The Sant Pau Research Institute (IR Sant Pau) has received a donation of 2,500 euros from the Viladecans Cancer Coordinator Association, aimed at boosting the research conducted by the centre on CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy), a hereditary disease that affects the small blood vessels of the brain and can cause migraine, psychiatric disorders, recurrent strokes, and dementia. Despite recent progress, there is still no curative treatment.

The contribution from the Viladecans Cancer Coordinator Association will support the drug repositioning project led by the Pharmacogenomics and Neurovascular Genetics Research Group at IR Sant Pau, headed by Dr. Israel Fernández-Cadenas. The team investigates medicines already approved for other conditions that may have beneficial effects on CADASIL—an approach that can accelerate the development of potential therapies.

The support of organizations committed to research is essential to keeping active the study of rare diseases. Contributions like this one help facilitate the acquisition of materials, specialized analyses, and the development of new studies that enhance understanding of the disease and explore new therapeutic avenues.

IR Sant Pau expresses its deep gratitude to the Viladecans Cancer Coordinator Association for its trust and support. Their contribution is vital to continue advancing scientific knowledge and improving the quality of life of people affected by CADASIL and their families.

The Sant Pau Research Institute (IR Sant Pau) has received new national funding from the Spanish State Research Agency (AEI), an agency under the Ministry of Science, Innovation, and Universities. This is through the 2025 Call for Grants for the Preparation and Management of European Projects and for Facilitating the Attraction of International Talent. This support will help consolidate and expand the structure of the European Projects Office (OPE) and is aligned with the institute’s strategy to strengthen its presence in the Horizon Europe program, articulated through the plan “Horizon Sant Pau: Enhancing Excellence and Innovation in Horizon Europe”, which guides the center’s main lines of international growth.

According to Noemí Carranza, head of the OPE, “this grant represents a decisive step toward further professionalizing our internationalization structure and better supporting research groups in preparing competitive proposals. Recently we have made great progress, but the demand for support continues to grow. Having a more robust structure allows IR Sant Pau to consolidate its leadership in Horizon Europe and open new opportunities for our research talent to participate in high-impact projects.”

The awarded grant amounts to €149,989.94, which will be used to promote advanced training in European programs, improve digital tools for analyzing funding opportunities, and strengthen technical support in preparing competitive proposals.

Sustained Growth in International Activity

Lately, IR Sant Pau has experienced sustained growth in its international activity. The creation of the OPE in 2021 marked a turning point: the number of proposals submitted to European programs has increased significantly, financial returns have risen substantially. In 2024, the institute obtained, for the first time, a coordinated Horizon Europe project with €7 million in funding, of which more than €1 million is allocated to the institute. In addition, researchers at the center have secured eight projects funded by the U.S. National Institutes of Health (NIH) in just three years, strengthening the diversification of its international portfolio and providing essential structural resources to support scientific management.

This progress has been consolidated thanks to a clear institutional commitment to internationalization, reflected in IR Sant Pau’s 2025–2030 strategy. This roadmap sets as priority objectives the strengthening of scientific leadership in Europe, the attraction of international talent, and the reinforcement of alliances with institutions, companies, and strategic networks. The new funding will deepen this direction by enabling intensive training programs, specialized workshops, coordinated proposal-preparation activities, and new semantic analysis tools that will facilitate the reading and interpretation of European work programs.

Strengthening the OPE will also improve internal coordination among the units involved in international projects, from innovation to clinical trials. It will also expand support for the clinical groups of Hospital de Sant Pau, from which a large portion of the institute’s research staff originates. This integration is essential to increase the quality, maturity, and robustness of proposals submitted to Horizon Europe, particularly in strategic areas such as neurosciences, cardiovascular research, hematology, oncology, and advanced therapies.

A Consolidated Track Record of Funding to Boost Internationalization

This new national grant adds to a solid trajectory of funding that has allowed IR Sant Pau to build and consolidate its international structure. In 2022, the institute received a national grant of €174,986.30 through the call for Preparation and Management of European Projects, allocated for the 2023–2024 period and extended until September 2025. This funding enabled staff expansion, stronger internal training, and improvements in analytical and research-support tools.

Additionally, the regional program Go Europe awarded IR Sant Pau €299,940, extended until June 2026. This support funds specialized human resources, technological platforms, partner-search tools, and networking and training activities—key elements for consolidating a professional and stable model of European project management.

Thanks to this trajectory, IR Sant Pau now has a mature structure that combines specialized technical staff, solid work procedures, advanced digital platforms, and an expanding network of national and international collaborations. The new funding allows the institute to take another step forward, strengthening its capacity to lead high-impact projects, attract competitive funding, and transfer knowledge for of the healthcare system and society.

Hospital de Sant Pau recently hosted the First National Meeting of the GEICEN Group (Stable Research Group in Gynecologic Cancer), a gathering that brought together researchers and specialists from across Spain dedicated to the study of gynecologic cancer from a basic, translational, and clinical perspective. GEICEN is made up of 10 research groups from different academic and hospital institutions, and its objective is to promote collaborative projects that advance the understanding of these tumors and the clinical management of patients.

The event featured the participation of the Gynecological and Breast Pathology Group of the Sant Pau Research Institute (IR Sant Pau), which served as host of this first edition. Dr. Silvia Cabrera, head of the group, highlighted that “this meeting is an essential step toward consolidating a national research network in gynecologic cancer. Sharing results, challenges, and methodologies allows us to move forward faster and offer more efficient responses to patients, and for our group, hosting this first meeting is an honor and a boost to continue growing in this field.”

The program included short presentations from each of the groups that make up GEICEN, with participation from IR Sant Pau, IRYCIS, IRBLleida, IDIBELL, UB, IDIS, FMDA, and VHIR, among others. The presentations made it possible to share strategic projects and research lines in areas such as biomarkers, preclinical models, emerging therapies, biobanks, omics technologies, and new diagnostic approaches in gynecologic oncology. Representing IR Sant Pau, in addition to Dr. Silvia Cabrera, Dr. Alba Farrés also participated, presenting a new project being launched on endometrial cancer.

Following the morning scientific sessions, the event continued with internal meetings focused on the strategy of principal investigators and the coordination of early-career researchers, aimed at defining new collaborative lines and preparing future competitive proposals. The holding of this first national meeting marks an important step for GEICEN, which aims to become a stable reference space for coordinated research on gynecologic tumors, which affect thousands of women every year.

Researchers from the Sant Pau Research Institute (IR Sant Pau) have conducted a clinical trial demonstrating that the combination of two widely available drugs, carvedilol and simvastatin, significantly improves the control of portal hypertension in patients with hepatic cirrhosis.

The study, published in the scientific journal Hepatology, lists Dr. Edilmar Alvarado and Dr. Anna Brujats as first authors and Dr. Cándido Villanueva as senior author. All of them are investigators of the Digestive Pathology group at IR Sant Pau and hepatologists at Hospital de Sant Pau. The collaborating team also includes researchers from the hepatology group at Hospital Sant Pau—Dr. Berta Cuyás, Dr. María Poca, Dr. Xavier Torras, and Dr. Angels Escorsell, among others—researchers in experimental immunology—Dr. E. Cantó—pharmacy—Ainhoa Rodríguez Arias—and biochemistry—Álvaro García-Osuna.

The research stems from a clear clinical need: to find new strategies capable of effectively reducing portal pressure in people with advanced cirrhosis. According to Dr. Alvarado, “These patients continue to have a very high risk of gastrointestinal bleeding, among other complications of portal hypertension, even with standard treatment, and we needed to explore simple options that could improve their prognosis.”

What Is Portal Hypertension and Why Is It Important?

Cirrhosis is a disease in which the liver gradually becomes hardened and scarred, hindering the flow of blood through it. As a result, the blood arriving from the digestive tract via the portal vein encounters more resistance as it passes through the liver, and pressure in this major vessel rises abnormally. This phenomenon, known as portal hypertension, is one of the main drivers of complications in advanced liver disease.

When portal pressure becomes too high, dilated veins form in the esophagus and stomach—the so-called varices—which are extremely fragile and can rupture, causing potentially life-threatening gastrointestinal bleeding. Portal hypertension also contributes to the accumulation of fluid in the abdomen (ascites) and to kidney problems. Reducing it significantly has proven crucial for improving survival and quality of life in these patients.

In clinical practice, this pressure is measured through the hepatic venous pressure gradient (HVPG), a procedure that reliably quantifies the severity of portal hypertension and helps determine whether a pharmacologic treatment is effective.

Available Treatments and Their Limitations

To prevent gastrointestinal bleeding, nonselective beta-blockers such as propranolol or nadolol have been used for decades, as they reduce the amount of blood reaching the liver. However, in many patients these drugs do not sufficiently lower portal pressure.

Recently, carvedilol has proved more effective because, in addition to blocking beta-receptors, it also acts on alpha-1 receptors in blood vessels. This dual action causes greater relaxation of intrahepatic vessels, more effectively reducing resistance to blood flow.

Still, in a substantial proportion of patients treated only with carvedilol, the goal of lowering portal pressure is not achieved. Dr. Alvarado explains the team’s reasoning: “We knew that statins could improve blood vessel function and reduce inflammation in the liver. We thought that administering a statin alongside carvedilol could create a complementary effect and increase treatment efficacy by further reducing portal pressure.”

Although several statins are available, simvastatin was chosen because it has the most prior research in cirrhosis, where it had shown the ability to improve liver blood vessel function safely.

A Clinical Trial Designed to Address an Unmet Need

With this hypothesis, the Sant Pau team launched a randomized, double-blind, placebo-controlled clinical trial. A total of 82 patients with advanced cirrhosis and high-risk varices were recruited, all of whom had shown an insufficient response to traditional beta-blockers.

First, the researchers confirmed that portal pressure had not decreased adequately with standard treatments. From that point on, all patients started taking carvedilol, and were then randomly assigned to receive either simvastatin or a placebo for 4 to 6 weeks, without doctors or patients knowing who received which treatment.

The impact of treatment was measured through HVPG. In addition, the researchers took measurements after a nutritional supplement, a moment when portal pressure typically increases and bleeding risk intensifies, to determine whether the combination could better blunt this effect. Blood samples were also collected to analyze inflammatory cytokines and oxidative stress markers, to assess whether the benefits extended beyond portal pressure reduction.

“We designed the study with real-life patient situations in mind—from the impact of meals to the inflammatory processes that accompany cirrhosis,” Dr. Alvarado explains.

A Step Forward in Preventing Gastrointestinal Bleeding

The results confirmed the initial hypothesis. Carvedilol alone and in combination with simvastatin both reduced portal pressure, but the decrease was significantly greater in the group receiving the two drugs. In absolute terms, HVPG fell from 18.6 to 15.7 mmHg with the combination (versus a reduction from 18.9 to 16.9 mmHg with placebo).

Additionally, 37% of patients treated with carvedilol plus simvastatin achieved a clinically meaningful pressure reduction (≥ 20%), compared with only 15% in the control group. The combination also blunted the increase in portal pressure after the nutritional supplement (12% versus 23%) and more strongly reduced several inflammatory blood markers. All of this occurred with good tolerance and a similar incidence of adverse events in both groups.

For Dr. Alvarado, these findings are promising: “This is a simple strategy using inexpensive, widely available drugs that could have a real impact on preventing decompensations associated with portal hypertension.”

This study opens the door to new therapeutic strategies in cirrhosis. Larger trials will be needed to confirm these results and to assess long-term effects on bleeding prevention and patient survival. But, as Dr. Alvarado concludes, “We have shown that even with well-known treatments, if we combine them effectively, we can take a meaningful step forward in caring for patients with cirrhosis.”

Reference Article:

Alvarado-Tapias E, Brujats A, Puente A, Ardevol A, Rodriguez-Arias A, Fajardo J, Pavel O, Garcia-Guix M, Aracil C, Poca M, Cuyàs B, Cantó E, Montañés R, Garcia-Osuna A, Escorsell À, Torras X, Villanueva C. Hemodynamic effects of carvedilol plus simvastatin in cirrhosis with severe portal hypertension and suboptimal response to β-blockers: A double-blind, placebo-controlled, randomized trial. Hepatology 2025;82:140–54. <a href=”https://doi.org/10.1097/HEP.0000000000001148″>https://doi.org/10.1097/HEP.0000000000001148

The third mission of La Aventura de la Mariona took place today at Tibidabo Amusement Park, with high participation from children and a day filled with science, play, and discovery. This activity offered workshops and interactive spaces dedicated to the respiratory system, bringing children closer to understanding how the apparatus that allows us to breathe works through hands-on experiences and playful activities.

The mission began with the workshop “How Does the Respiratory System Work?”, led by professionals from the Pulmonology Service at Hospital de Sant Pau and the Institut de Recerca Sant Pau (IR Sant Pau). Children were able to observe up close how air enters and exits the lungs, the movement of the diaphragm, and the role of the different structures involved in breathing. Through models, balloons, and anatomical replicas, they learned how gas exchange occurs and what happens inside the body when we breathe.

The workshop “When Breathing Gets a Little Harder,” guided by professionals in pediatric pulmonology and allergy, introduced children to situations in which breathing is affected. With visual explanations and direct experimentation, participants discovered the mechanisms of bronchospasm, airway inflammation, and why filling the lungs can sometimes be difficult. Movement-based activities and simple games helped the kids identify strategies to improve breathing in these situations.

In the afternoon, the workshop “Respiratory Infections: Viruses or Bacteria?”, organized with professionals from the CAP Doctor Carles Ribas and the Sant Pau University School of Nursing, introduced children to the world of microorganisms. They learned to distinguish between viruses and bacteria, observed magnified images of these organisms, and took part in a diagnostic game on the proper use of antibiotics and the prevention of respiratory infections.

Throughout the entire day, the space “A Journey Through the Respiratory System” offered an open pathway with 3D models and a question-and-answer game that reinforced workshop content in a fun and participatory way. One of the most anticipated features was the giant scientific-concept memory game, an emblematic activity of the project that tests children’s memory, agility, and teamwork. Kids played to match pairs related to scientific concepts, and, as in previous missions, they had the chance to win a Casio scientific calculator, a prize that always generates excitement and healthy competition.

With this mission, Mariona continues to establish herself as a leading educational initiative to bring biomedical research closer to children and spark scientific vocations. The next event will take place on February 15, 2026, with the Grand Final Celebration at Tibidabo Amusement Park, coinciding with the International Day of Women and Girls in Science, which will bring together workshops, activities, and researchers from Sant Pau.

More information is available on the website:
https://www.santpau.cat/es/web/public/mariona-investigadora

The Mariona Project

The “Mariona Investigadora” project is an educational and outreach initiative developed by IR Sant Pau. Mariona is a character representing an eight-year-old girl passionate about science and medicine, whose purpose is to inspire girls, boys, and young people to explore the world of scientific research. It is at this age—eight years old—when girls often begin to lose interest in science due to persisting stereotypes and the lack of role models, something this project aims to address.

Through a series of missions and challenges designed to take place at Tibidabo Amusement Park and the Barcelona Zoo, Mariona encourages young children to discover the secrets of the human body. They participate in scientific experiments, and learn about the importance of adopting a healthy lifestyle.

The project also highlights the role of women in science, showcasing real examples of female researchers who share their professional and personal experiences to promote gender equality in this field.

Science with a Gender Perspective

At IR Sant Pau, ongoing dialogue with society is actively promoted, aligned with its RRI plan and its objectives for scientific education and public engagement. As a CERCA center and as a Scientific Culture and Innovation Unit accredited by FECYT, the institute maintains a firm commitment to bringing research closer to the public. As the only research institute in Catalonia with a transversal gender research program, IR Sant Pau serves as a spokesperson for the latest scientific developments and stresses the importance of research with a gender perspective. It also emphasizes the role of women in research and the future of science.

Upcoming Activities in the Second Edition:

• February 15, 2026—Grand Final Celebration at Tibidabo Amusement Park, coinciding with the International Day of Women and Girls in Science.

The Sant Pau Research Institute (IR Sant Pau) hosted the Horizon Europe InfoDay—Cluster Health on November 20, a training event designed to provide practical information and strategies to strengthen the participation of research staff in Horizon Europe, the European Union’s main funding program for research and innovation.

Organized by the International Projects Unit of IR Sant Pau, the event aimed to provide concrete tools to increase the competitiveness of proposals submitted to Horizon Europe, particularly in the field of health. In addition, the meeting served as a space for exchanging experiences between institutions that have already secured European funding, with the goal of strengthening the collaborative research network in Catalonia.

The session opened with a presentation by Marta Marín, National Contact Point for Horizon Europe—Cluster Health, who introduced the draft of the 2026–2027 Work Programme and outlined the main updates and opportunities that this new European funding framework will offer. This was followed by a roundtable featuring representatives from institutions that have obtained Horizon Europe funding, including Juan Abolafia, Head of the International Projects Office at IDIBAPS; Carola Orrego, Principal Investigator at the Avedis Donabedian Foundation; and Olivia Belbin, Principal Investigator at IR Sant Pau, who shared her experience as coordinator of the first Horizon project awarded to the institute.

After an informal networking session over lunch, the event concluded with a hands-on workshop on proposal writing, delivered by a representative from the consultancy ERINN Innovation. The workshop focused on the Impact section, considered one of the most decisive parts of the evaluation process.

During the event’s opening remarks, Noemí Carranza, Head of the International Projects Unit at IR Sant Pau, highlighted the institute’s progress in securing European funding and the importance of collective work: “Four and a half years ago, our unit was created with a clear path and goals: to consolidate the attraction of funds that would allow us to support our researchers and accompany them in leading coordinated projects under the Horizon program. That has always been our purpose, and thanks to joint efforts, today we can celebrate that we have achieved it. This event is the best proof: our first coordinated project, a milestone that encourages us to continue growing and to strengthen the positioning of IR Sant Pau in Europe.”

Carranza also stressed that events like the InfoDay strengthen IR Sant Pau’s culture of international cooperation and help build a scientific community better prepared to face Europe’s research challenges in health.

For her part, Olivia Belbin, researcher at IR Sant Pau and coordinator of the recently awarded Horizon project, underscored the importance of having solid support structures within the institute: “Having a unit specialized in international projects makes a real difference. The team’s expertise and guidance were essential for transforming a strong scientific idea into a competitive and successful proposal. This first coordinated project shows that at IR Sant Pau we have the talent and the capacity to lead high-impact European initiatives.”

The Horizon Europe InfoDay—Cluster Health is part of the internationalization initiatives included in project STL028/23/000051, funded by the Department of Health of the Government of Catalonia, and brought together professionals from the biomedical field interested in strengthening their skills for preparing proposals within the European framework.

A team of cardiologists from the Sant Pau Research Institute (IR Sant Pau) and Hospital Sant Pau, in collaboration with the Autonomous University of Barcelona and the Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), has analyzed the anatomical differences between men and women with mitral regurgitation treated with transcatheter edge-to-edge repair (TEER), a minimally invasive technique that corrects improper valve closure without the need for open-heart surgery.

The study, published in the Revista Española de Cardiología, shows that although women have a smaller and more calcified mitral valve, their clinical outcomes are just as favorable as those of men. According to Dr. Chi-Hion Pedro Li, the study’s first author, “Our goal was to determine whether there were anatomical differences between sexes and whether those could have a real impact on repair outcomes. What we found is that, even though women’s valves are smaller (even after adjusting for body surface area), these anatomical differences do not affect outcomes. Women benefit from the treatment to the same extent as men.”

A Common and High-Impact Valvular Disease

Mitral regurgitation is one of the most common valvular heart diseases and a major cause of heart failure, especially among older adults. It occurs when the mitral valve—which separates the left atrium from the left ventricle—does not close properly, allowing blood to flow backward into the atrium. This forces the heart to work harder to maintain adequate blood flow, which over time can lead to cardiac dilation, fatigue, and shortness of breath.

Until recently, open-heart surgery was the only option for repairing or replacing the valve. However, many elderly patients or those with comorbidities are not candidates for surgery. For them, transcatheter edge-to-edge repair (TEER) offers a safe and effective alternative.

According to Dr. Dabit Arzamendi, senior author of the study, “Transcatheter edge-to-edge repair has radically changed how we manage mitral regurgitation. It allows us to safely treat patients who previously had no viable therapeutic option and, in most cases, achieves a significant reduction in symptoms and immediate functional improvement.”

However, despite the high prevalence of this condition, women have traditionally been underrepresented in clinical trials on mitral regurgitation, which has limited our understanding of their specific anatomical characteristics and their response to treatment. This study aimed to fill that gap and provide a more precise picture based on real-world clinical practice.

Anatomical Differences Between Men and Women

The study included 252 patients treated for severe symptomatic mitral regurgitation between May 2012 and December 2023. Of these, 78 were women (31%) and 174 were men (69%). On average, women were seven years older (82 vs. 75 years) and had a smaller body surface area (1.66 vs. 1.86 m²).

Regarding disease type, primary mitral regurgitation—caused by valve degeneration—was more frequent in women (40% vs. 27%), whereas the secondary form, associated with left ventricular dilation or dysfunction, was predominant in men (57% vs. 40%). Cardiac imaging revealed that women had a smaller and more calcified mitral valve, resulting in a smaller opening area (5.0 vs. 5.8 cm²) and shorter leaflets.

Mitral annular calcification, a form of tissue hardening around the valve, was three times more common in women (32% vs. 10%). Despite these differences, the procedure was equally successful in both sexes: in 96% of cases, mitral regurgitation was reduced to mild or moderate levels, with no additional complications in women. The only technical difference was a slightly higher mean mitral gradient in women (3.0 vs. 2.0 mmHg), attributable to the valve’s smaller size and greater stiffness, but without any impact on efficacy or clinical outcomes.

Equal Clinical Benefit Despite Different Anatomy

The researchers emphasize that the anatomical differences between sexes did not translate into worse clinical outcomes. The transcatheter repair procedure proved effective and safe in all cases, confirming that the technique is suitable for various anatomical profiles. According to Dr. Chi-Hion Pedro Li, “The main contribution of this work is showing that, although the procedure is equally successful in men and women, the female mitral anatomy—smaller and with greater annular calcification—results in a slightly higher transmitral gradient after repair. This finding encourages us to take that into account when planning each case, particularly when selecting the type and number of devices.”

Dr. Dabit Arzamendi adds, “Our results confirm that transcatheter edge-to-edge repair is a safe and effective technique in both sexes. However, knowing that female sex and smaller body surface area are factors associated with a higher gradient can help us optimize device selection and procedural approach.”

The specialist notes that this information could be valuable not only for current clinical practice but also for the development of new generations of mitral repair devices tailored to the anatomical differences between men and women. “Understanding these anatomical characteristics,” adds Arzamendi, “allows us to move toward more personalized and precision medicine, where each patient receives the treatment best suited to their individual anatomy.”

Implications for Clinical Practice

The study’s findings provide a more detailed view of how sex-specific anatomical characteristics can influence treatment planning. Incorporating this perspective from the initial evaluation will help tailor procedural strategies to each patient’s anatomy, improve device selection, and minimize the risk of residual gradients.

In addition, these findings could help refine imaging criteria used in echocardiography and patient selection, ensuring that structural differences between men and women are considered before the intervention. In the medium and long term, this line of research could foster the development of more versatile and adaptable devices capable of accommodating smaller or more calcified valves.

For the Sant Pau researchers, advancing in this direction means strengthening a more personalized approach to structural cardiology, in which therapeutic decisions are based on each patient’s anatomical and physiological features. This study also reinforces the role of clinical research as a tool to improve health equity and ensure balanced representation of men and women in cardiovascular studies.

According to Dr. Chi-Hion Pedro Li, “For decades, cardiovascular research has been based primarily on male populations, so understanding how sex and anatomy influence the outcomes of structural therapies is key to offering truly personalized treatments.”

The specialist also stresses that such long-term clinical studies allow researchers to translate scientific knowledge directly into patient care. In his view, this integrative approach not only enhances the quality and safety of interventions but also helps reduce long-standing inequities in cardiovascular health.

Reference Article:

Li C-HP, Asmarats L, Massó van Roessel A, Capellades H, Fernández-Peregrina E, Arzamendi D. Sex Differences in Mitral Regurgitation Anatomy and Outcomes of Transcatheter Edge-to-Edge Repair. Rev Esp Cardiol 2025;78:1010–2. https://doi.org/10.1016/j.recesp.2025.01.024

BASE4 BIOSCIENCES S.L. is the new spin-off of the Sant Pau Research Institute (IR Sant Pau), created to promote translational research and the application of precision biology in the field of women’s health. The initiative is led by Dr. José Manuel Soria, head of the Genomics of Complex Diseases Research Group at IR Sant Pau, and Dr. Ángel Martínez, genetic analysis expert and member of the same group, together with Pol Cervera, a specialist in technological development. The three are founding members of the new company.

BASE4 was born out of more than a decade of genomics and transcriptomics research conducted at IR Sant Pau, which has demonstrated a direct connection between gene expression in the blood and the functional state of organs. The project also involved Dr. Joan Carles Souto from the Thrombosis and Hemostasis Research Group at IR Sant Pau, who contributed to the technology’s development.

A Technology to Measure Biological Age and Tissue Alterations

Building on this scientific foundation, the team has developed a pioneering algorithm capable of identifying transcriptomic anomalies and predicting the biological age of tissues according to sex and the organ analyzed. This patented technology makes it possible, from a simple blood sample, to analyze the blood transcriptome—that is, the expression of more than 17,000 genes—to determine with great precision the biological age of tissues and identify the genes that accelerate or slow down their aging.

This knowledge is at the core of BASE4’s products and opens the door to personalized interventions to maintain optimal health and slow aging. Dr. José Manuel Soria, co-founder and Chief Scientific Officer of BASE4, explains that “our technology allows us to understand the real biological state of tissues at the molecular level, long before clinical signs appear. This opens a new era in preventive medicine, where we can act before functional deterioration of the organs occurs.”

“We have developed artificial intelligence models differentiated for men and women—an essential approach to reducing the gender gap in health and offering truly personalized recommendations,” adds Dr. Ángel Martínez.

The Problem: A Gap in Women’s Health

Historically, women were excluded from clinical trials until the late 1990s, leaving a gap in medical knowledge that continues to affect millions of women around the world. This knowledge gap means that current medical and artificial intelligence models do not reflect female biological diversity. As a result, many women receive clinical guidance based on patterns derived mostly from men, limiting professionals’ ability to effectively anticipate and treat issues related to fertility, ovarian function, or menopausal transition.

International data show that women are diagnosed four years later than men in more than 700 diseases, and they spend 25% more of their lives in poor health. “Most of today’s artificial intelligence models that aim to characterize human biology have been trained primarily with male data, without accounting for the specific features of female biology—especially during the transition from fertility to menopause,” explains Pol Cervera, CEO of BASE4.

“This bias means that millions of women do not understand the causes of their symptoms or receive incorrect diagnoses and treatments, generating an economic burden exceeding one trillion euros for public health systems worldwide,” adds Pol Cervera.

Knowledge Transfer and International Projection

The creation of BASE4 reinforces IR Sant Pau’s commitment to knowledge transfer and to the development of science-based companies as a way to bring research results to society. The institute holds a 10% equity stake in the new spin-off and contributes its expertise, intellectual property, and the support of its Technology Transfer and Innovation Unit, which has guided the project from the early stages of technological validation to its market launch.

BASE4’s business model combines the provision of advanced transcriptomic testing with the creation of a preventive health and wellness center for women, whose first location will be in Barcelona. In the medium term, the company plans to expand progressively to other European cities, with the goal of making its technology a global benchmark in personalized medicine.

At the same time, BASE4 has begun discussions with investors to launch a funding round aimed at accelerating the company’s growth and bringing its technology to market.

The Journal of the American Medical Association (JAMA) has recently published the updated version of the Sequential Organ Failure Assessment (SOFA), the global reference system in intensive care medicine used to assess the degree of organ dysfunction in critically ill patients. The results were also presented in parallel at the Annual Congress of the European Society of Intensive Care Medicine (ESICM LIVES 2025), held in Munich, in a featured session on current topics broadcast live.

SOFA-2, which replaces the model in place since 1996, incorporates advances in diagnostics, monitoring, and life support introduced over the past decades to more accurately reflect the reality of critically ill patients and the response of their organs to treatment.

The study was led by the international SOFA-2 Study Group consortium, with Dr. Otavio Ranzani, head of the Health DataLab at the Institut de Recerca Sant Pau (IR Sant Pau), serving as the leader of methodology and data analysis. The magnitude and diversity of the data analyzed—more than 3.3 million ICU admissions from nine countries—make this work the largest international review ever conducted on organ dysfunction measurement, setting a new benchmark for clinical practice and critical care research.

A New Standard for Measuring the Severity of Critical Illness

The SOFA system was conceived in 1994 and published in 1996 as a common language to describe dysfunction in six organs—brain, heart, lungs, liver, kidneys, and coagulation system—based on clinical and laboratory parameters. Since then, it has become an essential tool in both clinical practice and research, used to quantify the severity of critical illness.

Over the past three decades, intensive care has evolved profoundly. Today, clinicians have access to new monitoring devices, less invasive life-support therapies, and more specific drugs, as well as information systems that allow for a more dynamic and precise assessment of a patient’s condition. These advances made a complete update of the original model necessary.

“The way we treat patients in intensive care has changed enormously over the past three decades,” explains Dr. Otavio Ranzani, first author of the study. “We now have noninvasive ventilation, continuous renal replacement therapies, and circulatory support with much more precise devices and drugs. The SOFA system needed to reflect that reality so we can better describe organ dysfunction and compare patient severity consistently across the world.”

SOFA-2 maintains the structure of six organ systems but redefines the scoring thresholds and updates the variables used. Key innovations include the addition of extracorporeal membrane oxygenation (ECMO) and high-flow oxygen therapy in the respiratory component, a new classification for vasopressor dosing in the cardiovascular component, and revised criteria for assessing liver, kidney, and coagulation function. The new model achieves a more uniform gradation of severity and a tighter relationship between score and clinical outcomes.

An Unprecedented International Scientific Consensus

The SOFA update was conducted in eight stages, combining expert consensus with large-scale clinical data analysis. First, a Delphi process brought together 60 international specialists from 25 countries, including two from Spain—Dr. Otavio Ranzani and Dr. Ricard Ferrer from Vall d’Hebron University Hospital—who reached consensus on the conceptual principles and key variables of the new model. The research team then validated these proposals using advanced statistical analyses across ten national registries of critically ill patients, totaling more than 3.3 million ICU admissions from Australia, Austria, Brazil, France, Italy, Japan, Nepal, New Zealand, and the United States, thus encompassing diverse healthcare systems and resource levels across four continents.

The result is a system that preserves the simplicity of the original SOFA while providing a much stronger empirical foundation and revised clinical criteria based on the analysis of millions of real-world cases. Each point on the scale was calibrated to correspond to a progressive and clinically consistent increase in mortality risk, validated across different cohorts and countries. Additionally, detailed instructions for data collection and interpretation were incorporated, ensuring uniform application across various care settings. Altogether, SOFA-2 provides a more accurate and contemporary representation of critical care management in the 21st century while maintaining the clarity and ease of use that characterized the original model.

“SOFA-2 is the result of an unprecedented scientific consensus in intensive care medicine,” emphasizes Dr. Ranzani. “It integrates the best available evidence with the accumulated clinical experience from highly diverse settings—from high-complexity university hospitals to resource-limited units. This ensures that the tool is truly global.” The results confirmed that SOFA-2 more accurately describes the progression of vital organ function in critically ill patients, showing a highly consistent relationship between score and observed mortality.

More Precise, Practical, and Universal

Beyond its statistical performance, the main contribution of SOFA-2 lies in its greater clinical applicability. The new model accounts for the realities of hospitals with varying resource levels and defines clear rules for data recording and interpretation, reducing variability between units and countries.

“We wanted SOFA-2 to be useful both in a large European hospital and in an ICU in a developing country,” notes Dr. Ranzani. “Our goal was to provide a standardized, up-to-date, and global tool to support both research and clinical decision-making.”

The system also improves consistency in intermediate levels of dysfunction, avoiding abrupt jumps between categories and allowing for a more intuitive gradation of organ deterioration. This enhances its value for daily clinical monitoring and for comparing outcomes across institutions or therapeutic trials. Moreover, it includes instructions adapted to resource-limited settings, enabling reliable use even in environments where certain treatments or measurements are unavailable.

A New Starting Point for Intensive Care Medicine

Another key contribution of SOFA-2 is its ability to harmonize intensive care research. By incorporating globally applicable and updated criteria, SOFA-2 facilitates comparison across multicenter studies and improves the quality of clinical trials. This methodological uniformity is essential for advancing toward a more data-driven and internationally valid field of intensive care medicine.

Researchers also highlight its usefulness for monitoring quality of care in ICUs, as it provides a sensitive and standardized indicator of organ dysfunction among treated patients. The team considers this update a turning point in how critical illness is quantified, offering a more precise, dynamic, and practice-aligned framework.

“SOFA-2 is a long-awaited update that enhances intensive care medicine’s ability to measure, understand, and treat critical illness,” concludes Dr. Otavio Ranzani. “By more faithfully reflecting patients’ physiology and the interventions they receive, this new system will enable better evaluation of treatment effects and support progress toward more personalized and efficient care.”

You can listen to this podcast in English about the publication.
And here’s a video on Instagram.

Reference Article

Ranzani OT, Singer M, Salluh JIF, et al. Development and Validation of the Sequential Organ Failure Assessment (SOFA)-2 Score. JAMA. Published online October 29, 2025. doi:10.1001/jama.2025.20516

The Francesc Cambó Hall at Sant Pau was filled with people and laughter during ImproCiencia: Aging with a Sense of Humor, an event that brought together biomedical research and improvisational theater to address key questions about health and aging in a lively and engaging way. The activity, which landed in Barcelona for the first time, was part of Science Week and was organized, in its seventh edition, by the Sant Pau Research Institute (IR Sant Pau) and the Biomedical Research Networking Center (CIBER). The event, specially aimed at older adults (over 65 years old), received an enthusiastic response, drawing more than 180 attendees.

The show combined the talent of the actors from the ImproIMPAR company with the direct participation of researchers from IR Sant Pau, who are also members of CIBER, bringing scientific rigor and clinical experience to each of the scenes. The initiative is part of the joint work of the Scientific Culture and Innovation Units (UCC+i) of both institutions, which extend their collaboration beyond research to include science communication. This reinforces their shared commitment to bringing science closer to society through innovative formats. The goal was to show that science can be communicated differently—one that inspires reflection, emotion, and laughter at the same time.

“ImproCiencia shows that research can be explained in many ways and that science can also move people and make them laugh,” said Dr. Jordi Surrallés, director of IR Sant Pau and member of CIBER, highlighting “the excellent reception of a format that brings research closer to the public with naturalness and warmth.” According to Dr. Surrallés, initiatives like this one “reinforce the mission of Sant Pau and CIBER to bring research closer to society, making it accessible and meaningful for everyone, while showcasing the work of researchers dedicated to improving people’s health.”

Four Stories About Health, Aging, and Research Told with Humor

Through four short plays inspired by different areas of health, the audience was able to participate actively and discover how research helps to understand and prevent some main diseases associated with aging.

Dr. Idoia Genua and Dr. Alex Mesa, from the Endocrinology, Diabetes, and Nutrition Group, spoke about type 2 diabetes, a chronic but manageable disease when detected early and properly monitored. In their scene, the audience made decisions that changed the course of the story, illustrating how lifestyle habits directly affect metabolic health. “The message we wanted to convey is that type 2 diabetes can be prevented and controlled,” explained Dr. Idoia Genua, who emphasized the importance of maintaining a balanced diet and staying active to reduce the risk of complications.

The researchers used the interaction with the audience to debunk common myths and remind them that losing between 5% and 10% of body weight can significantly improve disease control. “Each patient is different, and that’s why treatment should be like a tailor-made suit that adapts to their needs and disease progression,” added Dr. Alex Mesa. The scene ended with an alternate version of the story showing how prevention and healthy habits can change the course of the disease and improve quality of life.

Meanwhile, Dr. Elena Cortés, from the Neuromuscular Diseases Group, focused her intervention on myasthenia gravis, a rare, chronic, autoimmune disease that affects the transmission of nerve impulses to muscles, causing weakness and fatigue. Through an interactive performance, the actors recreated the everyday challenges faced by people living with this condition, highlighting how medical and social support can make a difference.

The researcher explained that this disease can appear at any age and, although it has no cure, current treatments allow patients to maintain a good quality of life if diagnosed early. “It’s essential to recognize the first symptoms—such as drooping eyelids or difficulty speaking or chewing—so that we can act quickly and prevent serious complications,” emphasized Dr. Cortés.

The most emotional moment came with the participation of Érika Sánchez, a predoctoral researcher from the Neurobiology of Dementias Group, who studies Alzheimer’s disease. Through a symbolic narrative featuring a “disease-character” that gradually limited the protagonist’s actions, the researcher explained how Alzheimer’s damages neurons due to the accumulation of beta-amyloid and tau proteins, leading to memory loss and cognitive decline.

“Alzheimer’s doesn’t just affect memory—it also affects identity and relationships with others,” said Érika Sánchez during her talk, stressing that research is “an essential tool for better understanding the disease and developing prevention strategies.” The scene ended with a message of hope, emphasizing the role of prevention through exercise, the Mediterranean diet, proper sleep, and an active social life as key factors in protecting the brain.

To close the show, Dr. Jose Maria Guerra, head of the Clinical and Translational Cardiology Research Group, turned science communication into a lively late-night TV show. With humor and rhythm, he reviewed how the perception of cardiovascular diseases has evolved—from being considered inevitable to being understood as preventable conditions. The cardiologist reminded the audience that studies like the Framingham study demonstrated that factors such as smoking, hypertension, and diabetes are modifiable, and that prevention starts long before the first symptom. He also described recent advances in diagnosis and risk prediction—such as biomarkers, genetics, and artificial intelligence—that are enabling a more personalized approach to medicine.

“Cardiovascular diseases are not an inevitable consequence of aging; today we know that prevention and research have entirely changed how we approach them,” said Dr. Guerra, encouraging the audience to take care of their hearts from a young age.

Science Communication as a Bridge Between Research and Society

The performance held the audience’s attention and participation throughout, blending moments of humor, emotion, and shared learning. The balance between scientific accuracy and creative storytelling demonstrated that research can go beyond laboratories and classrooms to become a true meeting point with the public.

Both IR Sant Pau and CIBER value science communication as an essential part of scientific work—a tool that helps explain advances in a clear and relatable way. “Bringing research closer to people is a fundamental part of our mission as an institution,” concluded Dr. Surrallés, “and formats like ImproCiencia make it possible to do so in a dynamic, engaging, and meaningful way.”

The success of participation and the audience’s enthusiastic response consolidate ImproCiencia as a leading example of science communication—one capable of breaking down barriers between biomedical knowledge and everyday life and offering a new perspective on how to age with health, curiosity, and a sense of humor.

The Hospital de Sant Pau and the Institut de Recerca Sant Pau (IR Sant Pau), together with the Universitat Autònoma de Barcelona (UAB), hosted on Wednesday, November 5, one of the sessions of the Nobel Prize Inspiration Initiative (NPII), an international program that brings the experience and insights of Nobel Laureates closer to students, early-career researchers, and science professionals. This edition, organized by Nobel Prize Outreach in collaboration with the AstraZeneca Foundation and several Catalan academic institutions, featured Professor Craig C. Mello, Nobel Laureate in Physiology or Medicine in 2006 for the discovery of the mechanism of RNA interference (RNAi).

The event began at Casa Convalescència, where the American laureate held an open discussion with students and young scientists titled “What it takes to be a scientist?”, moderated by Adam Smith from Nobel Prize Outreach. The session opened with institutional greetings from Professor Albert Selva, Dean of the Faculty of Medicine at the Universitat Autònoma de Barcelona (UAB), and Susana García, Head of Institutional Relations at the AstraZeneca Foundation.

The session concluded with remarks by Dr. Jordi Surrallés, Director of IR Sant Pau and Professor of Genetics at UAB, who highlighted the value of such gatherings in fostering scientific vocations. “Welcoming a Nobel Laureate to Sant Pau is a privilege that reminds us that research is built on curiosity, perseverance, and teamwork. Initiatives like this inspire new generations of researchers and strengthen our commitment to scientific excellence and international collaboration,” noted Dr. Surrallés.

The program then moved to the Hospital de Sant Pau, where Craig Mello delivered his lecture, “RNAi: A Molecular Spark in an Information Inferno.” The session was opened by Assumpció Malgosa, Vice-Rector for Research at UAB; Xavier Prats Monné, President of the Board of Trustees of the Hospital de la Santa Creu i Sant Pau Foundation; and Susana García from the AstraZeneca Foundation. The event also featured an engaging discussion with the audience, once again moderated by Adam Smith.

“Barcelona’s innovative and collaborative scientific community is ready to play an increasingly important role in the revolution connecting human genetics to transformative treatments. It’s exciting to be here to share what we’ve learned about RNA—and to listen! Because, as someone once said, the ideas that change the world often come from young scientists who haven’t yet discovered what’s impossible,” said the American Nobel Laureate.

Craig C. Mello, Pioneer in Gene Silencing

Professor Craig C. Mello is a researcher at the RNA Therapeutics Institute at the University of Massachusetts Medical School (United States) and co director of the RNA Cell Biology Program at the Howard Hughes Medical Institute. In 2006, he was awarded the Nobel Prize in Physiology or Medicine, together with Andrew Z. Fire, for the discovery of the phenomenon of RNA interference (RNAi), a natural process through which cells regulate gene expression by silencing specific RNA sequences.

Until then, RNA was thought to play only a passive role as a messenger between DNA and proteins. Mello and Fire’s discovery transformed this view by demonstrating that RNA is also a key player in controlling genetic information. Their work revolutionized modern molecular biology and was essential to understanding how to manipulate RNA safely and effectively, paving the way for the development of multiple innovative RNA-based therapies.

This knowledge has led to advances ranging from gene-silencing therapies to new strategies for drug design and RNA-based vaccines, such as the mRNA vaccines developed against COVID-19. Today, RNAi research continues to expand its applications in the treatment of genetic, infectious, cardiovascular, and oncological diseases, as it allows precise modulation of the genes involved in disease progression.

A team from the Sant Pau Research Institute (IR Sant Pau) has discovered that basic fibroblast growth factor (bFGF) can reverse the functional impairments of adipose tissue–derived stem cells in people with type 2 diabetes. This restores their ability to proliferate, migrate, and form new blood vessels.

These cells, which under normal conditions play a key role in tissue regeneration, lose much of their effectiveness due to the adverse metabolic environment caused by diabetes. The new study indicates that bFGF can reactivate their immunomodulatory and proangiogenic behavior, restoring their proliferative potential and their ability to create new blood vessels, which are diminished by the disease.

The research, published in the journal Diabetologia, demonstrates that bFGF treatment not only enhances the functional potential of these cells but also modifies their microRNA (miRNA) profile—small molecules that regulate gene expression and are directly involved in blood vessel formation and vascular repair. These findings open the door to new personalized regenerative medicine strategies for vascular complications associated with type 2 diabetes.

Diabetes and the Loss of Regenerative Potential

Type 2 diabetes is a metabolic disease that, in addition to altering blood glucose levels, damages the vascular system and compromises the body’s ability to repair tissues. This dysfunction affects the heart, kidneys, brain, and lower limbs, creating a high risk of cardiovascular complications.

Adipose tissue–derived stem cells are an abundant and easily accessible source of cells with therapeutic potential. They can promote the formation of new blood vessels and support tissue regeneration, but in people with diabetes, they lose part of these properties: their proliferation decreases, they migrate less, and their transcriptomic profile is altered.

“We already knew that the metabolic environment of diabetes deeply impacts the behavior of stem cells,” explains Dr. Gemma Arderiu, principal investigator of the study and head of the Cell Therapy and Angiogenesis in Ischemic Pathology Group at IR Sant Pau. “That’s why we wondered whether it might be possible to ‘re-educate’ them before using them for therapeutic purposes. What we observed is very promising: bFGF treatment restores cellular functions that were severely impaired.”

How bFGF Acts on Stem Cells

The research team obtained samples of subcutaneous and visceral adipose tissue from each of the eight patients who participated in the study—four with type 2 diabetes and morbid obesity and four non-diabetic individuals of normal weight. From these samples, the researchers isolated the stem cells and cultured them for nine days in the presence of bFGF, a protein widely studied for its role in cell growth, wound healing, and blood vessel formation.

The treatment proved highly effective. The cells derived from patients with diabetes, which initially showed very limited proliferation and reduced migratory capacity, recovered their ability to proliferate and migrate, behaving similarly to cells from non-diabetic individuals. This effect was particularly notable in cells from visceral adipose tissue, which are most affected by the inflammation and metabolic stress characteristic of the disease.

To assess whether this recovery translated into functional improvement, the team performed various in vitro and in vivo assays. In three-dimensional cultures and in mouse models, the bFGF-treated cells showed a greater ability to organize into capillary-like structures and generate new blood vessels, confirming that the treatment restores their angiogenic and reparative potential.

“We have observed that bFGF functionally restores the angiogenic properties of endothelial cells,” explains Dr. Arderiu. “It reactivates their proangiogenic potential and their capacity to interact with other vascular cells and form new vascular structures. It’s a remarkable recovery, considering the extent of damage that diabetes causes in these cells.”

Changes in the Cells’ Genetic Language

The study also reveals how bFGF achieves this reparative effect. The researchers analyzed the miRNA profile—small molecules that act as genetic “switches,” regulating the activity of numerous genes involved in key processes such as cell proliferation, blood vessel formation, and cellular aging.

In people with diabetes, these miRNAs are often dysregulated: some are overexpressed, suppressing cell growth, while others fail to activate when needed. This imbalance prevents stem cells from functioning properly and limits their ability to repair damaged tissues.

Treatment with bFGF restored part of this lost balance. After exposure to the factor, the researchers observed a reduction in miR-24, miR-145, and miR-140—linked to growth inhibition and cellular senescence—and an increase in miR-17, a positive regulator of proliferation and survival. This shift in the miRNA pattern reactivated key molecular pathways, including TGF-β, Wnt, and integrin signaling, which are fundamental for blood vessel formation and repair.

“We could say that bFGF not only acts on the surface of the cell but also enters its internal programming and corrects it,” explains Dr. Arderiu. “This molecular adjustment allows the cells to once again respond to growth and regeneration signals, as they would in a healthy environment.”

The researcher adds that this cellular plasticity opens a very encouraging horizon. “If we can modulate gene expression in cells using biological molecules like bFGF, we can design more effective, patient-tailored regenerative therapies. It’s an important step toward precision medicine in metabolic and vascular diseases.”

A New Approach for Personalized Therapies

The study’s results point to a paradigm shift in the use of stem cells as a therapeutic tool. Treatment with bFGF not only restores their angiogenic potential but also enhances their adaptability and regenerative response, opening new possibilities for application in patients with type 2 diabetes.

“The ability to recover the therapeutic potential of a patient’s own cells is a highly significant breakthrough,” says Dr. Gemma Arderiu. “This study demonstrates that cells affected by diabetes are not lost; with the right strategy, they can regain their reparative function and help regenerate damaged tissues.”

She further emphasizes that this approach “represents a step forward toward more personalized and safer medicine, based on the use of the patient’s own cells pretreated in the laboratory.” According to her, bFGF preconditioning could be incorporated as a preparatory step in regenerative therapies aimed at restoring vascular function or improving wound healing in different types of lesions.

Research Bridging Basic Science and Clinical Application

The authors acknowledge that the study was conducted with a limited number of human samples due to the difficulty of obtaining both visceral and subcutaneous tissue from the same patient. Even so, the results provide a solid foundation for future preclinical research aimed at validating the safety and efficacy of the treatment in models of diabetic vascular disease.

“These results strengthen our commitment to translational research that brings laboratory advances closer to clinical practice,” concludes Dr. Arderiu. “We show that even under adverse conditions like type 2 diabetes, stem cells retain regenerative potential that can be reactivated. We just need to find the right stimulus to awaken it.”

The study was carried out at the Sant Pau Research Institute (IR Sant Pau) in collaboration with the Cell Therapy Network (TERAV and TERAV+), the Biomedical Research Networking Center in Cardiovascular Diseases (CIBERCV), and the University of Barcelona (UB). The research was funded by the Carlos III Health Institute and the Government of Catalonia.

Article reference:
Civit-Urgell A, Peña E, Bejar MT, Moscatiello F, Vilahur G, Badimon L, Arderiu G. bFGF rescues dysfunctional properties of adipose-derived stem cells from individuals with type 2 diabetes by modulating their miRNA profile. Diabetologia 2025. https://doi.org/10.1007/s00125-025-06533-0

Researchers and managers from the Institut de Recerca Sant Pau (IR Sant Pau) took part in the 3rd Conference of ISCIII Platforms for Support of R&D&I in Biomedicine and Health Sciences, held in Salamanca from October 27 to 29. The event, organized by the Instituto de Salud Carlos III (ISCIII), brought together more than 400 professionals from hospitals, health research institutes, universities, and public administrations, with the goal of promoting cooperation among the scientific infrastructures that support biomedical research in Spain.

This annual conference is the main meeting point for the three platforms promoted by the ISCIII: the ISCIII Platform for Biomodels and Biobanks, the ISCIII ITEMAS Platform (Innovation and Dynamization of the Industrial Capabilities of the National Health System), and the ISCIII SCReN Platform (Support for Independent Clinical Research). Each of these platforms plays a strategic role in advancing translational research and health innovation by promoting shared resources, common methodologies, and synergies among centers across the country.

The IR Sant Pau participated actively in all three platforms, contributing to discussions on current challenges and collaboration opportunities in the field of biomedical research. Key topics included the ethical and quality management of biobanks, technological innovation in hospitals, knowledge transfer to the industrial sector, and the role of independent clinical trial units in generating scientific evidence.

During the conference, Dr. Rosa Maria Antonijoan from IR Sant Pau and Hospital Sant Pau moderated the session “Interactive Discussion of Practical Cases” within the SCReN Platform track, together with Dr. Inma Fuentes from the Vall d’Hebron Institute of Research (VHIR). The session provided an opportunity to share real-world experiences in the management and coordination of clinical studies, highlighting the importance of collaborative networks and the methodological and regulatory support offered by the platform for independent research.

IR Sant Pau’s participation in this event reflects its commitment to scientific excellence, collaborative networking, and translational research aimed at improving clinical practice. Its involvement in the ISCIII platforms helps strengthen the research capacity of the healthcare system, foster innovation, and ensure that scientific progress translates into real benefits for patients and society.

The latest edition of La Marató de 3Cat, dedicated to research on respiratory diseases, raised 10 million euros that will be used to support 36 projects led by 60 research teams from across Catalonia. These conditions affect well over two million people in the country, are the second leading cause of hospital admission and the third leading cause of death, and represent one of the main current public health challenges.

In this context, the Institut de Recerca Sant Pau (IR Sant Pau) will participate in five projects funded by the Fundació La Marató de 3Cat, to which more than 800,000 euros will be allocated in total for the research activities carried out at the center. These projects cover a wide range of areas within respiratory health—from basic and preclinical research to public health and clinical research—and reinforce Sant Pau’s contribution to the study of these diseases.

The funded projects linked to Sant Pau involve the participation of researchers David de la Rosa Carrillo, David Ramos Barbón, Otavio Ranzani, Manel Esteller, and Ivan Castellví Barranco. All of whom are engaged in initiatives that will drive high-quality biomedical research in the field of respiratory diseases and foster collaboration between centers.

Among the initiatives led from Sant Pau, the clinical trial coordinated by Dr. David de la Rosa Carrillo stands out. With a budget of 200,000 euros, the study will evaluate the use of inhaled antibiotics in patients with bronchiectasis not associated with cystic fibrosis. The research aims to determine whether this type of treatment can reduce exacerbations and improve patients’ quality of life, as they are often affected by recurrent infections and progressive deterioration of lung function. The study will use a randomized, double-blind design to ensure maximum reliability of the results.

Furthermore, with a budget close to 200,000 euros, Dr. David Ramos Barbón will lead a study focused on the discovery and validation of new molecules capable of reversing airway remodeling in asthma. This structural process, which contributes to the severity and chronicity of the disease, will be addressed using preclinical models that will allow the therapeutic potential of different compounds to be evaluated. The results could pave the way for future clinical trials and new pharmacological approaches.

Dr. Manel Esteller will coordinate the project titled Impact of Vaping on the (Epi)Genome of Adults. With a budget of 200,000 euros, the study will examine the effects of electronic cigarette use on DNA methylation—a key epigenetic mechanism in gene regulation—using sputum samples from vapers, non-vapers, and smokers. The goal is to identify potential molecular alterations associated with vaping and contribute to the early detection of respiratory damage related to this practice.

Researcher Dr. Otavio Ranzani of IR Sant Pau will coordinate the project Protecting Respiratory Health in Catalonia: Climate, Air, and Health (PRISMA-CAT), with funding of approximately 125,000 euros. The study will analyze how air pollution and climate variations affect the respiratory health of the Catalan population. By integrating environmental, epidemiological, and public health data, the project aims to identify risk patterns and develop prevention strategies to protect the most vulnerable groups from the impact of climate change.

Finally, Dr. Ivan Castellví Barranco will take part in a project led by the Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), in which IR Sant Pau will receive 90,000 euros. The study will focus on identifying cellular and molecular biomarkers in bronchoalveolar lavage to improve the diagnosis and monitoring of sarcoidosis. This systemic inflammatory disease, which can impact various organs—particularly the lungs—will be analyzed using advanced techniques that will allow researchers to gain more profound insight into the immune mechanisms that determine its progression and response to treatment.

With these four projects, IR Sant Pau will strengthen its contribution to research on respiratory diseases and its commitment to the transfer of knowledge to improve population health. Collaboration with La Marató de 3Cat will continue to be a key driver in promoting excellent projects that link biomedical research with the real needs of patients.

The Sant Pau Research Institute (IR Sant Pau) is incorporating Dr. Manel Esteller, an ICREA (Catalan Institution for Research and Advanced Studies) researcher and one of the world’s most renowned scientists in the fields of epigenetics and oncology, to lead a new research group.

Dr. Esteller is an internationally recognized figure in epigenetics and oncology. His pioneering work has been instrumental in understanding how epigenetic mechanisms—processes that regulate gene expression without altering the DNA sequence—affect the development of cancer and other complex diseases.

The addition of Dr. Esteller strengthens IR Sant Pau’s critical mass of scientific talent and will drive research in areas such as applied epigenetics, translational oncology, and personalized medicine. His leadership and experience in building international networks will help attract competitive funding and top-tier researchers, positioning the center as a European benchmark in biomedical research.

A Strategic Boost for IR Sant Pau

This initiative is part of IR Sant Pau’s strategy to attract and retain scientific talent in the country. It is also a specific strategy approved by the IR Sant Pau Board of Trustees to encourage the recruitment and integration of ICREA researchers. It also aims to provide environments of excellence that enable top-level careers to flourish without the need to move abroad. In doing so, the center reaffirms its commitment to scientific progress and to Catalonia’s development in this strategic sector.

The Added Value of an ICREA Researcher

ICREA is an institution created by the Government of Catalonia to bring internationally leading researchers into the Catalan scientific system through a highly competitive, excellence-based selection process. Incorporating an ICREA researcher into a center is a mark of quality, leadership, and international projection.

With this step, IR Sant Pau consolidates its position within the CERCA system and reinforces its strategy to become a leading node in Catalonia’s public biomedical research landscape.

A Scientific Career of Excellence and Global Recognition

With more than 640 scientific publications and over 150,000 citations, Dr. Esteller is the most cited Catalan biomedical scientist and one of the most influential researchers worldwide. In the 2024 Stanford/Elsevier ranking, he is listed among the Top 2% of scientists worldwide. According to Research.com (2025 edition), he ranks first in Spain in medicine and second in genetics in the same edition. Research.com has also awarded him the “Medicine in Spain Leader Award 2025” and the “Genetics in Spain Leader Award 2025.”

Over more than two decades of career, he has directed the Epigenetics and Cancer Biology Program (PEBC) at IDIBELL (2008–2019) and later the Josep Carreras Leukaemia Research Institute (IJC) (2019–2024). He is a member of the Royal Academy of Medicine of Catalonia and the European Academy of Cancer Sciences, among other scientific institutions.

Among his many distinctions, he has received the King Jaime I Award for Basic Research (2013), the National Research Award of Catalonia (2015), the Josep Trueta Medal for Health Merit (2015), and the Royal National Academy of Medicine Award (2024).

Dr. Gemma Vilahur, head of the Molecular Pathology and Therapeutics of Atherothrombotic and Ischemic Diseases research group at the Institut de Recerca Sant Pau (IR Sant Pau) and member of the Steering Committee of the Spanish Biomedical Research Network Center for Cardiovascular Diseases (CIBERCV), has participated in an international review published in Nature Reviews Cardiology that explores how the interaction between inflammation and metabolism contributes to the development and progression of heart failure. In the article, the IR Sant Pau researcher served as corresponding author.

Heart failure is one of the leading causes of hospitalization and mortality in developed countries, and its incidence increases with population aging and improved survival after myocardial infarction. It is a chronic condition in which the heart is unable to pump enough blood to meet the body’s needs, leading to fatigue, shortness of breath, and fluid accumulation.

The paper, titled “Immunometabolism in Heart Failure,” compiles the latest scientific evidence on the role of immunometabolism—the interaction between metabolism and the immune system—in heart dysfunction within the context of heart failure and proposes new research directions aimed at improving diagnosis and prognosis for patients.

Inflammation and Metabolism: A Key Connection in the Failing Heart

In heart failure, damage to heart tissue triggers an initial inflammatory response necessary to repair the myocardium. However, often this reaction does not fully resolve and turns into chronic low-grade inflammation that progressively impairs heart function.

At the same time, both cardiac cells and immune cells modify their ways of obtaining and using energy. When the heart becomes less efficient at producing energy—such as after a myocardial infarction or under metabolic stress conditions like diabetes or obesity—alternative pathways are activated that consume more resources and generate by-products that perpetuate inflammation. In this process, immune cells switch their main energy source (“metabolism”) from oxidative phosphorylation, which depends on oxygen and the availability of fatty acids and takes place in the mitochondria, to glycolysis, a faster pathway that converts glucose into pyruvate but is less efficient in terms of ATP production.

The review also emphasizes that the bone marrow and spleen act as reservoirs of immune cells that are released and directed toward the injured heart. The continued arrival of these cells—especially when inflammation persists over time—contributes to the progression of heart failure.

This constant and bidirectional interaction between immune cells and cardiac tissue cells generates a true metabolic dialogue—or crosstalk—through which both influence each other. Immune cells alter the energetic environment of the myocardium by releasing inflammatory molecules that modify the metabolism and function of cardiomyocytes and fibroblasts. In turn, damaged cardiac cells send metabolic signals that again modify the immune response. This ongoing exchange of signals promotes adverse cardiac remodeling, characterized by fibrosis, loss of elasticity, and progressive deterioration of contractile function.

“The failing heart doesn’t just beat with less strength—it also changes the way it obtains and uses energy,” explains Dr. Gemma Vilahur. “This metabolic alteration stimulates an immune response that, in turn, worsens the damage. Understanding this dialogue is essential to breaking this vicious cycle.”

The review notes that these processes are detectable from the very early stages of heart failure and may even be present before clinical symptoms appear. Detecting these changes early could enable action before heart damage becomes irreversible, opening the door to more effective prevention and treatment strategies.

A New Approach for Future Therapies

The article also highlights that research in immunometabolism paves the way for new therapeutic strategies to prevent and treat heart failure. Understanding how immune and cardiac cells manage energy, and how these processes influence the inflammatory response, allows researchers to identify specific metabolic pathways that could be modulated with drugs.

In this regard, the authors suggest that adjusting the balance between glucose and fatty acid consumption or regulating mitochondrial activity—the organelles responsible for energy production—could help improve cardiac function and slow disease progression. Similarly, controlling the metabolic activation of immune cells could help limit the chronic inflammation that accompanies heart failure.

“Immunometabolism allows us to understand heart failure from a broader perspective,” adds Dr. Vilahur. “It’s not just about treating symptoms—it’s about targeting the cellular mechanisms that cause them.”

In addition, this integrated perspective opens new opportunities for developing biomarkers capable of reflecting the metabolic and inflammatory status of the heart. These biological indicators—detectable in blood or through advanced imaging techniques—could identify at an early stage which patients are at risk of disease progression, anticipate decompensations, and monitor treatment response. In the future, their clinical use could help select the most appropriate therapies for each patient profile, advancing toward truly personalized medicine in heart failure.

The use of advanced molecular imaging techniques, such as positron emission tomography (PET) or magnetic resonance imaging with specific tracers, will also make it possible to noninvasively track the trafficking and activation of immune cells in the heart. These tools provide a new way to observe the inflammatory process in real time, helping to assess disease progression and directly evaluate the effects of metabolism- or inflammation-targeted therapies.

Taken together, these strategies—far more precise than conventional treatments focused solely on improving pump function—represent a paradigm shift in the management of heart failure. By integrating the immune and metabolic components into diagnosis and therapy, they open the door to treating the disease at its biological root with a more effective, preventive, and personalized approach.

Scientific Leadership from IR Sant Pau

Dr. Vilahur’s participation in this publication reinforces IR Sant Pau’s leadership in researching the cellular mechanisms that link inflammation, metabolism, and cardiovascular disease. Her group has long focused on studying how the metabolic environment and the immune system contribute to the development of atherosclerosis, myocardial infarction, and heart failure.

“Our goal is to translate this knowledge into clinical practice to improve diagnosis and treatment for patients,” says Dr. Vilahur. “The future of cardiology lies in integrating molecular biology with personalized medicine and cardiovascular prevention strategies.”

Reference Article:

Andreadou I, Ghigo A, Nikolaou P-E, Swirski FK, Thackeray JT, Heusch G, Vilahur G. Immunometabolism in heart failure. Nat Rev Cardiol October 2025;22:751–72. https://doi.org/10.1038/s41569-025-01165-8.

Three new Cochrane reviews have found evidence that the new GLP-1 weight-loss medications produce clinically significant reductions in body weight, but the industry funding of the studies raises questions about their results. These reviews, conducted largely by researchers from the Iberoamerican Cochrane Centre (CCIb)—integrated into the Sant Pau Research Institute (IR Sant Pau) and coordinator of the Iberoamerican Cochrane Network (RCIb)—were commissioned by the World Health Organization (WHO) to inform future guidelines on the use of these medications for treating obesity.

The reviews, which examine the effects of three weight-loss drugs known as GLP-1 receptor agonists (glucagon-like peptide-1), found that all three medications lead to clinically significant weight loss compared with a placebo. However, evidence on longer-term effects and side effects remains limited or uncertain, partly due to potential conflicts of interest.

GLP-1 receptor agonists were originally developed to treat people with type 2 diabetes, and their clinical use began in the mid-2000s. In such patients—especially those with heart or kidney disease—these medications improved blood glucose control, reduced the risk of cardiac and renal complications, promoted weight loss, and lowered the risk of premature death.

More recently, trials have been conducted to study these drugs in people with obesity. The medications mimic the activity of a natural hormone that slows digestion and helps people feel full for longer. They are currently approved in Spain and other countries for weight management, combined with a low-calorie diet and exercise, in people with obesity or those who are overweight with weight-related health problems.

Weight Loss After One or Two Years

Across all reviews, tirzepatide, semaglutide, and liraglutide produced significant weight loss compared with placebo after one or two years, and these effects are likely to continue as long as treatment is maintained.

Tirzepatide (a once-weekly injection) led to an average weight reduction of about 16% after 12 to 18 months. Evidence from eight randomized controlled trials (6,361 participants) also suggested that these effects might be maintained for up to 3.5 years, although long-term safety data were limited.

Semaglutide (also a weekly injection) reduced body weight by about 11% after 24 to 68 weeks, with effects probably sustained for up to two years, according to data from 18 randomized controlled trials (27,949 participants). This medication increased the likelihood of achieving at least a 5% weight reduction but was associated with higher rates of mild or moderate gastrointestinal side effects.

Liraglutide (a daily injection) produced a more modest average weight loss of about 4% to 5%, according to 24 trials (9,937 participants), but still increased the proportion of people who achieved clinically meaningful weight loss compared with placebo. Evidence on longer-term effects, beyond two years, was more limited.

Across all reviews, there was little or no difference between these medications and placebo regarding serious cardiovascular events, quality of life, or mortality. However, adverse events—especially nausea and gastrointestinal symptoms—were more frequent among participants receiving GLP-1 medications, and some individuals discontinued treatment due to side effects.

“These medications have the potential to produce considerable weight loss, especially during the first year,” said Dr. Juan Franco, first author of one of the reviews and researcher at Heinrich Heine University Düsseldorf, Germany, affiliated with the Iberoamerican Cochrane Network. “It’s an exciting time after decades of unsuccessful attempts to find effective treatments for people living with obesity.”

Independent Research and Equitable Access

Most of the included studies were funded by the pharmaceutical industry, which played a major role in the design, conduct, analysis, and reporting of results. This raises concerns about potential conflicts of interest and underscores the need for independent research.

The authors also noted that broader use of these medications must consider the social and commercial determinants of health, including access, affordability, and coverage, to avoid worsening existing health inequalities among people with obesity. The high price of semaglutide and tirzepatide currently limits access to these treatments, while the expired patent for liraglutide has allowed more affordable generic versions to become available. The semaglutide patent is also set to expire in 2026.

The studies included in the three reviews were conducted primarily in high- and middle-income countries, with little representation from regions such as Africa, Central America, and Southeast Asia. Given the diversity in body composition, diet, and health behaviors across populations, the authors emphasize the importance of assessing how these medications perform in different global contexts.

“We need more data on long-term effects and other health outcomes, particularly cardiovascular ones, especially in people at lower risk,” said Dr. Eva Madrid, lead author of the reviews and researcher at the IR Sant Pau and the Iberoamerican Cochrane Centre, as well as professor at the University of Valparaíso (Chile). “Weight regain after stopping treatment could affect the long-term sustainability of the observed benefits. More independent studies with a public health perspective are needed.” Among the authors of the reviews are also Drs. Javier Bracchiglione, Marta Roqué, Ivan Solà, and Gerard Urrútia, researchers at the IR Sant Pau and the Iberoamerican Cochrane Network.

These reviews are part of a commission from the World Health Organization (WHO) to the Cochrane Evidence Synthesis Units (ESU) in Iberoamerica—coordinated by the Iberoamerican Cochrane Centre, based at IR Sant Pau—and Germany and the United Kingdom and will inform upcoming WHO guidelines on the use of GLP-1 receptor agonists for treating obesity. The guidelines are expected to be published soon, following a public consultation held in September.

Reference articles:

1. Franco JVA, Guo Y, Varela LB, Aqra Z, Alhalahla M, Medina Rodriguez M, Salvador Oscco EL, Patiño Araujo B, Banda S, Escobar Liquitay CM, Bracchiglione J, Meza N, Madrid E. Tirzepatide for adults living with obesity. Cochrane Libr 2025;2025. https://doi.org/10.1002/14651858.cd016018.
2. Bracchiglione J, Meza N, Franco JVA, Escobar Liquitay CM, Novik A V, Ocara Vargas M, Lazcano G, Poloni D, Rinaldi Langlotz F, Roqué-Figuls M, Munoz SR, Madrid E. Semaglutide for adults living with obesity. Cochrane Libr 2025;2025. https://doi.org/10.1002/14651858.cd015092.pub2.
3. Meza N, Bracchiglione J, Escobar Liquitay CM, Madrid E, Varela LB, Guo Y, Urrútia G, Er S, Tiller S, Shokraee K, Alvarez Busco F, Solà I, Ocara Vargas M, Novik A V, Poloni D, Franco JVA. Liraglutide for adults living with obesity. Cochrane Libr 2025;2025. https://doi.org/10.1002/14651858.cd016017

The Auditorium of Hospital de Sant Pau hosted today the Nursing Research Conference “Research in Care: The Necessary Boost for Better Health”, organized by the Sant Pau Research Institute (IR Sant Pau). The event brought together professionals from across Catalonia to share experiences and reflections on how research in care can help improve care quality, patient safety, and the sustainability of the healthcare system.

The opening ceremony was chaired by Dr. Jordi Surrallés, Scientific Director of IR Sant Pau, and Maria Lacueva Abad, Nursing Director at Hospital de Sant Pau, who highlighted the strategic role of nursing research in generating applied knowledge. “Research in care helps us better understand patients’ real needs and improve their care experience,” said Dr. Surrallés. “At Sant Pau, the scientific vocation and humanistic outlook of nursing professionals come together to move toward more comprehensive care,” he added.

For her part, Maria Lacueva emphasized that “nurses not only care for people; we also generate knowledge that improves care and the health of society as a whole. Nursing research is, undoubtedly, another way of caring.”

A Conference to Share Experiences and Challenges

The first panel, focused on promoting nursing research in management, was moderated by Laia Lacueva Pérez, Coordinator of the Care Process Management Service of the Nursing Directorate at Hospital del Mar, and included Maria Lacueva Abad, Nursing Director at Hospital de Sant Pau; Saray Alen Gobernado, Nursing Director at Hospital Clínic; Isabel Andrés Martínez, Nursing Director at Hospital Germans Trias i Pujol; and Mariona Peiró Robert, Head of Nursing for the Mountain-Right Area of Barcelona at the Catalan Health Institute. The participants shared their experience on the value of research as a tool to improve management, promote nursing leadership, and drive innovation from within the field of care.

In the session dedicated to the contribution of nursing research, projects were presented that showcased the diversity and vitality of this field. The presentations included work on the therapeutic relationship in acute mental health units, the influence of social determinants in advanced heart failure, the relationship between care intensity and clinical outcomes, the impact of advanced practice nursing roles in immunotherapy. They also included a training program for the detection of acute myocardial infarction with a gender- and age-based perspective.

The Head of Nursing Research at Hospital de Sant Pau, Dr. Jordi Torralbas Ortega, stressed that “these kinds of meetings are essential for sharing knowledge and raising awareness of the contributions and impact of nursing research.” He noted that nurses play a key role in generating scientific evidence that can transform clinical practice and improve people’s health.

After the break, the panel on challenges to boost nursing research, moderated by Ester Risco Vilarasau, Head of Research and Innovation in Care and Home Care at the Parc Taulí Foundation, brought together Antonio R. Moreno Poyato, Associate Professor and Vice Dean for Research and International Relations at the School of Nursing, University of Barcelona; Begoña Martí Cañiz, Director of Nursing Care for the Catalan Health System at the Department of Health of the Government of Catalonia; Ramón Mir Abellán, Head of Nursing Knowledge Management at Parc Sanitari Sant Joan de Déu; and Jordi Torralbas Ortega. The speakers shared insights on how to strengthen the visibility, funding, and institutional recognition of research in care, as well as the need to foster collaboration between centers and consolidate support structures for nursing research.

The conference concluded with the lecture “Funding and Visibility of Research in Care: Ideas to Move Forward”, delivered by Mayte Moreno Casbas, Director of the Research Unit on Nursing and Health Services (Investén-ISCIII) and Co-coordinator of the Health Care Committee of the Spanish Ministry of Health. She offered her perspective on the importance of continuing to advance recognition and support for research in care. In the closing segment, Adrià Comella, CEO of Hospital de Sant Pau, and Xavier Prats Monné, Chair of the Board of Trustees of the Hospital and IR Sant Pau, also spoke, expressing their gratitude and recognition for the work of the nursing teams.

Sant Pau’s Commitment to Research in Care

With this conference, IR Sant Pau reaffirms its commitment to research in care and to recognizing the scientific work of nurses, which represents one of its key strategies to promote a healthcare system based on evidence, innovation, and excellence in patient care. The Institute considers nursing research a key tool to transform clinical practice, create new person-centered models of care, and strengthen coordination between the clinical and scientific fields.

Through initiatives such as this conference, IR Sant Pau aims to promote a research culture that acknowledges the value of knowledge generated from within care practice. It encourages the participation of nursing teams in competitive projects and facilitates the transfer of research results into everyday clinical practice. This commitment to research in care consolidates the role of IR Sant Pau as a driving force for innovation and continuous improvement in health.

A multicenter study led by the Sant Pau Research Institute (IR Sant Pau) and the Hospital de Sant Pau, published in Neurology, demonstrates that the early and coordinated implementation of a comprehensive care protocol significantly improves functional recovery in patients with spontaneous intracerebral hemorrhage. This is one of the most severe forms of stroke.

The research confirms that rapid and standardized care is also decisive in hemorrhagic stroke, as it is in ischemic stroke, and shows that clinical measures applied in the first few hours can make a difference in the patient’s functional outcome. The results point to the need to organize specific care pathways for brain hemorrhage—a future “ICH Code” (for Intracerebral Hemorrhage)—that allow the immediate activation of medical resources and ensure the early application of interventions that save brain tissue and reduce long-term sequelae.

Stroke is one of the leading causes of death and disability. In Catalonia, more than 13,000 people suffer a stroke each year. The majority, about 85%, are ischemic strokes caused by the obstruction of a cerebral artery, but between 10 and 15% are hemorrhagic strokes, caused by the rupture of a blood vessel and the accumulation of blood inside the brain. This type of stroke usually has a poorer prognosis, with mortality rates that can exceed 40% and a high rate of severe disability. Until a few years ago, it was believed that there were few therapeutic options beyond general care, leading to a more passive approach to these patients.

A Simple but Effective Protocol That Improves Recovery

The new study led by Dr. Anna Ramos Pachón and Dr. Álvaro Lambea Gil, researchers with the Cerebrovascular Diseases Group at IR Sant Pau and neurologists in the Sant Pau Stroke Unit, confirms that this view must change. By analyzing more than 1,800 patients treated in the 28 public hospitals of Catalonia’s Xarxa d’Atenció d’Ictus between 2020 and 2022, the researchers found that the early application of a set of simple, protocolized medical measures—known as the care bundle protocol (CBP)—significantly improves functional recovery. This protocol includes the rapid control of blood pressure, blood glucose, body temperature, oxygenation, and the reversal of anticoagulant treatment when indicated.

The study confirms, in this population, the findings of the international clinical trial INTERACT3 and further shows that the beneficial effect persists for a longer period than previously described. It also demonstrates a benefit even among patients who arrive later at the hospital, although this effect is greater the sooner admission occurs.

The results show that patients in whom all protocol targets were achieved within the first 24 hours had a 66% greater probability of achieving a favorable functional recovery at three months. Particularly marked benefits were seen in those who arrived at the hospital within eight hours of symptom onset.

“For years it was assumed that little could be done in the case of brain hemorrhage beyond basic care. This study proves the opposite: that applying simple but well-coordinated measures early on greatly improves recovery prospects,” explains Dr. Álvaro Lambea-Gil. “The message is clear: time also matters in intracerebral hemorrhage, and we must act with the same speed and organization as in ischemic stroke.”

Toward an “ICH Code” to Improve Hemorrhagic Stroke Care

The study also shows that in only one out of four patients was full protocol compliance achieved, highlighting the need to improve adherence to these measures across the entire healthcare network. Even so, the results were consistent across all hospital types, demonstrating that these are low-cost, easily applicable interventions with major clinical impact.

“Until recently, the management of hemorrhagic stroke was more passive, partly due to the lack of specific treatments,” adds Dr. Lambea Gil. “Today we know there is much that can be done, and these measures should be applied systematically. That’s why we believe the time has come to implement an ICH Code in all hospitals—a dedicated pathway that ensures fast, protocolized care for patients with brain hemorrhage.”

The study also reinforces that the first hours are critical in brain hemorrhage and that the benefit of early action extends further than previously believed—up to approximately 14 hours after symptom onset. Therefore, the researchers insist that the public must continue going to the hospital immediately at any sign of stroke, since distinguishing between ischemic and hemorrhagic stroke is only possible through imaging tests.

“The message to citizens does not change: if stroke symptoms appear, call 112 immediately. Even if the scan later shows a hemorrhage, there are still things we can do that can make a difference,” summarizes Dr. Lambea Gil.

The HIC-CAT Registry: A Pioneering Population-Based Research Tool

The study was carried out using the HIC-CAT (Hemorràgia Intracerebral a Catalunya) registry, a project funded by the Fundació Ictus and promoted by Dr. Joan Martí Fàbregas from Hospital de Sant Pau, in coordination with the Pla Director de Malalties Vasculars Cerebrals of the Catalan Ministry of Health.

HIC-CAT was created with the goal of improving real-world knowledge of hemorrhagic-stroke care in Catalonia, an area for which there had previously been very little systematized population-based data. Its design made it possible to collect clinical, imaging, therapeutic, and outcome variables for each case and link them to care and short- and medium-term outcome indicators for all patients diagnosed with acute intracerebral hemorrhage in Catalan public hospitals capable of treating stroke.

Coordinated by IR Sant Pau and Hospital de Sant Pau, the registry involves the 28 public hospitals in Catalonia that constitute the Xarxa d’Atenció a l’Ictus, making it one of the largest prospective hemorrhagic-stroke registries in Europe. Thanks to this infrastructure, it has been possible to analyze for the first time how the systematic application of early-management measures can modify functional outcomes under real-world clinical conditions, beyond the controlled setting of clinical trials.

In addition, HIC-CAT serves as a collaborative research platform, facilitating the development of observational studies, quality-improvement projects, and future clinical interventions aimed at standardizing hemorrhagic-stroke care. Its modular structure and centralized coordination allow the inclusion of new variables or centers, and its integration with the Stroke Catalan Reperfusion Consortium ensures consistency with existing stroke-code programs.

“HIC-CAT represents a qualitative leap in how intracerebral hemorrhage is studied,” says Dr. Pol Camps, coordinator of the Cerebrovascular Diseases Group at IR Sant Pau and the Sant Pau Stroke Unit, and co-author of the study. “It allows us not only to describe what we do but also to identify which practices have a real impact on patient recovery and how we can implement them consistently throughout the healthcare system.”

IR Sant Pau’s Leadership in Stroke Research

The study on intracerebral hemorrhage is part of a consolidated line of research at IR Sant Pau that combines clinical practice, systematic data collection, and population-based analysis to improve the care and recovery of patients with all types of stroke. This line of work seeks to translate the knowledge generated from Catalonia’s stroke registries into clinical practice, with a multidisciplinary approach that integrates neurologists, radiologists, intensivists, and specialized nursing staff.

Recently, the Cerebrovascular Diseases Group, led by Dr. Pol Camps, has published in Neurology two internationally recognized studies that reinforce this commitment to useful, applicable research.

On one hand, a study led by Dr. Marina Guasch-Jiménez demonstrated that asymptomatic hemorrhagic transformations after endovascular treatment for ischemic stroke are also associated with poorer functional recovery and higher mortality, which calls for reconsidering the safety and follow-up criteria of endovascular therapy. The study, based on more than 3,000 cases from the Catalan Stroke Code registry (CICAT), is the largest population-based analysis conducted to date on this phenomenon.

On the other hand, research led by Dr. Garbiñe Ezcurra-Díaz confirmed that urgent carotid stent placement during mechanical thrombectomy improves functional outcomes and survival in patients with ischemic stroke caused by tandem lesions, without increasing hemorrhagic complications. This study, which included 578 patients treated in ten Catalan centers, provides some of the strongest evidence to date on the safety and efficacy of urgent carotid stenting.

“These studies reflect IR Sant Pau’s commitment to generating clinically useful evidence for real-world practice, leveraging the strength of Catalonia’s population-based stroke registries,” emphasizes Dr. Pol Camps. “Our goal is to continue advancing stroke care through collaborative, patient-centered research.”

Article References:

1. Lambea-Gil Á, Marti-Fabregas J, Cardona P, Rodriguez-Luna D, Millán M, Amaro S, Prats-Sanchez L, Silva Y, Seró L, Rodriguez-Campello A, Cánovas D, Martinez-Domeño A, Guasch-Jiménez M, Ezcurra-Díaz G, Carcel-Marquez J, Fernandez-Cadenas I, Pérez De La Ossa N, Abilleira S, Salvat-Plana M, Fagundez O, Camps-Renom P, Ramos-Pachón A, as the HIC-CAT investigators. Effect of onset-to-admission time and care bundle achievement on functional outcomes in patients with ICH: A population-based study. Neurology 2025;105:e214176. https://doi.org/10.1212/WNL.0000000000214176
2. Marti-Fabregas J, Ramos-Pachón A, Prats-Sanchez L, Núñez-Guillén A, Rodríguez BL, Rodriguez-Luna D, Amaro S, Silva Y, Rodriguez-Campello A, Puig I, Gomez-Choco M, Vázquez-Justes D, Guanyabens N, Cocho D, Cánovas D, Steinhauer EG, Llull L, Guasch-Jiménez M, Martinez-Domeño A, Marin R, Lambea-Gil Á, Díaz GE, Paipa-Merchan A, Quesada H, Casadevall MP, Wenger D, Pancorbo O, Seró L, Pérez J, Costa X, Zaragoza J, Rodríguez-Villatoro N, Catena E, Calvo NM, Krupinski J, De La Ossa NP, Abilleira S, Salvat-Planas M, Fagundez O, Camps-Renom P, for HIC-CAT. Influence of hospital type on outcomes of patients with acute spontaneous intracerebral hemorrhage: A population-based study. Neurology 2024;103:e209539. https://doi.org/10.1212/WNL.0000000000209539
3. Guasch-Jiménez M, Ezcurra-Díaz G, Lambea-Gil Á, Ramos-Pachón A, Martinez-Domeño A, Prats-Sanchez L, Fernández-Vidal JM, Toscano-Prat C, Marti-Fabregas J, Martínez-González JP, Fernandez-Cadenas I, Cardona P, Rodriguez-Villatoro N, Rodríguez Vázquez A, Gomis M, Xuclà-Ferrarons T, Rodriguez-Campello A, Cánovas D, Seró L, Purroy F, Salvat-Plana M, Abilleira S, Camps-Renom P, as the Catalan Stroke Code and Reperfusion Consortium (CICAT). Influence of asymptomatic hemorrhagic transformation after endovascular treatment on stroke outcome: A population-based study. Neurology 2025;104:e213509. https://doi.org/10.1212/WNL.0000000000213509.
4. Ezcurra-Díaz G, Cardona P, Rodriguez-Villatoro N, Doncel-Moriano Cubero A, Flores-Pina B, Figueras-Aguirre GL, Fernández-Pérez I, Xuclà-Ferrarons T, Purroy F, Flores A, Guasch-Jiménez M, Lambea-Gil Á, Prats-Sanchez L, Ramos-Pachón A, Martinez-Domeño A, Marti-Fabregas J, Fernández-Vidal JM, Abilleira S, Salvat-Plana M, Núñez-Guillén A, Lara-Rodríguez B, Rodriguez-Luna D, Hernandez D, Rodríguez Vázquez A, Cabero-Arnold A, Menéndez Albarracín A, Cánovas D, Camps-Renom P. Emergent carotid artery stenting in patients with acute ischemic stroke with tandem lesions: One-year follow-up results from the SECURIS study. Neurology 2025;105:e214067. https://doi.org/10.1212/WNL.0000000000214067.

Although endovascular treatment has revolutionized the prognosis of stroke patients, half of them do not regain their independence. Among the different causes explaining this lack of improvement are brain hemorrhages. These may occur after an ischemic stroke treated with endovascular therapy and have traditionally been considered concerning only when they cause evident neurological deterioration. However, a study published in Neurology and led by the Institut de Recerca Sant Pau (IR Sant Pau) shows that even asymptomatic forms of hemorrhagic transformation—those that do not cause clinical worsening—also have a negative impact on patients’ functional recovery and survival.

“Until now, we only paid attention to hemorrhages detected on the follow-up CT scan when the patient showed clinical deterioration,” explains Dr. Marina Guasch-Jiménez, first author of the study, researcher at the Cerebrovascular Diseases Group of the IR Sant Pau, and neurologist at the Stroke Unit of Hospital de Sant Pau. “Our data suggest that this is not the case. Even asymptomatic hemorrhagic transformations are associated with more limited functional recovery and higher three-month mortality.”

Dr. Pol Camps, principal investigator of the study and coordinator of the Cerebrovascular Diseases Group and the Stroke Unit at Sant Pau, adds that “these results call for a reassessment of endovascular treatment safety indicators. It is not enough to monitor only symptomatic hemorrhages; any hemorrhagic transformation, even if asymptomatic, should be considered a risk marker that can influence patient outcomes.”

A Population-Based Study With More Than 3,000 Patients

The study, titled “Influence of Asymptomatic Hemorrhagic Transformation After Endovascular Treatment on Stroke Outcome,” is based on the Catalonia Stroke Code (CICAT) population registry, a prospective and mandatory database that systematically collects stroke care data across the entire Catalan hospital network.

The study included 3,067 consecutive patients treated with endovascular therapy for an anterior circulation ischemic stroke between 2017 and 2023 in ten reference centers across Catalonia, including Hospital de Sant Pau. The researchers analyzed detailed clinical, radiological, and therapeutic data to determine whether asymptomatic hemorrhagic transformation, detected on control neuroimaging 24 hours after treatment, had an impact on functional recovery or medium-term mortality.

Among the more than 3,000 patients included, one in four (25.8%) experienced some form of hemorrhagic transformation, and one in five (20%) did so without associated clinical symptoms. Among the radiological categories described—hemorrhagic infarction types 1 and 2 (HI1, HI2) and parenchymal hemorrhage types 1 and 2 (PH1, PH2), in addition to remote parenchymal hemorrhage (rPH)—the milder forms (HI1 and HI2) were the most frequent, while the most severe (PH2) showed the lowest percentage of asymptomatic cases.

Multivariable analysis adjusted for known prognostic factors such as age revealed that the presence of asymptomatic hemorrhagic transformation doubled the likelihood of a worse functional outcome and was associated with a 50% higher mortality rate. Among subtypes, asymptomatic PH2 showed the highest risk of poor functional outcome.

“The value of this work lies in its representativeness: we analyzed over three thousand patients treated in real-world conditions, which allows us to draw solid conclusions applicable to daily clinical practice,” highlights Dr. Guasch-Jiménez. “Catalonia has a unique population-based stroke registry in Europe, offering the opportunity to generate high-quality clinical evidence on endovascular treatment and its complications,” adds Dr. Camps.

Associated Factors and Potential Clinical Implications

The study also identified several factors associated with the occurrence of asymptomatic hemorrhagic transformations, including higher glucose and systolic blood pressure levels at admission, greater initial neurological severity, lower ASPECTS score (indicator of viable brain tissue), and longer time from stroke onset to femoral puncture. It also identified more thrombectomy passes.

“Some of these factors are potentially modifiable, which opens the door to targeted clinical interventions,” notes Dr. Guasch-Jiménez. “Better control of blood glucose and blood pressure, as well as optimizing devices to reduce the number of thrombectomy passes, could help prevent this type of complication.”

According to Dr. Camps, “the results reinforce the need to include radiological monitoring of any post-treatment hemorrhage as part of safety assessments in clinical trials and routine practice. Understanding why even clinically silent hemorrhages affect prognosis may help us develop safer and more effective therapies.”

Furthermore, the authors suggest that studying the underlying mechanisms—such as toxicity due to blood extravasation or disruption of the blood-brain barrier—could improve understanding of post-stroke brain injury and guide the design of more specific neuroprotective strategies.

A Call to Review Safety Criteria in Stroke Treatment

The researchers emphasize that asymptomatic hemorrhagic transformations, far from being a benign or anecdotal finding, should be regarded as a relevant warning sign and a new safety parameter in acute ischemic stroke endovascular treatment. Although they do not cause immediate clinical worsening, the study data consistently show that their mere presence is associated with worse functional outcomes and higher medium-term mortality.

“These findings show that any type of hemorrhage following endovascular treatment, even without symptoms, may reflect underlying tissue damage that affects brain recovery,” explains Dr. Guasch-Jiménez. “Therefore, all hemorrhagic transformations, regardless of their clinical expression, should be systematically monitored and reported to improve safety and efficacy assessment of the procedure.”

According to Dr. Camps, “hemorrhagic transformations should be included as an additional safety indicator in clinical registries and trials on new reperfusion strategies. Incorporating this measure will provide a more comprehensive view of the real impact of endovascular treatment and help develop safer, more personalized protocols for each patient.”

The authors also highlight that identifying modifiable factors—such as hyperglycemia or elevated blood pressure at admission—reinforces the importance of a comprehensive approach to stroke care that combines metabolic and hemodynamic control with increasingly precise and safe endovascular procedures.

The study was conducted in collaboration with the Consorci Codi Ictus de Catalunya (CICAT) and funded by the Instituto de Salud Carlos III (project PMP21/00165) within the RICORS-ICTUS program (RD21/0006/0006), with support from FEDER and Next Generation EU European funds.

Article Reference:

Guasch-Jiménez M, Ezcurra Díaz G, Lambea-Gil Á, Ramos-Pachón A, Martinez-Domeño A, Prats-Sanchez L, Fernández-Vidal JM, Toscano-Prat C, Marti-Fabregas J, Martínez-González JP, Fernandez-Cadenas I, Cardona P, Rodriguez-Villatoro N, Rodríguez Vázquez A, Gomis M, Xuclà-Ferrarons T, Rodriguez-Campello A, Cánovas D, Seró L, Purroy F, Salvat-Plana M, Abilleira S, Camps-Renom P, as the Catalan Stroke Code and Reperfusion Consortium (CICAT). Influence of asymptomatic hemorrhagic transformation after endovascular treatment on stroke outcome: A population-based study. *Neurology* 2025;104:e213509. https://doi.org/10.1212/WNL.0000000000213509.