Authors Posts by Daniel Dunaief

Daniel Dunaief

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Above, Mikala Egeblad works with graduate student Emilis Bružas in the Watson School of Biological Sciences. Photo from Pershing Square Soon Cancer Research Alliance

By Daniel Dunaief

For some people, cancer goes into remission and remains inactive. For others, the cancer that’s in remission returns. While doctors can look for risk factors or genetic mutations, they don’t know why a cancer may come back at the individual level.

In a mouse model of breast and prostate cancers, Mikala Egeblad, an associate professor at Cold Spring Harbor Laboratory, has found an important driver of cancer activation and metastasis: inflammation. When mice with cancer also have inflammation, their cancer is likely to become more active. Those who don’t have inflammation, or whose inflammation is treated quickly, can keep the dreaded disease in check. Cancer cells “may be dormant or hibernating and not doing any harm at all,” she said. “We speculated what might be driving them from harmless to overt metastasis.”

Egeblad cautioned that this research, which was recently published in the journal Science, is on mice and that humans may have different processes and mechanisms.

CSHL’s Mikala Egeblad. Photo from Pershing Square Soon Cancer Research Alliance

“It is critical to verify whether the process happens in humans,” Egeblad suggested in an email, which she will address in her ongoing research. Still, the results offer a window into the way cancer can become active and then spread from the lungs. She believes this is because the lungs are exposed to so many external stimuli. She is also looking into the relevance for bone, liver and brain metastases. The results of this research have made waves in the scientific community.

“This study is fantastic,” declared Zena Werb, a professor of anatomy and associate director for basic science at the Helen Diller Family Comprehensive Cancer Center at the University of California in San Francisco. “When [Egeblad] first presented it at a meeting six months ago, the audience was agog. It was clearly the best presentation of the meeting!”

Werb, who oversaw Egeblad’s research when Egeblad was a postdoctoral scientist, suggested in an email that this is the first significant mechanism that could explain how cancer cells awaken and will “change the way the field thinks.”

Egeblad credits a team of researchers in her lab for contributing to this effort, including first author Jean Albrengues, who is a postdoctoral fellow. This group showed that there’s a tipping point for mice — mice with inflammation that lasts six days develop metastasis.

Egeblad has been studying a part of the immune system called neutrophil extracellular traps, which trap and kill bacteria and yeast. Egeblad and other researchers have shown that some cancers trick these NETs to aid the cancer in metastasizing.

In the new study, inflammation causes cancer cells that are not aggressive to develop NETs, which leads to metastasis. The traps and enzymes on it “change the scaffold that signals that cancer should divide and proliferate instead of sitting there dormant,” Egeblad said.

To test out her theory about the role of enzymes and the NETs, Egeblad blocked the cascade in six different ways, including obstructing the altered tissue scaffold with antibodies. When mice have the antibody, their ability to activate cancer cells after inflammation is prevented or greatly reduced, she explained.

The numbers from her lab are striking: in 100 mice with inflammation, 94 developed metastatic cancer. When she treated these mice with any of the approaches to block the inflammation pathway, 60 percent of them survived, while the remaining 40 percent had a reduced metastatic cancer burden in the lungs.

If inflammation is a key part of determining the cancer prognosis, it would help cancer patients to know, and potentially treat, inflammation even when they don’t show any clinical signs of such a reaction.

In mice, these NETs spill into the blood. Egeblad is testing whether these altered NETs are also detectable in humans. She could envision this becoming a critical marker for inflammation to track in cancer survivors.

The epidemiological data for humans is not as clear cut as the mouse results in Egeblad’s lab. Some of these epidemiological studies, however, may not have identified the correct factor.

Egeblad thinks she needs to look specifically at NETs and not inflammation in general to find out if these altered structures play a role for humans. “We would like to measure levels of NETs and other inflammatory markers in the blood over time and determine if there is a correlation between high levels and risk of recurrence,” she explained, adding that she is starting a study with the University of Kansas.

Werb suggested that inflammation can be pro-tumor or anti-tumor, possibly in the same individual, which could make the net effect difficult to determine.

“By pulling the different mechanisms apart, highly significant effects may be there,” Werb wrote in an email. Other factors including mutation and chromosomal instability and other aspects of the microenvironment interact with inflammation in a “vicious cycle.”

In humans, inflammation may be a part of the cancer dynamic, which may involve other molecular signals or pathways, Egeblad said.

She has been discussing a collaboration with Cold Spring Harbor Laboratory’s Doug Fearon, whose lab is close to hers.

Fearon has been exploring how T-cells could keep metastasis under control. Combining their approaches, she said, cancer might need a go signal, which could come from inflammation, while it also might need the ability to alter the ability of T-cells from stopping metastasis.

In her ongoing efforts to understand the process of metastasis, Egeblad is also looking at creating an antibody that works in humans and plans to continue to build on these results. “We now have a model for how inflammation might cause cancer recurrence,” she said. 

“We are working very actively on multiple different avenues to understand the human implications, and how best to target NETs to prevent cancer metastasis.”

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After living in our new house in Charlotte, North Carolina, for a few weeks, we were delighted to receive an invitation to a block party to meet our neighbors.

Up to that point, we’d only seen and spoken with one neighbor. She and her family welcomed us to the area, offered an air-conditioning reference and shared the garbage pickup schedule.

The morning of the upcoming gathering, my wife and I took a walk through the neighborhood. We admired the landscaping and architecture of nearby homes. We moved off the sidewalk as runners passed us. We trotted up one lawn to clear space for a biker whose steering wheel seemed to be pulling left and right.

Most of the people in cars waved as they passed, a regular occurrence here, even when they didn’t know us.

My wife believes I alert the canines in the area that I am a “dog person.” A golden retriever and a black Labrador spotted me from across the street and stared, causing their owner to stop and wait as they watched us disappear up the block.

A friendly man with a small dog stopped and chatted. He asked if we were residents and if we were attending the block party that evening. When we told him we moved here with our kids, he asked what brought us down.

“Work,” we said.

“Oh,” he said, turning to me. “Did you get a job with one of the banks?”

“No, my wife did,” I replied, directing his attention to her.

He was embarrassed and immediately apologized for assuming I had landed a job that required us to relocate. We reassured him it was fine and we kept walking.

I am proud of my wife and her professional accomplishments. I also recognize, even in a world where people regularly discuss equal opportunity, that we are still far from situations in which people can’t assume anything about the roles husbands and wives play when they meet a couple.

Later that evening, with our children in tow, we walked the few blocks to the party, waving politely at a man who almost certainly carried a beer the same way 20 years ago when he was in college, although his clothing, like ours, was probably a few sizes smaller. Maybe that’s an unfair assumption, too?

When we arrived on a tree-lined cul-de-sac, we noticed that most of the children were considerably younger than our pair, who snarled about an early exit.

After urging them to stay, we made some selections in the crowd and broke the social ice. Consistent with our experience since our arrival, we found people who came originally from Long Island, New York and New Jersey.

We chatted with a proud father, who pointed to his high school senior and proclaimed her the best athlete in her entire school.

“You must be in public relations,” I said.

He and his daughter laughed.

“That guy over there,” he said, pointing to a house.

“Yes?” I replied.

“He is a neurosurgeon who works with football players. His attends games and he does concussion protocol.”

“Really?” I asked.

“The players are supposed to say ‘spaghetti’ when they see him after a hard hit. They get hit so hard that they say things like ‘ham’ or ‘bologna’ because they can’t remember the first concussion word,” he offered.

Our children, despite their initial disappointment, found contemporaries that night and are cellphone buddies with the kids on the block. We received restaurant recommendations and local service provider referrals, while we also will recognize a few of the people who exchange pleasant waves on and off the block.

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The emails, text messages and calls came from all over the country. In the days leading up to Hurricane Florence’s arrival in North Carolina, friends and family shared good wishes for my family, who had moved to the Tar Heel State during the summer.

Preparing for the storm, we were under the impression that we were leaving the typical path of hurricanes when we moved this far west to Charlotte, which is more than 200 miles from the coast.

As the tone and urgency to prepare for the hurricane from meteorologists and politicians reached a peak, people lined up outside supermarkets, waiting to park their cars and navigate their overflowing carts through crowded aisles for their list of must-haves.

Clearly, water and bread were on every list, as the shelves at the 24-hour supermarket didn’t have a drop of bottled water. The only remaining bread was a cranberry concoction that sat on an otherwise bare shelf, examined closely perhaps by a desperate shopper and discarded at a rakish angle, a lone bread crumb telling the tale of the hurricane hurry.

Gas stations brought the same crowds, as drivers were as anxious as they would be on Long Island to gather fuel before trucks might be delayed and gas lines could grow.

People often referred to 1989, when Hurricane Hugo ripped through Charlotte.

Two days before the hurricane reached the area, the public schools closed despite the clear skies and the relatively calm winds. Several of the schools transformed into shelters for residents of the city and for those fleeing from points further east.

The day before the storm, a local bank teller told me about a nearby store that received a new water shipment. The parking lot for this rare find was as empty as the shelves were full of fresh water.

On the day of the hurricane, the forecast for the area called for squalls and heavy rains through much of the day. We stared outside, judging how far the trees bent over and how hard the sheets of rain were blown into our windows. Did we dare go out, especially when we didn’t know areas of local flooding all that well?

I called the local bagel store, where the man who answered the phone said the store planned to remain open through the afternoon.

We looked at trees that provide shade for us in a typical day and are homes for all manner of songbirds to see if we could figure out which of our arboreal friends were the most dangerous — and vulnerable — in the storm.

Eager to get fresh food and to leave the house before it was impossible, we drove around a few downed branches to the store, where we made the mistake of shopping when we were hungry and in provision mode.

When our teenage children awoke, we triumphantly presented the food. They seemed mildly impressed.

We still had electricity until Sunday afternoon, up until the time when we learned that schools would be closed for another day, as trees were removed from the area and power companies restored energy.

The calls and emails from outside the state continued to come in, as supportive friends continued to check to see how we were doing.

Even as other areas of the state dealt with unprecedented flooding, strong winds and tornadoes, we considered ourselves fortunate only to have lost a few trees and power for a day.

As with the response to Hurricane Sandy, our new neighbors in Charlotte offered advice. We may have moved to a fresh environment, but we were heartened by the support from up close and afar in the face of nature’s fury.

By Daniel Dunaief

We have to walk before we can learn to run. It’s a common metaphor that suggests learning new skills, like playing the bassoon, requires a comfort level with notes and scales before taking on complex compositions.

As it turns out, the expression also applies literally and evolutionarily to the part of our anatomy that is so instrumental in enabling us to walk and, eventually, run — the foot.

Carrie Mongle. Photo courtesy of SBU

Carrie Mongle, a doctoral candidate in the Interdepartmental Doctoral Program in Anthropological Sciences at Stony Brook University, recently joined a host of other researchers, including former SBU scientist Peter Fernandez and current clinical assistant professor in biomedical sciences at Marquette University, in a study on the evolution of bones in the foot that made the transition to a bipedal lifestyle possible.

Published in the journal Proceedings of the National Academy of Sciences (PNAS), the work by Fernandez, Mongle and other collaborators explored the forefoot joints of ancient hominins, looking at primitive primates from as far back as 4.4 million years ago.

By comparing the toe joint shapes of fossil hominins, apes, monkeys and humans, they were able to find specific bony shapes in the forefoot that are important in the development of bipedal locomotion — or walking on two feet.

“This study demonstrates that early hominins must have been able to walk upright for millions of years, since the 4.4-million-year-old fossil Ardipithecus ramidus, but that they did not fully transition to a modern walk until much later, perhaps in closer relatives within our own group, Homo,” Mongle explained in an email.

While modern humans are most pronounced in doming, a few primates that walk on the ground have similar foot biomechanics to bipedalism and have similar morphologies in their toes. Those, however, aren’t expressed exactly the same way because their toe bones look different from hominins generally, she explained.

Like the drawings so often associated with a knuckle-walking ancestor that transition to a familiar outline of a person walking, the foot also went through various stages of development, balancing between the need to grasp onto objects like tree limbs and an efficient ability to walk, and then run.

“The foot is a complex assemblage of bones, so it makes sense that not all of them would have changed at exactly the same time,” Mongle suggested. “Our study supports the hypothesis that the transition to bipedalism was a gradual, mosaic process.”

Mongle got involved in this study after discussions with Fernandez, who was at SBU two years ago when the work began. Fernandez suggested to her that, “If we team up together, we can combine our interests and answer some questions about this feature,” she recalled.

Fernandez and Mongle found this dome shape developed in the foot bone even as this early fossil still maintained the ability to grasp tree limbs or other objects.

Fernandez and several other researchers involved in the study collected the data from the fossils, while Mongle, who focuses on cranial morphology and teeth in her own research, performed the evolutionary modeling. “My role in this research was in analyzing and explaining the evolutionary models, which allowed us to reveal the timing and sequence of events that produced the modern human forefoot,” she explained.

As for her doctoral research, Mongle is broadly interested in updating the hominin family tree. She uses mathematical models to look at variations in the fossil record. She is currently studying a cave in South Africa, where researchers have been recovering fossils since the 1930s.The cave has a considerable number of teeth that are all blended together from a period of between 2.5 million and 3 million years ago.

The teeth could tell a more complete story about how human ancestors divided up the food and local resources available to them. If different species were in the same space, they might have divided up into different groups to relieve competitive stress.

Frederick Grine, the chairman in the Department of Anthropology at SBU, offered a strong endorsement of Mongle’s research.“I have no doubt whatever that her work on the cranium and the dentition will provide invaluable insights into human phylogeny,” he wrote in an email, calling her an “exceptionally gifted research scientist” and described her as having an “extremely keen intellect.”

One of Mongle’s overarching research questions is, “How did we become human?” Reconstructing the phylogenetic tree is an important part of that exploration.

While it isn’t central to her thesis work, Mongle appreciated the opportunity to explore the transition to bipedalism, which is one of the “major turning points” in the development of humans.

Mongle explained that several possibilities exist on why human ancestors might have stood upright and walked on two feet.

“One of the prevailing theories is that upright walking may have evolved because climate change led to a loss of forests,” she wrote in an email. “As a consequence of walking upright, we now have free hands to carry tools.

Bipedalism evolved from a type of locomotion that was already efficient, so the question of its evolution remains open and is “hotly debated,” Mongle explained.

The next steps, literally and figuratively, are to study other bones in the feet. “We only looked at one particular part of the foot,” she said. “We would like to expand these approaches to using other bones in the forefoot,” seeking patterns and changes that would also contribute to a bipedal lifestyle.

Mongle, who started her doctoral research in 2012, hopes to graduate from the program next May, at which point she will be looking for postdoctoral research opportunities.

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I didn’t see a horrifying and preventable accident this morning. I didn’t see a little girl, let’s call her Erica, on her way to her first week of school.

Erica, who, in our story, is 10 years old, wants to be a veterinarian, and has pictures of animals all over her room. She begged her parents so long for a kitten that they relented. They saw how well she took care of the kitten, putting drops in her eyes when she needed them, making sure she got the correct shots and even holding her kitten in the office when they had to draw blood to test for feline leukemia, which, fortunately, her kitten didn’t have.

Two years after she got her kitten, Erica continued to ask for additional animals, adding a fish, a rabbit and a hamster to her collection. Each morning, Erica wakes up and checks on all the animals in her little zoo, well, that’s what her father calls it, to see how they’re doing.

Her mother is convinced that the animals respond to her voice, moving closer to the edge of the cage or to the door when they hear her coming. When mother leaves to pick up Erica from school, the animals become restless.

I didn’t see Erica walking with her best friend Jenna. Like Erica, Jenna has a dream. She wants to pitch for the United States in softball in the Olympics. Jenna is much taller than her best friend and has an incredible arm. Jenna hopes the Olympics decides to have softball when she’s old enough and strong enough to play. Jenna thinks bringing a gold medal to her father, who is in the Marines and has traveled the world protecting other people, would be the greatest accomplishment she could ever achieve.

I didn’t see a man, whom I’ll call Bob and who lives only four blocks from Erica and Jenna, put on his carefully pressed light-blue shirt with the matching tie that morning. I didn’t witness him kissing his wife Alicia, the way he does every morning before he rushes off to his important job. I didn’t see him climb into his sleek SUV and back quickly out of his driveway on the dead-end block he and Alicia chose more than a dozen years earlier.

I didn’t see Bob get the first indication from his iPhone 7 that he had several messages. I didn’t witness Bob rolling his eyes at the first few messages. I didn’t see him drive quickly toward the crosswalk where Erica and Jenna were walking. The girls had slowed down in the crosswalk because Jenna pointed out a deer she could see across the street in a backyard. Jenna knew Erica kept an animal diary and she was always on the lookout for anything her friend could include in her cherished book.

I didn’t see Bob — his attention diverted by a phone he had to extend to see clearly — roll too quickly into the crosswalk, sending both girls flying. I didn’t see the ambulances racing to the scene, the parents with heavy hearts getting the unimaginable phone calls, and the doctors doing everything they could to fix Jenna’s battered right arm — her pitching arm.

I didn’t see it because it didn’t happen. What I did see, however, was a man in an SUV, driving way too quickly through a crosswalk, staring at his phone instead of looking out for Erica, Jenna and everyone else’s children on his way to work.

It’s an old message that we should repeat every year: “School is open, drive carefully.”

This Column is reprinted from September 14, 2017 issue.

Ute Moll. Photo courtesy of Stony Brook University

By Daniel Dunaief

In the battle against cancer, human bodies have built-in defenses. Cancers, however, can hijack those systems, turning them against us, not only allowing them to avoid these protective systems, but converting them into participants in a process that can often become fatal.

Such is the case for the p53 gene. One of the most closely studied genes among researchers and clinicians, this gene eliminates cells with damaged DNA, which could turn into cancer. Mutations in this genetic watchdog, however, can turn this genetic hero into a villainous cancer collaborator. Indeed, changes in the genetic code for p53 can allow it to produce a protein that protects cancer from degradation.

Ute Moll. Photo courtesy of SBU

Ute Moll, professor and the vice chair for research in the Department of Pathology at the Stony Brook University School of Medicine, has made important strides in studying the effect of mutations in this gene over the last five years, demonstrating how the altered gene and the protein it creates are an important ally for cancer.

Moll published her most recent finding in this arena in the journal Cancer Cell. The Stony Brook scientist, working with an international team of researchers that included collaborators from her satellite lab at the University of Göttingen, advanced the work on previous results.

This research, which is done on mice that develop tumors through a process that more closely resembles human cancer growth, is a “very good mimic in the molecular and clinical features of human colon cancer,” Moll said.

The main research was done on a faithful mouse model of human colorectal cancer that produces mutant p53, Moll explained. She then confirmed key findings in human colon cancer cells and in survival analysis of patients.

This model allowed Moll to “study tumors in their natural environment in the intact organism with its tumor surrounding connective tissue and immune system,” Ken Shroyer, the chairman of the Department of Pathology at SBU School of Medicine, explained in an email.

The tumors that develop in these mice are driven by mutant p53 and are dependent on it for their continued growth. “These tumors overexpress mutant p53 at high levels,” which makes them a “formidable drug target for their removal,” Moll said.

By deleting the mutant p53 gene, she was able to slow and even stop the progression of the cancer. “We can show that when we remove mutant p53 either genetically or pharmacologically, we are cutting down invasiveness.” Mice with deleted mutants had fewer and smaller tumors and showed over a 50 percent reduction in invasive tumor numbers, she explained.

Finding ways to mitigate the effect of mutant p53 is important for a wide range of cancers. The mutated version Moll studied is the single most common p53 mutation in human cancer, which has a mutation that switches an amino acid for an incorrect one. This amino acid change destroys the normal function of the p53 gene.

The mutation she studies represents about 4.5 percent of all cancers. That amounts to 66,000 cancer patients in the United States each year.

More broadly, mutations in p53 in general, including those Moll didn’t study, are involved in half of all human cancers, Shroyer explained, which makes it the “single most common cancer mutation.”

Yusuf Hannun, director of the Stony Brook University Cancer Center, suggested that the work Moll did could have important clinical implications.“The deciphering of this mechanism clearly indicates new cancer therapy possibilities,” Hannun wrote in an email. The models she worked with are “quite promising.”

In addition to finding ways to stop the progression of cancer in mice with this damaged gene, Moll and her colleagues also used an Hsp90 inhibitor, which blocks a protein that protects the mutant protein from being degraded.

Inhibiting this protein has other positive effects, as the inhibitor eliminates other co-mutant proteins that could also drive tumors. “We are hitting multiple birds with one stone,” Moll said.

Hsp90 inhibitors are a “complicated story” in part because they have strong side effects in the liver and the retina. Researchers are working on the next generation of inhibitors.

A class of anti-cholesterol drugs called statins, which Moll called “one of the blockbuster drugs of medicine,” also has mutant p53 degrading effects, which work against some mutants, but not in others. The benefits are inconsistent and involve confounding variables, which makes interpreting their usefulness difficult, she added.

Moll said her recent article in Cancer Cell has triggered a number of email exchanges with a range of people, including with a patient whose cancer involved a different type of mutation. She has also had discussions with researchers on several other possible collaborations and has started one after she published her recent work.

The scientist is hopeful that her studies will continue to contribute to an understanding of the development and potential treatment of cancer.

Degrading mutant p53 has shown positive results for mice, which indicates “in principle” that such an approach could work down the road in humans, she suggested.

Stony Brook University’s Larry Swanson, Malcolm Bowman and Carl Safina have been chosen to be part of the new state Ocean Acidification Task Force. Photo from Stony Brook University

Stony Brook University will be well represented on the new state Ocean Acidification Task Force examining the effect of acidification on New York’s coastal waters. The legislation was drafted by Assemblyman Steve Englebright (D-Setauket), chair of the Assembly Standing Committee on Environmental Conservation.

The university has three representatives on a 14-member team that will explore the impacts of acidification on the ecology, economy and recreational health of the coastal waters, while also looking to identify contributing factors and make recommendations to mitigate the effects of these factors.

“We have some of the best people in ocean acidification science who will be part of the process.”

— James Gennaro

Englebright said he was pleased to have the SBU representatives on the task force.

“We have these extraordinary scholars and researchers at the university who have a lot to contribute, and I hope that we’re able to listen closely to their advice regarding new policy and potentially new law to protect our coastal ecosystem and marine water.”

Larry Swanson, associate dean of the School of Marine and Atmospheric Sciences will join Malcolm Bowman, distinguished service professor and Carl Safina, endowed research chair for nature and humanity, both also from SoMAS. The task force, which will have its first meeting some time in September at SBU, was signed into law in 2016 and is operating under the direction of Gov. Andrew Cuomo (D) and the New York State
Department of Environmental Conservation.

“We will make recommendations to the Department of Environmental Conservation and the Legislature and will share information about what our understanding of the state of knowledge of ocean acidification is, what are the impacts that we know about in New York state waters,” Swanson said, adding the group will suggest factors to monitor for consequences of acidification.

The composition of the group reflects its wide-ranging mandate, with members including Karen Rivara, owner of Aeros Cultured Oyster Company and former president of the Long Island Farm Bureau.

“We have a very significant shellfish industry that’s potentially in jeopardy. We need to understand what ocean acidification is doing to that industry.”

— Larry Swanson

Ocean acidification has been increasing at a rapid pace amid the increasing output of the greenhouse gas carbon dioxide. Since the industrial revolution more than 200 years ago, ocean acidification has increased by about 30 percent, as absorbed carbon dioxide is converted into carbonic acid. The rate of change of ocean acidification is at a historic high and is 10 times faster than the last major acidification, 55 million years ago, according to a press release announcing the formation of the task force.

The task force, which will allow the public to provide input through a website it is developing and at its meetings, will focus on gathering existing data about the waters in and around Long Island, collecting additional information and offering the New York State Legislature suggestions for future policies.

The group will “figure out how to make science into policy-ready proposals,” said James Gennaro, chair of the task force and deputy commissioner at the DEC. Gennaro is pleased with the composition of the group.

“We have some of the best people in ocean acidification science who will be part of the process,” Gennaro said.

Swanson believes it’s important to consider understanding what is going on in the interior bays, including the Great South Bay and the Long Island Sound, as well as the New York Bight which is a curved area from Long Island to the north and east, and includes areas south and west to Cape May, New Jersey.

Some of the questions Swanson said he believes the group will explore include, “Can we measure changes based on what we know from historical information, how bad are those changes and what are the likely consequences?”

“This is very much a local water, coastal water, embayment improvement initiative.”

— James Gennaro

Improving the ecology of the ocean doesn’t have to be at the expense of the local economy, and vice versa, Swanson suggested.

Indeed, New York’s marine resources support nearly 350,000 jobs and generate billions of dollars through tourism, fishing and other business.

“We have a very significant shellfish industry that’s potentially in jeopardy,” Swanson said. “We need to understand what ocean acidification is doing to that industry. We can do things like control effluent going into the Great South Bay and Peconic Bay.”

Protecting and preserving the environment will “have a payoff” for the economy, Swanson added.

While the problem is global, monitoring agencies should oversee local impacts, Swanson and Gennaro agreed.

“This is very much a local water, coastal water, embayment improvement initiative,” Gennaro said, who added he is “eager” to get started.

The task force will meet no less than four times. The public will be able to follow the task force on the website that SBU and the DEC
are creating.

It is “imperative to do all we can to make sure we stay ahead of [and] act on” ocean acidification, Gennaro said.

Swanson suggested that local action can have consequences. People sometimes suggest that whatever policymakers do in New York will be a drop in the bucket compared to the overall problem of ocean acidification.

“If that’s the drop that causes the bucket to overflow, that’s an important drop,” Swanson said. “We can certainly make suggestions that we ought to do things on a national and global level.”

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Where people live, conflicts thrive.

It’s inevitable. Get two people in a room for long enough and, eventually, they will find elements about the other person that irritate them. It’s what drives people to watch some reality TV shows. Participants can’t stand each other, they call each other names and, before you know it, someone is screaming at someone else and the viewing audience at home is rubbernecking through the drama.

When it happens to other people, it’s entertainment. When it happens to us, it can hurt.

Why do we care what other people think? We know that some people will find fault with everyone — their mothers, siblings and bosses — making criticism inevitable and, ultimately, meaningless.

If someone stood on the side of the road and yelled “Duck!” often enough, pretty soon people would stop ducking, would stop looking for ducks, and, like so many other noises around them, wouldn’t hear the warning anymore.

And yet, when someone we know or even someone we’ve recently met indicates a disdain for us, scowls at our presence, or undermines our abilities, intelligence or effort, we feel cut to the quick. That person might just be repeating the same criticisms to us that he or she levies at everyone all the time.

It’s like a fortune cookie. We read something that says, “You need to think twice before taking advice.” Wow, we think, how incredibly insightful, even as we ignore the irony that we are taking advice from a small slip of paper crushed into a Pac-Man shaped cookie. Someone recently gave me advice that seems valuable, like quitting a job I hate, but maybe that person just wants to take my job or doesn’t want to hear me complaining. Maybe that advice doesn’t really apply to me after all.

The same holds true for insults, criticism and nastiness. It could apply to us or it could just be fortune cookie nastiness, conjured up by someone who may not enjoy the life he or she leads, trying to make everyone as miserable as them.

Insults are ubiquitous. Much of the time, however, the insult is an opinion, not a fact. There are times when an admonishment such as “You weren’t driving well” is accurate, particularly if you were driving the wrong way on a one-way street.

We don’t immediately imagine the person doing the insulting might be sharing an opinion about us that we would almost instantly dismiss if it were about our spouse, our children, our parents or our close friends. We think, “Maybe I am terrible at this,” or “Maybe I should be embarrassed.”

People make puppets, write stories about fictional characters, draw cartoons and imaginary figures because they want to control something.

But just because they want control doesn’t mean you have to give it to them. Even assuming someone doesn’t like you, your appearance or your ideas, so what? Our preferences are so subjective that we can’t or shouldn’t try to please everyone.

We don’t have to play those reindeer games. We can disagree and express our opinions without attacking someone else. We follow whatever rules we set for ourselves and don’t need to fight fire with fire, hit back 10 times harder or show that we mean business. We can be more graceful than our detractors.

When someone attacks us, we don’t have to act as if we’re wearing a target. We can look at that person, put a slow smile on our face and say, “It’s too bad you feel that way. Maybe a good fortune cookie would cheer you up?”

Aaron Sasson. Photo courtesy of Stony Brook Medicine

By Daniel Dunaief

Thanks to the efforts of Stony Brook University School of Medicine’s Chief of Surgical Oncology Aaron Sasson and numerous doctors and researchers at Stony Brook, Long Island has its first National Pancreas Foundation Center.

A nonprofit organization, the National Pancreas Foundation goes through an extensive screening process to designate such centers around the country, recognizing those that focus on multidisciplinary treatment of pancreatic cancer. The NPF offers this distinction to those institutions that treat the whole patient and that offer some of the best outcomes and improved quality of life for people suffering with a disease who have an 8 percent survival rate five years after diagnosis.

Sasson appreciates the team effort at the medical school. “As opposed to one person leading this, there are many people here who are required to have an interest in pancreatic cancer,” he said. “We are not only looking to build a great infrastructure for the treatment of pancreatic cancer, but we’re also looking to build a team for research on pancreatic cancer.”

Sasson highlighted the research efforts led by Yusuf Hannun, the director of the Cancer Center at SBU, who has helped attract a “tremendous number of scientists” to engage in research into this disease.

The recognition by the NPF helps the university recruit physicians who are clinically interested in developing ways to improve the outcome for patients.

Pancreatic cancer presents particular challenges complicated by its biological aggressiveness, its difficulty to detect and by the many subtypes of this disease. “It’s similar to lung and breast cancer,” Sasson said. “There are many facets of those cancers. You can’t lump them all together.”

Researchers and clinicians are still trying to understand pancreatic cancer in greater detail. Once they have done that, they can advance to treating the possible subtypes.

Numerous researchers at SBU have developed collaborations with scientists at Cold Spring Harbor Laboratory. David Tuveson, the director of the National Cancer Institute-designated Cancer Center, has engaged in collaborations with SBU scientists in his work on organoids, which are model human organs grown in a lab. Scientists use organoids to test drugs and molecular pathways involved in pancreatic cancer.

Members of the Long Island community can take comfort in the continuing dedication of the numerous staff members committed to finding a cure. “Residents of Suffolk County and Long Island should be proud of what Stony Brook has been able to accomplish,” Sasson said.

Stony Brook University has been involved in several clinical efforts. The university developed a drug called CPI-613, for which Rafael Pharmaceuticals is in the early stage of clinical trials in combination with other drugs.

In early stages, the treatment increases the vulnerability of cancer cells to numerous other drugs. Newark, New Jersey-based Rafael Pharmaceuticals is testing this treatment in pancreatic cancer and in acute myeloid leukemia.

At SBU facilities, Sasson explained that researchers and clinicians are taking a multidisciplinary approach in their work. One study, he said, is exploring the effects of a kind of radiation therapy for a subpopulation of pancreatic cancer that combines expertise in radiology, gastroenterology, pathology and medical and surgical oncology.

Sasson himself is interested in screening and biomarkers. At least half of his work is related to pancreatic cancer. When he thinks about people who have battled pancreatic cancer, several patients come to mind. He had a patient who was about 80 at the time of his diagnosis. His primary doctor told him to get his affairs in order.

“We operated on him and he lived another six or seven years,” Sasson recalls. “He was grateful to see his grandchildren graduate and to see his great-grandbabies being born.”

While every patient is unlikely to have the same outcome, Sasson said surrendering to the disease and preparing for the inevitable may not be the only option, as there may be other courses of action.

Another patient had advanced pancreatic cancer for 18 months before Sasson met her. She had received no treatment and yet the cancer didn’t progress, which is “almost unheard of and unbelievable.” In fact, the case defied medical expectations so dramatically that the doctors conducted two more biopsies to confirm that she had pancreatic cancer. “She did well for many years despite having advanced pancreatic cancer.”

In another case, a patient was receiving surveillance for lung cancer every three months. In between those visits, he had developed metastatic pancreatic cancer. This patient example and the previous one show the range of cancer progression.

The value of having an integrated clinical and research program is that scientists can look for subtle clues and signals amid the reality of cancer with a wide range of outcomes. Indeed, scientists attend the weekly tumor board meeting, so they can learn about the clinical aspects of the disease. Doctors also attend research collaborations so they can hear about developments in the lab.

Rather than dictating how researchers and clinicians should collaborate, Sasson hopes to facilitate an environment that sparks these partnerships.

Sasson joined Stony Brook Medical School almost three years ago. He said he is “impressed with the caliber of physicians.” It took time to get the critical mass and organization for pancreatic cancer to match the number of basic science investigators.

“I’m hopeful for the progress we’ll be able to make to treat this terrible disease,” he said.

Labor Day offers a chance to consider the division of labor that makes living on Long Island and in the United States so incredible.

Police officers stand ready to protect and serve. They leave their homes with the best of intentions, providing safety, security and order to our communities.

Similarly, firefighters offer an enormous measure of protection for us individually and collectively, racing into burning buildings to save us and keeping fires from spreading to nearby homes.

Members of the military protect our interests and help residents in our communities, country and strangers around the world.

Priests, rabbis, imams and other spiritual leaders encourage us to aspire to greatness, to see beyond our frustration and anger, and to believe in a higher purpose and a grander plan. They bring out the best in us and suggest ways to give our lives meaning beyond meeting our basic needs.

Psychologists and psychiatrists act as handrails for people’s minds and emotions, helping us deal with a wide range of challenges, frustrations and difficulties.

Doctors, nurses and medical health professionals refuse to allow bacteria, viruses or injuries to get the better of us, standing ready to help us fight an infection, determining what that mysterious pain is and, at best, help treat the cause of the disorder and not just the symptoms.

Sanitation workers enable us to keep our homes and communities clean.

Supermarket workers stock the shelves, help us find gluten-free food to manage our growing list of allergies, and make sure they have the specific brand of the milk we buy.

Car mechanics allow us to reach our appointments on time and make it to our children’s concerts.

Teachers feed hungry young minds, encouraging and inspiring the next generation, coming in before school or staying late to will students across another academic finish line.

Beyond offering the welcoming smile at many companies, receptionists wear numerous hats, directing traffic through offices, sending phone calls to the right extension, and knowing how to find anything and everything.

When we maneuver through the purchase of a home, the establishment of a will or the adoption of the newest member of our family, lawyers guide us through each process, becoming advocates for our interests and close confidants.

In the wee hours of the morning, bakers start the process of creating scones, heating up coffee and mixing the batter for birthday cakes.

Truck drivers spend hours on the road, carting all manner of goods, bringing foods or marble we have to have on our kitchen counters.

Ferry workers usher us back and forth on the Long Island Sound to visit family, to take ski trips, to return to college, or to visit sites in Connecticut and farther north.

Plumbers, electricians and structural engineers make sure our homes and offices operate smoothly, preventing a leak from becoming a flood, a spark from becoming a fire or a weak wall from becoming an accident site.

Driven by the desire to inform and to beat the competition, journalists search for news that offers valuable information.

Entertainers of all stripes keep us laughing, allow us to relate to people from other places or times — or take us on fantastic journeys to places in their minds.

Politicians represent our interests, debating and hopefully instituting the best policies for the rest of us.

Numerous others, whose professions didn’t make it into this space, also help our communities function.

While Labor Day is a chance to say “goodbye” to summer, it presents an opportunity to appreciate the hard work everyone performs.

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