Dr. Monika Safford, chief of the Division of General Internal Medicine at NewYork-Presbyterian/Weill Cornell Medical Center and Weill Cornell Medicine, finds that obesity is linked to more serious complications from COVID-19, including in younger people.

As the nation works toward controlling the coronavirus pandemic, scientists and researchers are racing to find out everything they can about the virus and who is most vulnerable. New evidence suggests that obesity is a risk factor for COVID-19, according to researchers at NewYork-Presbyterian/Weill Cornell Medical Center and Weill Cornell Medicine. The research also suggests that young people who are obese — whether they have other health issues or not — are especially at risk.

The data, published in the New England Journal of Medicine on April 17, looked at the first 393 consecutive patients with COVID-19 who were admitted to NewYork-Presbyterian/Weill Cornell Medical Center and NewYork-Presbyterian Lower Manhattan Hospital from March 3 to March 27. Obesity was defined as a body-mass index of 30 or higher, and 136 of the patients were in that category.

“We started this registry of patients so that we could help answer some tough questions that front-line healthcare workers were grappling with,” says Dr. Monika Safford, chief of the Division of General Internal Medicine at NewYork-Presbyterian/Weill Cornell Medical Center and Weill Cornell Medicine, and the senior author of the report. “Our goal was to inform physicians about which types of patients are likely to not do well, using data. This effort would not have been possible without the collaborative work of physicians, researchers, and Weill Cornell Medicine’s medical students.”

Health Matters spoke with Dr. Safford to understand what this research means for patients and the general public.

What is significant about this research?

The preliminary data confirms what many doctors and front-line staff have been saying, that many of their patients who are severely ill with COVID-19 are obese. What’s rather striking about the data we have compiled is that the obesity prevalence seems to be the greatest in people under the age of 65: Of the patients studied, almost half under the age of 65 are obese. We’re also seeing cardiovascular problems such as high blood pressure and coronary artery disease as risk factors. So, what is happening here? That is a big puzzle that needs a lot more work.

What surprised you about the data?

It was surprising to see the number of young people. A month or so ago, the message from various press outlets was that this virus was primarily a problem for people 65 years and older, and we’re discovering that this isn't the only vulnerable population.

Why does obesity make COVID-19 worse?

We don’t have all the answers yet, but there are several factors to consider. One area we’re looking at is whether these patients have conditions often associated with obesity, such as high blood pressure, diabetes, or cardiovascular disease. But the fact that we’re seeing more young people with obesity get into trouble is puzzling, so it may also speak to a genetic component. That’s a speculation, but when you see otherwise healthy people get such severe disease, it makes you wonder whether there's some sort of a genetic signature that puts certain patients at high risk.

Inflammation is another important factor. Obesity is a pro-inflammatory condition, and inflammation in the body changes the immune system. This could explain why obese patients who are otherwise healthy can contract a more serious coronavirus infection than others.

What’s happening with the immune system in these more serious cases?

Our immune systems are very complex, and hundreds of factors are involved — especially when the body is fighting an infection. With COVID-19, some patients’ immune systems go into overdrive, essentially going haywire. It’s a phenomenon referred to as a “cytokine storm,” an overproduction of activating compounds called cytokines, and it's very, very deadly. Most of those patients have to be intubated, which further complicates things. So, it seems that the coronavirus is triggering the immune system in some people, and instead of being a beautifully concerted effort, it's a complete storm and everything in the body goes out of control. For instance, of the 393 patients we studied, 15% were placed on dialysis due to declining kidney function even though they had no history of kidney disease, an example of how this immune activation can wreak havoc in the body and is very challenging to manage.

How do these findings affect patient care?

They’re having a big impact on patient care; they’re helping us to identify which patients are likely to do the worst and need the closest monitoring. This, in turn, helps front-line healthcare workers make vital decisions.

We’ve also implemented a strategy to prone intubated patients, to put them on their stomachs, when necessary, because it changes the dynamics of the lungs, alleviating pressure and increasing blood flow. Reports in other countries have proved this to be very effective for obese patients. Most intensive care units in the U.S. have not routinely proned patients, but now with COVID-19, everyone is doing it because it makes a difference.

What are other research findings?

In terms of obesity, the findings are pretty consistent here in the United States. We’re continuing to closely watch data from countries like China, Korea, Spain, and Italy. However, none of those countries has the prevalence of obesity that the U.S. has. So, it remains to be seen whether we’re going to have a higher mortality rate in part because of our much higher prevalence of obesity.

Did this research have any limitations?

We were not able to include mortality rates and outcomes in this report because a lot of patients who are intubated remain on a ventilator for a long, long time. Three weeks is not uncommon. Many of the patients in our registry are still on ventilators, and we don’t know what their final outcomes will be.

Are there plans to expand this research?

Yes, absolutely. We’re continuing to add patients to the registry, which currently has over 4,000 patients, and we are in discussions with NewYork-Presbyterian/Columbia University Irving Medical Center on how to conduct analyses in collaboration with them. A large Columbia team, also with medical students doing the bulk of the chart abstraction work, is using the same instrument we are, which will facilitate collaborations.

We’re also finalizing another analysis to help physicians identify the most at-risk patients and make decisions accordingly, based on the data. Decisions such as who needs a continuous pulse oximeter, which measures oxygen and heart rate, can be guided by the patients who are likely to do the worst and need the closest monitoring.

What can we learn from these data?

That more research is needed. There's a large group of physician investigators who are very interested in advancing knowledge for the rest of the country, so this is really just the beginning. More studies will be coming out in the near future.

The paper and full list of authors can be found here.

Monika M. Safford, M.D., chief of the Division of General Internal Medicine at NewYork-Presbyterian/Weill Cornell Medical Center and Weill Cornell Medicine, is a clinician-investigator known for her patient-centered research on diabetes, cardiovascular disease, and health disparities. Her more than 400 research articles have been published in medical journals including the Journal of the American Medical Association, Diabetes Care, Circulation, and the American Journal of Cardiology.

This story first appeared on NewYork-Presbyterian's Health Matters website.

NEW YORK (April 20, 2017) – A new weight loss procedure that reduces the size of the stomach without the need for surgery known as endoscopic sleeve gastroplasty (ESG) is safe and effective way for the treatment obesity and obesity-related comorbidities such as diabetes, high blood pressure and fatty liver, according to a new study by NewYork-Presbyterian and Weill Cornell Medicine researchers.

ESG is an incisionless, same-day outpatient procedure performed using an endoscope, a flexible instrument with an attached camera that allows the physician to visualize the stomach from outside the body. The goal of ESG is to reduce the length and width of the stomach to facilitate weight loss. NewYork-Presbyterian is currently the leading institution and the first in New York to offer this innovative treatment, and its physicians have performed the most procedures in the country.

The study will be published in the spring 2017 journal of Clinical Gastroenterology and Hepatology and is published online.

“Obesity is a significant health concern that affects millions of people across the country, but until now there hasn’t been an effective minimally invasive treatment we could offer patients,” said Dr. Reem Sharaiha, director of bariatric endoscopy and associate director of the Pancreas Program at NewYork-Presbyterian/Weill Cornell Medical Center and an assistant professor of medicine at Weill Cornell Medicine. “With ESG, we’re giving patients who are not eligible for surgery, or deemed to be too high risk for surgery a new option for their care.”

The study followed 91 patients who underwent ESG from August 2013 through March 2016. All patients were clinically obese with a body mass index (BMI) greater than 30 kg/m² and had failed non-invasive weight-loss measures, or had a BMI greater than 40 kg/m² and were not considered as surgical candidates or had refused surgery. At six months, patients in the study had lost 14.4 percent of their total body weight, 17.6 percent at 12 months and 20.9 percent loss at 24 months. In addition to sustained total body weight loss up to 24 months, ESG reduced key indicators of hypertension, diabetes and hypertriglyceridemia, a high level of a certain type of fat (triglycerides) in the blood that can predispose patients to cardiovascular disease.

Obesity is a significant public health challenge, affecting more than one-third of adults in the United States. The estimated annual health care costs of obesity-related illnesses are $190.2 billion, nearly 21 percent of annual medical spending in the U.S. It is strongly associated with an increase in mortality in both men and women of all ages and ethnicities. “It will soon rival tobacco as the leading cause of preventable premature deaths,” said Dr. Sharaiha.

A new randomized control study which will compare ESG to diet and exercise has been approved and is now recruiting patients.

Dr. Sharaiha is a consultant for Apollo Endosurgery, Inc.

NewYork-Presbyterian

NewYork-Presbyterian is one of the nation’s most comprehensive healthcare delivery networks, focused on providing innovative and compassionate care to patients in the New York metropolitan area and throughout the globe. In collaboration with two renowned medical school partners, Weill Cornell Medicine and Columbia University College of Physicians & Surgeons, NewYork-Presbyterian is consistently recognized as a leader in medical education, groundbreaking research and clinical innovation.

NewYork-Presbyterian has four major divisions: NewYork-Presbyterian Hospital is ranked #1 in the New York metropolitan area by U.S. News and World Report and repeatedly named to the magazine’s Honor Roll of best hospitals in the nation; NewYork-Presbyterian Regional Hospital Network is comprised of leading hospitals in and around New York and delivers high-quality care to patients throughout the region; NewYork-Presbyterian Physician Services connects medical experts with patients in their communities; and NewYork-Presbyterian Community and Population Health features the hospital’s ambulatory care network sites and operations, community care initiatives and healthcare quality programs, including NewYork Quality Care, established by NewYork-Presbyterian, Weill Cornell and Columbia.

NewYork-Presbyterian is one of the largest healthcare providers in the U.S. Each year, nearly 40,000 NewYork-Presbyterian professionals deliver exceptional care during more than 4 million patient visits.

For more information, visit www.nyp.org and find us on Facebook, Twitter and YouTube.

Weill Cornell Medicine

Weill Cornell Medicine is committed to excellence in patient care, scientific discovery and the education of future physicians in New York City and around the world. The doctors and scientists of Weill Cornell Medicine—faculty from Weill Cornell Medical College, Weill Cornell Graduate School of Medical Sciences, and Weill Cornell Physician Organization—are engaged in world-class clinical care and cutting-edge research that connect patients to the latest treatment innovations and prevention strategies. Located in the heart of the Upper East Side’s scientific corridor, Weill Cornell Medicine’s powerful network of collaborators extends to its parent university Cornell University; to Qatar, where Weill Cornell Medicine-Qatar offers a Cornell University medical degree; and to programs in Tanzania, Haiti, Brazil, Austria and Turkey. Weill Cornell Medicine faculty provide comprehensive patient care at NewYork-Presbyterian/Weill Cornell Medical Center, NewYork-Presbyterian Lower Manhattan Hospital and NewYork-Presbyterian Queens. Weill Cornell Medicine is also affiliated with Houston Methodist. For more information, visit weill.cornell.edu.

Weill Cornell Medical College student Abimbola Ayangbesan '18 has received the Ferdinand C. Valentine Medical Student Research Grant in Urology from The New York Academy of Medicine, which works to improve the health of people in New York City and cities across the world through its Institute for Urban Health.

The grant is awarded to as many as three medical students attending school in metropolitan New York who are committed to conducting basic or clinical research in urology over the summer. The academy provides a $4,000 stipend to support the students as they pursue 10- 12-week mentored research projects, the findings of which they will present at the Medical and Dental Student Forum on Aug. 18 in New York City.

"It's an honor to have been awarded the grant," said Ayangbesan, who first began urologic oncology research in bladder cancer patients the summer after his first year while working with Dr. Douglas Scherr, the Ronald Stanton Clinical Scholar in Urology and a professor of urology at Weill Cornell Medicine. "Having someone appreciate the undertaking of your project makes you believe you're moving in the right direction. It's motivation to keep on doing what I do."

Working with Dr. Scherr, Ayangbesan will examine a type of fatty tissue called white adipose tissue (WAT) to determine if it can be a potential biomarker for kidney cancer when inflamed. Previous research has shown that the presence of inflamed WAT in breast tissue in obese breast cancer patients has been associated with worse long-term prognoses than in patients who aren't obese; obese patients are at a higher risk of the disease returning and have a lower survival rate. Ayangbesan will be testing fatty tissue samples from patients with kidney cancer — a condition in which obesity is a risk factor — to determine if there is a similar connection that exists between inflamed WAT in kidney cancer patients and their long-term outcomes.

"The grant allows me the opportunity to continue my research in urology," Ayangbesan said, "and to further broaden my knowledge and attain better understanding of various urologic pathologies and morbidities."

Weill Cornell physician-scientists and Cornell University engineers collaborate — and patients benefit

By Beth Saulnier
Illustration by Heidi Schmidt

The triple-negative form of breast cancer is one of the disease's most challenging types, with lower survival rates and a more aggressive course. Pioneering cancer researcher Dr. Lewis Cantley '75, has been studying it from various angles for decades — and now, thanks to Ithaca-based engineers, he has a powerful new way to explore it from New York. "Increasingly, biological science is relying on high levels of technology to improve our ability to visualize what's going on in a tumor, and to be able to physically manipulate events within it and follow in real time what happens," says Dr. Cantley, a professor of cancer biology in medicine and the Meyer Director of the Sandra and Edward Meyer Cancer Center, who has been working with an Upstate colleague, Dr. Claudia Fischbach-Teschl, an associate professor of bio-medical engineering. "The technologies that have been developed in Ithaca are cutting-edge techniques in growing cells and even tumors in a controlled environment, where you can monitor and physically affect a tumor and look at its response. We're able to understand what's going on at a level that has never been possible in the past. It's a very exciting time."

The joint effort between Dr. Cantley — himself a doctoral alumnus of the Ithaca campus — and Dr. Fischbach-Teschl is just one of the many ongoing collaborations between Weill Cornell Medicine researchers and Cornell engineering faculty. Research teams are working together on topics from Alzheimer's to epilepsy, reconstructive surgery to heart disease. "From my perspective, it's absolutely crucial to have collaborations with engineers," says Dr. Jason Spector, a Weill Cornell Medicine professor of surgery. "Even though I have a background in some other disciplines, at heart I'm a clinical physician and my expertise is in taking care of patients. I may have a clinical insight but no way to pursue it because I don't have the technical knowledge in that particular field. The engineers have incredible expertise in diverse areas ranging from polymer chemistry to tissue engineering to the use of lasers and optical imagery, so their insights and perspectives are perfectly complementary to mine."

Over the past decade, the university has strengthened its commitment to fostering collaborations between the two campuses, including logistical support like the Cornell bus that runs between Ithaca and New York City several times a day, providing reliable Wi-Fi, snacks and a comfortable place to work during the 200-mile journey. Occasional retreats between engineers and their counterparts in Weill Cornell Medicine departments like surgery, neurological surgery, and radiology allow faculty to make matches with colleagues who have complementary research interests. The university has also offered several rounds of seed grant funding to help intercampus projects get off the ground — and according to one initial analysis, the investment has more than paid off.

In 2010, Dr. Lawrence Bonassar, a professor of biomedical engineering and of mechanical and aerospace engineering, studied the outside funding generated by roughly a dozen awards given in the previous five years, finding that the seed support had facilitated substantive results that impressed outside granting agencies. "It had about an eight-fold return on investment," reports Dr. Bonassar, whose collaborative projects with Weill Cornell Medicine surgeons include two types of implants made of living tissue: ears for children born without them, and replacements for degenerated spinal discs that cushion the vertebrae. "About $400,000 in grants had been given out — and they had returned, at that time, more than $3 million from other organizations including the National Institutes of Health, private foundations, and the National Science Foundation. So these tend to be productive collaborations that are well received by the outside world."

In the field of oncology research, intercampus collaborations got a particularly strong boost in 2009 with the awarding of a five-year, $13 million grant from the National Cancer Institute that created the Center on the Microenvironment and Metastasis. Established under the NCI's Physical Sciences-Oncology Centers initiative, it has fostered numerous projects including the ongoing effort by Weill Cornell Medicine's Dr. David Nanus, the Mark W. Pasmantier Professor of Hematology and Oncology in Medicine, and Dr. Evi Giannakakou, an associate professor of pharmacology, to develop a method to detect prostate cancer cells in the blood. They're working with Dr. Brian Kirby, an associate professor of mechanical and aerospace engineering who is based in Ithaca but holds a joint appointment in Weill Cornell Medicine's Division of Hematology and Medical Oncology. Says Dr. Kirby: "There's basically no way for me to impact human health directly unless I'm working with clinicians, looking at real samples, and trying to influence actual clinical practice."

Last summer's establishment of the Meinig School of Biomedical Engineering also strengthened intercampus research — elevating an existing department that had been founded in 2004. The school was created with a $50 million gift from undergraduate alumni Nancy and Peter Meinig and their children; as Weill Cornell Medicine Dean Dr. Laurie Glimcher, said at the time, their generosity "will enable us to expand our collaborations and advance our critical work translating new discoveries into the best patient care."

Weill Cornell Medicine researchers are also working with Cornell engineers who are based in Manhattan. Not only does the new Cornell Tech campus (temporarily located in Chelsea, but with three buildings currently under construction on Roosevelt Island) have a program devoted to health-related topics, but about 10 percent of students earning doctorates in biomedical engineering at the university are doing their thesis research at Weill Cornell Medicine. "When you look around the country, you'll see that there are no biomedical engineering programs in the top 10 or 20 that aren't strongly tied to a top medical school — and interestingly, there aren't many top medical schools that aren't strongly tied to a bio-medical engineering program," says Dr. Chris Schaffer, an Ithaca-based associate professor and director of graduate studies in biomedical engineering, noting that all of his department's first-year doctoral candidates spend about two months at Weill Cornell Medicine for an immersion program in clinical medicine. "Much of the future of biomedical research, and of improving healthcare, will involve increased reliance on quantitative and engineering approaches to drugs and diagnostics. We do that best when we do it together."

Ears for Kids

Of every 10,000 babies born worldwide, between one and four have a congenital birth defect called microtia, in which one or both outer ears is missing or deformed. Unfortunately for these kids and their families, the options for surgical reconstruction have long been limited and imperfect — consisting of either an artificial implant or one crafted from the patient's rib cartilage. But professor of surgery Dr. Jason Spector, and biomedical engineer Dr. Lawrence Bonassar, hope they'll soon be able to offer an alternative: a natural implant created from a patient's own cells that would grow along with the child and never require replacement. For several years, the two have been working together on the ears, which could either be formed through 3D printing or shaped in a mold. Since most cases of microtia occur on only one side of the head, computer imaging can be used to scan a patient's normal ear, so the implants can be custom-made for a perfect fit. While the work began using bovine tissue, it has evolved to comprise human cartilage; microtia patients usually have a small amount of vestigial ear tissue, which can be nurtured with stem cells until there is enough material to form an implant. The results have been highly promising: the growth system is working well, and the resulting ears are durable and have the proper anatomical form. The researchers hope to move into clinical trials in the next two to three years. "As a result of our collaborative efforts, we are poised to revolutionize the treatment of children who have microtia — and as we further develop these cutting-edge tissue engineering strategies, to make much needed 'replacement parts' in many other areas of the body," Dr. Spector says. "It's all very exciting."

Tumor-Cell Detector

It's known as a "liquid biopsy": taking a sample of blood from a patient and analyzing it for cancer cells. Potential uses for such technology include allowing oncologists to refine a diagnosis, detecting the spread of cancer from a tumor to elsewhere in the body, and predicting the efficacy of a certain drug — all without an invasive procedure. According to Dr. David Nanus, associate director of clinical services at the Meyer Cancer Center, "it's something that a lot of medical centers and cancer centers are working on that will have utility in the future." Dr. Nanus has been working with pharmacologist Dr. Evi Giannakakou, and engineer Dr. Brian Kirby, on employing liquid biopsies for a particular purpose: they're doing a proof-of-concept study using a microfluidic device to detect prostate cancer circulating tumor cells. An expert in microfluidics, Dr. Kirby devised a silicon chip known as GEDI; pronounced like the Star Wars heroes, it stands for Geometrically Enhanced Differential Immunocapture. "We coat the surface of the microdevice with a substance that will specifically stick to cancer cells and not to blood cells," Dr. Kirby explains. "We designed it to be sort of a maze that tricks the cancer cells into colliding with the surfaces many times over." The multi-institution study, involving about five dozen patients with late-stage prostate cancer, is looking for biomarkers that may predict sensitivity or resistance to a class of chemotherapy drugs known as taxanes. "A major goal is to figure out the mechanism of chemotherapy resistance," Dr. Nanus says. "If a patient progresses, can we look at their circulating tumor cells and — from an analysis of their DNA or RNA expression — determine the molecular reason why they have become resistant to treatment?"

Battling Breast Cancer

The "seed and soil" concept of cancer metastasis holds that tumors require fertile ground in which to grow — which means that making the body inhospitable to them is key to battling the disease. Dr. Andrew Dannenberg, the Henry R. Erle, M.D.- Roberts Family Professor of Medicine, and breast cancer specialist Dr. Linda Vahdat, have ongoing collaborations with biomedical engineer Dr. Claudia Fischbach-Teschl, whose Ithaca lab is devoted to studying the environment in which a tumor exists, including its surrounding blood vessels and other non-tumorous host cells. They have worked together to explore diagnosis, treatment and prevention from two major angles: the effect of obesity on patient outcomes and — a major focus of Dr. Vahdat's work — the promise of copper-depleting drugs in treating triple-negative breast cancer. For the obesity work, for example, Dr. Vahdat provided specimens from lean and obese breast cancer patients; Dr. Fischbach-Teschl was able to show that obese women have increased levels of proteins typically associated with wound-healing, which makes for a "soil" more hospitable to cancer, thus raising the likelihood of its spread. "Claudia's expertise is in physical factors that promote metastasis — getting down to the practical aspects of, 'How does a tumor cell get from point A to point B?' says Dr. Vahdat, a professor of medicine. "It's a totally different way to look at things, but it's highly complementary to what someone like myself does, which is on a very macro level, taking care of patients."

Back Pain Relief

Among the projects sparked during a retreat between Ithaca engineers and Weill Cornell Medicine surgeons is one that could someday provide relief to the millions of Americans suffering from chronic back or neck pain. Spinal surgeon Dr. Roger Härtl, is working with Dr. Bonassar to develop a bioengineered intervertebral disc to replace those lost to degeneration or herniation — be it from natural aging, playing contact sports, or other factors like obesity or years of manual labor. Currently, most patients are treated with pain medication or physical therapy — but 5 to 10 percent require more invasive methods such as injections or surgery. In the latter case, the most common procedure is spinal fusion, in which a damaged disc is removed and bone is fused into the gap; while artificial discs made of metal and plastic are available, they can damage adjacent tissue, and their longevity is unclear. So Dr. Härtl, a professor of neurological surgery and director of spinal surgery and neurotrauma at Weill Cornell Medicine's Brain and Spine Center, teamed up with Dr. Bonassar to design 3D-printed implants made of living tissue. The technology was successfully demonstrated in rats; in collaboration with the College of Veterinary Medicine, it's currently being tested in animals, who can suffer from disk degeneration just as humans do. Ultimately, the implants could be created based on MRI imaging of a patient's spine and comprise cells either taken from a cadaver or — a greater challenge — grown using a person's own tissue. Another project, which Dr. Härtl reports is much closer to clinical implementation, is a technique to repair injured discs using tissue-engineered biological "glues."

A 'Laser Scalpel' for Epilepsy

Of the two main kinds of epilepsy — general and focal — the latter is much harder to treat. While general epilepsy — in which the entire brain spasms with neural activity — can be well controlled with medication, focal epilepsy is more challenging. Often caused by brain trauma or congenital malformation, it involves too much neural activity in specific regions; to control it with drugs, says biomedical engineer Dr. Chris Schaffer, "you end up almost anesthetizing the brain." Instead, the condition is treated with resective brain surgery — an imprecise option that can lead to cognitive and motor deficits. But Dr. Schaffer, an expert in advanced optical techniques, is working with Dr. Theodore Schwartz, the David and Ursel Barnes Professor of Minimally Invasive Neurosurgery, to offer a much better surgical solution. They're collaborating to develop a "laser scalpel" that can cut with precision on the scale of a micron — one-millionth of a meter. They're writing up a paper reporting promising results in a rodent model, in which a targeted cut decreased seizures by 50 percent; they're currently studying whether the improvement is long-lasting. Dr. Schaffer is also working with Dr. Frank Wise '88, the Samuel B. Eckert Professor of Engineering in Ithaca's Department of Applied and Engineering Physics, to design the device, which pulses at a rate of 100 femtoseconds. "The ratio of 100 femtoseconds to a minute is about the same as the ratio of a minute to the known age of the universe [about 13.8 billion years]," Dr. Schaffer notes. "So it's a really, really short burst of light."

Heart of the Matter

At the Dalio Institute of Cardiovascular Imaging, director Dr. James Min, and colleagues aim to better understand heart disease, in the hope that it will lead to improved treatments and preventive measures. To that end, they use not only familiar tools like MRI, CT and PET — but also novel technologies like 3D printing and computer modeling of blood flow dynamics, drawing on the expertise of Ithaca-based engineers. Dr. Min, a professor of radiology and of medicine who is board certified in cardiology, has been working with Dr. Jonathan Butcher, associate professor of biomedical engineering and associate director of undergraduate studies in biomedical engineering, to study how the particulars of various surgical procedures — say, the shape and placement of a vascular graft — affect patient outcomes. Ultimately, grafts that have been designed for optimum performance in an individual person's heart could be fabricated through tissue engineering, obviating the need to obtain them from elsewhere in a patient's body. The grafts — or even entire heart valves — would be made of a patient's own cardiac cells, harvested by surgeons and grown on a scaffold of water-soluble polymers. In the best-case scenario, Dr. Butcher says, "we could do all of those procedures in the operating room, in one sitting." On the clinical side, the collaboration also involves veteran heart surgeon Dr. Leonard Girardi '89, chair of the Department of Cardiothoracic Surgery and cardiothoracic surgeon-in-chief at NewYork-Presbyterian/Weill Cornell Medical Center.

This story first appeared in Weill Cornell Medicine, Vol. 15, No.1.

Obesity impairs the body's ability to use vitamin A appropriately and leads to deficiencies of the vitamin in major organs, according to new research conducted at Weill Cornell Medicine.

Vitamin A is critical to the proper functioning of many systems in the body, including vision, fetal development, reproduction, immune responses, and wound healing. Vitamin A deficiency impairs these functions, and is also implicated in increased risk of respiratory infections, diabetes, infertility, and delayed growth and bone development. Because of these wide-ranging health effects, people are advised to get adequate amounts of the vitamin either through diet (eggs, milk, meat, and some fruits and vegetables are sources) or supplementation. But the study, published Nov. 2 in Scientific Reports, shows that obesity interferes with the body's ability to use vitamin A, even with adequate intake.

"Our research shows that, even if an obese animal consumes normal amounts of vitamin A, they have deficiencies of the vitamin A in major organs," said first author Dr. Steven Trasino, a postdoctoral fellow in pharmacology at Weill Cornell Medicine. "Obesity is categorized as a state of malnutrition, typically associated with consumption of too many calories and poor intake of essential nutrients. Our data expand on that definition by showing that obesity plays a role in the body's ability to use this essential nutrient properly."

Dr. Lorraine Gudas

The researchers fed mice a diet that had normal vitamin A levels, similar to the recommendations for human vitamin A intake.

"We found that normal-weight mice are healthy on that diet, but obese mice show severe vitamin A deficiencies in their livers, kidneys and pancreas," said senior author Dr. Lorraine Gudas, chair of the Department of Pharmacology and the Revlon Pharmaceutical Professor of Pharmacology and Toxicology at Weill Cornell Medicine.

When the obese mice lost weight, their vitamin A levels returned to normal. "Something about the state of obesity is impairing the body's ability to use vitamin A correctly," Dr. Gudas said.

What was particularly remarkable to the research team, which also included Dr. Xiao-Han Tang, an assistant research professor in pharmacology, and Dr. Jose Jessurun, a professor in pathology, was that the blood levels of vitamin A in all of the mice, including the obese mice, were normal. The deficiency was only noted when the researchers took tissue samples from various organs in the mice. "We call this ‘silent vitamin A deficiency' because it would not be picked up by a standard blood test for the vitamin," Dr. Trasino said.

The new findings suggest that obesity in humans is also associated with low vitamin A levels in many organs. Such deficiencies would have corresponding health effects.

"We know that obesity is associated with many illnesses, such as poor immune response and diabetes," Dr. Gudas said. "What we don't know is why. This gives us more information for understanding how the two go together, but many puzzles remain to be solved before we fully understand why obesity leads to less vitamin A in major organs of the body."

By Krishna Ramanujan

Postmenopausal women who are obese have a higher risk and a worse prognosis for breast cancer, but the reasons why have remained unclear. A study by researchers from Cornell University and Weill Cornell Medical College, published Aug. 19 in Science Translational Medicine, explains how obesity changes the consistency of breast tissue in ways that are similar to tumors, thereby promoting disease.

The study of mice and women shows obesity leads to a stiffening of a meshwork of material that surrounds fat cells in the breast, called the extracellular matrix, and these biomechanical changes create the right conditions for tumor growth.

These images reveal curly collagen fibers in normal weight mice (left), but a stiffer meshwork of straight fibers in obese animals. Collagen fibers are labeled magenta, and adipocytes (fat) and inflammatory cells are green. Image credit: Fischbach Lab

The findings suggest clinicians may need to employ finer-scale imaging techniques in mammograms, especially for obese women, to detect a denser extracellular matrix. Also, the results should caution doctors against using certain fat cells from obese women in plastic and reconstructive breast surgeries, as these cells can promote recurring breast cancer.

"We all know that obesity is bad; the metabolism changes and hormones change, so when looking for links to breast cancer, researchers almost exclusively have focused on the biochemical changes happening. But what these findings show is that there are also biophysical changes that are important," said Dr. Claudia Fischbach-Teschl, an associate professor of biomedical engineering and the paper's senior author. Bo Ri Seo, a graduate student in Dr. Fischbach-Teschl's lab, is the paper's first author.

"These findings provide important new mechanistic insights into the connection between obesity and breast cancer," said Dr. Andrew Dannenberg, a professor of medicine and associate director of cancer prevention in the Sandra and Edward Meyer Cancer Center at Weill Cornell Medical College and a co-author of the study. "Importantly, the current results are also likely to be relevant to other obesity-related cancers. A significant challenge and opportunity will be to develop new noninvasive strategies to identify women with abnormal extracellular matrix."

Fat tissue in obese women has more cells called myofibroblasts, compared with fat tissue in normal- weight women. Myofibroblasts are wound-healing cells that determine whether a scar will form. All cells secrete compounds to create an extracellular matrix, and they remodel and grab onto this meshwork to make tissue. But when myofibroblasts make an extracellular matrix, they pull together — the action needed to close a wound — stiffening the tissue.

But "these are cells in our body regardless of injury," Dr. Fischbach-Teschl said. In obese women, there are more myofibroblasts than in lean women, which leads to scarring and stiffening without an injury in the extracellular matrix. Tumors also recruit more myofibroblasts than are found in healthy tissue, which also leads to stiffer extracellular matrix.

In the study, the researchers studied obese mice and found scarred and stiffer extracellular matrices in the absence of tumors. They also examined tumor-free human breast tissues and found the same pattern of stiffness in the matrices of obese women compared with normal-weight women.

Fat tissue is made up of adipose (fat) cells and adipose stromal cells that also contain myofibroblasts. The researchers isolated adipose stromal cells from the breasts of lean and obese mice and used these cells to make matrices. When tumor cells were added onto the matrix from the obese cells, they grew. Through experiments, the researchers proved the stiffness of this matrix changed a cell's behavior and promoted tumor growth.

They also found that when calories were restricted in obese mice, myofibroblast content in the mammary fat decreased, suggesting a possible therapy for obesity-related cancer.

Many obese women get regular mammograms but signs of disease don't show up because detecting their dense extracellular matrix between the fat cells requires a finer-scale resolution. The findings "may inspire use of higher resolution imaging techniques to detect those changes," Dr. Fischbach-Teschl said. "Right now, people don't look for [stiffer extracellular matrices] as a clinical biomarker."

During plastic or reconstructive surgery following mastectomy in breast cancer patients, doctors may inject adipose stromal cells from obese donors to regenerate tissue. "What our data suggests is that it is really important where these cells are being taken from," Dr. Fischbach-Teschl said. "If you use these cells from an obese patient, they are very different and you may actually be driving malignancies if you implant them."

The study was funded by the National Institutes of Health, the National Science Foundation, the Breast Cancer Research Foundation, and the Botwinick-Wolfensohn Foundation.

Krishna Ramanujan is the life sciences writer for the Cornell Chronicle.

Eating protein and vegetables before carbohydrates leads to lower post-meal glucose and insulin levels in obese patients with type 2 diabetes, Weill Cornell Medical College researchers found in a new study. This finding, published June 23 in the journal Diabetes Care, might impact the way clinicians advise diabetic patients and other high-risk individuals to eat, focusing not only on how much, but also on when carbohydrates are consumed.

]"We're always looking for ways to help people with diabetes lower their blood sugar," said senior author Dr. Louis Aronne, the Sanford I. Weill Professor of Metabolic Research and a professor of clinical medicine at Weill Cornell Medical College, who is the study's principal investigator. "We rely on medicine, but diet is an important part of this process, too. Unfortunately, we've found that it's difficult to get people to change their eating habits.

"Carbohydrates raise blood sugar, but if you tell someone not to eat them — or to drastically cut back — it's hard for them to comply," added Dr. Aronne, who is also director of the Comprehensive Weight Control Center at Weill Cornell. "This study points to an easier way that patients might lower their blood sugar and insulin levels."

Patients with type 2 diabetes typically use a finger prick test to check their glucose levels throughout the day. Maintaining normal levels, specifically after meals, is of the utmost importance, because if a diabetics' blood sugar level is consistently high or frequently spikes, they risk complications of their disease, including hardening of the arteries and eventually death from heart disease.

This study looked to validate and advance previous research that showed eating vegetables or protein before carbohydrates leads to lower post-meal glucose levels. This time, though, investigators looked at a whole, typically Western meal, with a good mix of vegetables, protein, carbohydrates and fat.

They worked with 11 patients, all of who had obesity and type 2 diabetes and take an oral drug that helps control glucose levels, called metformin. To see how food order impacted post-meal glucose levels, they had the patients eat a meal, consisting of carbohydrates (ciabatta bread and orange juice), protein, vegetables and fat (chicken breast, lettuce and tomato salad with low-fat dressing and steamed broccoli with butter) twice, on separate days a week apart.

Dr. Louis Aronne. Photo credit: Carlos Rene Perez

On the day of their first meal, researchers collected a fasting glucose level in the morning, 12 hours after the patients last ate. They were then instructed to eat their carbohydrates first, followed 15 minutes later by the protein, vegetables and fat. After they finished eating, researchers checked their post-meal glucose levels via blood test at 30, 60 and 120-minute intervals. A week later, researchers again checked patients' fasting glucose levels, and then had them eat the same meal, but with the food order reversed: protein, vegetables and fat first, followed 15 minutes later by the carbohydrates. The same post-meal glucose levels were then collected.

The results showed that glucose levels were much lower at the 30, 60 and 120 minute checks — by about 29 percent, 37 percent and 17 percent, respectively — when vegetables and protein were eaten before the carbohydrates. Insulin was also significantly lower when protein and vegetables were eaten first. This finding confirms that the order in which we eat food matters, and points to a new way to effectively control post-meal glucose levels in diabetic patients.

"Based on this finding, instead of saying ‘don't eat that' to their patients, clinicians might instead say, ‘eat this before that,'" Dr. Aronne said. "While we need to do some follow-up work, based on this finding, patients with type 2 might be able to make a simple change to lower their blood sugar throughout the day, decrease how much insulin they need to take, and potentially have a long-lasting, positive impact on their health."

Genetics, environment, and behavior are all known to contribute to obesity. Now add in a fourth factor: human immunity.

Histologic images above and below showing characteristic murine beige fat cells that are implicated in increasing caloric expenditure and limiting weight gain. Images: Jonathan R. Brestoff and David Artis

In the Dec. 22 issue of Nature, a research team, led by investigators at Weill Cornell Medical College, has found that an immune cell type appears to help burn fat and prevent the development of obesity. The findings suggest new ways of possibly preventing or treating obesity and obesity-related diseases in humans, says the study's senior investigator, Dr. David Artis, an immunologist who leads the Jill Roberts Institute for Research in Inflammatory Bowel Disease at Weill Cornell.

"Understanding how the immune system regulates metabolism and the function of adipose tissue will help guide investigations into immune-based therapies to limit fat accumulation," he says. "Of course, a lot more work is needed before we get there, but this study provides significant insights into this pathway."

The researchers discovered that a subset of immune cells — called group 2 innate lymphoid cells (ILC2s) — allows fat tissue to take on a metabolically active state that burns calories. This process occurs by inducing the development of a specialized fat-burning cell type called the "beige" fat cell.

Beige fat cells are thought to reduce obesity and other metabolic diseases and are correlated with leanness.

Images: Jonathan R. Brestoff and David Artis

The researchers examined white fat donated by both obese and non-obese study participants, and found decreased levels of ILC2s in obese white adipose tissue. In pre-clinical studies, the investigators found that mice that lacked normal ILC2s became obese and exhibited signs of diabetes.

"Our studies indicate that ILC2s have beneficial effects that decrease obesity and suggest that boosting ILC2s in fat should be explored as a potential therapeutic strategy to treat obesity," says Jonathan Brestoff, a Perelman School of Medicine MD-PhD student in the Artis lab who performed the studies.

While the reasons for immune system involvement in the regulation of fat tissue remain unclear, Dr. Artis says immune control of fat tissue is likely a conserved evolutionary response to body stressors. "For example, imagine that a person infected with the flu is sick, feverish and has no appetite. One can envision the value in reprogramming metabolic processes — such as holding on to stores of body fat — to help the body get through this stressful period associated with infection."

Storing fat is an advantageous response to support survival during times of famine. ILC2 regulation of fat storage may have evolved to help coordinate a switch in metabolic status as food abundance changes. In the context of obesity, however, ILC2s become defective, thereby consequently disconnecting the immune system from metabolic pathways. This might trick the body into a persistent fat storage mode and promote further obesity, Dr. Artis says.

This work is supported by the National Institutes of Health, the Crohn's and Colitis Foundation and the Burroughs Wellcome Fund.

Dr. Michel Kahaleh

NEW YORK (December 15, 2014) — Gastric bypass surgery has become an increasingly popular treatment option for the some 30 percent of Americans struggling with obesity. However, many gastric bypass patients struggle with side effects from the procedure, which are difficult to treat due to the patients' surgically-altered digestive tract. In order to more effectively treat these conditions, NewYork-Presbyterian/Weill Cornell Medical Center developed EUS-Directed Transgastric ERCP (EDGE), the first minimally invasive procedure to treat pancreaticobiliary diseases in gastric bypass patients.

"With the EDGE procedure, patients with gallstones and other causes of bile duct obstruction can usually be treated without the need for open surgery, which improves recovery time and greatly increases their comfort," said Dr. Michel Kahaleh, chief of endoscopy in the division of gastroenterology and hepatology at NewYork-Presbyterian/Weill Cornell Medical Center and a professor of medicine at Weill Cornell Medical College, who developed the EDGE procedure. "We're proud to be the first hospital to successfully treat gastric bypass patients using this technique."

Altered Anatomy Presents Treatment Challenges

In gastric bypass surgery, a small pouch is created from the patient's stomach, with the remainder of the stomach cut off from the passage of food. The pouch is then connected to the small intestine to allow the digestive process to occur. Due to the rapid weight loss caused by the procedure, gallstones and bile duct obstructions are common side effects in gastric bypass patients. Nearly 50 percent of patients who undergo the most common gastric bypass procedure develop gallstones and 25 percent may have their gallbladder removed.

"When surgeons perform gastric bypass, they alter the anatomy to ensure that patients lose weight," said Dr. Kahaleh. "But the reconfigured stomach and intestines makes it difficult to access the bile duct and gallbladder through minimally invasive procedures."

EDGE Offers an Effective Solution

Dr. Kahaleh developed EDGE based on his extensive experience using the AXIOS, a lumen apposing metal stent, which is used to treat conditions such as pancreatic pseudocysts and bile duct obstructions. Using AXIOS, he connects the accessible pouch to the excluded stomach. While the stent is in place, a specialized endoscope can extract the gallstone and drain the pancreas or the bile duct internally without using surgery. During that process the bypass is temporarily rendered ineffective. Once the lumen apposing metal stent is removed and the pouch closed a few weeks later, the bypass efficiency is restored. Since April 2014, five gastric bypass patients with gallstones or obstructed bile ducts have been successfully treated with EDGE without experiencing weight gain. The patients did not have to undergo open surgery, which saves recovery time and costs.

NewYork-Presbyterian/Weill Cornell Medical Center

NewYork-Presbyterian/Weill Cornell Medical Center, located in New York City, is one of the leading academic medical centers in the world, comprising the teaching hospital NewYork-Presbyterian and Weill Cornell Medical College, the medical school of Cornell University. NewYork-Presbyterian/Weill Cornell provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine, and is committed to excellence in patient care, education, research and community service. Weill Cornell physician-scientists have been responsible for many medical advances — including the development of the Pap test for cervical cancer; the synthesis of penicillin; the first successful embryo-biopsy pregnancy and birth in the U.S.; the first clinical trial for gene therapy for Parkinson's disease; the first indication of bone marrow's critical role in tumor growth; and, most recently, the world's first successful use of deep brain stimulation to treat a minimally conscious brain-injured patient. NewYork-Presbyterian Hospital also comprises NewYork-Presbyterian/Columbia University Medical Center, NewYork-Presbyterian/Morgan Stanley Children's Hospital, NewYork-Presbyterian/Westchester Division, NewYork-Presbyterian/The Allen Hospital, and NewYork-Presbyterian/Lower Manhattan Hospital. The hospital is also closely affiliated with NewYork-Presbyterian/Lawrence Hospital in Bronxville. NewYork-Presbyterian is the #1 hospital in the New York metropolitan area, according to U.S. News & World Report, and consistently named to the magazine's Honor Roll of best hospitals in the nation. Weill Cornell Medical College is the first U.S. medical college to offer a medical degree overseas and maintains a strong global presence in Austria, Brazil, Haiti, Tanzania, Turkey and Qatar. For more information, visit www.nyp.org and weill.cornell.edu.

Jessica M. Bibliowicz, Successful Business Executive, Named New Chair of the Board

NEW YORK (December 9, 2014) — After 20 years of bold and visionary leadership that has transformed Weill Cornell Medical College into a global healthcare enterprise, Sanford I. Weill will retire as chair of the Weill Cornell Board of Overseers on Jan. 1. Jessica M. Bibliowicz, a successful entrepreneur in the financial services business for nearly three decades, who has served on the Board of Overseers for the past decade, will succeed Mr. Weill, the new chair emeritus.

Jessica M. Bibliowicz and Sanford I. Weill. All photos: John Abbott

The transition comes as the 116-year-old medical college embarks on a new chapter that builds upon the landmark successes Mr. Weill has realized in his two decades as chair. His enduring dedication to the institution that bears his name has resulted in an unprecedented expansion that is exemplified in Weill Cornell's excellence in medical education, biomedical research and clinical care. In collaboration with medical college leadership, Ms. Bibliowicz will help lead Weill Cornell as it continues to break new ground in New York and abroad by expanding its clinical enterprise and forging public-private partnerships that accelerate groundbreaking scientific discoveries for patients. Working closely with Dr. Laurie H. Glimcher, the Stephen and Suzanne Weiss Dean of Weill Cornell Medical College, Ms. Bibliowicz will help guide its transformation of medical education and drive dialogue on innovative healthcare delivery models that optimize the value and quality of patient care.

"When I joined the Board of Overseers more than 30 years ago, I was driven to try and make a difference in the world," Mr. Weill said. "It's truly humbling to see just how much of an impact Weill Cornell has had around the globe, and I believe we are poised to thrive far into the future. Weill Cornell Medical College is more to me than just an esteemed medical school — the people here are my extended family. I could think of no one better than Jessica to shepherd Weill Cornell into the next stage of its evolution."

"It's an honor and privilege to be able to support Weill Cornell Medical College's tremendous efforts to educate, innovate and heal," Ms. Bibliowicz said. "As a Cornell University alum, it's especially meaningful to me to try and help take this distinguished institution to the next level of excellence in New York and beyond. Our ever-changing healthcare landscape has sparked exciting opportunities to help shape national conversation, and I'm eager to work with Dr. Glimcher and the Board of Overseers as we strive to improve and prolong human health."

Dr. Laurie H. Glimcher, Sanford I. Weill and Jessica M. Bibliowicz

In the three decades he has served on the Board of Overseers and in the two decades he has been chair, Mr. Weill has been much more than a governing force. His benevolence and unwavering resolve to ensure a healthier future has touched every program area at Weill Cornell, establishing the medical school as an innovator in basic, clinical and translational research, and forging a new paradigm for global engagement and medical education.

Under Mr. Weill's leadership, the medical college has built bridges nationally and abroad. Weill Cornell forged an affiliation with Houston Methodist in Texas and, with Cornell University, established a medical school in Doha, Qatar. Since its inception in 2002, Weill Cornell Medical College in Qatar, which offers a Cornell University medical degree, has created 181 new doctors who have continued their graduate medical training in residencies and clinical research at outstanding institutions in the United States and Qatar. The Weill Cornell Qatar location has also established a world-class biomedical team and contributed to Qatar's goal of becoming a knowledge-based economy. In addition, Weill Cornell in 2007 established a formal affiliation with Bugando Medical Centre and the Weill Bugando University College of Health Sciences in Mwanza, Tanzania, named in recognition of the Weills' support. Weill Bugando has graduated an average of 100 new doctors every year for the past seven years in Mwanza, expanding Tanzania's core of providers who are empowered to deliver the best patient care, despite a resource-limited setting. This unique educational partnership has spurred new possibilities for cultural exchange, providing medical students at Weill Cornell in New York and residents at NewYork-Presbyterian Hospital with the opportunity to spend a month or two in Mwanza practicing medicine the way it used to be, with limited modern technology. They return to New York with a greater sense of gratification that reaffirms their commitment to global health and a career in academic medicine.

In recognition that building a healthier future also requires training an exceptional cadre of new doctors and scientists, Mr. Weill and his wife Joan in 1992 established the Joan and Sanford I. Weill Education Center, the heart of the medical college's education program, with their first gifts to Weill Cornell. The Weill Education Center comprises the Weill Auditorium and 20 classrooms and teaching laboratories outfitted with modern audio-visual, networking and wireless technology to provide the next generation of medical professionals with the best environment for learning.

Sanford I. Weill

In 2007, Weill Cornell opened the Weill Greenberg Center in New York City, the medical college's flagship and award-winning ambulatory care center, and in January opened the adjacent Belfer Research Building, a transformative 18-story, state-of-the-art facility that ensures that the medical college remains at the forefront of scientific discovery. Their proximity to each other ensures that breakthroughs made in the laboratory can be rapidly applied to patient care as improved treatments and therapies. Weill Cornell has successfully recruited some of the world's leading physicians and scientists to conduct this translational research. Last year, the Weills established the Weill Center for Metabolic Health, which strives to understand the basic biology and genetics of diabetes, obesity and metabolic syndrome, and translate discoveries into next-generation therapeutic approaches. Weill Cornell is conducting a national search for a renowned scientist to lead these efforts.

A self-made man who exemplifies the philosophy of leading by example, Mr. Weill, Mrs. Weill and the Weill Family Foundation have generously given more than $550 million in gifts to support Weill Cornell Medical College. They include a groundbreaking $100 million gift in 1998 — at the time the largest in Cornell University's history — a second $100 million gift in 2002, a $250 million gift in 2007 and another $100 million gift in 2013 to establish the Weill Center for Metabolic Health, as well as the Joan and Sanford I. Weill and the Weill Family Foundation Global Health Research Laboratories. In honor and appreciation of their unparalleled dedication and enduring commitment, the institution in 1998 was renamed Weill Cornell Medical College. With an additional gift of $50 million to Cornell University, the Weills' total giving tops $600 million.

The Weills' altruism inspired and galvanized Weill Cornell's numerous, loyal donors to support the medical college. In Mr. Weill's 20 years as chair, the medical college has raised $3 billion. Earlier this year, Weill Cornell celebrated the Weills' legacy by naming its department of medicine the Joan and Sanford I. Weill Department of Medicine.

"What Sandy has done for Weill Cornell, New York and the world is just breathtaking — it's a labor of love that will touch the lives of generations," Dr. Glimcher said. "His unwavering leadership, profound magnanimity and steadfast resolve to enhance medical education, advance discoveries and enrich clinical care is his lasting legacy. Jessica is an outstanding choice to assume Sandy's mantle and steer Weill Cornell into the future. I couldn't be more thrilled for what's to come."

"Sandy is a businessman, entrepreneur, philanthropist, visionary leader, chairman emeritus of Citigroup, Cornell alumnus and my good friend," said Cornell University President David Skorton. "As chair of the Board of Overseers of Weill Cornell Medical College, he has nurtured the college's growth, guided its progress and expanded its capacity for rigorous medical education, path-breaking research and superb clinical care — to the enormous benefit of our students, faculty, researchers and patients. I am delighted that Jessica Bibliowicz, who has provided exemplary leadership to the university and the medical college, has agreed to take on this new role as chair of the Board of Overseers."

"It is impossible to overstate the impact that Sandy has had on Weill Cornell Medical College, and on the whole of Cornell University, during his time as chair of the Board of Overseers," said Robert Harrison, chair of the Cornell University Board of Trustees. "He is someone who can not only articulate a strong and inspirational vision, but also bring people together to do what it takes to make the vision a reality. Although I will miss working with Sandy, I am very much looking forward to working with Jessica in her new role. She has been a very effective trustee and overseer for many years and clearly has the talent and energy to lead the Board of Overseers and the medical school to new heights."

About Jessica M. Bibliowicz

A Cornell University graduate in 1981 and after working 18 years in financial services, Ms. Bibliowicz became CEO of National Financial Partners in 1999, a financial services firm that specializes in benefits and wealth management. The company went public in 2003 and was sold to Madison Dearborn in 2013. Ms. Bibliowicz joined the Weill Cornell Board of Overseers in 2004. She is also a member of the Cornell University Board of Trustees and a member of the Cornell NYC Tech Campus Task Force. Currently, Ms. Bibliowicz is a senior advisor at Bridge Growth Partners and serves on the board of directors of Sotheby's(NYSE: BID); Realogy (NYSE: RLGY); and the Asia Pacific Fund (NYSE: APB). She is a board director/trustee of Prudential Insurance Funds and is also on the board of Jazz at Lincoln Center.

Weill Cornell Medical College

Weill Cornell Medical College, Cornell University's medical school located in New York City, is committed to excellence in research, teaching, patient care and the advancement of the art and science of medicine, locally, nationally and globally. Physicians and scientists of Weill Cornell Medical College are engaged in cutting-edge research from bench to bedside aimed at unlocking mysteries of the human body in health and sickness and toward developing new treatments and prevention strategies. In its commitment to global health and education, Weill Cornell has a strong presence in places such as Qatar, Tanzania, Haiti, Brazil, Austria and Turkey. Through the historic Weill Cornell Medical College in Qatar, Cornell University is the first in the U.S. to offer a M.D. degree overseas. Weill Cornell is the birthplace of many medical advances — including the development of the Pap test for cervical cancer, the synthesis of penicillin, the first successful embryo-biopsy pregnancy and birth in the U.S., the first clinical trial of gene therapy for Parkinson's disease, and most recently, the world's first successful use of deep brain stimulation to treat a minimally conscious brain-injured patient. Weill Cornell Medical College is affiliated with NewYork-Presbyterian Hospital, where its faculty provides comprehensive patient care at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. The Medical College is also affiliated with Houston Methodist. For more information, visit weill.cornell.edu.