As defined by the World Health Organisation (WHO), health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Health also lies in vaccines and advances in immunotherapy, in improvements in the living conditions of families, mothers and newborns, and in the search for cures for Alzheimer’s disease. And health also takes shape in any research that pushes the boundaries of knowledge, in all those scientific challenges that help us to find the solutions that transform the future and improve people’s lives.

As part of World Health Day, we explore the key role played by scientific excellence in the face of great biomedical challenges. With the help of researchers from the CaixaResearch network, we review the innovative advances they’re making in different areas which could represent a turning point for the future of medicine and global health.

 

Improving the health of mothers and newborns

Every year, nearly 300,000 women die during pregnancy or childbirth and more than two million newborns die in their first month of life. In addition, around 13 million babies are born prematurely, before 37 weeks of gestation. Caring for the health of mothers and newborns is essential to ensure a future with healthy families and communities. Consequently, to coincide with World Health Day, the WHO has launched the Healthy Beginnings, Hopeful Futures campaign to urge governments and the health community to ramp up efforts to end preventable maternal and newborn deaths. 

The challenge is great but research has made key strides in recent years. “Significant advances have been made in the field of maternal, foetal and neonatal health that have led to improvements in reproductive health and neonatal outcomes, such as the prevention of complications in pregnancy, the identification of high-risk cases of prematurity, the development of new foetal therapies and the improvement of intensive care for premature babies” explains Elisenda Eixarch, an expert in foetal medicine and surgery and coordinator of the CaixaResearch fetaLife at BCNatal FMRC project . Her team is developing an artificial placenta that replicates the physiological conditions of the womb so that the organs of extremely premature babies can develop normally and thereby improve their life expectancy. It’s a liquid incubator in which the newborn is provided with nutrition and oxygen through an umbilical cord, just like in the mother’s womb.

“Artificial placenta has the potential to completely transform the way extremely premature babies are treated, offering an alternative that could significantly reduce mortality and complications associated with premature birth. In fact, its feasibility has already been demonstrated in animal models” adds Eixarch. “With this project, we not only aim to improve the survival and development of the babies but also the quality of life of their families. Extreme prematurity has a huge emotional and logistical impact on the parents, who face long hospital stays and a lot of uncertainty”.

 

Overcoming antibiotic resistance

The development of antibiotics in the early 20th century is one of the great milestones in the history of medicine. Their widespread use revolutionised the treatment of bacterial diseases and surgery and helped to extend life expectancy worldwide. However, over time pathogens have become increasingly resistant to these drugs. Today, the WHO ranks antimicrobial resistance as one of the top threats to global health, food security and development. 

Joana Azeredo, researcher at the Centre of Biological Engineering at the University of Minho and leader of the CaixaResearch “FITTED” project, is very aware of the challenge and the keys to tackling it. “We need innovative strategies that not only eliminate resistant bacteria but also make them sensitive again to existing antibiotics” she explains. “In addition, we need to focus on developing faster diagnostic tools that can accurately identify resistant infections and apply targeted treatments”.

Joana’s team is tackling the challenge from an innovative perspective: using bacteriophage viruses, natural enemies of bacteria, to develop highly targeted therapies. Their innovative approach not only targets infections precisely but also protects the microbiota and avoids many of the adverse effects of traditional antibiotic treatments. 

“We’re developing synthetic bacteriophages with enhanced antibacterial properties that we can customise to target specific bacteria. There are challenges ahead, such as achieving greater scalability and moving into clinical practice, but the project has the potential to redefine the treatment of antibiotic-resistant infections” explains Joana Azeredo. “Its impact on global health could be significant, offering a new paradigm for the treatment of infectious diseases that moves away from broad-spectrum antibiotics, reducing mortality and preserving the efficacy of existing antibiotics”.

 

Can we be vaccinated against unknown diseases?

It took just 11 months from the time SARS-CoV-2, the virus that causes COVID-19, was first characterised until the first vaccine was administered to combat it. The development in record time of treatments to stop the pandemic is already one of the milestones of modern biomedicine and connects with a long series of recent successes in the development of effective, cheap vaccines that are easy to produce, store and administer. However, there are still no effective vaccines for other diseases, such as AIDS, tuberculosis and cancer. How is research progressing to overcome existing challenges and find solutions for these diseases?

Tuberculosis is the infectious disease that causes the most deaths in the world, particularly in resource-poor countries, highlighting the socio-economic context as a key determinant of health. “Currently, there are 14 vaccine candidates for tuberculosis under clinical development, i.e. they’re being tested on humans. They follow two main strategies: preventing the infection or preventing the disease”, explains Alberto Garcia-Basteiro, associate research professor at the Barcelona Institute for Global Health (ISGlobal), a centre promoted by “la Caixa” Foundation, and coordinator of the Tuberculosis Research Unit of the Manhiça Health Research Centre (CISM).

However, work is not only being carried out on vaccines for known diseases but also on treatments for new diseases that may emerge in the future, as was the case with COVID-19. The challenge here is both to optimise the development system and to be prepared in terms of logistics and distribution. “The Coalition for Epidemic Preparedness Innovations (CEPI) was set up with the aim of ensuring that the world can respond to a pandemic threat with a new vaccine within 100 days” says expert Marta Tufet, policy director for Gavi, the Vaccine Alliance, who recently took part in the documentary “Global Immunity”, produced by CaixaForum+ together with ISGlobal.

In recent years vaccines have also become an important ally against non-infectious diseases such as cancer. “So-called treatment vaccines are used to treat patients who’ve already been diagnosed with cancer; they’re not preventive. Their aim is for the body to eliminate the cancer cells that remain after treatment and stop the cancer from recurring” says Laura Angelats, a researcher at the August Pi i Sunyer Biomedical Research Institute (IDIBAPS) of Hospital Clínic de Barcelona.

 

The future is immune

Immunology has gone from being an emerging discipline to one of the keys to the medicine of the future. Innovations such as mRNA vaccines and immune checkpoint inhibitors are redefining the treatment of a large number of infectious and autoimmune diseases, as well as cancer, and their potential has been increased even further by their recent integration with artificial intelligence and personalised biomarkers, paving the way for more precise and effective medicine. 

However, as we move forward, new challenges also arise. “One of the most urgent challenges is to understand the complexity of the immune system at an individual level, to achieve more precise therapies and extend the benefit to the majority of patients whilst avoiding the toxicity associated with immunotherapies” explains Toni Celià-Terrassa, principal investigator at the Hospital del Mar Research Institute in Barcelona, who’s determined to tackle this challenge.

“With the support of “la Caixa” Foundation, we’re working on new mRNA therapies that make it easier for the immune system to detect and eliminate tumours more effectively. Our aim is to ensure that a high proportion of patients can benefit from these treatments” says Celià-Terrassa. “In addition, “la Caixa” Foundation is also supporting our research into the dynamics between the immune system and tumour cells during metastasis, which could have a significant impact on refining immunotherapies against metastasis”.

The CaixaResearch Institute, Spain’s first research centre specialising in immunology and one of the first in Europe, will soon open its doors in Barcelona. “Immunology is involved in most chronic pathologies, as well as in ageing and its associated diseases. That’s why its research and applications are applicable across the board in terms of health” adds Celià-Terrassa. “A centre capable of channelling this transversal nature is promising for scientific advances associated with improvements in health”.

 

The complex fight against Alzheimer’s disease

As the world’s population ages, neurodegenerative diseases are becoming more common. According to WHO data, in Spain alone more than 800,000 people are living with Alzheimer’s, a disease that still has no cure but for which a lot of progress has been made in terms of our understanding. The discovery of several biomarkers to improve the diagnosis of Alzheimer’s, the development of drugs capable of delaying the cognitive deterioration associated with the disease and the implementation of new preventive strategies are just some of the major advances in recent years related to this disease.

“Looking to the future, there are a lot of challenges” says Marc Suárez Calvet, “la Caixa” Foundation fellow and head of the new Biomarkers in Fluids and Translational Neurology Group at the Barcelonaβeta Brain Research Center (BBRC). “The first is to transfer all the knowledge we have of neurodegenerative diseases to clinical practice. In addition, at a global level it’s essential to implement prevention and education policies regarding the risk factors with an impact on brain health, from cardiovascular factors to pollution in cities”.

Suárez Calvet’s Group aims to develop biomarkers, discover new therapeutic targets and provide a better understanding of the molecular mechanisms of Alzheimer’s and other neurodegenerative diseases. “There isn’t actually one single Alzheimer’s disease but many subtypes with different prognoses and different symptoms, and which may also need different treatments in the future. For this reason, it’s also key to develop biomarkers that not only detect the disease but also its subtypes and the mechanisms involved” concludes the researcher and “la Caixa” Foundation fellow.