CDI Physician-Scientist Seeks to Catch Disease Earlier in the Process

Rachel Rosenstein, M.D., Ph.D., worked for two years at the National Institutes of Health in Maryland. There, the dermatologist saw some of the most challenging complications for cancer patients.

About a month into her tenure at Hackensack Meridian Health, where she splits her time between the Center for Discovery and Innovation (CDI) and Hackensack University Medical Center, the physician-scientist aims to make more of a clinical impact with her science than ever before.

"Patients come to the NIH oftentimes as a last resort – their home institutions had already been working very hard to treat the patients. We would often see patients in late stages of disease processes," said Rosenstein. "My goal now is to study disease earlier in the process."

Her niche seems highly specific, but it is a crucial one: diseases of the skin that develop in cancer patients (oncodermatology) – and not specifically skin cancer.

"We are excited to have Rachel at the CDI. Her training as a clinician and immunologist bring an important new dimension to our translational research program in Oncology." said David Perlin, Ph.D., chief scientific officer and senior vice president of the CDI. "We are fortunate to give her a place to pursue her studies, which could have so much clinical benefit to patients in years to come."

"Bringing Dr. Rosenstein to Hackensack Meridian Health has been a great collaborative effort between the CDI, the Department of Medicine at Hackensack University Medical Center, and John Theurer Cancer Center," said Ihor Sawczuk, M.D., FACS, the chief research officer and president of the northern region for Hackensack Meridian Health. "This is the kind of person who can make our network all the stronger."

Investigating Graft-versus-host-disease.At the NIH, Rosenstein trained in a clinical and translational research fellowship. At the CDI, she will have a split role, like other physician-scientists: clinical work at Hackensack University Medical Center – and a research portfolio expected to grow with grants and time. At the CDI her mentors will be senior immunologists Howard Xue and Robert Korngold, the CDI's deputy director.

One of Rosenstein's specialties is sclerotic chronic graft-versus-host disease (GVHD). It's an affliction for those who undergo bone marrow transplantation, in which the donor cells attack and damage the host, and the host produces inappropriate tissue repair responses, resulting in fibrosis of the skin and joints, which can restrict mobility and severely impact quality of life.

"GVHD is a multi-systemic disease," said Rosenstein. "It can affect the eyes, mouth, skin, gastrointestinal tract, lungs, joints, among other organs. And the effects in these organs can be quite heterogeneous.

"It's thought to occur because transplanted T cells attack the host," she added. "But the progression from inflammation and T cell infiltration into different tissues, to fibrosis, is still really being defined."

One of her main interests, and an early focus of her CDI research, is in understanding why and how fibrosis develops, and how best to mitigate its effects.

"There are now multiple treatment options for chronic GVHD, which have proven to work for some patients, and not for others, but understanding which patients will respond to which drugs and at which stage of their disease is difficult to tease out," she said.

Hackensack University Medical Center has a renowned bone marrow transplant program. The fit within the CDI and the translational aspect of the science, in addition to her clinical work in the hospital setting, brought her to the network.

"One objective at the CDI is to take lab discoveries to the clinic, and vice-versa – and that's always been an important goal for my research," said Rosenstein. " Being somewhere that can easily broach the divide between research and clinical care is a great opportunity."

"Her work is going to benefit patients in real-time," said Laurie Jacobs, M.D., chair and professor, Department of Internal Medicine at the Hackensack Meridian School of Medicine and Hackensack University Medical Center.

"Dr. Rosenstein's expertise will be a great asset for John Theurer Cancer Center not only for our large population of pts with skin cancers or skin lymphomas but also for dermatological complications in cancer pts particularly for graft versus host disease post allotransplantation. This is a great example of several Depts working together to hire physician scientists and further expand our research enterprise." said Andre Goy, M.D., M.S., physician-in-chief of Oncology, Hackensack Meridian Health.

Full Circle Rosenstein came to dermatology from a background in immunology. While at Yale University, she investigated allergens: protease allergens similar to house dust mite allergen, as well as bee and snake venoms, studying how they activated a type 2 immune response. Her interest in immunology naturally translated into studying human skin, as it is often the first line of defense and impacted so dynamically by outside triggers and is also easy-to-access for research. From allergy, she "switched gears" to other forms of inflammation – and now is focusing on the relationship between inflammation and fibrosis.

Medicine runs in Rosenstein's family. Her husband is a transplant surgeon physician-scientist working in New York. Her mother is a periodontist; her sister is a veterinarian; her brother is a medical student. Her father, Elliot Rosenstein, is a well-known New Jersey rheumatologist who has co-authored several papers with his daughter (the Rosensteins' specialties do clinically converge in many ways). The daughter said she hopes to work on cases with her father in the future.

"He's been a great resource for me," she said.

Coming to Hackensack Meridian Health is somewhat of a homecoming for Rosenstein, who grew up first in Montclair and then on a farm in Far Hills, with llamas and horses.

Now she lives in northern New Jersey with her husband, daughters aged 4 and 1, the elder of whom is being imparted horseback riding and classical piano Rosenstein herself grew up with.

"I came back to where I spent my formative years," she said.