A new study led by Cedars-Sinai Health Sciences University investigators found that prostate-specific antigen (PSA) levels in the blood, which are used to track the effectiveness of prostate cancer treatment, need to be 10 times lower than most physicians generally target for the best patient outcomes.

The study, published in Cancer, could help doctors better manage treatment of prostate cancer patients, maximizing patients’ chances of survival.

“PSA levels drop dramatically when patients receive hormone therapy,” said Stephen Freedland, MD, professor of Urology and director of the Center for Integrated Research in Lifestyle and Cancer at Cedars-Sinai, and first author of the study. “Our study found that the optimal PSA level was less than 0.2 nanograms per milliliter of blood. However, fewer than half of patients given hormone therapy alone reached that optimal level for overall survival.”

Investigators reviewed Veterans Health Administration data on 4,090 prostate cancer patients. They found that even if PSA dropped 90%, if it did not get below 0.2 nanograms per milliliter of blood, outcomes were not good.

Importantly, the study found that if doctors added drugs called androgen receptor pathway inhibitors to their hormone therapy, patients were much more likely to reach PSA levels below 0.2 nanograms per milliliter of blood.

“Many physicians don’t offer patients additional treatment because hormone therapy alone lowers their PSA levels below 2 nanograms per milliliter, which we previously showed was many physicians’ target level,” Freedland said. “We hope these data will change that practice.”

Additional authors include Wei Gao, PhD; Maëlys Touya, PharmD, MSc; Hongbo Yang, PhD; David Russell, MD, FACS; Jingyi Chen, MS; Grace Chen, MS; and Jasmina I. Ivanova, MA.

Funding: Sponsored by Pfizer Inc. and Astellas Pharma Inc.

Disclosures: Stephen J. Freedland reports consulting or advisory roles with Astellas Pharma Inc., AstraZeneca, Bayer, Candel, Eli Lilly, Johnson & Johnson Innovative Medicine (formerly Janssen), Merck, Novartis, Pfizer Inc., Sanofi, Sumitomo Pharma America, Inc. (formerly Myovant Sciences), and Tolmar.

New Tool Measures Thyroid Cancer Patients’ Anxiety

A new tool created by Cedars-Sinai Health Sciences University investigators is the first to measure anxiety in patients with thyroid cancer. Described in Thyroid, the Thyroid Cancer Modified Anxiety Scale (TC-MAX) could help doctors clarify patients’ expectations, better match their treatment to their needs, and improve patient outcomes.

“A patient’s distress greatly influences which thyroid cancer treatment the patient prefers and what their doctor recommends,” said Allen Ho, MD, professor of Surgery, co-director of the Thyroid Cancer Program at Cedars-Sinai Cancer and senior author of the study. “We found that our tool effectively assesses patient concerns to help doctors better determine the best course of treatment. This is especially important when the treatment options have similar likely outcomes but patient preferences vary widely.”

The tool includes 18 questions that measure a patient’s general cancer-related anxiety, their anxiety around ultrasound testing, which is used to monitor thyroid cancer progression, and their fear about whether their cancer will progress or come back. Investigators created TC-MAX in collaboration with Thyroid Cancer Survivors’ Association, the world’s largest thyroid cancer patient consortium. They relied on medical literature, physician expertise and the perspectives of more than 1,000 thyroid cancer patients.

The study showed that the extent of each patient’s anxiety mirrored the extent of surgery they chose, Ho said. When active surveillance, partial thyroid removal and total thyroid removal were all options, patients with the highest TC-MAX anxiety scores chose to have their entire thyroid removed, while those with lower average TC-MAX scores generally selected partial thyroid removal. Patients with the lowest scores chose active surveillance.

Ho said that the tool is now ready for use in clinical trials and patient care.

Additional Cedars-Sinai authors include Amanda J. Bastien MD, Sungjin Kim MS, Cynthia Zalt, Iris Cong PhD, Jewel Ng, Caroline Marshall, Christopher V. Almario MD MSHPM, Omer Liran MD, Brennan M.R. Spiegel MD, MSHS, Jon Mallen-St. Clair MD, PhD, Evan Walgama MD, Kevin S. Scher MD, Julie K. Jang MD, Yufei Chen MD, Samuel Zhang MD, Linnea Peterson MD, Wendy L. Sacks MD, and Zachary S. Zumsteg MD.

Other authors include Gary Bloom and Michelle M. Chen MD.

Funding: AAOHNS CORE Grant; Cedars-Sinai Jim and Eleanor Randall Department of Surgery Research Award.

Reducing Unnecessary Fluid Testing Could Lower Cancer Care Costs

Doctors might be able to safely reduce healthcare costs by skipping unnecessary laboratory tests for patients with advanced gynecologic cancers, according to a Cedars-Sinai Health Sciences University study. The paper, published in JAMA Network Open, examined testing on fluid drained from the abdomen or around the lungs.

Patients with advanced gynecologic cancer often experience fluid buildup in these areas. Draining the fluid helps relieve pain, pressure and other symptoms, but the investigators found that laboratory testing of the fluid is frequently unnecessary.

Cedars-Sinai gynecologic oncology fellow Yingao Zhang, MD, and obstetrics and gynecology resident Olivia Foy, MD, are co-first authors of the study.

“We undertook this study to determine how often unnecessary tests may be safely skipped, and to estimate how much this would help reduce healthcare costs,” Zhang said.

Investigators reviewed 976 fluid-draining procedures performed on gynecologic cancer patients at one hospital over 10 years. Laboratory testing was ordered in 40% of cases, a common practice done to rule out infection, check for the presence of cancer cells, and determine the cause of fluid buildup.

Nearly 80% of those orders included at least one test the researchers determined was likely unnecessary—either because a cancer diagnosis had already been confirmed or a patient had no symptoms that would prompt further fluid testing. The estimated cost of these tests was roughly $1million over 10 years.

The investigators found that unnecessary tests were more likely to be ordered in the emergency department or for hospitalized patients than in outpatient clinics. They also found that non-oncology care providers were more likely to order unneeded fluid tests than oncologists.

“Avoiding automatic lab testing on fluid from patients with known cancer diagnoses represents a low-risk opportunity to reduce healthcare costs,” Foy said.

The investigators identified clinician education as a way to reduce unnecessary testing and related costs, and suggested that similar analyses in other cancer types and other institutions could uncover additional cost-reducing opportunities.

Additional Cedars-Sinai authors include Grace Pipes, MD; and Margaret I. Liang, MD, MSHPM.

Funding: The Cedars-Sinai Honest Enterprise Research Broker (HERB) Committee, which assisted with cohort building, is supported by the NIH National Center for Advancing Translational Science (NCATS) UCLA CTSI Grant Number UL1TR001881.

Disclosures: Dr. Liang reported grants from Merck, grants from Foundation for Women’s Cancer, and personal fees from Association of Cancer Care Centers outside the submitted work.

How Your Brain Stays Focused on a Goal

Cedars-Sinai Health Sciences University investigators have discovered how the brain maintains focus when a person is working toward a goal. The study, published in Nature Human Behaviour, sheds light on how a person’s brain actively maintains task goals in working memory while that person responds to changes in their environment.

“Our findings show that the brain maintains memories of task goals by keeping certain neurons persistently active over minutes,” said Ueli Rutishauser, PhD, professor of Neurosurgery, at Cedars-Sinai and senior author of the study. “The two different brain regions we studied maintained such memories in two different formats, thereby giving people the flexibility to adapt while continuing to pursue the same goal.”

The study concentrated on two brain regions: the medial frontal cortex, which supports planning, decision-making and long-term goal achievement, and the hippocampus, which plays an important role in learning and memory.

Investigators recorded the activity of individual brain cells while study participants completed tasks designed to test how the brain remembers goals over many minutes without reminders.

By analyzing activity patterns in different brain regions, investigators found that task goals are stably and persistently represented by brain cells in the medial frontal cortex many minutes after instructions were given to the participants. In contrast, the hippocampus continuously updated task goal information as circumstances changed on the timescale of seconds. This allows a person to adapt quickly to change without losing sight of a desired long-term outcome.

Additional Cedars-Sinai authors include Hristos Courellis, Michael Kyzar, Juri Minxha and Adam Mamelak.

Other authors include Araceli R. Cardenas, Taufik Valiante and Ralph Adolphs.

Funding: This work was supported by the BRAIN Initiative through the NIH Office of the Director (U01NS117839 to U.R.), the Simons Foundation Collaboration on the Global Brain (to U.R. and R.A.), and by a merit scholarship from the Josephine De Karman Fellowship Trust (to H.S.C.).

Small Bowel Microbiome Offers Clues to Women’s Health        

A new study by investigators at Cedars-Sinai Health Sciences University has identified differences in the makeup and organization of the small bowel microbiome between women and men. The findings, published in iScience, could offer new insights into why some conditions are more prevalent in women.

The small bowel microbiome comprises a community of microorganisms that coexist in this part of the digestive tract and play vital roles in immune function, metabolism and hormonal regulation.

“One intriguing finding was a bacterial community containing Granulicatella, which we found only in women,” said Ruchi Mathur, MD, director of Clinical Research and Clinical Operations for the Medically Associated Science and Technology (MAST) Program at Cedars-Sinai and corresponding author of the study. “Bacteria in this community appear at increased levels in women with polyendocrine metabolic ovarian syndrome, formerly known as polycystic ovary syndrome.”

Investigators also found sex differences related to how small bowel microbes produce fructans, complex carbohydrates known for triggering digestive symptoms in irritable bowel syndrome (IBS), a condition far more common in women than men.

“Our findings show that biological sex is a critical variable in the small bowel microbiome,” said Mathur, also a professor of Medicine. “We must consider it as we move toward more personalized approaches to understanding and treating disease.”

Other Cedars-Sinai authors include Mohamad Rashid, Gabriela Leite, Gillian M. Barlow, Ava Hosseini, Daniel Brimberry, Dilara Flor, Gonzalo Parodi, Maritza Sanchez, Ignacio Rivera, Angel Trujillo, Maria Jesus Villanueva-Millan, Walter Morales, Stacy Weitsman and Mark Pimentel.

Funding: This study was supported by the Monica Lester Charitable Trust and the Elias, Genevieve and Georgianna Atol Charitable Trust in support of Ruchi Mathur’s research, and the National Philanthropic Trust in support of Mark Pimentel’s research.

Boosting the Accuracy of Disease Risk Prediction From Genetic Data

Investigators at Cedars-Sinai Health Sciences University have developed a new computational framework for improving how genetic data is used to estimate the inherited risk that an individual will develop conditions like Alzheimer's disease, Type 2 diabetes, high blood pressure and breast cancer.

The framework, called Adaptive Boosting of Pre-trained Polygenic Risk Scores (AB-PRS) and described in Nature Communications, builds on existing polygenic risk scores, tools that estimate disease risk based on many genetic variants across the genome, and identifies additional genetic signals that may not be fully captured by current scoring methods.

"As more people undergo genetic testing, it's becoming increasingly important to make the best use of that information," said Ruowang Li, PhD, co-corresponding author of the study and assistant professor of Computational Biomedicine at Cedars-Sinai. "Our findings aim to improve the accuracy of genetic risk prediction, allowing us to better predict disease risk and guide more personalized care."

Polygenic risk scores are increasingly used in research and clinical settings to estimate genetic susceptibility to common diseases, but their accuracy varies across diseases, datasets and populations. Investigators trained AB-PRS to identify genetic signals that existing risk scores may miss. They tested the approach using genetic data from the UK Biobank and validated the findings in three independent biobanks. The method consistently matched or outperformed existing polygenic risk scores across multiple diseases. The researchers say additional validation, particularly in more diverse populations, will be needed before the approach can be widely used in clinical care.

Additional Cedars-Sinai authors include Raelynn Chen, Olivia Wu, Okan Bilge Ozdemir, Zaldy Tan.

Other authors include Jie Hu, Maxwell Salvatore, Yiwen Lu, Shawn Murphy, Elizabeth Karlson, Atlas Khan, Krzysztof Kiryluk, Iftikhar Kullo, Johanna Smith, Eimear Kenny, Yuan Luo, William G. La Cava, Marylyn D. Ritchie and Yong Chen.

Funding: J.H. and Y.C.’s efforts were supported in part by National Institutes of Health

(U01TR003709, RF1AG077820, R01AG073435, R01DK128237). R.L. is supported

by the National Institutes of Health grants R01 AG094962, P30 AG094848 and U01 AG066833 and in part by Cedars-Sinai Department of Neurology/Jona Goldrich Center for Alzheimer’s & Memory Disorders. R.C. and O.B.O. are supported by the Department of Computational Biomedicine, Cedars-Sinai.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

Las células cerebrales que liberan dopamina —una sustancia química mensajera que interviene en el control del movimiento— la almacenan en pequeños sacos rodeados de membrana llamados vesículas sinápticas. Y estas vesículas son diferentes de las que utilizan las células cerebrales que liberan otras sustancias químicas mensajeras, según demuestra un estudio dirigido por investigadores de Cedars-Sinai Health Sciences University.

El estudio, publicado en Science Advances, podría contribuir a una mejor comprensión de la enfermedad de Parkinson, un trastorno del movimiento que provoca la muerte progresiva de las células cerebrales que liberan dopamina. La muerte de estas células causa los problemas de movimiento característicos de la enfermedad.

“Nuestra investigación arroja luz sobre las distintas formas en que las células cerebrales liberan mensajeros químicos, que utilizan para comunicarse entre sí”, dijo Katlin Silm, PhD, profesora asistente de Ciencias Biomédicas y Neurología y autora principal del estudio. “Identificamos diferencias clave entre las células cerebrales que liberan dopamina y las que liberan otras sustancias químicas cerebrales”.

Las vesículas sinápticas ayudan a las células cerebrales a comunicarse al fusionarse con la membrana celular y liberar su contenido en el espacio entre las células. En los cerebros de ratones de laboratorio, los investigadores descubrieron que las vesículas sinápticas que contienen dopamina transportan un conjunto de proteínas distinto al de aquellas que contienen otras sustancias químicas mensajeras.

“Nuestros hallazgos demuestran que la composición de una vesícula es fundamental para determinar cómo se liberan las sustancias químicas mensajeras del cerebro”, dijo Silm, quien también es investigadora científica del Board of Governors Regenerative Medicine Institute. “Las diferencias que identificamos ayudan a explicar las propiedades únicas de la liberación de dopamina y sientan las bases para explorar cómo esto afecta la estabilidad a largo plazo de las células cerebrales productoras de dopamina”.

Otros autores de Cedars-Sinai incluyen a Hrach Asmerian, Alexia J. Diaz, Jacob Alberts, Barathan Gnanabharathi, Anna M. Sanetra y Noah Carr.

Otros autores incluyen a Hongfei Xu, Juan A. Oses-Prieto, Poulomi Das, Alma L. Burlingame y Robert H. Edwards.

Financiamiento: Este trabajo recibió apoyo de The Larry L. Hillblom Foundation, subvención 2022-A-004-SUP (KS); Brain and Behavior Research Foundation, subvención 29845 (KS); National Institutes of Health, subvención R01NS138465 (KS); National Institutes of Health, subvención R01NS103938 (RHE); y National Institutes of Health, subvención R01NS129803 (RHE). La espectrometría de masas se realizó en el Mass Spectrometry Resource de UCSF, que cuenta con el apoyo de la Dr. Miriam and Sheldon G. Adelson Medical Research Foundation (JAO-P y ALB).

Nuevo Método Podría Aumentar el Valor de los Análisis de Sangre para Monitorear el Cáncer de Colon

Los análisis de sangre podrían convertirse en una herramienta más eficaz para monitorear la progresión del cáncer de colon y la respuesta al tratamiento, según un estudio dirigido por investigadores de Cedars-Sinai Health Sciences University. Los hallazgos, publicados en Experimental Hematology & Oncology, utilizaron perfiles unicelulares para analizar las células tumorales circulantes y las células no cancerosas presentes en la sangre de los pacientes.

“Nuestro método va más allá del tumor para comprender también la respuesta del paciente al cáncer”, dijo Jun Gong, MD, director médico de Cáncer Colorrectal de Cedars-Sinai y autor del estudio. “Podría ayudar a orientar decisiones de tratamiento más personalizadas basadas en el comportamiento del tumor y el estado del paciente”.

Los investigadores analizaron muestras de sangre de pacientes con cáncer colorrectal avanzado, examinando 10 características celulares diferentes y utilizando análisis unicelular para precisar sus hallazgos.

El método revela cambios importantes, como las medidas que adoptan las células tumorales para evadir al sistema inmunitario o la presencia de inflamación en células normales. Según Gong, estos cambios pasarían inadvertidos con las pruebas existentes.

Si estos hallazgos se validan en estudios de mayor tamaño, dijo Gong, este método podría complementar las herramientas existentes para monitorear el cáncer, incluidas las pruebas de diagnóstico por imágenes y los análisis de laboratorio estándar.

Otros autores de Cedars-Sinai incluyen a Francesca Aguirre, MD; Lisa Zhou, BS; Aaron Denmark, BS; Rocio Alvarez, MsC; y Daniel M. Kim, MD.

Otros autores incluyen a Gabriela Felix, PhD, y Megan P. Hitchins, PhD.

Financiamiento: Este estudio fue financiado en parte por la subvención R01CA252042 del NCI (MH), el Cedars-Sinai Cancer Developmental Fund (MH) y el ASCO Conquer Cancer Career Development Award (JG).

Declaraciones: J.G. informa haber recibido honorarios por consultoría y otros honorarios de las siguientes compañías: EMD Serono, Exelixis, Natera, Eisai, Janssen, Pfizer, Bayer, Taiho, Agenus, Seagen y Caper Labs. G.F., J.G. y M.H. tienen una solicitud de patente provisional (solicitud n.º 64/039,184) relacionada con el trabajo descrito en este manuscrito.

Gas de Sulfuro de Hidrógeno Está Relacionado con Daños Más Graves en el SII

Investigadores de Cedars-Sinai Health Sciences University han identificado cómo el exceso de gas de sulfuro de hidrógeno producido por ciertos microbios intestinales altera la actividad genética en el intestino delgado. Sus hallazgos, publicados en mSystems, ofrecen nuevos conocimientos sobre afecciones asociadas con el síndrome del intestino irritable (SII), uno de los trastornos gastrointestinales más comunes.

El sobrecrecimiento bacteriano del intestino delgado (SIBO, por sus siglas en inglés), el sobrecrecimiento de metanógenos intestinales (IMO) y la sobreproducción intestinal de sulfuro (ISO) son afecciones en las que los microbios productores de gases se multiplican excesivamente en el intestino delgado. Estos trastornos suelen estar relacionados con el SII.

“Nuestros resultados demuestran que ISO, IMO y SIBO son afecciones biológicamente distintas que requerirán diferentes enfoques de tratamiento”, dijo Mark Pimentel, MD, director ejecutivo del Medically Associated Science and Technology (MAST) Program de Cedars-Sinai y autor para correspondencia del estudio. “Los genes alterados en estas afecciones están relacionados con diversos síntomas, y comprender estos mecanismos nos ayudará a desarrollar mejores terapias para los pacientes”.

Los investigadores analizaron muestras de tejido del intestino delgado de pacientes y animales de laboratorio. Encontraron los cambios más extensos en la actividad genética en las muestras de pacientes con ISO, y cambios más limitados en las muestras de SIBO e IMO.

Los cambios genéticos afectaron la actividad inmunitaria, la absorción de líquidos, el movimiento de nutrientes a través del intestino, las defensas antioxidantes y la producción de energía celular. Estos hallazgos podrían ayudar a explicar por qué la sobreproducción de sulfuro de hidrógeno se ha asociado con diarrea, dolor abdominal y otros síntomas gastrointestinales graves en pacientes con SII con predominio de diarrea.

Pimentel dijo que se necesitan estudios de mayor tamaño que integren pruebas de aliento y perfiles del microbioma para validar aún más estos hallazgos e identificar cómo podrían contribuir al desarrollo de nuevas terapias.

Otros autores de Cedars-Sinai incluyen a Juliana de Freitas Germano, Gabriela Leite, Maria Jesus Villanueva-Millan, Daniel Brimberry, Mohamad Rashid, Ava Hosseini, Dilara Flora, Said Bogatyrev, Walter Morales, Stacy Weitsman, Maritza Sanchez, Ignacio Rivera, Cristina Moreno Fajardo, Victoria Murray, Gonzalo Parodi, Margie Parra, Gillian M. Barlow, Ali Rezaie y Ruchi Mathur.

Otros autores incluyen a Zhe Lyu.

Financiamiento: Este estudio recibió apoyo principalmente del Medically Associated Science and Technology (MAST) Program de Cedars-Sinai Medical Center, Los Ángeles, California, y fue financiado en parte mediante donaciones privadas al MAST Program.

Declaraciones: Los doctores Pimentel, Mathur y Rezaie informan tener participación accionaria en APQ Health y haber recibido honorarios por licencias o consultoría relacionados con tecnologías de diagnóstico mediante pruebas de aliento de Gemelli Biotech y Brio-Medical. Los demás autores declaran no tener conflictos de intereses.

Cedars-Sinai Health Sciences University está impulsando investigaciones innovadoras y formando a los futuros líderes en medicina, ciencias biomédicas y ciencias de la salud afines. Más información.

Brain cells that release dopamine—a messenger chemical that drives motor control— package it into tiny membrane-bound sacs called synaptic vesicles. And these vesicles differ from vesicles used by brain cells that release other messenger chemicals, a study led by Cedars-Sinai Health Sciences University investigators shows.

The study, published in Science Advances, could lead to better understanding of Parkinson’s disease, a movement disorder that causes dopamine-releasing brain cells to progressively die. The death of these cells leads to the movement problems that characterize the disease.

“Our research sheds light on the different ways brain cells release chemical messengers, which the cells use to communicate with each other,” said Katlin Silm, PhD, assistant professor of Biomedical Sciences and Neurology and senior author of the study. “We identified key differences between brain cells that release dopamine and those that release other brain chemicals.”

Synaptic vesicles help brain cells to communicate by fusing with the cell membrane and releasing their contents into the space between cells. In the brains of laboratory mice, investigators found that dopamine-containing synaptic vesicles carry a distinct set of proteins compared to those containing other messenger chemicals.

“Our findings show that a vesicle’s composition is critical to determining how brain messenger chemicals are released,” said Silm, also a research scientist in the Board of Governors Regenerative Medicine Institute. “The differences we identified help explain the unique properties of dopamine release and lay the groundwork to explore how this affects the long-term stability of dopamine-producing brain cells.”

Additional Cedars-Sinai authors include Hrach Asmerian, Alexia J. Diaz, Jacob Alberts, Barathan Gnanabharathi, Anna M. Sanetra, and Noah Carr.

Other authors include Hongfei Xu, Juan A. Oses-Prieto, Poulomi Das, Alma L. Burlingame, and Robert H. Edwards.

Funding: This work was supported by The Larry L. Hillblom Foundation grant 2022-A-004-SUP (KS), Brain and Behavior Research Foundation grant 29845 (KS), National Institutes of Health grant R01NS138465 (KS), National Institutes of Health grant R01NS103938 (RHE), National Institutes of Health grant R01NS129803 (RHE). Mass spectrometry was performed at the Mass Spectrometry Resource at UCSF, which is supported by the Dr. Miriam and Sheldon G. Adelson Medical Research Foundation (JAO-P & ALB).

New Method Could Boost Blood Tests’ Colon Cancer Monitoring Value

Blood tests could become a more powerful tool for monitoring colon cancer progression and treatment response, based on a study led by Cedars-Sinai Health Sciences University investigators. Their findings, published in Experimental Hematology & Oncology, used single-cell profiling to analyze circulating tumor cells and noncancerous cells in patients’ blood.

“Our method looks beyond the tumor to also understand the patient’s response to the cancer,” said Jun Gong, MD, medical director of Colorectal Cancer at Cedars-Sinai and an author of the study. “It could help guide more personalized treatment decisions based on tumor behavior and patient condition.”

Investigators analyzed blood samples from patients with advanced colorectal cancer, looking at 10 different cellular characteristics and using single-cell analysis to refine their findings.

The method reveals important changes, such as tumor cells taking action to evade the immune system or normal cells showing inflammation. These changes would be missed with existing tests, Gong said.

If these findings are validated in larger studies, Gong said, this method would complement existing tools for cancer monitoring, including imaging and standard laboratory tests.

Additional Cedars-Sinai authors include Francesca Aguirre, MD; Lisa Zhou, BS; Aaron Denmark, BS; Rocio Alvarez, MsC; and Daniel M. Kim, MD.

Other authors include Gabriela Felix, PhD; and Megan P. Hitchins, PhD.

Funding: This study was funded in part by NCI grant R01CA252042 (MH), Cedars-Sinai Cancer Developmental Fund (MH) and the ASCO Conquer Cancer Career Development Award (JG).

Disclosures: J.G. reports receiving consulting fees and honoraria from the following companies: EMD Serono, Exelixis, Natera, Eisai, Janssen, Pfizer, Bayer, Taiho, Agenus, Seagen, and Caper Labs. G.F., J.G. and M.H. have a provisional patent application (Application No.: 64/039,184) related to the work described in this manuscript.

Hydrogen Sulfide Gas Linked to More Severe IBS Damage

Investigators at Cedars-Sinai Health Sciences University have identified how excess hydrogen sulfide gas produced by certain gut microbes alters gene activity in the small intestine. Their findings, published in mSystems, offer new insight into conditions associated with irritable bowel syndrome (IBS), one of the most common gastrointestinal disorders.

Small intestinal bacterial overgrowth (SIBO), intestinal methanogen overgrowth (IMO) and intestinal sulfide overproduction (ISO) are conditions in which gas-producing microbes over-multiply in the small intestine. The disorders are often connected to IBS. 

"Our results show that ISO, IMO and SIBO are biologically distinct conditions that will require different treatment approaches," said Mark Pimentel, MD, executive director of the Medically Associated Science and Technology (MAST) Program at Cedars-Sinai and corresponding author of the study. "The genes altered in these conditions are linked to a variety of symptoms and understanding these mechanisms will help us develop better therapies for patients."

Investigators analyzed small bowel tissues samples from patients and laboratory animals. They found the most extensive changes in gene activity in samples from patients with ISO, and more limited changes in SIBO and IMO samples.

The genetic changes affected immune activity, fluid absorption, movement of nutrients through the gut, antioxidant defenses and cellular energy production. These findings may help explain why hydrogen sulfide overproduction has been associated with diarrhea, abdominal pain and other severe gastrointestinal symptoms in patients with diarrhea-predominant IBS.

Pimentel said larger studies integrating breath testing and microbiome profiling are needed to further validate these findings and identify how they might inform new therapies.

Other Cedars-Sinai authors include Juliana de Freitas Germano, Gabriela Leite, Maria Jesus Villanueva-Millan, Daniel Brimberry, Mohamad Rashid, Ava Hosseini, Dilara Flora, Said Bogatyrev, Walter Morales, Stacy Weitsman, Maritza Sanchez, Ignacio Rivera, Cristina Moreno Fajardo, Victoria Murray, Gonzalo Parodi, Margie Parra, Gillian M. Barlow, Ali Rezaie and Ruchi Mathur.

Other authors include Zhe Lyu.

Funding: This study was primarily supported by the Medically Associated Science and Technology (MAST) Program at Cedars-Sinai Medical Center, Los Angeles, CA, and funded in part through private donations to the MAST Program.

Disclosures: Drs. Pimentel, Mathur and Rezaie report equity in APQ Health and have received licensing or consulting fees related to diagnostic breath-testing technologies from Gemelli Biotech and Brio-Medical. The remaining authors declare no competing interests.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

The Endocrine Society, which organizes the annual meeting, is a global medical society dedicated to discovering the causes and effective treatments to care for patients with hormone disorders.

Cedars-Sinai is a leader in endocrinology, diabetes and metabolism research and clinical care. Experts attending the conference are available to discuss a wide variety of subjects, including cortisol regulation, pituitary gland disorders, puberty, adrenal function, neuroendocrine-disrupting tumors, and growth hormones.

Cedars-Sinai Presentations at ENDO 2026

Gut Bacteria and Polycystic Ovary Syndrome

Gabriela Leite, PhD, lead project scientist for the Medically Associated Science and Technology (MAST) Program, will present findings from three laboratory mouse studies suggesting that Rothia mucilaginosa, a bacterium found in the human small intestine, may contribute to polycystic ovary syndrome (PCOS)-like changes, including disrupted reproductive cycles, elevated testosterone levels and altered ovarian function. Additional findings suggest the microbe can persist in the small intestine with minimal disruption to the surrounding microbial community. Lead investigator Ruchi Mathur, MD, director of Clinical Research and Clinical Operations for MAST program, is also available to discuss the presentations.

Cortisol, Blood Sugar and Fatigue

Michelle L. Koh, MD, an endocrinologist and research fellow in the Division of Endocrinology, Diabetes and Metabolism in Cedars-Sinai’s Department of Medicine, will present new findings linking overnight low blood sugar to persistent fatigue in adults with adrenal cortisol insufficiency despite hormone replacement therapy.

Amino Acids and Type 2 Diabetes Risk

In a second oral presentation, Koh will share study results revealing how 20 amino acids may influence the risk of developing type 2 diabetes by affecting insulin sensitivity, secretion and clearance. 

Prostate Enlargement

Vera Chesnokova, PhD, a professor of Research in the Department of Medicine, will detail study results suggesting prolactin produced within the prostate, a hormone best known for stimulating breast milk production, may contribute to age-related prostate enlargement.

Pituitary Adenomas

Shinsuke Onuma, MD, PhD, a postdoctoral scientist in the  Ruf-Zamojski Lab, will present research identifying cellular signaling pathways that may help improve the diagnosis and treatment of nonfunctioning pituitary adenomas that often go undetected for years. Study leader Frederique Ruf-Zamojski, PhD, an associate professor of Research in the departments of Medicine and Biomedical Sciences, also is available to discuss the findings.

Craniopharyngioma

Odelia Cooper, MD, professor of Medicine, and director of the Clinical and Translational Research Center, will present research linking distinct protein and metabolic profiles in craniopharyngioma, a rare brain tumor, to differences in disease presentation and management. Cooper will also lead a discussion on recent advances in the diagnosis and management of posterior pituitary pathology.

Central Precocious Puberty

Roma Gianchandani, MD, vice chair of Quality and Innovation in the Department of Medicine and program director for Diabetes, will lead a session on the Endocrine Society’s updated guidelines for the diagnosis and treatment of central precocious puberty.

How the Pituitary Responds to Low Cortisol

Anat Ben-Shlomo, MD, associate professor in the Department of Medicine and co-director of the Multidisciplinary Adrenal Program, will present findings from a laboratory mouse study that show how the pituitary gland maintains hormone production during prolonged cortisol deficiency.

Growth Hormones and the Adrenal Gland

Deepika Watts, PhD, research associate in the Melmed Lab, will present results of a study identifying a growth hormone-related receptor in the adrenal gland that may influence its growth, function and disease. Study leader  Anat Ben-Shlomo, MD is also available to comment on the findings.

Media Contact

To schedule an interview with a Cedars-Sinai expert, contact Laura Coverson at 310- 562-1112 or laura.coverson@cshs.org.

The National Institutes of Health has launched its first agencywide Strategic Plan for Autoimmune Disease Research, a five-year initiative aimed at accelerating research into diseases that affect an estimated 50 million Americans and cost more than $100 billion annually.

Autoimmune disorders occur when the immune system, designed to protect the body from viruses, bacteria and other threats, mistakenly attacks healthy tissues. Nearly every part of the body can be affected, including the skin, joints, heart, lungs and nervous system.

The result is often chronic and debilitating illness as most autoimmune diseases have no permanent cure and require lifelong management. While treatments continue to improve, many patients still rely on the long-term use of immunosuppressive therapies to manage their disease.

One of the key features of autoimmune diseases is that they disproportionately affect women, who account for more than 70% of patients worldwide, a distinction the NIH initiative will explore.

At Cedars-Sinai, scientists and clinicians with the Kao Autoimmunity Institute are working to understand how biological sex influences immune responses and disease risk. In lupus, for example, 90% of the patients are women and investigators are trying to understand what factors drive that enormous disparity and what could improve treatment.

Autoimmune disease and lupus investigator Caroline Jefferies, PhD, scientific director of the Center for Research in Women’s Health Science at Cedars-Sinai, and rheumatologist Mariko Ishimori, MD, associate director of the Clinical and Translational Research Center, sat down with the Cedars-Sinai Newsroom to discuss how sex differences can shape lupus risk, symptoms and patient care.

Why do autoimmune diseases affect women more often than men?

Jefferies: Differences in sex chromosomes, hormones and environmental exposures all influence the immune system. Some genes involved in regulating immune responses are located on the X chromosome. Although females typically have two X chromosomes, one is usually switched off in each cell. Certain immune-related genes, however, can escape that inactivation process and remain active, which may contribute to a heightened immune response and help explain why autoimmune diseases are more common in women.

How does the immune system function differently in women compared to men?

Jefferies: Women generally mount stronger immune responses than men, resulting in faster responses to viruses and better responses to vaccines. This was especially evident during the COVID-19 pandemic, when men experienced higher mortality and more severe disease. But that significant antiviral advantage also may contribute to the higher rates of inflammatory and autoimmune diseases seen in women, including lupus.

Why is lupus a key example of sex differences in autoimmune disease?

Jefferies: About 9 out of 10 lupus patients are women, and lupus was one of the first autoimmune diseases linked to overactivation of antiviral immunity. Decades ago, researchers discovered that interferons—proteins released when the body detects viruses—were elevated in lupus patients. Interferons drive immune cell activation, antibody production and cell death, all of which can contribute to the development of autoimmunity and illness.

Does lupus present differently in women and men, and can those differences affect diagnosis or treatment?

Ishimori: Women are far more likely to develop lupus, especially during their reproductive years, when the ratio of women to men with the disease is about 9 to 1.

Lupus symptoms can vary widely, but women commonly experience fatigue, joint pain, swelling, rashes and oral ulcers. Men may be more likely to develop inflammation around the heart or lungs, or organ-threatening disease affecting the kidneys or heart. Because there is no definitive blood test, or single symptom, that confirm lupus, delays in diagnosis can occur. Men may face additional delays because lupus is generally considered more common in women and may be less likely to be considered in the differential diagnosis in men.

Are there stages in a woman’s life when autoimmune symptoms may change or become more noticeable?

Ishimori: During pregnancy, the immune system adapts to tolerate a growing fetus while continuing to protect the mother. Some women with autoimmune disease experience flares during pregnancy, while others do not. Patients with known autoimmune disease are generally encouraged to achieve good disease control before conception because well-controlled disease is associated with fewer pregnancy complications. Several weeks after delivery, there may be an increased risk of disease flare or even a first presentation of autoimmune disease as the immune system readjusts.

Around menopause, some autoimmune symptoms can overlap with changes naturally associated with that stage of life, which can sometimes complicate diagnosis of a specific disorder.

What should women do if they think they may have an autoimmune disease?

Ishimori: Autoimmune symptoms often persist over time, although they may come and go. Because infections and other illnesses can sometimes cause similar symptoms, it’s important to look at the bigger picture. Keeping track of symptoms—such as fevers, rashes or patterns of joint pain—can help patients have more informed conversations with their doctors. Patients should feel comfortable asking what conditions are being considered, what tests are being ordered and whether autoimmune disease could be a possible explanation for their symptoms.

How could a better understanding of sex differences change autoimmune disease treatment?

Jefferies: One of the biggest gaps in our knowledge is understanding how sex chromosomes and sex hormones influence the immune system across different tissues and organs. A better understanding of those mechanisms could eventually help researchers develop more targeted treatments for organ-specific complications of lupus, including heart and lung disease. Ultimately, that is why we do this work—to help patients, many of them women, live healthier lives.

Read more from Cedars-Sinai Stories and Insights: Cultivated Care for Autoimmune Diseases

“We were really looking forward to it, discussing what kind of parents we’d be,” Sarkis said. “But we hardly ever talked about how hard it was going to be.”

Then the emotional challenges began.  

The couple’s first attempt to start a family ended in an ectopic pregnancy that required Seakly to have emergency surgery. The results of the procedure left the couple wondering if they would even be able to have a child.

But within the year, the Manukyans were elated to discover Seakly was pregnant again. During labor, however, the couple faced another frightening ordeal when complications led to an emergency cesarean section. After his birth in December of 2024, Masis, their son, had to spend 11 days in the Neonatal Intensive Care Unit at Cedars-Sinai Guerin Children’s (NICU).

After they brought their baby home, the couple worked on adjusting to the major changes in their lives. Sarkis said the emotional weight of the experience began affecting him.

“Two months later, these fears started surfacing: Am I doing enough to protect my family?” he said. “Are we doing everything we can to keep something bad from happening?”

Sarkis said the fearful thoughts increasingly consumed him, fueled by stress, sleep deprivation and the pressure he felt to protect his wife and child.

Experts say growing awareness around maternal mental health is widening the conversation to include the emotional wellbeing of the entire family—especially fathers—during pregnancy and the postpartum period.

“You can’t predict the impact of having a new baby, especially after a difficult childbirth and time in the NICU,” Sarkis said. “Sleep deprivation and everything else just begins piling up.”

Seakly said she began noticing signs that her husband was struggling emotionally after the traumatic birth, as both parents devoted nearly all their energy to caring for their newborn son.

“I saw it pretty quickly, but I think I was in denial because all of our attention was on the baby,” she said. “Sarkis lost a lot of weight after Masis was born, and a few months later, when he finally verbalized how he was feeling, it clicked for me that partners can be just as affected by birth trauma as mothers.”

Drawing from her own positive experience of getting therapy during the ups and downs of their journey to become parents, Seakly, who is a registered nurse at Cedars-Sinai, encouraged Sarkis to seek professional support as well.

“I learned that taking care of ourselves and each other is vital to the physical, emotional and mental health of our child,” she said. “Without Sarkis’ support mentally and emotionally, the domino effect of all the negative things we experienced could have been detrimental to our family.”

With his wife’s encouragement, Sarkis sought support through the Reproductive Psychology Program at Cedars-Sinai.

Sarkis worked with therapist Ruth Maouda, PsyD, a postdoctoral fellow in the program. Maouda says new parents often experience self-doubt, anxiety and emotional overwhelm during the transition from pregnancy to postpartum—particularly after traumatic birth experiences or severe sleep deprivation.

“One of the most important things I tell first-time postpartum parents is that they are entering an experience of ‘firsts,’” Maouda said. “Nothing can fully prepare you for becoming a parent and acknowledging that learning curve can help relieve some of the anxiety and pressure parents place on themselves.”

Sarkis said that during his sessions with Dr. Maouda he also learned practical coping strategies such as breathwork and mindful meditation, techniques that have helped him manage anxiety and obsessive thinking during high-stress moments.

“Therapy helped me to show up better for my son because now I feel equipped,” Sarkis said. “I have tools I can use every day.”

Maouda said supporting a parent’s mental health can have a positive ripple effect throughout the household.

“Raising a child takes a village,” Maouda said. “Supporting a parent’s mental health allows them to better support their partner and child. Protecting your own mental health helps prevent stress from rippling across the entire family system.”

Sarkis believes that talk therapy and developing coping strategies helped him become more emotionally present and patient, allowing him to enjoy everyday moments with Masis and feel more connected to his family.

Eynav Accortt, PhD, director of the Cedars-Sinai Reproductive Psychology Program, said studies estimate paternal postpartum depression affects about 10% of fathers, and the risk doubles when mothers are also experiencing perinatal mood or anxiety disorders.

“If one or both parents are struggling with their mental health, it affects the entire family,” said Accortt, a clinical psychologist who supervised Maouda’s care of Sarkis. “Supporting the emotional wellbeing of both parents is essential to building strong family bonds during the transition to parenthood.”

Sarkis believes seeing a therapist ultimately strengthened not only his mental health, but also the couple’s communication and partnership.

“My husband’s decision to get professional help was one of the most impactful acts of love—for himself and for our family,” Seakly said. “It helped him become the father he wanted to be for Masis and the partner he wanted to be for me.”

Sarkis hopes other fathers will recognize that they, too, may need support during the transition to parenthood.

“I think that having children is romanticized a lot. It’s beautiful but it’s also life-altering, It’s OK to ask for help if you are struggling,” he said. “That made all the difference for me and my family.”

Read more from Cedars-Sinai Stories and Insights: Research Aims to Improve Maternal Health Equity

The study, published in the Journal of Clinical Endocrinology & Metabolism, found that patients with hypothyroidism had more than double the risk of developing SIBO compared to those with normal thyroid function. The risk was even higher in patients with autoimmune thyroid disease, where the body’s immune system attacks the thyroid gland, but appeared lower in those receiving hormone treatment for the condition.

The findings offer insight into how specific changes in gut bacteria could contribute to disease beyond the gastrointestinal system.

“Studies like this remind us how interconnected the body’s systems are and the important role the microbiome plays in overall health,” said endocrinologist Ruchi Mathur, MD, director of Clinical Research and Clinical Operations for the Medically Associated Science and Technology (MAST) program and the study’s corresponding author.

Mathur sat down with the Cedars-Sinai Newsroom to share key takeaways from the investigation.

What did the study reveal about gut bacteria activity in patients with thyroid disease?

We found that patients with hypothyroidism had different patterns of bacteria in the small intestine compared with those without thyroid disease. In patients with both hypothyroidism and SIBO, we found Klebsiella bacteria dominated rather than the bacterial groups we more commonly see in SIBO. This suggests hypothyroidism may not only increase the risk of SIBO but may also influence the types of bacteria involved.

Could this mean a more severe form of SIBO?

Possibly, more research is needed to confirm this. Previous Cedars-Sinai research has shown that Klebsiella can disrupt the balance and interaction of bacteria in the small intestine more than some other bacterial groups.

How does thyroid hormone treatment affect SIBO risk?

One of the more interesting findings of our study was that patients receiving levothyroxine to treat their thyroid condition appeared to have a lower risk of developing SIBO compared with untreated patients. It is possible that thyroid hormone replacement affects gut motility, which may help reduce bacterial overgrowth in the small intestine. More research is needed, but the finding suggests thyroid treatment may influence digestive health in ways we are only beginning to understand.

Why is it important to study the small intestine directly?

Many microbiome studies rely on stool samples, but the bacteria found in stool can differ significantly from those living in the small intestine. The small intestine plays a central role in digestion, metabolism and hormone function, so studying it directly gives us a much more accurate picture of what may be happening in diseases such as hypothyroidism and SIBO. It also may help researchers identify future therapeutic targets.

What can physicians and patients learn from these new insights?

It is important to recognize the relationship between hypothyroidism and SIBO and address symptoms accordingly. If a patient with hypothyroidism is complaining of gastrointestinal symptoms such as bloating or altered bowel habits, their care team should consider evaluating them for SIBO. Likewise, if a patient presents with bloating, constipation or unexplained gastrointestinal symptoms, thyroid testing may also be appropriate.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

But when the former collegiate long-distance runner struggled to conceive, she didn’t expect the journey to motherhood to become a grueling marathon.

“I was in my early 30s, and we’d been trying for about two years,” said Lagat-Fischer, a nurse in Tucson, Arizona. “I started thinking that something was not right and that we needed help.”

Rather than finding help, she said she endured two years of shuttling from one specialist to another, with visits to several OB-GYNs and fertility specialists who immediately wanted to start costly in vitro fertilization (IVF).

One physician erroneously told Lagat-Fischer that she had endometriosis. Another doctor told her that she had benign uterine fibroid tumors, a more common condition among Black women that often leads to higher rates of fertility issues. She later found out that her fibroids were small and not the cause of the couple’s fertility challenges.

“It was frustrating and discouraging. My husband and I are both healthcare professionals, and we felt the care we received was all over the map. I didn’t feel like our difficulty conceiving was being fully assessed, and there was never a deeper conversation about what might be causing it in my individual case,” Lagat-Fischer said.

Her experience as a Black woman seeking fertility care is common, according to recent studies.

Difficulty conceiving among Black women and men has been understudied. But research published in Fertility & Sterility found that Black women in the U.S. are significantly less likely to seek or receive a fertility evaluation or treatment compared with white women. Despite having a higher or equivalent prevalence of infertility, Black women appear to face barriers that result in delayed care and lower utilization of services.

Lagat-Fischer also noticed that when her husband, Keith, who is white, started accompanying her to every visit, whether he was having tests or not, there was more focused attention from the specialists. When her husband asked the questions, she felt the information they were given was clearer and more direct.

“I felt like I was being heard differently when he was there,” she said. “That was very difficult for me to experience, and the emotional toll was significant. There were times I would be driving and just crying.”

The emotional toll their fertility journey was taking on his wife was very difficult for Irine’s husband.

“We struggled to conceive, which was stressful,” said Keith Fischer, a physical therapist. “Then, when we sought help, we were met with incomplete answers, a lack of attention to our needs and poor guidance from the medical experts.”

“It was hard to navigate a situation where you have a partner that is sad, frustrated and fearing she’ll never have a family. It was gut-wrenching for me,” Fischer said.

After two years of frustration and $20,000 of unsuccessful IVF attempts, a friend in Arizona suggested the couple go to Los Angeles to seek fertility care at Cedars-Sinai.

“Even though Irine had already been through IVF, I took a step back and tried to evaluate from the beginning, with a fresh perspective. Every couple deserves an individualized plan that is tailored to their specific health needs,” said Jessica Chan, MD, a reproductive endocrinologist and clinic director of the Fertility and Reproductive Medicine Center at Cedars-Sinai.

Chan said that after reviewing all of their testing, she recommended they try a less invasive option before returning to IVF. After discussing the options, the Fischers and Chan agreed upon a treatment plan.

“When we came to Cedars-Sinai, it was a completely different experience. From the moment we walked into the clinic, I felt like someone was really listening and taking the time to understand the full picture,” Lagat-Fischer said. “Two weeks after treatment, I found out I was pregnant. I honestly couldn’t believe it after everything we had been through.”

Does Chan believe racial bias can play a role in the kind of fertility evaluation and treatment a patient might receive?

“Communication and building trust between the doctor and the patient are critical in the fertility care process, as is a thorough understanding of a patient’s medical and social history,” Chan said. “But we know that implicit bias is also a significant factor that can lead to disparities in care and outcomes.”

It was a very long journey, but the couple says that their now 3-year-old twins, Lily and Liam, were well worth the difficulties they had.

“I would go through that journey again to have my children. It was all worth it,” Lagat-Fischer said. “My advice to other Black women is to advocate for yourself. Ask questions, seek thorough answers, and if you feel like you’re not being heard, get care somewhere else.”

Read more from Cedars-Sinai Stories and Insights: How Cedars-Sinai Is Working to Improve Black Maternal Health

Revealing How Transplanted Neural Stem Cells Preserve Vision

Cedars-Sinai investigators working to optimize a cell-based treatment for retinitis pigmentosa have uncovered how transplanted neural stem cells interact with host retinal cells to preserve vision. The findings, published in Nature Communications, may guide future research toward strategies to treat degenerative eye disease.

“We used single-cell analysis to show that neural stem cells can protect vision in several ways, including providing protective proteins, restoring retinal cells to a healthier state, reducing cellular stress, and maintaining retinal integrity,” said Clive Svendsen, PhD, executive director of the Board of Governors Regenerative Medicine Institute and co-corresponding author of the study.

Investigators transplanted neural stem cells into the retinas—the light-sensitive tissue lining the back of the eye—of laboratory rats with retinal degeneration. Previous studies have shown the transplants significantly reduced vision loss in the animals for up to 180 days, the equivalent of about 20 years in humans. In this study the team examined interactions between the transplanted cells and diseased retinal cells to better understand the neural stem cells’ protective effects.

“Our study reveals that the interaction between neural stem cells and host retinal cells dynamically changes over time,” said Shaomei Wang, MD, PhD, professor of Biomedical Sciences and co-corresponding author of the study.  “Through a better understanding of this process, we may be able to develop more powerful approaches to treat eye diseases in the future.”

Investigators are now evaluating the use of neural stem cells engineered to express key protective proteins identified in this study to further improve the host retinal environment. 

Additional Cedars-Sinai authors include Saba Shahin, Shaughn Bell, Bin Lu, Hui Xu, Jason Chetsawang, Stephany Ramirez, Jorge S. Alfaro, Alexander Laperle and Soshana Svendsen.

Other authors include Somanshu Banerjee and Vivek Swarup.

Funding: This work was supported by the California Institute Regenerative Medicine (LSP1-08235). J.C. was supported by CIRM-EDUC-08383 and S.R. was supported by CIRM-EDUC2-12638, and funding from the Board of Governors Regenerative Medicine Institute at Cedars-Sinai Medical Center.

Preclinical Study: Protein Regulates Autoimmune Response

Cedars-Sinai Health Sciences University investigators have identified for the first time a protein’s role as a “dimmer switch” that can calm an overactive immune system and restrain harmful inflammation. The protein, Butyrophilin 2A2 (BTN2A2), interacts with a key molecule that controls the strength of T-cell responses.

The findings, published in Nature Communications, define a unique pathway that helps balance immune activity and could be harnessed to limit damage caused by a variety of autoimmune diseases.

In laboratory mice, loss of BTN2A2 led to exaggerated immune reactions and an increase in damaging kidney inflammation called glomerulonephritis. Treatment with BTN2A2 reduced disease severity by increasing immune-regulating T cells and lowering inflammation.

Supporting laboratory experiments in human T-cells demonstrated similar immune-calming effects.

“Glomerulonephritis remains a leading cause of chronic kidney disease and kidney failure worldwide, with limited treatment options,” said Ananth Karumanchi, MD, co-corresponding author of the study and director of the Renovascular Research Center at Cedars-Sinai. “Our findings provide a strong foundation for future studies aimed at modifying immune-driven kidney disease rather than simply managing its symptoms. The pathway could also be targeted in a range of autoimmune and inflammatory diseases including rheumatoid arthritis, multiple sclerosis, inflammatory bowel disease, and transplant rejections.”

Other Cedars-Sinai authors include Shafat Ali, Anders H. Berg, Michifumi Yamashita, Ambart E. Covarrubias, Jordan Mundell, Pranali N. Shah, Ruan Zhang, Vincent Dupont, Bong-Ha Shin, Shen Yang, Madhusudhanarao Katiki, Ramachandran Murali, Margareta D. Pisarska, Ravi Thadhani, Peter S. Heeger and Stanley C. Jordan

Pinpointing Indicators of Cancer Wasting Syndrome

An analysis of biomarkers in patient blood samples by Cedars-Sinai Health Sciences University investigators could help with early detection of cachexia, or cancer wasting syndrome.

The study, published in Cancers, explores biologic signals detectable in the blood that could be used to design future strategies for assessing patient risk and develop therapies aimed at mitigating fatigue and muscle and fat loss experienced by many patients with cancer.

“We found that in patients with advanced non-small cell lung cancer, cachexia biomarkers change over time,” said Kamya Sankar, MD, co-medical director of the Thoracic Disease Research Group at Cedars-Sinai Cancer and corresponding author of the study. “And treatments targeting one of the early cachexia biomarkers we identified, an inflammatory protein called GDF-15, are already under evaluation in clinical trials.”

Investigators measured the blood of 27 patients with non-small cell lung cancer at two different time points. In patients with early cachexia, they found higher levels of inflammatory proteins such as GDF-15. In patients with later-stage cachexia, they found increased mitochondrial DNA, which comes from the parts of cells that convert food into energy.

Larger, prospective studies are required to validate the clinical benefit of these biomarkers, but they could serve as the basis for risk assessment of patients and may inform design of future clinical trials of therapies for cancer-associated cachexia, Sankar said.

Additional Cedars-Sinai authors include Elham Kazemian, Nicole Lorona, Carlos D. Cruz-Hernández, Mitra Mastali, Akil A. Merchant, Jennifer Van Eyk, Karen L. Reckamp, Neil A. Bhowmick, and Jane C. Figueiredo.

Other authors include Alex K. Bryant and Puneeth Iyengar. 

Funding: This work was supported by the U.S. National Cancer Institute (U54CA260591, PI Figueiredo), Department of Defense (LC240075, PI Sankar), and Cedars-Sinai CTSI grant (UL1TR001881, PI Sankar).

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

Los trastornos hipertensivos del embarazo, incluida la preeclampsia, son una de las principales causas de complicaciones posparto graves y reingresos hospitalarios. El riesgo de problemas cardiovasculares graves puede persistir mucho más allá del parto, por lo que es fundamental realizar un seguimiento estructurado durante y después del período posparto.

“El posparto es un momento vulnerable para las pacientes con hipertensión relacionada con el embarazo y, con demasiada frecuencia, es cuando la atención se fragmenta”, afirma la directora del programa, la Dra. Sonya Fabricant, especialista en medicina materno-fetal en Cedars-Sinai. “Este programa se diseñó para proporcionar estructura, continuidad y apoyo cuando las pacientes regresan a casa y aún necesitan un estricto seguimiento”.

El Apoyo Comienza en Casa con el Programa de Hipertensión Posparto

Casi 500 mujeres se han inscrito en el Programa de Hipertensión Posparto y han recibido brazaletes para medir la presión arterial para usar en casa. Durante dos semanas, las pacientes registran las lecturas de presión arterial a través de un portal seguro para pacientes integrado en su historial médico electrónico. Esto permite al equipo de atención médica revisar los resultados de manera oportuna y responder cuando las lecturas requieren atención.

“Nuestro programa no se limita a las cifras”, afirma Fabricant. “Se trata de garantizar que las pacientes comprendan lo que significan sus lecturas de presión arterial, se sientan apoyadas y sepan que alguien les presta atención y está dispuesto a intervenir si es necesario”.

Mejora del Seguimiento Cardiovascular a Largo Plazo

Uno de los objetivos principales del Programa de Hipertensión Posparto es mejorar el seguimiento con los profesionales de la salud que pueden evaluar y controlar el riesgo cardiovascular a largo plazo.

Entre las pacientes que recibieron atención dentro del sistema Cedars-Sinai, el 72 % acudió al médico en los seis meses posteriores al parto, y el 83 % de las inscritas en el programa realizó un seguimiento con un especialista en los 12 meses siguientes.

“Los trastornos hipertensivos del embarazo no se limitan al embarazo en sí, sino que son un indicador temprano del riesgo cardiovascular futuro”, afirmó la Dra. Sarah J. Kilpatrick, presidenta del Departamento de Obstetricia y Ginecología del Cedars-Sinai, que supervisó la creación de la iniciativa de seguimiento. “Programas como este ayudan a garantizar que las pacientes sigan conectadas con la atención médica y den prioridad a su propia salud después del parto, cuando las madres tienden a centrarse más en el recién nacido y en sus familias”.

Altas Calificaciones de las Pacientes

De acuerdo con Fabricant, las encuestas a las pacientes destacaron de manera consistente el impacto del programa en el bienestar emocional durante la transición posparto. Las participantes informaron con frecuencia que se sentían menos ansiosas después del alta y más seguras para controlar su presión arterial en casa.

“Lo que escuchamos repetidamente de las pacientes fue lo tranquilizador que era saber que su presión arterial estaba siendo monitoreada de cerca durante un momento estresante”, dijo Fabricant. “Esa tranquilidad ayudó a muchas pacientes a mantenerse comprometidas con el cuidado de su salud durante la recuperación posparto temprana”.

Lea más en Historias y Perspectivas de Cedars-Sinai: Un Salvavidas para Embarazos de Alto Riesgo

The findings are published in the journal Gastroenterology.

“Among Hispanic patients, higher African ancestry was associated with more severe Crohn’s disease throughout the digestive tract, while higher Amerindian ancestry was linked to disease affecting primarily the colon,” said Talin Haritunians, PhD, the corresponding author of the study and a research associate professor of Medicine at Cedars-Sinai.

Many Hispanic individuals have mixed genetic ancestry that can include Indigenous American ancestry, plus European and African contributions that are the result of centuries of migration and colonization. Amerindian Hispanics have ancestry from indigenous Maya, Aztec and Inca civilizations—and from Spain. 

“Our findings show that genetic ancestry can help explain important differences we see in how inflammatory bowel disease affects patients, even within a single ethnic group,” Haritunians said.

An estimated 3 million people in the U.S. have inflammatory bowel disease, according to the Centers for Disease Control and Prevention. The disorder can produce chronic, painful and often destructive inflammation in the digestive tract. The two most common forms of IBD are Crohn’s disease, which can impact any part of the gastrointestinal system, and ulcerative colitis which affects just the colon and rectum.

Ancestry-Aware Analysis

Investigators analyzed genetic and clinical data from more than 7,300 Hispanic patients from the U.S., including Puerto Rico, who had IBD. They also analyzed the same data from patients without the disease. Using a new method of genomic analysis that takes specific ancestry into account, investigators examined how genetic risk and disease presentation and severity varied across ancestral backgrounds.

Hispanic populations often include individuals with mixed genetic ancestry, reflecting a mosaic of Indigenous American, European, and African genetic contributions, the result of centuries of migration and colonization.

“Our group has had a longstanding commitment to extending studies to include diverse populations. Here, we were able to identify ancestry-specific variations in IBD patterns that may be overlooked in broader genetic studies, which often focus on European populations,” said Dermot McGovern, MD, PhD, a co-author of the study and director of Translational Research in the Inflammatory Bowel and Immunobiology Research Institute.

One group in the genetic study was found to be at higher risk for developing a serious and painful form of inflammatory bowel disease.

“Increased risk of penetrating Crohn’s disease was associated with higher African ancestry among Hispanic patients. It is a severe form of IBD in which inflammation extends through the layers of intestinal wall and increases the risk of complications that often require surgery,” McGovern said.

The findings also highlight the importance of examining genetic risk alongside other factors, such as diet and environment, to better understand inflammatory bowel disease across diverse populations.

“Largescale genetic studies that include diverse patients and populations historically underrepresented in research are essential for advancing our understanding of IBD and helping patients,” Haritunians said. “Expanding research in this way will help us move toward more inclusive approaches with the potential to improve treatment options and the lives of patients.”

Additional Cedars-Sinai authors include Dalin Li, PhD; Shaohong Yang, MD; Sweta Sinha, MPH; Emebet Mengesha; Maria A. Quintero, MD; Stephan R. Targan, MD; Shervin Rabizadeh, MD; and Maria T. Abreu, MD.

Other authors include Ashley H. Beecham, PhD; Steven W. Brugger, PhD; Mary F. Davis, PhD; Esther A. Torres, MD; Lissette Gomez, MSc; Paola Lopez-Marte, MD; Mark Daly, PhD; Christine R. Stevens; James S. Leavitt, MD; Oriana M. Damas, MD; Ksenija Sabic; Judy H. Cho, MD; and Jacob L. McCauley, PhD.

Funding: This work was supported by the F. Widjaja Foundation Inflammatory Bowel Disease Institute; the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (NIH/NIDDK) through grants U01 DK062413, U24 DK062429-18, U01 DK062422-18, U01 DK062431, and DK062432; the Leona M. and Harry B. Helmsley Charitable Trust; the Fred L. Hartley Family Foundation; the Micky & Madeline Arison Family Foundation Crohn’s & Colitis Discovery Laboratory; the Sanford J. Grossman Charitable Trust; and the National Institutes of Health through grants U54HG003067 and 5UM1HG008895.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about university.

Los resultados se han publicado en la revista Gastroenterology.

“Entre los pacientes hispanos, una mayor ascendencia africana se asoció con una enfermedad de Crohn más grave en todo el tracto digestivo, mientras que una mayor ascendencia amerindia se relacionó con una enfermedad que afectaba principalmente al colon”, explicó la Dra. Talin Haritunians, autora correspondiente del estudio y profesora asociada de investigación de Medicina en Cedars-Sinai.

Muchas personas hispanas tienen una ascendencia genética mixta que puede incluir ascendencia indígena americana, además de aportaciones europeas y africanas que son el resultado de siglos de migración y colonización. Los hispanos amerindios tienen ascendencia de las civilizaciones indígenas maya, azteca e inca, y de España.

“Nuestros hallazgos muestran que la ascendencia genética puede ayudar a explicar diferencias importantes que observamos en cómo la enfermedad inflamatoria intestinal afecta a los pacientes, incluso dentro de un mismo grupo étnico”, afirmó Haritunians.

Se estima que 3 millones de personas en los Estados Unidos padecen enfermedad inflamatoria intestinal, de acuerdo al Centro para el Control y la Prevención de Enfermedades. Este trastorno puede producir inflamación crónica, dolorosa y, a menudo, destructiva en el tracto digestivo. Las dos formas más comunes de EII son la enfermedad de Crohn, que puede afectar a cualquier parte del sistema gastrointestinal, y la colitis ulcerosa, que afecta solo al colon y al recto.

Análisis Basado en la Ascendencia

Los investigadores analizaron datos genéticos y clínicos de más de 7300 pacientes hispanos de Estados Unidos, incluido Puerto Rico, que padecían EII. También analizaron los mismos datos de pacientes que no padecían la enfermedad. Mediante un nuevo método de análisis genómico que tiene en cuenta la ascendencia específica, los investigadores examinaron cómo variaban el riesgo genético y la presentación y gravedad de la enfermedad en función de los antecedentes ancestrales.

Las poblaciones hispanas suelen incluir individuos con ascendencia genética mixta, lo que refleja un mosaico de contribuciones genéticas indígenas americanas, europeas y africanas, resultado de siglos de migración y colonización.

“Nuestro grupo tiene un compromiso de larga data con la ampliación de los estudios para incluir poblaciones diversas. En este caso, pudimos identificar variaciones específicas de la ascendencia en los patrones de EII que pueden pasarse por alto en estudios genéticos más amplios, que a menudo se centran en poblaciones europeas”, afirmó el Dr. Dermot McGovern, director de Investigación Traslacional del Instituto de Investigación en Inmunobiología e Intestino Inflamatorio, coautor del estudio.

Se descubrió que un grupo del estudio genético presentaba un mayor riesgo de desarrollar una forma grave y dolorosa de enfermedad inflamatoria intestinal.

“El aumento del riesgo de padecer la enfermedad de Crohn penetrante se asoció con una mayor ascendencia africana entre los pacientes hispanos. Se trata de una forma grave de EII en la que la inflamación  se extiende a través de las capas de la pared intestinal y aumenta el riesgo de complicaciones que a menudo requieren cirugía”, explicó McGovern.

Los hallazgos también destacan la importancia de examinar el riesgo genético junto con otros factores, como la dieta y el entorno, para comprender mejor la enfermedad inflamatoria intestinal en diversas poblaciones.

“Los estudios genéticos a gran escala que incluyen a pacientes y poblaciones diversas históricamente infrarrepresentadas en la investigación son esenciales para avanzar en nuestra comprensión de la EII y ayudar a los pacientes», afirmó Haritunians. «Ampliar la investigación de esta manera nos ayudará a avanzar hacia enfoques más inclusivos con el potencial de mejorar las opciones de tratamiento y la vida de los pacientes”.

Otros autores de Cedars-Sinai incluyen Dalin Li, PhD; Shaohong Yang, MD; Sweta Sinha, MPH; Emebet Mengesha; Maria A. Quintero, MD; Stephan R. Targan, MD; Shervin Rabizadeh, MD; y Maria T. Abreu, MD.

Otros autores incluyen Ashley H. Beecham, PhD; Steven W. Brugger, PhD; Mary F. Davis, PhD; Esther A. Torres, MD; Lissette Gomez, MSc; Paola Lopez-Marte, MD; Mark Daly, PhD; Christine R. Stevens; James S. Leavitt, MD; Oriana M. Damas, MD; Ksenija Sabic; Judy H. Cho, MD; y Jacob L. McCauley, PhD.

Financiación: Este trabajo ha sido financiado por el Instituto de Enfermedades Inflamatorias Intestinales de la Fundación F. Widjaja; los Institutos Nacionales de Salud/Instituto Nacional de Diabetes y Enfermedades Digestivas y Renales (NIH/NIDDK) a través de las subvenciones U01 DK062413, U24 DK062429-18, U01 DK062422-18, U01 DK062431 y DK062432; la Fundación Benéfica Leona M. y Harry B. Helmsley; la Fundación de la Familia Fred L. Hartley; el Laboratorio de Investigación de la Enfermedad de Crohn y la Colitis de la Fundación de la Familia Micky y Madeline Arison; la Fundación Benéfica Sanford J. Grossman; y los Institutos Nacionales de Salud a través de las subvenciones U54HG003067 y 5UM1HG008895.

La Universidad de Ciencias de la Salud de Cedars-Sinai está impulsando investigaciones innovadoras y formando a los futuros líderes en medicina, ciencias biomédicas y ciencias de la salud afines. Más información sobre la universidad.

Highlights and media interview opportunities include:

• Awarding Health Equity Research—Mariam Naqvi, MD, associate professor of Obstetrics and Gynecology, will receive the Disparities Award for Best Research on Diversity and Disparity in Health Outcomes. Naqvi’s study examines whether a standardized substance-use screening program can help reduce racial differences in urine toxicology testing during pregnancy.
• Improving Childbirth Safety With Artificial Intelligence—Melissa Wong, MD, director of Informatics and Artificial Intelligence Strategies in the Department of Obstetrics and Gynecology, is available for media interviews about her new research that uses artificial intelligence to analyze labor-monitoring data and identify early signs of fetal distress.
• Lowering Postpartum Blood Pressure Risk—Sonya Fabricant, MD, a maternal-fetal medicine fellow, is available to explain how a special home monitoring program for patients treated for high blood pressure after giving birth led to a reduction in health complications and better connections to health services.
• Addressing Economic Barriers to Preeclampsia Prevention—Emily Wong, PhD, a research data scientist in Cedars-Sinai’s Department of Computational Biomedicine, can discuss how gaps in social and clinical data—for example, income information—can lead to missed opportunities for preventive care. The missing data may affect some patients’ access to early detection and aspirin therapy to reduce the risk of preeclampsia.
• Managing Postpartum Hemorrhage During an IV Fluid Shortage—Gabriella Dellapiana, MD, assistant professor of Obstetrics and Gynecology and Catriona Lewis, MD, are available to discuss their research examining the impact of using intramuscular injections of oxytocin to manage postpartum bleeding during a national intravenous fluid shortage. The study found no significant difference in postpartum hemorrhage rates compared with standard intravenous administration.

In addition to discussing research presentations, Cedars-Sinai maternal-fetal medicine clinicians and scientists are available to comment on pregnancy, childbirth, and best practices in high-risk pregnancy care.

Media Contact

To arrange interviews, contact Laura Coverson at 310-562-1112 or Laura.Coverson@cshs.org.

The IBD Prehabilitation Program, pioneered at Cedars-Sinai, has significantly enhanced surgical outcomes and reduced complications for patients with the digestive disease.

Gil Melmed, MD, director of Inflammatory Bowel Disease Clinical Research, led the development of the multidisciplinary program and is eager to study its effectiveness in healthcare systems serving patient populations where English is not the primary language.

“We don’t know if the positive outcomes from the program are specific to our local environment and patient population or if they also have wider application,” Melmed said. “This generous grant from the Helmsley Charitable Trust enables us to expand the IBD prehabilitation protocols to a completely different environment and to patient populations in an international setting.”

Cedars-Sinai will partner with Sheba Medical Center through its ARC innovation center, along with two additional Israeli hospitals, to establish prehabilitation programs for IBD patients in need of surgery.

The 10-week program involves comprehensive care starting a month before surgery. Patients receive tailored dietary, mental health and physical therapy interventions both before and after their procedures.

“We have found that people participating in the program experienced a significant reduction in complications after surgery, as well as a reduction in 30-day readmissions and repeated surgery. They also required less opioid medication for pain,” said Melmed, who is also the associate director of the Karsh Division of Gastroenterology and Hepatology at Cedars-Sinai.

An estimated 3 million people in the U.S. have inflammatory bowel disease, according to the Centers for Disease Control and Prevention. Worldwide, the Crohn’s & Colitis Foundation estimates that about 10 million people are living with IBD. The disorder produces chronic and often destructive inflammation in the digestive tract. The two most common forms of IBD are Crohn’s disease and ulcerative colitis, with Crohn’s disease patients generally requiring abdominal surgery at least once in their lifetime.

“As part of the grant, we will develop patient materials in multiple languages, including English, Spanish, Arabic and Hebrew. If successful, we hope to expand to other countries to share this approach to meaningful improvement in health outcomes for people who require surgery to manage their disease,” Melmed said.

In 2022, the Helmsley Charitable Trust awarded Cedars-Sinai $1.25 million for initial development of the IBD prehabilitation program aimed at optimizing care and improving surgical outcomes and the overall health of patients undergoing major abdominal surgery.

Read more from Cedars-Sinai Stories and Insights: Is It IBS or IBD?

Suze Lopez, enfermera de Bakersfield, California, estaba programada para finalmente extirparse un quiste ovárico de 22 libras que había crecido durante años. Pero los resultados de una prueba de embarazo de rutina, requerida antes de la cirugía, le dieron la sorpresa de su vida.

“Debido al gran quiste ovárico que había estado creciendo durante años, podría haber sido un falso positivo, incluso cáncer de ovario,” dijo Lopez. “Y estaba acostumbrada a tener periodos muy irregulares y algo de molestia abdominal. No podía creer que, después de 17 años de orar y de intentar tener un segundo hijo, realmente estuviera embarazada.”

Tres días después de descubrir que estaba embarazada, la enfermera de 41 años compartió la buena noticia con su esposo, Andrew, durante una cita en un juego de béisbol de los Dodgers en Los Ángeles. Pero durante el viaje, Lopez comenzó a sentir dolor abdominal, así que se dirigieron a Cedars-Sinai.

Al llegar al centro médico, Lopez tenía la presión arterial peligrosamente alta. John Ozimek, DO, director médico de Labor y Parto, y su equipo trabajaron rápidamente para estabilizarla, solicitando un MRI, análisis de sangre y un ultrasonido.

Ozimek quedó asombrado por lo que revelaron las imágenes diagnósticas: un embarazo ectópico abdominal muy poco común.

“Suze estaba embarazada, pero su útero estaba vacío, y un quiste ovárico benigno gigante de más de 20 libras ocupaba gran parte del espacio,” dijo Ozimek. “Luego descubrimos un bebé casi a término en un pequeño espacio del abdomen, cerca del hígado, con su trasero apoyado sobre el útero. Un embarazo que se desarrolla así de lejos fuera del útero es casi inédito.”

Según Ozimek, a medida que el bebé crecía detrás de la masa dentro del abdomen de Lopez, empujaba el enorme quiste hacia adelante. “Tiene sentido que ella pensara que el tumor simplemente estaba creciendo otra vez, no que pudiera estar embarazada.”

¿Qué es un Embarazo Ectópico Abdominal?

En un embarazo ectópico abdominal, el óvulo fertilizado se implanta fuera del útero, a menudo sobre órganos vitales o vasos sanguíneos mayores. La placenta no puede crecer de manera segura allí, lo que crea un riesgo extremadamente alto de hemorragia materna catastrófica y muerte fetal. Que un bebé sobreviva es extraordinariamente raro y suele enfrentar complicaciones severas.

“Fue impactante ver a un bebé a término sentado detrás de un tumor ovárico muy grande y no dentro del útero. En toda mi carrera, nunca había oído de un caso que llegara tan lejos,” dijo el oncólogo ginecológico Michael Manuel, MD, del Providence Cedars-Sinai Tarzana Medical Center, quien fue llamado para extirpar el enorme quiste.

“Teníamos que descubrir cómo entregar al bebé con una placenta y vasos sanguíneos adheridos en el abdomen, extirpar la masa ovárica y hacer todo lo posible por salvar a la madre y al niño,” dijo Manuel.

Un Milagro Médico

Se necesitó un equipo de unas 30 personas para realizar un parto y cirugía altamente coordinados y complejos. Especialistas en medicina materno-fetal, oncólogos ginecológicos, enfermeras, anestesiólogos y un equipo de técnicos quirúrgicos especialmente capacitados llenaron casi por completo la sala de operaciones.

Manuel levantó el enorme quiste dermoide para que Ozimek y su equipo pudieran entregar rápidamente al bebé y pasarlo al personal de la Unidad de Cuidados Intensivos Neonatales (NICU). Luego continuaron con la cirugía.

“En cuanto el bebé nació, Lopez comenzó a tener una hemorragia severa. Éramos un equipo especialmente capacitado de anestesiólogos obstétricos y estábamos preparados, pero aun así fue intenso,” dijo el anestesiólogo Michael Sanchez, MD. “Ya había preparado una máquina especial que administra productos sanguíneos rápidamente porque cada segundo cuenta. Usamos 11 unidades de sangre.”

Cedars-Sinai es el único hospital de Atención Materna Nivel IV en California, una designación otorgada por su capacidad de brindar atención integral antes, durante y después del parto.

“La capacidad de brindar atención tan especializada, coordinada y multidisciplinaria para pacientes de altísimo riesgo puede marcar una diferencia crítica en la salud de la madre y el bebé, como vimos en este extraordinario caso de Suze y Ryu Lopez,” dijo Sarah J. Kilpatrick, MD, PhD, presidenta del Departamento de Obstetricia y Ginecología.

El equipo médico se emocionó al ver que, después de un embarazo tan raro y peligroso, el pequeño Ryu llegó al mundo con muy pocos problemas de salud, abundante cabello y un peso de 8 libras.

Sara Dayanim, MD, neonatóloga de Guerin Children’s de Cedars-Sinai, dijo que una preocupación fundamental era si los pulmones del bebé se habían desarrollado bien y si funcionarían correctamente.

“Estábamos muy preparados para manejar cualquier problema pulmonar. Pero salió de la anestesia bastante rápido y estaba muy activo,” dijo Dayanim. “Al día siguiente pudimos retirar el tubo respiratorio y, durante sus dos semanas con nosotros, Ryu alcanzó rápidamente todos los parámetros esenciales para sobrevivir bien. Venció todas las probabilidades.”

El Ángel Enfermero

Como su recién nacido, Lopez también estaba decidida a recuperarse rápidamente para poder pasar tiempo en la NICU con Ryu, su esposo y su hija adolescente, Kaila. Recuerda especialmente a Carmen Chavez, MSN, RN, subgerente de la Unidad de Cuidado Materno-Fetal, quien la acompañó antes y después de la desafiante cirugía y parto. Lopez aún se refiere a ella como su ángel guardián en todo el proceso.

“Ella me revisaba constantemente,” dijo Lopez. “Estuvo en las consultas con los médicos para asegurarse de que entendiéramos todo lo que estaba enfrentando. Incluso nos ayudó a contarle a mi hija sobre el embarazo. Yo misma soy enfermera, pero lo que hizo Carmen fue más allá. Significó todo.”

Chavez dijo que sintió que Lopez merecía todo el apoyo posible.

“Este fue un caso extremadamente de alto riesgo y tuvimos que planificar cada detalle,” dijo Chavez. “Todo nuestro equipo de enfermería se involucró. Conociendo las complejidades de la situación de Suze y lo que ella y su bebé estaban por enfrentar, quería permanecer cerca.”

Los padres de Ryu creen que él es la respuesta a años de oraciones por un segundo hijo. Andrew Lopez dijo que por eso escogieron “Jesse” como su segundo nombre; significa “regalo de Dios”.

“Él es nuestro regalo. Y Ryu y Suze son mis milagros,” dijo Lopez. “Me permitieron estar en la sala de operaciones, y fue difícil ver lo que ella estaba viviendo, y a la vez maravilloso ver nacer a Ryu. Así que sí, muchas oraciones fueron contestadas.”

“Valoro cada pequeña cosa. Todo. Cada día es un regalo y nunca lo voy a desperdiciar,” dijo Suze Lopez. “Dios me dio este bebé para que él fuera un ejemplo para el mundo de que Dios existe—que los milagros, los milagros modernos, sí suceden.”

Lea más en Noticias de Cedars-Sinai: Cedars-Sinai Obtiene la Máxima Calificación en Atención Materna

Suze Lopez, a nurse from Bakersfield, California, was scheduled to finally have a 22-pound ovarian cyst removed; one that had been growing for years. But the results of a routine pregnancy test that was required before the surgery would give her the shock of a lifetime.

“Because of the large ovarian cyst that had been growing for years, it could have been a false positive, even ovarian cancer,” Lopez said. “And I was used to very irregular periods and some abdominal discomfort. I could not believe that after 17 years of praying, and trying, for a second child, that I was actually pregnant.”

Three days after finding out she was pregnant, the 41-year-old emergency room nurse shared the good news with her husband, Andrew, during a date night at a Dodgers baseball game in Los Angeles. But during the trip Lopez started having pain in her abdomen and they headed to Cedars-Sinai.

When they arrived at the medical center, Lopez had dangerously high blood pressure. John Ozimek, DO, medical director of Labor and Delivery, and his team got to work, stabilizing her blood pressure and ordering an MRI, blood work and an ultrasound.

Ozimek was stunned by what the diagnostic images revealed: a very rare abdominal ectopic pregnancy.

“Suze was pregnant, but her uterus was empty, and a giant benign ovarian cyst weighing over 20 pounds was taking up so much space,” Ozimek said. “We then discovered a nearly full-term baby boy in a small space in the abdomen, near the liver, with his butt resting on the uterus. A pregnancy this far outside the uterus that continues to develop is almost unheard of.”

Ozimek said that as the baby grew inside Lopez’s abdomen, behind the mass, it pushed the very large cyst forward. “It makes sense that she just thought the tumor was getting bigger again, not that she could be pregnant.”

What Is an Abdominal Ectopic Pregnancy?

In an abdominal ectopic pregnancy, the fertilized egg implants outside the uterus, often on vital organs or major blood vessels. The placenta cannot safely grow there, creating an exceptionally high risk of catastrophic maternal bleeding and fetal death. A surviving infant is extraordinarily rare and often faces severe medical complications.

“It was profound to see this full-term baby sitting behind a very large ovarian tumor, not in the uterus. In my entire career, I’ve never even heard of one making it this far into the pregnancy,” said gynecological oncologist Michael Manuel, MD, of Providence Cedars-Sinai Tarzana Medical Center, who was called in to remove the giant cyst.

“We had to figure out how to deliver the baby with a placenta and its blood vessels attached in the abdomen, remove the very large ovarian mass and do everything we could to save mom and this child,” Manuel said.

Delivering a Medical Miracle

It took a team of about 30 experts to pull off a highly coordinated, complex delivery and surgery. Maternal-fetal medicine specialists, gynecological oncologists, nurses, anesthesiologists and a host of specially trained surgical technicians filled the operating room to near capacity. 

Manuel lifted the massive dermoid cyst out of the way so Ozimek and team could quickly deliver the baby and hand him off to the Neonatal Intensive Care Unit (NICU) staff. Then they got back to work.

“As soon as the baby was delivered, Lopez started hemorrhaging badly. We were a specially trained team of obstetric anesthesiologists and well prepared, but it was still intense,” said anesthesiologist Michael Sanchez, MD. “I had already powered up a special machine that delivers blood products fast because every second matters. We used 11 units of blood.”

Cedars-Sinai is the only Level IV Maternal Care hospital in California, a designation earned for its ability to provide comprehensive care for mothers before birth, throughout labor and delivery and after childbirth.

“The ability to provide this level of highly trained, coordinated and multidisciplinary care for extremely high-risk patients can make a critical difference in the health of both mother and baby, as we saw in this extraordinary case of Suze and Ryu Lopez,” said Sarah J. Kilpatrick, MD, PhD, chair of the Department of Obstetrics and Gynecology.

The medical team was elated to see that after such a rare and dangerous pregnancy, the little boy the Lopezes named Ryu came into the world with very few health problems, a full head of hair and weighing 8 pounds.

Sara Dayanim, MD, a neonatologist with Cedars-Sinai Guerin Children’s, said a critical concern was whether his lungs had developed properly and if they would be functioning.

“We were very prepared to handle any lung problems the baby might have. But he came out of anesthesia pretty quickly and he was feisty,” Dayanim said. “The following day we were able to remove the breathing tube, and over the course of his two weeks with us, Ryu quickly reached all of the important benchmarks for surviving well. He defied all the odds.”

The Nurse Angel

Like her newborn, Lopez was feisty and focused on recovering quickly so she could spend time in the NICU with Ryu, her husband and teenage daughter, Kaila. She especially remembers Carmen Chavez, MSN, RN, assistant manager of the Maternal-Fetal Care Unit, for coming alongside her before and after the challenging delivery and surgery. Lopez still refers to as her guardian angel through it all.

“She checked on me so often,” Lopez said. “She sat in on the consults with doctors to make sure we understood everything I was facing at a difficult time. She even helped us tell my daughter about the pregnancy. I’m a nurse myself, but what Carmen did was above and beyond. It meant everything.”

Chavez said she felt Lopez deserved all the support she could get.

“This was an exceptionally high-risk case, and we had to plan every detail,” Chavez said. “It was all hands on deck for our nursing team. Knowing the complexities of Suze’s situation, knowing the challenges she and her baby were about to face, I wanted to stay close.”

Ryu’s parents believe he is the answer to years of praying for a second child. Andrew Lopez said that is why they chose “Jesse” for Ryu’s middle name; it means “gift from God.” 

“He is our gift. And Ryu and Suze are my miracles,” Lopez said. “They let me in the operating room, and it was tough to watch what she was going through, and amazing to see Ryu delivered. So yes, many prayers have been answered.”

“I appreciate every little thing. Everything. Every day is a gift and I’m never going to waste it,” Suze Lopez said. “God gave me this baby so that he could be an example to the world that God exists—that miracles, modern-day miracles, do happen.”

Read more from the Cedars-Sinai Newsroom: Cedars-Sinai Earns Highest Designation for Maternal Care

Pimentel señala que los días entre Acción de Gracias y Año Nuevo son de los más riesgosos para intoxicaciones alimentarias, especialmente cuando comidas abundantes, buffets y sobras forman parte de las celebraciones. Cada año, alrededor de 48 millones de estadounidenses—aproximadamente 1 de cada 6—se enferman por enfermedades transmitidas por alimentos, lo que provoca unas 128,000 hospitalizaciones y 3,000 muertes, según los Centros para el Control y la Prevención de Enfermedades.

Pimentel y el dietista clínico de Cedars-Sinai, Albert Abayev, RD—quien trabaja con pacientes sometidos a cirugía para bajar de peso y cirugía general—ofrecen respuestas a preguntas comunes sobre la seguridad alimentaria durante las fiestas.

¿Qué nuevos hallazgos han surgido en los últimos años sobre la intoxicación alimentaria—sus causas, riesgos y prevención?

Pimentel: Las enfermedades transmitidas por alimentos siguen ocurriendo por contaminación con bacterias como E. coli, Salmonella, Shigella o Campylobacter jejuni. El manejo inadecuado continúa siendo una fuente importante de contaminación. Los alimentos que permanecen fuera por horas—algo común en buffets y reuniones grandes—crean las condiciones ideales para el crecimiento bacteriano.

Abayev: Muchos problemas alimentarios relacionados con las fiestas provienen de tradiciones pasadas de moda o de ambientes acelerados. Los largos periodos con la comida sobre la mesa, el pavo o el relleno poco cocidos, el refrigerador sobrecargado, descongelar carnes en el mostrador y la multitarea que causa contaminación cruzada son algunos de los errores más frecuentes.

¿Cuánto tiempo tarda en aparecer una intoxicación alimentaria—y siempre es culpa de la última comida?

Pimentel: Los síntomas no siempre aparecen de inmediato. Algunas infecciones pueden tardar hasta 48 horas en incubarse. Para identificar el origen probable, considere los alimentos ingeridos en los dos días previos y si otras personas que comieron lo mismo también se enfermaron.

¿Cuánto dura una intoxicación alimentaria—y es contagiosa?

Pimentel: La mayoría de los casos se resuelven en pocos días. El E. coli suele desaparecer rápido, mientras que Salmonella y Campylobacter pueden durar una semana o más. Las enfermedades transmitidas por alimentos no son contagiosas como un virus, pero puede haber contaminación si una persona enferma prepara comida para otros. Cualquiera con síntomas debe evitar cocinar hasta recuperarse por completo.

¿Cuáles son los errores más comunes en la cocina durante las fiestas?

Abayev: Permitir que la comida permanezca a temperatura ambiente por largos periodos es el problema más común. Una vez que la comida lleva más de dos horas fuera, las bacterias crecen rápidamente. Cocinar insuficientemente el pavo, el relleno y las cazuelas es otro error frecuente; todos los platillos deben alcanzar los 165 grados Fahrenheit. La contaminación cruzada, el refrigerador demasiado lleno y descongelar de manera incorrecta también aumentan el riesgo.

¿Qué tan confiables son la “prueba del olfato” o la “prueba de la vista” para evaluar las sobras, y cuánto tiempo permanecen seguras?

Abayev: La apariencia y el olor no son indicadores confiables de seguridad. Muchas bacterias dañinas no alteran el olor o el color de los alimentos. Las sobras deben refrigerarse en un plazo de dos horas, consumirse dentro de tres a cuatro días y recalentarse a 165 grados. También pueden congelarse para preservar su calidad durante varios meses.

¿Cómo deben manejar las comidas festivas las personas con trastornos digestivos—o quienes usan medicamentos GLP-1 para perder peso?

Pimentel: Quienes tienen síndrome de intestino irritable, enfermedad inflamatoria intestinal u otras afecciones gastrointestinales crónicas son más susceptibles a intoxicaciones alimentarias, y una infección puede empeorar sus síntomas o provocar brotes. El manejo cuidadoso de los alimentos, la cocción completa y elegir opciones de bajo riesgo son especialmente importantes.

Abayev: Las personas que usan medicamentos GLP-1 para el control del peso pueden experimentar vaciamiento gástrico más lento, lo que hace que los alimentos pesados de las fiestas causen más molestias. Porciones pequeñas, comer despacio, priorizar las proteínas y mantenerse en posición vertical después de comer pueden ayudar. Debido a que la comida permanece más tiempo en el estómago, la contaminación puede provocar síntomas más fuertes.

¿Qué deben hacer las personas para recuperarse de una intoxicación alimentaria?

Pimentel: La recuperación comienza con la hidratación. Tomar pequeños sorbos frecuentes de agua, bebidas con electrolitos o caldo ayuda a reponer líquidos. Los alimentos suaves como pan tostado, arroz, plátanos o sopas a base de caldo pueden añadirse conforme mejoran los síntomas. Se debe buscar atención médica si los síntomas duran más de un par de días o si hay fiebre alta, sangre en las heces o señales de deshidratación.

¿Cuál es una de las mayores preocupaciones de seguridad alimentaria este año?

Pimentel: La mejor vigilancia ha reducido la contaminación en carnes, pero ahora los productos agrícolas representan una preocupación creciente. Las condiciones en los campos pueden limitar el acceso de los trabajadores a una higiene adecuada y muchos vegetales se consumen crudos, lo que elimina el beneficio de seguridad que aporta la cocción.

¿Cuál es la recomendación más importante para anfitriones e invitados durante las fiestas?

Abayev: El control de temperatura es la base de la seguridad alimentaria. Los alimentos calientes deben mantenerse calientes, los fríos deben mantenerse fríos y las sobras deben refrigerarse de inmediato.

Pimentel: Más vale prevenir que lamentar; nadie quiere una dosis de intoxicación alimentaria junto con su comida festiva.

Lea más en el Blog de Cedars-Sinai: Medicamentos para Bajar de Peso—Lo que Debe Saber Ahora

Pimentel points out that the days between Thanksgiving and New Year’s are among the riskiest for food poisoning, especially as large meals, buffets and leftovers become part of the festivities. Each year, about 48 million Americans—roughly 1 in 6—get sick from foodborne illnesses, leading to an estimated 128,000 hospitalizations and 3,000 deaths, according to the Centers for Disease Control and Prevention.

Pimentel and Cedars-Sinai clinical dietitian Albert Abayev, RD, who works with patients undergoing weight loss surgery and general surgery, serve up answers to common holiday food safety questions.

What new insights have emerged in recent years about food poisoning—its causes, risks and prevention?

Pimentel: Foodborne illness continues to result from contamination with bacteria such as E. coli, Salmonella, Shigella or Campylobacter jejuni. Improper handling remains a major source of contamination. Foods left out for hours—common during buffets and large gatherings—create ideal conditions for bacterial growth.

Abayev: Many holiday-related food safety issues stem from outdated traditions or rushed environments. Long stretches of food left out on counters, undercooked poultry or stuffing, crowding the refrigerator, thawing meats on the counter, and multitasking that can lead to cross contamination are among the most frequent problems.

How long does it take to get food poisoning—and is the last meal always to blame?

Pimentel: Symptoms do not always appear immediately. Certain infections may take up to 48 hours to incubate. When determining the likely source, consider foods eaten in the prior two days and whether others who shared them also became ill.

How long does food poisoning usually last—and is it contagious?

Pimentel: Most cases resolve within a few days. E. coli often clears quickly, while Salmonella and Campylobacter may last a week or longer. Foodborne illness is not contagious like a virus, but contamination can occur if a sick person prepares food for others. Those with any symptoms should avoid preparing meals until fully recovered.

What are the biggest food safety mistakes people make in holiday kitchens?

Abayev: Allowing food to sit at room temperature for extended periods is the most common issue. Once food has been out for more than two hours, bacteria grow quickly. Undercooking turkey, stuffing and casseroles is another frequent problem; all dishes should reach 165 degrees Fahrenheit. Cross contamination, refrigerator overcrowding and improper thawing also add to the risk.

How reliable are the 'smell test' or 'eye test' when judging leftovers, and how long do leftovers stay safe?

Abayev: Appearance and smell are not reliable indicators of safety. Many harmful bacteria do not alter a food’s odor or color. Leftovers should be refrigerated within two hours, used within three to four days and reheated to 165 degrees. Also, freezing the food preserves quality for several months.

How should people with digestive conditions—or those using GLP-1 medications for weight loss—approach holiday meals safely?

Pimentel: Individuals with irritable bowel syndrome, inflammatory bowel disease or other chronic gastrointestinal conditions are more susceptible to foodborne illness, and an infection can worsen symptoms or trigger flares. Careful food handling, thorough cooking and choosing low-risk foods are especially important.

Abayev: GLP-1 users on weight management programs may experience slower stomach emptying, making heavy holiday foods more likely to cause discomfort. Smaller portions, slower eating, prioritizing protein and staying upright after meals can help. Because food remains in the stomach longer, contamination may result in stronger symptoms.

What should people do to recover from food poisoning?

Pimentel: Recovery starts with hydration. Small, frequent sips of water, electrolyte drinks or broth help replace losses. Bland foods like toast, rice, bananas or broth-based soups can be added as symptoms improve. Medical care is appropriate if symptoms last more than a couple of days or if there is high fever, blood in the stool or signs of dehydration.

What is one of the biggest food safety concerns this year?

Pimentel: Improved monitoring has reduced contamination in meat but produce now poses growing concern. Field conditions may limit workers’ access to proper hygiene, and many vegetables are eaten raw, eliminating the safety benefit of cooking.

What is the most important takeaway for holiday hosts and guests?

Abayev: Temperature control is the foundation of food safety. Hot foods should stay hot, cold foods should stay cold and leftovers should be refrigerated promptly.

Pimentel: Better safe than sorry; no one wants a side of food poisoning with their holiday meal.

Read more on the Cedars-Sinai Blog: Weight-Loss Drugs—What to Know Now

Hepatology Experts Available

Shelly Lu, MD, the Women's Guild Chair in Gastroenterology and director of the Karsh Division of Gastroenterology and Hepatology, is presenting research related to alcohol-associated liver injury and colorectal-liver metastasis.

Alexander Kuo, MD, professor of Medicine and medical director of Liver Transplantation, is presenting results of a California Liver Network study exploring factors associated with being “too early” for liver transplantation.

Walid Ayoub, MD, professor of Medicine and associate medical director of Liver Transplantation, is available to explain cholestatic and autoimmune liver diseases and related research.

Ju Dong Yang, MD, associate professor of Medicine and director of the Liver Cancer Program, can address questions regarding liver cancer and immunotherapy for hepatocellular carcinoma.

Ekihiro Seki, MD, PhD, professor of Medicine, is moderating a session about therapies for treating alcohol-associated liver disease.

Paul Martin, MD, director of Clinical Hepatology Education and Research, is presenting updated practice guidelines on long-term care of liver transplant recipients.

Maria Lauda Tomasi, PhD, associate professor of Medicine, is available for interviews about alcohol-associated liver disease and related clinical research.

Hyunseok Kim, MD, MPH, PhD, hepatologist and assistant professor of Medicine, is presenting research on the impact of coffee intake on liver health, including coffee’s association with cirrhosis and liver cancer.

Media Contact

To arrange interviews, contact Laura Coverson at 310-562-1112 or Laura.Coverson@cshs.org.

“In the morning, we will host a clinician track on best practices for treating women with IBD,” Khanna said. “In the afternoon, patients and families are invited to a dedicated session covering pregnancy, fertility, nutrition, mental health and more. There is also time for patients and providers to connect.”

An estimated 3 million people in the U.S. have inflammatory bowel disease, according to the Centers for Disease Control and Prevention. The disorder produces chronic and often destructive inflammation in the digestive tract. The two most common forms of IBD are Crohn’s disease and ulcerative colitis. While some cases can be mild and manageable, many IBD patients are faced with a constellation of health problems including severe diarrhea, malnutrition, dangerous blood clots, and extensive and painful scarring.

IBD occurs in men and women at about the same rate, but the disease can leave women facing unique health challenges. There can be difficult decisions about proceeding with certain drug therapies while trying to conceive or during pregnancy and menopause. 

“For women living with IBD, simply knowing that their needs are recognized and that there is a community and program designed for them can be incredibly empowering,” Khanna said.

The Cedars-Sinai Newsroom interviewed Khanna about how IBD impacts the health and wellbeing of women, including finding a good healthcare provider and effective therapies available to them.

In what ways can IBD impact women and men differently?

While inflammatory bowel disease occurs at about the same rate in both sexes, women often present differently. After age 30, Crohn’s disease is more common in women than in men. We also see sex-specific patterns: Women are more likely to have Crohn’s limited to the colon, less extensive ulcerative colitis, and more frequent extraintestinal conditions, such as eye inflammation and skin disorders. Recognizing these differences is critical for timely diagnosis and effective management.

Are there differences in diagnosis, disease course or treatment protocols for women?

The diagnostic workup for IBD is the same regardless of sex and typically involves colonoscopy, imaging, lab testing. However, the course of the illness can vary. Women may experience flares around hormonal changes, such as those occurring during menstruation or pregnancy.

Treatment approaches are generally the same for men and women, but side effects can differ. For example, women are more likely to develop drug-induced lupus with certain biologic therapies. Providers must stay alert to sex-based responses to various treatments for IBD. For women of childbearing age, therapy selection must consider whether a medication is safe in pregnancy. Most of them are, but not all.

Does IBD impact a woman’s reproductive life, including menstruation, fertility and pregnancy?

Absolutely. Many women report worsening symptoms during menstruation due to hormone fluctuations. Fertility can be reduced in women with active inflammation or prior pelvic surgery, although more research is needed on that front. Pregnancy outcomes are best when disease is in remission for at least three to six months before conception. Interestingly, we have found that some women with IBD may actually experience improvement in symptoms during pregnancy.

Most IBD medications can be safely continued during pregnancy, particularly when the disease is under control. Methotrexate, an immunosuppressant medication, should be avoided. There are other classes of medications, such as JAK inhibitors, whose safety and use should be discussed with your provider. At Cedars-Sinai, our IBD Pregnancy and Fertility Clinic brings gastroenterology and obstetrics together so women receive coordinated care.

Do women find it challenging to get an accurate IBD diagnosis? What advice would you offer?

Many women do face delays. They may see multiple providers before reaching a gastroenterologist who recognizes their symptoms as inflammatory bowel disease. My advice is to advocate for yourself. If you are not being heard, seek a second opinion, ideally at a dedicated IBD center. A colonoscopy and appropriate testing are essential to confirm the condition.

How do IBD patients benefit from a multidisciplinary approach to care?

One young woman in her 20s came to me after years of aggressive Crohn’s disease. She had seen specialists across the country, endured multiple treatments, and was facing another surgery. She broke down in tears, telling me she felt abandoned by her doctors. I reassured her and then brought her case to our weekly IBD meeting where top experts could collaborate on her care. That sense of not being given up on, and of building a trusted partnership with a care team, can be life-changing for patients living with a chronic illness.

The Women and IBD conference will take place at Cedars-Sinai on Saturday, Sept. 13. Attendance is free but registration is required. Those interested in attending can email groupibdwomensprogram@cshs.org to register and receive more information.

Read more on the Cedars-Sinai Blog: A Good Grip on Crohn’s Disease

A Level IV Maternal Care hospital, also known as a Regional Perinatal Health Care Center, provides comprehensive care before birth, throughout labor and delivery and after childbirth. The Joint Commission Maternal Levels of Care (MLC) Verification program operates in collaboration with the American College of Obstetricians and Gynecologists and recognizes the devotion to patient safety and quality of care.

Facilities with this top designation must be staffed with maternal-fetal medicine specialists and critical care physicians to deliver multidisciplinary and integrated treatment for patients with complex obstetric complications such as severe preterm preeclampsia or maternal heart disease.

Level IV medical centers also collaborate with other hospitals by providing medical education and easy access to consultations and transfers to Cedars-Sinai, if needed.  

“Access to this comprehensive level of specialty care can make a crucial difference in the health of both mother and baby and has been proven to reduce maternal morbidity,” said Sarah J. Kilpatrick, MD, PhD, chair of the Department of Obstetrics and Gynecology at Cedars-Sinai and an expert in maternal-fetal medicine.

“This Level IV verification recognizes our ability to provide coordinated, multidisciplinary care involving obstetricians, maternal-fetal medicine specialists, anesthesiologists, cardiologists, neurologists and any other specialty needed to effectively care for these extremely high-risk patients,” Kilpatrick said.

Approximately 3.6 million babies are born each year in the United States, including about 6,000 at Cedars-Sinai, one of the busiest labor and delivery hospitals in California.

The only other hospital in California to be formally verified for any level of maternal care by The Joint Commission is Torrance Memorial Medical Center, an affiliate of Cedars-Sinai. In 2023, Torrance Memorial received verification as a Level III Maternal Care facility.

“The Joint Commission commends Cedars-Sinai for being named a Level IV Maternal Care verified facility and for its efforts to standardize maternal care and reduce maternal morbidity and mortality,” said Ken Grubbs, DNP, MBA, RN, executive vice president of Accreditation and Certification Operations and chief nursing officer at The Joint Commission.

Hospitals receive Level IV designation following an on-site evaluation and a thorough review of their maternal care services as well as other medical specialties.

“The Level IV verification affirms not only the advanced capabilities of our institution but also the unwavering dedication of our maternal care team—especially our extraordinary nurses, who bring a rare combination of clinical expertise, compassion and readiness to respond to even the most complex maternal-fetal challenges,” said David Marshall, JD, DNP, RN, Cedars-Sinai senior vice president, chief nursing executive and chair of the Department of Nursing.

The Maternal Levels of Care Verification program will also help strengthen awareness of a regionalized approach to care for mothers where needed.

“This prestigious recognition reflects the outstanding professionalism of our multidisciplinary clinical teams who care for these vulnerable patients. The comprehensive management of the highest level of obstetric care is a hallmark of Cedars-Sinai’s service to our community,” said Shlomo Melmed, MB, ChB, executive vice president of Medicine and Health Sciences, dean of the Medical Faculty and the Helene A. and Philip E. Hixon Distinguished Chair in Investigative Medicine.

When pregnant patients receive the right level of care for their unique needs, it leads to safer births and healthier moms and babies.

“Importantly, most women in the U.S. appropriately give birth at Level I and Level II facilities with excellent outcomes. But one of the keys to reducing maternal morbidity and mortality is matching the level of care a patient requires with the right hospital,” Kilpatrick said.

“This ‘triage’ approach means that most women can stay in their communities, closer to home, family and support. But if things do not go as planned, the highest level of care can be readily available to them.”

Read more on our Cedars-Sinai Blog: Keeping Time With the Baby Blues

Inequities in pain medication treatment received postpartum, after giving birth, were found in a Cedars-Sinai study of 18,000 women. The disparities were observed even among patients reporting the highest pain levels.

The retrospective cohort study was published in The Joint Commission Journal on Quality and Patient Safety.

Both opioid and non-opioid pain medications given to patients were examined. Investigators wanted to see if the lower opioid doses reported in some studies finding racial and ethnic differences in peripartum pain management could be due to those patients receiving other kinds of drugs for their discomfort.

“Even after adjusting our analysis to include non-opioid medications, Black and Hispanic patients who reported the highest pain scores received lower doses of opioid-containing medication. The fact that they also received non-opioid drugs could not explain the lower opioid treatment they received when compared with white patients,” said Naomi Greene, PhD, principal investigator of the study and research assistant professor of  Obstetrics and Gynecology.

Pain associated with labor and delivery can make it challenging for women to care for themselves and their newborns. Investigators looked at many variables available in the electronic medical records of the patients who delivered at Cedars-Sinai over a three-year period, 2019−2021. White, Black, Asian and Hispanic women were part of the large cohort.

“We attempted to identify factors that might have mitigated the apparent differences, such as the number of pain assessments, use of epidurals, the amount of non-opioid medication, maternal age, the number of pregnancies, and body mass index. But none of these factors could account for the racial and ethnic disparities in the amount of effective opioid pain management given to them,” said Sarah J. Kilpatrick, MD, PhD, the Helping Hand of Los Angeles Chair in Obstetrics and Gynecology and senior author of the paper.

Investigators emphasize that further study is needed to identify what factors might explain the persistent racial and ethnic disparities in pain management that could point to potential interventions to eliminate the inequities.

“This study adds to the growing body of literature on peripartum pain medication disparity. While confirming previous findings, we added to it by showing that the amount of non-opioid medication used could not explain those disparities in opiate-based therapy given to patients in pain,” Greene said.

It is likely that pain perception and assessments are affected by a complex set of factors, the study authors noted.

“Healthcare provider beliefs, attitudes, and biases concerning pain rating in patients of different races and ethnicities are part of the challenge. Exploring this would necessitate a prospective intervention, such as a survey distributed to nurses and doctors to assess these beliefs and biases. Also, beyond recording a number for a pain score, we need to find ways to allow patients to directly assess their satisfaction with the pain management they are receiving,” Kilpatrick said.

Read more on the Cedars-Sinai Blog: Equitable, Personalized Care for Women and Children of Color

Addressing the complexity of causes behind poor health outcomes for Black mothers requires commitment, investment and innovation to produce meaningful, measurable change.

“Ensuring equitable outcomes for our patients is a priority at the highest level of Cedars-Sinai. Black Maternal Health Week raises awareness about birthing inequities that exist, and the multidisciplinary work required to close the gap,” said Christina Harris, MD, Cedars-Sinai vice president and chief health equity officer.

“But the work of preventing harm and saving Black lives is a continuous process that is not confined to one week. It is 24 hours a day, seven days a week, every week and every year. That is the level of commitment that is required,” Harris said.

Cedars-Sinai initiatives to improve Black maternal health include lowering the rates of a common cause of death during childbirth, funding community partners, providing mandatory anti-discrimination education and bridging the gap in maternal mental health care.

Community Conversations

Throughout the year, Cedars-Sinai partners with BlackDoctor.org for a series of Community Conversations that address a wide range of health and public health concerns. This month’s conversation will focus on Black maternal mental health.

According to the American Counseling Association, Black women face an increased risk of perinatal mood and anxiety disorders, including depression and post-traumatic stress disorder. On April 10, “Shining a Light on Black Maternal Mental Health” will feature a panel of healthcare experts discussing the importance of early diagnosis and access to support and effective treatment. The conversation will include an inspirational Black mom who shares her journey of recovery from serious postpartum depression. 

AI Plus Aspirin Eliminates Racial Disparities in Preeclampsia Treatment

"Whenever we focus on eliminating racial or ethnic disparities in care, we ultimately end up increasing the quality of care for everybody,” said maternal-fetal medicine specialist Melissa Wong, MD.

Aspirin can reduce the risk of developing preeclampsia, a dangerous hypertensive complication of pregnancy that can lead to serious complications and even death. But Black pregnant women are particularly vulnerable to being overlooked for aspirin treatment.  

A study led by Wong found that using artificial intelligence to automate decision-making about prescribing low-aspirin—and to identify patients at risk for preeclampsia—resulted in an increase in appropriate aspirin treatment and eliminated the racial disparity in care.

Perinatal Antidiscrimination Initiative

“Not being heard, or having assumptions made about you or your condition, can be a critical barrier to getting good medical care. I've found there are differences in how people perceive respect, or disrespect, based on race and ethnicity," explains Kimberly Gregory, MD, MPH, director of Maternal-Fetal Medicine and vice chair of Women's Healthcare Quality and Performance Improvement in the Department of Obstetrics and Gynecology.

“Always Listening and Learning with You”—ALLY—is a phrase developed by the Cedars-Sinai perinatal unit to characterize an effective approach to patient advocacy and health equity.

The principal of “allyship” is the foundation of annual department compliance training on unconscious bias. The course demonstrates the value of inclusive terminology, offers opportunities to explore how to advocate for  patients and colleagues and emphasizes the critical role staff members play in improving the experiences of patients.

Black Maternal Mental Health

“Black women are twice as likely to experience perinatal mood and anxiety disorders, including postpartum depression, than their white counterparts. They are also less likely to receive treatment,” said clinical psychologist Eynav Accortt, PhD, director of the Reproductive Psychology Program.

Cedars-Sinai investigators are recruiting participants for an NIH funded study aimed at addressing those disparities. The Resources, Inspiration, Support, Empowerment (R.I.S.E.) for Black Maternal Mental Health study tests a mobile health web application designed to help manage stress in pregnancy.

Black women living anywhere in the U.S. who are 12-32 weeks pregnant and at least 18 years old can participate in the study. Click here for more information.

Community Partners

Cedars-Sinai also partners with trusted community organizations committed to improving Black maternal and infant health.

Since 2022, Cedars-Sinai has committed over $3.5 million to 14 organizations which focus on reaching perinatal and postnatal Black women in Los Angeles County, across the continuum of care. Grantees include highly respected partners such as the California Black Women’s Health Project, which provides health education and other resources meant to build empowering relationships within the community of Black pregnant and parenting women they serve.

“Striving for health equity among all populations has long been a goal of Cedars-Sinai. These organizations are key partners in that mission. The grants—and opportunities to combine resources for the good of public health—are an important way we can contribute to improving Black maternal health and well-being,” Harris said.

Read more on the Cedars-Sinai Blog: Equitable, Personalized Care for Women and Children of Color                           

It is one of the most common and painful disorders, affecting more than 6 million women in the United States. Endometriosis is often difficult to diagnose and effectively treat. But Cedars-Sinai experts find patients can now benefit from minimally invasive procedures, medications and integrative medicine.

Endometriosis occurs when cells similar to the uterine lining are found growing in the wrong places, most commonly in the ovaries or fallopian tubes or in the abdominal cavity. Sometimes the errant endometrial tissue can migrate to the bladder, rectum and vagina. More than 11% of women have the disorder, according to the Office on Women’s Health in the U.S. Department of Health and Human Services.

Cedars-Sinai endometriosis experts Matthew Siedhoff, MD, a minimally invasive gynecological surgeon and vice chair, Department of Obstetrics and Gynecology, and Kelly Wright, MD, director of Minimally Invasive Gynecological Surgery, answer some of the most common questions about the condition and offer guidance on finding effective treatment and support for the challenges many women face.   

Dr. Siedhoff, what are common, and uncommon, symptoms of endometriosis?

Classic symptoms of endometriosis include pain with periods, noncyclic pelvic pain, pain with intercourse, and infertility. Very painful periods in adolescence can be an early warning sign of the disease, and it is sometimes associated with other symptoms such as vomiting or loose stool. Bowel and bladder dysfunction, migraines, fatigue and pain throughout the body can also be associated with endometriosis. However, some patients are completely asymptomatic, and the condition is diagnosed almost accidentally when it can be seen on imaging done for other reasons, such as an infertility workup.

Dr. Wright, why is endometriosis so difficult to diagnose?

There are no good noninvasive tests for endometriosis, and it doesn’t always show up on imaging studies. Since the condition can present in a variety of ways, patients can be passed from specialist to specialist before it is finally considered as a possible diagnosis. It can then be hard for a patient to find a physician familiar with the nuances and complexities involved in effectively treating the disease. In too many cases, the road from initial symptoms to a diagnosis of endometriosis can take seven to 10 years.

The symptoms of endometriosis, such as pain, sexual dysfunction and infertility, can be difficult to talk about during medical visits. Some providers don’t actively inquire about these symptoms, relying on patients to volunteer them. Sometimes clinicians minimize the symptoms a patient shares telling them that what they are experiencing is normal for a woman. And sometimes they are told that their physical complaints are psychological or all in their head.

Dr. Siedhoff, what are the current best practices for effectively diagnosing and treating endometriosis?

Endometriosis can sometimes be diagnosed by imaging or physical exam, but most of the time, laparoscopic, or minimally invasive, surgery is required to definitively confirm the diagnosis. If a provider suspects endometriosis based on a patient’s clinical presentation, it is perfectly reasonable to start treatment without surgical confirmation. If initial nonsurgical treatments aren’t working, that’s often a sign it’s time to consider surgery.

It’s important that patients see a surgeon with considerable experience in endometriosis surgery. Less experienced surgeons sometimes superficially treat endometriosis lesions by burning them away, a procedure called fulguration. This approach may help the patient a little, but actually cutting out the tissue results in greater pain reduction, decreases the risk the endometriosis will recur and produces better fertility outcomes.

Dr. Wright, is minimally invasive surgical removal of endometriosis a complicated procedure?

Finding how far the disease has spread and removing it often requires working around delicate structures, such as the intestines, kidneys, bladder, blood vessels and nerves. The severity of the patient’s endometriosis—and where the lesions will be found—can be difficult to predict before surgery, so it’s important to have a skilled surgeon prepared to remove the tissue regardless the location. Also, in younger women, the appearance of endometriosis can be subtle and requires an experienced eye to identify it and remove it.

The good news is that minimally invasive gynecological surgery is associated with less postoperative pain, faster recovery and lower infection rates. Our team at Cedars-Sinai is highly experienced and dedicated to improving the health and quality of life for patients who have been suffering with endometriosis.

Dr. Siedhoff, what is the best advice you can give frustrated patients trying to get help and relief?

First of all, don’t give up. There is effective treatment available. Often their condition will be one that is managed rather than cured. It usually takes some time to find the right treatment plan, and it may involve a variety of specialists, including gynecological surgeons, urologists, reproductive endocrinologists, gastroenterologists and integrative medicine specialists. But our patients do improve, and sometimes dramatically.  

Endometriosis Patient Resources

Endometriosis can sometimes lead to feelings of isolation, hopelessness and depression. Emotional support and practical strategies for managing endometriosis can help people navigate the anxiety, stress, loneliness and pain. Here are support programs available to Cedars-Sinai patients.

Endometriosis Peer Support Network: Patients can connect directly with volunteers who have had their own extensive endometriosis journeys and understand the emotional, psychological and healthcare challenges women face. For more information, contact Caryn Lindsey, LCSW, at 310-423-2412 or by email at caryn.lindsey@cshs.org. There is no fee.

Endometriosis Support Group: Connect with others who are facing challenges living with an endometriosis diagnosis. Currently, the group meeting is virtual. Register here. The fee is $15.

Empowered Relief (chronic pain management class): A single-session, two-hour class providing patients with in-depth knowledge about chronic pain and effective pain management.  Register here. The fee is $30.

Read more on the Cedars-Sinai Blog: You’re Not Alone: Coping With Endometriosis

The findings are published in JAMA Network Open.

The development and use of medications to treat acute and chronic health conditions has improved longevity and quality of life. But for some older adults, taking multiple medications can do more harm than good. Polypharmacy—the use of five or more medications—is associated with a higher risk for falls, fractures, hospitalizations, along with functional and cognitive decline for some aging patients.

“Polypharmacy, especially harmful or inappropriate polypharmacy, is bad. But the research community hasn’t figured out how to consistently move the needle on hospitalizations, quality of life, mortality and other adverse outcomes associated with being on several medications at once,” said corresponding author Michelle Keller, PhD, a health services scientist in the Department of Medicine at Cedars-Sinai.

Investigators analyzed 14 studies that systematically evaluated various tactics used to address the risks of taking five or more medications. They could not find a clear set of practices that consistently helped polypharmacy patients, but some approaches showed promise.

“Intensive, face-to-face interventions were effective in some studies. In those cases, having a healthcare provider review the patient’s medical record, go over the drugs with them to discuss medication adherence or whether a drug was still appropriate, and providing patient education all appeared to reduce hospitalizations,” said senior author Joshua Pevnick, MD, co-director, Division of Informatics at Cedars-Sinai.

Adults 65 and older tend to take more medications. According to a report by the Centers for Disease Control and Prevention, about a third of adults in the U.S. who are in their 60s and 70s take five or more prescription drugs. Medications to control cholesterol, high blood pressure and diabetes are the most common.

“We must weigh the benefit of prescribing a new medication against the possible risk it may present. Can it interact with other medications the patient is taking or impact the disease course in the older adult? For example, a new medication may effectively treat a specific condition but make the person drowsy, putting them at higher risk for a fall or impair their cognitive abilities. The more tools we develop to help us assess the risk-benefit of medications for our patients, the better care we can give them,” said  Sonja Rosen, MD, chief, Section of Geriatric Medicine at Cedars-Sinai.

While time spent discussing medication use with a healthcare provider, in person, did reduce some negative polypharmacy consequences in a few studies, a simple consult with a pharmacist also proved protective in some cases.

“Older adults often develop a good rapport with their pharmacists, and in some of the studies we reviewed, relatively short consults with them were very helpful to polypharmacy patients—especially those who may be at risk for falls or cognitive decline. I think a lot of health systems are recognizing the important role a pharmacist can play in the overall healthcare of their patients,” Keller said.

Identifying who is at higher risk for adverse polypharmacy outcomes is critical in order to develop effective interventions and is the focus of a pilot program in development at Cedars-Sinai.

“We want to create a risk-prediction model using data from the electronic health records of patients seeing primary care physicians. For the polypharmacy patients we identify as being at high risk for health problems associated with their medication regimen. As a first step, we can flag the record and send a message to their physician recommending a consult with a pharmacist, as a first step,” Keller said.

The Cedars-Sinai pilot program is expected to begin this spring.

Funding: This work was supported by National Institutes of Health grant numbers K01AG076865 and K24AG047899.

Follow Cedars-Sinai Academic Medicine on X (Twitter) for more on the latest basic science and clinical research from Cedars-Sinai.

Read more on the Cedars-Sinai Blog: The Balancing Act of Fall Prevention

Cedars-Sinai investigators examined the potential effects of consuming non-sugar sweeteners, including both non-aspartame non-sugar sweeteners and aspartame alone, on the composition of the stool and duodenal microbiomes. Compared to controls in the study, scientists noted significant differences in both stool and duodenal (small intestine) microbial diversity and composition. Levels of circulating inflammatory markers were also altered in participants who consumed non-aspartame non-sugar sweeteners as well as those using aspartame only.

Background

More than 140 million people in the United States use sugar substitutes, according to data from the U.S. Census Bureau. Sucralose, aspartame, saccharin and the plant-based stevia leaf extract are among the most popular. These artificial sweeteners are frequently used by people trying to reduce their sugar intake or lower calories from sugar for weight management. But there are increasing concerns about the potential health risks associated with the use of non-sugar substitutes based on data suggesting they do not help with long-term weight loss and may be linked to higher risks for Type 2 diabetes, heart disease and death. There are also questions about the potential negative effects the sugar substitutes may have on the gut microbiome, which plays a vital role in overall health.

In a controlled study, Cedars-Sinai investigators analyzed and compared the duodenal luminal microbiome in subjects consuming artificial sweeteners, aspartame alone or no sugar substitutes. The stool microbiome in some of these subjects was also compared.

Method

Investigators obtained samples from a small group of adults undergoing standard of care esophagogastroduodenoscopy without colon prep. All enrolled subjects provided duodenal luminal aspirates as well as fasting blood samples for analysis, and a subset also provided optional stool samples. Scientists analyzed the duodenal luminal microbiome in subjects consuming non-aspartame non-sugar sweeteners (NANS, N=35), aspartame only (ASP, N=9), and controls (CON, N=55), and the stool microbiome in a subset (N=40).

Impact

Artificial sweeteners are associated with a variety of changes depending on the area of the intestine. Significantly, the effects of these substances on the gut microbiome differ in the small bowel compared to the large bowel. These changes may be potentially important for health and warrant future study.

Journal

The study is published in the journal iScience.

Expert Commentary

“Artificial sweeteners are not benign for the microbiome of the gut. We found that the richness of the bacteria in the small bowel was less in those subjects consuming non-aspartame non-sugar sweeteners when compared to controls, whereas bacterial richness in those consuming aspartame was similar to controls,” said Ruchi Mathur, MD, a professor of Medicine at Cedars-Sinai and the lead author of the study.

“Interestingly, when we looked at predicted metabolic pathways in these bacteria, we noted that the pathway of cylindrospermopsin, a toxin, was enriched specifically in small bowel bacteria of subjects who consumed aspartame. This pathway is recognized for its harmful effects on the liver and the nervous system, and it is classed as a potential cancer-causing agent,” said Mathur, an endocrinologist and corresponding author for the paper.

Authors

Other Cedars-Sinai authors include Ava Hosseini, MPH; Gillian M. Barlow, PhD; Gabriela Leite, PhD; Mohamad Rashid, MD; Gonzalo Parodi; Jiajing Wang, PhD; Walter Morales; Stacy Weitsman, MS; Ali Rezaie, MD; and Mark Pimentel, MD.

Funding

This research was supported by Frank Lee, the Monica Lester Charitable Trust and the Elias, Genevieve, and Georgianna Atol Charitable Trust.

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The findings are published in the journal Gastroenterology.

“Even though biologic medications have significantly improved outcomes for our patients with Crohn’s disease or ulcerative colitis, some people do not respond well to these therapies. In our study, we found that the patients with higher amounts of internal abdominal fat were less likely to improve and experience remission from their disease,” said gastroenterologist Andres J. Yarur, MD, the corresponding author of the study.

Unlike some conventional anti-inflammatory drugs which treat inflammation in a non-selective way, biologics work by blocking specific targets that cause inflammation in the body.

Patients in the study with higher visceral fat levels had lower concentrations of the biologic medications in their blood after treatment, and lower rates of steroid-free remission and bowel healing.

“It may not be body weight or body mass index [BMI] that is the reason some of our patients benefit from these approved biologic medications. It seems the fat tissue on the inner side of the abdomen, in particular, impacts treatment, so we may need to use higher doses of the drugs to help these patients,” said Gil Melmed, MD, a co-author of the study and director of Inflammatory Bowel Disease Clinical Research at Cedars-Sinai.

Investigators treated 141 IBD patients with one of three biologic medications: infliximab, ustekinumab or vedolizumab. Reliable body composition measurements were taken for both the IBD group and the 51 healthy control subjects to ensure fat composition for the two groups were similar.

“We found that higher visceral adiposity was associated with higher levels of pro-inflammatory cytokines, suggesting that fat tissue promotes inflammation, the opposite of what we want, and increases resistance to biologic drug therapy. More research is needed because we don’t know whether lowering visceral fat or giving higher doses of the medications would improve drug efficacy,” said Melmed.

Yarur, the study’s principal investigator, agrees, adding that a different kind of medication may be more effective in patients with a high intra-abdominal visceral fat. 

“We need to investigate drugs with different mechanisms of action, especially other small molecules, to see if our findings hold. As the prevalence of obesity and metabolic syndrome increases in our population, we need to find interventions that would improve the body composition of these IBD patients who are not currently helped by these biologic treatments,” said Yarur.

DOI: https://doi.org/10.1053/j.gastro.2023.06.036

Funding: The pilot study for this investigation was funded by a grant from the Digestive Disease Center at the Medical College of Wisconsin.

Conflicts of Interest:  Andres Yarur is a consultant, and member of the advisory board, for Takeda, which manufactures vedolizumab, and for Celltrion Healthcare, which produces one biosimilar of infliximab. Gil Melmed is also a consultant to Takeda and Janssen Immunology, the makers of infliximab and ustekinumab.

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Read more on Discoveries Magazine: Ancestry Matters: Genetic Risk Factors for IBD

An estimated 100,000 people in the U.S. are living with scleroderma, and there are about 7,000 to 8,000 new cases every year. In advanced stages of systemic sclerosis, which disproportionately affects women, the chronic symptoms can lead to irreversible organ damage and death. There is no cure.  

“Scleroderma is the epitome of complex autoimmune rheumatic disorders because it can affect any organ in the body. Scleroderma is a chronic illness that can place an incredible burden on patients and their families for a long period of time,” said Francesco Boin, MD, the chair of Rheumatology and director of the Scleroderma Program in the Kao Autoimmunity Institute at Cedars-Sinai.

Research That Benefits Patients

Cutting edge research is the best care we can offer scleroderma patients, said Boin, and leading that effort at Cedars-Sinai is Nunzio Bottini, MD, PhD, the director of the Kao Autoimmunity Institute.

“Our research priorities at the Kao Autoimmunity Institute are twofold: first, how to prevent, and hopefully reverse, the progression of fibrosis in patients with scleroderma, and secondly, we want to identify risk factors for the development of interstitial lung disease, a major complication of scleroderma, that can lead to an early death,” said Bottini.

A Super-Family of Enzymes

Groundbreaking research on the role a group of enzymes Bottini calls a “super-family,” protein tyrosine phosphatases (PTPs), has been a key focus of his work investigating the development of rheumatic diseases.

“PTPs have recently emerged as important drug targets for a multitude of diseases. For scleroderma, we want to better understand precisely how this family of enzymes regulates the progression of fibrosis, the production of excessive collagen that can scar and thicken tissue, a hallmark of scleroderma,” said Bottini, who has been continuously funded by the National Institutes of Health for autoimmune disease research since 2007.

Spatial Biology: Location Matters

Cells in the body exist in relationship to one another, they are not islands. Spatial biology explores how the neighborhood, the location of one cell within tissue relative to another, could affect cellular activity.

“The fibroblast cell’s behavior is affected by different types of cells, including immune cells, that are located near it. Spatial biology has the potential to help us understand pathology in a new way. How might the behavior of the fibroblast be influenced by specific factors in the immune cells or by its location in the skin or the lungs? In autoimmune disorders, like scleroderma, that information could be a game changer,” said Bottini.

“All that we do at the Kao Institute is geared toward helping patients. That is the end goal.  We study specimens graciously donated by our patients and we make our hypotheses about targets for potential therapies. Then we test the hypotheses and based on the results of the experiments, develop therapies tailored to patients with scleroderma. We want to enable personalized care.”

Autoimmune disorders affect 24 million adults and children in the U.S., according to the National Institutes of Health. 

“Autoimmune diseases are a leading cause of death and disability. At the Kao Autoimmunity Institute, we want to bring top investigators and clinicians together and leverage the culture of scientific excellence and collaboration here. Our goal is to promote personalized medicine by developing  novel, evidence-based therapies that can help patients,” said Bottini.

Read More on the Cedars-Sinai Blog: Lifelong Journey: A Scleroderma Patient and Her Doctor

Having a child is a major life event accompanied by physiological changes and the stress of caring for a completely dependent little human. That experience is commonly referred to as “the baby blues.”  

But 15% to 20% of women who give birth will experience major changes in their mood and overall wellbeing that can linger for months. These new mothers can suffer from perinatal mood disorders that can include depression, anxiety, obsessive-compulsive disorder and even post-traumatic stress.

Cedars-Sinai clinical psychologist Eynav Accortt, PhD, director of the Reproductive Psychology Program, shares information on what is known about these changes in mental health faced by millions of women and the types of treatment and support that are available to help mothers recover.

Newsroom: What do we know about the scope of maternal mental health disorders?

It's a much wider range of symptoms and diagnoses than described by the term postpartum depression or “the baby blues.”  Perinatal mood and anxiety disorders can be experienced during pregnancy and up to a year after birth, when symptoms often develop. When diagnosed, this can include major depressive disorder, bipolar depression, generalized anxiety, panic disorder, post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder.

Newsroom: What are the risk factors for developing perinatal mood disorders?

Things that may increase the risk for developing a perinatal mood and anxiety disorder include genetic factors such as a family or personal history of mental illness. Even medical complications during pregnancy, such as preeclampsia or gestational diabetes, can elevate a woman’s risk. At Cedars-Sinai, we are investigating a possible connection between these pregnancy illnesses and inflammation. We want to know if inflammation may increase the risk of developing depression during and after pregnancy.  

Parents with a newborn in a neonatal intensive care unit have twice the risk of developing postpartum depression, anxiety and PTSD. Research also points to race and ethnicity as risk factors for mental health problems associated with maternity. Black mothers are twice as likely to develop a perinatal mood or anxiety disorder than white women, primarily due to the impact of  racial discrimination.

Newsroom:  When should a new mother be concerned about her mental health?

If two weeks post-delivery a woman continues to experience symptoms of depression and anxiety that interfere with her ability to function or to care for herself and her baby, it’s important to get some professional help. A good first step is to speak with your obstetrician and let them know what you are going through. In addition to feeling sad or crying all the time, persistent feelings of anger, worthlessness and inadequacy, or feeling disconnected from the baby, are associated with perinatal mood and anxiety disorders. In extreme cases, intrusive, negative thoughts about self-harm, or hurting the child, can be part of mental illness associated with pregnancy, childbirth and motherhood.  

Newsroom: What kind of help is available to women experiencing anxiety and depression during pregnancy and postpartum?

Therapy, including cognitive behavioral therapy. interpersonal psychotherapy or other modalities, can provide meaningful help. Antidepressants can be part of a treatment plan by providing relief and helping improve mood and regulation of emotions. In particular, Zoloft proved to be a safe and effective antidepressant to use during pregnancy and breastfeeding.

The Reproductive Psychology Program at Cedars-Sinai is dedicated to helping women experiencing mental health conditions before, during and after pregnancy. We make sure women can receive the resources, support, care and treatment they need to improve their emotional and mental wellbeing.

Mothers should not suffer in silence. The important first step is to talk to someone—a partner or other family member, a friend, a co-worker, or your physician—and let them know you are struggling. The well-baby checkups that happen frequently in the first six months of life offer a perfect opportunity for a new mother to talk to a healthcare provider about her problems.

Newsroom: As a therapist who counsels women struggling with their mental health during pregnancy or postpartum, what encouragement do you offer?

Every reproductive journey is different. Getting pregnant, having a baby, and going through the postpartum period can be stressful, life-changing experiences. It's important to give yourself grace, and to reach out to your loved ones. If you don't feel well, and you're not able to take care of yourself or your baby, there are services and providers available to help you. There is no reason to lose hope.

Read more on the Cedars-Sinai Blog: The Difference Between Postpartum Anxiety, OCD and Psychosis