A physician, a scientist, a visionary leader, a sports enthusiast, an athlete... Being the organiser of one of the leading world conferences in the field of personalised medicine, forensic and anthropologic genetics, Professor Dragan Primorac, M.D., Ph.D., has been bringing to Croatia distinguished scientists, including Nobel Prize laureates, for many years. This summer, the world’s scientific elite gathered in Split.
DRAGAN PRIMORAC
EXCELLENCE IN ALL SEGMENTS
A physician − a paediatric medical doctor, a forensic expert, a geneticist. A scientist − the first Global Ambassador of Penn State University (founded in 1855), Chair of the International Affairs Committee of the American Academy of Forensic Sciences (AAFS), President of the International Society for Applied Biological Sciences (ISABS), President of the Croatian Society of Human Genetics, President of the Croatian Society of Personalised Medicine, President of the Croatian Competitiveness Cluster for Personalised Medicine, President of the Thematic Innovation Council for health and quality of life of the Republic of Croatia. A leader of the introduction of pharmacogenomics and personalised medicine into clinical practice. A visionary leader − in collaboration with the leading American healthcare institution, Mayo Clinic, St. Catherine Hospital and with the support of the AAFS, he’s been organising scientific conferences for over 20 years, which the most prominent world scientists, including Nobel Prize laureates, regularly participate in. Our interviewee, Professor Dragan Primorac, M.D., Ph.D., is all this and much more. He’s also an athlete, a sports enthusiast, a former state junior vice-champion in Taekwondo, he was inducted into the Taekwondo Hall of Fame, as a young man he trained football and athletics, so his hospital − St. Catherine Specialty Hospital, a European centre of excellence in Zabok and Zagreb, which he founded eight years ago − is the official hospital of the Croatian National Football Team and of the Croatian Olympic Committee. In addition, the AAFS has recently presented him with one of the most prestigious awards, the Mary E. Cowan Outstanding Service Award for his excellence, international renown and contribution to the development of forensic sciences. Despite all this, he’s a simple man, someone who is easy and pleasant to talk to, and whom spending time with conversing is a delight.
There are so many things that you do and so many fields that you’re involved in that just listing them is difficult without forgetting to mention one or two. Your 2019 started with an award you’ve recently received from the American Academy of Forensic Sciences, the Mary E. Cowan Outstanding Service Award. You’ve been awarded after 26 years of work as one of the pioneers of the development of modern forensic genetics. The explanation of the decision of the Board of Directors of the AAFS reads that this year’s award was bestowed upon Prof. Primorac, M.D., Ph.D., for his excellence, international renown and contribution to the development of forensic sciences. − I take the award I was given by the American Academy of Forensic Sciences, the most respected world forensic sciences organisation, as acknowledgment of not only my work, but also the work of all my colleagues from the United States and Croatia with whom I’ve been working in the field of forensic genetics for more than 26 years. At the same time, the award is a huge incentive for me to continue doing what I do and to continue contributing to the development of forensic sciences.
You organised a major scientific conference in the field of personalised medicine, forensic and anthropologic genetics again this year. − Yes. From 17th to 22nd June, the world’s leading scientists in the field of personalised medicine, forensic and anthropologic genetics gathered in Split. The conference was organised by the International Society for Applied Biological Sciences (ISABS), the leading American healthcare institution, Mayo Clinic, and St. Catherine Specialty Hospital, in collaboration with the American Academy of Forensic Sciences (AAFS) and a number of other institutions. The importance of the project is best evidenced by the fact that, over the last 20 years, around 5000 scientists and 600 invited lecturers from 70 countries from all around the world participated in the work of ISABS’s conferences. A number of Nobel Prize laureates also participate in the conference, and the Nobel Spirit is truly a unique world event. I’m immensely grateful to Nobel Prize winners for having recognised the importance of transferring their knowledge to students and young scientists coming from all over the world to participate in the work of the ISABS conference. You can imagine what a powerful inspiration and motivation for young people the participation of Nobel Prize winners is. This year’s conference was attended by dear friends, Nobel Prize winners and people whose contribution to the development of world science is immeasurable: Prof. Paul Modrich (Duke University), Prof. Avram Hershko (Technion − Israel Institute of Technologies), Prof. Robert Huber (Max Planck Institute of Biochemistry) and Prof. Ada Yonath (Weizmann Institute of Science). In the past, we also hosted Prof. Richard Roberts (New England Biolabs) and Prof. Aaron Ciechanover (Technion − Israel Institute of Technologies), both Nobel Prize winners. This year’s key topics were precision (personalised) medicine, epigenomics, cell, gene and immunotherapy, regenerative medicine, pharmacogenomics, and forensic and anthropologic genetics.
You graduated from the Zagreb School of Medicine in 1991. Shortly after, you received the annual Maurice Attie Memorial Award awarded by the American Society for Bone and Medical Research, and this because of your participating in discovering the molecular mechanism of a mild type of brittle bone disease in children. Undoubtedly, you immediately dedicated your life to medicine and science. What attracted you to these two fields? When and how did you know that what you wanted to do in life was medicine? − Medicine has always been my love. When I came into contact with molecular medicine as a young physician, I realised that my life path would be a combination of science and clinical medicine. This concept is today popularly called translational medicine. It’s a great privilege to be part of a team that contributes to the development of science, something that will ultimately have an impact on human health. This wasn’t any different in the early 1990s when we discovered that a certain change in the collagen gene actually causes a failure of message transport or, more precisely, of collagen type I messenger RNA responsible for protein synthesis. When that happens, only 50 percent of protein is produced and all this leads to a typical clinical picture in patients. However, this discovery prompted us to think that we could induce this natural phenomenon in cases when a damaged message is produced in order to prevent its translation to the protein.
That practice is, besides theory, immensely important to you is testified to by the fact that you lead the way in introducing pharmacogenomics and the concept of personalised medicine into clinical practice. What does this mean for patients specifically? − The concept of personalised or precision medicine is based on knowing and understanding processes on the molecular level, which is crucial to treatment. In other words, genome analysis provides information that may be important for disease prevention, making an early diagnosis, but also when finding optimal treatment and monitoring the effectiveness of therapy. The right therapy for the right patient at the right time is the key motto of personalised medicine, and is particularly important when it comes to pharmacogenomics. Pharmacogenetics is a newer branch of the pharmacological sciences that studies the link between the genetic predisposition of an individual and their ability to metabolise a drug or a foreign compound. It helps us understand why some people respond to medication and others don’t, why some people need higher and others lower medication doses to achieve optimal therapeutic effects, and it can also point out patients who won’t respond to therapy, or those who may experience toxic side effects. Data published a few years ago by the leading American medical journal JAMA caused serious concern with the public because what the data says is that annually more than two million hospitalised patients in the United States alone have serious adverse or unwanted drug reactions after taking medication, and that over 100,000 of them die as a result. Simply put, each individual responds individually to the medication they’re given, and the only way to find out what this reaction will be like is to analyse the gene which is key to drug metabolism, its transfer in the body, the receptors that the drug will bind to or some other mechanism. Prescribing medication according to the genetic profile of the individual significantly reduces the likelihood of side effects, while also reducing the likelihood of an overdose when compared to typical situations in which the same medication is prescribed in accordance with the patient’s body weight and age. Accordingly, pharmacogenetics plays a key role in choosing the best possible drug and its dose, while reducing the risk of side effects, overdoses and adverse effects caused by drug interactions. The Right- Med test that we’ve recently introduced into clinical practice in collaboration with OneOme, founded by Mayo Clinic, currently analyses 25 plus three additional genes and 111 polymorphisms to predict the therapeutic response to more than 350 drugs. Pharmacogenomics is key to huge savings that can be made in the healthcare system associated with drug prescription and the consequent treatment of complications caused by unwanted side effects.
Eight years ago, you founded St. Catherine Specialty Hospital, a European centre of excellence, which is also the official hospital of the Croatian National Football Team and the Croatian Olympic Committee. The world’s top athletes are treated there. Besides athletes, who is this hospital intended for and what does it mean for ordinary people? − St. Catherine Specialty Hospital is amongst the first healthcare institutions that fully live the concept of personalised medicine. In our work, the key criteria are excellence in all segments of work, knowledge, collaboration with the best, systematic staff training, and the application of cutting-edge medical procedures and the latest scientific discoveries. Our highly trained medical experts and their unique work performance is our special strength, that’s what sets us apart. We’ve intentionally set high standards and we take all the necessary steps to reach them. Patient satisfaction is our only success indicator. We’re particularly proud of the Croatian National Football Team, and all of Croatia’s top athletes who’ve been promoting our country in the best possible way.
As far as practice is concerned, you’ve achieved extremely important, revolutionary in fact, results in stem cell therapy for cartilage repair. − What we’re particularly interested in is therapy for osteoarthritis, a degenerative joint disease which is mainly caused by cartilage loss in the joints. This disease is one of the leading causes of disability in the modern world and it’s assumed that more than 750 million people worldwide suffer from osteoarthritis. Osteoarthritis treatment has long been based solely on the modulation of pain and in the most severe cases on the implantation of a partial or total endoprosthesis. Great advances in the fields of tissue engineering and regenerative medicine have been made based on new findings, and one of the methods is the use of stem cells in the treatment of osteoarthritis, with which we’ve achieved exceptional results, best testified to on a daily basis by our patients. The results of our study have recently been published in the Genes journal.
What will you dedicate yourself to in your position as Chair of the International Affairs Committee of the American Academy of Forensic Sciences, the leading forensic organisation in the world? − The American Academy of Forensic Sciences, headquartered in Colorado Springs, is the world’s most prestigious forensic sciences organisation. It counts over 7,000 members coming from the 50 states of the US, Canada and 74 other countries. My role is to promote the values of the American Academy of Forensic Sciences around the world, and to network forensic experts from all continents with a view to contributing to the fight against crime and to making the world a safer place to live through teamwork, collaboration, and the exchange of experiences and results.
When many years ago you left for the US for postdoctoral fellowship, you intended to become a paediatric geneticist. But as life often goes down unpredictable paths, because of the aggression against Croatia and the tragic consequences of the war, you’ve been involved in the process of identification of war victims. How much has that part of medicine advanced? − True, the path of life is unpredictable, and so was mine. During my postdoctoral fellowship in the United States on a project aiming to identify the molecular basis of bone disease in children, at a colleague’s invitation, I got involved in the process of identifying victims of the Homeland War. In the early 1990s, when we first started identifying skeletal remains found in mass graves, we didn’t have the necessary technology, knowledge and databases. But we had the heart and a great desire to help families who lost their loved ones. In collaboration with leading US forensic experts who worked at the FBI at the time, the New York and Connecticut State Police, the Armed Forces Institute of Pathology, and the Analytical Genetic Testing Center, we worked on developing methods and procedures that resulted not only in a large number of successful identifications, but also in setting a standard during identification procedures using nucleus, mitochondrial DNA or Y chromosome analysis. Today, forensic genetics is a scientific discipline without which it’s impossible to imagine the existence of modern forensic sciences.
You’ve been publishing articles in the world’s most prominent scientific journals. You also have a new book on forensic genetics coming out soon, which is to be published by the American CRC Press publishing company. What have you focused on in your latest book? − Particular emphasis is placed on the latest technologies available for the purpose of forensic DNA analysis, the prediction of features of perpetrators of criminal offenses based on DNA analysis (or forensic phenotyping), molecular autopsy, the interpretation of DNA analysis results in court, bioterrorism, paternity testing, the ethical principles of DNA analysis, offender DNA databases, etc. The book also describes some of the most major cases in the United States, including the terrorist attack on the World Trade Center. I would like to thank my publisher, CRC Press, for their ongoing support.
In collaboration with colleagues from the Bavarian Regiomed Clinic and the University of Split, you started a unique project in Split and Bavaria. What is it about? − Regiomed is one of the biggest healthcare institution chains in Germany. This is a unique collaboration, thanks to which some 30 students from Bavaria come to the School of Medicine of the University of Split every year for their pre-clinical part of education, while the clinical part of their education is a combination of training at the University of Split and hospitals that are part of the Regiomed Clinic network. This is an exceptionally important and unique concept of integrated studies at European level which I also advocated as Minister of Science, Education and Sport of the Republic of Croatia. The model that we’ve been promoting through this collaboration is unique and innovative, even at EU level. Apart from education, such collaboration opens up opportunities for clinicians from both countries to exchange experiences, to participate in education and training processes together, and to compete for the most attractive EU projects.
How do you see the future of medicine? − The concept of personalised medicine, regenerative medicine, new technologies and artificial intelligence will define the future of medicine. Artificial intelligence has enormous potential for transforming diagnostic and therapeutic procedures into the best possible solutions. Personalised medicine will enter the next century on the crest of a wave of molecular diagnostics, cell and gene therapy, immunotherapy, particularly gene manipulation for the purpose of repairing damaged DNA using, say, CRISPR-Cas protocol, pharmacogenomics, etc.
How much time do you have left for all the other things you love in life − family, sport...? − Medicine is my love, science a continuous challenge, forensics my inspiration, and sport my passion since I was a child. By doing sport, I learned how to fall and rise, be a team player, but also how to build myself up systematically. I spend time with my family whenever I can because they’re my inexhaustible source of love and peace, my greatest strength and motivation. Collaboration with leading world physicians and scientists is an endless source of inspiration in developing new diagnostic and therapeutic procedures for human wellbeing.
You’re a passionate Croatian National Football Team fan. St. Catherine Specialty Hospital is the official hospital of the Croatian National Football Team. Tell us about your relationship with Croatia’s national football team, the Vatreni, how do you see their successes and how do you help them be successful? − With their commitment, fair play and fellowship, Croatia’s team has won the hearts of people around the world and has strongly positioned Croatia in the world. I know most of the national team players personally, and I’m very happy that St. Catherine Specialty Hospital contributes to their success, as does their entire backroom staff. Looking after the health of Croatia’s top athletes requires an interdisciplinary approach, which very often involves specialists from various fields of the medical sciences, and this with a view to making sure that the best possible treatment has been selected. But, let’s not forget, all the hard work is done and the recent successes achieved by Croatia’s players themselves who’ve demonstrated how the interests of Croatia are fought for.
See the article on this link: Dragan Primorac, Croatia Airlines Inflight magazine, July 2019 (PDF 1.2 MB)
