Sahlgrenska Academy Health sciences in the real world
Graphic design & production: Frank & Earnest. Photographers: Per Friberg, photo page 2-3 Hans Wretling, photo page 11 Ann-Mari Svennerholm. Printing: TMG Tabergs 2014. This corporate brochure is printed on environmentally friendly paper. Nordic Ecolabel 341 271. Cover Munken Polar 300g, inner pages 150g.
Gothenburg is situated on the west coast of Sweden
by the sea of Kattegat. With a population of 500,000 it is Scandinavia’s fifth largest city – home to 50,000 students and many world renowned companies. Here you’ll find one of Scandinavia’s youngest and largest medical faculties – Sahlgrenska Academy.
It is also the site of Sahlgrenska University Hospital – one of the largest in northern Europe.
Health sciences in the real world – eight accounts of the Sahlgrenska Academy
The art of generating a positive spiral
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Side by side against a common enemy
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Bringing new insight to the enigma of child cancer
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A patient-centered account
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Vaccine to alleviate malnutrition
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New light on the Alzheimer riddle
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En route towards genetically produced spare parts
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The importance of following the heart
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Sahlgrenska Academy is the medical faculty at University of Gothenburg. We conduct research and education in medicine, odontology and healthcare science. Top researchers, among them a Nobel Prize laureate, and young students come together under our roof – always in close contact with real-world healthcare. We are a young enterprise that doesn’t let convention or preconception stand in the way of progress. Instead, our doors are open to collaboration – wherever it might help us to see new perspectives with better ways to prevent or treat illness. We often choose an approach that is close to the patient. We collaborate with Sahlgrenska University Hospital and the Public Dental Service. Here, we present a few of our co-workers and their research – eight accounts from real life to give you a picture of Sahlgrenska Academy.
“ It’s nice to be in a place where people are happy when you do well”
To describe Fredrik Bäckhed as one of Sweden’s most successful young researchers is no overstatement. He and his team have a phenomenal ability to attract grants and are frequently published in respected journals. The secret? A combination of timing, hard work and a positive atmosphere on the research team. Fredrik Bäckhed did his postdoc at Washington University in St. Louis. He had already been recognised as a rising star and the world was open to him. When it was time to establish his own research team, he chose Sahlgrenska Academy and Gothenburg. “I had a good feeling early on. Sahlgrenska Academy was extremely welcoming and exuded self-confidence – without any arrogance. When I came here, I immediately felt great support. People are happy when you do well. There’s no jealousy here,” explains Fredrik Bäckhed. Specialised in gut microbiota Today, at 42, Fredrik Bäckhed leads a research team that is specialised on the significance of the gut microbiota to health. The 25-person strong team is regularly published in the bigger journals.
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“When you work with a subject that’s relatively unexplored, there’s a great deal of news to share, so of course the major journals find it exciting. But we also refine our articles a great deal before we submit them. You really only get one chance and there is no room for carelessness. But sooner or later, you have to let them go. One of my professors in St. Louis said ‘an article is never done, just abandoned.’ I think about that a lot,” says Fredrik Bäckhed. The art of generating a positive spiral Today, the team is in a positive spiral where researchers and research teams from around the world want to collaborate. “Often, development is a matter of combining research fields. We are strong in the field of intestinal bacteria, and don’t need to be experts on everything else. Instead, we bring in research partners who are authorities in their own fields. The two most recent publications were collaborations initiated by teams in the US and France who approached us.” Conscious effort shapes the team Everything begins with the strength of the individual research team. Fredrik Bäckhed consciously works to achieve a good mix of competencies and people as well as a good atmosphere.
“We work hard, but with substantial freedom. It has to be driven by goodwill. The whole point of having a broad group is that we think together and attack the problems with different tools and ideas. This means it won’t work with people who only focus on their own project.” The selection process is meticulous and Fredrik Bäckhed leaves nothing to chance. “We begin by scanning through the applications and picking out the ones that have interesting CVs. Then I have an hour-long Skype interview with a few selected individuals. Those who feel right come for a visit and meet the entire team for two days. We have one prospective postdoc from China here right now, and will make our decision soon. The right person with the right attitude can be a boost for the entire team.” Closeness a crucial factor Proximity to the clinic and the patients is important for Fredrik Bäckhed, who has a lab and his mice at Sahlgrenska Academy, but his office and main lab across the street at Sahlgrenska University Hospital. He also likes being close to the little metropolis of Gothenburg. “It’s possible to have a very high quality of life here. We live by the sea and are still close to work and day care. Not many can compete with that,” says Fredrik Bäckhed.
Fredrik Bäckhed PhD at Karolinska Institutet in 2002. Professor of Molecular Medicine at University of Gothenburg in 2012, at University of Copenhagen in 2011, Visiting Professor at University of Oslo in 2013. Selection of appointments and distinctions: Ingvar Carlsson Award, Fernström Prize for promising researchers, Göran Gustafsson Prize in medicine, Prince Daniel Research Grant, Principal Investigator at the Wallenberg Laboratory, Member of Young Academy of Sweden.
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Student and professor side by side against a common enemy
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They approach the disease from different places. Lauren Meiss has it in her body and is in Gothenburg to study for her life. Gunnar C. Hansson has it in his family and has relentlessly driven the research field forward for nearly 25 years. Now they are working together to defeat their common enemy. Sahlgrenska Academy in Gothenburg, Sweden, is far from Phoenix, Arizona. But Lauren Meiss has never let such things get in her way. At three months, she was diagnosed with cystic fibrosis, an incurable disease with a deadly outcome. Already as a teenager, she struggled to raise money for research on the disease. At university, Lauren Meiss earned top marks in biotechnology, and when ready for the next step, there was one place in the world she felt that she could really make a difference: Gunnar C. Hansson’s research team at Sahlgrenska Academy. “I contacted Gunnar and he invited me over on the spot. Now I’m here and it feels super-exciting. There are loads of important questions to try and answer and we discover new things every day. It’s almost incredible that the field hasn’t been researched more,” says Lauren Meiss. The thin membrane that keeps us from being eaten up from within Gunnar C. Hansson has a son with cystic fibrosis – this is his driving force. But it is not actually the specific disease he has focused his research upon. Nevertheless, he is probably the world’s most knowledgeable person about mucins, the mucus that exists in our digestive tracts and lungs. “The only thing that protects us from millions of aggressive bacteria in the intestines, and consequently from ‘eating ourselves up’, is a millimetre thin layer of mucus. How this mucus layer works and interacts with intestinal bacteria has largely been unknown to science. So right now, I’m travelling around like a kind of preacher, promoting our new insights to inspire others to begin research on mucus,” explains Gunnar C. Hansson.
Possible new avenues for treatment Gothenburg researchers’ discoveries about the function of mucin open entirely new possibilities to treat inflammatory intestinal disorders, but are also relevant to cystic fibrosis. “One effect of cystic fibrosis is that the mucus in the intestines and lungs becomes thick and viscous. This leads to problems with nutrient uptake, difficulties in breathing and repeated pneumonias, which – in turn – is the reason that many fall victim to an alltoo early death. We have already published interesting results concerning the large and small intestines. Now we are expanding our knowledge on mucins to include the respiratory tracts, which is what Lauren is working on,” explains Gunnar C. Hansson. Grateful to medical development “I use lungs from pigs to study how mucins are formed and move through the respiratory tracts. In the first stage, it’s about understanding the basic functions of the mucin, but also why the mucus gets stuck and how we can influence it so that it behaves normally. Of course, the goal is to be able to help the patients,” says Lauren Meiss. After nearly a year and a half in Gothenburg, Lauren is now returning to the US to continue her medical studies. The pace of life is high. Where does she get the energy? “I have deep respect for every day I’m given. The fact that I am alive at all is thanks to medical development, and I guess I simply want to fill every day with as much as possible,” says Lauren Meiss.
Gunnar C Hansson PhD at University of Gothenburg in 1981. Professor of Medical and Physiological Chemistry in 1998. Selection of appointments and distinctions: Board Member of the Swedish Society for Biochemistry, Biophysics and Molecular Biology, Chairman of Swedish Mass Spectrometry Society, Board Member of Sahlgrenska Academy, Director of Lederhausen Centre for Cystic Fibrosis Research.
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As the surgeons at Sahlgrenska University Hospital are getting ready to operate, Helena Carén receives a phone call. Soon after she takes the footbridge back to the lab carrying her cooler. Inside is a piece of insight needed to help solve the enigma of childhood brain cancer. Keeping cancer cells alive outside the body is difficult. This also applies to cells from childhood brain tumours. Fortunately, Helena Carén does not have far to go. Glass-enclosed footbridges connect the hospital with Sahlgrenska Academy, which increases the chances of the cancer cells surviving the journey from operating table to research lab. Live stem cells for research But the cancer cells must not only survive. It’s also important they retain their original characteristics. In Helena Carén’s laboratory, cells are successfully cultured from the tumour samples collected by the team using specifically developed and validated protocols. “There haven’t really been any relevant cell cultures developed from childhood brain tumours up until now. This is why we are focusing on creating a test arena where we can study different sorts of tumours,” says Helena Carén. Epigenetics in focus One of the challenges of brain tumours is that they contain cancer stem cells that may be resistant to treatment, and which researchers believe may give rise to recurring tumours. The cancer stem cells are controlled, in part, via what is known as epigenetic regulation. Helena Carén works with the hypothesis that defective epigenetic regulation can be influenced. “If we manage to correct the defective regulation in the cancer stem cells, we can also stop them developing tumours,” she says. A close liaison with the treating physicians The team also investigates how various treatments affect the cultured cancer cells.
The objective is to develop more effective ways of reaching the tumour-generating cells. “We liaise closely with the doctors at Sahlgrenska University Hospital, using the same cancer treatment as our basis. The children are often treated with a cocktail of numerous medicines. But it’s hard to know which of the substances actually have an effect. This is why we test them, individually and in different combinations. The more precise we can make future treatment protocols, the less the risk of over-treatment that can harm the child’s healthy tissue.” Possibility of reducing severe side effects Brain tumours are one of the most common kinds of cancer among children. The prognosis varies according to the type of tumour, but generally, seven out of ten afflicted children survive. Furthermore, side effects of the treatment can be lasting – being able to mitigate them is one of Helena Carén’s driving forces. “A growing brain is highly affected by treatments such as chemotherapy and radiation. This can lead to learning difficulties and other complications later in life. Which is why it’s particularly important to find the right treatment for every single child.” Helena Carén is clearly on the right track. Five years after completing her PhD, at just 34, she was awarded prestigious grants from Swedish Research Council, Swedish Cancer Society, Swedish Childhood Cancer Foundation and the Marie Curie Career Integration Grant. “These awards mean that we have the opportunity to continue developing our research. Hopefully it will also lead to new advances in the treatment of childhood brain tumours.”
Helena Carén PhD at University of Gothenburg in 2009. Postdoctoral Research Fellow at University College London and since 2013 team leader at Sahlgrenska Cancer Center. Selection of grants and distinctions: Assar Gabrielsson Award for an excellent dissertation in cancer research, Wenner-Gren Fellow, Hasselblad Foundation Grant to women researchers, Swedish Society for Medical Research.
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Bringing new insight to the enigma of childhood cancer
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A formula for better care – listen to the patient
To make a difference in healthcare, medical progress alone is not enough. New research shows that an undertaking of healthcare that focuses on the patient’s experience improves quality and reduces the care time. The formula is simple. Listen to the patients. “Traditionally, patients are passive in their contact with healthcare. They receive care, they’re examined and treated. Here we stand for a radically different way of approaching the task,” says Inger Ekman, manager of Gothenburg Centre for Person-centred Care (GPCC), Europe’s only research centre of this kind. The power of a garden Person-centred care is about the patient being an active partner. The starting point is listening to the patient’s account. Based on this narrative and other investigations, the patient and the healthcare professional then formulate a plan together – for the course of care. “In one of our studies, we interviewed a woman who was over the age of 90 and had suffered a fractured hip. It was spring and when asked what she most wanted to be able 12
to do, she said she wanted to return to her garden. ‘Okay,’ said the interviewing nurse, ‘then we’ll make a plan with that as the goal.’ The old lady returned to her garden. In fact, nearly everyone in the test group was able to return home. Whereas in the control group, where they received traditional care, most were forced to move into a nursing home.” From research project to reality Since established in 2010, the Centre for Person-centred Care has worked systematically for research findings to be implemented in healthcare. One project of notability began at Sahlgrenska University Hospital. The results were so promising that the experiment has now been expanded to several wards. Resident Physician Elin Hultgren is one of those who participated and had a chance to try the person-centred approach. “We notice that it works. The patients are in hospital substantially fewer days. The relatives are also very positive. None of us who work here want to go back to the old way of working,” explains Elin Hultgren. Greatest impact where most needed Inger Ekman believes that many people have an incorrect view of the hospital as a place where acutely ill people come in, are cured and go home.
The patient’s account is the starting point. Resident Physician Elin Hultgren has seen the advantages of a person-centred approach in daily care.
“This is an image kept alive by TV series such as ER and Grey’s Anatomy, but it’s not accurate. In reality, most of the patients are elderly, fragile people, individuals with long-term and lasting symptoms. It’s here that the majority of healthcare resources are spent, and it’s in these very groups that our experiments have shown the best results.” Patient empowerment – a trend growing from the grass roots The person-centred care in Gothenburg is a part of an international wave where the patients are demanding participation and partnership. One current example is the website patientslikeme.com, which was established by the brother of a young man with ALS who wanted to start a dialogue with other patients. The response was overwhelming. Today, the site has more than one million reports on patients’ conditions and researchers pay a lot to gain access to their data. Another example is the international movement ‘No decision about me, without me.’ This demands that the patient be an active participant in
decisions on different forms of treatment. “We are on the way to changing how we interact with patients in healthcare. But it will take time. There is a strong culture in healthcare and this is nothing you change overnight,” says Inger Ekman. A good arena for clinical healthcare research With an ageing population, finding new ways towards better health and shorter care times is a matter of global importance. GPCC is coordinating an EU project that is about preparing a road map for the healthcare of the future. When the Swedish government conducted a strategic survey in healthcare research, the University of Gothenburg – led by Sahlgrenska Academy – was deemed to have the greatest potential to develop the field. “These are complex issues that concern various subjects such as economics, pedagogy, philosophy and ethics. The University of Gothenburg is skilled at clinical research, has good relationships with healthcare and, with its breadth, is well-equipped for the challenge,” says Inger Ekman.
Inger Ekman PhD at Umeå University in 1999. Professor of Nursing at University of Gothenburg in 2007. Selection of appointments and awards: former Head of the Department of Health Sciences and Health and Vice-Dean of Sahlgrenska Academy, since 2010 Director of the University of Gothenburg Centre for Person-centred Care (GPCC). GPCC conducts interdisciplinary research in person-centring in healthcare. More than 100 researchers and 30 doctoral students are affiliated with the centre, which is financed by the government and University of Gothenburg.
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ETEC kills 300,000 a year – a vaccine is on its way In high season at the large diarrhoea hospital in Dhaka, thousands of patients must be cared for on bunks under makeshift tents. This is where the poorest lay, those who do not have access to clean water and food. The children are the hardest hit. In the autumn and spring, when rain or drought worsens the water quality, Dhaka, the capital of Bangladesh, is struck by epidemic outbreaks – forcing the diarrhoea hospital to temporarily expand outdoors. Many patients have cholera, but even more have been struck by ETEC (enterotoxigenic E. coli). According to WHO this disease is behind 400 million cases of diarrhoea and 300,000 deaths of children under five each year. “All of us have E. coli bacteria in our intestines. But ETEC can grow in the upper intestines and form a choleralike poison causing severe diarrhoea. In Bangladesh and many other countries, ETEC diarrhoeal disease is a huge problem,” says Ann-Mari Svennerholm, who has devoted much of her research life to the subject. Close collaboration with Bangladesh Ann-Mari Svennerholm regularly travels to Bangladesh where she, together with researchers in Dhaka, works intensively to develop a vaccine against ETEC. “The poverty is enormous in our field. Many people don’t have proper toilets or clean drinking water and an incredible number of children have diarrhoeal diseases. However, many are committed and positive to doing something about it, and it’s not difficult to get mothers and children involved in our studies,” says Ann-Mari Svennerholm. Promising results The new vaccine has been developed and refined for more than a decade. A working solution is now close. 14
“The initial tests have gone very well. The most recent version we’ve developed is free of side effects and will provide protection against up to 80 percent of all ETEC infections – so we are feeling very optimistic. Now we’re preparing an extensive study in Bangladesh. We begin by vaccinating adults and then the lower age groups, finally testing on our main target group – children under the age of two years,” says Ann-Mari Svennerholm. Research further challenged by economics How can a sickness that affects millions of people around the world still not have a cure? Why isn’t there a vaccine on the market already? According to Ann-Mari Svennerholm, the reason is a combination of research and financial challenges. “It’s difficult to create immunity against all different types of E. coli bacteria and we have worked for a long time to develop a mix with exactly the right components. Furthermore, intestinal immunity is a challenge in itself. This is not a vaccine that you inject into the blood, but a drinkable vaccine that should stimulate cells in the intestines to form antibodies. And that’s a complicated process. “Another challenge is getting the financiers and pharmaceuticals industry to invest money in a vaccine that’s not primarily for a market in western society – and yet an effective ETEC vaccine could also be very useful for travellers to ETEC-exposed countries.” Vaccine against malnutrition? The researcher who succeeds in developing a good vaccine can make a huge difference in people’s lives. This is something many researchers dream of. For Ann-Mari Svennerholm there is a further dimension to vaccine research. “The latest research shows that repeated diarrhoea is a common cause of malnutrition – in most places more common than a shortage of food. So if we can develop good vaccines, for ETEC in particular, we can also reduce malnutrition, and that really is something to dream about,” concludes Ann-Mari Svennerholm.
Ann-Mari Svennerholm PhD at University of Gothenburg, 1975. Professor of Infection and Immunity in 1988. Selection of appointments and distinctions: Member of the Royal Swedish Academy of Sciences, Chair of the WHO Committee for Diarrhoeal Vaccine Research and Research Council of Norway’s programme for global health, board appointments for the International Vaccine Institute and International Centre for Diarrhoeal Disease Research.
Many children in Dhaka lack clean water and proper toilets. ETEC and other diarrhoeal diseases are very common.
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Cutting-edge research on the disease that costs more than cancer, heart disease and stroke altogether
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Kaj Blennow
Henrik Zetterberg
PhD at University of Gothenburg in 1990. Professor of Clinical Neurochemistry,
Earned his PhD at University of Gothenburg in 2003. Professor of Neurochemistry
2003. Senior Unit Physician at Sahlgrenska University Hospital. Selection of
at University of Gothenburg, 2011, Professor at University College London since
appointments and distinctions: Inga Sandborg Prize, Alois Alzheimer research
2012. Senior Physician in Clinical Chemistry at Sahlgrenska University Hospital.
award, ECNP research award, Alzheimer’s Association Research Award, David
Selection of appointments and distinctions: FernstrĂśm Prize for promising young
Ingvar Prize, IFRAD European Grand Prix in research.
researchers, Inga Sandborg Prize, Wallenberg Academy Fellow 2014.
Alzheimer’s is one of our major widespread diseases. Suffering to the individual is immense, the care-intensive course of the disease leads to large costs for society, and effective treatments have not yet been developed. But in the darkness there are signs of light. One comes from the Sahlgrenska Academy in Gothenburg.
In countries such as the US, Japan and Germany, Alzheimer’s disease is a prioritised field for research investment. Sweden is far behind. In spite of this, with Gothenburg as their base, Kaj Blennow, Henrik Zetterberg and their team conduct cutting-edge research on how Alzheimer’s can be diagnosed and treated. “Here in Sweden we are good at carrying out research in close proximity to the patient – thanks to our open and publicly financed healthcare. We don’t have the same problems – of who will cover the different costs and how to organise the administration – that I have experienced in, say, the UK,” says Henrik Zetterberg. “At Sahlgrenska we don’t complicate matters, but try to make it simple to conduct research on patients in parallel with examination and treatment,” adds Kaj Blennow.
Biomarkers in spinal fluid The Gothenburg researchers have developed a method using biomarkers in a regular spinal fluid sample to diagnose Alzheimer’s early on. After a large number of scientific publications, the method has now come in to practical use worldwide. “We work in a combined research and healthcare lab. This means that as soon as the methods are scientifically evaluated, they can be carried out in the clinics. The US, Japan, Australia and several large European countries have followed suit and now work with our methods,” says Kaj Blennow.
Early diagnostics invite hope Alzheimer’s is a disease that creeps up on you. Mental and bodily functions are disabled as the nerve cells wither and die. An early diagnosis makes it possible to provide treatment, or at least some form of medicine to slow it down, before too many nerve cells have been affected. The method of diagnosis is also of interest for continued research. “Previous pharmaceutical studies have had a considerable uncertainty factor. Probably up to a third of the patients surveyed didn’t even have Alzheimer’s, but some other form of dementia. Of course, this makes it difficult to draw any definite conclusions on the results. But with better diagnostic tools, we can all make progress,” says Kaj Blennow. “Once Alzheimer’s can be identified at an early stage, it becomes possible to study how the disease develops,” adds Henrik Zetterberg. From Alzheimer’s to concussions In another project the method has been used to examine elite hockey players who have suffered concussions. “Alzheimer’s is an incredibly complex disease. Therefore we wanted to test our markers in a simpler scenario, namely a concussion. We measure a protein called tau, which only exists in nerve cells. With a strong blow to the head, the nerve cells burst and the protein leaks into the blood. This way, we can see if the player was injured and how long it takes to heal. With help of the test, we can better assess how soon a player can be back in action after a concussion,” explains Henrik Zetterberg. A dynamic duo – solving problems together Kaj Blennow and Henrik Zetterberg always work as a duo, an approach that is not entirely obvious to the rest of the world. “We are occasionally questioned. When we send in applications, the research funding bodies are not accustomed to dual applicants. But it’s a major advantage for us,” says Kaj Blennow. “We have more than 50 members on the team; some are employed on the university side, others on the hospital side. By sharing the responsibility, we can ignore the boundaries and concentrate on making progress with the research,” concludes Henrik Zetterberg. 17
En route towards genetically produced organs Nightmares about losing your teeth or hair? At Sahlgrenska Academy a small research team is making real progress on genetically produced spare parts. The Institute of Odontology research team consists of just six people. Despite their small size, they are conducting world-class research, and this in a heavily competitive field. Conversation-driven research As is often the case, it’s a matter of being smarter and more flexible than the resourceful research giants that dominate the field. “I believe that we’re successful precisely because we’re small, because we work closely together and talk with one another the whole time. It seems like there are no energy losses along the way. And then we work together on every project. It’s both more fun and produces better results,” explains Associate Professor Amel Gritli-Linde who is the team’s leader and central force. The secret of a stem cell Her hunger for knowledge is what drives her. As one of ten children, Amel Gritli-Linde learned to roll up her sleeves early on. Today she focuses her energy and curiosity on the mechanisms in the cells that regulate how various organs are formed. “At the very beginning, developing teeth, salivary glands or hair follicles look much alike under the microscope. They also
contain largely the same molecules. Yet one becomes a tooth, the other a gland and the third a hair follicle. It’s an almost magical process that we have to learn more about,” says Amel Gritli-Linde. A sensitive signal system The team has already succeeded in showing that if a gene is manipulated so that it stops producing a certain protein there are drastic consequences. A deformity can arise or the cells can change identity and become a completely different organ. “It’s a signal system that is extremely sensitive to influence. But it’s possible to take advantage of this sensitivity. If we learn to understand and create models for how teeth or glands are formed, we may also be able to produce them later on,” says Amel Gritli-Linde. Not a dreamer, but a visionary When tomorrow’s researchers begin to replace implants with genetically produced teeth, help cancer patients suffering from dry mouths, or find the ultimate medicine against hair loss – it will hopefully take place with contributions from Amel Gritli-Linde and her little research team. Of course, more research is needed before we arrive at genetic spare parts. Amel Gritli-Linde likes to see herself as a visionary. But she is no dreamer. “Only when you have truly studied and are fully awake can you make the important discoveries. Like author Paul Valery said: ‘The best way to make your dreams come true is to wake up’,” says Amel Gritli-Linde.
Amel Gritli-Linde PhD at Université Paris Descartes in 1995. Docent at University of Gothenburg in 2004. Selection of appointments and distinctions: Research position through the Swedish Research Council 2005-2010. Thuréus Prize 2014, selected in the Red10 external evaluation as one of four outstanding research teams at University of Gothenburg.
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”This man is not completely Finn Waagstein was declared a reckless doctor and mocked by the international academic community. But instead of giving up he continued to promote his unusual theory of treating heart failure with beta blockers. He followed his heart and subsequently saved thousands of others. In time, he came to set a new standard for how to treat heart disease. In the mid-1970s, the prevailing view was that a weak heart should be stimulated. In Gothenburg one young doctor had the opposite theory. When Finn Waagstein sent his first article on beta blockers to the British Heart Journal, his supervisor felt obliged to attach a covering letter. It began with the words: “This man is not completely insane”. “British Heart Journal sent back a three-page reply saying that they had met several times and decided that it was worth publishing, even though the content seemed rather odd,” explains Finn Waagstein. Harsh criticism from the world at large It would take more than a decade before the world really started to listen. Initially, Finn Waagstein and his colleagues were harshly criticised, especially in the UK. “Professors wrote editorials in the Lancet about ‘the perverse Swedish cardiologist’ who gives beta blockers to patients with heart failure and risks taking their lives. And they were strong people with a great deal of influence,” says Finn Waagstein. Following his conviction But at home the young Gothenburg doctor had support. Both the management and his colleagues backed him up and Finn Waagstein decided to continue. “Even the nurses at the ward supported me. Every time a patient got better, we believed more in what we saw with our own eyes than what the critics thought.” A chamber of horrors Finn Waagstein conducted the first experiments with beta blockers on his own accord.
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“It would not have been possible to do so today, but it’s important to understand how cardiac care looked in the mid-1970s. Mortality was almost 50 per cent. The heart attack patients lay in a room in a regular medical ward with only drapes between the beds, hearing their neighbours receiving cardio resuscitation. It was like a chamber of horrors.” “Some patients with acute cardiac infarction and a high pulse also had acute heart failure. Lacking other treatment methods, I tested my beta blocker theory. They received an intravenous dose without worsening the heart failure. On the contrary, we were able to see that pain was reduced and the ECG changes subsided,” explains Finn Waagstein. The rest is history Finn Waagstein and his colleagues conducted a number of smaller studies on selected patients with chronic heart failure and high pulse – and were able to show a clearly improved heart function after 6-12 months. But resources were too scarce for a large controlled study. This forced Finn Waagstein to make a drastic decision. “I simply applied beta blockers to a group of patients and showed that they got better. Then I took away the treatment and could show that they all got worse. Of course it was risky, but it was necessary in order to convince the world that it really was effective. The results of the study were published in 1989. This sparked interest in the US. We conducted a joint study and the rest, as they say, is history.”
insane”
Finn Waagstein PhD at University of Gothenburg, 1976. Professor of Cardiology in 1999. Selection of appointments and awards: European Society of Cardiology – silver medal, King Faisal International Prize – gold medal, Lars Werkö Prize, Lifetime Achievement Award from the Heart Failure Association. Appointments to the European Society of Cardiology. External adviser to the German Research Foundation.
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Nobel Prize in Medicine In the year 2000, Arvid Carlsson was awarded the Nobel Prize in Physiology or Medicine for his pioneering research on the signal substances of the brain. By acquiring knowledge on how substances such as dopamine and serotonin can be influenced, Arvid Carlsson and his research team are now part of developing medicines that increase the mobility of Parkinson’s patients and help improve the lives of those with schizophrenia. In addition, their research is laying the foundation for today’s modern medicines against anxiety and depression. Arvid Carlsson is one of the Gothenburg researchers who set the stage for close cooperation with the pharmaceuticals company Astra Hässle, later AstraZeneca – a collaboration that led to internationally renowned medicines like Seloken, Zelmid, Plendil and Losec.
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training programmes
2,2 billion SEK in turnover
188 professors
6500
students in medicine, odontology and healthcare science
1640 co-workers, including 950 researchers
sahlgrenska.gu.se Sahlgrenska Academy, Medicinaregatan 3, SE-413 90 Gothenburg, Sweden