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Daniel Dunaief

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By Daniel Dunaief

They don’t always follow the same path with any two sufferers, but people who have migraines can and often do find themselves with symptoms including head pain, discomfort, numbness and nausea that make working, caring for family members or functioning difficult.

Dr. Sharon Nachman. Courtesy Stony Brook Medicine Facebook page

Among the first symptoms listed when COVID-19 became a pandemic in 2020, headaches can and have become more severe for people who become infected and then endure additional symptoms in the ensuing weeks and months.

People with migraines often suffer from a throbbing headache, nausea, sensitivity to light and loud noises that worsen with movement.

The other associated features can be “just as disabling as the pain,” said Dr. Noah Rosen, director of the Headache Program for Northwell Health. “Now that we see some of the symptoms cross over with long COVID symptoms, that becomes more salient.”

At this point, amid anecdotal evidence of migraines and long COVID, health care providers can’t say conclusively whether an infection with the current strain of the virus presents any more risk of developing migraines sometime after an infection than they were with earlier strains of the SARS-CoV-2 virus.

“There’s no central reporting of symptoms,” said Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital. “If you get a vaccine and you have an adverse event, you can report it. There’s no such thing for long COVID.”

Indeed, with people continuing to pass along the virus in schools, workplaces, crowded subways and other places where people gather in confined indoor spaces, the long COVID population has “overtaken any ability to track those symptoms,” Nachman said.

Nachman added that migraines could be a symptom of something else.

“It’s hard to say a true cause and effect” with regard to a particular symptom, as some immune systems may have such a strong response that they are creating autoimmune problems.

Migraines are also seen in patients with autoimmune diseases, Nachman said.

For some patients, doctors may want to do a full immune workup to make sure they are not having an autoimmune reaction.

As for long COVID symptoms, people “across the board” are developing various maladies after contracting the illness that caused the pandemic, Nachman said.

While it’s unclear at this point whether migraines or other specific symptoms increase amid the current strain of long COVID, doctors urged people who have underlying medical conditions to get tested when they develop symptoms.

“Fewer people are actually treating the acute phase,” said Rosen. “There was some evidence that early treatment with Paxlovid can reduce the risk of long-term COVID.”

Indeed, people in high-risk groups can lower the chance of dealing with additional symptoms, called sequelae, after an initial infection.

Treatments

While numerous treatments are approved for migraines, it is unclear which might be best for people who develop these extreme and potentially debilitating headaches in the aftermath of COVID.

“Many of the new treatments haven’t been specifically looked at for post-COVID” migraines, said Rosen.

Migraines can become enough of an interruption to daily life that people alter their behaviors in between episodes, during the so-called interictal period.

Even without the pain, migraine sufferers can avoid activities because they are afraid of a trigger.

This can affect people’s social interactions or their job choices, among other decisions.

“If people are noting that they are unable to do things that they were doing before or are avoiding certain tasks, they need to step up in treatment,” said Rosen.

In terms of treating migraines, Rosen suggested that beneficial pharmacological options, such as triptans, have been around since the 1990s.

Triptans are a group of medicines that treat migraines by changing how blood circulates in the brain and how the brain processes pain signals, according to the Cleveland Clinic.

Rosen said Imitrex and Maxalt are used to treat migraines during the mild phase.

“Early treatment can lead to shorter symptoms or less medicine being used and less disability,” Rosen said.

The average migraine lasts about four hours. A migraine that lasts more than 72 hours is described as “migrainosis,” which can be disabling and can require a combination of medications.

People can reduce the risk of migraines through some lifestyle modifications, such as ensuring sufficient hydration, not skipping meals, getting regular sleep, avoiding stress or engaging in behaviors that improve resilience to stress, and exercise, Rosen said.

Migraines affect about 12 percent of the population. Additionally, anyone with a migraine has about a 70 percent chance of having a first-degree relative — a parent, sibling or child — who also has migraines, according to Rosen.

Researchers have identified over 40 genes associated with migraines, which makes determining a specific genetic link complex, Rosen said.

With a link between migraines and hormones, women suffer from them at about a three-to-one ratio to men.

Other triggers

Migraine sufferers often try to identify triggers that can bring on these painful and disturbing episodes that can cause fatigue and discomfort even after the episodes end.

Many people are sensitive to environmental changes, like low barometric pressure from storms or excessive changes in temperature.

All of those are increasing amid climate change, which has had a significant effect on migraine sufferers, Rosen said.

Obesity, which is a health issue for the country, can also affect migraines.

“That places an additional burden on the health of people who suffer” from migraines, said Rosen.

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Olaf Kleingbeil at the Pezcoller24 Symposium in Italy in June, 2024. Photo by Claudia Tonelli

By Daniel Dunaief

The wreck-and-check method sometimes works, providing the kind of clues that lead to cures.

In the case of cancer, however, taking out one gene or one protein may not be enough, particularly when a combination contributes to cancer growth or to inactivating the body’s defenses against the disease.

Olaf Klingbeil. Photo courtesy of CSHL

Over the course of seven years, first developing a technique, then searching for possible clues about what the work might reveal, Olaf Klingbeil, a postdoctoral researcher in the lab of Professor Chris Vakoc at Cold Spring Harbor Laboratory, discovered two proteins that work together to do cancer’s bidding.

Called Mark 1 and Mark 2, these two proteins in combination keep a tumor suppressor called Hippo from doing its job, enabling a wide range of cancers from continuing to grow.

The Hippo pathway is one of the most dysfunctional in all human cancer biology.

The journey to this discovery is as compelling as the finding itself.

Klingbeil honed a technique that took out a series of genes, hoping to find out how more than one protein might be involved in the kind of on-off switch geneticists are often seeking to slow or squelch cancer.

Indeed, disrupting either of the proteins on its own would not have been enough, as the disease would have progressed with a singular inhibitor.

“When you manipulate A or B individually” you don’t see much difference in the cancer cells, Vakoc said. “When you manipulate A plus B, you get a massive effect.”

Vakoc suggested that his lab developed a new technology to find cancer targets, enabling them to search for processes and contributors that were otherwise invisible. Klingbeil used lentiviruses to introduce CRISPR gene editing into cancer cells.

“What [Klingbeil] developed, a method where you can introduce two [changes] at the same time, can be engineered to target combinations of genes,” Vakoc said. “It took years to figure out how to do this.”

Klingbeil explored the effect of making these double knockouts through many perturbations.

“It was the largest project in my lab to this point,” said Vakoc.

A eureka moment

Klingbeil examined several potential leads that might provide clues about how to attack cancer cells. He published 1,719 single gene knockouts and 2,529 paralog double knockouts and expected to find a few jewels. 

Christopher Vakoc. Photo courtesy of CSHL

He likens the process to panning for gold at a creek, which involves getting rid of numerous stones before discovering that gold nugget, which, in this case came in the form of two kinases, which add phosphate labels to macromolecules.

When Klingbeil honed in on Mark 2 and Mark 3, he couldn’t immediately understand why inhibiting these enzymes affected some forms of cancer, but not all of them. 

The postdoctoral researcher read a study in which the researchers looked at the tumor suppressive function of Yap/Taz in leukemia and neuroendocrine cancers and realized that these were the cancer types that didn’t show a reaction to inhibiting these kinases.

This was the first hint that Marks 2 and 3 and Yap/Taz might work together, Klingbeil explained.

The affected cancers include liver, lung, colorectal, ovarian, triple negative breast cancer, pancreatic cancer and prostate cancer. That list also includes rhabdomyosarcoma, a rare form of pediatric cancer for which Vakoc, in particular, is eager to develop new treatments.

While numerous scientists are seeking ways to block this pathway directly, the focus on Mark 2 and Mark 3 presents a new potential opportunity.

Marks are “totally overlooked in the community” and are “not a known target,” said Vakoc. “This is the first paper that announces these as cancer targets in a compelling way.”

An existing drug

Once he discovered this link, Klingbeil searched for existing drugs that might target Marks 2 and 3. Fortunately, he found one that Merck had tried to develop for Alzheimer’s disease.

While that didn’t work as well as the pharmaceutical company had hoped, the CSHL researchers are looking to use it as a starting point for a future therapy.

“We are excited that there’s a chemical matter” that might help treat cancer, Vakoc said, adding that such a treatment will likely require “a lot of love by chemists to give them the ideal attributes” for any therapeutic approach.

The drug Merck produced inhibited Marks 1 and 4 as well as 2 and 3, which provides opportunities to tailor it for the most relevant enzymes. By increasing the specificity of the drug for two of the four proteins, researchers and pharmaceutical companies could reduce the side effects of inhibition.

To be sure, Vakoc and Klingbeil cautioned that this discovery, while encouraging, wouldn’t likely provide a magic bullet for cancer, which has a way of becoming resistant to treatments and to tapping into other unknown or unseen pathways to continue to cause harm.

Effective future treatments that involve inhibiting Marks 2 and 3 could require the use of a combination of therapies, which might outmaneuver or slow the progression of cancer.

A personal message

Earlier this year, Klingbeil learned that the journal Cancer Discovery had accepted the paper for publication in an unusual way. He was attending a dinner one night at a conference in Italy when Elizabeth McKenna, the Executive Editor of the journal, approached him.

“She told me she was about to send an email” to Vakoc that the paper was accepted, Klingbeil said. “I was very excited. I’m happy to publish it and that I could convince the most critical reviewers about the value of the work.”

After a productive and rewarding collaboration with Vakoc, Klingbeil is preparing for the next steps in his career. He is speaking with various institutions, particularly in Europe, where he can be closer to his family and his native Berlin, Germany while continuing to advance his scientific career. He plans to continue to work with Vakoc after he leaves.

“The discovery was big enough to carve out a piece for him and me,” Klingbeil said and suggested he would study Mark function in pancreatic cancer in more detail.

On the personal front, fate lent a hand when Klingbeil first arrived on Long Island.

He started his life here in the middle of the winter, without a car or a driver’s license. The lab provided temporary housing on campus. He had a choice to share an apartment with either a French or an Italian postdoctoral researcher.

He chose to live with postdoctoral researcher Claudia Tonelli, who works in the lab of Cancer Center Director David Tuveson and is now his partner. The two researchers, who started dating a few months after living together, have a daughter Lily.

As for his work, he is cautiously optimistic that this discovery may one day help with new and effective therapies.

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Thoracic surgeon Dr. Andrea Carollo in front of the ION robot. Photo courtesy Lee Weissman

By Daniel Dunaief

Early and prompt detection of any cancer can and often does lead to better patient outcomes. With that in mind, Huntington Hospital recently added a new ION Robotic-Assisted Bronchoscopy to identify and perform biopsies on lung nodules. The robotic system, which the hospital has used on 25 patients, can trim the time for a diagnosis to as little as two to four weeks from as much as 70 days.

“We felt it would be an appropriate investment for the patient population so they wouldn’t have to travel to get a diagnosis in a timely manner,” said thoracic surgeon Dr. Andrea Carollo.

Lung cancer is the leading cause of cancer in Suffolk County, according to Dr. Nick Fitterman, Executive Director of Huntington Hospital. On top of that, two out of three lung cancers are in the outer third of the lungs, which the ION Robot specializes in sampling. Prior to the introduction of this system, patients either traveled to South Shore Hospital or would receive more extensive surgery to sample nodules.

For 90 percent of the patients, these nodules are benign. Not every nodule warrants a biopsy. Doctors use standard guidelines to monitor nodules and perform a procedure when these nodules require further investigation. With the ION Robotic-Assisted Bronchoscopy, these patients, who are under general anesthesia during the analysis, can go home the same day.

Get screened

Huntington Hospital. File photo

Doctors typically recommend further evaluation when nodules come up on a CAT scan. While many residents receive screenings for breast cancer, colorectal cancer, cervical cancer and prostate cancer, few take the time to receive a lung screen, even among those who would benefit from initial and ongoing surveillance. About 79 percent of people eligible for a mammography get one. Of the people eligible for lung cancer screening, however, only about 6 percent receive them, Fitterman added.

“We are woefully, woefully deficient in lung cancer screening,” Fitterman said. “There’s an effective screening tool out there that is widely under utilized.”

The US Preventive Services Task Force recommends that high risk patients between 50 and 80 receive lung cancer screening. High risk patients include those who have smoked a pack of cigarettes a day for 20 years and are either current smokers or have quit smoking within the last 15 years.

“If you are a smoker, you should definitely get involved in lung cancer screening,” said Carollo.

By screening more patients, the hospital can offer immediate services, including surgery and various treatment regimes such as chemotherapy.

Options

Once a CAT scan reveals a nodule that warrants further imaging, doctors have three potential surgical options.

They can use trans-thoracic biopsy if the nodule is of a good size, is in a favorable location and the interventional radiologist performing the procedure thinks it is technically possible.

The overall risk of a collapsed lung is about 10 percent with this approach, but much higher in patients with central lesions and  considerable emphysema. The risk is lower in patients with peripheral nodules and no emphysema. If a pneumothorax occurs, sometimes the patient requires a chest tube and hospital stay for as long as one to seven days.

With ION, the procedure is done through a breathing tube in the mouth and into the airways. The risk of a collapsed lung is less than one percent.

If there is a high suspicion of cancer, doctors can also go straight to surgery, which could be the case for a 50 year-old smoker with a 0.7 centimeter nodule that grew to one centimeter and shows activity on a PET scan.

In that case, the nodule and a portion of the lung are removed and sent to pathology, which evaluates it on site and, in about 20 minutes, can indicate whether it’s cancer. From there, doctors can take more lung tissue and lymph nodes for completion of a cancer operation. They review the tissue samples, which takes about 7 to 10 days to get a full answer of the type of cancer and stage if any mutations occurred.

The ION procedure, which has been available for over five years, decreases the risk of a collapsed lung and bleeding and provides an analysis of the nodule more rapidly. The complication rate is lower than with trans thoracic surgery.

At this point, Carollo is doing the majority of these ION-assisted biopsies, while pulmonologist, Dr. Nazir Lone, is doing some, as well.

In the ION procedure, doctors use a roller ball and a wheel that requires eye-hand coordination.

The company provides training to get certified and it takes about 10 to 15 of these procedures for a surgeon to feel comfortable doing them on his or her own, Carollo said.

Huntington Hospital ensures that doctors have sufficient training before allowing them to treat or diagnose patients. “Whenever we adopt any new technology or procedure, we have significant quality guardrails,” said Fitterman.

“We make sure that anyone operating on a machine first is proctored by someone else who is facile with it. They sign off and say, ‘Yes, you now met competencies. You can do it.’”

The speed of the analysis has important implications for patients. “If we can get this done in 30 days from the time we find something to treatment, that’s huge,” Carollo said. “Patients tend to have better outcomes. They live longer,” he continued. Delays over 50 days lead to decreased one and five year survival.

Other new developments

Huntington Hospital has several other new developments in the works.

The hospital is building a new cancer center in Greenlawn as well as expanding its labor and delivery capacity to provide services to more pregnant women.

Ever since St. Catherine of Siena closed its obstetrical unit on Feb. 1, Huntington Hospital has seen an increase in the number of pregnant patients.

The labor and delivery suites will add four beds and will refresh the space the hospital currently uses. The mother-baby units are “beautiful,” but the suites have to “catch up to that,” said Fitterman.

In the third quarter of next year, during the renovation, the labor and delivery areas will move to a place where the old emergency space had been. The improvements are expected to take about three months.

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Bottom row, from left, Andrew Whitely, VP Business Development and Technology Transfer at CSHL; Dr Susan Poser, President of Hofstra University; students Dimitri Dumontier; Charlie Chung, Yong Lin, Stephen Staklinski and Javier Anduaga; Dr. Janet A. Lenaghan, Dean of the Frank G. Zarb School of Business at Hofstra University; and Erick Hunt, Director of the Institute of Innovation and Entrepreneurship at Hofstra University Top row, from left, students Zifei Wang, Viet Hang Lee, Yujia Li, Jed de Ruiter-Swain, and Eva Lentsch. Photo courtesy of Hofstra University

By Daniel Dunaief

Ten graduate students and postdoctoral researchers stepped outside their familiar surroundings at Cold Spring Harbor Laboratory into a different campus and discipline recently.

As a part of the inaugural Bioscience Business Innovation Program, these developing scientists spent a week working with a collection of business professors at the Frank G. Zarb School of Business at Hofstra University, where they learned a range of subjects such as financial planning, intellectual property, leadership and project management.

The program, which will include a second week of training in March, is designed to teach developing scientists about market validation, Food and Drug Administration processes, and the creation of business models. The program also teaches leadership, team building and communications, which could help researchers who enter the pharmaceutical or biotechnology fields after they leave CSHL.

The goal is to “familiarize these new researchers on several aspects of business, marketing, finance, and management” which will help them consider the potential commercial application of their work, said Anoop Rai, Finance Professor at Zarb and one of the instructors in the Bioscience Business effort.

Indeed, in applying for some grants for startups from agencies like the National Science Foundation, researchers need to answer questions relating to growth, profitability and a target market.

“A knowledge of business is probably very important in that sense,” added Rai.

Scientists often have an interest in developing an innovation that could be useful for society, whether that’s a drug to treat a disease, a test to monitor health, or a new product. Such efforts need to “be marketed to become successful,” Rai said. “This group may, at some point, try and make [their findings] into a successful venture.”

Scientists would benefit from knowing about business in case they move to the next stage in their research or business development. To be sure, a two-week course offers an opportunity to learn and to develop an awareness of the business world, but doesn’t provide a comprehensive formula for success. The students will “get a feel more on the venture funding side, not so much on the complete running of a business,” said Rai.

Still, at the end of the program, the CSHL researchers will have an opportunity to make a pitch alongside a law student and a MBA candidate that a group of experts will evaluate. These pitches will require a basic understanding of business.

Student experience

Some of the students, who put most of their research aside for a week to immerse themselves in intensive training from a host of lecturers and experts, felt they have already benefited from such instruction.

Stephen Staklinski

One of the biggest take-home messages for PhD candidate Stephen Staklinski, who works in the lab of Professor Adam Siepel, involved understanding the consumers of any future product.

In research, Staklinski reads papers and looks for information that’s missing in the field. He rarely communicates directly with people who might be affected by any future discovery until a project is well under way. With a business viewpoint, he gained a new perspective he feels he can integrate effectively into his research.

Staklinski recognized the value of talking to physicians and cancer patients about some of their biggest issues. He sees the benefit of these open communications about how to serve patients who are battling various conditions.

In his current research, Staklinski builds statistical probabilistic models around the human genome. Specifically, he’s looking at molecular sites in RNA and is searching for targets that lead to metastatic processes. In working with experimental collaborator, Staklinski said he can “think about therapeutics to block this.”

Viet Hang Le, a postdoctoral researchers in the lab of Professor Linda Van Aelst, felt she received an introduction on how to develop fundamental research findings towards making new therapies.

“We got to learn about the laws and policies involved” in creating a new company, said Le. On the clinical safety side, she also learned how new products maneuver through health care and reach patients.

Her original curiosity was to see how research findings could lead to real-life treatments. Understanding business fundamentals opens more career options.

Indeed, even if Le and her colleagues continue to conduct research, she feels she can communicate more effectively with industry partners. It also whet her appetite for more business learning.

“It really bridges the gap between our background in fundamental science and the requirement for an MBA course,” Le explained. 

She is working on two projects in Van Aelst’s lab. In the first, she is studying early onset epilepsy, which is a symptom of an X-linked intellectual disability in patients carrying a mutation in the gene Oligophrenin 1.

In the second, she is exploring how the nervous system influences the progression of cancer in main tumors and metastatic tumors.

“We built a hypothesis on how different branches of nerves might increase the growth of cancer,” said Le. In Van Aelst’s lab, they are working with primary breast cancer and liver metastasis.

Originally from Dan Nang, Vietnam, Le spent a number of weeks during several summers as a part of the US Navy Pacific Partnership delivering medical treatment to medically underdeveloped areas in the country.

Through her lab work and any budding business interest, she would like to figure out how to deliver medical care to patients who might struggle with the financial or logistical challenge of affording care.

By connecting with experts who’ve negotiated various obstacles, “I’m gaining a clearer sense of how to streamline the path from discovery to patient care, cutting down unnecessary costs and time without compromising safety,” she said.

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Participants of last year's Human Library event. Photo by Rachael Eyler, Stony Brook University

By Daniel Dunaief

Stony Brook University is providing another opportunity for students and the community to venture beyond the labels that define and, at times, limit our views and understanding of each other.

Chris Kretz

For the second year, the university is hosting the Human Library, which gives participants an opportunity to learn about other people’s lives.

Started in 2000 in Denmark, the Human Library brings “books” (people from different walks of life, which has included a refugee, disabled parent, and person with bipolar disorder) with “readers,” who have a chance to ask questions for 30 minutes with each book.

The chapters these books share has surprised readers and given them a chance to reconsider how they view people whose lives or life experiences are different from their own.

“It’s not meant to teach people something or have them leave being converted to some new thought process,” said Chris Kretz, Head of Academic Engagement at Stony Brook University Libraries. “It gives [readers] an opportunity to speak with someone they may never normally encounter or have a conversation they may not get to have.”

The Human Library event occurs on Wednesday, Nov. 20 from noon to 3 p.m. and from 5 p.m. to 7 p.m. at the Frank Melville Jr. Memorial Library’s Central Reading Room. Participants don’t need to pre-register and can show up at the library, where about 110 readers visited last year.

Kretz recommended the latter session for interested community members, which would allow them to park for free to attend the event.

Following the defined structure created by the original Human Library, attendees won’t know about the specific backgrounds of the books until they arrive. The people that represent the books will all sit at desks wearing the same black t- shirts.

“In the conversation, the colors come out,” Kretz said.

Indeed, Richard Tomczak, Director of Faculty Engagement in the Division of Undergraduate Education at SBU and a reader at last year’s Human Library, can attest to that. Tomczak spoke with a book who grew up in the outer boroughs of New York as a member of the working class.

“When you’re having a conversation about shared experiences or experiences that are new to you, it brings out the human characteristics,” said Tomczak. “I wanted to listen and absorb it all.”

Choosing a book

When readers sit down, the book offers a prologue about their lives, providing some details about their experiences. Readers who aren’t sure where to start asking questions or perusing through different chapters in the book can use prompts at each desk to begin their interaction. Readers who stay for an entire session  will be able to interact with three or four books.

Participants of last year’s Human Library event.
Photo by Rachael Eyler, Stony Brook University

“This is an opportunity for people to hone their conversational skills,” said Kretz, as well as to learn about the lives of the books who are offering details that may surprise and move the readers.

Indeed, this year, the university is stocking tissues near each book for those readers who may feel particularly touched by the stories they hear.

The university would like to ensure that the conversation is respectful and that both sides are comfortable with the discussion.

“We have rules for readers,’ said Kretz. “When they sit down with the book, the pages are in mint condition. We want to make sure everyone is on the same page. Books don’t necessarily have to answer every question.”

Kretz urged attendees to recognize that the interaction is not a debate, but presents ways for people to understand more about their own judgments and, as the Human Library website suggests, to “unjudge” each other. In addition to speaking and asking questions, readers and the books will have a chance to process what they’ve heard.

“By design, it’s a session where you have to listen,” said Kretz. “One of the values is that people get a chance to practice this muscle.”

Second year

In the second iteration of the Human Library, Stony Brook added the later time so people could come after work. The administrators have also reached out to journalism classes and to people in international programs. 

Students from other countries will “have a chance to meet people they wouldn’t have met” during their time abroad, Kretz added.

After speaking with the people who served as books last year, Stony Brook heard that the books also wanted to serve as readers of some of the other people’s lives.

University officials were pleased with the exercise last year.

“I’m impressed by how open our community was,” said Kretz. “People learned a great deal from listening to each other.”

The university is considering making this an ongoing annual tradition and might even bring people together each semester.

Other New York schools and libraries have embraced the Human Library process, including Adelphi and SUNY Albany. The Human Library has also caught on globally, as people in 85 countries on six continents have helped facilitate these conversations.

While the participants engage in meaningful discussion, the exchange isn’t designed to create a lasting social network or lead to ongoing connections between the readers and the books.

“It’s not meant for them at the end of the reading to shake hands and exchange business cards,” explained Kretz.

The event is sponsored by the University Libraries and the DEIA (Diversity, Equity, Inclusion, Accessibility) Team with the Division of Student Affairs, Office of Diversity Inclusion and Intercultural Initiative, Office of Military and Veteran Affairs, and Diversity, Intercultural and Community Engagement, and the Program in Public Health.

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From left to right: Scientific and Pedagogic Director Professor Cesaltina Ferreira Lorenzon, Executive Vice President for Stony Brook Medicine Dr. William Wertheim and Dr. Washington. Photo courtesy Stony Brook University

By Daniel Dunaief

In the midst of the pandemic, a new health effort started at Stony Brook Medicine, the medical enterprise of Stony Brook University, that is saving lives and paying other important dividends.

Dr. Sierra Washington. Photo courtesy Stony Brook University

Led by the Director of the Stony Brook Center for Global Health Dr. Sierra Washington, the university’s initiative has improved the outcomes for many people in Mozambique, particularly pregnant mothers, over the last few years.

The maternal mortality rate at Hospital Central de Maputo was 544 per 100,000 births when Washington, who was trained at Harvard Medical School and is an obstetrician/ gynecologist, joined Stony Brook. That’s about 39 times the rate in Suffolk County, which is about 14 per 100,000 live births.

For a doctor in Mozambique, “you’re losing a mother every week,” Washington said.

When mothers die, the rates of infant and child mortality increases as well.

The rate of maternal mortality by 2023 dropped to 365 per 100,000 live births.

“That’s a testament to our sustained collaboration and the work we’ve done,” Washington said, but “it’s still way too high.”

She is aiming for a 50 percent reduction within the next five years.

The benefit for pregnant mothers extends beyond one area, as residents in obstetrics and gynecology train at Hospital Central de Maputo before they are posted to other hospitals across the nation. 

Stony Brook introduced numerous ways to improve outcomes for expectant mothers. Washington introduced education and skills building and created and stocked single use medication kits for quick evaluation and treatment of a hemorrhage or infection, built systems to perform emergency C sections in a timely way and built systems to resuscitate the mother.

In addition to obstetrics and gynecology, Stony Brook has brought expertise and equipment in emergency medicine and general surgery to Mozambique.

“It’s a bilateral exchange,” said Washington. “We send learners in both directions.”

Medical trainees travel to Stony Brook, where they return with ideas and implement them in Mozambique.

So far, 11 faculty and four residents, meanwhile, have traveled over 8,000 miles to the southeastern part of the African continent to Mozambique to teach.

Additionally, the Department of Obstetrics and Gynecology at Stony Brook gives resident lectures every Wednesday over zoom to residents in Mozambique. Washington would like to duplicate that in emergency medicine and surgery.

“Almost everyone who comes here once wants to come back,” said Washington.

Indeed, this type of program can help recruit and retain talented medical care professionals eager to contribute to the world as global citizens.

“We definitely feature the program on interview days in departments that are engaged” in this global health effort, said Washington.

Mission

Dr. Sierra Washington (left) teaching surgery to Edite Magumber (right) at the Hospital Central de Maputo. Photo courtesy Stony Brook University

Washington explained that the mission of the program is to advance global health equity, beginning in Mozambique, by building capacity for care, education and research.

Collaborators in the two countries are working on five ongoing research projects on women’s health.

The framework she has used to build the system comes from the late Dr. Paul Farmer, who was a medical anthropologist at Harvard University.

Farmer coined the five S’s of global health, which include stuff, staff, skills, space and systems.

The stuff includes critical equipment and supplies, essential medicines, sutures, gloves and other products.

“These are the things Americans take for granted when they walk through the door” at a hospital or a medical practice, Washington said.

The Global Health Equity program currently has one other full-time staff member besides Washington who is an administrator.

She would like to recruit and retain a field director in emergency medicine and surgery in the next calendar year.

Additionally, Stony Brook Health would like to add expertise in nursing, pediatrics and anesthesiology, which she considers part of phase two.

The third phase involves bringing in the kinds of systems that help make hospitals run effectively in areas such as biomedical engineering, computer science and environmental science.

These experts could help ensure that a blood pressure cuff is functioning, that the ultrasound works, the lights turn on, and outlets provide power.

Africa is where people “send second-hand medical equipment that goes to die,” Washington explained. “Without properly trained and equipped maintenance departments and without industry service contracts, there is no way to repair most equipment.”

Financial reality

The Mozambique effort has been operating on what Washington described as a “shoestring budget” of around $100,000 per year.

The system leans on grant money, the good will of the hospital center, and on private donors.

Washington would like to raise $1 million over the next year, which, she suggested, would pay dividends in the health of the population.

Additional funding would help Washington develop a tool kit to reduce maternal mortality for the country.

During their eight week visits, Stony Brook’s visiting residents have stayed with Washington when they travel to Mozambique because the university cannot afford faculty/ resident housing.

“We would love to have an eponymous donation to be able to have a Stony Brook campus here, which would include short term housing, flexible learning space and meeting space,” she explained in an email.

Since the program inception, Stony Brook has raised about $500,000 in cash or in kind. The program currently has a balance of $165,000 that will last for one more year.

Washington is passionate about and committed to the effort, which she describe as “her life’s work.”

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METRO photo

By Daniel Dunaief

My wife and I have visited with another couple, whom I’ll call Ben and Jill, several times through the years. We’ve attended sporting events and chatted at meals in different cities.

They are both pleasant and agreeable and seem pleased to reconnect with us each time.

Recently, we had an unhurried dinner where the stories went from the routine to the sublime.

Jill is worried about her second son, who is working incredibly long hours and doesn’t seem to have much, or any, work-life balance.

Her husband Ben, who is in a similar line of work to their son, worked incredibly long hours in the first years of their marriage, too.

Indeed, back in his day, Ben would work all day, come home to take a shower while a car service waited outside and then would return to work, without so much as a meal or a rest.

“I wasn’t as worried about Ben,” she said, as she spent her waking hours taking care of three children who required her considerable attention.

Like many other parents of children in the 30-ish range, Jill is eagerly waiting for her oldest son, who has been in a relationship for years, has purchased a house with his girlfriend and shares custody of a dog, to take those next steps that would not only net her a daughter-in-law but would also bring her grandchildren.

“Honestly,” she shrugged, “I thought I’d be a grandparent by now.”

Speaking of grandparents and grandchildren, Jill shared that her grandfather died last year at the age of 105.

Doing quick math, I realized that he was born the year before the Spanish Influenza of 1919 and died after the end of Covid, which means that he was one of probably a select few who lived through two pandemics in different centuries.

He had served in World War II in Washington state as a code breaker and was a widower for the last few decades of his life.

When her grandfather was 90, he needed heart surgery. Doctors wouldn’t normally perform such a procedure on a 90-year old, but they said he was much more like a typical, healthy 80 year-old.

They put a device in his heart that was supposed to last 10 years. When her grandfather reached 101, the device faltered and he had sepsis. This, the family thought, could be the end of his long life. He rebounded, however, and lived another four years, enduring vision limited in part by reduced visits to the ophthalmologist during Covid.

The conversation turned to baseball, as Ben and Jill are avid Mets fans.

I told them my memories from Game 6 of the 1986 World Series, when I was living in the Boston area and was surrounded by giddy Red Sox fans on the verge of their first championship since 1918.

Ben’s eyes lit up and he told us that he and Jill attended Game 7 of that series.

No, they hadn’t purchased tickets. They knew two people who had worked at Shea Stadium as vendors, but hadn’t worked in a while. They borrowed their vendor badges, which didn’t have their names or pictures on them, arrived at Shea two hours before the game started, and casually walked through the gate.

When they sat down in left field seats, a security guard asked them what they were doing there and they said they worked at the ice cream vendor in left field. The security guard informed them that there were no ice cream vendors in that area. They considered leaving, but instead hid in a stair well until the crowds came in.

They found an usher who allowed them to sit on the concrete steps — empty seats were unlikely in a winner-take-all game — and watched the Mets come back to clinch the title.

Whenever anyone asks Ben to share something people don’t know about him, he relates the story of their bold and successful effort to watch live the last Mets team to win a World Series.

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Cold Spring Harbor Laboratory. Photo courtesy Cold Sping Harbor Laboratory website

By Daniel Dunaief

A stock fund is taking a page out of the Newman’s Own playbook.

The food company which was started by the late actor Paul Newman and author A.E. Hotchner donates its after tax profits to charity through the Newman’s Own Foundation, enabling consumers to feel that they aren’t just covering their salad with tasty dressing but are helping the world through their consumer choices.

Range Cancer Therapeutics, an exchange-traded fund that purchases a broad basket of cancer therapeutic stocks, created a new partnership with Cold Spring Harbor Laboratory to contribute to cancer research.

The fund, which was started in 2015, plans to contribute 23 percent of its revenues, reflecting the 23 pairs of chromosomes in the human genome, each quarter to Cold Spring Harbor Laboratory.

“The contribution from Range will directly benefit the research efforts at CSHL, underscoring our commitment to advancing scientific innovation in oncology therapeutics,” Range ETF’s founder and CSHL Association Board Member Tim Rotolo, said in a statement. The ETF provides “exposure to nearly the entire lifecycle of drug development and distribution, and this new collaboration with CSHL provides an opportunity for investors to also see their money go toward the earliest stages of cancer breakthroughs.”

Revenues collected by the fund are likely to vary by quarter, depending on the amount of money the fund manages. With an estimated $12.1 million in assets under management as of the end of September and an expense ratio of 0.79%, the fund could contribute about $21,850.

“Hopefully, people will feel when they’re buying the ETF that they are in some ways supporting cancer research,” said Charles Prizzi, Senior Vice President for Advancement & Special Advisor to CSHL President Bruce Stillman.

Prizzi anticipates that the funding could support the lab’s efforts to conduct a broad range of research as CSHL’s staff, who come to the site from all over the world, seek to address the kinds of questions that can lead to advancements in a basic understanding of processes as well as to translational breakthroughs that can help in the prevention, diagnosis and treatment of various diseases.

Prizzi hopes this partnership will attract attention and inspire other fund managers or businesses to contribute to the lab, particularly amid periods when the budgets for federal funding agencies that support research rise and fall.

Borrowing from the language of genetics, Prizzi hoped that this kind of arrangement will be “replicated” by others.

 NASDAQ event

The NASDAQ stock market, which is where the Range Cancer Therapeutics Fund trades under the ticker CNCR, will celebrate the partnership on November 14th in New York City.

The Nasdaq tower will feature a visual display, while Range ETFs and CSHL leadership and guests come together at the Nasdaq podium to mark the ongoing contribution.

Dave Tuveson, head of the Cancer Center, Professor Adrian Krainer, who developed an effective treatment for spinal muscular atrophy using antisense oligonucleotide to affect gene splicing, Vice Chair Howard Morgan, and Goldman Sachs’s Roy Zuckerberg, and others will attend the event.

d Spring Harbor Laboratory President Bruce Stillman. File photo

“Cold Spring Harbor Laboratory is one of only seven national basic biological research cancer centers designated by the National Cancer Institute in Washington, DC,” Bruce Stillman, CEO of the lab said in a statement. “The institution is investing heavily in the growth of our cancer program, specifically in multidisciplinary, collaborative ventures as part of our new brain-body physiology initiative.”

Prizzi is often searching for novel ways to support research and was pleased with the contribution and hopeful that it would spur other creative donations and support.

“I hope people will learn from it and copy it,” Prizzi said. “It will benefit the lab for many years to come.”

Rotolo joined the board at CSHL earlier this year and has supported the lab for about a decade.

Rotolo had approached the lab to establish this financial commitment.

The laboratory is a 501c3 nonprofit institution, which means that donations to the lab are tax deductible.

Prizzi suggested that interested donors often reach out to him towards the end of December.

“We would love to have more people support what we’re doing,” said Prizzi.

CSHL is home to eight Nobel Prize winners and employs 1,000 people, including 600 scientists, students and technicians.

The Meetings & Courses Program bring in more than 12,000 scientists from around the world each year, offering opportunities for researchers to meet and establish collaborations and to learn about the latest scientific breakthroughs.

CSHL is in the first phase of a Foundations for the Future project, which is a seven-acre expansion effort that will tackle research in neuroscience, neuro-AI and the brain-body. Scientists will pursue better patient outcomes by exploring cancer’s whole-body impacts.

In the second phase of the project, the lab will create a new conference center and collaborative research center.

As for the connection with Range, Prizzi added that CSHL is a “lab, we like experiments. This is like an experiment. I hope it goes well and other people build off of it.”

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By Daniel Dunaief

A male mouse embryo surrounded by a group of female embryos during development in some cases is protected against developmental delays caused by a viral infection of their mother.

That’s one of a host of intriguing observations and findings from a recent set of experiments conducted by postdoctoral researcher Irene Sanchez Martin, who works in the lab of Assistant Professor Lucas Cheadle at Cold Spring Harbor Laboratory.

Irene Sanchez Martin and Lucas Cheadle at Cold Spring Harbor Laboratory. Photo by Justin Park

Sanchez Martin is studying how maternal exposure to viruses triggers immune responses, particularly inflammation, which can contribute to developmental delays characteristic of autism. 

In mice as in humans, males are much more susceptible to the onset of the kinds of neurological developmental behaviors that are characteristic of autism than their female counterparts.

“The advantage of our model is that it helps us understand why this happens, providing insights into the underlying mechanisms driving this increased vulnerability in males,” Sanchez Martin explained.

Researchers have been studying viral exposure and developmental disorders for a while. The new element in Sanchez Martin’s research is that she can observe phenotypic changes as early as 24 hours after a pregnant mouse is exposed to a virus, providing a much earlier window into how maternal immune activation affects development.

At an early stage of gestation, when sensory organs, the head, spine and other organs are starting to develop, the male mice demonstrate disruptions in normal development, which affects these structures in different ways. Sanchez Martin hopes these kinds of studies help uncover the pathways through which environmental factors contribute to the development of some cases of autism.

Sanchez Martin’s work is part of a broader effort in Cheadle’s research.

“My lab is interested in understanding how interactions between the nervous system and the immune system shape the development and plasticity of the brain,” Cheadle explained. One goal is to understand how systemic inflammation during prenatal stages leads to heightened risk of autism in offspring.

To be sure, the genetic component suggests that inflammation is not necessary for the development of autism. Nevertheless, exposure to prenatal inflammation can increase autism risk by about three times, making inflammation a likely “key contributor to the development of autism in some, but not all, individuals,” said Cheadle.

Sanchez Martin found that female mice did not develop the same changes as males. She believes this is one of the most valuable applications of the model she’s working on with Cheadle, as it can reveal the biological and developmental differences that contribute to this gender disparity.

Timing

Sanchez Martin studied mice that were exposed to a virus between 12 to 13 days after fertilization, which is similar to the end of the first trimester in a human embryo. Mice develop more rapidly, so the process doesn’t track exactly the same as it would in humans.

About a day after the maternal exposure, some males looked different through ultrasound than they would during typical development. The differences are subtle and it is still too early to assume these changes could serve as a diagnostic marker for autism spectrum disorder.

A host of disruptions could affect the growth of the embryo. The placenta serves as a bridge between the mother and the developing embryo, allowing communication, filtering substances, and protecting the embryo during development. Each mouse embryo has its own placenta and its own amniotic fluid in its amniotic sac, creating a unique microenvironment.

In her lab work, Sanchez Martin is collaborating with Dr. Brian Kalish at Boston Children’s Hospital, who is helping to analyze molecular changes in the placentas of affected and unaffected embryos. Sanchez Martin has data indicating differences between the placentas of affected and healthy individuals, as well as in the amniotic fluid.

“This suggests a dysfunction in the placenta in affected cases” indicating it is not adequately performing its protective and filtering function, she explained.

Female mouse embryos may be more protected in part because of their more active immune response. Other studies have shown that female immune systems, as early as the developmental stage, express higher levels of interferon-stimulated genes and have stronger responses to infections, which may offer better protection than males.

While male mice in some cases benefit from the protection provided by their nearby sisters, Sanchez Martin and Cheadle are “still working to fully understand the underlying mechanism,” she explained.

Epidemiology

By looking at the prevalence of conditions such as autism in the aftermath of larger viral infections, researchers have demonstrated that these illnesses can and do have impacts on the incidence of autism and schizophrenia, among other conditions. It’s not only the pathogen that is responsible, but also the immune response triggered by the infection, as well as the timing of the infection during pregnancy.

Covid, which infected over 100 million Americans, may cause an increase in the number of children born with autism.

“There is precedent from studies of other viral infections during pregnancy, which suggest that maternal immune activation can contribute to altered neurodevelopment in offspring,” Sanchez Martin said. “There is some evidence that male children exposed to SARS-CoV-2 during pregnancy might have a slightly elevated risk of other neurodevelopmental disorders.”

Additional research with longer-term follow up is necessary to confirm these findings. The timing and the immune response during pregnancy could be key factors in determining the outcomes​​.

Cheadle appreciated the effort and dedication of Sanchez Martin, whom he described as being “bright, talented, motivated and an excellent experimentalist. Her work is among the most important projects in the lab.”

From Madrid to CSHL

Born and raised in Madrid, Spain, Sanchez Martin has been a master of motion. During her final years of her Veterinary Medicine studies at Universidad Alfonso X El Sabio in Madrid, she moved to the University of Helsinki to complete her clinical rotations.

She later earned her PhD at the Centre National de la Recherche Scientifique in Marseille, France and defended her thesis at the Aix- Marseille University. During her PhD, she was a visiting student at Biocenter Oulu in Finland.

Her first job was at Laboklin in Bad Kissingen, Germany, where she worked in a clinical laboratory.

She did her first postdoctoral research in the Microbiology Department at Mount Sinai. During the pandemic, she was involved in studying innate and adaptive immune responses in different in vitro models, focusing on vaccine candidates for Covid-19 and influenza.

A resident of Manhattan, Sanchez Martin has contributed to Cheadle’s lab for two years.

She enjoys listening to classical music, reading, and swimming, which she likes to do several times a week as she has some of her best ideas when she’s in the water.

As for her work, Sanchez Martin appreciates the opportunity to conduct her research as a part of Cheadle’s team that is hoping to identify the molecular mechanisms that contribute to autism in mice.

“It’s an ongoing effort and we hope that with time and collaboration, we can gain more insight,” she explained.

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Pixabay photo

By Daniel Dunaief

Daniel Dunaief

Many people had an enormous stake in the election.

Beyond the policies, the ideas, the rallies and all the other hoopla around the hotly contested Election of 2024, people contributed significant amounts of money to back their favorite candidate or candidates.

OpenSecrets predicted that the 2024 federal election cycle would be the costliest on record, at $15.9 billion.

That’s a lot of advertisements funded by people who felt compelled to offer their financial support to candidates they thought would be the best for them, their counties, their states and the country.

So, what did we get for all that money?

Well, for starters, we had advertisements that decried the unqualified or awful nature of the other candidate. Sure, I suppose there’s some value in that.

But as a die-hard Yankees fan — a fitting phrase this year after the Bronx Bombers committed the kind of errors my son described as U8 mistakes — I’m not sure I’d want my team to spend so much time and effort trash talking, beating up or insulting their opponents.

Yes, I get it. Sports and politics aren’t the same, and yet, we the fans, supporters and general public invest in people in these arenas, hoping for the best from them.

Talking about how bad the competition is doesn’t make you better. It can scare people into voting for you, I suppose, but that doesn’t seem like a particularly honorable way to win. It also doesn’t set the tone for our children, who watch these advertisements or hear the words from would-be political leaders and wonder why they should exercise restraint on the playground after they’ve heard political leaders call each other names or insult each other. 

I suppose all those horrible words and a readiness to “fight” is far preferable to the historic human way of changing government regimes. In previous generations and in non-democratic societies, people shed blood to create a new government or bring in new leaders.

In theory, every four years, We the People can go to the ballot box and alter the direction of the country with our vote.

That brings me back to the money. Beyond the contribution to our candidate, what do we get back for the money we spend?

To borrow from Wall Street, what’s the return on our investment? Can we ask to speak with some of these leaders? Can we send ideas to improve the way government works?

No matter who wins any election, that person has a duty and responsibility to represent everyone, including those people who didn’t vote for them and their adversaries in the election cycle. The once and future president, whether he likes it or not, represents his constituents and his adversaries.

Getting elected doesn’t just give them power: it places enormous responsibility on their shoulders.

They came to us, electronic palms outstretched, asking for money and we gave it to them, despite concerns about our economic future, our desire to save for ourselves and our children and our need to invest in ourselves.

How else could we have spent that money? Could we have taken classes that enabled us to find other jobs? Could we have sent that money to charity to provide for the basic needs of people who are struggling to survive?

Now that donations helped fill many of those seats, those politicians, on day one, should make sure they listen to people, should affect positive changes and policies, and should work to ensure that they reward the public with effective leadership.

Let’s hope that money backed the right candidates, which can and should benefit the entire country.

Is it too much to ask that, one day, we all see a reasonable return on these investments?

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