The Sant Pau Research Institute (IR) will launch a new Phase I/IIB clinical trial for patients with Fanconi anemia diagnosed with head and neck cancer. The study, known as the AFAN trial (EU CT No.: 2024-511477-29-00), is led by Dr. Jordi Surrallés, head of the Cancer Predisposition Syndromes Group, scientific director of the IR Sant Pau, and professor in the Department of Genetics and Microbiology at the UAB. The trial will evaluate the safety and efficacy of the drug afatinib in patients with Fanconi anemia and locally advanced, unresectable, or metastatic squamous cell carcinoma located in the oral cavity, oropharynx, hypopharynx, or larynx, making it the first clinical trial worldwide for this indication. The study, approved by the Spanish Agency for Medicines and Medical Devices (AEMPS) last August, began recruiting patients this October, with a process expected to last approximately four years.

This project is the result of joint research by the Sant Pau Research Institute (IR), the Autonomous University of Barcelona (UAB), and the Biomedical Research Networking Center (CIBER), which led to the discovery of a new therapeutic use for afatinib, a drug currently administered to treat certain types of lung cancer in the general population. This project is, therefore, a drug repurposing initiative, transferring a treatment from a common disease to a rare disease with no therapeutic alternatives.

Fanconi anemia is a rare genetic disorder caused by a defect in DNA repair. It leads to bone marrow malfunction, and patients are particularly prone to developing head and neck tumors at a very young age. Due to their genetic defect, cancer patients cannot undergo chemotherapy and therefore have no effective treatments beyond surgery, making this the leading cause of mortality among the adult population affected by this disease.

The new use of afatinib developed by researchers from these institutions has led to a patent recently granted in Europe and pending in the United States. Additionally, as a rare disease, the project has received afatinib’s designation as an Orphan Drug by the EMA, expediting the development timeline for this new drug use.

To carry out this clinical trial, the crucial collaboration of Boehringer Ingelheim, the current owner and distributor of afatinib, has been secured, and they will provide the drug to be administered to patients during the study. This advancement marks a significant step forward in the treatment of patients with Fanconi anemia, who have developed this type of cancer and currently lack therapeutic alternatives. To ensure the success of the trial, patients will be treated not only at Sant Pau Hospital but also at Hannover University Hospital in Germany, where EMA approval is also expected soon.

The AFAN research team, led by Dr. Jordi Surrallés, includes Dr. Georgia Anguera, AFAN’s principal investigator, and Dr. Oscar Gallego (oncologists from the Medical Oncology Service at Sant Pau Hospital), Drs. Núria Berga and Maria Estela Moreno from the hospital’s Pharmacy Service, with the collaboration of Dr. Javier León from the Otolaryngology Service and Dr. Ramón García-Escudero from the Research Institute at Hospital 12 de Octubre, who will perform genomic analyses associated with the trial.

The institutions wish to thank all the entities that have made possible all the preclinical research and the current AFAN clinical trial, including industry partners like Boehringer Ingelheim, who support cutting-edge R&D, as well as the various institutions and patient associations that have provided financial support for the clinical research project, such as the Carlos III Health Institute (ICI22/00076, funded by the European Union – NextGenerationEU) and the Fanconi Anemia Research Fund (https://fanconi.org/).

The Sant Pau Research Institute (IR Sant Pau) held its 1st Primary Care Research Conference this Monday, October 28, aimed at emphasizing the significance of research in this field. The event brought together researchers from the institution and professionals from various Primary Care centers to foster debate on the current state of this research and the opportunities it may offer.

“With this conference, within the framework of IR Sant Pau, we aimed to promote collaboration among Primary Care professionals, both doctors and nurses, and those from the hospital. We also sought to establish connections with public health professionals, as research in Primary Care is deeply linked to community care and public health,” explained Dr. Carlos Brotons, head of the Primary Care research group at IR Sant Pau and director of the EAP Sardenya Research Unit, one of the organizers of the event along with Dr. Pablo Alonso-Coello, director of the Epidemiology, Public Health, and Primary Care area at IR Sant Pau.

Brotons added: “Additionally, we organized a roundtable on clinical trials in Primary Care, a field with great development potential. For this, we invited experts with successful experiences in this area to share their knowledge.”

Throughout the day, clinical research experiences were presented in areas such as musculoskeletal diseases, with projects focused on osteoporosis and gout; non-oncologic chronic pain, highlighting the importance of preventing and reducing the use of pharmacological treatments as the sole therapeutic option; diabetes; and heart failure. Community research topics were also addressed, including health surveys in Barcelona, used to monitor Primary Care from the population’s perspective and analyze inequalities; colorectal cancer screening as a collaborative research opportunity; and the “Barcelona Salut als Barris” program.

The event featured Pilar Gayoso, Deputy Director of Research Evaluation and Promotion at the Carlos III Health Institute in Madrid, who delivered a lecture on the present and future of Primary Care research and its integration into health research institutes. “Institutes must incorporate Primary Care researchers, but not forcibly; the goal is to encourage their proactive integration,” Gayoso emphasized during her presentation. She also added, “It’s essential that these professionals do not abandon clinical care but rather have spaces to reflect on the results they obtain in consultations.”

To carry out this event, IR Sant Pau collaborated with EAP Sardenya, Dreta de l’Eixample, and Disset de Setembre; ABS Sagrada Familia; the Primary Care Consortium of Barcelona Esquerra (CAPSBE), the Catalan Institute of Health (ICS); IDIAP Jordi Gol; the Barcelona Public Health Agency (ASPB); professionals from various departments of the Hospital de la Santa Creu i Sant Pau, and the Carlos III Health Institute.

Two recent studies, led by researchers from the Sant Pau Research Institute (IR Sant Pau) and conducted in collaboration with hospitals across Spain, have identified significant genetic loci, or DNA regions, associated with lacunar stroke and spontaneous intracerebral hemorrhage. These discoveries open new possibilities for the development of personalized therapies and underscore the importance of genetics in risk stratification for these severe cerebrovascular diseases.

CTNND2 Gene and Lacunar Stroke

The first study, published in Stroke and led by Dr. Jara Cárcel Márquez and Dr. Israel Fernández-Cadenas from the Pharmacogenomics and Neurovascular Genetics Group at IR Sant Pau, focused on lacunar stroke, a subtype of ischemic stroke caused by the occlusion of small cerebral vessels. This study, the first comprehensive genomic analysis conducted on the Spanish population, highlighted the importance of the CTNND2 gene in the risk of lacunar stroke, particularly in men.

Researchers analyzed data from 9,081 individuals, including 3,493 ischemic stroke cases and 5,588 healthy controls, and validated their findings with international consortia such as MEGASTROKE, GIGASTROKE, and the UK Biobank. One of the most noteworthy discoveries was the identification of locus 5p15.2, with the rs59970332-T variant being the main one associated with lacunar stroke. The CTNND2 gene, located near this locus, may play a crucial role in vascular health and the formation of new blood vessels. Additionally, associations were found with other stroke-related genes, such as F2 and FGG.

This genetic study on the Spanish population has confirmed risk variants in 12 known genes associated with stroke in other international populations, which is essential for the application of precision medicine in Spain. Dr. Cárcel emphasizes that these findings “can help us identify individuals at higher risk of stroke, enabling the implementation of targeted preventive measures in the future.” According to the researchers, this study represents a significant advance in understanding the genetic basis of ischemic stroke and highlights the need to consider sex differences in genetic research.

Newly Discovered Loci in Spontaneous Intracerebral Hemorrhage

The second study, published in Neurology and also from the IR Sant Pau group, led by Dr. Elena Muiño and Dr. Israel Fernández-Cadenas, investigated spontaneous intracerebral hemorrhage (ICH), a serious condition affecting 30 out of every 100,000 people globally each year. Using an innovative approach, the study uncovered genetic variants associated with this disease that had previously gone undetected in traditional studies.

The key innovation was a meta-analysis integrating genetic data from various diseases associated with intracerebral hemorrhage, such as vascular conditions, rather than limiting the scope to genetic variants exclusively tied to cerebral hemorrhage. This approach increased statistical power, leading to the detection of four genetic loci associated with ICH that had not been identified before.

Until now, GWAS studies had identified only two main loci associated with ICH: APOE for lobar hemorrhage and locus 1q22 for non-lobar hemorrhage. However, by analyzing data from 1,543 patients with ICH, alongside five related phenotypes and a replication cohort of 399,717 individuals from the UK Biobank, the research team identified several new genetic loci, including OBFC1 (10q24.33), NECTIN2 and APOC1 (19q13.32), and the SH3PXD2A gene, now linked to ICH risk. Additionally, loci ICA1L (2q33.2) and COL4A2 (13q34), previously described, were replicated for the first time.

“This approach allowed us to identify several new genetic loci, including those associated with biological processes like amyloid protein deposition or lipid metabolism, which could be promising therapeutic targets to reduce intracerebral hemorrhage risk in genetically predisposed individuals,” explains Dr. Muiño.

The study employed bioinformatics tools like TWAS (Transcriptome-Wide Association Studies) and PWAS (Protein-Wide Association Studies), enabling a deeper understanding of the underlying biology of ICH by examining the relationship between genetic variants and protein or transcript expression.

“This is a significant step forward in understanding the genetic basis of intracerebral hemorrhage,” notes Dr. Muiño. “The identification of these loci not only provides critical insight into the underlying biological mechanisms but could also point to new therapeutic targets to reduce the risk of ICH in the future and aid decision-making in complex patients.”

The study lays the groundwork for future research, including the use of methods like Mendelian randomization to explore whether the proteins associated with the discovered loci, beyond being associated with hemorrhage, are causal factors in this condition.

Funding and Collaboration

The lacunar stroke study was funded by the Instituto de Salud Carlos III, ERA-NET NEURON, the Cooperative Health Research Network on Vascular Diseases, the Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED), European Union Next Generation funds, the CERCA program from the Generalitat de Catalunya, the Marató de 3cat, and the National Institutes of Health (NIH).

The intracerebral hemorrhage study received funding from the Instituto de Salud Carlos III, the Generación Project, the Maestro Project, the INVICTUS+ network, and European Union Next Generation funds. Both studies were made possible through collaboration with multiple hospitals in Spain and international consortia.

Reference Articles

Cárcel-Márquez, J. et al. (2024) “Sex-stratified genome-wide association study in the Spanish population identifies a novel locus for lacunar stroke”, Stroke; a journal of cerebral circulation, 55(10), pp. 2462–2471. Disponible en: https://doi.org/10.1161/STROKEAHA.124.047833

Muiño, E. et al. (2024) “Identification of genetic loci associated with intracerebral hemorrhage using a multitrait analysis approach”, Neurology, 103(8), p. e209666. Disponible en: https://doi.org/10.1212/WNL.0000000000209666

Dr. Antoni Betbesé-Roig, a researcher from the Intensive Care Medicine Group at the Sant Pau Research Institute (IR) and a professional from the Intensive Care Medicine Service at Hospital Sant Pau, and Dr. Mercedes Camacho, from the Complex Disease Genomics Group at IR, have participated in a study led by Hospital Universitari de Bellvitge and IDIBELL, which has just been published in the Journal of the American Medical Association (JAMA). The results show that the use of a new extracorporeal blood purification membrane significantly reduces acute kidney injury after high-complexity cardiac surgery.

Acute kidney injury is a condition in which the kidneys suddenly stop functioning and cannot remove toxins from the blood, a common issue in critically ill patients or those undergoing high-complexity cardiac surgeries. This has driven research into procedures that may help address this problem, leading to the SIRAKI02 study. Researchers from Hospital Universitari Germans Trias i Pujol also participated in this study.

The aim of the study was to assess whether using an enhanced adsorption membrane, known as oXiris®, during cardiac surgery could reduce the incidence of kidney injury in patients requiring extracorporeal circulation. This membrane is already used in intensive care units for sepsis treatment and continuous renal replacement, but this is the first time it has been associated with positive clinical outcomes in the context of cardiac surgery.

The trial included 343 patients from Bellvitge and Germans Trias i Pujol hospitals who underwent surgeries between 2016 and 2022, requiring extracorporeal circulation for more than 90 minutes. The inflammatory response of the patients was measured through indicators obtained before and after the procedure, in collaboration with the Biochemistry Laboratory at Hospital Sant Pau.

The results show that, in the control group (169 patients), 40% developed acute kidney injury in the week following surgery, while in the group treated with the new membrane (174 patients), this percentage dropped to 28%. Furthermore, no additional complications were detected from using the device, and perfusionists reported that it was simple and efficient to operate.

If these results are confirmed in larger studies, this device could become a routine part of treatment for high-risk patients undergoing cardiac surgery with extracorporeal circulation, with the potential to reduce ICU stay time and offer other clinical benefits.

Reference Study:

Pérez-Fernández, X. et al. (2024) “Extracorporeal blood purification and acute kidney injury in cardiac surgery: The SIRAKI02 randomized clinical trial”, JAMA: the journal of the American Medical Association [Preprint]. Available at: https://doi.org/10.1001/jama.2024.20630

Researchers at the Sant Pau Research Institute (IR Sant Pau) have published a study showing that “brain alterations related to the more aggressive forms of cognitive decline in Parkinson’s disease can be detected years before cognitive impairment manifests.” The research is part of a project funded by the Fundación la Marató de TV3 and led by Dr. Javier Pagonabarraga, researcher of the Parkinson’s Disease Group at IR Sant Pau and neurologist at the Movement Disorders Unit of the Neurology Department at Hospital de Sant Pau. The results open new avenues to anticipate, understand, and intervene in cognitive disorders related to this disease.

Unlike what occurs in other neurodegenerative diseases like Alzheimer’s, not all people with Parkinson’s develop cognitive impairment or dementia. Unfortunately, a significant proportion does, and in some cases, cognitive decline is very aggressive during the early years of the disease.

Currently, it is very difficult to predict which recently diagnosed Parkinson’s patients or those without cognitive problems will develop dementia, but researchers have a clear understanding of the brain and cognitive anomalies that are commonly present in people with Parkinson’s who experience severe cognitive disorders.

“In many cases, when the brain is becoming diseased, neuropsychological evaluation tests and brain imaging techniques do not allow us to see phenomena that are already present. When we detect problems clinically, we know that significant brain damage has already occurred. Therefore, to intervene before the brain damage becomes too extensive, we need to develop techniques that allow us to observe phenomena that are already present in those who will experience a more aggressive form of the disease, but which we cannot yet detect,” explains Dr. Saül Martínez-Horta, researcher of the Parkinson’s Disease Group at IR Sant Pau and neuropsychologist at the Movement Disorders Unit of the Neurology Department at Hospital de Sant Pau.

In this study, researchers focused on newly diagnosed Parkinson’s patients without cognitive problems and followed them for four years. Initially, they measured brain activity using an electroencephalogram (EEG), took brain images using magnetic resonance imaging (MRI), and measured the levels of a blood marker related to neuronal damage known as neurofilament light chain (NfL); in addition, every year they underwent an extensive neuropsychological examination to assess their cognitive state.

The follow-up showed that there are two large groups of patients: one group did not show significant cognitive decline during the first four years, while the other group dramatically worsened after the second year. Interestingly, MRI measures, NfL levels, or cognitive performance during the first visit did not detect differences between these two groups. In other words, these commonly used measures did not anticipate how the patients would progress. However, EEG analyses showed that those who would experience clear cognitive decline two years later already exhibited significant slowing of brain activity in the temporal, parietal, and frontal lobes during the first visit.

According to Dr. Arnau Puig-Davi, researcher of the Parkinson’s Disease Group at IR Sant Pau and neuropsychologist at the Movement Disorders Unit of the Neurology Department at Hospital de Sant Pau, “thanks to resting EEG, we can detect brain anomalies related to changes that already affect patients who will later present clear cognitive decline and dementia, even in the early stages before mild cognitive impairment.”

This study opens new horizons for the early detection of cases that will develop dementia associated with Parkinson’s disease. The results obtained will help researchers better study and understand the mechanisms underlying the cognitive evolution differences observed in Parkinson’s patients. The researchers believe that this discovery could be very useful for early evaluation of treatments aimed at minimizing the risk of developing Parkinson’s-related cognitive impairment.

Reference article

Arnau Puig-Davi, Saül Martínez-Horta, L., et al. (2024). Prediction of Cognitive Heterogeneity in Parkinson’s Disease: A 4-Year Longitudinal Study Using Clinical, Neuroimaging, Biological and Electrophysiological Biomarkers. Annals of Neurology 2024 Aug 5; 00:1-13 DOI: 10.1002/ana.27035

Project funded by the Fundación la Marató de TV3: “Blood and Neurophysiological Markers of Cognitive Decline Progression in Parkinson’s Disease” (Expedient: 20142910; PI: Dr. Javier Pagonabarraga).

Every minute, a person dies in Europe due to thrombosis. This October 13 is World Thrombosis Day, and for that reason, we want to give a voice to this disease, which is often invisible but has serious consequences. Thrombosis occurs when blood clots form in veins or arteries, partially or completely blocking blood circulation. This condition can trigger complications such as heart attacks, strokes, or pulmonary embolisms, and it is the leading global cause of mortality related to cardiovascular diseases.

Dr. José Manuel Soria, head of the Genomics of Complex Diseases group at the Sant Pau Research Institute, highlights the importance of understanding the risk factors of this disease, which range from genetics to environmental causes. “It is a complex combination of genetic and environmental factors,” explains Dr. Soria. These factors can include prolonged immobilization, major surgeries, pregnancy, use of contraceptives, or other illnesses such as cancer or severe infections like COVID-19. It is essential to understand these risk factors to prevent this disease.

Research Is Key

At Sant Pau, thrombosis research is a priority. Our researchers are working to develop new biomarkers that can help predict which patients are at higher risk of thrombosis, enabling the application of personalized treatments that reduce mortality.

A Charitable Book: “La vida corre per les teves venes”

To mark World Thrombosis Day, the Activa’TT Association and the Sant Pau Research Institute are organizing an event to launch one of their fundraising projects: the presentation of the book La vida corre per les teves venes, a work that shares the experiences of renowned mountaineers and their connection to thrombosis. Some of them have experienced this disease, showing how it can affect anyone.

The book will be available in the coming weeks and can be purchased through this link. The proceeds will be directed to thrombosis research, particularly in cancer patients, one of the most vulnerable groups.

Join the Fight Against Thrombosis

You can support this cause by purchasing the book or making a direct donation through this link. We encourage you to become aware of this disease and collaborate in the research that will allow us to advance its prevention and treatment.

The Vall d’Hebron University Hospital has developed, in collaboration with the Hospital de Sant Pau and the Hospital del Mar, a predictive model, published in The Lancet, which helps oncologists identify which patients with metastatic cancer and systemic treatment who are admitted to emergency care, primarily for pain, fever, or difficulty breathing, are at greater risk of dying in the next 90 days.

This tool, called “PROMISE Score” stands for “Prognostic Score for Hospitalized Cancer Patients” It is a simple web application for healthcare professionals to use. Based on clinical and laboratory information readily available at the time of admission, it accurately predicts the 90-day mortality risk in patients with advanced cancer receiving active treatment. The main goal of this application is to assist the medical team in identifying patients who are more likely to survive without the need for further testing and to help them make decisions.

Identifying risk parameters at the time of admission helps the medical team guide their care, improve the quality of assistance, and avoid unnecessary procedures in situations where there will be no clear benefit from treatment, beyond cost reduction. “The model we have developed has strong predictive power for patients with a favorable prognosis, with whom we can more confidently opt for aggressive therapeutic interventions,” explains Dr. Oriol Mirallas, an attending physician in the Medical Oncology Department at Vall d’Hebron Hospital and a researcher at the Molecular Therapy Research Unit UITM-CaixaResearch at the Vall d’Hebron Institute of Oncology (VHIO). Dr. Oriol Mirallas is the lead author of this study, which involved the collaboration of 41 professionals, along with Dr. Joan Carles, head of the hospital’s section and head of the Genitourinary, Central Nervous System, Sarcoma, and Unknown Primary Tumor Unit, as well as the Genitourinary, Central Nervous System, and Sarcoma Tumor Group at VHIO, and Dr. Rodrigo Dienstmann, head of the Oncology Data Science (ODysSey) Group at VHIO, who helped develop the model and the web tool.

Thanks to this new tool, patients at high risk of mortality can be spared invasive treatments that will not improve their prognosis, reducing unnecessary suffering. “It is proven that nutritional support and community-based palliative care improve the quality of life and survival of patients in this advanced stage of the disease” emphasizes Dr. Joan Carles.

First Tool Filling a Gap in Clinical Practice

Survival estimates are a key element when making decisions about cancer patient care. “Until now, professionals used clinical data validated in outpatient patients, such as tumor stage, treatment response, or the patient’s functional level according to the ECOG scale (designed by the Eastern Cooperative Oncology Group and validated by the World Health Organization), which assesses the quality of life of cancer patients, combined with clinical experience to determine the best medical management” explains Dr. Oriol Mirallas. “But with this prognostic model, we have an objective and quantifiable measure that will help us understand the patient’s evolution upon admission. The PROMISE tool will provide more precise data to improve and facilitate decision-making” he adds.

Dr. Berta Martín Cullell, from the Medical Oncology Department at the Hospital de Sant Pau and a researcher in the study, comments that “with the validation of the PROMISE Score tool at our center, we have confirmed that this model allows us to accurately predict the prognosis of oncology patients admitted with acute complications” “This helps us identify which patients may benefit from more aggressive interventions and improves the quality of medical decisions. This tool, based on accessible clinical data, is a valuable resource for optimizing personalized treatment and preserving the quality of life of patients” she specifies.

Dr. Sònia Servitja, head of the Breast Section of the Medical Oncology Department at the Hospital del Mar and a researcher in the study, adds that “it was essential to develop a tool to individualize the therapeutic intensity for admitted patients, beyond parameters like ECOG and treatment response” “Currently, we are able to individualize treatment thanks to molecular studies; we have toxicity prediction scales for cancer treatments, especially in older and/or frail patients, which allow us to decide whom and how to treat, but we lacked more objective data to decide when to stop treatment, avoiding doing more harm than good. Now, with the PROMISE Score, we can identify hospitalized patients with a better prognosis, and it will help us make decisions” she emphasizes.

This new prognostic model fills a gap in the knowledge and clinical practice for hospitalized oncology patients. The available studies to date have focused on geriatric patients or studies conducted in a single center, with few patients primarily treated with chemotherapy, which does not reflect the current therapeutic landscape. “The current availability of personalized oncology treatments, with combinations of immunotherapy and other targeted therapies applied to thousands of patients, has forced us to seek new tools to assess prognosis and impact in this population, in order to optimize and adapt our daily clinical practice” points out Dr. Sònia Serradell, head of the Medical Oncology ward at Vall d’Hebron.

A Personalized Algorithm

To create this application and obtain an objective measure, a sample of 1,009 patients was analyzed: 749 admitted to Vall d’Hebron and 260 from the Hospital de Sant Pau and the Hospital del Mar, who have been the validation group. At the time of admission, the patients were over 18 years old, had a confirmed advanced or metastatic solid tumor (primarily lung, gastrointestinal, or gynecological, the most prevalent), had received anticancer systemic treatment at least six months before hospitalization, and were admitted to emergency care or the ward for a minimum of 24 hours. The patients in the Vall d’Hebron model creation group were admitted between March 2020 and February 2022, and those in the external validation group between January 2021 and February 2022. The average age was 65 years, 51% were women, with an average time since diagnosis of 22 months, and the average hospitalization lasted 9 days.

The web application https://promise.vhio.net/ allows for the calculation of an individualized value to predict 90-day mortality in patients hospitalized for emergency care with advanced cancer and active treatment. It analyzes a series of clinical and laboratory factors readily available at the time of admission. A high level of LDH (tumor burden), neutrophils (inflammation), and albumin (a protein that indicates the nutritional status of the patient) in the blood analysis at emergency admission are associated with a worse prognosis. The ECOG functional status, the latest CT reports estimating treatment response and disease progression, the tumor stage, and the patient’s emotional state are also evaluated. With these values, the PROMISE Score calculates an algorithm that helps identify those patients who would have a survival exceeding 90 days without the need for additional testing. “The survival percentage is an objective measure that helps the medical team make clinical decisions, but the final strategy planning will always be done in consensus with the patients, their families, and the treating physician” specifies Dr. Oriol Mirallas.

Care Adapted to Each Patient

“Unscheduled hospitalizations are common in cancer patients and are usually related to complications arising from cancer, infections, or treatment-related toxicity problems” states Dr. Joan Carles. This tool can help expedite decisions and optimize hospitalizations, as well as reduce prolonged and repeated admissions that can be avoided in terminal patients. Cancer treatment is a delicate balance between prolonging survival and maximizing quality of life. Hospitalization does not always provide benefits and can even be a stressful experience for both patients and caregivers, as well as impose a greater financial burden compared to outpatient care. “We are fully committed to the well-being and care of our patients, and this tool will help us tailor therapeutic efforts to each patient, achieving maximum benefit” emphasizes Dr. Sònia Serradell.

The web application is available for professionals treating oncology patients through the link https://promise.vhio.net/. “We will continue working to refine and validate the PROMISE Score in other populations and contexts to help as many patients and professionals as possible” concludes Dr. Oriol Mirallas. This tool, which will now be implemented in other centers to conduct an international study with more patients, was designed during Dr. Oriol Mirallas‘s second year of residency and also involved the collaboration of physicians from the Medical Oncology Department, the supervisor of the Medical Oncology ward, Ada Alonso, nursing auxiliary care technicians, and the nutrition team.

Going to a concert by a favourite performer or to the theatre to see a moving play often cause feelings of pleasure, well-being and satisfaction that transcend the moment and spill over into our lives, lifting our mood. For this reason, the arts are considered by the World Health Organization to be an effective tool for improving the emotional well-being of the population. But are they beneficial for everyone? What about people with neurodegenerative diseases? Can they serve as non-medical therapy to influence their mental health?

These are some of the questions that will be tackled by the research project Dramatizing health: the role of theatre in emotional, social and cognitive well-being, promoted by Universitat Oberta de Catalunya (UOC) researchers in association with the Teatre Lliure and the Hospital de la Santa Creu i Sant Pau. The aim is to evaluate the emotional and cognitive benefits of a theatrical arts programme in patients with Parkinson’s disease.

“It’s not art therapy, because we’re not going to treat the symptoms of the disease directly, but Arts in Health is an indirect way of providing benefits to people through participatory activities, such as going to the theatre, and participatory workshops that will be given by experts in coaching actors,” said Marco Calabria, researcher at the eHealth Center’s NeuroAdas Lab and member of the Faculty of Health Sciences at the UOC.

Arts in Health

The project, which has been selected in the “la Caixa” Foundation Social Observatory’s Connecta funding call, is based on a previous pilot study carried out last year by UOC researchers, also in association with the Teatre Lliure and the Hospital de la Santa Creu i Sant Pau, in which they studied the effects of therapeutic intervention based on the performing arts. These new tools, called “arts in health”, use forms of art, such as theatre, dance or the visual arts, to generate emotional and cognitive benefits.

The new project will seek to establish a theoretical framework that explains the relationship between the enjoyment of the moment and an improvement in the spectator’s emotional state and how this is transferred to mental health.

“We want to see if this well-being produced by the arts has a domino effect that has an impact on the real lives of patients,” said Calabria, the principal investigator. He pointed out that, unlike other experiences, this project “was created with a clear research focus. Many interventions involving the arts are intended to have an impact on health, but their effectiveness hasn’t been studied.”

“We’re delighted to continue working with the UOC and the Hospital de Sant Pau on this project, which links the arts and health; the pilot test enabled us to obtain some initial positive results and see the development of the participants,” explained Alícia Gorina, head of the Teatre Lliure’s Educational Programme. Violeta Sugranyes, the theatre’s project coordinator, added: “We want to continue working to develop a method that can be applied in other social contexts and strengthen the argument for prescribing the arts as part of the health system in the future.”

Parkinson’s, the second most prevalent neurodegenerative disease

The project focuses on patients with Parkinson’s because it is the second most prevalent neurodegenerative disease in society and its incidence is expected to increase considerably over the next 20 years. In addition to problems with movement, sufferers have cognitive difficulties, especially in terms of attention and working memory; they also tend to suffer from apathy, anxiety and even depression. Moreover, there is still a stigma attached to the condition, which leads to a reduction in social relationships.

Participants will be recruited with the assistance of the Movement Disorder Unit at the Hospital de la Santa Creu i Sant Pau. For its part, the Teatre Lliure will be in charge of designing activities together with the UOC researchers, selecting the plays that the participants will see and organizing the workshops.

According to Carmen García, neuropsychologist with the Neurology Service at the Hospital de la Santa Creu i Sant Pau, “the therapeutic approach to Parkinson’s disease is complex and requires a combination of pharmacological and non-pharmacological treatments. We’re very happy to be participating in this project, which offers an opportunity to contribute to our knowledge of the efficacy of non-pharmacological therapeutic options applying the necessary scientific rigour. The project combines performance activities and has the therapeutic advantage of being carried out in the context of a group of people with the same disease, which is very beneficial psychologically”.

A total of 50 volunteers will participate, divided into two groups: 25 will participate in theatre activities and another 25 will be limited to doing cognitive stimulation, attention and memory activities from home with materials that will be supplied to them. In both groups, the emotional and cognitive state of the participants will be evaluated before and after the intervention.

In a second phase, they will repeat the theatre activity but online, with the aim of breaking down barriers for people who do not live near cultural facilities. “We’ll try to determine whether remote participation brings the same benefits as face-to-face participation. Here, the key element will be the role played by the group factor”, Calabria commented.

The emotional and cognitive alterations of neurodegenerative diseases have a negative impact on the quality of life of those affected and their environment, with a progressive worsening throughout the disease. We therefore need to investigate new approaches to treating these alterations in combination with pharmacological therapy. Arts in Health could be an innovative methodology to meet this need to improve well-being.

Dr. Noemí Rotllan Vila, principal investigator of the Pathophysiology of Lipid-Related Diseases Group at the Sant Pau Research Institute (IR Sant Pau), has been consulted as an expert by the Science Media Centre platform to provide her assessment of the awarding of the Nobel Prize in Physiology or Medicine to scientists Victor Ambros and Gary Ruvkun. This award recognizes their significant contributions to the discovery of microRNAs, small non-coding RNA molecules that play a fundamental role in regulating gene expression.

“I cannot hide my joy in seeing how the pioneering work of two great scientists, who began their research in the 1980s, is recognized worldwide,” Dr. Rotllan stated. According to the expert, the studies of Ambros and Ruvkun have not only expanded the understanding of cellular development but also opened the door to new therapeutic avenues for various diseases, including cancer and cardiovascular diseases.

Dr. Rotllan highlighted that her own research also focuses on the fascinating world of microRNAs. “These small sequences of only 19-22 nucleotides are capable of regulating gene expression at the post-transcriptional level, either by inhibiting translation or promoting messenger RNA degradation. It is astonishing how a single microRNA can control more than 100 mRNAs and, at the same time, how a single mRNA can be regulated by several microRNAs,” she explained.

Additionally, the researcher emphasized the potential of microRNAs as therapeutic targets and biomarkers in various pathologies. “Although clinical trials are in their early stages, as is the case with Miravirsen, the first drug specifically targeting a microRNA, it is a promising step towards personalized medicine,” she noted. Nonetheless, Dr. Rotllan wanted to remind that much research remains to be done before these therapies can be widely applied.

Finally, she underscored the importance of basic research conducted with model organisms, such as the small worm Caenorhabditis elegans. “Studies with these organisms are key to understanding fundamental biology and should not be underestimated,” she concluded.

This recognition of the discovery of microRNAs not only celebrates their scientific relevance but also highlights the path that remains to be traveled in the field of biomedicine, a path that researchers like Dr. Noemí Rotllan Vila continue to pave.

Biomarkers have revolutionized the understanding of Alzheimer’s disease (AD), enabling early detection and opening the door to personalized treatments. A series of six papers published in The Lancet Healthy Longevity and eBioMedicine, coordinated by researchers from the Sant Pau Research Institute (IR Sant Pau)—who led two of the six studies—highlight the main technical, clinical, and regulatory challenges currently faced when integrating these biomarkers into daily clinical practice and adapting them to different healthcare settings. The goal is to make them truly useful, accelerate Alzheimer’s diagnosis, and improve global access to preventive and therapeutic treatments.

In this series, experts emphasize the transformative potential of biomarkers in advancing the diagnosis and treatment of Alzheimer’s disease, while also underscoring the complex challenges of integrating these tools into clinical practice and trials. Research on biomarkers—or biological indicators—for Alzheimer’s disease has traditionally focused on their sensitivity and specificity in diagnosing the pathology. However, in clinical practice, their utility will greatly depend on their positive and negative predictive value, which is significantly influenced by different healthcare settings.

One of the two papers led by IR Sant Pau, “Challenges in the practical implementation of blood biomarkers for Alzheimer’s disease,” highlights the challenges in implementing newly developed plasma biomarkers to detect this neurodegenerative disease and discusses the main limitations for their use in different settings, stressing the need for standardization to ensure accuracy and reliability of results.

“For example, in specialized or primary care, or in potential implementation in screening programs, among others. Some of these challenges are as basic as understanding the influence of preanalytical effects, such as how the sample is extracted and processed before the biomarker analysis itself,” explains Dr. Daniel Alcolea, researcher at the Memory Unit of IR Sant Pau and member of the Neurology Department at Hospital de Sant Pau. “Another challenge is understanding the influence of other diseases that may alter the interpretation of these markers’ results.”

A special case: Biomarkers in Genetic Forms of Alzheimer’s Disease

The series of papers highlight two clinical practice scenarios where the importance of context in their use stands out. The first, addressed in the study led by Dr. Maria Carmona, researcher at the Memory Unit of IR Sant Pau and member of the Neurology Department at Hospital de Sant Pau, “Clinical and research application of fluid biomarkers in autosomal dominant Alzheimer’s disease and Down syndrome,” is the use of biomarkers in genetically determined forms of Alzheimer’s, such as early-onset autosomal dominant or Down syndrome. “Here, they are not so useful for diagnosing the disease, but rather help us understand what stage it’s in and monitor its progression.”

The second is the diagnosis of Alzheimer’s disease in populations with intellectual disabilities, one of the greatest challenges. In these individuals, symptoms may be masked by the underlying disability, and the use of reliable biomarkers can significantly improve diagnostic accuracy and facilitate access to disease-modifying therapies. This is especially important at a time when current diagnostic frameworks often exclude these populations.

Beyond the diagnostic realm, the six studies also emphasize the growing and crucial role of biomarkers in clinical trials, using them for appropriate participant selection, monitoring disease progression, and evaluating treatment efficacy. Biomarkers are essential tools that can significantly accelerate the development of effective treatments for Alzheimer’s and related dementias.

Reference Articles

1. Schöll M, Verberk I, del Campo M, et al. Challenges in the practical implementation of blood biomarkers for Alzheimer’s disease. THELANCETHEALTHLONGEVITY-D-23-00585R2.
2. Carmona-Iragui M, O’Connor A, Llibre-Guerra J, et al. Clinical and research application of fluid biomarkers in autosomal dominant Alzheimer’s disease and Down syndrome. EBIOM-D24-01284R2.
3. McFeely A, O’Connor A, P Kenelly S. The use of biomarkers in the diagnosis of Alzheimer’s disease in adults with intellectual disability. THELANCETHEALTHLONGEVITY-D- 2300442R1.
4. McGlinchey E. Duran-Aniotz C, Akinyemi R, et al. Biomarkers of neurodegeneration across the Global South. THELANCETHEALTHLONGEVITY-D-23-004551R3.
5. Pascoal T, Aguzzoli C, Lussier F, et al. Insights into the use of biomarkers in clinical trials in Alzheimer’s disease. EBIOM-D-24-01017R1.
6. Karlawish J, Grill J. Alzheimer’s disease biomarkers and the tyranny of treatment. EBIOM-D-23-04741R3.

Yang Song, postdoctoral researcher at the Iberoamerican Cochrane Centre, has been awarded the 2024 Najoua Mlika-Cabanne Prize by the Guidelines International Network (GIN) during the recent Global Evidence Summit (GES) held in Prague from September 10 to 13. Yang is the third researcher to receive this award for projects conducted at the Iberoamerican Cochrane Centre, following Robin Vernooji and Héctor Pardo, in the 12 editions of these awards.

Song, who also works as an assistant professor at the Chinese University of Hong Kong (Shenzhen), has been focused for the past six years on improving methodology and implementing guideline adaptation. Notably, she has led the RIGHT-Ad@pt checklist, participated in guideline adaptation, and contributed as vice-chair of GIN’s Adaptation Working Group.

“I am deeply honored to have been selected to receive the prestigious GIN Award in 2024, named after the esteemed Dr. Najoua Mlika-Cabanne. I am grateful for this recognition from the GIN community and am committed to continuing to promote innovation and collaboration in her legacy,” Yang Song stated.

She was nominated for this award by her doctoral thesis supervisor, Pablo Alonso Coello, a researcher at the Sant Pau Research Institute and collaborator at the Iberoamerican Cochrane Centre, for her contribution to advancing methodology for guideline adaptation, including living guidelines. Her role as vice-chair of GIN’s Adaptation Working Group also demonstrates her potential leadership in the methodological community.

On September 4th, Dr. M. Rosa Ballester i Verneda, Head of Responsible Research and Innovation (RRI) at the Sant Pau Research Institute, was inducted as a Corresponding Academic at the Royal Academy of Pharmacy of Catalonia. During the Extraordinary Public Session, held in the Academy’s auditorium, she delivered her speech titled “Gender and Sex Perspective in Biomedical Research: An Ethical Issue.”

This induction recognizes her outstanding career and reinforces the commitment of the Sant Pau Research Institute to integrating gender and sex perspectives into science, and to promoting research that upholds equality and ethics across all fields.

A study led by the Pharmacy and Neurology Services, with the collaboration of Impuls Digital, has evaluated the persistence, effectiveness, and tolerability of monoclonal antibodies targeting the calcitonin gene-related peptide (anti-CGRP) in patients with chronic migraine (CM) under real-world clinical conditions. Anti-CGRPs are drugs that work to prevent migraines, helping to reduce the pain burden on patients. The drugs studied include erenumab, fremanezumab, and galcanezumab.

If a patient is treated with one drug and does not improve, switching to another is possible, as even in a third of cases, the patient may respond to the change.
The retrospective and observational study included 281 patients treated with anti-CGRP between January 2019 and December 2022 at the Hospital de Sant Pau. Treatment persistence was measured, as well as the percentage of patients who maintained the treatment at 3, 6, and 12 months. Effectiveness was defined as a ≥50% reduction in the number of monthly migraine days (MMD), and tolerability was measured by the number and type of adverse events reported.

The results, published in the journal Headache, showed that treatment persistence at 12 months was higher with the first anti-CGRP treatment (66.7%) compared to the second (49.8%) and third (37.2%). Regarding effectiveness, a ≥50% reduction in MMD was achieved in 57.6% of patients with the first treatment at 3 months, while only 25.0% and 11.8% of patients achieved this response with the second and third treatments, respectively. In terms of tolerability, 55 adverse events were reported in 43 patients (15.3%), mostly mild, and only 14 patients (5.0%) discontinued treatment due to these effects.

The study concludes that persistence with anti-CGRP treatment is higher with the first anti-CGRP treatment and decreases with subsequent treatments, especially when the change is due to lack of effectiveness or severe adverse effects. Additionally, it confirms that the tolerability profile of anti-CGRP monoclonal antibodies is favorable, with a relatively low number of treatment discontinuations due to side effects.

The researchers emphasize the need for further studies to identify predictors of response after changes in anti-CGRP treatment in patients with chronic migraine.

Reference Article:

De Dios A, Pagès-Puigdemont N, Ojeda S, Riera P, Pelegrín R, Morollon N, Belvís R, Real J, Masip M. Persistence, effectiveness, and tolerability of anti-calcitonin gene-related peptide monoclonal antibodies in patients with chronic migraine. Headache. 2024 Sep 13. doi: 10.1111/head.14827. Epub ahead of print. PMID: 39268992.

A new study reveals a therapeutic pathway that could improve the cardioprotective potential of “good” cholesterol (carried by HDL) in people with familial hypercholesterolemia, a genetic disorder that leads to very high levels of “bad” cholesterol (LDL). The study was conducted by researchers from the CIBER Diabetes and Associated Metabolic Diseases (CIBERDEM) and Cardiovascular Diseases (CIBERCV) areas of the Sant Pau Research Institute and the Hospital de Sant Pau in Barcelona.

Heterozygous familial hypercholesterolemia is a disorder primarily inherited due to mutations in the LDL receptor gene and is characterized by high levels of LDL cholesterol, often associated with low HDL cholesterol levels. Familial hypercholesterolemia is quite common, with an estimated prevalence of at least 1 in 250 people, and carries a high cardiovascular risk.

The study, led by Joan Carles Escolà Gil and Francisco Blanco Vaca, researchers from CIBERDEM at the Sant Pau Research Institute and Hospital de Sant Pau in Barcelona, has been published in the journal JACC: Basic to Translational Science.

New Pathway to Eliminate “Bad” Cholesterol

PCSK9 protein inhibitors are among the most advanced and effective treatments for reducing LDL cholesterol levels and, consequently, cardiovascular risk. This new study has now identified a new metabolic pathway through which these PCSK9 protein inhibitors promote HDL’s ability to transport cholesterol from macrophages in the arterial wall and transfer it to LDL, allowing its subsequent elimination from the body through the liver, bile, and feces.

The study’s results show that functional alterations in the LDL receptor reduce cholesterol transport from macrophages and its elimination from the body, which can be reversed with PCSK9 inhibitors. Carla Borràs, the first author of the study and a researcher at CIBERDEM in the Sant Pau Research Institute, indicates that “the findings of this new study could open up new therapeutic possibilities to prevent cardiovascular risk in patients by increasing this metabolic pathway.”

Additionally, Marina Canyelles, co-first author of the study, from the same research group, states that “future research should analyze the effects of PCSK9 inhibitors on this pathway in other forms of hypercholesterolemia and their association with the reduction of cardiovascular events.”

Researchers from the Sant Joan University Hospital in Reus, the Institute for Biomedical Research of Barcelona/CSIC, the Ramón y Cajal University Hospital, and Finnish institutions such as the Wihuri Research Institute and the Minerva Foundation Institute for Medical Research also participated in the study.

Reference Article

Carla Borràs, Marina Canyelles, Josefa Girona, Daiana Ibarretxe, David Santos, Giovanna Revilla, Vicenta Llorente-Cortes, Noemí Rotllan, Petri T. Kovanen, Matti Jauhiainen, Miriam Lee-Rueckert, Luis Masana, Francisco Arrieta, Javier Martínez-Botas, Diego Gómez-Coronado, Josep Ribalta, Mireia Tondo, Francisco Blanco-Vaca, Joan Carles Escolà-Gil, PCSK9 Antibodies Treatment Specifically Enhances the Macrophage-specific Reverse Cholesterol Transport Pathway in Heterozygous Familial Hypercholesterolemia, JACC: Basic to Translational Science, 2024, ISSN 2452-302X, https://doi.org/10.1016/j.jacbts.2024.06.008. (https://www.sciencedirect.com/science/article/pii/S2452302X24002535)

A recent study published by researchers from the Reproductive Health Group of the Sant Pau Research Institute (IR Sant Pau) and the Gynecology and Obstetrics Service of Sant Pau Hospital concludes that there is a clearly direct and significant relationship between the intensity of changes in emotional state due to stress factors during the COVID-19 pandemic lockdown and the incidence of menstrual changes: regularity, duration, and amount of menstruation. The research, published in the journal Medicina Clínica, was conducted based on the responses of more than 6,000 women to a survey and is one of the most extensive studies carried out so far on the impact of the pandemic on Reproductive health.

“Changes in emotional state, but not the duration and intensity of isolation or exposure to the disease, significantly influenced menstrual disorders during the COVID-19 lockdown,” explains Dr. Joaquim Calaf, director of the Reproductive Health Group at IR Sant Pau and Honorary Professor at the Autonomous University of Barcelona (UAB). “Women who experienced greater emotional stress during the lockdown, whether due to restrictions on activities, fear of getting sick, or concern about infecting their relatives, showed an increase in menstrual cycle alterations,” according to Dr. Josep Perelló, from the Reproductive Health Group at IR Sant Pau and adjunct of the Gynecology and Obstetrics Service at Sant Pau Hospital.

The results were obtained from anonymous surveys of women who had menstruation between the ages of 15 and 55 residing in Spain between March 14 and May 2, 2020, with 22 questions related to sociodemographic characteristics and social and work activities; psychological state and sexual activity; and menstrual changes and impact on quality of life during the lockdown. In total, 4,989 survey responses were analyzed.
According to the researchers, in crisis situations like the pandemic, it is essential to consider the impact of emotional well-being on women’s physical health, particularly in aspects such as menstruation, which can be strongly influenced by stress. Moreover, they state that this study opens the door to future research that could help better understand the relationship between mental health and reproductive health, and also to design more effective interventions to support women in times of crisis.

Other results obtained in this study are that 50.1% of women reported a worsening of their quality of life during the lockdown and that 19% indicated that their quality of life associated with menstruation worsened. Furthermore, 49.8% of participants reported a decrease in sexual activity during this period.

Changes in Menstrual Cycle Duration Associated With Vaccination Timing

In a previous study, the Reproductive Health Group of IR Sant Pau also found that there is an association between the menstrual cycle phase at the time of vaccination and changes in the duration of the menstrual cycle. According to Dr. Calaf, “vaccination during the luteal phase, that is, between ovulation and the first day of menstruation, would have a protective effect on the action of the COVID-19 vaccine and the induction of menstrual cycle disorders, compared to vaccination during the follicular phase, that is, before ovulation.” Both Dr. Calaf and Dr. Perelló point out that the results “suggest considering the menstrual cycle phase for the design of future COVID-19 vaccination policies and vaccination recommendations during the luteal phase.”

Specifically, the researchers observed that women who were vaccinated during the follicular phase had an average increase in cycle duration of one day, while those vaccinated during the luteal phase did not experience any increase. Moreover, in the group of women vaccinated in the follicular phase, 11% experienced an increase in menstrual cycle duration of more than 8 days, a clinically significant value.

This study, published in the American Journal of Obstetrics and Gynecology and developed jointly by researchers from Sant Pau, IIIA-CSIC, the University of Geneva (Switzerland), and the Catalan Agency for Health Quality and Evaluation (AQuAS), was conducted using data collected by the Lunar App.3 mobile cycle tracking app, which allows for a review of the cycle and menstruation, recording the start and end and other data such as pain intensity, amount of blood loss, and COVID-19 vaccination status. The analyzed database included 28,876 women and 126,529 cycles.

Reference Article

Calaf, J. Perelló-Capó, I. Gich-Saladich et al. Effects of SARS-COVID-19 lockdown on menstrual patterns: A transversal large sample survey. Medicina Clínica 2024. Jun, Vol. 162, Issue 12, P. 581-587. https://doi.org/10.1016/j.medcli.2024.01.016

Patients with type 2 diabetes mellitus (T2DM) have a higher prevalence of cardiovascular disease, including both coronary artery disease and heart failure. Diabetic cardiomyopathy is a condition where cardiac dysfunction occurs independently of the presence of coronary atherosclerosis. This condition may be due to various factors, such as metabolic alterations or an increased inflammatory state. T2DM patients have a larger volume of epicardial fat, which is in direct contact with the cardiac myocardium. Under normal circumstances, this fat has a protective function and supplies fatty acids as an energy source for cardiomyocytes. However, when there is an increased volume of epicardial fat, it favors the presence of cardiac dysfunction.

In this context, the hypothesis of the present study was that, in addition to a greater volume, the epicardial fat of T2DM patients is dysfunctional and exerts a harmful effect on the functionality of cardiomyocytes. In the study conducted by members of the CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM) at the Sant Pau Research Institute (IR Sant Pau) in Barcelona, it is described how the epicardial fat, obtained from cardiac surgery, of T2DM patients shows alterations in the expression of inflammatory genes and genes related to lipid accumulation, and also releases lipids with a negative effect on cardiomyocytes. Specifically, the cultured epicardial fat from T2DM patients secretes more atherogenic ceramide species and, in the case of T2DM with coronary disease, more saturated free fatty acids than that of non-diabetic patients. The study demonstrates how these lipid species are responsible for the inflammatory and cytotoxic effects exerted by epicardial fat on cultured cardiomyocytes.

ApoJ is a protein with chaperone action, contributing to the proper folding of other proteins, and has been attributed cardioprotective properties. A particularly relevant result of this study is that the addition of apoJ minimized the deleterious effects of T2DM epicardial fat on cardiomyocytes. Therefore, the results suggest that apoJ could improve cardiac function, particularly in T2DM patients, by counteracting the harmful effect of epicardial fat.

Dr. Sonia Benítez, CIBERDEM researcher at IR Sant Pau, the last author and corresponding author of the article, points out that “it is highly relevant that T2DM patients, in addition to having a larger volume of epicardial fat, also present a qualitative alteration in it that leads to the secretion of lipid species with inflammatory and toxic effects on cardiac cells, as this could contribute to the onset of the so-called diabetic cardiomyopathy.”

Meanwhile, Dr. José Luis Sánchez-Quesada, also a CIBERDEM researcher and corresponding co-author of the article, states that “the inhibition of the deleterious effect of T2DM epicardial fat by apoJ opens a pathway for the design of strategies based on this molecule aimed at reducing the risk of heart failure.”

Both researchers believe that the findings are innovative, but further research into the mechanisms involved, and the physiological consequences is needed.

Reference Article:

Apolipoprotein J Protects Cardiomyocytes from Lipid-Mediated Inflammation and Cytotoxicity Induced by the Epicardial Adipose Tissue of Diabetic Patients.

Puig N, Rives J, Gil-Millan P, Miñambres I, Ginel A, Tauron M, Bonaterra-Pastra A, Hernández-Guillamon M, Pérez A, Sánchez-Quesada JL*, Benitez S*.

Biomed Pharmacother 2024 Jun;175:116779.

doi: 10.1016/j.biopha.2024.116779. Epub 2024 May 21. PMID: 38776681

A study published in the journal Neurology concludes that the use of statins—drugs to lower blood cholesterol—significantly reduces the risk of recurrent stroke without increasing the risk of brain hemorrhage in patients with cerebral microbleeds. The Sant Pau Research Institute (IR Sant Pau), specifically the Cerebrovascular Diseases Group, has been one of the 32 cohorts that carried out this work based on their data, included in the international registry of patients with stroke and microbleeds called the Microbleeds International Collaborative Network (MICON).

The research included 16,373 patients with an average age of 70 years and a follow-up period of 15 months. Of these patients, 10,812 received statins after hospital discharge—4,669 of whom had one or more cerebral microbleeds. Compared with the control group, statin treatment in these patients was associated with a lower risk of any stroke: 53 versus 79 per 1,000 patient-years, and a lower risk of ischemic stroke during follow-up: 39 versus 65 per 1,000 patient-years. As for the risk of intracranial hemorrhage, the results were 11 versus 16 per 1,000 patient-years.

“According to this study, the use of statins does not increase the risk of intracranial hemorrhages in patients with cerebral microbleeds, offering a safe and effective alternative for secondary stroke prevention,” explains Dr. Luis Prats, researcher of the Cerebrovascular Diseases Group at IR Sant Pau and member of the Cerebrovascular Diseases Unit at the Neurology Service of Sant Pau Hospital.

Cerebral microbleeds are small blood leaks that can be detected with an MRI, often associated with cerebrovascular diseases. They are classically considered a marker of hemorrhagic risk, which is why the use of oral anticoagulants or statins has been controversial.

The Cerebrovascular Diseases Group at IR Sant Pau is a multidisciplinary team of professionals with a long and established track record in the study of stroke from both a clinical and basic perspective. Moreover, the Cerebrovascular Diseases Unit at Sant Pau Hospital is certified by the European Stroke Organization, recognizing Sant Pau as a reference center for the treatment of patients with stroke of any complexity, 24 hours a day. Additionally, it is part of the Catalonia Stroke Code (CICAT), an urgent action protocol that includes the activation of a network of healthcare devices aimed at providing immediate and appropriate care to patients with suspected stroke.

Reference Article

Prats-Sanchez, L., et al. (2024). Statin Therapy for Secondary Prevention in Ischemic Stroke Patients With Cerebral Microbleeds. Neurology. 2024 Apr 9;102(7).

https://doi.org/10.1212/WNL.0000000000209173

A study conducted by researchers at the Institut de Recerca Sant Pau (IR Sant Pau) has revealed that a greater quantity of T cells in lymphocytic foci is associated with an increased risk of severe flares in Sjögren’s syndrome. The work has been published in the journal Frontiers in Immunology.

Sjögren’s syndrome is a rare autoimmune disease that primarily affects the salivary and lacrimal glands. This study analyzes data from 78 patients over a 3-year follow-up period. Specifically, the composition of lymphocytic foci in minor salivary gland biopsies and its relationship with severe flares of the disease and its severity were studied.

The results indicated that a greater quantity of T cells in the lymphocytic foci was associated with an increased risk of severe flares of the disease. Additionally, it was observed that improvements in the Sjögren’s syndrome disease activity index were related to a higher count of total lymphocytes and T and B cells in the lymphoid composition of the foci. These findings underscore the importance of the composition of lymphocytic foci in minor salivary gland biopsies as a prognostic indicator for severe flares of the disease in patients with Sjögren’s syndrome.

Dr. Laura Martínez, from the Inflammatory Diseases group, and Dr. Hye Sang Park, from the Multi-organ Damage and Rheumatology group at IR Sant Pau, explain that although Sjögren’s syndrome primarily affects the salivary and lacrimal glands, “it can also have serious implications in other organs, such as the nervous system.”

This study not only aims to improve the diagnosis of the disease, but “also helps identify prognostic indicators that allow us to predict severe flares in patients.”

Although the technique is relatively non-invasive, it offers a large amount of information that could be crucial for the clinical management of patients with Sjögren’s syndrome, many of whom may be underdiagnosed.

“In short, our research not only contributes to better diagnosis but also opens the door to new therapeutic strategies and a better understanding of the underlying mechanisms of the disease.”

Reference Article

Park H-S, Martínez-Martínez L, Magallares López B, Castellví I, Moya P, Codes-Mendez H, Hernandez Sosa N, Diaz-Torne C, Laiz A, Sainz L, Tandaipan JL, Mariscal A, Franco-Leyva T, Casademont J, Juarez C and Corominas H (2024) Prognostic significance of lymphocytic foci composition in minor salivary gland biopsies for severe disease flare and severity in Sjögren’s syndrome: a 3-year follow-up cohort study. Front. Immunol. 15:1332924. doi: 10.3389/fimmu.2024.1332924

If the healthcare system were a country, it would be the fifth most polluting in the world in terms of global warming. Moreover, between 25% and 50% of its carbon footprint is due to medications, with pressurized inhalers being among the most impactful on the environment. To raise patient awareness about the importance of correctly recycling them at the SIGRE Point in pharmacies, the Hospital de Sant Pau and the Sant Pau Research Institute (IR Sant Pau) have launched the multicenter GIMAFH project, which involves 42 other hospitals across Spain with the support of the Spanish Society of Hospital Pharmacy (SEFH). In fact, experts estimate that if inhalers were recycled properly, over 100,000 tons of CO2 emissions could be avoided annually.

Inhalers, of which 15 million units are sold annually in Spain, are among the most polluting medical devices, mainly because they contain gases called hydrofluoroalkanes that have a potency between 1,300 and 3,500 times greater than CO2 and contribute to the greenhouse effect: using each inhaler is equivalent to 300 kilometers of car CO2 emissions. Additionally, they also contain other components, such as plastic, metal, cardboard, and paper, which must also be correctly recycled at the SIGRE point, where they are sent to the treatment plant for packaging and medical waste, sorted, and given the most appropriate treatment in each case.

“Many times, mainly due to lack of knowledge, inhalers are thrown directly into the trash or the yellow container, but their components require specific treatment to prevent environmental damage,” explains Noé Garin, a researcher in the Pharmacy Research Group at IR Sant Pau and assistant at the Pharmacy Service of the Hospital de Sant Pau. Despite the significant impact inhalers have, “they are essential bronchodilator medications for treating respiratory diseases like asthma or COPD, and we cannot stop administering them to patients. Faced with this situation, we considered what we could do as healthcare professionals and as a hospital, and this has been the starting point of the GIMAFH project.”

A project in two phases: the first research and the second educational.

The GIMAFH project, led by Sant Pau, is carried out with the participation of 42 hospitals across Spain and with the support of the SEFH. Its first objective is “to know the degree of awareness of the patients who come to the hospital to collect their medication about the environmental impact of pressurized inhalers and also to know what management they make of these wastes once the treatment is finished, has expired, or if their doctor has modified the prescription and they will no longer use it. We do this with a brief survey that also allows us to know if there are certain personal factors that influence this greater or lesser awareness: age, sex, health status…”.

In this phase, patients are also provided with an explanatory infographic of the different parts and components of the inhaler, with data illustrating its environmental impact, “such as that if their inhaler were a car, it would emit 30 kg of CO2, equivalent to 300 km of car emissions,” and information that they should always take them to the SIGRE point at their pharmacy to recycle them and minimize their environmental impact. “It’s about empowering patients in this regard,” says Noé Garin.

In a second phase of the GIMAFH project, which is carried out three months after the first, patients are re-contacted to see if the information initially provided has translated into better awareness of the environment and also about the handling and recycling of inhalers. This data will be available towards the end of the year.

Although the first phase of the GIMAFH project has been carried out with about 400 asthma patients, “the idea is to extend it to other respiratory diseases where pressurized inhalers are also prescribed, such as chronic obstructive pulmonary disease (COPD) and also to patients not only adults but also children…”, explains Noé Garin.

Another future goal is that the informative infographic “is available to all hospitals in Spain -both for those who have participated in the project and for the rest- for Primary Care and for various professional profiles: doctors, nurses, pharmacists… because together we can carry out proper management and recycling of these wastes.”

Another step, further ahead and related to these goals of reducing the environmental impact of inhalers, would be to work on a “green prescription project” for these devices. This means exploring whether it is possible to opt for other types of inhalers that are not pressurized, depending on the needs and characteristics of each patient,” concludes Noé Garin

Cochrane, an international scientific organization, has announced the creation of five Evidence Synthesis Units (ESU) as a result of a competitive call to which 15 proposals from 10 countries of 6 continents. One of these five units, which will be responsible for undertaking evidence synthesis tasks from organizations around the world and producing high-quality systematic reviews, is the Iberoamerican Cochrane ESU, promoted from the Iberoamerican Cochrane Center – located at Sant Pau Campus Salut Barcelona – whose director is Gerard Urrútia. This ESU will be directed by Eva Madrid and Tomás Pantoja. The other four ESUs are those of Australia, India, Germany and Nigeria.

The new Cochrane ESU Iberoamerica is made up of seven partners or synthesis subunits, among which are those of the Iberoamerican Cochrane Center, coordinated by Marta Roqué, and that of Cochrane Madrid, located at the Ramón y Cajal Hospital in Madrid, coordinated by Jesús López Alcalde and Javier Zamora. The other five subunits are those of the Instituto de Efectividad Clínica y Sanitaria (IECS), from Argentina, the Pontificia Universidad Católica de Chile, the Instituto Universitario del Hospital Italiano de Buenos Aires, from Argentina, and the Centro Interdisciplinary Health Studies (CIESAL) in Valparaíso (Chile).

In addition, ESU Iberoamerica will initially have three collaborating institutions to develop its work: Cochrane Switzerland, Cochrane Holland and the Universidad de Antioquia, in Colombia.

The geographical distribution of the new units, each on a continent, reflects Cochrane’s commitment to producing evidence that helps improve the health of people around the world. In addition to generating high-quality evidence synthesis, the units will also adopt innovative methods, promote health equity and advocate for research integrity, and strengthen or develop partnerships with stakeholders to support long-term sustainability Cochrane term.

Following Cochrane’s announcement of the creation of the Iberoamerican ESU, its director, Eva Madrid, noted: “We envision becoming a leading evidence synthesis unit in the Iberoamerican region, recognized for its rigorous methodologies, its timely delivery and its contributions to the advancement of health knowledge.Through strategic alliances and cutting-edge technologies, we aspire to drive positive change and foster better health and more equity in diverse communities”.

For her part, the Editor-in-Chief of the Cochrane Library, Karla Soares, emphasized that the new Evidence Synthesis Units are a key part of a wider program of change at Cochrane: “Our program ‘ The Future of Evidence Synthesis’ is having a transformative impact on Cochrane’s ability to deliver reviews that respond to the needs of our users worldwide.By implementing structural changes, Cochrane aims to be more agile and adaptable in a competitive environment, allowing the organization to effectively execute its new science strategy.”