In Vivo #9 EN by IN VIVO

CHUV-EPFL SPECIAL ISSUE

Think health

No. 9 – JULY 2016

BIOINFORMATICS / DIGITAL HEALTH / 3D PRINTING

DOCTORS AND ENGINEERS WORKING TOGETHER

INTERVIEW Patrick Aebischer and Pierre-François Leyvraz PERSONALISED MEDICINE A large-scale project in Western Switzerland REPORT The CIBM’s new imaging techniques Published by the CHUV www.invivomagazine.com IN EXTENSO ENHANCED HUMANS

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IN VIVO / NUMBER 9 / JULY 2016

CONTENTS

FOCUS

11 / RESEARCH Doctors and engineers working together Combining expertise to innovate BY JULIEN CALLIGARO AND WILLIAM TÜRLER

MENS SANA

22 / INTERVIEW

Patrick Aebischer and Pierre-François Leyvraz BY BERTRAND TAPPY

IN SITU

Joining forces for personalised medicine

06/ HEALTH VALLEY

BY SAMUEL SOCQUET

Manifacturing mini-organs

CORPORE SANO

CURSUS

31 / IN THE LENS

42 / COMMENTARY

BY MARIELLE SAVOY

Ten issues, 1,000 subscribers

36 / INSIGHT

44 / TANDEM

At the root of schyzophrenia

Patrick Omoumi and Igor Letovanec

Imaging in all formats

BY GENEVIÈVE RUIZ

38 / INNOVATION Dr. Robot BY ERIK FREUDENREICH

NEW ARTICLES ON WWW.INVIVOMAGAZINE.COM COMING DURING THE SUMMER

In 2012, experiments led by Grégoire Courtine, a spinal cord rehabilitation expert at EPFL, enabled paralysed rats to walk again. In a partnership formed with CHUV experts, clinical trials on humans are expected to begin this year. This project embodies the collaboration between researchers and doctors, the focus of this issue of “In Vivo”, in a report specially designed by CHUV and the Mediacom department at EPFL. ALAIN HERZOG / EPFL

27 /INNOVATION

CONTRIBUTORS

SAMUEL SOCQUET

MARIELLE SAVOY

Samuel Socquet has investigated a number of social issues for magazines and is the author of about 10 books. For “In Vivo”, he looked into personalised medicine in the Lake Geneva region (p. 27).

Marielle Savoy recently graduated from the Academy of Journalism and Media at the University of Neuchâtel. For her thesis, she studied journalism’s coverage of health care topics. For the “In the lens” section of this issue of “In Vivo”, she interviewed researchers from the Centre for Biomedical Imaging (p. 31).

JULIEN CALLIGARO With a degree in political science from the University of Geneva, Julien Calligaro works as a journalist for LargeNetwork. He produced this issue’s focus report on the alliance between medicine and engineering (p. 11).

Editorial

OUR “PERSUADERS!”

PATRICK DUTOIT

BÉATRICE SCHAAD Chief editor

Comparing their backgrounds is like watching the opening theme to the cult British television series “The Persuaders!”. They both studied medicine, one in Geneva, the other in Lausanne. One is passionate about neuroscience, the other about the musculoskeletal system. One went off and spent nearly 10 years at Brown in the United States, but they both ended up at the same hospital, Lausanne University Hospital (CHUV), in the 1990s. They share the same intuition: Pierre-François Leyvraz, currently the general director of CHUV and Patrick Aebischer, president of the Swiss Federal Institute of Technology (EPFL), have always firmly believed that innovation is sparked by combining life sciences and engineering. In the 1990s, Patrick Aebischer worked tirelessly to develop a system to encapsulate genetically modified cells to fight Parkinson’s disease. To find new materials, he began working with EPFL. A few years earlier, Pierre-François Leyvraz, an orthopaedic doctor, founded a research group at EPFL, before becoming director of the Interinstitutional Center of Translational Biomechanics then full professor while continuing as a professor at CHUV. Each now at the head of a large institution, the two men bring down barriers and build bridges between disciplines. Both history and literature buffs with a keen interest in the arts, they do not limit themselves to integrating life sciences and engineering alone. Instead, they surround these scientific fields with the humanities, through a constructive partnership with the University of Lausanne. With UNIL’s Rector, Dominique Arlettaz, the three leaders are convinced that progress in medicine and engineering must also pass through the prism of philosophy, sociology and the history of science. Today, one is building a science hub on the edge of Lake Geneva, while the other is working with the Rector to set up a university hospital campus in the hills overlooking Lausanne, at the Biopôle science park in Epalinges. And all three encourage young scientists to take full advantage of the metro line connecting the two sites to share their knowledge with others. Every day, countless researchers and clinicians come and go, embodying the future of science (see p. 19). Thanks to these three innovators, the region has become a hub for advanced expertise, not only in medical research and biotechnology, but also in related fields such as microtechnology, nanotechnology and medical technology [diagnostics, instruments, implants, etc.]. This multidisciplinary approach is now one of the region’s most valuable strengths. Pierre-François Leyvraz, Patrick Aebischer and Dominique Arlettaz show how science cannot be confined to an institution or even a canton. Science will only have meaning if it overlooks geographical and mental borders and disregards barriers and territorial disputes. And scientific progress takes both brain power and the power of friendship. ⁄

Thanks to its university hospitals, research centres and numerous start-ups specialising in healthcare, the Lake Geneva region is a leader in the field of medical innovation. Because of this unique know-how, it has been given the nickname “Health Valley”. In each “In Vivo” issue, this section starts with a depiction of the region. This map shows the Earth’s surface in three dimensions without vegetation or buildings. It was generated by Swisstopo, Switzerland’s geoinformation centre.

IN SITU

HEALTH VALLEY Panorama of the latest innovations.

LAUSANNE

P. 06

FEDERAL OFFICE OF TOPOGRAPHY

The start-up SUN bioscience produces mini-organs in vitro.

IN SITU

HEALTH VALLEY

NEUCHÂTEL

P. 09

A new centre for obesity.

SION

P. 09

A new neuroprosthetics laboratory opens at Suva.

ÉPALINGES

Mymetics comes out with a new malaria vaccine.

P. 08

IN SITU

HEALTH VALLEY

Manufacturing mini-organs Making miniature organs to test drugs is not just a wild idea out of a science fiction novel. The Lausanne-based start-up SUN bioscience stands out in this fast-growing field.

Sylke Hoehnel and Nathalie Brandenberg, co-founders of the Lausanne start-up SUN bioscience are on a roll. Over the past few months, their project has sparked the interest of the California-based support organisation for earlystage start-ups, Founder.org, and the Swiss Federal Commission for Technology and Innovation (CTI), with more than 700,000 Swiss francs at stake. The young EPFL graduates have also attracted the attention of the American magazine Forbes, which has included them on its 30 Under 30 list of promising innovators. “That has given us incredible visibility,” says Nathalie Brandenberg. SUN bioscience is active in the production of mini-organs, currently one of the most exciting areas in the life sciences. What the start-up has done is develop a platform for culturing three-dimensional stem cells (undifferentiated cells that can produce specialised cells) on a large scale. This innovation responds to one of the main problems faced by researchers. Current techniques use a two-dimensional space that is very different from the reality of the human body. The young company has also made its mark by developing a soft, flexible substrate that recreates the cell environment, unlike the ill-adapted hard plastic surfaces currently used for cell cultures. The new material is designed for laboratories, research institutes and pharmaceutical companies. “Miniature organs created using our platform can be used to better 6

PHILIPPE GÉTAZ

TEXT SOPHIE GAITZSCH

understand how cells react to diseases and to test the effect of drugs on various pathologies,” Sylke Hoehnel and Nathalie Brandenberg explain. “Using mini-organs has the dual advantage of reducing animal testing while achieving better results. It’s a win-win situation,” says Marcus Textor, a microtechnology and nanotechnology expert at the CTI who reviewed the start-up. SUN bioscience has also developed technology in personalised medicine. Cells harvested from a patient can be used to recreate their individual profile and accurately determine which treatment will be most effective. Marcus Textor believes this to be another promising field. “For example, many breast cancer patients don’t benefit from standard treatments

but experience the side effects. Mini-organs increase the chances of striking the right combination on the first try. That’s much easier on the patient and saves money by avoiding expensive therapies that aren’t effective.” SUN bioscience plans to begin commercialising its product in 2016. Several potential customers, including research groups at the Nestlé Institute of Health Sciences and the University of Bern, have already expressed interest. ⁄

HEALTH VALLEY

LYSIA FORNO / SCIENCE PHOTO LIBRARY

IN SITU

3 QUESTIONS FOR

ERIC BONVIN

Modelling Parkinson’s disease

A team of scientists from the Swiss Federal Institute of Technology in Lausanne (EPFL) has developed animal models that reproduce the accumulation of Lewy bodies, a protein which aggregates in neurons in people with Parkinson’s disease. The discovery was used to create cell models and more accurately simulate the spread of the disease in mice. These new models could be used to support the research and development of new drugs. Californian and British research teams also participated in the study, which was published in the American journal PNAS. BRAIN

THE VALAIS HOSPITAL BEGAN AUTHORISING ASSISTED SUICIDE IN THE SPRING OF THIS YEAR. THE HOSPITAL DIRECTOR OFFERS FURTHER EXPLANATION.

WHERE DID THE HOSPITAL’S DECISION COME FROM?

A hospital’s purpose is to treat people. But it must also listen to its patients when they’re suffering and bring a response to requests for assisted suicide expressed within its walls. We introduced the option of making this exception when a person’s wish to die cannot be granted because they can no longer leave the hospital. After personally listening to the patient, our clinical ethics committee can suggest whether hospital staff should support the individual and direct them towards a professional or an organisation that can help them in their decision. Our hospital staff don’t participate directly in assisted suicide. OTHER HOSPITALS IN FRENCH-SPEAKING SWITZERLAND INTRODUCED SIMILAR DIRECTIVES SEVERAL YEARS AGO. WHY DO IT NOW?

THE DEVICE

SMART SHOES Researchers at EPFL and Geneva University Hospitals (HUG) have developed a shoe sole that electronically controls the pressure applied to the arch of the foot. The idea is to let the foot ulcers that typically develop from diabetes heal properly and prevent secondary infections.

Religious values remain firmly grounded in the Canton of Valais, and the debate over assisted suicide raises a lot of controversy and fears. The issue has been around for a long time, but we had to wait for it to be addressed in the political arena and for the Valais Cantonal Commission for Medical Ethics to publish its review before we could do anything. HOW MANY REQUESTS FOR ASSISTED SUICIDE ARE SUBMITTED AT THE VALAIS HOSPITAL?

We only receive one or two a year. Often, people who have joined organisations such as Exit or Dignitas want that freedom but don’t use it. I believe that it reflects their lack of trust that medical staff will be there to support them on a human level if they’re in extreme pain. That’s a signal we have to take into account. / Eric Bonvin has been director of the Valais Hospital since 2012.

IN SITU

HEALTH VALLEY

START-UP

“We’ve discovered a new genetic disease.”

ALLERGIES

The innovation award-winning allergy screening device developed by the Lausanne company Abionic is now used in pharmacies. The solution can rapidly detect the most common respiratory allergies – mites, dog, cat, birch and grass pollen – with a single drop of blood.

FUND RAISING

Anergis, an allergy immunotherapeutics company operating out of Epalinges, raised 5 million Swiss francs in a funding round with existing investors. The funds will be used to finance a phase of clinical trials for AllerT, a fast-acting birch allergy treatment. Testing will begin this autumn on 450 patients, with results expected in the third quarter of 2017.

BLINDNESS

Developed in Lausanne, EyeWatch is the first eye implant used to monitor the build-up of liquid in the eye due to glaucoma, one of the world’s leading causes of blindness. The commercial launch of the device by the start-up Rheon Medical is set for 2017.

BIOPHARMACY

GeNeuro celebrated its IPO on the Euronext Paris stock exchange in mid-April, raising €33 million. The biopharmaceutical company based in Plan-les-Ouates offers novel ways of treating auto immune diseases, including multiple sclerosis. The treatment blocks the inflammatory and neurodegenerative components that are the causal factors of the disease.

ANDREA SUPERTI-FURGA FULL PROFESSOR AT THE UNIVERSITY OF LAUSANNE AND CHIEF OF THE DEPARTMENT OF PAEDIATRICS AT CHUV. THE YET UNNAMED DISEASE CAUSES INTELLECTUAL DEVELOPMENTAL DELAYS AND ABNORMAL BONE GROWTH. THESE PROBLEMS ARE DUE TO A MUTATION IN NANS (N-ACETYLNEURAMINIC ACID SYNTHASE), THE GENE THAT CONTROLS THE SYNTHESIS OF SIALIC ACID, WHICH PLAYS A KEY ROLE IN BRAIN GROWTH.

97%

The percentage by which the vaccine developed by Mymetics, a company based in Epalinges, reduces the transmission of the malaria-causing parasite “Plasmodium falciparum”, based on preclinical trials

The length, in millimetres, of an implantable capsule developed at the Swiss Federal Institute of Technology in Lausanne (EPFL) to fight Alzheimer’s disease. The mechanism is placed under the skin and releases antibodies designed to clear amyloid-beta proteins. The accumulation of these proteins is believed to be one of the causes of the disease.

Discovery made in Geneva to fight hepatitis B

VIRUS An international team led by University of Geneva researchers uncovered one of the survival techniques used by the hepatitis B virus. These findings published in the journal Science could lead to new treatments for the disease. The scientists detected a small protein dubbed the “X protein”, which attacks the defence mechanism of infected cells. This discovery made in Geneva could be used to fight other viruses, such as herpes and human papillomavirus. The World Health Organization (WHO) estimates that hepatitis B affects 240 million people worldwide and kills nearly 800,000 individuals every year.

Regaining the sense of touch

PERCEPTION A hand amputee was able to distinguish between smooth and rough surfaces with an artificial finger surgically connected to the nerves in his arm. Using technology developed at EPFL, this advance opens new possibilities in the development of bionic prosthetics designed for sensory perception.

IN SITU

HEALTH VALLEY

OBESITY

The Neuchâtel Hospital and Neuchâtel Centre for Psychiatry have set up a facility for people suffering from obesity. The aim is to combine all the fields of expertise that deal with treating the disease and related eating disorders, including doctors, surgeons, psychologists and dietitians. Obesity is rising steadily in Switzerland, affecting 11% of the population, and a growing number are teenagers and young adults.

HEADACHES

About 10% of the Swiss population suffer from migraines, and 20% from tension headaches. In autumn 2016, CHUV will open a centre for people with debilitating headaches. The new facility is designed so that headache specialists with different skill sets, who often work isolated from one another, can better coordinate their approaches and therapies. Headaches can be caused by conditions ranging from neurological to ear, nose and throat and even musculoskeletal problems.

SPECIALISED CENTRES Several facilities are opening in French-speaking Switzerland that bring together experts from a variety of fields to fight a specific health issue. Overview.

INFERTILITY

In the spring of 2016, Geneva University Hospitals (HUG) opened their new medically assisted reproduction laboratory. FertisupportHUG offers more comprehensive care for infertility problems by centralising consultations, testing, analyses and treatments, especially in vitro fertilisation. The number of couples that use medically assisted reproduction is growing. In Switzerland, the figure doubled between 2002 and 2010 to reach more than 6,000 per year.

CANCER

The Swiss Cancer Centre is a partnership between the Lausanne University Hospital (CHUV), the University of Lausanne (UNIL), the Swiss Federal Institute of Technology in Lausanne (EPFL) and the Swiss Institute for Experimental Cancer Research (ISREC). The facility is scheduled to open in 2018 in a brand new building located in Lausanne, near CHUV. The 80 million Swiss franc project will bring together between 250 and 300 researchers, creating a community of experts at a single site to promote the exchange of knowledge between disciplines and between researchers and clinicians.

Development in Valais

THE MOLECULE

DEBIO 1143 HERMINE BLANQUART

This oral chemo-radiosensitizer which targets IAPs (inhibitors of apoptosis proteins) has recently been granted orphan drug designation by the U.S. Food and Drug Administration. Orphan status offers companies regulatory and financial incentives for developing treatments for rare diseases. Debio 1143 was developed by the Lausanne-based firm Debiopharm to treat ovarian cancer. 9

NEUROPROSTHETICS The Swiss Federal Institute of Technology in Lausanne (EPFL) continues to make advances in health research in Valais. In late August, a new laboratory will open with the support of the Defitech Foundation, with teams working alongside researchers from the Centre for Neuroprosthetics in Sion, at Suva and the Valais hospital. The robot developed by Professor Grégoire Courtine (see p. 17) will also be installed.

IN SITU

HEALTH VALLEY

BENOÎT DUBUIS Director of the Campus Biotech site and Chairman of BioAlps

Impatience can be a good thing!

In our already frenetic environment, we can feel the full effects of this acceleration in French-speaking Switzerland and more recently in the Canton of Vaud with the explosive growth of UniverCité. Now with a community of more than 200 innovators, UniverCité has opened a unique makerspace which enjoys all the benefits of the regional ecosystem and was the magnet that attracted the MassChallenge. This accelerator programme has brought together talent, makers and inspirational leaders in one place, giving our region the incredible opportunity to rediscover the power of time and the need to move faster, much faster, and to live at the pace of the future. Now, with little nostalgia, I pore back over the texts about how fast our world is moving, reminding us of the meaning of slowness. Being time rich. Slowness is a state in which we have enough time to do what we have to do. It is the time left after doing everything. I feel no nostalgia when people extol the virtues of slowness, explaining that it’s the state when we have enough time available to use it freely. However, let’s not forget that in German, Muße (meaning leisure, creativity) is the opposite of boredom. “Slowness is the feeling of not being under the pressure of an emergency, not having to do something without having the time to do it.” Being time rich is neither boredom nor being forced to slow down. It is about both personal and temporal autonomy.

The time we have to disseminate an innovation keeps getting shorter. It took refrigerators 35 years to work their way into every household, mobile phones 15 years and the Internet less than 10. And with the latest digital innovations, we wonder how we lived without them just a few months ago. We’ve all been caught up in this accelerating spiral and pulled into this participatory economy that no one imagined a short number of months beforehand. Whether we’re for or against it, we should remember that, from the point of view of innovation dynamics, the era of the good old Intel 086 is far behind us now and that today we simply no longer have any choice. If we take too much time, we’ll wake up outside the system. If we don’t act now, we’ll be left out. Switzerland missed the biotech wave, but our large firms bounced back by buying companies that put them back in the race, with Roche picking up Genentech, and Ciba-Geigy annexing Chiron. If we miss the digital health revolution, who’ll buy Google or Amazon to get back into the saddle? No one has that kind of money! We can’t afford to be slow, so wisdom will just have to adapt. Otherwise we’ll be stuck with plenty of time reminiscing about our glorious past. ⁄

FOR MORE INFORMATION

www.bioalps.org the platform for life sciences in Western Switzerland

Popular wisdom values patience and continuously reminds us that impatience leads us astray. But do we really have time to wait? In a world where everything keeps moving faster and faster, definitely not!

The modern dream is that technical advances will make us time rich. Essentially, we hope that technical acceleration will enable us to do more things within each unit of time. And that’s exactly what technology has done. Cars go faster, giving us the possibility to do other things within the same amount of time. But what are we doing with all the time we’ve saved? How good are we at adapting our speed and the cycles within which we work, innovate and develop to being so time rich these days?

FOCUS

CHUV-EPFL

COLLABORATION

STETHOSCOPE OR ALGORITHM, IT’S THE SAME FIGHT /

Doctors and engineers have begun to combine their strengths, and new professions and innovative therapies have come out of it.

CREDIT: CMCS @EPFL – AUTHOR: S. ROSSI

Electromechanical modelling of the heart developed by the Chair of Modelling and Scientific Computing (CMCS) at EPFL.

/ BY

JULIEN CALLIGARO AND WILLIAM TÜRLER

FOCUS

CHUV-EPFL

FIGURES In Lausanne, many bridges have been built between the university hospital and the polytechnic school:

434

scientific studies by researchers from the two institutions have been published between 2011 and 2015.

hen Idris Guessous talks about his work group, he often compares it to a family. “When the GIRAPH (Geographic Information Research and Analysis in Public Health) programme was launched in 2013, my colleague Stéphane Joost and I formed a team of scientists,” says the physician and epidemiologist. “The family then grew and now includes children and friends who are our students and employees.” What’s special about this twoman team? One is a registered physician with the Lausanne University Medical Polyclinic (read the portrait p. 15), and the other is specialised in geographical information systems at EPFL.

patents were filed in 2015 by EPFL’s Faculty of Life Sciences. 5 start-ups were founded and 7 licences granted.

1,007 /

students were enrolled at the Faculty of Life Sciences at EPFL in 2015. That number was 364 in 2005.

300

million Swiss francs will be donated over the next 30 years to the Ludwig Center for Cancer Research in Lausanne. CHUV, EPFL and UNIL all work together at this centre to conduct anti-cancer research.

This example is not a one-off incident. These days, medicine and engineering are increasingly fused to bring about innovation. Piergiorgio Tozzi, an associate physician with the Cardiac Surgery Service at Lausanne University Hospital (CHUV), has been working with engineers for 18 years. Together, they designed a medical device to improve the surgical treatment of mitral insufficiency. This little valve in the heart prevents blood from flowing back from the left ventricle into the left atrium. After four years of development, the medical practitioner hopes to implant the device in a patient for the first time this year. 12

SPEAKING TWO DIFFERENT LANGUAGES Certain ingredients have to be added for the blend to work. “Passion, curiosity and an open mind,” Piergiorgio Tozzi says. T hat doesn’t mean that everything will go smoothly. As the cardiac surgeon says, “Engineers and doctors speak two different languages. Engineers are used to precision and certainty, while doctors have to deal with a lot of surprises.” This difference can complicate things, at least at first. But it’s easy to work around. “We just have to be patient and diplomatic,” the expert says with a smile.

Having worked in both fields, Jacques Fellay admits there is “a natural gap between medicine and engineering. But we now need to bridge that gap, given everything patients have to gain. Major innovations will develop from these partnerships.” As a genomics researcher at EPFL, Fellay holds a central role in this alliance. He studied infectious diseases and came to EPFL in 2011. He is in direct contact with scientific and IT engineers. Together, they hope to map out the human genome to determine whether differences influence the body’s response to infections. Today, he spends

FOCUS

CHUV-EPFL

PROFESSIONS OF THE FUTURE BIOTECH ENGINEER

10% of his time at CHUV, as a way of keeping one foot in both worlds. Jacques Fellay conducts what is called “translational” research, i.e. transforming laboratory discoveries into concrete applications that benefit patients. The cardiac surgeon Piergiorgio Tozzi very clearly says that his field of science can’t do without this collaboration. “When doctors detect a problem ‘in the field’ they can ask engineers for help to develop a solution.” This offers a dual advantage. Practitioners give engineers an idea, and they put it into application. “They actually find it very rewarding to work on health data,” says the epidemiologist Idris Guessous.

These engineers come up with new materials, forms of energy or bacteria for the chemical, food, pharmaceutical and other industries. Their inventions are intended to bring solutions to technical issues relating to product design or production.

DIGITAL HEALTH SPECIALIST These experts develop new digital technology to be used in health care. Solutions are designed to help individuals better understand and manage their medical data and allow health care workers to personalise treatments and choose the most effective care strategies for patients.

BIOETHICS EXPERT

NOT JUST FOR DOCTORS Most of the time, this type of cooperation comes about by chance. Doctors and engineers are brought together at seminars or study-abroad programmes. In the United States especially, medical students do translational research and dissertation work right at clinical facilities and realise that synergies exist between the two fields. Some doctors may also be approached directly by engineers looking for a clinical application for their product. That’s what happened to the ergotherapist Julien Moncharmont, who was contacted by Andrea Biasiucci, a biomedical engineer and co-founder of the EPFL spin-off Intento. Together, they developed 13

Sometimes called “bioethicists”, they study ethical issues arising from advances in medicine. At a hospital, the bioethics expert could be responsible for determining a patient’s ability to make an informed decision. These experts, employed by the government or an NGO, work to develop ethical health policy.

MEDICAL DEVICE DEVELOPER These specialists design innovative instruments and systems to improve or simplify medical procedures. Their inventions, such as medical robots, are used to prevent or treat health conditions and diseases.

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CHUV-EPFL

BIOINFORMATICIAN These computer technology experts build software used to develop drugs, improve quality control in the food industry and protect biodiversity. They analyse researchers’ needs and translate them into computer programmes used in areas such as protein structure modelling and genome annotation.

DIAGNOSTICS TECHNOLOGY DEVELOPER These experts come up with techniques for diagnosing new pathologies or simplifying research to identify certain diseases. For example, they may develop cheaper solutions to screen for health problems in poor countries.

Promoting partnerships The Swiss National Science Foundation (SNSF) set up the research programme Sinergia to support interdisciplinary cooperation. The SNSF financed 42 new Sinergia projects in 2015, for a total of 63.8 million Swiss francs. Out of the 126 requests for funding submitted, 26% of the projects were related to mathematics, natural sciences and engineering, while 54% involved biology and medicine. Higher education also emphasises this fusing of scientific expertise. Schools in Basel, Ticino and Zurich have even teamed up to offer a new medical studies programme in 2017. Students who complete their bachelor’s degree at the Swiss Federal Institute of Technology in Zurich can do their master’s in medicine at one of the partner universities. They can specialise in areas such as medical information technology or biomedical imaging. The University of Lausanne (UNIL) began to offer crossover programmes combining biology and bioengineering with medicine in 2012. “We want to strengthen that approach,” says Giorgio Zanetti, director of the medical school at UNIL, “to better integrate the expertise we need.” 14

technology for functional electrical stimulation aimed at hemiplegic patients. “Electrodes placed on the arm create a series of contractions that reproduce the functional movement of the limb, such as picking up or setting down a glass,” Moncharmont explains. “This technique brings hope for patients with chronic hemiparesis to be able to move their arm and use it in daily living activities.” An experimental project was conducted on about 12 patients in the autumn of 2015, producing conclusive results.

RAPID EXPANSION Although the collaborative efforts between medicine, health care and engineering are growing fast, they’re nothing new. “Back in ancient times, technicians would use engineering principles to develop processes that could be used in medicine, such as orthopaedic implants,” says Vincent Barras, medical historian at CHUV. “But it wasn’t until the late 19th century that this type of cooperation became clear. Doctors would seek out engineering staff to develop new techniques.” For example, radiologists have been working with physicists since 1899, when X-rays were discovered. These non-medical experts are responsible for the technical aspects concerning the production and use of ionising radiation to ensure the safety of patients and health care staff. “Interaction between the two fields is becoming more widespread,” Fellay says. The new experts emerging from the combination of technology and medicine will become as essential as general practitioners. “Bioengineers and bioinformaticians will soon play a key role in our health system,” says Fellay. Researchers and practitioners need to work more closely together than ever, as new technologies change the way doctors work. Some teams, including the one overseen by the epidemiologist Idris Guessous, have already brought in programmers or digital health specialists. /

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CHUV-EPFL

“In Vivo” met nine experts from CHUV and EPFL who, through their project and experience, embody the alliance between medicine and other sciences. PHOTOS: HEIDI DIAZ

IDRIS GUESSOUS Head of the Unit of Population Epidemiology at HUG and registered physician with the Lausanne University Medical Polyclinic

THE BOOM IN GEOMEDICINE

dris Guessous is convinced that what he learnt as a medical student is not enough to do the best he can at his job. “Individual data don’t explain everything,” says the physician from the Unit of Population Epidemiology at HUG and Lausanne University Medical Polyclinic. “Environmental and contextual factors also play a role in patient health. But to study those aspects, we need tools other than the ones we have.” After working in general internal medicine at HUG and CHUV and completing a PhD in epidemiology in the United States, in 2013 Idris Guessous set up the work group GIRAPH with Stéphane Joost, a geographical information systems specialist from EPFL. They wanted to better understand how the urban and human environment affects health.

“The two scientific approaches are complementary,” Guessous says. “Even if we come from different fields, we are united by our shared ambition to achieve scientific success.” However, this partnership between doctors and geographical information systems specialists did not take off immediately. It was just the two of them when the project was launched. “But the family gradually grew,” the physician says. “Engineers actually find it very rewarding to work on health data.” This cooperation led the team to unveil in January 2016 a map of Lausanne showing that urbanism and neighbourhood influence obesity. “Doctors should not feel ashamed about seeking help from other experts,” the epidemiologist says.

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CHUV-EPFL

LEE ANN LAURENT-APPLEGATE Director of the Unit of Regenerative Therapy at CHUV

RESCUING SKIN

ee Ann Laurent-Applegate teamed up with EPFL engineers and biologists to develop the second generation of biological bandages for severe burn victims. Burn wounds are a real nesting ground for microbes. These bandages are unique in that they prevent bacteria from proliferating on wounds and therefore reduce the risk of death due to infection. The technology is based on a biodegradable bandage made of animal collagen and ‘progenitor’ cells that can multiply quickly. “I bring in engineers and biologists every day to the operating room,” says the director of the Unit of Regenerative Therapy at CHUV.

“Working with people from different fields is a fascinating experience. It forces us to push ourselves further. I don’t use the same words when I’m talking to a doctor or to an engineer.” Partnerships between practitioners and experts is nothing new for Lee Ann Laurent-Applegate. Born in the United States, she studied biology in Switzerland after coming to the country in 1989. “In the United States, doctors and other experts – such as engineers and biologists – are used to working in networks,” she says. “Back in those days, we didn’t see that happening in Europe.”

While attending a conference after recently being appointed assistant professor at Baylor College of Medicine in Houston, she met a representative from the Swiss Institute for Experimental Cancer Research. She decided to come back to Switzerland for nine months to work on skin cancer. And she never left.

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CHUV-EPFL

GRÉGOIRE COURTINE Neuro-rehabilitation researcher at EPFL

TREATING MOTOR DISORDERS

his 41-year old neuroscientist has a background in both physics and medicine. At his laboratories at EPFL, in Lausanne, Geneva and soon Sion and at Suva, he works on spinal cord injuries. A few years ago, the researchers used pharmacological agents and electrical stimulation to help paralysed rats walk again. Grégoire Courtine and his team developed an electrochemical neuroprosthesis that switched the neural network in the spinal cord from a dormant state to a functional state, and a new robotic system to support the rat in any direction. After several months of work, certain connections were rebuilt. The team refined its algorithms and interfaces to create a more sophisticated system and conduct experiments on primates which showed greater recovery. A platform for humans was also designed to track muscle activity in real time. The first clinical trials are expected to launch this year. They aim to eventually develop therapies to minimise motor impairment for spinal cord injury patients, stroke patients and patients with multiple sclerosis.

Grégoire Courtine sees himself as a “conductor who enables people who speak different vocabularies to understand each other.” He strongly recommends drawing on the model of a single geographical location that brings together researchers and doctors from different campuses in the United States, such as Harvard and the University of California, Los Angeles (UCLA). In fact, he personally feels the “break-up” taking place in Lausanne, as EPFL and CHUV are no longer located on the same site. “We should bring research more to hospitals,” he says.

WATCH GRÉGOIRE COURTINE’S TED TALK ON WWW.INVIVOMAGAZINE.COM

PATRICE JICHLINSKI Chief of the Service of Urology at CHUV

UROLOGY GOES HIGH-TECH

he urologist Patrice Jichlinski worked with EPFL researchers for the first time in 1994. He was developing lasers to treat benign prostatic hyperplasia as part of a joint study conducted between EPFL and the urology departments at CHUV and HUG. EPFL took that opportunity to support and strengthen its expertise in the applications and fundamentals of laser-tissue interactions by working with the urology teams from the two university hospitals. Since then, Patrice Jichlinski has continued to develop the potential of alliances between researchers and practitioners. “As early as the 1990s, the hospital encouraged employees to work with the existing research networks,” he says. The chief of the Service of Urology at CHUV teamed up with EPFL researchers again to develop a technique using fluorescence to detect bladder cancer. Their product is now patented. Patrice Jichlinski, trained entirely in Geneva, has also been chief of the Department of Surgery and Anaesthesia Services since 2012. Today, he continues to work alongside researchers, now from UNIL’s Centre for Cancer Research, on immunotherapy for bladder cancer. “Their work is useful to medicine,” the surgeon says. He believes that the devices developed by scientists, especially engineers, enhance medical learning because they expand the range of surgical instruments. All of the joint projects he has worked on have brought conclusive results. “It all depends on group cohesiveness. If one person is no longer motivated, the entire project can collapse in a short period of time.”

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BRIGITTE JOLLES-HAEBERLI Director of the Swiss Biomotion Laboratory at CHUV, professor at UNIL and EPFL

SMART IMPLANTS

rigitte Jolles-Haeberli studied microengineering at EPFL and holds a degree and PhD in medicine. She became specialised in arthritis surgery in Toronto and in orthopaedic surgery and traumatology in Lausanne. These days, she spends her mornings performing hip and knee replacement surgery and moves on to research in the afternoon. Alongside teaching at UNIL and EPFL, she leads the Swiss Biomotion Lab at CHUV. This laboratory specialises in analysing movement. It is a place where doctors and engineers work together to find ways of delaying arthritis and better treating the disease. The lab’s experts use a variety of cutting-edge techniques, especially virtual reality, to change how people support themselves to relieve arthritis pain. Brigitte Jolles-Haeberli – with Julien Favre, Charles Baur and Simon Henein – is working on a custom-fit insole designed to shift the points that support the force on the joints and automatically self-adjust over time.

The expert is also working on another innovation set for launch soon, a “smart” knee implant. The device is fitted with sensors to provide information that currently remains unknown to the doctor. This same technique could eventually be used for hips and shoulders. “Closing the gap between technical and medical expertise makes the unimaginable imaginable,” the surgeon says. She adds a third area, biology, into the mix, which she believes will deepen knowledge by breaking it down to a smaller scale.

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IOANNIS XENARIOS Director of the Swiss Institute of Bioinformatics

INFORMATION TECHNOLOGY USED TO TREAT PEOPLE

oannis Xenarios, 48, completed his PhD with the Institute of Biochemistry and the Ludwig Center for Cancer Research at the University of Lausanne (UNIL) before moving on to postdoctoral work in bioinformatics at the University of California, Los Angeles (UCLA) in the United States. He built the first knowledge base on protein interconnections, which became an international benchmark. He then worked for seven years at Merck Serono, developing algorithms in genomics and proteomics. Today, Ioannis Xenarios travels between Lausanne and Geneva

on behalf of the SIB to manage two groups, Vital-IT and Swiss-Prot. These two groups bring together a total of more than 120 professionals specialised in a wide range of areas. There are bioinformatics experts, doctors, engineers, physicists, genomics experts and mathematicians. “We try to combine the right skills to make our projects feasible,” he says. These projects include a prenatal test without amniocentesis performed using the mother’s blood. This product is now used in Switzerland and recognised by Swiss national health insurance. The databases developed by the

teams overseen by Ioannis Xenarios are important at both local and international levels. (UniProtKB/Swiss-Prot, the global database containing knowledge about all proteins, is used every month by more than 500,000 people worldwide.) When he’s not supervising research projects, Ioannis Xenarios also plays a role in partnerships with industry and academics. He has been working with CHUV on setting up tools used to analyse genetic variations within the population. This project provided the opportunity to teach doctors about the techniques used in bioinformatics.

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RETO MEULI Chief of the Department of Medical Radiology at CHUV

IMAGING IN MOVEMENT

eto Meuli, 60, is a magnetic resonance imaging expert with degrees in both engineering physics and medicine. He was first confronted with the emerging MRI technology, used to take pictures inside the human body, when he was based in the United States in the 1980s. “With the advances in computer technology, h uge progress was made in magnetic resonance techniques between the 1980s and the early 2000s,” he says. “Now the procedure is reaching certain physical limitations. For example, the technology doesn’t require additional computing capacity. Today, one of the main challenges is in functional magnetic resonance imaging, used to measure organ function.” Using fMRI, we can see the brain working and the heart beating or watch a drug’s effect on the body. Reto Meuli has no doubt about it. “In the years to come, imaging will play an increasingly important role in personalised medicine.” With his training in both medicine and engineering, he can find connections between the needs of patients at CHUV and the findings of engineers at EPFL, who for example work at the school’s Centre for Biomedical Imaging. “My role is to understand and express these needs so that concrete applications can be developed that directly benefit patients.” Meuli believes in the importance of working in line with the philosophy unique to each of the two worlds. He also points out that it is crucial to leave researchers with a bit of spontaneity while taking into consideration the tight financial restrictions.

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OLIVIER MICHIELIN Physician with the Department of Oncology at CHUV and group leader at the Swiss Institute of Bioinformatics

BIOINFORMATICS WORKING TO SERVE ONCOLOGY

fter studying physics at EPFL, Olivier Michielin, 47, completed a full doctor training programme. He also did his PhD dissertation between Harvard and Strasbourg under the guidance of his supervisor, Martin Karplus, winner of the Nobel Prize in Chemistry for 2013. Together, the two men developed simulation techniques to understand how lymphocytes recognise tumours. Olivier Michielin then took his research in this area forward with his team in Lausanne. “We went beyond understanding recognition mechanisms and modified the receptor in lymphocytes to make them better at recognising tumours.” These “super lymphocytes” have demonstrated their effectiveness on mice. Clinical trials are scheduled to begin in 2017 at CHUV on patients with melanomas.

This research could give rise to new treatments for other forms of cancer. In addition to his work as a doctor, which is how he spends most of his time at the oncology department at CHUV, and in research, which positions him half-way between medicine and molecular engineering, Olivier Michielin is also group leader at the Swiss Institute of Bioinformatics (SIB) in Lausanne. “We’re trying to bring bioinformatics into oncology,” he says. “We’ve only taken the first steps, but it’s one of the key challenges for the future of our discipline. Bioinformatics can be used, for example, to better manage the massive amounts of data to benefit the patient.”

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ALAIN FARRON Chief of the Service of Orthopaedic Surgery and Traumatology at CHUV

“J

3D PRINTING IN SURGERY

ust a few decades ago, orthopaedic surgeons would prepare bones for an implant with little more than the naked eye,” says Alain Farron. “But to keep up with the progress in medicine, these doctors had to find new techniques to prepare the bone site with greater precision.” In a partnership with EPFL and private industry, the chief of the Service of Orthopaedic Surgery and Traumatology at CHUV worked on developing new tools such as 3D printing and computer-assisted surgery to do that. “Bringing engineers to work with orthopaedic surgeons is essential,” Farron says. “We need them as much as they need us.”

The doctor works in direct contact with the engineers. Together, they use 3D printing to develop instruments tailored to each patient to find the optimal positioning of implants. After finishing medical school at the University of Lausanne in 1984 and his post-graduate studies at CHUV and the Cantonal Hospital of Fribourg, he went to work in Philadelphia in 1996. After his experience abroad, he began working with engineers from EPFL. “Relations between the two worlds can be challenging at first,” he says. “But after years of working together, we’ve developed a language we all understand.”

Alain Farron believes that cooperation between engineers and orthopaedic surgeons will grow in the future. He offers the example of the new Balgrist Campus in Zurich, where engineers develop instruments that surgeons immediately put to use.

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“We met in the early 1990s. Even back then, we discussed how doctors could benefit from working with engineers.” PATRICK AEBISCHER AND PIERRE-FRANÇOIS LEYVRAZ

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INTERVIEW

PATRICK AEBISCHER AND PIERRE-FRANÇOIS LEYVRAZ

Discussing anecdotes, advances and breakthroughs, the directors of EPFL and CHUV met with us to talk about why they want their institutions to work closely together. INTERVIEW BY: BERTRAND TAPPY PHOTO: ERIC DÉROZE

“People won’t talk about healthy or sick, but about managing health” was in the early 1990s, and I’d only recently The sun is finally shining at the Swiss Federal Institute of returned from the United States. PierreTechnology in Lausanne (EPFL), after remaining in hiding François came to see me to talk about setting for several long weeks. But no one is out basking in the sun up his biomechanics lab at EPFL, and all the on this campus. While students are nailed to their chairs potential benefits medicine stood to gain from to squeeze in some last-minute study time before their collaborating with the world of engineering.” exams, the administrative and teaching staff whittle away at the standard mountain of paperwork that goes Dr. Leyvraz had sensed this far from the Lausanne with the end of the academic year. University Hospital. Actually, it was thousands of kilometres away, in the middle of New York City. We have agreed to meet in the CE building where the “When I saw the first Macintosh for sale at Macy’s in management staff is. Patrick Aebischer greets us the early 1980s, I realised that from then on technowith the director of CHUV, Pierre-François logy could transform medicine, that we were going to Leyvraz. What immediately strikes the observer is go from a static to a dynamic approach. When I came how well the two men get on. They’ve known back to Switzerland, I immediately went to see the chief each other for more than 20 years and share the of my service. I wanted to meet the professors from EPFL same viewpoint – and concerns – about the isto turn that idea into a reality. It was totally new, and I sues affecting health care. And their friendship was lucky to have a boss who was won over. And gave me began the very first time they met. “I rememfull freedom. He essentially just told me, ‘Figure it out’,” ber it perfectly,” says Patrick Aebischer. “It

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INTERVIEW

the director of CHUV says with a smile. “I had to convince And neither of them is trying to say that all doctors should trade in their stethopeople and, more importantly, find a common language with scopes for 3D printers. “What’s most imthe engineers. They weren’t enthusiastic about my idea at portant is that everyone can talk to each first, until I gave them a practical example, the challenge of other,” says Pierre-François Leyvraz. “That developing knee implants.” kind of open communication is vital for our university centre. A radiologist or orthopaedic doctor who wants to do research must have a dual profile, like Professors Meuli and Jolles (see p. 18 and 20). But that kind of background is rare. We simply want to facilitate the flow of people and knowledge in this new environment. Again, we’re only talking about 10% to 15% of the medical profession. We’ll always need practitioners. But even they will have to get used to new tools. They don’t need to know how it works, just how to use it!”

A LITTLE MORE THAN 30 YEARS AGO, SEEING A DOCTOR WALK DOWN RUE DU BUGNON TO GO TO ANY SCHOOL OTHER THAN THE SCHOOL OF MEDICINE WAS AN EXTREMELY RARE SIGHT. BRIDGING THE GAP

A little more than 30 years ago, seeing a doctor walk down Rue du Bugnon to go to any school other than the school of medicine was an extremely rare, if not extraordinary, sight. “These days, seeing biologists, physicians and engineers working together seems unquestionably obvious,” Patrick Aebischer says. “With the bridges we’ve built, science is no longer perceived as a set of blocks, but as a whole, an integrated system which requires creating several profiles. That’s why I developed life sciences at EPFL. The idea was obviously not to compete with the Faculty of Biology and Medicine. Actually, biology has continued to attract people, while our department is the second most popular speciality here. Promoting this mix means we’re also promoting the development of innovative new projects. An engineer who spends six months at a clinical department won’t become a doctor, but will more clearly understand the health care environment and its needs.”

A NEW EDUCATION PARADIGM

Artificial intelligence, personalised medicine, robotics, and so on. Behind all the thousands of promises are revolutions that are just beginning to happen. Who – doctor or comBIOGRAPHIES puter – will be giving the diagnosis? Patrick Where will patient data go? “We’re only in Aebischer completed his educathe early stages,” says Patrick Aebischer. tion in medicine “Technology is everywhere. Telemedicine, and neuroscience for example, exists even in developing in the 1980s in countries.” And where does the patient fit French-speaking Switzerland. in? “When patients are surrounded by a After spending growing number of increasingly specialseveral years ised professionals, a new type of profile in the United – let’s call them integrators – will be esStates and then at CHUV, he sential for monitoring patients throughbecame Presiout their course of care and maintaining dent of EPFL in an overview of the care given,” says March 2000. Pierre-François Leyvraz. His counterpart Pierre-François from the Lausanne Institute of TechnoloLeyvraz has gy agrees. “Health care providers, biolobeen the gengists, engineers and doctors will team up. eral director of But we haven’t yet defined the common CHUV since 2008. Prior to denominator. Career changes will probathat, he headed bly be more frequent. Doctors will no the Orthopaelonger be able to do what’s common nowdic Hospital in adays, simply finish their degree and French-speaking Switzerland move on.” and was chief of the Service of Orthopaedic Surgery and Musculoskeletal Traumatology at the Orthopaedic Hospital and at CHUV.

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INTERVIEW

types of teachers so that they can piece the entire image During his visit to the EPFL campus, back together.” Google CEO Eric Schmidt made no secret about the tech giant’s ambitions in health care. Huge resources are moving technology forward much faster than governments. Pierre-François Leyvraz and Patrick Aebischer believe we need to act fast. “Soon, we probably won’t be able to treat cancer without genomics,” says Pierre-François Leyvraz. “Techniques continue to advance faster than mindsets. How can we currently imagine what the social, legal and ethical issues will be when our progress in genomics will transform 750,000 citizens of the Canton of Vaud into 750,000 future patients? Or we might still be able to visit our great-great-grandparents who’ve been retired for 60 years and are still liv– PATRICK AEBISCHER ing off an inheritance. People won’t talk about healthy or sick, but about managing health.” As the interview comes to a close, we naturally asked both professors what field they would choose if they “WE’LL ALWAYS NEED TEACHERS” were to begin their studies in 2016. “I would become Lines have been blurred. And scientists have only an organ player. It’s a passion I’ve had since I was a been defining this world in the past few years, duryoung kid,” the director of CHUV says jokingly. “Acing which medicine has undergone more changes tually, I didn’t realise I wanted to become a doctor than it has in centuries. However, despite this prountil my first internship. Today I’d make the same gress, we should not give in to the temptation to choice, but with a more solid base in biology.” And completely rethink the way we train doctors. “Let it Patrick Aebischer is clear about his choice. “I’d be be clear. Technology will never be the easy road to a student at EPFL in life sciences to approach the best career,” says Pierre-François Leyvraz. “I’ve medicine from a technological point of view. I always fought so that clinicians could become profesdidn’t have that revelation until late in life! Howsors, because it is important not to spread oneself too ever, I have to admit that my exthin. Surgeons should first reperience as a doctor is invaluable. main surgeons. But they have to HEALTH VALLEY Having so much responsibility learn how to do their job in the Both men agree that Health Valley every day, without ever being able best way possible. We need – and should not become arrogant or to rest on your laurels was the will always need – teachers, like pretentious. “We can’t be the best at everything,” Patrick Aebischer best management school you can César Roux was in his day.” says. “We don’t have the resources imagine!” Now more than ever, of giants like Harvard University to humility remains the safest bet Throughout the discussion, the make huge investments. We have to for the future of medicine. ⁄ same words keep coming up: or- focus on our strengths. Fortunately, ganisation into systems, need for our leading areas of expertise are an overview, etc. “The MOOCS we concentrated in biology, medicine offer are wonderful knowledge in- and technology within a small tegrators,” says Patrick Aebischer. radius, like in Zurich.” “But for students to know where to go, we’ll have to define new Pierre-François Leyvraz is also optimistic about the future. “I’m amazed at the change in mindset in the region over the past 30 years. The northern shore of Lake Geneva has found its potential and its pride. And that has attracted fresh talent. Additionally, with political stability and numerous investors, the region offers the ideal biotope!”

“AN ENGINEER WHO SPENDS SIX MONTHS AT A CLINICAL DEPARTMENT (...) WILL MORE CLEARLY UNDERSTAND THE NEEDS OF HEALTH CARE.”

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COMMENTARY

MARCEL SALATHÉ Marcel Salathé, director of the Digital Epidemiology Lab at EPFL

We don’t want to let a monopoly develop in medical data Computers have for a long time been good at some things, like doing math, but bad at other things we humans are good at. For example, just 10 years ago, it was practically impossible for a computer to look at a few images of different animals, and correctly classify the cat as cat, the dog as dog, etc. – something a two year old can do easily. But research in artificial intelligence has made such tremendous progress in the past few years that computers can now do this just as well as humans, or even better. And they can do it millions of times faster. We can now build software - based on ideas about how our own brains work - that can “learn” what a cat looks like. And of course, such learning is not limited to images of cats, but can be extended to any situation imaginable. In a recent study for example, a computer learned to identify the correct type of skin cancer based on an image alone - and ended up being better at it than a dermatologist at Stanford Hospital.

Artificial intelligence thrives on data – and we are in the age of big data. We collect, both individually and institutionally, enormous amounts of data on everything we do. From our DNA up to how many steps we take per day, it costs almost nothing to collect any kind of data you’d want to have about yourself. And when hundreds of millions of people do this, massive amounts of data are generated that artificial intelligence can learn from. But who owns this data?

Artificial intelligence is here to stay. The search engine you use is based on artificial intelligence. The map you use to get from A to B as fast as possible is based on artificial intelligence. Markets move based on decisions made by artificial intelligence. One day soon, many medical diagnoses will be based on artificial intelligence. Whoever controls the data, controls the artifiRemarkably, building such software is very easy, cial intelligence. Rather than having this control not at least thanks to the open source movement. concentrated in a few commercial players, I hope The large digital companies of this world are we can create a situation where all of us – medical now openly releasing the software that powers professionals, researches, corporations, patients – artificial intelligence, accelerating the rapid are in control of this new technology. For this progress in this field even more. to happen, all stakeholders need to work together to find ways to open medical data to the wider community. Otherwise, our future medical system risks being controlled by a select few who have PROFIL Marcel Salathé is an access to the data. ⁄ associate professor at EPFL, where he heads the Digital Epidemiology Lab. He is the author of Nature, in Code and a co-founder of PlantVillage, a knowledge sharing platform on plant diseases.

TO KNOW MORE

ROEL FLEUREN

www.natureincode.com

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INNOVATION

JOINING FORCES FOR PERSONALISED MEDICINE

TEXT: SAMUEL SOCQUET ILLUSTRATION: JOÃ&#x2039;LLE FLUMET

Five institutions along the northern shore of Lake Geneva have launched a vast scientific cooperation programme called Health 2030. The idea is to combine their strengths and expertise to build the medicine of tomorrow.

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“This project brings together 2.5 million researchers.” That’s how Professor Didier Trono, head of the laboratory of virology and genetics at the Swiss Federal Institute of Technology, likes to describe this new initiative to come out of the Lake Geneva region, Health 2030. “It’s not just scientists. It involves citizens throughout Western Switzerland.” Together, they will contribute to the development of personalised medicine. Also referred to as “precision medicine”, this approach aims to offer a more precise diagnosis and treatment customised to each patient. The model also emphasises the importance of prevention by identifying the risk of disease in early stages. “Personalised medicine requires considerable resources and a wide range of expertise. It won’t work at merely a regional or even national level,” says Philippe Moreillon, vice dean of the University of Lausanne. He is one of the three members of the Health 2030 coordination team, alongside Didier Trono and Denis Hochstrasser, vice rector of the University of Geneva and head of the Department of Genetic and Laboratory Medicine at the Geneva University Hospitals (HUG). This large-scale project was initiated in 2015 by the University of Lausanne (UNIL), the University of Geneva, the Swiss Federal Institute of Technology (EPFL), Lausanne University Hospital (CHUV) and Geneva University Hospitals (HUG).

INNOVATION

Philippe Moreillon has referred to the cooperation, extended this year to Bern, as “remarkable”. “It’s one of the rare projects that combines all the expertise in Western Switzerland.” BRINGING TOGETHER TOP EXPERTS

The project aims to pool the financial resources and develop the know-how needed to build powerful and efficient personalised medicine tools. The best genomics experts will work together at a sequencing centre located in Geneva and designed by HUG and EPFL, where DNA samples from the entire region— and beyond—will be centralised. Another centre, likely to be set up in Zurich, will be responsible for proteomics, the study of proteins (gene expression, or proteins, must be looked at to understand what differentiates two organisms with the exact same genes). In 2013, CHUV opened the Lausanne Institutional Biobank (BIL), which already holds the biological samples of nearly 30,000 people, sick and healthy alike, who agreed to donate tissue to research. The BIL will be able to centralise samples from partners and, once the funding is available, these tens of thousands of DNA samples can be sequenced. UNIL will examine epidemiological and ethical issues. “Social sciences —anthropology, ethics, psychology, law and sociology—also play a key role. “Today, we have to evolve towards an interdisciplinary system. And that’s a very positive thing,” says Philippe Moreillon.

ANALYSING MULTIPLE FACTORS

Denis Hochstrasser points out that personalised health is about more than genetics. “This movement has definitely been driven by advances in high-speed genome sequencing, but genetics is just one of the tools used, along with proteomics and metabolomics,” he says. Metabolomics is the study of metabolites, or molecules

KEY PLAYERS IN THE HEALTH 2030 INITIATIVE 1

Philippe Moreillon is vice dean of the University of Lausanne. He previously worked at CHUV as head of the Antimicrobial Agents Unit, and then at the Infectious Diseases Service. In 2002, he became director of the Institute of Fundamental Microbiology at UNIL.

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Denis Hochstrasser, vice rector of the University of Geneva since 2013 and head of the Department of Genetic and Laboratory Medicine, currently oversees operations at Campus Biotech. He is a co-founder of the Swiss Institute of Bioinformatics and scientific founder of the start-ups GeneProt, Genebio and Eclosion. 3

Didier Trono is a professor with the laboratory of virology and genetics at EPFL. After studying internal medicine and infectious diseases in Geneva in the 1980s, he worked for several years at prestigious institutes in the United States. When he returned to Europe, he headed the EPFL School of Life Sciences from 2004 to 2012.

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produced from metabolic processes, present in a cell. “Precision medicine also takes into account all factors that affect a population’s health, including genetics, ecosystems (microbes and toxins) and behaviour (hygiene, diet, physical activity).” If we attach social and emotional variables, such as the family and professional environment

INNOVATION

and so on, we can easily understand the challenge faced by doctors and engineers in interpreting these massive amounts of information, commonly referred to as “big data”. CANCERS AND ALLERGIES

What will patients actually be getting out of such a massive

cooperation project? With DNA sequencing alone—just one of the techniques used in personalised medicine—applications are immediately available in oncology, says Didier Trono. “We can already stratify therapies, i.e. assign the best treatment based on the tumour’s molecular signature. For example, we no longer diagnose ‘lung cancer’ but analyse

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The Health 2030 initiative in the Lake Geneva region was jointly launched by the University of Geneva, UNIL, EPFL, HUG and CHUV. Didier Trono from EPFL, Denis Hochstrasser from HUG and Philippe Moreillon from UNIL are the project’s three leaders.

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INNOVATION

the tumour’s mutations, which can be identical in other forms of cancer. This allows doctors to offer more effective therapies,” he explains. “We can detect the immunological profile of the tumour and target it using immunotherapy. Genetic risk testing is also available, as Angelina Jolie showed the world. The actress underwent a preventive double mastectomy at age 37 after finding out that she carried the BRCA2 gene mutation, which meant that she was predisposed to develop breast or ovarian cancer.” Allergology is another area where the Health 2030 project is expected to bring solutions, says Philippe Moreillon. “Allergies are a real public health issue. We’ll eventually be able to expand our scope of action, especially by combining patient data with data from the Federal Office for the Environment.”

Switzerland—of the concentration of microparticles or detect the presence of allergens and compare that information with local health issues, we’ll be able to act to eliminate the causes. These are all possible applications in the future. All we have to do is develop the know-how,” says Didier Trono. We are moving towards a clinical-research system in which research will be applied to the clinical experience in near real time. “The challenges are huge,” says Denis Hochstrasser. “We will not only have to balance the technical, medical, ethical and legal issues, but also rethink how we train practitioners and inform patients.” The revolution of our health care system is now. ⁄

And the analysis of those findings can benefit the population in the long term. “One day, when we can inform people—in real time and across all of French-speaking

A NETWORK WITHIN A NETWORK The Swiss Personalized Health Network (SPHN) is a national initiative to support personalised medicine. The SPHN aims to “harness the potential of personal health data shared throughout Switzerland, to better manage individual health, disease and research,” says Peter Meier-Abt, president of the Swiss Academy of Medical Sciences, the organisation in charge of coordinating the project through the implementation phase from 2017 to 2020. The Health 2030 programme in Western Switzerland will participate in the SPHN. “For Switzerland to establish its position in personalised health research, efforts will have to be coordinated nationwide. It will take the involvement of both medical and non-medical partners, including the government, research funding institutions, health care system and industry,” says Peter Meier-Abt.

IMAGING IN ALL FORMATS

Along Lake Geneva’s northern shoreline, the different units of the Centre for Biomedical Imaging are developing leading-edge technologies to push the limits of medicine ever further. A close-up view of some of the research in progress. TEXT: MARIELLE SAVOY IMAGES: PHILIPPE GÉTAZ AND CIBM

IN CORPORE SANO

INNOVATION Based in Geneva, Lausanne and Renens and working in the shadow of hospitals and laboratories, the scientists from the Centre for Biomedical Imaging (CIBM) are the ones making things happen at this cutting-edge research facility, a joint initiative from the Swiss Federal Institute of Technology in Lausanne (EPFL), University of Lausanne, University of Geneva, the Lausanne University Hospital (CHUV) and the Geneva University Hospitals (HUG). They aim to develop imaging techniques to better understand disease, working with both animals and humans. “We can easily imitate human diseases in rodents,” says Nicolas Kunz, a scientist at CIBM. “They also have the advantage of being more stable models than humans, as their condition depends less on external factors such as the environment.”

MOTION CORRECTION

(See page 31) Very high-definition scanners are extremely sensitive to any involuntary movements by the patient, which affect the quality of the image. To solve that problem, researcher Daniel Gallichan has developed a technique for observing the amounts of fat in the brain. This method detects movements made during the exam and then corrects the images. Above, a clear difference can be seen between the initial reconstruction of this image of brain arteries (top) and after the movements were corrected (bottom).

POWERFUL SCANNERS

With a magnetic field of 14 Tesla, the most powerful scanner at CIBM (right) takes ultra-precise images. As a point of reference, MRI equipment used in hospitals features standard magnetic fields of 1.5 to 3 Tesla. But this machine, with its tunnel measuring only 12 centimetres in diameter, is reserved for use on small animals such as rats and mice. “It’s technically very complicated to produce such intense magnetic fields that can cover the entire human body,” says the researcher Ileana Jelescu. At EPFL, the MRI device used on humans has a magnetic field of 7 Tesla (left). CORPORE SANO

IN THE LENS

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IN THE LENS

DIFFUSIONWEIGHTING

Several CIBM employees are conducting research to expand our knowledge of the brain. With images from diffusion-weighted MRI, a technique based on the diffusion of water within biological tissue, Nicolas Kunz created this computer-generated colour image of the network of connections in a rat’s brain (top). “In the case of a tumour, for example, we can observe the connections to determine how the brain will react once the tumour is removed.” Meanwhile, Ileana Jelescu uses functional MRI to detect areas of the brain activated by different stimuli (right, in red).

CORPORE SANO

IN THE LENS

LAYERING

To make even more accurate observations, the scientists at CIBM have come up with a way of combining the two main types of images produced by MRI technology. The different or additional information appears here in colour. “Some regions of the brain could be more easily identifiable by combining the techniques. That is true for the structures located in the centre of the brain in this image. It would be difficult to identify them with a single contrast,” Gallichan says.

3D PRINTING

The 3D FatNav motion correction technique has been used to produce 3D models of a hippocampus. “This part of the brain, which plays a crucial role in memory, is one of the first areas of the brain damaged by Alzheimer’s disease,” Daniel Gallichan says. Being capable of observing it in detail could lead to valuable medical advances.

CORPORE SANO

IN THE LENS

AT THE ROOT OF SCHIZOPHRENIA Advances in research on the genetic and environmental factors that cause schizophrenia could help experts develop new drugs to treat the disease. TEXT: GENEVIÈVE RUIZ

or nearly 15 years in Lausanne, psychiatrists have been working with neuroscientists to better understand schizophrenia. This relatively unique collaboration has resulted in some promising advances. “It may seem logical for neuroscientists and psy chiatrists to work together,” says Kim Do Cuénod, professor at the Center for Psychiatric Neurosciences at Lausanne University Hospital (CHUV). “But it rarely happens. By teaming up to study the disease, we can easily compare neuroscientific findings against patient problems.” As a result, she has been able to show the relationship between schizophrenia symptoms and oxidative stress.

“The nervous system, which accounts for 2% of our body weight but uses 25% of our oxygen consumption, is particularly vulnerable to oxidative stress,” says Kim Do Cuénod. “We’ve observed CORPORE SANO

deficiencies in the SCHIZOPHRENIA antioxidant system Schizophrenia is a psychological disease in which a person loses contact with reality. This mental disorder in the brain of affects about 0.7% of the population, with the first schizophrenic symptoms generally emerging in early adulthood. patients through Schizophrenics typically experience delusions, hallucinations, disorganised thinking and altered either brain emotional expression. Despite common misconcepimaging or tions, schizophrenia should not be confused with cerebrospinal fluid multiple personality disorder or aggressive behaviour. analysis.” This work is conducted as part of the close This deficit in turn impairs partnership conduction in nerve fibres and between the Centre for Biomedical Imaging at the Swiss disrupts the synchronisation of impulses between the different Federal Institute of Technology parts of the brain. in Lausanne (EPFL), in which researchers use imaging to “This discovery could be measure antioxidant levels in included in a biomarker profile animal and human brains and used to confirm a diagnosis in intracerebral connections. of schizophrenia, which is ne of the factors that currently established solely causes schizophrenia based on clinical symptoms,” could in some cases Do Cuénod says. But perhaps be genetic. It prevents more importantly, these control of the oxidative balance advances could lead to the in the brain, which brings on development of new treatments. a whole slew of problems, The Lausanne-based researcher such as the deterioration of and her team have been the insulating myelin sheath studying a group of 60 patients surrounding nerve cells. receiving care at the Service

O INSIGHT

ERIC DÉROZE

BRAIN ACTIVITY IN A HEALTHY BRAIN (LEFT) VERSUS A SCHIZOPHRENIC BRAIN (RIGHT)

SCIENCE PHOTO LIBRARY

KIM DO CUÉNOD

of General Psychiatry since 2008. of the Service of General A group of them have taken a Psychiatry at CHUV. “If we could drug to counter the effects of detect high-risk subjects, we oxidative stress, and the results could offer them a preventive are impressive. “We’ve observed treatment that would improve an improvement in cognitive the oxidative balance in the abilities and hallucinatory brain.” These discoveries have symptoms in patients defined given Philippe Conus a great based on markers of blood deal of hope. “Psychiatry has redox,” the expert says. Neuromade enormous progress in leptics, the only drugs currently caring for schizophrenic given to schizophrenics, fail patients and improving their to treat cognitive quality of life. We used impairment approprito have 700 beds for ately. And the medicathem here at the OXIDATIVE STRESS tion has a number of Hospital of Cery. Cells need a balance side effects, especially between free radicals Today there are on metabolism. only 95. People either and antioxidants to function properly. live at home or in a That is what is hese treatspecialised centre.” referred to as redox ments also But the expert feels balance. A redox offer new that these results, imbalance can lead to oxidative stress. solutions for achieved through preventing the disease. If this state persists a combination of over a long duration “We now know that the or occurs during neuroleptics and causes of schizophrenia critical periods in psychotherapy, are brain development lie in a complex set not enough. “Of the (gestation or the of environmental, patients who experiearly years of life), psychological and ence a first psychotic it can damage cell genetic factors,” says episode, 30% will membranes, proteins and DNA. Philippe Conus, chief recover, 30% will

CORPORE SANO

INSIGHT

CAUSES OF SCHIZOPHRENIA Most experts now agree that schizophrenia is the result of a multitude of genetic, environmental and psychological factors. For example, the vulnerability gene DISC-1 was found to have mutated in a large Scottish family with several members who had been diagnosed with schizo phrenia. Flu infections, nutritional deficiencies and severe psychological stress during pregnancy have been associated with a higher risk of the disease. Psychological or sexual abuse during childhood and the use of cannabis by children under the age of 14 also increase the likelihood of developing schizophrenia.

have an intermediate outcome and 30% will experience many subsequent relapses.” Identifying biomarkers and developing early intervention strategies could improve this outlook. ⁄

SCIENCE PHOTO LIBRARY

Dr. Robot

few weeks ago in the United States, the surgical robot STAR (Smart Tissue Autonomous Robot) performed surgery entirely on its own. Based on a number of measures, the machine beat human surgeons at stitching back together segments of the intestine, a procedure commonly applied to remove cancerous tumours in the bowel. “By eliminating human intervention, autonomous robots can potentially reduce complications and improve the safety and effectiveness of surgical interventions on soft tissues,” said the team of scientists from George Washington University in charge of the project. But for the time being, completely autonomous intervention remains the exception. Meanwhile, doctors

and machines continue to work closely together. Spearheading this technological invasion into operating rooms is the robot da Vinci. This surgical system developed by the American company Intuitive Surgical is used for minimally invasive surgery, chiefly in procedures performed on the abdomen. Instead of opening the abdominal cavity or rib cage, the surgeon makes small incisions to insert the instruments and guide them to the surgical site. More than 3,000 da Vinci systems have sold worldwide, at a cost of between 1 million and 2 million Swiss francs, since the robot hit the market about 15 years ago. The contraption consists of several separate components, including four effector arms (in the latest

version) that hover over the patient. The interactive arms hold the surgical instruments and an endoscope and are controlled remotely from a console where the surgeon is seated comfortably. “The robot is used to perform surgery more intuitively using a high-definition 3D vision system and with greater stability to carry out extremely precise movements,” says Nicolas Demartines, chief of the Visceral Surgery Service at CHUV. MARKETING SLANT

However, the physician is more reserved about the advantages of robotics for the patient. “Studies have proven that for treating cancer, which is my main area of expertise, medical robotics is

Robots are increasingly used in the operating room to assist surgeons. A number of start-ups at EPFL are developing more advanced machines. Overview. TEXT: ERIK FREUDENREICH

just as effective as conventional surgery or laparoscopy,” he says. “But for now it hasn’t shown that the technique is better because robotics tends to be used for easier operations that are more spectacular and offer greater marketing value. The advantages of robot-assisted surgery remain in many ways unexplored. In fact, robotics has seen few major technical improvements since their use emerged in the mid-1990s. But the positive aspects – ergonomics and the surgeon’s comfort during the operation – are worth noting.” And KB Medical, a start-up based in Lausanne, wants to do something about it. This spin-off from the Swiss Federal Institute of Technology in Lausanne (EPFL) has recently received European CORPORE SANO

certification for its robotic assistant, AQrate. The medtech company launched its project four years ago, after being contacted by John Duff, a physician from the Service of Neurosurgery at CHUV, to find a novel technological solution to meet the challenges of cervical spine surgery. “We discussed developing our product with a fundamentally different approach from what currently exists on the market,” says its CEO, Jean-Marc Wismer. “Unlike da Vinci, our device doesn’t copy the surgeon’s movements but offers assistance to ensure the precision of the trajectory when piercing tissue or placing screws in vertebrae.” AQrate is basically a robotic arm that holds the surgical instrument inserted INNOVATION

by the doctor and takes it to the desired position intuitively, similar to an exoskeleton. Its sensor allows the system to follow any movements and provide force feedback. “Once the instrument is inserted, the robot maintains an extremely rigid trajectory to pierce tissue and place screws precisely without deviating.” ADAPTING TO THE SURGEON

This solution offers the utmost precision in the trajectory of the movement, despite any challenges related to the instruments used or types of tissue involved. This reduces the risk of injury to the patient’s arteries and spinal cord, especially in minimally invasive surgery. “The other major difference with our system is that our robot is integrated into the

Switzerland at the forefront of medical robotics ERIGO The Erigo robot designed by the Zurich-based start-up Hocoma helps comatose patients wake up. The device can also be used to stimulate the recovery of neurological functions in patients who have had a stroke or head injury.

traditional operating procedure. The robot adapts to the surgeon’s movements, not the other way around,” Wismer says. “We’ve recently concluded a clinical study on 24 patients, with physicians who each have a different surgical technique. Our robot could be used rapidly by each surgeon, as they didn’t have to adapt their procedure to the machine.” Recently approved for the CE mark, a prerequisite to commercialisation, AQrate will be rolled out in the coming year at a limited number of hospitals. “We want to continue gaining experience by working with these medical centres to get through any teething problems and determine which techniques are best suited for day-to-day use,” he says. “Large-scale commercialisation is expected to begin in 2018 in partnership with a major group with adequate sales and support teams.” Medical robotics is also developing beyond applications in surgery. The department of Clinical Neuroscience at CHUV CORPORE SANO

uses the robot Erigo to encourage comatose patients to wake up. The device developed by Hocoma, a start-up based in Zurich, is used to stimulate the recovery of neurological functions in patients who have had a stroke or head injury. GHOST IN THE LAB

Another example of robotic applications in medicine comes from the Laboratory of Cognitive Neuroscience at EPFL, led by Professor Olaf Blanke. One of his team’s current projects aims to better understand the brain functions activated when hallucinations are experienced by patients with neurological or psychiatric conditions, such as Parkinson’s disease and schizophrenia. Researchers have developed a robotics system to replicate the “feeling-of-a-presence” phenomenon that some patients suffer from. In the experiment, blindfolded subjects extended their arm in front of them. The robot analysed and reproduced the same movement, touching the patient’s back. After the INNOVATION

KB MEDICAL SA, HOCOMA

AQRATE The start-up KB Medical based in Lausanne has developed the robot AQrate, a robotic arm that offers surgeons precise guidance and an uncompromising trajectory when placing implants or screws in vertebrae. AQrate is expected to be brought to market in 2018.

experiment was over, subjects spontaneously reported feeling a presence behind them. “This experiment gives us a way of studying the brain in a state of hallucination while in a controlled, and therefore more precise, environment,” says Giulio Rognini, the scientist in charge of the study led in cooperation with CHUV. “The next immediate step is to see how our robotics system could contribute to developing new diagnostics tools. In the longer term, we would also like to use it therapeutically to reduce hallucinatory episodes, such as in a wearable device.” The EPFL scientist believes that “cognetics”, i.e. interfacing between cognitive functions and robotics, is merely in its infancy. “Dr. Blanke’s research has shown that many complex brain functions, such as the perception of our body, are based on tactile stimuli,” Rognini says. “One day, we should be able to give amputees the sensation that their prosthetic arm is really part of their body via a neural interface.” ⁄

VINCENT ADATTE

Senior nurse in charge of strategic projects at the Department of Patient Care at CHUV

The modern hospital is a giant start-up focused on developing innovation, listening to its market and meeting its users’ needs.

Public hospitals used to be thought of as institutions that serve captive patient groups and were typified by their burdensome red tape. If anyone still believes in that notion, it’s time to change it!

SAM-CHUV

Racked with steep competition and inescapable cost-cutting, today’s hospitals are forced to rethink the way they operate. They can no longer get by simply providing the same services as the next establishment down the road. Nor can they get away with performing the same procedures as other institutions but with lesser quality or at higher prices. Hospitals now have to position themselves on a map that is constantly being redrawn by the endless changes in the world of health care.

The ageing population, cancer or the health of migrants are examples of issues that affect society as a whole. Hospitals sometimes start coming up with solutions 10 to 20 years in advance. Everyone working in health care should take a proactive approach by asking themselves, “Where would it be useful to go? What are the current and future needs? What is the latest expertise and technology that we can use to respond to those needs? How can we make sure that we will have the individual and collective skills required to meet those needs? What contribution can I make and who should I be working with?”

Innovation often involves taking risks. Professionals driven by a strong entrepreneurial spirit understand the importance of minimising risk and analysing potential failures, just like in a start-up. It’s also a process. The organisation is inspired by Any entrepreneur launching a start-up must a vision and fuels it in return. It relies on first identify market needs, bring together expertise and tangible data while simultanethe skills necessary to develop an innova- ously drawing on intuition and the calling tive product that meets those needs and to offer solutions to those who need them. find financing. Although what they offer is Innovating means inventing a new future. ⁄ primarily a service, health care providers draw on these principles and pay careful attention to the environment they work in. Health care needs are their “market”. Professionals predict and anticipate how these needs will change and develop their skills to bring an appropriate response. They monitor progress on a dashboard with indicators that measure the satisfaction, quality and effectiveness of care along with economic and organisational variables.

CORPORE SANO

COMMENTARY

CURSUS

COMMENTARY

Bertrand Tappy Editorial manager at CHUV

or nearly three years now, In Vivo has been faithfully reporting on Western Switzerland’s leadership in medical innovation and making it relevant to you. Whether it’s at the patient’s bedside or in laboratories, health care continues to amaze us and shape our future. And we want to challenge that future with you. As we reach the symbolic milestone of our tenth issue, we thought the time was right to expand our horizons and focus more on advances in fundamental research. This field often operates outside the public eye, producing more dry scientific publications than fancy promises of new drugs. But fundamental research often gives scientists the opportunity to take a new look at the phenomena that they thought they had understood for ages.

And in this respect as well, the region along the northern shore of Lake Geneva boasts a huge advantage. The Faculty of Biology and Medicine at the University of Lausanne, with which the Lausanne University Hospital works closely, has agreed to join us in developing a new section of this magazine. Starting with the next issue, you’ll find new categories of articles (in the CURSUS section) presenting a behind-the-scenes look at research and the work of researchers who are trying to understand the secrets of the living world. Plus, a few surprises are in store. In any case, we hope you’ll like these new features. Don’t hesitate to let us know what you think on our social media sites: Facebook, Twitter and Google+! We’d also like to thank you for your loyalty and the quality of the feedback you regularly send us. Another landmark figure is also around the corner: our 1,000th subscriber! We thought it’d take several years to reach that mark, but this accomplishment will motivate us to continue to meet and report on the people who are building the hospital of the future. ⁄

PATRICK DUTOIT

CURSUS

CAREER AT THE CHUV

Ten issues, 1,000 subscribers

CURSUS

New collaborative platforms Thousands of researchers worldwide are involved in the Human Brain Project (HBP), the ambitious research programme led by the Swiss Federal Institute of Technology (EPFL) which aims to simulate an entire human brain using a computer. Six computer platforms were designed so that these researchers can work together. CM HUMAN BRAIN PROJECT

Predicting complications from meningitis The genetic analysis of a protein produced by immune cells can be used to predict patient outcome in cases of bacterial meningitis. This discovery was made by a team from the Infectious Diseases Service at CHUV led by Professor Thierry Calandra and reported in a study published in the American journal PNAS. These findings aim to reduce the complications and mortality caused by these deadly infections. CM INFECTIOUS DISEASE

NEWS

Faster allergy desensitisation A new allergen immunotherapy has been developed at CHUV. This method, currently undergoing tests, could bring about faster allergy desensitisation treatments. RESEARCH

Five injections over two months instead of weekly injections, then monthly allergy shots over three years. That is the protocol researchers are aiming for with this new allergy immunotherapy method. Allergies are excessive, abnormal reactions from the immune system to substances called allergens. These allergens cause the overproduction of antibodies in the body, which thinks it is fighting an invader. This can lead to unpleasant symptoms and sometimes serious complications when people are allergic. Professor François Spertini and his team at the Service of Immunology and Allergy at CHUV, who have been studying allergies for more than 10 years, have discovered that if allergens are cut into small enough pieces, they are no longer recognised by the

antibodies but can still stimulate immune cells. Immune cells eventually get used to being in contact with these allergen fragments and can be desensitised. Researchers do not yet know whether this immunotherapy can completely suppress allergic reactions. To find out, they are focusing on birch pollen. A product based on these small pieces of allergens has been developed and tested on mice and humans for safety and efficacy. The initial findings, published in the Journal of Allergy and Clinical Immunology, confirm that the allergy was reduced. “We’re now going to extend our studies to cover broader population groups,” Professor Spertini says. CM

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PATRICK OMOUMI

CURSUS CURSUS

CAREER AT THE CHUV

arcomas are Patrick Omoumi and Igor Letovanec That’s where radiology rare tumours can bring additional are responsible for a crucial step that develop insight. If we don’t in patient care at the Sarcoma Centre work with imaging in different types of tissue, including data and talk about at CHUV: diagnosis. bones, muscles, bone tumours with the TEXT: BERTRAND TAPPY, PHOTOS: PHILIPPE GÉTAZ tendons and other radiologist, it could soft and connective lead to an error.” tissue. With more than 160 types of tumours that can develop anywhere in the body and at varying Each patient case at the Sarcoma Centre is growth rates, these cancers can be a real reviewed at a weekly meeting. “You might say nightmare for doctors to identify. “Patients that a part of diagnosis is based on the radio with this form of cancer require treatment in a logist’s macroscopic view and the pathologist’s specialised care facility as soon as it’s detected,” microscopic view,” says Patrick Omoumi. “Onsays Patrick Omoumi, the physician responsible cologists and surgeons can then combine our for musculoskeletal imaging at Lausanne views to decide on the best therapy. Experience University Hospital (CHUV) for the past three is vital with this type of disease. That’s why we years. Radiologists are in charge of the particucame together as a specialised care centre at larly sensitive step of taking images of the tumour CHUV, where more than 52% of the patients and performing the biopsy. “When we suspect we care for come from another canton,” he says. a sarcoma, we have to remove a sample of the “However, in the very rare cases when we’re still tumour for analysis according to a very specific not sure, we send the radiological images and procedure to prevent the tumour from spreading histological sections to Massachusetts General and to achieve the best possible outcome for the Hospital in Boston, one of the world’s leading patient, working with the surgeon who will take sarcoma research centres, to be as sure as we over from there.” can be of getting the diagnosis right.” After the biopsy is when pathological analysis comes in. “With the advances in biopsy techniques, we can now reach almost any tumour,” says the pathologist Igor Letovanec, specialised in musculoskeletal and thoracic diseases. “But the samples are much smaller. That makes the procedure less painful for the patient, but the pathologist’s work becomes more complex. Imagine you have to identify a painting by only looking at an ever smaller part of it.

Once the diagnosis is made, the surgeon takes over – as surgery is the only effective treatment for sarcoma – along with the oncologist to care for the patient. In 2015, the Sarcoma Centre cared for 80 new patients, including nine children, with a survival rate after one year of 95%. ⁄

CURSUS

Mould’s got it tough The Institute of Microbiology at CHUV, working with Harvard University, has identified chemicals that can cancel resistance to antifungal agents in certain types of fungi that cause 400,000 deaths worldwide every year. These new drugs are used to extend the use of antifungal therapies and make it easier to treat infected patients. Their findings were published in the prominent journal Nature. CM MICROBIOLOGY

New master’s degree

Swiss hospitals with a cardiac surgery department and specialised medical societies have decided to introduce a new master’s programme in cardiovascular perfusion. Perfusionists are highly skilled professionals who play a vital role in cardiac surgery by maintaining proper blood circulation throughout the procedure. Students who successfully complete the new professional training course will obtain a federally recognised diploma. CM

Understanding sepsis in severe burn victims The CHUV Burn Centre and University of Geneva have teamed up to study exudates, the fluids that seep out of severe burn wounds, to understand how burn wound sepsis develops. This infection is the main cause of morbidity and mortality in severe burn victims. In a study published in the journal mSphere by the American Society for Microbiology, researchers report that exudates contain immune molecules that can destroy certain bacteria but stimulate the growth of the opportunistic pathogen Pseudomonas aeruginosa. The expression of the bacterium’s virulence factors and antibiotic resistance can be regulated in the host. These research teams are now working to create an artificial medium of the environment to better understand and fight these infections.

INFECTIOUS DISEASE

Teaming up for palliative care Since 1 May 2016, Professor Ralf Jox, a palliative care specialist, neurologist and ethics expert, and Dr. Eve Rubli Truchard, a geriatrics expert at the CHUV, have been working together to lead the new chair in geriatric palliative care of the Faculty of Biology and Medicine at the University of Lausanne. This programme, partly financed by donations from private foundations, is the only one of its kind. The overarching objectives of the chair are to develop geriatric palliative care as an academic discipline, offer training in this expertise for all types of healthcare professionals and improve treatment and end-of-life care for the elderly, especially outside the hospital. MM NOMINATION

ERIC DÉROZE

EDUCATION

NEWS

CURSUS

CAREER AT THE CHUV

MIGRATION

After living in the Netherlands, China and the United States, Ron Stoop has settled in Lausanne to do research in psychiatric neuroscience. Can you tell us about your background? I studied medical biophysics in the Netherlands and did part of my master’s degree at Peking University. As I was fascinated with Chinese culture and scientific progress, I went back to study Chinese and take the two-year biophysics programme at Tsinghua University, the Chinese equivalent of MIT. There I met Mu-ming Poo, who was very active in scientific developments in China. He was a professor at Columbia University in New York and asked me to join him there to do a PhD in neuroscience. How did you come to settle in Lausanne? I met my future wife in New York, who was doing postdoctoral work after studying biology in Lausanne. We came back to Switzerland together. After a two-year postdoctoral position at Glaxo Wellcome in Geneva, I was lucky enough to get a job as a junior researcher with the Department of Fundamental Neuroscience at the University of Lausanne (UNIL). I then joined the Center for Psychiatric Neurosciences in Cery in 2004.

GILLES WEBER

What is your current role? I’m an associate professor at UNIL-CHUV in Cery, where I lead a research team of about 15 people

LAST NAME Stoop FIRST NAME Ron AT CHUV SINCE 2004 TITLE Associate professor at UNIL-CHUV in Cery

to study the neuronal basis of emotional disorders involving anxiety and fear. Twenty years ago, a little cluster of nuclei called the amygdala was identified as playing a crucial role in regulating fear. We then discovered that oxytocin—an endogenous hormone released by the brain to stimulate breastfeeding, labour and bonding with the baby—can reduce fear through its effect on the amygdala. This finding attracted international attention and led major pharmaceutical groups such as Roche to develop new drugs that target oxytocin receptors. ⁄ WT

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