A Journey in Science: Medical Scientist in Translation

Anthony Cerami Award in Translational Medicine A Journey in Science: Medical Scientist in Translation Göran K Hansson Karolinska Institute, Department of Medicine Solna and Center for Molecular Medicine at Karolinska University Hospital, Stockholm, Sweden Real innovations in medicine and science are historic and singular; the stories behind each occurrence are precious. At Molecular Medicine we have established the Anthony Cerami Award in Translational Medicine to document and preserve these histories. The monographs recount the seminal events as told in the voice of the original investigators who provided the crucial early insight. These essays capture the essence of discovery, chronicling the birth of ideas that created new fields of research; and launched trajectories that persisted and ultimately influenced how disease is prevented, diagnosed and treated. In this volume, the Cerami Award Monograph is by Göran K Hansson, MD, PhD, Karolinska Institute. A visionary in the field of cardiovascular research, this is the story of Dr. Hansson’s scientific journey. Online address: http://www.molmed.org doi: 10.2119/molmed.2014.00092 INTRODUCTION My decision to go to medical school was based in equal parts on a desire to help people, a wish to have a meaningful job and the challenge to get into a program that was, at the time, the most coveted one in the Swedish university system. I had dreams of becoming a thoughtful psychiatrist, a decisive cardiologist or perhaps a doctor for the poor somewhere in a developing country. I made it to and through medical school, but I fulfilled none of these dreams. After a short time in internal medicine, the research bug had bitten me and I became a physician-scientist, with the emphasis gradually moving toward the latter part of the term. I grew up in a small town in the province of Bohuslän on the Swedish North Sea coast. My dad ran the local newspaper of the town, and my mum was a nurse at its small hospital. The town of Lysekil was dominated by the sea surrounding it. Commercial fishing, herring canneries, and a factory producing boat engines were its main activities. In summer, the coast was invaded by tourists from the big cities—Stockholm, Göteborg and Oslo. When the sea warmed up, we went swimming, canoeing and sailing. Life was magical for a teenager—sailing in the day and partying at night. Winds from the big world brought new influences and new sounds, such as the Beatles, Bob Dylan, Address correspondence to Göran K Hansson, Karolinska University Hospital, Center for Molecular Medicine L8:03, SE-17176 Stockholm, Sweden. E-mail: ; Phone: +46-8-5177-6222. Submitted May 1, 2014; Accepted for publication May 1, 2014; Epub (www.molmed.org) September 5, 2014. world politics and student protests. The 1960s were an exciting time. MEDICAL SCHOOL AND HOW TO SURVIVE IT The curriculum in medical school started with anatomy. It was a nightmare. We were expected to memorize Latin names for hundreds of structures on bones—fossae, sulci, capita and so on. We were incessantly told that knowledge of all these anatomical details was absolutely necessary for any clinical doctor. When I started working as a clinician myself, I found this kind of descriptive anatomy completely useless. In real life, bones have tendons and muscles attached; they are not bare except in the cemetery. One day, I saw a poster in the corridor outside the anatomy department. The neighboring department of histology invited students to an evening with information about medical research. We talked about it over a beer in the park when we were skipping another boring hour of anatomy, and decided to attend. That evening, we met other kinds of teachers. They were scientists and told us about MOL MED 20:381-389, 2014 | HANSSON | 381 A MEDICAL SCIENTIST IN TRANSLATION Figure 1. Göran Hansson smashes some glassware while trying to isolate organelles. Caricature by student colleague Tom Björnheden, 1980; reproduced with permission from him. medical problems that needed to be solved, pointing out methods for solving them. And they wanted us to join them in that endeavor. We immediately signed up. Our first experiment was not a success. My classmate, Per Elias, and I joined a neurobiology project to analyze biochemical changes in the cerebellum after alcohol exposure. Our main finding was that the cerebellum is completely devoid of protein. Neurobiology was not ready for such a paradigm shift, and we decided to move to other fields. In the laboratory of Sören Björkerud, I heard about cardiovascular disease, the major cause of death in our society. Sören was an enthusiastic teacher. It was fascinating to hear him explain how the cells of the blood vessels form a barrier to prevent cholesterol from accumulating and how that barrier could be damaged by the forces of blood pressure, leading to atherosclerosis and ultimately to myocardial infarction. I was assigned to work with Göran Bondjers, a young physician-scientist who had just finished his PhD in Sören’s lab. Göran taught me how to dissect arteries, analyze cholesterol in tissues and label dividing cells with radioactive isotopes. I was learning the craft of science (Figure 1). Life was intense. There were lectures and classes in physiology, pharmacology and pathology in the mornings and afternoons, work to do in the research lab in the evenings, and books to read at night. And there were a thousand things to protest against in endless demonstrations, ranging from the war in Vietnam to the new curricula in universities. My girlfriend (and future wife), Margareta, who was studying psychology, and I were busy all the time. And things were to get even busier. Margareta was pregnant, and we hadn’t even finished our educations. Our son, Emil, was born the day I had my major exam in internal medicine. Axel followed 3 years later. Margareta switched from psychology to physiotherapy when it became obvious that job opportunities were dwindling in psychology. I continued in medical school and could even continue with part-time research, thanks to an understanding wife and a modest need for sleep. IMMUNITY IN BLOOD VESSELS? Immunology immediately captivated me in medical school. I took immunology courses as part of my PhD program and learned about antibodies, vaccination and memory. I was fascinated by the fact that this powerful defense system was patrolling our bodies, next to the blood vessels where atherosclerosis developed. “How would the immune system react to a pathology that builds up in its immediate vicinity?” I asked myself. “Someone must know,” I reasoned, and I went to the library and read all the textbooks and review papers I could find about cardiovascular pathology. Not a word was said about the immune system. I asked Göran Bondjers. His answer was “Go and find out.” I knocked on the door of the microbiology department, and they allowed me to 382 | HANSSON | MOL MED 20:381-389, 2014 come and learn. The head of the (...truncated)