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Roast Pork with Garlic and Rosemary

By Barbara Beltrami

Garlic. Is there anyone who doesn’t love it? It has long been known to keep vampires away, and some say that it also, like the apple, keeps the doctor away. In fact, wise women and men have been touting its health-preserving properties for ages.

To name but a few of the myriad ancient civilizations that put their faith in its medicinal and culinary benefits, as far back as 1550 B.C. the Egyptians were prescribing no less than 22 garlic-based remedies for physical ailments. Good old Hippocrates swore by its use as a digestive aid, and my nana claimed, as did yours I bet, that it warded off cramps, colds and hiccups. And it certainly wards off other people, particularly if you breathe in their faces after you’ve eaten it.

As well as its medical virtues, garlic has a spate of gastronomic ones. If cooked properly and not allowed to burn or if used only in its freshest form, garlic can be intense and sublime. It makes a pork roast regal when combined with rosemary; a simple pasta sauce that uses an olive oil base splendid; and is a terrific compliment to vegetables, meat, poultry and shellfish. For the ultimate garlic experience, try cream of garlic soup.

Roast Pork with Garlic and Rosemary

Roast Pork with Garlic and Rosemary

YIELD: Makes 4 to 6 servings

INGREDIENTS:

8 to 10 garlic cloves

2 sprigs fresh rosemary, defoliated

2 tablespoons olive oil

Salt and freshly ground black pepper, to taste

One 3- to 4-pound pork loin roast, bones in (allow at least one bone per person)

DIRECTIONS:

Place garlic, rosemary leaves, olive oil, salt and pepper in bowl of food processor and pulse to create a coarse paste. Place pork in roasting pan; rub the paste on all surfaces. Cover loosely with aluminum foil and let sit for 30 minutes. Preheat oven to 375 F. Roast pork uncovered for approximately 30 minutes per pound or until a meat thermometer reads 170 to 185 degrees. Remove from oven and let sit for 15 to 20 minutes. Carve between the bones to create individual pork chops. Place on serving platter; reheat pan juices and pour over chops. Serve with roasted potatoes and a hearty green veggie.

Spaghetti with Garlic and Olive Oil

Spaghetti with Garlic and Olive Oil

YIELD: Makes 4 to 6 servings

INGREDIENTS:

10 garlic cloves

¼ cup extra virgin olive oil

1 cup finely chopped fresh Italian parsley

1 teaspoon anchovy paste

½ teaspoon dried hot pepper flakes

¾ cup freshly grated Parmesan cheese

1 pound good quality spaghetti

DIRECTIONS:

Mince half the garlic and coarsely chop the other half. Place all in a medium skillet with the oil, parsley, anchovy paste and pepper flakes and heat, stirring constantly, until the garlic sizzles but has not begun to brown. Remove from heat and set aside. In a large pot cook spaghetti according to package directions until it is tender but firm to the bite (al dente). Drain, place in a large bowl and toss with the garlic and oil mixture. Pass grated cheese separately. Serve immediately with a crunchy mixed green or tomato salad or sautéed broccoli rabe or escarole.

Cream of Garlic Soup

Cream of Garlic Soup

YIELD: Makes 4 to 6 servings

INGREDIENTS:

4 tablespoons unsalted butter

2 onions, coarsely chopped

4  garlic bulbs, peeled and mashed

1 quart chicken broth or stock

½ pound stale French or Italian bread, sliced

1 bay leaf

2 sprigs fresh thyme, defoliated

6 ounces cream

Salt and pepper, to taste

DIRECTIONS:

In a large saucepan melt butter; add onion and garlic and sauté over medium heat for about five minutes, until onion becomes transparent but garlic doesn’t brown. Stir in bread slices, bay leaf and thyme leaves.  Add broth, stir and simmer 20 minutes; remove bay leaf and discard. Remove mixture from heat and let cool for 10 minutes. Place in small batches in food processor and puree until smooth. Return to pot. Add cream and stir but do not allow to boil. Add salt and pepper to taste. Serve hot in winter or cold in summer with crusty bread, cheese and a kale or spinach salad.

Note: This article is adapted from one written by the author for this publication in 1990.

Photo courtesy of Kent Animal Shelter

MEET SASHA!

Sasha

Eagerly waiting for you at Kent Animal Shelter is Sasha, a 3½-year-old shepherd/husky mix who is full of life and energy. On her short wish list is a great big fenced-in yard to play in and to have all of your attention, so she would prefer to be the only pet in the home. This sweet girl walks nicely on a leash and would do best in an active, adult home where she can get lots of exercise and lots of love. Sasha comes spayed, microchipped and up to date on all her vaccines.

Kent Animal Shelter is located at 2259 River Road in Calverton. For more information on Sasha and other adoptable pets at Kent, visit www.kentanimalshelter.com or call 631-727-5731.

Above, Begonia ‘Pink Minx,’ with its constant bloom of bright pink flowers and unique Angel Wing leaves, is easy to grow, making it a top contender for the title of perfect houseplant. Photo courtesy of Logee’s Plants for Home and Garden

By Kyrnan Harvey

As a plantsman and gardener, I have always been more generalist than specialist. There are avid collectors of day-lilies or hostas, roses or rhododendrons, Japanese maples or dwarf conifers, snowdrops, dahlias and peonies. There are rock garden enthusiasts who have to grow every Saxifraga and Primula and Penstemon. In the U.K. and Ireland there are 630 National Plant Collections in which special-interest plant groups are identified, documented and conserved in private gardens, nurseries, local parks, botanic gardens and historic estates.

I love all these plants. Phases of zeal come and go for me, but of paramount importance to the garden designer is the creation and sustaining of harmonious environments, keyed in to the genius loci, pleasing to our senses and attractive to wildlife too — the whole is greater than the sum of its parts.

Houseplants too can inspire passions. Cacti and succulents are ideal objects for homes with plenty of bright light but excessively dry heat. If you are not one to turn your thermostat down to 60 at night, but keep your home uniformly cozy at 72, then you can have a dozen or more different African violets featuring delightful colors on extremely compact plants. Following International Aroid Society on Instagram has been an eye-opener for me: stunning foliage in unbelievable variety. I would collect these Philodendron and Anthurium and Monstera and Alocasia if I had a large airy home or lived in the tropics.

Above, Begonia ‘Potpouri’ is the perfect houseplant for winter months, covering itself with fragrant rose-pink blooms from January to June. Photo courtesy of Logee’s Plants for Home and Garden

But I must say, if I were to amass a small collection of a single plant group of houseplants, it would be begonias. There was a great bookstore back in the aughts on Bedford Ave in Williamsburg. The owner Miles kept a solitary cane begonia in a glazed Oriental jardiniere in the center display table a good distance from the storefront window. I donated an old jade plant for the window and neither it nor the begonia ever received water. When my brother was moving last summer, I adopted two cane begonias. They hadn’t been watered in months. I cut the woody stems down to a few inches; then repotted and watered the plant. A few weeks later it was gorgeous.

The wax begonias that we plant as annuals are dead easy to grow, and cane begonias (these are the old-fashioned “angel-wing” begonias, now also called “fibrous”) are nearly so. They are very resilient and tolerant of neglect. Let them dry between waterings indoors, cut the canes hard at the end of winter, and move outdoors in bright — but indirect — light from May to October. The leaves can be reddish or green and mottled or spotted in white or silver. Logee’s catalog has a couple dozen varieties, and in the summer they will outdo themselves with the most charming sprays of pendant flowers in varying shades of pink. Such dignified plants, begonias give much more than they require.

The leaves of rhizomatous begonias are even more stunning, a limitless variety of color, texture and form. More compact than cane begonias, they also will be covered in flowers. Be sure to let them dry between waterings, but then water until it reaches the saucer.

Rex begonias are a type of rhizomatous (creeping rootstocks) begonia, in the prima donna class: showboats with their psychedelic leaves but demanding more accurate watering, humidity and temperature. Even then, they go dormant in winter for two or three months. A well-grown rex is spectacular, but their flowers are inconspicuous.

Any and all houseplants should summer outdoors. Indeed, this is crucial to their prosperity. Best to resist the temptation of moving them outside too early; wait until well into May and acclimate them by moving them during a forecast of two or three mild, sunless days. I like soft rain on warm days.

Do not leave them, in the first week or two, exposed to full sun, even for a couple hours, or desiccating wind. Situate them in bright, filtered light, and you will treasure your begonias when, in October, you can cut the exuberant growth and bring them indoors.

Kyrnan Harvey is a horticulturist and garden designer residing in East Setauket. For more information, visit www.boskygarden.com.

FROZEN IN TIME

Margo Arceri of Strong’s Neck snapped this photo of two Betsy Ross flags flying at the grave site  of Patriots Selah and Anna Smith Strong at St. George’s Manor Cemetery in Setauket on a chilly Jan. 30. This version of the United States flag, rumored to have been created by Betsy Ross, was used from 1777 to 1795 and has 13 stripes with 13 stars in a circle all facing outward to represent a new constellation.

Send your Photo of the Week to leisure@tbrnewspapers.com.

One simple lifestyle change is to make certain that those susceptible to gout attacks remain hydrated and consume plenty of fluids. Stock photo
Most risk factors are modifiable

By David Dunaief, M.D.

Dr. David Dunaief

Gout is thought of as an inflammatory arthritis. It occurs intermittently, affecting the joints, most commonly the big toe. The symptoms are acute (sudden onset) and include extremely painful, red, swollen and tender joints. In terms of symptoms, if you have ever had kidney stones, gouty arthritis is just as painful.

Uric acid (or urate) levels are directly related to the risk of gout attacks. As uric acid levels increase, there is a greater chance of urate crystal deposits in the joints. Although, and unfortunately, some patients can still experience gout attacks without high levels of uric acid.

This disease affects approximately 8.3 million people in the United States (1). This number has doubled since the 1960s. Men between 30 and 50 years old are at much higher risk for their first attack (2). For women, most gout attacks occur after menopause.

There are a number of potential causes of gout, as well as ways to prevent and treat it. The most common contributors include drugs, such as diuretic use; alcohol intake; uncontrolled hypertension (high blood pressure); obesity; and sweetened beverage and fructose intakes (3). Though heredity plays a role, these risk factors are modifiable.

The best way to prevent and treat gout is by modifying medications and lifestyle. One simple lifestyle change is to make certain, just like with kidney stone prevention, that those susceptible to gout attacks remain hydrated and consume plenty of fluids.

Just like there are medications that may cause gout, there are also medications that can treat and help prevent gout. If you do get a gout attack, NSAIDs such as indomethacin or steroids such as a Medrol pack help treat the symptoms. In terms of prevention, allopurinol helps to reduce the risk of a gout attack.

I thought we might look at gout by using a case study. I had a patient who had started a nutrient-dense, plant-based diet. Within two weeks, she had a gout episode. Initially, it was thought that her change in diet with increased plant purines might have been an exacerbating factor. Purines are substances that raise the level of uric acid. So, it is not surprising that foods with containing purines might substantiate a gout attack. However, not all purines equally raise uric acid levels.

Animal versus plant proteins

In a case-crossover (epidemiologic forward-looking) study, it was shown that purines from animal sources increase our levels of purines far more than those from plant sources (4). The risk of a gout incident was increased approximately 241 percent in the group consuming the highest amount of animal products, whereas the risk of gout was still increased for those consuming plant-rich purine substances, but by substantially less: 39 percent.

The authors believe that decreasing the use of purine-rich foods, especially from animal sources, may decrease the risk of incidences and recurrent episodes of gout. Plant-rich diets are the preferred method of consuming proteins for patients who suffer gout attacks, especially since nuts and beans are excellent sources of protein and many other nutrients.

In another study, meats — including red meat, pork and lamb — increased the risk of gout, as did seafood (5). However, purine-rich plant sources did not increase risk of gout. Low-fat dairy actually decreased the risk of gout by 21 percent. The study was a large observational study involving 49,150 men over a duration of 12 years.

There are several more studies indicating and reaffirming that plant foods do not increase the risk of gout attacks. The Mayo Clinic also suggests that plants do not increase the risk of gout. When considering my patient’s circumstances, it was unlikely that her switch to a nutrient-dense, plant-rich diet had increased her risk of gout.

Diuretics (water pills)

My patient was on a diuretic called hydrochlorothiazide for hypertension (high blood pressure). There are several medications thought to increase the risk of gout, including diuretics and chronic use of low-dose aspirin. In the ARIC study, patients who used diuretics to control blood pressure were at a 48 percent greater risk of developing gout than nonusers (6). In fact, nonusers had a 36 percent decreased risk of developing gout. This study involved 5,789 participants and had a fairly long duration of nine years. The longer the patient is treated with a diuretic, the higher the probability they will experience gout. It is likely that my patient’s diuretic contributed to her gout episode.

Vitamin C

Vitamin C may reduce gout risk. In the Physicians Follow-up Study, a 500-mg daily dose of vitamin C decreased levels of uric acid in the blood (9). However, be careful with vitamin C supplementation because it can increase the risk of kidney stones.

Medical conditions

There are a number of medical conditions that may impact the risk of gout. These include uncontrolled high blood pressure, diabetes and high cholesterol (7). My patient’s high blood pressure was under control, but she also had diabetes and high cholesterol. These disorders may have also contributed.

Obesity

Obesity, like smoking, seems to have its impact on almost every disease. In the CLUE II study, obesity was shown to not only increase the risk of gout but also to accelerate the age of onset (8). Those who were obese experienced gout three years earlier than those who were not. Even more striking is the fact that those who were obese in early adulthood had an 11-year earlier onset of gout. The study’s duration was 18 years. My patient was obese and had just started to lose some weight before the gout occurred.

Prevention

The key to success with gout lies with prevention. Patients who do get gout writhe in pain. Luckily, there are modifications that significantly reduce the risks. They involve very modest changes, such as not using medications called diuretics in patients with a history of gout; losing weight for obese patients; and substituting more plant-rich foods for meats and seafood. Increasing levels of uric acid may be a useful biomarker for indicating an increased risk of gouty arthritis attacks. However, gout attacks do occur without a rise in uric acid levels, so it is not a perfect. Although the cause of gout may be apparent to you, always check with your doctor before changing your medications or making significant lifestyle modifications, as we have learned from this case study of my patient.

References:

(1) Arthritis Rheum. 2011 Oct;63(10):3136-3141. (2) Arthritis Res Ther. 2006;8:Suppl 1:S2. (3) Am Fam Physician. 2014 Dec 15;90(12):831-836. (4) Ann Rheum Dis. online May 30, 2012. (5) NEJM 2004;350:1093-1103. (6) Arthritis Rheum. 2012 Jan;64(1):121-129. (7) www.mayoclinic.com. (8) Arthritis Care Res (Hoboken). 2011 Aug;63(8):1108-1114. (9) J Rheumatol. 2008 Sep;35(9):1853-1858.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

By Joanna Chickwe, MD

Dr. Joanna Chickwe

February means heart health awareness, but taking care of your heart requires a year-round commitment that has lifelong benefits. What will you do differently to take better care of your heart?

Heart disease can affect anyone, regardless of gender, age or background. That’s why all of our cardiac care experts at Stony Brook University Heart Institute remain focused on how to best prevent heart disease and heal the heart.

We fight cardiovascular disease from every angle, using the best that cardiovascular medicine can offer: risk factor prevention; state-of-the-art diagnostics, such as 3-D cardiovascular imaging; advanced minimally invasive interventions, including mitral valve repair using a patient’s own valve tissue versus an artificial heart valve; and advanced lifesaving technology, including ECMO (extracorporeal membrane oxygenation) that gives new hope to people with a serious heart or lung failure.

In the hands of our highly trained heart specialists, these and other important new state-of-the-art therapies are changing cardiac care and lives:

• Transcatheter aortic valve replacement (TAVR) for patients with inoperable aortic stenosis (failing heart valves)

• MitraClip, a less invasive treatment option for mitral regurgitation (caused by a leaky mitral valve), for patients who are not candidates for open-heart surgery

• The HeartMate 3 left ventricular assist device (LVAD) for patients with advanced heart failure

• Watchman to provide lifelong protection against stroke in appropriate patients for heart rhythm disorders

• Impella, the world’s smallest heart pump, making procedures safer for high-risk individuals

And while we hope that you and your family never need our acute cardiac services, you can be assured knowing that Long Island’s only accredited Chest Pain Center is right in your community. As one of only nine Chest Pain Centers statewide, Stony Brook Heart Institute is a leader in saving the lives of heart attack victims.

Since “time is muscle” when it comes to treating heart attacks, it is critical to treat patients as fast as possible, so less muscle is damaged. Stony Brook has achieved a “door-to-balloon” time, spanning the arrival at the hospital until the blockage is cleared, of 55 minutes — much better than the American College of Cardiology and the American Heart Association guidelines to open the blockage in 90 minutes or less.

And, if you suspect a heart attack, it’s best to call 911. Ambulances are equipped with defibrillators and most are equipped with 12-lead EKGs (electrocardiograms), which means they can transmit results to the hospital while en route. At Stony Brook, we assemble the treatment team and equipment you need before you arrive.

Have a question about heart disease prevention? Seeking a solution to a cardiac problem? Call us at 631-44-HEART (444-3278). We’re ready to help.

Joanna Chikwe is the director of Stony Brook University Heart Institute; chief, Cardiothoracic Surgery; and T.F. Cheng professor of cardiothoracic surgery.

The TCJA enacts a number of important tax changes. Stock photo

By Nancy Burner, ESQ.

Nancy Burner, Esq.

The Tax Cuts and Jobs Act increased the federal estate tax exclusion amount from $5 million to $10 million indexed for inflation for decedents dying in years 2018 to 2025. This amount is indexed for inflation back to 2011. The exact amount of the exclusion amount is not yet known for 2018. However, it is estimated to be $11.18 million. This means that an individual can leave $11.18 million and a married couple can leave $22.36 million dollars to their heirs or beneficiaries without paying any federal estate tax.

This also means that an individual or married couple can gift this same amount during their lifetime and not incur a federal gift tax. The rate for the federal estate and gift tax remains at 40 percent.

The doubling of the basic exclusion also means that the generation-skipping transfer tax (GST) exclusion is doubled to match the basic exclusion amount of $11.18 million for an individual and $22.36 million for a married couple.

The sunsetting of the doubled basic exclusion amount after 2025 raises the prospect of exclusions decreasing in 2026. Taxpayers with estates over $11.18 million will want to discuss with their estate planning attorneys the potential for making transfers to take advantage of the larger exclusion amount before the anticipated sunset.

The act does not make changes to the rules regarding step-up basis at death. That means that when you die, your heirs’ cost basis in the assets you leave them are reset to the value at your date of death.

The portability election, which allows a surviving spouse to use his or her deceased spouse’s unused federal estate and gift tax exemption, is unchanged. This means a married couple can use the full $20 million exemption (indexed for inflation). To make a portability election, a federal estate tax return must be timely filed by the executor of the deceased spouse’s estate.

In 2018, the annual gift tax exclusion has increased to $15,000. This means that an individual can give away $15,000 to any person in a calendar year ($30,000 for a married couple) without having to file a federal gift tax return.

Despite the significantly larger federal estate tax exclusion amount, New York State’s estate tax exemption for 2018 remains at $5.25 million. New York State still does not recognize portability.

With the current New York State estate tax law as enacted in 2014, there is a limited three-year look-back period for gifts made between April 1, 2014, and Jan. 1, 2019. This means that if a New York resident dies within three years of making a taxable gift, the value of the gift will be included in the decedent’s estate for purposes of computing the New York estate tax.

The following gifts are excluded from the three-year look-back: (1) gifts made when the decedent was not a New York resident; (2) gifts made by a New York resident before April 1, 2014; (3) gifts made by a New York resident on or after Jan. 1, 2019; and (4) gifts that are otherwise includible in the decedent’s estate under another provision of the federal estate tax law (that is, such gifts aren’t taxed twice).

Under the act’s provisions, most taxpayers will never pay a federal estate tax. Even with the enlarged exemption, however, there are many reasons to engage in estate planning. Those reasons include long-term care planning, tax basis planning and planning to protect your beneficiaries once they inherit the wealth.

In addition, since New York State has a separate estate tax regime with a significantly lower exclusion than that of the federal regime, it is still critical to do estate tax planning if you and/or your spouse have an estate that is potentially taxable under the New York State law.

Nancy Burner, Esq. practices elder law and estate planning from her East Setauket office.

Orange Bundt Cake with Candied Orange Peel Glaze

By Barbara Beltrami

I was eating an orange the other day and got to thinking about the February some years ago when we received a crate of oranges as a gift. There was no way we could consume them all, and after I had given half of them away, I still had more oranges than we could eat. It was a bitter cold winter like this one, and as an antidote to cabin fever I did what I always do. I started cooking and concocting.

One morning it was freshly squeezed orange juice with sliced bananas; one night it was orange, fennel, radicchio and red onion salad. Another day it was orange pound cake drizzled with the orange syrup left over from making candied orange peel from all the oranges we had eaten. And there was also orange marmalade.

As it turned out, shortly thereafter, we flew south to visit the same people who had sent us the oranges. And guess what I took with me — a gift bag of bottled orange syrup, candied orange peel, a couple of jars of marmalade and an orange bundt cake.   Neither cooks nor bakers themselves, they had always thought of an orange as something you peeled and ate or squeezed and drank. Period. So they were delighted with  my fancy orange by-products.

Now that’s regifting.

Orange Bundt Cake with Candied Orange Peel Glaze

Orange Bundt Cake with Candied Orange Peel Glaze

YIELD: Makes 12 servings.

INGREDIENTS:

2 sticks unsalted butter at room temperature

2 cups sugar

5 large eggs

3 cups flour

1 tablespoon baking powder

½ teaspoon salt

¾ cup orange juice

½ cup very finely minced candied orange peel or grated zest of one orange

¼ cup unsalted butter, melted

1 cup confectioners’ sugar

DIRECTIONS:

Preheat oven to 350 F. Grease a 10-inch bundt or tube cake pan. In a large bowl beat together the butter and sugar until light and fluffy; add the eggs one at a time being sure to incorporate them thoroughly in mixture. In a medium bowl sift together the flour, baking powder and salt; alternating with the orange juice, gradually beat flour mixture into butter mixture. Stir in half the candied orange peel, then pour batter into prepared pan. Bake about 55 minutes, until a cake tester inserted in center comes out clean. Remove from oven and let cool on rack about 10 minutes.

Carefully invert pan onto serving plate. While cake is cooling, make the glaze by combining the melted butter, confectioners’ sugar and remaining half of candied orange peel; stirring frequently heat over boiling water. While cake is still warm, using a two-tined meat fork, poke holes all over top of cake; then pour on glaze and allow it to run down sides of cake and seep into top. Serve warm, at room temperature or freeze for later use. Serve with whipped cream, vanilla ice cream or orange sorbet.

Candied Orange Peel

Candied Orange Peel

YIELD: Makes four to five cups

INGREDIENTS:

4 large oranges or 6 small or medium

3 cups water

4 cups sugar

DIRECTIONS:

Peel oranges and remove as much of pith as possible. Reserve the fruit of the oranges for another use. Cut peel into quarter-inch julienned strips. Cook in large pot of boiling water for 15 minutes. Drain, rinse and drain again. Meanwhile, combine 3 cups of the sugar with 3 cups water; stir and bring to a gentle boil. Add the orange peel, bring back to a boil, then reduce heat and simmer, stirring occasionally, until just tender, for 30 to 40 minutes.

With a slotted spoon remove peel from syrup and spread on cookie sheet. Reserve syrup for another use. Toss peel with remaining cup of sugar, spread out on aluminum foil or waxed paper and set aside to dry for 2 to 3 days, until slightly crunchy. Toss to expose all sides of strips to air once or twice a day. When sufficiently hardened, store in an airtight container. Serve with tea and cookies or as garnish or topping for desserts.

Photo courtesy of Kent Animal Shelter

MEET AMBER!

Photo courtesy of Kent Animal Shelter

This week’s shelter pet is Amber, a 4-year-old Shepherd mix who came to Kent Animal Shelter from Texas with two of her pups. Her pups have since found their forever homes — now it’s Amber’s turn!  Amber is a super sweet girl and loves all the attention she can get. She’s great with kids and loves belly rubs too! Amber also loves to eat, so pick up a bag of treats and come on down to visit her. She comes spayed, microchipped and is up to date on all her vaccines.

Open seven days a week from 10 a.m. to 4 p.m., Kent Animal Shelter is located at 2259 River Road in Calverton. For more information on Amber and other adoptable pets at Kent, visit www.kentanimalshelter.com or call 631-727-5731.

Daniel Mockler in his office at Stony Brook University. Photo from SBU

By Daniel Dunaief

At first, people didn’t believe it. Now, it seems, they are eager to learn more.

Working with a talented team that included postdoctoral researchers, doctoral students and doctors, Kenneth Shroyer, the chairman of the Department of Pathology at Stony Brook University, noticed something odd about a protein that scientists thought played a supporting role, but that, as it turns out, may be much more of a villain in the cancer story.

Known as keratin 17, this protein was thought to act as a tent pole, providing structural support. That, however, isn’t the only thing it can do. The co-director of Shroyer’s lab, Luisa Escobar-Hoyos, found that this protein was prevalent in some types of cancers. What’s more, the protein seemed to be in higher concentration in a more aggressive form of the disease.

Now, working with Long Island native Daniel Mockler, a clinical assistant professor in the Department of Pathology, Shroyer and his team discovered that the presence of this particular protein has prognostic value for endocervical glandular neoplasia, suggesting the likely course of the disease.

Published in the American Journal of Clinical Pathology, the article by Mockler and his team in the Sept. 1, 2017, issue attracted the attention of pathologists around the world. It ranked as the third highest read article in the final month of 2017, according to Medscape. It was behind two other papers that were review articles, which made it the most read primary research report in pathology in December.

The response “did exceed my expectations,” Mockler stated in an email. “I would have thought [Shroyer’s earlier] paper showing that k17 can function in gene regulation would have been more popular. But I guess this [new paper] illustrates that topics that have a possible direct impact on practicing surgical pathologists will draw a lot of attention.”

To be sure, while the recent study is an early indication of the potential predictive value of this protein, there may be some mitigating factors that could affect its clinical applicability.

“It’s premature to know what the clinical utility of this marker will be,” Shroyer said. “To determine that would require a large-scale prospective clinical trial” that would involve other patient populations and other laboratories.

Still, depending on the outcome of research currently underway in Shroyer’s lab, the protein may offer a way of determining the necessary therapy for patients with the same diagnosis.

Doctors don’t want to give patients with milder version of the disease high levels of chemotherapy, which would cause uncomfortable side effects. At the same time, they want to be as aggressive as possible in treating patients whose cancers are likely a more significant threat.

“The goal of having an excellent prognostic biomarker … is to avoid over and under treatment of patients,” suggested Mockler, who is also an attending pathologist at SBU and Stony Brook Southampton.

Shroyer was delighted with the efforts of the team that put together this well-read research. “As is true of all our clinical faculty, I want to give them every opportunity to take advantage of their ability to collaborate with research faculty in our department and throughout the cancer center and the school of medicine to advance their scholarly careers and academic productivity,” he said.

Mockler’s success and the visibility of this paper is “an excellent example of how someone with a busy clinical practice can also have a major impact on translational research,” Shroyer added.

Mockler appreciated the support and work of Escobar-Hoyos, who had conducted her doctoral research in Shroyer’s lab. She has “been the main driving force, along with [Shroyer] in the initial discovery of k17 including its prognostic implications as well as its possible function in regulating gene expression,” he said.

Mockler said he spends about 80 percent of his time on patient care, with the remaining efforts divided between research and academic pursuits. His first priority is providing “excellent patient care.”

Working with Shroyer and Escobar-Hoyos, Mockler explained that they have started looking at k17 in organ systems including the esophagus, pancreas and bladder. “We are currently looking at k17 from a diagnostic point of view in regards to bladder cancer,” he said. “Discoveries that impact the daily signout of surgical pathologists by allowing us to make better and more consistent diagnoses interests me very much.”

A resident of Kings Park, Mockler, who grew up in Hicksville, lives with his fiancée Danielle Kurkowski, who is a medical technologist of flow cytometry research and development at ICON Central Laboratories in Farmingdale.

Daniel Mockler on a recent snowboarding trip to Aspen. Photo from Daniel Mockler

Outside of his work in medicine, Mockler is an avid snowboard enthusiast. He tries to get in as many trips as possible during the winter, including a vacation a few weeks ago to the Austrian Alps. A more typical trip, however, is to western mountains or to Vermont, including Killington, Okemo and Stratton.

“To blow off steam and relax, nothing is better than being on a snow-covered mountain,” he said.

Mockler is pleased with the developments in the department. He has seen the “research goals of the department change quite significantly,” adding that Shroyer has “done a tremendous amount of recruiting.”

Mockler suggests to residents that it’s “good to get involved. I always tell them that [Shroyer] has a pretty active research lab and he likes it when residents get involved.”

As for his work on k17, Mockler is pleased that he’s been able to contribute to the ongoing efforts. Shroyer “has been doing this a while and I have seen the excitement and energy he has put into k17,” he explained, “so I know that we are onto something big.”

And so, apparently, do readers of pathology journals.

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