A Battle Plan for Pancreatic Cancer Blue in The
NYU HEALTH LANGONE
FALL 2017
A Battle Plan for Pancreatic Cancer
MAGAZINE Blue in the Face (and Everywhere Else) A Medical Mystery
The World’s Heaviest Medical Textbook
For patients with severe inflammatory
FALL 2017 bowel disease, doctors at NYU Langone Health are redefining what’s possible. Help Us Make Dreams Come True
EVERY ASPIRING PHYSICIAN DREAMS OF THE DAY SOMEONE WILL MAKE A GIFT ONLINE CALL HIM OR HER “DOCTOR” FOR THE FIRST TIME. But getting there Please visit takes a lot more than hard work and dedication—it takes resources. nyulangone.org/give/funds/ By contributing to NYU School of Medicine students, you help ensure that scholarships our next generation of physicians will have access to the best teaching and research, along with a competitive financial assistance package. To discuss special giving opportunities, contact When you make a gift, you help us guarantee that all of our students will Diana Robertson at have the means to complete our rigorous education. One day, you may 212-404-3510 even have the privilege of addressing them yourself as “Doctor.” or [email protected]
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JOHN CARNETT Message from theDean andCEO What’s inaName? his dream of becomingadoctor—andhis dream of diditinjustthree years. the world’s poorest countries, Medicinewho cameto to NYUSchoolof fulfill adaptivegenetic immunity;andagraduate, puzzleof bornandraised inoneof tory bowel disease;aresearcher who illuminates the enduringanddaunting what others cannot—or will not—do to inflamma treat the mostdire casesof each,includingasurgeonThis issuespotlightsshiningexamples of who does ment to excellence inpatientcare, medicaleducation,andscientific research. care to our patients. that bringsforth thebrightest ideasandallows usto provide thebestpossible to where our patientslive and work. Finally, itcaptures thecollaborative spirit the ourwalls of hospitalsanddeliver abroader clinicalservicescloser range of more aptly healthcare, reflects as thefuture of we continue to expand beyond their well-being. We’re abouthealthfirst and foremost. Second,thename ourmension thatreflects theessenceof role: to helppeople maintainor regain organizations thatare forward thinking, nimble,anddynamic. change signifiesgrowth, development—progress—and it’s only possibleat magazine, formerly NYUPhysician. flect our new identity, our andthecore of mission, we have also renamed this I find doingso.myself July Asof 20, we are now NYULangone Health. To re- never have imaginedthatI would preside over another namechange, and yet million gift was thelargest intheinstitution’s history. Backthen,I would theBoard, Kenneth G.Langonechairman of and his wife Elaine, whose $200 the NYUElaine A. andKenneth G.Langone Medical Center, inhonor our of In 2008,a year after IbecamedeanandCEO, our institution was renamed Robert I.Grossman, MD,Saul J. Farber Dean andCEO “What’s inaname?”Shakespeare famously asked. Plenty. What will notchange, however—what will never change—is our commit Our new nameisimportantfor several reasons. First, itaddsa vital new di Many peopleresist change, butI’ve always beenoneto embrace it. To me, FALL 2017
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1 FALL 2017 A Battle Plan for Pancreatic Cancer
Blue in the Face (and Everywhere Else). A Medical Mystery
The World’s Heaviest Medical Textbook Contents
For patients with severe inflammatory bowel disease, doctors at NYU Langone Health are redefining what’s possible.
NEW YORK UNIVERSITY
William R. Berkley Chair, Board of Trustees
Andrew D. Hamilton President
NYU LANGONE HEALTH Kenneth G. Langone Chair, Board of Trustees
Robert I. Grossman, MD Saul J. Farber Dean and CEO Kathy Lewis Senior Vice President, Communications and Marketing
NYU LANGONE HEALTH MAGAZINE Steven B. Abramson, MD Editor, Science and Medicine
Nicole Dyer Director of Publications
Thomas A. Ranieri Contributing Editor Larisa Manouilovitch “PATIENTS, INCLUDING YOUNG GIRLS, FACE DEVASTATING CHOICES Print Production Coordinator AS THEY TRY TO BALANCE CANCER TREATMENT AGAINST THEIR ABILITY TO HAVE CHILDREN IN THE FUTURE. WE NEED BETTER OPTIONS.” Modus Operandi Design Art Direction KARA GOLDMAN, MD
ON THE COVER: Departments Illustration by Chad Hagen 01 Dean’s Letter 38 Post 48 Anatomy of a Leader What’s in a Name? NEW PEOPLE, PLACES, Life Lessons from AND PROJECTS Steven B. Abramson, MD 04 Scope Faculty Conversation 38 NEWS FROM MEDICINE Q & A with surgeon-scientist Diane Simeone, MD, head of Can an experimental cancer the new Pancreatic Cancer drug protect fertility? 06 Center
How the cold sore virus sidesteps PLUS the immune system 10 The Science Building A gold-standard reference for Opens 42 psychiatrists celebrates its golden anniversary 12 Highest Honors from the NIH 44 The quest for liquid biopsies 13 In Memoriam:
Steven H. Ferris, PhD 47 CHAD HAGEN LUONG TONY BEN BAKER; KOZOWYK; JONATHAN TOP: FROM CLOCKWISE
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14 GUT INSTINCTS Feza Remzi, MD, the new director of NYU Langone’s Inflammatory Bowel Disease Center, has a singular focus: alleviating human suffering. BY ADAM PIORE
22 THE CONTORTIONIST Jane Skok, PhD, studies a fantastical world of looping DNA to crack the secrets of autoimmune disease and blood cancer. BY JOSIE GLAUSIUSZ
30 WHY SO BLUE? How a team of clinical sleuths uncovered the mysterious condition that discolored a young woman’s skin—and threatened her life. BY KENNETH MILLER CHAD HAGEN LUONG TONY BEN BAKER; KOZOWYK; JONATHAN TOP: FROM CLOCKWISE
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NYU HEALTH LANGONE “Patients, includingyoung girls,face devastating choices asthey to try balance cancer treatment against to theirability have children inthefuture. We needmore options.” FALL 2017
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PHOTO CREDIT “Patients, includingyoung girls,face devastating choices asthey to try balance cancer treatment against to theirability have children inthefuture. We needmore options.”
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5 6 mature oocytes. “And itonly works stimulation and surgical retrieval of sive andinvasive, requiring hormonal limitations: theprocedure isexpen apy. That approach, however, hasits embryos prior to starting chemother cancer canelectto freeze their eggsor National Academy of Sciences. The study appears inProceedings of the ovaries andpreserves their fertility. chemotherapy protects theanimals’ ing adrugcalledeverolimus alongside searchers have shown thatadminister Using female miceasamodel,there- patients andeven treat somecancers. prevent organ rejection intransplant an immunosuppressant drugusedto plucked hopefrom anunlikely source: investigators,team of Dr. Goldmanhas “We needmore options.” at theNYULangone Fertility Center. and gynecology, who treats patients man, assistantprofessor obstetrics of children inthefuture,” says Dr. Gold treatment against their ability to have choices asthey try to balancecancer cluding young girls, face devastating NYU Langone Health. “Patients, in 2014, duringaresearch fellowship at Goldman, MD, to pursue asolutionin reproductive endocrinologist Kara leave women permanently infertile. ments cansave lives, they canalso survival, because while cancer treat pounded by reproductiveworries of age when survivalworries are of com diagnosed with breast cancer. It’s an ican women under 40are theage of Each year, an estimated 13,000 Amer By Karen Hopkin of chemotherapy could extend women’s reproductive window. An experimental cancer drug shown to protect egg cells from the ravages YouthFountainof New Cluesto anOvarian Scope
Currently,diagnosed with women Working with aninterdisciplinary That heartbreaking reality inspired ...
NYU HEALTH LANGONE FALL 2017 ------Department of Obstetrics and GyneDepartment of stetrics andGynecology, chair the of Stanley H.KaplanProfessor Ob- of study coauthor David Keefe, MD, the the time,”about 50 percent of says each menstrual cycle, a small clutch berty, about300,000 remain. During cased inaprotective follicle. By pu cytes—1 millionto 2million,eachen are born with afinite number oo- of reserve eggsontwo fronts. of Women delay intreating their cancer. can’t afford theprocedure—or the to find it didn’t work.” Many women extensiveof exposure to hormones out $15,000 andundergo six weeks NYU Langone. “Soapatientcanlay cology, andprofessor cellbiology of at Chemotherapy attacks a woman’s - - - ment. delay intreat- freezing—or the expense of egg afford the cancer can’t women with Many young action can lead to infertility by pre - gush,” addsDr. Keefe. That overre - “so follicles becomesa thetrickleof licles. The ovaries overcompensate destroy theseactively growing fol kill rapidly dividing tumor cells,also erate. Chemotherapy agents, which ovulation, andtheothers will degen ing follicles will release itseggduring explains Dr. thematur Keefe. Oneof develop “like afaucetsetontrickle,” theseprimordial follicles beginstoof for themouse.” drugs, adjustedduration and dose of author onthestudy. “So an equivalent humans,” says Dr. Schneider, asenior ly aspossible with thoseused to treat way couldhelppreserve fertility. was keen to explore whether thepath mTOR plays inbreast cancer, andhe gone, hasspent years studying therole for therapeutics alliancesatNYU Lan radiation oncology, andassociate dean Molecular Pathogenesis, professor of Sabin Professor Microbiology of and comes in.Dr. Schneider, the Albert B. adverse chemotherapy. effects of overreaction and thereby block the soned, shoulddampenthisfollicular like everolimus, theinvestigators rea that pathway with an mTOR inhibitor helps direct cellular growth. Blocking ing pathway known as mTOR, which activation isregulated by asignal Institute revealed thatthisfollicular burnout.” reserve—an effect dubbed “follicular maturely depleting a woman’s ovarian What theyWhat saw “Our protocol was alignedasclose That’s where Robert Schneider, PhD, A 2008study from theKarolinska Illustration by [ CONTINUED ON P. 8 Chad Hagen ------]
JULIANA THOMAS
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7 8 huge, huge impact.” results inaclinicaltool, it will have a if we canturnthisinto somethingthat chose andexecuted agreat project, and NYU Langone Fertility Center. “Kara ogy andInfertility, anddirector the of ReproductiveDivision of Endocrinol stetrics and gynecology, director the of Jamie Grifo, MD, PhD, professor ob of way we practice,” says study coauthor search fellows really helpimprove the culture at NYU Langone. “Our re- indications, andby the collaborative medication already approved for other transition facilitated by a the useof in a year or so,anunusually speedy team expect to launchaclinicaltrial reserve. cancer, soshecanassesstheir ovarian conditions unrelated to infertility or lymphangioleiomyomatosis, rare inhibitors for tuberous sclerosis and alreadytreatingmTOR women with she hascontacted clinicians who are says Dr. Goldman. To gather thatdata, serve ovarian functionin women,” strate thatmTOR inhibitors canpre- the clinic.“First, we needto demon cused ontranslating their results to Schneider. studies are very early,” cautionsDr. in healthy young mice. “But those early age, canextend reproductivity mTOR inhibitor, when given atan ceive. Preliminary datashow thatthe for healthy women strugglingto con hance it,pointingto new therapies only preserve fertility, but also en few produced nopupsatall. were, onaverage, thesize,anda half ed with Cytoxan alonehadlitters that number asthoseuntreated. Micetreat sevenof pups,essentially thesame treated micegave birthto anaverage itor preserved theanimals’ fertility: in humans. as a clinical marker ovarian of reserve rian hormone,amoleculethatserves showed higher levels anti-Mulle of - alone. The treated animalsalso the chemotherapy drugCytoxan many follicles asthosetreated with were left with up to three times as was thatmicetreated with everolimus Scope
If all goes If well, Dr. Goldmanand For now, the researchers are fo - The treatment strategy couldnot More important,themTOR inhib- ...
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imaging center. lishing Togo’sfirst mind: Eventuallyestab - who hasanotheronein true,” saysDr.Yaya, feels likeadreamcome at NYULangone.“Itall terventional radiology year residencyin- journey towardasix- to trimayearoffhis Degree Pathwayprogram itive Three-YearMD cine’s highlycompet- to NYUSchoolofMedi- hospitals, heapplied gist atseverallocal a radiologytechnolo- College, andworkingas College andManhattan from BronxCommunity After earningdegrees sights onbecomingone. sicians, butsethis he notonlymetphy- to theU.S.in1996, followed hisparents When 7-year-oldKamalou is thetownherbalist. medical practitioner most peopletheonly 20,000 citizens,soto by onedoctorforevery 7.3 millionisserved Togo’s populationof becoming aphysician. never gaveathoughtto Dr. KamalouYaya(’17) poorest countries, one oftheworld’s African nationofTogo, Growing upintheWest 8:56 pm 8:56 Wednesday, May 17 Graduation 2017
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PHOTO CREDIT Photograph by Joshua Bright FALL 2017 The numberof 2017 graduates graduated oneyear early, with Degree Pathway Program who in NYU Schoolof Medicine’s prestigious Three-Year MD guaranteed residencies at
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9 10 revolutionize healthcare. 1940s whenantibiotics—and evidence—began to drained into abowl until thepatient fainted. adjusted thedepth of theincisions.Bloodwas typically ears, orat thebase of thespine. Atwist of theknob the elbow, bloodvessels at the temples, behindthe four steel blades.Therazors would slice into avein at lever of thedevice compresses aspringattached to word meaning “to make scratch.” aslight Thecurved Some were decorated withelaborate scrollwork. brass, butothers were typically fashioned from silver. Clarence delaChapelle Medical Archives—is madeof artifacts housed inNYU Langone Health’s Lillianand benefit from bloodloss. were amongthemost common ailments believed to years. Fever, hypertension, edema andpulmonary dure practiced inoneform oranother for nearly 2,000 of bloodletting, also known asphlebotomy, aproce- widely used by physicians to practice theancient art asanalternativecentury to lancets, scarifiers were from thehistory of medicine. Invented intheearly 18th Behold the“scarifier,” afinelycrafted yet cruderelic Scope
Remarkably, scarifiers were common until the derives fromThe name“scarifier” anancient Greek This modelfrom of hundreds the1800s—one of ...
NYU HEALTH LANGONE The Scarifier ARTIFACT FALL 2017 In rare cases,infections canleadto emerge months or even years later. festers, andfadesaway, only to re - in which a painful blister erupts, few endure unpredictable outbreaks without symptoms, butanunlucky 10 people in the US harbor the virus virus type 1, or HSV-1. As many as 6 in coexisting with theherpessimplex sore knows the intermittent agony of Anyone who’s ever suffered acold By Julie Grisham jostled from dormancy, sidesteps the immune system. NYU Langone Health researchers discover how the cold sore virus, from Angry Cold Sores WeWhat Can Learn to liedormantin ahost’s cells, outof latency,as viral allowswhich viruses linger on:ahibernationstate known ruses, have evolved aclever tacticto ruses, includingherpessimplex vi virus and eliminates it. But some vi system eventually overwhelms the goes well for thehost,immune host compete to all take thelead.If both invader and immune system, as arms race with the molecularkind of ruses engage ina viruses. and other herpes ly eradicate HSV-1 treat andpotential novel therapies to paves the way for cal discovery that system—a criti evades theimmune ered how the virus Health hasdiscov NYU Langone research team at a multidisciplinary encephalitis. Now, serious conditionslike blindnessand Infectious vi - - - - without causing disease,” explains Ian can also reactivate, cause symptoms, Mohr, PhD, professor of microbiology at NYU School of Medicine. “But they “Viruses can lurk in a human forever“Viruses and spread to a new host.” - - PhD, professor cellbiology, of and journal recently published a paper in the Medicine,leagues atNYUSchoolof toms, andspread to anew host.” they can also reactivate, cause symp- PhD, professor microbiology. of “But causing disease,” explains Ian Mohr, can lurk inahumanforever without theimmunesystem.sight of “Viruses types of cells, in types of Mohr. “It containsmany different like a miniature organ,” explains Dr. on cells in isolation. “The ganglion is because it’s difficult to study gangli has beenpoorly understood, inpart viruses emerge from thissanctuary neuroscience andphysiology. Buthow reawakens and,intheprocess, evades triguing new detailsabouthow HSV-1 Dr. Mohr, along with other col Cell Reportsdescribingin Illustration by
author Moses Chao, explains study co- forturbed years,” can remain unper which alatent virus sent astableplacein nerve cells repre nal ganglion. “These called the trigemi nervearea cells of the brain, in anof deep insidethebase system, nesting into thenervous burrowsThe virus cureless andlifelong. HSV-1 infections are virus infections, As with all herpes system to reproduce. the host’s immune - [ CONTINUED ONP. 12 Michael George Haddad ------]
KARSTEN MORAN; DEVON JARVIS (FAR LEFT)
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11 Scope
cluding immune cells.” The researchers’ solution was an innovative culturing technique THEY WROTE THE BOOK ON IT “made of nothing but neurons,” says Dr. Mohr. “It allows us to study the molecular signaling and circuitry in Four Questions for Psychiatrists Drs. Benjamin and Virginia Sadock depth, without interference from other cells.” With a clear window onto the infected cells, the research- ers made a startling discovery: when jostled awake by stress, HSV-1 bursts this may marked the 50th anniversary of Kaplan & Sadock’s Comprehensive Text- into action, releasing a flood of pro- book of Psychiatry, the gold-standard reference for clinicians in training and sea- teins that jams the host’s immune soned professionals alike. Over the years, the seminal tome has grown from 600 reaction to interferon signals from pages to more than 5,000 pages in two volumes, drawing on 650 experts in the infected cells, effectively disarming mental health field. We caught up with NYU School of Medicine coeditors Benjamin the cells’ alarm system. “This hap- J. Sadock, MD, the Menas S. Gregory Professor of Psychiatry, and his wife, Virginia A. pens in the very first instant that Sadock, MD, professor of psychiatry, to discuss the book, now in its 10th edition, and HSV-1 reactivates,” explains Angus the milestone. The book’s other coeditor is Pedro Ruiz, MD, professor of psychiatry Wilson, PhD, an associate professor at Baylor College of Medicine. of microbiology and another of the paper’s coauthors. The latest edition weighs 25 pounds. pulses of electricity are delivered to spe- The findings may have implications Has it always been so expansive? cific areas of the brain to help patients for understanding other, more harm- with obsessive-compulsive disorder and ful pathogens that also exhibit laten- Dr. Benjamin Sadock: Yes. The original major depression. Although the science cy, like varicella zoster, a herpes virus concept was brought to several major is in its infancy, it holds great promise for that causes chicken pox and shingles, medical publishers, all of whom turned advancing our field. and even tuberculosis and HIV. “This it down. There were so many schools work is very exciting,” says Elisabeth of thought back then that they feared Which topics in this edition are new or Cohen, MD, professor of ophthalmol- getting a large group of psychiatrists extensively updated? ogy who is leading a federally funded, to agree would be like herding cats. But multicenter study of varicella zoster we got people to work together and Dr. Virginia Sadock: One new section infections of the eye, a potentially se- express their points of view without is transgender identity disorder, which rious complication that can result in attacking each other. Our contributors has undergone many conceptual chang- blindness and chronic pain. “When write whatever they want and are never es. Most children have a pretty solid these viruses come out of latency, censored. If they take issue with a con- gender identity as early as two or three they can cause many problems,” adds cept or declare, “This drug shouldn’t be years of age. But in some people, there is Dr. Cohen, who was not involved in used,” we encourage them to say it. Our confusion, a dissonance. A transgender the herpes simplex research. “If you goal is to improve and maintain the pro- person is saying, “You may look at me can understand the process by which fessional competence of practitioners. and see a woman, but inside I’m a man.” that happens, you might be able to find Or vice versa. We now know that gender JARVIS DEVON new ways to prevent them from caus- What has been the biggest shift ing harm.” in psychiatry since you began this Currently, infections with both project? HSV-1 and varicella zoster are treated with antiviral drugs. These medica- Dr. Benjamin Sadock: Over the past tions block the virus from replicating, 25 years, we’ve witnessed a pharma- which can eliminate symptoms of in- cologic revolution due to the vast array fections, but they are not a cure. of drugs developed to treat all types of “The holy grail of this research is mental disorders. It’s crucial, however, to one day eradicate latency either by that drugs not supplant psychothera- getting the virus out or sealing it up py. The doctor-patient relationship is permanently,” says Dr. Mohr. “Under- the cornerstone of psychiatry, and drug standing all the interactions between therapy combined with psychothera- viruses and hosts could yield findings py has been found to be more effective that result in better treatments for a than either used alone. Words matter. number of viral diseases. There are They can damage the brain, but they many implications, and we’ve only can also heal the brain. A second revo- scratched the surface.” lution is called neuroregulation, in which CREDIT PHOTO
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DEVON JARVIS of psychiatry. symptoms. Neuroscience is the future can finallydomore thanjust treat the tially influence themto findacure. We brain connect—or don’t—we can poten stand how the 100 billion neurons in the beginning to change. If we can under we didwhenwe started. But things are about the cause of schizophrenia now as editing this textbook, we know as little Dr. Benjamin Sadock: In50 years of What’s on the horizon for your field? and psychiatry has much to offer them. Theytia. bear atremendous burden, the caregivers of patients withdemen- We also addedachapter oncaring for es such as cocaine, alcohol, or opioids. suicidal, or addicteddying, to substanc nogenic drugs to treat patients who are the experimental use of some halluci- issues. Several areas of thetext cover much more involved withend-of-life lation ages, psychiatrists are getting Dr. Benjamin Sadock: As - our popu become much more nuanced. spectrum. Our approach to therapy has identity isnot blackandwhite—it’s a - - - the diseaseis managed. “The abili ries, couldeventually improve how conjunction with Bio-Rad Laborato- tumors, thenew tests, developed in routine skinexams, butfor metastatic moved before they spread, thanks to caught early and can be surgically re ful, andcostly. can beinvasive, pain Trouble is,biopsies targeted treaments. tumor growth andpointto highly mation aboutgene mutationsdriving sis, but also reveal a universe infor of not only material for routine diagno- by needleor by surgery, canprovide management. A tiny sample, acquired creasingly important role in cancer medicine, tissuebiopsiesplay anin personalizedIn the emerging era of By Julie Grisham developing simple blood tests to monitor metastatic melanoma. Investigators at theLaura andIsaac Perlmutter Cancer Center are Liquid Biopsy QuestforThe a to 75% of melanomapatients,”to 75% of hesays. “Our tests couldbeusefulfor up skincancer.ma, thedeadliesttypeof gene mutationslinked to melano- in thebloodstream andhelpidentify that candetect tumor DNA circulating blood tests, known as“liquidbiopsies,” novel oping aseriesof for his part, is devel Center. Dr. Polsky, Perlmutter Cancer the Laura andIsaac and aresearcher at Langone Health ic oncology atNYU fessor dermatolog of W. Kopf, MD, pro- MD, PhD, the Alfred says David Polsky, push for alternatives,” The majority melanomasare of “There’s abig ------
FALL 2017 tology anddirector theInterdisci of O. Perelman Derma Department of Osman, MD, professor intheRonald inaccessible tissue,”kle of says Iman blood allows usto overcome the wrin ty to capture DNA that’s shedinthe changer.” a more invasive procedure isagame simple blooddraw rather thandoing able to follow their progression with a reanalyzed. The idea that we may be to treatment and frequently need to be that have alterations evolve resistance Langone. “We know that some tumors Medical Oncology Program atNYU MD, PhD, director the of Thoracic within atumor,” says LeenaGandhi, medications target molecular changes many lung cancers today because some howessential componentof we treat in theUS. “Molecular diagnosisisan Dr. Polsky explains, isto anaylze a at NYULangone. The long-term goal, plinary Melanoma Cooperative Group
NYU HEALTH LANGONE both menand women cancer killer among cancer, theleading in particular lung other cancers as well, plications for many hold profound im to switch therapies. and thepatientneeds growth hasresumed, working, cancer ment hasstopped possible when atreat determine asearly as follow-upto visits tumor mutationsat patient’s bloodfor Liquid biopsies
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NYU HEALTH LANGONE FALL 2017 at NYU Langone’s Inflammatory Bowel Disease Center are How colorectal surgeon Feza Remzi, MD, andhisteam tackling thetoughest of tough cases PHOTOGRAPHS BY JONATHAN KOZOWYK BY ADAM PIORE
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15 Sarah Johnson Sarah By the time 16 the colon, had lefttacks the lining of tion in which the immune system at with severe ulcerative colitis,acondi her case would be. A lifelong battle cords, herealized justhow difficult as heexamined Johnson’s medicalre- me to make theimpossiblepossible.” tients, “Dr. Remzi adds,“she asked eight years. “Like so many my of pa surgery attheCleveland Clinicfor colorectal chair thedepartmentof of post last September after serving as ease Center. Dr. Remzi assumedthe Langone’s Inflammatory Bowel Dis- sor surgery of anddirector NYU of to give up,” recalls Dr. Remzi, profes- was told, was her besthope. ulcerative colitis.Dr. Remzi, Johnson tinal conditions,Crohn’s diseaseand term for two debilitatinggastrointes- tory bowel disease(IBD), anumbrella inflamma treat themostdire casesof others cannot—or will not—do to lastresort,tal surgeon doing of what made anamefor asacolorec himself decades inmedicine,Dr. Remzi has travelthe world. elephant poloandambitiousplansto old homemaker with apassionfor was anintolerable fate for the53-year- with apermanent ostomy bag. That news: thesafest way forward was life livered some version the same bad of order. Surgeon after surgeon had de achronic bowelcomplications of dis- her 27th operation to cope with the Remzi, MD, in2003, she was facing (not thepatient’s real name) metFeza
Dr. Remzi balks atachallenge but “Sarah person was notthetypeof Over nearly the course of three ...
NYU HEALTH LANGONE FALL 2017 ------is as high as 15%. Dozens of sutures oris ashigh15%. Dozens of with risk. The failure rate for pouches ing theneedfor anexternal bag. theanalcanal,eliminat to thetop of testine. The pouchissutured directly ervoir, or thesmallin pouch,outof which surgeons form aninternal res- dergo amore complex operation in ulcerative colitiscases—they canun limited to thecolon,asitisinmany dominal wall. Or—if inflammationis surgically created openingintheab- an external bagattachedto astoma, a patients musteliminate stool through for its temporary storage. Without it, pares waste for elimination,andallows organs, thecolonabsorbs water, pre- colitis. for one in five people with ulcerative and rectum removed—an eventuality So in her mid-40s, she’d had her colon perforated seemingly beyond repair. Johnson’s large intestine scarred and chances of complications risedramat chances of tends to tear, scar, and puncture. The voir fragile intestinal tissuethat outof staples are required to sculptthereser haunt her for years. leaks andinfections that of would 26 inall,to deal with achronic string ishing number revision surgeries, of time to heal andstrengthen. dures that give theintestinal tissue forming two or three separate proce- they did for Johnson, rather thanper pouch during the same operation, as geons remove thecolonandcreate a ically, Dr. Remzi explains, when sur- That procedure, however, isfraught One of thebody’sOne of least heralded As aresult, sheendured anaston
------home run all around,” IBD-related surgical Feza Remzi, MD, has the Cleveland Clinic MD, (right) chair of NYU Langone from already performed says Leon Pachter, the Department theof Department recruitment was a procedures. “His Since arriving at last September, more than 450 Surgery. less than 4%, understood keenly why render and accept a permanent bag. ommending that Johnson simply sur so many other surgeons were now rec treat symptoms, people upto 45% of Although some medicationsexist to care requires astrong surgical team. whose multidisciplinary approach to Inflammatory Bowel Disease Center, NYU Langone’s rapidly expanding made himtheidealchoice to direct with his passion for the problematic, His extensive experience, coupled than any other surgeon in the world. cedures, and more pouchrevisions more than1,000IBD surgical pro- second chance.” fering. I want to give thesepatientsa opportunity to alleviate humansuf colorectal surgery because it was an he says. “Ifell inlove with thispartof the limitsandchallengingnorm,” in theoperating room meanspushing have asituationlike this,commitment complexityof helives for. “When you case, heexplained, provides thekind theprocedure heperformed.of The last April, Dr. Remzi pulledupa video case inhisofficeonan overcast day after 26surgeries? thispatient’sof pelvic cavity looklike Remzi wondered,contents the would obscuring healthy tissue. Dr.What, adhesions form between scar tissue, pelvic cavity and the ease with which due to the cramped space within the pouchsurgerya redo of ischallenging Even under circumstances, thebestof Dr. Remzi, whose failure rate is To date, Dr. Remzi hasperformed Recalling Johnson’s remarkable - - -
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17 18 researches theunderlying causesof associate professor medicine, of who troenterologist Lea Ann Chen,MD, much more than bowels,” says gas- IBD.the ordeal of ical supportto helppatients cope with nutritional counselingandpsycholog medical andsurgical interventions to includes everything from expertise thelatest center’s the Today, care. laboration to offer themostadvanced disciplinary team working in close col what he’s doingis a10. All thetime.” difficultyRemzi. “The degree of in Surgery,of who helpedrecruit Dr. Surgery and chair the Department of George David Stewart Professor of to 10,” says H.LeonPachter, MD, the difficultyjudged onadegree of 0 from tions, includingcancer. potentially life-threatening complica lead to abscesses,blockages, andother gery to remove diseased areas that can eventually require sur some form of people of with Crohn’s disease, will with ulcerative colitis,andupto 75% gold standard, hebelieves, isamulti when hejoinedNYU Langone. The ology, set theplan in motion in 2012, rector Gastroenter theDivision of of Professor Gastroenterology of anddi B. Pochapin, MD, theSholtz/Leeds patients from around the world. Mark
“This diseaseendsupaffecting so “In many Olympic sports, you’re ...
r. remzi’s arrival marks the a modelIBD center thatdraws gone’s ambitious plan to build “In many Olympicsports, you’re judged onadegree of difficulty from 0 to 10. NYU HEALTH LANGONE latest phase of NYULan latest phaseof The degree of inwhat difficulty he’s doingisa 10. Allthetime.” FALL 2017 ------H. LEON PACHTER, MD, THEGEORGE DAVID STEWART PROFESSOR OF them meldacohesive treatment plan. share their perspectives, which helps that alldisciplinesgain familiarity and Clinicians present individual casesso cialists insurgery, medicine,oncology, weekly confabthatdraws some50spe that have sincebeenformalized into a regular cross-departmental meetings with their cancer cases. They held the way hisgastroenterologists dealt model for a new approach to IBD in ity inpatientcare.” metrics of measuring outcomes or tracking qual database, nobestpractices. No one’s tissue,nopatient no biobankingof he says. “There’s no unifying center, phone callfrom onedocto another,” chapin. “Patient care istypically a devoted solely to IBD, notes Dr. Po- specialists coordinated lack centers sion making.” clinical care thatleadsto better deci the samepage. It’s ateam approach to make sure that their providers are on take thepatients thepressureto off “The idea is to coordinate care and IBD andinvestigates new treatments. Radiology andPathology.” we doisdependentonSurgery and Medicine, because somuchof what of Gastroenterology or theDepartment “It doesn’t justlive intheDivision of for apatient,” Dr. Pochapin explains. in theroom to figure outthebestcare different specialtyfrom areas a lotof of sense that expertiseyou needa lotof radiology, pathology, and other “IBD is very similar to cancer in the Dr. Pochapin saw apromising Unfortunately, mostmedical IBD is poorly understood. Ulcer SURGERY ANDCHAIR OFTHEDEPARTMENT OF SURGERY fi e lds. lds. - - - - “ last May. at Tisch Hospital in a surigical suite Dr. Remzi, seen here ing the norm,” says limits and challeng means pushing the the operating room in Commitment
- linked to thedisease), environmen IBD (more than200 genes have been are key indetermining who develops ern world suggests that while genetics recent riseincasesoutsidethe West debate and exploration. To many, the as Africa, Asia, andEastern Europe. IBD has traditionally been rare, such casesinplaces seen asurgewhere of In recent years, epidemiologistshave for as many these cases. as 80,000 of dation of America. Children account ing to theCrohn’s andColitisFoun about200,000from 2011,accord of cans currently have IBD, anincrease ever since.Some1.6million Ameri has continuedto grow ataslower rate exploded between 1940 and1990 agnosed cases in the Western world testine andanus. The number di of mouth allthe way to thesmall in the digestiveof system, from the condition and can affect other parts Crohn’s diseaseisamore general the large intestine, mation of while ative colitisinvolves chronic inflam Yet thecausesremain amatter of
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PHOTO CREDIT PHOTO CREDIT Illustration by J-shaped loop.J-shaped pelvic cavity, forming a intestine down into the pulls theendof thesmall colon andrectum, then A surgeon removes the surgeon Feza Remzi, MD, hasperformed more J-pouch procedures thanany other surgeon inthe world. is considered thegold standard for treating severe ulcerative colitisunresponsive to medicaltherapies. NYULangone Colorectal for apermanentexternal bag. Today, aJ-shaped reservoir fashionedfrom thepatient’s smallintestine—known asaJ-pouch— The technique was life changingfor patientsbecauseitallowed themto eliminate solid waste normally without theneed In 1969,aSwedish surgeon namedNils Kock introduced thefirst intestinal reservoir to replace adiseasedcolonand rectum. A New Role for theSmallIntestine theLarge When Intestine Fails SIX STEPS TO BUILDINGAJ-POUCH 1 Todd Detwiler INTESTINES NORMAL stool. storage reservoir for to create aninternal sewn orstapled together descending sections are The loop’s upturned and 2 intestine. seal theendof thesmall A staple gun isused to 3 staples withsutures. Dr. Remzi reinforces the 4 pouch to test for leaks. Saline isinjected into the 5 FALL 2017
NYU HEALTH LANGONE perineum andtheanus. bottom of theJ to the surgeon connects the In thefinalstep, the
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19 “What defines me professionally—and what defines our team— is the concept that we can do the things that others cannot, or will not, do. Our ability to take on the most challenging cases elevates even the most routine procedures.”
FEZA REMZI, MD, DIRECTOR OF NYU LANGONE’S INFLAMMATORY BOWEL DISEASE CENTER
tal factors, such as antibiotic use and a cadre of highly trained colorectal est departments, everything changed. diet, may also play an important role. surgeons already performed IBD Dr. Fazio was already routine- The multifaceted nature of IBD de- procedures, care wasn’t available as a ly performing the kind of grueling, mands multifaceted clinical care. The uniform program, notes Dr. Pochapin. complex surgeries Dr. Remzi him- year before Dr. Pochapin arrived, gas- “You would have to find the surgeon self would come to master. It was Dr. troenterologist Lisa B. Malter, MD, who would do it, and then find the Fazio who introduced Dr. Remzi to clinical assistant professor of medi- gastroenterologist who would care the J-pouch and taught him many of cine, began to notice that a significant for you afterwards.” That all changed the techniques he had pioneered to number of patients coming through with Dr. Pochapin’s vision and the ar- ensure the success of the pouch. New York City’s public hospitals rival of Dr. Remzi, who is helping to When performing the J-pouch pro- were suffering from IBD and weren’t quickly transform NYU Langone into cedure, a surgeon removes the colon receiving the care they needed, in part a global destination for complex cases. and rectum, then pulls the end of the because they lacked access to special- Already, he has performed more than small intestine down into the pelvic ists who understood the full spectrum 450 IBD-related surgical procedures. cavity. The next step is to loop the end of the disease. On her own, and with “What defines me professionally,” of the small intestine and staple or sew few resources, she set up an IBD clinic Dr. Remzi says, “and what defines together the loop’s upturned and de- at Bellevue Hospital Center. our team is the concept that we can scending sections to create a storage To match her effort at Tisch Hos- do the things that others cannot, or reservoir for waste. The connected pital, Dr. Pochapin recruited gastro- will not, do. Our ability to take on the loop has the shape of the letter J, with enterologist David Hudesman, MD, most challenging cases elevates even the upturned reservoir end shorter assistant professor of medicine, and the most routine procedures. We can than the tube of intestine that feeds appointed him medical director of the handle the unexpected.” into it. The surgeon then connects the Inflammatory Bowel Disease Center. bottom of the J to the perineum and (Dr. Malter and Dr. Hudesman con- the anus. tinue to collaborate closely and have native of ankara, turkey, Over the years Dr. Remzi learned coauthored numerous papers.) Dr. Dr. Remzi grew up around and developed a number of his own Pochapin also recruited gastroenter- medicine. Both of his parents techniques—both big and small—that ologist Seymour Katz, MD, clinical were physicians trained in the helped him deal with the challenges of professor of medicine, a renowned US who chose to return to their redo surgeries. Like how to unstick a IBD expert with a thriving practice homeland to help bring modern med- clump of inflamed tissue and separate on Long Island. Dr. Katz now directs icine there. Dr. Remzi’s mother was a it into its component parts: you spray NYU Langone’s Inflammatory Bowel pediatrician, and his father was a sur- it with saline solution. Or how to make Diseases Outreach Programs, which geon who established the first modern sure the ends of a chronically infected help educate community physicians urology department in Ankara. Dr. J-pouch can heal properly. Part of what about IBD. Remzi intended to follow in his fa- makes him one of the world’s top IBD With a roster of veteran gastro- ther’s footsteps when he arrived at the specialists, beyond the requisite tech- enterologists, colorectal surgeons, Cleveland Clinic in 1989 for a one-year nical skill and knowledge, is the sheer nurses, nutritionists, and other kinds surgical fellowship. But when he did a number of cases he has done in this of specialists on call, NYU Langone surgical rotation with Victor Fazio, one small surgical niche. He has coau- was poised to create a premier mul- MD, a pioneering colorectal surgeon thored by far the most comprehensive
tidisciplinary IBD center. Although who headed one of the nation’s busi- analysis of outcomes for complex IBD MORAN KARSTEN JOHN
20 ... NYU LANGONE HEALTH FALL 2017 procedures, including 4,000 of his “ IBD is very similar to to patients possible is my wife’s devo- of digestive tract, removed from Sarah own, and helped train more than 150 cancer in the sense tion to our family. She put her derma- Johnson in 2003, once resembled a that you need a lot protégés. “My passionate message is of expertise from tology practice on hold to support me sleek J-shaped pouch. But any remnant that these types of procedures should a lot of different in my mission at NYU Langone, and of the smooth tubular structure with areas of specialty,” be done only by surgeons who do it says NYU Langone’s I am as grateful to her as my patients its roughly parallel sections is hard to every day,” he says. “Not once in a blue Mark Pochapin, MD are to me.” recognize in the current mass of angry moon, not once a month. Every day.” (center), who has red tissue displayed on the screen. assembled a veteran Elite surgeons like Dr. Remzi, roster of IBD experts, “There’s no normal tissue anatomy notes Dr. Pachter, begin to develop a including fellow gas- itting in his 23rd-floor here,” Dr. Remzi says. troenterologist David sixth sense, even in areas so scarred Hudesman, MD office of NYU Langone’s -Am In the end, he determined the by previous surgeries and so inflamed (left), and colorectal bulatory Care Center, Dr. J-pouch itself was so damaged that he surgeon Feza Remzi, that normal anatomical landmarks MD (right). Remzi flips through images on needed to excise it entirely and finish have disappeared. “They’ve done it so a computer screen. He’s impeccably what others had failed to do: construct many times,” he says, “that they know dressed in a tailored blue suit and a J-pouch flawlessly. Nearly 15 years all the pitfalls, where not to go, what yellow tie, with not a single strand of later, Johnson is living a vibrant, active complications might arise.” For Dr. closely cropped hair out of place, so life. Dr. Remzi knows, because he is Remzi, the gut instinct that enables it’s hard to imagine him amid the still in touch with her. The updates are him to push beyond the limits of what blood and guts of the OR. That is, until the part of the job he enjoys most. is normally possible in such cases is, he finds what he’s looking for. Tapping “I’m committed to taking care of indeed, metaphysical in its origin. a button on his keyboard, he pulls up a my patients for the rest of their lives to “There’s a force that guides me,” he picture of an inflamed, heart-size lump ease their suffering,” says Dr. Remzi. says, “and frankly the source of it is of intestine sitting neatly atop a teal “I fell in love with this kind of relation-
JOHN KARSTEN MORAN KARSTEN JOHN my family. What makes my devotion cloth backdrop. This particular piece ship. It’s why I do what I do.”
FALL 2017 NYU LANGONE HEALTH ... 21 22 Contortionist The
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NYU HEALTH LANGONE FALL 2017 Illustration by Paul Tebbott
PHOTO CREDIT PHOTO CREDIT makes quantumphysics lookquaint.Her hard-won insightsare notonly upending conventional genetic organization, butalsocracking notionsof thesecrets of some autoimmune diseasesandbloodcancers. Jane Skok, PhD, investigates afantastical loopingDNAworld of that FALL 2017
b y josie glausiusz
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ty. It took her more thana year to re- laboratory spaceatNew York Universi her labshutdown, her team moved to 24 is devastating,” Dr. Skok says. “But we store thestatus quo.“Losingeverything reagents stored inher freezers melted. calls Dr. Skok. What’s more, precious and they wouldn’t breed properly,” re our mice, but they were traumatized, survived, butatacost.“We didn’t lose thology Medicine, at NYU School of Jane Skok,of PhD, professor pa of The 900miceliving inthelaboratory drowned when saltwater flooded labs. ly, research rodents butthousandsof No human lives were lost,miraculous premature babies. 322 inpatients,including and forced theevacuation of it knocked outthepower Center onOctober 29,2012, into NYULangone Medical colossal storm surge slammed HurricaneWhen Sandy’s
After thebuilding thathoused ...
NYU HEALTH LANGONE FALL 2017 - - - -
test thingseasily, we should startover.” took thelong view we thatif couldn’t single scientific paper inmorea than a mother four—she of hadn’t read a turned to science in1997—by then kidney problems. Dr.When Skok re- frequently hospitalized with serious ing two young them children, oneof PhD thesisingenetics while rais- from thelab,after she completed her That journey included a 12-year break genetics andimmunology.yrinths of by twistsand turns, through the lab- has pursued apaththathastaken her, ic do-overs. Born in Johannesburg, she gone in2006,isnostranger to dramat Dr. Skok, who arrived atNYULan
- - ith stressful situa “ people in it.” to motivate all the to run, and you need Skok, “you have a lab you can’t,” says Dr. sit down and cry, but Sandy, you want to tions like Hurricane W - genes inside the nucleus of each cell. eachcell. genes insidethenucleusof a handful of ited genetic material of cell receptors, drawing from the lim 100 billiondifferent antibodiesand T system—can generate more than theadaptive immunelinchpins of howing puzzleof Band T cells—the In particular, shestudiestheendur an impossibly space. small amount of genetic information inside amount of how cellsstore animpossibly large clear organization, or thescienceof close collaborator. Medicine, at NYUSchoolof who isa Pathologychair the Department of of the Hermann M.BiggsProfessor and cancer biologist Iannis Aifantis, PhD, and became a leader her of field,” says came back to science but came back decade. Despite this gap, “she notonly al structure, spoolingintelligently lapses into a tiny three-dimension DNA, scientistsnow understand, col as the nucleus in which it resides. The which is about 200,000timesas wide would feet stretch long, sixand ahalf untangled,theDNAIf from eachcell looks more knotted like aballof wool. is thatinhumancells,nuclear DNA axis like aspiral staircase. The reality with strands neatly wound around an Francis Crickin1953: adouble helix, constructed by James Watson and dna goes awry. which canarise when theprocess blood cancers and immune disorders, plications for certain thetreatment of Cracking this puzzle has profound im Dr. Skok’s field,specifically, isnu Many people, when they picture , might think of the famous model thefamousmodel , mightthinkof Photograph by Tony Luong ------
MICHAEL HEIMAN / GETTY
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26 in Imperial College, studying the bi PhD, at the Medical Research Center research fellow with Amanda Fisher, and began working asapostdoctoral Trust Career Re-entry Fellowship when she was awarded a Wellcome elaborate in1999, process took off ety foreign antigens. of can recognize analmostinfinite vari versatile B-and T-cell receptors that dna match, andjoindistantsegmentsof cutting and pasting to mix, ballet of organization orchestrates adelicate techniques to study how chromatin cated imagingandmolecular biology another 10 years’ time.” it, I’d bestandinginthesameplace a fear I didn’tof that “if get back into “zero confidence” butpersevered out At thetime,sheconfessed, shehad ing like crazy to itall.” make senseof Medicine inLondon,“readSchool of immunology from ImperialCollege the gap, earningamaster’s degree in year career break, shereoriented after doctorate ingenetics before her 12- Dr. Skok hadmanaged to complete a ology,” says Dr. Aifantis. Even though important questionsinthestudy bi of that would become“one themost of tion, letaloneadvance inquiry a lineof would build acareer around thisques in 1997, shehadlittleideathat packaging process regulate thegenes? does thisdeliberate, highly controlled a complex calledchromatin. Buthow around nucleosome proteins to form
When Dr.When Skok returned to science Dr. Skok’s fascination with this Today, Dr. Skok employs sophisti ... andultimately generate wildly
NYU HEALTH LANGONE other onalinear chromosome actually findpartners asfrequently asthosecloseby. “Dr. Skok’s work showed that variable DNA regions of thatare far from each The system shehaselucidated provides equalopportunitiesfor all.” FALL 2017 ------go recombination. Her fishanalyses can bebrought into contactto under arated segmentsona very longgene howsolve thepuzzleof widely sep- Dr. Skok’s major contribution was to recombination,studied thistypeof dna probes to locate andbindto specific provides equalopportunitiesfor all.” says. “Thesystem shehaselucidated frequently asthosecloseby,” Murre chromosome actually findpartners as that are far from eachother onalinear showed that variable DNA regions of ifornia San Diego. “Dr. Skok’s work ular biology at the University Cal of Kees Murre, PhD, professor molec of was a very importantfinding,” says occurs through chromatin looping.“It revealed eachgene thatcontraction of or 3- or al fluorescence technique calledthree-dimension made a with theaidof visualization folded into rosettes. The insight was center, contracting like apaper napkin riphery thecell’s of nucleustoward its T-cell receptors migrate from thepe- ment, thegenes encodingtheB-and ing that during lymphocyte develop- handful of widely cited papers, show she andcollaborators publisheda ology B cells. It of was in London that tackling particular immune diseases Although many other labshad KEES MURRE,PHD,PROFESSOR OFMOLECULAR BIOLOGY sequences. d d fish, which uses fluorescent AT THEUNIVERSITY OFCALIFORNIA SAN DIEGO cine, t nyu school of medi lecular mechanisms by ened her focus onbasicmo- Dr. Skok has broad in situ hybridization, ------breaks in developing Molecular biologists close collaborators, ing how errant DNA are now investigat Iannis Aifantis and B and T cells can spawn leukemia Jane Skok, PhD, and lymphoma.
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looping andnuclear organization. thored at least six papers on dna Dr. Aifantis, for example, have coau in ahighly collaborative way. Sheand and pioneeringnew techniques, often dren, bringshislab’s extensive ex leukemiaa commonform inchil of T-cell acute lymphocytic leukemia, and developing new treatments for major stridestoward understanding cancers. Dr. Aifantis, who has made in celldevelopment canleadto these such mutationsandother missteps million. It aimsto study precisely how aroundtimated $1.3 annualbudget of this fallfor their project, with anes - posal to the National Cancer Institute and Dr. Aifantis planto submitapro - Perlmutter Cancer Center, Dr. Skok lymphoma canfollow. ally happensalot.” Leukemia and together,” explains Dr. Skok. “It actu wrong chromosome bitsto bejoined errant curring too frequently, for instance— theprocessWhen goes astray—oc segments that code for antibodies. cisely cutsandpastes thegene zymes, calledrag1 andrag2, pre- trolled process by which apair en of She has investigated the tightly con cers usingtheBand T mice. cellsof these can the underlying causes of cells. Inher lab,Dr. Skok hasstudied ma, cancers thatinvolve white blood leukemiaprogression andlympho of nuclear organization canaffect the the molecular mechanismsby which search program that would explore The pair are now planning a major re Working with NYU Langone’s dna breaks cancause“the Photograph by
Tony Luong ------
PHOTO CREDIT
DNA’s double helix structure (light blue and light pink) tightly coils around a chain of eight histone proteins (multicolored).
pertise in this form of cancer, as well France in Paris, marvels at Dr. Skok’s as animal models it has developed for technical ingenuity. “There aren’t different types of the disease. Col- many people who are able to look at laboration has been key in advancing the processes of immune gene regula- their science. “Jane is very open to tion at the single cell-level using both sharing tools, sharing techniques, imaging and molecular techniques,” sharing reagents, and sharing ideas,” says Dr. Heard. “She is one of the rare he says. people who combine all of these ap- proaches. She ends up getting things done efficiently.” f every cloud has a silver Tracking this intricate dna dance, lining, not everyone can see it. with its potential missteps and care- Jane Skok is different. When ful repairs, is another apt analogue to she relocated her laboratory Dr. Skok’s career trajectory. “I didn’t downtown after Hurricane Sandy, she plan anything in my life. Everything met researchers with whom she now that I planned never happened,” she collaborates on numerous projects. In says. “So I stopped planning.” Dr. one such collaboration, published last Skok’s mantra of going where life May in Nature Communications, Dr. takes her is a clue to her resilience Skok employed the genome-editing and optimism. Her 12-year gap from technique crispr-Cas9 to label science and the early experience of repeat regions of dna within live motherhood—trekking to and from cells, with “guide rnas” tagged with hospitals with a sick child whose fluorescent proteins. This new imag- illness was undiagnosed for years— ing approach is a step up from fish, was a “complete nightmare,” she which looks at fixed cells. “fish is says, and yet an important part of her only a snapshot in time, like taking a journey that put life’s hardships in photograph of a crowd of people,” Dr. perspective. Skok explains. “If you took a photo- “If your child’s health is threat- graph five minutes later, they’d be in ened, that is the worst thing that can a completely different conformation.” happen to you. Everything that comes Like video, the technique enables her after it, you think, ‘Okay, this is bad. to track mouse cells over time. “Our But it isn’t as bad as that,’ ” Dr. Skok aim,” she says, “is to label up a whole says calmly. “With stressful situations locus and follow recombination as it’s like Hurricane Sandy, you want to sit going on—so you can see the bit down and cry, but you’d better not, that’s being deleted as it’s being de- because you have a lab to run, and leted.” you need to motivate all the people Former collaborator Edith Heard, in it. Nothing terrible happened to PhD, professor of epigenetics and anybody. So you think, ‘I better pick cellular memory at the Collège de myself up and carry on.’ ”
28 ... NYU LANGONE HEALTH FALL 2017 PHOTO CREDIT DNA binding sites. concealing and revealing but also help regulate it by not only compress DNA Histones (multicolored) enough cell receptorsenough to recognize analmost infinite variety of foreign antigens. lynchpins of adaptive immunity. Theprocess, remarkable inits complexity, ultimately generates and pasting to match, mix, andjoindistant segments of DNAindeveloping BandT cells, the molecular biology techniques to study how chromatin orchestrates adelicate ballet of cutting proteins to form acomplex called chromatin, shown here. collapses into structure, atiny three-dimensional spoolingintelligently around nucleosome 200,000 timesas wideas thenucleusinwhich it resides. scientists The DNA, now understand, wool. Ifuntangled, the DNA from each cell would stretch sixandahalffeet whichisabout long, a spiral staircase. Thereality isthat in human cells, nuclear DNA looks more like aballof knotted Watson andFrancis Crick in1953: adoublehelixwithstrands neatly wound around anaxis like Many people, whenthey picture thinkof might the famous DNA, modelconstructed by James The Genetic Code, withaTwist NYU Langone molecular biologist Jane Skok, PhD, employs sophisticated and imaging FALL 2017
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PHOTO CREDIT threatened her life. a youngwoman’s condition thatdiscolored sleuths uncovered themysterious How clinical a team of skin By By Why So So Why Kenneth Miller —and —and
Phot ographs by Ben Baker
FALL 2017 Blue
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31 32 C-section dueto oxygen deprivation, son hadto bedelivered by emergency actly what it was. In2001,after her older her heart,butshe’d never learnedex something was wrongthat with decade Colon hadknown for more thana and go ondisability. her job as acity maintenance worker pounds. She’d recently hadto give up ballooned with fluid retention to 225 her already hefty five-foot frame had though sheoften vomited after eating, sensation several timesanight. Al hard. She woke up with achoking too shepushedherself passed outif ached constantly, andshesometimes getting severely winded. Her chest walk her first-grader to school without someone atleasttwiceher age. (formerly NYULutheran), butshefelt like landed atNYULangone Hospital–Brooklyn Jeanne Colon was 34 years old when she She couldn’t stairs or climbaflightof
The singlemother two boys, of ...
NYU HEALTH LANGONE FALL 2017 - - flow, as well. ambiguous was into coronary arteries to show blood which adye visible in X-rays isinjected clear picture. A coronary angiogram, in ty, however, madeitdifficult to get a herimages of heart.Colon’s obesi sound probe on her chest to obtain echocardiogram, placing an ultra clinicians performed atransthoracic known ascyanosis. To findthecause, skin took onabluishtint—a condition blood oxygen dropped so low that her ized after amiscarriage, andher own out probing further. potential repercussions, she’d left with genital cardiac defect. Afraid to facethe had found evidence that she had a con doctors atanother New York hospital Doctors thenproposed amore in Then, in2005, she was hospital
------change everything. The decision would Disease Program. Congenital Heart Langone’s Adult specialists at NYU doctor to consult pallor prompted her her unexplained blue Hospital-Brooklyn, at NYU Langone (right) arrived Jeanne ColonWhen diogram (tee vasive test: atransesophageal echocar throat to take thebeating aclose-up of probe isinserted down thepatient’s That didn’t solve thepuzzle, however. atria, or upper the heart. chambers, of ( agnosed with anatrialseptaldefect time, sheunderwent a she was found to becyanotic again. This want it.’ ” second operation. I was, like, ‘Idon’t terrified her. “My momdiedafter her her surgery anxious,andthethoughtof and death. Just being inside one made she associated hospitals with suffering lost her mother to cancer asateenager, reason to avoid stickingaround: Having all this hassle?’ ” Colon hadanother ‘What’s going through the point of something to worry about.Ithought, at times, but nobody told me it was or upset,andmy lips would turnpurple always raced when I was stressed out sick,” sheexplains. “My hearthad the hospitalagain. and after a few days, shesignedoutof say how longthat would take, though, oxygen levels recovered. No onecould sues, it was putonhold untilColon’s oxygenthe amountof reaching her tis which could worsen the deficiency in performed under moderate sedation, heart. Becausetheprocedure was to be asd “At thatpoint,Ididn’t actually feel )—a holeinthe wall between the olon’s condition soon talized for amouthabscess, hospi she was 2008, when began to deteriorate. In ), in which anultrasound tee and was di - - - -
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34 met with Thao Ngo, MD, clinical in brought it vast new clinicalresources. merger with NYU Langone had hadbeenbornand self whose recent called Lutheran, where Colon her offered to take her to what was then be handledthere. An auntinBrooklyn that her condition was too complex to near her home in Harlem, but was told records shecould any longer. She brought what medical But oncemore, Colon lenging to uncover anddifficult to treat. Such complicating factors can be chal elsewhere inthecirculatory system. ed pulmonary diseaseor aproblem seldom occurs unlessthere isassociat simply patching thehole,cyanosis and can sometimes berepaired by thesymptoms Colon of was suffering, Although asd in vestigationcomplete. was
By early 2015, she was too illto delay That August, Colonandher aunt ...
NYU HEALTH LANGONE s commonly trigger many fi nd to ahospital fl ed before the FALL 2017 - - - - newly appointed director the of Adult sistant professor medicine and the of tended atalkby DanHalpern, MD, as in specializedhelp.Shehad justat simple asd clear signthatthis was more thana saturation remained subnormal—a on oxygen. After three days, her blood mitted to thecardiac care unitandput anosis was sosevere that she was ad the appointed morning,Colon’s cy but it, too, had to be postponed. On heart. Another the indicate a weakness inthe left side of inconclusive, thoughthey seemed to echocardiogramtransthoracic were As before, the electrocardiogram and Ngo ordered yet another tests. set of imaging results were unavailable, Dr. change over time,andColon’s earlier cardiovascular effects of noninvasive cardiology. Becausethe structor medicineanddirector of of Dr. Ngo knew it was timeto bring . was ordered,tee was asds may - - - - e seen something “ heart operation.heart Colon’s four-hour who led Jeanne Ralph Mosca, MD, cardiac surgeon 20 years,” notes a dozen times in like this fewer than I’v
missing valves andmisdirected coro- with severe abnormalitiessuchas congenital heart disease, even those after extended wear and tear. lon’s, thatbecome problematic only years—particularly those,like Co- such defects go undiagnosedfor now survive to adulthood.Butmany with heart defects, more than 90% infants born nary the 1% of arteries. Of Colon’s case. Dr. Halpern, who agreed to take on deeply about his patients.” Shecalled remembers. “It was clear thathecared but by hiskindnessandhumility,” she only by hisexpertise andjudgment, NYU Langone. “I was impressed not Congenital Heart DiseaseProgram at n recent decades, pediatric strides insaving children with geons have maderemarkable cardiologists andcardiac sur -
KARSTEN MORAN
PHOTO CREDIT PHOTO CREDIT ventricle, andispumpedbackto the the rightatrium, flows into theright ygen-depleted blood returns through circulated throughout the body. Ox with great force through theaortaand ventricle, from which it’s pumped atrium anddownward into theleft courses from thelungsinto theleft In ahealthy heart,oxygen-rich blood defect involving aholeintheseptum. ry disorder canarisefrom any heart menger’s syndrome. This circulato- untreated sociated with from acomplicationoccasionally as- symptoms resultedconstellation of keep her from boltingagain. goes.’” Hisreassuring manner helped Just stay for thetesting andseehow it live so you canbethere for your kids. she recalls. “He said,‘You’ve got to sure I want to findout what’s wrong,’” Dan, Itold him,‘I’m scared. I’m not no other physician Imet had.“When Halpern to connect with Colonas the world.” them theconfidenceto go outinto dren’s Hospital. “You have to give to NYU Langone from Boston Chil them,” says Dr. Halpern, who came ic illness.“It’s importantto empower lifelong, andlife-threatening, chron patients cope awith thestresses of care, theprogram’s missionisto help providing state-of-the-art medical recognized cardiac defects. Besides tients with bothpreviously andnewly itskind,servesleading centers pa of Heart the DiseaseProgram, oneof Dr. Halpern suspected thatColon’s ht prah nbe Dr. enabled approach That NYU Langone’s Adult Congenital what’s wrong. He said,‘You’ve got to live so you can bethere for your kids. “When ImetDan, Itold him,‘I’m“When scared. I’m notsure I want to findout asds: Eisen PATIENT - - - - - Just stay for thetesting andseehow itgoes.’ ” “ preconceptions.” that challenge your unique conditions confronted with MD. “You’re often ogist Dan Halpern, field,” says cardiol tensely collaborative cardiology is an in- congenital Adult CONGENITAL JEANNE COLON DAN ON DR. HALPERN, DIRECTOR OF THE ADULT HEART DISEASE PROGRAM AT NYU LANGONE - be aheart-lung transplant or alung only available optionsmay sometimes as structural changes intheheart, versible damage to the lungs, as well Because the syndrome involves irre anosis and other serious problems. is pumpedinto thebody, causingcy to-left shunt. Now, oxygen-poor blood the heartisreversed, creating aright- ens, thepressure differential inside As therightside’s muscle tissuethick heart to work harder to overcome it. pressure in the lungs and forcing the laries form scar tissue,raising blood the overburdened pulmonary capil handle. In Eisenmenger’s syndrome, blood to thelungsthanthey caneasily as aleft-to-right shunt,may sendmore hole inthe wall. This diversion, known the lower-pressure right through the from thehigh-pressure leftsideinto a septaldefect, bloodtypically leaks lungs to bereplenished. Inaheart with - - - - FALL 2017 enough to justgo inandtake pic workup she’d ever had.“It’s not team gave Colonthemostdetailed gone’s congenital cardiac imaging says. unexpected pathology,” Dr. Halpern sometimes comeacross acompletely the only possibility. “Inthisfield, you transplant with heartsurgery. merely closing the hole would not solve right ventricle spiked, con the shunt. The bloodpressure inher flating a 3-centimeter balloon to block “trial occlusion” her of septal defect, in in her heartandlungs,he performed a blood flowpressure of at key locations vein. After measuringthedirection and through Colon’s groin into thefemoral ization Laboratory, inserted acatheter and director thePediatric of Catheter MD, assistantprofessor pediatrics of gerously low. Finally, Michael Argilla, Colon’s oxygen saturation becamedan latter thatcouldbequickly reversed if sedationforTEE, usingaform of the transthoracic echocardiogram anda a cardiac mri roscience, and physiology, conducted professor radiology of medicine,neu nations. First, Leon Axel, MD, PhD, tional supportas well ashelpfulexpla through the process, offering emo- pretsee.”what you ized knowledge sothat you caninter cardiology. “You have to have special and medicaldirector noninvasive of PhD, associate professor medicine of tures,” observes Muhamed Saric,MD,
To unmask the culprit, NYU Lan But Eisenmenger’s was far from Dr. Halpern shepherded Colon
NYU HEALTH LANGONE . Dr. Saric performed a fi r ming that ming that
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35 ------“My sons tell me, ‘You look better, Mom. You’re not sick all the time,’ ” she reports, adding that she has grown close to Dr. Halpern, who continues to oversee her care. “I never trusted a doctor before, but Dan has been there for me every step of the way.”
PATIENT JEANNE COLON
her problems. the surgeon added, Colon’s health up her sternum with heavy wire. From When the results were in, the team would likely continue to decline. start to finish, the operation took about members (including Puneet Bhatla, Colon consented to the plan, de- four hours. MD, assistant professor of radiology spite her fears. To maximize the chanc- Colon’s recovery, like that of many and pediatrics, and director of pediat- es of a positive outcome, she was sent patients who undergo open-heart sur- ric and congenital cardiovascular imag- home with oxygen canisters and med- gery, was slow and arduous. She spent ing) agreed that Colon’s case was truly ications aimed at lowering her pulmo- a month in the hospital and was seen extraordinary. Her troubles stemmed nary pressure. After three months, her by visiting nurses for months after that. not from Eisenmenger’s syndrome readings were normal. Only recently has she gained enough but from something far rarer—a pair stamina to begin cardiac rehab, doing of defects seldom found in tandem. In supervised workouts at a gym three addition to a large asd, she had a mark- n a frigid morning in times a week. She still struggles with edly undersized right ventricle, about February 2016, Dr. Mosca her weight (coached by NYU Lan- half the normal dimensions. This raised and his team cut through gone nutrition consultants), with her the chamber’s internal pressure relative Colon’s chest. After attach- medication regimen (assisted by pa- to the left side of the heart, creating an ing her to a heart-lung bypass tient-support workers), and with her intermittent right-to-left shunt that machine, they began the Glenn proce- longtime depression and anxiety (aided mimicked Eisenmenger’s. “I’ve seen dure, meticulously dividing the supe- by a psychiatrist at the Medical Center). something like this fewer than a dozen rior vena cava (svc) and sewing it onto But today, she can climb stairs and walk times in 20 years,” notes Ralph Mosca, the right pulmonary artery. Normally, for blocks without tiring. Her chest MD, the George E. Reed Professor of the SVC transports deoxygenated pain and nausea are gone, and she can Cardiac Surgery and chief of the Divi- blood from the upper body to the right sleep without choking. She envisions sion of Pediatric and Adult Congenital side of the heart. If the procedure returning to work in the near future. Cardiac Surgery, who met with the worked as intended, it would divert “My sons tell me, ‘You look better, group to map out a course of treatment. one-third of that flow directly to the Mom. You’re not sick all the time,’ ” The good news was that Colon’s lungs, lessening the pressure that she reports, adding that she has grown lungs were undamaged, and her pul- fueled Colon’s right-to-left shunt. One close to Dr. Halpern, who continues monary pressure only slightly elevated. potential side effect, however, was that to oversee her care. “I never trusted a That allowed Dr. Mosca to suggest an pressure could build up in the svc, doctor before, but Dan has been there approach that Eisenmenger’s would causing swelling in Colon’s head. To for me every step of the way.” have ruled out: rerouting her faulty car- prevent this, Dr. Mosca created a Dr. Halpern, however, defers to his diovascular plumbing. The safest and runoff channel using a nearby vein. colleagues. “Adult congenital cardiol- most effective option, he explained, Next, he stopped Colon’s heart and ogy is an intensely collaborative field,” would be to combine a partial asd clo- opened up her right atrium. Using a he says. “You’re often confronted with sure with a technique known as a bidi- small piece of pericardium, the mem- unique conditions that challenge your rectional Glenn procedure. Although brane enclosing the heart, he made preconceptions. You need a team of this method is typically employed as a patch to cover the septal defect, specialists with the skills and experi- part of a multistage repair process for cutting a pinhole in the middle as an ence to ask the right questions, and babies born with a single ventricle, he escape valve. Then, he restarted her you can’t stop asking until you fully had used it successfully on adults as heart, checked to make sure her blood understand the answers.” well. Without such an intervention, was circulating properly, and stitched
36 ... NYU LANGONE HEALTH FALL 2017 Right atrium
An undersized right ventricle shunts poorly oxygenated blood through a hole in the septum.
A large hole in the dividing wall of the heart disrupts the flow of blood between the heart and lungs. Seeing Is Believing
Jeanne Colon was a 35-year-old mother of two when doctors discov- ered a rare combination of congen- ital heart defects (as revealed on this MRI) that turned her skin blue and left her feeling twice her age. In February 2016, Ralph Mosca, MD, led a four-hour surgery to patch a large hole in the dividing wall of her heart. During that time he also rerouted blood vessels to alleviate a pressure imbalance caused by a markedly undersized right ventricle.
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... New People, Places, and Projects at NYU Langone Health
NYU HEALTH LANGONE diagnosed with pancreatic cancer every year. odds for themore than50,000patientsintheUS Dr. Simeoneto discussher missionto improve the resistant to treatment. We recently caughtup with cells within tumorsulation of thatare especially covered pancreatic cancer stem cells,asubpop - Cancer Center. There, sheledthe team thatdis- at theUniversity Michigan Comprehensive of director thegastrointestinal oncology of program Cancer Center. Previously, Dr. Simeoneserved as itsnewlyand headof establishedPancreatic lational research atthePerlmutter Cancer Center Langone lastMarch asassociate director for trans- recognized surgeon andscientist,joinedNYU diane m.simeone, MD, aninternationally turn thetideagainst adeadly cancer. Center, andanambitiousresearch strategy to at theLaura andIsaac Perlmutter Cancer Diane M.Simeone, MD, discusses hernew roles CANCER? TO BEAT PANCREATIC WHAT WILLIT TAKE Faculty Conversation FALL 2017 3
PHOTO CREDIT Photographs by Jonathan Kozowyk FALL 2017 NYU LANGONE HEALTH ... 39 POST
What sparked your interest in pancreatic-cancer research? Identifying precancerous pancreatic tissue (seen here in mice) is among Dr. Simeone’s most When I was a surgical resident, I was pressing research priorities. amazed to learn how few people were doing research on pancreatic cancer. It became clear to me that to tackle a tough disease like this, it wasn’t enough to be a surgeon—I also had to pursue laboratory research. Having a close-up view of the cancer makes it very personal.
Despite recent advances in the treat- ment of cancer overall, pancreatic cancer still has a single-digit average survival rate. What makes it different from other cancers?
The disease rarely causes symptoms until it’s quite advanced, so most people have widespread disease at the time they’re diagnosed. Only about one in five have a tumor that can be surgically removed.
Even among that subset, pancreatic cancer rebounds 75% of the time, and the five-year survival rate is still only about 25%. Why is even the best-case scenario so dire?
Clearly, there is something unique about the biology of pancreatic cancer Diane Simeone, MD, con- that makes it deadly right from the sults with Lidong Wang, PhD, a researcher in her start. Understanding why is core to lab. Dr. Wang studies the our research mission. mechanisms that drive metastasis in pancreatic Encouragingly, we already have a cancer. few significant clues. Not only do pan- creatic cancer cells grow unusually fast, but they can also break off from the tumor early in the disease and spread. We know that scar tissue tends to form around the tumor, which may serve as a barrier to therapeutic agents. And there’s a complex interplay be- tween the tumor and its environment which further protects the tumor from chemotherapy and radiation and helps it evade the immune system.
Where do you see the biggest opportu- nities for making advances to address this disease?
First, our center is establishing a first- of-its kind program for early detection and prevention. This includes a re-
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NATIONAL INSTITUTES OF HEALTH (TOP LEFT) affected by pancreatic cancer, about had aclosefriend or family member ask how many intheaudience have Ispeakto alargeWhen group and I cancer. isoutreach Why so vital? promote awareness about pancreatic advocacy groups, andyou work to You’re involved withseveral patient- more likely to beeffective. personalized therapies that are much mental treatments sothatpatients get is to create a wider experi pipelineof ence into novel treatments. Our goal to translate the best laboratory sci called Precision Promise, which aims through anew clinical trialconsortium Pancreatic Cancer Action Network, clinical trials, with funding from the pharmaceutical industry onaseriesof new treatments. an unprecedented interest infinding cancercause of death by 2020, there is ing it will becomethesecond-leading common cancer. But with data predict because ithasbeen viewed asanun drugs for pancreatic cancer patients pharmaceutical companiesto develop there hasn’t incentive been a lot of for treatments for patients.Up untilnow, eries made in the lab and effective large gap between scientific discov a cure. cellsisessentialto subpopulation of radiation. We believe targeting this treatment with chemotherapy and tasis, andare particularly resistant to to drive tumor initiationandmetas- cancer stem cells, which are known For one, we are studying pancreatic more effective treatments? What are you doingto develop creatic cancer inhigh-risk individuals. delay or prevent pan theformation of new treatment paradigms to markedly creatic cancer. The goal isto develop who have mutationslinked to pan members with pancreatic cancer or people who have had multiple family cancer cells. We’re alsofocusing on intervene before they becomeinvasive abnormalpancreatic cellsso of we can search initiative to identify biomarkers We’re currently partnering with the We also recognize that there is a
------e’s traditionally beenanihilism “ have. We really needto change that.” to tell others what kindof cancer they to discuss theirdiagnosis. They don’t want it isso deadly. People are often afraid surrounding pancreatic cancer because Ther cancer metabolism. who investigates radiation oncologist Pacold, MD, PhD, a in the lab of Michael research assistant Sophia Bustraan, a more peopleknow, theeasier it will be power patients to talk about it. The nities to make progress. I want to em advances, we now have real opportu and alsoto know that,thanks to recent about this disease and its challenges, awareness. I want everyone to know gress and many other groups to raise change that. cancer they have. We really need to don’t want to tell others what kindof afraid to discuss their diagnosis. They because itissodeadly. People are often ism surrounding pancreatic cancer single-digit survival. incidence andremains adisease with that pancreatic cancer isincreasing in ing. It isimportant thatpeople know which everyone usually finds surpris- one-third raise to one-half their hands, I’ve spoken Con to members of There’s traditionally beenanihil
- - - - FALL 2017 and real hopefor patients. our obligation to provide real answers into theproper clinical context. It’s are being addressed in the laboratory to helpthem putthequestionsthat lenges that basic scientists face, and laboratory chal andseethekindsof don’t dobench work to cometo the side, it’s importantfor clinicians who an operation looks like. Ontheother and meetthepatients,to see what work with me to come to the clinic with pancreatic cancer. someone whoof hasbeendiagnosed apatient orshoes of theloved one need to be able to put yourself in the next paper. To work inthisarea, you more thanthenext experiment or the team. Our research isaboutsomuch urgencysense of to everyone on my laboratory meetings,Itry to relay that drives me every day. I run myWhen urgency—itme a sense of is what Caring for people who are dying gives the disease? with pancreatic cancer willdiefrom the fact that most of your patients How doyou cope emotionally with to increase fundingfor research. I encourage allthescientists who
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41 - NEW FUNDING 42 this funding,” Dr. Schmidtexplains. really critical of part why we were chosen for “There’s going to whichisa bealot of sharing, gy, willoversee a postdoc training program. of theLeon H.Charney Divisionof Cardiolo Additionally, Glenn I. Fishman, MD, director interventions in200 patients withobesity. tute, willcompare two behavioral weight-loss gator Eran Segal, PhD, of theWeizmann Insti- professor of population health, andcoinvesti- Annclinical trialin ScD, Sevick, which Mary loss. Thefinalproject isapopulation-based loss andthechallenges inmaintaining weight the inflammatory response relates to weight leading aclinical team to assess ifandhow MD, assistant professor of medicine, are Diabetes, andMetabolism, andJose Aleman, director of theDivisionof Endocrinology, At thetranslational level, Ira J. MD, Goldberg, RAGE affects lossweight andmetabolism. study how acell-surface receptor known as basic science end,Dr. Schmidt’s labwill projects spanning bench to bedside. On the to simultaneously tackle three interwoven for InvestiGating Novel Obesity SoluTIONS teama multidisciplinary called NYU Ignition, Langone’s Dr. part, Schmidthas assembled so hard to sustain,” says Dr. For Schmidt. NYU goal is to identify exactly why weight loss is novel approaches for treating obesity. “Our led by NYU Langone Health, to investigate perts across four academic medical centers, The AHAgrant brings together obesity ex WHAT ITFUNDS to keep theweight off,” says Dr. Schmidt. people in weight-loss programs, itisdifficult overweight orobese. “We know that for many know they have About it. 85% of them are from diabetes globally, andhalfdon’t even More than385 million people now suffer WHY ITMATTERS Young Professor of Endocrinology 3 LEAD INVESTIGATOR American Association Heart SOURCE Four years HOW LONG $4 million HOW MUCH THE GRANT POST Network onObesity Strategically Focused Research Ann MarieSchmidt, MD, PhD, theDr. Iven
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FOR RESEARCH A SLEEK NEWHOME and translational research. into ahubfor basic,clinical, thecampus the southendof starting inthefall,integrating Building will openinphases history, the16-story Science initiative inNYULangone’s renovation andconstruction themostsweepingPart of the centerpiece of thateffort.”the centerpiece of science, “and thisbuildingis vice president and vice deanfor Dafna Bar-Sagi, PhD, senior over thenext five years,” says to doubleour research capacity strategy for growth. “We plan in theinstitution’s broader occupants, itplays akey role to accommodate upto 800 Center in2005. Designed since theSmilow Research laboratories (80 inall)to open first andlargest collectionof The new facility housesthe BLDG BOOM
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PHOTO CREDIT New People Rachel Bluebond-Langner, MD
in a watershed moment for the medical care of transgender people, the Centers for Medicare and Medicaid Services began to allow coverage of trans- gender surgery in 2014, with some commercial insurers following suit. As such procedures have become more accessible and affordable, more people have opted for gender-affirming surgery. In January, Rachel Bluebond-Langner, MD, a spe- cialist in this field, joined NYU Langone Health’s Hansjörg Wyss Department of Plastic Surgery as part of a larger effort to expand its multidisciplinary program for transgender patients. The Laura and Isaac Perlmutter Associate Professor of Reconstructive Plastic Surgery, she will collaborate with a growing team to pro- vide an array of services for transgender adults and adolescents, including sur- gery and hormone therapy. Her primary collaborator is Lee Zhao, MD, assistant professor of urology, who specializes in using minimally invasive robotic surgery to access the depths of the pelvic region. For the nearly 1 million American adults who identify as transgender, the impact of gender-affirming surgery can be lifesaving. In the transgender com- munity, an estimated 40% attempt suicide at one point in their lives (compared to a rate of 1.6% in the general population). Gender-affirming surgery involves procedures that change the body, in appearance and anatomy, to conform to the patient’s gender identity. “Everybody’s journey and transition is different,” explains Dr. Bluebond-Langner. “Some will socially transition, others will take hormones, and still others will go on to have surgery.” For transgender women, Dr. Bluebond-Langner performs breast augmenta- tion, facial feminization, reduction of the Adam’s apple, fat grafting, and vag- inoplasty. For transgender men, she performs body contouring, chest mascu- linization, and phalloplasty. “Gender-affirming surgery is the embodiment of plastic surgery, using creativity and artistry to restore form and function,” says Dr. Bluebond-Langner. “It applies all the techniques I was trained in to achieve a natural aesthetic appearance while minimizing risks and ensuring safety.” Previously, Dr. Bluebond-Langner served as an assistant professor in the Di- vision of Plastic and Reconstructive Surgery at University of Maryland School of Medicine. After earning her MD at Johns Hopkins School of Medicine, she com- pleted a residency in plastic and reconstructive surgery at the Johns Hopkins/ University of Maryland Plastic Surgery Program and a fellowship in craniofacial
JONATHAN KOZOWYK (TOP RIGHT) (TOP KOZOWYK JONATHAN microsurgery at the Hospital General Dr. Manuel Gea González in Mexico City.
FALL 2017 NYU LANGONE HEALTH ... 43 NEW FUNDING 44 evidence unfolds,” says Dr. Moore. pivot to follow exciting new leads as the goes. “It’s exciting to have theflexibility to research andfollow thedata wherever it now has the freedom to expand herlncRNA vidual honor bestowed by NIH—Dr. Moore NHLBI award—considered thehighest indi- cholesterol (HDL) in theblood.Withthis called CHROME can alter thelevels of good Dr. Moore has found evidence that alncRNA are expressed. Among hermany insights, tothought influence how and whengenes doesn’t code for proteins, lncRNAs are now Once considered “junkRNA” because it immune response to atherosclerotic plaque. orlncRNAs, inregulatinging RNA, thebody’s class of RNAmolecules called longnoncod- Dr. Moore investigates therole of anunusual WHAT ITFUNDS 20 years,” says Dr. Moore. vascular disease that willhappeninthenext seeing globally, andtheincrease incardio about theepidemicof obesity that we are of vascular disease. “It’s troubling to think atherosclerosis remains theleading cause introduced more than20 years ago, and beyond cholesterol-lowering statins, drugs Unfortunately, few treatment options exist substances, andcellular waste clogs arteries. in whichplaquemadeof cholesterol, fatty is a risk factor for coronary atherosclerosis, Mounting evidence suggests that obesity ing cause of death intheWestern world. Cardiovascular diseases are thelead- WHY ITMATTERS Leon H.Charney Divisionof Cardiology professor of medicineandcell biology inthe David Blechman Professor of Cardiology, 3 LEAD INVESTIGATOR National Institutes of Health SOURCE Seven years HOW LONG $6.7 million HOW MUCH THE GRANT POST Investigator Award Blood Institute Outstanding National Lung, Heart, and Kathryn J. Moore, PhD, the Jean and
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FALL 2017 - FLYING HIGHTHANKS TO $25 MILLIONGIFT HOSPITAL-BROOKLYN,NYU LANGONE Philanthropy remain focused over thelong term. in theDepartment of Population Health to ensure that care strategies and childdevelopment. Itwill also establish anendowed professorship care across thehospital, withthegoal of improving outcomes infamily health studentsthan 14,000 at its 31School Based Health Centers. prenatal andinfant health) at its nineFamily Health Centers, andserves more babiesannually,4,500 has over 600,000 outpatient visits each year (many for initiatives for children andfamilies inBrooklyn. Thehospital delivers some Langone Hospital-Brooklyn—the largest gift inits history—to support major bration of milestone. amajor Theirfoundation pledged $25 millionto NYU Board Chair Kenneth G.Langone, crossed theEast River to attend thecele communities produce healthy children. realize theirfull potential, andtheirconviction isthat healthy families and Jeff is founder andCEO of Amazon.com), theirmission is to helpchildren As president andvice president of theBezos Family Foundation (their son rode NYU Langone’s ferry onJuly 19to NYU Langone Hospital-Brooklyn. insurance, inSunset Park thenumberismore thandoublethat: 27%. figure of 12% is29%. midtown’s While residents lackany form of health town’s residents live below thefederal poverty level, butinSunset Park the minutes But thetwo long. are neighborhoods worlds Some13%of apart. mid- Manhattan to NYU Langone Hospital-Brooklyn inSunset Park isjust 30 By ferry, thetripfrom NYU Langone Health’s maincampus inmidtown The gift willfund new positions andinitiatives to advance mother/baby Mr. andMrs. Bezos, joinedby Dean &CEO Robert I.Grossman, MD, and The gap inhealthcare was not lost onJackie andMiguel Bezos as they
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THE GRANT Macrophage Dysfunction in Obesity, Diabetes, and Atherosclerosis
HOW MUCH $12 million
HOW LONG Five years
SOURCE National Heart, Lung, and Blood Institute
LEAD INVESTIGATOR Edward A. Fisher, MD, PhD, the Leon H. Charney Professor of Cardiovascular Medi- cine at NYU School of Medicine, director of the Center for the Prevention of Cardiovascu- lar Disease
WHY IT MATTERS Two-thirds of Americans are overweight or obese, conditions that fuel diabetes and heart disease. “Unfortunately, people with obesity and diabetes overwhelmingly die of heart dis- ease,” explains Dr. Fisher, a clinician-scientist whose research focuses on atherosclerosis, the leading cause of heart attacks. “These New People three conditions likely share molecular mechanisms.” Dr. Fisher and his colleagues Kathryn Moore, PhD, and Ann Marie Schmidt, Lawrence Newman, MD MD, PhD, are zooming in on the particular role of macrophages. Lawrence Newman, MD, considers himself a true success story. Not because he was the first neurologist in the country WHAT IT FUNDS to complete a fellowship in headache medicine. Or because The word macrophage means “big eater” he served as president of the American Headache Society. Or in Greek. These white blood cells are the because he was recently appointed director of the Division of immune system’s early responders, engulfing and digesting pathogens. But obesity, dia- Headache Medicine in NYU Langone’s Department of Neu- betes, and atherosclerosis can turn macro- rology, leading one of only a handful of fellowship-accredited phages against the body. “As obesity leads to programs in this field nationwide. diabetes, macrophages in fat tissue become Dr. Newman is most proud of the fact that, plagued by debil- very active, angry and inflamed, making the itating, misdiagnosed headaches since the age of 11, he correct- diabetes worse,” Dr. Fisher explains. “Some- thing similar happens in atherosclerotic ly diagnosed himself as a migraine sufferer in medical school, plaques. The macrophages start damaging ultimately obtaining treatment that has cut his attacks from 16 the arteries.” Dr. Fisher and his colleagues per month to 5 per year. have individually been working for years to At NYU Langone, Dr. Newman leads a team of five fellow- understand the role macrophages play in atherosclerosis, obesity, and diabetes. Over ship-trained headache specialists. An expert in rare headache the next five years, using mouse models, this disorders, he also directs clinical trials to investigate promising trio will pool their efforts, seeking factors treatments. Dr. Newman previously served as director of the that activate or repress macrophage inflam- Headache Institute at St. Luke’s–Roosevelt Hospital Center and matory activity in each disease. “An exciting Beth Israel Medical Center. He earned his MD at the Universi- possibility is that we might one day find a magic bullet that lets us kill three birds with dad Autonomous de Guadalajara and completed a residency in one therapeutic stone,” says Dr. Fisher. internal medicine at Elmhurst Hospital Center and a residency in neurology at Albert Einstein College of Medicine.
FALL 2017 NYU LANGONE HEALTH ... 45 NEW FUNDING 46 entire process.” by thehandandnavigate themthrough the issue,” Dr. Ravenell says. “We take people knowing how to get screened isa wholeother that you needscreening but isone thing, hoods throughout New York City. “Knowing beauty salons, andchurches inneighbor they feel comfortable—such as barbershops, health counseling to people inplaces where pivots around theproven idea of bringing with affordable screening. Hisapproach awareness aboutcancer and connect people tive community-based programs that raise Dr. Ravenell will expand andrefine innova State Cancer Prevention Program, Services Institute of Urban Health, andtheNew York ofthe Department Health, theArthur Ashe Over thenext three years, in partnership with cancer screening inminority populations. work to minimize barriers to breast andcolon This grant supports Dr. Ravenell’s ongoing WHAT ITFUNDS providers, mistrust—and fear.” insurance, aboutcost, worry limited access to screened. There’s lack of information, lackof there are formidable barriers to getting Health. “But inunderserved communities, Change in theDepartment of Population Langone’s Center for Healthful Behavior Ravenell, aninternist andmemberof NYU often betreated if caught early,” explains Dr. screenings. “Breast and colon cancer can cancers—could beprevented withtimely ularly those caused by breast andcolorectal cancers, andmany of these deaths—partic rate of any racial group intheUS for most African Americans have thehighest mortality WHY ITMATTERS School of Medicine sor of population health andmedicineat NYU 3 THE INVESTIGATOR Mental Hygiene NYC of Department Health and SOURCE Three years HOW LONG $4,050,000 HOW MUCH THE GRANT POST in Navigation inNew York City Communities Partnering Joseph E.Ravenell, MD, associate profes
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PHOTO CREDIT MODERN BUILDING MODERN BUILDING MODERN CARE, will bestate-of-the-art.” patientcare “and allaspectsof Saul J. Farber Dean andCEO, Robert I.Grossman, MD, the all single-beddedrooms,” says the KimmelPavilion will have flagship Tisch Hospital and Langone Health. “By 2020,our Children’s Hospital atNYU facility, theHassenfeld partof a 68-bedpediatricinpatient Kimmel Pavilion will house gle-bed inpatientrooms, the in New York City with sin- space. The first clinicalfacility Langone Health’s clinical significantly increases NYU image-guided surgical labs,it and 30 operating rooms and to acute care. With 374 beds clinical network dedicated campus into afully integrated the form thenorthendof S. KimmelPavilion will trans- 21-story Helen L.andMartin itopensnext When year, the BLDG BOOM
law, Catherineand Amy; and four grandchildren. wife, Arlene; hissons,David andMarc; hisdaughters-in- and mentored students. He hundreds of is survived by his perbaric oxygen. Dr. Ferris authored over 300 publications thefirst NIH-fundedone of trialsondementia using hy Soon after joining NYU SchoolMedicine of in 1973, he led ing attheUS Navy submarinebaseinGroton, Connecticut. University New of York. He completed postdoctoral train stitute andaPhDinexperimental psychology from theCity heimer’s DiseaseCenter. also served asprincipalinvestigator atNYULangone’s Alz tidisciplinary research centers onaginganddementia.He theearliest NIMH-funded,ers thatestablishedoneof mul Center atNYULangone in1974, research buildingateam of and Neurology, founded the Aging andDementiaResearch more than5million Americans. dementia affectingcommon form older of adults, afflicts develop current treatments. Alzheimer’s disease,themost ods used worldwide for early thedisease,and detection of trials helpeddefinemildcognitive impairment,devise meth well asimportantstudiesonbehavioral interventions. These Ferris led numerous psychopharmacology clinical trials, as recognized for hiscontributionsto Alzheimer’s research, Dr. and codirector from 2015, died on April 5. Internationally Center, director the center of from its inception in 1990, man Professor NYULangone’s of Alzheimer’s Disease Steven H. Ferris, PhD, theGerald J. andDorothy R.Fried 1943-2017 Steven H.Ferris, PhD InMemoriam Dr. Ferris earnedaBSfrom Rensselaer Polytechnic In Dr. Ferris, Psychiatry amember theDepartmentsof of FALL 2017
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47 ------and Pathology Professor of Medicine of Medicine Chair of the Department and Academic Affairs Education, Faculty and Vice Dean for Senior Vice President Steven B. Abramson, MD WHO: 48 Anatomy of a Leader
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NYU HEALTH LANGONE
care. to improve patient research side to bedone onthe much thatneeds cure. There’sso eases that we can and very few dis- well as we should; that we treat as very few diseases in reality, there are certain drugs.But it withure,treat we congestive heartfail apatienthastreating. If about theconditions we’re think that we know everything a research question. Almost every patient can inspire gain thatconfidence. learned Icould,butittook monthsto I beableto take patients?”I care of I becameanintern. Ithought,“Will most terrifying day was July 1,theday graduated from medical school,the accomplished physicians. should trust in their ability to become newWhen doctors doubt their skills, they behave, notjust with our patientsbut . with everyone a doctor, andthatbringsobligations regarding how we sion today. There’s something very specialabout being Those ancient words theprofes- stilldefineprinciplesof quires physicians to upholdcertainethicalstandards. a 2,500-year-old oath,theHippocratic Oath, which re- lege. Learning how to care for people is a unique privi • and Teams lecture series.Here, afew highlights. versation Medicine’s NYUSchoolof was partof Leaders tinguished clinician,researcher, andeducator. The con about what he’s learnedfrom nearly five decadesasadis- Abramson, MD, spoke to first-year medicalstudents Last winter, NYULangone Health leader Steven B. Medicine istheonly profession thatissworn to andthat brings obligations regarding how we behave, Steven B. Abramson, MD FALL 2017
not just withourpatients butwitheveryone .”
- We tend to AfterI
“There’s something very specialaboutbeingadoctor,
- - Commit to yourCommit work. thecontinualresolveimportance of for excellence. Grossman, another longtimementor, hasepitomized the enduring passionfor scienceandknowledge. And Dean my predecessor asdirector rheumatology, of embodied bility to medicineasaprofession. Gerry Weissmann, MD, educationandthephysician’sthe importanceof responsi Medicine, taught theSchoolof Medicine anddeanof of training, SaulFarber, MD, former chair theDepartment of been fortunate to have several role models.Duringmy early your career andthinkcritically about your profession. I’ve Role models are essential. A mentor canhelp you navigate To be a leader, you need listening skills and emotional nities will cometo you. tion to your job—and you doit well—leadership opportu intelligence, but more important, where your group needsto go, what’s onthehori Make every encounter with a patient or col- league as positive as possible. aphysicianWhen zon, andhow to get there. better. you hadn’t before. thoughtof They make you Hire people who are smarter than you. You thing.” peopledeliverThose typesof ideas and by the way, Ididthis,that,andtheother own who say, “Idideverything you asked, want people with expertise greater than your leaves theroom, thepatient—no matter how sick—should there is feel asif When When you bringeffort anddedica a littlemore hopeintheroom than when heor shefirst came in. You can’t beperfect. There will befrustrations. But if But if you’re inaposition of authority,of you have an obligation to helpothers others. contributions of sodependent onthe sincemy successis several times each day, I try to say thank you when possible. You need vision. you need a sense of you needasenseof
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ANDREW NEARY
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