Olivier Dunant was born in 1946, in Sevenoaks, Kent, England. He is a graduate of the University of Geneva Law School (lic. iur, 1969) and of the Southern Methodist University Law School (Master in Comparative Law, 1973). Olivier Dunant joined Borel & Barbey in Geneva (1974) as an associate and has been a partner of the firm since 1980. Borel & Barbey is a law firm based in Geneva, Switzerland, founded in 1907.
Olivier Dunant is a member of the Board of Directors of the Southern Methodist Law School (Dallas, Texas). He is also member of the Geneva Business Law Association, the Swiss Lawyers Federation, the Geneva Bar Association and the Suisse Romande Branch of the Society of Trust and Estate Practitioners (STEP). Olivier Dunant is General Honorary Consul of Norway since 1986.
Olivier Dunant focuses his practice on banking, finance and securities law, commercial and business law, corporate law, mergers & acquisitions, trusts & estates and international taxation. He is the legal counsel and trustee of families living in the United States and in Europe. He is a board member or trustee of several charitable or philanthropic organisations, including the Ludwig Institute for Cancer Research. He is also member of the board of directors of Swiss and foreign finance and banking organizations.
Please join Serono Symposia International Foundation in giving a warm welcome to Dr. Dunant.
Serono Symposia International Foundation
The first session proposed a series of lectures aimed at showing how MS populations are changing and the criteria to differentiate the various MS phenotypes. According to Per Soelberg Sørensen epidemiological studies performed in different geographic areas have shown that prevalence of MS can be explained considering, genetic, immunity factors, and environment. In particular the degree of genetic relationship strongly affects MS susceptibility demonstrating its importance in the development of the disease. This and other epidemiologic data were reviewed and in conclusion Sørensen intriguingly stated that disease-modifying therapies have changed the progression of disability and this should be considered in designing studies and enrolling patients in clinical trials, because response to treatments can be strongly influenced by the individual trend to progression.
Bruce Cree had an exhaustive lecture on the state of the art of genetic research in MS. If in the past the search for altered gene (or genes) responsible for the disease development was the priority, now the evidence collected suggests that “pathways comprising normal-functioning genes work together, in aggregate, to predispose to a disease state”. Then the speaker reviewed the available data on IL2R and IL7R polymorphisms and in particular on HLA-DRB1*1501 allele. The latter was demonstrated to have the higher impact on MS susceptibility and the speaker presented also the hypothetic mode of action of this polymorphism in the disease development. In a answering a question during the discussion concerning where research on MS genetics is going to take specialists, Bruce Cree stated that it could reveal how networks of genes by interacting could affect immune and nervous systems in each individual in a different way.
Helen Tremlet opened her lecture stating that benign MS is a reality. It should be considered as a transitory phase for most of the MS cases and the disease course is variable. Despite the lack of consensus on a standardized definition of benign MS and diagnostic criteria, the bulk of available data support her statement and suggest that tailored treatments are needed.
After an elegant presentation held by Christian Confavreux on Juvenile MS, Peter Rieckman introduced a critical issue related to disease management: the “patients’ willingness to take risks”. Results of clinical trials can be friendly presented to patients in a friendly manner to help them in evaluate the benefit-to-risk ratio of the different treatments. The speaker showed the results of a study performed in USA where 96% of patients preferred to be informed on therapeutic options. Interestingly, in the same population, 52% of subjects preferred to leave to their doctors the final decision, but some subgroups (e.g.: women) asked for a more active role in the treatment identification. Sharing information and decisions with patients, drop-outs may be reduced and disease management optimized.
In order to individualize the treatment of a disease like MS it should be carefully classified for each patient. Xavier Montalban, in the lecture that opened the second session of the Symposium, provided a comprehensive review of the available standardized criteria (quail) for MS classification. He clearly showed pros and cons of these tools when used in research and in clinical practice.
The progressive forms of MS represent a major challenge for specialists working on MS. Jaume Sastre Garriga stressed all the aspects of these forms, from the pathogenesis to diagnosis, and concluded that further simplifications in the MS diagnostic algorithm may help to better define progressive forms.
The last session of the Symposium was dedicated to new therapies and future perspectives in MS treatments. Robert Weissert’s presentation was focused on oral treatments. Drugs like fingolimoid and cladribine are producing promising results and could solve some unmet needs of MD treatment in the near future. They could overcome patient complaints about low manageability and side effects of injectable drugs and could also become part of sequential treatment regimens. Frauke Zipp opened her lecture on new injectable drugs claiming that if interferons and glatiramer acetate have limitations in tolerability, natalizumab and mitoxantrone, recently introduced in MS treatment, showed severe adverse events that suggest limitations in clinical use of these agents. The speaker concluded that there is still a need for better tolerated, safer and more effective medicines that are addressed to specific target, rather than non-specific immune suppression. The speaker provided a comprehensive overview of major line of research in this field.
In hope that new drugs will solve the present open issues in MS management, the use of available treatments should be improved to maximize benefits. Giancarlo Comi reviewed strategies ready to be implemented in practice, such as early treatment and use of higher doses of immunomodulators. Comi stated that there is a need to start these agents in the early phases of the disease, when inflammation is the prevailing pathogenetic mechanism, because it allows the possibility to obtain results that become more difficultly attainable in later phases. Intensive immunosuppression and combination therapies are further option and the speaker reported that 28 ongoing trials are evaluating the latter. The proposal of these more aggressive approaches introduces a question: is the traditional escalation strategy always the best solution for pharmacological treatments, or should an early aggressive treatment be considered, at least for some subgroups of patients? Future studies might provide more exhaustive answers to this question, but Giancarlo Comi pointed out that treating patients with mitoxantrone and IFN beta-1b has been shown to be more effective than IFN beta-1b alone in preventing relapse and progression of disability in patients with very active RRMS.
Gianvito Martino closed the Symposium with an outstanding lecture on emerging strategies targeted to neuroprotection, a MS unmet need only marginally influenced by available treatments. The most challenging issue in MS is that in each patient there may be several heterogeneous lesions, some of which are in an inflammatory phase, others that are in a degenerative phase. The speaker claimed that only stem cells can be so therapeutically plastic to produce different mediators and factors at the same time so that can either induce neurotrophic support or immune modulation, depending on the microenvironment. Gianvito Martino concluded that “stem cell therapy is definitely the future” in MS management, thus providing the specialists participating in the meeting with further hopes to dramatically improve the outcomes in their patients.
This symposium successfully gave an updated knowledge on the tools useful to classify or stratify MS patients according to their different phenotypes and thanks to the available and future treatments plus the increased knowledge in the long term clinical outcomes using these treatments, patients and doctors can see light at the end of the MS tunnel.
Tommaso Sacco
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LITERATURE REVIEW
Stem Cell Transplantation in Multiple Sclerosis is now available on the Serono Symposia International Foundation website |
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NEW ONLINE COURSE IN REPRODUCTIVE HEALTH & ENDOCRINOLOGY
Does LH play a role? Defining subgroups who may need LH in ART is now available on the Serono Symposia International Foundation website |
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TWO NEW ONLINE COURSES IN DERMATOLOGY
Psoriasis Management: Historical Perspective and Psoriasis Management: Patient Perspective are available on the Serono Symposia International Foundation website |
The program opened with a keynote lecture by Jan-Åke Gustafsson that exhaustively reviewed the role of alteration of estrogens signalling system on many tissues and functions. Estrogen receptor ß (ERß) dysfunction is based on a genetic alteration and seems to be involved in the alterations of reproductive functions, cancer development, autoimmune disease pathophysiology in females plus many other diseases and disorders. The subsequent session was dedicated to some major challenges in reproductive health and, in particular, to those involving the interaction between genes and the environment such as the decrease in male fertility related to the endocrine disruptors like phthalates, that induces, among other disorders, Testicular Dysgenesis Syndrome, the trends in incidence of breast and prostate cancer and the influence of genes and environment on Polycystic Ovary Syndrome (PCOS).
Session two was dedicated to the effects of polymorphisms of LH, FSH and androgen receptors and 5-alfa-reductase enzyme receptors on fertility, male reproductive system development and cancer pathogenesis. The methodological aspects of genomics, proteomics and the epidemiology of gene-environment interaction were addressed in the session that opened day two. In particular, Paolo Vineis exhaustively addressed the aspects of genetic predisposition to cancer that usually have a relatively small influence on the pathophysiology of the disease without the important contribution of environmental factors. Only highly penetrating and rare mutations have been more strictly related to cancer development. Starting from these considerations, the speaker introduced the limitations and methodological bias of gene-environment interaction studies. After a session dedicated to selected oral presentations, where young researchers presented interesting results of their work, the other lectures were dedicated to the methodology of gene-environment interaction. The environment may affect human reproduction not only through toxic compounds, but also with psychological and social conditioning. Moreover, infertility, whatever the etiology, and assisted reproduction techniques become, in some individuals, ground of stress and mood disorders. Four lectures addressed all these aspects stimulating a lively discussion with the audience.
The last sessions were focused on gene-environment interaction and on the consequences of this interaction on reproductive health, dealt from different points of view: the advanced research on damage of pollutants on DNA, the evaluation of consequences of this damage on natural and assisted reproduction as well as the role of public health. The round table that closed the meeting confirmed how useful and stimulating are events where an interdisciplinary topic, like gene-environment interaction, is treated and discussed by top level experts. The hope expressed by many participants in the event was that this Symposium will be repeated on a regular basis in order to offer scientists working in this field the opportunity to discuss the results of their research.
Tommaso Sacco
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I am clinical andrologist and chairman of the Reproductive Medicine Centre at Malmö University Hospital in Sweden. Academically, I am adjunct professor at the Lund University again in Sweden.
2) What are the main fields your activity is focused on?
Clinically, I am working with different aspects of andrology, the majority of my patients being men coming to me due to infertility problems and hypogonadism. However, at our centre we are not only seeing and offering treatment (including advanced assisted reproduction) to men and women with infertility problems. We have also experts within the areas of gynaecological and paediatric endocrinology, urology, clinical chemistry and clinical genetics. Our ambition is to be able to cover all aspects of reproductive medicine from the birth to the end of life.
Scientifically I am leading a research group, together with my wife Yvonne, focusing on gene-environment interaction in relation to the reproductive function. We try to apply a translational approach, performing clinical and epidemiological studies and working with in vitro models to enlighten possible mechanisms of disease.
3) What are the most relevant evidences gathered by the important epidemiological studies performed in andrology in which you participated?
During the period 2002-2006 we have been involved in a EU supported project focusing on the impact of the exposure to persistent organohalogen pollutants (POP), as PCB or DDE, on male reproductive function. In this international collaboration coordinated by Prof. Jens Peter Bonde from Århus (Denmark), we found that exposure to these compounds did have a negative effect on sperm motility and DNA integrity. The latter finding is rather worrying since it means that environmental exposure can lead to sperm chromosome defects, which might have implication, not only for fertility, but even for the offspring.
Another interesting finding was that although there was no difference in sperm numbers between those with high and low POP exposure in 20% of men, having specific variant of the androgen receptor gene, high POP exposure was associated with 40% lowering of sperm numbers. This is one of the first examples of gene-environment interaction in relation to semen quality.
4) Do you think that the information already available on the effects of pollutants on human fertility should bediffused in order to raise the attention on this issue? If yes, how?
We are facing a development which is potentially worrying. There are several indications of a time-related impairment of the male reproductive function, including declining sperm counts and increasing incidence of genital cancer and congenital abnormalities of male reproductive organs. Andrology has traditionally been considered as a “low priority” area of science. In view of the emerging epidemiological evidence backed up by experimental studies, it is necessary to increase the awareness about these problems. This can only be achieved by increasing funding for studies on environment and reproductive function. Furthermore, international collaboration on this topic is warranted and EU should make it on of the top topics on the scientific agenda.
5) Do you think that there are interventions, reasonable and sustainable, to reduce the impact of pollutants on human fertility? If yes, what type?
Unfortunately, our knowledge about the effect of specific environmental chemicals on male reproductive function is still very limited. Therefore, I think that we need more data before any reasonable and sustainable interventions can be made. However, what we know for sure is that mother’s smoking during pregnancy has a negative impact on the semen quality of her son. More intensive efforts should, therefore, be made to additionally reduce tobacco smoking, in particular that of women in fertile age.
Thank you very much.
Enno Christophers, in a keynote lecture that opened the Symposium, introduced the concept of psoriasis as a systemic disease, stimulating dermatologists in managing it not only to improve and heal skin lesion, but also to reduce the risks related to its co-morbidities. The first session of the meeting started with a lecture on how a full systemic disease could be diagnosed and managed, with the Metabolic Syndrome as a model where different diseases affecting several systems are combined and linked by common inflammatory mechanisms. The subsequent lectures were focused on some of the cardiovascular, metabolic and inflammatory diseases most frequently associated with psoriasis ending with a presentation that addressed an emerging topic: the efficacy of statins in the treatment of Alzheimer’s disease. Contrasting results, observed in clinical trials performed in this indication, were showed by Peter Passmore, geriatrician from Northern Ireland.
Christopher Griffiths with his lecture on “The evolving paradigm of psoriasis management” introduced the second part of the session, focused on psoriasis. Traditional treatment algorithms, used in psoriasis for decades, are being increasingly superseded by new approaches thanks to two major achievements: availability of biologics, highly effective in this disease, and advances in the understanding of the immunological and genetic basis of psoriasis. Pharmacogenomics will further improve the management of the disease through protocols tailored according to the individual response to therapy profile. A chronic disease such as psoriasis could last for decades thus a long-term perspective is needed. Three lectures were dedicated to this aspect that is now a mainstay for the top experts but not always accepted by patients and implemented by doctors, particularly in the primary care setting. Wayne Gulliver showed how epidemiologic studies observed that the inflammatory background of psoriasis is frequently shared by other chronic conditions like obesity, atherosclerosis and Crohn’s disease and the next speakers addressed the topic of the long-term pharmacological treatment of psoriasis.
In order to offer to participants the opportunity to interactively discuss topics and issues related to the practical management of psoriasis, the second session of this SSIF Symposium was organized as a series of workshops where the audience, divided in smaller groups, could meet some of the experts.
The second day opened with an exhaustive review of drugs under investigation in psoriasis therapy which could improve the therapeutic armamentarium of dermatologists. Peter Foley from Australia, addressed the topic of long-term safety profiles of biologics used in psoriasis. Interestingly, he concluded that “biological therapies appear to have a superior long-term safety profile compared to traditional psoriatic therapies” and that the different safety profiles of TNF-alfa-blockers and T-cell agents should be considered in the choice of treatment and must suggest a monitoring aimed to prevent and diagnose early more severe adverse events. The final lectures gave the audience a leap into the future of psoriasis treatment and other severe skin diseases and Giampiero Girolomoni, that closed the series of these lectures, offered an interesting link between the bulk of knowledge on psoriasis already available and future directions of research and clinics. Psoriasis must be approached as a chronic systemic disease on a long-term basis. Co-morbidities should be diagnosed and cardiovascular and metabolic risk profile defined in each subject. According to these characteristics, available treatments could be selected and included in comprehensive protocols, in order to reach the best therapeutic results in a safe way. Considerable unmet needs remain, but further insight in the pathogenesis of psoriasis could lead to other therapeutic options.
Tommaso Sacco
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This second edition of this major congress was titled “ART Paving the way for new frontiers - Celebrating 3 decades of ART” and is an answer to the European Society for Human Reproduction and Embryology (ESHRE) Annual Meeting that in 2008 is at its 24th edition (July 6-9 2008 Barcelona, Spain). The ASPIRE-PRSFS Congress is an important and strategic meeting point for all practitioners in ART, especially from ASIA-Pacific with an attendance of about 700 people.
In this scientific environment Serono Symposia International Foundation was present with a pre-Congress “Polycystic Ovary Syndrome” that took place on April 11. The one-day conference had speakers coming from Europe, Australia and Asia reviewing and discussing available data on the Polycistosis Ovary Syndrome (PCOS), in terms of diagnostic tools and management criteria of the disease, with particular attention to infertility in Asian patients.
Prof. Norman from Australia started the conference with a presentation on the different definitions of PCOS. It is a common agreement that PCOS is a metabolic chronic syndrome but there have been a number of definitions across the world and this has led to both doctor as well as patient confusion regarding this condition. The two that have some currency are the NIH Consensus Conference Definition which concentrates on irregular periods, hyperandrogenism and exclusion of other conditions, and the Rotterdam criteria that incorporates irregular period, hyperandrogenism and ultrasound of the ovaries with two out of three being essential with the exclusion of the other conditions. The use of the Rotterdam definition was strongly recommended for the Asian PCOS patients and the need for a single international definition of the disease using simple criteria that are relevant for all the population groups was stressed.
Prof. Bruno Lunenfeld presented an elegant talk on the pathogenesis of PCOS and how this chronic syndrome is expressed differently during childhood, puberty, adolescence, the reproductive period, menopause and senescence. He highlighted the health risks associated with PCOS such as diabetes, infertility, complication of pregnancy, endometrial and breast cancers, cardiovascular diseases and stroke.
Prof. Moon from Korea gave an overview of the genetic background and the environmental components of the disease. In spite of the etherogenicity of the phenotypes, he presented date demonstrating that there are several genetic loci associated with PCOS such as CY11A (the P450 cytocrome side chain cleavage enzyme encoding gene), CAPN10 (calpain-10 encoding gene), the insulin gene VNTR and others.
Three different speakers covered the management of PCOS. The first line treatment must be an appropriate attention to diet and weight management as well as exercise. Secondly, the use of clomiphene citrate or metformin is advised, the latter also to reduce insulin resistance. Gondadotropins were presented as an excellent form of treatment at low doses and data on the use of GNRH antagonist protocols was also offered to reduce the high risk of Ovary Hyper Stimulation Syndrome (OHSS) that is very common in these patients. Safer treatment options were proposed with a combination of oral contraception pill pre-treatment, GnRH antagonist protocol and advanced Vitrification techniques.
After a very good panel discussion, Prof. Lunenfeld concluded the day summarizing all the critical topics covered and highlighting how it was relevant this working day on PCOS only focused on the Asian population.
The involvement of SSIF in these International Congress will continue this year during the 24th edition of ESHRE with a Reproductive Health Academia once again demonstrating the Foundation’s commitment to deliver education in the most prestigious arenas.
Monica Lispi
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Assisted reproductive technologies include ovarian stimulation in the majority of the cases. In the recent years, experience accumulated in the treatment of infertile couples led to the individualization of ovarian stimulation protocols. Every patient needs to be treated according to strategies developed with the help of basic science research devoted to a better understanding of ovarian physiology. This symposium therefore includes basic science and clinical experience.
Technological advances in the field of infertility treatment have been implemented over the last few decades without the necessary time for consideration of their ethical implications. The moment has definitely come for a gathering of professional stakeholders who deal on a daily basis with some of the most daunting ethical dilemmas faced in medicine today. This conference is designed to highlight some of the most challenging scenarios and to discuss and attempt to resolve, within an ethical framework, some of the conflicts that have arisen between our capacity to deliver treatment and our professional obligation to do so.
The objective of this course is to provide participants with the most updated knowledge on IVF procedures and with skills useful in IVF practice. At the end of the workshop, among the various learning objectives, the attendees will have acquired information on the current ethical, regulatory and legal issues on IVF in Europe, the ability to diagnose infertility in males and females, the background needed to choose the right IVF procedure and the best way to interact with patients.
The objective of this workshop is to provide its participants with up-to-date information and views on Multiple Sclerosis (MS) in order to ensure optimal disease and treatment management of persons living with MS.
This is an educational programme created to encourage the dissemination of scientific knowledge in the field of MS. It will stress the benefits of new diagnostic tools for defining the natural history of MS and disease activity monitoring. Current diagnostic criteria for MS will also be reviewed in the light of new medical evidence. A review of recent clinical trials and treatment optimisation guidelines will also be presented.
This is an educational program created to encourage the dissemination of scientific knowledge among nurses from all over the world in the field of MS.
GH/IGF-I/IGFBP-3: Metabolic Syndrome and Chronic Diseases; June 12-14, 2008; Sao Paulo, Brazil
The aim of this symposium is to present the current state-of the-art in diagnosis as well as therapy of endocrine and cardio-metabolic disorders in a highly scientific environment. The attendees can be continuously updated on synergies among endocrine, cardiovascular and metabolic disorders over the next couple of years.
A New Era in Management of Psoriasis; May 22, 2008; Istanbul, Turkey
