El Dr. Pablo Alonso Coello, director de l’Àrea d’Epidemiologia, Salut Pública i Atenció Primària de l’Institut de Recerca de l’Hospital Santa Creu i Sant Pau – IIB Sant Pau i investigador del Centre Cochrane Iberoamericà figura novament a la llista dels científics més citats del món que publica Clarivate Analytics.

Aquesta llista reconeix investigadors de tall mundial seleccionats pel seu treball excepcional en investigació, demostrat per la producció de diversos articles altament citats que es classifiquen al top 1% de citacions per camp i any a la Web of Science.

El Dr. Alonso ja ha aparegut en altres ocasions entre els investigadors més citats del món al seu camp. Aquest any apareix també a la classificació de la Universitat de Stanford (Estats Units) que publica una llista amb el 2% dels científics més citats del món.

Next January 31 at 7 p.m., Dr. Javier Briones, director of the Cell Immunotherapy and Gene Therapy Research Group at the Research Institute of the Hospital de la Santa Creu i Sant Pau – IIB Sant Pau and head of the Clinical Hematology Unit of the Service d ‘Hematology of the same hospital, participates in the CaixaResearch Debate “What are CAR-T therapies against cancer?” to explain the latest developments in this area. The debate will be moderated by Beatriz Pérez, journalist at El Periódico de Catalunya, and will be streamed and you can sign up here.

The group of Dr. Briones led the creation of the first CAR-T in Europe for patients with classic Hodgkin’s lymphoma and non-Hodgkin’s lymphoma, a disease that affects 3 out of every 100,000 people according to data from the Spanish Society of Medical Oncology. In fact, Sant Pau is one of the only two authorized centers in Catalonia to produce these types of medicines.

It has also recently successfully presented the results of the first CAR-T30 clinical trial in Europe, of its own production, for the treatment of this type of cancer in relapse or refractory. The objective of this Phase I study, in which 10 patients refractory to all approved conventional treatments from various spanish communities and other european countries have participated, has been safety and establishing the optimal dose for Phase II of the essay. The results obtained show that all patients have shown a favorable response to the treatment, while 50% have had a complete response with the disappearance of the lymphoma, so that HSP-CAR30 has an excellent safety profile at the doses administered

In the CaixaResearch Debate “What are CAR-T therapies against cancer?”, together with Dr. Briones, Dr. will also participate Dr. Manuel Juan, head of the Immunology Service at the Biomedical Diagnostic Center (CDB) of the Hospital Clínic-IDIBAPS, who has developed the first CAR-T in Europe for the treatment of multiple myeloma, which accounts for 10% of cancers bone marrow and is the second most common blood cancer.

In the CaixaResearch Debates cycle, the medical and scientific experts who receive grants from the “la Caixa” Foundation, through the Research Program, explain first-hand the latest developments in their field. These debates are a meeting point between society and research results, new medical practices and current challenges in health and quality of life.

Recent studies demonstrate that bilingualism can delay the onset of dementia by an average of 4-5 years. Miguel Ángel Santos, researcher at the Neurobiology of Dementia group at IIB Sant Pau and member of the Memory Unit at Hospital Sant Pau, together with Stephanie Grasso, group leader at University of Texas, Austin, have been awarded with an R01 grant (clinical trial) from the NIH’s National Institute on Aging (NIA). This grant will allow them to establish associations between bilingualism factors and the onset, decline, and treatment response of Hispanic bilinguals (Castilian Spanish – Catalan) with primary progressive aphasia.

Outcomes will also provide crucial knowledge regarding neural mechanisms of language re-learning and will address how the bilingual experience influences cognitive reserve and linguistic resilience in language-prominent dementia.

Total amount of this grant is $3.4 million and the Hospital Sant Pau Research Institute – IIB Sant Pau will receive $1 million over the next five years.

A study carried out by researchers from the Neuromuscular Diseases laboratory of the Research Institute of the Hospital de la Santa Creu i Sant Pau – IIB Sant-Pau and the Memory Unit of the Neurology Service of the same hospital, which is directed by Dr. Alberto LLeó, has concluded that patients with amyotrophic lateral sclerosis (ALS) have abnormally high levels of NOD2 and Spp1 proteins, so these molecules are postulated as new biomarkers in the pathophysiology of this neurodegenerative disease.

The work, published by the journal Neurology Neuroimmunology and Neuroinflammation, provides data that contributes to a better understanding of the biological basis of this disease, according to Dr. Ricardo Rojas-García, researcher in the Neuromuscular Diseases group at IIB Sant Pau and one of the main authors of the study.

ALS is a neurodegenerative disease that affects nerve cells in the brain and spinal cord, causing rapidly progressive muscle weakness. Although its symptoms are well known and its clinical diagnosis is relatively simple, its origin is still a mystery and its pathophysiology is still poorly understood. So far, no specific biomarkers are known for molecular diagnosis or to predict the prognosis.

In virtually all patients with ALS, it can be seen that there is an anomalous deposit of proteins in the motor neurons of the cerebral cortex, motor nuclei of the brainstem and anterior horns of the spinal cord, that is to say, they are delocalized and deposited in inclusions in the cytoplasm of these neurons.

“Through neuropathological studies, what we see is that there is an abnormal deposit of proteins. In other words, some proteins that are normally physiologically found in the nucleus are deposited in the cytoplasm”, explains Dr. Rojas-Garcia.

NOD2 and Spp1 proteins are involved in the specific pathophysiological pathway of innate immunity and protein homeostasis, “which makes a lot of sense and leads us to think that they probably play a role in the mechanism by which proteins are deposited in the brain of patients with ALS”, explains the researcher.

One more step to know the pathophysiology of the disease.

The main objective of this study, which has been carried out in collaboration with the Navarra Research Institute (IdisNA), within the framework of the Center for Biomedical Research in the Rare Diseases Network (CIBERER) and the Center of Biomedical Research in the Network of Neurodegenerative Diseases (CIBERNED), was to try to find both diagnostic and prognostic biomarkers for ALS.

The researchers analyzed data from a cohort of 123 ALS patients, 30 Alzheimer’s disease patients, 28 frontotemporal dementia patients and 102 age-matched healthy controls. The results showed that NOD2 protein levels were significantly higher in ALS patients compared to participants diagnosed with Alzheimer’s, frontotemporal dementia and the control group. This is the first time that NOD2 has been associated with the pathophysiology of ALS.

In addition, the study found that Spp1 levels were elevated in ALS patients compared to healthy participants. However, no significant differences were found in the levels of this protein between patients with ALS and patients with Alzheimer’s or frontotemporal dementia.

“Our data support an important role of the neuroinflammation process in the pathophysiology of ALS and may be useful to help identify new targets for research and development of treatments that can modulate these pathways for these patients” , concludes Dr. Rojas-Garcia.

Reference article

Noemí de Luna, Álvaro Carbayo, Oriol Dols-Icardo, Janina Turon-Sans, David Reyes-Leiva, Ignacio Illan-Gala, Ivonne Jericó, Inma Pagola-Lorz, Cinta Lleixà, Luis Querol, Sara Rubio-Guerra, Daniel Alcolea, Juan Fortea, Alberto Lleó, Elena Cortés-Vicente, Ricardo Rojas-Garcia. Neuroinflammation-Related Proteins NOD2 and Spp1 Are Abnormally Upregulated in Amyotrophic Lateral Sclerosis. Neurol Neuroimmunol Neuroinflamm Mar 2023, 10 (2) e200072; DOI: 10.1212/NXI.0000000000200072

Twenty per cent of the Spanish population suffers from chronic pain, and between 7 and 10% from neuropathic pain. This condition, mostly caused by nerve damage, causes people to feel intense and constant pain. Treatments are scarce and often involve a large number of adverse effects that affect the patients’ quality of life. For this reason, the Molecular Neuropharmacology research group, coordinated by Olga Pol at the Sant Pau Biomedical Research Institute and the UAB Institute of Neurosciences, is looking for new therapeutic possibilities that can help people who suffer from it.

Now in a study published in the journal Antioxidants, they have analyzed the effects of administering to mice models of neuropathic pain water enriched with hydrogen molecules, a treatment that had already shown positive effects in neurological disorders, such as Alzheimer’s disease and depression. The results point to this strategy as a very promising candidate for the treatment of neuropathic pain and associated emotional disorders, due to its analgesic and anti-inflammatory effects, as well as its anxiolytic and antidepressant properties.

“This treatment can alleviate not only the pain caused by a nerve injury, but also the states of anxiety and depression that accompany it, which would substantially improve the patients’ quality of life. This is important because it can allow a more effective and global treatment of neuropathic pain with fewer side effects”, explains Olga Pol.

In the study, the treatment was administered to mice by injection, but in the future other routes will be tested, such as oral administration. The next steps will be to investigate how the treatment works in animal models of pain associated with chemotherapy, because many times cancer patients present neuropathic pain as a side effect of the treatment, as well as evaluating its effects on the memory and emotional deficits that these same patients can also suffer.

Article de referència

Maria Martínez-Serrat, Ignacio Martínez-Martel, Santiago Coral-Pérez, Xue Bai, Gerard Batallé and Olga Pol, Hydrogen-Rich Water as a Novel Therapeutic Strategy for the Affective Disorders Linked with Chronic Neuropathic Pain in Mice, Antioxidants 2022, 11, 1826. https://doi.org/10.3390/antiox11091826 

The Innovation team of the Research Institute of the Hospital de la Santa Creu i Sant Pau – IIB Sant Pau has presented two innovative projects created entirely by professionals from Sant Pau at The Collider’s OnCampus.

The Collider is Mobile World Capital’s innovation program that enables deep tech transfer between science, the market and society to promote the development of technology startups.

The projects that the IIB Sant Pau has presented are:

1) A medical device for the enhancement of bronchoscopy procedures. Principal Investigators: Marta Navarro Colom and Laura Moreno Gómez.

2) A digital health platform to improve the ongoing care of endometriosis patients and provide them with a tool to improve the management of their disease. Principal Investigator: Dr. Josep Estadella.

Professionals from both the hospital care area and the Nursing Innovation team, the hospital’s 3D Manufacturing unit, the Digital Health unit and the Technology Transfer and Innovation unit of the Research Institute (IR) have participated in the projects. Sant Pau.

From the IR Innovation department they explain that the OnCampus program “represents a great opportunity both to move forward with the projects, and to validate the value propositions by establishing a relationship with the main stakeholders of the ecosystem and developing technology transfer strategies.”

An international study in which researchers from the Research Institute of the Hospital de la Santa Creu i Sant Pau – IIB Sant Pau and the Universitat Autònoma de Barcelona (UAB) have participated has identified the mechanism by which patients with Fanconi anemia develop head and neck tumors and have been able to verify that it is the same mechanism that explains why smoking and drinking increase the risk of this type of cancer in the general population.

The results, published by the prestigious journal Nature, show that the deficiency in the cells’ natural process to repair the damage produced by chemicals that damage DNA, called aldehydes, is responsible for the risk of developing carcinoma of head and neck squamous cells.

Dr. Jordi Surrallés, head of DNA Repair Syndromes and Predisposition to Cancer research group and director of the Research Institute of the Hospital Santa Creu i Sant Pau – IIB Sant Pau and the Research Unit in Genomic Medicine Sant Pau- UAB and CIBERER researcher, is the only Spanish author of the study. He says that “these results help us understand the mechanisms involved in the origin of this type of tumor and allow us to look for new strategies aimed at trying to counteract this risk not only in patients with Fanconi anemia, but also in the population general where the combination of tobacco and alcohol also greatly increases the risk of suffering from these tumors”.

Aldehydes and DNA repair

Human cells are exposed to different aggressions from the environment that can cause DNA damage, so they need constant repair. In any cell at any given time, molecular processes are taking place to seal cracks in the double helix or correct the genetic code to maintain the proper functioning of the organism.

People born with Fanconi anemia -a rare disease characterized by genomic instability and a deficiency in DNA repair, resulting in chromosomal fragility- lack one of these repair systems functioning, which it makes its cells unable to eliminate the injuries created by different environmental factors.

These people may suffer from numerous medical problems throughout their lives, such as bone marrow failure, congenital malformations, and also a very high risk of developing head and neck tumors. “It is a type of cancer that is usually diagnosed at the age of 60-70 and in people with Fanconi anemia it can appear around the age of 20-30 and with an incidence that can be 700 times higher than in the general population”, explains Dr. Surrallés.

In this study, led by Dra. Agata Smogorzewska at the Rockefeller University in New York (United States), researchers have analyzed the genetic signatures of tumors from half a hundred patients with Fanconi anemia and have compared them with data from hundreds of sporadic tumors. They have thus been able to verify that the mutational signature is very similar in both types of tumors. Specifically, they have identified that cells cannot repair the damage caused by aldehydes in DNA, causing the mutations that will eventually cause cancer to accumulate.

A link with smoking and alcohol

One of the most important aspects that emerge from the results of this study is that drinking and smoking, which subject the body to aldehydes, promote the appearance of tumors by mechanisms similar to those involved in Fanconi anemia. “When the body is exposed to a greater amount of damage than the cells can repair, a process similar to that seen in people with Fanconi anemia occurs, and that’s when these tumors appear”, says Dr. Surrallés.

In other hand, Dra. Smogorzewska says these findings could also explain why head and neck tumors in patients with Fanconi anemia tend to be particularly deadly, with an average survival of just 17 months after diagnosis. “You have complete genomic havoc, simultaneously disrupting many different systems that normally prevent our cells from developing into cancer, and we think that’s one of the reasons for the aggressiveness of these tumors.”

With these results, new future challenges are raised, such as finding drugs that affect the repair mechanism of the damage caused by aldehydes, or manipulating the process to try not to accumulate this harmful substance in the body to try delay or prevent the appearance of these tumors both in patients with Fanconi anemia and in the general population. Dr. Surrallés explains that “we are already working in this direction by participating in two clinical trials”.

Reference article

Webster, A.L.H., Sanders, M.A., Patel, K. et al. Genomic signature of Fanconi anaemia DNA repair pathway deficiency in cancer. Nature (2022). https://doi.org/10.1038/s41586-022-05253-4

Exheus, a genetics and data science company specializing in RNA analysis, spin-off of the Research Institute of the Hospital de la Santa Creu i Sant Pau – IIB Sant Pau, the Universitat Politècnica de Catalunya – BarcelonaTech (UPC), Summit SL and Mobile World Capital Barcelona’s innovation program, The Collider, received a private capital injection of 650,000 euros.

In parallel, in addition to these fundings, which add up to a total of 900,000 euros, Exheus has also received another grant of 50,000 euros from EIT Health, the largest European body for health innovation, whose mission is to accelerate entrepreneurship and innovation, providing new opportunities and resources for the benefit of all citizens.

The injection of all this capital will be used to consolidate the following axes: start the international expansion of the business in European markets; create a commercial structure that allows access to the health system of these countries; and work on regularizing the legal requirements necessary for the company to operate internationally. Likewise, it plans to digitize the product following a B2B approach so that, with the development of a digital, automated and interactive platform, doctors and practitioners can directly access the patient’s results and, with this, give an assessment of the test of RNA.

“The effort invested these two years has helped us to obtain the most advanced health report in the world. This increase in capital will allow us to continue building the future of Exheus and promote the consolidation of personalized medicine, both in Spain and in other European markets, always focusing on improving the lives of patients”, says Teresa Tarragó, CEO of Exeus

A unique RNA test in the world

Exheus was born as a spin-off of the Complex Diseases Genomics Research Group of the Sant Pau Hospital Research Institute – IIB Sant Pau, the Biomedical Engineering Research Center (CREB) of the Universitat Politècnica de Catalunya – BarcelonaTech (UPC), Summit SL and Mobile World Capital Barcelona’s innovation program, The Collider, which makes technological transfer between science, the market and society possible.

The company analyzes the expression of all the genes in the human body present in the blood transcriptome to detect and correct abnormalities that affect the individual’s health. Today, Exheus is positioned as the most sophisticated commercial RNA analysis technology in the world.

Thanks to this analysis, the expression levels of all the genes in the genome are monitored, making it possible for the health professional to offer personalized recommendations and optimize the intervention for their patients in a personalized way.

Patients with diabetes and previous macrovascular complications (coronary artery disease, cerebrovascular disease, or peripheral arterial disease) admitted for COVID-19 to a hospital have a worse prognosis and twice the mortality compared to the general population. This is described by an international study in which European research groups from France, the United Kingdom and Spain participate, led by the Diabetes and Associated Metabolic Diseases area of CIBER (CIBERDEM), the Research Group on Endocrinology, Diabetes and Nutrition of the Research Institute of the Hospital de la Santa Creu i Sant Pau – IIB Sant Pau, and the Endocrinology Service of the Hospital del Mar and which publishes the journal Cardiovascular Diabetology.

Diabetes, a risk factor

The COVID-19 pandemic has had a negative impact on people with diabetes. It is considered that diabetes poses a greater risk of presenting more serious forms of infection by the SARS-CoV2 virus, being associated with a higher rate of complications and mortality. However, the impact of having chronic complications associated with diabetes on the prognosis of COVID-19 was unknown to date.

Toward this end, this multicenter retrospective study collected cases from several cohorts and analyzed data from a total of 4,106 adults with preexisting diabetes hospitalized for COVID-19 infection in the United Kingdom, France, and Spain during the early phase of the pandemic. (between March 2020 and October 2020). Of these patients, a total of 1,652 (40.2%) had some previous macrovascular disease, with a death rate of 28.5%.

“This work is the first to demonstrate that the presence of macrovascular complications in patients with diabetes who are admitted for COVID-19 implies a worse prognosis and double the risk of mortality”, explains Dídac Mauricio, head of the CIBERDEM group at the IIB Sant Pau and coordinator of the study. “A subsequent analysis revealed that ischemic heart disease and cerebrovascular disease were the main contributors to these adverse results”, adds Gemma Llauradó, also a researcher in the study, assistant to the Endocrinology and Nutrition Service at the Hospital del Mar, researcher at IMIM-Hospital del Mar and CIBERDEM.

Along with these findings, the work has also shown that these patients had a lower proportion of ICU admissions and need for mechanical ventilation, possibly associated with selective admission criteria at this stage of the pandemic.

“Our findings in this research highlight the importance of correctly assessing the prognosis of these patients, as well as performing intensive follow-up in this high-risk subgroup. In addition, these results highlight the need to design specific public health programs aimed at preventing SARS-CoV2 infection in this population, which include for example, among other measures, strengthening vaccination campaigns”, the researchers conclude.

This research has been led by the head of the CIBERDEM group, Dídac Mauricio (Hospital de la Santa Creu i Sant Pau), in close collaboration with researcher Gemma Llauradó (Hospital del Mar), belonging to the CIBERDEM group led by Joan Vendrell. The publication of this work is the result of the collaboration between researchers from 3 European countries, England (Association of British Clinical Diabetologist – ABCD Diabetes), France (CORONAvirus SARS-CoV2 & Diabetes Outcomes -CORONADO- Study) and Spain (Hospital del Mar, Hospital de la Santa Creu i Sant Pau and HM Hospitals).

Reference article

Llauradó G, Vlacho B, Wargny M, Ruan Y, Franch-Nadal J, Domingo P, Gourdy P, Saulnier PJ, Hadjadj S, Wild SH, Rea R, Cariou B, Khunti K, Mauricio D; CORONADO, the ABCD COVID-19 diabetes national audit, HM Hospitales investigators and the Hospital del Mar – Hospital de la Santa Creu i Sant Pau Diabetes Research Group. The association between macrovascular complications and intensive care admission, invasive mechanical ventilation, and mortality in people with diabetes hospitalized for coronavirus disease-2019 (COVID-19). Cardiovasc Diabetol. 2022 Oct 19;21(1):216. doi: 10.1186/s12933-022-01657-8.

An international study in which researchers from the Dementia Neurobiology Group and the Memory Unit of the Research Institute of the Hospital de la Santa Creu i Sant Pau – IIB Sant Pau participated, leaded by Alberto Lleó, discovered two new genes associated with a significantly increased risk of developing Alzheimer’s disease.

The study, which has just been published in Nature Genetics, analyzes data from more than 32,000 complete genomes of Alzheimer’s disease patients and healthy controls. It’s the largest study of its kind in this pathology and that has been possible thanks to a collaborative effort by an international group led from the Amsterdam University Medical Centers, in the Netherlands; the Pasteur Institute in Lille and the University of Rouen Normandie, both in France, with the participation of the IIB Sant Pau as the only center in Spain.

The results of this work allow us to conclude that rare genetic variants in five genes: SORL1, ABCA7, TREM2, ATP8B4 and ABCA1, are associated with an increased risk of developing Alzheimer’s disease. “While this was already known for the first three genes, the finding that deleterious genetic alterations in ATP8B4 and ABCA1 can lead to Alzheimer’s disease had not been previously observed,” says Oriol Dols-Icardo, one of the authors of the study at IIB Sant Pau.

In addition, the researchers found that harmful mutations in a sixth gene, ADAM10, will most likely also lead to an increased risk of Alzheimer’s disease. However, the authors observed very few individuals with mutations in this gene, so this association will have to be confirmed by comparing an even larger population of Alzheimer’s disease patient genomes and healthy controls in order to classify ADAM10 as a “ Alzheimer’s gene”, explains Dols-Icardo.

Functions of these genes

All the genes identified in this study are involved in maintaining proper brain health, and deterioration of any of them is indicative of pathological processes associated with Alzheimer’s disease.

The previously discovered “Alzheimer’s genes”, which are SORL1, ABCA7 and TREM2, are involved in the processing of β-amyloid protein by neurons or in the brain’s immune system. Newly discovered genes go in this same direction. The ABCA1 gene maintains healthy cholesterol and phospholipid levels in brain cells and is associated with lower levels of amyloid aggregate protein, the accumulation of which in plaques is well known to be a hallmark of Alzheimer’s disease.

Like ABCA1, the (newly discovered) ATB8B4 gene is involved in phospholipid transport, primarily in immune cells in the brain. For its part, the ADAM10 gene plays a major role in the processing of the β-amyloid precursor protein, but in such a way that it prevents the formation of this protein. As explained by the IIB Sant Pau researcher, these identified genes, together, represent the molecular mechanisms that are most affected in Alzheimer’s patients, which helps to improve knowledge of the biological bases of the disease and puts on the table the possibility to investigate these genes as potential therapeutic targets.

It is estimated that between 60 and 80% of the risk of Alzheimer’s disease can be explained by genetic factors. In the case of early-onset disease (before age 65) this figure rises to more than 90%. Therefore, the single genome is postulated as a tool that could help to better stratify the risk of this disease in the future.

Reference article

Holstege, H., Hulsman, M., Charbonnier, C. et al. Exome sequencing identifies rare damaging variants in ATP8B4 and ABCA1 as risk factors for Alzheimer’s disease. Nat Genet (2022). https://doi.org/10.1038/s41588-022-01208-7 DOI: 10.1038/s41588-022-01208-7

The research group in Neurobiology of Dementias of the Research Institute of the Hospital de la Santa Creu i Sant Pau – IIB Sant Pau, leaded by Dr. Juan Fortea, designed a detailed protocol for the enrichment of extracellular vesicles derived from astrocytes to from human plasma that will help improve the study of these cells and explore their role in the development of different neurodegenerative diseases.

Astrocytes have very important functions in various neurological processes, so the study of the content of extracellular vesicles derived from these cells could be an interesting platform for the discovery of biomarkers and the exploration of brain inflammatory pathways in a non-invasive way.

The principal investigator of this study, Natalia Valle, explains that the protocol was validated after a detailed analysis of the methods for isolating extracellular vesicles and contextualizing it in the field of neurology, specifically, astrocytes.

Extracellular vesicles are nanoparticles that are naturally secreted by all cells in the body. They contain many cellular components, such as genetic material, proteins, and lipid metabolites that often reflect the contents of their cell of origin. These cells participate in a wide range of functions by acting and transferring their contents to other cells under physiological and pathological conditions.

Given their small size, these vesicles are capable of diffusing into all biological fluids such as plasma and cerebrospinal fluid, from where they can be selected based on the specific surface markers they express, accurately reflecting the specific tissue environment from which they originate. Therefore, they represent an excellent non-invasive diagnostic tool, and can be considered a liquid biopsy for biomarker discovery. This trait is of special interest in neurology.

Currently, one of the main limitations for the use of these vesicles in research is that there is a lack of standardization of methodological protocols for their isolation. The IIB Sant Pau researchers present this new detailed protocol that consists of a first isolation of total extracellular vesicles by means of polymer precipitation, followed by a second step of immunoprecipitation of these vesicles.

Reference article

Valle-Tamayo, N., Pérez-González, R., Chiva-Blanch, G., Belbin, O., Serrano-Requena, S., Sirisi, S., Cervantes González, A., Giró, O., Sánchez-Aced, É., Dols-Icardo, O., Alcolea, D., Carmona-Iragui, M., Jimenez, A., Lleó, A., Fortea, J., Iulita, M. F. Enrichment of Astrocyte-Derived Extracellular Vesicles from Human Plasma. J. Vis. Exp. (186), e64107, doi:10.3791/64107 (2022).

A team of 6th year Medicine students from the Sant Pau Teaching Unit – UAB: Berta Rifà, Inés Clavero, Irene Rexach and Júlia de Mas, with the support of Dra. Marilina Santero, researcher at the Hospital de la Santa Creu i Sant Pau Research Institute and the Ibero-American Cochrane Center, won the hackathon organized by Xartec Salut.

A hackathon is a meeting of programmers with the aim of collaborative software development. On this occasion, it was about proposing a solution to current health challenges in the areas of rare diseases, mental health and childhood cancer.

The proposal of the Sant Pau group was the Burtoola tool, based on evidence and which connects clinical information and PROMs (patient reported outcomes) with the aim of reducing the prevalence of burnout among university students. The students beat the other 14 multidisciplinary groups that submitted and received recognition as part of the HealthTech 2030 Summit. The awards consist of the opportunity to participate in mentorships with potential sponsors to develop the project towards a test phase of concept.

The levels of the α-klotho protein could have a useful role as a biomarker to help identify patients with type 1 diabetes who are at increased risk of developing arteriosclerosis and thus increased cardiovascular risk. This is suggested by a study published in the journal Cardiovascular Diabetology, led by CIBERDEM researchers from the Endocrinology, Diabetes and Nutrition Research Group of the Research Institute of the Hospital de la Santa Creu i Sant Pau – IIB Sant Pau, directed by Dr. Dídac Mauricio, head of the Endocrinology Service of the same hospital.

Patients with diabetes have a higher risk of developing arteriosclerosis, especially those who also have kidney problems. Previous studies had already detected that these patients had altered levels of α-klotho. This protein is one of the main molecules involved in mineral metabolism, but until now its circulating levels had been found to be reduced in early stages of renal dysfunction, which had been associated with an increased risk of developing cardiovascular diseases.

“In people with diabetes, atherosclerosis is more frequent compared to the non-diabetic population. For this reason, it is very important to anticipate the development of atherosclerotic plaques subclinically, that is, when they have not yet caused symptoms”, explains Josep Julve, one of the main authors of the study at the IIB Sant Pau.

In this study, the researchers analyzed the relationship between circulating levels of different determinants of mineral metabolism related to calcium/phosphorus metabolism in relation to the burden of subclinical carotid arteriosclerosis in patients with type 1 diabetes. The results show that the proteins FGF23 and α-klotho present alterations associated with the progression of chronic kidney disease.

In this new investigation, unlike previous studies, the relationship between α-klotho levels in patients with type 1 diabetes without chronic kidney disease was analyzed. The results demonstrate, for the first time, that serum levels of this protein are increased in diabetics with subclinical arteriosclerotic disease. Furthermore, circulating levels of α-klotho were also related to the number of subclinical arteriosclerotic plaques in people without diabetes, postulating it as an independent risk factor and thus a potential biomarker.

The researcher comments that “one of the most relevant aspects of this study is that the association between high levels of α-klotho and the development of atherosclerotic plaque was observed in the absence of impaired renal function or established diabetic nephropathy.”

From these results, new research questions are derived that will give rise to new studies, both clinical and translational, to confirm the importance of this protein as an early risk factor for subclinical arteriosclerosis in patients with type 1 diabetes.

CIBERDEM researchers from the Endocrinology and Nutrition Service of the Hospital Universitario Arnau de Vilanova – Institut d’Investigació Biomédica de Lleida (IRB Lleida) and the Washington University School of Medicine, in Saint Louis, Missouri (United States) also collaborated in the development of this study. ).

Reference Article

Castelblanco E, Hernández M, Alonso N, Ribes-Betriu A, Real J, Granado-Casas M, Rossell J, Rojo-López MI, Dusso AS, Julve J, Mauricio D. Association of α-klotho with subclinical carotid atherosclerosis in subjects with type 1 diabetes mellitus. Cardiovasc Diabetol. 2022 Oct 11;21(1):207. doi: 10.1186/s12933-022-01640-3. PMID: 36221075; PMCID: PMC9554979

The Research Institute of the Hospital de la Santa Creu i Sant Pau – IIB Sant Pau participated, together with twenty research centers in Catalonia, in the II Gender Summit of the Health Research Centers of Catalonia, which promotes work in favor of progress towards more responsible health research.

The conference, chaired by the Minister of Health, Manel Balcells, and the Minister of Research and Universities, Joaquim Nadal, has been organized by the Health Quality and Assessment Agency of Catalonia (AQuAS) and the General Sub-Directorate of Research and Innovation of the Department of Health, in coordination with the Department of Research and Universities and iCERCA, and with the collaboration of the “la Caixa” Foundation. The event was attended by Maria Rosa Ballester, head of Research and Innovation in charge of IR Sant Pau and member of the organizing committee of this summit, and the director of IR Sant Pau, Dr. Jordi Surrallés.

The success of the second edition of the Summit is a firm step in the commitment signed by the health research centers in 2019, in order to contribute to the progression of women’s scientific careers, in the ‘elimination of barriers and implicit biases that affect health research.

In addition, with the aim of improving the quality of the knowledge produced for the benefit of the entire population, the commitment signed commits to incorporating the gender perspective in research and innovation. And although the gender gap still exists, the efforts of the centers have resulted in a slight improvement in the situation of inequality in teams and leadership.

Science Law, in terms of gender

During the course of the day, it was made clear that the future Catalonia’s Science Law, currently in the final stages of processing in Parliament, will establish a specific Catalan scientific policy defined, among other features, by the transversal incorporation of the gender perspective. The rule will promote the adoption of measures against gender bias and any other form of discrimination, and among its main objectives will set the promotion of parity between women and men in all areas of the knowledge system.

This law is also expected to integrate as organizing principles key points in gender matters such as the equality of women and men in the scientific career or the inclusion of the gender perspective in all phases of research, development and innovation .

Likewise, it foresees that public agents of research, development and innovation are equipped with a gender equality plan. This plan will need to incorporate measures to move towards gender equality, at the same time as including gender expert personnel in the evaluation and advisory bodies and ensure the balanced composition of the governing bodies. It will also be necessary to determine the evaluation tools for compliance with the plans, which will have to provide for the corresponding corrective measures.

The agents of the research, development and innovation system of the public sector must also include in the ethical codes the obligation to act in the event of sexual harassment and gender-based violence. In the same way, they will need to establish protection and support mechanisms for victims.

Hypatia’s engagement letter

The first edition of the Gender Summit took place in 2019 in Girona. Driven by the same objective, it hosted the creation of the Hypatia Practice Community and the signature, by the directors of the attending centers, of the Hypatia Charter of Alexandria. Among them, he signed IR Sant Pau. This agreement contained the twelve main points on which they focused their itinerary to reverse the situation of gender inequality shown by the nominal data.

This law integrates in its articles, therefore, the spirit of the commitments gathered from the Charter of Hypatia, focused on advancing towards gender equality in research and contributing to diversity in the world of science. The document focuses on specific aspects such as wage inequality, the elimination of obstacles that pose a problem for accessing a stable professional career after the doctorate, the improvement of employment contracts or the promotion of changes in organizational culture and the ‘professional structure.

Along these lines, the Hypatia Community, formed by the research centers in which AQuAS participates, has worked on various aspects to advance the Hypatia commitments. Recently, he has created and published the Tool to integrate the perspective of gender and sex, with the aim of guiding researchers when considering the incorporation of sex and/or gender in studies of basic science, clinical , health services and public health. The Tool contains a list of questions and sub-questions that address the integration of sex and gender in research, with specific aspects and examples of how to incorporate them in research.

The Community of Practice is also involved in the creation of an inclusive language guide for the world of research and in the Train the trainers program. This program is focused on training volunteer facilitators in unconscious bias so that they can provide training to people in their own institution.

In the area of research, the CERCA Institution, for its part, has since 2013 had a gender commission with representation from research centers, where initiatives in the field are coordinated and cases are exchanged ‘success. The activity has fundamentally focused on raising awareness and incorporating policies with a gender perspective in order to facilitate the incorporation of female researchers, especially in managerial positions. For its part, the Women and Science Commission of the CIC, in operation since 2006, has as its mission the development of women’s policies in the field of higher education and research.

During the celebration of the 15th Congress of ANECORM, the National Nursing Association Coordinating Materials Resources, awarded Marta Navarro Colom and Laura Romero Roca with the 13th Prize for a research work for the project Device for holding in bronchoscopies: study of concept and usability, that will be developed next year at the Interventional Pneumology Department of the Hospital de la Santa Creu i Sant Pau, in Barcelona.

The nurse and nursing assistant technician of this department come up with the idea of building a functional prototype of a device to maintain the immobilization of people undergoing flexible bronchoscopy and demonstrate through a study the usefulness of the prototype and its applications.

This project won in an initial phase a grant from The Collider On Campus (UAB-MWC), a 7-week online entrepreneurship program based on the Lean Launchpad methodology. This method helps to assess the commercialization feasibility of scientific and technological entrepreneurship projects, and to facilitate their development as a product.

ANECORM’s commitment guarantees the continuity of the product validation study and allows progress in the technological transfer process and the arrival of this health product in clinical practice.

This impulse represents a clear recognition of the nurse’s role in all phases of product development, in the innovative capacity and in the ease of multidisciplinary work with the 3D laboratory of the Hospital de Sant Pau and with the Technological Transfer and Innovation Unit of the Research Institute of Sant Pau – IIB Sant Pau.

The combination of preoperative chemoradiotherapy and transanal endoscopic microsurgery could be useful in helping to reduce local recurrence of rectal cancer. This therapeutic strategy could contribute to minimizing the sequelae in these patients. This is suggested by the results of the TAUTEM study, a phase III multicenter, randomized and controlled clinical trial published by the journal Annals of Oncology.

The research, in which Dr. Pilar Hernández, Dr. María del Carmen Martínez Sánchez and Dr. Eduardo Mª Targarona, researchers from the General and Digestive Surgery Group of the Santa Creu i Sant Pau Hospital Research Institute – IIB Sant Pau and specialists from the Gastrointestinal and Hematological Surgery Unit of the same hospital, has been led by Dr. Xavier Serra Aracil, from the Colorectal Surgery Research Group of the Parc Taulí Research and Innovation Institute (I3PT), in Sabadell.

Colorectal cancer is one of the most prevalent among the population. It is the second most common tumor among women – after breast cancer – and the third most common in men, only behind lung and prostate cancer. One in four cases of colorectal cancer affects the rectum.

Currently, the standard treatment for rectal cancer is surgery, which in most cases involves removing the rectum permanently. Patients who undergo this operation must live with a bag permanently or temporarily, and many may also suffer problems in the urinary bladder and present sexual dysfunctions, with all the consequences that this entails for their quality of life. life

This study suggests that, in the short term, the results of this new therapeutic strategy are equivalent to conventional treatment, but it represents a much less invasive option that allows the rectum to be preserved.

Article de referencia

Serra-Aracil, C. Pericay, J. Badia-Closa, T. Golda, S. Biondo, P. Hernández, E. Tarragona, N. Borda-Arrizabalaga, A. Reina, S. Delgado, F. Vallribera, A. Caro, J. Gallego-Plazas, M. Pascual, C. Álvarez-Laso, H. Guadalajara Labajo, L. Mora-Lopez. Short-term outcomes of chemoradiotherapy and local excision vs total mesorectal excision in T2–T3ab,N0,M0 rectal cancer. A multicentre randomised, controlled, phase III trial (the TAUTEM study). Annals of Oncology, 2022, ISSN 0923-7534, https://doi.org/10.1016/j.annonc.2022.09.160.

La Marató de TV3 Foundation will finance 4 mental health projects of the Sant Pau Biomedical Research Institute (IIB Sant Pau), thanks to the funds raised in the last edition, especially dedicated to these diseases.

One of the projects is led by Dra. Maria Portella and consists of a phase III clinical trial, randomized, controlled with an active comparator, to study the effectiveness and safety of the Integral Cognitive REMediation (INCREM) program in patients with depression.

On the other hand, Dr. Joaquim Soler will conduct a randomized controlled trial to evaluate the effectiveness of RODBT skills training in patients with eating disorders and autism spectrum traits, which will be a proof-of-concept study.

Dr. Javier de Diego Adeliño will carry out work on depression and the role and modulation of miRNAs in the anterior cingulate cortex as peripheral biomarkers and targets for promising nanotherapies, within the framework of a project coordinated by the CSIC.

In addition, Dr. Narcís Cardoner Álvarez will study the influence of the intestinal microbiota and derived metabolites in major depression in a neurometabolomics study of knowledge transfer in the irritable bowel and porcine model.

In total, 36 research projects, led by 81 research teams who are experts in mental health, will be financed with the funds raised in the last edition of La Marató de TV3 and Catalunya Ràdio.

At the event where the selected projects were made public, the researcher at the Santa Creu i Sant Pau Hospital Research Institute, Dra. M. Jesús Portella, representing all the awardees, thanked for the award and assured that he is aware of the responsibility that receiving these funds represents: “I want to thank the La Marató Foundation for dedicating a program to the mental health, which, with the solidarity of the people, allows us to carry out this research, which is what drives us.”

In the 2021 edition, 150 projects were presented, which were evaluated by 111 international scientists specializing in this subject based on their quality, methodology and relevance. The management of the evaluation was carried out by the Health Quality and Evaluation Agency of Catalonia, of the Department of Health.

A study in which Dr. José Martínez-González, researcher at the Instituto de Investigaciones Biomédicas de Barcelona (IIBB-CSIC) and the IIB-Sant Pau, carried out at the National Cardiovascular Research Center (CNIC), reveals a key factor that protects the heart after a heart attack.

The research, led by Dra. Pilar Martín, head of the Inflammatory Processes Regulatory Molecules Group of the CNIC and published today in the Journal of Clinical Investigation, describes that the expression of the CD69 receptor in regulatory T lymphocytes confers protection after suffering a myocardial infarction, since it acts as a control point for the exacerbated inflammation responsible for heart damage in the medium term.

In addition, the work in which researchers from the Cardiovascular Diseases area of the CIBER (CIBERCV) from the group of Dr. Francisco Sánchez-Madrid at the CNIC and the La Princesa University Hospital have also participated, reveals that expression levels of this CD69 receptor in peripheral blood could predict the development of heart failure, that is, serious sequelae in the functionality of the heart.

Regulatory T lymphocytes, explains Dr. Rafael Blanco-Domínguez, first signatory of the work, “are cells in charge of controlling other elements of the immune system to prevent uncontrolled inflammatory responses from ending up causing unwanted damage”.

The researchers, through the analysis of blood immunologic markers of 283 patients with myocardial infarction, ischemic heart disease and the main cause of death in the world, have discovered that there is an increase in the expression of this receptor CD69 in regulatory T lymphocytes in the first hours after the ischemic event.

Thanks to experiments with mouse models, this team of scientists has revealed that the absence of CD69 leads to an increase in inflammation, cardiac dysfunction and the death rate after a heart attack.

This phenomenon, explains Dra. Martín, “this is because the regulatory T cells that express CD69 are recruited at the site of the infarction and are necessary to inhibit the gamma-delta T cells, which secrete the pro-inflammatory interleukin-17. The presence of CD69 makes the regulatory T cells more efficient in inducing death and inhibiting the secretion of interleukin-17 by means of a novel mechanism independent of specific antigens”.

Research has also shown that a very relevant fact: therapy with regulatory T cells that express CD69 after a heart attack in mice deficient in CD69 is sufficient to compensate for the deficiency of this molecule and thus reduce cardiac inflammation and improve survival.

The follow-up of patients with heart attacks in two independent cohorts, in close collaboration with the Cardiology Services of the University Hospital of La Princesa in Madrid and the Hospital de la Santa Creu i Sant Pau in Barcelona, revealed another very promising result for the clinic.

The levels of expression of CD69 in peripheral blood serve to predict the development of heart failure, that is to say, serious sequelae in the functionality of the heart. In other words, explains Dr. Blanco-Domínguez, those patients with low levels of CD69 in the first hours after a heart attack “had a greater risk of developing heart failure during the first two and a half years after hospital admission”.

The authors conclude that this work reveals a new regulatory mechanism of inflammation after myocardial infarction and opens the door to the development of CD69 as a prognostic and therapeutic candidate for this global cardiac affectation.

This study has had the support of the Ministry of Science and Innovation (MCIN), through the Carlos III Health Institute (ISCIII) – Health Research Fund; Scholarships Community of Madrid; Foundation La Marató TV3; CIBERFES, Human Frontier Science Program; Leducq Transatlantic Networks; Marie Skłodowska-Beca, and support from the University Teacher Training program of the Ministry of Education, Culture and Sports.

Reference article

Blanco-Domínguez … José Martínez-González, Pilar Martín. CD69 expressió on regulador T cells protects from immune damage after myocardial infarction. J Clin Invest. 2022. https://doi.org/10.1172/JCI152418.

“El temps és cervell”, afirma el Dr. Joan Martí-Fàbregas, cap de la Unitat d’Ictus del Servei de Neurologia de Sant Pau. Una frase que va en línia amb el lema del Dia Mundial de l’Ictus d’enguany: Els minuts poden salvar vides, però amb el missatge de que “l’èxit en ictus no només és sobreviure, sinó fer-ho amb qualitat de vida, de manera que els pacients tornin a ser funcionalment independents”.

L’Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau, té dos grups dedicats a l’estudi de l’ictus: Malaltia Vascular Cerebral i Farmacogenòmica i Genètica Neurovascular.

El primer, dirigit pel Dr. Martí-Fàbregas, lidera estudis en ictus isquèmic:  beneficis i riscos de la trombòlisi intravenosa; beneficis i riscos del tractament endovascular (trombectomia mecànica), maneig de la pressió arterial post-trombectomia, circulació col·lateral en el pacient amb oclusió de gran vas, paper de les estatines en l’ictus isquèmic i hemorràgic; cèl·lules progenitores endotelials en ictus, vulnerabilitat de la placa carotídea ateroscleròtica; monitoratge no invasiu del flux cerebral amb mètodes òptics aplicats. També en hemorràgia intracerebral: prevenció de l’hemorràgia cerebral per anticoagulants; rellevància de l’edema perihematoma, influència de la microbiota, factors associats al creixement de l’hematoma, influència del tipus d’hospital i altres aspectes logístics en els resultats clínics.

El segon, que lidera el Dr. Israel Fernández, es focalitza en estudis genètics i epigenètics de l’ictus, participa en diversos consorcis internacionals i coordina un consorci estatal sobre el mateix tema que engloba el treball d’uns 15 hospitals i centres de recerca de l’Estat. Un dels darrers estudis publicats, en la revista Clinical Epigenetics, ha analitzat possibles canvis epigenètics que expliquin perquè no tots els pacients pateixen les mateixes alteracions neurològiques i la mateixa evolució. El treball conclou que podria ser degut a alteracions en la metilació d’un gen anomenat EXOC4, implicat en el procés conegut com a excitotoxicitat, pel qual les neurones són danyades i destruïdes en l’ictus.

El grup està duent a terme diversos projectes en el vessant farmacogenètic, sobre fàrmacs que s’utilitzen per prevenir l’ictus o per millorar la resposta dels pacients. L’equip està investigant si hi ha factors de risc genètic associats a l’evolució d’aquests pacients després de l’administració d’aquests fàrmacs i d’altra banda s’investiga sobre els factors genètics que predisposen a una resposta als fàrmacs que serveixen per prevenir l’aparició d’altres ictus en el mateix pacient.

Cada minut és important

Per això són cabdals la informació i les campanyes a la població per saber-ne identificar els primers símptomes i sol·licitar atenció mèdica urgent, rebre els tractaments apropiats a la fase aguda, l’ingrés en Unitats d’Ictus amb un equip de professionals multidisciplinari. També cal remarcar que l’ictus es pot prevenir, i tenim mesures per la prevenció primària i també en la prevenció secundària de l’ictus. Tant la prevenció com el tractament de la fase aguda són d’especial importància donat que l’ictus és la primera causa de discapacitat i la segona de mort.

Cal considerar l’ictus com una emergència mèdica tractable. “Quant més aviat arriba el pacient a l’Hospital, més podem fer per ell. Hem de poder revertir el procés i evitar possibles seqüeles per assolir una màxima capacitat de recuperació, és a dir, que el pacient torni a fer tot el que feia abans a nivell laboral, social, personal… Sobreviure no és un èxit, sí fer-ho amb qualitat de vida. Per això la població, des del mateix malalt fins a la seva família, els companys de feina… tothom ha de saber identificar els símptomes de sospita d’ictus”, segons el Dr. Martí-Fàbregas.

“El millor tractament aplicable per a tots els malalts és l’ingrés en una Unitat d’Ictus, com la que tenim a Sant Pau, igual que els malalts amb infart agut de miocardi ingressen en una Unitat Coronària. Està demostrat que això serveix per canviar l’evolució dels malalts”. A més, l’Hospital té una Comissió Multidisciplinària de l’Ictus, de manera que els professionals dels diferents Serveis i àmbits de tractament avaluen els casos un a un i proposen accions de millora que més tard es posen en pràctica en casos reals. Això ha permès avenços en la rapidesa d’administració de tractaments, esdevenint un dels hospitals amb millor temps de resposta i resultats clínics i un protocol compartit de derivació de pacients procedents del Sistema de Salut d’Andorra.

El Dr. Martí-Fàbregas destaca que “un element clau en l’abordatge de l’ictus és el treball multidisciplinari i coordinat entre els professionals” de Neurologia, Urgències, Anestèsia, Neuroradiologia, Radiologia Intervencionista, Infermeria quirúrgica, Infermeria d’Urgències, Fisioteràpia i Rehabilitació, Logopèdia, trasllat, i l’estreta col·laboració amb el Servei d’Emergències Mèdiques de Catalunya (SEM).

Sant Pau també participa en el Codi Ictus, el protocol d’actuació urgent del Sistema de Salut Públic de Catalunya que comprèn una xarxa de dispositius assistencials per donar una atenció immediata i adequada als pacients amb sospita d’ictus. Hi participen 29 hospitals.

Prevenció primària, però també secundària

L’ictus és el resultat d’una alteració de la circulació de la sang al cervell. Es classifiquen en ictus isquèmic (quan és degut a una obstrucció arterial i l’arribada de la sang a una zona del cervell s’altera i provoca que les cèl·lules cerebrals de l’àrea afectada morin per manca d’irri­gació sanguínia), i ictus hemorràgics (quan es trenca una artèria i s’acumula la sang en forma d’un hematoma a l’interior del cervell).

Es calcula que 1 de cada 6 persones tindrà un ictus en algun moment de la seva vida. Aquesta malaltia és més freqüent en homes, però més mortal en dones – en elles és la primera causa de mort per sobre dels 65 anys i, en ells, la tercera per sobre dels 75 anys.

A l’hora de prevenir-lo, hi ha una sèrie de factors no modificables, com l’edat i la genètica, per exemple, però també n’hi ha d’altres que podem canviar, com la hipertensió arterial, la diabetis, el sedentarisme, l’augment de colesterol, l’obesitat, el tabaquisme… “La feina comença quan donem d’alta els malalts amb ictus i tornen a casa seva, intentar que no tingui un segon episodi”.

Segons el Dr. Martí-Fàbregas, “afortunadament tenim tractaments molt eficaços en la fase aguda, de reperfusió, que tornen a enviar sang al teixit que s’ha quedat sense circulació com a conseqüència de l’ictus. Utilitzem fàrmacs com la trombòlisi intravenosa o altres que administrem de forma endovascular, com la trombectomia mecànica en la fase aguda”.

The Sant Pau Biomedical Research Institute (IIB Sant Pau) hosted the first edition of the ÀGORA BRN 2022 Meeting Point for Research Projects in Respiratory Health, organized by the Barcelona Respiratory Network (BRN) Foundation. The meeting was opened by Dr. Vicente Plaza, president of the BRN Foundation and director of the Pneumology and Allergy Department; and Dr. Jordi Surallés, director of the Sant Pau Research Institute. Mrs. Montserrat Llavayol, Deputy Director General of Research and Innovation in Health of the Generalitat de Catalunya, participates in the conference “Investigation in health in Catalonia. Present and future”.

ÀGORA BRN 2022 awards the 5 best posters, 2 of which are from Sant Pau professionals. The first, “Project CASSANDRA (Cancer Screening Smoking Cessation and Respiratory Assessment)”, is by Dr. Juan Carlos Trujillo, clinical head of the Thoracic Surgery Department. And, the second, “Electronic biopsy of lung tissue in-vivo based on electrical impedance spectroscopy”, by Dra. Virginia Pajares, deputy of the Bronchoscopy Unit of the Pulmonology and Allergy Service.

It has also given the RECERCAD’OR Award to Dr. Josep Maria Antó, director of the Environmental Epidemiology Research Center (CREAL) and of the Biomedical Research Network of the Center of Epidemiology and Public Health (CIBERESP) and professor of Medicine at Pompeu Fabra University (for his track record of excellence) and the RECERCADOC Award to Dr. Clara Martín Ontiyuelo, from the Pneumology Service of the Hospital del Mar (as a young researcher and with the best thesis published in the last two years).