Paolo Zamboni (born 25 March 1957,
Ferrara
Ferrara (, ; egl, Fràra ) is a city and ''comune'' in Emilia-Romagna, northern Italy, capital of the Province of Ferrara. it had 132,009 inhabitants. It is situated northeast of Bologna, on the Po di Volano, a branch channel of the main stream ...
,
Italy
Italy ( it, Italia ), officially the Italian Republic, ) or the Republic of Italy, is a country in Southern Europe. It is located in the middle of the Mediterranean Sea, and its territory largely coincides with the homonymous geographical re ...
) is an
Italian
Italian(s) may refer to:
* Anything of, from, or related to the people of Italy over the centuries
** Italians, an ethnic group or simply a citizen of the Italian Republic or Italian Kingdom
** Italian language, a Romance language
*** Regional Ita ...
doctor and scientist. He is full Professor and Director of the School of Vascular Surgery at the
University of Ferrara
The University of Ferrara ( it, Università degli Studi di Ferrara) is the main university of the city of Ferrara in the Emilia-Romagna region of northern Italy. In the years prior to the First World War the University of Ferrara, with more than 5 ...
in Italy.
He is known to have discovered, identified and described a vascular disease called
chronic cerebrospinal venous insufficiency
Chronic cerebrospinal venous insufficiency (CCSVI or CCVI) is a term invented by Italian researcher Paolo Zamboni in 2008 to describe compromised flow of blood in the veins draining the central nervous system. Zamboni hypothesized that it migh ...
(CCSVI)
strongly related with
multiple sclerosis
Multiple (cerebral) sclerosis (MS), also known as encephalomyelitis disseminata or disseminated sclerosis, is the most common demyelinating disease, in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This d ...
and other neurodegenerative diseases such as
Ménière and
Parkinson.
Biography
Graduated with honors in Medicine and Surgery in 1982, Zamboni specialized in General Surgery in 1987 and in Vascular Surgery 1992. In 1992 he obtained the fellowship at the Department of Vascular Surgery of the
University of California
The University of California (UC) is a public land-grant research university system in the U.S. state of California. The system is composed of the campuses at Berkeley, Davis, Irvine, Los Angeles, Merced, Riverside, San Diego, San Francisco, ...
in San Francisco. From 1993 to 2000 he was visiting professor at the Department of Surgery of the Uniformed Services University of the Health Sciences of
Bethesda, Maryland
Bethesda () is an unincorporated, census-designated place in southern Montgomery County, Maryland. It is located just northwest of Washington, D.C. It takes its name from a local church, the Bethesda Meeting House (1820, rebuilt 1849), which in ...
and from 2008 to 2012 at the Jacobs Institute of Neurology in
Buffalo, New York
Buffalo is the second-largest city in the U.S. state of New York (behind only New York City) and the seat of Erie County. It is at the eastern end of Lake Erie, at the head of the Niagara River, and is across the Canadian border from South ...
, and at the Neuroscience Department of
Harvard University
Harvard University is a private Ivy League research university in Cambridge, Massachusetts. Founded in 1636 as Harvard College and named for its first benefactor, the Puritan clergyman John Harvard, it is the oldest institution of higher le ...
(2010) and
Chicago University
The University of Chicago (UChicago, Chicago, U of C, or UChi) is a private research university in Chicago, Illinois. Its main campus is located in Chicago's Hyde Park neighborhood. The University of Chicago is consistently ranked among the be ...
(2012).
Since 2004 he is director of the Vascular Disease Center of
Ferrara University
The University of Ferrara ( it, Università degli Studi di Ferrara) is the main university of the city of Ferrara in the Emilia-Romagna region of northern Italy. In the years prior to the First World War the University of Ferrara, with more than ...
. In 2008 he announced the discovery of a new venous pathology, called chronic cerebrospinal venous insufficiency (CCSVI) and postulates a controversial correlation between this pathology and multiple sclerosis
During 2010-2011 he was the president of the International Society for Neurovascular Diseases (ISNVD).
Chronic Cerebrospinal Venous Insufficiency – CCSVI
Chronic Cerebrospinal Venous Insufficiency
Chronic cerebrospinal venous insufficiency (CCSVI or CCVI) is a term invented by Italian researcher Paolo Zamboni in 2008 to describe compromised flow of blood in the veins draining the central nervous system. Zamboni hypothesized that it migh ...
is characterized by defective venous drainage from the brain and spinal cord as a result of outflow obstruction in the extracranial venous system, mainly caused by
stenosis
A stenosis (from Ancient Greek στενός, "narrow") is an abnormal narrowing in a blood vessel or other tubular organ or structure such as foramina and canals. It is also sometimes called a stricture (as in urethral stricture).
''Stricture'' ...
, defective valves, hypoplasia, and or compression of the
Internal jugular vein
The internal jugular vein is a paired jugular vein that collects blood from the brain and the superficial parts of the face and neck. This vein runs in the carotid sheath with the common carotid artery and vagus nerve.
It begins in the posteri ...
,
azygos vein
The azygos vein is a vein running up the right side of the thoracic vertebral column draining itself towards the superior vena cava. It connects the systems of superior vena cava and inferior vena cava and can provide an alternative path for blood ...
. CCSVI was initially brought forth as possible contributing factor to the pathogenesis and clinical manifestations of multiple sclerosis and of other neurodegenerative diseases. Indeed, in 2009 he claimed to have found this vascular condition in an
unblinded preliminary study that in over 90% of the participants with
multiple sclerosis
Multiple (cerebral) sclerosis (MS), also known as encephalomyelitis disseminata or disseminated sclerosis, is the most common demyelinating disease, in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This d ...
there were problems in veins draining their
brain
A brain is an organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It is located in the head, usually close to the sensory organs for senses such as vision. It is the most complex organ in a v ...
.
He also noted a high level of accumulation of iron deposits in the brain, presumably due to limited blood outflow.
Studies have demonstrated a relationship between tissue iron accumulation and the inflammatory changes associated with chronic venous insufficiency, so the presence of iron may contributes to the
neurodegeneration
A neurodegenerative disease is caused by the progressive loss of structure or function of neurons, in the process known as neurodegeneration. Such neuronal damage may ultimately involve cell death. Neurodegenerative diseases include amyotrophic ...
of
brain
A brain is an organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It is located in the head, usually close to the sensory organs for senses such as vision. It is the most complex organ in a v ...
.
Nowadays evidence already exists for reduced perfusion in patients with MS that in turn contributes to neurodegeneration.
Current data suggests that defective extracranial venous drainage reduces the
perfusion
Perfusion is the passage of fluid through the circulatory system or lymphatic system to an organ or a tissue, usually referring to the delivery of blood to a capillary bed in tissue. Perfusion is measured as the rate at which blood is deliver ...
of brain
parenchyma
Parenchyma () is the bulk of functional substance in an animal organ or structure such as a tumour. In zoology it is the name for the tissue that fills the interior of flatworms.
Etymology
The term ''parenchyma'' is New Latin from the word π ...
.
Attention has been drawn to the role of abnormal venous drainage in multiple sclerosis in the form of CCSVI. Recent quantitative studies on cerebral venous drainage demonstrate that flow in the jugular veins is linearly related to global brain perfusion.
According to Zamboni some symptoms of multiple sclerosis in his own wife as well as in 73% of his patients were abated after an
endovascular
Interventional radiology (IR) is a medical specialty that performs various minimally-invasive procedures using medical imaging guidance, such as x-ray fluoroscopy, computed tomography, magnetic resonance imaging, or ultrasound. IR performs b ...
procedure to open these veins.
The theory was controversial. The
National Multiple Sclerosis Society
The National Multiple Sclerosis Society (NMSS) is a nonprofit organization that was founded in New York City as the Association for Advancement of Research on Multiple Sclerosis on March 11, 1946 by Sylvia Lawry. Ms. Lawry was a lawyer looking fo ...
had said that, while "there is not yet enough evidence to conclude that obstruction of veins causes MS," that "
amboni'shypothesis on CCSVI and its corrective treatment is a path that must be more fully explored and one that we are supporting with research funding." Since 2010, there has been more research that disputes the Zamboni theory.
On November 28, 2017, Zamboni admitted that balloon venous angioplasty cannot be indiscriminately applied to all patients affected by relapsing remitting MS with associated CCSVI on the basis of "a double-blind randomized controlled trial versus sham therapy. A further expanded analysis of the same double blinded randomized sham controlled trial (Brave Dreams)
showed that venoplasty decreases new cerebral lesions at 1 year in a wider patients population which includes also secondary progressive MS. Further post hoc analysis demonstrated the need to select patients. Patients appropriate for venoplasty, according to the morphology of venous malformation, were more likely to be free from accumulation of new cerebral lesions at MRI.
Research on Chronic Venous Insufficiency - CVI
Zamboni has conducted research on lower extremity
Chronic venous insufficiency
Chronic venous insufficiency (CVI) is a medical condition in which blood pools in the veins, straining the walls of the vein. The most common cause of CVI is superficial venous reflux which is a treatable condition. As functional venous valves are ...
, testing a minimally invasive and conservative treatment of the saphenous vein: the
CHIVA method
CHIVA method is a type of surgery used to treat varicose veins that occur as a result of long term venous insufficiency. The term is a French acronym for Conservatrice Hémodynamique de l'Insuffisance Veineuse en Ambulatoire (ambulatory conserva ...
. On this topic he conducted several randomized clinical trials and published books.
The CHIVA and the stripping methods are equivalent regarding recurrence of varicose veins, but the CHIVA method may slightly reduce nerve injury and hematoma. The CHIVA method is also equivalent to either radio frequency ablation or endovenous laser therapy regarding recurrence and side effects.
Cell therapies for the treatment of severe vascular ulcerations of the lower limbs are another Zamboni field of study. Randomized studies with
autologous stem-cell derived from adipose tissue were conducted by his team.
Research on physiology of cerebral venous drainage
The cerebral venous return was investigated by Professor Zamboni also in the Space, as PI of the study Drain Brain of the International Space Station, promoted by NASA, ESA and ASI. A novel post processing analysis of jugular vein ultrasound and strain gauge plethysmography allowed to monitor the astronaut cerebral venous drainage in microgravity condition. Space trials involved the Italian astronaut
Samantha Cristoforetti
Samantha Cristoforetti, OMRI (; born in Milan on 26 April 1977) is an Italian European Space Agency astronaut, former Italian Air Force pilot and engineer. She holds the record for the longest uninterrupted spaceflight by a European astronaut (1 ...
.
Zamboni also described other anomalies of cerebral venous return which generates neurological symptoms, as well as models in physiology of brain drainage
Diagnosis on painting
Initially started as a hobby, identify disease processes in paintings and canvas is lately one of the Professor Zamboni’ research fields.
Diagnosis ranges from the Raphael's
Michelangelo
Michelangelo di Lodovico Buonarroti Simoni (; 6 March 1475 – 18 February 1564), known as Michelangelo (), was an Italian sculptor, painter, architect, and poet of the High Renaissance. Born in the Republic of Florence, his work was insp ...
,
Rembrandt
Rembrandt Harmenszoon van Rijn (, ; 15 July 1606 – 4 October 1669), usually simply known as Rembrandt, was a Dutch Golden Age painter, printmaker and draughtsman. An innovative and prolific master in three media, he is generally consid ...
's
Bathsheba at Her Bath
Bathsheba ( or ; he, בַּת־שֶׁבַע, ''Baṯ-šeḇaʿ'', Bat-Sheva or Batsheva, "daughter of Sheba" or "daughter of the oath") was the wife of Uriah the Hittite and later of David, according to the Hebrew Bible. She was the mother of ...
and
Caravaggio
Michelangelo Merisi (Michele Angelo Merigi or Amerighi) da Caravaggio, known as simply Caravaggio (, , ; 29 September 1571 – 18 July 1610), was an Italian painter active in Rome for most of his artistic life. During the final four years of hi ...
's Bacchus. In "The medical enigma of Rembrandt's Bathsheba", Zamboni solves the mystery of the controversial detail of the woman's left breast, furrowed by an irregular, slightly swollen mark of a color between bluish and brownish. The model for the Bathsheba, admired by millions of visitors to the Louvre, was suffering from thrombophlebitis of a superficial vein of the breast, a condition described by Mondor in 1939," states the professor. So not mastitis or carcinoma, as believed for centuries.
According to Zamboni, the varicose veins on the legs and knees are evident in Michelangelo, in the role of Heraclitus, frescoed by Raphael in
The School of Athens
''The School of Athens'' ( it, Scuola di Atene) is a fresco by the Italian Renaissance artist Raphael. The fresco was painted between 1509 and 1511 as a part of Raphael's commission to decorate the rooms now known as the , in the Apostolic Pala ...
. The evident anemia, brown skin, and acanthosis nigricans of
Young Sick Bacchus
The ''Young Sick Bacchus'' ( it, Bacchino Malato), also known as the ''Sick Bacchus'' or the ''Self-Portrait as Bacchus'', is an early self-portrait by the Baroque artist Michelangelo Merisi da Caravaggio, dated between 1593 and 1594. It now han ...
of Caravaggio exhibited at the
Galleria Borghese
The Galleria Borghese () is an art gallery in Rome, Italy, housed in the former Villa Borghese Pinciana. At the outset, the gallery building was integrated with its gardens, but nowadays the Villa Borghese gardens are considered a separate tourist ...
in Rome, according to Zamboni suggest the diagnosis of
Addison's disease
Addison's disease, also known as primary adrenal insufficiency, is a rare long-term endocrine disorder characterized by inadequate production of the steroid hormones cortisol and aldosterone by the two outer layers of the cells of the adrenal ...
, a condition described in the 1800s affecting the adrenal glands.
Works
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*
*
Awards and recognition
Zamboni was appointed "Commander" of the
Order of Merit of the Italian Republic
The Order of Merit of the Italian Republic ( it, Ordine al Merito della Repubblica Italiana) is the senior Italian order of merit. It was established in 1951 by the second President of the Italian Republic, Luigi Einaudi.
The highest-ranking ...
in 2017.
He is listed on topitalianscientists.org.
References
External links
Paolo ZamboniPaolo Zamboni on Google scholarPaolo Zamboni research profileon
BiomedExperts
{{DEFAULTSORT:Zamboni, Paolo
1957 births
Living people
Italian vascular surgeons
Physicians from Ferrara
University of Ferrara faculty