Foundation I.R.C.C.S. Carlo Besta Neurological Institute
Dr Fabrizio Tagliavini
The Foundation I.R.C.C.S. “Carlo Besta” Neurological Institute – was founded in Milan at the end of the First World War to treat veterans with head injuries. It became a public body in 1923 and underwent considerable development in the early 1930s thanks to a generous donation by Piero Puricelli who supported neurologist Carlo Besta’s far-sighted idea of uniting clinical neurology, neuroradiology and neurosurgery in single specialist structure for treating neurological diseases and also for carrying out neurological research. In 1935 the first pediatric neurology clinic in Europe was created within the Institute. The clinic eventually became a Department and was further expanded in 1960. In 1952, the Institute was designed “Specialized Institute for Research and Treatment” of neurological disorders and in 1981 was recognized as I.R.C.C.S. by the Italian Ministry of Health. In 2006, and with the support of the Region of Lombardy, Italian Ministry of Health and Municipality of Milan, the Institute became a Public Foundation. The Besta Foundation is a recognized center of excellence for neurological research and the treatment of the major neurological diseases. The scientific director is dr. Fabrizio Tagliavini.
The neuro-oncology area in the Foundation I.R.C.C.S. Carlo Besta Neurological Institute has been growing steadily and, at present, is organized in a functional department. The department of Neuro-Oncology includes all branches of brain tumor’s diagnosis and therapy, aiming to the best integration of disciplines to ensure complete care of patient. Brain tumor diagnosis includes state of the art neuro-imaging (with 1.5 and 3T machines), and integrated diagnosis combining neuropathology and molecular genetics. Neurosurgery, with more than 1000 craniotomies per year, features stereotactic and frame less biopsy, awake anesthesia and intra-operative monitoring of functional area in low-grade tumours, endoscopic approach of deep brain tumors. Intra-operative fluorescence microscopy with 5 ALA or fluorescein and intraoperative ultrasounds are routinely used to optimize aggressive tumors resection. Conventional radiotherapy complemented by radiosurgery with Cyberknife in patients with acoustic neuroma, meningioma brain and spinal metastases. Two clinical units are devoted to medical therapies with increasing focus on clinical trials, a critical part of clinical research at the Besta Institute.
The Department of Neuro-Oncology of the Institute has a wide range of projects in clinical and laboratory research. The major focus is on glioblastoma and other malignant gliomas. One area of growing relevance relates to the novel use of ultrasound devices to improve identification of tumor borders.. The Institute has pioneered and is sponsoring cancer immunotherapy in the neuro-oncology arena: two trials based on the use of clinical grade dendritic cells manufactured in the Unit for the Production of Therapeutic Cells (UPTC) are presently ongoing. Other immunotherapy trials based on on the inhibition of the PD1 immune checkpoint are ongoing . Other studies have included the use of alternate electric fields and bevacizumab, the anti VEGF antibody that we pioneered in Italy for the treatment of globlastoma. On the border between clinical and laboratory research is the TheraGlio program, funded by the European Union Seventh Framework Programme. TheraGlio wants to develop a multimodal imaging system for Theranostics (therapy+diagnosis) of malignant gliomas. This technology will use new generation Microbubbles that can simultaneously act as drug delivery system and contrast agent for MRI and intra-operative Contrast-Enhanced Ultrasounds. Radiobiological study on meningioma and endothelial cells are active as also prospective clinical studies on the radiosurgery of meningiomas and acoustic neuromas. A promising collaboration on the diagnostic use of Delayed-Contrast MRI in glioma manangenment is ongoing between our Neuroradiology Unit and the Sheba Medical Center in Israel. A critical tool for our research is the Brain tumor Biobank, a member of the BBMRI network (www.bbmri.it). The bank allowed our collaboration to important international projects like TCGA and also with the Cancer Genetics department at the Columbia University and the Neuro-Oncology Unit at Pitié-Salpetrière in Paris. The department is also equipped with tools for the genetic analysis of sporadic and familial tumors, like neurofibromatosis type 1. Next generation sequencing analysis of brain tumors (adult and pediatric gliomas, in particular) is under development. One important focus of the laboratory research of the department is on cancer immunology and biology. The main projects are presently related to correlations between glioblastoma microenvironment and the immune system, the role of NK and NKT cells in immunotherapy studies using dendritic cells or other vaccines and the interactions with chemo- and radio-therapy with immune responses. Another major project is dedicated to glutamate transport in glioblastoma and its relevance in edema formation.
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