JOURNAL OF THE AMERICAN COLLEGE OF VOL. 72, NO. 21, 2018

PUBLISHED BY ELSEVIER ON BEHALF OF THE AMERICAN

COLLEGE OF CARDIOLOGY FOUNDATION

GUEST EDITOR’SPAGE

JACC INTERNATIONAL

In Memoriam Professor Bongani Mayosi, 1967 to 2018

George A. Mensah, MD

rofessor Bongani Mawethu Mayosi, Dean of and community, and commitment to create oppor- P the Faculty of Health Sciences at the Univer- tunities for the underserved stem from his early sity of (UCT) and professor and experiences in the village of Ngqamakhwe. His love of former head of the Department of at Groote the practice of medicine, however, came from child- Schuur Hospital and UCT, was born in uMthatha in hood Saturdays spent in the backseat of his doctor South Africa’s Eastern Cape Province on January 28, father’sLandoverashisfather“drove to patient after 1967. He died in Cape Town on July 27, 2018. As his patient along very ragged, bumpy roads” in the family disclosed, Professor Mayosi took his life after remote Eastern Cape Province of South Africa (4). a battle with clinical depression in the preceding Professor Mayosi graduated with multiple distinc- 2years(1). He was only 51 years of age and was tions from St. John’s College in uMthatha. His passion already a recipient of the Order of Mapungubwe for biomedical research came later, in the middle in 2009, the highest honor awarded to South African of his undergraduate training in medicine at the citizens for “achievements that have impacted inter- University of KwaZulu-Natal, now the Nelson nationallyandservedtheinterests of the Republic Mandela School of Medicine. He was the first person of South Africa” (2). Other distinguished recipients inthatmedicalschooltograduatewith2degrees— of this award include former South African president one in medicine (MbChB) with distinction and Nelson Mandela for his achievements in national another in medical sciences (BMedSci) with distinc- reconciliation and nation-building. This memorial tion given for the research he conducted during an tribute provides a brief review of Professor Mayosi’s extra year. This year of research instilled in him a background and remarkable contributions to biomed- lifelong passion for accelerating capacity-building ical research, research training and mentorship, and for clinical and biomedical research in Africa. His the spirit of forging and nurturing international reputation and international recognition for high- collaborations for health. quality, scientific research have been impeccable. ProfessorMayosiwas1of5siblings.Hisfather,Dr. His scientific publications, now numbering >330 in George Timketson Sikhumbuzo Mayosi, was a the PubMed database of the U.S. National Library regional district surgeon in the Eastern Cape Province of Medicine, demonstrate an unsurpassed clarity of and later a specialist in obstetrics and gynecology. His thought, originality, and scientificrigor.Threeareas mother,Mrs.NontleMayosi,wasanursewhosus- of scientific interest he actively investigated—acute pendedherowncareerfor14yearstostartaschool rheumatic fever and rheumatic heart disease, tuber- with help from other mothers who were teachers in culous pericarditis, and the genetic etiology of the village of Ngqamakhwe in the former Transkei (3). —deserve mention. Professor Mayosi’s humility, devotion to his family First, Professor Mayosi has published >3dozen papers with primary emphasis on acute rheumatic fever and rheumatic heart disease, the prototype of

From the Center for Translation Research and Implementation Science, neglected cardiovascular disease of poverty. For National Heart, Lung, and Blood Institute, National Institutes of Health, example, he and his colleagues documented the Bethesda, Maryland. The views expressed in this article are those of the persistently high incidence and burden of rheumatic author and do not necessarily represent the views of the National Heart, Lung, and Blood Institute, the National Institutes of Health, or the U.S. heart disease in Soweto, at a time when the burden of Department of Health and Human Services. this disease was declining in other regions of the

ISSN 0735-1097/$36.00 https://doi.org/10.1016/j.jacc.2018.10.009 2672 Mensah JACC VOL. 72, NO. 21, 2018 Guest Editor’s Page NOVEMBER 27, 2018:2671– 3

tuberculous pericarditis from multiple centers in TABLE 1 Selected Clinical Studies and Trials Published by Professor Bongani Mayosi and Collaborators, 2014 to 2018 Kenya, Malawi, Mozambique, Nigeria, Sierra Leone, South Africa, Uganda, and Zimbabwe. Findings from Study Name Study Title Selected Publication these studies have contributed substantively to our MANAGE Dabigatran in patients with myocardial injury Lancet 2018;391: after non-cardiac surgery (MANAGE): an 2325–34 understanding of the clinical characteristics, outcome, international, randomized, placebo- immunology, diagnosis, and treatment of tuberculous controlled trial pericarditis (13–15).Histeam’s pursuit of both human INTERSTROKE Practice patterns and outcomes after stroke across Lancet 2018;391: countries at different economic 2019–27 and animal research in tuberculous pericarditis, levels (INTERSTROKE): an international including the description of a unique pro-fibrotic observational study cytokine signature in effusive-constrictive pericar- CREOLE Rationale and design of the comparison of 3 Am Heart J 2018;202: combination therapies in lowering blood 5–12 ditis in tuberculous pericardial effusion, holds pressure in black Africans (CREOLE study): significant promise for new treatment targets in this 2 Â 3 factorial randomized single-blind multicenter trial disease (16,17). THESUS-HF Symptoms and signs of heart failure at J Card Fail 2017;23: Third, Professor Mayosi also carried out funda- admission and discharge and outcomes in 739–42 the Sub-Saharan Acute Heart Failure mental discovery and basic science research (THESUS-HF) registry in . For example, he and his PURE Availability and affordability of blood pressure- Lancet Public Health colleagues explored the spectrum of causal genetic lowering and the effect on blood 2017;2:e411–9 pressure control in high-income, middle-income, mutations and clinical outcomes of hypertrophic and low-income countries: an analysis of cardiomyopathy (18–20).In2017,after20yearsof the PURE study data work, Professor Mayosi led the South African team of AFROStrep Rationale and design of the African group A BMJ Open 2016;6: streptococcal infection registry: the AFROStrep e010248 researchers who, in partnership with collaborators study from Italy and Canada, published for the first time REMEDY Clinical outcomes in 3343 children and adults Circulation 2016;134: with rheumatic heart disease from 14 low- 1456–66 several lines of evidence that implicated mutations in and middle-income countries: two-year follow- the Cadherin 2 (CDH2) gene as a likely new genetic up of the Global Rheumatic Heart Disease Registry (the REMEDY Study) cause of arrhythmogenic rightventricularcardiomy- BA-HEF Bi treatment with hydralazine/nitrates vs. Eur J Heart Fail 2016;18: opathy (21). This major breakthrough could lead to – placebo in Africans admitted with acute 1248 58 improved diagnosis and treatment of arrhythmogenic HEart Failure (BA-HEF) right ventricular cardiomyopathy (21). IMPI Prednisolone and Mycobacterium indicus pranii N Engl J Med. 2014;371: in tuberculous pericarditis 1121–30 In addition to the research conducted in these 3 COPPS-2 Colchicine for prevention of post-pericardiotomy JAMA 2014;312: areas, Professor Mayosi had a gift for forging and fi – syndrome and postoperative atrial brillation: 1016 23 fi the COPPS-2 randomized clinical trial nurturing strategic partnerships and scienti ccol- laborations to advance clinical research in countries across the full range of sociodemographic indexes, world (5). More recently, in the REMEDY (Global and especially in sub-Saharan Africa. Several of Rheumatic Heart Disease Registry), he initiated and his research collaborators came from countries and directed the first prospective, multinational study of centers where neither formal cardiology practices nor rheumatic heart disease demonstrating a high burden a previous track record of clinical research existed. of cardiovascular complications and low uptake of Several of the multicenter and multinational studies proven-effective interventions in this disease (6).In that Professor Mayosi organized or contributed to declarations from Drakensberg (7) and Mosi-o-Tunya over the past 4 years are shown in Table 1.They (8), he galvanized researchers across Africa to join include studies in myocardial injury after noncardiac him in fighting these diseases of poverty and training surgery, differences in the management of stroke the future generation of health scientists in Africa. across countries at different levels of economic His additional research efforts and results in this development, comparative effectiveness of strategies area have informed health policy development and for hypertension control, the clinical epidemiology provided promising foundations for vaccine devel- and outcomes of heart failure in Africans, and the opment against rheumatic heart disease (9–11). prevention of post-pericardiotomy syndrome and Second, Professor Mayosi has produced an equally post-operative atrial fibrillation. impressive list of publications on the diagnostic eval- In all his research activities, he made teaching, uation and management of tuberculous pericarditis. research training, and career development of the For example, he was the architect of the studies on future generation of researchers a top priority, espe- the Investigation of the Management of Pericarditis, cially for under-represented black African men and named IMPI for the Zulu warriors, the Impi (12). womeninSouthAfrica.Inhisinauguraladdressas The IMPI studies enrolled 1,400 patients with chair of the Department of Medicine at the University JACC VOL. 72, NO. 21, 2018 Mensah 2673 NOVEMBER 27, 2018:2671– 3 Guest Editor’s Page

ofCapeTown,ProfessorMayosicalledforanational sorely missed by all of us who had the opportunity to program to train “at least 1,000 clinical PhD scholars know him and by many more who knew of him. who will change the fortunes of clinical medicine in Professor Mayosi left behind his wife, Professor Africa for the next 100 years” (3).Hewasinstru- Nonhlanhla Khumalo, 3 daughters, his mother, and mental in working with the Academy of Science of his extended family. South Africa, the National Health Research Commit- ACKNOWLEDGMENT The author would like to thank tee, the Council, and the National Professor Nonhlanhla Khumalo, Professor Mayosi’s Department of Health to make this a reality in South widow, for her careful review and constructive Africa (22). The government of South Africa has now commentsonanearlierversionofthisdocument. launched a PhD training program that is on track to enroll 1,000 new PhD students in the health sciences by 2022 (22). ADDRESS FOR CORRESPONDENCE: Dr. George A. Above all, Professor Mayosi was a kind and gentle Mensah, Center for Translation Research and Imple- giant. He was engaging, empathetic, and always mentation Science (CTRIS), National Heart, Lung, and giving with his characteristic big smile and a Blood Institute, National Institutes of Health, One wonderful sense of humor. He was also a creative Rockledge Centre, 6705 Rockledge Drive, Suite 6070, force of unparalleled vision, dedication, energy, Bethesda, Maryland 20892. E-mail: George.Mensah@ optimism, and inspiration for thousands. He will be nih.gov. Twitter: @NHLBI_Translate, @ProfMensah.

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