Josep Maria Grinyó is head of Nephrology Service at Bellvitge Hospital, professor at the University of Barcelona and group leader of IDIBELL's Nephrology and Renal Transplantation research group. Dr Grinyó believes that health care and research should go hand in hand, and he is convinced that clinical and basic investigators should work together. Dr Grinyó was one of the pioneers in our country to do experimental research in Nephrology and now he has launched a spin off to apply the results of years of research in transplant immunology.
What is this spin-off for?
We have generated a costimulatory molecule silencer involved in posttransplant acute rejection, in ischemia-reperfusion syndrome and in autoimmune glomerulonephritis. The results in laboratory and in animal models are very good, and we believe in its potential therapeutic use. From a research institute to the industry there is a long way that includes the dose study, the toxicity and the therapeutic efficacy test. This cannot be covered entirely in the academic field. Therefore we have created the spin-off. The academic world has a lot of innovation in the hands and a great ability to generate therapeutic tools, but unfortunately it cannot go beyond the animal validation phase. Often this capacity is just losing on the road. It has happened to us before and this time we have enough tools to make it worth a try.
These three diseases -acute rejection syndrome, ischemia-reperfusion and autoimmune-glomerulonephritis- seem so different. How could they be dealt together?
The immune response has a very fine regulation. If it wasn't, people would die of infections or autoimmunity. This balance is possible thanks to the costimulation. Nature always seeks effective, economic and redundant solutions. This is what happens to the path we have chosen, involving both the alloimmune response and the autoimmunity, so we can deal with the same strategy different clinical entities that share the same response pathway. The three entities are very different from the pathogenic point of view. The ischemia-reperfusion syndrome is triggered by innate immunity, the rejection is activated through the alloimmunity and the glomerulonephritis is triggered through the adaptive immunity. But all three share the same pathway of costimulation.
The therapy could be applied to other types of transplants?
Perhaps in the case of the heart is more complicated because it is a muscular organ, very vascular, quite different, but it could be extended to other models of transplantation, such as the liver.
What other lines of research are being carried out by your group?
We have a line of research in experimental diabetic nephropathy. We have made animal models of type one and two diabetes to study the contribution of growth factors and stem cells in reversing the damage of diabetic nephropathy. Another line of research we have recently started is the therapy in mesenchymal cells, from another animal model of chronic rejection. We also have a clinical line of biomarkers of immune response in renal transplantation, as part of a European consortium, from the fact that the evolution of graft and kidney damage is determined specifically by this type of response against the donor. In the laboratory we also have a line of research on dendritic cells in innate and adaptive immunity. We also make pharmacokinetics and pharmacogenomics studies... Things are going pretty well. We have always wanted to be translational in both directions. The laboratory results should be translated to the clinical practice, and experimental research must also answer clinical questions.
Do doctors are aware of the importance of this translation?
More and more clinicians concerned about this fact, and the sample is found in the same IDIBELL, especially among younger people.
Is there, then, good integration between basic and clinical research in IDIBELL?
IDIBELL has a long tradition in basic research, but in recent years strong clinical groups have arisen. These groups use clinical knowledge to perform experimental models. This should lead us to integrate clinical practice and quality research. It should be the main objective of a health research institute. Doctors should make research because they are who know the patients best. Therefore, it is important that IDIBELL, which now has a very good basic researchers, bears clinicians in mind, because they are the ones who give meaning to IDIBELL.
Do you think the current economic situation will make clinicians stop his research?
It is important to avoid that clinicians leave research. This would be like going back twenty years and it must be avoided at all costs. In our case, the [Bellvitge] hospital is better positioned than many other hospitals. We have a very high level of complexity and we are well prepared for the future. We are better than most hospitals and therefore we should not be pessimistic. But, of course, the hospital needs to be well treated.
"Transplantation is in a very mature moment"
This year, La Marató de TV3 [the Catalan television telethon] is dedicated to transplantation. Do you think this initiative will make society aware of the importance of transplants?
A few years ago TV3 dedicated another telethon to transplants and it was very positive. The transplant has two components. On one side it is a high-level therapy. Therefore, care is a commitment and a challenge for research. On the other hand, it has a great social impact. When I started, 80% of families refused and 20% accepted the donation of organs. Today this is backwards. Nowadays, transplantation is in a very mature moment. After many years of good medical care, we now need a good response in research.
But it seems that there are fewer donors.
It's true that the last year the number of donors was lower, but donation rates are maintained. The ageing of the population reduces the number of valid organs.
Do crossover transplants are an alternative?
Now the crossover transplants are incidental. To have a successful crossover transplant program we need to have more candidates who want to cross their donations. When we have a critical mass who want to cross their donation the odds of receiving an organ will increase greatly. But let me say that a successful transplant program should not be based on cross-transplantation; it should be a complement to the programs of cadaveric and living donor transplant.
The Spanish model of transplant coordination is an international reference. Is this success commensurate with the level of our research in this area?
More and more. Today the gap between clinical care and research is closing. Once established the clinical quality is time to expand research in transplantation, both clinical and experimental. I think we are on track. We have twenty years to consolidate the transplant programs. We are now at a more grateful stage, it's time to use it.