10/8/2019
Research Spotlight: Ana Emiliano, MD

Ana Emiliano, MD lights up when she discusses her favorite part of the brain, the hypothalamus.

“I decided I wanted to become an endocrinologist because I love the hypothalamus,” she said. “It is this tiny little part of the brain that is full of mysteries and is responsible for a lot of our behaviors in response to homeostatic needs.”

At the Naomi Berrie Diabetes Center, Dr. Emiliano runs a small (yet very busy) lab on the 6th floor where her clinical knowledge and scientific curiosity intersect. Using mouse models, she studies, among other things, a common phenomenon that occurs after bariatric surgery—that patients experience near loss of appetite, and even aversion to highly caloric foods, but that outcome can be short-lived. Some patients can become severely obese again, sometimes only a few years after the weight loss surgery. Understanding the mechanisms involved has the potential, in the future, to help these patients.

To find out why some bariatric surgery patients lose their appetite, “we harvested the hypothalamus of mice after the surgery looking for populations of neurons that would underlie this phenomenon,” said Dr. Emiliano who was born in Rio, Brazil, and recently joined the Berrie Center from Rockefeller University. “What has been activated by the surgery that makes the mice uninterested in food?”

Thus far, her team identified two cell types in the hypothalamus that are involved in food intake regulation. Another series of experiments are underway to determine another mechanism through which the surgery seems to be inducing appetite inhibition.

In addition to studying how bariatric surgery may work through the brain to decrease appetite, her lab also studies how bariatric surgery interferes with the peripheral nervous system, leading to weight loss and glycemic improvement.

“This project focuses primarily on parts of the peripheral nervous system that work like a mini brain in the center of our gut,” said Dr. Emiliano. “There are thousands of neurons in the gut and we believe if we can modulate their function, we can come up with metabolic benefits similar or greater than bariatric surgery.”

Dr. Emiliano’s goal is to develop therapies that can help people lose weight and have better glucose regulation “without requiring your GI tract to be completely rerouted,” she said.

How can someone experience the same benefits of bariatric surgery-related weight loss and glycemic improvement without going through surgery, which is both extremely expensive and inaccessible to most patients that need it? This question drives Dr. Emiliano.

“I felt really propelled to look into the mechanisms of why these surgeries help people lose weight and lead to type 2 diabetes remission,” she said, “and I felt really responsible for helping understand whether these surgeries have a lasting effect on metabolism or whether some of the benefits are reversible over time.”

While Dr. Emiliano is eager to find the answers to her questions, she admits that the pace of research is slow. At this point relatively very little is known about why exactly bariatric surgery works. “Even if I will never see the clinical ramifications of the research I do, I feel compelled to keep going. Fifty years later it might help in some way.”

In addition to conducting research, Dr. Emiliano sees patients with type 1 and type 2 diabetes at the Berrie Center. This ability to be a physician scientist really drew Dr. Emiliano to Columbia University Irving Medical Center. At Columbia, she said, “you provide care, but you are also working on the research that will actually change medical care. The science that we do here is very connected with our clinical questions too and also with a commitment to help patients down the line.”

Dr. Emiliano’s wealth of knowledge has made her a welcome addition to the team. “Dr. Emiliano's work in animals fits well into ongoing clinical investigations of the physiological consequences of bariatric surgery on glucose homeostasis and body weight regulations,” said Dr. Rudy Leibel, Berrie Center Co-Director and the Christopher J. Murphy Memorial Professor of Diabetes Research. “The Berrie Center is an ideal environment for these studies.”

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