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CDA President Welzl visits Karolinska Institutet in Stockholm

Vienna/Stockholm, 8 March 2023 – 21:00 CET In 2015 Zhejiang-born Tu Youyou was the first mainland Chinese scientist who received a Nobel Prize in a scientific category. She was also the first – and so far only - Chinese scholar who received the Nobel Prize in Physiology or Medicine. Also against this backdrop it was a honour for CDA that Professor Lars Y. Terenius - who became a Member of the Nobel Assembly for the Nobel Prize in Physiology or Medicine at Karolinska Institutet in 1990 and is a Member of the Royal Swedish Academy of Sciences (KVA) - supported CDA from its very beginning. In 2020, amidst the global COVID-19 pandemic, the Swedish neuroscientist and pharmacologist Lars Terenius accepted the invitation by CDA President Alexander G. Welzl to take the European Chair of the CDA Scientific Advisory Board.

In March 2023, against the backdrop of the Swedish Presidency of the Council of the European Union, both of them decided to meet again for the first time after the end of the pandemic in person in Stockholm. Taking place at Karolinska’s Center for Molecular Medicine (CMM), founded and officially opened by Lars Terenius in 1997, this meeting marked at the same time the 20ies anniversary of Lars’ and Alex’ first collaboration in the field of performance-based measurement, management and reporting of CMM’s research achievements. This time their talks addressed amongst others framework conditions for Sino-European collaborations, the question of how language affects scientific reasoning, aspects of mutual dependence of US and China in geoeconomic terms and sea-turtles – called Haigui海归 in Chinese this means students and scholars returning back to China from overseas.

During his three days’ stay President Welzl was also invited to a bilateral talk with neuroscientist Professor Martin Ingvar formerly Karolinska Institutet’s Dean of Research as well as Deputy Vice-Chancellor responsible for future healthcare and external collaborations. Martin’s and Alex’ talk focused mainly on digital transformation and the impact of AI and machine learning on healthcare systems in the near future.

From left to right: Martin INGVAR (Professor at Karolinska Institutet), Alexander G. WELZL (President of CDA) at

Karolinska Institutet campus – Nobels väg building complex

Lars Y. Terenius – Focus on Molecular Mechanisms in the Human Brain

Professor Lars Terenius is a neurobiologist at Department of Clinical Neuroscience at Karolinska Institutet whose research focuses on neurogenetics and psychiatric diseases, and on alcohol and drug dependence. He was among the first to show that certain small peptides, produced naturally in the body, act on the brain's opiate receptors in a manner similar to that of other opiates. Later named endorphins – also called ‘happy hormones’ - these chemicals are released when the human body feels pain or stress. They’re also released during pleasurable activities such as exercise, massage, eating and sex. Endorphins help relieve pain, reduce stress and improve peoples sense of well-being. In 1973 Lars Terenius and his research group in Uppsala announced the discovery of specific receptors for such opiates in the brain almost simultaneously with two other groups of researchers (Solomon Snyder and Candace Pert of Johns Hopkins University, Eric Simon of New York University). This discovery helped elucidate the pharmacological effects of opiates and other painkillers, widely used in the practice of medicine. It also gave important insights into the chemistry of the brain, helping researchers to better understand the origins of some mental disorders resulting from chemical imbalances.

In 1990 Lars became a Member of the Nobel Assembly for the Nobel Prize in Physiology or Medicine and was for three years also Member of the Nobel Committee. He is a Member of the Royal Society of Sciences (Uppsala, since 1985), the Royal Academy of Sciences (Stockholm, since 1987), the Academia Europaea (Cambridge, since 1989) and the American Academy of Arts and Sciences (Boston, MA, since 1999). Since 2011 until present Lars is also a Visiting Professor at the Department of Cellular and Molecular Neuroscience of Scripps Research institute in La Jolla, CA, in the US.

From left to right: Lars Y. TERENIUS (Professor at Karolinska Institutet, Member of the Royal Swedish Academy of Sciences), Gunnar NORSTEDT (Professor at Karolinska Institutet) and Alexander G. WELZL (President of CDA) at Center for Molecular Medicine

As the founder of Karolinska’s Center for Molecular Medicine (CMM) Lars Terenius was also its first managing director until 2008. Inaugurated in 1997 the mission of CMM is to increase understanding in the common chronic diseases (atherosclerosis, rheumatoid arthritis, diabetes, allergy, and alcoholism) and to improve the possibilities for treatments as a center of translational research. CMM is founded on the vision that researchers in different medical research fields can benefit from each other in an interdisciplinary environment. Another central theme of CMM’s vision is that an important dimension is added to medical research when research is conducted in close collaboration with the clinics and their patients. Following this vision, CMM on the one hand integrates four departments at Karolinska Institutet (Department of molecular medicine, Department of medicine, Department of clinical neuroscience, and Department of woman and child health). On the other hand CMM is located on the campus of Karolinska University Hospital one of the world’s leading general hospitals with a proud history of research featuring developments such as the pacemaker and the gamma-knife. As of 2023 CMM gathers more than 500 staff members with clinical experience from Karolinska University Hospital and with research competence from Karolinska Institutet organised in 48 research groups. Göran K Hansson, who was a leader of a research group at CMM later became Secretary of the Nobel Assembly at Karolinska Institutet 2009 – 2015, Vice Chairman, Board of Directors, of The Nobel Foundation 2010 - 2022 and Secretary General of the Royal Swedish Academy of Sciences 2015-2022. Currently he is a Senior Professor of Cardiovascular Research at Karolinska Institute and affiliated with its Department of Medicine and Center for Molecular Medicine (CMM).

In 2021 Professor Lars Terenius, in collaboration with two US groups (including colleagues from The Scripps Research Institute, La Jolla, CA in the US), has been awarded a 5-year Prime Project Grant of 2.8 million US dollars from The National Institutes of Health (NIH), USA, to study how selected drugs affect the dynamics of opioid systems in Alcohol Use Disorders (AUD). This NIH R01 Research Prime Project Grant, which is awarded in an extremely competitive program being the original and historically oldest grant mechanism used by NIH, builds on a larger front-line approach by the KI researchers to study molecular interactions at the single molecule level in living systems. The project can be linked to a joint effort at the Centre for Psychiatry Research (CPF) at Karolinska Institutet to visualize dependence and conditioned responses in the human.

Martin Ingvar - Digital transformation, AI and Big-data in Health Care

During his three days’ stay President Welzl was also invited to a bilateral talk with cognitive neuroscientist Professor Martin Ingvar. The bilateral talk at Ingvar’s office focused mainly on the societal impact of digital transformation as well as the use of artificial intelligence (machine learning) and big data in health care and life sciences to improve performance for patients and within the health-care value chain in clinical reality.

Martin Ingvar is Professor at Karolinska Institutet since 1998, firstly of Neurophysiology and, as of 2007, he is Barbro and Bernard Osher Professor of Integrative Medicine as well as leading research activities at the Osher Center for Integrative Medicine. He has written several popular science books about the brain, the most recent about how the machinery of thinking can be transferred to artificial intelligence. Furthermore Martin served in numerous leadership roles at Karolinska Institutet, including as Dean of Research and Deputy Vice-Chancellor for Future Healthcare (since 2014) and Deputy Vice-Chancellor for External Cooperations (since 2017).

Martin Ingvars present research interest is in formal description of clinical knowledge and quality in clinical care. He has devised new modes for semantic interoperability in information systems and laid a foundation for patient centric knowledge building in health care. A personalized, multi-, and interprofessional approach is key. Today, healthcare is poorly organized to meet this complexity with the isolation between care levels, logic silos of the different healthcare professions, and lack of continuity of care along the patient's journey with the healthcare system. In order to meet the criteria for integrated, personalized care for diseases, the structural capabilities of healthcare to support a comprehensive approach and continuity of care needs improvement.

Based on an information model for a complete annotation of actions in clinical pathways Martin Ingvar and colleagues developed a functionally successful pilot, demonstrating a seamless appearance for the health care professionals, while at the same time generating data that could serve quality registries and clinical research. The interprofessional process support improved the communication between the stakeholders (health care professionals, clinical scientists and providers). Against this backdrop the use of a patient centered information model and data annotation focused on the care pathway simplifies the annotation of data for different purposes and supports sharing of knowledge along the patient care path.

In 2012 Martin Ingvar, Stefan Larsson (Boston Consulting Group) and Michael Porter (Harvard Business School) founded and launched the International Consortium for Health Outcomes Measurement (ICHOM). It grew out the conviction that the universal development and reporting of patient outcomes by medical condition is the single greatest enabler of delivery system transformation. Working with patients, leading providers, and registries to create a global standard for measuring results by medical condition, from prostate cancer to coronary artery disease ICHOM supports one of the key strategic agenda items in Michael Porter’s Value-Based Health Care Delivery framework. While Michael Porter was developing his health care framework at Harvard Business School, Martin Ingvar at the Karolinska Institute together with Stefan Larsson were exploring the potential of outcomes measurement based on studying the impact of Sweden’s extensive disease registries. Their work underlined the need for a value-based healthcare approach aimed to transform care by aligning different stakeholders to focus on patient centric outcomes. In recent years the sets of patient-centric outcomes measures (“standard-sets”) developed by ICHOM were updated to facilitate their implementation in health information systems and to provide annotations to make the sets machine-readable in the sense of using them for AI-applications. Martin Ingvar also contributed to the CODE-EHR framework which seeks to leverage the digitisation of health data to increase the efficiency of health-care systems and improve the lives and wellbeing of patients. Martin Ingvar is also a Member of the Board of Directors of the Swedish company Inify Laboratories which is a fully digital histopathology laboratory providing AI-powered diagnostic services within selected cancer types, having started with prostate biopsies in early 2023. It uses a fully digital, standardized and AI-supported workflow to optimize quality and response times. The company is located on the campus of Karolinska Institutet in Solna, Stockholm.

On the 1st EU-China Health Summit on Medical Innovation and Technology Transfer: Blueprint for a joint Mission in Aging held during the 17th World Congress of Medical and Health Informatics (Medinfo2019) titled “Health and Wellbeing: E-Networks for All” in Lyon (France) on 4 September 2019 Martin Ingvar delivered the closing keynote on the ‘Blueprint for a joint mission on aging’ stating three principles: (1) The information must follow the patient and allow for sharing of planned actions; (2) Shared interprofessional decisions requires shared information; (3) The patient has the right to access all individual information.

Karolinska Institutet – Seat of the Nobel Assembly for Physiology or Medicine

Founded in 1810 by Kung Karl XIII Karolinska Institutet was given the right to select the Nobel Prize in Physiology or Medicine based on Alfred Nobel’s testament in 1895. The first Nobel Prize was awarded in 1901. In summer of 1993 the building of the Nobel Forum was finished. It was designed primarily for the Nobel Assembly at the Karolinska Institute. Here the Nobel Committee announces the year’s Laureate in Physiology or Medicine, and here the Nobel Secretariat carries on its daily work.

(Picture credit: Alexander G. Welzl, CDA 2023)

The Nobel Forum at Karolinska Intitutet

The nomination process of the Nobel Laureates for physiology or medicine follows a strict procedure.

Karolinska Institutet and China – Top-level Intercultural Research Groups

Over the recent decades institutes, research groups and individual researchers worked together with Chinese colleagues and institutions. Actually Karolinska Institutet has had research collaboration with universities and institutions in China since the 1970’s. Each year Karolinska Institutet receives a number of official delegations from Chinese universities and hospitals as well as governmental agencies. Intensified research collaboration with Chinese partners has led to increased interest among Chinese PhD students to come to Karolinska Institutet, both for short-term visits as well as candidates wanting to do a full PhD.

In medicine and dentistry Karolinska Institutet established bilateral exchange agreements with Shanghai Jiao Tong University regarding bachelor's and master's education. In nursing there is a bilateral exchange agreement with Shandong University for bachelor's and master's education.

An example for Chinese scholars and scientific talent involved in ongoing research at Karolinska Institutet is the Medical Digital Twin Research Group at the Department of the Clinical Science, Intervention and Technology. Recent research results regarding the use of digital twin technology for effective treatment of inflammatory diseases were published jointly with (amongst others) a colleague from Jiangsu Key Laboratory of Immunity and Metabolism, Department of Pathogenic Biology and Immunology at Xuzhou Medical University in Xuzhou PR China.

Lars Y. Terenius and Alexander G. Welzl – 20th Anniversary of First Pioneering Collaboration

In 2003 Lars Y. Terenius and Alexander G. Welzl started to work together to develop a specific intangible asset (intellectual capital) based value creation model to describe and report the output and outcome of the translational research performed in life-sciences and health-care at Karolinska Institutet’s Center for Molecular Medicine (CMM) using specific performance measures (indicators). The goal was to raise transparency, support research management and communicate results related to inputs towards all internal and external stakeholders.

The pilot CMM Intellectual Capital Report for the business year 2002 was published in Swedish and was the first report on intangible assets related outputs and outcomes of a research organisation in life-sciences worldwide. In 2004 Terenius and Welzl continued their collaborative work to develop the CMM Intellectual Capital Report 2003. It was published in English. Based on this pioneering collaboration Lars Terenius wrote a preface in the worldwide first intellectual capital report for a whole university, the University of Natural Resources and Life Sciences (BOKU, Austria). The BOKU Intellectual Capital Report 2004 was developed by the Rectorate of the university advised by Alexander G. Welzl and published with a preamble of Elisabeth Gehrer the then Austrian Federal Minister for Education, Science and Culture.

In the following years Lars followed invitations to contribute to several international conferences Alex organized together with departments of the Austrian Federal Ministry for Science and Research in Vienna to talk about experiences at CMM regarding performance measurement and reporting based on indicators describing the intangible assets as well as outputs (short-term results) and outcomes (mid-term results) of translational research at CMM.

At the conference ‘Milieus of Creativity in University Research’ taking place in October 2010 in Vienna Lars and Alex gave remarks on scientific excellence and responsibility towards the citizens as well as economic impact and macroeconomic wealth creation in higher education research. At this occasion also distinguished colleagues from OECD in Paris, National Science Foundation (USA), University of Oxford and Chinese Academy of Social Sciences in Beijing contributed with their remarks.

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