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Daniel Dunaief

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Dr. Henry Tannous during surgery. Photo from SBU

By Daniel Dunaief

While she hasn’t resolved the debate about two approaches to a type of heart surgery, Laurie Shroyer, Professor and Vice Chair for Research in the Department of Surgery at Stony Brook University’s Renaissance School of Medicine, has contributed considerable information over a long period of time.

Laurie Shroyer. Photo from SBU

In a recent study released in JAMA Surgery, Shroyer, who is the principal investigator and co-PIs Fred Grover and Brack Hattler of the Rocky Mountain Regional Affairs Medical Center, revealed that coronary artery bypass grafting had similar post-surgical death rates for the veterans in their study whether the surgeon used a heart-lung machine, called “on pump,” or performed the surgery without the machine, called “off pump.”

Using long-term results from 2,203 mostly men at 18 VA Centers in the Department of Veterans Affairs Randomized On/Off Bypass (ROOBY) trial, Shroyer determined that the death rate at 10 years was 34.2 percent for off-pump, compared with 31.1 percent for on-pump.

Patients typically need bypass graft surgery when they have a narrowing of their coronary arteries, which comes from fatty material accumulating in the walls of the arteries. Doctors take a part of a healthy blood vessel from the leg, wrist or elsewhere and bypass the blockage, building a detour for the blood and enabling better circulation in the heart.

Using the “off pump” procedure means doctors operate on a heart that’s still pumping blood through the body. The “on pump” procedure uses a heart lung machine to pump blood while the heart remains still.

While the results of this study don’t end the debate over whether one procedure is superior to another, doctors welcomed the data as a well-researched and detailed analysis.

“There’s always going to be this ever-last question of whether off versus on pump bypass surgery is better,” said Dr. Henry Tannous, Chief of Cardiothoracic Surgery at the Renaissance School of Medicine at Stony Brook University. “There’s always going to be very little nuances with different patients that will make us pick one or the other.”

Dr. Tannous who has performed the majority of all bypass surgeries at Stony Brook over the last five years, said the hospital offers surgeries with and without the pump. SB has doctors who specialize in each kind of bypass in case of a change in the expected procedure.

Doctors typically get a clear sense of whether a patient might benefit from on or off pump procedures before starting surgeries. In the great majority of cases, doctors perform the surgery according to their pre-planned expectations for the use of the pump.

Rarely, they convert to the other procedure based on inter operative findings that dictate the switch, Dr. Tannous explained.

Dr. Jorge Balauger, Associate Chief of Cardiothoracic Surgery and Director of Advanced Coronary Surgery, has performed 4,000 CABG procedures, including about 1,000 without the heart lung machine, or “off pump.”

In his considerable experience, he suggested that an 80-year old, who has renal or liver dysfunction and/or arteries in his or her neck that are partially blocked or had another type of comorbidity, such as something in the bone marrow, would not tolerate a heart lung machine well. A person with cirrhosis also would likely be better served with an off pump operation.

“Avoiding the heart lung machine on the older, sick patients is beneficial,” Dr. Balauger said, adding that he looks at the CABG procedure as being akin to a “tailor made suit” that has to fit the patient specifically.

In cases where patients need a second bypass procedure, Dr. Balauger also recommends off pump efforts because a second operation on pump is “way more complex” and requires “dissection of all the scar tissue around the heart, which makes it not only time consuming, but also risky.”

Dr. Henry Tannous. Photo from SBU

Dr. Tannous appreciates the perspective Shroyer brings to the discussion. “Sometimes, it’s an asset to have a researcher and statistician with a very scientifically oriented mind lead the study,” he said, adding that when surgeons meet with patients, they will discuss the use of the pump.

Dr. Baulager described the trial conducted by Shroyer as having an “excellent design” from a scientific standpoint.

He believed, however, that the study didn’t include surgeons who had sufficient expertise in off pump procedures. Dr. Baulager thought more experienced surgeons likely ensured better outcomes for off pump procedures.

One aspect of the study that was “refreshing” to Shroyer was how durable the surgical procedure is, with about 70 percent of patients who received this procedure, both on and off pump, still experiencing improvements in their pre-surgical chest pain symptoms after 10 years.

“We never expected the high proportion of patients would do so well longer term in terms of freedom from events, and in terms of symptoms,” she said. “The fact that the symptoms weren’t different between on and off pump is good news.”

After this type of study, Shroyer will work with several other trials to identify if certain sub-groups of high risk patients may have benefits from an off pump procedure.

To be sure, Shroyer cautioned that these results couldn’t be extrapolated to the general population, especially to women, as almost all of those the study followed were men.“Veterans are a unique population,” she said. “Many received cigarettes as part of their rations, and hypertension is quite high. They are a different population in terms of their [health care] complexities and their [underlying] illnesses.”

While the 10 year outcomes were similar, Shroyer found a shorter revascularization-free survival period among off pump patients. 

Dr. Tannous said this kind of study would generate considerable interest among cardiac surgeons.

“Everything [Shroyer] has written about bypass surgery from the ROOBY trials will catch any cardiac surgeon’s attention nationwide,” he said. “This paper is not any different. It has the extra long-term follow up that makes it more relevant.”

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During the height of the pandemic, a COVID-19 drive-thru testing area was set up in the South P Lot of Stony Brook University. Photo by Stony Brook Medicine

This week marked two years after the World Health Organization declared COVID-19 a pandemic, leading to the shutdown of schools, the closing of businesses, a surge in emergency room visits, and a desperate search for treatments to a new disease that was sickening and killing people around the world.

Pastor Doug Jansson, below, of Living Word Church in Hauppauge hugs his family while in SBU hospital for COVID-19. Photo from Stony Brook Medicine

For health care providers, life two years after the pandemic has dramatically improved from those first few days when medical professionals had far more questions than answers.

“The cloud that was hanging over our heads seems to have disbursed,” said Dr. Sunil Dhuper, chief medical officer at Port Jefferson’s St. Charles Hospital. “I feel a lot more optimistic now.”

Indeed, Suffolk County officials tracked a host of numbers throughout the pandemic, which carried different meanings at different times. In 2020, state officials considered a 5% positive testing rate as a potential warning sign to consider closing schools. Entering another phase of reopening businesses required that hospitals have at least 30% of their hospital beds available.

Those numbers, fortunately, have declined dramatically, with the current positive seven day testing rate at 1.5% for Suffolk County as of March 15 and 35% of hospital beds available, according to the New York State Department of Health.

Lessons learned

Amid much more manageable levels of COVID-19, health care officials reflected on the last two years.

For Dr. Adrian Popp, chair of Infection Control at Huntington Hospital/Northwell Health, the “most important lesson we have learned is that we can never lose hope,” he said in an email.

Despite an initial United States response to the pandemic that Popp described as disorganized and confusing, he said “communities got together fast, local leaders took charge and, I think, we did our best under the circumstances.”

Carol Gomes, chief executive officer for Stony Brook University Hospital, suggested that one of the biggest lessons was to remain flexible, with the “ability to pivot into paradigm shifts that were unimaginable,” she wrote in an email.

She described how most good business practices suggest a just-in-time inventory, which is efficient and cost effective.

“During the pandemic, when the national supply chain was considerably weakened, we shifted to an entirely different model and now focus on stockpiling key supplies to ensure continuity of services,” Gomes wrote in an email.

Stony Brook Hospital has dedicated more space to ensure the availability of supplies by securing additional warehouse facilities, Gomes said.

Dhuper said a high level of coordination and cooperation in health care created the ability to “work wonders. A classic example of that is the mRNA COVID-19 vaccines. I think it has been a phenomenal accomplishment and a true game changer,” Dhuper said.

Signage outside of Stony Brook University Hospital. Photo from Stony Brook Medicine

Low point

Amid a series of challenges over the last two years, health care professionals also described some of the low points.

Popp recalled April of 2020, when COVID hit one of the nursing homes in the community. Of the 50 elderly residents under his care, 24 died in the span of two weeks. During this time, the hospital couldn’t even test for COVID. Popp described the losses as “heartbreaking.”

Dhuper, meanwhile, pointed to the roller coaster created by variants that brought concerns about infections and sicknesses back even as vaccinations seemed to create a viral firewall.

The delta variant followed by omicron “eroded confidence” in the viral response, as millions of people contracted variants that were more infectious than the initial Wuhan strain.

Monoclonal antibodies were also not as effective against these strains, which was “another blow,” Dhuper said. “Everything seemed like there was no end in sight and we were not going to come out of it” any time soon.

Message from 2020

If he could go back in time and provide advice to health care providers and the public in the early stages of the pandemic, Dhuper said he would encourage more mask wearing, particularly before vaccines became available.

“The mask was the only guaranteed protection in the absence of any medications,” Dhuper said. “That message was not very well delivered. Hand washing was good, but masks definitely helped.”

Gomes would urge the 2020 version of herself to remain on the same path traveled, which is to focus on the “safety and well being of our community, including our staff, faculty, patients and community at large,” she explained in an email. “What has worked well in the past may not necessarily help with a new crisis. Flexibility is key.”

Next steps

Recognizing the burden COVID-19 placed on health care providers, area hospitals have focused resources on the mental health strain.

Stony Brook has “significantly expanded its resources to provide support and assistance for health care staff,” Gomes explained. Resilience at Stony Brook is a special location within the hospital dedicated for staff and faculty that includes pet therapy, aromatherapy, massage chairs, counseling services, mindfulness and meditation classes, among other options.

Stony Brook also has a crisis management intervention team to support staff and faculty.

Outside the clinical setting, Dr. Adam Gonzalez, director of the Mind-Body Clinical Research Center and assistant professor of Psychiatry at the Renaissance School of Medicine at Stony Brook University, said several studies have shown a rise in anxiety and depression across the country and increases in suicide ideation for sub-groups.

Stony Brook Medicine launched depression screening throughout its practices to identify those in need of mental health care.

Positive signs

Health care providers appreciated the support they received from the community and the collaborative spirit that strengthened the medical community.

“We functioned as a team often working with health care providers that were not our usual team members,” Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital, explained in an email. “It was not uncommon to see adult and pediatric physicians covering care of COVID-infected patients or working with residents across the spectrum of specialties making rounds together.”

For many health care workers, including Popp, the support from the community for health care workers was helpful and inspiring.

“I saw people and businesses alike help frontline workers in any way they could, making masks, bringing in food to the hospital, helping quarantined people with food shopping,” Dr. Popp wrote in an email.

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Pixabay photo

By Daniel Dunaief

Daniel Dunaief

It’s been a long time since I took a child to a playdate or to the first day of a kindergarten class. And yet, I felt as if I had gone through a time warp recently when my daughter, who is home for spring break, and I took our three-year-old dog Bear for his second visit to a dog run.

While I’m sure many dog owners are familiar with the process, I found the collection of dogs circling trees, bushes and owners fascinating and familiar.

When we arrived, several dogs played in groups of shifting sizes while their owners, like anxious parents hoping their children play well together, stood by, observing the action and preparing to intercede.

Dog owners looked back and forth at my daughter and me, trying to figure out which of the collection of pets straight of a Dr. Seuss book filled with colorful illustrations of dogs of all shapes and sizes was ours.

That process isn’t as obvious as the genetics of trying to match the faces of young children with the parents standing by, waiting for the bell to ring and a teacher to bring their children inside.

Like protective parents, many of the dog owners watched their pets carefully, not only to make sure they were behaving, but also to ensure that none of the other dogs was threatening them.

Some dog owners shared stories about their dogs, much as my children’s classmates had done over 15 years ago, talking about what their dogs like to do and how eager they are for their dogs to get out all their energy now, so they’ll sleep well. Just as it does for young children, a day of healthy activities means a good night’s sleep.

A medium-sized dog paused in a puddle, stomping in the squishy mud. Her owner raced over and barked at Roxy to “stop,” annoyed that her paws looked like they had brown booties.

Meanwhile, a giant dog with the name Zeus written on a horse collar lumbered from one group to another, his head held higher than other dogs who came up to his shoulder.

Bear shifted from one group to another, awed by the athletic prowess of two huge dogs that vaulted onto a picnic table. 

At one point, Bear trotted to the other extreme end of the park, almost out of sight. I whistled for him and, despite his tendency to ignore me at home, he immediately picked up his head and pitched his ears forward. I signaled for him to come back and, to my amazement, he jogged the length of the field, where my daughter and I pet him appreciatively.

While Bear played with the other canines, he also visited every pet owner, thrusting his head towards their knees and staring up at them with his best “I-know-you’re-a-dog-person-so-please-pet-me” face.

An aggressive dog barked and nipped at the others who had been playing peacefully. After the newcomer lunged at Bear three times, he trotted to the exit, glancing over his shoulder periodically to make sure we were coming. We obediently followed.

Once we were near our car, an unleashed dog raced around the lot, as his owner shouted for Oliver repeatedly to come back and to stay away from cars moving slowly enough to avoid loose dogs.

As we drove home, with our dog panting from the exertion in the back seat, I glanced at our daughter and appreciated the brief trip down memory lane when we brought her home from playing with her peers.

Our dog has no intention of trekking off to college, even if he’s eager to explore the world of our neighbors’ houses, where the grass sometimes seems greener.

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Jonathan Sanders on assignment in Moscow. Photo from CBS News

Stony Brook University Associate Professor Jonathan Sanders, who won an Emmy and an Edward R. Murrow Award, reported on Russia for a range of news organizations, including as CBS News Moscow correspondent.

Jonathan Sanders on assignment in Moscow. Photo from CBS News

Sanders, who knew several important figures in late 20th century Russian history, spent considerable time with former Russian President Boris Yeltsin, who is the immediate past president of Russia before Vladimir Putin.

“I knew Yeltsin extremely well, I know his kids,” Sanders said.

Sanders believes the late Yeltsin’s extended family is “appalled” at Putin’s decision to invade Ukraine. He also thinks the late Andrei Sakharov, who helped build the hydrogen bomb for Russia and then was awarded the Nobel Peace Prize for opposing the abuse of power and working for human rights, would also be similarly shocked at Putin’s attacks

While Sanders thinks noteworthy and important Russian families likely oppose the invasion of Ukraine that has cost thousands of lives, forced millions to flee their homes and disrupted stock and commodities markets around the world, the associate professor said the Russian population itself is likely divided in its response to the war.

“People whose sole source of information is the Russian central media are aggressively listening to the message coming out of the Kremlin,” he said.

The people in this group tend to be 45 and older and are less urban. They know of events in Ukraine in the context of a military operation in Donetsk, rather than an outright war against a neighbor.

For many people in this older crowd, the message connected to hostilities between Russia and the rest of the world has echoes of earlier times, during World Wars and the Cold War.

After losing millions of their fellow Russians in World War II, many Russians “had a grandfather or great grandfather who served” in the military, “this makes rallying around the national cause important. The Cold War is radioactive material with a long half life,” he added.

They believe the West, and, in particular, the United States, “wants to destroy” them.

The culture and mythology that informs their world view comes from the country’s own tradition of spies and spy novels that are similar to the ones many Americans have read, except that the “bad guys” are the Americans and West Germans the way the protagonists of American spy novels are often Russian.

Younger people who are 35 and below, however, particularly those in cities, get their information from places like TikTok and foreign press, where they don’t receive the Putin party line.

These information lines have created tensions during family gatherings. Sanders described reports of students at teaching colleges getting into arguments with grandparents who believe in the state media, if not in Putin

Sanders has lectured in Russia, where the students in Moscow are “more astute and more diligent in reading the New York Times and watching the BBC than my students here in the United States.”

Sanders said the reason Russians who are protesting the war are younger not only reflects the reality that protesters in general tend to be younger, but also the fact that these are the people seeing and hearing firsthand information about the damage the invasion has caused to Ukraine and to the Russians rolling into the country in tanks.

Over time, pressure might build on Putin when the number of Russians killed continues to climb, although the pace of sharing information about the safety of the troops may remain slow enough that Russians families may not know about their lost loved ones, Sanders said.

Sanders was impressed with the military intelligence released just prior to the invasion of Ukraine.

The information that came out before the war was “remarkable. It’s going to mean there’s going to be a witch hunt of enormous proportions conducted by Putin for who is leaking things out of the Kremlin and the Ministry of Defense.”

Sanders is not particularly optimistic about the outcome of this war for Ukrainians.

Sanders, who produced and edited the documentary “Three Days in September” that was narrated by Julia Roberts and described the siege of a Russian school by Chechen rebels in 2004, recognizes critical differences in the way Putin thinks tactically.

In a hostage situation, most countries and leaders put a priority on saving hostages. Putin, however, puts a priority “on killing the terrorists doing the hostage taking,” Sanders said.

Putin is likely hunkered down and isn’t listening to anyone else closely, even those who might try to tamp down on his most militant impulses, Sanders said.

Former President Donald Trump (R) “didn’t want to listen to anyone [about the 2020 election]. He only wanted to hear about election fraud. He didn’t want anyone to contradict him. That is mild compared to how Putin has isolated himself.”

As for Ukrainian president Volodymyr Zelensky, Sanders hailed the embattled leader for his ongoing commitment to the country and inspirational messages. After Zelensky spoke to the British parliament, echoing sentiments expressed by former Prime Minister Winston Churchill at the onset of World War II, Zelensky may be “the first charismatic hero of the digital age,” Sanders said.

While Americans and British saw Zelensky’s address as a tribute to his commitment to his country and his eagerness to preserve a democracy, Russians saw images of Zelensky with a different spin.

“He’s sucking on the teat of the West,” Sanders said. Members of state media believe Russia attacked Ukraine because of “great conspiracy” against the country.

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Famotidine molecule Image courtesy of Wikipedia

By Daniel Dunaief

An over-the-counter stomach-soothing medication may also relieve some of the symptoms of mild to moderate COVID-19.

Tobias Janowitz Photo courtesy of CSHL

In a study recently published in the journal Gut, Cold Spring Harbor Laboratory Assistant Professor Tobias Janowitz and a team of collaborators at CSHL and The Feinstein Institutes for Medical Research at Northwell Health demonstrated that Famotidine, the active ingredient in Pepcid, shortened the duration of symptoms for a diverse patient group of adults soon after developing COVID-19 symptoms.

In a placebo-controlled study, people taking 80 milligrams of Famotidine three times a day reported that symptoms such as headaches declined after 8.2 days, compared with 11.4 days for patients who were taking the placebo.

“We think that the results are preliminary, but encouraging,” Janowitz explained in an email. 

The research, which included 55 volunteers, may offer health care providers another tool to help treat mild to moderate cases of COVID-19. In the clinical study, the use of Famotidine helped reduce a potentially overactive inflammatory response without suppressing the immune system’s efforts to ward off the virus.

Participants in the study received Famotidine or placebo pills along with a host of instruments they could use at home to gather clinical data about themselves, including a cellular activated Apple iPad, a scale, thermometer, fitness tracker, spirometer to measure air flow in and out of the lungs and a pulse oximeter, which measured oxygen levels by taking a reading over a person’s fingernails.

The protocol for the study allowed volunteers to stay home, where they gathered results from the instruments and reported on their health and any symptoms they felt. Technicians came to the home of each volunteer on the first, seventh, 15th, and 28th days after entering the clinical trial.

Researchers and doctors involved in the analysis of the effectiveness of COVID believe this remote approach to participating in clinical trials could prove a safe and effective way to conduct research for other diseases.

“In today’s virtual world, our clinical trial strategy has significant implications for how to study new drugs in patients at home,” Dr. Kevin Tracey, president and CEO of the Feinstein Institutes, explained in a Cold Spring Harbor Laboratory news brief.

Janowitz added that other studies could also use testing protocols at home, including for other diseases. “We are looking forward to employing it to help develop better treatments for people with cancer,” which is the disease at the center of his research, he explained.

The CSHL Assistant Professor focuses on the whole body response to cancer, although many of the biological considerations are transferable to other diseases.

Pivot to COVID

According to Janowitz, “It was relatively easy for us to pivot to COVID research when it was a global area of unmet need.” 

The researchers chose Famotidine because of encouraging studies and from a case series, Janowitz explained. They also found a potential mechanism of action where Famotidine blocked the H2 receptor, which encouraged them to move to a phase 2 randomized clinical trial.

The researchers were pleased that the participants in this small trial included people from a range of ages and ethnic groups. Nearly two thirds of patients, who were 18 years and older, were from black, mixed-race or Hispanic communities.

“Patients with different ancestry may have different responses to this disease,” Janowitz explained. “It helps to learn about the generalizability of the results.”

In a CSHL news brief, Nicole Jordan-Martin, executive director for New York City Health + Hospitals, added that “accessible, safe and low-cost outpatient treatment options are a priority in our global efforts to combat COVID-19.” Northwell and New York City Health + Hospitals provided care for the communities most in need of support for New York City, she added.

The collaborators were also encouraged by their teamwork.

“Our institutions worked extremely well together to face challenges the pandemic posed, like offering digital solutions and reaching populations who struggled for access to care,” Dr. Christina Brennan, vice president of clinical research at the Feinstein Institute and co-investigator of the trial, said in the news brief. 

“From screening patients to organizing home delivery of the equipment and medication, this sets a new model for future trials and convenience for participants.”

Janowitz described the safety profile of Famotidine as “excellent” and said it “appears to have few interactions with other drugs and very few side effects in general.”

To be sure, Janowitz cautioned doctors and patients not to stock up on Famotidine before researchers conduct additional studies.

“Our trial is not conclusive and an early phase clinical trial (phase 1 or 2) is not sufficient to inform clinical practice,” he wrote.

Additionally without further study, researchers don’t know the best potential dose and dosing interval for this possible treatment. At this point, they know how long the drug stays in the blood and the strength of its binding to its receptor.

A dose of 20 milligrams per day or less may be too little to achieve an effect, but “we do not know this for certain,” Janowitz explained.

While researchers agreed that further studies were necessary to answer key questions, they believed that the results from this research could provide fodder for studies outside of the COVID world.

“It is possible that sustained inflammation contributes to illness in other contexts and changing this inflammation would be beneficial,” Janowitz wrote. “This will have to be explored separately. Importantly, the methods used in this trial are also transferrable, so we have learned a lot of important information” from this research.

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Pixabay photo

By Daniel Dunaief

Daniel Dunaief

When my daughter was young, one of her favorite songs was “Old MacDonald.” Maybe she loved it because it was a song about farm animals and we lived in Manhattan, where most of our non-human wildlife consisted of squirrels and pigeons.

When she was an infant, she could make an incredibly convincing pigeon coo, thanks to hearing them all day long outside her window.

Maybe she also liked the song because, unlike Bette Middler’s “The Rose” and “One” from “A Chorus Line,” my wife and I couldn’t butcher the relatively simple melody with our unimpressive singing skills.

Anyway, she liked to say “duck” when we got to the animal on the farm. She liked ducks, or maybe the “quack quack” sound so much that she’d protest when we told her the farm already had a duck. She would say, “another duck,” to keep us quacking. The song and the quacks made car rides more palatable.

The song popped into my head recently when a friend told me that his second daughter was pregnant with their fourth grandchild. My friend has three daughters. His fourth grandchild is a girl, which means he’ll also have four granddaughters.

He was extremely pleased to share the news by email about “another granddaughter,” and he has every right to be. He is preparing for the seventh consecutive girl in his immediate family.

Then again, I couldn’t help thinking how he or the rest of the world would have felt if he had a grandson. Would that be a greater cause for celebration because they had a boy in their midst? I suspect he doesn’t, and didn’t, care.

For so many people, the gender doesn’t matter as long as the baby and mother (and somewhere in there, hopefully, the father) are healthy.

When my daughter was born, the big surprise was that I, unlike my parents or my older brother, could have a girl. As I told my wife, as the second of three boys and an uncle to two nephews, I expected to continue the male tradition.

My daughter started out proving me wrong and, thankfully, continues to do so regularly.

Once I’d broken the ‘all boys’ pattern, I was convinced my son was a girl, so, he, too, defied our expectations.

So, what is it with gender reveal parties? Is it another way to celebrate a coming birth? Is it a way to unveil one of the few mysteries left before birth?

In an era that increasingly understands and supports the transgender population, gender reveal parties seem anachronistic, celebrating a birth gender that may conflict with a person’s developing identity.

Like so many other events, such as a first birthday party that a child will never remember, a gender reveal party may be a way to celebrate the parents, giving them a chance to anticipate the coming birth and to imagine life as the parent of a boy or girl.

Gender reveal parties have received bad press because of the injuries from pyrotechnics and other exploding blue or pink streamers or images. But maybe beyond the danger from these explosions, the gender reveal also pigeon holes children into specific color patterns.

Don’t we want our children to think for themselves, even about their favorite colors, instead of limiting them to blue for boys or pink for girls?

Maybe, instead of colors or gender, we can celebrate the sounds of their heartbeat, the Alien-like moments when we can see their feet in their mom’s abdomen, or the foods their mothers crave during pregnancy.

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Jose M. Adrover and Mikala Egeblad. Photo by Lijuan Sun

By Daniel Dunaief

Cold Spring Harbor Laboratory Professor Mikala Egeblad thought she saw something familiar at the beginning of the pandemic.

Mikala Egeblad. Photo from CSHL

Egeblad has focused on the way the immune system’s defenses can exacerbate cancer and other diseases. Specifically, she studies the way a type of white blood cell produces an abundance of neutrophil extracellular traps or NETs that can break down diseased and healthy cells indiscriminately. She thought potentially high concentrations of these NETs could have been playing a role in the worst cases of COVID.

“We got the idea that NETs were involved in COVID-19 from the early reports from China and Italy” that described how the sickest patients had severe lung damage, clotting events and damage to their kidneys, which was what she’d expect from overactive NETs, Egeblad explained in an email.

Recently, she, her post doctoral researcher Jose M. Adrover and collaborators at Weill Cornell Medical College and the Icahn School of Medicine at Mt. Sinai proved that this hypothesis had merit. They showed in hamsters infected with COVID and in mice with acute lung injuries that disabling these NETs improved the health of these rodents, which strongly suggested that NETs are playing a role in COVID-19.

“It was very exciting to go from forming a hypothesis to showing it was correct in the context of a complete new disease and within a relatively short time period,” Egeblad wrote.

Egeblad, Andover and their collaborators recently published their work in the Journal of Clinical Investigation Insight.

Importantly, reducing the NETs did not alter how much virus was in the lungs of the hamsters, which suggests that reducing NETs didn’t weaken the immune system’s response to the virus.

Additional experiments would be necessary to prove this is true for people battling the worst symptoms of COVID-19, Egeblad added.

While the research is in the early stages, it advances the understanding of the importance of NETs and offers a potential approach to treating COVID-19.

An unexpected direction

Jose Adrover. Photo from CSHL

When Adrover arrived from Spain, where he had earned his PhD from the Universidad Complutense de Madrid and had conducted research as a post doctoral fellow at the Spanish Center for Cardiovascular Research in March of 2020, he expected to do immune-related cancer research.

Within weeks, however, the world changed. Like other researchers at CSHL and around the world, Egeblad and Adrover redirected their efforts towards combating COVID.

Egeblad and Andover “were thinking about the virus and what was going on and we thought about trying to do something,” Adrover said. 

Egeblad and Adrover weren’t trying to fight the virus but rather the danger from overactive NETs in the immune system.

Finding an approved drug

Even though they were searching for a way to calm an immune system responding to a new threat, Egeblad and Adrover hoped to find a drug that was already approved.

After all, the process of developing a drug, testing its safety, and getting Food and Drug Administration approval is costly and time-consuming. 

That’s where Juliane Daßler-Plenker, also a postdoctoral fellow in Egeblad’s lab, came in. Daßler-Plenker conducted a literature search and found disulfiram, a drug approved in the 1950’s to treat alcohol use disorder. Specifically, she found a preprint reporting that disulfuram can target a key molecule in macrophages, which are another immune cell. Since the researchers knew this was important for the formation of NETs, Daßler-Plenker proposed that the lab test it.

Working with Weill Cornell Medical College and the Icahn School of Medicine at Mt. Sinai, Adrover explored the effect of disulfiram, among several other possible treatments, on NET production.

Using purified neutrophils from mice and from humans, Adrover discovered that disulfiram was the most effective treatment to block the formation of NETs.

He, Assistant Professor Robert Schwartz’s staff at Weill Cornell and Professor Benjamin tenOever at Mt. Sinai tried disulfiram on hamsters infected with SARS-Cov-2. The drug blocked net production and reduced lung injury.

The two experiments were “useful in my opinion as it strengthens our results, since we blocked NETs and injury in two independent models, one of infection and the other of sterile injury,” Adrover said. “Disulfuram worked in both models.”

More work needed

While encouraged by the results, Egeblad cautioned that this work started before the availability of vaccines. The lab is currently investigating how neutrophils in vaccinated people respond to COVID-19.

Still, this research offered potential promise for additional work on NETs with some COVID patients and with people whose battles with other diseases could involve some of the same immune-triggered damage.

“Beyond COVID, we are thinking about whether it would be possible to use disulfiram for acute respiratory distress syndrome,” Egeblad said. She thinks the research community has focused more attention on NETs.

“A lot more clinicians are aware of NETs and NETs’ role in diseases, COVID-19 and beyond,” she said. Researchers have developed an “appreciation that they are an important part of the immune response and inflammatory response.”

While researchers currently have methods to test the concentration of NETs in the blood, these tests are not standardized yet for routine clinical use. Egeblad is “sensing that there is more interest in figuring out how and when to target NETs” among companies hoping to discover treatments for COVID and other diseases.

The CSHL researcher said the initial race to gather information has proven that NETs are a potentially important target. Down the road, additional research will address a wide range of questions, including what causes some patients to develop different levels of NETs in response to infections.

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Director of the Heart Rhythm Center at Stony Brook Heart Institute Dr. Eric Rashba is holding the new Watchman FLX device, which provides protection from strokes for people with atrial fibrillation. Photo from Stony Brook Medicine

The butterflies that color backyards are welcome companions for spring and summer. The ones that flutter towards the upper part of people’s chests can be discomforting and disconcerting.

In an effort to spread the word about the most common form of heart arrhythmia amid American Heart Month, the Stony Brook Heart Institute recently held a public discussion of Atrial fibrillation, or A-fib.

Caused by a host of factors, including diabetes, chronic high blood pressure, and advanced age, among others, A-fib can increase the risk of significant long-term health problems, including strokes.

In atrial fibrillation, the heart struggles with mechanical squeezing in the top chamber, or the atrium. Blood doesn’t leave the top part of the heart completely and it can pool and cause clots that break off and cause strokes.

Dr. Eric Rashba, who led the call and is the director of the Heart Rhythm Center at Stony Brook Heart Institute, said in an interview that A-fib is becoming increasingly prevalent.

A-fib “continues to go up rapidly as the population ages,” Rashba said. It occurs in about 10% of the population over 65. “As the population ages, we’ll see more of it.”

The Centers for Disease Control and Prevention estimates that 12.1 million people in the United States will have A-fib over the next decade.

As with many health-related issues, doctors advised residents to try to catch any signs of A-fib early, which improves the likely success of remedies like drugs and surgery.

“We prefer to intervene as early as possible in the course of A-fib,” Dr. Ibraham Almasry, cardiac electrophysiologist at the Stony Brook Heart Institute, said during a call with three other doctors. “The triggers tend to be more discreet and localized and we can target them more effectively.”

Different patients have different levels of awareness of A-fib as it’s occurring.

“Every single patient is different,” said Dr. Roger Ran, cardiac electrophysiologist at the Stony Brook Heart Institute. Some people feel an extra beat and could be “incredibly symptomatic,” while others have fatigue, shortness of breath, chest discomfort, and dizziness.

Still other patients “don’t know they are in it and could be in A-fib all the time.”

Doctors on the call described several monitoring options to test for A-fib.

Dr. Abhijeet Singh, who is also a cardiac electrophysiologist at the Stony Brook Heart Institute, described how the technology to evaluate arrhythmias has improved over the last 20 years.

“People used to wear big devices around their necks,” Singh said on the call, which included about 150 people. “Now, the technology has advanced” and patients can wear comfortable patches for up to 14 days, which record every single heartbeat and allow people to signal when they have symptoms.

Patients can also use an extended holter monitor, which allows doctors to track their heartbeat for up to 30 days, while some patients receive implantable recorders, which doctors insert under the skin during a five-minute procedure. The battery life for those is 4.5 years.

Additionally, some phones have apps that record heartbeats that patients can send by email, Singh said. “We have come a long way in a few years.”

Dr. Roger Fan, a cardiac electrophysiologist at the Stony Brook Heart Institute, added that all these technologies mean that “we are virtually guaranteed to get to the bottom” of any symptoms.

Drugs vs. surgery

Doctors offer patients with confirmed cases of A-fib two primary treatment options: drugs or surgery.

The surgical procedure is called an ablation and involves entering the body through veins in the groin and freezing or burning small areas that are interfering with the heart’s normal rhythm. The procedure breaks up the electrical signals in irregular heartbeats.

Performed under general anesthetic, the procedure generally takes two to three hours. Patients can return home the same day as the operation, Rashba said.

As with any surgery, an ablation has some risks, such as stroke or heart attack, which Rashba said are “very rare” and occur in fewer than one percent of the cases. Additionally, patients may have groin complications, although that, too, has declined as doctors have used ultrasound to visualize the blood vessels.

In extremely rare occasions, some patients also have damage to the esophagus behind the heart, said Rashba, who is also a professor of medicine.

For patients experiencing symptoms like A-fib, doctors recommended a trip to the emergency room, at least the first time.

“If it’s not going away, one, you can reassure yourself, two, you can get treatment, and three, you can get a diagnosis quickly,” said Almasry.

The Stony Brook doctors said choosing the best treatment option depends on the patient.

“Everybody has different manifestations of their A-fib,” said Fan.

Among other questions, doctors consider how dangerous the A-fib is for the patients, how severe the symptoms are, and how much they affect the quality of life.

Doctors urged residents to make the kind of healthy lifestyle choices that keep other systems functioning effectively. Almasry cited a direct correlation between obesity and A-fib.

Reducing body weight by 10%, while keeping the weight off, can reduce the likelihood of A-fib recurrence, he said.

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An overhead view of flooding at the Ranomafana area in Madagascar, above. Photo by Dina Andrianoely

Stony Brook University distinguished professor and award-winning scientist Patricia Wright has been traveling back and forth to Madagascar for over 34 years to study the charismatic lemurs on the island nation off the southeastern coast of Africa.

A damage to a road in Madagascar. Photo by Dina Andrianoely

Recently, Wright was in Madagascar when Tropical Cyclone Emnati struck the nation, tearing roofs from homes, destroying crops and polluting drinking water.

“The actual howling of the wind was very eerie,” said Wright in an interview a few days after returning from Madagascar. “The river is right beneath the station and it was scary to watch it go from white water rapids, into roiling coffee-colored water. Every 15 minutes, you could notice a difference” in the flooded waters.

Wright, her daughter Amanda Wright Poston, who is a project manager with the Woodwell Climate Research Center, and PhD candidate Amanda Rowe are seeking donations through WISE Tropics.

Created in 2020, WISE Tropics, which stands for Wright’s Institute for Science & Environment, has numerous goals, including saving lemurs, planting new rainforests and helping people in Madagascar and other tropical countries that have high biodiversity and high poverty.

In response to Tropical Cyclone Emnati, which is the fourth cyclone to hit Madagascar this year, WISE Tropics is trying to raise $20,000 from donors to provide food for people whose crops were destroyed by
the storm.

“People are displaced from their homes and they are really hungry,” Wright said. “The crops are gone: they are washed away.”

Wright said she hoped to buy as many as 100 bags of 50 kilograms of rice, plus beans, sugar and salt that could support communities around Ranomofana National Park, which provides the nearby setting for research through Stony Brook’s Centre ValBio.

She hopes to raise enough money that she can provide additional food every two weeks for the next two months.

A week after Emnati, residents of Madagascar were also struggling with contaminated drinking water, which was causing diarrhea. 

Wright said she hasn’t seen this level of devastation to Madagascar in about a decade.

An overhead view of flooding at the Ranomafana area in Madagascar, above. Photo by Dina Andrianoely

She hopes Long Islanders support those struggling after a spate of storms disrupted their lives and threatened their futures.

“Long Islanders are very generous when it comes to donating for disasters,” Wright said. “We had Sandy ourselves. We can make this island to island connection.”

Wildlife on Madagascar, like endangered lemurs, are often able to survive during natural disasters.

Lemurs move close to the center of trees and lower down to avoid the strong winds, Wright described. While she has seen lemurs who died amid storms, many survive by finding natural protection.

Wright recognizes that the number of crisis points in the world has grown, with refugees and survivors leaving their homes in Ukraine amid Russia’s armed attack and amid flooding in parts of Australia.

One of the lessons she’s learned from working with people in Madagascar amid past disasters is that donations sometimes meet the immediate need but don’t always provide enough sustained support.

Origins of WISE

Amanda Poston said they established WISE Tropics to give donors who wanted to give 100% of their gifts directly to specific efforts.

“We created this so we could really have them participate in these on-the-ground projects,” Poston said.

Before the cyclones hit, donors had contributed to reforestation efforts and lemur research, which is at the heart of what Patricia Wright studies.

“People who are interested in Ranomofana and have a connection to Madagascar are able to help” through these donations, Poston said.

WISE Tropics has almost no overhead, which means that donations go directly to the intended recipients.

At this point, the need to help the Malagasy people get food and shelter is high, as the island nation recovers from storms that have closed off roads and demolished bridges.

Poston, who spent a good part of her childhood in Madagascar, said the Malagasy “respect [her mother] and are amazed at her continuous contributions to their country.”

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Pixabay photo

By Daniel Dunaief

Daniel Dunaief

If I knew exactly when Russian president and peace shatterer Vladimir Putin were planning to attack Ukraine, I could be spectacularly rich.

Putin, however, knew exactly when he was going to give the order to start shooting, causing markets around the world to plunge.

No stranger to making a buck or two, Putin, whose wealth is estimated in the billions, may have seen the opportunity to create suffering for everyone else, while making himself even richer.

Have options markets around the world checked the trading just before the day he started killing people in Ukraine? Does anyone know whether he, through shell companies or, perhaps even more directly, through trades he holds in his own name, made a financial killing by destroying neighborhoods and shattering peace on a scale not seen since World War II?

Maybe he positioned his portfolio just as he was moving his military. He could have also dabbled in the commodities markets, where wheat, aluminum and gold prices have soared.

While the Russian president may not need the money personally, he could offset some of the effect of sanctions through the equivalent of his own “big short” on stock markets, betting in a game he helped control that the markets would fall.

Putin could have gone to stock markets outside of Russia, where he could have set up huge trades just a few days before a move the previous president of the United States described as “genius.”

Perhaps Donald Trump, who is also no stranger to capitalizing on financial opportunities, recognized the financial move Putin was making. Putin doesn’t appear to care much about the people he’s displacing or the Russian soldiers who may no longer return to their families to pursue a war against a neighbor whose biggest offense seems to be that they live in a democracy and want to join NATO, whose members consider an attack against one of them as an attack against all of them. As the “Between You and Me” column in these papers from last week made clear, Ukraine has abundant natural resources, which raise its appeal to Putin. At the same time, though, maybe he also saw this move as a chance to make money and to stay relevant.

It’s not every day that people write your name, even if it’s for nefarious actions, in papers throughout the world. Sitting on a stockpile of nuclear weapons that could easily turn Global Warming into a distant afterthought if he and his intended targets used them, Putin is dominating news coverage around the world, displacing COVID. Too bad there’s no vaccine for the world’s population against Putin.

By putting his nuclear forces on high alert after disrupting peace with his attack on Ukraine, he also gets to play bully and victim at the same time. He’s a bully for sending his armed forces into a neighboring country and killing men, women and children. Bullets don’t discriminate between innocent civilians and members of an opposition’s armed forces.

He is also a victim, claiming the heated rhetoric against his military’s unprovoked attack is enough of a threat to him that he needed to put his nuclear arsenal on high alert. His despotic desperation suggests maybe he needs a hug or some counseling.

He also defies logic by calling the Jewish president of Ukraine, Voldymyr Zelenskyy a “neo-Nazi,” when some of Zelenskyy’s own ancestors died in the Holocaust.

Putin may not make sense, but, at least in the first few days after his unjustified attack, he may be making tons of money.

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