KI News

Karolinska Institutet (KI) has implemented a number of initiatives aimed at dealing with the flaws in the organisation brought to light by the Macchiarini case. For example, recruitment procedures have been tightened and a new procedure introduced for cases of suspected scientific misconduct. In some cases, the work to implement these initiatives has taken longer than planned and further efforts are required. Approximately one year ago, KI management prepared an action plan designed to rectify the flaws highlighted by the inquiries into KI’s handling of the Macchiarini case.  This action plan was based on the recommendations in KI’s audit of the department in which Macchiarini worked, as well as on the report presented by external investigator Sten Heckscher. This report criticized KI for, among other things, a nonchalant attitude towards regulations, flawed research documentation and handling of public documents, as well as flawed recruitment procedures. The points to be addressed affect almost every area of KI’s organisation. The work is being led and implemented by management and at KI’s internal boards and administrative departments.  A coordination and monitoring committee was appointed to support and coordinate the implementation of the action plan. This committee has now presented its report describing the situation as of the end of the second quarter 2017. “All activities have either been implemented or are the subject of a long-term plan detailing how they are to be resolved. However, this has often required greater consideration than initially planned, meaning that implementation has taken longer than scheduled,” says Sven-Erik Dahlen, professor at the Institute of Environmental Medicine and chair of the Coordination and Monitoring Committee. Strategic assignment for the new ethics committee One of the activities is the implementation by KI of new procedures for handling cases of suspected misconduct in research. This work was underway before the action plan was prepared, and since spring 2016 the Pro-Vice-Chancellor and the Legal Office have had a clearer division of responsibility. The spring also saw a strengthening of resources in the form of a specific and academically highly competent administrator to assist in the investigation. A proposal for a new ethics committee has been drafted. This committee will not investigate misconduct cases but rather work strategically on issues regarding research ethics. Committee members are yet to be appointed but this will take place during the autumn. “This is an important element in KI’s ongoing work to create a solid ethical platform for the organisation. There is no reason to delay further,” says Karin Dahlman-Wright, Pro-Vice-Chancellor. If the ethics committee is almost ready for implementation, work on KI’s inner life – its work environment, leadership, employeeship – demands a considerably longer time horizon, explains Karin Dahlman-Wright. “We have begun to implement certain components; improving communication to the organisation and investigating laboratory environments for example. However, the big picture is far from complete,” she says. The review of KI also revealed flaws in the documentation of research. Since 2010, KI has employed a system for electronic research documentation. However, the use of this system has not been obligatory. A decision has now been made to make electronic research documentation mandatory at KI from 2019 and an implementation plan is in place. After stern criticism of how KI handled the recruitment of Macchiarini, administrative routines for reviewing application documentation have been improved. Improved procedures for obtaining references and checking CVs have been developed and the responsibilities of the Recruitment Committee have been clarified. Certain flaws appear to be obvious, such as not routinely checking candidates' references. Why haven’t these been addressed previously?  “Yes, it is strange. But as long as things are running smoothly it doesn’t occur to anyone that change is needed. However, procedures for obtaining references were in place before the action plan was adopted,” says Karin Dahlman-Wright.  The division of responsibility between KI and Karolinska University Hospital has been clarified. A common certificate of responsibility for clinical research is now in use, signed by the operational manager of the specific hospital department, the researcher leading the project and the head of department. “This is not new but now there is a stronger commitment. KI and the Hospital have also entered into more in-depth discussions on clinical research through our joint working groups, although more such cooperation between KI and healthcare is required on several issues,” says Sven-Erik Dahlen.  Great importance placed on leadership  The action plan also focuses on leadership. KI’s guidelines for leadership development are under revision and will be ready this year. An overview of leadership training with regard to ethics and compliance is underway and a new, obligatory course for new heads of department and heads of administration will begin in 2018. However, according to the Coordination and Monitoring Committee this may not suffice. They believe that new training initiatives for research-group leaders should also be a priority. “We recommend that compulsory training be introduced for all research-group leaders in the form of regular, repeated online courses,” says Sven-Erik Dahlen.  They would also like to see the further development of introductory courses for new employees and that these be made compulsory for everyone irrespective of background. From the autumn, new researchers will be offered one-day courses focusing on research documentation, data management and ethics – although this will not be compulsory. Rules for affiliating external researchers have been revised and it has been made clearer that all such affiliations to KI must be approved by the head of department. New guidelines for secondary occupations have been adopted, although the coordination group would like to see more systematic monitoring and also believe that external employees should also be required to report secondary activities. The investigation into KI also highlighted deficiencies in delegation rules. Work to rectify this has begun but the task has grown into a larger review of internal regulations. According to University director Per Bengtsson, this is expected to be completed during the current year. Work on a new procedure for case management is another activity that is not fully complete. “We have addressed the immediate flaws uncovered by the Heckscher investigation; such as departmental case management and the handling of public documents. However, with regard to the overall procedure, there is more to do,” says Per Bengtsson. He explains that training initiatives have been focused on departmental administrative managers and registrars in order to meet the need for knowledge of regulations relating to public documents, the principle of public access, documentation and case management. Initially, these measures may lead to increased administration for certain employees in the form of new regulations and systems. If so, according to operations controller and Coordination and Monitoring Committee team coordinator Björn Forslöw, this is a temporary problem. “In the long-run, we are convinced that if the system is wisely crafted it will make the work easier,” he says. In order to make regulations and aids easily available, the coordination team recommends that a new, user-friendly regulations website be created. This has been duly noted by Vice-Chancellor Ole Petter Ottersen: “There is a need for developed support for staff in order to simplify the running of the organisation in accordance with applicable regulations. It is not more regulations and guidelines that are required but rather an ethical attitude to research,” he says. How can we ensure that the mistakes that have been made are not repeated? ”This is a long-term project in which we should work with equal diligence to achieve excellence and high levels of ethical awareness in our work culture, and excellence in education and research. This is a responsibility that rests not only with the academic leadership but with all members of staff, and is an insight that must permeate the entire organisation,” says Ole Petter Ottersen. It was initially expected that work on the action plan would continue during 2017. The Coordination and Monitoring Committee now recommend that situation be reviewed again at the end of the second quarter 2018. Text: Sara Nilsson

MedTechLabs is now open – the research centre formed by a close collaboration between Karolinska Institutet (KI), the Royal Institute of Technology (KTH) and Stockholm County Council (SLL). The objective of the centre’s first project is to develop technology to improve diagnosis and treatment of patients who have, for example, suffered a stroke. MedTechLabs shall work with advanced research into medical technology. The centre will be located in the BioClinicum in Karolinska University Hospital. Researchers from KI and KTH will work there together to develop technology and methods that can be implemented into health care. A pilot project has already been implemented, led by Staffan Holmin, Professor at the Department of Clinical Neuroscience at KI and Consultants and R&D Managers at R&D neuroradiology at Karolinska University Hospital, together with Mats Danielsson, Professor at the Clinic for Physics of Medical Imaging at KTH. The two Professors are together with Jan Andersson, Director of Research and Innovation at SLL, the instigators for the new research centre. The aim of the pilot project is to develop technology that can be utilised for diagnoses and treatment of cardiovascular diseases including strokes and cancer. Spectral CT is an advanced X-ray method with high resolution and a completely new functionality that improves the security of diagnosis and treatment. Endovascular technology is utilised to navigate around the body’s vessels, using X-ray images, to extract blood clots, for example. The technology also allows samples to be taken or medicines to be injected or deposited locally in organs that are difficult to access. “Medical technology has a major impact on the outcome for patients. Many lives have been saved by technology,” confirms Staffan Holmin. Where advanced technology and the needs of patients meet  MedTechLabs shall focus on the needs of the major groups of patients, but the main starting point for the centre is technical innovations, according to Staffan Holmin. “We have to find a match between advanced technology and the needs of health care.” Staffan Holmin has collaborated with KTH for several years. “Engineers have an entirely different way of thinking and can solve problems I did not believe were possible, and in an organised fashion. On the whole, it is very positive to form teams of persons who have varying expertise.” In total, the pilot project will employ around 12 persons. Prominent researchers making their mark will be recruited from Sweden and abroad. MedTechLabs also aims to educate health and medical care personnel, so that they can subsequently make use of the methods in healthcare. Proximity to health care is essential It was very important that the centre could be located nearby the hospital, according to Staffan Holmin. “We wanted a test lab for new medical technology in an environment where patients were fully safe and where we have access to a full range of medical personnel, from anaesthetists to intensive care personnel,” he says. From SLL's perspective, the investment in MedTechLabs is largely the result of a need to in a safe manner test medical technology innovations. “For many decades, we have had a polished processes for evaluating the safety of pharmaceuticals and vaccines. Now, as the first facility in Europe, we are able to evaluate similarly how safe medical technology is, in so-called phase one trials, before continuing on evaluating its medical effect. In addition, we get better documentation of the entire development process," says Jan Andersson. Anders Gustafsson, Dean of Research at KI, tells us that the main reason why KI is taking part in MedTechLabs is the rapid development within medical technology. “Medical technology is of increasing importance, and KI does not have a proper organisation for this field. We can also benefit from increasing our collaboration with KTH, and naturally we are very happy to have the financial support of the County Council. Both health care and research are increasingly technological, so this is obviously a win-win situation,” confirms Anders Gustafsson. What are KI’s long-term goals for MedTechLabs? “We hope this collaboration will increase survival rate and quality of life for patients. It will also generate new and interesting research. Prominent clinical research centres around the world, such as John Hopkins and Mayo, have a similar working method and produce quality research that is rapidly implemented to benefit patients.” Additional projects to be launched Scheduled opening of premises in BioClinicum is 2018-2019. Until then, the pilot projects will be run from premises at KTH and Karolinska University Hospital. KTH will be the principal for MedTechLabs. The centre has a steering group with four committee members from the County Council, and two members each from KI and KTH. Activities are financed by all three parties. Symposiums and seminars will also be held at MedTechLabs. Further projects will be implemented during the first four years. After four years, activities will be subject to evaluation. Text: Ann Patmalnieks Foto: Erik Flyg

The Future Education Leaders course, a program to highlight and develop the skills of Karolinska Institutet’s (KI) educational leaders, will conclude on 10 October. Participants will be holding a poster presentation in Aula Medica and KI PRIME recipient Brian Hodges will be giving a lecture. “This is a hybrid between a pedagogical and leadership course. An important element is that participants build networks with each other,” explains Sari Ponzer, course project manager. This is the second time that the course has been held. The project was initiated by the Board of Higher Education with the overall aim of ensuring the future supply of scientifically qualified educational leaders within the teaching organisation. “We have two core activities at KI, research and education, and it is therefore self-evident that those who choose to become educators must be offered the opportunity to be assigned to leading positions. Specific skills are required of educational leaders,” says Annika Östman Wernerson, Dean of Higher Education.  The requirements for participants, who are nominated by their heads of department, are that they must have a PhD and documented pedagogical experience. They must also be employed at KI within education or research, or affiliated to the university as a researcher, teacher or clinician. Interest in participation was high and the total number of applications was approximately twice the 20 available spaces.  “The participants come from a very wide range of professional backgrounds and disciplines, as well as from various departments within the educational organisation,” says Sari Ponzer. Course lecturers have included Carola Lemne, Director General of the Confederation of Swedish Enterprise, and Brian Hodges, recipient of the 2016 Karolinska Institutet Prize for Research in Medical Education (PRIME). Hodges will also be closing the course with a presentation on the theme of leadership.   Networking an important component of successful leadership The content of the course focuses on the regulatory frameworks of educational activities, formal and informal decision-making structures and KI’s core values and ethical code of conduct. An important element of the course is the building of personal networks prior to a continued career at KI, something that, according to the course evaluation, has proved successful.   “Surveys carried out during the course have shown that participants are positive, with a general feeling that they have learnt from one another and gained a useful network,” says Sari Ponzer. Ann-Helen Patomella, deputy head of division in the Division of Occupational Therapy and one of this year’s course participants, concurs with this positive feedback. In addition to establishing networks, the course has also contributed other insights.  “The importance of having someone with whom one can discuss leadership issues, as well as the vital role of communication in providing a clear leadership.” The Future Education Leaders course will not be held the upcoming years, but the issue will not be allowed to fall by the wayside, declares Annika Östman Wernerson. “I believe that the course may be held again in a couple of years, although no decision has yet been made. Now it’s important that those who have taken the course are provided with the opportunity to develop their leadership within the organisation, and we will be monitoring their future progress.  Closing in Aula Medica  This year’s course participants will be presenting their final projects in a poster exhibition on 10 October from 3 pm-5 pm on the 4th Floor of Aula Medica. The exhibition will be preceded by a presentation on the theme of leadership by PRIME award winner Brian Hodges, 2 pm-3 pm at the same venue.

Maria Kasper, Senior researcher at the Department of Biosciences and Nutrition at Karolinska Institutet, is awarded the LEO Foundation Gold Award 2017 of DKK 1 million. She is rewarded for her exceptional advances within dermatology research. The LEO Foundation Gold Award is awarded to young scientists whose work contributes in an extraordinary way to medical research. The chairman of the foundation says that Maria Kasper's research has increased the understanding of skin diseases and that her research can lead to improved treatments. “My friends often call me ‘skin nerd’ since I love everything about skin. Thus, it’s such a happiness and great honour for me to receive this prestigious prize”, says Maria Kasper in an article on the LEO Foundation’s website.  

Peter Ueda, postdoc at Karolinska Institutet’s Department of Medicine, Solna, won the Researchers’ Grand Prix Stockholm during Researchers’ Friday 29 September. As Stockholm’s most inspiring research presenter 2017, he will now go on to the national final on 28 November. During his four-minute presentation, Peter Ueda explained how he uses large data files containing millions of observations to discover how treatments for a wide range of illnesses can be improved. He also carries out research into the side-effects of pharmaceuticals and how well they actually work, as well as finding new ways to identify patients with a high or low risk of illness (for example myocardial infarction) or adverse reactions, so that treatment can be tailored to the individual. During the Researchers’ Grand Prix (Forskar Grand Prix), researchers compete to present their work in the most entertaining and informative manner possible in only 4 minutes. The winner is decided by the audience together with a panel of expert judges.  

When vice-chancellor Ole Petter Ottersen visited the Department of Public Health Sciences during his tour of Karolinska Institutet (KI), two issues took centre stage – artificial intelligence and global health. He also opened the way for changes to the incentives system in order to strengthen education. During the autumn, KI’s management will join new vice-chancellor Ole Petter Ottersen in visiting every department, in order to meet staff and students within the organisation. The Department of Public Health Sciences presented a number of research projects, as well as their students in the Master’s Programme in Global Health. PhD student Nora Döring presented her research project “Primary Prevention of Childhood Obesity”, an attempt to identify methods and treatments for preventing childhood obesity. Studies carried out in the project demonstrated that those methods tested had failed to make any significant impact, and now researchers must follow up on why. Ole Petter Ottersen took the opportunity to emphasis the importance of also presenting negative research results. “In general, negative data receives too little attention and it requires a degree of tenacity to get this type of data published,” said Ole Petter Ottersen. Nora Döring was pleased after the vice-chancellor’s visit. "It feels very good that the vice-chancellor comes here and listens to us, and he makes us feel that the work we do in global health is important. It is also great that he has a clear picture of what to do, and is full of enthusiasm and energy, she says. During the visit, Ole Petter Ottersen highlighted that KI is a university characterised by strong competition, and that the creation of a system of rewards for everyone working to strengthen, improve and contribute to teaching is one of the important issues that management needs to address. “It is true that there is a great deal of competition within KI, but its not always negative. But it’s important that there is room for 'failed results' or rather 'null-results' and explore the reasons, if we are to make progress,” Nora Döring says. Global migration and the spread of TB KI’s management also had the opportunity to look at postdoc Anna-Karin Danielsson’s research project on alcohol, tobacco and drugs. Knut Lönnroth, professor and senior physician, spoke about the effect of global migration on the spread of TB, and visiting professor Johan Lundin presented research on how artificial intelligence can simplify diagnosis and treatment globally. Afterwards, the vice-chancellor reflected on the importance of ensuring access to data in healthcare and noted his appreciation of the department’s focus on the global perspective, especially bearing in mind KI’s strategic work aimed at 2030, in line with the timetable for the UN’s Sustainable Development Goals (SDGs). Discussion of the UN’s 17 SDGs continued during the vice-chancellor’s meeting with students from across the world participating in the Master’s Programme in Global Health. Goal number three, specifically dealing with good health and wellbeing, naturally falls within the scope of KI’s own vision, although Ole Petter Ottersen pointed out that all of the goals are linked to global health. The goals of eradicating poverty and hunger, along with the goal of achieving a world in which all people have access to clean water and sanitation, are indivisible. Student and doctor Prithviraj Thumaiah from Mauritius trained in Pretoria and currently works in the KwaZulu-Natal province of South Africa. He acknowledged the UN goals but offered a reminder of the realty of the situation. “Most of us will work with the SDGs in the future, but it is difficult for systems to change. How will we deal with systems that counteract our work?” Ole Petter Ottersen’s replied that it will demand collaboration and alliances in order to succeed, and unexpected ones at that. “As academics, everything we do must be based on scientific fact but for many of you, a political reality awaits,” he said. “In order to succeed where their is opposition we must build alliances, for example with NGOs but also with industry and the private-sector. Many companies today realise that, in future, it will no longer only be the ‘bottom line’ in their financial statement that counts.” Text: Andreas Andersson

Stroke patients with dementia treated with intravenous thrombolysis using powerful clot-busting drugs are at no higher risk of brain haemorrhage or death than other patients receiving the same treatment, a study from Karolinska Institutet published in the journal Neurology reports. Ischemic stroke is the most common form of stroke and is caused when a blood clot blocks the blood flow to the brain. Treatment with intravenous thrombolysis (IVT) using powerful clot-busting drugs within 4.5 hours of onset can greatly improve the prognosis and reduce the likelihood of patients losing the ability to speak or walk. “Hospitals have tended to shy away from giving powerful clot-busting drugs to patients with dementia in the belief that such patients, especially those with Alzheimer’s disease, are more prone to brain haemorrhages,” says Sara Garcia-Ptacek, postdoc at Karolinska Institutet’s Department of Neurobiology, Care Sciences and Society. “We wanted to find out how great this risk really was.” Both expected and unexpected results By studying data from the Swedish Dementia Registry (SveDem) from the years between 2010 and 2014 and cross-referencing them with the Swedish Stroke Registry, the researchers found 1,300 stroke patients with a previous diagnosis of some form of dementia. They then studied what percentage of the patients had received thrombolysis treatment for their stroke and how they had subsequently fared compared to a control group with stroke but without dementia. Doing so, they found that people under the age of 80 with dementia and stroke were not given intravenous thrombolysis as often as patients with stroke but no dementia. “Yet we also saw that dementia patients over 80 suffering from a stroke received thrombolysis treatment as often as non-dementia patients with stroke, which was unexpected,” says Dr Garcia-Ptacek. The researchers then examined the therapeutic outcomes for both groups that had received thrombolysis treatment to ascertain whether or not the risk of complications varied. Sudden bleeding not more common in dementia patients “It’s important to stress that sudden bleeding in the brain, what we call an intracerebral haemorrhage, a well-known complication that can arise in combination with thrombolysis treatment, was no more likely in people with dementia and stroke than in non-demented people with stroke when both groups received IVT ,” says Maria Eriksdotter, professor in geriatric medicine at the same department. The researchers also studied the risk of death after treatment and found that there was no difference between patients with dementia and those without who received IVT. They did, however, find worse functional outcome in dementia patients with stroke three months afterwards. These patients were also more likely to be discharged to nursing homes compared to stroke patients without dementia. “Our study indicates that thrombolysis treatment is just as safe for dementia patients as for other patients with the same physical status and that the risk of treatment complications is no higher,” says Professor Eriksdotter. “Thus, IVT treatment can be considered in stroke patients with dementia.” The study was financed with grants from the Swedish Stroke Association, the Swedish Order of St John, the Swedish Society for Medical Research, the Swedish Research Council and the Swedish Association of Local Authorities and Regions. Publication “Thrombolysis in acute ischemic stroke in patients with dementia: a Swedish registry study” Eva Zupanic, Mia von Euler, Ingemar Kåreholt, Beatriz Contreras Escamez, Johan Fastbom, Bo Norrving, Dorota Religa, Milica G. Kramberger, Bengt Winblad, Kristina Johnell, Maria Eriksdotter, Sara Garcia-Ptacek Neurology, online 6 October 2017

Eighteen research scholarships in medicine have been awarded to Karolinska Institutet by the Swedish Society for Medical Research (SSMF) this year. A total of 34 post-docs at six Swedish universities will share close to SEK 80 million. “Post-doc education is an absolute necessity to be able to continue to pursue a successful career in research. A scholarship from SSMF allows a researcher to not only gain important experience in a new research setting but also establish a network of his or her own for continued collaborations,” says professor Mats Ulfendahl, who chairs the SSMF, in a press release. The post-docs at Karolinska Institutet who have been awarded the two-year scholarship are Julio Aguila Benitez, Andreas Björklund, Melissa Borg, Stephanie Böhm, David Conradsson, Sara Garcia-Ptacek, Anna-Maria Georgoudaki, Shawon Gupta, Anna Karin Hedström, Hildur Helgadottir, Anders Näsman, Marc Panas, Maria Peleli, Elin Rönnberg Höckerlind, Eric Thelin, Kaisa Thorell, Peter Ueda and Ferdinand von Walden.

Star-shaped cells called astrocytes are much more than simple support cells in the brain. In a new study on mice, researchers at Karolinska Institutet demonstrate that they also play a key part in the respiratory centre of the brainstem and release inflammatory molecules that regulate breathing. The results, which are presented in eLife, can provide important clues as to the causes of respiratory disease and the sudden unexpected postnatal collapse of newborn infants (SUPC). The control of breathing is essential for life. Without an adequate response to increased carbon dioxide levels, people can suffer from breathing disturbances, sickness, and panic. In a worst-case scenario, it can lead to premature death, as in sudden infant death syndrome. While it is known that respiration is regulated by the brainstem, just how this occurs remains very much a mystery. It is known that there are control mechanisms that cause the body to react to changing blood concentrations in CO2, thereby preventing death. Eric Herlenius’s research group at Karolinska Institutet has previously shown that the molecule prostaglandin E2 (PGE2), which is normally released during inflammation and fever, is triggered in the brainstem at high levels of CO2, influencing the pattern and characteristics of respiration. The group has now shown that so-called non-neuronal astrocytes in the respiratory centre of the brainstem secrete this molecule. Not just the brain's glue “Astrocytes were once viewed just as a kind of glue that holds everything in place in the brain. Then they were considered as mere housekeepers providing structural and metabolic support for neurons. However, new research shows that they are involved in several vital processes, including respiration,” says Eric Herlenius, professor of paediatrics at the Department of Women’s and Children’s Health. “Our study shows that the astrocytes play an important part in the regulation of breathing by affecting the neurons and their network activity.” To study the role of astrocytes in respiration, the researchers used an in-house developed technique in which part of the brainstem of a mouse is kept alive in a special culture dish. For several weeks neurons and astrocytes continue to be interconnected, and can transmit signals and generate rhythmic motor neuron activity as if they were “breathing”. The mice astrocytes were labelled with a fluorescent molecule, and contained a receptor that the researchers could stimulate in order to activate them. While most of the astrocytes seemed not to participate in rhythm generation, some of them formed their own functional network in the respiratory centre, displaying rhythmic activity similar to the neurons. These astrocytes integrated with the neurons, influencing their activity and consequently respiration. Inflammatory molecules involved “We knew that the astrocytes have the capacity of signalling just before inspiration but not that there’s this kind of connection from the astrocytes to the neurons,” says the study’s lead author David Forsberg, doctoral student at the same department. “Our hypothesis is that the astrocytes adjust the respiratory process with the help of the inflammatory molecule PGE2, and in doing so links breathing with the inflammatory system.” Interestingly, the role of astrocytes seemed to differ between the two brainstem respiratory centres that were studied. In one, astrocyte activation caused an increase in neuronal activity, whilst in the other, neuronal activity remained unaffected. This suggests the presence of different types of astrocytes, and a diverse distribution of them in the brainstem. Could explain life-threatening breathing problems Activation of the astrocytes also caused raised levels of PGE2 and weakened the respiratory centre’s reaction to high CO2 concentrations, suggesting that the astrocytes become fatigued. Since PGE2 is released during inflammation and fever, the researchers suggest that these conditions disrupt normal physiological reactions to CO2, which can lead to potentially life-threatening breathing problems. “We now want to find out if astrocyte fatigue can explain phenomena like SUPC, when newborn babies suddenly develop respiratory problems,” says Dr Forsberg. “Birth triggers a powerful stress reaction in the baby, which gives rise to high PGE2 levels. This has beneficial effects on newborns but we think this can be dangerous in combination with high levels of CO2.” The study was financed by several bodies, including the Swedish Research Council, Stockholm County Council, Karolinska Institutet, the Swedish Brain Fund, the Marianne and Marcus Wallenberg Foundation and the Heart and Lung Foundation. Eric Herlenius is a coinventor of a patent application regarding biomarkers and their relation to breathing disorders. The other authors have not reported any competing interests. Publication “Astrocytes release prostaglandin E2 to modify respiratory network activity” David Forsberg, Thomas Ringstedt and Eric Herlenius eLife, online 4 October 2017, doi: 10.7554/eLife.29566

Women with asthma suffer more often from preeclampsia (PE) and run a higher risk of giving birth to underweight babies. These and other complications during pregnancy and delivery can not be explained by hereditary or environmental factors, according to a study from Karolinska Institutet published in The Journal of Allergy and Clinical Immunology: In Practice. Asthma is a common disease caused by chronic inflammation in the lungs with symptoms of coughing and breathlessness, and affects between 8-10 percent of women of childbearing age in Sweden. Using data from the Swedish birth, prescribed drug and patient registers, researchers at Karolinska Institutet have been able to examine the link between asthma in pregnant women and pregnancy/delivery outcomes. Studying more than 1 million births to just over 700,000 women between 2001 and 2013, they found that 10 percent of the babies born had a mother with asthma. “Four percent of all pregnant women develop preeclampsia. We found that the risk of preeclampsia is 17 percent higher in women with asthma compared to women without asthma”, says the study’s lead author Dr Gustaf Rejnö, obstetrician and doctoral student at Karolinska Institutet’s Department of Medical Epidemiology and Biostatistics. Additionally, women with asthma were more likely to have underweight babies, instrumental deliveries, caesarean sections and shorter pregnancies. Studied the women’s cousins and sisters To ascertain whether the complications could be attributed to hereditary or environmental factors, the researchers also identified the women’s asthma-free cousins and sisters who had given birth during the same period. On comparing the groups they found that the correlations between maternal asthma and complications during pregnancy and delivery held. “It seems to be the asthma per se that causes these complications,” says Dr Rejnö. “This means that well-controlled asthma during pregnancy could reduce the relative incidence of complications during pregnancy and childbirth. In an earlier study we saw that this was indeed the case.” The study was financed by the Swedish Research Council, Stockholm County Council, FORTE, the Strategic research programme in Epidemiology and the Swedish Heart and Lung Foundation. Publication ”Adverse Pregnancy Outcomes in Asthmatic Women: A Population-Based Family Design Study” Gustaf Rejnö, Cecilia Lundholm, Kjell Larsson, Henrik Larsson, Paul Lichtenstein, Brian D’Onofrio, Sissel Saltvedt, Catarina Almqvist Journal of Allergy and Clinical Immunology: In Practice, online 4 October 2017, doi: 10.1016/j.jaip.2017.07.036

This year’s Nobel Prize in Physiology or Medicine has been awarded for work dedicated to the connection between celestial body movements and molecular fluctuations in our cells. Or, in simpler terms, to our internal biological clocks, also known as our circadian rhythm. “The 2017 Nobel Prize in Physiology or Medicine goes to Jeffrey C. Hall, Michael Rosbash and Michael W. Young for their research and findings in relation to molecular mechanisms that control circadian rhythm,” announced Thomas Perlmann, Secretary of the Nobel Committee, at Monday’s press conference at the Karolinska Institute (KI). He pointed out that this year’s Prize actually has more to do with astronomy in some ways. The fact that the Earth rotates on its own axis, which is why the planet has day and night, is something that almost all organisms – including human beings – need to deal with. In a nutshell, the chances of surviving are better if you are awake at the times when it is most easy to find food, and retreat when you are at most risk of getting attacked. The internal clock function a mystery Although it has long been known that both animals and plants have a circadian rhythm that controls their behaviour, how this internal clock works has also been a mystery for a long time. Hall, Rosbash and Young, having now solved this mystery, are being rewarded for their efforts in the form of this year’s Nobel Prize. In 1984, two research groups working independently of each other – Hall and Rosbash’s group at Brandeis University, USA, and Young’s group at Rockefeller University, USA – managed to isolate a gene, the ‘period’ gene, which controls circadian rhythm. The researchers discovered that the protein concentration encoded by the gene fluctuates across the 24-hour cycle, and is highest at night and lowest by day. These fluctuations occur because the gene and protein together form a negative feedback loop – the gene leads to the protein being made, but the protein leads to the gene being blocked. When the protein concentration decreases, the gene is reactivated and the circle closes. Another important piece of the puzzle was put in place a decade later when Young discovered another gene, timeless, which was found to be necessary in order for the loop to occur. Young subsequently discovered the doubletime gene too, which influences the length of the loop by slowing down one of its stages. The research was conducted on fruit flies from the outset, but the same principles were subsequently proven to be applicable to many other organisms, including human beings. This years winners a surprise Unusually, there were very few questions asked during the press conference, suggesting that this year’s prizewinners came as a surprise to the media. “Being able to surprise people is fun,” said Anna Wedell, professor and chair of the Nobel Committee, after the press conference. She pointed out that the Nobel Prize in Physiology or Medicine is really ‘just’ for Physiology this year. “The prizewinners have made a fundamental discovery into how we have adapted to living on this planet. Most forms of life use this clock in some way - it is a major evolutionary benefit, for example, if you can automatically prepare yourself for the imminent sunrise, instead of adjusting to what has just occurred,” she informs us. Thanks to this year’s prizewinners, we now understand ourselves, and all other lifeforms on Earth, a little better. According to Anna Wedell, circadian biology is an important field of research that has expanded rapidly in recent years - research that has been made possible to a large extent by Hall’s, Rosbash’s and Young’s discoveries. “Clinical applications may very well be possible in reality, eventually. At the moment, research into circadian biology is about continuing with efforts to chart the internal clock’s mechanisms in greater detail, but also about attempting to understand how our surroundings and lifestyles impact on this clock,” says Anna Wedell. She points out that we already know a good deal about the effect that daylight has, but need to know more about other factors. “Does it matter what time of day we do things? How do our mealtimes (for example) affect our metabolism and our risk of being overweight? These are very pertinent questions in society today. Maybe we can learn how to take small steps towards feeling better by taking our internal body clocks into consideration.” Text: Anders Nilsson Three KI researchers comment the Nobel Prize 2017 Anita Göndör, researcher at the Department of Oncology and Pathology: How do you feel about this year’s Nobel Prize in Physiology or Medicine? “It is bringing well-deserved attention to an important field of research that does not receive the recognition it needs. Given how important circadian rhythm is for so many of the cell’s functions, I think far too little research is done in this area.” You do research in this field yourself. What exactly are you doing? “We started to tackle these issues 3 1/2 years ago and haven’t stopped! Among other things we have done basic research that demonstrates how genes controlled by the internal biological clock are controlled by the genes’ positioning in different physical environments of the cell nucleus. We are also investigating how cancer cells can exploit the system for their own gain. In another project, we want to find out more about the role played by a disrupted circadian rhythm in the various health effects experienced during polycystic ovary syndrome (PCOS), a condition that affects between five and ten percent of all fertile women.” More on Anita Göndör’s research Circadian genes go to sleep every day at the periphery of the nucleus Sandra Ceccatelli, Professor at the Department of Neuroscience: How do you feel about this year’s Nobel Prize in Physiology or Medicine? "They’re the right winners but it was unexpected. Their findings have led to the emergence of a large and dynamic field of research that has important broader implications for our health and wellbeing." You do research in this field yourself. What exactly are you doing?     "We have recently demonstrated that mice who develop depression-like behaviour and do not get better from treatment with antidepressant Fluoxetine have experienced changes to their circadian rhythm. Long before the symptoms of depression develop, they lose their ability to adjust their activity to the light and dark cycle. To investigate whether similar changes occur in humans, we are now conducting a measurement of patient movement. The hope is that we will be able to use the changes to the circadian rhythm as a marker of how the patient will respond to antidepressant medication and to identify individuals who are at risk of being affected by depression." More on Sandra Ceccatelli’s research Circadian rhythm linked to depression Gabriella Lundkvist, a researcher affiliated with the Department of Neuroscience and Scientific Coordinator at the Max Planck Institute for Biology of Ageing in Germany: How do you feel about this year’s Nobel Prize in Physiology or Medicine? "It really is well-deserved. My hope now is that it will give all researchers in this field a boost and improve understanding of how important this research is." You do research in this field yourself. What exactly are you doing?     "I have conducted research into the molecular clock in people with schizophrenia, and right now my colleagues and I at Huddinge are conducting a study of people with bipolar disease, in which we are investigating the connection between disease-related disruptions to the patient’s day/sleep and disruptions to circadian rhythm. There are still a lot of things in this area that we do not understand, however, such as the exact mechanisms behind it. Working together with Andrea Carmine Belin, we are also researching the connection between the circadian clock and Horton disease. Working with Barbara Canlon, meanwhile, we have discovered the clock in the ear and studied the circadian rhythm in a certain type of hair cell. The findings may explain why sensitivity to hearing damage varies over a 24-hour period." More on Gabriella Lundkvist’s research Text, three researchers: Cecilia Odlind

Ole Petter Ottersen was installed as the new vice-chancellor of Karolinska Institutet (KI) during a ceremony conducted in Aula Medica on 29 September. In his installation speech, he among other things, emphasised the important role of education and KI’s responsibility from an international perspective as one of the world’s leading medical universities. To the tones of Karolinska Institutet’s ceremonial march, performed by the Medical Students’ Association Chamber Ensemble, the procession entered Aula Medica behind massed banners for the installation of KI’s new vice-chancellor – Ole Petter Ottersen. The ceremony commenced with a welcoming speech by Mikael Odenberg, Chair of the Board of Karolinska Institutet. He greeted the new vice-chancellor and also expressed deep gratitude to Karin Dahlman-Wright, who was appointed acting vice-chancellor in 2016, during a period of turbulence for KI. “You executed your duties in an exemplary manner. Karolinska Institutet is greatly indebted to you Karin,” said Mikael Odenberg, whereupon a lengthy period of warm applause filled the auditorium. After a moving choral performance by the Medical Students’ Association Chamber Chorus and a short film about the new vice-chancellor, revealing among other things Ole Petter Ottersen’s passion for running, Karin Dahlman-Wright spoke. She expressed the hope that the vice-chancellor would focus on the conditions for young researchers and stand behind ongoing efforts to safeguard and promote education at KI. She also emphasised the university’s independence as a prerequisite for public trust, and as a central issue for the vice-chancellor. “Both teaching and research must be protected if we are to provide the results that society expects of us. We must guard academic freedom but equally we must uphold academic responsibility – to listen, question, discuss and debate,” said Karin Dahlman-Wright. She then installed her successor by handing over the vice-chancellor’s chain of office to Ole Petter Ottersen, an act that was followed by a fanfare. Noble Prizes gladly – but ethics, responsibility and quality come first Helene Hellmark Knutsson, Minister for Higher Education and Research, offered Karin Dahlman-Wright the government’s thanks for her work in laying the foundations for change and welcomed Ole Petter Ottersen. “Naturally, I would gladly see five more Nobel Prizes and a continued top ranking for KI. However, it is even more important that the research and education you conduct maintains the highest possible levels of quality and rests on solid ethical values,” she said. County Finance Commissioner Irene Svenonius emphasised the important collaboration between KI and the Stockholm County Council, explaining that she was looking forward to an even closer dialogue going forward. Student representatives – Max Kynning, chair of the Medical Students’ Association, and Stephanie Ammer-man, chair of the Dental Students' Association – were of the opinion that education at KI had been left standing somewhat in the shadow of research. They did however pin high hopes on Ole Petter Ottersen. “As early as this spring he identified many of KI’s problems and has already begun to address them,” said Max Kynning. Sustainability issues and education are high on the new vice-chancellor’s agenda The students’ concerns were addressed in Ole Petter Ottersen’s installation speech, during which education and the importance of KI’s students were prominent topics. He confirmed that, thanks to the firm ground on which the university now stands, his focus would be on looking forward and formulating a new and more long-term strategy reaching as far as 2030. “By 2030, and preferably even earlier, KI shall occupy just as strong a position internationally in education as it does in research. However, this means that we must review our incentives structure and how we reward the work of teachers,” he said. This long-term perspective will also focus attention on the career paths of younger researchers and the importance of postgraduate education. Ole Petter Ottersen emphasised that 2030 is not an arbitrary choice. This is also the time horizon for the UN’s Sustainable Development Goals, something he believes should inspire KI’s own activities and that demands innovation in structuring new study programmes. “Our responsibility as one of the world’s leading medical university stretches far beyond the borders of our country. From a global as well as regional perspective, health is subject to vast inequalities. However, with insight, dedication and research we can make contributions that lead to change. I see this as one of the most important tasks for both Karolinska Institutet and myself as vice-chancellor,” he said. Ole Petter Ottersen told the audience that he had looked up to and been inspired by KI throughout his career. “It is with pride that I take on this task, to work together with you for improved health, sustainable development and a just and tolerant society. I humbly thank you for your trust.” Text: Sara Nilsson Photo: Erik Cronberg

A novel microscopy technique to examine tumour tissue in three dimensions can more accurately diagnose cancer than current two-dimensional methods, according to a study conducted at Karolinska Institutet and Karolinska University Hospital and published in Nature Biomedical Engineering. Every day, a vast number of tumour tissue samples are examined by pathologists around the world, whose pronouncements inform the treatment their patients are given. In some cases it is very difficult to make the correct diagnosis, which could mean that the wrong treatment is given, causing suffering for the patient and sometimes death. Current methods of pathological examination for assessing the stage of a tumour use two-dimensional light microscopy. The cancer staging describes how much the cancer has grown and spread, and is necessary for prescribing the right treatment. Studying three-dimensional objects with methods that can only see in two dimensions is, however, not optimal and causes information gap. Hard to study 3D structures “To be sure, the tumours can be divided into sections for individual study, but three-dimensional structures such as the blood and lymph systems are very hard to study in this way,” says lead investigator Per Uhlén, professor at Karolinska Institutet’s Department of Medical Biochemistry and Biophysics. The researchers have applied a new imaging technique, one that is used in basic research, to study human tumour tissue. The technique involves making the tissue transparent and then reproducing it in three dimensions in what is known as a light-sheet microscope. By using specific antibodies, researchers can label certain proteins and analyse them in more detail. “Light-sheet microscopy has been used in basic research for a while, but it is only in recent years that it’s been refined so much that it can be used practically in hospitals,” says Professor Uhlén. “It was an unforgettable experience to look inside a tumour from a patient for the first time.” Blood system structures give important information Working with clinicians from Karolinska University Hospital, the researchers were able to study stored samples from patients with bladder cancer and then by recreating, amongst other structures, the three-dimensional blood system feeding the tumours, show that these structures say a great deal about how aggressive the tumours are. The new technique was able to diagnose muscle-invasive tumours, which can be missed with two-dimensional methods, with greater accuracy. “We’ve also studied other cancer types and judge that the method has considerable potential in the clinical diagnosis of all forms of solid tumours, especially cases that are difficult to diagnose,” says Professor Uhlén. “I hope that one day more pathological examinations will be conducted using 3D imaging.” Available at a KI core facility The light-sheet microscope used for the study is one of only a few in Sweden and is housed at the core facility CLICK (Center for Live Imaging of Cells at Karolinska Institutet). The study was financed by the Swedish Research Council, the Swedish Cancer Society, the Swedish Brain Foundation, the Knut and Alice Wallenberg Foundation, the Swedish Royal Academy of Science, the David and Astrid Hagelén Foundation, the Takeda Science Foundation, the Scandinavia-Japan Sasakawa Foundation and the Wenner-Gren Foundations. Publication “Whole-tissue biopsy phenotyping of three-dimensional tumours reveals patterns of cancer heterogeneity” Nobuyuki Tanaka, Shigeaki Kanatani, Raju Tomer, Cecilia Sahlgren, Pauliina Kronqvist, Dagmara Kaczynska, Lauri Louhivuori, Lorand Kis, Claes Lindh, Przemysław Mitura, Andrzej Stepulak, Sara Corvigno, Johan Hartman, Patrick Micke, Artur Mezheyeuski, Carina Strell, Joseph W. Carlson, Carlos Fernández Moro, Hanna Dahlstrand, Arne Östman, Kazuhiro Matsumoto, Peter Wiklund, Mototsugu Oya, Ayako Miyakawa, Karl Deisseroth, Per Uhlén Nature Biomedical Engineering, online 2 October 2017. doi:10.1038/s41551-017-0139-0

The Nobel Assembly at Karolinska Institutet has today decided to award the 2017 Nobel Prize in Physiology or Medicine jointly to Jeffrey C. Hall, Michael Rosbash and Michael W. Young for their discoveries of molecular mechanisms controlling the circadian rhythm. Life on Earth is adapted to the rotation of our planet. For many years we have known that living organisms, including humans, have an internal, biological clock that helps them anticipate and adapt to the regular rhythm of the day. But how does this clock actually work? Jeffrey C. Hall, Michael Rosbash and Michael W. Young were able to peek inside our biological clock and elucidate its inner workings. Their discoveries explain how plants, animals and humans adapt their biological rhythm so that it is synchronized with the Earth's revolutions. Using fruit flies as a model organism, this year's Nobel laureates isolated a gene that controls the normal daily biological rhythm. They showed that this gene encodes a protein that accumulates in the cell during the night, and is then degraded during the day. Subsequently, they identified additional protein components of this machinery, exposing the mechanism governing the self-sustaining clockwork inside the cell. We now recognize that biological clocks function by the same principles in cells of other multicellular organisms, including humans. With exquisite precision, our inner clock adapts our physiology to the dramatically different phases of the day. The clock regulates critical functions such as behavior, hormone levels, sleep, body temperature and metabolism. Our wellbeing is affected when there is a temporary mismatch between our external environment and this internal biological clock, for example when we travel across several time zones and experience "jet lag". There are also indications that chronic misalignment between our lifestyle and the rhythm dictated by our inner timekeeper is associated with increased risk for various diseases. Brief facts about the 2017 Nobel Prize in Physiology or Medicine Laureates Jeffrey C. Hall was born 1945 in New York, USA. He received his doctoral degree in 1971 at the University of Washington in Seattle and was a postdoctoral fellow at the California Institute of Technology in Pasadena from 1971 to 1973. He joined the faculty at Brandeis University in Waltham in 1974. In 2002, he became associated with University of Maine. Michael Rosbash was born in 1944 in Kansas City, USA. He received his doctoral degree in 1970 at the Massachusetts Institute of Technology in Cambridge. During the following three years, he was a postdoctoral fellow at the University of Edinburgh in Scotland. Since 1974, he has been on faculty at Brandeis University in Waltham, USA. Michael W. Young was born in 1949 in Miami, USA. He received his doctoral degree at the University of Texas in Austin in 1975. Between 1975 and 1977, he was a postdoctoral fellow at Stanford University in Palo Alto. From 1978, he has been on faculty at the Rockefeller University in New York.

Very prominent female researchers and academics can be selected to the AcademiaNet portal, but only after being nominated by one of the AcademiaNet's partner organizations. Agneta Ståhle, Professor in Physiotherapy, was nominated by the Swedish Research Council and selected during the late summer this year. “It is a tremendous honor to be nominated for and a part of this forum of female world-leading researchers," says Professor Ståhle, active at Karolinska Institutet's Department of Neurobiology, Care Sciences and Society. The purpose of the portal is to gather and make available prominent female researchers and academics, active within different disciplines. The idea is that this will make it easier to appoint leadership positions with female representatives, both in scientific organizations and other organizations. Additional target groups for the portal include journalists and conference organizers looking for experts. In order to be elected and to have a profile on the portal's website, the candidate must have outstanding academic qualifications, independent leadership activities, and very good academic credentials.

Forte, the Swedish Research Council for Health, Working Life and Welfare, has announced the granted applications in the call ”Research in ageing and health”. Three researchers at Karolinska Institutet (KI), all active at the Department of Neurobiology, Care Sciences and Society, were granted in total SEK 14 920 000.  Six out of 113 project applications were granted funding, summing up to 30 MSEK to be distributed. This between the years of 2017 and 2019. KI researchers receiving the grants Sara Garcia-Ptacek Project: Stroke rehabilitation in older persons and persons with dementia Grant: 5 225 000 SEK Amaia Calderón Larrañaga Project: Does our healthcare system truly fit older people? Impact of multidimensional health trajectories on the use of medical and social care services Grant: 4 890 000 SEK Debora Rizzuto  Project: Can a Healthy Physical and Social Environment Compress the Period of Disability in Older Adults? Grant: 4 805 000 SEK

Forte’s board has granted SEK 302 million in funding to 89 research projects in the fields of health, working life and welfare. In total, SEK 76,575,000 will go toward financing projects at Karolinska Institutet (KI). This year, Forte received a total of 1,247 applications in the annual open call for project, junior and postdoctoral research in the fields of health, working life and welfare. Of these, 27 applications from KI were approved. A record number of 18 junior researcher grants were approved in this year’s open call, five of which went to KI. The open call for proposals for the coming year will open in December.

The Undergraduate Awards (UA) is an international awards programme that annually recognises the best undergraduate work in 25 categories covering the fields of sciences, humanities, business and the arts. Eight KI students qualified as the top ten percent with their papers this year, and Paulina Werner was named as a Regional Winner. This year, eight students at Karolinska Institutet – studying medicine, biomedicine and biomedical laboratory sciences – have been placed in the top ten percent for their undergraduate work and have therefore been named as Highly Commended Entrants. Within each category, a number of Regional Winners are also named based on the quality of their degree work, as well as their field and geographic location. Paulina Werner, a student of biomedicine at KI, is the European winner in the Medical Sciences category.  Later this autumn, the annual UA Global Summit will be held in Dublin, Ireland and Paulina Werner and two fellow KI students will be invited to participate. All eight KI students will also become members of the UA Network and Alumni Portal, as are previous KI alumni who have been successful in the awards. Competition in the UA 2017 was tough, with 6,472 submissions from around the world. KI submitted 25 degree projects for assessment this year. Highly Commended Entrants at KI in 2017 Camille Wilhelmi, Bachelor's Programme in Biomedicine Paulina Werner, Bachelor's Programme in Biomedicine (Regional Winner) Alfredo Dueñas Rey, Bachelor's Programme in Biomedicine Malin Strömgren, Study Programme in Biomedical Laboratory Science Tina Yanting Lorentzon, Study Programme in Biomedical Laboratory Science Karl Björkström, Study Programme in Medicine Biying Huang, Study Programme in Medicine Besaf Pirmosa, Study Programme in Medicine

The Knut and Alice Wallenberg Foundation (KAW) have granted close to SEK 108 million to four research projects at Karolinska Institutet. In total this year, the Foundation has granted SEK 560 million to 18 research projects, which are considered to be of the highest international class, and offering potential for future scientific breakthroughs. “Project funding is mainly granted to basic research within medicine, engineering and natural sciences. This support give researchers the opportunity to invest in risky and long-term projects. The basic idea is to give them the freedom to succeed and fail without any demands on results or applications, "comments KAW's Chairperson Peter Wallenberg Jr, in a press release. KAW is the largest private research financier in Sweden, celebrating its 100 year anniversary in 2017. The Foundation applies a strict peer review process, assigning leading international researchers in each area to evaluate the grant applications. 2017 project grants at KI Project: Understanding malaria-parasite survival in the human body for developing antimalarial drugs Funding: SEK 27 500 000 over a period of five years Lead applicant: Mats Wahlgren, Professor, Department of Microbiology, Tumor and Cell Biology Project: The Achilles’ heel of breast cancer Funding:  SEK 36 800 000 over a period of five years. Lead applicant: Anita Göndör, Senior Researcher, Department of Oncology-Pathology Project: Elucidating the principles of allelic Funding: SEK 18 400 000 kronor over a period of five years. Lead applicant: Rickard Sandberg, Professor, Department of Cell and Molecular Biology Project: Deciphering Spatial Signaling of Protein Clusters at the Membrane Funding: SEK 25 150 000 over a period of five years. Lead applicant: Björn Högberg, Associate Professor, Department of Medical Biochemistry and Biophysics

Only people with migraine with aura have a higher risk of stroke, shows a twin study with 12-year follow-up, from Karolinska Institutet published in the journal Brain. The study also found that the risk is lower than previously demonstrated and possibly related to familial factors. Between 11 and 13 per cent of the population suffer migraines. The condition, which is up to three times more common in women, often debuts in adolescence or early adulthood. Sufferers have recurrent headaches combined with symptoms such as nausea, vomiting or hypersensitivity to light and sound. For one in three sufferers, the headaches start with an aura of neurological symptoms, leading to the migraine classification “with/without aura”. Repeated studies, conducted over the past 30 years or more, have shown that migraine – particularly with aura – increases the risk of stroke. Gender (being female), young age (under 45), smoking and contraceptive pills have also been linked to a higher risk of stroke in migraine patients. Studied 53,000 twins Using the Swedish Twin Registry, the researchers looked at over 53,000 twins over a twelve-year period, 16.2 per cent of whom had any form of migraine, and 6.7 migraine with aura. During the follow-up time, 1,297 of the 53,000 twins had a stroke. On examining the link between this and migraines, they found that the data corroborated with earlier studies, although with a lower general risk. “Our results showed no increase in stroke risk for individuals with migraine without aura, and a somewhat higher risk in twins with migraine with aura, even though this risk was lower than previously demonstrated,” says Maria Lantz, postdoc at Karolinska Institutet’s Department of Clinical Neuroscience. Familial factors could play a role The results also remained largely unchanged when the researchers controlled for other risk factors, such as smoking and high blood pressure. “Further analyses of twin pairs indicate that familial factors, such as heredity and childhood environment, can exacerbate the risk,” says Dr Lantz. The results of the study provide valuable clinical information both for sufferers of migraine without aura, where there is no observable increase in risk, and for sufferers of migraine with aura, where the risk of stroke is lower than previously demonstrated. The study was financed by Stockholm County Council through the ALF scheme and the Swedish Migraine Society. Publication “Migraine and risk of stroke: A national population-based twin study” Maria Lantz, Johanna Sieurin, Arvid Sjölander, Elisabet Waldenlind, Christina Sjöstrand, Karin Wirdefeldt Brain, online 26 September 2017