New Pathology Center at Mount Sinai

Mount Sinai medical centerThe department of pathology at the Icahn School of Medicine at Mount Sinai has just established the Center for Computational and Systems Pathology, with the goal of using advanced computer science, mathematical techniques, cutting-edge microscope technology and AI to revolutionize pathology practice.  This new facility will explore efforts to more accurately classify diseases and guide treatment with computer vision and machine learning techniques.  It will also serve as a hub for the development of new tests, partnering with Mount Sinai-based “Precise Medical Diagnostics” (Precise MD).  

The new center will be overseen by Carlos Cordon-Cardo, MD PhD, and will be continuing his role as chair of the department of pathology at the Mount Sinai Health System and professor at the Icahn School of Medicine.  Associate professor Gerardo Fernandez, MD will be the medical director, working closely with pathology research professor Michael Donovan, MD PhD and Jack Zeineh, MD, director of technology for Precise MD.  Precise MD is developing new approaches to characterizing an individual’s cancer through combining multiple data sources and then using mathematical algorithms to analyze them, offering a more sophisticated alternative to standard approaches.  

In its initial phase this summer, Precise MD will complete a test used for patients who have had prostatectomies at Mount Sinai Health System to determine which of them are more likely to have a recurrence of cancer and may need additional therapy.  The approach will give researchers an in-depth knowledge about the biological behavior about prostate cancer, which will allow them to choose the appropriate patients for active surveillance.  A second test will follow next year, which will be used to characterize prostate cancer in newly-diagnosed patients, by which time all prostate cancer patients at Mount Sinai will have the chance to receive this test.  

If you’d like to learn more, you can click here!

A Lab in a Needle

While working alongside collaborators from two major institutions in Singapore, researchers at a lab in a needleHouston Methodist have developed a lab in a needle device that could provide instant results to routine lab tests to accelerate treatment and diagnosis by days.  One place where this device will be effective is in quickly detecting liver toxicity, a common side effect of chemotherapy.  It will test toxicity in 30 minutes; compare that to the several days it takes to currently perform the same test due to the multiple steps required before a physician interprets the test results and communicates them to the patient.

Developed by Houston Methodist, NTU Singapore, SIMTech and A*STAR, this invention was explained in the most recent issue of the Royal Society of Chemistry’s Lab on a Chip.  Investigators demonstrated that two important steps of the lab in a needle approach accurately detected liver toxicity in AST and ALT.  The proteins that these indicators represent are among the most sensitive and widely-used liver enyzmes in all liver function tests today.  The joint research group were looking to develop a new class of device to collect patient samples, prepare them for testing, evaluate toxicity and display results in one easy-to-use process that would allow doctors and patients to immediately discuss treatment options.

Sample preparation was accomplished on one chip that incorporated a miniature motor and microfluidics, while amplification was performed on a second connected chip.  Evaluations in the two examined gene markers of liver toxicity were then accurately detected and consistent with previously-known changes, indicating that lab in a needle is an appropriate diagnostic option.  According to the researchers, the next step is to integrate the sample preparation and analysis chips into a miniaturized device.  Both A*STAR and SIMTECH have manufacturing process capabilities to develop a cost effective lab in needle device that can be scaled for mass production.

This study outcome represents the first time that all processes involved in the lab in a needle were integrated together successfully, and represents an important step in bringing a new real-time, easy-to-use diagnostic to the clinic and field with an immediate potential to improve patient outcomes and quality of life.  If you’d like to learn more, you can click here!

Manipulating Pollen

Ragweed plant

Also known as Ambrosia, the ragweed plant is known for its aggressive pollen.

Recently, scientists at Helmholtz Zentrum in Munich have discovered that pollen of the common ragweed has higher concentrations of allergen when exposed to NO2 exhaust gases.  The study also indicates the presence of a possible new allergen in the plant.  Researchers of the Institute of Biochemical Plant Pathology (BIOP) studied how nitrogen oxides affect the pollen of the plant, specifically by fumigating the plants with various concentrations of NO2, which is generated during combustion processes of fuel.

The data from the study revealed that the stress on the plant caused by NO2 modulated the protein composition of the pollen, with different isoforms of the known allergen Amb a 1 being significantly elevated.  In addition, scientists observed that the pollen from NO2-treated plants have a significantly increased binding capacity to specific IgE antibodies of individuals who are allergic to ragweed, which frequently starts an allergic reaction in humans.  The plant researchers also identified a protein, not previously known to be an allergen in ragweed, that was present when NO2 levels were elevated.  It has a strong similarity with a protein form a rubber tree, in which context it was previously described as an allergen whose effect was also seen in fungi and other plants.

Due to air pollution, it is expected that the already aggressive ragweed pollen will become even more allergenic in the future.  Originating in the Americas, ragweed is believed to have come to Europe through imported birdseed, and due to climate change, it’s become widely dispersed across the continent.  Ragweed pollen is very aggressive, and since it doesn’t bloom until late summer, it lengthens the “season” for those who are allergic to it.  Studies have already shown that ragweed plants growing along highways are clearly more allergenic than those growing away from road traffic.  The researchers plan on doing further studies in the future, where they plan on showing that pollen only treated with NO2 can also elicit stronger in vivo reactions.

The Problem with UHC’s New Program

Out in Florida, the battle rages on between one of the country’s largest health insurance corporations and physicians, clinical laboratory managers and pathologists.  This fight started because of the restrictive, burdensome requirements imposed last fall by UnitedHealthcare (UHC) and administered by BeaconLBS on medical laboratory test ordering.  For one Florida rheumatologist, Olga Kromo, this new decision-support system that physicians currently have to use when ordering clinical laboratory tests is highly flawed.

Michael Weilert MD Ogla Kromo

Olga Kromo, the physician who has become an outspoken opponent of the new system imposed by UHC.

Other Florida physicians have begun to rally around Kromo, pointing out that the new system is time-consuming, onerous and difficult to use.  Kromo, however, has gone even further, claiming that the BeaconLBS system could have an adverse effect on patient care and increase negative outcomes across the board.  In a recent interview with “The Dark Report”, Kromo has explained that patients with connective tissue disease are at higher risk for other serious health conditions such as lymphoma.  This is true for patients with systemic lupus and Sjögren’s syndrome.  If ordering medical laboratory tests is overly complicated or time-consuming, she said, then patients may not get tested as much as needed for their physician to properly identify complications and spot the signs of ailments such as lymphoma early on.  Kromo is one of four doctors at the Arthritis and Rheumatic Care Center in Miami.

Among patients with lupus and Sjögren’s, Kromo says, there’s a high risk of developing lymphoma.  A clinical laboratory test is recommended for timely monitoring these patients, although UHC says that BeaconLBS needs to pre-authorize the test before doctors can run it.  If long-established clinical guidelines specify that a test is recommended for lupus patients with Sjögren’s, Kromo argues, why would physicians need to request authorization from a health insurer?  Kromo’s argument has raised a serious issue as to why UHS and its contractor, BeaconLBS, are interposing themselves between physicians and patients when physicians are ready to order medical lab tests that UHC requires to be pre-authorized.  Various state and national medical societies have written letters to UHC objecting to this interference with established medical standards of practice.

It takes a particularly long time to use the newly-required system and, since there’s a limited number of electronic interfaces between BeaconLBS and electronic health record systems, physicians need to enter orders for tests twice: once to obtain pre-notification ,and a second time to enter the order in the EHR.  As well as patient care concerns, Kromo has found the BeaconLBS system to be so difficult that those in her four-physician practice aren’t even using it, and instead are having a workaround with another lab.  If Kromo’s practice were to use the BeaconLBS system, she estimated that the phlebotomist on her team would need to stay an extra hour or two every day; just the paperwork for Beacon tests takes about 20 minutes per patient.  And since such a large percentage of Kromo’s patients (95%) need lab tests on almost every visit, this system significantly disrupts patient flow.