Research at the Center

The CNIC is organized into two departments, one focused on Basic Research and the other on Clinical Research. Research in these fields is fully interconnected through three multidisciplinary Research Areas. The core technical units hosted by each Area support the work of all CNIC scientists.

was demonstrated for mitochondria in triggering pulmonary hypertension with heart right ventricle failure. 7) Kinase modulators and next generation gene-therapy vectors were used to develop therapies for complex cardiomyopathies for which no treatment curently exists. 8) Intra-cardiomyocyte edema was identified by in vivo magnetic resonance imaging as the earliest marker of cardiac toxicity caused by anthracyclin treatment. 9) Another study showed that cardiotoxicity can be prevented or treated by therapeutic strategies targeting mitochondria.

The Area’s core technical units support the work of all CNIC scientists in transgenesis, pluripotent cell technology, viral vectors, and comparative medicine, which supports in vivo work in the animal facility. The Transgenesis Unit is using and refining the CRISPR/ Cas9 gene-editing system and microinjection of a single blastomere into a two-cell mouse embryo. The new Clinical Trials Coordination Unit began its activity in 2018, coordinating the CNIC’s mission to boost Spanish leadership in clinical trials in the cardiovascular area.


Juan A. Bernal
José Antonio Enríquez
David Filgueiras Borja Ibáñez
José Jalife Enrique Lara-Pezzi
Silvia Priori
Mercedes Ricote
Guadalupe Sabio
David Sancho


Pluripotent Cell Technology
Comparative Medicine
Viral Vectors
Clinical Trials Coordination

REBOOT trial

The prescription of beta-blockers to patients after an MI is based on evidence from trials performed in the pre-reperfusion era. While there is solid evidence for their benefit in post-MI patients with reduced ejection fraction, such evidence is lacking for patients with preserved ejection fraction. Despite this, more than 80% of post-MI patients in this category are prescribed beta-blockers for the rest of their lives. REBOOT (tREatment with Beta-blockers after myOcardial infarction withOut reduced ejection fracTion) is a multinational trial that will enroll 8600 post-MI patients with a left ventricular ejection fraction above 40%. Patients will be randomized to beta-blocker therapy (type and dose decided by the attending physician) or to no treatment. The primary endpoint is the composite of all-cause death, reinfarction, or heart failure admission during 3-year follow-up. This trial is coordinated by the CNIC Clinical Trials Coordination Unit and is run in close collaboration with the Mario Negri Institute of Research in Milan. More than 50 hospitals in Spain and more than 20 in Italy participate in this large- scale project that will have a major impact on clinical practice. The first patients were enrolled in October 2018.

H2H study

There is increasing awareness of the association between atherosclerosis and cognitive function, but the mechanisms linking these processes are not fully understood. The Heart-to-Head (H2H) study is testing the hypothesis that extensive subclinical atherosclerosis is associated with subtle cognitive decline and beta-amyloid deposition in the brain. This transatlantic collaboration is framed within an agreement between the CNIC and Mount Sinai Hospital in New York and is led by CNIC General Director Valentin Fuster. In Spain, the H2H project is coordinated between the CNIC and 12 de Octubre Hospital. Other university hospitals (Fundación Jiménez Díaz, Clínico San Carlos, and Gregorio Marañón) participate in the project, which receives funding from the Carlos III Institute of Health through the Proyecto Integrado de Excelencia program. A total of 300 participants are undergoing extensive atherosclerosis phenotyping (multi-territory 3D vascular ultrasound and cardiac computed tomography) and thorough brain imaging (anatomical and functional magnetic resonance imaging and positron emission tomography (PET)-amyloid scan), as well as cognitive function testing. Enrollment will be completed in the second quarter of 2019.

Translation of CNIC studies into clinical practice guidelines.

The European Society of Cardiology (ESC) produces concise guideline documents for specific cardiovascular conditions that present up-to-date treatment recommendations based on robust clinical research evidence. The international impact of these clinical practice guidelines is huge, with therapies being implemented on the basis of these documents. Recent ESC clinical practice guidelines have included recommendations based on two CNIC studies. The FOCUS trial, testing the effect of the CNIC polypill on treatment adherence in secondary prevention, features in the 2016 Cardiovascular Disease Prevention in Clinical Practice guidelines, and the METOCARD-CNIC trial, testing the infarct-limiting effect of early i.v. metoprolol in patients having an acute myocardial infarction, features in the 2017 Guidelines for the Treatment of Acute Myocardial Infarction. The 2016 cardiovascular prevention guidelines also reference the PESA study, and the recent ESC myocardial infarction guidelines cite a total of eight CNIC studies. The large ongoing CNIC-led clinical trials SECURE and REBOOT will have an impact on clinical practice guidelines in the coming years.


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