Interview: Elena Tremoli – Scientific Director, Centro Cardiologico Monzino, Italy

UntitledElena Tremoli, Scientific Director at Centro Cardiologico Monzino, explains the importance of both applied and cardiovascular research in Italy, and how prevention in this area will be key in the future.

Centro Cardiologico Monzino is the only institute of excellence in Europe exclusively devoted to cardiovascular diseases. Can you describe the foundation’s mission and what differentiates it from other institutions?

There two main differences: first, we only attend to heart and vessel diseases and second, we combine research with clinical care. This allows us to provide our patients with the latest approaches and treatments in terms of care. Indeed, at Monzino we combine our clinical activities with the university as well as research. This means that we have three different areas working hand in hand to arrive at better, more integrated results. This also means that we go beyond basic research into applied research, applying our research findings to the problems of our patients To be able to do so, for instance, our researchers receive medical samples directly from our surgical rooms. This integration and constant exchange of knowledge is a very unique dimension of Monzino that ultimately leads to better patient outcomes.

To be able to provide this holistic approach, you need to have the right talent. Do you agree with the statement that Italy is experiencing a “brain drain” of talented scientists leaving the country for good?

At Monzino, we are very lucky to have skilled and talented researchers. I agree however, that overall, we are facing the problem of losing talented scientists, sometimes because they are unable to find a suitable place in Italy to conduct their research. At Monzino, it is my purpose to create the right environment for researchers in order to attract as well as keep them. Nevertheless, I think researchers should be able to move freely from one place to another. I do not want my researchers to start their career here and stay here until the end. I believe it is important to change, maybe stay abroad for a few years – to export the Italian knowledge to other places in the world and ultimately import the knowledge that has been  acquired elsewhere.

Centro Cardiologico Monzino’s research is performed at the interface of basic and clinical research focusing on developing new translational approaches. To facilitate this process, you performed a structural reorganization of the research laboratories, generating 12 independent Research Units in 2013/14. Can you tell us the rationale behind this overhaul?

The structural reorganization into the 12 independent research units results in benefits for the whole organization. These research units are headed by principal investigators who are working close together with their collaborators  and have a high degree of independency in their research.

Dividing research into these 12, relatively small, groups also means a divided responsibility in our research in order to make the group grow as a whole.

Indeed, we are currently working on defining the role of Monzino’s researchers, which will of course be different from the role of Monzino’s clinicians. While we foresee the principal investigator will  stay within the Monzino group, we expect that collaborators will most likely move around more often. I believe that knowledge exchange is important and within the metropolitan area of Milan we collaborate with  excellent institutes, such as the San Raffaele Hospital  and the University of Milan.

Do you collaborate with the pharmaceutical industry in research and/or clinical trials?

In order to develop cardiovascular treatments, we collaborate with the pharmaceutical industry, especially in clinical trials. Beyond the pharmaceutical industry, we collaborate with the medtech and medical device sectors to test the latest developments in the field of interventional cardiology and heart surgery,  and thus we have become a leading center for these activities.

We also perform basic research for the pharmaceutical industry, but unfortunately the sector does not invest as much in research. However, I am convinced that there should be more research activities because the results, especially in applied research, will ultimately benefit the industry.

Can you briefly discuss the projects you are most excited about?

One of the programs we are engaged in is ProSALUTE, a cardiovascular prevention program that was started here at Centro Cardiologico Monzino.  The goal of the program is to involve the inhabitants of Ponte Lambro in individual and community actions to improve their overall health and well-being. The program includes a first meeting in which we try to understand the status quo of people’s health and lifestyles (i.e. questions and blood tests). Based on the results, second meetings are conducted in which our teams draw up personalized plans for cardiovascular prevention.

With an increasing number of cardiovascular patients, prevention plays a key role in the fight against the disease. While the majority of people are aware of the dos and don’ts to avoid cardiovascular risks, including diet and fitness, they do not act accordingly to prevent the disease. As a result, prevention has become an increasingly important factor of our strategy  at Centro Cardiologico Monzino.

What is the state of cardiovascular disease research in Italy?

I think that research on cardiovascular disease is slightly increasing because the consequences of the disease can lead to death.

Furthermore, the results that we achieve can be applied to other treatment areas, such as oncology. Indeed, an area that has emerged from the exchange of knowledge between these two therapeutic areas is cardioncology.

Moreover, the number of patients suffering from cardiovascular disease continuously increases and researchers nowadays face different scenarios – the disease is not the same as it was 20 years ago. Nevertheless, the one thing we still have to investigate is what actually causes the disease. We cannot expect to find a single factor that will sufficiently explain a multifactorial disease.

What are your ambitions as scientific director of Menzino?

My ambition is to really strengthen our mentality aimed at getting results. Furthermore, I want to be able to identify risk-patients before they suffer from cardiovascular disease and to understand the genetic basis of cardiovascular disease, something that we still do not know much about. Lastly, I want to develop devices that are biocompatible

These are three very ambitious goals but for me, research is not simply a job – it is a way to live!

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