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THE MAGAZINE OF WEILL CORNELL MEDICAL COLLEGE AND WEILL CORNELLGRADUATE SCHOOL OFMEDICAL SCIENCES

weillcornellmedicineWINTER 2013

Looking UpIn Tanzania, WCMChelps local staff

improve burn care

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weillcornellmedicineTHE MAGAZINE OF WEILL CORNELL MEDICALCOLLEGE AND WEILL CORNELLGRADUATE SCHOOL OFMEDICAL SCIENCES

WINTER 2013

26 BRAIN STORMANDREA CRAWFORD

As neurosurgery is redefining itself—with the riseof minimally invasive procedures, novel thera-pies, and technological innovations—the role ofthe neurosurgeon is evolving as well. Whilebrain surgeons were once seen as iconoclasts,says department chairman Philip Stieg, MD,PhD, they’ve become team players in the van-guard of translational medicine. A look at thepioneering work in Weill Cornell’s Departmentof Neurological Surgery, whose surgeon-scientistsare exploring new approaches to a variety of dis-eases and conditions—including some long con-sidered inoperable.

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YouTube.com/WCMCnews

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Cover photograph by David Chalk

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32 MORE THAN SKIN DEEPBETH SAULNIER

Medical service trips to developing nations havetraditionally consisted of Western doctors andnurses providing care to local residents for aweek or two—and then leaving. But a new para-digm is evolving: one in which the visitors aimto empower the host nation’s health-careproviders to treat their own people. Thatapproach was exemplified by a 2012 trip toTanzania in which a Weill Cornell team helpedlay the groundwork for a dedicated burn unit atWeill Bugando Medical Centre. There, theycoped with the harsh reality of burn medicine inAfrica—which sees frequent injuries due to prim-itive cooking equipment, has a dearth of special-ized care, and suffers a heart-rending level oflong-term disability and disfigurement.

38 INFECTIOUS ENTHUSIASMKRISTINA STRAIN & SHARON TREGASKIS

Linnie Golightly, MD ’83, has dedicated hercareer to fighting the infectious diseases of thedeveloping world. A Weill Cornell faculty mem-ber since 1997, Golightly has traveled the globeto treat patients and study such diseases as malar-ia, West Nile virus, dengue fever, and cholera,and mentored many medical students with aninterest in global health. Her current workincludes a project, funded by the Gates Found -ation, to develop a quick, portable method ofdiagnosing malaria using a $15 lens attached to acell phone. “Linnie is a real humanist,” says col-league Francis Barany, PhD, professor of microbi-ology and immunology. “She always goes all outto help individuals in need.”

Digital edition:www.weillcornellmedicine-digital.com

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2 W E I L L C O R N E L L M E D I C I N E

3 DEAN’S MESSAGEComments from Dean Glimcher

4 REUNION 2012

6 LIGHT BOXKodachrome moment

8 SCOPEStorm surge. Plus: Feils honored, medical library turns fifty, Gates grants, hypertensionguide, mapping the oryx, Schafer joins IOM, three awards for Dean Glimcher, pediatricsleep center, dean’s blog, master’s in informatics, new prostate center, and a colorful view.

12 TALK OF THE GOWNStem cell breakthrough. Plus: Geriatricians wanted, prostate progress, adolescent drink-ing, the psychology of heart disease, suburban MS center, teaching leadership, the prom-ise of a “magic pill,” and orphan diseases decoded.

44 NOTEBOOKNews of Medical College alumni and Graduate School alumni

47 IN MEMORIAMAlumni remembered

48 POST DOCAll in the family

DEPARTMENTS

weillcornellmedicineTHE MAGAZINE OF WEILL CORNELL MEDICALCOLLEGE AND WEILL CORNELL GRADUATE

SCHOOL OF MEDICAL SCIENCES

Printed by The Lane Press, South Burling ton, VT. Copyright © 2013. Rights for republication of all matter are reserved. Printed in U.S.A.

Weill Cornell Medicine is produced by the staff of Cornell Alumni Magazine.

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Jim Roberts

EDITOR

Beth Saulnier

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Published by the Office of External AffairsWeill Cornell Medical College and Weill Cornell Graduate School of

Medical Sciences

WEILL CORNELL SENIOR ADMINISTRATORSLaurie H. Glimcher, MD

The Stephen and Suzanne Weiss Dean, Weill Cornell MedicalCollege; Provost for Medical Affairs,

Cornell University

Larry SchaferVice Provost for Development

WEILL CORNELL DIRECTOR OF COMMUNICATIONS

John Rodgers

Weill Cornell Medicine (ISSN 1551-4455) is produced four times a year by Cornell Alumni Magazine, 401 E. State St., Suite 301,Ithaca, NY 14850-4400 for Weill Cornell Medical College and Weill Cornell Graduate School of Medical Sciences. Third-classpostage paid at New York, NY, and additional mailing offices. POSTMASTER: Send address changes to Office of External Affairs,1300 York Ave., Box 123, New York, NY 10065.

JOHN ABBOTT

Shahin Rafii, MD12

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An Auspicious Beginning

Dean’s Message

Laurie H. Glimcher, MD, Dean of the Medical College

Last fall, I was delighted to celebrate Reunionand meet many Medical College alumni. It’sthrilling to imagine, when our current studentsreturn to campus decades from now, what greatthings our institution will have achieved.

At Weill Cornell, we are united in the com-mon cause of improving the health and well-being of all—bringing hope to patients and theirfamilies. As my son told me when I asked himwhy he had decided to switch from law to med-icine: “Because I want to do something where Inever have to wonder why I do it.” At WeillCornell—and in medicine at large—we aredeeply fortunate to do some of the most mean-ingful work imaginable.

Robert Browning said that you shouldmeasure the height of a person’smind by the length of the shadow itcasts. The measure of a community,

therefore, is how well it enriches the lives of allits members—and I have learned over the lastyear that, in this way and so many others, WeillCornell is truly remarkable.

I assumed the deanship a year ago, drawn bya passion to make a great medical college evengreater. As I said at the time, our country’shealth-care system is at a watershed moment,and academic medical centers face formidablechallenges. But challenges bring opportunities—and Weill Cornell has the potential to lead theway in solving the most complex problems inhealth care today. In my first months, I laid outmy vision for our College: to become amongthe world’s best in each element of our tripartitemission—research, education, and clinicalcare—while holding patient care at the center ofeverything we do.

Since then, we at Weill Cornell have begun toexecute a strategy to take our institution to newheights, building on a pioneering attitude in dis-covery and translational research and a culture ofcooperation, collaboration, and transparency. Wehave sought new partnerships with other univer-sities and medical colleges; begun revising ourcurriculum; worked to enrich the faculty experi-ence; launched a robust effort to attract the finestscientific minds to strengthen our research enter-prise. This list represents just a small fraction ofwhat we have accomplished so far—and it onlyhints at the achievements to come.

For more than a century, the MedicalCollege has demonstrated excellence in educa-tion, research, medicine, and patient care—andits star is on the rise. One measure of that, as Iam proud to report, is that this year’s incomingmedical class had the highest mean GPA in theCollege’s history. These talented future physi-cians and researchers will build on WeillCornell’s remarkable history; with our faculty’sguidance, they will truly bend the curve in aca-demic medicine for the twenty-first century.

LISA BERG

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Light Box

The old neighborhood: John Kuiper, MD ’61,took this Kodachrome photo on a Sundayafternoon in the fall of 1959. . .and then forgot about it. When he found it, more thanhalf a century later, he sent it to Weill CornellMedicine. “The 69th Street image brings backmemories of Soo Lee’s, where most of usbrought our shirts to be laundered andpressed; of Morris and Lou Garfinkel’s delicatessen just around the corner on FirstAvenue, where we occasionally lunched on pastrami on rye and cream soda; of the two orthree Cuban men rolling cigars from dawn todusk in their 70th Street storefront; of myhome care patient a few streets further to thenorth,” writes Kuiper, a retired internist andnephrologist living in Los Angeles. “And ofcourse, memories of a magnificent medicalcenter, international in scope, pursuing thehighest standards of medical education,research, and patient care, but always groundedin its mission to benefit the health and well-being of all mankind—as represented in myphotograph by those living and working in itsimmediate neighborhood. In addition to beingsomewhat archival, it reminds us of DeanGlimcher's appeal that ‘our patients be at thecenter of everything we do.’’’

JOHN KUIPER, MD ’61

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ScopeNews Briefs

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PROVIDED

State of emergency:During HurricaneSandy, patients wereevacuated fromflooded hospitals toother institutions,including NYP/WeillCornell.

hub for such diseases and conditions asAlzheimer’s, Parkin s on’s, stroke, andmultiple sclerosis. The Feil gift will allowfor the recruitment of four top-tier neu-roscientists; state-of-the-art equipment;training scholarships for postdocs, fel-lows, and clini c ians; scholarships formedical students; and more. Says theInstitute’s director, Costantino Iadecola,MD, the Anne Parrish Titzell Professor ofNeuro logy: “This generous gift enablesthe Institute to be a focus of intensemultidisciplinary research that willadvance the pace of discovery and the development of new treat-ments, and will create a greater platform for obtaining federal grantsand tapping into other sources of extramural funding.”

The Feil family has supported Weill Cornell since the Eighties;their philanthropy includes scholarships, endowed professorships,clinical scholar awards, and the establishment of the Judith JaffeMultiple Sclerosis Clinical Unit in the Weill Greenberg Center. Thefamily has also supported training in neurology, cancer, and cardi-ology, along with programs in diabetes and metabolic disorders. In2010, Weill Cornell named its scientific facility on 61st Street theGertrude and Louis Feil Building in honor of Overseer Jeff Feil’s par-ents. Says Feil: “There has never been a more critical time toadvance research in neuroscience and neurodegenerative disease.”

W hile Weill Cornell emerged from HurricaneSandy largely unscathed, several city medicalinstitutions did not—prompting WCMC tooffer aid and support in a variety of ways. AfterNYU’s hospital and medical school suffered

flooding and power outages and was forced to close, Weill Cornellcreated nine clerkship spots in psychiatry and pediatrics; offeredspace for lab samples, specimens, and research animals; and hosteddisplaced scientists. Student volunteers helped with medical care inshelters around the city, and PTSD expert JoAnn Difede, PhD, mobi-lized a team to provide free counseling at community centers.

As patients were rerouted from NYU and Bellevue—whose clo-sure left NYP/Weill Cornell as the only Level I trauma center for halfof Manhattan—the Emergency Department saw a 150 percent spikein patient visits; venues such as the Greenberg Pavilion lobby andPerelman Heart Institute were pressed into service for the care anddischarge of ED patients. Said Dean Laurie Glimcher: “These acts ofcollaboration stand as testament to the resilience and teamworkthat symbolize the Weill Cornell community.”

Brain and Mind Institute Named for Feil FamilyIn recognition of a $28 million gift from the Feil family, Weill Cornellhas named its new neuroscience center the Feil Family Brain andMind Research Institute, in honor of Gertrude and Louis Feil.Established in September, the Institute will be a translational research

Weill Cornell Aids Neighborsin Sandy Aftermath

Jeff Feil

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TIP OF THE CAP TO. . .Glimcher Wins Trio of Awards for ResearchDean Laurie Glimcher was recently honored with three major awards,all recognizing her body of research in immunology and cancer: theErnst W. Bertner Memorial Award from the University of Texas MDAnderson Cancer Center; the William B. Coley Award forDistinguished Research in Basic Immunology from the CancerResearch Institute; and the Dr. Luis Federico Leloir Prize ofInternational Cooperation in Science, Technology, and Innovationfrom the government of Argentina. Glimcher’s many previous honorsinclude membership in the American Academy of Arts and Sciences,the National Academy of Sciences, and the Institute of Medicine.

Schafer Elected to Institute of MedicineAndrew Schafer, MD, chairman of theDepartment of Medicine and the E.Hugh Luckey Distinguished Pro fessorof Medicine, has received one of hisfield’s highest honors: election to theInstitute of Medi cine of the NationalAcademy. Schafer was one of seventynew members and ten foreign associ-ates elected in 2012. Established in1970, the IOM recognizes people whohave made major contributions to theadvancement of the medical sciences;at least a quarter are selected fromfields outside the health professions.This recent group also includedneuro-oncologist Lisa DeAngelis, MD, chair of neurology at Sloan-Kettering and a Weill Cornell professor of neurology.

WCMC Medical Library Turns FiftyLast fall, Weill Cornell’s medical library marked its fiftieth anniver-sary. The facility, known as the Samuel J. Wood Library, moved toits current location in October 1962, combining the previousMedical College and nursing libraries. The facility has undergoneseveral renovations and modernizations in recent years, includingthe creation of a sunken reading room and a refurbished computerlab. Recent innovations include the development of a mobile web-site and an online chat service for reference assistance; plans are inthe works to embed librarians in research labs and to offer studyspace that’s available twenty-four hours a day.

WCMC Wins Three Gates Challenge GrantsWeill Cornell researchers have won three Grand ChallengesExplorations grants totaling more than $1.5 million. The awards,from the Bill & Melinda Gates Foundation, support innovativeapproaches to problems in global health and development. A$100,000 grant went to Juan Cubillos-Ruiz, PhD, a postdoc in thelab of Dean Laurie Glimcher, MD, for work on using tailored nano-devices to understand HIV resistance. Carl Nathan, MD, chairmanof microbiology and immunology, the R. A. Rees Pritchett Professorof Microbiology, and director of the Abby and Howard MilsteinProgram in the Chemical Biology of Infectious Disease, was award-ed about $647,000 for tuberculosis research. Kyu Rhee, MD, PhD,associate professor of medicine and of microbiology and immunol-ogy, received about $783,000, also for work on TB.

Medical students Sha-har Admoni, Nipun Verma, andAndrew Ji, named Howard Hughes Medical Instituteresearch fellows. MD-PhD student David Roy had his fellow-ship renewed for another year.

Curtis Cole, MD ’94, associate professor of clinical medicineand of clinical public health, elected a fellow of theAmerican College of Physicians.

Robin Davisson, PhD, the Andrew Dickson White Professorof Molecular Physiology, winner of the Arthur C. CorcoranMemorial Award from the American Heart Association fordistinguished research on hypertension.

Peter Fleischut, MD, assistant professor of anesthesiology,and Gregory Kerr, MD, associate professor of clinical anes-thesiology, winners of the John M. Eisenberg Patient Safetyand Quality Award from the National Quality Forum andthe Joint Commission.

Rainu Kaushal, MD, director of the Center for HealthcareInformatics and Policy and the Frances and John L. LoebProfessor of Medical Informatics, elected to the New YorkAcademy of Medicine.

Professor of clinical psychiatry Marlin Mattson, MD, win-ner of the Planetree Caregiver Award, given to promotepatient-centered care.

Fabrizio Michelassi, MD, the Lewis Atterbury StimsonProfessor and chairman of the Department of Surgery, whoreceived the Grand Award of Merit from the AmericanSociety of the Italian Legions of Merit, its highest honor.

Shahin Rafii, MD, director of the Ansary Stem Cell Instituteand the Arthur B. Belfer Professor in Genetic Medicine, andXin-Yun Huang, PhD, professor of physiology and bio-physics, elected fellows of the American Association for theAdvancement of Science.

William Reisacher, MD, director of allergy in theDepartment of Otolaryngology, and Michael Stewart, MD,chairman of otolaryngology and the E. Darracott VaughanJr., MD, Senior Associate Dean for Clinical Affairs, winners ofhonor awards for meritorious service to the AmericanAcademy of Otolaryngology—Head and Neck Surgery.

William Schaffner, MD ’62, chair of preventive medicine atVanderbilt University, winner of the Abraham LilienfieldAward, the highest honor from the American College ofEpidemiology.

Steven Wexner, MD ’82, chairman of colorectal surgery atCleveland Clinic Florida, elected a fellow of the AmericanSurgical Association and appointed to the board of regents ofthe American College of Surgeons.

Andrew Schafer, MDAMELIA PANICO


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WCMC-Q Maps Genome of Qatari AnimalResearchers at the Qatar branch have mapped the genome of theArabian oryx, the first animal to be sequenced in the emirate. Theoryx, a white-and-brown antelope with long, needle-like horns, isthe national symbol of Qatar; its wild population fell to just a cou-ple hundred during the Fifties and Sixties, and it’s currently classi-fied as “vulnerable.” The findings, which will help strengthengenetic diversity in the nation’s captive breeding program, couldallow more of the animals to be released into the wild.

Dean Glimcher’s Blog Debuts Dean Laurie Glimcher has inaugurated a blog to address issues ofinterest to the Weill Cornell community and the wider world.Begun last fall, the blog has featured such topics as the shortage offuture doctors, the role of the physician-scientist, and curriculumchanges at WCMC. “In writing it,” she says, “I hope to give yougreater insight into my activities and news that I’m currently excit-ed about, pondering, or simply want to share with you.” The essayscan be found at weill.cornell.edu/about-us/dean/blog.

Mann Publishes Hypertension and YouProfessor of clinical medicine Samuel Mann, MD, has publishedHypertension and You, his latest general-audience book about highblood pressure. The book, from Rowman & Littlefield, explores thedrug therapies currently in vogue—and argues that older medica-tions, or smaller doses, can often be more effective. “It is not anoverstatement to say that millions of people are on more bloodpressure medication than they need because their blood pressure ismeasured incorrectly either at the doctor’s office or at home,”Mann writes. “Worse, in most cases, neither the doctor nor thepatient is aware that the blood pressure is being overtreated.”

Pediatric Sleep Center Opens The Komansky Center for Children’s Health at NYP/Weill Cornellhas opened a Pediatric Sleep Center, featuring child-friendly sleeplabs and staffed by a multidisciplinary team that includes pulmon -

Rooms with a view: A brightly colored mural, entitled Time andTime, has replaced a bare wall at NYP/Weill Cornell, offering acheerier view to patients on the west side of the hospital.

Hearing hoofbeats: The oryx

GOOGLE IMAGES

ologists, otolaryngologists, neurologists, psychologists, pediatricians,and sleep specialists. “Many behavioral problems we see in childrenare the result of sleep problems,” says Haviva Veler, MD, assistantprofessor of pediatrics and director of the new center. “Once youaddress sleep, these problems, be it moodiness or depression or evenADHD, may disappear.” The facility aims to address a range of issues,from the inability of babies to sleep through the night to more seri-ous problems such as apnea and insomnia.

Informatics Master’s Program LaunchedThe Center for Healthcare Informatics and Policy has begun a masterof science program in health informatics. Offered through theGraduate School of Medical Sciences, the program will combine thestudy of health systems, information systems, and research method-ology to prepare students for careers in health information technolo-gy—its implementation, analytics, management, research, and policy.The thirty-credit program began accepting applications last fall andlaunched in January.

Prostate Cancer Center EstablishedNewYork-Presbyterian Hospital and the Medical College have estab-lished a comprehensive center dedicated to research and treatmentof prostate cancer. The Center for Prostate Cancer at NYP/WeillCornell will include advanced screening and diagnostic methodssuch as fusion biopsy, focal therapy for localized tumors, refinedimaging techniques, open and robotic surgery, treatments foradvanced disease, and rehabilitation for urinary and sexual issuesfollowing treatment. It will be led by Ashutosh Tewari, MD, directorof the LeFrak Center for Robotic Surgery and the Ronald P. LynchProfessor of Urologic Oncology. “My main focus is to not let any-one get to an advanced cancer stage,” Tewari says. “Therefore, wewill use a combination of imaging, genomics, surgery, and noveltherapies to augment our surgical results and thus improve survivalwhile maintaining quality of life.”

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FROM THE BENCH

Grant Funds Study ofMetabolomics in COPDWeill Cornell researchers have been awarded afive-year, $6.5 million grant from the NationalHeart, Lung, and Blood Institute to investigatemetabolic changes of airway epithelial cells inthe lungs of patients with chronic obstructivepulmonary disease (COPD). Caused by smoking,COPD currently has no cure, few effective treat-ments, and no known biomarkers for early diag-nosis. The study will be the first time thatresearchers use metabolomics to identify, ana-lyze, and profile COPD-related changes in thelungs. Pharmacology professor Steven Gross, PhD,calls metabolomics “a powerful new approach todiscover how airway epithelial cells are disturbedby smoking and how this may lead to COPD.”

Electronic Health RecordsImprove CareIn the Journal of General Internal Medicine, WeillCornell public health researchers reported that

electronic healthrecords (EHRs) can bet-ter the quality ofpatient care. The study,which examined datafrom nearly 500 physi-cians and 75,000patients, foundimprovements acrossfour measures: hemo-globin A1c testing indiabetes as well as

screening for breast cancer, chlamydia, and colo -rectal cancer. “EHRs may improve the quality ofcare by making information more accessible tophysicians, providing medical decision-makingsupport in real time, and allowing patients andproviders to communicate regularly and securely,”says Rainu Kaushal, MD, director of the Centerfor Healthcare Informatics and Policy and theFrances and John L. Loeb Professor of MedicalInformatics. “However, the real value of thesesystems is their ability to organize data and toallow transformative models of health-care deliv-ery, such as the patient-centered medical home,to be layered on top.” The work was conductedwith the Health Information TechnologyEvaluation Collaborative, a multi-institutionaleffort directed by Kaushal and associate profes-sor of public health and medicine Lisa Kern, MD.

Overcoming Fear Difficultfor Teenage BrainsAdolescent brains have a hard time recoveringfrom a fear response—which may explain whyanxiety and depression spike during the teenageyears. Researchers found that after being exposedto fear-inducing stimuli, adolescents—bothhuman and rodent—maintained their fearresponse even after the stimuli were removed. “Ifadolescents have a more difficult time learningthat something that once frightened them is nolonger a danger, then it is clear that the standarddesensitization techniques from fear may notwork on them,” says senior co-investigatorFrancis Lee, MD, PhD, professor of pharmacologyand psychiatry. The human experiments, whichpaired noxious sounds with colored squares, wereconducted at the Sackler Institute for Develop -mental Psychobiology.

Tool Reveals AntibioticMechanisms Inside CellsUsing mass spectrometry, scientists are now ableto “see” how antibiotics target bacteria insideliving cells—providing insight that may lead tothe improvement of drugs for infectious diseaseslike tuberculosis. Associate professor of medicineKyu Rhee, MD, PhD, and colleagues exposed theTB bacterium to the antibiotic para-aminosalicylicacid (PAS), the second-oldest TB drug on themarket, and through mass spectrometry analysisdiscovered that PAS itself becomes toxic onceinside the bacterium. Says Rhee: “The study find-ings show us that sometimes there is a profounddisconnect between what we think a drug isdoing and how it actually works inside cells.”

Drug Combo Could StemBlood Vessel GrowthA combination of two kinds of FDA-approveddrugs could retard the growth of abnormal bloodvessels—potentially treating such diseases ascancer, diabetic retinopathy, macular degenera-tion, and rheumatoid arthritis. In DevelopmentalCell, researchers described the efficacy of thetwo types of drugs—one (prescribed for autoim-mune neurological diseases like multiple sclero-sis) that targets the protein S1P1, and another(used to fight cancer and other conditions) thatinhibits vascular endothelial growth factor. SaysTimothy Hla, PhD, director of the Center forVascular Biology: “This research defines one ofthe fundamental mechanisms of blood vesselgrowth that is vital to normal health and thatalso fuels many diseases.”

Pain Drug Kills Resistant TBThe anti-inflammatory drug oxyphenbutazonehas been found to kill drug-resistant TB in thelab. The drug—whichdates from the Fiftiesand is long off-patent—would cost just twocents a day in develop-ing countries. But CarlNathan, MD, the R. A.Rees Pritchett Professorof Microbiology, worriesit may never reach the500,000 patients it couldbenefit. “It is difficulttoday to launch clinical studies on a medicationthat is so outdated in the United States, that ismainly used here in veterinary medicine to easepain,” Nathan says. “No drug firm will pay forclinical trials if they don’t expect to make aprofit on the agent. And that would be the casefor an off-patent drug that people can buy overthe counter for pain in most of the world.” Headds that it faces another hurdle: the FDArequires animal testing for safety and efficacy,but mice metabolize the drug too quickly.

Praise for On-Site HIV TestsIntegrating rapid on-site HIV testing into drugabuse treatment programs is cost-effective, WeillCornell researchers have found. Using data froma 2009 study in which 80 percent of patientsoffered on-site testing accepted and obtainedtheir results, they found that earlier diagnosisand treatment paid off in terms of increased lifeexpectancy, lower risk of transmission, andother measures. The findings were published inDrug and Alcohol Dependence.

WCMC-Q Launches DatePalm Research Program Four years after mapping the date palm genome,WCMC-Q has established a formal Date PalmResearch Program—aiming to make Qatar theinternational leader in the field. The program, acollaboration with the Qatari Ministry ofEnvironment’s Biotechnology Center, kicked offin October with video conferencing among lead-ing experts. “Integrated research like this hasnot been conducted on the date palm before,and we expect that the results will directlyimpact this important crop in the future,” saysJoel Malek, PhD, director of genomics at WCMC-Q. Dates, which have been grown in the MiddleEast for thousands of years, are an essentialpart of the diet in the Arab world.

Rainu Kaushal, MDABBOTT

Carl Nathan, MDPANICO

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Talk of the GownInsights & Viewpoints

L ike Goldilocks in the classic fairy tale,stem cell scientists have been stymiedby two extremes. Embryonic (or“pluripotent”) stem cells have the

potential to become any cell in the body—but insome ways, they’re too elastic. Efforts to coaxthem into becoming viable adult cells to curedisease or repair organ damage have not yetborne fruit. And worse: their inherent malleabil-ity puts them at risk of turning cancerous.

At the other end of the spectrum are adult

stem cells, which scientists—facing severe restric-tions on government funding for embryonic stemcell research—are also studying, exploring theirpotential to become therapeutic agents. “But thatprocess is very inefficient,” says Shahin Rafii, MD,director of the Ansary Stem Cell Institute and theArthur B. Belfer Professor of Genetic Medicine,“and it is not clear if directly programming anadult fibroblast is clinically feasible.”

But in what Rafii calls a “major, landmarkbreakthrough,” he and colleagues at the Ansary

Growth Potential

The Ansary Stem Cell Institute

announces a major breakthrough

JOHN ABBOTT

Shahin Rafii, MD

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Institute have found a highly promisingmiddle ground. “Could you find a cell thatis not as pluripotent as a human embryonicstem cell, but is not as inflexible as anadult fibroblast? Could you find a cell thatis a compromise?” Rafii asks rhetorically.“Our lab has found that cell.”

That avidly sought middle ground, amid-gestational amniotic cell, is the sub-ject of a paper published in Cell in October2012. In it, Rafii and colleagues—includingZev Rosenwaks, MD, director of theRonald O. Perelman and Claudia CohenCenter for Reproductive Medicine at WeillCornell and a longtime contributor to theAnsary Institute’s research—describe howthey have taken sloughed-off fetal cellsobtained through routine amniocentesisand coaxed them into becoming endothe-lial cells, the essential building blocks ofthe vascular system. “This is going to betransformative, because we have been ableto generate endothelial cells that are veryclose in function, phenotype, and all otherfeatures of an adult endothelium,” saysRafii. “We have achieved a milestone thatwas set when we established the AnsaryStem Cell Institute: to generate a cell thatcan be translated to the clinic.”

Established with a $15 million giftfrom Shahla and Hushang Ansary—he is aformer vice chairman of the Board ofOverseers and former Iranian ambassadorto the United States—the Ansary Institutehas engendered myriad discoveries sinceits founding in 2004. They include successin converting adult mouse spermatogonialstem cells to endothelial cells (published inNature in 2007); work on how endothelialcells play a vital role in liver regeneration(Nature and Nature Cell Biology, 2010); thediscovery that endothelial cells producegrowth factors key to the creation of adultstem cells (Cell Stem Cell, 2010); andresearch on how blood vessels supportlung regeneration (Cell, 2011).

The new Cell paper chronicles theprocess by which amniotic stem cells,derived from routinely sampled amnioticfluid at sixteen weeks of gestation, aretranscriptionally reprogrammed into vas-cular endothelial cells, or rAC-VECs. “Wehave designed and micro-fabricated a cellthat, by reconstructing the blood supply,can benefit any organ that is damaged,”says Rafii, who is also studying the cellsin a mouse model. “I can envision some-day that if someone has a heart attack, wecan transplant genetically matched,amniotic-derived rAC-VECs that are

trained and educated to behave as a car-diac endothelium.”

While the Ansary Institute has focusedon the creation of endothelial cells, otherlabs could adapt the technology to othertypes of cells, such as neurons lost throughbrain disease or islet cells integral toinsulin production, notes co-author SinaRabbany, PhD. The next step for theInstitute team, he says, is to work on scal-ing up production to clinical levels. “Atypical clinical intervention would require200 billion to 300 billion cells,” saysRabbany, adjunct associate professor ofgenetic medicine and of bioengineering inmedicine. “For instance, if the goal is torevascularize the heart of someone whohas suffered a massive heart attack, you’dprobably need to inject at least severalhundred billion cells into it to hope forangiogenesis and regeneration of heartmuscle. So the challenge would become,how could we use bioengineering modali-ties to produce large quantities of thesecells in a short period of time?”

When the Ansary Institute was found-ed, one of its purposes was to offer asource of private funding to counter the

Studying the stuff of life: Rafii in the lab

strictures on federal grants for embryonicstem cell work. The researchers point outthat, among its other advantages, amnioticstem cells don’t involve the same kind ofthorny ethical issues. “They’re freely avail-able,” Rabbany notes. “There’s no contro-versy in terms of destruction of anembryo, and we can access them fromamniocentesis, which happens in hospitalson a daily basis.”

In fact, the first amniotic cells used inthe research came—with Weill Cornell’sknowledge and permission—from Rafii’swife, who was carrying their twin boys,now aged three. With samples from somefour dozen separate subjects that success-fully generated rAC-VECs in the yearssince, Rafii can see a world in which amni-otic fluid is cryopreserved and banked forfuture medical use, as cord blood is today.Human clinical trials, he says, could beginin as little as four years. “With the publica-tion of this paper, we have achieved one ofthe biggest milestones that we promised—not only to the Weill Cornell community,but also to Mr. Ansary,” Rafii says. “I hopethis will be the foundation for more.”

— Beth Saulnier

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If there’s one condition that emergencyphysicians see often, recognize easily, andusually manage well in younger patients, it’sagitated delirium. But in elderly patients,

assessing an acute change in mental status canbe more difficult. “With delirium in older adults,unless the patient comes in with a full medicalhistory or family members who can speak forthem, it’s hard to know if that’s the baseline or ifthey’ve acutely changed,” says Anthony Rosen,MD ’10. Once emergency physicians rule outpotentially life-threatening causes of deliriumsuch as heart attack, stroke, and liver or kidneyfailure, the standard next step is typically med-ication. “But often,” says Rosen, “that’s not the

The Geriatrics Gap

Program aims to spark student interest

in treating older patients

appropriate thing for older adults.” Rosen is a third-year resident in emergency

medicine at NewYork-Presbyterian, and he haslong been drawn to geriatrics. That interest deep-ened during the summer after his first year ofmedical school, when he participated in theMedical Student Training and Aging Research(MSTAR) program. Each year, forty students fromaround the country are selected for MSTAR,which is funded by the American Federation forAging Research and hosted by participating cen-ters. Weill Cornell, a host institution, also sup-ports students through the Henry AdelmanFund, created in honor of the father of RonaldAdelman, MD, co-chief of the Division ofGeriatrics and Gerontology.

The eight- to twelve-week program is designedto encourage interest in aging-related researchand to expose students to clinical geriatric medi-cine. They typically participate after their firstyear of medical school—attending weekly lec-tures, joining the geriatrics consult and palliativecare teams, shadowing the division’s physicians asthey make house calls, and learning to criticallyreview literature. They also visit such sites as theIrving Sherwood Wright Center on Aging, Weill

Anthony Rosen, MD ’10, withhis mentor, Michael Stern,MD ’01

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Cornell’s outpatient facility; Dorot, a Jewish non-profit dedicated to aging services and volun-teerism; and area nursing homes and hospices.

In addition to introducing students to aging-related investigations, MSTAR exposes them tostructured research in general; they begin theirown projects under faculty mentorship and learnhow to present their findings. Last summer ninestudents, from Weill Cornell and other schools,took part. “If they become geriatricians, we’ll bedelighted,” says Adelman, professor of clinicalmedicine. “But with 10,000 Americans turningsixty-five every day, we just want them—in what-ever subspecialty they choose—to be advocatesand look after the needs of older people.”

In the next two decades the population ofelderly in the United States will double—andgeriatricians are already in critically short supply.The reasons for the practitioner gap, while chal-lenging, are no mystery. “Although people whodo geriatrics are among the most satisfied ofphysicians,” Adelman notes, “income for geriatri-cians is significantly less than it is for other sub-specialties.” That’s compounded by the fact thatmedical students tend to see only the frail andsick elderly in their traditional training, a deficitthe program aims to counter. “They see modelsof aging that dispel stereotypes—people agingsuccessfully, even if they have a number of co-morbid illnesses,” Adelman says.

Students encounter patients engaged in vol-unteerism, exercise programs, and meaningfulemployment—including, for example, one nona-genarian who continues to teach and anotherwho works on Wall Street. Such exposure showsstudents that with respect to health issues—as inother things—elderly patients often want to focuson function and comfort, or simply to know thatsomeone is listening to and caring about them.“They don’t necessarily want every high-tech testthat can be ordered,” says Veronica LoFaso, MD,associate professor of clinical medicine and co-director of the summer program, “so we reallypush the idea of seeing people as individuals.”

LoFaso says that one particularly rewardingaspect of geriatrics is the long-term relationshipsthat physicians develop with their patients—andthose, too, can be hard for students to experi-ence during medical school. “Unfortunately, stu-dents often see just a snapshot of the sickestpatients in the hospital setting, so they maythink that represents all geriatric care. We try toencourage them to come to our outpatient prac-tice to see some of our highly functional patientsas well, so they get a more rounded picture ofwhat we do,” says LoFaso, the Roland BalayClinical Scholar. “Geriatrics requires patienceand the ability to appreciate small steps ofprogress.” She hopes that more outside special-ists—such as urologists, cardiologists, and

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orthopaedic surgeons—will become what sheterms “gero-friendly.”

Anthony Rosen, with his dedication toaddressing the particular needs of older patientsin the ED, represents the growing number ofyoung physicians training in many different dis-ciplines who are becoming more knowledgeableabout geriatric issues. “Caring for older adults isreally about understanding that medical prob-lems are not due to a single cause but are almostalways multi-factorial,” Rosen says. “The goal ofcare is not always curing an illness but ratherimproving quality of life and functional status.”

Rosen credits Mark Lachs, MD, co-chief of theDivision of Geriatrics and Gerontology as a keyinfluence in his work. “Dr. Lachs was my mentoras a student,” says Rosen, “and he continues tobe my mentor on nursing home and outpatientprojects.” In the ED, Rosen is mentored byMichael Stern, MD ’01, assistant professor ofmedicine, who preceded Rosen on a similar pathyears earlier. After his emergency medicine resi-dency, Stern helped Neal Flomenbaum, MD,NYP/Weill Cornell emergency physician-in-chief,start the nation’s first Geriatric EmergencyMedicine Fellowship in 2005.

Scott Connors ’15 aided Rosen in the emer-gency department this summer as an MSTARparticipant. During his time there, the ED imple-mented a new protocol conceived by Stern andAlexis Halpern, MD, another Weill Cornell emer-gency physician and GEM Fellowship graduate,to help the staff better recognize agitated deliri-um in elderly patients. With a simple alphabeti-cal mnemonic, the protocol is being used totrain emergency physicians, physician assistants,nurse practitioners, and nurses to screen for suchpotential causes as lack of pain control, constipa-tion, dehydration, and drug interactions.Connors helped with the assessment of ED per-sonnel before and after the protocol was intro-duced and also with database analysis. ForConnors, the balance between clinical exposureand research opportunities is precisely whatmakes the program so appealing. “Because geri-atric patients comprise a larger and larger part ofthe patient population across the nation andespecially in places like New York City,” he says,“I thought having a greater appreciation forthese issues would help me in the future.”

As part of the MSTAR program, Connors andhis fellow participants must submit a poster tothe American Geriatric Society’s annual meeting.Such research can lead to investigations thatcontinue long after graduation. Last spring,Rosen won the award for best resident posterpresentation for his study of resident-to-residentelder abuse in nursing homes—work he began asan MSTAR student.

— Andrea Crawford

‘If they becomegeriatricians,we’ll bedelighted,’ saysAdelman. ‘Butwith 10,000Americans turn-ing sixty-fiveevery day, wejust want themto be advocatesand look afterthe needs ofolder people.’



Talk of the Gown

F or doctors who diagnose prostatecancer and men concerned aboutthe disease, these are uncertaintimes. The conventional wisdom

that males over fifty should be screened annuallyusing the PSA test—a measure of protein secretedby the organ—was upended in May 2012, whenthe U.S. Preventive Services Task Force recom-mended that the test no longer be given routine-ly. The advisory group concluded that too manypatients with non-progressing or slow-growingtumors were undergoing invasive biopsies, sur-geries, and other procedures following their testresults, and that too few were living any longer

Targeted Treatment

Pathologist Mark Rubin, MD, takes a multifaceted approach

to the battle against prostate cancer

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than they would without the screen. Enter Mark Rubin, MD, the Homer T. Hirst

Professor of Oncology in Pathology, whoseresearch on the molecular underpinnings ofprostate cancer may one day help pinpointwhich of the approximately 240,000 men annu-ally diagnosed with prostate cancer truly needintervention—and how patients with the mostdeadly tumors can be treated more effectively.“It’s not clear how many men are being over-treated—there’s disagreement in the field—but itmay be anywhere from fifty to one hundred ormore who are being treated to save one life,”Rubin says. “Obviously for that one individual

Mark Rubin, MD


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PROVIDED

it’s important. We want to have the ability to detect very early onthe tumors that are going to progress, because the best way to treata metastatic tumor is to not let it spread.”

Developing the means to identify tumors by their molecularsignature and then base treatment decisions on that information isat the heart of precision medicine—the targeting of treatment tothe biology of an individual patient’s disease—and the basic sci-ence questions that Rubin is asking. Since arriving at Weill Cornellfive years ago to help develop the College’s translational cancerresearch, Rubin has published more than fifty studies that arebeginning to provide insight into the molecular distinctionsbetween lethal and indolent (inactive or benign) prostate tumors.

Some of that work—building on his research at HarvardMedical School, where he was associate professor of pathologyfrom 2002 to 2007—has led to the development of two clinicaltests. Both incorporate discoveries Rubin made with a longtimecollaborator at the University of Michigan, Arul Chinnaiyan, MD,PhD, that about half of prostate cancers contain a fusion of twogenes. The fusion causes one gene that is regulated by the malehormone androgen to be over-expressed, driving tumor growth.“That represents an important class of biomarker because it’s notlike PSA, where it can be elevated because you have a large orinflamed prostate,” Rubin explains. “It’s a prostate cancer-specificmutation.” A tissue test based on the finding, from VentanaMedical Systems, is available in the U.S. and Europe to classifyprostate tumors and help predict how a patient will respond totreatment. And a urine test in development at Gen-Probe couldmore reliably diagnose prostate cancer—particularly aggressivetumors. (This work was patented by Harvard and Michigan. Rubinand Chinnaiyan are inventors and receive royalties for these com-mercial assays.)

Rubin’s research is wide ranging. In addition to parsing themolecular distinctions between aggressive and harmless tumors andflagging the subtypes linked to specific treatment responses, he istrying to understand why therapies for metastatic prostate cancersfail and explain the genetic alterations that trigger and drive thedisease’s growth. In a study published in April by the Proceedings ofthe National Academy of Sciences, Rubin elaborated on the discoveryof the prostate cancer fusion genes, modeling how pathways crucialto cancer progression are altered in patients with the fused genes,and suggesting that they are at risk of further mutations accumulat-ing in their tumors if they are not effectively treated.

In several studies published in the last year, Rubin has cata-loged previously unknown mutations linked to prostate cancerand explained why they may spur tumor growth. Another paperpublished in PNAS documented two copy number variations—deletions of DNA—associated with a tripling or quadrupling ofaggressive prostate tumor risk, depending on which alteration aman inherits. One of the variations may trigger cancer by causinggenes associated with cell growth to be over-expressed; the other’scontribution to prostate tumors is still being investigated.

Mutations in another gene, SPOP, also are thought to play arole in prostate cancer, though their influence is unclear. In apaper published in May 2012 in Nature Genetics, Rubin, collaborat-ing with other Weill Cornell physicians and Broad Institute scien-tists, reported that mutations in the gene were seen in 15 percentof prostate cancers. Scientists believe the mutations prevent thegene from carrying out its usual function of trashing no-longer-needed proteins, a factor that may allow tumors to progress. Rubinand Pengbo Zhou, PhD, professor of pathology and laboratory

medicine, are now working out how the normal SPOP gene targetsproteins for disposal, knowledge that may enable the developmentof new treatments.

Developing medications based upon specific genomic alter-ations was the subject of a paper Rubin published in CancerDiscovery. In that study, he demonstrated that an investigationaldrug that targets the AURKA gene can shrink the growths in micewith neuroendocrine tumors, an especially aggressive form ofprostate cancer. AURKA makes the protein aurora kinase, which isinvolved in cell growth and has been implicated in a variety of can-cers. Millennium Pharmaceuticals is now sponsoring a multi-centerclinical trial being set up by Himisha Beltran, MD, assistant profes-sor of medicine, to see if the drug works in humans and to look forother mutations in patients with neuroendocrine tumors.

That this complex lab work has real-world impact on patients,especially the 28,000 men who die of prostate cancer annually, isnever far from Rubin’s mind. In April 2012, he was made part of a“dream team” of prostate cancer investigators from seven centerswho were awarded $10 million by the nonprofits Stand Up toCancer and the Prostate Cancer Foundation. Over the next threeyears, the team will sequence the tumors of 500 men participatingin clinical trials for so-called castration-resistant prostate cancer, alethal type of the disease that even the best new hormone therapiesultimately cannot cure.

“We have many men being put onto these clinical trials formetastatic prostate cancer,” Rubin says. “They’re treated, they fail,and they go on to the next drug in the regimen. To date we haven’tlearned much from that experience.” The team will try to under-stand what mutations such patients have, with a goal of under-standing why their treatment failed and what drugs might be moreeffective. “We’d love to cure prostate cancer,” Rubin says, “but inthe meantime, we want to decrease the suffering of men withadvanced disease.”

— Jordan Lite

Closer look: A microscopic view of a prostate cancer, with a magnified image of the red granules within its tumor cells (inset,upper right). Lower right inset: A DNA test confirms that two particular genes (seen as red and green dots) are fused.



Drinking Problems

Jennifer Epstein, PhD, studies how to prevent

teens from using drugs and alcohol

Talk of the Gown

hard to say no—even if theymight be inclined to abstain.“The transition to the first yearof college, in particular, is acritical age and life period ofincreased independence,”Epstein says, “when health andwell-being are put to the testby the convergence of oppor-tunity and peer pressure todrink heavily.”

In an effort to combat alco-hol abuse among college stu-dents, Epstein is meetingmillennials on their own turf:the virtual world. With a three-year, $500,000 grant from theNational Science Foundation,Epstein and computer scientistCharles Hughes, PhD, of theUniversity of Central Floridaare designing virtual reality sce-narios in which students con-front thorny situations andpractice negotiating them—say, to opt for water ratherthan binge drinking. “Youcould simulate scenarios thatwould be high-pressure situa-tions, like a party off campus,”Epstein says. “That would

allow students to try out these experiences with-out really being in them. They could even makemistakes and learn from them.”

The project, which is currently under devel-opment and will begin enrolling subjects in thefall, is Epstein’s latest work in the field of youthsubstance abuse prevention. For the past twodecades, she has studied how students in middleschool, high school, and college make decisionsabout using alcohol, tobacco, and illegal drugs—with an eye toward curbing those risky behaviors.Such habits, she stresses, can become entrenchedand cause long-term damage, both medical andsocial. “The younger you start drinking, the morelikely you are to become alcohol dependent,”Epstein says. “So some of it is a matter of delay-ing initiation.”

Epstein’s work mainly focuses on economically

It’s a scenario that plays out innumerabletimes on any given weekend: an underagestudent goes to a party and is offered alco-hol. While young people may see such

behavior as a rite of passage, psychologistJennifer Epstein, PhD, points out that for somewho wind up drinking again and again due topeer pressure, it can lead to excessive consump-tion and possible alcohol dependence. That posesits own health risks and raises the likelihood ofdrunken driving, assaults, unprotected sex, pooracademic performance, and other ills.

“It’s a national concern,” says Epstein, anassistant research professor in the Division ofPrevention and Health Behavior in theDepartment of Public Health, “because the rateof binge drinking among college students is inthe range of a third.” But for many students, it’s

STOCK PHOTO


W I N T E R 2 0 1 3 1 9

disadvantaged youth; she notes that whenshe came to the field, much of the existingresearch had been done on white, subur-ban teens. She has published dozens ofpapers on a wide range of topics, including

the relationship between linguistic accul-turation and alcohol, smoking, and druguse among Hispanics; the effect of familydrinking on alcohol use in inner-city teens;the perceived social benefits of smokingand drinking among rural youth; the rela-tionship between alcohol consumptionand use of social media; risk factors for sui-cidal ideation and suicide attempts; andhow peers and parents influence addictivebehaviors and computer use.

Epstein was drawn to the field duringher graduate work at Columbia, where shecollaborated on a smoking cessation study;she came to Weill Cornell in 1992. Shenotes that while tobacco use has droppedsteeply since her student days, publichealth officials haven’t had the same suc-cess with adolescent drinking—and whilegirls traditionally drank much less thanboys, the gender gap is closing, yetremains palpable for frequent alcohol useand binge drinking among high schoolseniors. “Alcohol usually is the drug ofchoice in this country,” Epstein says.“Even though prevalence rates have gonedown, they’re still unacceptably high.”

— Beth Saulnier

Heart and Mind

Exploring the connection between

well-being and coronary disease

One evening in the early Eighties, cardiologist Stephen Scheidt, MD,drove from Manhattan to Long Island to observe a group therapysession for patients with coronary heart disease. Robert Allan, PhD,the psychologist who ran the group, recalls that at the end of the ses-

sion, Scheidt looked around the room and said, “I just want you folks to know thatthere’s not a shred of scientific evidence to support what you’re doing.”

They set out to change that. In 1983, Scheidt (who died in 2007 after a nearly forty-year career at Weill Cornell) and Allan co-founded the Coronary Risk Reduction Programat what was then the New York Hospital; in 1996 they published Heart and Mind: ThePractice of Cardiac Psychology. Now, Allan has co-edited a new edition of Heart and Mindwith cardiologist Jeffrey Fisher, MD, a clinical professor of medicine at Weill Cornell.Summarizing the growing body of research about the connection between psychosocial

Robert Allan, PhD, and Jeffrey Fisher, MD

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‘The younger you startdrinking, the morelikely you are tobecome alcoholdependent. So someof it is a matter ofdelaying initiation.’



factors and cardiovascular disease, the newbook includes a review of cardiology gearedtoward mental health professionals, enu-merates psychosocial risk factors, and high-lights important recent trials.

What has changed in the fifteen yearssince the first edition? “Data,” says Allan, aclinical assistant professor of psychologyin medicine. “A mountain of data.” Wherethe initial book gathered empirical evi-dence into just one chapter, Allan andFisher have distilled some 59,000 paperson the subject, more than half pertainingto the major psychosocial factors—depres-sion, social isolation, anger, anxiety, dis-tressed personality, post-traumatic stressdisorder—that have been linked to coro-nary heart disease, the leading cause ofdeath in the U.S.

The connection between heart andmind has been explored since antiquity.One of the book’s contributors describesthe case of an eighteenth-century Englishsurgeon who believed, somewhat prescient-ly, that anger could cause his death—andthen fulfilled his own prophecy after argu-ing with colleagues. In the twentieth cen-tury researchers began to find an empiricalbasis for the anecdotal evidence; in 1959,Meyer Friedman, MD, and Ray H.Rosenman, MD, originators of the type Abehavior pattern, first reported a linkbetween psychological stress and myocar-dial infarction.

In the current literature, depressionshows the strongest connection toincreased risk of heart attack and stroke. Itis associated with generalized inflamma-tion throughout the body, a tendency forthe blood to clot more avidly, and lessheart-rate variability, a factor associatedwith increased mortality. Anxiety anddepression stimulate “sympathetic tone,”raising blood adrenaline. Increased sympa-thetic tone contributes to atherosclerosis—“hardening of the arteries”—and thetransient surge in adrenaline can lead torupture, causing heart attacks and acuteheart failure in “broken heart syndrome.”

“Anxiety and depression need to betreated as much as high blood pressureand high cholesterol,” says Fisher. Thesephysiological factors are also exacerbatedbecause people suffering from depressionare less likely to follow doctors’ orders andadhere to healthy lifestyles, and more likelyto self-medicate with alcohol, drugs, andfattening food.

Psychosocial factors contribute to car-diovascular disease in two ways, both as

long-term effects and as a trigger. “Thehypothesis is that various stress factors,such as anxiety or easily aroused anger,damage arterial linings and make arteriesmore susceptible to plaque accrual, just assuch standard risk factors as elevated cho-lesterol or high blood pressure do,” saysFisher. As for emotions triggering a cardiacevent, evidence has emerged showing thatthe heart muscle can be damaged by a sud-den release of adrenaline. “Cardiologistshave had to come to grips with the factthat an emotional event or trauma cancause a ‘broken heart,’ ” Fisher says.

Acceptance of cardiac psychology hasindeed been growing. In 2008, theAmerican Heart Association began recom-mending that cardiac patients be screenedfor depression, and in 2010, Medicareapproved coverage for the program estab-lished by Dean Ornish, MD. His LifestyleHeart Trial, published in 1990, showedactual regression of coronary plaque inpatients who incorporated diet, exercise,and lifestyle changes, including supportgroups and an hour a day of yoga andmeditation. Time spent in meditationshowed the strongest connection.

Still, the field of cardiac psychologyremains “scientifically imbalanced,” Allan

By the early Nineties, New York City police officer Richard Fernandez wasnoticing some weakness in his right leg, particularly after going on longruns. He was also having balance problems; on a ski trip, his friends oncewrongly assumed that he’d had a few cocktails before hitting the slopes.

Then, after scuffling with a perpetrator while on duty on Manhattan’s Upper West Side,he suffered a minor back injury. “My back was fine by the time I saw a doctor,”Fernandez recalls. “But I told him about my right side and he said, ‘I think you shouldsee a neurologist.’ ” The diagnosis: multiple sclerosis.

On one level, Fernandez was fortunate: the year he was diagnosed, 1993, was thesame one in which the FDA approved Betaseron, the first MS-specific drug. His diseaseremained relatively well-controlled for the next two decades, with symptoms progress-ing slowly. He rose to the rank of sergeant and stayed with the NYPD until October2011, when he put in his retirement papers. “In the last three years in particular I’venoticed shifts in my health,” says Fernandez, who was honored with the force’s

and Fisher write, with tens of thousands ofepidemiologic studies and only forty-threerandomized clinical trials. And some long-standing work has come under criticism inrecent years. “We have this absolute para-dox that type A isn’t studied epidemiolog-ically anymore,” says Allan, “but the mostrobust clinical trials have made extensiveuse of the theory.”

While much research remains to bedone, both men emphasize that clinicalcare of patients with coronary heart dis-ease needs to include psychosomaticapproaches—otherwise, internists and car-diologists are too often treating outcomesrather than causes. Group therapy, Allansays, is the treatment of choice for muchof this population. One investigation, theStockholm Women’s Intervention Trial,provided 237 cardiac patients with oneyear of group therapy; following up sevenyears later, enrolled patients had one-thirdthe mortality of controls.

Incorporating into his practice aninvestigation of the psyche as well as thesoma, Fisher says he cannot fully treat hiscardiac patients without knowing theiremotional state. “I don’t take their innerworlds for granted,” he says.

— Andrea Crawford

Talk of the Gown

Convenient Care

Nyack clinic offers specialty treatment for local

MS patients—no bridge or tunnel required


W I N T E R 2 0 1 3 2 1

Theodore Roosevelt Award, given to officers whoserve despite medical hardship. “I thought it wasbest to pack it in.”

A Rockland County resident, Fernandez hadlong seen MS specialists in Manhattan—butaround the time that he retired from the NYPD,he learned that he could get treatment closer tohome. Weill Cornell had just opened an MS clinicat Nyack Hospital; Fernandez could get checkups,drug infusions, imaging scans, and rehab sessionsa half-hour from his home in Stony Point. “It’sextremely convenient to have quality MS carelocally,” says the forty-five-year-old. “That’s not aknock on other local neurologists, but they’re alsoseeing someone with stroke, with Parkinson’s; it’snice to have a nearby location that has MSexperts.”

Established in August 2011, the center is ajoint effort between Nyack Hospital andNYP/Weill Cornell’s Judith Jaffe Multiple SclerosisCenter, under the direction of Timothy Vartanian,MD, PhD. The Nyack center is headed by JaiPerumal, MD, an assistant professor of neurologyand the Feil Family Clinical Scholar in MultipleSclerosis II. Based in Manhattan, Perumal spendsone day a week in Nyack. Jennifer Reardon, aNyack Hospital nurse practitioner with specializedtraining in MS treatment, is at the clinic threedays a week, while an administrator works full-time to coordinate patient care. In its first yearthe practice grew to some 200 patients fromthroughout the New York metro area; plans are inthe works to expand the clinic hours with an eyeto being open Monday through Friday. “Patientsseem very grateful we’re here,” Perumal says. “It’sgreat for us to do this, because there’s nothing likethis close by. It’s gratifying for us. We’re seeingpatients across the spectrum—from the newlydiagnosed to those who have been seen at othercenters and want to transfer their care.”

Having an easily accessible care provider ismore than just a matter of convenience for MSpatients, who often grapple with fatigue and limitedmobility. The Nyack facility is one of a handful ofdedicated MS centers in the region that are outsideNew York City; others are located in White Plainsand Teaneck, New Jersey. “Patients in this areahave a reluctance to go into Manhattan,” Perumalsays. “If they have gait issues, it can be difficult.”Says Reardon: “They may need someone to drivethem to the city. Then they have to find parking,see the provider, and drive home. It’s half a day forone doctor’s appointment, for someone whoalready has fatigue.”

Natasha Adams, a forty-one-year-old whoworks in quality assurance, was diagnosed in 2008after a bout of optic neuritis, another commonMS symptom. Shortly after the Nyack clinicopened, the Nanuet resident transferred her carefrom a practice in Manhattan. “Now everything is

Walking tall: Treatment has helped MS patient Richard Fernandez(with nurse practitioner Jennifer Reardon) retain his mobility.

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Follow the Leaders

Weill Cornell is in the vanguard of

training students in leadership skills

Talk of the Gown

W hen MD-PhD student Megan Riddle found out who was inone of her problem-based learning groups a few years ago, shewas thrilled—at least at first. “I thought, This is going to be

phenomenal; I like them all, they’re really intelligent,” recalls Riddle, who recentlydefended her dissertation on the neuroscience of eating disorders. “But I foundthat a number of them had very strong, outspoken leadership styles—and wheneveryone was in the room together, we couldn’t all be leaders at once. I thought,This is not working. It has to change. Some people are speaking all the time andothers are not being heard.”

In retrospect, Riddle says, she wishes she’d had some training not only in the content they were grappling with, but in how to handle the contentiousdynamics of the group itself. “When you take these intelligent, driven folksand put them together, it can sometimes lead to conflict with all those strong personalities,” she says. “With more training in group dynamics, that might be mitigated.”

Riddle has gone on to become a student leader at the Medical College; she’sexecutive co-director of the Weill Cornell Community Clinic and past co-directorof the Female Association of Clinicians, Educators, and Scientists (FACES), a sup-port and mentoring group for women in the MD-PhD program. She is also serv-ing on a student-faculty committee working to integrate leadership training intothe curriculum. The effort is part of an overhaul spurred in part by theAccreditation Council for Graduate Medical Education, which has called for cur-ricular innovation in the wake of the Flexner 2.0 report that re-evaluated thefield a century after the landmark study that established the current system.“Medicine is different than it was a hundred years ago,” says Joseph Abularrage,MD, MPH, MPhil, professor of clinical pediatrics and liaison for curricular proj-ects, who is heading the effort for leadership training at Weill Cornell. “Our stu-dents already have significant leadership experience prior to coming to theMedical College. These students will go on to become leaders in medicine.There are definable skills that will help them fulfill their potential as successfulleaders. We believe that leadership skills are important for success, and they canbe taught. Some people say, ‘You’re either a leader or you’re not.’ But we allhave the potential to lead.”

Chairman of pediatrics at New York Hospital Queens, Abularrage has longgiven weekly leadership seminars to Weill Cornell students and pediatric resi-dents. Last academic year, under a pilot program, he spearheaded a requiredleadership module for first-year medical students. It included a self-assessmentexercise, called the Personal and Company Effectiveness (PACE) Palette,designed to promote self-awareness and empathy for others. It categorizes per-sonality types into four colors—from the adventurous (red) to the introverted(green)—and offers insights into how people with those temperaments can bestwork together. Such knowledge is aimed to facilitate interpersonal dynamics—whether in the classroom, on the wards, at a scientific conference, in a profes-sional society, or in the exam room. “Leadership skills are part of the portfolio

right there,” says Adams. “I no longer have to travelacross the bridge; the specialist is ten minutes frommy home. It’s awesome.” She praises the clinic stafffor their attentiveness, not only in terms of practi-cal issues (like obtaining ice packs to counter theheat sensitivity that the disease sometimes causes),but in helping her cope with the depression thatMS patients often suffer, both for psychological andneurological reasons. “There have been timeswhere I was an emotional wreck and called Jen andshe was very concerned about me,” Adams says.“She suggested I see a therapist and followed upwith me. Whenever she says she’s going to call youback with information, she does it—every time.Any time I need her, she’s right there for me.”

For patients diagnosed with MS, the prognosishas improved dramatically over the past twodecades. The advent of new drug therapies likeTysabri has made MS a livable, manageable dis-ease—particularly if it’s caught early, monitored

closely, and treated appropriately. “People have animage of MS as a disabling disease, but as we’restarting patients on treatments earlier, we’re seeingthat less and less,” Perumal says. “It has changedfrom a field where you couldn’t do much to a fieldwhere you can make a big difference. Often MSpatients are young—diagnosed in their twentiesand thirties—so if you treat them effectively you’remaking a difference, not only in terms of how theylive now, but in their long-term outcome.”

Adams has remained active—working, rearingtwo children, and leading a team (“Tasha’sTroopers”) that has raised more than $15,000through MS walks. Although Fernandez has begunusing crutches, he works out regularly on a station-ary bike and aims to launch a new career, possiblyin the nonprofit sector. “There are always chal-lenges in life,” he says. “You can complain about it,or you can do your best. Some people have perfecthealth, but they can’t go out and do anythingbecause they have no job or money. The glass ishalf full or half empty—it depends on how youlook at it.”

— Beth Saulnier

‘People have an image ofMS as a disabling disease,’Perumal says, ‘but as we’restarting patients on treatments earlier, we’reseeing that less and less.’


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medical team there were different perspec-tives based on personalities. Everybody hadthe same goal of taking care of the patient,but they were coming from different anglesin the way they were thinking about theclinical content.” A tool like the PACEPalette, she says, “would have helped put mein their shoes in terms of the way they wereviewing the situation.”

Abularrage points out that althoughsome residencies and fellowships have aleadership training component—and someinstitutions offer it to faculty at variouscareer stages—Weill Cornell is now the onlymedical college requiring students to partici-pate in a curriculum designed around train-ing in leadership. “We did a literature reviewon teaching leadership in medical schools inthe U.S.” he says, “and it turns out thatthere was none.” But just as new doctorshave long been told to go forth and teach—without having received any dedicatedinstruction in pedagogy—they’re expected tohave the innate ability to guide others andwork well in groups. “All of a sudden, some-one taps us on the shoulder and says, ‘OK,we’d like you to run this,’ ” Abularrage says.“But nowhere in our education do we gettrained in leadership skills.”

Fourth-year student Matthew Goodwin,PhD, has been an enthusiastic supporter ofAbularrage’s efforts. He calls leadership train-ing vital to countering “an outdated hierar-chical system” in which those at the bottomare expected to follow orders unquestioninglyat the potential expense of optimal outcomes.

“More people are looking at other industries likeaviation and saying, ‘There are better ways to dothings,’ ” he says. “They’re starting to realize thatmedicine is behind the curve on finding innova-tive solutions to our problems.”

Starting this fall, all first-years will undergothe PACE self-assessment training, and second-years will have the conflict resolution module inthe spring; instruction on public speaking is alsoin the works. Abularrage’s committee is weigh-ing further development of leadership trainingin the curriculum, while other teams are work-ing on enhancing mentoring, offering teachertraining, dissolving boundaries between basicscience courses and the clinics, adding morehumanities instruction, and other curricularissues. “Sometimes as students, if we’re notspecifically learning about medicine, we thinkthat maybe it’s not as important,” says Riddle.“But leadership is one subject that’s criticalregardless of where you end up. Whether it’s pri-vate practice, public policy, consulting, or aca-demics, this is going to help you along the way.”

— Beth Saulnier

that every student who graduates from ourMedical College should have, at least at a basiclevel,” says Carol Storey-Johnson, MD ’77, seniorassociate dean for education. “We’re attemptingto produce the future leaders of medicine, what-ever our students go into. They need to under-stand what dynamics are useful to foster change.”

In addition to the self-assessment exercise,students did a module on conflict resolution,conducted by Sally Klingel from the faculty ofCornell’s School of Industrial and LaborRelations. Clinical Skills Center director YoonKang, MD, a member of the leadership curricu-lum committee, notes that such training wouldhave come in handy when treating a pastpatient, a Jehovah’s Witness whose religiousbeliefs put strict limitations on his care. “Some ofthe negotiation skills that we learned from thisbrief conflict resolution pilot would have beenhelpful to me in terms of interacting with thispatient and his family,” says Kang, the Richard P.Cohen, MD, Associate Professor of MedicalEducation. “Also, it would have helped to under-stand that beyond different expertise on the

Joseph Abularrage,MD, MPH, MPhil

ABBOTT

‘We believe thatleadership skillsare importantfor success, andthey can betaught,’ saysAbularrage.‘Some peoplesay, “You’reeither a leaderor you’re not.”But we all havethe potential to lead.’



mice—with no toxicity—by stimulating key anti-aging pathways in cells. NR appears to improvethe function of mitochondria, the source of mostenergy in cells; mitochondrial decline is associatedwith diseases of aging, including cancer andneuro-degeneration. “The compound was able tostimulate physiology in such a way as to resistmetabolic syndrome, make the animals healthierand improve their stamina, and correct the toxiceffects of this high-fat diet,” says Sauve, a phar-macologist and organic chemist.

Sauve’s investigations of NR began in anti-aging research. He and other colleagues were try-ing to understand how anti-aging enzymesknown as sirtuins get upregulated, or increased,by factors such as extreme low-calorie diets orexercise. The enzymes, they found, are highlydependent upon nicotinamide adeine dinu-cleotide (NAD), a metabolite central to counter-acting metabolic syndrome and protecting cellsfrom oxidative stress.

Others had theorized a connection betweenNR and NAD years ago; while working on NADmetabolism in the Fifties, Nobel Laureate ArthurKornberg recognized that NR could play animportant role. But he tested NR on cells that hadbeen broken open in a test tube, and these earlytests produced no interesting results. More thanfive decades later, Sauve and his team posed thesame question but used a different approach. “Wethrew NR on whole cells—and what happened?The cells made a lot of NAD,” he says. “It tookfifty-five years for people to actually answer thequestion, ‘What does NR do in cells?’ ”

To answer that question, however, Sauve firstneeded to procure large enough quantities of NR.He invented a method to synthesize NR in highlypure form and in the large multi-gram amountsrequired for testing. He published this synthesis in2007, and in the same paper showed for the firsttime that NR is, indeed, a super NAD enhancer.

Still, it was not clear that increasing NADwould make the anti-aging sirtuins work better.With this latest research, he says, they’ve nowshown “that NAD gets it done.” In the past twoyears, Sauve and his Swiss colleagues proved thatby increasing NAD genetically they could stimu-late the correct pathways: mice with geneticmodifications to increase NAD proved resistantto the effects of a high-fat diet. Now, they haveachieved the same results without manipulatingany genes but by delivering NR directly to themice in their food.

The findings demonstrate the potential ofNR—both as a natural compound and in novelderivatives for pharmaceutical uses—not only tofight obesity and metabolic disorders, but also toplay a role in treating conditions such as spinalcord injuries, Parkinson’s disease, and mitochon-drial disorders. “People have known for a long

Magic Pill?

Pharmacologist Anthony Sauve, PhD,

investigates a form of vitamin B that could aid

healing, prevent aging, and combat obesity

Talk of the Gown

One group of test subjects ate ahigh-fat diet, and—as expected—gained weight, developed dia-

betes, had higher cholesterol, lost muscle fiber,and suffered other ill effects. Another group atethe same thing but received a special supple-ment. They gained significantly less weight,maintained strength and endurance, and did notdevelop negative health effects.

What was this supplement that sounds like amagic pill—something that produces the benefitsof a low-calorie diet and exercise without requir-ing one to engage in either? It was the moleculenicotinamide riboside (NR), a natural form ofvitamin B that exists in very small amounts inmilk, as well as beer and other foods made fromyeast, which secretes the compound. “What hashappened here,” says Anthony Sauve, PhD, asso-ciate professor of pharmacology, “is that we’vediscovered a super-vitamin.”

In a study that appeared in the June 2012issue of Cell Metabolism, Sauve and colleaguesfrom the Polytechnic School in Lausanne,Switzerland, showed that, when given in highdoses, NR produced these remarkable effects in

Anthony Sauve, PhDABBOTT


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time that some of the same things thatprotect you from metabolic syndrome alsogive you protection against neuro-degener-ation and sarcopenia, or muscle-wasting,two debilitating conditions of aging,”Sauve says. He showed, in a 2007 paperwritten with Harvard’s David Sinclair(known for his research on resveratrol, thebeneficial substance in red wine) and othercolleagues, that increased levels of NAD inmitochondria protect cells from dying.“NR has this special property. It hits themagic organelle—the mitochondria—andmakes it have more NAD,” he says. “Thisis exactly what you want to target in orderto get these protective effects.”

In one example of this potential, Sauvehas collaborated with Samie Jaffrey, MD,PhD, another faculty member in theDepartment of Pharmacology, and BrettLangley, PhD, whose lab at the BurkeRehabilitation Center seeks ways to protectand regenerate cells of the nervous system.They are now in the fourth year of a five-year grant from the New York State SpinalCord Injury Center of Research Excellenceto study whether NR could be given at thetime of spinal cord injury to arrest celldeath and axonal degeneration. “The stud-ies look fantastic,” says Langley, assistantprofessor of neurology and neuroscience atWeill Cornell. “These compounds are ableto protect cells from dying.”

When the spinal cord is injured, anumber of chemical and physical barriersprevent regeneration from occurring.Many of these inhibitory factors comefrom the myelin, the insulation aroundaxons (the nerve fibers that project fromthe cell body and transmit the electricalimpulses of the nervous system), whichplays an important role in maintainingaxonal integrity. “We’ve modeled growthinhibition factors in vitro, and when weincrease NAD by giving NR we can actuallyget axons to grow through barriers theynormally wouldn’t grow through,”Langley explains. They are now testing theresponse in animals and expect to publishtheir findings in 2013. “Prior to Dr. Sauve’swork, no one really had good ways ofincreasing NAD in cells. He was able tofind ways of synthesizing NR in largeenough quantities that we can actually useit both as an investigative tool and as atherapeutic drug,” he says.

Sauve’s method for synthesizing NR hasbeen patented by Cornell’s Center forTechnology Enterprise and Commer-ciali zation and licensed to ChromaDex

Corporation. The company is now workingto manufacture it on a scale required forformulation in products for human con-sumption, pending safety approvals. Beforelong, NR could be available as a dietarysupplement. “There are a lot of importantbioactive compounds in food—possiblenew vitamin forms or other nutrients thatare packaged by nature in ways that affect

their potency and how well the body canconvert them into something beneficial,”Sauve says. “It’s only in recent years thatwe’ve had the analytical capabilities tobegin to interrogate more complex actionsof vitamins and nutrients. With greaterattention and NIH research funding, we’llsee more of these kinds of discoveries.”

— Andrea Crawford

The New Normal

PhD grad pioneers nonprofit for

rare genetic diseases

Nearly 26 million Americans havediabetes. More than 5 million haveAlzheimer’s disease and a million

have Parkinson’s. Each condition has a clear diag-nosis and a cadre of scientists delving into itsmechanisms and exploring potential treatments.If only people with rare diseases were so lucky.

The constellation of rare diseases comprisessome 8,000 conditions, each affecting fewer than200,000 people. Symptoms often emerge ininfancy, but accurate diagnoses—and effective treatments—can be hard to come by. Andbecause most rare diseases are caused by genetic mutations, as many as 30 percent of thepeople who have them die before they enter kindergarten. Few reach old age.“Identifying potentially causative genes is the first step,” says Naira Rezende, PhD ’12.“The second step is to use that information to design a treatment that makes sense.”

In 2011, Rezende partnered with fellow medical and graduate students at JohnsHopkins, Washington University in St. Louis, Yale, and Harvard to form the RareGenomics Institute (RGI), a virtual nonprofit staffed exclusively by volunteers—many,like Rezende, former Howard Hughes scholars. “It’s possible to use genome sequencingto help people with a whole spectrum of diseases,” says Rezende, who earned a PhD instem cell biology under Lorraine Gudas, PhD, the Revlon Pharmaceutical Professor ofPharmacology and Toxicology. “We want to make sure every family that needs it hasaccess to this technology.”

Through its website, RGI recruits patients with genetically based diseases, clinical sci-entists investigating those conditions, and donors willing to help fund the effort. Thenonprofit’s eighteen volunteers facilitate introductions. “As I finished my PhD, I noticedthat I didn’t have much contact with the patient community,” says Rezende, who nowworks as a scientific associate at the law firm of Wilson, Sonsini, Goodrich & Rosati inManhattan and leads RGI’s patient advocacy team. “I wanted to be in contact with thefamilies we were working at the bench to benefit.”

Already, the nonprofit has facilitated sequencing for three children; twenty more arebeing evaluated for sequencing through RGI partnerships. “The families provide a greatmotivation,” says Rezende. “There were days in graduate school where I wondered, ‘Whyam I doing this?’ It’s been humbling, connecting with these amazing families who putall of their money, time, and energy into helping their children.”

— Sharon Tregaskis

ISTOCK.COM


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The pons, as medical students learn, is the bridge-likepart of the brainstem that connects the brain with thespinal cord. Tumors found there, called diffuse intrin-

sic pontine glioma (DIPG), strike children and grow aggres-sively among the key cranial nerve structures responsible forsensory and motor functions such as equilibrium, chewing,swallowing, and respiration. Upon diagnosis of DIPG, patientsreceive radiation as palliative care. There are no other options.

Brain Storm

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By Andrea CrawfordPhotographs by John Abbott

New techniques, agents, and technologieshave sparked a revolution in neurosurgery

For years, Mark Souweidane, MD, director of the Weill Cornell Pediatric Brain andSpine Center, has seen the disease take its toll on patients and their families. “You watcha child succumb to a tumor the size of a walnut—you watch the angst, turmoil, and frus-tration it causes the family,” he says. “You receive their continuous questions as to whythere’s nothing better. There’s no stronger motivation than that to look for a better way.”

Twelve years ago, Souweidane set out to look for that better way. He scoured the lit-erature, collaborated with bench scientists, and assembled a team. They devised a treat-ment concept, found a promising therapeutic agent, and created a surgical procedure toadminister it directly into the tumor, bypassing the blood-brain barrier. This past spring,with the opening of a clinical trial, Souweidane’s team may have finally changed the par-Mark Souweidane, MD


adigm, offering hope where there had been none. “We had to startat ground zero, amid a lot of criticism that what we were doing wasunfathomable,” Souweidane says. “We wanted to infuse things intothe brainstem that no one had ever tried before, and when webegan there was no evidence that you could do this.”

In May they operated on a four-year-old girl, the first attempt atsurgical treatment for a patient with DIPG. In July they operated ona second child with the disease.

The current phase-one clinical trial is designed to look at safetyand feasibility, and over the next one to two years the team plans toadminister the treatment to a minimum of twelve patients betweenthe ages of three and twenty-one. While it will be a long time beforethey can begin to assess efficacy, the surgery offers the first glimmerof hope for treating a disease long considered inoperable.

During the surgery, a radioimmunotherapeutic agent reaches thetumor through a method called convection-enhanced delivery(CED), a pressure-driven infusion through a surgically placed cannu-la. The agent, known as 124I-8H9, consists of an antibody producedby mice, which binds to the tumor to administer a radioactive sub-stance to kill its cells. The technical feat alone is challengingbecause the tumors are small lesions, nine centimeters beneath thesurface of the brain, which the team targets using interoperativeMRI, a recently FDA-approved navigation system, and speciallydesigned micro-catheters.

With its combination of innovative surgical technique—in whichthe team treated an area of the brain that had never before beenaccessed—and its novel application of an agent that uses antibodiesto attack the tumors with radiation, the work on DIPG demonstrates

2 8 WE I L L CORNEL L MED IC INE

some of the ways in which neurological surgery is in the midst of arevolution. Minimally invasive techniques have radically alteredhow neurosurgeons work, and the emerging field of molecular med-icine—using surgery to deliver agents such as genes, cells, drugs, orantibodies to targets in the nervous system to treat a variety of dis-eases—is changing the way surgeons think about clinical care.

As the field redefines itself, the traditional role of the neurosur-geon is evolving as well. When Philip Stieg, MD, PhD, chairman ofthe Department of Neurological Surgery and of the Weill CornellBrain and Spine Center, entered the field three decades ago, he says,“neurosurgeons were considered iconoclasts, unfriendly and inac-cessible. Today neurosurgeons at NYP/Weill Cornell are part of alarge team of physicians who take care of complex neurologic disor-ders.” That approach extends from the operating room to the labo-ratory, as surgeons do their part not only in bringing scientificbreakthroughs to their patients, but in taking ideas from the ORback to the lab—and helping to generate those breakthroughs.

Technology has driven much of the revolution. “When I started,I was operating with an incandescent light bulb,” Stieg says, “andan advanced OR was one that had a microscope.” Now he and histeam of neurosurgeons use computer-guided instruments and three-dimensional technology. They get much better visualization of thebrain’s structures with bright illumination and magnification inextremely high resolution, advances that enable them to lookaround corners, around the brain stem, and at the complex relation-ships between compressive structures like blood vessels on nerves.“Our ability to visualize pathology has changed dramatically,” Stieg says.

When Souweidane arrived at NYP/Weill Cornell inthe mid-Nineties, no one had ever used an endo-scope in the brain; today, 20 to 30 percent of the

neurosurgeries they do are endoscopic. He points out that on a recentday he performed four operations: two tumor removals, one proce-dure to treat hydrocephalus (the overproduction of cerebral spinalfluid inside the brain’s ventricles), and one biopsy of a tumor in thebrain stem. In the not-too-distant past, each of those surgeries wouldhave required traditional craniotomies, yet he had done each througha “burr hole,” a quarter-inch opening in the skull. “These techniques

Philip Stieg, MD, PhD

‘Patients undergoingtreatment today haveno comparison to howit used to be—thankgoodness. They’rebeneficiaries of anamazing amount ofinnovation.’


have hugely impacted the field,” Souweidane says. “Patients undergo-ing treatment today have no comparison to how it used to be—thankgoodness. They’re beneficiaries of an amazing amount of innova-tion.” Stieg agrees, noting the improved speed and ease of recovery.“With less invasive surgeries,” he says, “patients get better faster withthe same outcomes.”

In addition to making surgery easier on patients, endoscopicand minimally invasive techniques have also broadened what sur-geons can do—changing the way they treat congenital malforma-tions, brain tumors, and cystic structures such as colloid cysts,benign but potentially deadly tumors located deep in the centralpart of the brain. Weill Cornell neurosurgeons are removing tumorspreviously considered inoperable. For example, Theodore Schwartz,MD, a professor of neurological surgery who directs the center forepilepsy surgery and specializes in anterior skull base approaches forthe treatment of pituitary tumors, uses endoscopes to take out typesof tumors that very few surgeons would be able to remove, his col-leagues say.

Spinal surgeons such as Roger Härtl, MD, the Leonard and FleurHarlan Clinical Scholar and the neurosurgeon on call for the NewYork Giants, and Eric Elowitz, MD, assistant professor of neurologi-cal surgery, use computer navigation guides, resulting in much lessdestruction of muscle tissue, which is key to recovery and rehabili-tation. Technological advances also allow interventional radiologists

Pierre Gobin, MD, professor of radiology in neurological surgery,Athos Patsalides, MD, the Alvina and Willis Murphy AssistantProfessor of Neurological Surgery, and Jared Knopman, MD, assis-tant professor of neurological surgery, to more safely, efficiently, andeffectively treat intracranial vascular lesions such as aneurysms andarteriovenous malformations. Technology has reached the pointwhere even noninvasive procedures are available. Susan Pannullo,MD ’87, director of neurosurgical radiosurgery, delivers radiation totumors and other targets through instruments that use beams anddo not require incisions.

Perhaps the most surprising shift in neurosurgery has been inthe emerging field of molecular techniques and treatments. In 2003Michael Kaplitt, MD ’95, PhD, associate professor of neurologicalsurgery and vice chairman for research, was the first person in theworld to administer gene therapy to the brain. Last year, he con-cluded a phase-two study of that work in treating Parkinson’s dis-ease—the first time that a randomized, double-blind study showedpositive results for any type of biological therapy in a neurologicaldisease. In 2009 John Boockvar, MD, associate professor of neurolog-ical surgery, in collaboration with Gobin and Patsalides, was the firstto infuse the chemotherapeutic agent Avastin directly into aglioblastoma tumor, bypassing the blood-brain barrier—work fea-tured in the New York Times.

“If you had asked about the future of neurosurgery twenty years

W I N T E R 2 0 1 3 2 9

Michael Kaplitt, MD ’95, PhD, with Dr. Stieg



ago, almost everybody would have said it was in new types ofdevices and hardware,” says Kaplitt. “Our current approaches wouldhave been unthinkable then. Yet now there’s not a field of neuro-surgery where there aren’t people actively taking leadership roles inboth basic and translational research to apply molecular therapies ormolecular techniques to novel problems.” Jeffrey Greenfield, MD’02, PhD, assistant professor of neurological surgery in pediatricsand the Victor and Tara Menezes Clinical Scholar in Neuroscience,agrees. “Molecular medicine may not have changed our day-to-daypractice of neurosurgery, but it’s starting to make inroads in how wethink about our patients, how we plan our surgeries, and how wethink about their postoperative care,” says Greenfield.

In an effort to allow clinicians and scientists at Weill Cornell toconduct more research into ways to attack rare tumors, lastyear Souweidane and Greenfield launched the Children’s BrainTumor Project. It grew out of conversations Greenfield had had

with a patient, who was a college sophomore in 2010 when shelearned she had gliomatosis cerebri—an inoperable, diffuse, andhighly aggressive tumor—in almost every lobe of her brain. The

patient died in May 2012, and that summer, using her tumor,Greenfield’s team finished the first complete DNA mapping ofgliomatosis cerebri, a vital step in finding potential therapies.

Over the eighteen months of treatment, Greenfield had to tellhis patient and her family that physicians know virtually nothingabout gliomatosis cerebri. “It was quite frustrating to be forced toadmit that there’s not a lot of research on rare diseases becausethere’s no NIH funding impetus to take care of a disease that affects200 people a year,” he says. A foundation established by thepatient’s family helped to launch the Children’s Brain TumorProject. “We’re going to figure out what we can do to offer hope tothose patients,” Greenfield says. “That’s what the patient wanted.”

Recently, we have seen the first surgery to attempt to treat DIPG,the first genomic analysis of gliomatosis cerebri, and now the firstattempt to treat addiction through neurosurgery. This past summer,Kaplitt received FDA approval for a phase-one trial to treat cocaineaddiction by stimulating the reward center of the brain. His workdemonstrates how research in neurological surgery is further revolu-tionizing the field by changing the definition of what constitutes aneurosurgical case. His long-standing research on Parkinson’s—andin treating its non-motor symptoms such as depression, addictivebehaviors, and memory problems—has led to advances that could

RENE PEREZ

Jeffrey Greenfield, MD ’02, PhD


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benefit millions who suffer from major depression, drug addiction,and metabolic diseases.

A few years ago, working with the Rockefeller University’s PaulGreengard, PhD, the 2000 Nobel laureate in medicine, Kaplitt foundthat a protein known as P11 acts as a shuttle to bring neurotrans-mitter receptors to the surface of the cell, thus influencing itsresponse to serotonin and dopamine. In a paper published in Sciencetwo years ago, they showed that when P11 is knocked out withgene therapy in the nucleus accumbens, a reward center in thebrain, depression-like behavior occurred in animals; when theyoverproduced P11, normal behavior returned. The findings werecorroborated in human samples from the brain bank of collaboratorCarol Tamminga, MD, of Southwestern Medical Center. “So there’sa human proof of principle that suggests that low P11 levels in thisarea of the brain may be one of the causative factors that definehuman depression, which we can potentially reverse genetically,”Kaplitt says.

More recently, he has determined that P11 also has a profoundinfluence in a second region of the brain, the subgenual cingulatecortex—an area currently being closely studied in relation to depres-sion—and that its effects there may be opposite from what it doesin the nucleus accumbens. “It seems to do very different things inthese two regions, which highlights the value of focal neurosurgicalinterventions because drugs would influence the pathway only inone direction or another,” says Kaplitt, who is preparing to publishhis findings. “It’s interesting in a way that fits nicely with what’sknown about depression through brain imaging technology.”

Kaplitt has similar data showing how parts of the brain mayinfluence metabolism, which Stieg notes could have application fortreating eating disorders. That’s just one example, Stieg says, where“we’re waiting for the molecular biology, whether it be the creationof viral or genetic or chemotherapeutic agents, to catch up with thesurgical technique.” Neurosurgeons have therefore become impor-tant participants, even leaders, in helping to push the molecularbiology. “We believe that neurosurgeons have a lot to offer in thescientific realm, and that the historical biases about neurosur-

geons—that they may be smart but they operate and that’s it—arefundamentally flawed,” says Kaplitt, noting that almost half of thedepartment’s current residents have PhDs. “We believe that neuro-surgery is completely compatible with quality science.”

Each member of the department has numerous patient-centeredtrials where they’re not only operating but also attempting to pushthe envelope for the entire field. “Our department on the whole isincredibly translational, and everyone, top to bottom, is runningbasic science labs that are taking things from the operating roominto the lab and vice versa,” says Greenfield. Kaplitt citesSouweidane as a prime example. With no formal background inresearch science, he simply had a strong desire to help his patientswith intractable brain tumors. “So of his own volition he started aresearch effort,” Kaplitt says. “He focused on a problem that was astrong unmet need in his field, and that evolved from an idea to thepoint where, now, he’s treating patients.”

His fellow surgeons give credit to Stieg, under whose leadershipthe department has supported its members’ efforts to bring newtherapies to patients. Even as its traditional surgical volume hasgrown dramatically in the last decade, the department had beenstructured to support research to an unusual degree, creating anenvironment where ideas flourish, says Kaplitt.

A prime example of Stieg’s leadership and focus on mentoringhis faculty was the department’s launch of a Brain Summit in June2011. Under the direction of Boockvar—working with Stieg, WCMCDean Laurie Glimcher, MD, and NYP President Steven Corwin,MD—the Brain Summit brought together top neuroscientists fromacross the country and representatives of biotech firms to help drivescientific collaboration to accelerate cures. In addition, the forumprovided an opportunity to expose promising research approachesto potential funders.

Stieg’s drive for scientific collaboration also resulted in taking hiswhole department to Ithaca to meet with biomedical engineers,sparking several collaborations that continue to bear fruit. WeillCornell’s Härtl and Cornell’s Larry Bonassar, PhD, associate directorof the Department of Biomedical Engineering, for example, areworking to bioengineer artificial spinal disks. These could offer treat-ment for patients with degenerative spinal disease with a substancethat, unlike plastic or metal, mimics the qualities of human disks.Similarly, they are working to create tissue to repair annular defects,which currently have no treatment. “There are so many opportuni-ties now, so much interest,” Kaplitt says. “Smart, creative, energeticpeople with the right institutional backing and the right idea canstart pushing these things into the clinic.”

Stieg’s mission to share his team’s expertise globally and build aworld-class collaborative teaching facility led to the launch in 2010of the Surgical Innovations Lab, the only one of its kind in theworld. Demonstrations of advanced neurosurgical techniques pio-neered by Stieg and his team are shared in real time with othermedical professionals via multimedia technology. Recently, Chinese,Arab, and Italian neurosurgeons watched and commented as Stiegtaught residents how to perform complex surgical approaches to theskull base.

Recent scientific and technical advances are greatly broadeningthe range of what neurosurgeons are able to treat, even as an agingpopulation increases the frequency with which surgeons see the con-ditions they have long treated, such as back pain, stroke, and move-ment disorders. But as vast as neurosurgery’s scope may be today,Stieg says, its mission lies at the historic foundation of medicine:“We’re always thinking about how to alleviate pain and suffering.” •

‘Our department onthe whole is incrediblytranslational, andeveryone, top to bottom, is runningbasic science labs thatare taking things fromthe operating roominto the lab and vice versa.’



Mother courage: A woman and her children at Weill Bugando Medical Centre.Only a lucky few in the nation get appropriate treatment for burn injuries; many others endure a lifetime of disfigurement and disability.

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His name was Charles, and he’d survived a horrificaccident that had killed most of his family: theirhome had been destroyed when a tank of

propane cooking fuel exploded, taking the lives of his parentsand four of their seven children. Suffering third-degree burnsover some 25 percent of his body including his chest, hands,and entire face, the twelve-year-old had traveled 170 miles toWeill Bugando Medical Centre in Mwanza, Tanzania, for treat-ment—but given its limitations of equipment and training,there was little the staff could do but clean and cover hiswounds. By the time burn surgeon James Gallagher, MD, sawCharles, eight days after the explosion, his bandages weretinged green with infection. “His life was definitely threat-ened,” says Gallagher, the leader of a Weill Cornell team thatvisited Mwanza last March.

More ThanSkin Deep

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On a service trip to Tanzania—where burninjuries are common and physicians arefew—Weill Cornell surgeons and nursesaimed to help colleagues at Weill Bugando

By Beth SaulnierPhotographs by David Chalk


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Gallagher and his colleagues—including surgical resident KatrinaMitchell, MD, three nurses, and a rehabilitation therapist—spentthree weeks working side by side with Bugando staff. They demon-strated approaches such as employing tourniquets to minimizeblood loss during surgery, the use of skin grafting instruments, andthe vital role of rehab in recovery. “Everyone knows that Africa issuffering and that there aren’t enough doctors—but what does thatmean?” muses Gallagher, who spent a year doing general surgery inthe sub-Saharan region a decade ago, before specializing in burns.“Well, it means that things present very late. In the hospital thereare lots of kids with open burn wounds who’ve been there formonths, but the surgeons don’t operate on them because they don’thave the proper tools, they have no track record of success, and thehospital has many patients with other surgical problems needingcare. The surgeons focus their time and effort on problems theyknow they can solve, and the burn patients often get dischargedwith open wounds.”

Even in the developed world, extensive burn injuries can be dev-astating. In addition to requiring multiple surgeries and intensivepostoperative care, such injuries often raise difficult emotional andpractical issues. Despite successful treatment, burns—especially tothe face—can mean permanent disfigurement, with all the psycho-logical damage that entails. Burns to the hands can cause dexterityproblems that impede patients from performing everyday tasks oreven earning a living.

And if burns aren’t properly treated in the hours, days, and weeksfollowing injury—as they rarely are in the developing world—theoutcomes are infinitely worse. Patients endure chronic wounds inwhich granulation tissue—which, under normal circumstances, playsan essential role in the healing process—is never covered by healthyskin; they suffer contractures in which scar tissue forms and hardens,fusing fingers together or even sealing limbs to the body. “The gran-ulation just keeps growing; we’ve seen adults with chronic woundsremaining from childhood,” Gallagher says. “It’s pretty terrible. Inthe community you see all of these horrible contractures, and theanatomy underneath is completely deformed.”

Gallagher and his team hoped to counter that—not bysweeping in and treating a few lucky patients over thecourse of a few weeks before jetting home again, but

by helping Bugando’s staff develop its own burn-treatment infra-structure. “The best thing you can do,” Mitchell says, “is try tostrengthen the local institution by improving care protocols and theways they educate themselves and their colleagues.” In fact,Mitchell notes, these days one-off “mission trips” by Western med-ical teams—while clearly gratifying to the participants themselves—are increasingly understood to be of limited benefit; they can evenbe counterproductive, by introducing conflicting treatment proto-cols or providing equipment that local staff aren’t trained to use ormaintain. “Traveling to a place for a few days, taking care of a fewpatients, and leaving does very little to improve an institution orlocal health care,” she says. “It is more important to direct fundingand human resources into sustainable projects that will affect hun-dreds or even thousands of patients into the future.”

In a video chronicling the Bugando trip, Gallagher notes thatwhile there is one doctor for roughly every 350 people in the devel-oped world, in Africa the proportion is one for every 33,000. Only afraction of those MDs are surgeons—and severe burn injuries are

Medical mission: (Clockwise from above) A young patient; WeillCornell’s James Gallagher, MD, and Katrina Mitchell, MD, conferwith Bugando’s Geofrey Giiti, MD; Gallagher in the operatingroom; burn surgery instruments; a Bugando OR.



developing countries could treat them successfully. “At the hotel inMwanza you’d run into other visiting physicians, and many ofthem were overwhelmed and frustrated that they can’t change any-thing,” Gallagher says. “I’m grateful that I don’t feel that way. I’mexcited because I feel that we have a practical solution and can helpthe local African surgeons to ease the suffering from burn injury intheir people.”

According to Giiti, Weill Bugando has indeed begun to makeprogress in bettering its burn treatment since the March trip. “Dr.Gallagher’s burn team demonstrated to us the role of a multidiscipli-nary approach in treating burn injuries,” he says. “We have startedto involve other specialties like rehabilitation therapists in manag-ing burn patients. In deep burn, we are advocating early surgery bytangential excision and early skin grafting. In the past, the practicewas to delay surgery until after skin granulation had taken place,which was associated with long hospital stays and bad aesthetic out-comes.”

The ultimate goal, Giiti says, is to establish a dedicated burn unitin Mwanza. Weill Cornell will continue to offer training and support,including the development of surgical simulators; Gallagher is cur-rently conducting a study on the efficacy of a low-tech simulationsystem for evaluating and training burn surgeons. In November, heand his team learned that they’d been awarded a $191,000 grantfrom the ELMA Foundation for the pilot phase of developing a pedi-atric burn unit, including reorganizing surgical spaces and establish-ing care protocols for nursing and rehabilitation; Dean EmeritusAntonio Gotto, MD, DPhil, has pledged to spearhead fundraising ofan additional $120,000. “Over the next few years, quarter by quarter,it will build upon itself and be a model or proof of concept that canbe taken anywhere,” Mitchell says. “To say, ‘If you’re a care providerinterested in burns, this is the stepwise way to go about establishinga burn center anywhere in a resource-limited environment.’ ” Now asenior resident in the Weill Cornell general surgery program,Mitchell ultimately plans to practice internationally, most likely intrauma and critical care surgery. “It’s challenging in a different waythan working in the States,” she says of practicing in developingcountries. “It makes you think more practically and utilize all yourresources. Most of all, it’s incredibly rewarding. Patients are grateful,you have wonderful relationships with your colleagues across disci-plines, and it brings your work back to its roots. In Africa, I felt likemedicine was a joy.” •

surgical cases. Tanzania has just one dedicated burn unit, located inthe capital city of Dar es Salaam, more than 1,000 miles fromMwanza. “Apart from the paucity of human resources,” saysGeofrey Giiti, MD, a lecturer and general surgeon at Weill Bugandowho is spearheading the improvement of burn treatment at thehospital, “there are inadequate facilities for resuscitating acute burninjury, consumables for dressing burn wounds, shower tables, prop-er surgical instruments, and facilities for rehabilitation therapy.”

While treatment resources are few, the need is acute: burninjuries are heartbreakingly common in Africa, where cooking ismainly done around open fires. Those fires are often low to theground—at child height—and many pediatric injuries involvescalding by hot water, tea, or porridge. “You have unprotectedkitchens, and you also have the fact that people are boiling water tomake it drinkable,” Gallagher says. “So there’s a lot of boiling goingon and a lot of cooking in what we would call unsafe conditions.When I lived in Africa the first time, the conclusion I drew is thatfor much of the population it’s like long-term camping. If you pic-ture yourself camping, sleeping on the ground and cooking over anopen fire—that’s what it’s like to live in much of Africa.”

The Mwanza burn efforts began with a meeting betweenGallagher and Mitchell, who was in New York on leave from a two-year stint at Weill Bugando, where she was working on surgical edu-cation development. Gallagher, with his dual interests in burnmedicine and global health, asked about the state of burn treat-ment at Bugando—an institution that is not only affiliated withWeill Cornell but shares a common benefactor in Sanford Weill.“She said, ‘There’s really nothing going on with burns,’ ” he recalls.“But she knew a surgeon who would be a good candidate to leadthe charge and be the person who invites us—because we want towork with the surgeons on the ground and say, ‘What do you guysneed? We’re your partners.’ ” Giiti signed on, and in August 2011Gallagher and Mitchell—who eventually opted to stay in Tanzaniafor a third year to work on the burn project—took a two-week fact-finding trip to assess the state of burn treatment at the hospital,from operating rooms to nursing staff to the kitchens that providenutrition; they even visited the local fire department.

During the March trip, which also included a volunteer photog-rapher, the team focused its efforts on a half-dozen severely injuredpediatric patients. They included Charles—on whom they per-formed successful skin grafts, including a dramatic repair of hisface—and a girl of toddler age who’d fallen face-first into hot coals;after two months in the hospital, her skull remained exposed.During their second week in Mwanza, a woman came into SekouToure Hospital, a nearby facility that the team also visited; a house-hold maid, she’d been accused of stealing from her employers. “Shedenied it, and they took her to a witch doctor, who poured anaccelerant on her and said if she was innocent she wouldn’t go onfire,” Gallagher says. “Quite naturally she went on fire, and sufferedthird-degree burns to both of her legs.” Under the guidance of theWeill Cornell surgeons, the Tanzanian staff did skin grafts just threedays after her injury. “Normally it would be months in the hospi-tal, contracted,” Gallagher says. “I’m not exaggerating. Shewould’ve ended up a cripple, because she would’ve had chronicwounds for months, or more likely permanently.”

Gallagher points out that while burn injuries can be devastat-ing, their treatment is often fairly straightforward: dressing changes,possibly skin grafts, and rehabilitation. That means that with train-ing and the proper surgical instruments—which are generally low-tech—it’s realistic to expect that surgeons and support staff in


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Treating and training: (Clockwise from top left) Rehab specialist Sam Yohannan works with a pediatric patient;Mitchell and Yohannan with local children; Mitchell outside the OR; Gallagher lectures to Bugando staff.


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L innie Golightly, MD ’83, was at the end of her sec-ond year of medical school when a class foundedby legendary professor of tropical medicine and

public health Benjamin Kean, MD, introduced the Detroitnative to the roster of diseases common in developing coun-tries. At the end of that year, she traveled deep into theBrazilian rain forest with Warren Johnson, MD, now the B. H.Kean Professor of Tropical Medicine at Weill Cornell. “Therewas no doctor, no health-care professional,” recalls Golightly,now an associate professor of clinical medicine and of medi-cine in microbiology and immunology at the Medical College.“When we were there, people would come from miles aroundbecause there was somebody who could help them.”

InfectiousEnthusiasm

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By Kristina Strain & Sharon Tregaskis

Professor Linnie Golightly, MD ’83, is dedicatedto battling malaria and other devastating diseases, in the developing world and at home

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N A

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OTT


Johnson still laughs, recalling the day—the ground slick with mud from a recent downpour—whenhe sent Golightly out with their host, parasitologist Philip Marsden, MD, a British expatriate who hadestablished clinics throughout Brazil. When they returned, Johnson asked how things had gone. “Philipsays, ‘She nearly killed me—you didn’t tell me she was a runner! She’s as sure-footed as a mountaingoat!’ ” That same energy still infuses Golightly’s work, says Johnson, who recruited his protégé to joinWeill Cornell’s faculty in 1997. “It’s symbolic of her perseverance,” he says. “There were a certain num-ber of patients to be seen that day, and Linnie was going to see them.”

Until then, Golightly had imagined she might train as a neurosurgeon, then return home. Intriguedby basic science, she rotated in the laboratory of Ira Black, MD—then chief of Weill Cornell’s Laboratoryof Developmental Neurology, the Nathan Cummings Professor of Neurology, and a stem cell pioneer—who was investigating the molecular pathways of nerve regeneration. But a return to Brazil withJohnson at the end of her fourth year of medical school cemented her course in international medicine.

In the intervening three decades, Golightly has gone on to investigate the molecular basis of drugresistance in Plasmodium falciparum—the parasitic strain responsible for the most deadly form of malar-ia—and the genetic underpinnings of its life cycle. “Parasitic diseases were the diseases nobody wasstudying, yet they cause so much mortality worldwide,” she says. “I decided I wanted to do somethingabout it.” Today, Golightly is still pursuing her longtime interest in neuroscience and infectious disease,tackling a variety of seemingly disparate projects linked by their shared potential to help peoplethroughout the developing world. Traveling among Manhattan, Ghana, and Haiti, she seeks clues tosuch diseases as malaria, West Nile virus, dengue fever, and cholera. “Sometimes it sounds exotic, doingmedicine abroad,” says Golightly, who also oversees medical students testing their own interest in sucha career, “but it’s not a vacation.”

Every year nearly one million people die of malaria—the vast majority of them African chil-dren under the age of five. The disease causes a constellation of symptoms including alter-nating fever and chills, nausea, diarrhea, listlessness, and even coma. Yet few Africanchildren in malaria’s throes see a health-care professional. On average, there is just one doc-tor, nurse, or midwife available for every 2,000 people on the continent; by contrast, there

is one health-care worker for every seventeen Americans.Instead, in a region where malaria is perhaps the most deadly cause of such pediatric symptoms,

health-care providers and families often skip straight to treatment—if the medicine is available and rela-tives have the resources to pay for it. “If a child comes in to NewYork-Presbyterian suspected of havingmalaria, we do blood smears to verify the diagnosis and blood cultures to assess for bacterial infections—and if the child is in a coma, we perform lumbar punctures and CT scans or an MRI,” says Golightly, whotravels regularly to Accra, Ghana, a malarial hotspot just a nine-hour flight from Manhattan. “It’s the stan-dard of care in the U.S., but in Africa sometimes people don’t even have money for a smear to verify thatthe child in fact has malaria.” On a continent where malaria claims nearly 3,000 lives daily, doctors work-ing in remote areas often rely on a subjective history of fever alone to begin treatment. But in combating

Tiny invaders: A blood smear containing Plasmodium falciparum, the parasiteresponsible for malaria

CDC



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the panoply of parasitic, bacteri-al, and viral diseases—all charac-terized by fever—that arerampant throughout sub-SaharanAfrica, Southeast Asia, and India,conflating fever and malariaposes its own hazards, includinghigh rates of misdiagnosis.

For people with limitedmeans living far from a dispensa-ry, getting the right treatment iscritical. Not only are anti-malari-als expensive, they don’t combatother infections with similarsymptoms—leading to increasedmorbidity and mortality when apatient gets the wrong treat-ment. And the hazards extendfar beyond a single patient’srecovery: overuse of the few reli-able anti-malarials exacerbatesthe public health challengesassociated with increasinglydrug-resistant strains of the dis-ease. “In the U.S., we do bloodcultures to see if there might be abacterial infection along with themalaria,” says Golightly. “There,all too often, they assume it’smalaria, give them malariadrugs, and will only go back tolook for bacterial infections ifthey don’t improve.”

In a pilot project funded bythe Bill & Melinda Gates Foundation, Golightly and collaborator Alberto Bilenca, PhD, a senior lecturer inbiomedical engineering at Israel’s Ben-Gurion University of the Negev, aim to deploy cell phones to speedaffordable front-line diagnosis. “In remote areas you don’t have the infrastructure to diagnose malaria witha microscope and complicated staining methods, but cell phones are everywhere in Africa,” says Bilenca,who found Golightly in an online search for clinicians expert in the basic science of malaria, then calledher about the possibility of collaborating. “You don’t need to be trained to use a cell phone.”

The biology behind Golightly and Bilenca’s cell phone solution is relatively simple. Inside red bloodcells, Plasmodium—the parasite responsible for malaria—moves fast. To avoid detection by the spleen, theonly organ in the body equipped to detect the abnormally shaped infected cells, Plasmodium generates asticky surface protein that causes infected blood cells to cling to the walls of the blood vessels they traverse,much like cholesterol hardening an artery. Vessels compromised by this buildup change from red toorange to white as the plaque of infected cells gets thicker; eventually, circulation shuts down completely.

Meanwhile, hungry for food to fuel its conquest, the parasite devours the oxygen-carrying hemoglo-bin at the core of each red blood cell. As calling cards go, the crystalline product that results—hemo-zoin—is unmistakable. It’s known as the “malaria pigment” for its reddish-brown hue and can providescientists with a diagnostic cue that the parasite is present.

The crystalline hemozoin molecule bends light. “If there’s hemozoin in the blood, it will affect theamount of light we’re detecting,” says Bilenca, an expert in optics. “When light shines directly throughthe crystal, it rotates; hemozoin changes the polarization.” Capitalizing on the crystal’s unique opticalproperties, Bilenca and Golightly are developing a cell phone application sensitive to its light-bendingways. Outfitted with a $15 lens accessory, the phones become diagnostic tools, confirming a case ofmalaria by detecting the presence of hemozoin and even determining the severity of a case by gaugingthe extent of adhesion in the blood vessels. “Measuring blood flow with a cell phone, non-invasively,sounds like a fiction,” says Bilenca. “But it works.”

In young African children who have yet to develop resistance to the parasite, Plasmodium can affect

Rapid detection: David Tay andregistered nurse LorrainePierre-Destine, technicians inGolightly’s lab, with the cellphone-based device that helpsdiagnose malaria

ABBOTT



the blood-brain barrier. That leads to cerebral malaria, which wreaks havoc in the vessels that supplyoxygen and nutrients to the core of the nervous system. “You don’t know which child is going to getit. They suddenly develop seizures and go into coma,” says Golightly, “and we can’t predict who’sgoing to recover.” Children treated with anti-malarial medications may still develop cerebral malaria—and those who recover may appear well but have lifelong neurocognitive defects. More than a quarterof the children who develop cerebral malaria never come out of coma and die.

Even worse, the finger prick and blood smear that reveals the presence of Plasmodium doesn’t indi-cate whether the infection has spread to the brain. “There’s currently no simple diagnostic test for cere-bral malaria,” says Golightly. As a workaround to scarce, high-tech equipment that can revealPlasmodium’s influence on blood flow to the brain, scientists have turned their attention to the eye,where a dilated pupil provides a window into cerebral vascular tissue. For nearly a decade, they’veknown that a specialized ophthalmic exam can reveal the severity of a malaria infection and whetherthe patient has cerebral malaria. But finding a trained ophthalmologist in sub-Saharan Africa is no eas-ier than finding a laboratory set up for conventional malaria smears or blood cultures.

Now, by aiming Bilenca and Golightly’s cell phone camera at a malaria patient’s eye, the diagnos-ing physician could be anywhere. “This is telemedicine,” says Bilenca. “Basically, a regular person doesthe medical measurement and transmits it to an MD in some other part of the globe.” This year,Golightly and Bilenca will submit their work to the Gates Foundation in a bid for an extension of their$100,000 Grand Challenges in Global Health Explorations award—an additional $1 million in funding.“It’s a long road,” says Golightly, who is currently testing the device in vivo in mice at Weill Cornell.

In the Fifties and Sixties, there were aggressive public health campaigns to wipe out Plasmodium—first DDT to kill mosquitoes, then the anti-malarial drug chloroquine mixed into table salt in tropicalcountries—but Plasmodium has persisted and rebounded whenever the campaigns were withdrawn. Theindiscriminate use of chloroquine and other anti-malarials has led to tougher, drug-resistant parasitesthat are gaining ground around the world as scientists like Golightly race to understand how theybreach the blood-brain barrier to cause cerebral malaria. “Somehow a parasite inside a red blood cell onthe other side of the vascular lining affects the brain,” says Golightly. “Nobody knows how.”

Working with Shahin Rafii ’82, MD, the Arthur B. Belfer Professor of Genetic Medicine and co-directorof the Ansary Stem Cell Institute, and collaborators at the Noguchi Memorial Institute for MedicalResearch in Accra, Golightly has focused her investigations on the possible role of circulating endothelialprogenitor cells (CEPCs)—the small population of stem cells responsible for regenerating and repairingblood vessel linings—in recovery from cerebral malaria. In a 2009 article in the American Journal of TropicalMedicine and Hygiene, the NIH-funded team documented that African children who develop cerebralsymptoms have lower levels of CEPCs than those with malaria whose brains hold Plasmodium at bay.

The team’s current work may determine whether pharmaceutically boosting CEPCs—a strategy pro-posed to promote circulatory health in people with cardiovascular disease—could treat or even protectagainst cerebral malaria. “If the hypothesis proves true and repair mechanisms [like CEPC] are impor-tant in cerebral malaria, then you might be able to use drugs to augment repair,” says Golightly. “Butfirst we have to prove that we’re correct.”

For more than a decade, Golightly’s research has toggled between the search for greaterinsight into the molecular basis of malaria and the quest for better, faster tools to diagnosethe panoply of infectious agents—dengue virus, West Nile virus, even food-bornepathogens—that afflict the developing world. The latter has drawn heavily on the expertiseof colleagues Davise Larone, PhD, professor of clinical pathology and laboratory medicine,

and Francis Barany, PhD, professor of microbiology and immunology and the inventor of groundbreak-ing gene amplification and detection techniques including the universal array. Two forthcoming papersexamine the effectiveness of using two of Barany’s techniques—polymerase chain reaction and ligasedetection reaction—to reveal the presence of viral diarrhea and hemorrhagic fever agents. Much fasterthan a conventional culture, which can take eighteen hours or longer to deliver a result, this rapid diag-nostic system has the potential to aid physicians combating the spread of a particularly fast-movingcontagion such as cholera or even a bioterror agent.

The trio began collaborating in the aftermath of 9/11, motivated by conversations about what theymight do to help. As anthrax scares made headlines and the threat of further bioterror agents—manyof them common diseases in developing countries—loomed large, Golightly, Barany, and Laroneapplied for funding from the National Institute of Allergy and Infectious Diseases to develop molecu-lar methods using Barany’s gene amplification technique to speed diagnosis. Rather than waiting a full


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day to identify a hazard like bubonic plague, doctors would be able to use the trio’s high-speed approachto zero in on pathogens in just minutes.

In 2007, the Journal of Clinical Microbiology published a description of the result: an assay to detecttwenty infectious agents common worldwide, including those that cause anthrax, tularemia, bubonicplague, and Malta fever. More recently they’ve refined the technique to identify West Nile virus, denguefever, and drug-resistant Staphylococcus aureus, the cause of many hospital-acquired infections. “This isvery translational work,” says Barany. “The idea is to aid in our country’s defense against bioterroragents but at the same time help people in developing countries.” For instance, when a cholera outbreakfollowed the catastrophic earthquake that struck Haiti in January 2010, Golightly asked colleagues at theWeill Cornell-affiliated GHESKIO clinic for stool samples. She, Barany, and Larone retooled their diag-nostics to analyze the samples, finding that multiple pathogens—not just cholera—were present.

One of Barany’s favorite anecdotes about Golightly stems from an incident a few years ago, when hespent a Saturday night in an emergency room with a friend suffering severe stomach pains. Says Barany:“At six on Sunday morning, I called Linnie and said, ‘I hate to wake you, but something’s not righthere.’ Golightly listened to his description of the symptoms, agreed, and immediately called a gastroen-terologist friend—who, at her request, sprang into action. “He was visiting his mother,” Barany recalls,“but he got in the car and drove ninety minutes to see a patient whom Linnie had never even met.”Within hours, Barany’s friend was in emergency surgery, which saved her life. “Linnie is a real human-ist,” he says. “She always goes all out to help individuals in need.” •

PROVIDED BY DR. LINNIE GOLIGHTLY

Field work: Golightly (center)with collaborators at a hospitalin Ghana


Dear fellow alumni:I am pleased to be writing my first letter as

president of your Alumni Association. As 2013begins, we look back at what has been a veryexciting time for Weill Cornell.

Over the past year, Dr. Laurie Glimcher,Stephen and Suzanne Weiss Dean, hasimmersed herself in the many excitingand innovative developments happeningat the Medical College, while crafting hervision to position it as one of the world’sleading academic medical centers. She isenthusiastic to strengthen biomedicalresearch on campus, and her continuedsupport in this area of growth is evident.

In August we welcomed the Class of2016 to York Avenue. The 101 incomingstudents received their white coats andstethoscopes at the annual ceremony andhave been hard at work since. As always,we thank the Buster Foundation for itssupport of this ceremony, which hasbecome a tradition at Weill Cornell, andits continued funding of the Paul F.Miskovitz, MD ’75, Stethoscope Initiative,which generously provides students withthat essential medical instrument.

During the weekend of October 19–20,more than 400 alumni and guests gathered inNew York for Reunion 2012. In addition toreconnecting with old friends and colleagues,meeting current students, and touring WeillCornell’s facilities, alumni had the opportunityto meet Dean Laurie Glimcher and hear fromCornell University President David Skorton, MD,who moderated a panel of alumni involved incross-campus research initiatives. The weekendconcluded with a gala dinner dance at Cipriani


NotebookNews of MedicalCollege and GraduateSchool Alumni

R. Ernest Sosa, MD ’78

PROVIDED

42nd Street, where we reminisced about oldtimes and discussed the exciting changes takingplace at Weill Cornell.

I am happy to say that alumni remain gener-ous supporters of the Medical College, especiallyin the area of scholarship. Our medical studentswill incur, on average, more than $147,000 indebt upon graduation. This is lower than thenational average, but still a daunting number. Tofind out more information about the various giv-ing opportunities at Weill Cornell or to join theDean’s Circle, please contact the Office of AlumniRelations at (646) 317-7419.

We look forward to the new and exciting ini-tiatives and increased research opportunities inthe year ahead. Through these developments,alumni will continue to play a welcome andvaluable role in the continued growth of ourmedical school.

Once again, thank you for your support ofWeill Cornell Medical College, the AlumniAssociation, and our students.

Best and warmest wishes,

R. Ernest Sosa, MD ’78President, WCMC Alumni [email protected]

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1950sMarjorie F. Hughes ’47, MD ’50: “I retired in

1992. I’d been a doctor for the Arlington PublicSchools for 36 years. Two years ago, I entered aretirement home just across the Potomac Riverfrom Washington, DC.”

Stanley Birnbaum, MD ’51: “I am still ingynecology practice and live in Manhattan withmy wife, Michele. We now have two grandchil-dren: Spencer, 6, and Riley, 3.”

Lowell L. Williams, MD ’51: “Although Iretired in 1995, I am keeping current in myresearch interests of epigenetics and new findingsin immunology.”

Bernie Siegel, MD ’54: “Since graduating, Ihave had an interesting life experience. I am nowthe author of twelve books and noted to be inthe top twenty of living spiritual healers on theplanet. Still doing teaching, lecturing, and run-ning support groups for cancer patients. Survivorbehavior, human potential, and self-inducedhealing are not accidents. My next book will con-tain many drawings to show how they anddreams reveal somatic aspects of health and dis-ease and the wisdom of therapeutic choices. Nomedical school tells its students that Carl Jungdiagnosed a brain tumor from a patient’s dream.I have done the same things with patients’ draw-ings. My website (http://berniesiegelmd.com) hasa webinar sharing some examples.”

Joseph E. Johnston, MD ’55, was featured ina recent issue of the magazine Our South, high-lighting his 57 years of practice in Mt. Olive,Mississippi. Before his retirement in 2012, Dr.Johnston served patients in his home clinic, theGreen Tree Family Medical Clinic, area hospi-tals, and nursing homes. His son, Dr. WordJohnston, joined his father’s practice in 1984,and his granddaughter, Eden, is a student at theUniversity of Mississippi Medical Center. Dr.Johnston’s professional honors include runner-up for national Family Physician of the Year,past president of the Mississippi Academy ofFamily Physicians, and the John B. HowellMemorial Award.

Jay Cohn, MD ’56: “I remain active as a pro-fessor of medicine and director of the RasmussenCenter for Cardiovascular Disease Prevention atthe University of Minnesota. I have receivedlocal, national, and international awards inrecent years—probably a tribute primarily to mypersistence and longevity. My mission currentlyis to convince the world that early detection andtherapy of asymptomatic cardiovascular diseasecan greatly prolong healthy life and profoundlyreduce health-care costs. We are developingscreening centers to provide communities withaccess to this evaluation. Syma and I spend eightmonths a year in Minneapolis, but enjoy an alter-

native winter lifestyle on Longboat Key inFlorida.”

James K. Van Buren ’55, MD ’59: “I contin-ue to enjoy family, golf, travel, and medicalconferences at Emory. I miss seeing patients, butdon’t miss the paperwork, computers, and ‘pro-ductivity’ that go with the practice and art ofmedicine as we learned it. Mary and I look for-ward to any visits.”

1960sAnthony A. Goodman, MD ’65 has a new

novel, None But the Brave, that tells the story ofthe surgeons, nurses, and medics who riskedtheir lives to tend the wounded in World War II.Dr. Goodman is an adjunct professor of medi-cine at Montana State University and an affiliateprofessor at the University of WashingtonSchool of Medicine. He served as a surgeon inthe US Army Medical Corps during the VietnamWar and on the Project HOPE hospital ship.

Edgar J. Kenton III, MD ’65, was appointeddirector of the Stroke Program and director ofthe Neurology Department, Geisinger HealthSystem in Danville, PA.

Kermit Dewey ’63, MD ’67: “Bruce Lidston,MD ’67, and his wife, Carolyn, stoppedovernight on their way home after visiting theirson and grandson in Maine. We had a great time

Cutting a rug: CardiologistCharles Stone, MD ’81, andhis wife, Tanya, on the dancefloor at Reunion 2012

WCMC



WCMC

James S. Reilly, MD ’72: “I’m a pediatric oto-laryngologist at Nemour-DuPont Hospital forChildren in Wilmington, DE. After hours I spendtime in Ocean City, NJ, at the summer homethat my wife, Barbara, and I have redone. Iremain happy working as a clinician and hospi-tal leader and enjoy my grandchildren. I remem-ber most the physical diagnosis introductionclasses with Dr. Elliot Hochstein.”

George C. Ellis, MD ’74: “In the spring of2013, I am changing my mode of practice intoone in which I will be caring for only 50 families.I’m partnering with Dr. Mark Brown, who Itrained with at the Medical College. We are join-ing an organization called MD2 (www.md2.com).Our new office will be at 860 Park Avenue.”

Gerald Kolski, MD ’76: “I’m semi-retired,working one day a week in Huntsville, TX. Susanand I are near our daughter Andrea and grand-daughter. Our son, Brian, completed a cardiologyfellowship at UCSD and is doing interventionalcardiology. Melissa is working in Chicago, run-ning educational programs for RIC and writing abook on pain management.”

Samuel Silver, MD ’79: “I’m professor ofinternal medicine in hematology/oncology andassistant dean for research at the University ofMichigan Medical School. I was just elected as aMaster of the American College of Physicians.”

1980sRosemary Meisner Klenk, MD ’80: “I’ve

worked almost 30 years in full-time pediatricgroup practice in Stamford and New Canaan, CT.I’m proud that my son Colin has just startedColumbia Medical School and is doing well sofar. My youngest son, Kevin, is a 2012 graduateof West Point and is training as a tank com-mander at Fort Benning, GA. To have a little funon Saturday night in NYC, go to KaraKlenk.comand see my eldest daughter host a weeklystandup comedy show at 8:30 p.m. at UCB East.”

Ann Engelland, MD ’81: “As a proud MedicalCollege alumna, I had every intention of gettingto the reunion, but I broke my leg three daysbefore! So sorry to have missed my old friends.You may know that my work as an adolescentmedicine physician was featured in Weill CornellMedicine in the Winter 2008/09 issue. Since thenI have moved into school and college health andhave been an advocate for good management ofhead injury. I have just published It’s All in YourHead: Everyone’s Guide to Managing Concussions.This book helps all members of the communityto recognize and respond to concussions. Manyspecialties and their patients—from pediatrics tointernal medicine, neurology, orthopaedics, andpsychiatry—will benefit from it.”

Sharon Strong, MD ’81: “I really enjoyed see-

catching up on 40-plus years, and my wife,Valerie, finally got to meet them.”

1970sDaniel M. Hayes, MD ’72: “I have retired

from my medical oncology practice of 36 years.Phyllis is getting used to my being around more,and I’m adjusting with many interests, some pro-fessional, as we both await formalized travelplans. Our three daughters live in Maine, and ason and daughter-in-law and two grandchildrenin New York keep us moving a lot. You can reachme at: hayesd @ mccm.org.”

We want to hear from you!Keep in touch with your classmates.

Send your news to Chris Furst:[email protected] by mail:Weill Cornell Medicine401 East State Street, Suite 301Ithaca, NY 14850

Facebook photos: DorothyZimmerman Jones, BSNursing ’47, and RudolphJones, MD ’45, view somevintage images at Reunion2012.


W I N T E R 2 0 1 3 4 7

ing lots of classmates at the reunion in October.My husband, Phil Bossart, MD ’81, continues towork in the ER and has become involved withmedical school admissions. I enjoy palliative careand geriatrics. We enjoy travel, tennis, andbridge. Son Chris is a second-year med student.Daughter Abby is majoring in Spanish and savingmoney to travel to South America. Son Matt is acollege junior studying engineering.”

Grace Makari-Judson, MD ’82: “One of oursons, Tim, is a Weill Cornell second-year studentliving in Lasdon. When Peter, MD ’82, and Ivisit, we get quite nostalgic.”

Barnaby Starr, MD ’82: “I’m continuing torun an old-fashioned general pediatric practice inBaltimore. I employ five people including a part-time pediatrician and a pediatric nurse practition-er. I miss all my old classmates and wish you allwell.”

Perry Kamel, MD ’84: “Elena and I have twokids in college this year. Only one child left athome.”

Alexander Babich, MD ’88, received an awardfor his virtual artwork “Ethiopian Bride” at the7th Virtual Medical Complex Art Shows at theWeill Cornell Medical Library. Both the virtualand physical shows opened on November 5,2012, and continued until January 31, 2013. Hereis a link to the “Art in the Library” page, whichfeatures the virtual show: http://library. weill.cornell.edu/Art/. Other alumni in the showincluded Edgar Figureroa, MD ’00, GeraldCordani, MD ’70, Muriel King Taylor ’58, MD ’62,and Gus Kappler ’61, MD ’65.

1990sScott Tarantino, MD ’94: “I’m continuing in

orthopaedic surgery practice in Maryland. I havethree great kids—Lucia, 15, Jack, 12, and Maya,6—and my wonderful wife, Bonnie. I’m coachingLucia’s basketball team and Jack’s travel baseballteam. Life is good.”

Jeffrey Yao, MD ’99: “I was recently promot-ed to associate professor of orthopaedic surgery atStanford University Medical Center.”

2000sJosh Dines, MD ’01: “I’m the youngest mem-

ber named to the American Shoulder & ElbowSurgery Society and team doctor for the US DavisCup tennis team.”

Rafael Vazquez, MD ’06, started working as astaff anesthesiologist at Massachusetts GeneralHospital. He works primarily in the vascular serv-ice providing high activity care to patients under-going complex thoracoabdominal aneurysmrepairs.

’39 MD—Augustus W. Sainsbury of Canan -daigua, NY, November 3, 2012; general surgeon;veteran; singer.

’48 MD—Robert J. Oehrig of Minneapolis, MN,October 16, 2012; medical director, Home LifeInsurance Co.; geriatric physician, ChristianMedical Center; veteran; medical missionary; layminister; active in religious affairs.

’48 MD—Warren G. Sarrell of Birmingham, AL,September 27, 2012; retired cardiologist andinternist; co-founder and president, AnnistonMedical Clinic; established the first heartcatheterization lab, Regional Medical Center, in1972; co-founder, Regional Medical CenterFoundation; helped found the Sarrell DentalClinic; veteran; president, Alabama HeartAssociation; active in professional affairs.

’52 MD—Sterling W. Obenour of Zanesville, OH,October 17, 2012; general and vascular surgeon;veteran; served on the staffs of Bethesda andGood Samaritan hospitals; president, Muskin -gum County Academy of Medicine; governor,American College of Surgeons; pilot; photogra-pher; musician; active in community, professional,and religious affairs.

’54 MD—Herbert A. Kroeze Jr. of Madison, MS,June 10, 2012; physician.

’57 MD—Anne Shannon Morgan of Westmore-land, NH, April 5, 2012; physician.

’70 MD—Richard T. Nist of Anchorage, AK,October 28, 2012; obstetrician; active in commu-nity affairs.

InMemoriam

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Mission of Mercy

Seeking a kidney for their child, parents travel 9,500 miles

Post Doc

tumors and renal failure. “In six months, her kidneys went from 100percent function to 25 percent,” says Shami, who stopped working asa consultant in the oil and gas industry when her daughter was diag-nosed. Daaniya, who went on dialysis, needed a transplant as soon aspossible—but family members weren’t viable matches and a Facebookcampaign proved fruitless. And there was another hurdle: the familywas living in Singapore, where Zaidi worked as a banker. “We were ina country where the waiting list for a kidney is nine years,” Shamisays. “Donation—especially live donation—is not something thathappens there very often. So we had to make a choice.”

The couple opted to move halfway around the globe—to anapartment just blocks from NYP/Weill Cornell—so their daughtercould have the best chance for a transplant. After Zaidi’s bank trans-ferred him to New York, the family relocated in February. “It’sextremely unusual,” says Sandip Kapur, MD ’90, chief of transplantsurgery and director of the Kidney and Pancreas Transplant Programs,whom the couple chose to do the operation after an internationalsearch. “I’ve been doing this for eighteen years, and it’s the only timeI’ve seen a family pick up and move here for their child.” Father anddaughter became part of a transplant chain—a system that allowssomeone to give a kidney to a stranger while his or her relative getsan organ from a donor in the same situation. “They don’t donatedirectly to their loved one,” Kapur says, “but they allow their lovedone to get a nicely matched, well-functioning, live-donor kidney.”

Since Daaniya’s condition can cause malignant tumors, sur-geons removed her kidneys while she awaited a transplant; mean-while, her father underwent donor testing. In June, they becamepart of a chain of nine recipients and ten donors, with the extradonor forming the first link in a future chain. Daaniya received anorgan from a thirty-three-year-old woman in California—it wasshipped via red-eye—and her father gave a long-awaited kidney toa forty-eight-year-old New Yorker who’d been difficult to match.“It’s not quite the same as donating to your child,” says Zaidi, whohas suffered no ill effects, “but it’s a very close second.”

Daaniya has been doing extremely well since the transplant—growing, gaining weight, and bursting with energy. “It was verysuccessful,” says Valerie Johnson, PhD ’76, MD ’77, associate profes-sor of clinical pediatrics, director of the Division of PediatricNephrology, and a member of the patient care team of the Phyllisand David Komansky Center for Children’s Health at NYP. “You’dhardly know this is the same child.”

Although Daaniya will need anti-rejection drugs and regularcheckups throughout her life—and will likely require another trans-plant in her late twenties—she’s essentially a normal, healthy pre-schooler. After the long months of dialysis, dietary restrictions, andbans on activities like bathing, swimming, and rough play (due toher catheter), the girl can snack and romp with her peers. “Seeingher healthy, happy, growing—just being a child—is fantastic,” Zaidisays. “You forget some days that she went through an enormousamount to get where she is. Sometimes, you’re in the happy posi-tion of taking it for granted.”

— Beth Saulnier

Daaniya Zaidi is an energetic three-year-old with dark hair, deepbrown eyes, and a sunny disposi-

tion. Colorfully clad in tie-dye and polka dots,she careens around her family’s Upper EastSide living room with her toddler brother oneafternoon in late October. “I like to do dressup,” the little girl announces, describing herpreferences for fairies and princesses and herplan to wear a ladybug costume for Halloween.“I like to go to the playground.”

But not long ago, Daaniya didn’t have as much time or energy forplay. Despite her young age, she can speak in detail about life beforeher June kidney transplant. “I had to go to dialysis all day, and I hadto stay there,” she says. “Now,” she adds to the exhausted amusementof her mother, Samareen Shami, “I can run all over the house.”

A year ago, Shami and her husband, Salman Zaidi, could scarcelyhave hoped to see their daughter so healthy. Around age two, Daaniyawas diagnosed with a congenital condition that leads to kidney

JOHN ABBOTT

Daaniya Zaidi

48-48WCMwinter2013postdoc_WCM 1/22/13 2:49 PM Page 48

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