Dr. Drake has been a consultant in the Division of Endocrinology, Diabetes, Metabolism, and Nutrition at the Mayo Clinic in Rochester, Minnesota since 2007. He assumed a dual role as a consultant in Mayo Clinic’s Division of Hematology in 2017. He has been an Associate Professor of Medicine at the Mayo Clinic College of Medicine and Science since 2015.

Dr. Drake will ensure the continued excellence of the clinical, educational and investigative programs in the Division of Endocrinology and the Metabolic Bone Service. He will work with HSS physicians and staff to optimize quality, the patient experience and outcomes. His role will include collaboration with internists and orthopedic surgeons at HSS, particularly those focused on joint replacement, sports medicine and spine, to identify and address risk factors related to bone health that could affect surgical outcomes.

“Dr. Drake is a world-renowned endocrinologist with clinical and research expertise on age related bone loss, and we enthusiastically welcome him to HSS,” said S. Louis Bridges, Jr., MD, PhD, physician-in-chief and chair of the Department of Medicine at HSS. “His impressive background and considerable experience are vital assets that will enable us to maintain our role as a leader in the diagnosis, treatment and research in endocrine and metabolic bone diseases.”

“With its outstanding reputation for providing the highest standards of care, passion for excellence and innovation, and strong commitment to improving the lives of patients everywhere, it is an honor and a privilege to join HSS,” said Dr. Drake. “I look forward to working closely with the clinical and research staff and collaborating with a highly motivated team of specialized faculty to achieve our best musculoskeletal health outcomes.”

The recipient of numerous research grants from the National Institutes of Health, Dr. Drake will play a key role in the internationally recognized research programs at HSS, collaborating with leaders of the HSS Research Institute, the Department of Orthopedics and the Division of Rheumatology, to define priorities for investigation.

Dr. Drake’s own research has focused on the underlying mechanisms and skeletal changes related to age-related bone loss. He has also sought to better understand how cancer affects bone health. Dr. Drake believes that unraveling the mysteries of how normal aging or the presence of malignancies leads to the softening or destruction of bone mass could ultimately lead to new or improved methods to prevent and treat bone loss.

Dr. Drake’s dedication to his field includes a long list of professional activities. He has served as an independent content reviewer on the Task Force on Cell-Based Therapies for the American Society for Bone and Mineral Research (ASMBR); as a member of the Task Force on Managing Osteoporosis Patients after Long-Term Bisphosphonate Treatment for the ASBMR; and on the scientific advisory boards of the Rare Bone Disease Alliance, Fibrous Dysplasia Foundation, and the Soft Bones Foundation.

His research has been featured in 125 peer-reviewed articles, and he has written 11 book chapters on topics that include the pathogenesis of osteoporosis, myeloma bone disease, and disorders of calcium and bone metabolism.

Dr. Drake graduated Magna Cum Laude from Harvard College, where he received an AB degree in Biology. He attended Washington University earning his MD degree in addition to a PhD in Molecular and Cell Biology. He went on to an Internal Medicine/Endocrinology residency at Duke University Medical Center, where he also completed a clinical research fellowship. His academic accomplishments include a second clinical research fellowship in Endocrinology at the Mayo Clinic College of Medicine.

“The advancement of patient care practices at HSS is demonstrated through our commitment to recruiting outstanding physician leaders in our clinical specialties,” said Douglas E. Padgett, MD, surgeon-in-chief and medical director at HSS. “Drs. Drake’s and Stein’s dedication and expertise in the field of endocrinology demonstrates our relentless focus on high-quality and high-value healthcare for our patients.”

Spinal fusion is among the most commonly performed orthopedic surgeries in the United States, with more than 400,000 patients undergoing the procedure each year. Although most cases are successful, as many as 45 percent of patients experience complications after the operation, often resulting from the bone’s inability to tolerate the hardware surgeons use to support the skeleton. 

The most widely used technology to evaluate patients’ bones before spine fusion surgery is called dual x-ray absorptiometry, or DXA. DXA imaging gives physicians a rough sense of the strength of a person’s bone, but it is not foolproof. In some cases, surgeons find that patients whose DXA scans appear normal have bones that are so weak that the appliances they use during spinal fusion are at risk of failure. 

The HSS researchers hypothesized that a more sensitive measure of bone quality could identify abnormalities in the skeleton that DXA does not detect, and that these defects would be linked to postoperative complications. 

For the new study, the team led by Emily Stein, MD, an endocrinologist and bone specialist, along with spine surgeons Han Jo Kim, MD, Matthew Cunningham MD, PhD, and Frank Schwab, MD, turned to a cutting-edge technique for assessing bone called high-resolution peripheral quantitative computed tomography (HR-pQCT). HR-pQCT can separately measure how much bone is in the outer (cortical) and inner (trabecular) compartments and measure on a microscopic level how the inner trabecular bone network is organized, including the number, thickness and spacing between the parts of that network called trabeculae. These measurements—known broadly as the microarchitecture—may provide a much more robust assessment of skeletal health than DXA, particularly in this population of patients who frequently have changes in the area of the fusion which undermine the utility of DXA. 

“DXA provides a two-dimensional measure of bone density, or the amount of bone present, whereas HR-pQCT provides a true three-dimensional measurement of the bone density,” Dr. Stein said. “This provides additional information about the structural features of bone that can be leading to weakness or fragility.”

The study included 54 men and women scheduled for spinal fusion at HSS between December 2017 and December 2019. Patients underwent conventional DXA scans, as well as HR-pQCT scans of the radius (forearm) and leg bone (tibia).

Of the 54 patients in the study, 14 experienced complications within the first six months of surgery, including broken rods, loosened bone screws, fractures and abnormal bending of the spine. Although the number of people in the study was small, the researchers found that those with abnormalities on HR-pQCT were significantly more likely to experience complications than those without such defects -- abnormalities that were not evident on DXA imaging. These abnormalities involved lower bone mineral density in the trabeculae (the spongy tissue in the center of bones), fewer and thinner trabeculae, as well as thinner cortices.

“We used HR-pQCT to show for the first time that abnormalities in the microscopic structure of bone are directly related to the development of complications after fusion. Our study identified several abnormalities in patients who had complications,” Dr. Stein said.

For the moment, HR-pQCT is a research tool that’s not widely available to surgeons. “I think that it does provide a lot of additional information that we’re not getting from DXA. On DXA, the spine is almost always going to look fine, which can be misleading,” noted Dr. Stein. 

Dr. Stein’s group is expanding their study to include more patients. “Spinal fusion surgeries are so invasive, the potential for complications is high,” she explained. “We want to have the most optimal strategies for lowering complications in our patients, and that begins with understanding who is at risk and why. In our future work with additional patients, we hope to be able to define which features, or group of features of the bone structure is most important in contributing to surgical success. This will help us to devise the most targeted treatment strategies for our patients.”

Dr. Stein's team published their findings in the journal Bone, and made available online first on November 4, 2020.

HSS is the world’s largest academic medical center specialized in musculoskeletal health, spanning orthopedics, rheumatology and related disciplines. The HSS Research Institute maintains 20 laboratories dedicated to solving debilitating orthopedic and rheumatic conditions such as arthritis, bone and soft tissue injuries, autoimmune diseases, and musculoskeletal pain and deformities. There, more than 300 dedicated personnel focus on tissue repair, improving surgical outcomes, autoimmunity and inflammation, genomics, new treatments, and precision medicine.

“HSS has a long history of contributing to the collective base of clinical and basic science knowledge and finding healthcare solutions for complex conditions,” said Louis A. Shapiro, President and CEO, HSS. “We’re proud that through the joint efforts of our institution and philanthropic support, we will have the ability to make a strong impact on this growing and vital area of research.”

“As experts in inflammatory disorders and in the development of interventions for overactive immune responses, the clinicians and researchers at HSS are well-positioned to investigate many of the adverse effects of COVID-19,” says Lionel B. Ivashkiv, MD, Chief Scientific Officer at the HSS Research Institute. “This includes studying the causes of these adverse effects as well as how to prevent and treat them.”What follows are descriptions of the first group of funded projects in basic/translational research:

Activation of pDCs by SARS-CoV-2 and Its Impact on Macrophage Response

Principal Investigator: Franck Barrat, PhD

Co-Investigator: Marie-Dominique Ah Kioon, PhD

This project will study cell types that are responsible for cytokine storm syndrome — the hyperactive immune response seen in people with COVID-19 — by looking at how certain immune cells are activated by SARS-CoV-2. Research in mice infected with SARS-CoV, a coronavirus similar to the one that causes COVID-19, has suggested that plasmacytoid dendritic cell precursors (pDCs) are key to the immune response to infection. These pDCs activate macrophages, which in turn secrete cytokines. In the SARS-CoV research, depletion of pDCs appeared to protect the mice from lethal lung injury. Using blood samples from donors, the investigators will study the pathway by which pDCs activate macrophages and look at ways to therapeutically block that process.

Inhibiting RNA Polymerase II Transcription Complexes in Macrophages to Target COVID-19–Associated Cytokine Storm

Principal Investigator: Inez Rogatsky, PhD

Co-Investigators: Steven Josefowicz, PhD, and Robert P. Fisher, MD, PhD

This pilot project will dissect the role of macrophages in SARS-CoV-2-induced acute respiratory distress syndrome (ARDS), the main driver of COVID-19-associated mortality. We will test small-molecule inhibitors of RNA Polymerase II (Pol II) transcription complexes for their ability to modulate type I interferon and inflammatory pathways in monocytes/macrophages. This research will be done using cultured macrophages as well as donor blood and blood from COVID-19 patients.

Mechanisms of Cytokine Storm in Patients with COVID-19

Principal Investigator: Mary K. Crow, MD

Co-Investigators: Mikhail Olferiev, MD, and Lionel B. Ivashkiv, MD

The objectives of this study are to describe the process of the cytokine storm in people with COVID-19 and to identify biologic predictors of a favorable outcome in patients with severe cases of the disease. The project aims to characterize immune cell populations seen in COVID-19 patients who experience cytokine storm and compare them to those patients who do not, to compare the immune response before and after patients are given the anti-inflammatory drug anakinra, and to identify measures that suggest patients are more likely to decline and eventually require mechanical ventilation. The research will employ blood samples from HSS patients who are being treated for COVID-19 at New York–Presbyterian Hospital and who meet certain other qualifications.

What follows are descriptions of the first group of funded projects in the areas of clinical and health outcomes research:

Response to and Recovery from TKA in Patients with Antibodies to SARS-CoV-2

Principal Investigator: Miguel Otero, PhD

Co-Investigators: Meghan Kirksey, MD, PhD, and Peter K. Sculco, MD

It is unknown if people who have been exposed to COVID-19 may be at higher risk of experiencing an abnormal immune response following surgery, resulting in poor outcomes. This study will evaluate the response to and recovery from total knee arthroplasty (TKA) in people who have antibodies to COVID-19 — a marker of exposure. This study will include both patients who have COVID-19 antibodies and those who don’t, to act as controls. Patients will be followed for six weeks after surgery and evaluated for the presence of certain immune markers in the blood, as well as symptoms of inflammation including pain and stiffness in the joint.

SARS-CoV-2 Exposure and the Role of Vitamin D Among Hospital Employees

Principal Investigator: Emily M. Stein, MD, MS

Co-Investigators: Theresa T. Lu, MD, PhD; Andy O. Miller, MD; Jeri Nieves, PhD; and Alana Serota, MD

It is unknown if people with vitamin D deficiency may be more likely to become infected with COVID-19. This study will investigate vitamin D status and associated immune markers as risk factors for COVID-19 infection in a cohort of healthcare workers. Healthcare workers are at higher risk of contracting COVID-19 than the general population, making them a good group to study. Vitamin D is critical for immune function and is known to be protective against respiratory-tract infection and tuberculosis. This prospective, observational study will follow healthcare workers at HSS and at other healthcare facilities for one year, to determine whether levels of vitamin D and certain immune cells in the blood make someone more susceptible to COVID-19 infection.

Association of Immunomodulatory Medication Use and Social Determinants of Health with COVID-19 Infection in Systemic Rheumatic Disease Patients in New York City

Principal Investigator: Medha Barbhaiya, MD, MPH

Co-Investigators from HSS: Lisa Mandl, MD, MPH; Catherine MacLean, MD, PhD; Vinicius Antao, MD, PhD; Jane Salmon, MD; and Mayu Sasaki, MPH

Other Co-Investigators: Candace Feldman, MD, MPH (of Brigham and Women’s Hospital); Debra D’Angelo, MS (of Weill Cornell Medicine)

Using data from the INSIGHT Clinical Research Network, a central repository containing longitudinal electronic health data for residents of New York City, investigators will assemble a cohort of patients being treated with immunomodulatory medications for rheumatic disease. This patient population will then be used to study the effect of these medications on COVID-19 incidence and outcomes. Retrospective data will be used to evaluate the incidence and severity of COVID-19 in these patients. Patients will also be studied prospectively to determine whether there’s a relationship between COVID-19 infection and future rheumatic disease as well as to study connections between infection and future psycho-social issues.

Assessment of Surgical Outcomes in the COVID-19 Pandemic Era

Principal Investigator: Andy O. Miller, MD

Co-Investigators: Scott A. Rodeo, MD, and Mark Fontana, PhD

Investigators will implement a patient registry to evaluate how COVID-19 affects outcomes and complication rates after orthopedic surgery. This registry, along with COVID-19 screening procedures, will provide the tools to address specific research questions. Among these questions are determining the incidence of current and prior infection among the HSS surgical population, the clinical features associated with current and prior infections in this patient population, and whether COVID-19 status affects short-term complication rates.

What follows is a description of an integrated multidisciplinary study being undertaken jointly by the Adult Reconstruction and Joint Replacement (ARJR) Perioperative Research Group, Anesthesiology and Rheumatology:

Prediction and Prevention of Postoperative Blood Clots in COVID-19 Patients

Principal Investigators: Friedrich Boettner, MD; Kethy M. Jules-Elysee, MD; Lisa A. Mandl, MD, MPH

Co-Investigators: ARJR surgeons: Alejandro Gonzalez Della Valle, MD; Jason Blevins, MD; David J. Mayman, MD; Peter K. Sculco, MD; Geoffrey H. Westrich, MD and Thomas P. Sculco, MD

Medicine/Rheumatology: Medha Barbhaiya, MD, MPH; Doruk Erkan, MD, MPH; Deanna Jannat-Khah, DrPH

Pathology: Thomas W. Bauer, MD, PhD

Anesthesiology: Stavros G. Memtsoudis, MD, PhD, MBA; Alexandra Sideris, PhD

ARJR: Amethia Joseph, MHA; Ethan Krell, MS

Weill Cornell Medicine: Raymond David Pastore, MD

Recent literature suggests that one of the major complications seen in people with COVID-19 is thrombosis (the formation of blood clots) due to endothelial dysfunction, persistent inflammation and potentially antiphospholipid antibodies. As elective surgeries resume, those with prior exposure to SARS-CoV-2 will inevitably present for treatment, and some may have perioperative management considerations related to their risk of deep-vein thrombosis. This project will use, a noninvasive device that can determine clotting risks, to investigate whether people who have had COVID-19 have a more dysfunctional endothelium preoperatively and at 24 hours after surgery. The investigators will measure antiphospholipid antibodies and inflammatory markers, and evaluate the prevalence of asymptomatic post-operative deep-vein thrombosis in people who undergo TKR and have SARS-CoV-2 antibodies.

COVID-19 Translational Research Core at HSS

Principal Investigator: Theresa Lu, MD, PhD

Co-Investigators: Jessica Andrés-Bergós, PhD; Miguel Otero, PhD and Emily M. Stein, MD, MS

The COVID-19 Translational Research Core (TRC) was designed to fill critical gaps in the resources needed to promote the broad range of COVID-19–related clinical and translational research at HSS. The TRC will provide consultation on the design and implementation of COVID-19 research in the areas of orthopedics, rheumatology and metabolic bone disease; support for a COVID-19 biobank; and technical expertise and facilities required for clinical and translational researchers working on COVID-19–related projects. The TRC staff will help to acquire, house, and track biospecimens from investigator-initiated COVID-19–related research studies.

“The HERO-HCQ trial is more than an important opportunity to evaluate the effectiveness of hydroxychloroquine as a preventative measure against COVID-19. We also hope to learn a lot more about the disease and how it affects healthcare workers and their families,” said Andy O. Miller, MD, an infectious disease specialist at HSS who is part of the leadership team responding to the COVID-19 pandemic and spearheading the trial. “We’re calling on HSS healthcare workers to share their perspectives so that we can understand and provide answers to the problems they face in real time — and over time.”

Hydroxychloroquine (Plaquenil®) is an oral prescription medication approved by the US Food & Drug Administration for the treatment of malaria and autoimmune diseases such as lupus and arthritis. “There is a lot of interest in testing this drug as a preventative agent for COVID-19 because it appeared to block SARS-CoV-2 from entering cells in lab studies,” explained Emily Margaret Stein, MD, MS, an internal medicine specialist and clinical researcher at HSS who is collaborating with Dr. Miller on the HERO-HCQ trial. “But like all medications, there are potential risks as well as benefits. Before we make recommendations on who should or should not be taking hydroxychloroquine, we need solid evidence.”

Researchers at the Duke University Clinical Research Institute designed and are leading the nationwide HERO-HCQ trial. The Patient-Centered Outcomes Research Institute is providing up to $50 million in funding. As partners of the INSIGHT Clinical Research Network, the PCORnet affiliate organization in New York City, HSS, along with New-York Presbyterian/Weill Cornell Medical Center, Columbia University Medical Center and Mount Sinai Hospital are collaborating on the trial since they are caring for large numbers of patients with COVID-19. “HSS has long been working with PCORnet to answer big healthcare questions,” said Dr. Stein. “COVID-19 is the challenge we are facing today.”

All healthcare workers who provide care, supplies or services to patients at HSS —including doctors, nurses, registrars, housekeepers, food delivery staff and janitors — can register to see if they are eligible to participate in the study. People with existing conditions, such as renal disease or heart conditions that put them at risk for known adverse effects associated with the drug, will not be eligible to participate.

Dr. Miller and Dr. Stein hope to recruit at least 350 study volunteers at HSS. As a double-blind, randomized, placebo-controlled study, participants will take either hydroxychloroquine or a placebo tablet once daily for 30 days. Clinical assessments will involve nasopharyngeal swab tests for COVID-19 and blood tests to detect the presence of antibodies at the beginning of the study and after four weeks. Researchers will also collect information about participants’ health and ask them to fill out quality-of-life surveys.

The target completion date for the HERO-HCQ trial is July 2020. Different from typical studies that take months to collect and analyze data, researchers will analyze data from the study every two weeks. “As soon as there is clear evidence of an effect, either way, the lead investigators will stop the trial and make a recommendation,” said Dr. Stein. “If the evidence shows the drug provides no benefit in preventing COVID-19, that will still be a useful result — we will save time and resources and look for other ways to help healthcare workers. If there is clear evidence of a benefit, they will recommend using the drug as preventative therapy.”

“It’s difficult to think that by doing our daily jobs, we could get sick, and we could also infect our loved ones at home,” said Dr. Miller. “This is the time to be proactive, to develop ways to stay safe on the front lines. I encourage all HSS healthcare workers to be a part of HERO-HCQ—and to be part of the solution.”

Learn more about the HERO Registry here.