Professor Dino Amadori: from a young research doctor to a world-famous luminary

by Mundi Live

buy Margherita Chiara Immordino Tedesco

Professor Dino Amadori, a luminous essay in the fight against cancer, is the Scientific Director of IRST IRCCS (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori) and President of IOR (Istituto Oncologico Romagnolo). He graduated with honours from the University of Bologna in 1961, and immediately clashed with the painful reality of the territory; those were the years in which, in fact, Romagna recorded a high mortality rate linked to cancer among its inhabitants.

Always at the forefront throughout his professional life in the fight against cancer, he founded the Istituto Oncologico Romagnolo in 1979 and established the Service of Oncological Prevention of the USL Company of Forlì.

He is the creator of the Cancer Registry of Romagna and in 1986 he carried out home care for the terminally ill. Professor Dino Amadori was also responsible for the creation of the Biological Oncology Laboratory at the Division of Medical Oncology of the USL of Forlì and the Unit of Epidemiology and Biomedical Statistics of the Romagna Oncology Institute. His prestigious career, as well as his constant commitment to the fight against cancer diseases, ranges from the medical care of cancer patients, to raising awareness on the subject of prevention, to the improvement of the quality of life of terminally ill people, as well as the creation of special facilities and laboratories.

His illustrious scientific work boasts over 380 publications, most of which are published in international journals indexed Pubmed. He is the co-editor of numerous scientific monographs, including: Genetic Oncology (Poletto Editore, 2001); Palliative Care Book (Poletto Editore, 2003); Manual of Semiotics and Oncological Diagnostics (Poletto Editore, 2003); Molecular Therapy in Oncology (Poletto Editore, 2005); Development of oncological drugs with molecular target from tradition to innovation (Poletto Editore, 2006); Cardioncology (Poletto Editore 2009); Osteo-oncology text book (Poletto Editore 2010).

Margherita Chiara Immordino Tedesco, met Dr. Dino Amadori in an interview:

Professor Dino Amadori, how did the European excellence of the Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori come about?

The IRST of Meldola (Forlì-Cesena) – devoted to treatment, clinical, biological and translational research and training in oncology – was founded in 2000, as a non-profit limited liability company, with all the requirements typical of a social enterprise, starting with the obligation to reinvest profits in improving activities aimed at its mission. The first stone was laid in 2003, completing the renovation project of the former Civil Hospital of Meldola. In 2006, the first activities of the company began, with Biomolecular and Translational Research Laboratories. The following year, with the transfer of the Medical Oncology Operating Unit, the Biosciences Laboratory and the Oncology Pharmacy Laboratory from the AUSL of Forlì to the IRST, assistance, diagnostics and translational research activities began in full. 2009 was the first full year.

In 2011 he took over the management of the Oncohaematology Service of the “Bufalini” Hospital in Cesena and a new wing was inaugurated, destined for Diagnostic Nuclear Medicine and the Radiopharmaceutical Workshop. As the culmination of a bureaucratic process that began in 2009, in 2012 the IRST was recognised by the Ministry as a Scientific Institute for Hospitalization and Treatment (IRCCS). Being a private institute allows us access to European calls, as well as being able to take advantage of many opportunities that are not offered to public companies, such as that of 5 per thousand, which encourages the provision of additional resources. So much so that, out of the 83 million of the global budget, with the Research and Calls that we win, 11/12 million euros arrive in these ways. The 5 per thousand this year has almost reached €700,000 and is destined to grow.

In 1979 I founded the IOR – Istituto Oncologico Romagnolo – as a voluntary organization to promote and integrate cancer interventions in areas not sufficiently covered by the National Health Service, such as Research and Prevention. Thanks to it, we have been able to establish and strengthen oncological structures in Romagna hospitals, raising them to ever higher levels. The IOR has invested almost 80 million euros in the health care system of this region. The former director of the IOR, Miserocchi, each year collects about €5,000,000, which invests both by strengthening the hospital facilities, both providing the IRST of what is needed to carry out more research, using the most advanced technologies.

So, an eloquent example of a successful alliance between public and private non-profit organizations?

Surely yes. To date, its members are, on the public side: the Region, the City of Meldola, the AUSL of Romagna – with 75% of the share capital – and the University Alma Mater of Bologna with 5%, on the private side, the IOR, with 12.5% and the Carisp Foundation, with the remainder. Together, IOR and the Foundation provide funds mainly for new works. For example, thanks to their precious contribution, a home has been built to accommodate the families of the sick who are hospitalized here, thinking of those who live further afield. It was a gift from the Cassa dei Risparmi Foundation of Forlì, while the IOR takes care of the management of the structure free of charge. Every year the IOR dedicates almost €1,000,000 to us, to facilitate the progress of our research. We were able to purchase a number of cutting-edge devices as well. In the most recent past, since 2014, we have had the management of Radiotherapy at the “Santa Maria delle Croci” Hospital in Ravenna and, since 2015, the IRST Bioscience Laboratory has been accredited as an Industrial Research Laboratory in Emilia Romagna and is part of the High Technology Network.

A story full of incessant commitment and active industriousness.

Professor Amadori, what are the main interactions of the IRST with foreign countries?

Today we are the twelfth Italian Institute of the sector, with a dense network of relationships established at the international level. Among them, those with the United States stand out, such as that of Huston or with the Ferrari group, the world’s most advanced centre for nanotechnologies. We are in close and fruitful cooperation with the group of Muller Fabbri in Honolulu.

Fabbri is a collaborator of mine, who in the USA has twice won the prize for best researcher in the United States. We are also very active with Princeton, with whom we deal with the problem of bone metastases. In America, we also work in close contact with Pittsburgh. Last but not least, I want to remember Leiden, in Holland.

Does this offer new opportunities for young graduates, especially now that, according to Eurostat, four out of ten graduates are unable to find work until three years after they have graduated?

Absolutely. I remember a girl who came from Lecce, he made a competition to enter us, won it and the next day he came to me crying and said: “Look, I decided to move here. I’m moved, because this is the first time that a serious competition has finally been held. I took part in various competitions in my territory, but I got from fifteenth to twentieth and in the meantime, I saw ‘some’ pass, inexplicably, in front of me”.

This young woman, later, has collected a series of remarkable successes. She went first to London, then to New York, Harvard and won the award for three consecutive years for being among the top 10 young researchers abroad. All this would have been difficult for her if she had served only within the local health authority, which is important, but the function to which deputy is essentially to manage diligently assistance and care. In fact, she does not have extended tasks in the field of research. She can develop clinical research, but generally only on the wave of what is launched by the major institutes promoting research.

Dr Amadori, what are the most recent researches, whose results have not yet emerged in terms of widespread communication? What kind of expectation can we have in this sense?

The research on which the most significant results are to be expected in the next twenty years is in the field of immunology. This is because, finally, the mechanism by which revolutionary successes can be achieved has been discovered. In the past, although the “soldiers” of our defences, the T lymphocytes, were stimulated, they did not respond and therefore the consequent therapies did not bring any improvement. It is recent the discovery of the mechanism which has highlighted the reason for their paralysis. When these soldiers of ours attack the tumor cell, in fact, the same reacts, sleeping them with a substance that injects into the lymphocyte, which unfortunately manages to neutralize the activation. This epoch-making discovery, due to the merit of two pioneering researchers – the American James P. Allison and the Japanese Tasuku Honjo, Nobel Prize for Medicine in 2018 – has made possible a crucial leap forward in cancer immunotherapy. This is because the specific antidote for the substance has been developed and produced, so that the lymphocyte can awaken and begin to function fully again.

So this will be the future, all in the field of immunology? 

At the same time, there are also equally important paths, such as that of nanotechnology, capable of ensuring that new drugs penetrate better into the cell, that is, to act at the level of its ultra-microscopic components. The tracks on which to proceed are therefore mainly these two. It will be essential to increase the capacity of drugs that affect neoplastic cells, so that they are more effective in making the environment where the tumor would grow hostile to him.

This is a very important century.

New research, new discoveries and new applications. A century, then, that will take us further and further in the treatment and cure of cancer diseases?

We have moved from “empirical” medicine and oncology to personalized therapies. The paradox is, however, the following. Until yesterday there was lung cancer, recognized in three types and they corresponded, for one, a special chemotherapy, for the other two another type of chemo, which was the same for both, while the third also contemplated a drug, but all with very poor results. Today, however, lung cancer is declined in at least 10-12 different varieties, based on genetics and for each of these is provided a specific drug. Hence the paradox of precision medicine, which is this: more drugs for the same tumor and a drug for more tumors.

So DNA study and gene therapy are the future?

Today, tumors will no longer be classified by organ and tissue, but by genetics. Gene therapy involves, within a cell that has a part of DNA altered, the insertion and replacement of the same part with a healthy one. We are therefore moving towards the sector of genetic transformation of cells. It is possible to change a person’s genetic heritage by intervening on embryonic stem cells and this will also prove very useful in oncology. It’s all there now, even in 3D DNA copying. It is in the single gene and the DNA contains about 40,000 genes. It’s the gene that counts, the chromosome is now a thing of the past.

As for Faith, what is your relationship with God? 

I am a believer, I have never understood well what the other part of life will be like. I don’t know how it will be, but what it will be, I’m convinced of it. The message that has been given by the Church about the existence of God is anachronistic compared to today’s times, it is a God all too much anthropomorphized, that could have a value in the times that were. I am also convinced, given the perfect harmony in the Universe, from the infinitely great to the infinitely small, that it cannot be chaos that generates everything.

Einstein said that in his research he was trying to understand God’s thoughts. A subtle, though important, philosophical interpretation of Research in the medical-scientific field.

From an ethical point of view, when you try to do Good and do your job well in this area, I believe that you automatically approach a higher value.

How did you come about, the desire to go down this road? Was there any particular episode?

As a child I was impressed by the mourning of the community in my country. When someone died of cancer, I would ask my mother: “But why does this happen?”. The answer was: “Because he died of an illness, a bad illness, incurable”. As a result, I wanted to give a name to this disease and cure it, so my reaction was “When I grow up I want to do what heals that stuff there”, calling the tumor “that”, because there was no precise cancer name at the time. To get to being an oncologist, I went through a very transversal path, not being able to afford to stay at the University, because my parents did not have the financial means to support me. As a volunteer, after graduation, not having been able to be a medical officer for physical reasons – a role that would have allowed me to have a salary then to stay in Bologna – I went to work in Santa Sofia. In that small town in the Forlì Apennines, the future prospects were zero, but I stayed there for a year and a half, learning how to be a Doctor, and then went on to Surgery. It was not my intention to be a surgeon, but I practiced for four and a half years in Forlì.

Professor Amadori, what advice would you give young researchers for their future?

Today there is no room if a young person does not already study to the maximum of his possibilities from the first high schools, because, if you want to undertake a professional activity, you need to engage up to the University here in Italy, but then find some experience outside. In Italy, unfortunately, our students are among the least prepared. We are the last wheel of the wagon. Today you can’t help but know at least English. I started studying it when I was forty, when I migrated to the United States. I used to go in the evening to take English lessons, after having worked all day long. The first month I was there, I felt like I was deaf and dumb, I didn’t understand anything, I didn’t speak at all, then I slowly learned.

In his professional autobiography “Soul and courage. My life against cancer”, there is a dedication: “to those who suffer in hope. To the volunteers who make their lives full. To researchers, so that our hope may not be empty”; a book that demonstrates his great personal and professional stature. From Romagna, we reach the realities of the African continent. What is your relationship with Africa?

I had wanted to go to Africa since long ago, because I was a great friend of Annalena Tonelli, a woman from Forlì who attended the Classico and who was one year younger than me. When she graduated in Law, she first went to the United States, to the Bronx, to see what the state of degradation and poverty of those people was like, then to London, where she took a course in tropical medicine and then to Africa and from there she never returned. Every now and then we felt and I was tempted to do the same, but then I took another path. I got engaged, married and decided to stay. Then a friend and colleague of mine, Vittorio Tison, who was a pathologist from Faenza, died of melanoma. During the years of his voluntary work in Africa, he had created a sort of small outpatient clinic to give birth to women, who would otherwise have given birth on the street. He died early and in his honor I founded an association with his name. With the funds raised over time, I managed to create a laboratory of pathological anatomy in Tanzania, in the city of Mwanza, in a large hospital with about 800 beds, then full of malaria, tuberculosis and AIDS, which had neither laboratory nor suitable equipment. So much so that they moved the patients to other locations to obtain a diagnosis. But the laboratory now works perfectly and is called Vittorio Tison.

Thanks to the Association she founded, therefore, destiny took her to Africa anyway. Tell us.

I went to visit the laboratory and found that there was a huge emergency of cancer diseases, many of which were unknown and that affected mainly children and young people. Most of them were cancers related to viral bacterial infections. I asked myself what was the point of going to make a diagnosis in those places, when there was no possibility of treatment and care for patients. I then found a very motivated young man, Dr. Masalu, who moved to Ferrara for 5 years and specialized in Oncology. He passed the 5,000 tests scheduled and then went back there. Since we started a clinical activity together with a day-hospital, launching a screening program for uterine and breast cancer. After meeting the Minister of Health, we signed a protocol of understanding with Tanzania, in the presence of the Minister of Health, who was here in Meldola. The memorandum of understanding was signed between the Ministry of Tanzania, the IOR, the IRST and the Emilia Romagna region. There was still a problem, the patients did not have the drugs. Dr. Mattia Altini and I went to the Minister of Health, explaining to him that there was an urgent need to administer morphine to sick patients, which at the time was not used for ideological reasons and that it was necessary to build a building with bunkers for radiotherapy. Fortunately he listened to us and within a year and a half he built a beautiful building, with 6 bunkers for 6 different radiotherapy instruments with a day-hospital for all the patients who are treated there today. Finally, for the last year and a half there has been a building for radiotherapy, one for brachytherapy or that type of radiotherapy performed locally and one for cobalt therapy. Recently Dr. Masalu told me that a month ago an agreement had been signed between the Aga Khan Foundation, the Ministry of Health, the Hospital Management, Dr. Masalu himself and the President of Electa, to install a new accelerator and reconstitute one of our accelerators that I sent him a few years ago, still packed. An ambulance service was therefore set up in sub-Saharan Africa, in a territory with about 300 million inhabitants, of whom about 200 could not benefit from radiotherapy, due to the lack of facilities. So it is already for the most part, but we hope that it will become the most important structure of radiotherapy in sub-Saharan Africa. Moreover, the President of the Republic of Tanzania has guaranteed the funds to build the Mwanza Cancer Institute in front of this building, including the oncology surgery department, the laboratories and the availability for hospitalization.

We are therefore increasingly confident that our work will lead to ever greater success.

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