Among medical specialties, pathology is considered the science of diagnosis. Having diseases as its main object of study, the area examines blood, liquids, secretions, and tissues taken from different organs, seeking to understand the nature of the problem and help other health professionals to give accurate diagnoses. This medical specialty interacts with all the others, which is why it’s also a strategic research area at the D’Or Institute for Research and Education (IDOR) for its translational studies, which connect basic and laboratory research with healthcare.
At Rede D’Or, pathologists act very closely with the physicians directly involved in patient care, and this model benefits both basic and clinical research. It also has one of the most complete and technological infrastructures in the country: the Pathological Anatomy laboratory complex of IDOR / Rede D’Or, which has units in Brasília, Salvador, Rio de Janeiro, and São Paulo, the last city being its main center and headquarters of the Molecular Pathology laboratory.
Working with the same integrated database in all units, the laboratory complex performs biochemical, cytological, histological, immunohistochemical, and molecular analyses to understand the nature of the investigated processes and arrive at a diagnosis. The recent incorporation of molecular tests into its arsenal has profoundly transformed medical practice, enabling the so-called personalized medicine, in which the recognition of markers that explain the development of the disease allows the orientation of more appropriate treatment for each patient.
“The purpose of the laboratory is to be a hybrid between patient care and research support. It’s very complete and carries the infrastructure to work in all molecular pathology areas. In terms of technology, it is comparable to the main laboratories in the world, but the great difference in this complex is the connection between the researcher and the physician. This is personalized medicine and integrated research”, comments Dr. Fernando Soares, pathologist and leading researcher of the pathology area at IDOR and Rede D’Or.
The new laboratory represents a great achievement for assistance due to its complete diagnosis technology, and a leap in research, which aims to seek predictive biomarkers related to the evolution of diseases and their response to treatments.
Another approach is to understand the etiopathogenesis (origin) of the diseases through the analysis of morphological alterations in cells and tissues and to correlate these findings with the development of pathologies. “One of our goals in pathology research is to carry out translational studies that can permeate and unite clinical questions with morphological and molecular answers. This is what we call precision medicine”, details the researcher.
a. Molecular panels for detection of genetic material variants of tumors (DNA and RNA);
b. Panels for liquid biopsy for identifying genetic material of tumors in blood circulation, relating these findings to the evolution of the disease and responses to treatment;
c. Methylation panels for recognizing epigenetic alterations and understanding their correlation with the evolution of diagnosed cancer;
d. Spatial biology analysis, which combines morphological analysis of the tumor tissue with the molecular profile of cancer to characterize different cell populations in tumors;
e. Transcriptome and RNAseq analysis.
This scanner is capable of scanning thousands of samples per day and is primarily used for DNA analysis. Some lines of research at IDOR, such as Epigenetics, use this equipment for DNA methylation analysis.
Digital RNA and spatial biology analysis platform (a frontier science of molecular biology, which studies tissues in three-dimensional contexts and regards their environment, being able to identify aspects that are not possible through sequencing or other technologies. It has been especially used in oncology and neurobiology studies).
Advanced equipment that performs sequencing of the entire genome, exome (hereditary diseases), and large-scale sequencing of RNA, among others.
State-of-the-art sequencer that simplifies and accelerates genomic analysis. It’s used for several applications in research, clinical diagnostics, and precision medicine.
These are some of the equipment available for analysis at the laboratory complex, which is still expected to expand to other Brazilian cities in the coming years.
As if the project of leading the pathology laboratory was not challenging enough, Dr. Fernando Soares is also leading the structuring of the Biobanco IDOR / Rede D’Or, which is a national biobank that will store biological samples from patients for use in research.
This sample collection is of great relevance not only for research in pathology but for any translational study. At the moment, the project has some Biological Analysis Processing Centers and is already receiving some samples for storage, a collection that will be nationalized after the official start of the biobank’s activities. “After the final approval, we will start the ant work along with the hospitals, because feeding a biobank requires an instrumental preparation. Creating a biobank is laborious, time-consuming, and somewhat anonymous, as it doesn’t return with traditional recognition expectations, such as a publication in the Nature journal. However, the biobank allows you and other scientists to do great research – and great publications to emerge – from that data. The biobank is not a project, but an essential research instrument”, explains the pathologist.
Having over 500 publications in international journals and the curriculum of the former president of the Brazilian Society of Pathology wasn’t enough reason to make Dr. Fernando Soares conceited. He believes in the importance of leaving a better structure to his younger
colleagues and future researchers in Brazil. In addition to his great contribution to the area of oncological pathology — being the first Brazilian pathologist to join the standing committee of the World Health Organization (WHO) for the classification of tumors — Dr. Soares also has over 25 years dedicated to the construction of biobanks, a role that he still alternates between his duties as a professor at the University of São Paulo, a pathologist at Rede D’Or and a researcher at IDOR.
“My routine is divided into a tripod of assistance, administration, and investigation. In addition to research, part of my day is dedicated to medical activity and assistance with diagnosis, another part is to the administrative organization of Rede D’Or, such as organizing the databases, and there is also the support I offer to my Ph.D. students and residents”, shares the professor, who is also associated with the Doctorate and Residency in Pathology at IDOR.
Managing and structuring research environments is a signature of the pathologist, who maintained this modus operandi throughout his career. When he arrived at Rede D’Or, about 5 years ago, the pathology area wasn’t perfectly structured for developing translational research, so he accepted the mission to do this. “IDOR was already fantastic in basic research, but the translational development in pathology was still lacking. I came from scratch, I had to form a team, build a structure, and these efforts were crowned with the start of the Pathological Anatomy laboratory activities. Today I have files, databases, samples, and professionals. I feel that my role is to add even more to the possibility of research at IDOR.”
Besides his research, when asked about leaving an important legacy for other researchers and society, Dr. Fernando Soares believes that collective work and the construction of a functional environment for research are successful strategies for any specialty.
“I’ve always seen with great sadness the careers of some excellent researchers who left no legacy. The day they retire, the laboratory is locked and nothing else is produced there. I think that if the system works, I do too, because we all surf the wave of organization. When everything is organized, everything flows, it becomes almost like a machine. Perhaps my greatest virtue is organizing people and providing conditions for them to develop and give their best. Those with talent need a base behind them, and it’s wonderful when the whole group works. I am most proud to hear that my department works well. This Fernando is fleeting, it’s just a part – I hope an important part (laughs) –, but it will pass. And if the structure remains solid after this passage, that is what matters to me”, he concludes.
Written by Maria Eduarda Ledo.