Vol. 17 No. 1 • March 2018

Celebration of Success: Special Issue Page #

The Academic Odyssey of Naranjan S. Dhalla 2

2018 Honours and Awards for Naranjan Dhalla 9

Report of the IACS India Section Meeting, Madurai, India, 2018 10

Academy Presents Distinguished Achievements, Leadership and Service Awards 16

Academy Bestows Exemplary Service Awards 19

CV Network Editorial Board 22

Academy Competition Award Recipients, IACS, Orlando 23

Caribbean Heart Health Group in Partnership with the Academy Honors Dr. Charles Greenidge 25

Cardiac Adaptation as a Novel Approach to Reduce the Risk of Heart Failure Using Clinically Relevant Interventions 26

Cardiovascular Health Research and Practice in Serbia 30

IACS Officers and Executive Council Members 31

The Challenges and Opportunities in Providing High Quality Cardiovascular Care in the Caribbean, Case Study: Jamaica 32

Cardiovascular Health in the Caribbean: The Cuban Perspective 37

Local Caribbean Group along with St. Boniface Hospital Research Centre Send Medical Equipment/Supplies to Guyana 39

In Memoriam: Dr. Jacques Genest, Montreal 41

Official Partnering Journals of the Academy 42

Announcement of the IACS North America Section Meeting Havana, Cuba, June 2018 43

Program of the IACS 5th European Section Meeting: Bratislava, Slovakia, May 2018 46 CV Network Vol 17 No 1 • March 201 8 www.heartacademy.org 1 Announcement of the 4th Congress of Physiological Sciences of Serbia Nis, September, 2018 52

My Academic Odyssey: Opportunities, Challenges and Excellence

Editor’s Note: This article is based on the plenary talk given at the International Conference on Recent Advances in Cardiovascular Science –10th Annual Conference of the International Academy of Cardiovascular Sciences – India Section, School of Biotechnology, Madurai Kamaraj University, Madurai, India, during February 8 –10, 2018

Naranjan S. Dhalla, Distinguished Professor, Institute of cardiovascular Sciences, St. Boniface Hospital Albrechtsen Research Centre, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada Email for Correspondence: [email protected]

By agreeing to give this industry so that one day I will become a movie director plenary talk on my and help improving the social structure and administration academic journey, I found of justice in India. However, it appears that I was that I have taken a most destined to enter in the world of Medical Research. difficult task in describing Accordingly, I started working as a volunteer in the Govt. a major aspect of my Medical College in Amritsar, a great city which is famous professional performance for the Golden Temple. Within 3 months, I learnt the during the past 60 years. techniques for the measurement of tissue respiration by The main difficulty in this employing the Warburg apparatus. One day, Dr. Chaman regard stems from the fact L. Malhotra, while visiting Amritsar observed me that there is a great deal of working and offered me a position in the Department of insecurity of painting a Pharmacology, Lady Hardinge Medical College, New self-portrait of success Delhi as he needed someone with my training to examine Dr. Naranjan S. Dhalla when I am fully aware that the effects of some herbal medicines on tissue respiration. all the progress in my This is how I started my career in Medical Research and academic career has been dependent upon my Mentors, became truly fascinated about gaining new knowledge; Advisors, Well-wishers, Associates, Fellows and however, it was very clear to me that it was going to be a Students. Although I have always considered myself as a constant struggle to make any progress in this profession. man of average intelligence, hard work, sincerity and truthful approach have been the salient features of my Academic Development character. Furthermore, I have an extraordinary I have chosen to tell my academic journey as well as commitment to serving the mankind, and have developed experiences and research achievements in the form of 4 special talents for building long lasting professional stages for my professional development; these are shown relationships and personal friendships. Thus at the onset, in Table 1. The first stage was devoted to Apprenticeship I can clearly indicate that the story of my journey in the at the Lady Hardinge Medical College, New Delhi where world of medical research is based upon the efforts of I learned different techniques for studying the effects of numerous individuals, who have helped me to get several herbal medicines on cardiovascular and central involved and showed me the path, provided me the nervous systems under the guidance of Prof. C.L. opportunities, and guided my development. Malhotra, who was interested in investigating drug effects on the brain at a biochemical level, as well as Dr. Prasun After completing my undergraduate Degree from a highly K. Das, who was known for his expertise in the area of prestigious institution, Khalsa College Amritsar (Fig.1), cardiovascular pharmacology. In addition, I carried out Panjab University in 1957, I was contemplating on the several experiments in the field of phytochemistry under pros and cons for my career in the movie–making the supervision of a well-established expert. I served the Department of Pharmacology in my capacity as Chemist, Research Assistant and then as Assistant Research Officer. The second stage of my academic career, Fellowship Stage, was concerned about studying for M.S. Degree at the University of Pennsylvania under the guidance of Professor Niels Haugaard (a pioneer in the field of Biochemical Pharmacology) and Ph.D. Degree at the University of Pittsburgh under the guidance of Figure 1. Khalsa College, Amritsar Professor Paul L. McLain (a highly respected

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 2 program for studying the cardiovascular system at Table 1 –Various Stages of Development in molecular and cellular levels. I progressed through Medical Research academic ranks and was appointed Professor of

1. Apprenticeship (1957-1961): Lady Hardinge Physiology in 1974. While Dr. Naimark, became the Medical College, New Delhi, India; Supervisors – Dean of Medicine (and later as President of the University Drs. Chaman L. Malhotra and Prasun K. Das; of Manitoba), the Department of Physiology was Professional Ranks – Chemist, Research Assistant fortunate to be directed by a Distinguished and Assistant Research Officer. Endocrinologist, Dr. Henry Friesen (who discovered 2. Fellowship (1961-1968): University of Pennsylvania, human prolactin). Dr. Friesen believed in excellence, Philadelphia, University of Pittsburgh, Pittsburgh, & practiced excellence and preached excellence, and he was St. Louis University, St. Louis, USA; Supervisors – a source of great inspiration to me. I feel truly honoured Drs. Neils Haugaard, Paul McLain & Robert E. to have a close association with him, learnt a lot from him Olson; Professional Ranks – Graduate Student, and build a long lasting relationship with him. Research Associate and Assistant Professor. 3. Investigatorship (1968-1987): University of Dr. Friesen took a special pride and a great deal of Manitoba, Faculty of Medicine, Winnipeg, Canada; satisfaction to see me developing a strong research and Professional Ranks – Assistant Professor, Associate graduate training program. In fact, the first Centre of Professor and Professor of Physiology (Departmental Excellence in Heart Research in Canada was established Heads – Drs. Arnold Naimark and Henry G. Friesen). under my direction by the Medical Research Council in 4. Mentorship (1987-Present): St. Boniface Hospital 1978. Later on, Dr. Friesen encouraged me to undertake a Research Centre, Winnipeg, Canada; Professional Ranks – Director, Institute of Cardiovascular challenge to build a multidisciplinary Cardiovascular Sciences (1987-2006); Distinguished Professor, Science Program at the St. Boniface Hospital Research University of Manitoba (1991-present); Director of Centre (Fig. 2) and I was appointed as Head of the Cardiovascular Development (2006-present). cardiovascular pharmacologist). After completing my education for the Ph.D. Degree, I accepted the position as Instructor in Pharmacology at the same place and started to develop my own laboratory. It was here that I met with an extraordinary scientist, Dr. Julius Axelrod (who later received the Noble Prize), who was visiting our Figure 2. St. Boniface Hospital Albrechtsen Department at that time. While explaining my research Research Centre work, I indicated that I have a strong desire to find a cure Division of Cardiovascular Sciences at the St. Boniface for heart disease. He smiled and made me realize that I Hospital Research Centre in 1987. This started the 4th would require further training in the field of myocardial stage (Mentorship) of my academic development which I metabolism if I have to achieve my objective. It was on consider was a unique opportunity for me to recruit his advice that I moved to the Department of several highly talented faculty members for the Centre to Biochemistry, St. Louis University, in 1966 to work as a carry out biomedical and translational research. I was also Research Associate with Dr. Robert E. Olson (a highly able to maintain an active research program of my own in influential and powerful Nutritional Biochemist), who had the field of Experimental Cardiology and the University developed the concept that heart failure is a consequence of Manitoba considered me worthy for the appointment as of defects in the process of energy production or in the Distinguished Professor in 1991. In view of the high process of energy utilization. Within nine months of my profile research and graduate training program as well as working with him, Dr. Olson had me appointed as the excellent quality of Faculty Members, the University Assistant Professor in the Department of Pharmacology of Manitoba changed the name of the Division to the and provided me a well-equipped laboratory in his Institute of Cardiovascular Sciences with my appointment Department so that I could continue collaborating with as Director in 1996. The Medical Research Council him. designated this place as Centre of Excellence in Cardiovascular Research. I was able to establish ten The third stage (Investigatorship) of my professional endowment awards to be given annually in the name of career started when I was recruited as Assistant Professor individuals, who helped me build this unique institute of in 1968 by Dr. Arnold Naimark (a highly Progressive and national importance. The St. Boniface Hospital Visionary Physiologist), who was attempting to build a Foundation established the Naranjan Dhalla Chair in this strong Department in the Faculty of Medicine, University institute. Although I am still struggling to achieve of Manitoba, Winnipeg, Canada. He provided me excellence, there are very many of my well-wishers who excellent facilities and encouraged me to develop a

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 3 consider that I have a highly successful career. One of the Table 2 – Experiences and Achievements during the great people from India has recently expressed his Apprenticeship Stage thoughts about my progress in his book. [Remarks by Dr. Prem Chand Dandiya Jaipur, India (Reproduced from the A. Learning Experiences: Book “Pharmacologists of India: Their Contribution”, 1. Biomedical Techniques for Studying Herbal ed. by P. C. Dandiya, S. K. Kulkarni and G. D. Khilnani, Medicines - Phytochemistry, Cardiovascular Vallabh Prakashan, Delhi, India, 33-44, 2017. Pharmacology & Neuropharmacology. Reproduced from - My Professional Journey, N. S. 2. Biochemical Pharmacology – Measurement of Dhalla, CV Network, Vol 16 No 1, pp. 6-11, 2017, Neurohormones & Tissue Respiration. www.heartacademy.org]. 3. Data Analysis - Literature Survey & Writing of Research Papers.

“Reading Dr. Naranjan Dhalla’s 60 years journey into B. Research Achievements: Pharmacology was a treat for me. Going thru it, I was 1. Isolated a New Glycoside, Hersaponin, from Herpestis reminded of a young, enterprising, articulate and Monniera with Marked Cardiotonic and ambitious young man, whom I met 56 years back in Delhi Neuropharmacologic Actions. under Dr. PK Das’s tutorage. I was highly impressed by 2. Isolated a total Alkaloid preparation from Withania the clarity of his mind and the zeal to achieve big. Dr. Somnifera with Marked Antihypertensive Effects. Dhalla has not only done big, he has done the impossible. 3. Studies on Tissue Respiration Provided Evidence that In those days so few Indians went to the West but he did Relaxation of Unstriated Smooth Muscles is an Active the extraordinary in the USA and then created a position Process. for himself in Canada that remains unparalleled. If I had myself not seen his statue in the Hall of Fame in Winnipeg medicinal plant, Herpestis Monniera, which upon further I would have not believed its presence. His rise as a purification was found to be a new glycoside/seponin scientist who delved into the intricacy of various aspects compound (Hersaponin) with marked cardiotonic and of Cardiology is monumental. The fact that he was able to neuropharmacological effects. I was also given the create an International Research Centre in Cardiology in responsibility for this Drug Research Unit and was Canada is highly praise worthy. This write up on his life promoted to the position of Research Assistant. I also and achievements is spell bounding. I hope story of his succeeded in isolating and making a total alkaloid life will motivate many a young scientists and physicians preparation from another medicinal plant, Withania to emulate him and do big in life”. Somnifera, which showed marked antihypertensive actions. Although my supervisor, Dr. C.L. Malhotra was Research Experience very much satisfied with my performance in the area of Nevertheless, at this point I wish to describe my analytical phytochemistry, I became more interested in experiences at each stage of my academic development learning pharmacological techniques for carrying out and to indicate whether or not I made any achievement. experiments with these drug preparations. All this was When I joined the Lady Hardinge Medical College, New made possible by Dr. P. K. Das, who took keen interest in Delhi in 1957 as a Chemist, I learned that although my development and taught me a wide variety of Warburg apparatus was present in the Department of experimental techniques and designs for studying the Pharmacology, all its accessories and associated cardiovascular pharmacology. He helped me learn the glassware had to be imported for the measurement of analysis and interpretation of results as well as writing tissue respiration. After a lot of inquiries, I found that manuscripts. Dr. Das was of the firm belief that sincerity, there was a German glass blower working at the National honest attitude and hard work are the fundamental Physical Laboratory in New Delhi, who could help requirements for a successful career and thus I started making the required equipment if could provide the following his example and devoting lots of time in detailed specifications. Since this whole process for carrying out pharmacological research. making the Warburg apparatus functional was going to take a long time, I was asked to learn some phytochemical When the Warburg apparatus became functional, I techniques for the isolation of active ingredients from undertook a series of experiments to examine the actions some well-known Indian medicinal plants (Table 2). of four different herbal preparations on brain respiration. While I was learning various procedures for making crude Such biochemical observations were helpful in explaining extracts and different fractions from medicinal plants in the mechanism of neuropharmacologic effects of some association with a brilliant research scientist, Mr R.K. herbal medicines at the metabolic level. My ability to Kocchar, I started acquiring some knowledge of my own measure tissue respiration also attracted the attention of a in analytical chemistry of herbal medicines. After about a very famous physiologist, Dr. Inderjit Singh (from the year, Mr Kocchar left for higher studies in USA and I Govt. Medical College, Agra), who asked me to carry out became successful in isolating a white powder from a some experiments by employing unstriated smooth

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 4 muscles. On the basis of this study, it was proposed that Table 3 – Research Experiences and Achievements muscle relaxation is an active process; this extended the during the Fellowship Stage previous concept that muscle contraction was an active process. These types of activities encouraged me to build A. Learning Experiences: a broad background in medical research and I started 1. Study of Pharmacology, Physiology, Biochemistry and Allied Medical Sciences for M.S. & Ph.D. devoting much more time in reading different Degrees. pharmacological journals in the library. In view of my 2. Sympathetic Nervous System – Catecholamine research productivity and commitment for studying the Stores and Adrenergic Mechanisms. mechanisms of drug action in general, I was promoted to 3. Training in Cardiovascular Pharmacology, the rank of Assistant Research Officer. However, my Myocardial Metabolism and Experimental appointment was subjected to a condition that I should Cardiology. upgrade my qualifications within three years. In this regard, our efforts to have the Department of B. Research Achievements: Pharmacology recognized by the Delhi University for 1. Relationship between Metabolic Alterations and carrying out research for M.Sc. Degree were not Stimulation of Cardiac Function due to successful. Thus, I had to take an alternative route to Sympathomimetic and Cardioactive Interventions. fulfill the requirement, and I was lucky that within one 2. Relationship among Metabolic Alterations, year I cleared all the required examinations for the AIC Ultrastructural Changes and Cardiac Dysfunction Diploma (equivalent to M.Sc. Degree) from the due to Oxygen-lack. 2+ Institution of Chemists in Calcutta. I must admit that it 3. Relationship Among Changes in Subcellular Ca - would not have been possible for me to obtain this transport, Catecholamine Stores and Myocardial qualification without the guidance of a capable colleague, Metabolism during Contractile Failure due to Substrate-lack. Mr. M. S. Sastry. During this period, I also had a unique opportunity of presenting my research work to a star scientist from Jaipur, Dr. Prem Chand Dandiya, who was 1963. Then I moved to the School of Medicine, visiting New Delhi. He thought that I have all the University of Pittsburgh for studies towards Ph.D. Degree characteristics of becoming a good pharmacologist and he in cardiovascular pharmacology under the supervision of encouraged me to undertake graduate studies outside Dr. Paul McLain. He paid special attention for me to India. I have therefore been indebted to Professor develop into an independent investigator and encouraged Dandiya for identifying my potential and showing the me to undertake several formal courses so that I could path for my development. have a well-rounded background in biomedical sciences. I was asked to carry out research on the role of Although I was accepted for graduate studies in phosphorylase activity in the actions of several pharmacology with adequate fellowship support by the sympathomimetic agents on the heart for my thesis work. University of Toronto in Canada (where Dr. Dandiya I was also encouraged to establish research collaboration recommended), I joined the Department of Pharmacology, with other investigators to understand the impact of School of Medicine, University of Pennsylvania in sympathetic nervous system on the heart. Philadelphia on August 20, 1961 as a graduate student. nd This was the beginning of the 2 stage of my academic After completing my Ph.D. Degree in 1965 and a short career, Fellowship (Table 3). This Department was stay in same Department, I moved to the St. Louis chaired by a world-renowned pharmacologist and a great University where I undertook studies in the field of human being, Dr. George B. Koelle, who discovered the Experimental Cardiology. Since substrate-lack and presence of cholinesterase in neuromuscular junction. I oxygen-lack were known to be the main factors for the was assigned to work under the supervision of Dr. Neils pathogenesis of ischemic heart disease, I started Haugaard, who was dedicated to the understanding of investigating the effects of these interventions on cardiac cellular functions at a biochemical level. He was function and seek relationship with changes in myocardial convinced that changes in phosphorylase activity play a metabolism, energy metabolism, catecholamine stores and critical role in determining cardiac contraction (cyclic cardiac ultrastructure. Our studies established that AMP was not discovered at that time). I carried out my although adequate operation of metabolic processes and research work on the phosphorylase activity in different the function of endogenous energy stores were essential species under his direction. I also found that my for the maintenance of cardiac performance, the interaction with several faculty members in this relationship of defects in energy metabolism and different Department was truly a great learning experience. In metabolic processes with cardiac dysfunction was of a addition, I undertook several formal courses for studies in complex nature. It was here in 1968 I observed that there pharmacology, physiology and biochemistry and other occurs a subcellular defect in Ca2+- handling by the allied medical sciences to complete my M.S. Degree in myocardium during the development of contractile

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 5 failure. At that time not much was known about Ca2+- Table 4 – Research Projects and Achievements during handling in diseased cardiac muscle and thus our the Investigatorship Stage 2+ observations regarding changes in Ca -transport by both A. Research Projects: the sarcoplasmic reticulum and mitochondria in the 1. Pathogenesis of Cardiac Dysfunction in Heart Failure. failing heart were of novel nature. I had the opportunity 2. Pathophysiology of Ischemic Heart Disease of discussing this work with Dr. George Koelle from the 3. Pathophysiology of Cardiac Dysfunction in Chronic University of Pennsylvania while he was visiting St. Diabetes Louis. He was very much impressed with my research 4. Pathogenesis of Stress-induced Heart Disease productivity since I left his Department four years ago. He felt that it was the right time that I should have an B. Research Achievements: independent faculty position and from my office he called 1. Role of Subcellular Defects in Dilated, Hypertrophic one of his friends, Dr. Ian Innes, Head of the Department and Infective Cardiomyopathies. of Pharmacology at the University of Manitoba in 2. Role of Subcellular Abnormalities in the Development Winnipeg, Canada. Since Dr. Innes had no opening in his of Diabetic Cardiomyopathy. 2+ department at that time, he brought my name to the 3. Role of Intracellular Ca -overload in Myocardial Cell attention of Dr. Arnold Naimark, who recruited me to the Damage, Metabolic Alterations and Cardiac Department of Physiology and provided excellent Dysfunction. opportunities for the development of my professional 4. Role of Oxidation Products of Catecholamines in career. Stress-induced Cardiac Dysfunction, Subcellular Defects, Coronary Artery Spasm and Arrhythmias.

The third stage of my academic development (Investigatorship) started when I moved from St. Louis to became clear that the development of intracellular Ca2+- Winnipeg in August 1968. It was not an easy task for me overload plays a critical role in inducing metabolic and to leave Dr. Robert Olson, who devoted considerable subcellular abnormalities. Hearts reperfused with Ca2+- resources and efforts for promoting my research program containing medium, after a brief period of perfusion with in his department and mentored me to expand my Ca2+-free medium, provided further evidence for the role horizons to look at problems in a broader perspective. of intracellular Ca2+- overload in producing a wide variety Nonetheless, he permitted me to take this new position of defects in Ca2+-handling, metabolic pathways, with understanding that we will continue to collaborate ultrastructure and contractile function. Extensive work for a few years to complete the projects we started at his was carried out for studying the pathophysiology of institution. In fact, he was most generous to let me take cardiac dysfunction in different types of cardiomyopathies several pieces of equipment, chemicals and supplies from including genetic cardiomyopathy in hamsters, infective the laboratory at my disposal in St. Louis to Winnipeg cardiomyopathy in rabbits, diabetic cardiomyopathy in and this helped me to start my experiments at a new place rats as well as catecholamine cardiomyopathy in rats. We without any delay. I was made to feel very welcome in the were able to demonstrate that the pathogenesis of cardiac Department of Physiology in Winnipeg and Dr. Arnold dysfunction in heart disease was not only limited to Naimark provided the great incentives to build a strong changes in energy production due to mitochondria or research for understanding the molecular and cellular energy utilization by myofibrils but other subcellular basis of heart dysfunction during the development of heart organelles such as the sarcoplasmic reticulum and disease. I was successful in obtaining grant funding from sarcolemma also become defective for inducing Ca2+- various agencies such as the Medical Research Council of handling abnormalities in cardiomyocytes. These Canada, Canadian Heart Foundation, Canadian Diabetes conclusions were based on observations mainly for Association as well as several private and corporate changes in myofibril ATP hydrolysis and protein content, agencies. Very rapidly I was able to develop a highly mitochondrial oxidative phosphorylation and Ca2+-uptake functional laboratory with state-of-the-art equipment. activities; sarcoplasmic reticular Ca2+-pump and Ca2+- Several of my fellows working in the laboratory perfected release activities; and sarcolemmal Na+-K+ ATPase and different sophisticated techniques for monitoring changes Na+- Ca2+ exchange activities in the experimental animals. in cardiac metabolism, Ca2+-handling and signal It was indeed a very productive period of my research transduction mechanisms. Some of the fellows working career; however, I wish to indicate that I did not do any with me developed new methods for the isolation of experiment with my own hands and all the work was done subcellular organelles whereas others developed expertise by my graduate students, postdoctoral fellows, visiting in hemodynamic and electron microscopic measurements. scientists and technical staff. Of course I played the role Thus, the experimental cardiology laboratory was on its of a supervisor to provide adequate resources, create way to carry out research on diverse projects (Table 4). independent investigators, ensure that they work hard and While investigating the mechanisms of cardiac promote their interests in achieving excellence. dysfunction due to substrate-lack and oxygen-lack, it

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 6 It was in 1987 when I was given the responsibility to progression of heart failure. Therapy of diabetic animals develop the cardiovascular research and training program with Ca2+-antagonists, 5-HT receptor antagonists, at the St. Boniface Hospital Research Centre and with this antioxidants and metabolic interventions was found to move from the Health Sciences Centre, I began the attenuate the development of diabetic cardiomyopathy. journey for the 4th stage (Mentorship) of my academic On the basis of our research in the area of ischemia- career essentially as an advisor. Four of my faculty reperfusion injury, we concluded that oxidative stress, colleagues namely Drs. Vincinzo Panagia, Pawan Singal, intracellular Ca2+-overload and protease activation are the Grant Pierce and Vetta Kardami in my group in the most viable targets for the treatment of ischemic heart Department of Physiology moved with me to this new disease. It was demonstrated that pyridoxal 5’-phosphate, building. Dr. John Forester, the Director of Research, was an ATP-receptor antagonist, was highly effective in most helpful to me in the recruitment of several new preventing the ischemia-reperfusion injury. We have also faculty members as well as in providing adequate been successful in the isolation and purification of a new resources (from the St. Boniface Hospital Foundation) for Ca2+/Mg2+ ecto-ATPase from the cardiac cell membrane launching this highly viable program. I ensured that all and on the basis of data thus far, it is proposed to serve as investigators develop and maintain their own research a Ca2+-gating mechanism for the entry of Ca2+ during the laboratories independently but actively participate in the development of intracellular Ca2+-overload for the educational and training programs of the Institute as a occurrence of ischemia-reperfusion injury. unit. Research Achievements My own research laboratory (Experimental Cardiology Although we have made many observations in the field of Laboratory) was relatively large and thus I was occupied pathophysiology and pharmacology of heart disease, I in conducting research in four different areas for studying wish to emphasize only a few salient features to the pathophysiology and therapy of heart disease (Table underscore my research achievements in different 5). By employing an experimental model of heart failure research projects: due to myocardial infraction, we were able to demonstrate 1. For the Research Project on Ischemic Heart Disease, our major research contributions are given in Table Table 5 – Research Projects and Achievements 6. It was demonstrated that the mechanisms of during the Mentorship Stage

A. Areas of Investigation: Table 6 – Major Research Contributions in the 1. Pathogenesis and Therapy of Myocardial Area of Ischemic Heart Disease Infarction-induced Heart Failure. 2. Mechanism of Ischemia-Reperfusion Injury to the 1. Cardiac Dysfunction due to Hypoxia and Substrate- Heart. lack is Determined by Both Metabolic Changes and Ca2+- handling Abnormalities in the Myocardium. 3. Therapy of Diabetic Cardiomyopathy. 2+ 4. Role of Ca2+/Mg2+ecto-ATPase in Cardiac 2. Oxidative Stress, Intracellular Ca -overload and Function in Health and Disease. Proteases Activation Play a Critical Role in the Development of Irreversible Ischemic Injury and B. Research Achievements: Cardiac Dysfunction. 3. Provided Evidence for the Involvement of 1. Blockade of Renin-Angiotensin & Sympathetic Ca2+/Mg2+ecto-ATPase as a Novel Mechanism for Nervous Systems, Platelet Activation and the Occurrence of Intracellular Ca2+-overload and Metabolic Derangements Prevented/Delayed the Cardiac Dysfunction. Progression of Heart Failure. 4. Regulation of Intracellular Ca2+ Concentration and 2. 5-HT Receptor Antagonist and Antioxidants Cardiac Function by Both Adrenergic and Attenuated the Development of Diabetic Purinergic Receptor Mechanisms is Impaired in the Cardiomyopathy. Ischemic Heart and ATP-Receptor Antagonists are 3. Oxidative Stress, Intracellular Ca2+-overload and most effective in preventing the Ischemia – Proteases activation were demonstrated to be reperfusion Injury. Molecular Targets for the Therapy of Ischemic 5. Lack of Oxygen, Intracellular Ca2+-overload and Heart Disease. Oxidative Stress are Important Stimuli for Inducing 4. Isolation and Characterization of Ca2+/Mg2+ecto- Alterations in Cardiac Gene Expression and ATPase as a Novel Ca2+-gating Mechanism for the Subcellular Remodeling in the Ischemic Heart Entry of Ca2+ in Cardiac Cells. Disease.

that blockade of the renin-angiotensin system, cardiac dysfunction associated with ischemia- sympathetic nervous system, platelet activation as well as reperfusion injury involve both oxidative stress and metabolic derangements prevented or delayed the intracellular Ca2+-overload. The mechanisms of

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 7 cardiac contractile defect due to oxidative stress are phosphate was found to be most effective in concerned with changes in the function of different preventing the ischemia- reperfusion injury. subcellular organelles as a consequence of the 3. For the Research Project on Diabetic modification of gene expression as well as protein Cardiomyopathy, our major research contributions sulfhydryl and amino groups, and lipid peroxidation. are given in Table 8. We have demonstrated that Furthermore, our research has also shown that the mechanisms of cardiac contractile dysfunction due Table 8 – Major Research Contributions in the to intercellular Ca2+-overload involve molecular Area of Diabetic Cardiomyopathy remodeling of subcellular organelles as a consequence of the activation of proteases and 1. Cardiac Dysfunction in Chronic Diabetes is phospholipases, as well as alterations in cardiac gene associated with Alterations in Sarcolemma, Sarcoplasmic Reticulum, Mitochondria and expression. These investigations have provided Myofibrils. experimental evidence for the use of combination 2+ 2. Subcellular Derangements in Diabetic therapy with antioxidants and Ca -overload Cardiomyopathy are the Consequence of Hormonal inhibitors for the treatment of ischemic heart Imbalance, Metabolic Alterations and Oxidative disease. Stress. 2. For the Research Project on Heart Failure, our major 3. Metabolic Interventions and Antioxidants were research contributions are given in Table 7. We have demonstrated to Attenuate the Development of established that contractile dysfunction in heart Diabetic Cardiomyopathy. failure is associated with Ca2+- handling abnormalities due to molecular defects in the cardiac dysfunction in chronic diabetes is not only sarcoplasmic reticular and sarcolemmal membranes associated with metabolic alterations in the Table 7 – Major Research Contributions in the myocardium but is also due to molecular defects in Area of Heart Failure the sarcolemmal and sarcoplasmic reticular membranes in the heart. The research in our 1. Cardiac Dysfunction in Heart Failure is not only laboratory has provided evidence that insulin due to Defects in Contractile Proteins and 2+ deficiency leads to marked activation of the Mitochondria but is also associated with Ca - sympathetic nervous system as well as platelets, handling Abnormalities in the Sarcoplasmic development of oxidative stress, membrane Reticulum and Sarcolemma. abnormalities and metabolic defects for the 2. Provided Evidence for the Role of Renin- occurrence of diabetic cardiomyopathy. Different Angiotensin and Sympathetic Nervous Systems as antioxidants, Ca2+-channel antagonists, and 5-HT well as Platelet Activation in Cardiac Remodeling, receptor antagonists have been shown to exert Subcellular Remodeling and Cardiac Dysfunction. 3. Ca2+-handling Defects due to Oxidative Stress Play beneficial effects in preventing diabetes-induced a Major Role in the Transition of Cardiac cardiomyopathies. Hypertrophy to Heart Failure. 4. For the Research Project on Stress-induced Heart 4. Subcellular Remodeling is a Consequence of Disease, our major research contributions are given Changes in Cardiac Gene expression, Proteases in Table 9. It is now well known that chronic stress Activation and Phospholipase Activation. due to a wide variety of social, physiological and 5. Attenuation of Inotropic Responses of the Failing Heart is due to Alterations in Adrenergic Receptor, Table 9 – Major Research Contributions in Area of Adenylyl Cyclase, Protein Kinase A and Calcium- the Stress-induced Heart Disease Calmodulin Kinase System. 1. Excessive Amounts of Circulating Catecholamines were shown to Produce Cardiac Dysfunction and in addition to mitochondrial and myofibrillar Ca2+-handling Abnormalities in Sarcolemma and alterations. We have shown that the subcellular Sarcoplasmic Reticulum. remodeling in the failing heart is induced by 2. Catecholamine-induced Cardiomyopathy, Cardiac hormonal imbalance as a consequence of chronic Dysfunction and Subcellular Defects are Mediated activation of renin-angiotensin system, sympathetic through the Formation of Oxidation Products such as nervous system and platelets as well as defects in the Adrenochrome. endothelium. Our experimental work on subcellular 3. Cardiac Dysfunction, Cell Damage, Coronary Spasm remodeling in the failing heart has provided and Arrhythmias due to Stress-induced Heart Disease are the Consequence of Aminochrome evidence for the use of different hormonal receptor 2+ Formation, Oxidative Stress and Intracellular Ca - antagonists for the treatment of heart failure. overload. Furthermore, ATP-receptor antagonist, pyridoxal 5’-

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 8 pathological factors is associated with increased Concluding Remarks levels of circulating catecholamines and From the foregoing description of events during my cardiovascular abnormalities including arrhythmias, academic career, it is evident that I have been actively coronary spasm and cardiac dysfunction. We have engaged in carrying out cardiovascular research, training demonstrated that these defects in stress-induced the future generation of cardiovascular scientists and heart disease are induced by the oxidation products building a strong base for cardiovascular sciences at the of catecholamines such as aminochrome and University of Manitoba and St. Boniface Hospital oxyradicals rather then catecholamines per se. In Research Centre. My own research in the area of fact, adrenochrome has been shown to produce experimental cardiology has been concerned about the arrhythmias, coronary spasm, subcellular defects, molecular and cellular basis of cardiac dysfunction in ultrastructural damage and cardiac dysfunction. ischemic heart disease, congestive heart failure, diabetic These experiments have indicated the use of cardiomyopathy and several other experimental models of antioxidants for the prevention of stress-induced heart disease. All my research achievements would not heart disease and sudden cardiac death. have been possible without the intimate involvement of a host of graduate students, postdoctoral fellows and Table 10 – Research Trainees, Presentations, visiting scientists as well as excellent facilities and Publications and Recognitions generous financial support from the Canadian public and private sources. I always wanted my associates to be 1. Research Trainees: 37 Visiting Scientists; 50 better than me and thus it was a special joy and pride for Postdoctoral Fellows; 31 PhD Students; 28 M.Sc. me to see them succeed. Students; 17 B.Sc. Med. Students. 2. Invited Presentations: Gave 363 Symposia Talks at A summary of my research trainees, research productivity National & International Conferences and 148 Talks as well as recognition of research work during my at Different Academic Institutions. 3. Research Publications: Published 626 Papers in academic career are given in Table 10. Indeed, I am Referred Journals; 182 Articles in Books and grateful to the University of Manitoba and the St. Monographs; 627 Abstracts and Edited 56 Books in Boniface Hospital as well as several mentors and well- Experimental Cardiology. wishers for their enthusiastic and unqualified support for 4. Research Citations: Google Scholar shows more me to achieve my goals. Of course, there were lots of than 25,000 Citations with an h-index of 73. difficulties and problems on my way for accomplishing 5. Academic Recognitions: Received 6 Honorary my tasks but I considered these as challenges. Overall, my Doctorate Degrees and 5 Honorary Professorships academic journey has been truly a wonderful and from Different Institutions & Universities; and 185 enjoyable experience. My path was based on the concept Other Honours & Awards from All Over The World. of “Satyam, Shivam, Sundram” (Truth, Purity and Beauty) and I consider myself very fortunate to be given the extraordinary opportunities at every turn of my academic progress towards excellence.

2018 Honours and Awards for Naranjan Dhalla

During his recent visit to India, Dr. Naranjan Dhalla, Distinguished Professor, University of Manitoba at the St. Boniface Hospital Albrechtsen Research Centre was honoured at three different conferences held during February 7 to 19, 2018. At the 10th Annual Conference of the India Section of the International Academy of Cardiovascular Sciences (IACS) at Madurai Kamaraj University, he was honoured as a Patron of the Conference and gave a plenary talk – My Academic Odyssey: Opportunity, Challenges and Excellence. Four Young Scientists were also given Awards at the “Prof. N. S. Dhalla Poster Awards Competition”, which is held annually at the IACS-India Section Conferences. In Dr. Naranjan Dhalla lighting the lamp for additions, Dr. Dhalla received the Golden Jubilee Award promoting knowledge

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 9 in recognition of dedicated Service at the 50th Indian time Achievement Award of the India Section of the Pharmacology Society Conference, Held in Mumbai and International Society for Heart Research (ISHR) and gave gave the inaugural address – Lysophosphatidic Acid a plenary lecture – Role of Lysophosphatidic Acid in Receptors may be a Novel Target for the Therapy of Vascular Smooth Muscle Remodeling and Hypertension. Hypertension. This highly prestigious Society in Medical The ISHR-Indian Section has established “Naranjan Sciences in India has established an annual “Naranjan Dhalla Young Investigator Award Competition, which is Dhalla Oration”, which is given by an outstanding also held annually to promote students and fellows in investigator in India. Dr. Dhalla also received the Life- cardiovascular medical Sciences.

Report on the International Conference on Recent Advances in Cardiovascular Sciences and the 10th Annual Conference of the IACS (India Section), Madurai Kamaraj University Madurai, India, February 08-10, 2018

Sankar Natesan, PhD and Andiappan Rathinavel, MD, PhD Madurai Kamaraj University and Madurai Medical College, Madurai Emails for Correspondence: [email protected]; [email protected]

The International Conference on Recent Advances in Cardiovascular Sciences and the 10th Annual Conference of the International Academy of Cardiovascular Sciences (India Section) IACS-2018 was organized by and held at Madurai Kamaraj University, Madurai, India from February 08-10, 2018. This was a multidisciplinary medical conference where eminent basic cardiovascular scientists, cardiologists and cardiothoracic surgeons participated and interacted on a common platform and deliberated upon the recent developments in cardiovascular sciences. Eminent experts, delegates and resource persons from across the world like Canada, USA, Europe and India participated in this epic meeting. Prof. Sankar Natesan, Department of Genetic Engineering, School of Biotechnology, Madurai Kamaraj Dr. CC Kartha lighting the lamp with Vice- University was the Organizing Chairman and Prof. A. Chancellor, Prof. P.P. Chellathurai, MKU Rathinavel, Department of Cardiothoracic Surgery, Madurai Medical College and Government Rajaji Hospital, Madurai was the Organizing Secretary for the conference. Prof. P.P. Chellathurai, Vice-Chancellor, MKU and Prof. Maruthupandian, Dean, Madurai Medical College, were the Patrons.

The Conference was inaugurated on 08/02/2018 with invocation “Thamizhthai Vazhthu” followed by lighting the lamp. The Vice-Chancellor of Madurai Kamaraj University, Prof. P.P. Chellathurai presided over the inaugural function with the chief guest, Prof. Maruthupandian, The Dean of Madurai Medical College & Government Rajaji Hospital. The guests of honor Prof. Dr. CC Kartha, President, IACS India Section being C. Rajamanickam, former Professor of Biochemistry honoured at the opening ceremony department, School of Biological Sciences, Madurai

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 10 Kamaraj University, Prof. N.S. Dhalla, Executive S.K. Gupta Oration, Prof. R.K. Goyal Oration, Prof. H.S. Director, IACS, Winnipeg and Prof. C.C. Kartha, Buttar Oration and Prof. Rakesh Kukreja Oration. President, IACS, India-Section were accompanied by Prof. Sankar Natesan and Prof. A. Rathinavel in the dais. The Scientific Program was started with a Plenary Lecture by Prof. N.S. Dhalla on “My Academic Odyssey: Several luminary basic and medical cardiovascular Opportunities, Challenges and Excellence” a brain scientists along with the graduate and Master’s students storming story about a cardiovascular researcher to were the audience to grace the occasion. Prof. Sankar educate especially the young researchers and students, Natesan welcomed the gathering and wished all to have a chaired by Prof. C.C. Kartha. After a break this was wonderful scientific discussion. The IACS Indian followed by the prestigious Prof. H.S. Buttar Oration, President, Prof. C.C. Kartha highlighted the achievements delivered by Dr. Rajesh Kumar (PGIMER, Chandigarh, of the IACS India Section and the activities. Prof. P.P. India) on “Rheumatic Heart Diseases (RHD): A neglected Chellathurai gave the presidential address and stressed on public Health Priority”. He was presented with the the bench to bedside transformation of scientific Oration award of Rs. 15,000/-, a plaque and a certificate knowledge for the benefit of underprivileged poor and this session was chaired by Dr. Madhu Anand community in the villages. Prof. D. Maruthupandian Srivastava, Canada.

Session I - Cardiovascular Diseases Epidemiology Next, the scientific session I. Cardiovascular Diseases Epidemiology, chaired by Dr. Jack Rubinstein and Dr. Peter Nanasi was started with the presentation of Dr. Ramesh Goyal, DPSRU, New Delhi on “Significance of IACS in Halting the Emerging Cardiovascular Epidemics: A call of National Health Policy 2017” highlighting the prevalence of cardiovascular diseases in India and the

Dr. Rajesh Kumar receiving Dr. H. S. Buttar Oration Award narrated the current requirements of the cardiovascular patients and the importance of collaboration of the basic and clinical scientists to bring out novel therapeutics for the benefits of the poor. The guest of honor Prof. C. Rajamanickam remembered the nostalgic moments of the very first basic cardiovascular sciences laboratory in India Dr. Peter Nanasi being honoured with Dr. S. K. Gupta and the hurdles faced by the non clinician doing surgery Oration Award in small animals to induce cardiac hypertrophy and his laboratories achievements. Prof. A. Rathinavel delivered importance of novel therapeutics to overcome this burden. the vote of thanks and acknowledged all the distinguished This was followed by the presentation by Dr. Sakthivel guests, delegates, participants, volunteers, sponsors and Sadayappan, Cincinnati, USA on “Recent Advances in the media. the Molecular Genetics of Familial Hypertrophic Cardiomyopathy in South Asian Descendents” describing The conference IACS-2018 was organized for three days the identification of novel mutations in MyBPC gene in from 08-10, February 2018 with a plenary lecture, these patients. Next, Prof. H.S. Buttar, Ottawa, Canada, Orations, Scientific Sessions, Oral presentations by young presented his work on “Pathogenesis and Risk Factors of faculty and researchers and poster presentations. The Erectile Dysfunction and Cardiovascular Diseases. Finally young faculty and researchers were honored with several this was concluded with the presentation by Dr. award sessions like Prof. Suresh C. Tyagi Young Faculty Dhandapany PS, Bangalore, India, on Sarcomeric Disease Awards, Prof. Devendra K. Agrawal Young Investigator due to Non-Sarcomeric Proteins” highlighting the MAPK Awards, Prof. N.S. Dhalla Poster awards and Prof. C.C. pathway genes mutations and its contribution in the Kartha Travel Awards. The presentations/awardees were development of Cardiac Diseases. selected by the committees constituted by the IACS Executive committee. There were four Orations viz. Prof.

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 11 After the lunch the next prestigious Oration Prof. S.K. India on “The Protective Effect of Quercetin in an Animal Gupta Oration was presented by Dr. Peter Nanasi, Model of Experimentally Induced Diabetic Nephropathy” Winnipeg, Canada on “Properties of Ca2+ activated and Dr. V.T. Siddharth, Madurai Medical College, Chloride Current in Canine Ventricular Cells”. He was Madurai, India on “Effect of Pre-Operative presented with the Oration award of Rs. 15,000/-, a Plasmapheresis on AChR-Ab Levels in Patients with plaque and a certificate and this session was chaired by Myasthenia Gravis Undergoing Thymectomey and its Prof. Andras Varro. Influence on Post-Operative Outcome” was evaluated by the selection committee. Both of them were presented Rs. Session II - Novel Cardiac Therapeutics 5,000/- and a certificate and the Winner Dr. V.T. Followed by this the Scientific Session II Novel Cardiac Siddharth was presented a plaque. Therapeutics was started, chaired by Dr. Ramesh Goyal and Dr. Pramjit Tappia. The first presentation was by Dr. Devendra K Agrawal Young Investigator Awards V. Elangovan, UNOM, Chennai, on “Natriuretic Peptide Followed by this Prof. D.K Agrawal young Investigator Receptors in Hypertrophied Heart: A Potential Awards presentations by Ms. Vinu Ramachandran, Therapeutic Drug Targets” described the different NPA UNOM, Chennai, India on “miRNA characterization in receptors and its role in ISO induced cardiac hypertrophy. Ventricular Septal Defects by next generation Next presentation was by Dr. Jack Rubinstein, Cincinnati, sequencing”, Ms. Hital Shah (Anand Pharmacy College, Gujarat, India) on “Quercetin prevents Doxorubicin- Induced cardiomyopathy through activation of Nrf2 pathway”, Mr. Venkatraman Ravi, IISc, Bangalore, India on “Sirtuin6 controls global protein synthesis by transcriptionally regulating the mTOR signaling pathway”, Mr. Vikas Kumar, RGCB, Trivandrum, India on “ABCB7, a Mitochondrial Membrane Transporter is Vital to Maintain Mitochondrial Function During Aging

Dr. V.T. Siddharth receives the Dr. Suresh Tyagi Young Faculty Award from Drs. Natesan and Kartha USA on “Probenecid for the Treatment of Patients with Heart Failure with Reduced Ejection Fraction” highlighted the importance of an old molecule for the current therapy. Dr. Madhu Khullar, PGIMER, Chandigarh, India presented her work on “Pathogenic Function and Therapeutic Potential of Exosomes in Ms. Navdha Vyas receives the Dr. Devendra Cardiac Fibrosis” followed by the presentation by Dr. Agrawal Young Investigator Awards from Drs. Arunabha Ray, VPCI, New Delhi on “Stress and Brain- Natesan, Agrawal and Kartha Heart Axis: Possible Regulation by Nitric Oxide (NO)” and Pathological Cardiac Hypertrophy”, Mr. Sanjay explained the NO produced due stress and its impact on Kumar Dey AIIMS, New Delhi on “Dopamine-- the heart. This session was concluded by presentation by hydroxylase Inhibitors Obtained by Structure Based Dr. Tejal Gandhi, Anand Pharmacy College, Gujarat, Methods Exibited Anti-Hypertensive Effect in L-NAME India on “Prasugrel Attenuates Isoproterinol Induced induced Hypertensive Rats”, Mr. Sarad Saxena, JIIT, Myocardial Injuries in Rats” narrated the effect of Noida, India on “Identification and Functional Prasugrel in preventing injuries in the heart induced by Characterization of Novel microRNAs from Fetal Heart ISO. Using Next Generation Sequencing”, Mr. Abrar Khan,

IITM, Chennai, India on “Crucial role of miR-27a in the Suresh C. Tyagi Young Faculty Awards post-transcriptional regulation of 3-hydroxy-3-methyl Suresh C. Tyagi Young Faculty Award Presentations by glutaryl-coenzyme A reductase”, Mr. Sriram, SASTRA Ms. Navdha Vyas, Anand Pharmacy College, Gujarat, University, Thanjavur, india on “Sodium Thiosulfate

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 12 Conditioning has Differential Protective Impact on Heart Session IV - Vascular Signaling Suffering from Ischemia Reperfusion Injury” and Ms. The next Scientific Session IV Vascular Signaling chaired Lakshmi Subramanian, IITM, Chennai, India on “Human by Dr. Kalpana SR, begun with the presentation by Dr. Chromogranin A gene promoter Haplotypes in an Indian Ashok K. Srivastava, Montreal, Canada on “Role of Store Population: Implications for Cardiometabolic Disorders” Operated Ca2+ entry (SOCE) in Angiotensin II Induced were evaluated by the selection committee and Ms. Hital Signaling and Egr-1 Expression in Vascular Smooth Shah, Mr. Venkatraman Ravi, Mr. Vikas Kumar and Ms. Muscle Cells” followed by a presentation by Dr. Manoj Lakshmi Subramanian were presented Rs. 5,000/- and a K. Barthwal, CDRI, Lucknow, India on “Role of certificate and the Winner Ms. Lakshmi Subramanian was Autophagy in Vascular Remodeling and Abdominal presented a plaque. Aortic Aneurism”

The long day scientific deliberations were followed by a Prof. N.S. Dhalla poster Awards cultural program in which the traditional art of Followed by this session during lunch break Prof. N.S. Tamilnadu, India “Thappaatam” and “Oyillaatam” were Dhalla poster presentations begun and following performed by the Master’s and Graduate Students of presentations were displayed. “Cytochrome b5 reductase Folklore department of Madurai Kamaraj University, 3: A novel target to curb hypertension” by Gaurav Kumar, Madurai, India. These mesmerizing performances were University of Delhi, Delhi, India, “Prevalence of applauded by the audience. hypertension and determination of its risk factors in northern India” by Pankaj Prabhakar, University of Delhi, Delhi, “Valporic acid induces cardiomyocyte-specific over-expression of Natriuretic Peptide Receptor-A and enhances the ANP mediated cGMP/PKG anti- hypertrophic signaling in isoproterenol treated H9c2 cells in vitro” by Senthamizharasi Manivasagam, UNOM, Chennai, India, “Curcumin as natural cardio-protectant against anti-hypotensive drug induced stress” by Aditi Jain, JIIT, Noida, India, “Dietary advanced glycation end products promote cardiac inflammation and hypertrophic growth in experimental mice: Protective role of curcumin” by Boopathi Sowndhar, UNOM, Chennai, India, “Cyclophilin A promotes macrophage-derived foam cell formation in high glucose conditions by inducing ER stress” by Vinitha A, RGCB, Trivandrum, “Sodium Butyrate attenuates Isoproterenol-induced Hypertrophic growth in H9c2 cells: Role of Histone Dr. Madhu Anand Srivastava being honoured with Dr. Deacetylase” by Navvi Chandrasekar, UNOM, Chennai, R.K. Goyal Oration Award presented by Drs. Natesan, India, “Quercetin ameliorates pancreatic beta cell Kartha, Goyal and Agrawal

Session III - Diabetic Cardiomyopathy-Signaling & Therapeutics The second day scientific deliberations began with Prof R.K. Goyal Oration by Dr. Madhu Anand Srivastava, Montreal, Canada on “GI Protein as Potential Target for the Treatment of Hypertension” chaired by Dr. Madhu Khullar. Followed by this the Scientific Session III Diabetic Cardiomyopathy-Signaling & Therapeutics, chaired by Dr. Madhu Anand Srivastava and Dr. Devendra Agrawal was started with the presentation by Dr. Pramjit Tappia, Winnipeg, Canada on “Cardioprotective Effects of Aminoacids in Diabetes” followed by a presentation by Dr. S. K. Banerjee, DDRC, THSTI, Faridabad, India on “Modulation of SIRT-1 and SIRT-3 by Resveratrol Therapeutic Implications in Drs. Natesan, Kartha, Varro, and Dhalla with Young Diabetic Heart” Investigators Awardees

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 13 Pediatric Rheumatic Heart Disease in South Indian Population” by P. Maheshkumar, MKU, Madurai, India. From the above poster presentations four presentations by Ms. Sentamizharsi Manivasagam, Ms. Aditi Jain, Ms. Vinitha A and Dr. Mrudula Spurti were selected by the selection committee as best poster presentations. The selected candidates were presented Rs. 5,000/- and a certificate.

Session V – Vascular Therapeutics After the poster session the next prestigious Rakesh Kukreja Oration was presented by Dr. Vivek Jawali on “Stents or Bypass in Multivessel Coronary Artery Disease-Evidence in 2018” presented evidences for the treatment of CAD by different procedures in India. Young Investigators receiving Naranjan S. Dhalla Followed by the orations the next session on Vascular Best Poster Award Therapeutics was started with the presentation by Dr. Devendra Agrawal, Nebraska, USA on “Epicardial dysfunction under oxidative stress induced by tertiary Adipose Tissue in the Pathogenesis of Neointimal butyl hydrogen peroxide” by Dhanya Rajendran, RGCB, Hyperplasia following Coronary Intervention. The next Trivandrum, India, “FoxO transcription factors: novel speaker Dr. Surya Ramachandran, RGCB, Trivandrum, concepts for the cardiovascular diseases” by Anjali J. India presented on “Metformin suppresses Diabetic Singh, Anand Pharmacy College, Gujarat, India, Accelerated Atherogenesis by Inhibiting Cyclosporin-A. “MicroRNAs: novel therapeutic opportunities for This session was concluded in the presentation by Dr. cardiovascular diseases” by Karishma J, Anand Pharmacy Gopal, MKU, Madurai, India on “Circular RNA College, Gujarat, India “Gene editing in cardiomyopathy” Expression Profiles Alters Significantly in Mouse Brain After Transient Focal Ischemia”. After the session the time was allotted for “Networking” for the interaction among the scientific community.

IACS-2018 Award Ceremony The organizing committee arranged a lavish banquet in hotel The Thangam Grand close the venue of the conference. At the start Prof. N. S. Dhalla and Prof. C.C. Kartha were invited to initiate the proceedings. The following were honored with special IACS awards. All these awardees were introduced by Prof. N.S. Dhalla and requested for a brief speeches after receiving the award.

Dr. Vivek Jawali honoured with Dr. Rakesh Kukrerja Oration Award,presented by Natesan, Kartha and Buttar by Milap D. Purohit, Anand Pharmacy College, Gujarat, India, “Epigenetics- A New ‘Beat’ for Cardiovascular Disease” by Riddhi B. Prajapati, Anand Pharmacy College, Gujarat, India, “3D Bioprinting: Emerging Technology in Cardiovascular Diseases” by Vaibhav H. Shah, Anand Pharmacy College, Gujarat, India, “TLR2 deficiency induces aging-associated cardiac dysfunction in mice” by Dr. Mrudula Spurti, IISC, Bangalore, India, “Cadmium stimulates monocyte differentiation and up regulation of miRNA 155 in THP1 cells” by Sashikumar, Dr. C. Rajamanickam honoured with Guest of MKU, Madurai, India, and “Clinical Spectrum of Honour Award from Drs. Natesan, Kartha, Dhalla and Varro

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 14 Prof. C. Rajamanickam, the very first basic cardiology researcher in India, MKU, Madurai was honored with Guest of Honour Award.

Prof. A. Rathinavel, Organizing Secretary, IACS-2018 was honored with the Distinguished Service Award in Cardiovascular Sciences, Medicine and Surgery,

Dr. CC Kartha, President of IACS India Section being hourned with Makoto Nagano Award, presented by Drs. Dhalla and Varro All the awardees thanked IACS for bestowing upon them these prestigious awards. The other awards like Suresh C.Tyagi Young Faculty Dr. A. Rathinavel being honoured with awards, Devendra K. Agrawal Young Investigators Distinguished Service Award, presented by Drs. awards, Prof. N.S. Dhalla Poster Awards and Prof. C.C. Kartha, Dhalla and Varro Kartha travel awards to the emerging cardiovascular scientists were presented during this gathering. Prof. Sankar Natesan, Organizing Chairman, IACS- 2018 was honored with the Distinguished Leadership Session VI – Clinical Studies in Cardiovascular Award in Cardiovascular Sciences. Sciences The final day of scientific deliberations in clinical studies in cardiovascular sciences was started with the presentation by Prof. Andras Varro, Szeged, Hungary on “Basic Cardiac Electrophysiological Considerations to Better Understand the Mechanism of Sudden Cardiac Death in Top Athletes” followed by Dr. Kalpana, SR, Bangalore, India on “Association of Enterovirus Infection

Prof. Sankar Natesan honoured with Distinguished Leadership Award from Drs. Kartha, Dhalla and Varro Prof. C.C. Kartha, President IACS-India Section was honored with the Makoto Nagano Award of the IACS for his outstanding contribution in the field.

Some of attendees at the conference

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 15 with Chronic Rheumatic Heart Disease-A study by NISH Shakila Mohan welcomed the gathering, followed by the and IHC on Mitral valves. The next presentation was by vindicatory address by Prof. C.C. Kartha, President Dr. Biju Soman, Trivandrum, India on “A Lifestyle IACS-Indian Section. Prof. Sankar Natesan thanked all Prescription to control NCDs in India” narrated about the the delegates, faculty, administrators, volunteers and way of living to prevent cardiovascular diseases. Finally sponsors for making this conference a successful one. this session was concluded with the presentation by Dr. Finally the session was concluded with National Anthem. Sathish Kumar, Kulasekharam, India on “Scope of In summary the IACS-2018 conference of Madurai Homeopathy in Ischemic Heart Disease-A Case Study” Kamaraj University, Madurai was an excellent event, presented some evidences about the homeopathy which served as a meaningful platform for the interaction medicine one of Indian medicine as an treatment option of basic and clinical cardiovascular scientific community for IHD. and dissemination of knowledge in the field especially the young scientific community. Followed by this last session of the conference, the valedictory session of the conference was held. Dr.

Academy Presents Distinguished Achievements, Leadership and Service Awards

The following three awards were presented during the India meeting of the IACS in Madurai, February 8-10, 2018:

1. Makoto Nagano Award for Distinguished Achievements in Cardiovascular Education to Dr. CC Kartha, Trivandrum, India 2. Distinguished Leadership Award in Cardiovascular Sciences to Dr. Sankar Natesan, Madurai, India 3. Distinguished Service Award in Cardiovascular Science, Medicine and Surgery to Dr. Andiappan Rathinavel, Madurai, India

CC Kartha Receives Makoto Nagano Award for Distinguished Achievements in Cardiovascular Education

Dr. Chandrasekharan mentor and a popular science writer. His research focused Cheranellore Kartha (born on investigating the causal and pathogenic mechanisms of 1951), is an Honorary cardiovascular diseases and exploring novel biomarkers Distinguished Professor, for disease diagnosis and strategies for cell based Disease Biology and regenerative therapies. He has employed tools of cell Molecular Medicine at Rajiv biology, biochemistry, physiology, pharmacology, Gandhi Center for molecular biology, experimental cardiology and Biotechnology, an epidemiology for his pursuits. He has thus used an autonomous institute under interdisciplinary approach and has been successful in the Department of providing training linking basic sciences and clinical Biotechnology, Government cardiology to the young investigators he has guided. His of India. He was earlier, contributions to the molecular basis of diseases have Senior Professor and Head of received acclaim among physicians and scientists alike Dr. CC Kartha the Division of Cellular and over the years. Molecular Cardiology at Sree Chitra Tirunal Institute for Medical Sciences and During the early part of his career, his focus was to Technology, an Institute of National Importance under delineate the cause of endomyocardial fibrosis, a tropical Department of Science and Technology, Government of cardiomyopathy. His studies disengaged the India. He also served as the Dean of academic affairs of aetiopathogenesis of the disease from a confusing network the Institute in the years 2000-2003. Dr. Kartha has an of hypotheses and placed it in the context of a outstanding record as a cardiovascular pathologist and as a geochemical cause with the primary tissue response being serious investigator in disease biology. He has interstitial in nature. Kartha has evaluated through distinguished himself as a medical scientist, an inspiring experimental and epidemiological studies, the

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 16 geochemical hypothesis proposed by MS.Valiathan and cardiac failure. A notable feature of his research is the Kartha. The geochemical view on the causation of distinct emphasis on questions directly related to endomyocardial fibrosis was later cited in many standard mechanisms of human cardiovascular diseases. textbooks and definitive monographs in cardiology and pathology. His studies on endomyocardial fibrosis spurred Dr. Kartha has published more than 100 articles in peer- his interest in the biology of cardiac endothelium and he reviewed journals, authored a book, edited 5 books and has made original contributions to the current focused editions of 2 journals, authored 15 reviews and understanding of the role of endocardial endothelium in contributed chapters in 14 books. He has also authored the regulation of cardiac function and in cardiac several popular science articles for Sasthragathi and remodeling secondary to cardiac failure. In recent times, Thanima, Malayalam magazines and a chapter on Medical he has directed his attention to developing a blood marker Technology for the Balakairali Illustrated Encyclopedia for predicting vascular disease in patients with type 2 on Technology published by Kerala State Institute of diabetes and delineating the genetic basis for varicose Children’s Literature. He has served on the editorial veins. These efforts have led to identification of boards of several international journals and is the founder cyclophilin A as a biomarker for vascular disease in type 2 editor of Health Sciences. He has organized several diabetes and the discovery that Forkhead box C2 promoter national and international conferences, symposia, variant c.-512C.T is associated with increased seminars and workshops as well as brain storm meetings susceptibility to varicose veins. Kartha’s other significant to identify thrust areas for cardiovascular research in contributions are related to delineating the mechanism of India. He has been an invited speaker at several national arterial calcification induced by hypervitaminosis D, and international meetings in diverse disciplines. He has molecular basis for the use of the flavonoid quercetin as a served on the Governing Council of Indian Academy of key strategy for reducing the risk of atherosclerosis in Sciences and Kerala University for Health sciences diabetes and demonstration in an animal model that (Chancellor’s nominee), as Chairman of the Research genetic engineering of circulating endothelial progenitor Council for Science and Engineering, Kerala State cells with endothelial nitric oxide synthase is efficacious Council for Science, Technology and Environment and as in treating ischemic conditions. Co-Chairman of the Expert Group on Cardiac, Renal and Metabolic Diseases, Chronic Disease Biology Task Force, Dr. Kartha graduated from Trivandrum Medical College Department of Biotechnology. He has also served as a in the year 1979 and took his MD degree in Pathology Chairman or member of advisory, ethics and selection from All India Institute of Medical Sciences, New Delhi. committees of several institutions and Government He joined Sree Chitra Tirunal Institute in its formative bodies. Currently he is Chairman of the International years as Lecturer in Pathology and rose to the position of advisory Committee for Aushadhi, an open innovation Additional Professor of Pathology in 1988. He was platform for translational research, set up by Indian responsible for organizing and leading the cardiac Institute of Technology, Guwahati. pathology services, initiating structured cardiovascular pathology training to residents in cardiology and Dr. Kartha has recently initiated Pro Heart Health Among cardiovascular surgery and establishing an electron Children (PROHeart C), a program in schools to increase microscopy laboratory in the Institute. He was also awareness about risk factors and prevention of heart associated with the early stages of development of diseases and promote good heart health in children and disposable blood bags, dental materials and a large Matters of the Heart, a news letter designed to provide diameter vascular graft. In 1993, he was appointed as the public health education for cardiovascular health Professor and head of the then newly created Division of protection. Dr. Kartha is an elected Fellow of Royal Cellular and Molecular Cardiology, an interdisciplinary College of Physicians, London, International Academy of group for cardiovascular research. He is credited with Cardiovascular Sciences (Canada), National Academy of organizing the first Molecular Cardiology division in Medical Sciences (India), Indian Academy of Sciences, India. In 2009, Dr. Kartha was invited by Rajiv Gandhi National Academy of Sciences (India) and Indian College Center for Biotechnology as a Professor of Eminence to of Pathology. He is the current President of India Section initiate translational cardiovascular biology and establish a of International Academy of Cardiovascular Sciences and division of cardiovascular disease biology. He has a former Vice President of India Section of International established a most comprehensive interdisciplinary Society for Heart Research and Kerala Academy of laboratory for cardiovascular research at Rajiv Gandhi Sciences. Dr. Kartha is a bibliophile, violinist and a Center, where he also initiated research on a broad range student of south Indian Carnatic music. He is married to of clinically relevant themes which include, cardiac stem Dr. Mira Mohanty, a pathologist and former Associate cell biology, vascular disease in type 2 diabetes, molecular Head of Biomedical Technology Wing, Sree Chitra pathogenesis of tetralogy of Fallot varicose veins and Tirunal Institute for Medical Sciences and Technology. arteriovenous malformations, and metabolic switch in

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Dr. Sankar Natesan Receives Distinguished Leadership Award in Cardiovascular Sciences

Dr. Sankar Natesan is a research. His major research interest is in studying the Professor in the contribution of InsP3 receptors in the development of Department of Genetic hypertrophic cardiomyopathy and heart failure. His recent Engineering, School of finding is activation of CaMKIId by InsP3R mediated Biotechnology, Madurai Ca2+ and phosphorylation of InsP3R by a negative feed- Kamaraj University, back which is an early and continuous process in the Madurai. He obtained initiation and development HCM. His research is focuses his Bachelor’s degree in on Developing CAMIN peptide and CAMAb scFv zoology and Master’s antibodies for the inhibition of InsP3R followed by degree in Biology from activation of CaMKIId in the heart. The other area of his Madurai Kamaraj research focuses on the involvement of environmental, University. Subsequently social and sexual interactions in the development of Dr. Sankar Natesan he worked with Prof. C. cardiac diseases and effect of cardiovascular drugs. Dr. Rajamanickam, the very Sankar has received many awards and honors and recently first basic cardiac researcher in India and obtained his the Monitoring and Evaluation Committee member of PhD from Madurai Kamaraj University. Sankar worked in ICMR-MDRU, Govt. Medical College, Theni, Tamilnadu. National Cancer Centre of Singapore followed by He is an expert committee member in Govt. of India Northwestern University, Chicago and then in Loyola granting agencies and serves as an academic and research University, Chicago. At present he is a Professor and committees in many institutions. He is currently interested coordinator of Department of Biotechnology, Govt. of in delivering lectures to the undergraduate students to India sponsored M.Sc Biotechnology program in Madurai promote research interest among them. Kamaraj University and involved in teaching and

Dr. Rathinavel Receives the Academy Distinguished Service Award

Dr. Andiappan degree in Molecular Cardiology from the School of Rathinavel is Professor Biological Sciences, Madurai Kamaraj University in and Head of Department Madurai, Tamil Nadu. In 2005, Dr. Rathinavel was of Cardiothoracic awarded the GC Sharma Fellowship by the Indian Surgery, Madurai Association of Cardio vascular - Thoracic Surgeons Medical College, Tamil Conference in Kochi, India. He is currently the Secretary Nadu, India. He is a of the Blood Donors Club of Madurai Medical College, General Surgeon with General Secretary of the Students Council, Madurai over 20 years experience Medical College, State President of the Tamil Nadu and specialization in Postgraduates Association (that includes 11 Medical Cardio-Thoracic and Colleges) and is Joint Secretary of the Tamil Nadu Vascular Surgery. He is Government Doctors Association, Madurai Medical the first to perform heart College. Dr. Rathinavel is a member of several transplantation in South professional organizations including life membership of Tamil Nadu (25-10- the International Society of Heart Research, Indian Dr. Andiappan Rathinavel 2017) Dr. Rathinavel Association of Cardio Thoracic and vascular surgeons, completed his M.B.B.S. Vascular Society of India, Association of Surgeons of degree in 1989 from the Madurai Medical College & India and Indian Medical Association. He was the Rajaji Government Hospital, Madurai. He obtained M.S. organizing Joint Secretary of the National IACTS degree in General Surgery in 1995 as well as M.Ch. Cardiac CME 2014 Madurai and is presently Secretary degree in Cardiothoracic Surgery and Vascular Surgery in Madurai Cardio-Vascular & Thoracic Surgeons Forum. 2004 from the same institute. He also received his Ph.D. His teaching responsibilities include theory classes for

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 18 M.B.B.S. students, M.S. Post Graduates and M.Ch. Post published 15 papers in peer reviewed journals including 2 Graduates as well as in Clinical demonstration and Cardio in Nature Genetics, Atherosclerosis and Molecular and Thoracic Care and Critical Care classes for Nurses in Cellular Biochemistry. He has also presented papers in Government Rajaji Hospital. To date, Dr. Rathinavel has several symposiums locally as well as internationally.

Academy Bestows Exemplary Service Awards for Contributions Made for Promoting Heart Health

The International Academy of Cardiovascular Sciences has chosen to recognize individuals for their continued distinguished services over the past several years. This special honour is for contributions made for promoting heart health. These recipients are as follows:

1. Mr. Nikolaus (Klaus) Lahr, CEO, RBC Convention Centre, Winnipeg 2. Mr. Kamta Roy Singh, Tim Hortons, Winnipeg 3. Yetta & Jack Levit Family, Lakeview Management, Winnipeg 4. Dr. Sonny Dhalla, General Surgeon, Brandon

Mr. Nikolaus (Klaus) Lahr, CEO, RBC Convention Centre, Winnipeg

Klaus is a native of Restaurant & Food Services Association and the Elevator Germany, where he was Board of the Province of Manitoba. educated and trained in the Hotel and Hospitality Mr. Nikolaus Lahr is an individual with exemplary Industry. He is a graduate of leadership qualities, a visionary and a gentleman with the Hotel School of Trier, amiable personality traits. He has provided a distinguished West Germany. After service to the people of Manitoba that has clearly brought graduating, he worked in economic benefit and raised the profile of the Province. numerous 5 star resorts in Klaus is a pleasant person, with excellent moral and Switzerland, Norway, Greece ethical character. He has been a great promoter of and Belgium. He also culturally diverse communities. He is committed to high worked a number of years on work ethics, has a friendly and jovial temperament, and is Mr. Klaus Lahr a Norwegian luxury cruise kind and compassionate to other human beings, regardless liner before he immigrated to Canada in 1977. He of whether they are familiar faces or complete strangers. furthered his education in Ithaca, NY, Memphis, TN and In fact, he is quite sensitive to others’ viewpoints. These Guelph, ON. He worked in Winnipeg for the Winnipeg are the human characteristics and qualities of great Inn before travelling north to open his own business. After distinction. several years in the north, he joined the pre-opening team of Minaki Lodge in 1983 with Radisson Hotel Klaus has actively promoted the profile of the Folklorama Corporation out of Minneapolis. He remained with festival, a flagship event of Manitoba. He has created a Radisson Hotel Corporation for 6 years and then joined hub for Folklorama at the RBC Convention Centre. Holiday Inns here in Winnipeg. He was soon promoted to Indeed, in Folklorama 2017, the Convention Centre General Manager of the Holiday Inn in Saskatoon from served as the venue for 5 different pavilions over the 2 where he joined the Winnipeg Convention Centre as the week period, namely, the Pavilions of Mexico, Cuba, General Manager in 1993 and has been the President & Poland, Brazil and First Nations. This undoubtedly CEO of the RBC Convention Centre for 25 years. Klaus enhanced the quality of the Folklorama product and has been an active member in several organizations markedly enhanced the Folklorama experience of all including Rotary International, the Variety Club and the visitors. Under the direction and guidance of Klaus, his SKAL Club, the Children’s Wish Foundation and Camp staff at the RBC Convention Centre have instilled Manitou and is currently on the Board of the Manitoba confidence and allowed communities of different origins

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 19 to not only work together, but with his leadership, he has profile of the local Punjabi community has been raised to brought diverse communities together in harmony and a new level. Klaus has played a critical role in the success understanding. Furthermore, he has enabled newcomers to of these events. Winnipeg truly integrate with mainstream populations. The International Academy of Cardiovascular Sciences His extraordinary commitment to communities is further has also organized several public forums as well as testified by his support for the East Indian community of national and international conferences and without the Manitoba. Klaus has been instrumental in the success of support, conviction and direction from Klaus such events the Diwali Festival of Lights Celebrations. This event has would not have been possible, let alone be successful. It is been hosted out of the RBC Convention Centre for more pointed out that the growth of the City of Winnipeg has than 2 decades. Such sustainability, success and growth been concomitant with the extension of the RBC can only be credited to the leadership, interpersonal skills Convention Centre. This is the Hallmark of a visionary, and community values of Klaus. More recently, he whole builder, innovator and promoter of communities as heartedly supported the local Punjabi community to host exemplified by Klaus. He is an extraordinary person and the inaugural Punjab Pavilion and encouraged the Asian the most deserving individual of any accolades that Women of Winnipeg to host Lohri Festival (a celebration recognize his dedication to the Province and its diverse of the end of winter in the Punjab and new beginnings) at communities. the Convention Centre. Again, under his direction, the

Mr. Kamta Roy Singh, Tim Hortons, Winnipeg

Mr. Kamta Roy Singh is the He plays and coaches cricket for over 27 years. He played President of Caribbean and represented Manitoba in both western and Canada Heart Health provincialcricket tournaments. He volunteers with Tim Education as well as one of Bits Sports and sponsors many young people attending the its founding members. He is Tim Horton’s children camp every year. He is responsible the CEO of Singh to build two cricket ground and two cricket nets in Enterprises Incorporation Winnipeg and the first Artificial cricket pitch and practice and KRS Singh Inc. and nets in Manitoba. owner of four Tim Horton’s franchise. He has a long In 2006 the members and executive board of the history of volunteering with Guyanese Association of Manitoba awarded Kamta with sporting, cultural and the Entrepreneur of the Year award; in 2013 the Senior community organizations. Program members and executive praised him with a Mr. Kamta Roy Singh He is the past president of heartfelt award of thanks for his unconditional and never The Guyana Association of ending dedication for the program. He was acknowledged Manitoba for 8 years and presently executive members. by the Filipino Association of Manitoba in 2013 as He is also the past executive member of WIICCOM (West Business Man of the Year for his unconditional support Indian Indo-Canadian Cultural Organization of Manitoba), and employment of their community. Kamta has received Indo Canadian Arts & Cultural Center, Rama Krishna recognition awards from India School of Dance for Temple and Passage of Canada. He had been invited to Volunteer and Financial Support in 2014 and 2016, and speak for passage of Canada, at University of Winnipeg recently was awarded Volunteer of the Year by Maples and Manitoba of his success as an entrepreneur. In 2005 Elwick Community Centre. Kamta has evolved and prided the University of Manitoba made a video of him called himself as a powerful business man, a proud Guyanese “Manitoba is my Home”. Currently he is also the and Canadian, a strong cricketer, and a passionate, President of Lions Cricket and Sports Club as well as The committed and an enthusiastic supportive Community Manitoba Hindu Seniors organization. Member.

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Yetta & Jack Levit Family, Lakeview Management, Winnipeg

The Levit Family determination and boundless energy. For example, he has stated that developed three Sheraton Hotels in Canada in one year “Our father alone, a feat previously unheard of. Mr. Levit later built wanted to what is now the Hilton Suites Hotel, the Sheraton Four continue funding Points and the Winnipeg Grand Hotel at the Airport as the work of the well as the Lakeview Resort and Conference Centre in International Gimli. He acquired the exclusive franchise for building Academy of the Country Inns and Suites in Canada, developing 13 of Cardiovascular these properties. Sciences to promote He then set his sights on developing his own brand of prevention and hotel, Lakeview Inns and Suites. With the assistance of early detection of Mr. Levit, over 20 such hotels proudly operate in Canada Back Row: Diane Levit, Keith heart disease in under the Lakeview Banner. But Mr. Levit did not limit Levit, Shelley Levit. Manitoba. For the himself to real estate. He developed several Ichiban Front Row: Jack Levit, Yetta Levit past 4 years our Japanese Steakhouses in Canada and the United States, family has been including one in Winnipeg which recently celebrated its privileged to be associated with the Yetta & Jack Levit 40th anniversary, and created a hotel in-room video Distinguished Lecture with St. Boniface Hospital entertainment system, MovieBar. Mr. Levit was a man of Albrechtsen Research Centre and the Institute of many interests. He performed as a vocalist in several Cardiovascular Sciences. We would like to thank all of the Gilbert and Sullivan operettas, played tennis, loved theatre members of the Institute of Cardiovascular Sciences who and music and became a star bowler, winning the City 10- have been instrumental in bringing to fruition the goals pin bowling championship. Because of his passion for the our father wanted to achieve with his donation”. game, Mr. Levit built three 10-pin bowling alleys in Western Canada. Mr. Levit loved travelling, spending Mr. Jack Levit, 1927-2014, lived all his life in Winnipeg's wonderful times with family in interesting locations. In north end, attending the Peretz Folk School, Machray later years, Mom and Mr. Levit spent winters in Hawaii, School and St. John's High. Jack began his working career where Mr. Levit relaxed, but always had his sketch pad with his father, in the sign business. Together they grew and tracing paper nearby for when he came up with a new their small business into one of Canada's largest private development idea. Underneath his accomplishments, he neon sign companies, being the first to introduce lighted was a humble, down-to-earth person - a man with a deeply plastic signs to Western Canada. Mr. Levit was a true personal generosity, a mentor and problem-solver. He was visionary. In the 60s and 70s, where others saw barren proud of his contribution to the development of the pieces of land, he saw the potential for bustling Winnipeg Convention Centre, Kinsmen RehFit Centre, development. He taught himself the real estate business the Myles Robinson Heart Foundation and the Asper and in 1964 started Lakeview. At the age of 35, he turned Jewish Community Campus. He served as President of the a city block into the Courts of St. James which included Peretz School and played a pivotal role in establishing the Western Canada's first underground walkway, connecting sister city relationship between Winnipeg and Setagaya three apartment towers to the complex's shopping centre. Japan. Many of Winnipeg's entrepreneurs and This was followed by his development of projects that professionals have recently conveyed their gratitude for forever changed the Winnipeg skyline including Lakeview the extremely positive business acumen and experience Square, Colony Square, the Intercity Gas Building, the that they gained from working under his watchful eye and Royal Trust Building, as well as numerous residential, training. Jack Levit loved Winnipeg. He never slowed office, industrial and retail complexes including the down. He was proud to have contributed to the Towers of Polo Park, Moray Village, Kenaston Estates, development of the city and to the employment and well and the Kenaston Village Mall. Mr. Levit was also the being of hundreds of our community's citizens. Lakeview, brainchild of the Winnipeg skywalk system, building the the Winnipeg Company that he created, continues to City's first skywalk in 1972, connecting Lakeview Square thrive five decades on. [Excerpt taken from Winnipeg to the Convention Centre. Mr. Levit was a man of Free Press Passages published on Nov 29, 2014].

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Dr. Sonny Dhalla, General Surgeon, Brandon

Dr. Sonny Dhalla has made Surgeons (Canada) in the same year. Dr. Dhalla obtained significant donations to the Certification from the American Board of General International Academy of Surgery since 1990. In 2012, he was elected as the Cardiovascular Sciences Governor for the American College of Surgeons and throughout its more than 20 continues to serve in this capacity. He is an active year existence. He has been member of several prestigious organizations including most generous for providing Canadian Association of General Surgeons, American support to the Academy for Gastroenterology Association and the Canadian holding international symposia Association of Gastroenterology. He is the founding and public forums in Winnipeg. member of the Canadian Association of Physicians of Dr. Dhalla is a General Surgeon Indian Heritage (CAPIH) and of the Manitoba with special interests in Association of Asian Physicians (MAAP). His teaching Endoscopy, ERCP, Laproscopic responsibilities include teaching in the Department of and Radio-guided Surgery, Surgery, University of Manitoba. Dr. Dhalla has been the Dr. Sonny Dhalla located at the Brandon Medical recipient of many honours and awards including Young Arts Clinic in Brandon, Surgeon for Manitoba Award by the American College of Manitoba, Canada. He is presently, Chief, GI Unit, Chief, Surgeons in 1993 and Distinguished Service Award from Nutrition and TPN Team within the Brandon Regional the India Canada Culture and Heritage Association in Health Centre. Dr. Dhalla obtained his B.Sc. degree in 2011. He has 2 named awards; Dr. Sonny Dhalla Award 1979 with a major in Microbiology from the University of for Academic Excellence for University students in Manitoba, Winnipeg and went on to attain his M.D. Winnipeg as well as the Dr. Sonny Dhalla Best Teacher degree in 1983 also from the University of Manitoba. He Award for the promotion of excellence in education completed his General Surgery Residency Training established in India. Dr. Dhalla has several research Program at the University of Manitoba Affiliated publications and has also presented papers in several Teaching Hospitals and went on to a Fellowship in ERCP symposiums locally as well as internationally. In addition, at St. Michael’s Hospital, Toronto in 1989 and received a he has designed some innovative techniques in the field of General Surgery Fellowship from the Royal College of general surgery.

CV Network Editorial Board EDITOR: Paramjit S. Tappia ASSISANT EDITOR: Sukhi Bhullar

EDITORIAL ASSISTANTS Sanjay Ganapathi (India) Simaran Kaur (Canada) Vladimir Jakovljevic (Serbia) Teri Moffatt (Canada) Chandrasekharan Kartha (India) Andrea Edel (Canada) Madhu Khullar (India) Naoki Makino (Japan) EDITORIAL BOARD Rizwan Manji (Canada) Paras Mishra (USA) Ursula Muller-Werdan (Germany) Danina Muntean (Romania) Petr Ostadal (Czech Republic) Tanya Ravingerova (Slovakia) Taylor Salinardi (USA) Ram B. Singh (India) Dinender Singla (USA) Belma Turan (Turkey) Shelley Zieroth (Canada)

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Academy Competition Award Recipients, IACS, Orlando

The following are recipients of the different award competitions during the 2017 annual meeting of the IACS-North America section meeting held in Orlando, USA.

Gary Lopaschuk Competition for Graduate Students Jamillah Hammond, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida, USA

James T. Willerson Competition for Postgraduate Fellows and Residents Andrea L. Edel, Institute of Cardiovascular Sciences, Albrechtsen Research Centre St. Boniface Hospital & University of Manitoba, Winnipeg, Manitoba, Canada

Roberto Bolli Competition for Young Faculty in Translational Science Sanjiv Dhingra, Institute of Cardiovascular Sciences, Albrechtsen Research Centre St. Boniface Hospital, Regenerative Medicine Program, University of Manitoba, Winnipeg, Manitoba, Canada

Grant Pierce Competition for Young Faculty in Biomedical Science Chandrakala Alugantinarasimhulu, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida, USA

Awards being presented to (from top left corner, in clockwise order) Jamillah Hammond, Andrea Edel, Chandrakala Alugantinarasimhulu and Sanjiv Dhingra

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Andrea Edel Receives James T. Willerson Award

Andrea Edel is Fellowship for Research in Functional Foods and currently a Research Nutraceuticals, the Frederick Banting and Charles Best Fellow in the Canada Graduate Scholarship through the Canadian Institutes Cardiovascular of Health Research and the Focus on Stroke Heart and Stroke Lipidomics Foundation of Canada doctoral award. To date, Andrea has Laboratory at the co-authored 34 publications some of which appear in JACC: Albrechtsen Basic to Translational, Hypertension, Current Hypertension Research Centre, St. Reports, Journal of Chromatography B, Journal of Nutrition, Boniface Hospital in European Journal of Nutrition and Journal of the American the lab of Dr. Amir College of Nutrition. Since beginning in Dr. Ravandi’s Ravandi. She earned laboratory in 2015, an abstract she co-authored describing her Bachelor of the oxolipidomic profile of human aortic valves in patients Dr. Andrea Edel Science, majoring in having undergone aortic valve replacement surgery was Chemistry, at the awarded an ATVB Travel Award for Young Investigators at University of Winnipeg in 1996. She then completed her the American Heart Association 2016 meeting in New Masters in Science (1999), also in Chemistry, from the Orleans, USA. Recently, she was also awarded the James University of Manitoba under the supervision of Dr. Alaa Willerson Young Investigator Award in Cardiovascular Abd-el-aziz, funded by a Manitoba Hydro Graduate Medicine at the International Academy of Cardiovascular scholarship. After completing her MSc, Andrea accepted a Sciences 2017 meeting in Orlando, USA. Andrea has given position with Dr. Grant Pierce in the Institute of numerous presentations in various schools at all levels of Cardiovascular Sciences at the University of Manitoba. education in hopes of inspiring others. For the past 4 years, During this time, she sharpened her analytical skills using a she has volunteered with the Heart and Stroke Foundation of variety of purification strategies and chromatographic Canada as a Gold Heart Canvasser sharing with friends and techniques. In fall 2009, Andrea began her PhD studies in the neighbours the lifesaving research happening right here in Department of Physiology and Pathophysiology in the Winnipeg and throughout Canada. In addition, she has also College of Medicine at the University of Manitoba under the paddled for a decade on an all-women’s Dragon Boat Team co-supervision of Dr.’s Grant Pierce and Michel Aliani. that competes and raises funds for various health During her program, she held several prestigious graduate organizations throughout Winnipeg. fellowships including the James Gordon Fletcher PhD

Sanjiv Dhingra Receives Roberto Bolli Award

Dr. Sanjiv Dhingra is Winnipeg. Dr. Dhingra received Outstanding Leadership an Assistant Professor Award in Cardiovascular Research from the Life Science and Director of the Association of Manitoba. He also received several young Canada Italy Tissue investigator awards and recognitions based on his research Engineering Laboratory including Vivien Thomas Young Investigator Award at the at the Institute of American Heart Association (AHA)-2012 Scientific Cardiovascular Sessions, Los Angeles, Early Career Investigator Award in Sciences, St. Boniface 2010 at the World Congress of ISHR in Kyoto, Japan and Hospital Research Young Investigator Award from the Canadian Centre, University of Cardiovascular Society in 2017. He has published more than Manitoba, Winnipeg, 40 papers in the field of cardiac stem cell therapy in high Dr. Sanjiv Dhingra Canada. His research impact journals including Circulation, Eu. Heart J and interests are focused on FASEB J. His laboratory is currently funded by multiple the post-myocardial infarction cardiac regeneration and agencies including CIHR and Research Manitoba. He tissue engineering using stem cell therapy and biomaterials. continues to serve as committee member on several granting Prior to joining as a faculty member at the University of agency review panels such as CIHR and Heart and Stroke Manitoba, Dr. Dhingra received postdoctoral training at the Foundation of Canada. McEwen Centre for Regenerative Medicine, Toronto General Hospital and St. Boniface Hospital Research Centre in

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Caribbean Heart Health Group in Partnership with the Academy Honours Dr. Charles Greenidge

Paramjit S. Tappia, PhD, Secretary General CCHHE Asper Clinical Research Institute, St Boniface Hospital, Winnipeg, Canada Email for Correspondence: [email protected]

that necessity is the mother of invention and Caribbean people have found innovative ways to achieve good results at a lower cost. Surgery continues to be a challenge in the Caribbean but as a resourceful people they continue to look for ways to improve the level of care offered to patients.

Dr. Greenidge is a General Surgeon. He completed his MD degree at the University of the West Indies and his surgical training initially at the Queen Elizabeth Hospital, Barbados and later in Plaque presentation to Dr. Charles Greenidge: L to R: Glasgow, Scotland. He Dr. Paramjit Tappia, Mr. Kamta Roy Singh, Dr. Grant trained in General Pierce, Dr. Charles Greenidge, Dr. Bram Ramjiawan, Surgery with Minister Rochelle Squires and Hon. Terry Duguid specialization in arterial and venous disease, endoscopic and laparoscopic surgery. He recently (2012-2013) On February 17, 2018, the Caribbean Canada Heart returned to Scotland to do a fellowship in gastro-intestinal Health Education organization in collaboration with the surgery which included laparoscopic surgery and International Academy of Cardiovascular Sciences hosted rd gastrointestinal cancer surgery in addition to surgery for its 3 gala dinner in Winnipeg, Canada, in honour of Dr. gall stones, oesophageal reflux and obesity. He was a Charles Greenidge from the Bay Medical Centre, St. travelling fellow of Royal College of Physicians and Lucia, W.I. About 300 community members were in Surgeons of Glasgow and visited Mercy Medical Centre, attendance as the local Caribbean community reached out Iowa, USA in May 2000. He is the current secretary of the to assist the Caribbean countries in heart health education Caribbean College of Surgeons. For many years he was a and practice. In his key note address, Dr. Greenidge spoke reserve officer in the Barbados Regiment and spent time about the gap in health care standards between the first both in the field and the Medical Unit. He has worked as a and the developing world. He mentioned that there are consultant surgeon at Victoria Hospital in St. Lucia 1996- three main supports of the bridge across this gap which is 2002, Queen Elizabeth Hospital 2002-2004 returning to education, collaboration and innovation. Education Victoria Hospital 2004-2012. From 2013 he has been involves activities such as continuing education practicing at Tapion Hospital, St Lucia. He was an conferences, lectures and workshops that transfer hands associate lecturer at the University of the West Indies on skills. Caribbean people are really friendly and this from 2002-2004. He has been a volunteer at St. Jude allows them to form very meaningful bonds with persons Hospital, St Lucia since 2015. His current practice from the first world who over the years have been includes a wide range of areas including abdominal tremendously supportive in providing both training and surgery, peripheral vascular disease, breast, endoscopy equipment allowing us to provide a high-level of medical and laparoscopic surgery. care despite our lack of financial resources. He concluded

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Cardiac Adaptation as a Novel Approach to Reduce the Risk of Heart Failure Using Clinically Relevant Interventions

Tanya Ravingerova, MD, PhD, DSc, FIACS Center of Experimental Medicine, Slovak Academy of Sciences Institute for Heart Research, Department of Cardiovascular Physiology and Pathophysiology, Bratislava, Slovak Republic Emails for Correspondence: [email protected]

Background hand, over the age of 65, both genders have the same risk Cardiovascular diseases (CVD) are the leading cause of for developing heart failure and in females, the risk of HF death worldwide and it is estimated that by 2030 is increasing even more than in males [18]. This is approximately 24 million people will die from CVD (2). attributed to the cardioprotective properties of ovarian Although the advances in the prevention, diagnosis and hormones and to the fact that their insufficiency management of CVD have progressed in the past three contributes to the development of hypertension, diabetes decades, heart failure (HF) remains the leading cause of and hyperlipidemia [19]. This often leads to improper mortality in the developed countries [1]. In Europe, more management of AMI in females including late hospital than 14 million people suffer from HF, and the number of attendance and the onset of revascularization cases is increasing (300 000 per year) with prediction of interventions leading to development of HF [18]. In 30 million patients by 2020 [2]. The fact that the average addition, although gender differences play an important life expectancy is constantly increasing not only in role in the heart response to ischemia and subsequent western society but also in the developing world and that preservation/deterioration of heart function, research to the prevalence of HF is increasing with advanced age, it date has been focused mostly on the investigation of will remain a major health problem in the world [1]. cardioprotection in healthy male subjects of adult age Syndrome of HF is so called “end point” for several [19]. Our studies demonstrated gender-related rat heart diseases, of which ischemic heart disease (IHD) and its response to ischemia associated with age [20,21] that has most serious manifestation, acute myocardial infarction been manifested already during maturation, whereas (AMI) are on the first place. Although the number of gender differences with respect to cardiac ischemic patients that successfully survive AMI is increasing, due tolerance were present even in the juvenile animals. to the modern treatment including pharmacotherapy, interventional cardiology and cardiac surgery, the Management of heart failure alteration of the heart muscle will manifest later on (even One of the important strategies to combat heart failure is years after the heart attack) by chronic failing of pumping to treat the initial disease that caused heart failure in the function of the heart [3,4]. Patients after AMI live longer, first instance, followed by supporting cardiac activity and however, their already impaired heart is more susceptible cardioprotection. The treatment can be pharmacological, to failing. Moreover, risk factors associated with modern instrumental (cardiac device), surgical or as a last option – lifestyle such as hypertension, chronic stress, diabetes, heart transplantation. As the most common reason of HF hyperglycemia, and dyslipidemia not only have an is IHD and AMI, early restoration of blood flow in the adverse impact on myocardial response to ischemia [5,6], ischemic myocardium is a prerequisite for its salvage. On but also suppress the innate cardioprotective properties of the other hand, delayed revascularization may lead to the myocardium and accelerate thus the progression of HF ischemia/reperfusion (I/R) injury [22]. Despite improved [7] . Other factors, such as cardiomyopathies due to pharmacological and cardiac device therapies, neither metabolic diseases [8-10], cardiotoxicity subsequent to effective prevention of AMI nor reduction of I/R injury is chemotherapy and radiotherapy in oncological patients currently available. Thus, there is a substantial unmet [11-13], or hypertrophy of the heart pumping against need for novel approaches, ideally those, that specifically increased resistance in peripheral arteries in hypertension address repair and regeneration of damaged and/or lost [14,15], contribute to the development of chronic HF. myocardium (given limited endogenous repair of cardiomyocytes in adults). Current trends of alternative Impact of gender and aging on the development of approaches to management of patients suffering from heart failure multiple ailments leading to heart failure differ from Incidence of cardiac ailments differs with gender and age traditional pharmacological treatment often focused on [16-18]. It has been shown that the risk for developing targeting only one pathophysiological mechanism. In heart failure is twice as high in males compared to contrast to that, complex targeting of several females in the age group between 55 and 64. On the other

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 26 pathophysiological mechanisms may represent a platform reduced the extent of ventricular remodelling and for the development of novel strategies to fight HF. mortality over 28 days after AMI in a rat in vivo model [32]. Furthermore, repeated RPC increased endothelin- Preconditioning of the heart dependent vasodilatation in healthy humans and in Numerous experimental and clinical studies demonstrated patients with chronic HF [33]. Thus, it could be expected that some stressful stimuli (e.g., transient episodes of that RPC could exert a positive effect with respect to ischemia/hypoxia, reactive oxygen species) exert not only suppression of HF development. deleterious effects but also trigger short-term or longer lasting adaptive processes in the heart, which render it Potential mechanisms of RPC more resistant to IR injury. The concept of heart’s own Mechanisms of RPC have not been investigated in details protection is based on the principle that short-term cardiac so far, however, it is suggested that RPC triggers complex adaptation to certain forms of moderate stress increases humoral and neuronal signaling leading not only to an resistance of the heart against subsequent sustained increased resistance to IR in a distant organ, but also acts ischemia – phenomenon of preconditioning (PC). via activation of a systemic response as well (anti- Ischemic PC has been observed in all animal species inflammatory, anti-oxidative effects, changes in gene including humans [3,23]. It is manifested by a delay of transcription and attenuation of endothelial dysfunction), necrotic and apoptotic processes in the cardiomyocytes, which is supported, e.g., by up-regulation of IL-10 in reduction of lethal arrhythmias and by an improved post- mice exposed to RPC 24 hrs prior to myocardial IR [34]. IR functional recovery. However, in clinical situations, It is proposed that humoral signaling is dependent on the application of classical ischemic PC has certain activation of “survival” RISK (reperfusion injury salvage limitations, due to its short-term duration, or due to kinase) – PI3K/Akt- GSK3β- mPTP (mitochondrial requirement of chest opening (to get access to coronary permeability transition pore) [35] cascade and SAFE arteries) that can be performed only by trained personnel (survival activating factor enhancement) - TNFα- IL-10- in the specialized hospitals. STAT3- mitoKATP (mitochondrial ATP-dependent K+ channels) pathway [36]. Clinically applicable forms of preconditioning On the other hand, other forms of PC appear to be Micro-RNAs perspective from the clinical point of view. One of these Several pathophysiological mechanisms of HF, as well novel forms is so called remote ischemic preconditioning the mechanisms of protection against IR are regulated by (RPC), in which induction of ischemia in any organ small non-coding RNA (micro-RNA or miRNA) [37]. It confers protection to other, distant organs/tissues [22,24- has been demonstrated that out of the great number of 26]. Importantly, animal (and some clinical) studies those miRNAs, in particular, miRNA-144 participates in documented a beneficial effect of non-invasive cardioprotective effect of RPC, and it is also associated modification of RPC (limb ischemia) leading to cardiac with enhanced RISK signaling [3,38]. protection against IR [27-29]. This does not require invasive surgery (such as chest opening), and thus, can be Nuclear receptors PPAR applied even in the ambulance or during the transportation Furthermore, nuclear receptors PPAR have been also of a patient to the hospital. These interventions include suggested to play a role in the mechanisms of RPC in inflation (200 mmHg) and deflation of a pressure cuff normal and pathologically altered myocardium [26,39]. placed on an upper or lower limb and realized in three 5- Their main role is regulation of genes involved in min cycles. Moreover, in relation to ischemia, RPC may processes of metabolism and energy production in the be applied in settings of pre-, per- or post-conditioning heart [40], during different pathological conditions in (after the end of ischemia during surgical interventions). CVS including IR, diabetes and HF. Moreover, it has Its similar effectiveness in these settings offers relatively been shown that the ligands of these transcription factors great time window for its realization, in contrast to (hypolipidemics) may induce preconditioning-like lipid- classical ischemic PC, that makes RPC more attractive independent genomic and non-genomic effects including from the clinical point of view. In particular, non-invasive antiapoptotic, anti-oxidative and antiinflammatory effects and easy application of limb RPC has been started to be (so called pharmacologically induced PC) with implemented in clinical conditions, e.g., in treatment of subsequent myocardial protection against acute IR patients with AMI [30]. Beneficial effects of RPC have [41,42]. In addition, this protection was associated with been also demonstrated during surgical interventions in activation of PPAR downstream pro-survival targets children with congenital heart defects [31]. Further (PI3K/Akt-eNOS) and MMP-2 inhibition [43]. However, important finding was that RPC could be applied not only the role of PPAR in chronic processes leading to the in the acute setting of several bouts of limb ischemia, but development of HF and in the mechanisms of protection it could be also administered as repeated cycles of limb IR conferred by RPC is still not completely understood. in the long-term that increased the efficiency of RPC:

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 27 Mitochondria as a key effector of cardioprotection 3. Heusch G. Molecular basis of cardioprotection: Maintenance of mitochondrial membrane function and signal transduction in ischemic pre-, post-, and respiratory properties has been shown as an important remote conditioning. Circ Res. 2015;116:674-99. mechanism induced by RPC [44]. Experimental studies 4. Sutton MG, Sharpe N. Left ventricular remodeling proposed that brief episodes of stress activate cell after myocardial infarction: pathophysiology and signaling mechanisms from membrane receptors through therapy. Circulation. 2000;101:2981-8. postreceptor enzyme systems of protein kinases up to the 5. Ferdinandy P, Hausenloy DJ, Heusch G, et al. end-effector systems in the mitochondria (mitoKATP; Interaction of risk factors, comorbidities, and mPTP) attenuating processes leading to cell death [45]. comedications with ischemia/reperfusion injury and Opening of mitoKATP induces moderate increase in free cardioprotection by preconditioning, oxygen radicals production, which in turn, activates postconditioning, and remote conditioning. protective signaling suppressing mPTP opening during Pharmacol Rev. 2014;66:1142-74. reperfusion activating mechanisms of cell death [3,25]. 6. Ravingerová T, Čarnická S, Nemčeková M, et al. Thus, it appears as a promising approach – to simulate the The impact of lifestyle-related risk factors on cardiac effect of RPC by pharmacological modulators of mPTP response to ischemia and possibilities to restore opening by drug cyclosporin A, which, in addition, has impaired ischemic tolerance. Physiol Res. been already successfully applied in patients with AMI 2012;61:S1-S10. prior to angioplastic intervention [46]. Preservation of 7. Andreadou I, Iliodromitis EK, Lazou A et al. Effect function (energy production) and biophysical properties of hypercholesterolaemia on myocardial function, of cardiac mitochondrial membranes might represent a ischaemia-reperfusion injury and cardioprotection promising therapeutic approach under conditions of by preconditioning, postconditioning and remote chronic heart ailment. Basic understanding of conditioning. Br J Pharmacol. 2017, 174, 1555- mitochondrial biology will be critical for the development 1569. and optimization of mitochondria-targeted therapies of 8. Dhalla NS, Liu X, Panagia V, Takeda A. Subcellular chronically failing myocardium. remodeling and heart dysfunction in chronic diabetes. Cardiovasc Res. 1998;40:239-47. Conclusions 9. Giricz Z, Lalu MM, Csonka C, et al. Hyperlipidemia In conclusion, cardiac resistance to acute IR injury is to attenuates the infarct size-limiting effect of ischemic a major extent affected by the presence of further preconditioning: role of matrix metalloproteinase-2 comorbidities (hypertension, hyperlipidemia), is related to inhibition. J Pharmacol Exp Ther. 2006;316:154-61. the age of the subjects and their gender. Under these 10. Zálešák M, Blažíček P, Pancza D, et al. Severity of conditions, not only myocardial response to ischemia per lethal ischemia/reperfusion injury in rat hearts se but also the efficiency of the heart's endogenous subjected to ischemic preconditioning is increased protective mechanisms is altered, which accelerates the under conditions of simulated hyperglycemia. progression of HF. The translation of RPC to clinical Physiol Res. 2014;63:577-85. practice has been relatively successful, however, negative 11. Simůnek T, Klimtová I, Kaplanová J, et al. Rabbit outcomes have been reported as well, and model for in vivo study of anthracycline-induced pharmacological recruitment of cardioprotective signaling heart failure and for the evaluation of protective has been largely disappointing so far. Thus, further agents. Eur J of Heart Fail. 2004;6:377- 87. investigation of molecular mechanisms of RPC is 12. Xie Y, Collins WJ, Audeh MW, et al. Breast Cancer urgently needed. Activation of innate adaptive Survivorship and Cardiovascular Disease: Emerging mechanisms of the heart might represent a promising Approaches in Cardio-Oncology. Curr Treat Options therapeutic strategy under conditions of chronic heart Cardiovasc Med. 2015;17:60. ailments. Moreover, multifactorial approach to solving 13. Slezak J, Kura B, Babal P, et al. Potential markers these problems is a way to prevent the development of and metabolic processes involved in the mechanism HF. These approaches may increase the arsenal of non- of radiation-induced heart injury. Can J Physiol invasive interventions that might be potentially Pharmacol. 2017; 95:1190-1203. implemented in human medicine, and lead to 14. Okin PM, Wachtell K, Gerdts E, et al. Relationship optimalization of HF management preventing the rise in of left ventricular systolic function to persistence or its incidence, especially in elder generation. development of electrocardiographic left ventricular hypertrophy in hypertensive patients: implications References for the development of new heart failure. J 1. Braunwald E. Heart failure. JACC Heart Fail. Hypertens. 2014;32:2472-8. 2013;1:1-20. 15. Elliott P, McKenna WJ. Hypertrophic 2. WHO. Cardiovascular Diseases: Fact Sheet Number cardiomyopathy. Lancet. 2004;363:1881-91. 317. World Health Organization. 2013.

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 28 16. Abete P, Calabrese C, Ferrara N, et al. Exercise 31. Zhou W, Zeng D, Chen R, et al. Limb ischemic training restores ischemic preconditioning in the preconditioning reduces heart and lung injury after aging heart. J Am Coll Cardiol. 2000;36:643-50. an open heart operation in infants.Pediatr. Cardiol. 17. Barrett-Connor E. Sex differences in coronary heart 2010;31:22-29. disease. Why are women so superior? The 1995 32. Wei M, Xin P, Li S, et al. Repeated remote ischemic Ancel Keys Lecture. Circulation. 1997;95:252-64. postconditioning protects against adverse left 18. Vaina S, Milkas A, Crysohoou C, Stefanadis C. ventricular remodeling and improves survival in a Coronary artery disease in women: From the Yentl rat model of myocardial infarction. Circ Res. Syndrome to contemporary treatment. World J 2011;108:1220-5. Cardiol. 2015;7:10-8. 33. Kimura M, Ueda K, Goto C, et al. Repetition of 19. Booth EA, Lucchesi BR. Estrogen-mediated ischemic preconditioning augments endothelium- protection in myocardial ischemia-reperfusion dependent vasodilation in humans: role of injury. Cardiovasc Toxicol. 2008;8:101-13. endothelium-derived nitric oxide and endothelial 20. Ledvenyiova V, Pancza D, Matejiková J, et al. progenitor cells. Arterioscler Thromb Vasc Biol. Impact of age and sex on response to ischemic 2007;27:1403- 10. preconditioning in the rat heart: differential role of 34. Cai ZP, Parajuli N, Zheng X, Becker L. Remote the PI3K-AKT pathway. Can J Physiol Pharmacol. ischemic preconditioning confers late protection 2013;91:640-7. against myocardial ischemia-reperfusion injury in 21. Griecsová L, Farkašová V, Gáblovský I, et al. Effect mice by upregulating interleukin-10. Basic Res of maturation on the resistance of rat hearts against Cardiol. 2012;107:277. ischemia. Study of potential molecular mechanisms. 35. Hausenloy DJ, Yellon DM. New directions for Physiol Res. 2015;64:S685-96. protecting the heart against ischaemia-reperfusion 22. Tapuria N, Kumar Y, Habib MM, et al. Remote injury: targeting the Reperfusion Injury Salvage ischemic preconditioning: a novel protective method Kinase (RISK)-pathway. Cardiovasc Res. from ischemia reperfusion injury--a review. J Surg 2004;61:448-60. Res. 2008;150:304-30. 36. Lecour S. Multiple protective pathways against 23. Vohra HA, Galiñanes M. Myocardial reperfusion injury: a SAFE path without Aktion? J preconditioning against ischemia-induced apoptosis Mol Cell Cardiol. 2009;46:607-9. and necrosis in man. J Surg Res. 2006;134:138-44. 37. Weiss JB, Eisenhardt SU, Stark GB, et al. 24. Botker HE, Schmidt MR. The potential for remote MicroRNAs in ischemia-reperfusion injury. Am J ischemic conditioning to improve outcomes in heart Cardiovasc Dis. 2012;2:237-47. failure. Expert Rev Cardiovasc Ther. 2015;13:1173- 38. Li J, Rohailla S, Gelber N, et al. MicroRNA-144 is a 6. circulating effector of remote ischemic 25. Heusch G, Bøtker HE, Przyklenk K, et al. Remote preconditioning. Basic Res Cardiol. 2014;109:423. ischemic conditioning. J Am Coll Cardiol. 39. Lotz C, Lazariotto M, Redel A, et al. Activation of 2015;65:177-95. peroxisome-proliferator-activated receptors α and γ 26. Ravingerová T, Farkašová V, Griecsová L, et al. mediates remote ischemic preconditioning against Noninvasive approach to mend the broken heart: Is myocardial infarction in vivo. Exp Biol Med "remote conditioning" a promising strategy for (Maywood). 2011;236:113-22. application in humans? Can J Physiol Pharmacol. 40. Huss JM, Kelly DP. Nuclear receptor signaling and 2017; 95:1204-1212. cardiac energetics. Circ Res. 2004;95:568-78. 27. Li SJ, Wu YN, Kang Y, et al. Noninvasive limb 41. Ravingerová T, Ledvényiová-Farkašová V, Ferko ischemic preconditioning protects against M, et al. Pleiotropic preconditioning-like myocardial I/R injury in rats. J Surg Res. cardioprotective effects of hypolipidemic drugs in 2010;164:162-8. acute ischemia-reperfusion in normal and 28. Kharbanda RK, Mortensen UM, White PA, et al. hypertensive rats. Can J Physiol Pharmacol. Transient limb ischemia induces remote ischemic 2015;93:495-503. preconditioning in vivo. Circulation. 42. Ravingerová T, Carnická S, Nemčeková M, et al. 2002;106:2881-3. PPAR-alpha activation as a preconditioning-like 29. Ovize M, Thibault H, Przyklenk K. Myocardial intervention in rats in vivo confers myocardial conditioning: opportunities for clinical translation. protection against acute ischaemia-reperfusion Circ Res. 2013;113:439-50. injury: involvement of PI3K-Akt. Can J Physiol 30. Yellon DM, Ackbarkhan AK, Balgobin V, et al. Pharmacol. 2012; 90: 1135-44. Remote Ischemic Conditioning Reduces Myocardial 43. Barlaka E, Ledvényiová V, Galatou E, et al. Delayed Infarct Size in STEMI Patients Treated by cardioprotective effects of WY-14643 are associated Thrombolysis. J Am Coll Cardiol. 2015;65:2764-5. with inhibition of MMP-2 and modulation of Bcl-2

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 29 family proteins through PPAR-α activation in rat 45. Ong SB, Samangouei P, Kalkhoran SB, Hausenloy hearts subjected to global ischaemia-reperfusion. DJ. The mitochondrial permeability transition pore Can J Physiol Pharmacol. 2013 Aug;91(8):608-16. and its role in myocardial ischemia reperfusion 44. Ferko M, Kancirová I, Jašová M, et al. Remote injury. J Mol Cell Cardiol. 2015;78:23-34. ischemic preconditioning of the heart: protective 46. Hausenloy DJ, Boston-Griffiths EA, Yellon DM. responses in functional and biophysical properties of Cyclosporin A and cardioprotection: from cardiac mitochondria. Physiol Res. 2014;63:S469- investigative tool to therapeutic agent. Br J 78. Pharmacol. 2012;165:1235-45.

Cardiovascular Health Research and Practice in Serbia

Vladimir Jakovljevic MD, PhD1, Vladimir Zivkovic MD, PhD1 and Dragan Djuric MD, PhD2 1Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia 2Insitute of Physiology “Richard Burian”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia. *On behalf of Serbian Association of Arteriosclerosis, Thrombosis and Vascular Biology Research Emails for Correspondence: [email protected]; [email protected]

Recent data from the Institute of Public Health of Serbia hypertension, and their combination. Furthermore, they "Dr. Milan Jovanovic Batut", cardiovascular diseases created novel pharmacological (drugs and hyperbaric (CVD) are the leading cause of mortality among Serbian oxygenation) and nonpharmacological approaches (plant population with share of 52.4% from all causes of death. extracts and exercise) to ischemia/reperfusion injury of rat The incidence is higher in women (54.6%) than in men heart. Molecular focus of their studies is pro-oxidant (45.4%). Moreover, ischemic heart disease (IHD) and molecules and enzymes of the anti-oxidative defense cerebrovascular disease (CBVD) together are the leading system. Major field of investigation of Prof. Dr Dragan causes of death in this group of diseases. In the period Djuric and his coworkers (Institute of Physiology, Faculty from 2006 to 2015, mortality rates from CVDs in Serbia of Medicine, University of Belgrade) include research on fell from 795.0 per 100,000 to 766.3 per 100,000 the role of homocysteine and sulphur containing amino inhabitants. Mortality rates from these diseases during this acids, as well as signaling gaseous transmitters such as period declined in women by 2.1% and in men by 5.3%. nitric oxide (NO), carbon monoxide (CO) and hydrogen In the same period mortality rates due to high blood sulfide (H2S) on the cardiovascular system (CVS) of rats. pressure increased by 92.9% and decreased in case of IHD Prof. Djuric is pioneer for homocysteine research in and CBVD by 27.4% and 24.6%, respectively. In 2015, Serbia and is also investigating the role of NMDA acute coronary syndrome (ACS) accounted for 50.7% of receptors and acetylcholinesterase (AChE) activity within all deaths due to IHD. In recent decades increasing the rat CVS. attention has been paid on both experimental and clinical approaches of cardiovascular disorders in Serbia. These two laboratories in Kragujevac and Belgrade Although there is still room for improvement, progress in working simultaneously and cooperate very closely. Main experimental and clinical investigations as well as focus of scientific advisors Djurdjica Jovovic and Zoran monitoring, diagnosing and treatment of cardiovascular Miloradovic (Institute of Medical Research, University of diseases (CVDs) has been made. Belgrade) are mechanisms of action of biologically active molecules, polyphenols originating from foods, Experimental cardiovascular research is predominantly vasoconstrictor molecules, receptor antagonists, inhibitors concentrated around the work of few preclinical and stimulators of oxidative enzymes in models of laboratories. One team exists at the Department of hypertension, acute and chronic renal insufficiency and Physiology, Faculty of Medical Sciences, University of combined hypertension models associated with acute renal Kragujevac under the leadership of Prof. Vladimir failure. Jakovljevic. This laboratory has several ongoing projects in the field of cardiovascular pathophysiology. In previous On the other hand, from a clinical view point there are years this laboratory has developed different models for several centers of national interest. Institute for investigation of heart function and perfusion implying Cardiovascular Diseases "Dedinje" is a highly specialized metabolic disorders (diabetes mellitus, medical institution at the tertiary level, using state-of-the- hyperhomocysteinemia, hypercholesterolemia, etc.), art health technologies, top knowledge and skills provide

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 30 high quality health services, including scientific and Physiological Society) and HISPA (Hypertension, educational activities, and occupies an important position Infarction and Stroke Prevention Association). These in the management of cardiovascular diseases as a priority associations have helped in accomplishing improvements health problem in Serbia. The Institute for Cardiovascular through well-coordinated and integrated network of Diseases Vojvodina – Sremska Kamenica is another hypertension, infarction and stroke prevention centers all important institution in the field of cardiology and cardiac over Serbia. In this regards, SATVBR has attracted the surgery in Serbia and the region. Its goal is to apply and most important cardiovascular scientists in Serbia as well improve the latest diagnostic and therapeutic procedures as from neighboring countries, while HISPA represents a for treatment of the most complex cardiac conditions. network of highly specialized and moderately equipped Concrete and big steps are being made in the development centers for diagnosing and treating serious cardiovascular of conventional and modern electrophysiological patients in the territory of Republic of Serbia and the diagnostics and treatment as well as interventional Balkans. In conclusion, it is obvious that cardiovascular cardiology. Also, great efforts are being invested in the health research and practice in Serbia is on the treatment of cardiac insufficiency, transplant surgery and ascendance. Nevertheless, staying on this path and the application of mechanical circulatory support. In continuing to improve and evolve, requires additional addition to these specialized centers, the Military Medical effort and financial investments, as well as sufficient Academy and Clinical Center of Serbia are also number of competent personnel. significant Institutes for cardiovascular health in Serbia. Reference Significant progress in cardiovascular research Health statistical yearbook of Republic of Serbia 2015. identification, diagnostics, treatment and following Institute of Public Health of Serbia "dr Milan Jovanovic patients with elevated cardiovascular risks has been made Batut". 2016, ISSN 2217-3714 (Online). largely with partnership with the SATVBR (Serbian Association for Arterisoclerosis, Thrombosis and Vascular Biology Research, corporative member of the Serbian

International Academy of Cardiovascular Sciences Officers and Executive Council Members (Honorary Life President: Naranjan S. Dhalla)

President Executive Council Members Bohuslav Ostadal Michael Czubryt, Winnipeg Canada Prague, Czech Republic Ricardo J. Gelpi, Buenos Aires, Argentina

President-Elect Otoni M. Gomes, Belo Horizonte, Brazil Roberto Bolli Ramesh K. Goyal, New Delhi, India Louisville, Kentucky, USA Suresh K. Gupta, New Delhi, India Chandrasekharan Kartha, Trivandrum, India Past President Naoki Makino, Beppu, Japan James T. Willerson Dennis B. McNamara, New Orleans, USA Houston, Texas, USA Jawahar L. Mehta, Little Rock, USA

Executive Director Grant N. Pierce, Winnipeg, Canada Naranjan S. Dhalla Pawan K. Singal, Winnipeg, Canada Winnipeg, Manitoba, Canada Jan Slezak, Bratislava, Slovak Republic Atsushi Takeda, Tokyo, Japan Andras Varro, Szeged, Hungary Karl Werdan, Halle, Germany

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 31

The Challenges and Opportunities in Providing High Quality Cardiovascular Care in the Caribbean. Case Study: Jamaica

Lisa D’Oyen BA, MPA; Kristofer Madu1; Nickolas Kinslow, BSc2; Edwin Tulloch-Reid, MD, FACC; Felix Nunura, MD; Dainia Baugh, MD, ABIHM2, Ernest Madu, MD, FACC, FIACS2 Heart Institute of Caribbean, Jamaica and 1John Hopkins University, Baltimore, 2IHS Group, Nashville Email for Correspondence: [email protected]

Background institutional, socio-economic and behavioural barriers that Non-Communicable Diseases (NCDs) in developing have acted as impediments to the HIC mission. countries are a major public health and socio-economic problem, and a major challenge to development in the We believe that the impediments encountered are found in 21st century. According to the World Health various forms in other low resource nations around the Organization, total deaths around the world equal world. We also believe that the successes attained and the approximately 56 million. Of these, total deaths from non- lessons learned from our work in the Caribbean can be communicable disease equal 38 million, approximately replicated in other low resource settings to solve a myriad 68% of the total deaths globally (World Health of healthcare system challenges beyond cardiovascular Organization, 2014). Deaths from NCDs in developing disease, and in so doing, help build sustainable healthcare countries equal approximately 29 million, of which most capacity and alleviate the access gap in high quality care are preventable (World Health Organization, 2011). in other regions.

Cardiovascular disease accounts for most NCD deaths: This article aims to provide insight into the social, approximately 17.7 million deaths yearly (World Health operational and economic challenges of embarking on the Organization, 2017). An estimated 32 million heart HIC mission, as well as the opportunities that exist and attacks occur yearly worldwide, with 80% of the heart have been taken advantage of, despite the challenges. This attacks occurring in developing countries (World Health article will also explore health systems in other countries, Organization, 2010). Furthermore, 85% of the global including more developed countries, and draw lessons mortality and disease burden from cardiovascular disease that may be adapted within the Jamaican healthcare is in developing countries (World Health Organization, system to increase access to specialist care, particularly 2010). Life expectancy in many parts of the Caribbean cardiovascular care, and improve overall operational remains respectable but disease adjusted life expectancy is efficiency. declining. The worsening indices of health status in developing countries demand a fresh look at the way The Global Imbalance health systems in these countries are organized – a new The work of HIC is based on the belief that a global approach is needed. imbalance exists in the availability of modern cardiovascular care, with 80% of access being available in In Jamaica, cardiovascular disease is the number 1 cause the richest countries of the world, where the global need of death and disability. In 2005, the Heart Institute of the for cardiovascular care accounts for only 20% (Madu, E., Caribbean (HIC) began operations in Kingston, Jamaica Tulloch-Reid, E, 2009). This imbalance has created an with the mission to provide accessible, sustainable, high exploitive system where the poorest countries of the quality cardiovascular care to the people of the Caribbean. world depend on care from the richest countries, often at Before the establishment of HIC, access to cardiovascular an exorbitant cost. Citizens from low resource nations care on the island was limited. There was no cardiac expend considerable financial and emotional capital to centre of excellence, there were few cardiologists with access high quality cardiovascular care in high resource limited availability, and the waiting time for key nations, further depleting limited reserves from the low diagnostic procedures such as echocardiograms and stress resource nations (Madu, E., Tulloch-Reid, E, 2009). We tests was approximately 3 to 6 months. Improving find this arrangement to be inequitable, unjust and morally operational efficiency in the delivery of sustainable, high unacceptable. quality cardiovascular care and ensuring patient satisfaction has not been an easy mission, and since the In Jamaica, and in much of the Caribbean, individuals beginning of operations in Jamaica, HIC has encountered, with the means and access to the US have long depended and has learned to navigate a myriad of structural, on facilities in Florida and other parts of the US to access

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 32 cardiovascular services, usually at excessively high rates. than financing sustainable healthcare development While the majority of patients seeking care abroad are projects. We believe that this paradigm is rooted in a motivated by the desire to achieve best outcomes, a small mindset aligned with deeply entrenched affinity to but significant group do so to perpetuate the perception of dependency, and is therefore difficult to shake from the the implicit status symbol. Those institutions that have collective consciousness. The transition in thinking has to benefitted from this inequitable arrangement have been be made from dependency and short-term fixes, to long- active for decades in promoting such an arrangement in term meaningful and sustainable development. the Caribbean. Even though inimical to the development of sustainable healthcare infrastructure in low resource HIC recognized that relevant education and appropriate nations, the practice is frequently accepted as the norm use of technology are the main components of sustainable and indeed welcomed and appreciated by a significant and healthcare development (Madu, E., Ted Talk, 2007). The influential group within these countries. Challenging this programme at HIC is therefore designed to make paradigm was considered radical, and was met with maximum use of the advances in technology focusing on resistance by those who believed that comparable high multi-modality systems that are readily adaptable to low quality cardiovascular care, even if desirable, was not resource settings, easily serviceable, and durable enough achievable locally, by those who became too comfortable to withstand the stresses of the local environment. HIC with the status quo, and by those who benefitted in one employs the use of an electronic medical record system to way or another from the status quo. We believe that such easily access and share medical records with patients and a system designed to cater for only the very few, who their physicians, wherever they may be located, as well as could afford expensive care overseas, while neglecting the a telemedicine platform so that patients can readily access vast majority of Jamaicans, was not an appropriate second opinions from international experts on demand, if approach and was detrimental to development and group necessary. The programme further focuses on skills progress. Furthermore, we recognize that the very nature acquisition and the training of local personnel to improve of cardiovascular disease requires that every society must internal capacity and to minimize the need for dependence have a properly developed local programme, as time is on foreign entities. critical in providing the necessary care given the highly unpredictable and often sudden nature of a potentially Healthcare Financing and Social Safety Nets: catastrophic acute cardiac event. Locally and Internationally In addition to the challenges HIC faced in establishing General Obstacles and Opportunities operations in Jamaica to provide high quality The issue of access is compounded by low general health cardiovascular care in a sustainable way, Jamaicans who literacy and information asymmetry with respect to wanted and needed to access the services also encountered cardiovascular care. Many patients rely on a paternalistic the challenge of the lack of existing social safety nets to approach to care and depend solely on their physicians as facilitate their access to the healthcare they needed. While the source of information for their health related concerns, public hospitals and healthcare centres offer services free and therefore do not feel empowered to seek second or of charge to Jamaican citizens and residents under the no alternative opinions. HIC sought to change this with the user fee policy implemented in 2008, there are aim of raising awareness of the reality that cardiac infrastructural and staffing issues that affect the emergencies are life threatening and must be addressed by availability and quality of the care in the public system. highly qualified cardiologists supported by other This is especially true for highly specialized healthcare cardiovascular specialists with access to appropriate disciplines such as cardiovascular care – the infrastructure technology. and the expertise to provide a comprehensive high quality cardiovascular care programme simply do not exist. Bureaucratic hurdles were also a significant challenge. HIC encountered a disjointed and unwieldy approval Except for the National Health Fund (NHF) and the process, which added significantly to the financial risk Compassionate Fund of the Ministry of Health which exposure and general cost of doing business. These gives selective assistance, there is no government funded hurdles arose partly because of skepticism and partly subsidy for the large out-of-pocket payments charged in because of the complexity of the operations that HIC was the private sector. Furthermore, these subsidies only go so proposing. Furthermore, there was lack of credit and far in meeting the needs of the patients who require favourable financing terms for healthcare development specialized cardiovascular care. For example, the National and medical equipment, which is usually readily available Health fund focuses on increasing access to drugs through in developed economies around the world. Most subsidizing drugs necessary for the treatment of a certain multilateral agencies appear structured to provide non- number of select chronic illnesses (The National Health regenerative basic aid to support short-term medical Fund, 2017). More is needed. missions to developing and low resource countries rather

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 33 According to the World Bank, healthcare financing million to insurance companies “from individuals with systems should aim to raise enough revenue to provide health coverage who are preying on public hospitals citizens with essential services and financial protection where services are free.” Despite the fact that public against catastrophic medical expenses in an equitable, hospitals should receive payment from insurance efficient and financially sustainable manner (World Bank, companies when a policy holder uses public services, 1995). patients are not disclosing their insurance status (The Gleaner, July 2017). This situation puts further financial Equitable, efficient and financially sustainable healthcare strain on the already strained public health system. financing can be achieved through employing a number of different mechanisms. Social safety nets that provide A More Effective Healthcare Policy Needed Locally subsidies for all levels and specialties of healthcare are The vision for effective healthcare delivery in Jamaica, key for effective healthcare financing. Various countries where all levels and specialties of high quality healthcare have employed various methods of healthcare financing are available to all Jamaicans, must start with a paradigm with the goal of ensuring universal access to healthcare. shift that recognizes collective responsibility for high While some systems are very effective in achieving this quality healthcare and the need for collaboration and goal, it should be noted however, that each has its own cooperation between the public and private sector shortcomings. It should also be noted that while there are healthcare services systems. A new paradigm must lessons to be learned from the healthcare financing recognize and embrace the monumental technological and systems discussed here, the suggestion is by no means a research advances in healthcare over the past 25 years as copy and paste approach. Cultural considerations and the well as the direct relationship between good health, wealth current status of the healthcare landscape have to come and economic growth. Enabling conditions and into play when thinking about the best approach to infrastructure for good quality healthcare is a necessary improve universal access to all levels and specialties of social investment that would yield enormous returns to healthcare in Jamaica. the economy.

In the United Kingdom, healthcare is free and universal There are opportunities to leverage the diverse resources and has been that way since the development of the available in private healthcare facilities in Jamaica to country’s National Health Service in the 1940s. The augment the resources in the public sector with the National Health Service is funded through tax and ultimate goal of improving access and quality of care for compulsory national insurance contributions deducted all Jamaican, including the most indigent. The private from income. Other countries that use a similar tax based sector has always played a key role in setting the agenda system to fund healthcare include Finland, Sweden, for health industry development and competitiveness in all Portugal and Spain (Senthilingam, M., March 2017). countries. With the proper regulatory framework and Countries like Germany and France use a social insurance support, the private sector can do more in Jamaica. model to pay for their healthcare where deductions are Loosening government regulation and taxation on medical taken from income, everyone is covered and companies do equipment and, products and supplies will increase not make a profit. Those contributing to the system “own” investment in the sector. Improvement in the processes the organizations or funds involved through boards and that allow movement of skilled labour who bring value unions. People pay a minimal fee at point of care, which is added medical expertise will build internal capacity, later reimbursed in some cases (Senthilingam, M., March reduce expensive trips abroad for care, increase quality 2017). This is unlike the US, that spends the most on and content of local medical care and expand access to healthcare and has the highest percentage of people care for all Jamaicans. Cooperation engagement of the without health insurance. While the Affordable Care Act, private sector health care delivery system will improve a government programme designed to increase the quality the quality and content of care in the public health system, and affordability of health insurance making health reduce the economic burden on the public sector and free insurance accessible to more people (New York Times, up much needed capital for other development needs of October 2014), aimed to address this issue, the US still the nation. suffers from lower life expectancy and other deficits. This indicates that within the discussion of healthcare Thinking Outside the Box: HIC’s Economic financing, money cannot be the only consideration. The Innovations management of finances and the model of care must be In order to bridge the accessibility gap and make high considered (Senthilingam, M., March 2017). quality cardiovascular care available to all Jamaicans while remaining economically viable, HIC focused on Back to the case of Jamaica – Under the no user fee economic innovations to expand access and empower policy, public hospitals are generally under resourced. patients despite the challenges of the local environment. Furthermore, they are losing an estimated USD 2.5 The Heart Institute of the Caribbean Foundation (HIC

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 34 Foundation) was founded in 2008 and is focused on chest pain or a heart attack. HIC, again with the support of financing care for the most vulnerable patients. The HIC HIC Foundation, designed a new model that grants open Foundation is primarily internally funded and is the access to emergency cardiovascular care to the most pathway through which other entities and individuals are vulnerable group of patients at no cost. The free welcome to contribute toward the mission of ensuring emergency angiogram programme, launched in 2015, is access to, and affordability of our critical services to all based on the belief that open and accelerated access to Jamaicans, despite their ability to pay. Additionally, the coronary angiograms without financial consideration cross subsidy model utilized allows those with more would lead to quick diagnosis and allow clinicians to limited income to pay less because those who can afford define proper treatment strategies. By eliminating the to pay, pay. This model is partially executed through a financial hurdle to diagnosis in an emergency, patients differential pricing scheme where a standard rate is can apply their often-stretched resources toward treatment offered to patients who have health insurance or a third if necessary. These economic innovations and creative party guarantor, and a reduced rate is offered to patients solutions have proved to be necessary for the ongoing who are paying solely out of pocket. Furthermore, sustainable development of HIC. through the HIC Foundation, community clinic days are set where further reduced pricing is offered to patients Continuing To Care, the HIC Way who need further assistance. Twelve years since beginning operation, HIC continues to use innovation in all aspects as a force for continued The HIC Foundation has also assisted HIC in expanding evolution in the healthcare sphere in Jamaica, and has its reach across the island through the Heart Station/ECG recently made a complete transition to a full service Heart Shop model, thereby making care easily accessible to Hospital. The HIC Heart Hospital is the only Heart indigent patients in lower income and rural communities. Hospital in Jamaica. We now provide full outpatient and Through this model, patients are offered basic heart tests inpatient services in at our location in Kingston and offer at heavily subsidized rates, with quick turnaround times, complex cardiovascular surgical and percutaneous while still maintaining a high quality of service. Another interventions. The HIC Heart Hospital is open 24 hours a initiative driven by the HIC Foundation that is key to day, 7 days a week and has facilities for angioplasty sustainable development is the hosting of public health within minutes of patients experiencing an acute cardiac forums, where patients can gain information that will event. Furthermore, the facility features an Operating encourage them to take the necessary steps to achieve a Theatre Suite, a Cardiac Emergency Room, a Cardiac heart healthy lifestyle. Additionally, through the HIC Intensive Care Unit and a Telemetry Unit. An Emergency Foundation, HIC has also supported many programmes Cardiac Ambulance Service is accessible 24 hours a day aimed at nation building including providing free cardiac to respond to Cardiac emergencies. We have additional screening for young Jamaican athletes and their coaches, full service cardiovascular clinics in Mandeville and Ocho funding youth development programmes and sporting Rios operating as outpatients facilities, with referrals to activities, and providing free cardiovascular care to Kingston and Montego Bay facilities for more demanding Jamaican icons in their golden years. care.

Another key economic innovation developed by HIC to All in all, for the past twelve years, HIC has provided increase access to high quality cardiovascular care is the USD 1.5 to 2 million in free or subsidized care to ‘HIC Cares’ membership programme where, through financially challenged or indigent patients each year. HIC various tiers of membership, members are entitled to has led and continues to lead many innovations that have unlimited, ongoing access to certain key services such as improved the overall system of healthcare delivery in electrocardiograms and cardiology consultations, for a Jamaica. For these efforts, HIC has won several awards year at a fixed annual rate, while simultaneously and recognitions including the National Commercial Bank benefiting from special rates on other services. The HIC (NCB) Nation Builder and Innovation Award in 2014 and Cares membership programme is specifically designed to the American Chamber of Commerce Corporate Social cater to the needs of heart patients, as continuous follow Responsibility Award in 2015 and again in 2016. up with a cardiologist is necessary for patients with heart Additionally, HIC’s Chairman and CEO, Dr. Ernest Madu disease. The membership makes ongoing cardiovascular won the inaugural Global Health Champion Award from care accessible and affordable for many patients. the Centre for Global Health at the Perelman School of Medicine at the University of Pennsylvania. Dr. Madu While the HIC Cares membership programme provides a also recently won the distinguished International Service more affordable avenue for non- emergent follow up care Award from the American College of Cardiology. on an ongoing basis, there was the noticeable need for something to be done to increase access to care in an Our experience reinforces our core belief that high quality emergency, for example, when a patient is having severe cardiovascular care anchored on smart use of technology

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 35 and expertise, is achievable in low resource nations of the 7. Madu, E. (n.d.). World-class health care. Retrieved world, if driven by the appropriate dose of passion and July 28, 2017, from commitment. https://www.ted.com/talks/ernest_madu_on_world_cl ass_health_care References 8. Madu, E. C., Tulloch-Reid, E., Edwards, P., Baugh, 1. Afternoon, T. (n.d.). How U.S. health care stacks up D. S., & Kong, B. W. (2009). Developing against global systems. Retrieved July 28, 2017, Sustainable Cardiovascular Care for Low-Resource from Nations. Journal of the American College of http://money.cnn.com/2016/11/02/news/economy/ob Cardiology,54(11), 1038-1039. amacare- healthcare-systems/ doi:10.1016/j.jacc.2008.07.077 2. Dunlop, D. W., & Martins, J. M. (1995). An 9. New WHO report: deaths from noncommunicable international assessment of health care financing : diseases on the rise, with developing world hit lessons for developing countries. The World Bank,1, hardest. (n.d.). Retrieved July 28, 2017, from edi seminar series http://www.who.int/mediacentre/news/releases/2011 3. *world bank institute (wbi). Retrieved July 28, 2017, /ncds_20110427/en/ from 10. Non communicable diseases fact sheet. (n.d.). http://documents.worldbank.org/curated/en/4878214 Retrieved July 28, 2017, from 68758149918/pdf/multi0page.pd f http://www.who.int/mediacentre/factsheets/fs355/en/ 4. Global status report on noncommunicable diseases 11. Public Hospitals losing an estimated $300M to 2010(Rep.). (n.d.). Retrieved July 28, 2017, from insurance companies. (n.d.). Retrieved July 28, 2017, World Health Organization website: from http://jamaica-gleaner.com/article/lead- http://www.who.int/nmh/publications/ncd_report_ful stories/20170720/public- hospitals-losing-estimated- l_en.pdf 300m-insurance-companies 5. GLOBAL STATUS REPORT on noncommunicable 12. Senthilingam, M. (2017, March 17). How health diseases 2014 “Attaining the nine global care works around the world. Retrieved July 28, noncommunicable diseases targets; a shared 2017, from responsibility”(Rep.). (n.d.). Retrieved http://edition.cnn.com/2017/03/17/health/health- http://apps.who.int/iris/bitstream/10665/148114/1/97 care-global-uk- national-health-system-eprise/ 89241564854_eng.pdf 13. The National Health Fund - Individual Benefits. 6. Is the Affordable Care Act Working? (2014, October (n.d.). Retrieved July 28, 2017, from 26). Retrieved July 28, 2017, from http://www.nhf.org.jm/index.php/individual- https://www.nytimes.com/interactive/2014/10/27/us/ benefits. is-the-affordable-care-act- working.html#/

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Cardiovascular Health in the Caribbean: The Cuban Perspective

Delfin Rodriguez Leyva, MD and Ayelen Rodriguez Portelles, MD St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, Manitoba Email for Correspondence: [email protected]

Cardiovascular disease (CVD) is a highly complex health The annual report of the Ministry of Public Health of problem in Latin America and the Caribbean. In the Cuba (5), shows mortality related to cardiovascular Caribbean region, 25% of deaths are related to diseases with a rate of 217/100,000 inhabitants. The rate cardiovascular diseases (1) This situation imposes a heavy is higher in males with a 232.9/100,000 inhabitants (13 burden to most of the low-middle income countries of the 039 deaths) but also important in females at 202.6/100 region since approximately 40% of the deaths occur 000 inhabitants (11,423 deaths), which represents 24.6% prematurely (2). The discussion of the cardiovascular of all deaths in Cuba. Table 1 shows the main causes of health, disease and cardiovascular risk factors in the death in the Cuban population in 2015 and 2016. Caribbean provides the ways to implement intervention programs aimed at primary and secondary prevention of Table 1. Causes of death of Cuban population in 2015 and CVD. This article focuses on Cuba as a case study, but it 2016. is a starting point for further individual and regional analysis of the situation. Cause of death Number of Number of deaths in 2015 deaths in 2016 Cuba, officially the Republic of Cuba, is the largest Heart diseases 24,646 24,462 country by land area in the Caribbean with an area of 109,884 Km2. The main island is the sixteenth largest Cancer 24,333 24,303 island in the world (3). It is located in the Caribbean Sea Cerebrovascular 9,320 9,465 and lies just south of the Tropic of Cancer at the mouth of diseases the Gulf of Mexico. Cuba has a population of 11,239,224 Influenza and 6,617 6,806 according to the 2016 Census (4) comprising 50.1% men pneumonia and 49.9% women. Ethnic group distribution includes Accidents 5,511 5,505 64.1% White, 26.6% Mulatto, Mestizo, Zambo or Pardo Chronic diseases of 4,292 4,088 and 9.3% Black. the lower respiratory tract Estimated GDP in 2015 was US$ 254.865 billion with a Small artery 2,803 2,714 per capita of US$ 22,237 (2015). 50.03% of the diseases population is male and 49.97% is female; 6.5 million have Diabetes mellitus 2,352 2,247 high school or university education (4). Cuba’s public Liver cirrhosis and 1,516 1,550 health system is easily one of the best in Latin America. It chronic liver is universal, free and at reach of all Cubans no matter diseases their race, social status or religion; it is based on the social Self-inflicted 1,511 1,429 concept of health which goes beyond the absence of lesions diseases and even further than the limits of the individual; and encompasses her or his relation and interaction with Source: Annual report of the Ministry of Public Health of the environment where she or he lives and develops. Cuba. 2016

For several decades, Cuba’s health system has been Within cardiovascular diseases, ischemic heart disease focused on primary health care and preventive medicine. accounted for 2/3 of all reported deaths followed by Health indicators such as infant mortality (4.3/1,000 live hypertensive cardiomyopathy. In recent years, there has births), maternal mortality or mortality due to infectious been a decrease in the rheumatic valve diseases in the diseases are comparable to development countries. Life Cuban population. expectancy is (78.49 years). As a consequence, the main causes of mortality nowadays are cardiovascular diseases In Cuba, heart diseases have caused the mean loss of 11.2 and cancer, that is those of industrialized countries. potential years of life per 1000 inhabitants, 14.8 years in males and 7.7 years in females. In 2016, 7,177 Cubans died of a heart attack, 40% of then were women and 60% of them men.

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 37 Coronary risk factors in the population. However, this is still a major health Almost one out of four Cubans die of heart disease. There problem in the country. Cuba is the main exporting is a growing trend towards the increase in coronary risk country of Habanos in the world, which are recognized factors in Cubans, which is closely linked to the severity for their exquisite quality and are desired by millions of of the coronary heart disease and its complications. smokers worldwide. Arterial hypertension, dyslipidemia, obesity and smoking are highly prevalent coronary risk factors in Cuba. Based Arterial Hypertension on some epidemiological studies, a summary of their The prevalence of this risk factor is similar to the incidence in Cuba is provided below. prevalence in countries like Canada and USA, and varies

Causes of cardiovascular deaths. Cuba 2016

2% 1% 1% 2% Ischemic heart disease 4% Hypertensive disease 9% Heart failure 15% Cardiomyopathies 66% Cardiac arrhythmias Non rheumatic valve disease Rheumatic valve disease others heart diseases

Source: Annual report of the Ministry of Public Health of Cuba. 2016

Dyslipidemia between 27 to 34% according to several studies (6,7,8,9) Several studies have reported the presence of and is about the same among females (34.1%) and males hypercholesterolemia around 14 to 18%. The prevalence (32.6%). Adherence to hypertensive treatment is between of dyslipidemia is about 3% higher in adult females than 39 to 42%. Antihypertensive medication is available at in adult males (6,7,8,9). During the last few years the subsidized cost. There is a National Hypertension awareness about the relevance of proper diet and regular Program in Cuba and family doctors are the first line physical activity as ways for prevention of dyslipidemia health care providers that stratify and manage has increased. Indeed, Saturated fats have been linked to hypertensive patients. development of dyslipidemia. Sedentary lifestyle Obesity About 20 to 30% of the Cuban adults are considered About 30% of the Cubans are considered overweight physically active (7). There is a broad movement lead by while 16.7% qualify as obese (7). The prevalence of primary care physicians and physical education teachers overweight is about the same for both genders. However, that involves elderly members of the community offering prevalence of obesity is 11% higher in females than in regular physical activities in public parks and sport males. It is believed that this factor has been growing facilities. This is very attractive since it also implies during the last few years as a consequence of economic psychological support for the elderly and frequent improvements compared to the 90s. screening of blood pressure. During the last few years, there has been an important development of private gyms Smoking that are very attractive to younger people. For many years About 1/4 (23.5%) of Cuban adults are smokers. The Cubans have obtained excellent results in the Olympics prevalence is less in females (about 17%) than in males and world games. Cuba is the most successful Olympic (31%). Seventy eight percent of smokers are willing to team (by total medals won) among those nations who start smoking cessation program. The average start age for never even participated at Winter Olympics. smoking is 17 years (7). Cubans smoke more cigarettes than cigars. The Cuban government and the Ministry of Public Health have tried tirelessly to discourage this habit

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 38 Diabetes mellitus modification towards more healthy choices in order to The prevalence of diabetes mellitus is reported between improve quality of life and life expectancy. 10-15% in Cubans older than 15 years of age (7, 9). Currently, all diabetic patients are managed by primary References health care providers who stratify them according to the 1. Alcocer L, Meaney E, Hernandez-hernandez H. level of risk. Every municipality has specific facilities Applicability of the current hypertension guidelines dedicated to educate diabetic patients after been firstly in Latin America. Ther Adv Cardiovasc Dis. diagnosed. Education is oriented to dietary intervention, 2015;9:118-126. physical activity, self-management of insulin therapy and 2. Priorities for cardiovascular health in the Americas. prevention of complications. Newer Cuban biotechnology http://www1.paho.org/priorities/pdf-en/; Accessed: products for advance treatment of the diabetic foot ulcers March 12, 2018 are available to all the population either at no or 3. Geography of Cuba. subsidized cost. https://en.wikipedia.org/wiki/Cuba. Accessed: March 12, 2018. Human resources 4. Censo de Población y Viviendas 2016. Diagnosis and management of cardiovascular diseases in 5. Anuario Estadístico del Ministerio de Salud Pública Cuba is based on the strength of the primary care system de Cuba, 2016, http://www.sld.cu/sitios/dne/ that includes 10,749 family doctors distributed all over the 6. Rodríguez LD, Valdemira FE, Alvarez IE, island (5). Secondary and tertiary systems for advance Rodríguez MD. Disfunción Arterial y factores de management of cardiac patients is based on a structure of riesgo coronarios modificables. Correo Científico highly specialized hospitals (5 adult cardiocenters, one Médico de Holguín 2002;6(3). children cardiocenter) and a cardiovascular network that 7. Marimon Torres E, Orraca Castillo O, Casanova involves 760 cardiologist and 57 cardiovascular surgeons Moreno MC, et al. Prevalence of risk factors of non- (5). contagious diseases. Rev Ciencias Médicas Pinar del Río vol.17 no.2. 2013 Conclusions 8. Debs PG, de La Noval GR, Dueñas HA, González Cardiovascular diseases are a highly complex health PJ. Prevalencia de factores de riesgo coronario en problem in the Caribbean and the main cause of death in "10 de Octubre". Su evolución a los 5 años. Rev Cuba. Traditional cardiovascular risk factors are present Cubana Cardiol Cir Cardiovas 2001;15(1):14-20 among the Cuban population. Availability of human 9. Ordúñez GP, Cooper RS, Espinosa BA, Iraola FM, resources, particularly the program of the family doctor, Bernal MJ, La Rosa LY. Enfermedades impacts the acute and long term management of the cardiovasculares en Cuba: determinantes para una cardiac patients and their cardiovascular risk factors. epidemia y desafíos para la prevencióny control. Rev Main focus of Cuban medicine is prevention through a Cubana Salud Pública 2005;31(4) wide educational movement that focuses on lifestyle

Local Caribbean Group along with St. Boniface Hospital Research Centre Send Medical Equipment/Supplies to Guyana

Paramjit S. Tappia, PhD, Secretary General CCHHE Asper Clinical Research Institute, St Boniface Hospital, Winnipeg, Canada Email for Correspondence: [email protected]

On September 16, 2017, several members of the meticulously packed with many items that included beds, Caribbean Canada Heart Health Education (CCHHE) microscope, ultrasound machine, stretchers, wheelchairs, group along with Dr. Grant Pierce, Executive Director of examination tables, walkers, IV poles and operating room Research, St. Boniface Hospital, and Dr. Bram supplies. The shipment through Quad City Port Services Ramjiawan, Director of the Asper Clinical Research Inc., Quebec, reached Guyana November 13th and has Institute, helped load a 40 ft trailer, bound for Guyana, been distributed through the Ministry of Health with with medical equipment and supplies at the International volunteers from the local Lions Club. This is a significant Hope Canada warehouse. With around 20 other regular achievement for our organization, said Kamta Roy Singh, volunteers for Hope International the trailer was President CCHHE, and we are grateful to Drs. Pierce and

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 39 Ramjiawan in supporting our endeavours as well as the a Winnipeg based organization, under the auspices of the magnificent work that the volunteers and International International Academy of Cardiovascular Sciences, and is Hope Canada undertake. We also appreciate the efforts of involved in promoting the prevention of cardiovascular Dr. Sandra Sukhan (Honorary Consul to Guyana and Vice disease in the Caribbean through education and service. President of CCHHE) in initiating this project. CCHHE is

Guyana bound equipment and medical supplies on the floor of International Hope Canada warehouse, Winnipeg

L – R: Mr. David (loading master, International Hope Canada), Dr. Grant Pierce, Dr. Bram Ramjiawan and Mr. Kamta Roy Singh

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In Memoriam: Dr. Jacques Genest, 98, was a pioneer in the treatment of hypertension

Editor’s Note: Dr. Jacques Genest was the recipient of Distinguished Leadership Award from the Academy in 2001. He was the premier clinical investigator of Canada who promoted global hypertension research and established the Clinical Research Institute of Montreal. The following memoriam is reproduced with permission of author Fred Langan, Special to The Globe and Mail, updated version published on line, February 9, 2018.

Roosevelt as an example of someone who died relatively young because of hypertension. The gaunt, grey, Roosevelt was a sick man when he travelled to Yalta in the Soviet Union in February, 1945, to negotiate with Soviet leader Joseph Stalin. He died of a heart attack in April, 1945, at the age of 63. "Roosevelt had high blood pressure of over 220 diagnosed by his physician and, at the time, the physician wasn't really sure why. It's ridiculous to leave someone with this high blood pressure today unattended," Dr. Moroy says. "Dr. Genest was a major player in the field of hypertension."

Jacques Genest was born in Montreal on May 29, 1919. He liked to point out that was the date that a feature of Einstein's Theory of Relativity, that light could be bent by gravity, was proved during a total solar eclipse. Dr. Dr. Jacques Genest Genest joked that it contributed to his future scientific success. His father, Rosario, a lawyer, sent Jacques to World-renowned biomedical researcher Dr. Jacques Collège Jean de Brébeuf, the Jesuit classical college that Genest, who died in Montreal on Jan. 5 at the age of 98, educated prominent Quebeckers from Pierre Trudeau to helped find a treatment for hypertension. His Robert Bourassa. He graduated from the University of breakthrough in the 1950s was finding the link between Montreal in medicine in 1942, and after residence at the the hormone aldosterone and sodium; in plain English, he Hôtel Dieu hospital, he studied for many years at top found the connection between salt and high blood universities in the United States, including Harvard, Johns pressure. A pioneer in medical research in Quebec, he Hopkins and the Rockefeller Institute. "His interest in a started scientific research at the Hotel Dieu Hospital in scientific approach to patient care stemmed from his Montreal and later founded the Clinical Research Institute intense curiosity and the rejection of the dogmatic of Montreal (IRCM). approach taught by many of his European-trained

professors," his son said. Dr. Genest was a superstar in the world of medical research. He wrote more than 700 papers and contributed Dr. Genest returned to Montreal and Hôtel Dieu hospital, to three books, including one called Hypertension, which where he established the first clinical research department was the bible on the subject for decades. He received a in Canada, where practising medical doctors and scientists long list of awards, including 12 honorary degrees, and worked side-by-side to understand the causes of disease. was a companion of the Order of Canada, the highest Some of the doctors objected to Dr. Genest doing pure level, which is limited to 165 living people. "His most research while they treated patients. His research work significant clinical contribution was the treatment of expanded, encouraged by the hospital and the government hypertension by multiple medications, altering the natural of Quebec. In 1967, he acquired some land from a course of a once-fatal disease into a very manageable sympathetic order of nuns, many of whom had been one," said his son, Dr. Jacques Genest Jr., who is a helping operate hospitals in Quebec, and established the cardiologist and medical researcher at McGill University. Clinical Research Institute of Montreal. "The institute

does biomedical research. It is an academic setting Both the younger Dr. Genest and Dr. Tarik Moroy, the affiliated with universities and particularly with the current head of the Clinical Research Institute of University of Montreal, since it's a francophone Quebec Montreal, give the former U.S. president Franklin

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 41 institution, but also associated with McGill University. So and the artist Alex Colville were the two people from that we have graduate students from both universities in our first cohort who were present at the 100th investiture labs," Dr. Moroy says. awards. He was also an officer of the Ordre national du Québec. Quebec's chief scientist, Remi Quirion, said Dr. Dr. Genest operated the Institute from 1967 to 1984 and Genest understood "the significance of developing oversaw its physical expansion and its marriage of science research by fostering its expansion within hospitals, from and practical medicine. "The institute has outpatient patients' bedsides." Dr. Genest was a scientist and also a clinics within the building, which is a unique situation; practising Roman Catholic. "His life was motivated by usually, you have research institutes in hospitals and three principles. He was strongly religious, having been within big universities in Toronto and Montreal, but this raised in a very Christian family and attending a Jesuit institute has laboratories and outpatient research clinics school. He never deviated from his faith. The second is within the same building, Dr. Moroy says. "The clinicians the importance of the family as the knot that binds society and the researchers talk to each other, and the rift that together. Lastly, he had an open mind to science," his son exists between a practising medical doctor and a PhD lab said. "On a personal note, he was a wonderful husband to scientist is bridged, and they talk to each other on how to his wife, Estelle, with whom he had been married for discover mechanisms of diseases and find a therapy." nearly 65 years. As a father, he was loving and caring and provided a nurturing, if somewhat strict, environment. He Dr. Genest was on the first list of people awarded an certainly shaped my career." Order of Canada in 1967 for "his study of the role of hormones in arterial hypertension in men." In 2007, he

Official Partnering Journals of the Academy

Editors: Dr. Ghassan Bkaily Dr. Pedro D’Orléans-Juste

Editorial Office: Canadian Journal of Physiology and Pharmacology NRC Research Press 65 Auriga Drive, Suite 203 Ottawa, ON K2E 7W6 Canada Email: [email protected]

Editors: IACS partnering journals: Dr. Sidney Goldstein

Dr. Hani N. Sabbah 1. Canadian Journal of Physiology and Editorial Office: Pharmacology Heart Failure Reviews 2. Heart Failure Reviews 233 Spring Street 3. American Journal of Cardiovascular Drugs New York, NY 10013-1578 USA Email: [email protected] Readers are encouraged to submit original research articles and reviews to these partnering journals. Editor: Dr. Amitabh Prakash

Editorial Office: American Journal of Cardiovascular Drugs Adis, Springer Healthcare 5 The Warehouse Way, Northcote Auckland, 0627, New Zealand Email: [email protected]

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 42

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 43

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 44 Havana International Convention Centre, Havana, Cuba

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 45

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 46 Dear colleagues and friends,

It is our pleasure to inform you that 5th meeting of the International Academy of Cardiovascular Sciences – European Section (IACS-AS) „Advances ın cardıovascular research: from basic mechanisms to therapeutic strategies“ will be held in the Congress Center of the Slovak Academy of Sciences in Smolenice Castle near Bratislava on May 23- 26, 2018. The meeting will be organized by the Institute for Heart Research, Slovak Academy of Sciences in collaboration with IACS-ES, Ministry of Education of the Slovak Republic and other institutions in Slovakia and abroad. Scientific topics will include  Pathophysiology of cardiovascular diseases (CVD), risk factors and comorbidities - hypertension, remodeling, hypertrophy, ischemic heart disease, heart failure - radiation-induced heart disease, ROS-related pathologies, neurodegeneration - cardiomyopathies, mitochondrial disorders - arrhythmias, sudden death - metabolic abnormalities, endothelial dysfunction  Myocardial adaptation, novel pathways and targets of cardioprotection, mechanisms of cell survival and death  Genetic aspects of CVD  Combination therapy, nutrients, molecular hydrogen in management of CVD The meeting will feature basic scientific and clinical sessions, including lectures of invited keynote speakers and free oral communications selected from the submitted abstracts. We plan to provide vast opportunities for young investigators to discuss their latest results and to compete in both oral and poster sessions.

Please, do not forget to apply for a membership in IACS and get benefits of substantially reduced registration at the meeting. More detailed and updated information concerning registration, accommodation, abstracts and application forms will be available soon on the homepage of IACS-European Section: http://www.iacs.sav.sk/meetings.html

Looking forward to meeting you in Slovakia

Ján Slezák Honorary President [email protected]

Táňa Ravingerová Miroslav Barančík Miroslav Ferko President Vice- President Scientific Secretary

[email protected] [email protected] [email protected]

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MEETING ORGANIZERS INTERNATIONAL ADVISORY BOARD Ján Slezák (Honorary President), Táňa Ravingerová (President) Naranjan S. Dhalla, Pawan K. Singal, Miroslav Barančík (Vice-President) Grant N. Pierce, Bohuslav Ošťádal, Miroslav Ferko (Scientific Secretary) Danina Muntean, Dragan Djuric, Robert Hatala, Vladimir Jakovljevic, Lorrie Local organizing committee: Kirschenbaum, Zoltan Papp, Saadeh Monika Barteková - chair, Suleiman, András Varró, Istvan Baczko, Adriana Duriš Adameová, Veronika Morris Karmazyn, František Kolář, Jan Farkašová, Miroslav Ferko, Kristina Neckář Ferenczyová, Karel Frimmel, Lucia Griecsová, Barbora Kaločayová, Jakub CONTACTS Krizak, Branislav Kura, Ĺubomír Lonek, Institute for Heart Research SAS, Pavilion Robert Szabo, Barbora Szeiffová-Bačová, of Medical Sciences, Ľudmila Okruhlicová, Norbert Vrbjar, Dúbravská cesta 9, 841 04 Bratislava 4, Narcisa Tribulová, Vladislava Zohdi Slovakia

E-mail: Phone: +421 903 620 181 (JS) [email protected]; +421 903 419 337 (TR) [email protected]

GENERAL INFORMATION Venue and date Congress Center of SAS – Smolenice Castle, Slovak Republic May 23rd – 26th, 2018

Trasportation Participants are recommended to arrange their flights to reach Bratislava on May, 23 before noon. To reach Bratislava, the Vienna airport and a regular shuttle bus to the Bratislava Main bus station is optimal. Collective transportation by coach from the SAS campus (Pavilion of Medical Sciences, Dubravska cesta 9) to the venue of the meeting in Smolenice will be organized on the day of arrival May, 23 at 14.00 and on the day of Departure from Smolenice on May, 26 at 14.00. Options: arrival on May 22 and stay overnight in Bratislava, then join the coach. In the case of emergency, taxi from the Vienna airport to Bratislava/Smolenice is the next option.

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Registration at the Castle Wednesday, May 23rd, 2018, 15.00 – 17.00

Accommodation On the premises of the Castle and in Smolenice village

Information for presenters Oral presentations – 20 min including discussion; ♣ - Young investigators Oral and Poster Competition. Oral presentations: 10 min including discussion.

Posters should be mounted after the registration ACCORDING TO THEIR NUMBER IN THE LIST OF POSTERS. The authors should be present during the Moderated Poster session on May 24th in the afternoon. Poster size – 80 x 120 cm (vertical).

INSTRUCTIONS FOR ABSTRACT PREPARATION Your Abstract should be submitted as a separate Microsoft Word document, the word limit is 300. Please use Times Roman font type, size 12, space 1, 5. Please use the following order of information: TITLE (CAPITALIZED and BOLD fonts) Authors (bold fonts, without academic credentials, ie: do not include "MD", "PhD", "MSc", etc). Please indicate the presenting author with an underscore; Institutional affiliation (bold fonts, WITH city and country); Please organize the abstract body using the subheadings: BACKGROUND; OBJECTIVES; METHODS; RESULTS; CONCLUSIONS. Please, send your abstracts to the organizers by e-mail.

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Confirmed Presenters: O – oral 41. Le Baron Tyler (O) presentations, P – poster presentation, YI – 42. Lewis Martin (O) YI ♣ young investigators ♣ 43. Lepran Istvan (P) 44. Lonek Lubomir (P) 1. Agrawal Devendra (O) 45. Lopashuk Gary (O) 2. Bacova Szeiffova B (P) 46. Zsófia Mezei (P) 3. Baczko Istvan (O) 47. Miloradović Zoran (O) 4. Barančik Miroslav (O) 48. Morad Martin (O) 5. Barteková Monika (P) 49. Muntean Danina (O) 6. Beňak Daniel (P) 50. Netticadan Thomas (O) 7. Bkaily Ghassan (O) 51. Noda Mami (O) 8. Cyprová Michaela (P) 52. Ohta Shigeo (O) 9. Davidson Nicholas (P) 53. Okruhlicova Ludmila (O) 10. Demeter-Haludka Viv. (P) 54. Ostadal Bohuslav (O) 11. Dhalla Naranjan S. (O) 55. Ostadalova (coauthor) 12. Djuric Dragan M. (O) 56. Patel P. Sagar (O) YI ♣ 13. Dobrev Dobromir (O) 57. Papp Zoltan (O) 14. Duicu Oana (O) YI ♣ 58. Pechanova Olga (O) 15. Duris Adameova A. (O) 59. Pierce Grant (O) 16. Farkasova Veronika (P) 60. Radosinska Jana (P) 17. Ferdinandy Peter (O) 61. Rajtik Tomas (P) 18. Ferenczyova Kristina (P) 62. Ravingerova Tana (O) 19. Ferko Miroslav (P) 63. Schulze Wolfgang (coauthor 20. Frimmel Karel (P) of Wallukat) 21. Gazdag Péter (P) 64. Simko Fedor (O) 22. Griecsova Lucia (P) 65. Singal Pawan (O) 23. Grujic-Milanovic Jelica (O) 66. Singh RB (O) 24. Hall Katie (P) 67. Slezak Jan (O) 25. Hatala Robert (O) 68. Srivastava Ashok (O) 26. Horvath C, Kormanova (P) 69. Srivastava Madhu (O) 27. Hrdlicka Jaroslav (P) 70. Stienen GJM (O) 28. Hornyik Tibor (P) 71. Sturza Adrian (O) YI ♣ 29. Ivanov Milan (O) 72. Suleiman Saadeh (O) 30. Jacques Danielle (O) 73. Sykora Matus (P) 31. Jakovljevic Vladimir (O) 74. Tribulova Narcis (O) 32. Kalocayova Barbora (O) YI ♣ 75. Turan Belma (O) 33. Kamocsaiova Lucia (P) 76. Varro Andras (O) 34. Kararigas Georgios (O) 77. Vrbjar Norbert (O) 35. Karmazyn Morris (O) 78. Wallukat Gerd (O) 36. Kirschenbaum Lorrie (O) 79. Wigle Jeffrey (O) 37. Kolar Frantisek (O) 80. Ytrehus Kirsti (O) 38. Krajčovičová, Zeman (P) 81. Zalesak Marek (P) 39. Krizak Jakub (P) 82. Zohdi Vladislava (O) YI ♣ 40. Kura Branislav (O) YI ♣, (P)

CV Network Vol 17 No 1 • March 2018 www.heartacademy.org 50 PROGRAM OVERVIEW

Wednesday, May 23rd 15:00 – 17:00 Arrival to Smolenice, registration, accommodation 17:00 – 18:30 Plenary Session 19:00 Welcome Party & Dinner

Thursday, May 24th 08:00 – 09:00 Breakfast 09:00 – 09:30 Opening ceremony 09:30 – 10:50 Session I. PART I. 10:50 – 11:20 COFFEE BREAK and PHOTO 11:20 – 13:00 Session I. PART II. 13:00 – 14:00 LUNCH

14:00 – 15:40 Session II. PART I. 15:40 – 16:00 COFFEE BREAK 16:00 – 17:10 Session II. PART II.

17:15 – 19:00 Moderated Poster session. (Cheese & Wine) 19:00 Dinner

Friday, May 25th 08:00 – 09:00 Breakfast 09:00 – 10:10 Session III. 10:15 – 11:15 Session IV. PART I. 11:15 – 11:30 COFFEE BREAK 11:30 – 13:00 Session IV. PART II. 13:00 – 14:00 LUNCH

14:00 – 16:30 Free time. Optional excursions. 16:30 – 18.00 Wine tasting – Garden Party 18.30 – 22:30 Gala evening Announcement of the Winners of Young Investigator Oral and Poster Competitions. Awards giving ceremony.

Saturday, May 26th 08:00 – 09:00 Breakfast 09:00 – 11:50 Session V. 11:50 – 12:10 Plenary session of IACS-ES. 12:15 Closing remarks 12:30 – 13:30 LUNCH 14:00 Departure

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