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Dr. Àlvar Agustí

President of the Barcelona Respiratory Network (BRN)

He holds a PhD in Medicine from UB specializing in pulmonology. He has headed up the Barcelona Hospital Clínic Thorax Institute and since 2006 has been scientific director of the Networked Centre for Biomedical Research on Respiratory Diseases. He's one of the leading researchers in translational research to improve diagnosis and treatment of chronic obstructive pulmonary disease and has been a member of the Executive Committee of the European Respiratory Society. His newest challenge is presiding over the BRN to bring a global spotlight to Catalan research in respiratory disease.

More than twenty Catalan university hospitals, research centers, companies from the pharmaceutical industry and social organizations have created the Barcelona Respiratory Network (BRN), a non-profit foundation that has started working to strengthen and streamline research and innovation in the field of respiratory health.

The official presentation was made on 7 September at Palau Robert, coinciding with the congress held by the European Respiratory Society (ERS 2013), which brought together more than 20,000 professionals from around the world in Barcelona. Catalan Minister of Health Boi Ruiz and Barcelona City Council Health Delegate Cristina Iniesta attended the event in show of their respective government’s support for this public-private initiative.

Why has this network been created?

Respiratory diseases don’t have as high a profile in the media as other illnesses, but their impact on society and health is very significant. We must take into account that approximately 25% of all visits with general practitioners are regarding these pathologies. Lung cancer is the most frequent and malignant, asthma affects 5% of the population including children, chronic obstructive pulmonary disease (COPD) affects 10% of the adult population, tuberculosis, the flu, pneumonia… The BRN aims to tackle this frequent, expensive health problem that has significant consequences for public health.

Do you want to boost a global benchmark cluster in research and innovation in respiratory disease?

Yes. We haven’t invented this now. Barcelona has had a number of centers and scientists over the past 40 years that have been doing top-notch work in research and treatment of these diseases on a global level. Moreover, we have companies here at home that are interested and have strong research teams in this field. What the BRN Foundation will do is catalyze and bring all of this together, because if we join forces and seek out synergies, with support from the government, we will surely be able to gain greater visibility and boost our positioning as a cluster of excellence.

Will research institutions see you as competition?

The intellectual and conceptual discourse as to how to create the BRN took two years. One key point is that all members of the network already have their own research management system: Clínic has Idibaps, Bellvitge has Idibell, Vall d’Hebron has the VHIR, etc. The BRN isn’t a research center but a meeting point that serves as a catalyst to boost more and better research that will be carried out and managed by the institutions.

In the long term, are these networks expensive to run?

Not from an economic standpoint but they are costly in terms of interpersonal and inter-institutional relationships. There are always differing opinions and viewpoints, but I think that we want to understand each other and work together. Without that the BRN wouldn’t exist.

Have you worked together before?

Yes, some of the hospitals, research centers and industry stakeholders that belong to CIBERES have experience working together. Furthermore, although Barcelona is the driving force behind BRN, we are open to collaborating with centers and companies from around the country and the world.

What collaborative research projects have you started?

We are working on the very early stages of three very important projects. The first is a resource map, which will be made public and allow us to know what each center does, the resources and technology it has, the projects it is working on, the profile of its personnel, whether it has experimental models, etc. It is a project that will take months but we believe it will be a highly important tool for collaborating as a network.

The second project pertains more strictly to the research arena. We launched a call for expressions of interest to BRN researchers in order to find out which topics they believe are the most significant, taking into account that it will be research that will be transferred to society. After analyzing the responses, we have launched a call for a project on chronic respiratory patients with multiple hospitalizations, meaning patients that are often in the hospital for reason we don’t quite understand. We want to know why this happens and how we can treat them.

The third project we have underway is a workshop on personalized respiratory medicine, which we expect to hold in the first quarter of 2014 in Barcelona. We are negotiating with the American Journal of Respiratory and Critical Care Medicine, which is the most important journal in the world in this field, to co-organize the event.

Will the BRN receive funding from the Catalan government?

In theory, no. We have institutional support from the Government of Catalonia Department of Health and the Barcelona City Council, among others, but funding for joint projects will come through participation in public competitive calls or through private patronage. We are very proud to say that the economic resources to start up the foundation were donated by the Ramon Pla i Armengol Foundation.

In oncology and neurodegenerative and cardiovascular diseases, where Catalonia does cutting-edge research in the world, experts speak about advancing diagnosis and prevention. Is this true in respiratory diseases?

First of all, I want to clarify that Catalan research in respiratory diseases is also at the cutting edge in many fields. To give just one example, the tuberculosis-vaccine research being led from here at home. Additionally, it must be said that there is a very wide range of respiratory diseases, including infectious diseases, sleep disorders and cancer. This is why research in the respiratory field also varies widely, but anything that helps us advance in early diagnosis and early-stage treatment is a good investment. For example, there are studies in the USA that say that if at-risk patients (smokers) get periodic CAT scans, cancer can be detected earlier, treated and cured. Unfortunately, most of the time lung cancer is caught too late.  In Catalonia, there is a project dealing with this topic with the Department of Health that has been submitted to the La Marató de TV3 call for proposals. Another example is chronic obstructive pulmonary disease (COPD). 10% of the adult population suffers from this disease and 80% of them don’t even know they have it. It is important to make an effort to diagnose these people, treat them and stop the disease from progressing. For those who already have it, we are working towards personalized medicine.

The WHO predicts COPD will become the third cause of death worldwide by 2020. Are BRN researchers prioritizing research into new treatments for this disease?

As I mentioned before, 50% of the responses to the BRN call for expressions of interest (twenty proposals) were related to COPD. So, from the BRN we will work to carry out joint research projects of international quality that can have a real impact on COPD sufferers as a first initiative.

Are stem cells a field of research that may help curb respiratory diseases?

Stem cells will surely be very important, but careful, because there is still a lot of research to be done and the attempts to use them to treat diseases must yield results. I would like to think that they will play a key role with chronic respiratory diseases and we are working on it. But I have to be prudent. It’s one of the fields of the future.

Are smoking and air pollution the direct causes of half of all respiratory diseases?

Not only respiratory diseases, they are risk factors for cardiovascular diseases and many types of cancer. The WHO said it well: smoking is the number one preventable cause of disease in the world. In this case, we don’t need that much more research; we need to raise awareness and educate people. If no one smoked, lung cancer would be a rare disease and diseases like COPD would practically disappear. However, we can research ways to develop systems that make people stop smoking more efficiently. And the problem of pollution is overshadowed by smoking. We are just getting started at the BRN but I’m sure we’ll try to tackle this problem.

Photo of the Biocat E-News front page (N. 42): © RecerCaixa de "la Caixa"

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