Background: Chronic diseases (CDs) now account for 85% of all deaths in Chile, the most prominent being cardiovascular diseases (CVD, 27%), followed by cancer (26%) (WHO – Noncommunicable Diseases Country Profiles, 2018).

Advanced Center for Chronic Diseases (ACCDiS):  This is the first Chilean Center of Excellence to study CVD & cancer. Abi-institutional center incorporating the University of Chile (UCH) and the Pontifical Catholic University of Chile (PUC), ACCDiS is financed by the (FONDAP, Funds for Research Centers in Priority Areas) program of the Ministry of Science, Technology, Knowledge and Innovation (ANID). Funding was previously granted by CONICYT within the Ministry of Education. The goal of ACCDiS is to observe and dissect the natural history of CVD and cancer in Chile. The 6 Research Lines (RLs) and corresponding Principal Investigators (PIs) are:

  1. Metabolic signaling in heart failure (S Lavandero, UCH)
  2. Gender-related differences in the heart (P Castro, PUC)
  3. Tumor cell biology and inflammation (A Quest, UCH)
  4. The epigenomic landscape of gastric cancer (A Corvalán, PUC)
  5. The natural history of digestive cancers (C Ferreccio, PUC)
  6. Nanomedicine and chemical science for the diagnosis and therapy of CD and cancer (M Kogan, UCH).

Organizational strategy: In the promotion of synergy and collaboration, ACCDiS has organized: a) Academic Council zoom meetings; b) Scientific zoom meetings with internal ACCDiS speakers or invited national/international speakers; c) The ACCDiS annual retreat; d) Specific meetings to promote interactions in the areas of CD & cancer; e) Mentoring sessions for young investigators; f) Core Facility Coordination Meetings; g) Administrative meetings, and h) ACCDiS WhatsApp groups.ç

Integration strategy: To favor the integration of research efforts, we adopted the general strategy of focusing research on two principal topics of interest: heart failure and digestive cancers. Under this framework we narrowed the research lines (RLs) to epidemiology of heart failures, digestive cancers, angiotensin-(1-9) [Ang-(1-9)], exosomes and nanomedicine. To carry out this investigation we a) recruited PhD, MSc students, and post-doctoral fellows to work on (transversal) problems of interest. Special funding was established to promote collaborations on the   epidemiological Maule Cohort (MAUCO) project () 2) and in the set-up of core facilities providing support in the Basic, Preclinical, and Clinical (BPC) Core Facility.

Results: Now seven years as an operational center, ACCDiS continues to contribute to the formation of public health policy in Chile. Furthermore, ACCDiS generates technology transfer, participates as a center of reference (experts)on issues of national interest and is one of the key protagonists in the dissemination of science in Chilean society.

At year 7, ACCDiS has 6 PIs and 21 Associate Investigators (AIs) within a total of 272 people working in the 6 RLs, MAUCO and/or the two core facilities. The ACCDiS organizational structure incorporates an Administrative Office, an Academic Council, an Innovation Committee, an International Scientific Committee, and a National Advisory Committee.

In Advanced Training of Human Resources: Since 2019, ACCDiS has mentored 28 post-doctoral fellows, 40 undergraduate and 126 postgraduate students. Of these, 46% of the postdocs, 13% of the PhD and 5% of the MSc students are/were co-mentored between ACCDiS members from different RLs. Of the students and post-doctoral fellows in training at ACCDiS, 13% are foreigners. ACCDiS PIs and AIs coordinated and taught in various PhD, MSc, and undergraduate courses at both universities. The MAUCO initiative incorporated academics and undergraduate students from universities within the surrounding area (lower central Chile).

In Research: The MAUCO project. By December 2020, 9,277 participants had been enrolled. Of these, 6,998 participants have completed the year-2 follow-up, and 4,167 the 4-year follow-up (currently ongoing). The baseline characteristic of our population and the incidence of cardiovascular and cancer events have been published. Under an initiative of ANID, the Sentinel Center for COVID-19 was founded in MAUCO to establish a surveillance system in the county of Molina. In respect to publications & patents, during 2020 the Center published 87 ISI-indexed manuscripts, of which 18% were published in top 10 journals and 63% in Q1 journals. Furthermore, 18% were in collaboration between the RLs and 41% and 78% were in collaboration with international and national research centers or groups, respectively. The average ISI impact factor was 5.05. The Center has accumulated 14 patents (1 provisional and 13 new applications) and 2 licenses in the area of bioinformatics. The cumulative indicators obtained and expected (originally estimated, shown in parenthesis) are: ISI papers: 158 (131); papers in top 10 journals: 31 (24); papers published in Q1 journals: 87 (78); and average ISI impact factor: 4.91 (4.56). Of note is that almost all of our forecasted values have been exceeded.

In Outreach to Society: During these seven years of execution, ACCDiS has implemented and continued with its Communications Plan. This past year the Center was recognized by the SCImago Institutions Ranking (SIR) 2020 as the third most influential scientific institution in Chile. The obstacles resulting from the pandemic during this last year were overcome, and the events continued online. This had a positive impact on the 17 provinces of the Metropolitan Region that are encompassed in the ACCDIS Explora Regional Associative Program and the community in general. Our outreach indicators in the last year 2020 are 279 reports on websites, 9 newspaper articles, 26 television interviews, 510 appearances on social networks, and 36 radio interviews. ACCDiS also organized and participated in 153 face-to-face and virtual events to disseminate science and technology from 2019 to 2020 to more than 65,000 people. Through the Sentinel Center, the MAUCO Project has maintained a high communication level with the community of Molina during the COVID-19 pandemic. In relation to COVID-19, our researchers have been invited to various outreach activities with local and regional authorities, with health personnel from the Molina county and the general community.

In International Networking: We have active collaborations with outstanding international research centers in CVDs, cancer, epidemiology & nanobiomedicine. Moreover, 41% of our ISI papers were published in collaboration with international collaborators. MAUCO is in the international arena of large prospective cohorts (Director CF is a member of the steering committee of the International Hundred K Cohort Consortium), the largest cohort consortium worldwide.

In Contributions to Public Policies: MAUCO has been supporting the development of an endoscopic unit for Helicobacter pylori detection to be made available to the Molina community. The Sentinel Center for COVID-19 in MAUCO organized a network to study COVID-19 in Molina, which collaborated with local and regional authorities on public policies during the pandemic. ACCDiS members participated in drafting the new Cancer Law (September 2020) and developing the new Chilean guidelines for the management of heart failure and gastric cancer. Our PIs and AIs are advisers to national and international organizations such as IARC, American Association for Cancer Research (AACR), Pan American Health Organization, Ministry of Health, Ministry of Science, Technology, Knowledge and Innovation, Maule Regional Health Council, and the Antofagasta regional government. This year, our main concern was the impact of the COVID-19 pandemic on CDs’ control and management. We have become a scientific partner of the Molina Hospital, the Municipality of Molina, Municipality of Independencia, and their community organizations. We have focused on having a significant impact on the early prevention of CDs through education and intellectual development of school-age children, in addition to intervening with youth and adults.