial and Learning Disorders in recent studies on COVID-19. the VP&S Department of Psychiatry, to codify and amplify her laboratory’s work Joseph P. Harris Fellowship Fund on DVSD. This includes the identification Hope & Heroes Mr. and Mrs. Jeremiah J. Harris have of neural markers for the disorder and Clinicians and researchers at Columbia committed $1.25 million to establish the development of more effective treatments. who are advancing treatment and devel- Joseph P. Harris Fellowship Fund in the The support also funds work toward the oping cures for childhood cancers have VP&S Seymour, Paul and Gloria Milstein inclusion of DVSD in the Diagnostic and been able to rely on Hope & Heroes Division of Cardiology. The endowment Statistical Manual of Mental Disorders and for decades now. Founded in 1996 by payout from this fund will be used to pro- to build awareness of DVSD. Michael Weiner, MD, professor of pediat- vide fellowship support, with a focus on rics at VP&S, Hope & Heroes is a 501(c) cardiac electrophysiology. This gift honors (3) charitable non-profit embedded in Jose Dizon, MD, a passionate physician- Lawrence E. Golub Columbia. Over the past year alone, Hope scientist who has been part of the Colum- Lawrence E. Golub has made a generous & Heroes has raised more than $8 million bia family since 1991, when he completed donation to support virology research in support of Columbia’s pediatric cancer his cardiology and electrophysiology train- and education in the Department of Pedi- initiatives. These gifts include funding ing. This gift is also made in memory of atrics. The gift honors Mr. Golub’s late to underwrite the fellowship program in Jeremiah’s father, Joseph P. Harris.

2019–2020 Annual Report | ColumbiaMedicine 27 VP&S Research Highlights

Alzheimer’s Disease: Targeting Molecules in Innate Immune Cells

n the Department of Neurology and Aging Brain, and the Institute for Genomic If Dr. Bradshaw and her colleagues can the Taub Institute for Research on Medicine). “We have identified eight validate that the proteins are phosphory- I Alzheimer’s Disease and the Aging genetically associated proteins that may be lated and that the interactions occur in Brain, Elizabeth M. Bradshaw, PhD, has set working together in a tyrosine phosphoryla- situ in the Alzheimer’s disease brain, they her sights on microglia, the resident innate tion signaling pathway in innate immune can then dissect the signaling pathway immune cells of the central nervous system, cells. We now seek to identify the common in vitro to understand functional outcomes in the pathogenesis of Alzheimer’s disease. interacting molecules of these eight pro- and isolate targets for intervention. One “Genetic studies of Alzheimer’s directly teins, which we believe function together in specific target of Dr. Bradshaw’s investi- implicate the involvement of the innate microglia and for which we already have gations is the CD33 protein. “We found immune system,” says Dr. Bradshaw, the strong supporting evidence of a shared a very clear change in the amount of the Adler Assistant Professor of Neurological pathway. Finding a binding partner shared protein on the surface of innate immune Sciences (in Neurology, the Taub Institute by many genetically associated proteins cells based on someone’s genetic back- for Research on Alzheimer’s Disease and the may be an ideal therapeutic target for AD.” ground,” says Dr. Bradshaw. “The influence of this genetic change related to how much full-length CD33 was expressed on the surface of innate immune cells. We then looked at functional outcomes and found a difference in peripheral monocytes, as well as monocytes that we polar- ized, to be more microglia-like in their ability to internalize amyloid beta (Aß). We saw that this was associated with the genetic variation as well. The AD genetic risk led to more full-length CD33, as well as a decreased ability to internalize or to uptake the Aß (1-42) peptide, which is the major constituent of amyloid plaques in the brains of Alzheimer patients.” New preliminary data generated in collaboration with the laboratory of Franck Pol- leux, PhD, professor of neuroscience and principal investigator at Columbia’s Zuck- erman Institute, suggest a role in neuronal synapse remodeling as well. The research team wanted to better understand CD33 and how it could be manipulated therapeutically. “We know that full-length CD33 binds to sialic acid and that the genetic variation dictates how much of two different forms of CD33 you Elizabeth Bradshaw have: One can bind to sialic acid and one

28 Vagelos College of Physicians and Surgeons can’t,” she says. “The genetic variation Dr. Bradshaw. “We are now working on in vitro studies looking at target engage- actually leads to more of the form that can understanding the relationship of these two ment, funding has been provided to accel- bind to sialic acid.” proteins and to see if there is a possible erate the development of a preliminary The researchers conducted an unbiased therapy in creating small molecules that therapeutic first-round molecule. The screen and identified proteins that were disrupts the binding of the two proteins.” small molecule needs to be optimized for being bound to CD33 through sialic acid. Dr. Bradshaw and her colleagues have therapeutic application, but the team’s “We focused on CD45, in particular, since identified small molecules and anti- journey from hypothetical to probable has which is another immune-limited molecule bodies that they think have therapeutic garnered attention from the Alzheimer’s only expressed in immune cells,” adds potential. With promising data from early disease community.

Glaucoma: Accelerating in a mouse model and will Bacteria Engineered as Genetic Discoveries establish a clinical trial to Trojan Horse for Cancer Only about 5% to 10% of further evaluate the efficacy Immunotherapy glaucoma cases have genetic of vitamin B3 and the role Immunotherapy has trans- information that accounts for of metabolism in glaucoma. formed cancer treatment, but the disease. “It is still a wide Other research includes genetic only a handful of solid tumors open area for discovery,” says analysis of individuals with have responded, and systemic Jeffrey M. Liebmann, MD. pigmentary glaucoma; devel- therapy often results in signifi- Dr. Liebmann and a team of opment of a screening process cant side effects. Designing ther- clinicians and ophthalmic for small molecules that can apies that can induce a potent, researchers have launched modulate LOXL1, one of the Israel Fernandez, PhD. The anti-tumor immune response the Brown Glaucoma Genet- genes associated with exfolia- new gene editing tool would within a solid tumor without ics Initiative, a continuum of tion syndrome; and pursuit of improve the current wide- triggering systemic toxicity is investigative and therapeutic sustained-release drug delivery spread use of CRISPR-Cas9 a challenge being addressed projects focused on the dis- for the treatment of glaucoma, to quickly and cheaply make by VP&S and Columbia Engi- covery of novel genes, with such as an injection that lasts a precise modifications to the neering researchers who have the aim of developing treat- year instead of eye drops. genome of a cell. Most uses of engineered a strain of nonpatho- ments for specific subtypes of CRISPR involve cutting both the disease. “For the past two First Images of an strands of the target DNA, and years, we’ve been building our Upgraded CRISPR Tool the DNA break must then be genetics discovery program, Columbia scientists have repaired by the host cell’s own bringing in the requisite spe- captured the first images machinery. Controlling this cialists to help us advance of a new gene editing tool repair process is still a major from the science of genetics that could improve existing challenge in the field, and to the development of clini- CRISPR-based tools. The undesired gene edits are often cal therapies,” says Dr. Lieb- team developed the tool, introduced inadvertently in the mann. Columbia has a long called INTEGRATE, after genome. Additionally, existing history of pioneering work discovering a unique “jump- tools often perform poorly at in glaucoma research, including gene” in Vibrio cholerae inserting large genetic payloads genic bacteria that can colonize ing the development in 1996 bacteria that could insert in a precise fashion. Improving solid tumors in mice and safely of the groundbreaking drug large genetic payloads in the the accuracy of gene editing deliver potent immunotherapies, Xalatan. A new recruit to the genome without introducing is a priority for researchers acting as a Trojan horse that department this year is Simon DNA breaks. Published in and is critical for ensuring the treats tumors from within. The John, PhD, a noted geneticist Nature, the research harnessed safety of therapies developed therapy led not only to complete and glaucoma researcher who cryo-electron microscopy to with this technique. The new tumor regression in a mouse has pioneered the use of mice freeze the gene editing com- INTEGRATE system can model of lymphoma, but also for glaucoma studies. Dr. plex in action, revealing high- accurately insert large DNA significant control of distant, John and his research team resolution details about how sequences without relying on uninjected tumor lesions. The demonstrated that vitamin B3 it works. The research was led the cell’s machinery to repair findings, published in Nature potently prevents glaucoma by Sam Sternberg, PhD, and the strands. Medicine, create a potential for

2019–2020 Annual Report | ColumbiaMedicine 29 VP&S Research Highlights experts to engineer bacteria to dance of specific bacteria in the Biology Shown at the prime tumors locally and then gut within days, but the new Speed of Life stimulate the immune system technique also revealed that The Columbia team behind to seek out tumors and metas- the switch caused wholesale the revolutionary 3D SCAPE tases that are too small to be changes of microbial neighbor- microscope created a new detected with imaging or other hoods. A switch in diet in some version of this high-speed approaches. Nicholas Arpaia, cases eliminated specific regions imaging technology and in PhD, led the VP&S team in of bacteria, suggesting how collaboration with scientists collaboration with Tal Danino, a change in diet may impact from around the world used PhD, of Columbia Engineering. health. The research was pub- SCAPE 2.0 to reveal previ- lished in Nature Biotechnology. ously unseen details of living Faculty Honored for seed funding to six Columbia creatures—from neurons firing Research Excellence cancer researchers conducting In Cystic Fibrosis, Lungs inside a wriggling worm to the Angela Christiano, PhD, Molly early-stage research projects. Feed Deadly Bacteria 3D dynamics of the beating Przeworski, PhD, and Lor- Pseudomonas aeruginosa is heart of a fish embryo—with raine S. Symington, PhD, were Sampling the Neighborhoods a much-feared pathogen that far superior resolution and at elected to the National Acad- of the Gut Microbiome easily colonizes the lungs of speeds up to 30 times faster. emy of Sciences in recognition Composed of hundreds of dif- people with cystic fibrosis and Improvements to SCAPE, of their distinguished and con- ferent species of bacteria, the leads to chronic infections that published in Nature Methods, tinuing achievements in origi- gut microbiome is a complex are almost impossible to eradi- could impact fields as wide nal research. Dr. Przeworski community, with a spatial dis- cate and are ultimately fatal. ranging as genetics, cardiology, also was elected to the Ameri- tribution of microbes that are A VP&S study tries to explain and neuroscience. Elizabeth can Academy of Arts & Sci- not evenly distributed through- why P. aeruginosa, but not Hillman, PhD, explains the ences. Dr. Christiano’s research out the gut. That makes the gut other common bacteria, thrive benefit of faster 3D imaging: focuses on understanding the microbiome like a large city, in the lungs of CF patients. “The faster we can image, the genetic and molecular mecha- with multiple neighborhoods, The answer has to do with the more living processes we can nisms that underlie inherited each with its own mix of occu- bacterium’s culinary preference see, and imaging fast in 3D skin and hair disorders in pants and features. Scientists for succinate, a byproduct of lets us see the whole biologi- humans. Dr. Przeworski’s have developed a way to locate cellular metabolism, that is cal system, rather than just a work aims to understand how and characterize these neigh- abundant in the lungs. Prevent- single plane, offering a clear natural selection has shaped borhoods, which could shed ing infection by P. aeruginosa advantage over traditional patterns of genetic variation light on how microbes influ- microscopes.” For example, and to identify the causes and ence the health of their hosts. SCAPE 2.0 can track individ- consequences of variation in Harris Wang, PhD, led a team ual neurons firing in a whole recombination and mutation that took inspiration from the animal as it crawls around, rates in humans and other way plant ecologists use plot providing insight into how organisms. Dr. Symington sampling to survey sites. Using neural activity guides behavior. studies how the cell repairs small tissue samples from the In cardiology, SCAPE 2.0 can harmful DNA damage. GI tracts of mice, scientists study how the heart develops. added gel to fix the bacteria in Pediatrics researcher Kimara Velocity Ride’s Record Fund place, froze the gel, then broke Targoff, MD, uses zebrafish as Raising Support for Cancer the tissue samples into tiny par- an animal model to decipher More than 1,000 bicyclists, ticles. Each particle preserved the genetic mutations that can volunteers, and supporters the species from a particular cause heart malformations in raised $1.5 million at the third neighborhood. The research- could greatly improve the the embryo. “The problem annual Velocity, Columbia’s ers used new, high-throughput health of people with CF, and with imaging the beating heart Ride to End Cancer, in Octo- techniques to process the the study, led by Alice Prince, is that it beats fast, chang- ber 2019. The event raises data and identify all the spe- MD, suggests it may be pos- ing its shape as blood flows funds to support research and cies present on each separate sible to control infection by through it in a wide range of patient care at the Herbert particle, testing the technique targeting the bacteria’s use of directions,” says Dr. Targoff. Irving Comprehensive Can- with mice who switched from a succinate in the lung. Find- “With SCAPE 2.0, we can cer Center. The money raised low-fat to a high-fat diet. Diet ings were published in Science image the zebrafish embryo’s was used, in part, to provide is known to change the abun- Translational Medicine. beating heart in 3D and in real

30 Vagelos College of Physicians and Surgeons time, allowing us to see how made it possible to examine of dysfunctional cells, in calcium signals communicate these cells in unprecedented combination, triggers a cascade between heart cells, how the detail, and a team led by Serge of events that can lead to brain heart wall contracts, or how Przedborski, MD, PhD, will inflammation and, eventually, red blood cells flow through use a new center grant from nerve cell death. By analyzing the cardiac valves beat after the Parkinson’s Foundation to the genomes of 115,803 beat. Using this knowledge, launch the first comprehensive individuals—47,429 MS we can track how genetic look. Some evidence suggests patients and 68,374 healthy that another type of brain individuals—the researchers cell, microglia, may act as identified 233 genetic variants an accomplice of sorts in the that contribute to the onset death of dopamine neurons in of MS and analyzed the the substantia nigra compacta. The researchers repurposed downstream effects of these Microglia have been difficult a drug currently in develop- variants to determine the to study in the lab because ment for leukemia to repair sequence of molecular events they change rapidly when the mouse model’s dysfunc- in each immune cell type removed from the brain. But tional brain cells. The findings, that eventually perturb the laboratory and computational published in Neuron, chal- function of these immune techniques developed in the lenge the generally accepted past few years have made such belief that cellular disruptions studies possible. Single-nuclei underlying memory issues sequencing will give research- in schizophrenia cannot be ers in-depth details about what repaired once symptoms arise. is happening in thousands of “Schizophrenia is thought to mutations affect cardiac devel- individual neurons, microglia, be a neurodevelopmental dis- opment in an environment and other brain cells from order that begins years before that recapitulates the heart’s Parkinson’s patients. The data it can be diagnosed, mak- natural state.” One of several collected from these cells will ing the disease’s underlying projects under development be analyzed with a machine aspects extremely difficult to by Dr. Hillman’s team is a learning technique developed understand and treat,” says the cells and make them attack miniaturized version of SCAPE by the project’s bioinformat- study’s leader, Joseph Gogos, the brain and spinal cord. for medical use, to quickly dis- ics team to compare cells in MD, PhD. “We have shown The study, led by Philip L. De tinguish between healthy and healthy brain regions with cells a promising way forward—a Jager, MD, PhD, on behalf diseased cells within a patient’s from regions affected by Par- way to use knowledge from of the International Multiple body, which will give doctors a kinson’s. Ultimately, the goal genetic studies to identify Sclerosis Genetics Consortium, new way to guide how to per- of this project is not only to drugs that restore normal cog- was published in Science. form complex surgeries in the gain insights into understand- nitive and cellular function in operating room. ing why and how specific neu- the adult brain after the onset How Skin Senses Temperature rons are dying in Parkinson’s of disease.” Researchers have captured First Comprehensive but also to translate this new new detailed images of a Look at Neurons in knowledge into effective thera- MS: Genome Map Shows temperature-sensing molecule Parkinson’s Disease pies for this common disorder Many Peripheral and Brain in its open, intermediate, and Researchers have long tried to of the aging brain. Immune Cells Implicated closed states. The findings, understand why Parkinson’s A new study of susceptibility published in Nature Structural disease singles out some spe- Scientists Reverse to multiple sclerosis has and Molecular Biology, eluci- cific population of neurons Core Symptom of produced a genomic map of date the understanding of the such as dopamine-producing Schizophrenia in Mice the disease, which reveals that mechanics of hot, warm, cool, neurons in a small region deep Researchers restored normal MS begins with dysfunction and cold sensation and could inside the brain known as the working memory to a mouse in many different types of accelerate the development of substantia nigra compacta model of schizophrenia, elimi- immune cells throughout the drugs for a variety of condi- while largely sparing neighbor- nating a core symptom of the bloodstream and brain—not tions, including inflammatory ing dopamine neurons else- disorder that, in people, has only in lymphocytes, as had skin disease, itch, and pain. where. New techniques have been nearly impossible to treat. been thought. The array Perception of temperature and

2019–2020 Annual Report | ColumbiaMedicine 31 VP&S Research Highlights pain is controlled by special- standing a protein’s structure the parasite to expel drugs. ized sensory neurons. In the using cryo-EM imaging. The The new discovery may help late 1990s, scientists discov- resulting images revealed the scientists find ways to restore ered a superfamily of mol- structural changes that happen antimalarial potency and will ecules, called transient receptor in TRPV3 once it is activated allow health officials in other potential (TRP) channels, by heat. In another study pub- parts of the world to monitor inside these neurons. Of the lished in Nature Communica- for emerging resistance. 28 known TRP channels, 11 tions, Dr. Sobolevsky’s team are highly sensitive to changes used cryo-EM to determine the Contagious Cancer in in temperature. These “ther- structure of crTRP1, a ther- Shellfish is Spreading moTRPs” open and close in moTRP found in Chlamydo- Contagious cancers discovered response to temperature fluc- monas reinhardtii, a type of in shellfish have spread algae, the first time the struc- across the Atlantic Ocean ture of a thermoTRP has been and even into the Pacific. So described in a micro-organism. far, scientists have observed how cancer cells metastasize contagious cancers in three within humans could help New Images Show types of animals—Tasmanian physicians find ways to prevent How Malaria Parasites devils, dogs, and shellfish— cancer metastasis. Evade Drugs and none of these cancers can Malaria parasites are rap- be transmitted to humans. Heart Disease and Marijuana idly developing resistance to Researchers in the lab of Although the effects of smok- front-line drugs, threatening Stephen Goff, PhD, were the ing marijuana on the heart are to undo years of progress in first to discover contagious not fully understood, some reducing deaths from the dis- cancers in marine animals. studies suggest that marijuana tuations, allowing ions to pass ease. New pictures of a key In four species of bivalves can trigger heart attacks and through and transmit signals mediator of drug resistance (including clams, mussels, strokes in some users. Ersilia to the central nervous system. for the parasite Plasmodium and cockles), researchers DeFilippis, MD, led a team “How these channels sense falciparum—captured with found that cancer cells could that reviewed the medical temperature and then subse- single-particle cryo-electron travel through seawater literature to find out what quently undergo changes at the microscopy by a team of scien- from one animal to another is known and yet unknown molecular level has remained tists at VP&S—are providing to spread the disease and about marijuana’s effect on a puzzle,” says study leader clues about how to combat “infect” a different species. the heart. The report, pub- Alexander I. Sobolevsky, PhD. resistance. The study, co-led by In some mussel colonies, the lished in the Journal of the Since cryo-electron microscopy David Fidock, PhD, Matthias cancer was so contagious American College of Cardiol- was first used in 2013 to image Quick, PhD, and Filippo Man- that it had infected 13% of ogy, estimates that about representatives of the TRP the population. Researchers 2 million adults in the United channel family, almost every in this study, published in States who have cardiovascular type of TRP channel has been eLife, collaborated with disease use or have used mari- imaged. Scientists were unable marine biologists in South juana. With the potency of to capture cryo-EM images America and Europe and marijuana increasing steadily of thermoTRP channels at found cases of contagious over the past 30 years—from different temperatures—par- cancers in different mussel about 4% in the mid-1990s ticularly high temperatures, species along the coasts of to 12% in 2014—concern when heat-sensitive channels Argentina, Chile, France, and about the effect of marijuana are activated—but the new the Netherlands. Research on on the heart is warranted, study identified a mutation in how contagious cancers spread Dr. DeFilippis says. “Higher one of these channels, TRPV3, in shellfish will help biologists potency may translate into that increases its sensitivity cia, PhD, was published in develop more effective plans greater effects on the conduc- to temperature. By exploiting Nature. The study shows that to protect marine life. And tion system, the vasculature, this mutation, the team was multidrug resistance in P. fal- though transmissible cancers in and the muscle of the heart. able to fix the channel in open, ciparum is linked to a specific shellfish do not pose a threat to Although we need more data, sensitized, and closed states, transporter and illustrates how humans, parallels between how the evidence we do have indian essential step in under- mutations in this protein allow cancers spread in the ocean and cates that marijuana use has

32 Vagelos College of Physicians and Surgeons been associated with coronary The researchers have revealed locking the protein in an inac- symptoms. A genetic analysis artery disease, arrhythmia, that modifications to the tau tive state. The structure also uncovered a link between the cardiomyopathy, and more.” protein may influence the dif- reveals that a calcium ion and appearance of amyloid deposits ferent ways it can misfold in two phospholipids could play and APOE, a known Alzheim- Funding Innovative Research a person’s brain cells, differ- key roles in the receptor’s func- er’s gene, and the novel link to in Children’s Health ences that are closely linked to tion. The GABAB structure the RBFOX1 gene. A new Innovation Nucleation the type of neurodegenerative helps researchers understand Fund in the Department of disease that will develop—and how the receptor maintains its Feared Pathogen Turns Our Pediatrics will provide start-up how quickly that disease will inactive state and serves as a Lung Defenses Against Us funding for pediatrics research- spread throughout the brain. template for future drug design Superbug Pseudomonas aeru- ers, bringing a venture capital The study, published in Cell, ginosa resists many antibiotics approach to supporting new employed two complementary and often causes intractable research in children’s health. techniques to map the struc- pneumonia and death when “The Innovation Nucleation ture of tau and decipher the it infiltrates the lungs. A Fund allows our talented effects of additional molecules, new study led by Sebastián faculty the freedom to pur- called post-translational modi- Riquelme, PhD, and Alice sue innovative, bold ideas in fications (PTMs), on its sur- efforts. The research, led by Prince, MD, has revealed research that could lead to the face. These new insights could Oliver B. Clarke, PhD, Joachim how P. aeruginosa uses our next major breakthrough in help researchers identify new Frank, PhD, and Qing R. Fan, own immune defenses to children’s health,” says Jordan biomarkers that detect these PhD, was published in Nature. multiply and persist in our S. Orange, MD, PhD, chair of disorders before symptoms lungs. Our immune system the Department of Pediatrics. arise and design new drugs Alzheimer’s: New Gene May should fight off P. aeruginosa that target specific PTMs to Drive Earliest Brain Changes as it does other bacteria, but Tau Protein Exposed prevent the onset of disease. A newly discovered Alzheim- P. aeruginosa often resists in New Detail Scientists previously used tra- er’s gene may cause the first these defenses and becomes Scientists have struggled to ditional imaging techniques to appearance of amyloid plaques entrenched in the lungs inside understand how the pro- find clues to how tangles of tau in the brain, according to a an impenetrable biofilm. tein tau, long implicated are implicated in disease, but study led by Richard Mayeux, The research, published in in Alzheimer’s and a host this study used cryo-electron MD, and published in JAMA Cell Metabolism, shows that of other debilitating brain microscopy and mass spec- Neurology. Some variants of P. aeruginosa can sidestep an trometry to reconstruct the the gene, RBFOX1, appear to antibacterial substance—called structures of tau filaments and increase the concentration of itaconate—that normally helps provide new insights into how protein fragments that make up in the fight against pathogens, they form, grow, and spread the amyloid plaques and may ultimately adapting to generate throughout the brain. contribute to the breakdown a self-perpetuating bacterial of critical connections between community. “By identifying Cryo-EM Reveals A neurons, another early sign the mechanisms by which Molecular “Latch” that of the disease. In recent years, these organisms adapt and Controls Neuron Activity amyloid PET brain imaging has exploit our defenses,” says Scientists have captured a helped to reveal that the first Dr. Riquelme, “it is conceiv- near complete snapshot of the signs of Alzheimer’s disease— able that targeting these very gamma-aminobutyric acid deposits of amyloid in the adaptations may allow us to (GABA) B receptor, a protein brain—appear as early as 10 combat such infectious agents diseases, converts from its that regulates neuronal activity. or 15 years before symptoms and prevent the devastating normal, functional form into Defects in the GABAB receptor of the disease appear. To find diseases they cause.” a misfolded, harmful one. are closely related to neurologi- genes that drive early amyloid Researchers, led by Anthony cal and psychiatric disorders, accumulation, the research- “Silent” Genetic Changes May Fitzpatrick, PhD, in col- including epilepsy, addiction, ers examined the genomes Impact Human Health laboration with researchers at depression, and schizophrenia. of 4,300 people whose PET New analyses of tens of Mayo Clinic in Florida, used The high-resolution structure images revealed varying thousands of people show cutting-edge technologies to shows how different sub- degrees of amyloid deposi- that genetic changes previ- see tau in unprecedented detail units of the receptor are held tion in the brain but who had ously believed meaningless, in brain tissue of patients. together with a unique “latch” not yet developed Alzheimer’s or “silent,” may in fact play

2019–2020 Annual Report | ColumbiaMedicine 33 VP&S Research Highlights an important but overlooked expression levels change. In The images challenge a long- flow as tumors grow and role in human diseases, includ- BRCA1, for example, a gene held theory in the ion channel infiltrate the surrounding ing breast cancer. These silent well-known for causing breast field, which suggests that the brain. “Neuro-oncologists have genetic changes were first and ovarian cancer, the study activation gate is located at the focused on developing ways discovered when researchers found that mutations that external entrance of CNG chan- to selectively kill glioma cells, in the 1960s cracked the DNA reduce codon optimality may nels, and provide a blueprint but we are also interested in code. DNA gives cells instruc- impact the levels of the encoded for mapping the locations of understanding how infiltrating tions for making proteins in protein and possibly play an disease-causing mutations and glioma cells change the way strings of three-letter segments, important role in the disease. elucidating how the mutations that the brain functions. We called codons; each codon cor- alter CNG channel structure believe that this approach responds to a particular amino New View Emerges of Ion and function. The research team can lead to new treatments acid in the protein. But with 64 Channel Linked to Blindness included Joachim Frank, PhD, for this terrible disease,” says possible codons and only 20 Researchers have generated who received a Nobel Prize for Dr. Canoll. The results were amino acids, most amino acids high-resolution 3D images of an development of cryo-EM. published in Cell Reports. are encoded by several differ- ion channel that is essential for ent codons. That redundancy vision and smell in vertebrates. Neural Basis for Starving Pancreatic means some DNA mutations Cyclic nucleotide-gated (CNG) Sugar Cravings Cancer of Cysteine will not change the amino acid channels convert electromag- A study in mice has shown that A drug in development for a sequence of the protein. Geneti- netic and chemical signals into the brain responds not only rare kidney stone disease may cists have generally ignored electrical signals in the eye and when sugar touches the tongue have potential value in treating these synonymous DNA muta- nose, which are transmitted but also when it enters the gut. pancreatic cancer by starving tions, but recent studies have Discovery of the specialized tumors of an amino acid, cys- shown that synonymous muta- gut-brain circuit offers new teine, found to be critical to the tions can influence the amount insight into the way the brain survival of pancreatic cancer of protein that is produced; and body evolved to recognize cells. The study, conducted in so-called “optimal” codons and seek out sugar. The find- mice with pancreatic cancer, are faster for cells to process ings, reported in Nature, lay was published in Science and and lead to increased protein the foundation for new ways to led by Kenneth P. Olive, PhD, production. Testing the idea modulate the gut-brain circuit, and his PhD student, Michael that synonymous mutations are suggesting new paths to reduc- Badgley. Most pancreatic not meaningless requires mas- ing overconsumption of sugar. tumors ramp up the production sive amounts of genetic data, The study was led by Charles of oxidants that can kill many which has only recently become Zuker, PhD, and builds upon normal cells, but pancreatic available as more people have to and processed by the brain. decades of work to map the tumors thrive under these toxic their genomes sequenced. Mutations in CNG chan- brain’s taste system. conditions by importing large In a new study, led by Ryan nel genes are associated with amounts of cysteine into their Dhindsa, PhD, and David degenerative visual disorders Brain Tumor Growth: How cells. “Since pancreatic tumors Goldstein, PhD, and published that cause blindness or color Glioma Cells Advance appear to depend on cysteine in the American Journal of blindness. The research, pub- It is well known that gliomas, import for their survival, we Human Genetics, researchers lished in Nature Structural & a common type of brain tumor, hypothesized that it might tapped into databases contain- Molecular Biology, used cryo- can cause seizures, but a team be possible to selectively kill ing nearly 200,000 human electron microscopy to study of Columbia engineers and genomes and found the first the structure of TAX-4, a CNG cancer researchers has found clear evidence that natural channel found in roundworms new evidence that glioma- selection favors synonymous that is related to the human induced seizures can spur the mutations that improve opti- variant. The resulting images of tumor’s deadly progression. mality. A closer gene-by-gene the structure reveal for the first Researchers, led by Elizabeth analysis confirmed that genes time how the channel is acti- Hillman, PhD, and Peter that are more intolerant to vated: When cyclic nucleotide Canoll, MD, PhD, used a tumor cells by targeting this changes in synonymous codons molecules bind to the outside novel mouse glioma model amino acid,” says Dr. Olive. include those associated with of the channel, a double-barrier and brain imaging technology The strategy worked: When cancer, as well as those that gate located 5 nanometers away to track real-time changes in the gene that controls cysteine cause disease when their in the central cavity opens. neuronal activity and blood import was knocked out in mice

34 Vagelos College of Physicians and Surgeons with pancreatic cancer closely answered questions regarding congenital urinary tract malfor- facility that generates organoids resembling human tumors, the risks/benefits of CyberKnife and mations. “We are like detectives from different tissue types. tumors stopped growing. More- the likelihood of pursuing this going back in time and looking He cites the Cancer Genome over, some cells in the tumors versus other prostate cancer at genetic models to try and find Atlas, a project of the National died from an oxidative form of treatments. “We found that out what was the first thing that Cancer Institute that catalogs cell death, called “ferroptosis,” respondents who viewed scien- went wrong in development,” discovered almost a decade ago tific information were less likely adds Dr. Mendelsohn. By iden- by Columbia’s Brent Stockwell. to agree CyberKnife is superior tifying the gene mutations, the The researchers in the Science regarding impotence and uri- research could help physicians study achieved similar results nary dysfunction, and those determine which patients need when the mice were treated who viewed the advertisement surgery and understand what genetic mutations responsible with cysteinase, an experimen- and the advertisement with dis- mutation may be a problem in for cancer. “That information tal drug under development claimer were more likely to con- the future. is in the public domain. We elsewhere, that breaks down sider CyberKnife superior. The use it all the time. My hope is cysteine in blood. reality is much more muddled Patient-Derived Organoids that we can accomplish a simi- because patients’ disease risk Organoid models have grown lar atlas, sharing information Assessing the Impact and susceptibility to side effects in popularity among researchers across the country.” of Mixed Messages in vary greatly, and there is limited who seek methods to accelerate Prostate Cancer comparative evidence between the pace of drug screening to New Cellular Machinery Urologists treating patients stereotactic body radiation ther- identify more precise treatment Science Advances published a tested for prostate cancer favor apy, or CyberKnife, and other options. Organoid research at report of microscopic and bio- an approach that includes dis- therapies,” says Dr. Hyams, Columbia includes testing meth- chemical evidence of a novel, cussion about risks and benefits whose studies were published in ods to improve an organoid’s mobile form of the endoplasmic of screening and to individualize Urology and in Prostate Cancer congruence to human cells, reticulum. Dubbed ribosome- that discussion based on age, and Prostatic Diseases. testing an increasing number associated vesicle (RAV), the family history, ethnicity, and of tumor types, and develop- newly discovered organelle other factors that can affect Urinary Tract Defects ing a comprehensive atlas of all was directly visualized using a risk. Internet-based sources and Understanding the genetic organoids to help researchers combination of live-cell micros- consumer advertising obscure origins and complications of expedite their applications to copy and in situ cryo-electron the risk versus benefit messaging urinary tract abnormalities is a clinical care. With success in tomography in several secretory for men with regard to treat- research focus of developmen- developing organoid culture cell types, including pancreatic ment options. Elias S. Hyams, tal biologist Cathy Lee Men- approaches in prostate cancer, β-cells and neurons. Found MD, and his urology faculty delsohn, PhD. “Historically, Michael M. Shen, PhD, and primarily in the cell periphery, colleagues searched the Inter- developmental biologists have his research team have gener- RAV seems to play a role in net for information regarding worked in mouse models look- ated patient-derived bladder local protein translation, sug- “ablative” therapies for prostate ing at congenital abnormalities organoids, applying methods gesting a mechanism by which cancer and found substantial that affect a number of different and concepts from stem cell secretory cells throughout the inaccurate and incomplete infor- organs at the same time–kidney, and developmental biology to a body provide instantaneous, mation from both academic ureter, bladder, and urethra,” translational problem. A team localized response to activity and private practice websites. says Dr. Mendelsohn. She works led by Herbert Irving Compre- among cells and a means by In a study of the influence of with nephrologists Jonathan hensive Cancer Center Director which local translation can advertising on decisions about M. Barasch, MD, PhD, and Ali Anil K. Rustgi, MD, has created be rapidly activated at nerve treatment with stereotactic body Gharavi, MD, in Columbia’s esophageal cancer organoids junctions. The work provides radiation therapy, the research- George O’Brien Urological for both squamous cell carci- proof of concept of novel, high- ers randomly assigned 400 men, Center, which brings together noma and adenocarcinoma and resolution imaging techniques ages 40-80, to one of four arms research programs in human developed protocols to initiate, and suggests fresh treatment of an online survey they created: genetics and mouse models to grow, passage, and characterize strategies for diseases that trace a CyberKnife advertisement, address the causes of congenital patient-derived organoids of their roots to disruptions in the same CyberKnife advertise- urinary tract malformations. esophageal cancers. With the chemical signaling, including ment with disclaimers, scientific Their collective investigations number of patient-derived 3D schizophrenia, Parkinson’s, and information obtained from focus on identifying genetic organoids increasing for numer- diabetes. Columbia researchers peer-reviewed literature, and an mutations in mice that, in ous cancers, Dr. Rustgi is pursu- on the team included Joachim unrelated control ad. Subjects humans, are linked to causes of ing development of a centralized Frank, PhD.

2019–2020 Annual Report | ColumbiaMedicine 35 VP&S Clinical Highlights

In the Eye of the COVID-19 Storm

s COVID-19 began to sweep clinic, and development of an obstetric Hospital, describes how universal screen- through New York City in intensive care unit. Faculty published the ing developed. A early March, Department of first U.S. scientific investigations of the “We started to recognize early on that Obstetrics & Gynecology faculty moved virus related to OB patients. women presenting to the hospital from swiftly to initiate programs and protocols Dena Goffman, MD, professor of our community may have been exposed to to protect patients, their babies, and staff. obstetrics & gynecology at VP&S, chief COVID-19,” says Dr. Goffman. “While Programs included universal screening for of obstetrics for Sloane Hospital for we were telling everyone else to stay home, all pregnant patients being admitted to the Women, and associate chief quality officer these women had to come in for routine hospital, creation of a virtual COVID-19 for obstetrics for NewYork-Presbyterian care. In early March, we spent a lot of time brainstorming how to handle this, but on March 13, we had our first diagnosed case of COVID-19 in an OB patient. And then things escalated very quickly. “Our first OB patient diagnosed with COVID-19 was not yet due to deliver and was initially managed as an outpatient,” continues Dr. Goffman. “A week later, two women who were presenting for routine labor and delivery care and who were asymptomatic were screened at several points when they entered the hospital and before arriving at Labor and Delivery. Our nurses went through a symptom list and each woman had a temperature check. Everything was negative, normal. No complaints. No contact. No issues.” These two women then developed symptoms and became ill—one during delivery and the other while on the post- partum unit—then tested positive for COVID-19. “We had been caring for them for days without additional precautions or PPE. This was a huge wake-up call that we could have women presenting for routine obstetric care who didn’t screen positive based on any of the screening questions and could then expose upwards of 30 staff and team members to the virus. We realized that we had to do something different and quickly,” says Dr. Goffman. “That happened on a Friday. Starting on Sunday, we began universal testing with Dena Goffman nasopharyngeal swabs and a quantitative

36 Vagelos College of Physicians and Surgeons PCR test of all OB patients coming into who were positive for SARS-CoV-2 at and babies very closely,” says Dr. Goffman. Labor and Delivery.” admission (87.9%) had no symptoms of She describes the collective efforts that In a letter to the editor of the New COVID-19 at presentation.” accomplished so much during the height England Journal of Medicine published Adds Dr. Goffman: “With universal of the pandemic in New York City. “There on April 13, 2020, Dr. Goffman and her swabbing we were identifying 13% to was incredible collaboration from multiple colleagues detailed results of the universal 15% of patients being admitted to Labor disciplines required to take care of preg- testing of 215 pregnant women who deliv- and Delivery who were COVID-19 posi- nant women with a new condition that ered at NewYork-Presbyterian/Columbia tive that we would not otherwise have we knew nothing about just a few months and NewYork-Presbyterian Allen Hospital known about. This was important data earlier. It was all hands on deck. We were between March 22 and April 4, 2020: supporting the use of appropriate PPE taking care of patients. We were review- “All the women were screened on and helping us to make decisions about ing the literature daily. We were meeting admission for symptoms of COVID-19. caring for the newborn. There are also daily. We were writing guidelines by day Four women (1.9%) had fever or other many downstream effects—the rooms you and manuscripts by night to help inform symptoms on admission, and all four place patients in, the precautions you use. others. We participated in New York State women tested positive for SARS-CoV-2. We were very glad that we had made the webinars. We were invited to other states’ Of the 211 women without symptoms, decision for universal screening and made perinatal quality collaboratives across all were afebrile on admission. Nasopha- it quickly so that we could put safe pro- the country to share what we were see- ryngeal swabs were obtained from 210 cesses in place.” ing in the hope that they might be better of the 211 women (99.5%) who did not The team has now cared for hundreds of prepared when it got to them. And really, have symptoms of COVID-19; of these women with no cases of symptomatic verti- throughout the whole experience, all we women, 29 (13.7%) were positive for cal transmission in utero. “That’s reassur- were trying to do was our best to keep our SARS-CoV-2. Thus, 29 of the 33 patients ing, but we continue to follow these moms patients safe and our team safe.”

Physical Rehab Goes Virtual modifications (of particular clinical visits for hospital retinal vein occlusion, a major When the number of COVID- help for patients who required and professional billing and cause of blindness for millions 19 patients was at its highest, treatment with a ventilator to provide patients with a of adults worldwide. Nature the Department of Rehabilita- during their hospitalization). single integrated record across Communications published tion & Regenerative Medicine After patients were discharged Columbia, Cornell, and all findings from a study in mice developed a holistic virtual from the hospital, a reha- NewYork-Presbyterian sites rehabilitation program to bilitation doctor provided a to improve the continuity of help recovered patients com- telehealth video evaluation, fol- care among the institutions. bat lingering issues, such as lowed by a telehealth therapy All parts of NYP, Cornell, and weakness, shortness of breath, evaluation to allow patients to Columbia will be fully inte- memory loss, anxiety, and begin home-based exercise pro- grated into Epic by Dec. 31, depression, after release from grams with telemonitoring. The 2021. Epic, a company that has the hospital. Rehabilitation patient’s physician and therapy been in business since 1979, teams of physicians, psycholo- team monitored the patients provides electronic medical gists, and therapists offered for symptoms to ensure that record software for most of the that suggest that the experi- outpatient rehabilitation that the exercise program was done nation’s leading hospitals and mental therapy—which targets made use of a rehabilitation safely at home. academic medical centers. The a common cause of neurode- doctor and a physical, occupa- company awarded Columbia generation and vascular leak- tional, or speech therapist to A New Medical Record and its partners nine gold stars age in the eye—could have help patients regain strength Columbia launched a new (out of 10) in a program that broader therapeutic effects and address individual medi- integrated electronic medical measures usage and adoption than existing drugs. Carol M. cal needs during the stages of record—Epic—on Feb. 1 after success of the EMR system. Troy, MD, PhD, led the stud- recovery. The program focused years of preparation. More ies, which found that a highly on breathing exercises, muscle than 18,000 health care pro- Eye Drops May Prevent selective caspase-9 inhibitor, strengthening exercises, activi- fessionals and staff members Common Cause of Blindness delivered in the form of eye ties of daily living, and swal- are using Epic to document Eye drops developed at VP&S drops, improved a variety of lowing exercises and/or dietary inpatient and ambulatory could prevent vision loss after clinical measures of retinal

2019–2020 Annual Report | ColumbiaMedicine 37 VP&S Clinical Highlights function in a mouse model of logic Surveys on Alcohol and Recommended Diuretic ing can force a lot of people to the condition. The treatment Related Conditions in 2001- and Side Effects deal with challenging issues. reduced swelling, improved 2002 and 2012-2013 and com- Chlorthalidone, the guideline- These test results do not just blood flow, and decreased neu- pared nonmedical cannabis recommended diuretic for affect one person; they affect ronal damage in the retina. use patterns in adults with and lowering blood pressure, the whole family. But if you without pain (approximately causes more serious side effects can identify the underlying Undersized Airways 20% of participants in both than hydrochlorothiazide yet cause, then you can treat the and COPD surveys had moderate to severe is no more effective in reduc- person and also identify who Though COPD is often linked pain). Nonmedical marijuana ing blood pressure complica- may be at risk in the family for to smoking, one in four cases use increased from about 4% tions in real-world practice, developing these diseases or occurs in people who have in 2002 to 9.5% in 2013, and found a study led by George disorders.” Depending on the never smoked. A study of those with pain were signifi- Hripcsak, MD, and published results of the clinical genetic lung anatomy—CT scans of cantly more likely to engage in in JAMA Internal Medicine. testing, the patients may have more than 6,500 adults— frequent nonmedical cannabis The researchers found that opportunities to be involved in found that people with small use than those without pain patients taking chlorthalidone research projects and clinical airways relative to their lungs’ (5% vs. 3.5%). The risk of had nearly three times the risk trials at Columbia, including volume, a relationship termed cannabis use disorder was also of developing dangerously clinical trials for therapies and dysanapsis, are at increased significantly higher in those low levels of potassium and a identifying new genetic causes risk of COPD. “Our findings with pain (4.2% vs. 2.7%). greater risk of other electrolyte for ophthalmic disease. suggest that dysanapsis is a imbalances and kidney prob- major COPD risk factor, on Poor Sleep and Diet lems compared with those tak- Robotic Cane for Help par with cigarette smoking,” Studies have shown that peo- ing hydrochlorothiazide. The in Walking says lead author Benjamin ple who get less sleep are more study of 17 years of data on By adding electronics and com- M. Smith, MD. “Dysanapsis likely to develop obesity, type more than 730,000 individu- putation technology to a sim- is believed to arise early 2 diabetes, and heart disease als treated for hypertension is ple cane that has been around and that the relationship may the largest multisite analysis since ancient times, researchers be partially explained by diet. directly comparing the two transformed the cane into a But the studies were narrowly antihypertensive drugs in the 21st century robotic device focused on specific foods or general patient population. that can provide light-touch nutrients (fish, sweets, or satu- “Until we have more studies assistance in walking to the rated fat) or only measured directly comparing the two aged and others with impaired sleep duration, not sleep qual- diuretics, we don’t really know mobility. A team of mechanical ity. Findings in a new study whether the risk of the side engineering and rehabilita- in life. Understanding the designed to get a more com- effects seen in observational tion & regenerative medicine biological basis of dysanapsis prehensive picture in women studies outweighs the potential faculty, led by Sunil Agrawal, may one day lead to early by examining associations cardiovascular benefits,” says PhD, demonstrated the ben- life interventions to promote between overall diet quality Dr. Hripcsak. efit of using an autonomous healthy and resilient lung and multiple aspects of sleep robot that “walks” alongside development.” The research quality were published in the Clinical Genetics of a person to provide light-touch was published in JAMA. Journal of the American Heart Eye Disease support, much as one might Association. The findings Applied Genetics at Colum- lightly touch a companion’s Adults with Pain at Greater among the nearly 500 women bia Ophthalmology enables arm or sleeve to maintain bal- Risk for Cannabis Use Disorder studied: Women with worse patients to pursue clinical ance while walking. Nonmedical cannabis use— sleep quality consumed more genetic testing and interpreta- including frequent or problem- of the added sugars associated tion of the testing by experts. Genetic Testing for Parkinson’s atic use—is significantly more with obesity and diabetes; Megan Soucy, MS, CGC, Mutations in several genes common in adults with pain, women who took longer to fall a genetic counselor, meets increase the risk of Parkinson’s according to findings published asleep ate more calories and with the patient and/or fam- disease, but genetic testing was in the American Journal of food by weight; and women ily before and after testing. rarely offered until recently Psychiatry. Researchers, led with severe insomnia ate more “Genetic mutations are very when studies showed that gen- by Deborah Hasin, PhD, ana- food and fewer “healthy” complicated and can affect otype can help better estimate lyzed data on marijuana use fats. The research was led by multiple parts of the body,” the rate of disease progression. from the National Epidemio- Brooke Aggarwal, EdD. says Ms. Soucy. “Genetic test- New drugs designed for people

38 Vagelos College of Physicians and Surgeons with specific Parkinson’s genes The research was published in research teams that include only reinforces parents’ beliefs have entered clinical trials, the Proceedings of the National Jeffrey Kysar, PhD, and Anil about vaccination and can even including one at Columbia. Academy of Sciences. Lalwani, MD, the microneedle reduce the number of vaccine- “From our own genetic studies, has a shaft the thickness of hesitant parents who intend I realized many people were Getting to the Heart of Norms a human hair and the tip to get their kids vaccinated.” eligible to enroll in such trials, for Elite Female Athletes a radius less than 1% of a Researchers in this study, pub- but they didn’t know it because A study of 140 WNBA play- human hair’s thickness. The lished in Pediatrics, found that nobody told them about their ers shows how hearts adapt ultra-sharp tip can pierce the nearly 75% of children whose genetic status,” says Roy N. to intense physical training inner ear’s tiny membrane parents were given a fact sheet Alcalay, MD. His idea was and provides physicians with because it pushes aside—rather were vaccinated before the end championed by the Parkinson’s a frame of reference when than cuts—the membrane’s of the season compared with Foundation, which launched screening for cardiac prob- structural fibers. A single per- about 65% of children who PD GENEration to offer free lems in female athletes. The foration in the membrane of received usual care. genetic testing and counseling research resulted from a long- guinea pigs let drugs delivered to patients diagnosed with standing collaboration among to the middle ear quickly dif- New Center Combats Parkinson’s at Columbia cardiologists and researchers at fuse into the inner ear. Perfora- Substance Use Disorders and other centers across the VP&S, NewYork-Presbyterian, tions begin to heal over 24 to The New York State Psychi- nation. The study, which added the National Basketball Asso- 48 hours, with complete clo- atric Institute’s Division on a remote recruitment arm ciation, the Women’s National sure by one week, and hearing Substance Use Disorders, the because of COVID-19, will Basketball Association, and returns to normal within a day. Irving Institute for Clinical and test the satisfaction and impact players associations for the Their findings, published in Translational Research, and of receiving the Parkinson’s- NBA and WNBA. The group Otology & Neurotology, take Columbia’s School of Social related genetic results. also created a screening and the initial steps in conquering Work created the Center for monitoring program for the the barriers to precision medi- Healing of Opioid and Other New Diabetes Gene Found leagues and guidelines for team cine of the inner ear. Substance Use Disorders- Columbia researchers have physicians. The research team Enhancing Intervention, uncovered a previously previously reported similar Flu Vaccines in Children: Development and Implementa- unknown mechanism that data on NBA players. The Education Helps tion (CHOSEN) to draw on allows insulin-producing cells research, published in JAMA Young children are more likely expertise across Columbia to to function properly. Using Cardiology, was led by Sofia to suffer severe, even life- a combination of chromatin Shames, MD. threatening complications from immunoprecipitation studies, the flu, but less than two-thirds RNA analysis, and comparison Opening Ears to of children in the United States of human and experimen- New Treatments get the flu vaccine. A new tal animal data on super- Because the inner ear is sur- study found that the number enhancers, researchers led by rounded on nearly all sides by of children vaccinated for the Taiyi Diana Kuo, PhD, and one of the hardest bones in flu can be increased by giving develop and implement pro- Domenico Accili, MD, identi- the body and shielded from parents an inexpensive and grams, policies, and practices fied a previously unknown simple pamphlet available in that treat addiction. More than gene, C2cd4a, which they pro- the pediatrician’s waiting room. 30 scientists and researchers ceeded to functionally analyze The study—a randomized, con- from the business school, the with a genetically engineered trolled clinical trial—was one engineering school, the Data animal model. The experiments of the first to look at the effect Science Institute, and other showed that the newly discov- of educational information on programs work together to ered gene, C2cd4a, plays an substances in nearby blood influenza vaccination rates in find innovative solutions to a important role in insulin secre- vessels by a barrier similar to children. “Parents’ concerns seemingly intractable problem. tion. When the C2cd4a gene the blood-brain barrier, deliv- and misperceptions about vac- The center has four directors: was removed from the beta ering drugs to the inner ear is cines are on the rise,” says Frances Rudnick Levin, MD, cells of mice, the cells could a huge challenge. 3D-printed study senior author Melissa Edward V. Nunes, MD, and not secrete enough insulin to microneedles that pierce a Stockwell, MD, “but previous Muredach Reilly, MBBCh, meet the mouse’s demands, tiny membrane separating the studies have shown that, in all VP&S faculty, and Nabila similar to the way cells behave inner and middle ear may be some cases, offering informa- El-Bassel, PhD, from the in people with type 2 diabetes. one solution. Developed by tion to disprove vaccine myths School of Social Work.

2019–2020 Annual Report | ColumbiaMedicine 39 VP&S Clinical Highlights

Less Toxic, More Enduring and Aging outpatient practice at these medications carefully, limitations and drawbacks of Drug for Pancreatic Cancer at Allen Hospital reflect the one can discard three unneces- the test, such as false-positive Because pancreatic tumors aging of America’s popula- sary medications and encourage and false-negative results, recruit a thick layer of connec- tion. With many patients in good nutrition instead,” says discomfort or pain, and over- tive tissue called stroma that their 90s or 100s–the oldest Dr. Thomas. The team partners diagnosis or overtreatment is hardens the tumor and acts patient is 104–the team of four with pharmacies in the commu- where Dr. Hyams’ shared deci- like a shield, most traditional geriatricians and a geriatrics nity and uses other strategies, sion-making process becomes chemotherapy drugs need to be nurse practitioner focuses such as recommending pre- so relevant. “The challenge used at nearly toxic levels to be on preventing and managing poured pill boxes, blister packs, of screening is to identify common geriatric syndromes and caregiver supervision, to potentially dangerous cancers while also managing comor- combat polypharmacy. during a window of curability bid chronic conditions. A and avoid detecting low-risk high level of coordination Shared Decision-Making cancers not destined to cause among inpatient and outpa- in Prostate Cancer harm. It’s important to have tient geriatricians and nurse The multiple perspectives on a discussion about risks and practitioners is paramount, prostate cancer confound benefits of screening and to says Evelyn C. Granieri, MD, physicians and patients alike individualize that discussion division chief. Geriatrician as they navigate decisions based on age, family history, Bindhu K. Thomas, MD, sees on screening, diagnosis, and ethnicity, and other factors about two new patients per treatment. “There’s a lot of that can affect risk.” Instead day. “The population is aging confusion among referring of having men go directly from rapidly in this area. Because of physicians, primary care doc- PSA screening to a biopsy, the complexity of care, many tors, and certainly among Dr. Hyams and his colleagues primary care physicians are lay people about prostate use an approach called “risk- sending their older patients cancer,” says Elias S. Hyams, based” screening, using the effective. Research by Kenneth to see a geriatrician,” says Dr. MD. Although many prostate PSA as a starting point in Olive, PhD, and PhD student Thomas, who notes that many cancers are slow growing and appropriate men to understand Jaime Eberle-Singh may have of the patients come from the incidental to the aging process, their risk, followed by a deeper identified a good chemotherapy neighborhood though some some can metastasize or cause discussion about options avail- candidate, an experimental patients travel as long as two death and should be diagnosed able for clarifying risk. “Today, compound called PTC596 that hours to see a doctor in the early to prevent harm. “It’s there are potentially many had shown antitumor activity practice. She typically sees 13 our job to diagnose the lat- intervening steps, such as novel in mouse and human pancreatic patients each day, and appoint- ter at an early point, while blood and urine tests and imag- cancer cells. The drug survives ments with new patients last avoiding overdiagnosis of the ing studies, that allow patients for a long time and effectively 90 minutes compared with the former.” Also part of the mix to avoid the discomforts and penetrates into pancreatic typical half hour to 45 minutes are concerns men have about risks of a biopsy. But prostate tumors while evading a molecu- devoted to new internal medi- adverse urinary and sexual side cancer can kill and be very lar pump that many cancer cine patients in private office effects of treatment, making disabling when it’s metastatic cells use to expel drugs. The visits. The ability of patients to it difficult to weigh the pros or advanced. We now have the researchers tested PTC596 in adhere to medication regimens and cons of different treatment tools to allow us to hone in on combination with gemcitabine and polypharmacy continue approaches. Dr. Hyams has the men who are at greatest risk in genetically engineered mice to be major challenges for embraced the shared decision- and treat them accordingly.” with an aggressive form of pan- geriatricians, including those making model, which involves creatic cancer that is generally at Allen. “We ask patients engaging with the patient, Seizures, Coma from Synthetic resistant to chemotherapy. The to bring all of their medica- ensuring that the patient Cannabinoids in Teens mice treated with the two-drug tions to each visit and try to reviews and comprehends the Among teens treated in an combination lived three times discontinue unnecessary ones educational materials and emergency department for longer than those treated with to reduce pill burden. There is decision aids, and correct- drug-related symptoms, those only a single standard agent. great marketing for multivita- ing any misconceptions they who used synthetic can- mins and often our senior citi- have about prostate cancer. nabinoids (also known as A Model of Care for Aging zens are unnecessarily taking One issue that contributes to Spice, K2) were more likely Patients who visit Columbia’s one multivitamin plus vitamin confusion for patients is PSA to experience seizures and Division of Geriatric Medicine B and vitamin C. If one looks screening. Working around the coma compared with those

40 Vagelos College of Physicians and Surgeons who used natural cannabis, logical stress that may affect to make themselves visible to would have been better served researchers found. “Synthetic the likelihood of a male or T cells. “Many small com- if their transplant center had cannabinoids, whether taken female baby and risk of early pounds in skin care products accepted one of the offers.” alone or with other substances, birth. Researchers examined that trigger allergic contact are associated with severe 27 indicators of psychosocial, dermatitis lack the chemical Diagnosing Cardiac neuropsychiatric effects in physical, and lifestyle stress groups needed for this reac- Amyloidosis Earlier in adolescents and require higher collected from questionnaires, tion to occur,” says Dr. de Marginalized Communities acuity care than adults,” says diaries, and daily physical Jong. Researchers suspected VP&S researchers are sharing Sarah Ann Anderson-Burnett, assessments of 187 otherwise that CD1a, a lipid binding an NIH grant to establish a MD, PhD. The research was healthy pregnant women, ages molecule that’s abundant on screening program for cardiac published in Pediatrics. 18 to 45. They found that Langerhans cells (immune cells amyloidosis in minority com- pregnant women experienc- in the skin’s outer layer), might munities to response to research Columbia Pediatricians Join ing physical and psychological be responsible for making the that shows that heart failure Health Equity Initiative stress are more likely to have chemicals visible to T cells. By related to transthyretin cardiac Two VP&S pediatricians— a girl and to give birth prema- studying human cells in tissue amyloidosis disproportionately Stephanie Lovinsky-Desir, turely than unstressed mothers. culture, the researchers found affects older Black and His- MD, and Jennifer Woo Baidal, that several common chemi- panic Americans. Until recently, MD—were selected to join Why Some Creams and cals known to trigger allergic the amyloidosis was difficult to an initiative to help reduce Cosmetics Cause Skin Rash contact dermatitis were able diagnose and was perceived to childhood health disparities in A study led at Columbia by to bind to CD1a molecules on be very rare, but the research- New York City, where children Annemieke de Jong, PhD, sug- the surface of Langerhans cells ers, co-led by Columbia’s from low-income neighbor- gests that the way some chemi- and activate T cells, causing an Mathew Maurer, MD, will test hoods have higher rates of cals displace lipids in skin cells immune reaction. The study the hypothesis that highly sensi- asthma and obesity compared raises the possibility that aller- tive heart imaging and blood with children from wealthier gic contact dermatitis could be tests may help diagnose the neighborhoods. The initiative, stopped by applying competing disease earlier. Health Data for New York lipids to the skin to displace City—HD4NYC—is a partner- the compounds triggering the Ex-Smokers, Light Smokers ship of New York City Depart- immune reaction. Not Exempt from Lung Damage ment of Health and Mental People who smoke fewer than Hygiene and New York Acad- Many Who Die Waiting for a five cigarettes a day cause long- emy of Medicine. With Kidney Had Multiple Offers term damage to their lungs, funding through the Robert Most patients who die wait- according to a new study led Wood Johnson Foundation, ing for a kidney, or who are by Elizabeth Oelsner, MD. HD4NYC gives scientists removed from the transplant The study found that a light from academic centers across waitlist for poor health, had smoker could lose about the New York City unprecedented multiple opportunities to same amount of lung function access to a trove of health data receive a transplant, but the in one year as a heavy smoker at the city health department offered organs were declined might lose in nine months. The and fosters action-oriented, explains how many common by patients’ transplant teams study also tested an assump- collaborative research to pro- ingredients in creams, cosmet- and subsequently transplanted tion, based on a 40-year-old mote health equity among ics, and other topicals trigger in someone lower on the wait- study, that the rate of decline New Yorkers. allergic contact dermatitis. The list. “Presumably, these offers in lung capacity “normalizes” research was published in Sci- were declined primarily because within a few years after quit- Stress During Pregnancy: ence Immunology. Many aller- centers were expecting patients ting smoking. The new study Why It Matters gic reactions begin when the to get a better offer in a timely shows that although lung Experts agree that maternal immune system’s T cells recog- manner,” says study leader capacity declines at a much stress during pregnancy can nize a chemical as foreign. T Sumit Mohan, MD, whose lower rate in ex-smokers, the affect fetal and child develop- cells do not directly recognize research was published in JAMA decline doesn’t stop for at ment and birth outcomes, and small chemicals, and research Network Open. “In some cases, least 30 years. “There may be a VP&S study led by Catherine suggests that these compounds a decline may have been the anatomic differences in the Monk, PhD, has identified the need to undergo a chemical right decision, but our data sug- lung that persist for years after types of physical and psycho- reaction with larger proteins gest that many others probably smokers quit and gene activity

2019–2020 Annual Report | ColumbiaMedicine 41 VP&S Clinical Highlights may also remain altered,” says cine. Researchers led by Jason claims data from nearly 5 mil- diagnosed as hearing loss, are Dr. Oelsner. The research was Wright, MD, looked at insur- lion patients who had begun associated with measurably published in Lancet Respira- ance claims data for services drug treatment for hyperten- lower levels of cognition in tory Medicine. provided to female cancer sion. They found that patients older adults. Justin S. Golub, patients between the ages of who were first prescribed MD, led a team that analyzed Senior Founding Medical 18 and 45. Nearly 90% of thiazide diuretics had 15% data from the Hispanic Com- Director for Primary Care individuals included in the fewer heart attacks, strokes, munity Health Study and the David Buchholz, MD, joined study were treated for breast and hospitalizations for heart National Health and Nutrition VP&S as senior founding cancer. Among women 18 to failure, compared with those Examination Survey. Data medical director for primary 35 years of age, only 12% who were prescribed ACE from 6,451 adults showed that care at ColumbiaDoctors, received a fertility evaluation, inhibitors. Patients who began every 10 decibel decrease in Columbia’s faculty practice and patients in the South and with thiazides also experienced hearing was accompanied by a those living outside metro- fewer side effects. The research significant decrease in mental politan areas were least likely was published in Lancet. ability. The largest decrease in to receive fertility evaluation cognitive ability occurred in or services compared with Predicting Alzheimer’s those whose hearing was just patients in other regions. with Combined Smell and starting to become impaired, Cognitive Tests just 10 decibels off the perfect Columbia Announces Performing well on two brief mark. The study was published 1,000th Lung Transplant tests that measure cognitive in JAMA Otolaryngology- The Lung Transplantation ability and ability to identify Head & Neck Surgery. Program at Columbia marked odors indicates very low risk a major milestone: 1,000 for Alzheimer’s, according to Overactive Brain Waves transplants since 2001, with research led by D.P. Devanand, Trigger Essential Tremor medical director Selim Arca- MD. The research, published Research published in Sci- soy, MD, surgical director in Alzheimer’s & Dementia: ence Translational Medicine organization, and NewYork- Frank D’Ovidio MD, PhD, The Journal of the Alzheimer’s shows that essential tremors Presbyterian. He leads an and chief lung surgeon Joshua Association, analyzed data from are caused by overactive expanded primary care strat- R. Sonett, MD, transforming 749 older adults with mild brain waves at the base of the egy that will provide greater a small service into one of the cognitive impairment without brain, raising the possibil- access for patients to primary country’s top centers for lung dementia in an urban com- ity of treating the disorder care services across the New transplant care. Columbia’s munity. The participants were with neuromodulation to York metropolitan area. The team performs 80 to 90 lung followed for an average of four calm the oscillations. Previ- goal is to add 50 to 70 primary transplants annually, which years; 109 of the participants ous studies identified changes care physicians by 2025. Pri- makes the program one of the developed dementia, and the in brain structure in people mary care physicians are open- highest-volume lung transplant vast majority of them received with essential tremor but not ing practices in 2020 on the centers in the United States. a diagnosis of Alzheimer’s dis- how those changes caused Upper West Side, Midtown, ease. The researchers found tremors, says research leader and Westchester and adding to Most Prescribed Blood that 96.5% of the participants Sheng-Han Kuo, MD. Among existing practices in Harkness Pressure Drugs May Be who performed well on both Pavilion and Morningside. Less Effective tests failed to develop demen- A new multinational study tia during the period studied. Young Breast Cancer Survivors shows that the most popu- Among those with good scores and Fertility Preservation lar first-line treatment for on the tests, no one aged 70-75 A study from VP&S oncolo- hypertension is less effective or 81-83 years had transi- gists found that referrals for and has more side effects in tioned to dementia during the fertility-preserving services real-world practice than an study period. 20 essential tremor patients remain low among female alternative that’s prescribed examined with cerebellar EEG, chemotherapy patients, despite much less often. The research- Hearing Loss, Even most had strong oscillations in recommendations from the ers, including Columbia’s When Slight, Linked to the cerebellum that were not American Society of Clinical George Hripcsak, MD, and Lower Cognition found in any of the 20 control Oncology and the American Patrick Ryan, PhD, analyzed Slight levels of hearing loss, subjects. Patients with more Society of Reproductive Medi- electronic health records and even those too slight to be severe tremors had stronger

42 Vagelos College of Physicians and Surgeons oscillations. “Using cerebellar and whole fruit (not juice) Discovery of the potential it without any problem and EEG as a guide, we may be were less likely to have insom- benefit of putrescine came show no signs of sickness,” able to use neuromodulation nia. The study was published from an investigation into the says Dr. Tabas. techniques such as transcranial in the American Journal of body’s process for removing direct-current stimulation or Clinical Nutrition. dead cells using macrophages Treatment for a Rare transcranial magnetic stimula- to avoid inflammation and Twin Syndrome tion to reduce tremor,” says Fitness Class for tissue death. The process of Monochorionic twins are at Dr. Kuo. Cancer Patients removing dead cells is usually risk to develop a rare and seri- CancerFIT is a free exercise initiated within minutes of cell ous complication called twin- Risk of Overdose After class offered by the Herbert death, but studies have sug- twin transfusion syndrome Medical Treatment Ends Irving Comprehensive Cancer gested that the task is impaired (TTTS). Left untreated, the Among people treated with Center for cancer patients and in atherosclerosis, resulting in risk of losing at least one twin buprenorphine continuously survivors. Founded by physical buildup of dangerous arterial with severe TTTS is about for six to 18 months, about therapy students—one a breast plaque. Researchers set up 70% to 90%. Maternal-fetal 5% needed medical treatment cancer survivor, the other a human macrophages and dying medicine physicians at the Car- for an opioid overdose in the woman who lost her father to cells in a dish and watched the men and John Thain Center six months following the end cancer—CancerFIT helps par- process unfold. Macrophages, for Prenatal Pediatrics care for of buprenorphine treatment. ticipants counter emotional and they found, reclaim arginine the highest volume of TTTS Columbia researchers say the physical stresses associated with and other amino acids from cases in New York. The center true rate may be higher when diagnosis and treatment. The the dead cells they engulf and is one of a select group of cen- taking into account overdose weekly classes, paused during use an enzyme to convert argi- ters in the country that offer events that did not occur in the pandemic, combine high- nine into putrescine. Putrescine fetoscopic laser surgery for health care settings. A study then activates a protein that this disorder, which changes led by Arthur Robin Wil- signals the macrophages to the statistics to a more favor- liams, MD, and published eat more dead cells. In further able survival rate of at least in the American Journal of studies in mice, researchers 80% for one or both twins. Psychiatry found that the lon- found that mice with worsen- Under epidural anesthesia, the ger patients continued with ing atherosclerosis had a short doctor inserts a fetoscope (a treatment, the lower their supply of putrescine because long camera) into the recipi- risk of other types of adverse they didn’t have enough of a ent twin’s amniotic fluid sac, outcomes, suggesting that key enzyme to make the com- within the uterus. The placenta buprenorphine treatment may pound. By adding putrescine can then be directly inspected, be most effective as a long- intensity aerobics, stretching, to the animals’ drinking water, and abnormal blood vessels term therapy for those with and strength-training and are macrophages got better at eat- between the twins that are opioid use disorder and dis- led by physical therapy graduate ing dead cells and the plaques potentially disease-causing continuing buprenorphine may students. In addition to provid- improved. The authors also can be visually mapped. The be a life-threatening event. ing an evidence-based workout, showed that the same key proceduralist then uses laser the class serves as a support enzyme was reduced in human energy to photocoagulate Refined Carbs May group for participants going atherosclerotic plaques as blood within the abnormal Trigger Insomnia through similar experiences. they become more dangerous. vessels, thereby interrupting An estimated 30% of adults If putrescine could be used the blood transfusion from one experience insomnia, and a Putrid Compound May to treat atherosclerosis and twin to the other, says Russell study led by James Gangwisch, Have an Up Side other conditions character- S. Miller, MD, medical director PhD, suggests that diet may Putrescine is a compound ized by chronic inflammation of the center. Before the devel- be partly to blame. The study responsible for perhaps the and impaired clearance of opment of the fetoscopic laser found that postmenopausal foulest odor in nature—the dead cells, such as Alzheimer’s surgery, amniotic fluid volume women who consumed a smell of decomposing flesh— disease, inflammatory lung reduction was the primary diet high in refined carbohy- but it also may be a remedy diseases, and lupus, researchers therapy for TTTS, but it was drates—particularly added for atherosclerosis and other note that dissolving putrescine only a temporary solution with sugars—were more likely to chronic inflammatory diseases, into water, at least at the dos- lower success rates. Studies develop insomnia. Women according to a study led by ages needed to improve the have shown that laser surgery whose diet included higher Ira Tabas, MD, PhD, and plaques, eliminates the odor of is more effective than amnio- amounts of vegetables, fiber, published in Cell Metabolism. rotting flesh. “The mice drank reduction for improving twin

2019–2020 Annual Report | ColumbiaMedicine 43 VP&S Clinical Highlights survival and reducing the risk in 2020. The center, which ining the relationship between Mammogram Frequency of long-term neurologic dis- evolved from a concept of exercise and neurological disor- New data reported by research- ability among survivors. collaborative care initiated at ders, specifically the ability of ers at the Herbert Irving Columbia in 2004, was cre- exercise to decrease symptoms Comprehensive Cancer Center Designer Probiotic Treatment ated to bring together in a and delay disease progres- concluded that more frequent for Immunotherapy single location all specialists sion. Scott A. Barbuto, MD, mammograms among women Researchers at Columbia that pregnant women and PhD, leads an exercise training treated for early-stage breast Engineering, in collabora- their families may need after intervention for patients with cancer might not confer addition with VP&S scientists, a significant birth defect or spinocerebellar ataxia, which tional benefit at the expense of have engineered probiotics to genetic condition has been typically causes a gradual loss potential harm. The research, safely deliver immunotherapies detected. The center’s guid- of coordination, impaired bal- which was presented at the within tumors. These include ing principle is that caring ance, gait deviations, and severe annual meeting of the Ameri- nanobodies against two proven for babies with abnormalities progressive disability. In a pilot can Society of Clinical Oncol- therapeutic targets—PD-L1 starts before birth and con- study, Dr. Barbuto and col- ogy, was co-led by Katherine D. and CTLA-4. The drugs are tinues into childhood, with leagues randomized 20 patients Crew, MD, and Julia McGuin- continuously released by bac- neonatal and long-term pedi- with degenerative cerebellar ness, MD. Based on the find- teria to attack the tumor, even atric follow-up. Maternal-fetal disease to either aerobic or ings, Columbia has modified after just one dose, facilitating medicine experts also work as balance training five days per its mammography screening an immune response that ulti- part of the Mothers Center, week for four weeks. “When protocol to recommend annual mately results in tumor regres- which is directed by maternal- we compared aerobic training screenings for breast cancer fetal medicine physician Les- to balance training, we found survivors. Women treated for lie Moroz, MD. The center, that the two groups had similar early-stage breast cancer with created in 2018, provides benefits in terms of balance and lumpectomy remain at risk coordinated care to women gait speed but that the aerobic for local recurrence, and the who require specialized care training group did better in previous standard practice for because of pregnancy com- terms of ataxia severity and these patients was to obtain plications. Specialists across fitness level. The aerobic train- screening mammograms of the various medical and surgical ing group showed improvement ipsilateral, affected breast every subspecialty areas collabo- in ataxia, which is the primary six months for two to three rate to customize treatment complaint of these patients.” years after diagnosis, based plans to meet patients’ needs. Balance training to improve upon consensus opinion rather Services include coordinating motor skills and functional than data from randomized appointments with special- performance has been standard controlled trials. Dr. Crew’s ists, providing counseling, and treatment, but little evidence team examined the relationship establishing a care manage- exists that balance training can between frequency of ipsilateral ment plan. The Mothers Cen- effect change on the molecular surveillance and rates of false- sion. The versatile probiotic ter is the first center of its kind level in patients with degenera- positive biopsy and local recur- platform also can be used to in the country and serves as tive cerebellar disease. Now rence among women treated deliver multiple immunothera- a national model for the care experts are examining the role with breast-conserving therapy pies simultaneously, enabling of medically and surgically of exercise training as front- or lumpectomy. The study ana- the release of effective thera- complex pregnant women. The line, instead of adjunct, treat- lyzed mammography screening peutic combinations within Mothers Center team also con- ment. The team hypothesizes frequency among over 1,400 the tumor for cancers that are ducts research to advance care that although both aerobic and women with early-stage breast more difficult to treat, such as and education to improve the balance training will improve cancer and found that women colorectal cancer. The study, health of women everywhere. function, only aerobic exercise screened every six months vs. published in Science Transla- will affect disease progression yearly had a two-fold increase tional Medicine, was led by Exercise as Intervention for and slow cerebellar atrophy. in false positive breast biopsies Tal Danino, PhD. Cerebellar Ataxia Animal studies show encour- with no difference in detec- Doctors across the country are aging results, and a study at tion of local recurrence. The Prenatal Pediatrics Milestone writing exercise prescriptions Columbia is the first of its kind researchers suggest prospective The Carmen and John Thain for patients—but not just for to examine the benefits of aero- studies to determine optimal Center for Prenatal Pediatrics high blood pressure or diabetes. bic exercise as a primary out- screening strategies among celebrates its 10th anniversary Studies are increasingly exam- come in this patient population. breast cancer survivors.

44 Vagelos College of Physicians and Surgeons VP&S Education Highlights

2020 Graduates Take on COVID-19 in New Hospital Roles

ulie Hwang’s honeymoon in Bora “Columbia and NYP have been very Another 2020 graduate, Mary Bora, with her husband and class- conscientious about how to put us into Raddawi, spent her pre-residency project J mate Michael Chun, was post- effective roles that are not beyond the at her parents’ dining room table in poned. Instead, she spent the two months scope of what we can handle,” Dr. Hwang Illinois, speaking mostly Spanish over before the start of her anesthesiology said during her assignment. the phone with discharged COVID- intern year at NewYork-Presbyterian coor- Two other graduates, Randy Casals and 19 patients. With faculty physician dinating patient transfers from the com- Tyler Cooke, helped create a centralized supervision, she monitored each patient mand center at Columbia’s Baker Athletics telemetry station and developed a protocol for seven to 14 days. She advised them Complex at 218th Street, where a field for responding to alerts in a newly con- to take their temperature, provided verted intensive care unit so that all heart instructions on how to adjust oxygen monitors can be seen from one location on levels for those discharged with a tank, the sprawling floor. and listened to their concerns. “These months are supposed to be like a “There were a few on my panel that release valve on the stress of medical school I could tell were waiting for the call. It before the stress of residency starts,” Dr. was very comforting for them,” Dr. Rad- Casals said. He has felt a little angry, he dawi said. “They could then relax and admits, at this virus and this pandemic, and spend the rest of the day knowing ‘I’m the opportunity to help was a salve. He OK today. Everything is going in the right has since started his residency in urology direction.’” Dr. Raddawi has since started at Wake Forest Baptist Medical Center in her internal medicine residency at Massa- Winston-Salem, North Carolina. chusetts General Hospital in Boston.

Vagelos Education Center hospital opened in April for recovering COVID-19 patients from overburdened wards nearby. Dr. Hwang was one of 88 graduates from the VP&S Class of 2020 who graduated early on April 15 to start work to support health care workers at NYP. Many of the roles for the newly minted doctors were remote assignments, and other graduates continued their work with the COVID-19 Student Service Corps. Dr. Hwang was among the graduates who offered to fill on-site roles to assist over- From left: Tyler Cooke, Randy Casals, and Julie Hwang stretched front-line workers. O’ROURKEJENNIFER

2019–2020 Annual Report | ColumbiaMedicine 45 VP&S Education Highlights

Maggie Bogardus worked from her par- terms of dealing with COVID-19,” Dr. her realize the magnitude of challenges ents’ home in Connecticut before return- Bogardus said, “but we were doing impor- that hospitals face but also showed the ing to New York City for her residency tant work, so I don’t want to minimize it.” progress being made. Three patients were in obstetrics & gynecology at Columbia. Working in the command center at transferred on her first day of work at the She reviewed variables in patient charts 218th Street gave Dr. Hwang a view of the command center. After she and colleagues to input into national, state, and local front lines: A television live stream allowed developed a new protocol to make it as COVID-19 databases. “I knew I was not her to communicate with doctors in full simple as possible for the front-line physi- the one making the biggest sacrifices in PPE in the field hospital. That view made cians to approve, daily transfers tripled.

Students Honored for for the work that they do to Delivering PPE Commitment to Diversity support the VP&S community Columbia medical student A group of VP&S students and promote diversity within Adedeji Adeniyi joined other was honored at the annual our campus,” said Hilda medical center students to Martha A. Hooven Awards Hutcherson, MD, senior help procure and deliver for Excellence. The awards associate dean for diversity more than 10,000 pieces of honor contributions to the and multicultural affairs. personal protective equipment medical school’s workplace to area hospitals as a way to and community. More than Student Wins International help after their classes were 100 individuals and groups Poetry Prize moved online at the height were nominated for awards Lauren Fields, a student in the of the COVID-19 pandemic. presented in January 2020. VP&S Class of 2021, tied for Students also raised funds to The Diversity Award was given second place in the health pro- supply health care workers to the First Generation Low fessional category of the 2020 ative capacities. Dr. Lewis is a around the city with PPE. Income Partnership (FLIP), International FPM-Hippocrates 2016 Hippocrates Prize winner. Their GoFundMe campaign— which students established in Prize for Poetry & Medicine. A Laying on of Hands in 2017 to build community and Inspiration for her winning the OR promote the well-being and poem, “A Laying on of Hands visibility of medical students in the OR,” came during her Today, it feels like prayer – who come from a low income surgery rotation in her major the pause background and/or are the clinical year. “The difficult for a moment of peace first generation in their family cases that we saw really exem- before the raising of voices. to attend college. FLIP has plified the trust that patients We bow our heads over developed several initiatives have in their team of surgeons, an impossibility, “Mask On, March On!”— anesthesiologists, and nurses. raised thousands of dollars for There was a coming together over the bifurcation of life PPE for hospitals in COVID-19 that was unique to those par- and something that is not life. hotspots in New York City. ticularly stressful situations Today, it feels like a call and that was the spirit behind and response Precision Ophthalmology 2020 the poem.” Ms. Fields heard of masked voices across The Department of Ophthal- about the Hippocrates Prize mology in December 2019 from Owen Lewis, MD, who a body broken, across hosted the first conference to teaches the narrative medicine blood. We asked her to believe, focus on the role of genetics course, “Poetry: Close Read- to trust in ophthalmology, “Preci- to fulfill its objectives, such ing and Craft.” Narrative the work of hands and metal sion Ophthalmology 2020: as hosting conversations and medicine, a division within in this sterile sanctuary, Applying Genetics to Eye panels on relevant topics, Columbia’s Department of Care Today.” “We presented welcoming first-year students Medical Humanities & Ethics, where the buzzing of cautery cases that describe how the to the community, and helps students deepen their self- is a hymn, physician made the decision of coordinating financial planning awareness, clinical attunement, and a single, drumming heart which type of genetic testing to workshops. “We commend FLIP collaborative skills, and cre- keeps time. order and how to interpret the

46 Vagelos College of Physicians and Surgeons results to form a diagnosis,” Musical Mondays Lisa Mellman, MD, and Jona- and on our hospital inpatient says Jeffrey M. Liebmann, The VP&S Musicians’ Guild than Amiel, MD. Dr. Mellman, units. Many of you have asked MD, who hopes to establish played on during the pan- senior associate dean for stu- how you can help in this time an ophthalmic genetics fellow- demic. Starting April 6, the dent affairs, oversees admis- of great need. At this point in ship at Columbia to increase musicians continued their sions, diversity, financial aid, your education, each of you the current number (six) of “Musical Mondays”—30-min- and global health programs has demonstrated that you pos- individuals trained in human ute concerts featuring both as interim co-vice dean. Dr. sess the knowledge and clinical genetics and ophthalmology in live and pre-recorded musical Amiel, senior associate dean skills to play a vital role in the United States. pieces performed by students, for curricular affairs, oversees this effort. With this in mind, faculty, and staff—every week education programs, finance, and given the urgent need for Caring for Older Patients through Zoom and the Musi- administration, and the additional physicians, Colum- At Columbia’s outpatient cians’ Guild Facebook page. simulation center as interim bia University has decided to geriatric practice at Allen “Our mission is to deliver co-vice dean. move up the VP&S gradua- Hospital, the average patient respite and comfort to the tion to April 15.” Fourth-year age is 87, and the practice con- CUIMC community at large Two Graduation Events students who had not yet tinues to grow in numbers of through messages and music for VP&S Students taken the capstone Ready for older adults being seen. That played by members of the In late March, only a few Residency course were offered makes the practice an excellent Columbia community. Dur- weeks after all medical stu- the course in an accelerated training ground for internal ing moments of crisis, fear, dents were sent home to con- format. A Zoom celebration medicine interns who learn to and sorrow, music can play an tinue their education remotely, on April 15 was a lighthearted navigate the complexities of important role in healing spiri- VP&S announced an early sendoff for students who grad- multiple geriatric syndromes tually and emotionally at both graduation for the Class of and chronic conditions, espe- an individual and communal 2020. Offering diplomas about cially dementia, polypharmacy, level. While social distancing a month early gave the gradu- and challenges related to medi- measures drive us apart physi- ates an opportunity to join the cation adherence. Four internal cally, technology and music front lines of the pandemic in a medicine interns rotate for two can help bridge those distances variety of roles. Students in the two-week blocks with the geri- to provide comfort and hope Class of 2020 formally gradu- atric inpatient and outpatient ated April 15 (the original teams that include the geriatri- ceremony was scheduled May cian and the geriatrics nurse 20) and were offered tempo- uated early to join health care practitioner. “The interns work rary employment at NewYork- workers at NewYork-Presbyte- with us in both inpatient and Presbyterian Hospital (until the rian and provide support dur- outpatient rotations. We go beginning of students’ residen- ing the COVID-19 pandemic. over assessments, what to look cies) to increase the physician Graduates put their creative for in dementia, medications, ranks during the COVID-19 flair on display at the ceremony function, and how to discuss pandemic. A March 26 email with a musical performance, advanced care planning,” says to students explained the poetry reading, and reflections Bindhu K. Thomas, MD, a in an uncertain time,” say dire situation: “In this time about their time in medical geriatrician at the practice. Musicians’ Guild leaders. The of local and national need, school and the pandemic. On Geriatric house calls twice a group publishes a newsletter physicians and other health May 6, MD and PhD gradu- month are a large part of the that describes the past week’s care professionals around the ates participated in a more teaching curriculum for first- music and includes video clips. world are providing care for formal ceremony via Zoom, year residents. The residents patients of the coronavirus gathering as the traditional are often able to experience Two Share Interim pandemic under extraordinary “Pomp and Circumstance” home safety evaluations for Education Dean Role circumstances. The number of music played. Graduates lis- new patients or do follow-ups After Ronald Drusin, MD, confirmed cases in the New tened to traditional speeches, with patients after they are stepped down on Dec. 31, York City area climbs every the class history, and congratu- discharged. Thus, the interns 2019, as vice dean for educa- day, and we have begun rede- latory remarks. MD graduates are able to experience the vital tion after 11 years, two other ploying physicians and clinical recited the Hippocratic Oath comprehensive nature of care members of the education staff to help us manage the while family and other specta- for older adults and transitions team were tapped as interim surge of seriously ill patients tors watched videos submitted of care. co-vice deans for education: in our emergency department by graduates.

2019–2020 Annual Report | ColumbiaMedicine 47 VP&S Education Highlights

2020-21 Vanneck- from classroom education to ship in the National Academies Bailey Scholar seeing patients in hospital and of Sciences, Engineering, and Devon Rupley, MD, received ambulatory settings, including Medicine’s Action Collaborative the 2020-21 Vanneck-Bailey NewYork-Presbyterian Hospi- on Preventing Sexual Harass- Award from the Virginia Apgar tal. Several students in the class ment in Higher Education. Academy of Medical Educators received awards, and awards Columbia is a sponsoring mem- to help redesign the Ready for a medical student but also that were given to faculty, residents, ber of the collaborative, joining Major Clinical Year course. you are joining the profession of and other clinicians to recog- the effort as part of its commit- Dr. Rupley, assistant professor medicine today,” Dr. Thomson nize their teaching. The late ment to foster an environment of obstetrics & gynecology, told the first-year students, not- Steven Z. Miller, a 1984 VP&S free from gender-based discrimi- will collaborate with William ing that 2019 marked his 60th graduate, founded the first nation and harassment, includ- year as a physician. He empha- transition ceremony at VP&S. ing sexual assault and all other sized the values of medical forms of gender-based miscon- ethics and medical profession- Graduate Precision duct. The medical center’s par- alism as “superior guides for Medicine Fellows ticipation in the collaborative physicians” and urged students Six graduate fellows and 26 will facilitate additional partner- to always advocate for putting associate graduate fellows from ships and joint action to address the patient first. The ceremony across Columbia University and prevent sexual harassment was the first overseen by a new were selected to participate in and damaging behaviors, such senior associate dean for admis- the Precision Medicine: Ethics, as bullying and incivility, to sions. Anne Armstrong-Coben, Politics, and Culture Project create a climate of respect for MD, was appointed to the role for the 2019-2020 academic everyone. The collaborative after serving as interim dean year. The interdisciplinary builds on the National Acad- for nearly a year and helping project brings together faculty emies’ 2018 report that found Fuller, MD, assistant professor to select the Class of 2023. The from medicine, humanities, that between 20% and 50% of of medicine, to redesign the class has 50 women and 21% female students and more than course that marks the transi- of the class members are under- 50% of female faculty and staff tion between the pre-clinical represented minorities. experienced sexually harassing and clinical settings. Dr. Rupley behavior while in academia. The wants to make the course more Moving the Class of 2022 CUIMC representation is led by of a longitudinal experience for to Major Clinical Year Anne Taylor, MD, vice dean for students, including a simula- In January 2020, second-year social sciences, and law with academic affairs at VP&S and tion curriculum that ties to all medical students participated international visiting scholars senior vice president for faculty aspects of how students form in the Steven Z. Miller Stu- to discuss scientific, social, affairs & career development their professional identity. The dent Clinician’s Ceremony to and humanistic questions that at CUIMC. All four CUIMC VP&S Virginia Apgar Academy mark the start of their patient- could inform policy and future schools as well as NYP have of Medical Educators pro- centered training, not knowing research in precision medicine. agreed to participate. motes, rewards, and supports that their rotations would end a The fellows are enrolled in education for medical students, few months later when the pan- master’s degree or PhD pro- Genetic Counseling Program residents, fellows, and faculty. demic led Columbia to ask all grams in bioethics; biological Welcomes First Students students to leave campus. Since sciences; cellular, molecular, Columbia’s Genetic Counseling Welcoming the Class of 2023 1998, the annual ceremony has and biomedical studies; epide- Graduate Program welcomed The 140 members of the Class helped VP&S students shift miology; genetic counseling; its first class of 12 students of 2023 were welcomed to health administration; narrative in August 2019. The new VP&S at the White Coat medicine; neuroscience; nurs- two-year program immerses Ceremony in August 2019. ing; public health; sociology; students in clinical genetics, Gerald E. Thomson, MD, the and sociomedical sciences. counseling, communication, Samuel Lambert Professor genomic medicine, precision Emeritus of Medicine and Rob- Preventing Sexual medicine, and the social impli- ert Sonneborn Professor Emeri- Harassment in Higher Ed cations of advancing technolo- tus of Medicine, spoke at the Columbia University Irving gies. The program is one of 49 ceremony. “We are recognizing Medical Center has joined accredited genetic counseling not only that you are starting as Columbia University’s member- graduate programs in North

48 Vagelos College of Physicians and Surgeons America. Students in the pro- grated to New York City at age observed in New York City. “Introduction to Global and gram were selected through the 10. She speaks three dialects of Though his interests eventually Population Health,” before Genetic Counseling Admissions Chinese and is the first in her shifted to research, specifically applying to the Global Pop pro- Match, which places appli- family to attend college. After to cancer viruses and cancer gram. Students accepted into the cants in North America into graduating with a bachelor’s genes, “that experience in India program take a research meth- master’s-level genetic counsel- degree in biology from Cornell as a student was instrumental ods course to plan their work. ing programs accredited by University in 2017, she took a in some important decisions Most students conduct research the Accreditation Council for job as a research coordinator I made later in life,” he says. Genetic Counseling. The 12 and genetic counseling assistant “For example, during my time students enrolled in Columbia’s at the Center for Neurogenet- as director of the National inaugural Class of 2021 have ics at Weill Cornell Medicine. Institutes of Health, my interest a variety of educational back- “I was 12 the first time I met in building research programs grounds, including biology, a genetic counselor and was in Africa that would have an psychology, philosophy, global accompanying a family member impact on tropical diseases, such and public health, bioethics, for an appointment,” she says. as malaria, was driven in part by molecular and medical genetics, “I remember the experience what I had seen as a student in bioengineering, performing and being pleasant and we com- Bareilly.” Dr. Varmus also made abroad at established sites where municated by using a phone a gift to establish the Varmus Columbia faculty members have interpreter. After that appoint- Global Scholars Fund through ongoing projects. ment, I wondered if there were the Global Pop program. The any bilingual genetic counselors new fund provides stipends to a Sharing Pandemic available. I did some online few VP&S students to conduct Experiences with research and couldn’t find any novel global health research International Peers in my area. Ever since then, projects at international sites for This year’s eight-week online my interest in the field grew eight weeks to one year. In the summer exchange program— as I learned more by speak- summer of 2019, 56 students “International Collaboration ing to and shadowing genetic from across the medical center and Exchange Program–Prepar- media arts, music, and math- counselors. I hope to combine conducted global and popula- ing Global Leaders for Health- ematics. They have collectively my multilingual skills with my tion health projects: Half of care”—focused on COVID-19 engaged in diverse human ser- passion for genetic counseling them carried out research proj- experiences. The 70 students vice initiatives such as serving to expand care to non-English ects, and the other half partici- participating from 12 universi- in the Peace Corps, volunteer- speaking families.” pated in cross-cultural fluency ties around the world included ing in food pantries, participat- and community health-related 16 medical, dental, and pre- ing in global medical service Global and Population projects. The program offers medical students from Colum- trips, working with homeless Health Research educational opportunities in bia University. The exchange and disadvantaged populations, Nobel Laureate Harold Var- research, language immersion, program started in 2014 in and advocating for survivors mus, a 1966 VP&S gradu- clinical rotations, and program the Department of Pathol- of sexual assault and domestic ate, returned to Columbia development and evaluation in ogy & Cell Biology to offer violence. One member of the in September 2019 to speak the United States and abroad. medical, premedical, and dental class, Denise Ma, was chosen as with students who spent that Among the topics presented at students early international the first recipient of the Stein- summer conducting research the September event were lung experiences, both in person and hardt-Goldman Family Scholar- through the Program for Edu- cancer in Ethiopia, sexual health online, throughout the school ship, established by Jill and Lee cation in Global and Popula- in the Dominican Republic, year. This year’s program, says Goldman to honor Alice and tion Health (Global Pop). Dr. and oral hygiene in Washing- Anette Wu, MD, PhD, director Roger Steinhardt (a counselor Varmus recalled spending a ton Heights. The Global Pop of the program, gave students and a physician). The scholar- few months during medical program exposes students to a rare opportunity to have an ship is for students who have school in an apprenticeship global and population health international exchange about overcome substantial obstacles at the Clara Swain mission- topics early, when they are in a global pandemic of histori- to pursue life goals and have ary hospital in Bareilly, India, the first year of their medical, cal dimensions. The summer already shown academic merit where he observed the medi- dental, public health, nursing, portion of the program typi- and a commitment to genetic cal staff treating patients with and nutrition degree programs. cally includes in-person travel counseling. Ms. Ma was born leprosy, advanced tuberculosis, Students prepare for their sum- exchanges, but the pandemic in southern China and immi- and other diseases infrequently mer projects by taking a course, brought the students together

2019–2020 Annual Report | ColumbiaMedicine 49 VP&S Education Highlights virtually with peers and fac- from the National Taiwan foot facility on the second and the end of March as a grass- ulty from Austria, Canada, University online provided a third floors of 100 Haven Ave. roots project, the brainchild Japan, United Kingdom, Tai- good alternative to travel for (Tower 2) in August 2019. of VP&S student Vibhuti wan, and other countries for peer networking, improving cul- The facility has exam rooms, Krishna. “Faces” provides online small group discussions, tural competency, and practic- administrative offices, and digital platforms for sharing collaborative group work, ing international collaboration. common areas for students large group student debates, and health service staff. The and faculty presentations Student Health Service new space provides enhanced followed by Q&As led by on the Move privacy and accessibility to student moderators, including The Student Health Service enhance patient experience and Columbia’s Adedeji Adeniyi’23. moved to a new 10,000-square- increase capacity. The previous In college, Mr. Adeniyi offices of the Student Health received a Fulbright Scholar Service were spread out over Award to teach English in several rooms in 50 and 60 Taiwan, and he had hoped to Haven Ave. and disseminating stories from expand his experiences in the the COVID-19 front line and country during the summer Faces of the Frontline collecting words of affirmation of 2020. Connecting through “Faces of the Frontline,” for health care heroes. The the exchange program with both an Instagram account website is at www.facesofthe- students and faculty members and a website, was created at frontline.org.

VP&S Community Highlights

A Commitment to Mental Health in the Community

psychiatrist with one foot in the and NewYork-Presbyterian Hospital. He a partnership with clinicians, researchers, Department of Psychiatry and oversees community psychiatric services community providers, and NYP to imple- A the other foot in the Washington for adults, adolescents, children, and fami- ment new strategies to address the com- Heights community was honored this year lies through programs embedded within munity crisis for Latino youth. Beyond with the Martha A. Hooven Community schools, primary care clinics, and commu- serving on the task force, Dr. Ng has con- Service Award, one of a group of awards nity-based partnerships. He has provided tinued to work with Community Board for excellence that honor contributions by training to hundreds of community social 12 and Northern Manhattan Agenda’s members of the VP&S community. service providers, health clinics, and mental Behavioral Health Committee on evolving Warren Y.K. Ng, MD, professor of psy- health programs. He has served on New needs of the community and has provided chiatry, was honored for more than two York City’s Children’s Services Account- updates on clinical services to generate a decades of community service, ranging ability Review Panel since 2008 to improve dialog for voicing and sharing community from formal patient care to oversight of the care system for children in foster care. priorities and needs. school-based psychiatry services to partici- Dr. Ng contributed to the community’s “He contributes to the efforts to improve pation on a task force addressing suicide response to youth suicide through an ini- the quality of care for children who are among youth in the community. tiative led by Lou Baptista, MD, vice chair maltreated and abused. He is a well- Dr. Ng is medical director of outpatient of clinical services in psychiatry, in 2014. rounded, interested psychiatrist who truly behavioral health at the medical center The Task Force on Youth Suicide created embodies the principles of community

50 Vagelos College of Physicians and Surgeons VP&S Community Highlights service while serving the local community,” based services, such as the Critical Time said Jeffrey A. Lieberman, MD, psychiatry Intervention Team and Crisis Hub, to chair, in nominating Dr. Ng for the award. improve community access to quality care. As the director of clinical services for Added Dr. Baptista in his nomination of child and adolescent psychiatry and hav- Dr. Ng for the award: “Over the past year, ing led the Special Needs clinic, Dr. Ng Dr. Ng has been critical in partnering with has contributed to state and city groups NYP in meetings with several community that focus on HIV and children’s mental agencies such as CB12 and several local health. He has been the lead physician legislators to enhance engagement and for the department in NYS’s Delivery continue to pledge VP&S and NYP’s com- Pictured at the January 2020 awards ceremony System Reform Incentive Payment Pro- mitment to the community in important are Dean Lee Goldman, Dr. Ng, Dr. Baptista, and Rudina Odeh-Ramadan, then interim vice gram, which focuses on redesigning Med- issues such as teen suicide and access to dean for administration. icaid reimbursement to improve mental mental health care. His passion is com- health services in northern Manhattan. munity psychiatry and improving access to The program has focused on improving care for ethnic minority, underserved, and ioral Health Services Advisory Council, access, decreasing emergency room visits, communities affected by mental illness.” giving him another opportunity to con- and integrating primary care and mental New York Gov. Andrew Cuomo nomi- tribute to public mental health issues health. He has developed new community- nated Dr. Ng to serve on the state’s Behav- within our communities.

An Academy for Community bers in February. Members Bringing Books and age 8. At the same time, par- and Public Service were nominated by department Love of Reading to ents are provided with strate- The longstanding commitment chairs and center directors for Neighborhood Children gies and tools to help them be of VP&S to public service their community service efforts. Literacy Inc.—also known advocates and early teachers was formally recognized with The academy joins other VP&S as LINC—is on a mission to for their children. In 2019, the launch of the Academy academies that recognize the improve the reading abili- LINC engaged 13,520 children contributions of educators (the ties of children across New and 6,810 parents and distrib- Virginia Apgar Academy of York City. This year, a $3,500 uted 18,712 books. In upper Medical Educators) and clini- grant from the Medical Center Manhattan, LINC programs cians (the Academy of Clinical Neighborhood Fund helped have included Reading Bud- Excellence). VP&S is the first LINC expand its programming dies at PS 189 in Washington medical school in the country in Washington Heights and Heights and a bilingual Eng- to establish an academy for Inwood. The Medical Center lish-Spanish parents workshop community and public service. Neighborhood Fund is sup- at the Fort George Enrichment The academy was created ported by voluntary donations Center. Another program, through the Office of Commu- made by employees of Colum- Literacy Zone, identifies com- nity Service Programs, which bia University Irving Medical munity partners, ranging from aims to build upon the medical Center, NewYork-Presbyterian, the corner barbershop to the center’s ongoing community and the New York State New York Yankees, to provide service efforts to improve the Psychiatric Institute. LINC free books in public spaces or of Community and Public health and education of adults connects families to literacy to host read-aloud events. Service. The new academy and children in local commu- programs at schools, libraries, recognizes faculty who have nities. Under the direction of and other community spaces Welcome Haven made substantial contributions Rafael Lantigua, MD, the office in their NYC neighborhoods. Before the pandemic closed to promote and improve com- has held a range of community The organization’s comprehen- group activities around the munity health, particularly engagement and health promo- sive model starts with the very city, about 650 members of the among residents of Washington tion activities. Dr. Lantigua, youngest children and moves medical center’s community Heights and Inwood, Upper professor of medicine and asso- readers incrementally to inde- and neighborhood residents Manhattan, and parts of the ciate dean for community ser- pendent reading, instilling in from Washington Heights gath- Bronx. The academy welcomed vice in VP&S, was among the them a pre-literacy foundation ered in the new Haven Plaza 21 faculty as founding mem- academy’s inaugural inductees. to become strong readers by in October 2019 to view new

2019–2020 Annual Report | ColumbiaMedicine 51 VP&S Community Highlights

public art, sip apple cider, and selected to create the hand- tions are my attempt to create enjoy the crisp autumn day. painted illustrations as part of environmental awareness,” says Art depicting the biodiversity the Bollard Beautification Proj- Ms. Perez. “We keep forgetting of the flora and fauna of Upper ect. Some of the bollards were that Manhattan is unrecogniz- Manhattan illustrates Haven unveiled at the October event. able from what it used to be. I Plaza’s bollards, the large Her goal is for each bollard to want people to know about the concrete blocks at each end of represent a species of plant or plants and animals that came the plaza, which extends from animal native to the area, from before the skyscrapers and 168th Street and Fort Wash- easy-to-spot aster flowers and everything else.” The artist grew ington Avenue to 169th Street cardinals to the lesser known up in Mexico City and moved and Haven Avenue. Washington species of dutchman’s breeches to New York City to attend the Heights artist Emely Perez was and trilobites. “My illustra- School of Visual Arts.

VP&S COVID-19 Highlights

esearchers at VP&S began pub- lishing papers about COVID-19 R within weeks of the first patient arriving at Columbia in early March. By late May, 36 papers with Columbia first or senior authors had been published in 18 high-impact peer-reviewed journals, with many more awaiting publication. This section highlights some of the research findings and innovations that came out of Columbia during the first few months of the pandemic.

Heartburn Drug as in the United States showed developed the Family Liaison disease by preventing the virus Potential Remedy similar findings. The potential Service to facilitate communica- from entering lung cells, accord- Famotidine, a common heart- mechanism remains unclear. The tions between the clinical team ing to an analysis by David burn drug, may have potential Columbia study was led by Dan- and families of patients in the Goldstein, PhD, and Xinchen to fight COVID-19, according to iel Freedberg, MD, and Julian OR-ICU. A second group, the Wang, PhD, that was pub- a study published in Gastroen- Abrams, MD. A randomized Compassionate Care Connec- lished on preprint.org. Two terology. The retrospective study clinical trial is underway. tors, founded by chief radiology human proteins—TMPRSS2 found that hospitalized COVID- resident Elizabeth West, MD, and ACE2—help SARS-CoV-2 19 patients at Columbia were Connecting Patients facilitated phone and video calls to enter human cells. “The twice as likely to survive if they and Families with loved ones for patients new coronavirus cannot enter received the drug. Unpublished Members of the anesthesiol- affected by the no-visitor policy. cells without the help of the data from Wuhan, China, found ogy, surgery, and radiology TMPRSS2 proteins on our lung better outcomes in COVID-19 departments helped connect Keeping the Virus cells,” Dr. Goldstein says. “Our patients who took famoti- the sickest patients with their Out of Lung Cells analysis suggests that decreas- dine while hospitalized, and a families. Maya Hastie, MD, Lowering testosterone could ing testosterone will lower more recent study published EdD, and Yefim Vilnits, MD, lessen the severity of COVID-19 TMPRSS2, interfere with viral

52 Vagelos College of Physicians and Surgeons VP&S COVID-19 Highlights entry, and reduce the severity or steps: Share the prognosis, ers—to assess how the pandemic IMPROVE-COVID, a clinical duration of COVID-19.” A ran- clarify the patient’s care goals, affects the physical and mental trial led by Dr. Parikh and these domized clinical trial is testing and decide on a treatment plan. health of health care workers. investigators, aims to assess the the effect of reducing testoster- Dr. Nakagawa, who worked in Data from the registry, led by optimal strategy of preventing one in COVID-19 patients at VA the emergency department with Guohua Li, DrPH, MD, will be major clotting events in criti- hospitals in pandemic hotspots. COVID-19 patients unlikely to used to evaluate interventions cally ill COVID-19 patients. recover, says, “I always try to made available during the crisis Care for Newborns stick to this protocol because and to inform policymakers. Fol- Adapting Technology for Columbia and NYP launched if I don’t, the conversations get low-up surveys of the study will a New Rapid Test the COVID Nursery Clinic, led muddled and the patients and query respondents who report Researchers at Columbia’s Fer- by pediatricians Minna Saslaw, their families get confused.” high levels of moral distress, a tility Center developed a rapid, MD, and Melissa Stockwell, response that arises when a per- one-step diagnostic test that MD, in April to offer high-qual- Applying Computational son is forced to take actions that detects COVID-19 in saliva. ity, safe newborn care within Methods to COVID-19 challenge or violate core ethical The test, which has a single tube the first week after birth to A team led by Andrea Califano, beliefs. Many health care work- that contains all of the materi- babies delivered at the hospital. PhD, applied computational ers feel forced to make triage als needed to provide reliable In addition, pediatrician Katie methods to study host cell aber- decisions about scarce resources, results in about 30 minutes, Keown, MD, lent her clinical rations implicated in COVID-19 such as operating rooms, inten- was adapted from technology support. Using Columbia’s new and to evaluate FDA-approved sive care unit beds, or ventilators. used by fertility experts to look telemedicine infrastructure, drugs that might interrupt infec- “The idea is to understand and for genetic abnormalities in mothers in quarantine with tion. The work, published in learn from individuals who have embryos before implantation. COVID-19 connected with BioRxiv, adapts Dr. Califano’s been burdened with these feel- “We realized that the same health care providers to stay Darwin OncoTreat algorithm ings,” says Rita Charon, MD, technology that we use to help informed about the health of and identifies several drugs PhD, “and to find out what create lives could be repurposed their newborns. After an initial that show promise as potential interventions are helpful.” to help save lives during the consult, doctors followed the COVID-19 treatments, includ- COVID-19 pandemic,” says Zev baby as needed to ensure the ing drugs used to treat rheuma- Studying Heart Manifestations Williams, MD. The research was newborn’s health until they toid arthritis and several kinase Early reports from China sug- published in MedRxiv. could enter care in the commu- and transport protein inhibitors. gested that the risk of blood nity after the 14-day quarantine In a separate effort, Sagi Sha- clots is greater for COVID-19 Simplifying the period. The clinic also connected pira, PhD, and Barry Honig, patients than other severely ill Search for Trials mothers, as needed, to mental PhD, developed P-HIPSTer, a patients. Behnood Bikdeli, MD, The web-based COVID-19 Trial health professionals, social computational method (pub- and Mahesh Madhavan, MD, Finder helps users search for service providers, and other lished in Cell) that leverages gathered experts in cardiology COVID-related clinical trials. resources. Melissa Glassman the supercomputing infrastruc- and thrombosis from around The tool is based on DQueST, MD, of NYP’s Newborn Clinic ture at Columbia to identify the world to create consensus a trial finder developed by the was instrumental in the creation key interactions between recommendations for pre - lab of Chunhua Weng, PhD, of the clinic and has taken its all human-infecting viruses venting and treating clots in and described in the Journal of current operations under the (including coronaviruses) and COVID-19 patients. The rec- the American Medical Infor- Newborn Clinic with her nurse the cells they infect. In addition ommendations were published matics Association. The online practitioner Andrea Hercules. to studying vaccine design, they in the Journal of the American program generates user-specific are using the information to College of Cardiology. People questionnaires to dynamically Framework for identify FDA-approved drugs with preexisting heart disease filter out trials. Dr. Weng and Difficult Conversations that may be repurposed and have a four-fold greater mortal- collaborators adapted DQueST Shunichi Nakagawa, MD, immediately deployed. ity risk from COVID-19, says to create COVID-19 Trial authored a three-stage protocol Sahil Parikh, MD, who was a Finder, which can reduce a large in Mayo Clinic Proceedings Helping the Helpers coauthor of the international set of potential trials to only a as a framework for conversa- The COVID-19 Healthcare Per- guidance document. These handful based on answers to tions that prioritize the values sonnel Study will survey tens of investigators along with San- five or six eligibility questions. and wishes of patients as they thousands of employees on the jum Sethi, MD, were awarded A visualization of the geo- confront difficult decisions front lines of care in New York an American Heart Associa- graphic distribution of returned about their care during a seri- State—from doctors and nurses tion grant to study thrombotic trials is provided to potential ous illness. The protocol’s three to hospital food service work- events in COVID-19 patients. trail participants.

2019–2020 Annual Report | ColumbiaMedicine 53 aboutVPS& MEMBERSHIPS AND DATA CURRENT AS OF SEPT. 1, 2020, EXCEPT WHERE NOTED

Columbia University Amador Centeno, MS Phyllis Mailman Thyroid, Parathyroid and Adrenal Trustees Committee on Vice President, Facilities Edward D. Miller Jr., MD Center Task Force the Health Sciences Management and Campus Services Joseph M. Murphy Peter Grossman Lawrence Neubauer Noam Gottesman, Chair Ross Frommer, JD Jonathan Rosand, MD Transplant Forum Rolando Acosta Vice President, Government John W. Rowe, MD Johanna Pryluck, Chair, and Andrew Barth and Community Affairs Peter J. Sacripanti Lisa Coakley, Vice Chair Julissa Reynoso Thomas P. Sculco, MD Jonathan Rosand, MD Christopher DiFrancesco, MA Shoshana Shendelman, PhD Urology Council Chief Communications Officer G. Lynn Shostack Gary Schaevitz, Chair Frank V. Sica Senior Administration, William Innes, MS Richard Silverman Weinberg Family Cerebral Palsy Columbia University Irving Chief Human Resources Officer Dinakar Singh Center Advisory Board Medical Center Andrew Solomon, PhD Debby Weinberg, Chair Lee C. Bollinger, JD Chad Neal Sarah Billinghurst Solomon President of the University Interim Chief Information Officer Esta Stecher Women’s Health Care Council Leonard Tow, PhD Sarah Billinghurst Solomon, Chair Anil K. Rustgi, MD General Counsel Savio Tung Interim Executive Vice President Andy Unanue Patricia Sachs Catapano, JD and Dean of the Faculties of Joseph A. Walker Senior Administration, Associate General Counsel Health Sciences and Medicine Deborah Weinberg Vagelos College of Richard E. Witten Physicians & Surgeons Lorraine Frazier, PhD Roger Wu, MD CUIMC Board of Advisors Anil K. Rustgi, MD Senior Vice President, CUIMC Eugene Braunwald, MD, Membership as of June 1, 2020 Interim Dean Dean, School of Nursing Emeritus Member P. Roy Vagelos, MD, Chair Torsten Wiesel, MD, Anne Taylor, MD Linda P. Fried, MD, MPH Philip L. Milstein, Vice Chair Emeritus Member Vice Dean, Academic Affairs Senior Vice President, CUIMC George D. Yancopoulos, MD, PhD, Dean, Mailman School of Vice Chair Other CUIMC Advisory Groups Rudina Odeh-Ramadan, PharmD Public Health Armen A. Avanessians Babies Heart Fund Vice Dean for Finance Lisa M. Baker John Minio and Scott Roskind, and Administration Christian S. Stohler, DMD, Keith T. Banks Co-Chairs DrMedDent Michael Barry Steven Shea, MD Senior Vice President, CUIMC Stanley M. Bergman Cancer Advisory Council Senior Vice Dean, Affiliations Dean, College of Dental Medicine Gary B. Bettman Richard Witten and Dina Dublon, E. Garrett Bewkes III Co-Chairs George A. Cioffi, MD Development Dana Buchman Vice Dean, Clinical Affairs, and John A. Catsimatidis Lynne Roth Center for Radiological President, ColumbiaDoctors Anna Chapman, MD Senior Vice President Research Advisory Council Neil L. Cohen Paul Locke, JD, DrPH, Chair Community Service Erica Dewan Faculty Affairs Harris Diamond Rafael Lantigua, MD Children’s Board at Columbia Anne Taylor, MD Misook Doolittle Associate Dean Lawrence Neubauer, Chair Senior Vice President for Faculty F. Jonathan Dracos

Affairs and Career Development John L. Eastman Education Columbia’s Cardiac Council Loren Eng Peter J. Sacripanti, Chair Jonathan Amiel, MD Finance Helene Feldman Interim Co-Vice Dean and Marjorie Harrison Fleming William P. McKoy, MBA Diabetes Advisory Board Senior Associate Dean for Carl Frischling Senior Vice President / John, Jodie, Jay, and Curricular Affairs Lawrence E. Golub Chief Financial Officer Katama Eastman, Co-Chairs Marc D. Grodman, MD Lisa Mellman, MD Ara K. Hovnanian Francine Caracappa, MBA, CPA Precision Medicine Council Interim Co-Vice Dean and Senior Ann F. Kaplan Vice President, Finance, P. Roy Vagelos, MD, Chair Associate Dean for Student Affairs Samuel L. Katz and Controller Ilan Kaufthal Psychiatry Board of Advisors Hilda Y. Hutcherson, MD Karen A. Kennedy, MD Operations Patricia and William Ramonas, Senior Associate Dean for Jonathan S. Leff Co-Chairs Diversity and Multicultural Affairs Donna Lynne, DrPH A. Michael Lipper

Senior Vice President / Carol Ludwig, MD Chief Operating Officer Paul J. Maddon, MD, PhD

54 Vagelos College of Physicians and Surgeons Anne Armstrong-Coben, MD Mary E. D’Alton, MD Dermatology Radiology Senior Associate Dean Willard C. Rappleye Professor David R. Bickers, MD Lawrence H. Schwartz, MD for Admissions of Obstetrics & Gynecology and Chair, Department of Obstetrics Emergency Medicine Rehabilitation & Maurice Wright, MD & Gynecology Angela M. Mills, MD Regenerative Medicine Senior Associate Dean, Joel Stein, MD Harlem Hospital Gerard Karsenty, MD, PhD Genetics & Development – Programs in Paul A. Marks Professor of Gerard Karsenty, MD, PhD Occupational Therapy Joseph Giovannelli, MA Genetics & Development; Glen Gillen, EdD, Director Associate Dean for Professor of Medicine; Professor Medical Humanities & Ethics Education Administration Biomedical Engineering; and Rita Charon, MD, PhD – Programs in Physical Therapy Chair, Department of Genetics Debra Krasinski, PhD, Director Arthur G. Palmer III, PhD & Development Medicine Associate Dean for Graduate Affairs Donald W. Landry, MD, PhD Surgery Stavroula Kousteni, PhD Craig R. Smith, MD Elizabeth Shane, MD Professor of Physiology & Microbiology & Immunology Associate Dean of Cellular Biophysics Sankar Ghosh, PhD Systems Biology Student Research Andrea Califano, PhD Edward Owusu-Ansah, PhD Neurological Surgery Henry Weil, MD Assistant Professor of Physiology E. Sander Connolly, MD Urology Associate Dean, & Cellular Biophysics James M. McKiernan, MD Bassett Healthcare Neurology Amanda J. Powers, MD Richard Mayeux, MD Finance Assistant Professor of Surgery Institutes, Centers, and (in Anesthesiology) at CUMC Neuroscience VP&S Schoolwide Initiatives Robin Honig, CPA Steven A. Siegelbaum, PhD and Their Directors Chief Financial Officer and Carrie Ruzal-Shapiro, MD Chief Business Development Aaron Diamond AIDS Professor of Radiology at CUMC Obstetrics & Gynecology Officer for ColumbiaDoctors Research Center Mary E. D’Alton, MD David Ho, MD Beth A. Schrope, MD, PhD Human Resources Associate Professor of Ophthalmology Naomi Berrie Diabetes Center William L. Innes Surgery at CUMC George A. Cioffi, MD Robin S. Goland, MD Associate Vice Dean Rudolph L. Leibel, MD Michele Shirasu-Hiza, PhD Orthopedic Surgery Research Associate Professor of Genetics William N. Levine, MD Center for Family and & Development Michael L. Shelanski, MD, PhD Community Medicine Otolaryngology/ Senior Vice Dean for Research Richard Younge, MD Karen Soren, MD Head & Neck Surgery Professor of Pediatrics at CUMC Lawrence Lustig, MD Jennifer Williamson Catania, Center for Motor Neuron MS, MPH Biology and Disease Jessica L. Spellman, MD Pathology & Cell Biology Associate Vice Dean for Research Darryl De Vivo, MD Associate Professor of Kevin Roth, MD, PhD Policy & Scientific Strategy Serge Przedborski, MD, PhD Anesthesiology at CUMC Hynek Wichterle, PhD Pediatrics Muredach Reilly, MBBCh Jordan Orange, MD, PhD Associate Dean for Clinical and Center for Radiological Research Department Chairs Translational Research David Brenner, PhD, DSc (as of Sept. 1, 2020) Pharmacology Cory Abate-Shen, PhD Anesthesiology Columbia Stem Cell Initiative Executive Committee of the Ansgar Brambrink, MD, PhD Emmanuelle Passegué, PhD Faculty Council, 2019-2020 Physiology & Cellular Biophysics Andrew R. Marks, MD Biochemistry & Columbia Translational Cigdem I. Akman, MD Molecular Biophysics Neuroscience Initiative Professor of Neurology at CUMC Psychiatry Arthur G. Palmer III, PhD Serge E. Przedborski, MD, PhD (interim) Jeffrey A. Lieberman, MD Spencer E. Amory, MD Institute for Cancer Genetics Jose M. Ferrer Professor of Radiation Oncology Biomedical Informatics Riccardo Dalla-Favera, MD Surgery at CUMC George M. Hripcsak, MD Lisa Kachnic, MD Institute of Comparative Medicine Brian Karolewski, VMD, PhD

2019–2020 Annual Report | ColumbiaMedicine 55 aboutVPS& MEMBERSHIPS AND DATA CURRENT AS OF JULY 1, 2019, EXCEPT WHERE NOTED

Institute for Genomic Medicine Gertrude H. Sergievsky Center Clyde and Helen Wu Center for Harlem Hospital David B. Goldstein, PhD Richard Mayeux, MD Molecular Cardiology New York, NY Andrew Marks, MD Institute of Human Nutrition Taub Institute for Research James J. Peters Veterans Sabrina Diano, PhD on Alzheimer’s Disease and Wu Family China Center for Administration Hospital the Aging Brain Health Initiatives Bronx, NY Herbert Irving Comprehensive Richard Mayeux, MD David Ho, MD Cancer Center Michael L. Shelanski, MD, PhD Mary Imogene Bassett Hospital Anil K. Rustgi, MD Cooperstown, NY Transplant Initiative VP&S Hospital Affiliations Irving Institute for Clinical and Jean C. Emond, MD Stamford Hospital NewYork-Presbyterian Hospital Translational Research Stamford, CT New York, NY Muredach P. Reilly, MBBCh Weinberg Family Cerebral Palsy Center Helen Hayes Hospital New York State Kavli Institute for Brain Science Jason B. Carmel, MD, PhD West Haverstraw, NY Psychiatric Institute Eric Kandel, MD New York, NY Lawrence Hospital Bronxville, NY

FACTS & STATISTICS, FY20

MEDICAL SCHOOL ENROLLMENT, FALL 2019 DEGREES GRANTED, FY20 Total medical school enrollment ...... 580 MD ...... 147 Enrollment of in-state residents ...... 190 PhD ...... 91 Enrollment of international/nonresident students ...... 18 Physical therapy ...... 59 Enrollment of men ...... 294 Nutrition ...... 73 Enrollment of women ...... 286 Occupational therapy ...... 59 Certificate in psychoanalysis ...... 7 ENROLLMENT BY YEAR MALE .FEMALE APPLICATIONS (ENTERING CLASS 2019) First-year class 68 70 Number of applicants ...... 7,914 Second-year class 75 63 Number of applications considered ...... 7,080 Third-year class 60 77 Number of applicants interviewed ...... 1,073 Fourth-year class 91 76 Number of acceptance letters issued ...... 278 Total enrollment 294 286 FACULTY, 2019-2020 ACADEMIC YEAR MEDICAL SCHOOL ETHNICITIES Full-time faculty ...... 2,119 Hispanic/Latino ...... 73 Black or African American, non-Hispanic/Latino ...... 48 FACULTY HONORS (AS OF OCTOBER 2020) White, non-Hispanic/Latino...... 265 Nobel Prize in Medicine ...... 3 American Indian or Alaskan Native, non-Hispanic/Latino ...... 1 National Academy of Sciences ...... 24 Asian, non-Hispanic/Latino ...... 131 National Academy of Medicine ...... 53 Native Hawaiian or other Pacific Islander, non-Hispanic/Latino.... 1 American Academy of Arts and Sciences ...... 26 Two or more races, non-Hispanic/Latino ...... 20 Howard Hughes Medical Institute ...... 6 Race and/or ethnicity unknown ...... 23 FINANCIALS, FY20 (EXCEPT WHERE NOTED) OTHER STUDENTS Budget ...... $2.3 billion MD-PhD students ...... 103 Philanthropic support ...... $201 million PhD students ...... 406 Endowment ...... $2.1 billion Other students (PT, OT, Nutrition, Informatics, Endowed chairs/professorships ...... 305 Genetic Counseling) ...... 486 NIH research support (Federal FY 2019) ...... $422 million

56 Vagelos College of Physicians and Surgeons CONGRATULATIONS TO VP&S FACULTY who received top honors in their fields this year, including faculty elected to the National Academy of Medicine, the National Academy of Sciences, and the American Academy of Arts and Sciences.

2019 National Academy of Medicine - Rui Costa, DVM, PhD, Neuroscience - Anil K. Rustgi, MD, Medicine

2020 National Academy of Medicine - Sonia Yris Angell, MD, Medicine - Wendy Chung, MD, PhD, Pediatrics (in Medicine) - Kam W. Leong, PhD, Systems Biology

2020 National Academy of Sciences - Angela Christiano, PhD, Dermatology and Genetics & Development - Molly Przeworski, PhD, Systems Biology - Lorraine S. Symington, PhD, Microbiology & Immunology and Genetics & Development

American Academy of Arts and Sciences - Molly Przeworski, PhD, Systems Biology

MANY OTHER MEMBERS OF THE VP&S FACULTY WERE HONORED THIS YEAR with lifetime achievement awards, election to national association leadership positions, awards for distinguished service at VP&S and the world beyond, honorary degrees, and awards recognizing teaching, research achievements, and mentoring excellence. Other faculty were inducted into the new Academy of Community and Public Service and two existing academies, the Academy of Clinical Excellence and the Virginia Apgar Academy of Medical Educators. Many others received tenure or were promoted. The full list of 2019-20 faculty honors is available online at ps.columbia.edu/facultyhonors.

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