This graphic illustrates the mechanisms that occur in kidney disease that leads to a poor protective antibody response against influenza infection and following vaccination. Image prepared using Biorender.com
Fighting off infections when one has chronic disease is a common problem, and during the Covid-19 pandemic that scenario often turned out to be dangerous and deadly. A new study led by Stony Brook Medicine demonstrates that advanced kidney disease compromises the survival of B cells, a type of infection-fighting white blood cell that produces antibodies to kill microbes, and thus significantly reduces the immune response to the influenza virus. The findings are published in Nature Communications.
Comorbid health conditions are critical determinants of immune function. One comorbid condition associated with increased risk of severe infection and infection-related deaths is kidney disease. Infections are the second major cause of death in patients with kidney disease. According to the International Society of Nephrology, an estimated 20 percent of patients with kidney disease die from infection. During the Covid-19 pandemic, mortality rates were as much as 10 times higher for those who had kidney disease compared to those with normal kidney function.
Lead author Partha Biswas, DVM, PhD, a Professor in the Department of Microbiology and Immunology in the Renaissance School of Medicine at Stony Brook University, and colleagues, set out to better understand why those who have kidney disease are unable to mount a protective immune response. The study centered on the condition experienced during kidney disease called uremia – the accumulation of toxic metabolites in the body in the absence of kidney filtration of the blood.
To date clinical studies often show a poor B cell-mediated antibody response after an infection or vaccination in those with kidney disease. Additionally, kidney disease is a known predisposing factor for infection complications, however the reasons are not clear.
“Most studies linking kidney disease with abnormal B cell response were either performed in kidney transplant patients or arecorelative in nature. Since kidney transplant patients are immune compromised, it is difficult to assess the impact of kidney disease on B cell response per se,” explains Dr. Biswas.
The researchers used a multiple well-characterized murine model of kidney disease that progresses to renal dysfunction in the subjects. Healthy mice and those with kidney disease were immunized with model immunogens or infected with the influenza virus to trigger a germinal center (GC) response in the spleen, which is central to the development of protective antibody level and infection-fighting response.
They discovered several cellular changes that helps to illustrate the poor immune response in the kidney disease model:
Kidney dysfunction leading to accumulation of toxic metabolites triggered cell death in GC B cells leading to poor antibody response during immunization.
A previously unidentified role of uremic toxic metabolites hippuric acid (HA) is responsible for increased cell death of GC B cells.
HA drove increased death of GC B cells via activating a specific G protein coupled receptor for niacin, which appears to further affect normal B cell response.
Kidney disease had negative impact on and inhibits GC and antibody response following influenza virus infection.
According to Dr. Biswas, the paper provides mechanistic insights on how kidney disease negatively impacts protective B cell response infection and immunization. He and his co-investigators believe that the knowledge gained from the laboratory study may shed light on how to generate protective antibody response following vaccination in individuals with kidney disease.
Currently, Dr. Biswas and colleagues are tooling up to use this experimental system to address the apparent lack of response to SARS-CoV 2 vaccination in kidney disease individuals, which may have broader implications for other respiratory virus and bacterial infections seen in these patients.
The research was supported in part by numerous grants from the National Institutes of Health (NIH), including several to Dr. Biswas, grants AI142354, AI162616, AI159058, and AI181831.
Collaborators included scientists from numerous departments and facilities at the University of Pittsburgh, and the Medical College of Georgia.
At the Milestones in Microbiology ceremony, standing alongside the Department’s commemorative plaque and a NYS Assembly Proclamation, are, from left: Theresa Koehler, ASM President; Carol Carter, Eckard Wimmer, David Thanassi, Jorge Benach; and Lorraine Findlay, from the ASM Committee on the History of Microbiology and Archives. Photo by Constance Brukin Photography
ASM honors the Department for its decades of work against infectious diseases
The Department of Microbiology and Immunology in the Renaissance School of Medicine (RSOM) at Stony Brook University was named a “Milestones in Microbiology” site for its advancements in the diagnosis and treatment of infectious diseases globally. The designation by the American Society for Microbiology (ASM) recognizes academic and research programs in which “major developments and pivotal discoveries occurred.”
The RSOM Department is only the 20th program nationally to receive this distinction, the third in New York State and second on Long Island. Faculty from the Department and University gathered at a Wang Center Ceremony at Stony Brook University on October 17 to commemorate the honor. They received a plaque from the ASM that commemorates the outstanding research and discoveries by the Department at large, since its inception at Stony Brook in 1972.
“The designation of the Department of Microbiology and Immunology as a Milestones in Microbiology Site is an honor and recognizes the impact the Department has made through its groundbreaking discoveries,” said David Thanassi, PhD, the Zhang Family Endowed Chair of the Department of Microbiology and Immunology. “This distinction not only reinforces the significant contributions of our former and current faculty, students and staff, but also raises the profile of the Department and University to the wider scientific community.”
“ASM is delighted to recognize Stony Brook University’s Department of Microbiology and Immunology as a ‘Milestones in Microbiology’ site for its significant contributions to the microbial sciences,” said Theresa Koehler, PhD, ASM President. “The university’s pioneering work investigating causative agents of human diseases have had far-reaching impacts in the sciences and society at large.”
The Department was awarded the Milestones distinction for its broad research and many discoveries. Specifically, the ASM recognized the following accomplishments:
The landmark discovery by Founding Department Chair Joseph Kates, PhD, that viruses could package enzymes required for their replication, with the first demonstration of the vaccinia virus encapsulating the DNA-dependent RNA polymerase enzyme. This laid the groundwork for targeting viral polymerases as a widespread therapeutic strategy.
The discovery of Borrelia burgdorferi, the causative agent of Lyme disease, by Jorge Benach, PhD and colleagues, along with its isolation from patients and characterization of its environmental reservoir, paved the way for successful antibiotic therapies.
The first description of the de-novo chemical-biochemical synthesis of a virus (poliovirus) in the absence of a natural template by Dr. Eckard Wimmer and the co-discovery of the human receptor of polio virus. This marked the beginning of the total synthesis of microorganisms in the absence of natural templates, enabling new strategies in virus vaccine development.
“As a member of the faculty for several decades, it has been inspiring to witness the emergence of ideas and findings in which the outcomes have had such tremendous impact,” said Carol Carter, PhD, Distinguished Professor in the Department of Microbiology and Immunology. “Over the years, I have worked with incredible colleagues, students and supporting staff.”
Five decades impacting infectious disease discovery
In addition to the highlighted research of Drs. Kates, Wimmer and Benach, the Department during its five decades made other groundbreaking discoveries. These include pioneering work in molecular biology on the structure of DNA and regulatory mechanisms of RNA, foreshadowing research by others leading to the Nobel prize this year on the role of regulatory RNAs in eukaryotic cells.
The Department has contributed major findings related to tumor formation and cancer, and has long been a leader in research on pathogenic viruses, bacteria and fungi, revealing how these organisms cause infections and interact with our immune defenses. This research has yielded fundamental biological insights and provided a foundation for the development of therapeutics for the prevention and treatment of disease.
Some of the more recent work impacting the world of infectious diseases includes the role of how cancer-causing herpesviruses manipulate the host to establish life-long infections, advancing the understanding of Adenovirus replication, and unraveling the structure of bacterial appendages that enable kidney infections.
“Although the Milestones in Microbiology designation commemorates past accomplishments, it also sets the stage for future innovations and motivates the Department to keep pushing boundaries, pursue new questions, and lead the way in solving the challenges of tomorrow,” said Peter Igarashi, MD, the Knapp Dean of the RSOM, who pointed out that the Department has had consistently strong funding success, including 17 grants totaling more than $8 million in funding from the National Institutes of Health in fiscal year 2024.
During the ceremony the department also received a Certificate of Recognition, a Proclamation by New York State Assemblyman Hon. Ed Flood.
For more about the ASM Milestones Program and list of other awarded institutions nationally see this link.
The Department of Microbiology and Immunology is one of 25 departments within the RSOM. It is dedicated to advancing the knowledge of the fundamental causes, means of prevention and treatment of human diseases, and to educating the next generation of scientific investigators in infectious diseases and related fields. For more see this link.
Physician researcher and educator Dr. Joe Verghese joins the RSOM
Joe Verghese, MBBS, MD, MS, has been named Chair of the Department of Neurology at the Renaissance School of Medicine (RSOM) at Stony Brook University. Appointed by Peter Igarashi, MD, Knapp Dean of the RSOM, Dr. Verghese is a nationally recognized expert in the areas of gait and cognition in aging. His appointment began on October 14.
Dr. Verghese comes to the RSOM after more than two decades at the Albert Einstein College of Medicine in New York. Most recently, he served as Professor of Neurology & Medicine and was Einstein’s inaugural Chief of the Division of Cognitive & Motor Aging in the Department of Neurology. In addition to being the Murray D. Gross Memorial Faculty Scholar in Gerontology at Einstein and a former Chief of Geriatrics for Montefiore Medical Center’s Department of Medicine, he was also the Founding Director of the Montefiore Einstein Center for the Aging Brain, an interdisciplinary clinical dementia and cognitive assessment center named as a Center of Excellence in Alzheimer’s disease by the New York State Department of Health in 2016.
“Our aging society has a great need for medical experts who will advance preventive and treatment strategies for age-related illnesses, and the selection of Dr. Verghese as our new Neurology Chair ensures that this area of medicine will thrive within the Renaissance School of Medicine,” says Dr. Igarashi. “Dr. Verghese is a leading physician researcher, innovator and educator in neurology and specifically with cognitive aging issues.”
Dr. Verghese’s work has helped characterize non-cognitive features in prodromal stages of dementia, such as gait, and define Motoric Cognitive Risk Syndrome, a pre-dementia syndrome that provides an easy and clinically assessable way to identify older adults at high risk for dementia.
Much of Dr. Verghese’s career has centered on a broad range of investigation involving issues around aging and dementia. Early on he studied the epidemiology of dementia, particularly around pre-dementia syndromes and risk factors. Then he moved toward research of gait disorders, frailty and falling, but also investigated cognitive processes and brain substrates by way of a number of methods such as epidemiological, biological, experimental, clinical translation, and interventional research approaches.
“By harnessing the expertise of our exceptional Neurology team at Stony Brook, I believe we can deepen our understanding of neurological disorders, train the next generation of neurologists, and significantly enhance treatment outcomes for our patients on Long Island and beyond,” says Dr. Verghese. “My primary goal as Chair is to cultivate a collaborative environment that not only fosters innovative research and comprehensive patient care but also prioritizes education. I extend my heartfelt thanks to Dr. Igarashi for this opportunity.”
Dr. Verghese graduated from St. John’s Medical College in Bangalore, India, and completed postgraduate training in Internal Medicine and Neurology in the United Kingdom. He completed a Neurology residency at Einstein in 1998, followed by a fellowship training there in Neurophysiology and in Aging & Dementia.
The author of more than 300 peer-reviewed articles, reviews, and chapters, Dr. Verghese has secured more than $200 million in research funding from the National Institutes of Health (NIH). He has continually received NIH funding for his research since 2002 and is currently the Principal Investigator on five active NIH grants.
Dr. Verghese is a member and Fellow of the American Academy of Neurology, the American Geriatrics Society, the Gerontological Neurological Association, and the American Neurological Association. He has received numerous accolades during this career, including the Beeson Award from the National Institute on Aging, the Outstanding Scientific Achievement for Clinical Investigation Award from the American Geriatrics Society, and the Joseph T. Freeman Award from the Gerontological Society of America.
Having mentored more than 100 trainees and junior faculty over his time at Einstein, Dr. Verghese is the only faculty member to receive the Einstein Clinical Research Training Program’s Mentor of the Year Award twice.
They bother us, particularly in the summer, but they don’t need us.
The 23 species of Borrelia bacteria, which cause Lyme disease, have been around for millions of years, dating back to when the continents were all linked together like pieces of a puzzle in Pangea. The bacteria likely infected early mammals in those days.
In a recent paper in the journal mBIO, researchers from over 12 institutions put together the genetic sequence of these bacteria, which include 47 strains.
The scope of the work “was enormous and we were lucky” to have so many dedicated investigators, said Ben Luft, Edmund D. Pellegrino Professor of Medicine at the Renaissance School of Medicine at Stony Brook University, including lead senior author Weigang Qiu, Professor of Biology at Hunter College of the City University of New York.
The work, which took about a decade to complete, could provide a valuable resource to researchers and doctors today and in the future. The genetic information could lead to advances in diagnostics, treatment and prevention of Lyme disease.
Scientist could use the database to compare the genomes of different species and variations that cause different symptoms to help diagnose the likely severity of an infection as well as to search for specific pathways that lead to the virulence of an infection.
Some infections can lead to fever, headaches, fatigue and a skin rash. Starting with the bite of an intermediate host such as a tick, these infections, when left untreated, can lead to problems in the joints, heart, and nervous system.
The number of new cases of Lyme disease each year has been climbing, reaching close to 500,000 per year in the United States.
Researchers added that creating a genetic catalog of the different bacterial species can also help current and future scientists and doctors manage new threats from strains of bacteria that move into new areas amid climate change.
These species haven’t interacted with each other in the past, but climate change may create opportunities for bacteria to create recombinant genes, presenting new threats to human health.
“You may start seeing things that you didn’t see before,” said Luft. “We don’t know what’s going to happen” amid climate change. “There might be new forms” of Lyme disease.
The challenge with Lyme is not necessarily what happens in 2024, but how it might change in 20 years, when organisms develop a new pathogenicity.
Lyme on four continents
An international team of researchers sequenced the genomes of many species of Borrelia, the cause of Lyme disease. By comparing these genomes, the researchers reconstructed the evolutionary history of Lyme disease bacteria. The map shows many of the global regions where the team sequenced a species. Borrelia burgdorferi, the most common cause of disease, is indicated in red. Other species are indicated by different colors. Image created by Saymon Akther
In addition to generating a database of the Lyme disease bacterial genome, the researchers wanted to develop an understanding of its phylogenetic history.
“The goal really was to show how genetically diverse Borelia is throughout the world,” said Luft.
The researchers gathered genetic data from this bacteria, which was sampled in Europe, Asia, and North and South America.
By collecting the genetic information in each of these locations, the scientists were able to recreate the history of a bacteria that’s lasted considerably longer than many other organisms that have since become extinct.
“The genetic make up (genes and plasmids) hasn’t changed very much since the last common ancestor on Pangea (otherwise we would see different sets of genes and plasmids from different continents),” explained Qiu.
An extensive collaboration
Qiu and Luft were grateful for all the work scientists around the world did to contribute to this study.
On Long Island, Lyme disease is transmitted mainly by the bite of an infected deer tick, also is known as the black-legged tick.
The team of Claire Fraser and Emmanuel Mongodin at the University of Maryland School of Medicine and Richard G. Morgan of New England Biolabs helped use next generation sequencing to determine the bacterial genome.
Indeed, Fraser was the first to map the complete genetic code of a free-living organisms. She worked with the Haemophilus influenza, which causes respiratory infections and meningitis in infants and young children, according to the University of Maryland School of Medicine.
Qiu, who earned his Phd from Stony Brook in 1999, suggested that the effort required regular, ongoing work. He supervised Dr. Saymon Akther for her thesis work, which was the basis of the paper. He also performed additional evolutionary analysis.
“For the past two years, we have been having weekly meetings on zoom,” said Qiu. “It’s a big relief” that the researchers published the study and shared the information with the scientific community.
Qiu credited Luft with being a consistent coordinator of the sequencing effort and diversity study for over 20 years.
The next steps
At this point, Luft and his colleagues are eager to share the information with the broader scientific community.
The researchers hope experts in artificial intelligence, bioinformatics and computer programming can use the data to understand more about the genome and develop potential therapeutic targets.
Luft is eager to see “how smart people take advantage of a decade’s worth of work that has been very carefully done, to move it all forward,” he said. “We have certain ideas that we are doing” to fill in the gaps.
Qiu has some existing grants he’s using to work on diagnostics and vaccine development.
Qiu, along with chemistry-department colleague Brian Zeglis, and Lyme diagnostic/ vaccine researcher Maria Gomes-Solecki, has a joint NIH/ NIAID grant to develop a novel PET-based technology to detect Lyme pathogens in vivo. They have also proposed a new Lyme vaccine design strategy.
Additional sequencing of the variable plasmid, which is not a part of the chromosomal DNA but can replicate independently, would continue to help determine what genetic codes contribute to the level of virulence for each strain or species.
“That’s like the last mile for the communication network,” said Qiu. The challenges include annotating the genomes, providing comparative analysis and using informatics development to share the genome variability with the research community.
Stony Brook University named physician-scientist Dr. Imoigele “Imo” Aisiku as chair of the Department of Emergency Medicine at the Renaissance School of Medicine, starting Aug. 15.
A national leader who has dedicated his career to critical care and neurocritical care in emergency medicine, Aisiku worked for more than a decade at Brigham and Women’s Hospital and Harvard Medical School.
Aisiku, who was born in Nigeria and raised in Brooklyn and Auburn, Massachusetts, found several factors appealing about the Stony Brook role.
“My immediate family is predominantly in the Northeast” stretching from New York to Richmond, Virginia,” he said. Additionally, he suggested that numerous aspects of the role were “right in my area of expertise.”
His experience at Brigham and Women’s Hospital involved integrating systems, and he recognizes the opportunity to deploy that skill set at Stony Brook, where he will help integrate the emergency department at different hospitals.
He also has considerable experience in critical care, which is a strength at SBU.
“There are some natural synergies that you couldn’t script” he added, including strong clinical interest in stroke, telehealth, critical care and a desire to develop a systems integration model
Indeed, before he came to Brigham and Women’s Hospital, Aisiku worked at the University of Texas at Houston. UT Houston/Memorial Hermann was one of the earliest to be named a JCAHO Comprehensive Stroke Center.
Aisiku was the medical director of their neurosurgery intensive care unit, which had one of the first mobile stroke units in the country. The unit was a collaboration between EMS, neurology, the stroke division, EM and the ICU.
A mobile stroke unit can provide critical and timely diagnostics and care for people having a stroke, which can not only save lives but can also lead to a dramatic improvement in the outcome after a stroke event for patients.
Stony Brook currently has two mobile stroke units and is working on adding a third.
“I hope to leverage what is the strength of Stony Brook with my experiences” and strengthen any weaknesses in a bidirectional manner, said Aisiku, who will report to Peter Igarashi, dean of the Renaissance School of Medicine.
For his part, Igarashi was eager to welcome the new addition to the emergency department.
“We are thrilled that Dr. Aisiku will lead Stony Brook’s remarkable team of emergency physicians,” Igarashi said in a statement. “As a pioneering physician-scientist in neurocritical care, and as an emergency medicine scholar and researcher, Dr. Aisiku will help advance our capacity to save lives and care for critically ill patients in the years to come.”
Evolutionary change
The new emergency department chair is hoping to learn more about Stony Brook’s strengths and weaknesses before implementing any changes.
“I hope to make a change and a difference,” Aisiku explained in an email. “I believe it is prudent to aim for evolutionary change and, if there is an opportunity, for positive revolutionary change.”
His goal is to see the department grow from a regional strength to a national and even an international strength.
He plans to develop partnerships with other chairs and departments and hopes to enhance programmatic and faculty development.
Aisiku also hopes to develop opportunities for faculty at Stony Brook, including in areas that involve research. He would like to see the department earn more National Institutes of Health and federal funding.
DEI experience
An accomplished physician, researcher and administrator, Aisiku also has considerable experience building and encouraging opportunities for underrepresented groups in medicine.
Aisiku was the founder and director of the Offices of IDEaS, which stands for Inclusion, Diversity, Equity and Social Justice, in Emergency Medicine at Brigham and Women’s Hospital, where he credits a team of faculty administrative staff and supportive chair for the success of that effort.
Aisiku “played a crucial role in the development of the office of IDEaS,” Jayelani Hall, administrative manager for Emergency Medicine and the Office of IDEaS at Brigham and Women’s Hospital, explained in an email. Aisiku’s vision for creating an inclusive environment and commitment to equity and diversity were “instrumental in shaping the initiatives and programs that define IDEaS today.”
IDEaS has launched several initiatives, such as the Profile in Diversity Series and the SPAK Grant program, which provides funding to projects that advance diversity, equity and inclusion.
The office established scholarship programs to support underrepresented students pursuing careers in medicine and health care, Hall added.
The president of Brigham and Women’s Hospital named Aisiku endowed Distinguished Chair in Health Equity and Diversity.
The broader Stony Brook area extending to New York City “draws diverse and international people to the region,” Aisiku explained. “While I acknowledge that [DEI] is an area of controversy in our country, I believe continuing to strive for diversity has a significant role for the development of our youth all the way to impacting our patients.”
In speaking with the leadership of the hospital and medical school, Aisiku believes his diversity goals are “aligned in these efforts” as he looks forward to developing strategies that will lead to diverse students, residents and faculty.
In addition to providing opportunities to students in the health care field, a more diverse population of caregivers enhances the patient experience, Aisiku contends.
A diverse health care force provides greater opportunity for patient choice and advocacy, he added.
Aisiku, who has master’s degrees in business administration from Goizueta School of Business and a master’s in clinical research from Rollings School of Public Health at Emory University, would like to partner with the business school and the school of public health, among others, to build diversity, which may broaden and enhance his efforts in this area.
People who have worked with Aisiku appreciate his commitment and openness to those around him.
Aisiku is “known for his compassion and dedication both as a physician and as a leader,” Hall wrote. “He consistently goes above and beyond to ensure that his patients receive the best care possible and his commitment to equity in health care is evident in all his endeavors.”
Hall suggested that the Stony Brook community is fortunate to have Aisiku in this role.
“Given his track record, I fully expect him to engage deeply with students, faculty and community members, fostering connections and driving positive change,” Hall explained.
From left to right, Robert Samuel Decosta Higgins, Jayelani Hall, Imoigele Aisiku, Ron Walls and Mike VanRooyen, at a ceremony for Aisiku. Photo courtesy Imoigele Aisiku
Telehealth experience
Over a decade ago, Aisiku started iDoc Telehealth Solutions, a telemedicine company dedicated to critical and neurocritical care and tele-stroke services, with the goal of providing this type of care to people in areas that didn’t have enough clinicians with that experience.
Since then, he has become co-CEO of a public company called VSEE Health.
He expects to pass the torch on to other executives. His commitment is to the university as his obligation to the company is for about four more months.
To be sure, he wants to ensure there are no conflicts of interest in his roles at Stony Brook and in the decision about how and in what ways the university can continue to build telehealth capacity.
“If there is an opportunity to enhance an area, with full disclosure, there can be pathways to achieve things that improve the patient experience while separating ‘church’ and ‘state’ so to speak,” he explained in an email.
Morana Lasic, interim chief diversity & inclusion officer at Brigham and Women’s Hospital, suggested that Aisiku has served as a personal and institutional resource for a wide range of people.
Aisiku “works with those who are yet to enter the medical field and need mentorship, just as he does with institution presidents,” Lasic explained in an email. “He empowers those on his team and pays special attention to those who are often forgotten in mentorship (such as young administrative staff.)”
Lasic added that Aisiku was generous with his time and has reached out to her with emails and new thoughts and ideas at any time of day.
“Just like the rest of his life, his sleeping schedule is unique and his own, and he wears an Oura ring (which tracks sleep patterns) just to confuse it,” Lasic said.
In his research, Aisiku has focused on three areas: traumatic brain injury, subarachnoid hemorrhages and acute respiratory distress syndrome/sepsis.
Aisiku is living with his wife Diana, who is a nurse, and their 4 1/2-year-old son Myles in Westbury. They are in the process of searching for a home.
Outside of work, Aisiku has a black belt in the martial art of Jeet Kune Do, enjoys working out and played Division 3 tennis and basketball, at Worcester State University. He is also a motorcycle enthusiast.
As for his likely contribution to the Stony Brook community, Lasic, who has been at Brigham and Women’s Hospital for 25 years, suggested that she anticipated he would continue on an impressive journey.
Aisiku is “one of the most innovative leaders in academic medicine I have seen in a long time,” she wrote. “He is a true role model in his ability to connect with those around him.”
World Trade Center worker. Photo courtesy Steven Spak
By Daniel Dunaief
First responders who raced to the World Trade Center site on 9/11 or who helped with the massive clean up effort did so at risk to themselves.
That was as true during those days and weeks after the attack as it is now, with many of the first responders experiencing a range of diseases and conditions linked to the difficult work they did in 2001.
In a study released recently in the journal JAMA Network Open, Sean Clouston, Professor in the Program in Public Health and in the Department of Family, Population and Preventive Medicine in the Renaissance School of Medicine at Stony Brook University, showed that 4.6 percent of the responders in a study developed dementia. That compares with 0.5 percent for the general population of people who would develop cognitive declines in a similar age group.
Between November of 2014 and January of 2023, 228 responders without dementia and under 60 years old at the start of the study developed dementia over the next five years.
“It’s stunning to see these kinds of symptoms in such young people,” said Clouston.
Through the Stony Brook WTC Health and Wellness Program, Clouston and other researchers have documented some of the cognitive declines in this population, who likely inhaled the kinds of fine particulate matter that can enter the brain and cause damage even as the immune system fights to try to target the unwelcome contaminants.
“We assume this made it in the brain, but in such a way that it wasn’t overwhelming immediately,” said Clouston. “Once you get into a neurodegenerative space, most of these diseases take a long time to develop” with neurodegenerative processes sometimes taking decades to occur.
The exposure could have caused an immune reaction. They are not sure whether symptoms emerged because the reaction was stronger or if the symptoms developed because higher exposure triggered a stronger reaction.
“It’s like trying to fight a fire, and the truck rolls over a garden to do it,” said Clouston.
Fortunately, the brain has considerable redundancy, which makes it possible to reroute brain signals to compensate for problems. Over time, however, that ability might be damaged by that work or by the exposure.
Determining which particular chemical or chemicals causes the greatest damage is difficult, particularly because the collapse and burning of the buildings caused a heterogeneous mixture of so many industrial products to enter the air. It may not matter much, as any material in the brain could be a problem. The type of exposure may also affect the severity of the immune reaction or which parts of the brain are damaged.
Scientists suggest that some of the contaminants that have contributed to health defects may come from the various tools in offices, such as computers and air conditioners.
“As we go forward [with other studies], that will be a focus of ours, to see if we can’t isolate at least one or maybe a couple” of chemicals that could exacerbate the cognitive decline, Clouston said.
Different exposures
Clouston and his collaborators used surveys to find out exposure at the site.
Some of the first responders, for example, used face masks and wore personal protective equipment, including hazmat suits. The incidence of dementia among that group was considerably lower than it was for those who didn’t wear masks.
Five or six out of every 1,000 workers who wore PPE developed dementia, while those without protection developed cognitive decline at the much higher rate of 42 out of 1,000.
The researchers tried to address the possibility that those people who were masks lived a healthier lifestyle prior to 9/11 and may have already been less likely to develop diseases or health conditions.
“We tried to account for that,” Clouston said. In most cases, people aren’t avoiding the kinds of activities or decisions that likely contribute to dementia, such as diet and exercise, which, the general population “widely ignores already,” he said.
Additionally, while a family history of dementia or other medical conditions mattered to some degree for the reported cases, they weren’t sufficient to invalidate the statistically significant result.
To be sure, Clouston acknowledged that the study could have a screening bias, as cognitive evaluations every 18 months likely far exceeds how often most people in the same age group receive testing for their mental acuity.
This is one reason they developed a minimally exposed group that could account for that bias. In that group, dementia was close to, but still higher than the expected rates for the general population.
The number of first responders with dementia far exceeded this group.
Other health threats
Medical professionals have been studying the impacts of other events that release aerosolized particles that could be hazardous to people’s health and could damage the environment.
Burn pits, which the military used in Iraq and Afghanistan, among other locations, contributed to cancers and other diseases among members of the military serving overseas.
Natural disasters, such as the Maui fire last August that not only burned through forests but also destroyed commercial buildings, also create a hazard.
People fled the fire quickly and then returned to search for their loved ones, Clouston said, which exposed them to aerosolized dust.
It would be “good to think about studies to consider risk of dementia” from these events, he added.
“These studies would probably take a while to complete as the risk grows with time and with age.”
Salvatore Capotosto hugs his wife Federica Bove at Stony Brook Medicine Match Day 2024. Kristy Leibowitz
By Daniel Dunaief
A former professional soccer player from Italy, Salvatore Capotosto recently experienced a different kind of pressure, this time in front of his wife and her parents.
Joining the rest of the Renaissance School of Medicine at Stony Brook University class of 2024, Capotosto awaited the countdown for Match Day to learn where he would serve his residency.
Capotosto, who already knew he’d matched with one of the hospitals on his list for an orthopedic surgery residency, opened the same kind of envelopes medical students around the country were opening at noon Eastern Standard Time.
After the countdown, Capotosto learned he matched with his first choice, Mt. Sinai Hospital in New York City.
“It’s a very great dream for us,” said Capotosto, referring both to the opportunity for him and his wife Federica Bove to live in the city and to the excitement his extended family in the small town of Itri felt. Reading where he was going was “an explosion of emotion.”
Capotosto and Bove shed tears of happiness as they pondered the next step in an American journey that began eight years ago when they started college at Midwestern State University in Wichita Falls, Texas. While Capotosto received medical training at Stony Brook, Bove earned her Master of Business Administration at Pace University.
The first member of his family to become a physician,Capotosto said he spent considerable time explaining the lengthy residency and matching process to his family.
“It doesn’t matter how many millions of times” he shared the medical steps with them, he said, “they will still ask” about the next steps.
Humble origins
The son of cafe owner Luigi, the future orthopedic surgery resident didn’t always set his sights on either a high-powered athletic career or on becoming an American doctor.
“I used to walk to school and stop at my dad’s cafe and eat a croissant and drink cappuccino for breakfast and I would scream that I didn’t want to go to school and that I wanted to work at the cafe,”Capotosto said. His father kicked him out of the cafe and told him to “go study.”
The Capotosto son said he learned his work ethic from his extended family, for whom work is a responsibility and a passion. Watching his father put time and effort into his work helped him put in 100 or more hours some weeks to meeting his responsibilities and mastering medical material.
Capotosto hasn’t been able to convince his father visit him in New York since he arrived on campus. This year, however, his parents booked a trip to see their son graduate.
Packages from home supported him through school and helped reduce the distance from his close family, who sent olives and olive oil every few months that were made from the 200 olive trees on his grandfather Pietro Mancini’s property.
A rising soccer star
Capotosto developed a passion for soccer when he first started playing the game at the age of six. He poured considerable energy into developing as a goalie.
He achieved considerable success, playing in front of crowds of over 4,000 people for professional and semi professional teams. In Naples, he trained with his idol, goalkeeper Morgan De Sanctis.
Capotosto was in the academy of the professional Napoli team for four years, including training with the first team.
When he played soccer, Capotosto suggested he was a “perfectionist,” honing his technique through hard work and preparation.
During his playing days, Capotosto sustained several injuries that took him off the field, including a scaphoid bone injury that ended his career.
Unsure of the next steps in his life, Capotosto appreciated not only the help and support of the doctors who came to his aid on the field, but also the career inspiration.
“I like to say that orthopedics saved my life,” Capotosto said. “Without the flame to push me to stand up and find a new purpose, I would have taken wrong turns in those dark moments. I’m really grateful to this field.”
Some of Capotosto’s mentors at Stony Brook, in turn, appreciate the considerable positive energy the former goalie brings to medicine and the way he relates to everyone from hospital staff to patients.
“He’s immediately disarming,” said Dr. James Penna, orthopedic surgeon and Chief of Sports Medicine at the Renaissance School of Medicine at Stony Brook University. “Even patients who are scared or who are dealing with pain” relax when they are around him.
Dr. Edward Wang, Chief of Shoulder/Elbow Surgery and Clinical Professor in the Department of Orthopedics at the Renaissance School of Medicine, recalled that he offered Capotosto the opportunity to shadow him in the operating room early in his medical school career.
Capotosto picked up the do’s and don’ts of the operating room quickly, while the members of the team recognized his dedication and commitment.
“The staff took a real liking to him immediately,” Dr. Wang said. “Orthopedics is lucky he chose” the field.
In the last few months, Capotosto, who is 29 years old, has reached several milestones. He and Bove received green cards in February, which allow them to live and work permanently in the United States. The couple, who met when Capotosto was 18, also got married on April 22 in Central Park. They are planning a religious ceremony in Italy in May at Bove’s childhood church.
Sports and medicine
The field of orthopedics has attracted athletes from numerous sports, as former competitors have turned their focus and dedication towards preparing for games to the challenging world of helping people recover from injuries.
“A large percentage of applicants have some sorts of sports background,” with numerous doctors sharing stories about injuries such as a torn anterior cruciate ligament or about a relative who received knee replacement surgery, said Dr. Penna, who was not a college athlete.
“We have a lot of former athletes in our program,” added Dr. Wang, who swam competitively in a Division 1 program at the University of Miami. “Athletes like orthopedics because of the physicality and definitive nature and the exposure in the past.”
While Dr. Wang suggested that a range of character-defining elements helped shape Capotosto, he added that the former soccer star’s injuries enhanced his ability to connect.
“Being on the other side [as a patient] gives you empathy,” said Dr. Wang.
While Capotosto enjoyed his time in soccer, he is pleased with the current chapter in his life.
“Playing was a great opportunity, but, I think being an orthopedic surgeon is way better from my standpoint right now,” he said. “I believe in the mission.”
The Stony Brook medical staff, meanwhile, believes in him.
“There will be a lot of disappointed attendees” when Capotosto leaves the school, said Dr. Penna. “The janitors knew who he was.”
Dr. Harold Paz. File photo by Stony Brook Medicine/Jeanne Neville
Two years after he joined Stony Brook University as executive vice president for health sciences, Dr. Harold “Hal” Paz is no longer one of the most senior members of New York State’s southern flagship university staff.
An internal SBU announcement that went out Friday, Oct. 6, from the office of President Maurie McInnis indicated that Paz, whose page on the Renaissance School of Medicine website no longer links to information about him, will be replaced on an interim basis by Dr. William Wertheim.
Wertheim joined Stony Brook in 1996 and had been serving as the vice dean for graduate academic affairs at the Renaissance School of Medicine, where he had previously been interim dean.
Wertheim is also an Endowed Chair in Graduate Medical Education at the School of Medicine and is president of the Stony Brook Medicine Community Medical Group.
While Stony Brook didn’t offer a reason for Paz’s departure, officials indicated it is “not our practice to discuss personnel matters.”
Paz had come to SBU from The Ohio State University, where he was executive vice president and chancellor for health affairs and chief executive officer of the Ohio State Wexner Medical Center.
Paz, who was Chief Executive Officer of Stony Brook University Medicine, reported to McInnis and was a member of her senior leadership team.
When Stony Brook announced that executive vice president and provost Carl Lejuez joined the university in May 2022, the university signaled that Lejuez would work collaboratively with Paz.
Paz had also been working with academic, hospital and clinical leadership and with community partners in his role.
The announcement of Paz’s departure from SBU, which came two years and two days after his official start date, did not include a list of any of Paz’s achievements, initiatives or contributions to the university.
Before joining The Ohio State University, Paz was the executive vice president and chief medical officer for CVS Health/Aetna, serving as a leader in the company’s domestic and global businesses. He also served as dean of the College of Medicine at Pennsylvania State University and CEO of the Penn State Hershey Medical Center and Health System.
Paz had succeeded Dr. Kenneth Kaushansky, who retired as senior vice president of health sciences, in June 2021.
Paz serves on the National Academy of Medicine Leadership Consortium, the board of directors of Research America and the Curai Health advisory board.
In April, Paz was appointed to the National Academies of Sciences, Engineering and Medicine Amyotrophic Lateral Sclerosis: Accelerating Treatments and Improving Quality of Life committee.
Wertheim’s tenure
Wertheim started his Stony Brook career by leading the Medical Consult Services. He later served as associate program director and director of the primary care track of the Internal Medicine residency, then Internal Medicine residency program director, and then executive vice chair of the Department of Medicine and associate dean for clinical outreach.
Wertheim has also served as the president of the medical staff at Stony Brook University Hospital.
Wertheim graduated from Harvard University and New York University School of Medicine. He completed his residency at the University of Michigan Hospitals, where he served as chief resident.
Wertheim worked as a clinical faculty member at the University of Michigan’s Veterans Administration Hospital. In New York, he worked at The Brooklyn Hospital Center.
The letter from the president’s office announcing the changes urged the community to “join us in congratulating Dr. Wertheim on his appointment and welcoming him to his new role.”
Dr. Susan Hedayati, right, and Dr. Peter Igarashi attend the ASCI/AAP meeting in Chicago Spring 2023. Photo courtesy Hedayati
She is bringing two important parts of an effective team back together.
Dr. Susan Hedayati — pronounced heh-DYE-it-tee — recently joined the Renaissance School of Medicine at Stony Brook University as vice dean for research. Hedayati was most recently a professor of medicine and associate vice chair for research at the University of Texas Southwestern Medical Center.
Hedayati plans to help improve Stony Brook Medical School’s national and international reputation by coupling frontline research with translational and patient-oriented care and studies.
The combination of a research and clinical care focus will provide for the “betterment of the health of Long Island population of patients,” Hedayati said.
In addition to enhancing clinical care, such an approach would “facilitate funding of investigator-initiated [National Institute of Health] grants and aid in the recruitment and retention of excellent M.D.-investigators,” she explained in an email.
She said she is eager to build an institutional clinical trials infrastructure that would involve a dedicated research support team.
Adding Hedayati to the medical school faculty at Stony Brook University, where she will also serve as the Lina Obeid chair in biomedical sciences, also brings two prominent kidney specialists who have different approaches to their work back together again.
Dr. Peter Igarashi, dean of the Renaissance School of Medicine and a nationally recognized nephrologist, had recruited and collaborated with Hedayati when she joined the University of Texas Southwestern Medical Center after winning first place in a clinical research award at the Southern Society for Clinical Investigation Young Investigator Forum.
When Igarashi first met Hedayati as a judge of the fellowship competition, he suggested that her expertise stood out clearly.
“She has enormous content expertise in the field of nephrology and internal medicine more broadly,” he said.
He was also impressed with her “passion” for research and her “devotion to patients and research,” which has also made her a “perfect fit” for her current position at Stony Brook University.
Combining research and clinical care will enable SBU to provide one-stop shopping at facilities like the specialty practices in Commack and the one recently opened in Lake Grove in the former Sears building at the Smith Haven Mall, he said.
Patients can receive clinical care at the same time that they can enroll in clinical trials for potential treatments of some conditions.
Hedayati “set that up at the University of Texas at Southwestern, and I’m hoping she’ll be able to grow that capability here,” Igarashi said.
Igarashi also described Hedayati, who was offered the job after a committee conducted the search, as “personable and likable.”
Complementary strengths
Igarashi described the different research approaches he and Hedayati take as “complementary” strengths.
Igarashi’s research is basic, wet lab science, while Hedayati has focused on translational and clinical research.
Their backgrounds will “be very helpful for elevating the entire research enterprise, not only in basic science but also in clinical and translational research,” Igarashi noted.
For her part, Hedayati suggested that her short-term goal is to build the physical infrastructure for clinical research and clinical trials.
Such efforts will require a clinical research staff infrastructure composed of research coordinators, research managers, regulatory personnel and biostatisticians.
“I’m hoping that, within a year, we’re going to be making some big strides in those directions,” Hedayati said.
She also hopes to build upon the existing medical scientist training program for M.D./Ph.D. students to establish a physician training program for residents to retain M.D. investigators in academic and biomedical research careers. That, she suggested, is a pool that is dwindling nationally.
Ongoing research
Hedayati, who is transferring most of her grants to Stony Brook, plans to continue conducting her own research.
She has been studying the link between chronic kidney disease, which affects about one in seven people, and other conditions, such as premature cardiovascular disease, susceptibility to depression and the role of inflammation.
“This is an area that’s prevalent, but understudied,” said Igarashi.
She is searching for nontraditional biomarkers associated with kidney function decline, especially in patients with heart failure.
Patients with heart failure are at increased risk of acute and chronic kidney failure.
Igarashi is confident that Stony Brook’s new vice dean for research will serve patients on Long Island and beyond.
“She would not have taken this job unless we assured her that she would be able to continue to see patients in the clinic as well as in the hospital,” said Igarashi. “That is a core value for her.”
Echoing those sentiments, Hedayati suggested she has a “patient-centered approach in everything I do.”
136 students comprise the RSOM Class of 2027, shown here reciting the Hippocratic Oath.
New RSOM student Jasmine Stansil (center), with her parents and grandparents at the school’s White Coat Ceremony.
Dean Peter Igarashi, MD
Adam Bruzzese wearing his first white coat after receiving from Andrew Wackett, MD, Vice Dean of Undergraduate Medical Education.
136 students launch journey into Medicine at traditional White Coat Ceremony
At the Renaissance School of Medicine’s (RSOM) White Coat Ceremony, 136 incoming students donned their physician “white coats” and took the Hippocratic Oath for the first time. Held at StonyBrook University’s Staller Center, the annual ceremony brings students, their families, and faculty together as the academic year begins and members of the Class of 2027 embark on their journeys toward becoming physicians. The RSOM has held the White Coat Ceremony since 1998.
The incoming students are a select group, and according to RSOM administrators is one of the most diverse classes in the school’s history. Only 8.5 percent of all applicants to the RSOM for 2023-24 were accepted into the program. Approximately 20 percent of class consists individuals from historically marginalized communities, and 54 percent of the class are women.
Collectively the students received their undergraduate degrees from 66 different colleges and universities from around the country. StonyBrook University (20) and Cornell University (17) were the undergraduate schools with the most representation. The class has a combined median undergraduate GPA of 3.89. While many of the new students are from different areas of the country, 77 percent hail from New York State.
“To the Class of 2027, you are entering medicine at an exhilarating time,” said Peter Igarashi, MD, Dean of the RSOM, who presided over his first White Coat Ceremony. “Scientific discoveries in medicine are occurring at a breathtaking and awe-inspiring rate. Diseases that were rapidly fatal when I was a medical student, such as multiple myeloma and leukemia, are now routinely treated. Advances in human genetics have enabled truly personalized medicine, and the development of an effective Covid-19 vaccine less than one year after the onset of the pandemic saved almost 20 million lives and underscored the essential role that science plays in public health.”
All of the students have a story as to how and why they have chosen Medicine as a profession.
For New York City native Adam Bruzzese, an NYU graduate, his family’s difficulties and challenges they had within the healthcare system was a big trigger to increasing his passion for medicine. Adam’s 11-year-old sister had mysteriously become paralyzed, and he played an integral part in providing her healthcare as a teenager and college student. He witnessed disparities of care as she moved through the health system, plus the myriad of tests and physician opinions along the way. It was eventually determined her paralysis was caused by Lyme Disease.
Manteca, California native Jasmine Stansil, a standout student in high school and at the University of California, San Diego, was always fascinated by the human body as a kid. She also became captivated by how physicians can have an incredible impact on human life when she watched Untold Stories of the ER. But she was most inspired to pursue Medicine because of her grandmother, who endured multiple strokes.
“Watching doctors provide her care made me want to do the same for others,” says Stansil. “I am hoping to become an academic physician who will provide clinical care, teach and conduct research.”
Jerome Belford, one of the 20 class members who attended StonyBrook University as an undergraduate, described his interest in medicine as coming from a “passion that stems from a desire to promote physical and emotional health and wellness.”
From Long Island, Belford is a volunteer EMT who decided to attend the RSOM because of its broad research and clinical opportunities and standout education that provides experiential and hands-on medical training. He hopes to eventually provide patients who have historically not had access to the best medical resources improved care, either as an emergency physician or though primary care as an internist.
White coat ceremonies are an initiation rite and are symbolic to Medicine as a profession that combines professionalism with scientific excellence and compassionate care. In an era of telemedicine, aging populations, new knowledge about infections and diseases, and emerging technologies, Medicine remains a dynamic and changing profession that continues to impact the health and well-being of society.
