Interview with Prof G. London

Prof G. London Department of Nephrology Manhes Hospital Fleury-Merogis, France

Prof Zoccali:Even though you are a mature clinician, in a way you are a post-modern nephrologist. First generation nephrologists focused exclusively on mechanisms responsible for kidney diseases, while for almost all your career you have been fascinated and have thoroughly investigated cardiovascular and renal hemodynamics and the structure-function relationships of the arterial system in patients with hypertension and kidney diseases. You had vision because the terrain of your expertise is at a central stage in nephrology.

Prof London: I started my medical studies at Charles University in Prague in September 1960. Compared with today's knowledge it was "Middle ages". The development of knowledge and information in the following years was incredible and it inevitably led to specialisation and to slicing the medical practice into multiple specialisation. This approach was different from what we had in the sixties when we used to consider the patient as a complex but unique entity. This approach was the reason why I decided to specialise in nephrology. Indeed, when I made this decision in 1968 nephrology was probably the largest clinical specialisation including a complex metabolic and physiological approach, chronic kidney disease, acute renal failure, clinical immunology, transplantation and hypertension. Hypertension and the complex systemic and renal hemodynamic physiology was for me one of the greatest interests. One of the reasons was that this field had been largely developed by Jan Brod and his co-workers in Prague. In Paris I had the chance to pursue my nephrology "training" at Broussais Hospital where I met Dr Michel Safar who was one of the pioneers in the domain of hypertension and hemodynamics. We worked with him on multiple aspects of hemodynamic alterations in different forms of hypertension including renal hypertension. In the beginning we were principally working on central hemodynamics, but progressively we started to study more specific aspects like arterial function, low-pressure cardiopulmonary system function, microcirculation, etc.

Prof Zoccali: You were the first investigator to focus on mechanisms responsible for arterial rigidity in CKD. What led you to investigate this area, which proved to be so crucial in explaining the high cardiovascular risk of patients with renal insufficiency?

Prof London: In parallel with my work in Broussais with Michel Safar (now Prof) I was in charge of the department of Nephrology and Dialysis at Manhès Hospital. It was absolutely natural to apply all the techniques and investigations used to perform with Michel in Broussais to hemodialysis and CKD patients, since the cardiovascular complications were the leading cause of morbidity and mortality. It soon appeared that the arterial problems were one of the principal causes of these complications.

Prof Zoccali: Who were your mentors in nephrology and in cardiovascular medicine and how important have they been in your career?

Prof London:As I have already mentioned Jan Brod and Michel Safar largely influenced my career. But I should also mention Prof Paul Milliez who was the Chief of the Medicine at Broussais Hospital, and Prof Jean Hamburger in Necker where I started my training in Nephrology. Finally I cannot forget Prof Jean-Marie Idatte and Jean-Pierre Grunfeld.

Prof Zoccali: Who are the colleagues with whom you have established fruitful scientific and human collaborations?

Prof London: The list is long and I would just like to mention the main ones: Michael O'Rourke, Stéphane Laurent, Alain Tedguy, Bernard Levy, Antonio Santoro, Eduardo Slatopolsky, Timan Drüeke, Francisco Llach, and many others.

Prof Zoccali: Which is the research theme that intrigues you most at present?

Prof London: Presently, we are working principally on the different aspects of arterial and endothelial function (dysfunction). One of the themes concerns the calcification of the cardiovascular system – pathophysiology, consequences, prevention and treatment. The second theme concerns the interaction between determinants of shear stress and endothelial response, and the role of shear stress alterations on different aspects of arterial dysfunction in CKD and ESRD patients. One of the most interesting themes concerns ageing of the cardiovascular system in association with the systemic effects of ageing.

Prof Zoccali: How do you split your time between clinical and research activity? How should the vexing problem of competition between time spent on the ward and in the lab be solved?

Prof London: I would say 50% clinical and 50% research and teaching. It's not always easy to solve the problem but we have a good team and good internal organisation with my colleagues.

Prof Zoccali: Who is you favourite writer? Which book are you reading at the moment?

Prof London: Kundera, Mankell, Roth, Semprun, but also History books and biographies (!!!). Now I am reading Alexander the Great's biography.

Prof Zoccali: Which is the scientific paper that has arisen the greatest emotion in you?

Prof London: I cannot mention just one, but I am fascinated by those works concerning stem cells.

Prof Zoccali: Which hobbies do you have?

Prof London: Wine, cuisine (tasting it), ski, hiking, cinema.

Prof Zoccali: The final question is an embarrassing one. Please rank French, Italian and Californian wines...

Prof London: White wines – French Burgundy (Montrachet, Chevalier Montrachet, Batard Montrachet, Charlemagne, Meursault). For red wines I would choose French and Italian wines. The ranking is very difficult since I have tasted so many good wines produced in both these countries. Personally I have a small preference for Pinot Noir and French Burgundy (since Pinot Noir originates from Burgundy and the one grown in the rest of the world, even if it's improving, has still to make some progress).