KI News

Since the progress of diabetic kidney disease is difficult to slow, many patients have to undergo dialysis or kidney transplantation. However, researchers at Karolinska Institutet have managed to prevent diabetic kidney function deteriorating in mice using a new treatment method, and are confident that it could be a possible treatment for humans as well. The study is published in the journal Cell Metabolism. Diabetic kidney disease (or diabetic kidney failure) is the most common reason for dialysis. The clearest indication is the leakage of different plasma proteins into the urine, but there is also insufficient cleansing of waste products from the blood, impaired filtration and reduced urine production. There are currently few treatments available that can prevent the progressive deterioration of kidney function in patients, who often have no choice but to undergo dialysis or kidney transplantation.  It has long been known that people with diabetic kidney disease have an accumulation of lipid droplets in the kidneys, but scientists have not known what causes this phenomenon or the extent to which it exacerbates the disease. The researchers at Karolinska Institutet previously demonstrated that a special growth factor called VEGF-B (vascular endothelial growth factor B) controls the uptake of fats into muscles by regulating the ability of the cells coating the inner blood vessel walls to transport fat.oped Newly developed drug candidate By studying mice with diabetic kidney disease, the team has now uncovered a correlation between VEGF-B in the kidneys and the degree of pathological severity. When they blocked the biological effect of VEGF-B in mice with diabetic kidney disease using a newly developed drug candidate, they found a decrease in accumulated lipids in the kidneys. They subsequently managed to make special cells in the renal filtration apparatus called podocytes respond again to insulin signalling and thus prevent further deterioration in kidney function. “We’ve also been able to see from kidney biopsies that people with diabetic kidney disease also have raised levels of VEGF-B,” says Professor Ulf Eriksson at the Department of Medical Biochemistry and Biophysics. “This suggests that our treatment, in which we ‘freeze’ the effect of the disease, could work on people so that they are spared dialysis. But the drug candidate that we’ve used has to be shown to be safe and free from unacceptable adverse effects.” Hope to extend treatment The researchers now hope to extend their treatment concept to other kidney diseases that also cause the leakage of plasma proteins into the urine. Since diabetic kidney failure is also a significant risk factor in serious cardiovascular disease, Professor Eriksson was awarded the Heart and Lung Foundation’s grand prize in 2012. “Without the resources I then had at my disposal I would probably not have been able to complete this project,” he says. The study was financed by grants from several bodies, including the Swedish Heart and Lung Foundation, the Swedish Research Council, the Swedish Cancer Society and Karolinska Institutet. Annika Mehlem, Ulf Eriksson, Isolde Palombo and Annelie Falkevall hold shares in a diabetes company. Andrew Nash and Pierre Scotney are employed at CSL Limited, which also co-funded the study; Ulf Eriksson is a consultant for the same company. Publication Reducing VEGF-B Signaling Ameliorates Renal Lipotoxicity and Protects against Diabetic Kidney Disease, Annelie Falkevall, Annika Mehlem, Isolde Palombo, Benjamin Heller Sahlgren, Lwaki Ebarasi, Liqun He, A. Jimmy Ytterberg, Hannes Olauson, Jonas Axelsson, Birgitta Sundelin, Jaakko Patrakka, Pierre Scotney, Andrew Nash and Ulf Eriksson Cell Metabolism, published online 9 February 2017, DOI: 10.1016/j.cmet.2017.01.004 Text: Maja Lundbäck

Hans Rosling has died, as previously announced. Hans Rosling was by far Sweden’s most famous professor of international health, and lectured before the entire world. He was born 27 July 1948 and died on the morning of 7 February 2017. Nearly everything Hans Rosling undertook centred on global health. He grew up in the Luthagen district of Uppsala in a two-room apartment with a privy in the garden. During his popular lectures, he was known to describe the arrival of the first washing machine in his building, which magically freed his mother from the arduous labour of washing by hand with a washboard. His wife, Agneta Rosling (née Thordeman), embarked on a career in healthcare, and Hans followed in her footsteps by taking up medicine. They studied at Uppsala University and went through an exchange programme in 1972 to the Indian city of Bangalore. There, to his surprise, Hans realised that the Indian students were more advanced in their medical knowledge than he was himself. It was an eye-opener to which he would later devote much energy – puncturing holes in prejudices and preconceived notions based on outdated truths. Doctor Rosling Hans Rosling became a certified physician in 1975, after which he undertook specialist training in Hudiksvall. At the end of the 1970’s, Hans and Agneta decided to move to northern Mozambique to serve as a doctor and a midwife, respectively, for two years. There, Hans discovered konzo, a previously unknown paralytic disease, which he described in his doctoral thesis. He earned his PhD in 1986 and in 1990 was made associate professor of internal medicine at Uppsala University. He then taught courses about healthcare in developing countries until 1996, when he was made senior lecturer in international health at Karolinska Institutet. He became professor of international health at KI three years later. Hans was one of the founders of the Swedish branch of Doctors Without Borders, and was voted into the Royal Swedish Academy of Sciences in 2012. The whole world listened – and watched Hans Rosling’s sphere of influence extended far beyond Sweden. His son Ola Rosling and daughter-in-law Anna Rosling Rönnlund produced a computer programme offering a new model of visual statistics, through which the whole world came to listen to Hans’s lectures. Equipped with this novel tool, he was able to illustrate multiple variables while exposing changes and trends that debunked tired myths. His expanding, shifting bubble graphics showed that the state of the world is not static but in a constant state of flux – that today’s world is not the world of 25 years ago. In 2005, the three founded the Gapminder Foundation in order to promote global development through the greater use and understanding of social, economic and environmental statistics. Following a Ted talk that Hans gave in the United States in 2007, the founder of Google sought to buy the software on which his talk was based. The offer was accepted, since the very principle behind Gapminder was the universal accessibility of information, for which Google had an existing business model. The Ted talk earned Hans Rosling global renown. When the US magazine Foreign Policy listed the 100 thinkers whose ideas had shaped the world in 2009, Hans Rosling was number 96, and in 2012 he was included on Time magazine’s list of the “World's 100 Most Influential People”. He was named International Swede of the Year in 2012 for, through his work, having put Sweden on the map. He appeared twice on Swedish Radio as the host of its popular “Summer” and “Winter” programmes, and in 1999 competed in the equally popular general knowledge quiz show På spåret on Swedish Television. In his final years he was a much sought-after speaker for some of the world’s most influential minds at the World Economic Forum as well as for new students at KI. But it was his student lectures that always came first. He was also a friend and advisor to many people around the world, including Bill and Melinda Gates. A life threatened by illness Although Hans Rosling dedicated himself to healthcare, his own life was dogged by serious illness. Back in his late teens, it was noticed that he had an abnormal liver count, and years later, in the spring of 1978, when he was a 30-year-old father doing his internship in Hudiksvall, it was discovered that he had testicular cancer, which had spread to his abdomen. A more careful examination was then done of his liver count and chronic inflammation was confirmed. When hepatitis C was discovered at the end of the 1980s, it was this diagnosis that Hans received. He underwent a gruelling but successful course of radiation therapy for his testicular cancer, but his hepatitis C continued to ravage his liver for the rest of his life. By 2014, his condition was so serious that his life was in danger. By then, new drugs had appeared on the market, which he realised could help him; the problem was that they were not yet approved for use in Sweden. He therefore decided to seek treatment in Japan, at a personal cost of 120,000 kronor. The drugs worked and gave him a few more years of life. Sweden’s, and arguably the world’s, single most famous professor of international health lived a life under the shadow of his own serious disease. But this did not stop him from working relentlessly as a popular educator towards his goal of improving the health and living conditions of humankind, especially people living in extreme poverty. Hans Rosling passed away in the early hours of 7 February 2017. He was 68 years old. *** Hans Rosling TED talks Honour Hans Rosling with a donation to UNICEF  ”Hans believed it was always important to remember the most vulnerable. Therefore, it was his wish that any donations made in conjunction with his passing be directed to UNICEF”, writes Hans Rosling’s wife Agneta Rosling regarding the family’s memorial collection.  To the memorial collection A condolence book for Hans Rosling A condolence book in rememberance of Hans Rosling is available in the entrance hall of Aula Medica during reception hours until 10 February. Opening hours are from 8-17, address Aula Medica, Nobels väg 6, Solna. 

Hans Rosling, professor of international health, has passed away. He died early Tuesday morning, 7 February 2017, his family announces at the Gapminder foundation web site. Hans Rosling suffered from a pancreatic cancer which was diagnosed one year ago. "We are extremely sad to announce that Professor Hans Rosling died this morning. Hans suffered from a pancreatic cancer which was diagnosed one year ago. He passed away early Tuesday morning, February 7, 2017, surrounded by his family in Uppsala, Sweden," Ola Rosling and Anna R Rönnlund, Co-founders of Gapminder, write at gapminder.org "Our thoughts go out today to Hans Rosling's family," says Karolinska Institutet's Acting Vice-Chancellor Karin Dahlman-Wright. "It was with great sorrow that we learned today of Hans Rosling's passing. His work on behalf of public health and education was tremendous. His pedagogic lectures were groundbreaking, both in their ability to disseminate new knowledge and to question existing prejudices about the state of health in the world. I can only hope that many more will follow in his footsteps," Karin Dahlman-Wright continues.

A new study, in which researchers at Karolinska Institutet participated, has found that in mice adjusting levels of a compound called kynurenic acid can have significant effects on schizophrenia-like behavior. The study is published in the journal Biological Psychiatry. In recent years, scientists have identified kynurenic acid as a potential key player in schizophrenia. People with schizophrenia have higher than normal levels of kynurenic acid in their brains. KYNA, as it is known, is a metabolite of the amino acid tryptophan; it decreases glutamate, and research has found that people with this illness tend to have less glutamate signaling than people without the disease. Scientists have theorized that this reduction in glutamate activity, and therefore the higher KYNA levels seen in patients, might be connected with a range of symptoms seen in schizophrenia, especially cognitive problems. The study was led by, Professor Robert Schwarcz at the University of Maryland School of Medicine (UM SOM), who in 1988 was the first to identify the presence of KYNA in the brain, has studied the role of KYNA in schizophrenia and other neuropsychiatric diseases.  For the current study, Dr. Schwarcz and his team collaborated closely with Professor Sophie Erhardt and colleagues at Karolinska Institutet, and also with researchers at the University of Leicester, UK and KynuRex, a biotech company in San Francisco, US.  Levels of KYNA in the brain The research team studied mice which were deficient in kynurenine 3-monooxygenase, or KMO, an enzyme that is crucial for determining the levels of KYNA in the brain. Specifically, lower KMO results in higher levels of KYNA. Interestingly, patients with schizophrenia have lower than normal brain levels of KMO, which may be linked to lower levels of glutamate. The mice with lower levels of KMO showed impairments in contextual memory and spent less time than did a control group interacting with an unfamiliar mouse in a social setting. The low-KMO mice also showed increased anxiety-like behavior when put into a maze and other challenging settings. Since these behaviors are similar to behavioral traits in humans with schizophrenia, this suggests that KMO and KYNA may play a key role in the disease. Clinical implications According to the researchers, the new discovery has clinical implications as well. On its own, boosting glutamate on a large scale has serious side effects, including seizures and nerve cell death. The team amongst other things propose that modifying KYNA could adjust glutamate more precisely. This news article is an adapted version of a press release from UM SOM. The Swedish part of the study was funded by the Swedish Research Council, Hjärnfonden, Torsten Söderberg Foundation Vetenskapsrådet, Hjärnfonden, Torsten, and the AstraZeneca-Karolinska Institutet Joint Research Program in Translational Science. Publication Adaptive and Behavioral Changes in Kynurenine 3-monooxygenase Knockout Mice: Relevance to Psychotic Disorders Sophie Erhardt, Ana Pocivavsek, Mariaelena Repici, Xi-Cong Liu, Sophie Imbeault, Daniel C Maddison, Marian AR Thomas, Joshua L Smalley, Markus K Larsson, Paul J Muchowski, Flaviano Giorgini och Robert Schwarcz Biological Psychiatry, avaliable online as corrected proof 16 December 2016.

Consuming one or more pot of “snus” – Swedish snuff or dipping tobacco – per day increases the risk of developing type 2 diabetes by 70 per cent. This is the same risk increase as previously seen for smokers who smoke one packet of cigarettes a day. The study on the effects of snus was conducted by researchers at Karolinska Institutet and their colleagues at Umeå and Lund universities, and is published in The Journal of Internal Medicine. According to figures from the Public Health Agency of Sweden, 19 per cent of men and 4 per cent of women in Sweden take snus. Type 2 diabetes is also common; seven per cent of the adult population have a diabetes diagnosis and up to 20 per cent are in the risk zone. The disease is a serious one, as it can lead to complications, cardiovascular disease and premature death. The researchers at Karolinska Institutet and Umeå and Lund universities studied pooled data for a total of 54,500 men followed between the years of 1990 and 2013, during which time 2,441 of them developed type 2 diabetes. Owing to the size of the study, the team was able to estimate the effects of snus on never-smokers and thus avoid having the results contaminated by those who use both snus and cigarettes. Confirm earlier suspicions “We can confirm earlier suspicions that snus-users have a higher risk of type 2 diabetes, an effect that can seemingly not be explained by them being occasional smokers or having a lifestyle that is less healthy in other respects,” says Sofia Carlsson, researcher at Karolinska Institutet’s Institute of Environmental Medicine. There is also a 40 per cent increase in risk at a lower level of consumption (5-6 pots a week). A possible explanation for the result is the effect of nicotine, which experimental studies have shown can impair insulin sensitivity and thus possibly increase the risk of diabetes. Snus-users expose themselves to at least the same dose of nicotine as smokers, even though they are spared many of the other chemicals contained in cigarette smoke. No increased risk was seen in people who stopped using snus, which suggests that quitting snus can have a beneficial effect in this regard. “Because snus is relatively uncommon amongst women, we were unable to make corresponding analyses for them, so the impact of snus on the diabetes risk for women is an important matter for future research,” says Dr Carlsson. No less dangerous than cigarettes From a wider perspective, it is important to point out that existing research suggests that smokers are much more likely to develop cancer and cardiovascular disease than snus-users; it is in terms of type 2 diabetes that snus is no less dangerous than cigarettes. “The diabetes trend is largely driven by lifestyle factors, so to reduce your risk of diabetes you should not use tobacco, avoid being overweight and be physically active,” she says. The work was supported by Forte, The Public Health Agency of Sweden, Swedish Research Council and Swedish Diabetes Foundation. Publication Smokeless tobacco (snus) is associated with an increased risk of type 2 diabetes: results from five pooled cohorts Carlsson Sofia, Andersson Tomas, Araghi Marzieh, Galanti Rosaria, Lager Anton, Lundberg Michael, Nilsson Peter, Norberg Margareta, Pedersen Nancy L, Trolle-Lagerros Ylva, Magnusson Cecilia Journal of Internal Medicine, online 6 February 2017, DOI 10.1111/joim.12592

Commentary: Karolinska Institutet, KI, has received information that a researcher who has been active at KI is imprisoned in Iran on unclear grounds and without due trial. We have not been able to have this information confirmed, but any unjust detention of any person without due trial and under the threat of being punished is completely unacceptable. As a university, KI strongly defends the liberty of thought and the possibility and right of researchers to interact and build network across borders. This is a fundamental principle of a free world and a prerequisite for science. KI acting Vice-Chancellor Karin Dahlman-Wright has received an invitation to take part in the official delegation to Iran led by Prime Minister Stefan Löfven, and was planning to participate as part of existing collaborations between scientists and universities in Sweden and Iran. Given the current available information, it has not been decided whether she will participate.

Some questions to… Malin Kele, senior lab manager at the iPS Core Facility and coordinator of KI Facility Expo 2017 in Aula Medica on 14 February. A large number of core facilities linked to KI are taking part in the fair, which is being arranged with the support of the Board of Research. First of all, what is a core facility? "Exactly as the name might suggest, it provides specialist expertise to researchers, be it costly, high-tech equipment, a highly specialised method or a service that requires a great deal of experience and specially trained staff. Such a core research facility can offer support to researchers at different points in a project, from design and implementation to final processing and storage." What will you be doing on 14 February? "This is when KI’s first university-wide facility expo will kick off, gathering for the first time over 35 facilities under one and the same roof. There will be two levels of exhibition space with representatives from the different faculties. There will also be a speakers' corner with presentations running all day long." Who is the fair for? "Everyone working with research at Karolinska Institutet and the hospitals we collaborate with in the Stockholm area. Researchers outside KI and other interested parties are also welcome. It’s just as important for doctoral students to know what services are available as it is for senior researchers." This is an event that you at iPS Core Facility have instigated. Why? "We felt there was a need for a forum where facilities can exhibit themselves. After all, their most important function is to serve other researchers. An expo like this is an effective way for people to connect with many such facilities at once while finding out about others they didn’t even know existed! We ourselves use services from other facilities in our work, and so know how hard it is to find out which ones are available, what they can offer and how to find them. Not all of them are listed on the KI website and they are dispersed over at least two campuses and two hospitals." Two weeks to go. What are you most looking forward to? "To seeing all the facilities gathered in the same space and, of course, the crowds we hope will turn up. It promises to be a quarter of an hour well spent for anyone who looks in!"

Mikael Odenberg, the chair of the Karolinska Institutet board, writes in his blog today, 1 February, that the Election Committee will be consulting with the Consultative College on the proposal to put forward Ole Petter Ottersen’s name to the government for the position of vice-chancellor at Karolinska Institutet. This means that only one candidate will be proposed following the consultation between the board’s Election Committee and the Consultative College (which represents the university’s faculty, employees and students). The meeting is due to take place on 14 February. Mikael Odenberg comments that the Search Committee, whose task it was to identify suitable candidates, had made considerable progress in its work and shortlisted seven from a long list of 225 names, including eight applicants and 49 nominations, and interviews with dozens of potential candidates. Of these, Ole Petter Ottersen, Professor of Medicine and Vice-Chancellor of Oslo University, and formally in the running for the same post at Gothenburg University, was the only Scandinavian-speaking candidate. The other six were English speakers. “On 14 February, we will be presenting the Consultative College with a thorough report of the application process to date, and the deliberations that led the Election Committee to arrive at its decision,” writes Odenberg in today’s blog. “In our view, Ole Petter Ottersen has the leadership qualities that KI seeks and the ability to bring his colleagues and the university’s staff and students on board the change programme. He also has experience of leading a large university and conducts research of great significance.”   Text: Madeleine Svärd Huss Translation: Neil Betteridge, Sara Aldén

A change in attitudes, increased knowledge and more non-physician healthcare providers trained to perform safe abortions – this is the recipe for increasing the number of caregivers offering abortion care and fighting global maternal mortality, according to a doctoral thesis from Karolinska Institutet on abortion care in India, Sweden and elsewhere. Unsafe terminations claim tens of thousands of lives, particularly in the poorer parts of the world. “Abortion care provided by midwives is just as safe as when given by doctors,” says Dr Susanne Sjöström, who has recently presented her doctoral thesis at Karolinska Institutet’s Department of Women’s and Children’s Health. “The studies included in my thesis stress the extent to which education and knowledge influence the willingness of potential caregivers to perform safe abortions, which is crucial to reducing maternal mortality. We also show that abortion care given by non-physicians is more cost-effective, which is important since most countries have limited healthcare budgets.” From time immemorial women have had unplanned pregnancies, and when their situation has precluded having the baby, they have used a wide assortment of termination methods, often risking their own lives in the process Despite the wealth of knowledge available today about abortion and contraception, unsafe abortions cause at least 23,000 deaths and 7 millions of women with temporary or permanent morbidity every year around the world, most of them in the poorest regions of sub-Saharan Africa. Inexpensive and safe Unplanned pregnancies are preventable if contraceptive methods are available. Medical abortions and medical treatments of incomplete abortions are inexpensive and safe, and the drug misoprostol is widely available. But there are many barriers limiting women’s access to safe abortion, including a lack of caregivers, legal proscriptions, poor infrastructure, costs, stigma and women’s lack of knowledge.  Facts about unsafe abortions: ♦ Around 22 million unsafe abortions are estimated to take place worldwide each year, mainly in developing countries. ♦ Unsafe abortions cause annually at least 23,000 deaths among women. ♦ Around 5 million women are admitted to hospital as a result of unsafe abortion every year, while more than 3 million women who have complications do not receive care. ♦ Unsafe abortion imposes an enormous economic burden on society. Source: Susanne Sjöström and WHO The availability of caregivers is determined by their medical knowledge and willingness to provide safe abortion care. Society can also increase the number of abortion providers by allowing other medical professionals than doctors to perform abortions, which is recommended by the WHO. Dr Sjöström and her colleagues studied factors that influence the availability of caregivers for safe abortions in different settings. In one study conducted among medical students in India, where abortion has been legal since 1971 but where abortion-related maternal mortality rates remain high, the researchers found that students commonly misunderstood the laws regulating abortion and were uninformed about available abortion methods. The students were hugely affected by the stigma connected with abortion and even though the majority of medical students recognised that unsafe abortions are a huge problem in India, many claimed to be worried about reprisals and said that they were afraid to perform the procedure in their future practice. Just as acceptable Analyses made at a university hospital in Sweden showed that abortion care given by midwives is not only as safe but also much cheaper than when given by doctors. A systematic overview of randomised studies of abortion care also showed that women find that medical abortions and treatments for incomplete abortions administered by nurses and midwives are just as acceptable as those administered by doctors. “The fact that medical treatment is acceptable to the patient is highly significant for increasing the availability of healthcare”, says Dr Sjöström. “If women find the treatment or the caregiver unacceptable they risk turning to untrained or traditional carers, which can have serious health implications.” The research was financed with grants from the Swedish Research Council, FORTE and SIDA and through the ALF agreement between Karolinska Institutet and Stockholm County Council. The principal supervisor for the thesis was Professor Kristina Gemzell Danielsson. The thesis had its public defence on 20 January 2017. Doctoral thesis Increasing access to abortion – perspectives on provider availability from different settings Susanne Sjöström, Karolinska Institutet (2016), ISBN: 978-91-7676-363-6.

Five researchers at Karolinska Institutet have been awarded the Swedish Society for Medical Research’s (SSMF) four-year establishment grants on full-time or part-time. At most, the grants are worth a total of SEK 6.8 million each. Every year SSMF announces support to give young researchers an opportunity to establish themselves as independent researchers. KI receives five out of eight major grants for 2016: Daniel Andersson, Department of Physiology and Pharmacology, will map the link between rheumatoid arthritis and cardiac dysfunction. Christofer Juhlin, Department of Oncology-Pathology, will by means of genetic mapping identify markers for malignant thyroid cancer. Brent Page, Department of Medical Biochemistry and Biophysics, is developing new methods of studying the interaction between cancer drugs and their cellular target proteins. Sophie Petropoulos, Department of Clinical Science, Intervention and Technology, who aims to improve the outcome of in vitro fertilisation by studying how treatment with glucocorticoids affects development of the foetus. Jakob Wikström, Department of Medicine, Solna, will investigate the role that the mitochondria play in the wound healing process.  Text: Stina Moritz

As reported earlier, renowned photographer Lennart Nilsson has passed away. He was born on 24 August 1922 and died on 28 January 2017. Lennart Nilsson began taking pictures at an early age and sold his first picture to the Dagens Nyheter newspaper at the age of 16. When he turned 90, he donated his photographic equipment to Karolinska Institutet, where he had worked since the 1970s. Lennart Nilsson produced innumerable illustrated features for Swedish weeklies during the1940s and 1950s and later also for international magazines. He first achieved international fame in 1947 with his pictures from polar bear hunting in Svalbard. They were published in Life magazine, one of the most respected illustrated weeklies in the western world, and caused much debate. One of the pictures shows a polar bear cub with a rope around its neck trying to hug its dead mother. In the mid-1950s he began experimenting with different photographic techniques to be able to make extreme enlargements. His great international breakthrough in medical photography came in 1965 with his images of human foetuses. He had begun the project twelve years earlier, in 1953, and the images resulted in a 16-page feature in Life. The entire edition of eight million magazines sold out in a few days. His book A child is born was published later the same year. The book has been translated into some 20 languages and republished several times. For anyone looking at the pictures Lennart Nilsson took up through the 1970s, he seems to be everywhere. He was court photographer to the Swedish royal family, he photographed pygmies in the Congo, and Dag Hammarskjöld when he was appointed Secretary-General of the United Nations. Lennart Nilsson alone was allowed to enter Hammarskjöld’s new office. Close collaboration with researchers He worked closely with researchers at Karolinska Institutet from the 1970s until he was more than 90 year old. He visualised medical research and helped millions of people to better understand the human body. His pictures of the inside of the body can also be seen as works of art. He had a unique sense of form, colour and light but he always felt that the narration was the focus – not the picture in itself. “A photographer should record, not direct.” This approach eventually made him a master of waiting for the perfect moment and many of his medical photographs took several years to evolve from idea, through experiments, to finished picture.   Karolinska Institutet appointed him Honorary Doctor of Medicine in 1976 and his work has been of great importance to the university. Throughout his career he continued to push the boundaries for what is possible in medical photography. Among other things he photographed the viruses that cause HIV and avian flu and the parasite that carries malaria -- and always with the perfect picture as his ultimate objective. A sign on the wall of his laboratory at Karolinska Institutet read “Nothing is so good that it cannot be improved”. If there had been a Nobel prize for photography, Lennart Nilsson surely would have won it. He himself said that he never thought along those lines. He saw himself as a journalist and his driving force lay in “showing what is close to us, what we all know, in new ways” and his foremost objective was to surprise and touch people. As proof of his success he received a great many prestigious prizes and awards, including “Picture of the Year”, “The Hasselblad Prize”, and an Emmy Award. For Lennart Nilsson, the individual viewer’s reaction to his pictures was more important than fame. A photography prize named after Lennart Nilsson The Lennart Nilsson Award – the world’s foremost award in scientific and medical photography – was instituted in 1998 and is awarded annually by Karolinska Institutet. Lennart Nilsson had no formal education in medicine, although he had had plans to study medicine at KI in the late 1950s. He never intended to work as a doctor but he had an inquisitive mind and wanted to learn more, something that was part of his nature. He was advised against medical studies, however, by senior lecturer Axel Ingelman-Sundberg, who thought it would be a waste of his time. He nonetheless became a professor when the government awarded him the title in 2009 for “making the invisible visible and documenting the interior of the human body with scientific precision”. In 2012 he received the Karolinska Institutet Jubilee Medal (Gold class) for his life-long ground-breaking work on developing and rejuvenating the medical photograph. In conjunction with the award, he donated his photographic equipment to Karolinska Institutet. Lennart Nilsson was 94.   Text: Jenny Ryltenius

In January 2017, Irene Jensen began her two-year term as chair of Karolinska Institutet’s Work Environment Board. She intends to concentrate on making KI’s leaders more motivated to exploit the advantages of a good work environment. “I want to make more of KI’s managers and research team leaders aware of how much they have to gain from working with work environment issues. It impacts directly on our scientific production and quality,” says Irene Jensen. “We don’t intend to lecture or force the organisation to do things,” the new chair continues. “It’s more a matter of providing evidence-based ways of working, giving managers ideas for how to create the best possible working conditions for their staff.” Irene Jensen is a professor at the Institute of Environmental Medicine at KI and her research specialty is in fact work environment. To be more exact, questions concerning effective work environment management, what measures have an effect, and what ill-health in the workplace costs and how it can be prevented. Professor Jensen says that a good psychosocial work environment comprises three principal factors: possibilities for self-checking and independence in one’s work, leaders who encourage, inspire, listen to and emphasis with their staff members, and who welcome discussion and exchange of experiences. “Here we have a challenge in an academic world where people compete for funding and services. At the same time, research has shown that it’s worth striving for a culture where we share because it leads to better results from our scientific work,” she goes on. In her position as chair she also wants to strengthen collaboration between Karolinska Institutet’s central work environment board and the different departments’ work environment groups. The board is intended to be a support function for the groups so that they in turn can support managers and leaders at the departments. She has earlier led work environment efforts at KI for a total of six years and has among other things worked to institute regular organisation-wide employee surveys at KI. Irene Jensen succeeds Christer Sandahl.   Text: Selma Wolofsky

World-famous photographer Lennart Nilsson has died at the age of 94. With a microscope and pioneering keyhole photography, he explored the human body down to its cells. Long before medical imagery came into its own, Lennart Nilsson was doing groundbreaking work in the field. Lennart Nilsson joined Karolinska Institutet in the 1970s and was made Honorary Doctor of Medicine in 1976. In 2009, an honorary professorship was conferred upon him by the Swedish government. “Lennart Nilsson represents a wonderful era of photography and made trailblazing contributions to scientific imagery. We are extremely grateful to him and for the work he did at Karolinska Institutet,” says Karin Dahlman-Wright, Acting Vice-Chancellor at Karolinska Institutet. In 2012, Professor Nilsson was awarded Karolinska Institutet’s Gold Jubilee Medal for “his long-standing and groundbreaking contributions to the development and innovative advancement of medical photography”. Professor Nilsson received the accolade at a ceremony held in the Nobel Forum in celebration of his 90th birthday, at which he also declared that he was donating his photography equipment to Karolinska Institutet. On accepting the medal, he said: ”I feel enormously proud and honoured. I've had a wonderful time here at Karolinska Institutet and am exceedingly grateful to have had this opportunity to work with so many excellent scientists. This donation is a way for me to repay the generosity I've been shown at KI.” Professor Nilsson shot to fame in 1965 with his book A Child is Born and a much publicised photo feature in Life magazine. From that point on, he continued to push the boundaries of what was possible in medical photography, and to be showered with prizes and awards. Professor Nilsson’s books have been translated into more than 30 languages and The Miracle of Life is one of the most broadcast Swedish documentary series of all time. The Karolinska Institutet Jubilee Medal was instituted in 2010 to mark the second centenary of the university and is awarded in special recognition of people who have made outstanding contributions to medical research and to Karolinska Institutet.

The Swedish Olympic Academy is a new platform for science and sport and a new collaboration between the Swedish Olympic Committee, Karolinska Institutet, KTH Royal Institute of Technology and the Stockholm School of Economics (SSE). The aim is to strengthen Swedish sport. The initiative comes from the Swedish Olympic Committee, which wants to bring together some strong players in academia to strengthen Swedish sport, and in that context not least Olympic sport. The idea is to reach the various forms of competence that Karolinska Institutet, KTH and SSE have. “It’s a question of both understanding how people function, which is KI’s niche, and how we can, for example, develop the best tools, where KTH plays an important role. SSE then comes in with its expertise in innovation and entrepreneurship,” says Karin Dahlman-Wright, acting Vice-Chancellor at Karolinska Institutet. The new collaboration will give KI’s researchers stronger links to sport. “It might be interesting for some groups of researchers to come even closer to sport, to get to work with top athletes and trainers who can help define the problems they experience,” says Carl Johan Sundberg, professor at the Department of Physiology and Pharmacology and Karolinska Institutet’s Swedish Olympic Academy coordinator. He gives us a few examples of the type of research that might be conducted: “As far as KI is concerned, the collaboration will mainly involve bringing together groups of researchers carrying on research in for example injury prevention such as orthopaedists and physiotherapists, research relating to doping or performance optimisation – the best ways to train. Gender differences are also of interest – do men and women have any gender-specific prerequisites?” Karin Dahlman-Wright says that the collaboration has great potential to help KI’s researchers in physiology better understand the human body when it is performing at its maximum. Elite sport can also be important as regards public health. “We’ll see what bearing it has on public health. Elite sport is not by definition a health-promoting activity, so it’s important to understand how we can make it healthier. But our top athletes are also important role models for attracting young people to sport and this has an impact on society in general,” Karin Dahlman-Wright says. Text: Stina Moritz Photo: Agência Brasil/Creative Commons Sweden meets the USA during the 2016 Summer Olympics in Rio de Janeiro, where the country’s national football team tool silver.

In a review of existing research, commissioned by a committee of the European Parliament, a group of European researchers has identified benefits of organic food production for human health. The researchers recommend the parliament to consider giving priority to certain organic production practices and their use also in conventional agriculture. This recommendation comes from a one-year study resulting in the report 'Human health implications of organic food and organic agriculture'. The experts list several advantages of methods used in organic agriculture that benefit human health. The support of animal health and the restrictive use of antibiotics in organic animal production lead to a lower risk for the development of antibiotic resistance in bacteria, which is a major public health threat. Preventive measures of plant protection and restrictions of pesticide use in organic agriculture lead to a decreased pesticide exposure of consumers, with benefits for human health. Content of nutrients The experts also conclude that slight differences in the content of nutrients and other beneficial compounds between conventional and organic foods likely have no major implications for human health. The work behind the report was coordinated by Assistant Professor Axel Mie, affiliated to both Karolinska Institutet and the Swedish University of Agricultural Sciences. His conclusion is clear: “Several practices in organic agriculture, in particular the low use of pesticides and antibiotics, offer benefits for human health”, he says in a press release from the Swedish University of Agricultural Sciences. “Policymakers should support the use of such practices and their introduction in conventional agriculture, and make sure that organic agriculture continues to serve as a laboratory for the development of future healthy food systems.”

Intolerance, racial prejudice and misogyny are outdated phenomena. But what can we do to change such patterns in practice? Charlotte Signahl, a speaker on diversity, gave several examples when she spoke at Karolinska Institutet. As Charlotte Signahl hooks up her wireless microphone, she explains that the packaging stated that you should insert the receiver in the inside pocket of your jacket. But how many people have seen a ladies’ jacket with an inside pocket? The microphone’s headset is more suitable for a large ear size, and the colour of the microphone is light beige in colour, to blend in with a facial colour that not everyone has. “It’s small details like this that tell us that ‘you’re not the kind we’re expected to listen to’,” says Charlotte Signahl. It’s a Wednesday afternoon in January, and an interested group of researchers, students and staff is listening to a lecture on issues of diversity. Like most authorities, Karolinska Institutet has drawn up action plans, guidelines and codes of conduct to the effect that everyone should have the same opportunities regardless of factors such as gender, ethnic affinity, faith or functional impairment. But what does this mean? Charlotte Signahl starts with the Swedish Act on the Prohibition of Discrimination, believing that a poor translation into Swedish of human rights has affected the whole way we discuss issues relating to rights in Sweden. “The original text doesn’t talk about ‘... the equal value of all people’, but that we should treat all people ‘with the same dignity’. But this translation forms the basis of all our discussions about rights in Sweden.” At the same time, she poses a rhetorical question about what happens when we treat all people equally. Is the outcome the same? After discussing matters on the benches, the conclusion is mostly that you have to understand that everyone has different circumstances, so it is not always right to treat everyone the same. You cannot know an individual’s circumstances in a given situation. “That’s why it’s a big trap. When I start considering people’s possible circumstances that I go around and find, I can easily trip up,” says Charlotte Signahl. Sylvie Garnbeck is the organiser and coordinator for equal opportunity in Karolinska Institutet’s central HR Department. She explains that the purpose of the lecture is to inspire, to provoke new thoughts and to educate, but also recognises that it is easiest for them to reach those who are already converted, those with an interest in and knowledge about these issues. Malin Almgren, researcher at the Department of Clinical Neuroscience, in the audience, as was Anna-Lee Cöster Jansén, Main Health and Safety Delegate at KI, share her views. Maybe it’s not those who come to the lecture who should really be there. But Anna-Lee Cöster Jansén acknowledges the value in continuing to educate yourself: “Every time you go to a lecture like this you hear new arguments that you can take with you and use to try and convince backward-looking people,” she says.   Text: Stina Moritz Photo: Ulf Sirborn

Professor Jonas Ludvigsson with two of the 10 million Swedish citizens. Photo: Gustav Mårtensson   Friday 20 January 2017 was a historic date. It was the day when Sweden’s population surpassed ten million. “It didn’t take as long as we thought,” says Professor Jonas F Ludvigsson at the Department of Medical Epidemiology and Biostatistics at Karolinska Institutet. We met paediatrician professor Jonas F Ludvigsson at the maternity hospital in Örebro as he held up Lova Henriksson and Olle Lööf-Norrström who had just helped make Sweden’s population ten million. Professor Ludvigsson is the main author of a review article about the Swedish population that was published in the European Journal of Epidemiology. “The population registers have become so efficient that as good as a hundred per cent of all births and deaths, 95 per cent of immigrations and 91 per cent of all emigrations are reported within 30 days,” he says. Population statistics are collected in two registers: the Total Population Register (TPR), maintained by Statistics Sweden, and the Swedish Population Register, maintained by the Swedish Tax Agency. The registers make up what is commonly known as the population clock, which Statistics Sweden used to calculate that 20 January 2017 was the date when Sweden’s population would pass the ten million mark. But the population clock is ticking faster than it used to. In 2006 the forecast was that the population would reach ten million in 2029. But we reached it 12 years earlier. Is it because the registers have become so much more efficient than they were in 2006? “The registers are certainly improving all the time and registrations will soon be made faster than within 30 days, but the answer naturally lies elsewhere,” says Jonas F Ludvigsson. “Between 2010 and 2015 Sweden had the second fastest growing population in the EU, with an average of four per cent a year, compared to the other countries, where the average was one per cent.” Why is that? “Birth rates are high and people want to come here and apply for citizenship. We haven’t looked into why but we have some theories. It’s quite simply related to the fact that Sweden is doing well.” So you could compare a graph of reduced interest rates with one of the number of children born? “Ha ha. That might not be entirely wrong. But there are also a lot of other factors. When times are good, people might well choose to have that extra child. Child benefit and parental insurance also play their part. And we mustn’t underestimate the equality aspect with paternity leave and attitudes in the home. These days, more women can feel secure in not having to bear the whole load themselves. So greater equality leads to a larger population? “Exactly. It makes things much easier,” says Jonas F Ludvigsson. Statistics Sweden’s forecasts show that Sweden’s population will reach 11 million in 2024 and 12 million in 2040.   Text: PeKå Englund Photo: Gustav Mårtensson

Crimean–Congo hemorrhagic fever is a life-threatening disease that is caused by a virus of the same family as Ebola and that has a mortality rate of around 30 per cent. The Public Health Agency of Sweden, Karolinska Institutet (KI) and the Swedish National Veterinary Institute (SVA) are now leading a European project to develop a vaccine against the disease. Crimean–Congo hemorrhagic (CCHF) is caused by a tick-borne virus and was first described in the 1940s in south-west Russia. Today, the virus is found in Russia, eastern and southern Europe, large swathes of Africa, the Middle East and East Asia. The project, called CCHFVaccine, has been given a grant of EUR 6 million through the EU’s Horizon 2020 research programme and includes eleven other partners from Europe, the Middle East, Central Asia and the USA. The virus that causes the disease has been given a risk classification of 4, the highest possible for pathogenic agents, and must therefore be handled at the Public Health Agency’s safety laboratory, which is the only one in the Nordic region in the required class. “Crimean–Congo hemorrhagic fever, or CCHF, is an extremely serious disease that leads, at worst, to internal haemorrhaging and death for about 30 per cent of the people who contract it,” says researcher Ali Mirazimi, who is heading the work to develop a vaccine. “There is currently no specific treatment for the disease and no vaccine to protect against infection.” Further information can be found on the Public Health Agency of Sweden website

Investigators at Karolinska Institutet have identified a potential therapeutic target for treatment of obesity-associated metabolic diseases such as type 2 diabetes and nonalcoholic hepatic steatosis. The work, performed in collaboration with scientists at the University of California, Berkeley and Danderyd Hospital, is published in Cell Reports. The researchers utilized advanced biochemical techniques to map activities of an enzyme family in liver biopsies from obese and lean individuals. The results reveal that obese individuals only have half the activity of a protein called carboxylesterase 2 compared to their lean counterparts.  Carboxylesterase 2 is best known for its role in breaking down foreign substances, such as drugs, within the body. However, in follow-up experiments the investigators found that carboxylesterase 2 not only decreased with obesity but was an important regulator of the devastating effects of fat on metabolic health. Remarkably, restoring levels of carboxylesterase 2 in obese mice for only one week largely reversed obesity-induced disturbances in glucose metabolism and the deposition of fat within the liver. Ability to breakdown diacylglycerol Carboxylesterase 2 may have such profound health promoting effects because of its ability to breakdown diacylglycerol, a lipid intermediate known to have deleterious effects on glucose metabolism. This also appears to be the case in humans where individuals with higher carboxylesterase 2 activity had significantly lower levels of diacylglycerols and markers of improved glucose metabolism. “As effective therapies for metabolic disease are presently limited, developing therapies that restore activity of carboxylesterase 2 in obesity may have a profound public health impact. Moreover, given its known role in drug metabolism, decreased activity of carboxylesterase 2 may inform proper dosing in the context of obesity”, says Juleen Zierath, professor at the Department of Molecular Medicine and Surgery, Karolinska Institutet, who has led the investigation together with post-doctoral researcher Max Ruby. The work was supported by O. E. och Edla Johanssons Vetenskapliga Stiftelse, NovoNordisk Foundation, Stockholm County Council (ALF project), Swedish Research Council, Strategic Research Programme in Diabetes at Karolinska Institutet, European Research Council Ideas Program, Swedish Diabetes Foundation, Swedish Foundation for Strategic Research and Diabetes Wellness Sweden. Publication Human carboxylesterase 2 reverses obesity-induced diacylglycerol accumulation and glucose intolerance Maxwell A. Ruby, Julie Massart, Devon M. Hunerdosse, Milena Schönke, Jorge C. Correia, Sharon M. Louie, Jorge L. Ruas, Erik Näslund, Daniel K. Nomura, and Juleen R. Zierath Cell Reports, online 17 januari 2017, doi: 10.1016/j.celrep.2016.12.070  

Four researchers at KI will receive grants from Johnson & Johnson Innovation, committed up to the next 2–3 years.  The purpose is to identify and support high quality, innovative research that has the potential to provide new healthcare solutions. Strategic questions were centred on the development of novel therapeutic interventions, understanding disease biology and identification of novel biomarkers across multiple therapeutic areas. The selected projects will receive funding, resources and advice from Janssen, the pharmaceutical companies of the Johnson & Johnson group: Sophie Erhardt, professor at the Deptartment of Physiology and Pharmacology. Project: Investigation of a potential novel biomarker for treatment-resistant depression and suicide risk. Malin Flodström-Tullberg, professor and Susanne Gabrielsson, docent, Deptartment of Medicine, Solna. Project: Identifying potential biomarkers for virus-induced type 1 diabetes. Johan Sandberg, professor at the Deptartment of Medicine, Huddinge. Project: Research the role of MAIT cells in liver biology and chronic hepatitis B viral infection. Michael Uhlin, docent at the Deptarment of Oncology-Pathology. Project: Characterization of the immune microenvironment in early prostate cancer.