European Heart Journal (2014) 35, 877–882
doi:10.1093/eurheartj/ehu092
Portrait of the European Society of Cardiology
Council on Basic Cardiovascular Science
The Council increases the quality and visibility of basic science
by acting as an umbrella for European bodies in the field
The European Society of Cardiology (ESC) Council on Basic Cardiovascular Science was established in 2004 with Andrew Newby as the
first chairperson. He was succeeded by Karin Sipido in 2006, Raffaele
De Caterina in 2008, and Axel Pries in 2010. Today, Barbara Casadei
is at the helm.
The Council encompasses all the basic science Working Groups of
the ESC. These are the working groups on Thrombosis; Atherosclerosis and Vascular Biology; Coronary Pathophysiology and Microcirculation; Development, Anatomy and Pathology; Cellular Biology
of the Heart; Cardiac Cellular Electrophysiology; Myocardial Function; and Cardiovascular Pharmacology and Drug Therapy.
In addition, it includes the Editor of Cardiovascular Research, liaison
officers from the ESC Heart Failure Association and American Heart
Association, and representatives from a number of European affiliate
societies involved in basic cardiovascular science. These are the European Section of the International Society for Heart Research (ISHR),
the European Vascular Biology Organisation (EVBO), the European
Society for Microcirculation (ESM), the European Atherosclerosis
Society (EAS), the European Association for Cardiovascular Pathology (EACVP), and the European Council for Cardiovascular Research (ECCR).
‘This is what is unique about the Council’, says
Casadei. ‘It is a horizontal structure within the
ESC that also includes scholarly societies from
outside the ESC’.
Officers of the Council are chosen in a
two-step process. First, every Working Group
and Society elects one representative to the
Council. From that group of representatives, the chairperson, vicechairperson, secretary, and treasurer are elected. These officers
provide the strategic guidance and practical day-to-day management
of the Council.
She adds: ‘The quality and scope of what we can do together is so
much greater than what we would be able to do individually - this is
very satisfying for the people involved and very good for the ESC’.
Such a horizontal structure within the ESC also allows for integration;
Casadei says individual ESC Working Groups or Associations focus
on one theme. This has advantages but also the disadvantage that
ideas and discoveries are not discussed across the whole cardiovascular community.
As a collective group under the umbrella of the Council, the
Working Groups and Societies organize events which have been
important for increasing the impact, visibility, and quality of basic
and translational cardiovascular science.
The Council’s role within the ESC is to promote basic and translational science in the cardiovascular field, both at the main ESC Congress and at the Frontiers in Cardiovascular Biology (FCVB) meetings.
Casadei says: ‘Our model is to maintain a strong basic science programme within the ESC and to integrate basic science discovery with
the clinical programme’.
This integration at the ESC Congress is being accomplished
through various initiatives such as the ‘Science in Practice’ track. The
track aims to put advances in basic research into the context of clinical
needs and approaches. It is of interest to clinicians who want to learn
about the latest basic science findings and concepts that relate to
their area of clinical practice. It is also designed to provide insights
to basic researchers on how their innovations might be used in the
clinical environment.
‘We believe there is a continuum between basic, translational and
clinical science’, says Casadei. ‘As long as we can keep this vision
within the ESC and amongst the European funding bodies, the ESC
mission to reduce the burden of cardiovascular disease will thrive’.
While the ESC Congress covers the translational and clinical science
end of the continuum, the FCVB meeting’s main focus is at the basic
science end. The idea is to gather together all of the basic scientists
working on cardiovascular research in Europe in one venue. ‘There is
a place for small groups to do a focus meeting on a particular topic,
but there is also a risk of excessive fragmentation’, says Casadei. ‘To
have all of the science in one venue at FCVB and to promote cross fertilisation between all of the various Working Groups, Associations and
sister Societies is very important for achieving impact and progress’.
Another crucial strand of the Council’s work is to contribute to the
development of young scientists within Europe and beyond. One of
the main avenues for achieving this is the Scientists of Tomorrow group,
which includes young basic and clinician scientists.
Casadei says: ‘We are really hoping that through the Scientists of Tomorrow we will attract a young cadre of your researchers who would
not normally think of the ESC as their home because they believed it
was only for practising clinicians. We all need to be stimulated to look
at old problems with new eyes – a greater input from the younger
generation will help us doing that’.
She adds: ‘One of the ambitions of the Council, and certainly my
ambition, is to increase the critical mass of young people involved
in research and academic training within the ESC’.
Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2014. For permissions please email: [email protected]
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The Council also provides education and training through the Basic
Science Summer School, which is primarily targeted at early-stage
researchers (PhD and MD/PhD students in the first 3 years of their
research) and more experienced researchers whose PhD degree
was obtained within the last 2 years, and the Council has established
the First Contact Initiative Grants for young scientists or clinician scientists in Europe who want to set up a new collaboration or are considering changing labs. These grants enable them to spend a month or so
in a lab in a different country, either within or outside Europe. The aim
is to generate permanent contacts that lead to a fellowship or research affiliate position in basic cardiovascular science. Casadei
says: ‘It promotes that kind of mobility and exchange that are so
needed for the progress of science’.
Young researchers of all nationalities can apply for the ESC Basic Research Fellowship. One fellowship of E25 000 is awarded annually for a
researcher from any country to spend 1 year in a European research
laboratory. Casadei says: ‘This is to recognise excellence within
Europe. The model that if you want to do a really interesting postdoctoral you must go to the United States is a little obsolete’.
Travel grants are also provided to young researchers to attend the
ESC Congress or the FCVB meeting.
The Outstanding Achievement Award was established by the Council
to recognize basic researchers who are well on their way to becoming tomorrow’s leader in their field. Awardees receive E3000 and a
plaque during the Basic Science Poster Reception at the ESC
Congress.
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The council does not have its own official journal, but members
contribute significantly to the running of the ESC’s Cardiovascular Research. Sipido is editor-in-chief, de Caterina is consulting editor, and
Casadei, Pries, and other members of the council are associate
editors.
One aspiration in education is to increase the Council’s visibility
within the ESC eLearning platform, a web-based tool that aims to harmonize cardiovascular training across subspecialties. So far the
council has made a small contribution to ESC guidelines and this is
another area in which it wants increased visibility. Members of the
Council are also involved in the activities of the ESC EU Affairs Committee, providing input to the research agenda of this policy committee in the ESC.
Casadei sees a future in which there is more integration between
academic science and the science done in industry, particularly in
small biotech companies. Her ambition is for the Council to
promote an initiative in this area. She says: ‘I think that more interaction between these two groups of scientists would benefit both
and would help increase the impact and facilitate implementation
of scientific discovery’.
Inspiring the next generation of basic
cardiovascular scientists
Institutions that value research and clinical work will encourage young
scientists and foster excellence in cardiology
A career in science is unique and fantastic,
according to Prof. Karin Sipido, Leuven,
Belgium. ‘You are driven by curiosity, you want
to learn, you want to discover, you want to contribute’, she tells Scientist of Tomorrow, Dr
Senka Ljubojevic, on European Society of Cardiology (ESC) TV. ‘Coming to an academic environment you get an incredible amount of freedom to do the things
that drive you as a person’.
But how can young, budding talent be inspired to pursue basic cardiovascular science, given the potential for long hours and a reduction
in pay compared with full-time clinical work?
Having mentors was important for Sipido. It was David Brutsaert
who encouraged her to take up a scientific career, which she eventually pursued full time. Other mentors have provided advice and motivation along the way. When Sipido when to the USA, for example,
she began a post doc in the lab of Eduardo Marban, who at the time
was still an emerging scientist. ‘He has been extremely valuable in
guiding me throughout my career and I still meet with him regularly’,
she says to Ljubojevic.
She adds: ‘Everyone emphasised a certain aspect that helped me
moving forward’.
Sipido points out that a mentor is not someone you actively go out
and find. Instead, she says, ‘it’s someone you meet along the way. You
establish a connection and you keep it going for the rest of your career’.
While Sipido harbours some regrets about not carrying on with
clinical work, she acknowledges that doing both may have held her
back scientifically. But her message for today’s young cardiovascular
scientists is to work together. ‘That is something that I think is very
specific for these times, that we really need this collaboration
between basic science and clinical cardiology’, she says to Ljubojevic.
‘You have to specialise yourself, become expert, but build a network
and collaboration across a different expertise’.
Basic cardiovascular scientists can work solely in the lab or have a
dual career and be a clinician scientist. The latter is important but
challenging, says Prof. Stefanie Dimmeler (Frankfurt, Germany):
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‘Cardiologists appear to become more and
more like surgeons, being very active and doing
a lot of interventions, leaving very little time
for science’.
Cardiologists who want to do science need
free time but without a reduction in their salary.
This is a real problem, at least in Germany.
Dimmeler says: ‘In the end if you go to the lab and do science you
earn less money’.
Flexible time is also needed for the clinician scientist, which allows
them to have a part-time position in an academic environment. Cardiologists who want to perform interventions need training and so a
scenario in which they spend 2 or 3 days doing interventions and 2
days on science is one possibility.
Scientists do need a chunk of time off once in their career for training, whether they pursue a solely academic career or a dual career.
Clinician scientists must learn about statistics and basic scientists
need training in cell biology and animal biology. Both require a
minimum of 6 months to 1 year full time at the start.
Clinicians then need protected time during the week. ‘It’s no longer
possible to do it just in the evenings because science becomes more
demanding and a paper now takes two or three years’, says Dimmeler.
And with hospitals under pressure to make money, clinical work is
highly organized with little space to spontaneously take a couple of
hours out for science.
Clinician scientists have a better feeling for what the medical needs
are and can build translational research projects to answer relevant
questions. But Dimmeler says that the enthusiasm of young cardiologists for a dual career is decreasing because even if they get
regular time for science, they must spend extra time. ‘People want
to have a good work life balance’, she says. ‘On the other hand
there are still exceptional, highly motivated people who do it. And
maybe the percentage is not so relevant but [we should] support
those people who have this keen interest’.
Dimmeler adds: ‘You need people who are doing this not
only for their career but just because they are curious and have
this addiction to science. So it becomes fun for them and not only
work’.
Today’s generation can encourage young scientists by providing
good infrastructure in which to learn easily, mix with experts, and
draw on collaborators with different technologies. ‘It helps if . . .
you don’t have to build everything by yourself’, says Dimmeler.
‘The expectation is much higher to [use] a lot of different techniques
and you cannot do this by yourself anymore’.
The ESC Council on Basic Cardiovascular Science has recognized
the importance of nurturing the next generation and has created the
Scientists of Tomorrow group for young scientists and clinician scientists. A nucleus of young people involved in cardiovascular research
has been formed and one representative will meet with Council officers to discuss new initiatives.
Prof. Lina Badimon PhD (Barcelona, Spain),
vice-chairperson of the council, would like to
see the group collaborate with the ESC Cardiologists of Tomorrow. She says: ‘[Together] they
can bring new ideas that we can implement in
the future’.
Badimon says the concept of the clinician scientist has been quite successful in the USA but in
many European countries the type of research they can do is limited.
‘Research doesn’t bring breakthroughs and we want these within
Europe’, she says. ‘Probably the future will be in this new type of
person [who can] identify the clinical problem and bring solutions.
This requires basic research’.
There is anecdotal evidence of young fellows in the residency training track who do not want to do research because they feel the need
to finish their residency as soon as possible and get a stable clinical
position.
It is time to initiate a new era, says Badimon, in which young people
are not in a rush for staff positions, research fellowships are available
so they can take time out from clinical work, and institutions place a
high value on devoting time to research.
The top hospitals in Europe do recognize the importance of cardiovascular research. The benefits spread throughout cardiology
and extend to researchers and clinicians. ‘The stimulation of this
cross talk makes a general improvement’, says Badimon. ‘To have
strong research groups within the cardiology departments makes
everything better. The clinical work is better and there is an enthusiasm for the progress of cardiological science’.
Jennifer Taylor MPhil
Italy’s Institute of Clinical Physiology
Cardiovascular disease is the primary focus of the largest
biomedical institute of The Italian Research Council and is
headed by a cardiologist
Founded in 1968 by 40-year-old medical research tycoon Luigi Donato
with a disruptive multidisciplinary imprint, and lauded in 1996 as one of
the top-four beacons of Italian biomedical research by a Lancet survey
(Lancet 1996; 348:167–175), the Istituto di Fisiologia Clinica (IFC, Institute of Clinical Physiology) of Pisa is today the largest biomedical institute of the Italian National Research Council (CNR) (www.ifc.cnr.it).
Its primary focus is on cardiovascular disease and
relationships (in physiology and disease) between the heart
and lung, metabolism, environment, brain, and cancer. IFC’s
inter-, multi-, and trans-disciplinary approach is a breeding
ground for innovation.
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In the last 5 years, IFC has built six inter-institute laboratories in the
area, which are an ideal nursery for the development of new professional knowledge:
Number of IFC European projects 2007 –13
Istituto di Fisiologia Clinica now has 501 persons, of whom 181
are tenured staff, with 118 researchers and technologists: cardiologists, nephrologists, hypertensiologists, pneumatologists, radiologists, diabetologists, endocrinologists, biologists, engineers,
chemists, physicists, computer scientists, mathematicians, epidemiologists, and economists. Of this staff, 70% work at the Pisa
headquarters in the Research Area of CNR and 30% are deployed
at the offices in Reggio Calabria, Lecce, Massa, Milan, Rome, Siena,
and Messina, involved in top-level clinical settings.
At present, IFC has 79 running operating agreements on joint
projects with 29 different universities, 12 hospitals of the national
health system, 21 industries, and 17 other CNR institutes. The
spirit of this intellectual and administrative rainbow coalition is
expressed by the motto of the Institute (‘. . . e l’un dall’altro come
iri da iri parea riflesso..,’. . . one seems to be reflected by the
other, rainbow by rainbow . . .’, Dante, Paradiso, Canto XXXIII,
120), with the two rainbows of bedside technology-tocommunity medicine arising from a core interest in the patient
and the disease.
Istituto di Fisiologia Clinica’s infrastructure is divided into four main
areas, each equipped with state-of-the-art technology:
† molecular, cellular, and experimental medicine (with advanced
imaging facilities including micro-PET, micro-CT, and microultrasound);
† techno-sciences centred on the triangle of nano-bio-info
(e-health, nano-materials, biotechnology);
† clinical pathophysiology;
† clinical, environmental, social, and molecular epidemiology.
To avoid cultural fragmentation, as required by the quality standards
of multidisciplinary research, four areas of knowledge (the four stars
in the Institute logo) converge from different but complementary
perspectives on a few main topics of interest: atherosclerosis, cardiopulmonary, heart failure, environment, and health.
Another extraordinary asset of the Institute is its headquarters’ location at the core of the CNR Research Campus in Pisa, the largest
cluster of the Italian National Research Council boasting 1000
researchers working in 13 different institutes (‘13 institutes, one scientific soul’) covering a broad range of expertise from neurobiology
to nanomaterials, and from information/communication technology
to environmental science.
Earth-Environment-Health laboratory (with Institute of Ecological
Sciences);
Laboratory for Integrated Systems of Biology and Medicine (with Institute of Informatics and Telematics);
Laboratory for Multimodal Digital Semeiotics for Health and Wellbeing (with Institute of Science and Technology of Information);
Laboratory for Communication Physiology (with Institute of Computational Linguistics);
Train the Brain Lab (with Neuroscience Institute, for assessing cardiovascular roots of human dementia and the impact of an environmental enrichment programme on cognitive decline in early
stages of dementia); and
Environmental Biological and Isotopes Lab (with Institute of
Geoscience).
The number of publications in international peer-reviewed journals
has increased in recent years from 79 per year (average impact
factor 3.4) in 2002–07, to 280 in 2012 (average impact factor 4.0).
The number of European grants rose from two in 2007 to 27 today
(six as coordinator), with attraction of external resources of E9
million in 2012. The current IFC technology portfolio includes its
own radiopharmaceutical production site for sterile production of
radiopharmaceuticals under Good Manufacturing Practice, with nine
international patents, four licensed to industry, six deposited in 2012
and five incorporated in four active spin-offs—the two latest incorporating international patents of IFC engineers for innovative, operatorindependent, quantitative methods for ultrasound-based assessment
of vascular function (endothelium, compliance, and carotid intimamedia thickness in Quipu, based in Pisa) and osteoporosis (a known cardiovascular risk factor, in Echolight, based in Lecce).
Having left the overwhelming high volume of clinical activity (including top-level paediatric cardiac surgery) to the Tuscany Region in 2007,
IFC’s life began again at age 40 in 2008 with a special re-focus on innovative cardiovascular research. Since 2008, IFC has been headed by
Eugenio Picano (cumulative impact factor .1500, H-index¼ 60 by
Google Scholar), a 55-year-old clinical cardiologist with a strong background in cardiovascular imaging and multidisciplinary cardiovascular
research. Historically, the institute is specially credited for its pioneering contributions in computer science applied to cardiology (Carlo
Marchesi in the 1960s), role of coronary vasospasm in ischaemic
heart disease (Attilio Maseri in the 1970s), pathophysiology and diagnosis of pulmonary embolism (Carlo Giuntini in the 1980s), insulin resistance as a cardiovascular risk factor (Ele Ferrannini in the 1990s),
microvascular disease as a key determinant of myocardial ischemia in
coronary artery disease (Antonio L’Abbate) as well as in non-ischemic
dilated cardiomyopathy (Danilo Neglia), and stress echocardiography
in coronary artery disease (Rosa Sicari in the 2000s).
In the last 5 years, original contributions ‘made in IFC’ and impacting on cardiology practice include the need to evaluate the long-term
cancer risk (for patients and staff) in the risk–benefit assessment of
ionizing imaging tests, chest ultrasound for early diagnosis of pulmonary oedema in heart failure patients, and stress echo for innovative
applications beyond coronary artery disease (including aged donor
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heart recruitment and early diagnosis of pulmonary oedema in
extreme physiological settings).
In the pipeline, emerging evidence in a molecular epidemiology approach for early identification of non-cancer effects of environmental
pollutants and radiation exposure (including atherosclerosis in
exposed cardiologists) and a new information and communication
technology-based approach for cardiovascular imaging, characterized by pervasiveness (sensing everything from myocardial contractility to lung fluid), connectivity (acquiring images everywhere, from
Nepal to Sahara, and reading them in real time in Pisa), and sustainability (finding better ways to improve quality in healthcare at less cost
and risk).
Landmarks in the history of cardiology: II
From the distinguished physician Ibn-al Nafis (1213 – 88) to the
pre-Harvey era
In the seventh century, a period during which the West was in shock
from the collapse of the classical world and the barbarian invasions,
the Islamic civilization rose and contributed to the evolution of
several sciences. Islamic medicine flourished, enriched and improved
through the influence of the translated Greco-Roman medical manuscripts, keeping the medical torch lit during the period of medieval
darkness.
In the thirteenth century, the Arab physician Ibn-al Nafis (1213–
88), in his work titled: ‘Commentary on Anatomy in Avicenna’s
Canon’s’, provided one of the earliest accounts on pulmonary circulation when he wrote: ‘blood from the right chamber must flow
through the vena arteriosa (pulmonary artery) to the lungs, spread
through its substances, be mingled there with air, pass through the
arteria venosa (pulmonary vein) to reach the left chamber of the
heart and there form the vital spirit’.1
In the sixteenth century, the impact of Protestant Reformation
provided the impulse for a more experimental-based theory of
how the body worked, leading to anatomical dissection of corpses
that was prohibited under Catholicism. The Spanish theologian, physician, and humanist, Michael Servetus (1511–53), probably based on
the translated work of Ibn-al Nafis, also contributed to the schema of
blood circulation: ‘air is mixed with blood that is sent from the lungs
to the heart through the arterial vein; therefore, the mixture is made
in the lungs. The bright colour is given by the sanguine spirits of the
lungs, not by the heart’.2
Figure 1 De humani
corporis fabrica.
Figure 2 Heart in De
humani corporis fabrica.
During that period, the University of Padua, an example of civil,
political, and religious liberty, placed itself at the centre of the
anatomy revolution. Four remarkable anatomists contributed enormously to the study of the cardiovascular system. Andreas Vesalius
(1514–64) rekindled anatomy and broke Galen’s authority. A follower of Galen’s theories, Vesalius dissected the cadavers of condemned
criminals in an attempt to account for the differences in Galen’s writings. He discovered .200 anatomical errors in Galen’s work! In
1543, he published his magnum opus De humani corporis fabrica
(Figure 1) with 277 superb anatomy engravings (Figure 2). His
student, Realdo Colombo (1516–59) provided the first description
of a cardiac tumour, noticed the impermeability of the septum
between the right and left heart, and, in his book De re anatomica,
beautifully described the pulmonary circulation. Andrea Cesalpino
(1519–1603), a pupil of Colombo, discovered that blood in the
great veins flowed in only one direction, towards the heart. In
1589, in his manuscript Questiones medicinae, he invented the term
circulation without describing Harvey’s circulation theory.
In 1603, Hieronymus Fabricius of Acquapendente (1537–1619) published his manuscript
De venarum ostiolis (Figure 3) and meticulously
described the anatomy of venous valves
(Figure 4), even though they had been observed
years earlier by the Frenchman Charles Estienne
(1504–64) and the Italian Giovanni-Battista
Canani (1515–79).3,4
Figure 3 De venarum
Figure 4 Fabricius’ vein
ostiolis.
valves.
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It remained to Fabricius’ brilliant pupil, William Harvey (1578–
1657), to answer the mysteries and fit together almost all the
pieces of the puzzle in blood circulation.
References
1. Prioreschi P. Byzantine and Islamic Medicine. Omaha: Horatius Press; 2001, p270 –276.
2. Stefanadis C, Karamanou M, Androutsos G. Michael Servetus (1511 –1553) and the
discovery of pulmonary circulation. Hellenic J Cardiol 2009;50:373 –378.
3. Bounhoure JP. Histoire de la cardiologie: des hommes, des découvertes, des techniques.
Toulouse: Privat; 2004.
4. Grendler PF. The Universities of the Italian Renaissance. London: Johns Hopkins University Press; 2002, p328 –333, 339.
Corrigendum
doi:10.1093/eurheartj/ehtxxx
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Corrigendum to: Cardiopulse ‘‘When everything comes together!’ European Society of Cardiology Congress 2014’ [Eur Heart J
2014;35:331–332, doi:10.1093/eurheartj/eht564].
The author’s affiliations were incorrect for this article. Keith Fox’s correct affiliation is ESC Congress Programme Chair 2012-2014.
CardioPulse contact: Andros Tofield, Managing Editor. Email: [email protected]