Review Article Nobel Prizes: Contributions to Cardiology Evandro Tinoco Mesquita, Luana de Decco Marchese, Danielle Warol Dias, Andressa Brasil Barbeito, Jonathan Costa Gomes, Maria Clara Soares Muradas, Pedro Gemal Lanzieri, Ronaldo Altenburg Gismondi Universidade Federal Fluminense, Niterói, RJ – Brazil Abstract The objective of the present study was to review the major The Nobel Prize was created by Alfred Nobel. The first scientific discoveries that received the Nobel Prize and directly prize was awarded in 1901 and Emil Adolf von Behring was or indirectly contributed to advances in physiopathology, the first laureate in medicine due to his research in diphtheria diagnosis and treatment of cardiovascular diseases. serum. Regarding cardiology, Nobel Prize’s history permits a global comprehension of progress in pathophysiology, diagnosis Methods and therapeutics of various cardiac diseases in last 120 years. We performed a systematic search of the main non The objective of this study was to review the major scientific Nobel Prize winners from 1901 to 2013. The winners list discoveries contemplated by Nobel Prizes that contributed was obtained from the Nobel Prize site3 and, subsequently, to cardiology. In addition, we also hypothesized why Carlos information about the authors and their research were Chagas, one of our most important scientists, did not win the obtained from the Medline/PubMed database. Moreover, due prize in two occasions. We carried out a non-systematic review to the specific nature of the research involving historical and of Nobel Prize winners, selecting the main studies relevant to bibliographical data, the Google search engine was utilized, heart diseaseamong the laureates. In the period between 1901 using as descriptors the names of the researchers awarded and 2013, 204 researches and 104 prizes were awarded in the Nobel Prize. The results are displayed in ascending Nobel Prize, of which 16 (15%) studies were important for chronological order. cardiovascular area. There were 33 (16%) laureates, and two (6%) were women. Fourteen (42%) were American, 15 (45%) Europeans and four (13%) were from other countries. There was Results only one winner born in Brazil, Peter Medawar, whose career was all in England. Reviewing the history of the Nobel Prize in A brief history of the Nobel Prize physiology or medicine area made possible to identify which researchers and studies had contributed to advances in the For many historians, the interest of Alfred Nobel in 2 diagnosis, prevention and treatment of cardiovascular diseases. medicine derived from a poor health . There are reports of Most winners were North Americans and Europeans, and male. dyspepsia, headaches and bouts of depression. In adulthood, he would have suffered from coronary artery disease, with frequent episodes of angina. His doctors recommended Introduction the use of nitroglycerin, a substance Nobel manipulated in The Nobel Prize was created by Alfred Nobel (1833-1896) the explosives industry, but he would have refused. In later (Figure 1)1,2. In his will, the Swedish researcher determined the life he had a stroke and had to live with motor sequelae. creation of a foundation that would carry his name, of which Skeptical and suspicious, Nobel expressed in his will the wish main objective would be to reward every year, individuals that after his death, his veins were "open" and the signs of that provided outstanding contributions to mankind in the death confirmed by "competent doctors," before the body areas of Peace/Diplomacy, Literature, Chemistry, Physics and was sent to be cremated1. Physiology/Medicine. The first prizes were awarded in 1901 Nobel’s choice of the Karolinska Institute in his will and the first winner in Medicine was Emil Adolf von Behring, surprised many scientists. This institute was created in for his work with diphtheria serum1. Since that date, there 1810 from the merging of a Medical School and a small have been 876 Nobel Prize winners, of which 104 awards surgical center where barbers were trained to perform and 204 researchers in the area of Medicine or Physiology1. amputations. For years it did not have the status of School of Medicine and depended on a contract with the University of Uppsala, in Sweden, for the training of its professionals1. Keywords Currently, the institute is one of the leading Assistance Medicine and Research centers in Europe. Five Nobel Prize Cardiology; Nobel Prize; History; Cardiovascular Diseases winners over the last 120 years, came from this institute1. / trends. Mailing Address: Ronaldo Altenburg Odebrecht Curi Gismondi • Universidade Federal Fluminense. Rua Ministro Otávio Kelly, 185/701, Icaraí. The Nobel Prize and Cardiology Postal Code 24220-300, Niterói, RJ – Brazil In the area of cardiology, specifically regarding heart E-mail: [email protected], [email protected] Manuscript received November 22, 2014; revised manuscript February 9, failure (HF), knowledge of the history of the Nobel Prize helps 2015; accepted February 11, 2015. to understand important diagnostic and therapeutic advances made in the last 120 years (Chart 1). The first laureate in this DOI: 10.5935/abc.20150041 area was Alexis Carrel, for his discoveries related to blood 188 Mesquita et al. Nobel Prize and Cardiology Review Article Figure 1 – Nobel Prize Logo. Source: http://en.wikipedia.org/wiki/Nobel_Prize vessel suture, an important step in the further development of His early work was on surgical techniques in blood vessels and cardiac surgery1,3. Only one Brazilian, who lived in England, arteriovenous anastomoses. After 1908, he developed methods was awarded. His name is Peter Medawar and he has carried for organ cryopreservation and transplantation1-3,8. In 1935, he out researches in the immunosuppression area, with future created a system for sterile oxygen supply and preservation of applicability in renal and cardiac transplant4,5. organs removed from the body. He also cooperated with other Although Carlos Chagas researched and discovered the researchers for the development of cardiac valvotomy surgery etiological agent, the vector, the mode of transmission and and sarcoma cell culture. He published the books “The culture clinical forms of trypanosomiasis, a unique feat in the history of organs” and “Treatment of infected wounds”1-3,8. The suture of world’s science, he was a candidate for the Nobel a few of blood vessels was essential for the development of vascular times, but was unsuccessful. There are hypotheses that surgery in later years. attempt to explain why a genuinely Brazilian contribution in the field of cardiology has not been contemplated with Willem Einthoven – 1924: The Electrocardiogram the Nobel prize6,7. Willem Einthoven was born on May 21, 1860 on the island of Java, now Indonesia, and moved to the Netherlands Major studies important for Cardiology that were awarded in 1870, where he graduated from Medical School at the the Nobel Prize University of Utrecht, one of the oldest and most traditional medical schools in Europe. He was a physiologist and in Alexis Carrel – 1912: blood vessel suture the early 20th century, he published several papers on the Alexis Carrel, was born in Sainte-Foy-lès-Lyon, France, use of the galvanometer in the recording of the human graduated in Medicine from the School of Medicine of electrocardiogram (ECG), which served as the basis for the Lyon in 1893 and completed his doctorate in 1900, with current devices. The original equipment weighed more than a research on blood vessel sutures. He taught Anatomy 270 kg and was operated by several people in his laboratory. and Surgery at the University of Lyons and moved to the He described the P, QRS and T waves, as well as and their United States in 1904, where he worked at the University alterations in several diseases, especially in valvular heart of Chicago. Later, he joined the Rockefeller Institute for disease. Showing great wisdom, he wrote after his initial Medical Research in New York, where he performed most research, “the electrocardiogram should not be used, at of the experiments that led to the Nobel Prize in Physiology least exclusively, to diagnose valvular alterations, because or Medicine in 1912. He served the medical corps of the the ECG is the expression of the heart muscle contraction French Army during World War I (1914 -1918), where he and changes only to the extent that a valvular function failure 1,2,9 successfully used the Carrel-Dakin method of constant has influence on such contraction” . irrigation of wounds with antiseptic solution, which In addition to the ECG, Einthoven played an important decreased cases of death and amputations1-3,8. role in the development of the phonocardiogram1,2,9. Arq Bras Cardiol. 2015; 105(2):188-196 189 Mesquita et al. Nobel Prize and Cardiology Review Article Chart 1 – Main scientific discoveries that received the Nobel Prize in Physiology or Medicine related to the Cardiology area Year Author Prize 1912 Alexis Carrel Work on vascular suture and transplant of blood vessels and organs 1924 Willem Einthoven Electrocardiogram 1953 Hans Adolf Krebs Citric acid cycle (Krebs cycle) 1956 Werner Forssmann, Andre Cournard and Dickinson W. Richards Cardiac catheterization 1960 Frank Burnet and Peter Medawar Discovery of the immunological tolerance mechanism 1964 Konrad Bloch and Feodor Lynen Understanding of cholesterol metabolism 1979 Allan Cormack and Godfrey Hounsfield Computed tomography techniques 1982 Bengt Samuelsson, Sune Bergström and John Vane "Discovery" of the angiotensin-converting enzyme inhibitors 1985 Michael Brown and Joseph Goldstein Discovery of LDL-cholesterol receptors 1988 James Black, Gertrude Elion and George Hitchings Development of beta-blockers 1990 Joseph Edward Murray and Edward Thomas Development of organ and tissue transplant 1998 Robert Furchgott, Ferid Murad and Louis Ignarro Discoveries about nitric oxide 2003 Paul Lauterbur and Peter Mansfield Magnetic Resonance LDL: low-density lipoprotein. This device, now a museum piece in many medical schools, was in both ventricles of a horse1,16-19. In the 19th century, crucial in the supplementary examination to medical workup.