How a hospital’s research is transforming healthcare in Brazil

What does it take for a hospital team to make a difference on a national scale? At Hospital Israelita Albert Einstein in São Paulo, a group of neuroscience researchers is striving to improve stroke care — addressing one of Brazil’s most pressing health challenges¹. Heading the team is Gisele Sampaio Silva, a neuroscientist who trained in neurocritical care in Brazil and the United States. A clinical trial led by Silva is the largest undertaken globally to determine the ideal blood pressure level following ischemic stroke, enrolling more than 4,000 patients across Brazil. “By addressing this critical question in stroke management, the trial has potential to redefine standards of care and significantly improve outcomes for patients worldwide,” says Silva.

Einstein is collaborating with the Brazilian public health system on 38 projects through the PROADI-SUS programme, 12 of which focus on research. This highlights the organization’s commitment to advancing health in Brazil through research, care, teaching and innovation. Einstein, which ranks 28th in Newsweek’s World’s Best Hospitals 2024 and first in Latin America, manages 65 public and private care units, and 20 research, teaching and innovation units.

In 2018, Einstein launched its Academic Research Organization, which quickly made an impact, conducting large-scale clinical trials and collaborating with government agencies, pharmaceutical companies, and research centres in Brazil and beyond. In 2023, the organization invested R$144 million (more than US$24 million) in research, which spans molecular genetics, cell therapy, big data, chronic diseases, infectious diseases and ageing.

Before her time at Einstein, Silva had already played a pivotal role in transforming stroke treatment in Brazil. While in Boston, Massachusetts, she trained in mechanical thrombectomy — a technique that uses a catheter to remove blood clots from the brain following ischemic strokes. Returning to Brazil, she was determined to broaden access to this life-saving procedure.

Initially, the Brazilian public health system did not cover the procedure, restricting its availability to private hospitals. However, Silva and her colleagues in the Brazilian Stroke Network persuaded federal health authorities to approve its use. Their success came only after conducting a clinical trial² that demonstrated the technique’s safety and efficacy in a middle-income country. “This research changed the way we treat patients here,” Silva says.

Bringing CAR T therapy to Brazil

Einstein has also distinguished itself within Latin America in areas beyond stroke research and care. Thanks to the work of the haematology team, the institution recently became one of the first hospitals in Latin America to provide CAR (chimeric antigen receptors) T and CAR NK (natural killer) cell therapy to patients.

CAR T and NK cell therapy involves removing the immune cells from a patient and genetically modifying them to boost their cancer-destroying capabilities. They contain receptors that recognize specific antigens on the surface of cancer cells and attack them. The therapy is primarily used to treat hematological diseases such as various types of lymphoma and leukaemia.

Haematologist, Lucila Kerbauy, completed a research fellowship at the MD Anderson Cancer Center, where she focused on immunotherapy using enhanced NK cells from umbilical cord blood. She brought her expertise back to Einstein to expand access to life-saving treatment and conduct new research. With the support of a grant from the American Hematological Society, she worked to develop CAR T and CAR NK cells that target multiple myeloma. “I needed to bring cell therapy to South America, because we did not have much to offer our patients,” she says.

Only one other institution, the University of São Paulo, is conducting research on CAR T cells that were produced by their own researchers, but Einstein was the first to establish a clinical trial approved by the National Health Surveillance Agency³. The trial, which began in 2022, uses CAR T cells to attack cancers with CD19 antigens — commonly found in many blood cancers — in patients where first- or second-line treatment did not work, or who have relapsed.

“Participants were selected from different parts of Brazil, and from both the private and public health systems,” says Kerbauy, advanced cell therapy medical coordinator in Einstein’s cell therapy department. “We are trying to give everyone the opportunity to receive treatment.”

Improving health through nature

Increasingly, the medical community is realizing that good health is achieved not just through medical interventions but also by ensuring that people connect with nature. A growing body of research⁴ shows that time in nature can lower stress levels, reduce anxiety and depression, lower blood pressure, and improve immune function, among other benefits.

Eliseth Ribeiro Leão, a senior researcher at Einstein who studies how exposure to nature can improve health, has found that even simply viewing images of nature can provide health benefits in hospital settings. Her team has used these positive nature images — the e-Nature Positive Emotions Photography Database⁵ — as complementary care in patients undergoing chemotherapy. “This helped to reduce negative moods, increase positive moods and reduce clinical symptoms, such as pain and fatigue,” she says.

Leão leads the e-Natureza (e-Nature) research group, which conducts interdisciplinary studies on the connection between nature — particularly the unique ecosystems of Latin America — health, and well-being. “Existing knowledge about the connection between nature and health is scarce in the Global South,” she says. “Applying results from studies generated in the northern hemisphere may not be appropriate, because the natural environments and sociodemographic characteristics there are very different from Brazil.”

The e-Natureza group recently created a model⁶ called ‘A time with e-Nature’. It aims to deepen the connection to the natural world through activities such as birdwatching or nature photography. Alongside research, the model can also be used for training healthcare professionals and managers of natural areas. The group produced two free online courses, available on an Einstein teaching platform. Leão is now developing a randomized clinical trial on the impact of direct exposure to natural environments and indirect exposure through nature images on the immune system in people over 50.

“Understanding the importance nature in health can lead not just to better health outcomes, but also to greater support for conservation efforts, which is crucial to preserve biodiversity and address climate crises,” Leão says. “Our research has provided directions for society to adopt pro-environmental behaviours, which are so necessary for a healthy planet and healthy people.”

Looking ahead, all three researchers agree on the importance of continuing to work to improve access to the most appropriate health care and on how important research is to achieve this goal. At Einstein, Kerbauy says, “we aim to get good treatments to as many patients as possible.”