RAZGOVOR INTERVIEW - Dragan Primorac

10 _ CROATIA AIRLINES 2/2019

RAZGOVOR INTERVIEW

CROATIA AIRLINES 2/2019 _ 11

Liječnik, znanstvenik, vizionar, zaljubljenik u sport, sportaš... Već dugi niz godina prof. dr. sc. Dragan Primorac dovodi u Hrvatsku ugledne znanstvenike, među kojima i nobelovce, kao organizator jednoga od najznačajnijih svjetskih skupova iz područja personalizirane medicine, forenzične i antropološke genetike. Ovog se ljeta svjetska znanstvena elita okuplja u Splitu.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.

Piše/By _ Ksenija Žlof

Fotografije/Photos _ Saša Ćetković

IZVRSNOST U SVIM SEGMENTIMA

EXCELLENCE IN ALL SEGMENTS

D. PRIMORAC


Liječnik − pedijatar, forenzičar, ge-

netičar. Znanstvenik − prvi velepo-

slanik američkog Sveučilišta Penn

State osnovanoga još 1855. godine,

predsjednik Odbora za međunarodne

odnose Američke akademije za forenzič-

ne znanosti (AAFS), predsjednik Među-

narodnog društva primijenjenih bioloških

znanosti (ISABS), predsjednik Hrvatskog

društva za humanu genetiku, predsjednik

Hrvatskog društva za preciznu medicinu,

predsjednik Hrvatskog klastera konkuren-

tnosti personalizirane medicine, pred-

sjednik Tematskog inovacijskog vijeća

za zdravlje i kvalitetu života Republike

Hrvatske. Vizionar − predvodnik uvođe-

nja farmakogenomike i personalizirane

medicine u kliničku praksu. U suradnji s

vodećom američkom zdravstvenom insti-

tucijom Mayo Clinic i uz potporu Ame-

ričke akademije za forenzične znanosti

više od 20 godina organizira znanstvene

skupove na kojima redovito sudjeluju

najugledniji svjetski znanstvenici među

kojima i nobelovci.

Sve je to naš sugovornik prof. dr. sc.

Dragan Primorac, ali ne samo to. On je i

sportaš, zaljubljenik u sport, bivši državni

juniorski viceprvak u taekwondou, član

Kuće slave taekwondoa (Hall of Fame),

kao mladić trenirao je nogomet i atleti-

ku, a njegova je bolnica, Sveta Katarina,

europski centar izvrsnosti koju je osnovao

prije osam godina u Zaboku i Zagrebu te

službena bolnica Hrvatske nogometne

reprezentacije i Hrvatskog olimpijskog

odbora. Uza sve to, nedavno mu je od-

lukom Američke akademije za forenzične

znanosti uručena i jedna od najprestižnijih

nagrada Mary E. Cowan Outstanding Ser-vice Award za izvrsnost, prepoznatljivost

i golem doprinos razvoju forenzičnih zna-

nosti u svijetu. Pritom je sasvim običan

čovjek, jednostavan, ugodan sugovornik,

s kojim je uvijek zanimljivo razgovarati i

provesti vrijeme.

Toliko je aktivnosti i područja kojima se bavite da ih je teško i nabrojati a da se nešto ne zaboravi spomenuti. Nagradom koju ste nedavno dobili od Američke akademije za forenzične znanosti, Mary E. Cowan Outstanding Service Award, započeli ste 2019. godi-nu. Nagrada vam je dodijeljena nakon 26 godina rada kao jednomu od pionira razvoja moderne forenzične genetike. U svojem obrazloženju Odbor za do-djelu nagrade ističe da se ovogodišnje

priznanje dodjeljuje prof. dr. Primorcu za izvrsnost, međunarodnu prepo-znatljivost i golem doprinos razvoju forenzičnih znanosti u svijetu. − Nagradu Američke akademije za fo-

renzične znanosti, najuglednije svjetske

organizacije iz područja forenzičnih

znanosti, doživio sam kao priznanje ne

samo meni nego svim mojim kolegama

od SAD-a do Hrvatske s kojima više od

26 godina surađujem u području foren-

zične genetike. Istodobno, nagrada mi je

golem poticaj da nastavim kontinuirano

pridonositi razvoju forenzičnih znanosti.

I ove ste godine organizirali jedan od najznačajnijih svjetskih znanstvenih događaja iz područja personalizirane medicine, forenzične i antropološke genetike. − Točno, od 17. do 22. lipnja u Splitu su

se okupili vodeći svjetski znanstvenici iz

područja personalizirane medicine, foren-

zične i antropološke genetike. Skup su

organizirali International Society for Appli-ed Biological Sciences (ISABS), vodeća

američka zdravstvena institucija Mayo

Clinic i Specijalna bolnica Sv. Katarina, i

to u suradnji s Američkom akademijom

za forenzične znanosti i nizom drugih

institucija. O veličini projekta najbolje

svjedoči podatak da je tijekom zadnjih 20

godina u radu ISABS-ovih konferencija

sudjelovalo oko 5000 znanstvenika, 600

pozvanih predavača, ukupno iz 70 država

svijeta. U radu kongresa sudjeluje i niz

dobitnika Nobelove nagrade, a Nobel Spirit uistinu je jedinstven svjetski doga-

đaj. Neizmjerno sam zahvalan dobitnici-

ma Nobelove nagrade što su prepoznali

važnost prenošenja znanja studentima

i mladim znanstvenicima koji dolaze iz

cijelog svijeta i sudjeluju u radu ISABS-

ova kongresa. Možete samo zamisliti

koliko je sudjelovanje dobitnika Nobelove

nagrade snažna inspiracija i motivacija

mladim ljudima. Tijekom ovogodišnjeg

kongresa s nama su bili dragi prijatelji,

dobitnici Nobelove nagrade i ljudi čiji

je doprinos razvoju svjetske znanosti

nemjerljiv: prof. Paul Modrich (Sveučilište

Duke) i prof. Avram Hershko (Izraelski

Institut za tehnologije Technion), prof.

Robert Huber (Institut Max Planck), prof.

Ada Yonath (Institut Weizmann), a ranijih

su godina sudjelovali i Nobelovci prof.

Richard Roberts (New England Biolabs) te

prof. Aaron Ciechanover (Izraelski Institut

za tehnologije Technion). Ove su godine

ključne teme kongresa precizna (persona-

lizirana) medicina, epigenomika, stanična,

genska i imunoterapija, regenerativna

medicina, farmakogenomika, forenzična i

antropološka genetika.

Diplomirali ste 1991. godine na zagrebačkome Medicinskom fakultetu, a nedugo nakon toga, zbog sudje-lovanja u otkrivanju molekularnog mehanizma nastanka jednog od tipova bolesti krhkih kostiju u djece, dobili ste godišnju nagradu u SAD-u Maurice Attie Memorial Award, koju dodjeljuje American Society for Bone and Medi-cal Research. Nedvojbeno, odmah ste se punim kapacitetom predali medicini i znanosti. Što je u vama potaknulo zanimanje za ta dva područja? Kad ste i kako prepoznali da se želite baviti upravo medicinom?− Medicina je oduvijek bila moja ljubav.

Kad sam kao mladi liječnik došao u dodir

s molekularnom medicinom, shvatio sam

da će moj životni put biti spoj znanosti i

kliničke medicine. Taj se koncept danas

popularno naziva translacijska medicina.

Velika je privilegija biti dio tima koji pri-

donosi razvoju znanosti, nečemu što će

u konačnici utjecati na ljudsko zdravlje.

Tako je bilo i ranih devedesetih, kad smo

otkrili da određena promjena na genu za

kolagen zapravo uzrokuje nemogućnost

prijenosa poruke iz jezgre u citoplazmu ili,

kako drugim riječima tu poruku zovemo,

glasničke RNK odgovorne za sintezu

proteina. U tom se konkretnom slučaju

proizvodi samo 50 posto proteina i sve to

dovodi do tipične kliničke slike obolje-

loga. S druge strane, to nas je otkriće

potaknulo na razmišljanje o tome da ovaj

prirodni fenomen izazovemo u slučaju

kad se proizvodi oštećena poruka koja će

sigurno dovesti do stvaranja oštećenog

proteina i teške kliničke slike te stoga

želimo zaustaviti prepisivanje te oštećene

poruke u protein.

Da vam je osim teorije neizmjerno važna i praksa, svjedoči i to što ste predvodnik uvođenja farmakogenomi-ke i koncepta personalizirane medicine u kliničku praksu. Što to konkretno znači za pacijente?− Osnova koncepta personalizirane ili

precizne medicine temelji se na poznava-

nju i razumijevanju procesa na moleku-

larnoj razini, što je istodobno ključno i za

liječenje. Drugim riječima, analizom ge-

noma dobivaju se informacije koje mogu

CROATIA AIRLINES 2/2019 _ 13

biti važne za prevenciju bolesti, u ranoj

dijagnostici, ali i pri odabiru optimalnog

liječenja i praćenja učinkovitosti terapije.

Prava terapija za pravog pacijenta u pravo vrijeme ključna je sintagma personalizi-

rane medicine, posebno značajna kad je

riječ o farmakogenomici. Farmakogeneti-

ka je novija grana farmakoloških znanosti

koja proučava vezu između genetičke

predispozicije pojedinca i njegove spo-

sobnosti metaboliziranja nekog lijeka ili

stranog spoja. Pomaže razumijevanju

zašto neke osobe odgovaraju na lijekove,

a druge ne, zašto neke osobe trebaju više

ili niže doze za postizanje optimalnoga

terapijskog učinka, a može upozoriti i na

pacijente koji neće odgovoriti na terapi-

ju, odnosno na one kod kojih se mogu

pojaviti toksične nuspojave. Podaci koje

je prije niz godina objavio vodeći američki

medicinski časopis JAMA uznemirili su

javnost jer ističu da godišnje samo u

SAD-u više od dva milijuna hospitalizira-

nih bolesnika nakon uzimanja lijekova ima

ozbiljne štetne i neželjene učinke lijekova,

dok njih više od 100.000 zbog toga i

umre. Jednostavnije rečeno, svaka osoba

reagira individualno na lijek koji joj se daje

i jedini način da se ta reakcija utvrdi jest

analiza gena koji su ključni za metaboli-

zam lijeka, njegov prijenos u organizmu,

receptore na koje će se lijek vezati ili pak

neki drugi mehanizam. Propisivanje lije-

kova sukladno genskom profilu pojedinca

znatno smanjuje vjerojatnost popratnih

pojava istodobno smanjujući i vjerojatnost

predoziranja u odnosu na tipičnu situaciju

u kojoj se lijek propisuje sukladno bole-

snikovoj tjelesnoj težini i starosti. Stoga,

farmakogenetika ima ključnu ulogu u

izboru najboljega mogućeg lijeka kao i

njegove doze, istodobno umanjujući rizik

popratnih pojava, predoziranja i nepo-

voljnih posljedica interakcije lijekova.

Dijagnostički test RightMed, koji smo

nedavno uveli u kliničku praksu u suradnji

s kompanijom OneOme čiji je osnivač

Mayo Clinic, trenutno analizira 25 plus tri

dodatna gena i 111 polimorfizama kako

bi se predvidio terapijski odgovor na više

od 350 lijekova. Farmakogenomika je

ključna za goleme uštede u zdravstvenom

sustavu vezane uz propisivanje lijekova

kao i posljedično liječenje komplikacija

izazvanih neželjenim učincima lijekova.

Prije osam godina osnovali ste bol-nicu Sveta Katarina, europski centar izvrsnosti, koja je također službena bolnica Hrvatske nogometne reprezen-tacije i Hrvatskog olimpijskog odbora. U njoj se liječe vrhunski svjetski spor-taši. Osim sportašima, komu je sve namijenjena ta bolnica i što ona znači za obične ljude?− Specijalna bolnica Sv. Katarina među

prvim je zdravstvenim institucijama koje

žive koncept personalizirane medicine. U

našem radu ključni su kriteriji isključivo iz-

vrsnost u svim segmentima rada, znanje,

suradnja s najboljima, sustavna edukacija

kadrova te primjena najnovijih medicin-

skih postupaka i znanstvenih dostignuća.

Naša su posebna snaga izvrsni stručnjaci

i njihov odnos prema radu, to je ono što

nas izdvaja. Svjesno smo postavili visoke

standarde i poduzimamo sve potrebne

korake kako bismo ih dosegnuli. Zado-

voljan pacijent nama je jedini pokazatelj

uspješnosti. Posebno smo ponosni na

igrače Hrvatske nogometne reprezentaci-

je, ali i na sve naše vrhunske sportaše koji

našu domovinu promiču na najbolji način.

Kad je riječ o praksi, ostvarili ste i iznimno važne, zapravo revolucionarne rezultate u liječenju oštećenja hrskavi-ce matičnim stanicama. − Poseban nam je interes liječenje obolje-

lih od osteoartritisa, degenerativne bolesti

zglobova u čijoj podlozi glavnu ulogu ima

oštećenje zglobne hrskavice. Ova bolest

jedan je od vodećih uzroka invalidno-

sti u modernome svijetu i pretpostavlja

se da više od 750 milijuna ljudi širom

svijeta boluje od osteoartritisa. Liječenje

osteoartritisa dugo se temeljilo isključivo

na modulaciji boli i u najtežim slučajevima

ugradnjom parcijalne ili totalne endopro-

teze. Nove spoznaje idu u prilog velikom

napretku na polju tkivnog inženjeringa

i regenerativne medicine, a jedna od

metoda jest primjena matičnih stanica

u liječenju osteoartritisa s kojom smo

postigli iznimne rezultate, a o njima naši

pacijenti svakodnevno svjedoče. Rezultati

naše studije nedavno su objavljeni u

časopisu Genes.

Čemu ćete se najviše posvetiti na mjestu predsjednika Odbora za među-narodne odnose Američke Akademije za forenzične znanosti, najvažnije svjetske organizacije iz forenzike?− Američka akademija za forenzične zna-

nosti, sa sjedištem u Colorado Springsu,

najprestižnija je svjetska organizacija

iz područja forenzičnih znanosti. Ima

više od 7000 članova koji dolaze iz 50

saveznih država SAD-a, Kanade te iz 74 01

02

03

01Prof.dr.DraganPrimoracivodećiforenzičarsvijetaprof.dr.HenryLee

Prof.DraganPrimorac,M.D.,Ph.D.,andtheworld’sleadingforensicexpert,Prof.HenryLee,Ph.D.

02Prof.dr.AaronCiechanover,dobitnikNobelovenagradezakemiju2004.,prof.dr.DraganPrimoraciprof.dr.RobertHuber,dobitnikNobelovenagradezakemiju1988.

Prof.AaronCiechanover,Ph.D.,winnerofthe2004NobelPrizeinChemistry,Prof.DraganPrimorac,M.D.,Ph.D.,andProf.RobertHuber,Ph.D.,winnerofthe1988NobelPrizeinChemistry

03SbivšimpredsjednikomIzraela,ShimonomPeresom,dobitnikomNobelovenagradezamir1994.

WithShimonPeres,formerPresidentofIsraelandwinnerofthe1994NobelPeacePrize

Foto

graf

ije/P

hoto

s_A

rhiv

a/A

rchi

ve o

f Pro

f. D

. Prim

orac


pridružene države svijeta. Moja uloga jest

promovirati vrijednost Američke akade-

mije za forenzične znanosti širom svijeta

te povezivati forenzičare svih kontinenata

kako bi zajedničkim radom, suradnjom te

razmjenom iskustava i rezultata pridonijeli

borbi protiv kriminala i svijet učinili sigur-

nijim mjestom za život.

Kad ste prije mnogo godina odlazili u SAD na usavršavanje, namjeravali ste se baviti pedijatrijskom genetikom, ali kako život često krene u nekom nepredvidljivom smjeru, zbog agresije na Hrvatsku i tragičnih posljedica rata uključili ste se u procese identifikacija. Koliko je taj dio medicine napredovao?− Točno, životni put je nepredvidljiv pa

je tako bilo i sa mnom. Tijekom mojega

znanstvenog usavršavanja u SAD-u na

projektu utvrđivanja molekularne osnove

nastanka koštanih bolesti u djece, na

poziv kolega uključio sam se u postupak

identifikacije žrtava Domovinskog rata.

Ranih devedesetih, kad smo započeli

prve identifikacije skeletnih ostataka

pronađenih u masovnim grobnicama, bili

smo uglavnom bez potrebne tehnologi-

je, znanja, baza podataka, ali imali smo

srce i veliku želju pomoći obiteljima koje

su ostale bez svojih najmilijih. U suradnji

s vodećim američkim forenzičarima iz

SAD-a koji su tada radili u FBI-u, držav-

nim policijama New Yorka, Connecticuta,

Armed Forces Institute of Pathology i Analytical Genetic Testing Center razvijali

smo metodologije i postupke koji su re-

zultirali velikim brojem uspješno identifici-

ranih osoba, ali i postavljanjem standarda

tijekom postupaka identifikacije koristeći

analizu jezgrine ili mitohondrijske DNA

ili pak analizu Y kromosoma. Danas je

forenzična genetika znanstvena disciplina

bez koje je nemoguće zamisliti funkcioni-

ranje modernih forenzičnih znanosti.

Neprekidno objavljujete članke u najuglednijim svjetskim znanstvenim časopisima, a u pripremi je i vaša nova knjiga s područja forenzične genetike u izdanju američkog izdavača CRC Press. Na što ste se najviše usredoto-čili u toj knjizi?− Poseban naglasak stavlja se na najno-

vije tehnologije u svrhu forenzične DNK

analize, predviđanje izgleda počinitelja

kaznenoga djela na osnovi analize DNK,

molekularnu obdukciju, interpretaciju

rezultata DNK na sudu, bioterorizam,

utvrđivanje očinstva, etičke principe

analize DNK te baze podataka DNK

počinitelja kaznenih djela. Zahvaljujem

našem izdavaču CRC Pressu na konstan-

tnoj potpori, a u novoj knjizi detaljno su

opisani neki od najznačajnijih slučajeva u

SAD-u, uključujući i teroristički napad na

World Trade Center. S kolegama iz bavarske klinike Regi-omed te Sveučilišta u Splitu pokrenuli ste jedinstven projekt Medicinskog fakulteta u Bavarskoj (Split/Bavarska). O čemu je tu riječ?− Regiomed je jedan od najznačajnijih la-

naca zdravstvenih institucija u Njemačkoj.

Riječ je o jedinstvenoj suradnji tijekom

koje svake godine tridesetak studenata iz

Bavarske dolazi na pretklinički dio edu-

kacije na Medicinski fakultet Sveučilišta

u Splitu, dok će klinički dio biti kombina-

cija edukacije na Sveučilištu u Splitu i u

bolnicama koje su u sastavu Regiomed

Kliniken. To je iznimno važan i jedinstven

koncept integriranih studija na europskoj

razini za koje sam se zalagao kao ministar

znanosti, obrazovanja i sporta. Model koji

ovom suradnjom promičemo jedinstven

je i inovativan, čak i na razini EU-a. Takva

suradnja osim edukacije studenata otvara

mogućnosti kliničarima iz obiju država

za razmjenu iskustava kao i zajedničko

sudjelovanje u edukacijskim procesima

te natjecanje za najatraktivnije projekte

EU-a.

Kako vidite budućnost medicine? − Koncept personalizirane medicine,

regenerativna medicina, nove tehno-

logije i umjetna inteligencija odredit će

budućnost medicine. Umjetna inteligen-

cija ima golem potencijal transformacije

dijagnostičkih i terapeutskih postupaka u

najbolja moguća rješenja. U personalizi-

ranoj medicini molekularna dijagnostika,

stanična ili genska terapija, imunoterapija,

posebice manipulacija genoma u svrhu

popravljanja oštećenja DNK, recimo kori-

steći postupak CRISP-Cas9, farmakoge-

nomika itd. odredit će iskorak medicine u

naredno stoljeće.

Koliko vam vremena ostaje uz me-dicinu, znanost i forenziku, za sve ono što još volite − obitelj, sport...?− Medicina je moja ljubav, znanost

kontinuirani izazov, forenzika inspiracija,

a sport strast od najranijih dana. Kroz

sport sam naučio padati i dizati se, biti

timski igrač, ali i sustavno se izgrađivati.

S obitelji sam kad god mogu jer oni su

moj neiscrpni izvor ljubavi i mira. S druge

strane, moja mi je obitelj i najveća snaga i

motivacija. Suradnja s vodećim svjetskim

liječnicima i znanstvenicima trajna mi je

inspiracija u razvijanju novih dijagnostič-

kih i terapijskih postupaka na dobrobit

čovjeku.

Strastveni ste navijač i Hrvatske nogometne reprezentacije. Specijal-na bolnica Sv. Katarina službena je bolnica Hrvatske nogometne reprezen-tacije. Opišite nam svoj odnos s našim Vatrenima, kako doživljavate njihove uspjehe i kako im u tome pomažete?− Svojim zalaganjem, fair playom i zajed-

ništvom naša reprezentacija osvojila je

srca ljudi širom svijeta te snažno pozicio-

nirala Hrvatsku u svijetu. Osobno većinu

reprezentativaca jako dobro poznajem i

sretan sam što Sv. Katarina pridonosi nji-

hovu uspjehu, uostalom kao i cijeli stožer

naše reprezentacije. Skrb o zdravlju naših

vrhunskih sportaša zahtijeva interdisci-

plinaran rad u koji su vrlo često uključeni

specijalisti iz različitih područja medicin-

skih znanosti, u cilju najboljeg odabira

liječenja. No, ne zaboravimo, temelj

nedavnog velikog uspjeha naši su igrači

koji su pokazali kako se bori za interese

Hrvatske.

A physician − a paediatric medical doctor, a forensic expert, a geneti-cist. A scientist − the first Global

Ambassador of Penn State University (founded in 1855), Chair of the International Affairs Committee of the American Acade-my of Forensic Sciences (AAFS), President of the International Society for Applied Bio-logical Sciences (ISABS), President of the Croatian Society of Human Genetics, Presi-dent of the Croatian Society of Personal-ised Medicine, President of the Croatian Competitiveness Cluster for Personalised Medicine, President of the Thematic In-novation 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 Pri-morac, M.D., Ph.D., is all this and much


medicine as a young physician, I realised that my life path would be a combina-tion of science and clinical medicine. This concept is today popularly called trans-lational 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 messen-ger 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

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 impor-tance 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 confer-ences. 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 win-ners 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 (Weiz-mann Institute of Science). In the past, we also hosted Prof. Richard Roberts (New England Biolabs) and Prof. Aaron Ciech-anover (Technion − Israel Institute of Tech-nologies), both Nobel Prize winners. This year’s key topics were precision (person-alised) medicine, epigenomics, cell, gene and immunotherapy, regenerative medi-cine, 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 Medi-cal Research, and this because of your participating in discovering the molec-ular 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

more. He’s also an athlete, a sports enthu-siast, 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 con-tribution to the development of forensic sci-ences. Despite all this, he’s a simple man, someone who is easy and pleasant to talk to, and whom spending time with convers-ing 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 with-out 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 deci-sion 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 devel-opment 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 personal-ised medicine, forensic and anthropologic genetics gathered in Split. The conference

01Prof.dr.RobertHuber,dobitnikNobelovenagradezakemiju1988.,prof.dr.DraganPrimorac,prof.dr.AdaYonath,dobitnicaNobelovenagradezakemiju2009.,teprof.dr.HaraldzurHausen,dobitnikNobelovenagradezamedicinu2008.

Prof.RobertHuber,Ph.D.,winnerofthe1988NobelPrizeinChemistry,Prof.DraganPrimorac,M.D.,Ph.D.,Prof.AdaYonath,Ph.D.,winnerofthe2009NobelPrizeinChemistry,andProf.HaraldzurHausen,M.D.,Ph.D.,winnerofthe2008NobelPrizeinMedicine

02Sprof.dr.AvramomHershkom, dobitnikomNobelovenagradezakemiju2004. WithProf.AvramHershko,Ph.D.,winnerofthe

2004NobelPrizeinChemistry

02

01


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 regenera-tive 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 Interna-tional Affairs Committee of the Ameri-can Academy of Forensic Sciences, the leading forensic organisation in the world?− The American Academy of Forensic Sci-ences, 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 Ameri-can Academy of Forensic Sciences around the world, and to network forensic experts from all continents with a view to contribut-ing 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 identifi-cation of war victims. How much has that part of medicine advanced?

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, im-mensely 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 preci-sion medicine is based on knowing and understanding processes on the molecular level, which is crucial to treatment. In other words, genome analysis provides informa-tion that may be important for disease pre-vention, making an early diagnosis, but also when finding optimal treatment and moni-toring 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 pharmacologi-cal 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 ex-perience toxic side effects. Data published a few years ago by the leading American medical journal JAMA caused serious con-cern 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 indi-vidually 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 reduc-ing the likelihood of an overdose when compared to typical situations in which the same medication is prescribed in accord-ance 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 thera-peutic 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 Eu-ropean 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, knowl-edge, collaboration with the best, sys-tematic 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 intention-ally 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 treat-ment has long been based solely on the

Snajboljimnogometašemsvijeta,hrvatskimreprezentativcemLukomModrićemWiththebestfootballplayerintheworld,theCroatianNationalFootballTeamplayer,LukaModrić


with Croatia’s national football team, the Vatreni, how do you see their suc-cesses 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 play-ers personally, and I’m very happy that St. Catherine Specialty Hospital contrib-utes to their success, as does their entire backroom staff. Looking after the health of Croatia’s top athletes requires an interdisci-plinary approach, which very often involves specialists from various fields of the medi-cal sciences, and this with a view to mak-ing 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.

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 medi-cine?− 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 pur-pose of repairing damaged DNA using, say, CRISPR-Cas protocol, pharmacogenom-ics, 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 continu-ous 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 my-self 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. Collabo-ration with leading world physicians and scientists is an endless source of inspiration in developing new diagnostic and therapeu-tic procedures for human wellbeing. You’re a passionate Croatian Na-tional Football Team fan. St. Catherine Specialty Hospital is the official hos-pital of the Croatian National Football Team. Tell us about your relationship

− 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 col-laboration 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 identifi-cation procedures using nucleus, mito-chondrial 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 Ameri-can CRC Press publishing company. What have you focused on in your latest book?− Particular emphasis is placed on the lat-est technologies available for the purpose of forensic DNA analysis, the prediction of features of perpetrators of criminal offenses based on DNA analysis (or forensic phe-notyping), molecular autopsy, the inter-pretation 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 health-care institution chains in Germany. This is

01Prof.dr.DraganPrimoracskolegamaistudentima Prof.DraganPrimorac,M.D.,Ph.D., withcolleaguesandstudents

02NadodjelinagradeAmeričkeakademijezaforenzičneznanostispredsjednicomSusan

Ballou AttheawardsceremonyoftheAmerican

AcademyofForensicScienceswithPresidentSusanBallou

01

02

Documents

RAZGOVOR INTERVIEW - Dragan Primorac