The Faculty of Medicine

Spine disorders are a common cause of incapacity for work. Below is a brief description of some of the results of my research on spine disorders thus far, and information about some of the different studies that are in progress.

Idiopathic scoliosis is the most common type of scoliosis. It is partly hereditary and treatment is usually given in adolescence. By collecting genetic information, we are trying to find out which components control the development of scoliosis. The gene variants that have been discovered to date entail a small increase in risk, but do not wholly explain the genesis of this disorder. Idiopathic scoliosis is treated with a corset or surgery. Among the findings I can mention that corsets worn only at night by children with scoliosis appear to reduce the risk of an increase in the scoliosis, while scoliosis-specific training does not reduce the risk. Both surgical treatment and corset treatment lead to a reduced curvature of the spine, and an acceptable quality of life that seems to persist many years after the treatment.

Sacroiliac joint pain affects primarily women and can be disabling. Surgery has been described as a possible treatment. However, in people with sacroiliac joint pain, surgery did not successfully reduce the pain. It is unclear what is the best treatment for vertebral fractures in the transition between the thoracic and lumbar spine. I lead an international multi-centre study of whether surgical or non-surgical treatment is best for the sufferer. The study is now half complete, and we hope that the most important findings will be ready for publication in about three years.

Oncology, which deals with cancers, is an area that is developing rapidly. My work involves trying to cure cancers. In my research, I do clinical studies to introduce new drugs, but also biological research to find new markers for cancers, and register studies for long-term follow-up of survival rates and the side effects of treatment. The research aims to ensure that those who get cancer have as good a quality of life as possible both during and after their cancer treatment.

Malignant lymphoma is a group of about eighty different diseases that start in our white blood cells. I study primarily two of these diseases, namely mantle cell lymphoma, a kind of non-Hodgkin lymphoma, and Hodgkin lymphoma. Mantel cell lymphoma is a malignant lymphoma disease with a poor prognosis. Hodgkin lymphoma is the most common tumour disease in young adults. My studies aim to investigate the effects and side effects of newly introduced treatments, develop new therapy recommendations, and improve the prognosis, especially in older people who suffer from lymphoma. I have also broadened my research interest to include other cancers with studies of testicular cancer and ovarian cancer.

This research is directly relevant for people in Sweden today with mantle cell lymphoma and Hodgkin’s lymphoma – and indirectly for patients with other lymphomas or other cancers – as it involves studies of how new drugs are introduced in Sweden, and investigating the late effects of different groups of anticancer drugs, immunotherapy, or targeted drugs.

Today, we have a detailed understanding of many diseases at the molecular level. This justifies the development of better methods for investigating conditions at molecular level and for meeting the challenges in diagnostics where access to more accurate tests that can detect diseases at an early and curable stage is needed.

In my research, I focus on developing molecular tools to improve current tests or establish new diagnostic methods to detect hitherto undiscovered biomarkers at very low levels in various bodily fluids.

By using different variants of proximity ligation assays, a technology that enables selective recognition of target molecules and the amplification of detection signals, we can achieve extremely high specificity and sensitivity. This enables the detection of small amounts of protein biomarkers in complex environments such as blood or cells. I have also developed similar methods that enable the characterisation and detection, with high confidence, of a new group of biomarkers called extracellular vesicles. These are like miniature cells whose content reveals the state of the mother cell. This method has been used, for example, to establish a new test for the detection of a biomarker for the early diagnosis of prostate cancer. Furthermore, we have established methods for the parallel detection of viruses and bacteria. These methods are generally applicable, and can be applied if necessary to new disease biomarkers and infectious microorganisms.

Every human being has an enormous amount of cells – perhaps up to thirty thousand billion. Have you ever wondered how these cells coordinate with each other so that our bodies function as they should?

The answer lies partly in the amazing capacity of cells to communicate. They talk to each other by sending signals – often in the form of proteins. These signals create concentration gradients in our tissues, which can be likened to ‘maps’ that tell the cells where they are and what to do.

My research dives deep into this world of cell communication and cell signalling. For example, I explore how cells ‘talk’ using growth factors. And here’s the exciting and innovative part. To explore this, my team and I use 3D printing. We create new systems for studying cells and for diagnostics, and we want to build ever better 3D models of tissue types where we can mimic and study how cells react to different signals and treatments, just as if they were in a real body.

The dream is to one day be able to 3D-print tissue that can be used to test new drugs more efficiently, or even to make new tissue for transplantation. Imagine a future where we can print spare parts for the human body!

Radiological imaging methods such as positron emission tomography (PET), magnetic resonance imaging (MRI) and computed tomography (CT) are routinely used in diagnostics and follow-up in health care and research. These methods create detailed images of the body that are used for visual interpretation as well as for measuring various things such as glucose metabolism, tissue volume and fat content. These images and measurements are important for the medical assessment of an individual patient but can also increase our general understanding of medical links to and causes of diseases.

The images typically consist of millions of millimetre-size volume elements, known as voxels. Together, the voxels create complex image information that can be difficult to utilise optimally with common analysis methods such as visual interpretation of the image and manual measurements. My research is largely about developing, evaluating and applying new tools that better utilise the rich detail in these images.

It combines technology development and its application in medicine. Our research group has developed several new image analysis techniques to study the relationship between image data – at the tissue level and the voxel level – and other medical data from genetics, blood samples and lifestyle habits. These technologies make it possible to improve medical studies and even conduct quite unique studies that were not previously possible. A selection of these technologies have already been applied in studies that aim to increase our understanding of diabetes, cardiovascular disease and cancer, for example.

Throat cancer is a heterogeneous group of tumours in the oral cavity, pharynx, trachea, nose and sinuses, and the salivary glands. In Sweden, throat cancer is a relatively rare form of cancer, with about 1,600 new cases annually. However, its prevalence is rising, particularly among younger non-smoker individuals. The survival rate for patients with early stage disease is generally good, but the chance of curing the patient decreases if the disease has progressed.

The treatment of head and neck tumours consists of surgery, radiation therapy and chemotherapy, used as a sole therapy or combined in the case of tumours that have progressed. In many cases, the treatment results in acute side effects and lifelong impairments such as dry mouth and swallowing difficulties which affect the person’s quality of life. Consequently, choosing the therapy for a patient with throat cancer often involves striking a difficult balance between the maximum possible effect of the therapy and the risk of impacting essential functions and aesthetics. There is a great lack of clinically useful markers that predict the tumour’s potential to spread, how it will respond to treatment, and how likely it is to return. My research aims to identify factors in the patient, the tumour and available therapies that can guide us to choose the best therapy for each patient.

Every year, more than fourteen million people are diagnosed with cancer and eight million die from the disease. Today, half of all cancer patients receive radiation therapy as part of their treatment. Unfortunately, it is not always a curative treatment and the side effects can be difficult to manage.

There is a promising new form of radiation therapy called targeted radionuclide therapy. This method uses radioactive molecules that are designed to seek out and bind to the cancer cells in the body. When the radioactive target seekers accumulate in the tumour, a cancer-specific, local radiation therapy of the cancer cells is achieved, while surrounding organs are spared.

Our research focuses on developing new radioactive target seekers, as well as improving the effect of radiation therapy by making cancer cells more susceptible to the radiation. We do this by investigating which surface proteins on the cancer cells are suitable to target and design radiolabelled molecules that can bind to these targets. We then investigate which formats and which radionuclides are best suited as target seekers in each case, how well the target seekers will bind to the cancer cells, whether they have any therapeutic effect, and how we can enhance their efficacy.

Through our research efforts, we hope to contribute to improving treatment for cancer patients by developing more effective, precise treatment methods. This research paves the way for innovative advances in radionuclide therapy, and with continued research and development, we hope that this will lead to being able to offer patients a more customised and effective treatment in the fight against cancer.

Cancer often causes a number of indirect problems such as blood clots and organ failure in the patient. For example, at the time of diagnosis about half of those diagnosed with some form of cancer are already suffering from impaired kidney function. Besides the fact that impaired kidney function itself is a serious condition, it also presents an obstacle in cancer treatment because the dose of chemotherapy may need to be reduced if the patient’s kidneys are not functioning properly. This is because chemotherapy drugs are excreted via the kidneys and can cause damage if they accumulate in too high a concentration there. And it’s not just the kidneys. Heart function can also be affected by the presence of cancer in another part of the body. Although this is a clinical problem, the underlying mechanisms of this are largely unknown.

My research aims to understand how these systemic effects of cancer on healthy organs in the body occur, and how we can prevent or treat them My research group has shown that neutrophils, a type of blood cell, play an important role in cancer-induced organ failure by causing inflammation in the patient’s healthy organs. The primary task of neutrophils is to protect us from infections, but tumours can trick these immune cells into activating and fighting an infection that does not exist and thus cause tissue damage. I am now investigating why neutrophils are activated in this unwanted way and how the negative consequences can be prevented with different treatment strategies.

Cardiovascular diseases affect many people and have long been the leading cause of death globally. The most important risk factors are behavioural and consequently they are usually termed ‘modifiable’. Cardiovascular disease also affects how the patient feels mentally. This very concrete physical disease therefore interacts with psychological factors in multiple ways. Psychological factors can affect the body directly through our dynamic autonomic nervous system. For example, external stress affects many physiological processes. In addition, the body is indirectly affected through behaviours, including lifestyle-related behaviours such as smoking and physical activity. This relationship between the physical and the mental is mutual.

In my research, I have studied the relationship between depression and anxiety on the one hand, and the body’s physiological stress system on the other. Together with colleagues, I have investigated whether the use of psychotherapy methods can reduce anxiety and depression after a heart attack. We have specifically studied whether this can be done over the Internet. We have also investigated the significance of depression, anxiety and other psychological factors for how the patient handles the challenges they face when they suffer a heart attack, and how these factors affect the risk of further cardiovascular disease and death. For many, this is a difficult period with many mental health challenges.

RNA is the versatile sibling of DNA that can form the basis of a virus or a vaccine against it. Our work involves trying to understand what RNA molecules look like and how they move so that they can perform their functions.

By observing RNA molecules in resting and active states, we can understand their function and then manipulate it, which could lead to the development of next-generation drugs. The study of the various states and functions of the RNA molecule could be likened to closed scissors in a dormant state, which look like a dagger. It is only when you see the scissors open and close in an active state that their function becomes clear.

We use nuclear magnetic resonance imaging and biophysical methods to explore these questions in water solutions, and recently also in the complex environment of a human cell. To answer questions about RNA involved in diseases and drug development, we often tailor existing methods.

My research focuses on exploring the function of non-coding RNA – a group of RNA molecules that are present in our cells but have long been considered a mystery because their role has been unclear.

My work aims to understand how non-coding RNA contributes to skin development, cell differentiation, and the genesis of cancer. Through our research, we have identified unique non-coding RNA molecules that are specific to the skin and found exciting new regulatory functions for them, which are of great importance for the structure and function of the skin. In addition, our research has shown that non-coding RNA plays a significant role in the formation and development of skin cancer. Our results suggest that these molecules are crucial for cells’ ability to regulate basic processes such as cell division, differentiation, invasion and metastasis. They may also be relevant to ageing. Knowledge about non-coding RNA molecules and a deeper understanding of their mechanisms in gene regulation could lead to the development of innovative therapies that target these molecules and their role in cancer.

The skin is a vital organ that acts as a physical, chemical and immunological barrier between us and the outside world to protect us from infections and injuries. However, if the skin’s immune system remains permanently activated, it can cause chronic inflammatory skin diseases such as psoriasis and atopic eczema, two common skin diseases that significantly affect quality of life and occur in a large part of the population.

The goal of my research is to identify regulatory mechanisms that contribute to the chronic inflammation of the skin that occurs in these diseases. One of the most surprising discoveries of recent decades was that a large part of the non-protein coding portion of our DNA is transcribed into RNA, and these non-protein coding RNA can perform regulatory functions.

In my research group, we are systematically investigating the role of regulatory RNA molecules (microRNA, and long non-coding RNA) in inflammatory skin diseases, but also in the physiological functions of the skin. To do this, we use patient samples, cell culture, 3D skin models, and animal models. We have identified several regulatory RNA molecules that have important functions in the skin and in inflammatory skin diseases. The hope is that these basic studies will help to provide a better understanding of the skin’s biology and eventually lead to the development of RNA-based treatments for skin diseases.

Cancer is one of our most common diseases and the leading cause of death in people under eighty years of age in Sweden. In recent decades, significant progress has been made in the detection, diagnosis and treatment of cancer, which has increased the five-year survival rate from around 30% in the 1970s to over 75% today. However, cancer is not one disease but a whole spectrum of diseases. There is great variation in how it develops and in survival rates.

Glioblastoma is one of the cancers that still has a very poor prognosis with a five-year survival rate of around 5%. It grows invasively in the brain, which makes radical surgery impossible, and exhibits great diversity, both between patients and between cancer cells in the same patient, which increases its capacity to survive radiotherapy and chemotherapy after diagnosis.

My research aims to understand the fundamental mechanisms that lead to glioblastoma, focusing on how regulation in developmental biology contributes to the heterogeneity and malignancy of the cancer cells and their response to treatment. I also place great emphasis on building up a functional patient-derived biobank of glioblastoma tissue and cell cultures so that I and other researchers can carry out our studies in models relevant to this disease. Our goal is that the knowledge we produce will lead to the development of more effective and precise treatments for glioblastoma.