Francisco Fernández-Avilés, MD, PhD, FESC, FACC - Circulation

Circulation June 9, 2009
1994 team photograph of the
Department of Cardiology,
University Hospital, Valladolid.
Professor Fernández-Avilés was
appointed head of the Department
in 1990. Left to right, top
row: Dr Enrique Guillén; Juan
Carlos Muñoz; Dr Luis de la
Fuente; middle row: Dr Benigno
Ramos; Dr Joaquín Alonso; Dr
Jerónimo Rubio; Professor
Fernández-Avilés; Dr Zulema
Sainz (fellow from Bolivia); Dr
Lolita Diurzaeva (fellow from
Russia); bottom row: Dr Jose
Luis Vega; Dr José Bermejo; Dr
Federico Gimeno; Dr Justo
Torres; Dr Miguel Casado.
Photo courtesy of Professor
Fernández-Avilés.
mechanical repair of the culprit artery,” but more recently he
has focused on postinfarct sequelae. He explains, “I realised
after GRACIA-2 2 and other trials that reperfusion after AMI
is not enough, and we must now consider how to improve
left-ventricular function after an infarct. Even with optimal
PCI and thrombolysis, many patients will develop heart failure
and die. My main interest now, after the mechanical
approach [of reperfusion] has done what it can for the patient
acutely, is to use biological strategies [such as the use of
stem cells] to avoid heart failure. The future of cardiology is
the chronic patient because we are doing very well in the
acute setting, but [in the process] are creating many, many
chronic patients!”
One of the key events of Professor Fernández-Avilés’
time at Valladolid was his creation, in 2001, of the Stem
Cell Therapy for Myocardial Repair [Terapia Celular
Aplicada al Miocardio] (TECAM) project. He recalls, “In
2001, I founded the TECAM group to develop translational
research with stem cells to prevent and treat postinfarction
heart failure. 5 We have a number of AMI trials ongoing,
including 1 with 4 arms, comparing autologous mononuclear
bone marrow transplantation, resynchronisation, or
both, with conventional reperfusion therapy. For the more
difficult scenario of chronic myocardial infarction, the
PRECISE (adiPose-deRived stEm Cells In the treatment
of patients with non revaScularisable ischaEmic
myocardium) trial is currently in progress. This is a doubleblind,
randomised clinical trial of adipose-derived stem and
regenerative cells in the treatment of patients with nonrevascularisable
ischaemic myocardium. Adipose-derived
stem and regenerative cells will be injected into the left
ventricle and the outcomes of safety and feasibility will be
measured. The position and function of these cells will be
guided and assessed with a variety of imaging modalities,
including electromagnetic mapping with NOGA, magnetic
resonance imaging, single photon emission computed
tomography, and echocardiography.”
“Good Opportunities for the Use of Stem Cells in the
Myocardium, and for AMI There Is Already Enough
Evidence to Perform Large-Scale Clinical Trials”
In 2003, after TECAM, Professor Fernández-Avilés, on his
own initiative, held the first International Symposium on
Stem Cell Therapy and Cardiovascular Innovations
(http://www.cardiovascularcelltherapy.com), which has
become an annual fixture in Madrid and is attended by about
400 specialists from around the world, with a strong faculty
from Europe and the United States. In 2004, buoyed up with
the success of the first symposium and keen to spread news
of a new area of cardiovascular research, Professor
Fernández-Avilés presented a key lecture to delegates at the
ESC Congress in Munich, Germany, titled, “Cell
Therapy—The Genie Is Out of the Bottle.” Four years later,
in 2008, the message had moved on. When he addressed the
4th International Symposium on Stem Cell Therapy, held in
New York, NY, his lecture was titled, “Reconstructing the
Heart—Strategies for the Next Decade. Adipose-Derived
Cells for Chronic Myocardial Infarction.”
Commenting on the use of stem cells in cardiac repair,
Professor Fernández-Avilés says, “There are good opportunities
for the use of stem cells in the myocardium, and for
AMI there is already enough evidence to perform largescale
clinical trials. Several centres in Germany are almost
ready to start, although it will take 5 years before we have
any results. For chronic disease, we need to reinnervate
cardiac muscle, and for that we need very plastic stem
cells, such as induced pluripotent stem cells. However,
there are safety issues, principally the prevention of
tumours, which will have to be addressed before we can
consider clinical use.”
“Leading the Way Forward”
Since 2000, Professor Fernández-Avilés has served the
ESC in a variety of positions. He holds a silver medal of the
society and served as a vice-president between 2002 and
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Circulation: European Perspectives