An audio interview with Prof. Giuseppe Remuzzi

NDT Educational for kidney and blood pressure related disorders

Prof Zoccali: Professor Remuzzi, I have a very simple initial question for you. What led you to be interested in nephrology and who was the mentor that inspired you?

Prof Remuzzi: Well, that was absolutely by chance. I was working on coagulation in my early life, when I was a student and interested in platelet function and I wanted to be an haematologist by the way.
But I thought I had to start working at a certain point of my career and there was a position available in the Bergamo Hospital in nephrology.

So I said why don't I take this position and see whether there is any relationship between platelets and the kidney.
In fact this was of some interest because there are many relationships and I started working on uraemic bleeding and hemolytic uraemic syndrome and because there were not many nephrologists that were somehow professional in platelet function I was lucky, I had a couple of papers accepted, one in the Lancet, one in the British Medical Journal dealing with platelets in the kidney.
And my mentor was Stewart Cameron, one of the most eclectic and unbelievable men in nephrology.

Prof Zoccali: You are now perhaps the most successful clinical investigator and basic science investigator in the world, at least as far as renal diseases are concerned.
You are the top author in Pubmed, as far as renal research is concerned. I wonder which causes and which challenges do you have now at this stage of your career?

Prof Remuzzi: Well, it's always difficult to say. I think my challenge is having a group that is performing well enough that somehow can continue after me and I think that I'm now very concerned with young people and what I would like to do is see whether it is possible for young people living in our country to have a true scientific career, as they can have if they live in the U.K., France, Germany or in particular in the States.

Prof Zoccali: You pursue a large variety of scientific projects.
Is there any scientific project that you would then like to pursue but you've had no chance to pursue at least until now?

Prof Remuzzi: Yes, I think that what I would like to see, I have some interesting transplantation as you may know and I am frustrated to see that transplantation as a surgery is a very successful operation not simply for the kidney but for a number of other organs.
The point is that because patients still need anti rejection medications they suffer from the toxicity of anti rejection medication, particularly infection and cancer and a lot of other complications including the fact that for instance, you see a young girl having a transplantation taking steroids and cyclosporin and they change completely their physical aspects, which is also something which worries me very much and I wonder whether we can really achieve tolerance in humans, as we have achieved in rats, which means that your organ will consider the transplanted organ as if it were part of self.

This is difficult but I would like very much to try to contribute to achieve that sure I will do not successful or not be successful a lot.
There are a lot of people who have the same dream but I think our group can bring the modest contribution that maybe could help.

Prof Zoccali: I see that you have a great commitment with the COMGAN initiative.
This is, I think, a very generous and worthy and timely initiative to help people in the developing countries to join the group of societies that can guarantee renal disease treatment.
I'm sure that supporting this initiative costs you a lot of time and energy. Is there any particular reason why you started such a demanding commitment?

Prof Remuzzi: Well, actually I always thought that health should be global and we are living in a world that in fact, is very difficult as far as health is concerned because 90% of resources that are spent on health actually go to 10% of people and we in our field are confronted with a very successful treatment like dialysis and transplantation, which really makes a difference between life and death.
None of those treatments are available to the majority of world population.

So I think that this is enough as a motivation to try to do something and to try to export what we have achieved to other people that are less fortunate than we are.
In fact, I see that not so much as giving technology or giving medication but doing research with them and doing something that we may not be able to do ourselves.
Helping them to do some research means that they can have access to drug company monies for instance, and do some studies that are very difficult to do in Western studies.

For instance, we are now comparing the effect of an expensive drug, mycophenolate mofetil for transplantation with a very old, drug azathioprine.
This is something that is not so easy to do here because you have drug company pressure and publicity that is always versus the most novel medication but sometimes you have old drugs that have interesting properties that we have not fully explored and this can be done in less developed countries allowing them to grow in terms of science and access to therapies for those people.

Prof Zoccali: I know that in the past you liked very much acting. Do you still cultivate acting?

Prof Remuzzi: Well, I think that every speech that we do essentially is a play and I think I'm doing today what I was used to doing in the past with the difference that in the past our formal play was with a very little audience because you know it's always difficult to compete with professionals.
Now you have an audience, so I do the same things but with an audience which is something very rewarding.

Prof Zoccali: Which is the scientific paper that influenced you most?

Prof Remuzzi: Well, I think there are two of them.
One was at the beginning when I was studying platelet function and had an interest in hemolytic uraemic syndrome.
I had been very impressed by observations in the New England Journal of Medicine describing the fact that patients who were comatose because of brain microangiopathies due to thrombotic thrombocytopenic purpura could be completely awake and reverse in lesions by plasmapheresis.

Now we know that those patients had some genetic abnormalities of one of the proteases, which is cleaving von Willebrand factor and since then I think we had a great interest in this disease and in this apparently miraculous cure and we know now, it is a very severe disease by the way affecting young women and we now know the genetic basis of that and how to treat them in a very modern way, so this was important.
Also a paper in the Lancet ‘79 by Doctors at King's College Hospital, Johns and colleagues that reported the progression of renal disease in 9 diabetics, which showed to me that you may have some patients who progress very rapidly others who progress less rapidly and some who did not progress or who progressed very slowly and so, since I saw an important figure of this paper that I show in almost all my talks, it was so important, I realised that there is a way for nephrologists to shift the pattern of progression from very rapid to less or none and this was very influential to me.

Prof Zoccali: Which is the last book that you read and which book are you reading just now?

Prof Remuzzi: Well, I'm reading a book these days from a man called Pier Giorgio Odifreddi, in Italy who is dealing with mathematics. I'm not particularly fond of mathematics unfortunately, but I like the way the book is written and I like for instance, the idea that the old persons in ancient Greece have been able to measure exactly the circumference of the globe looking at the shadow between two different trees and looking at the sun in certain positions in respect to the seasons and so on.
This was really impressive because they apparently mistook the true measurements by something like metres, which is really unbelievable.

Prof Zoccali: Scientific research apart, what are your hobbies?

Prof Remuzzi: Well, I have some strange friends living in the mountains that have nothing to do with medicine and science.
They live hunting and fishing and doing you know, climbing in the mountains and so on.
I'm not as good as they are but they are kind enough to take me with them some Saturday afternoons.
I work Saturday mornings all morning but Saturday afternoon and Sundays and I like staying with them.

I don't have to be sociable; I don't have to say nice things.
I can be silent, alone and it's nice to stay with them without the need of having any social commitment or the pressure of being nice with people that we always have in this you know, all of us I think we are busy scientifically but we are also occasionally, socially busy.
You have to go to dinner, to behave properly and so on and sometimes it's nice to have no commitment with some people that you like.

Prof Zoccali: I recently visited Bergamo. I must say that I consider it one of the most beautiful Italian cities. How important is it for you to have been born there and be living there?

Prof Remuzzi: Well, I think it is important.
People from Bergamo are usually very linked to their own city. I like to leave Bergamo for the purpose of working.
I think that Bergamo is a relatively closed city, it's difficult to have important things happening in Bergamo even if now it is much better than it was but it's certainly a very pretty city and as all people from Bergamo, we are very proud of our small city, of our soccer team by the way and I like my city very much.

Someone told me that Bergamo is a city where it is nice to come back every time you have a long trip or you go to the States and so on, the idea of coming back to Bergamo is really something.
I think that I've been fortunate to have the opportunity to have other experiences in life but coming back to Bergamo is always very nice.

Prof Zoccali: Thank you.