ArgoSpine: An Interview with Professor Gérard Saillant
BY EDITOR, MARCH 28, 2008
The interview below, conducted by Anca Mitulescu, was first published in ArgoSpine News & Journal in September 2007. As part of our sponsorship of ArgoSpine, we're republishing select ArgoSpine News & Journal content for our audience.
Born out of the association of three world-renowned professors, Professor Gérard Saillant, an orthopaedist and traumatologist, Yves Agid and Olivier Lyon-Caen, neurologists, with the support of Luc Besson, Louis Camilleri, Jean Glavany, Maurice Lévy, Jean-Pierre Martel, Max Mosley, Michael Schumacher, Jean Todt and Serge Weinberg, the Institute for Cerebral and Medullary Disorders — ICM — is a planned international scientific centre of excellence, which will make possible to study the mechanisms of neurological conditions(such as Alzheimer’s disease, Parkinson’s disease, amyotrophic lateral sclerosis, multiple sclerosis, epilepsy, cerebrovascular neurologic disease, etc.) psychiatric conditions, (reactive depression, psychosis, schizophrenia, etc.), as well as brain and spinal cord injuries and resulting treatments. The Association for the development of research on brain and spinal cord (Adrec), is a French law 1901 association, whose purpose is to support, by all appropriate means, the development of research on brain and spinal cord, in particular by the promotion of the Institute for Cerebral and Medullary Disorders - ICM. The opening of the Institute for Cerebral and Medullary Disorders is planned for July 2009.
ArgoSpine News & Journal: Why set up an Institute bringing together research on the brain and the spinal cord?
Prof. Gérard Saillant: Before answering this question, I warmly recommend that readers visit our website (www.icm-institute.org) which, even if it is being updated, as it is rather old, provides a certain amount of information concerning both our activities and aims. In order to answer the question on the reasons of such a joined research on the brain and the spinal cord, we must consider that the issue is the same with regards to the lesions of the two structures: the brain and the spinal cord — i.e. it is always about cell death.
If we take the examples of tetraplegia after a spinal cord injury and Alzheimer’s disease, these are two different pathologies but the problem is the same — cell death with variable localisation. We are dealing with the need to provide an adequate response to the dead cell, fostering cellular plasticity as well as allowing connection of nerve circuits. The concern being the same, I believe we should think transversally not vertically, by putting the research together in the ambit of the same house, and not in different houses — the Alzheimer’s house, the multiple sclerosis’ house, the tetraplegia’s house, etc. It is a new reflection but I think a very important one as the neurons are the same and the intracellular convections are exactly the same, as well.
From this reflection we quickly realize that if we know a little more about the spinal cord we do not know much about the brain. If we want to progress, there are two important concepts: on the one hand, the network — we should work in partnerships with experts from different disciplines — and on the other hand, the need to have very big structures. Nowadays, we cannot be satisfied with supporting some structures here and there; instead, everything should be brought together on the same site. This can be achieved thanks to research centres which will focus their activities on the brain and the spinal cord. If we want to define this project, there are several words which characterise it.
We are dealing, of course, with an extremely ambitious project, almost megalomaniac: 23,000 m2 area of research laboratories, a primate breeding facility, 700 to 1,000 researchers, 5 MRI research units, of which 4 of 3 Teslas and 1 of 7 Teslas, representing an investment of 67 million euros. Secondly, it is an international project. Actually, the institute is located in France, in Paris, at the Pitié Salpêtrière Hospital, although it is rather an international project. It is a little like Formula One, where if you watch closely, there is no single national team. For instance, at Renault, the engine is made in France, the chassis in England, the racing driver is Spanish etc. We have to take the best in the world. This is an extremely important point. That is why, symbolically, the scientific committee that has operated for two years includes 12 people coming from all over the world while there is only one French citizen.
The third feature characterising our project is originality, first of all thanks to the public and private partnerships. This is a private foundation with all the advantages it entails, even if the funds are both public and private. As this project has been stateapproved, we can already count on the Ilede- France Regional Council with a 5 million grant, INSERM (National Institute for Health and Medical Research) which donated 3 million, the research institute of the FIA with a 6.5 million donation while the rest comes and will come from private donations.
The fourth important aspect is multidisciplinarity. We have to consider it is a unique centre in the world where we will bring together both the clinical and fundamental research. We also have to take into account that we have the chance, or misfortune, to see 100,000 neurological patients at the Pitié Salpêtrière Hospital. So there is a whole floor dedicated to clinical investigation, where the most outstanding researchers in the world will work, as for instance a world-renowned English researcher in the field of neuroimaging: he has accepted to join us only because of the possibility to have access to the patients. As a matter of fact, we have at our disposal DNA banks of about 30,000-40,000 patients. We also have brain banks. So, we handle a set of biological resources which are essential for our research. Originality is also due to the fact that the institute has allotted a whole floor — 3,500 m2 — to business incubators, so as to provide a prompt feedback between the patient, the research and the molecule. In this way, such a business incubator will be able to foster the development of entities for production and marketing which will be able to spread their wings once the products will have been worked out in our research facilities.
Finally, the last original feature of the Institute resides in its structure. In France we are acquainted with the traditional pyramidal management structure which often brings about a somehow slow administrative running, owing to a very strict hierarchy. The structure of the Institute is of an utterly different kind because of a flat organisation with 60 research teams of 5 to15 people working on 5 or 6 main topics, the general manager of the centre who is appointed by the board of directors and who has an international visibility — as he were a businessman just like the presidents of the American universities — with a deputy manager, in charge of administrative and financial matters. Instead of setting up big teams focussed on a specific pathology, there will be Transversal Research Programmes (TRP) in which the researcher will be a project manager, he will be backed up by a team in the field of neuroimaging, a team in the field of clinical medicine, a team in the field of proteomics, etc. The team is set up with some projects and contracts of objectives. These projects will be dealt with in close collaboration with public teams — INSERM, CNRS (National Centre for Scientific Research) and with some private partnerships either coming from the pharmaceutical field, who are endowed with research teams but who neither have at their disposal the imaging equipment nor the clinical means the Institute has; from now on the private teams will be financed by the ICM. These researchers will enter upon office on specific contracts of 3 or 4 years, depending on the projects. This was a general outline of the main features related to the running of this institute.
On the basis of these considerations, it must be taken into account the fact that both the initial set-up budget and the operating budget for the amount of 67 million has been collected and is nearly balanced, however if we want the institute to work in an effective way, we will have to find a yearly operating budget of about 10- 15 million euros. This budget will be made of one third of public funds, one third by means of private donations and finally the remaining one third will be secured by the valorisation of the research. Indeed, we strongly believe that the ICM (Institute for Cerebral and Medullary Disorders) is extremely important in order to allow research progress on spinal cord lesions, as we know too well that the column issue is twofold, the container and the contents. If nowadays we are able to solve the problem of the container — the bone and discoligamentous structures of the vertebral column — we still are confronted with the problem of the contents — the spinal cord.
The fight for the treatment of spinal cord disorders is a struggle which must not be contended with by the orthopaedists on one side, the neurologists and the neurosurgeons on the other; on the contrary, within the scope of neurosciencein an all-embracing perspective, we have to rely on the fact that the nervous system is something extraordinary, much more complex than a heart, with a dynamics of neurons which is absolutely unique.
ASN&J: You initially qualified as an orthopaedist. How have you come to involve yourself so much in the field of neuroscience?
GS: Life is made up of fortuitous events and as an orthopaedist, fortunately, I could attend a lot to the spinal cord and the vertebral column as well as to the tetraplegics. On the other hand, I was the Dean of the Faculty of Medicine: this enabled me to have a comprehensive view on all disciplines. Finally, I had the chance to work at Pitié Salpêtrière, which is the cradle of neuroscience. I quickly saw the opportunity to set up such a project. From that time on, everyone tells you “your project is brilliant, we have thought about it for 25 years but it is still a project”. You always need a sort of an inciting factor, a starter. The catalyst for this undertaking is a story of friends; I had gathered what we can call the “dream team”, starting with Jean Todt, and we had been working for a year together so as to see what we might do, afterwards we had gathered if not the best, remarkable people in their own areas of expertise who quickly adhered to our plan.
Among them I would mention Maurice Levy, Chairman of Publicis Groupe, public relations and media specialist, Serge Weinberg, Chairman of Weinberg Capital Partners and Chairman of the Board of Groupe Accor, who is also our treasurer, Jean Glavany, former minister, Max Mosley, President of the FIA Foundation, who has chosen to back up our project, Jean-Pierre Martel who is an outstanding lawyer, Louis Camilleri, Chairman of Altria, an American company, Luc Besson who is in charge of shooting a number of films for us, Michael Schumacher, Formula One racing driver who is helping us enormously, Lindsay Owens Jones, Chairman of L’Oréal who is responsible for the development as well as fundraising activities and, of course, Yves Agid and Olivier Lyon-Caen who are in charge of the scientific project.
So, we have a team who meet once a month — on Sunday — to work on the project of this institute on a voluntary basis, so that until a year ago we did not have any employees, not even a secretary. At present we have two secretaries; however, the other members of the team still volunteer their services selflessly. Jean-Michel Wilmotte, who is a very close friend, has accepted to carry out the futurist and magnificent architectural project of the institute, which is very functional, as we wanted this centre to be conceived in the same way as the Stade de France and the Bercy stadium: a structure which could be completely transformed within 24 hours. That is to say a 500 m2 laboratory apt to become a tertiary room in less than 24 hours. Everything is envisioned in this manner and is transformable according to our needs.
Of course, we had to find a balance between the budget envelope which cannot be increased, a splendid architectural project and then a scientific project which is viable and consistent. The team had to cope with this, we did a benchmarking study, by examining the universities worldwide, and our goal was to learn from their experiences so as to know about the mistakes we were not to make.
ASN&J: Does this institute have the vocation to be a centre of treatment also for the patients affected by neurological pathologies?
GS: No, it does not. In fact the patients are treated in specialised centres. If a comprehensive assessment is needed they can volunteer to take part in a clinical investigation; they come to ICM either for 24 hours in the outpatient department or they can stay on a weekly basis, and then they go back to the hospital where they are treated. So at ICM there is no medical care unit, it is rather a Centre for Clinical Investigation.
ASN&J: Is this scientific programme very much biologyoriented or is it rather a multidisciplinary programme?
GS: It is a multidisciplinary programme: there are genomics, proteomics, cell imaging, etc. Our aim is to tackle a problem from every point of view For instance, we are working with the Technological University of Compiègne — which has nothing to do with the medical field — in the branch of nanotechnologies, miniaturization and of image processing which will prove very useful in our research. With such a way of proceeding we will certainly need sociologists and philosophers as well. It is not solely a medical investigation we are aiming at; it is indeed a global approach with regards to the issue of brain and spinal cord injuries.
Professor Gérard Saillant is Chairman of the Institute of Cerebral and Medullary Disorders.
