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Professor Hugo A. Katus, Chair of Cardiology and Chief of Internal Medicine at the University Hospital, Heidelberg, Germany, is one of cardiology’s pioneers. With a distinguished career spanning over 40 years, he is probably best known to many for his ground-breaking work on the cardiac-specific troponin T biomarker.
So what does the man who changed the face of myocardial injury diagnosis and management think is the future of cardiology? “It’s all about personalising medicine,” he says. “We have learned a lot from evidence-based medicine and we have improved our treatment strategies. However, by now, there are new tools to characterise disease in individual patients, including molecular phenotyping and better imaging techniques, and this will only improve in the future, with the advent of increasingly sophisticated technologies, computational analysis and advanced modelling. Despite this, cardiologists are still treating all patients in the same way as if, for example, heart failure is one disease. It is not. Cardiovascular diseases are complex conditions for which it is crucial to know not just the molecular causes but also how the disease interacts with other comorbidities in any particular patient,” explains Prof. Katus.
“Cardiologists need to learn how to use the novel tools at their disposal to find better ways to identify individual risk and to develop a more personalised approach to diagnostics and treatment.”
This search for a greater personalisation of patient management is the overarching theme of Prof. Katus’ current research. “My group is continuing to work in gene therapy, looking at novel ways to very specifically target drugs to cardiomyocytes using viral vectors. We are also still doing quite a lot of basic research on the mechanisms of cardiomyopathy, including familial cardiomyopathy, and the genetic causes of this condition, together with clinical studies. This work is facilitated by the genotypical and phenotypical information we have gained from a registry of more than 2,200 patients compiled at the recently established Institute for Cardiomyopathies Heidelberg.” One of the research projects Prof. Katus is particularly enthusiastic about is digital cardiology. “We have created a Chair for Computational Cardiology within our department, with responsibility for overseeing the work on bioinformatic analyses, mainly on cardiomyoctes. We are also in the process of building a new research institute–Informatics for Life–that aims to bring together colleagues from cardiovascular medicine and specialists in information technology, computer modelling, mathematics and computational sciences. The research will focus on modelling disease, treatment and treatment targets and on analysing big data.”
These different research pathways all lead to the same destination, the characterisation of cardiomyocytes and an improved understanding of cardiomyopathy. “The work on gene therapy is complementary to our biomarker research, because new treatment strategies rely on good diagnostics. And our digital cardiology programme centres on heart failure and cardiomyopathy. We are building on many years of experience working with cardiomyocytes, which of course is where the findings on troponin originated from.” As to whether troponin has revealed all its secrets, Prof. Katus is confident that it still has much more to offer. “At the start, we wanted to improve diagnostics for myocardial infarction. Troponin then turned out also to be a marker of myocardial injury and, in patients with stable coronary artery disease or modest heart failure, to be linked to the pathophysiology of heart disease and outcome. More recently, we have begun to observe that even subtle changes in troponin levels within the normal range relate to remodelling of the myocardial cells or vasculature. So the next era will be to prove how much can be predicted by troponin in populations of presumably healthy people.”
On the challenge of achieving personalised management, Prof. Katus thinks that the cardiovascular community is ready. “Cardiovascular physicians have learned from oncology that there can be many different molecular pathways interacting in a disease and that more precise treatments are needed to target these different pathways. We are very much at the beginning of this journey, but that makes the next step all the more exciting, to build on evidence-based medicine to achieve more personalised and specific treatment approaches.”
Meet the Gold Medalist - H. Katus
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