Interview with researcher and innovator Niclas Roxhed. Niclas Roxhed wants to create a European Kendall Square in Hagastaden.

Niclas Roxhed took over as permanent director of MedTechLabs in November. As a researcher, he is renowned for both his inventiveness in the field of medical technology and his ability to translate new ideas into projects, business opportunities and patents. One of his most famous inventions is a pill that can be swallowed to inject drugs into the stomach lining. In this article, he discusses his research, entrepreneurship and how he sees Stockholm developing as a life science region.

What is it you do in your research?

“I lead the medical microsystems group at KTH. We work with things that are small enough to have in the body, such as microneedles that can penetrate the skin deep enough to deliver drugs but without being felt. Another area is minimally invasive brain therapy, where it is possible to insert minute implants containing drugs via the blood vessels. One idea we are working on is to insert implants into brain tumours and then activate them with a remote control, turning the drug delivery on and off as required.”

And you are a cofounder of the blood test company Capitainer?

“Quite so, Capitainer is a spinoff from my research at KTH. We develop technology that simplifies sampling of blood and other bodily fluids. The vision is to provide access to accurate measurements of biomarkers or drug levels on a much more frequent basis than is currently the case. Today, we might measure blood content on a few occasions, at the beginning of a treatment and so on. By simplifying tests, we can monitor the treatment and disease progression over time and achieve an entirely different level of insight and quality in the treatment.”

I believe that Capitainer has developed a kit for home testing that has been trialled during the pandemic?

“Our method ensures an accurate amount of blood on the sampling card and is so simply you can do it yourself at home. The correct amount of blood is crucial to measuring the right concentration of antibodies in the body. At the start of the pandemic we sent out our test kits to a random sample and had a good response rate. We repeated the process at the end of April and could see that 12% had been infected with COVID. At the time, there were no accurate figures available for the infection rate in Sweden. We conducted new tests in the summer to see what effect vaccination was having. I think our excellent response rate is down to the fact that we employ a copywriter when designing our mailshots.”

Why did you decide to go into research?

“I read electrical engineering at KTH and I guess I was thinking in terms of joining a company such as Ericsson. During my education, I began to wonder whether I should use my abilities to develop the next generation of mobile phone, or if there was something that felt more important. My conclusion was that I should set my sights on medical technology, where there were exciting challenges that involved people’s lives, which would motivate me more. Given that attitude, it was only natural to study for a doctorate, as a Degree of Master of Science in Engineering is not really sufficient if one wants to achieve great things.”

Could you tell us more about microsystems and medical technology?

“It might involve using light to create small microchips with a very high transistor density, or defining mechanical structures at nanometre level using etching or other techniques. We develop various types of sensors, as well as solutions for mechanically releasing drugs. For example, it’s possible to create a membrane to encase a drug capsule and then specifically affect it to control when it releases the drug. By using multiple membranes, one can release the right dose at the right time.”

You have also found time to conduct research at MIT. How did that come about?

“Professor Robert Langer works there and he is a doyen of drug delivery, as well as one of the founders of Moderna. He and physician and gastroenterologist Giovanni Traverso came up with the idea of delivering drugs from inside the intestine using needles. They started looking at microneedles that could be swallowed through the oesophagus and wanted a postdoc who was familiar with that field. Their announcement reached KTH, where we were among the first to work with microneedles, although in our case on the skin. This was in 2015, at which point I already had three doctoral students of my own. Still, as they were researchers who had long been an inspiration to me, I wrote that I would like to assist with the project. We found a solution whereby I combined a sabbatical year with a half-time salary from MIT as an expert. My family and I moved there for 18 months, until 2017. That work resulted in an article in Science with a famous illustration of our pill standing up in the correct position in the stomach ready to give the injection. We later developed a similar capsule for the intestine.”  

What is your own view of innovation and research?

“For us, it’s deeply ingrained. We develop highly specific applications and we are used to working closely with companies. When that collaboration pays off, it can save lives all over the world, something that has happened at our division previously. We also generate a great many patents; if I’m not mistaken, I am one of the KTH researchers with the most patents? Still, I have a long way to go to catch Bob Langer, who is both the most cited engineer in world history and the holder of most medical-technology patents. So, in my world innovation and research are intimately linked. If it is to pay off for society and for those who invest in research, the results need to be applicable in practice and protected by patents. Bob Langer has started some 30 companies and his commitment allows him to attract both money and good people. The fact that we have a COVID vaccine today has a great deal to do with Bob being such an entrepreneur. Even before the vaccine, someone calculated that Langer had affected the lives of two billion people with his innovations. Now, there are even more.”

In terms of research, what do you think is the difference between the United States and Sweden?

“One thing that immediately struck me as odd was the unconditional way they approached things. As they have greater resources in the US, they can afford to allow a doctoral student to take a thousand measurements of a given thing without having any clear idea at the beginning of what it might lead to. Their approach seemed almost idiotic! Why invest resources in something when we have no idea how we might use it? I now realise that one of the keys to their success is that they find and discover things almost by chance. While they’re at it, they also generate more and richer data that contributes to research in the long term. That’s one big difference compared to how things work in Sweden.”

What would you like to see more of in medical technology research?

“We should bear in mind that Sweden has a history of doctors and engineers working together to develop new medical technology; that’s how the gamma knife and pacemaker came about. But we need even closer interdisciplinary collaboration in order to achieve even greater feats. The time I spent in the US was very inspirational. What they have there that we do not yet have at KTH is their own animal facilities where they conduct experiments. This drives research on faster to the next stage, makes it more relevant and creates a greater impact. Thanks to my research collaboration with physician and researcher Staffan Holmin I have started to use the animal facilities at Karolinska Institutet, KI. So, these days I commute back and forth between KTH and KI. I look forward to KTH, KI and Karolinska University Hospital growing closer, even physically. As we get to know the organisations at KI and the hospital, the doctors and other staff there, this will facilitate collaboration.”

Finally, what are your hopes for Stockholm as a life science region?

“I hope that we get our own Kendall Square, like they have at MIT, where spinoffs, researchers and the business community are close enough to share coffee breaks. When Bob Langer was a postdoc in the 1970s, the area around Kendall Square was a slum; now, it’s the world’s leading life science centre. I wasn’t convinced that colocation was such a big deal, but it really creates expectations and ideas among the people who work in the area; one becomes more aware of the companies based there and their development. The area around KI, in the newly built Hagastaden district between Stockholm and Solna, can change in the same way and become a place that makes you say ‘wow’ when you visit it.”

On Friday 29 October, we inaugurated our new CT laboratory at BioClinicum, adjacent to Karolinska University Hospital in Solna. In addition to a tour of the laboratory and an ensuing reception, several speeches were given on the significance of the new CT laboratory. The following is an excerpt from the speech given by Sigbritt Karlsson, president of KTH Royal Institute of Technology.

“I would like to congratulate all of you who have worked so hard for many years to bring this new instrument here. This is an example of the drive that a researcher must have, to believe in one’s idea and work really hard to realise it. Way back in the early 1980s, when I was a student at KTH, I read a course on medical technology. Today, this field has grown, leading to the establishment of MedTechLabs, as well as to what is now SciLifeLab, a joint effort between ourselves, KI, Uppsala University and Stockholm University. These are fantastic organisations that reveal how crucial engineers are to Swedish and international healthcare.”

“That said, another incredibly important factor is collaboration. There are of course many pressing societal problems that demand solutions, and ideally we would like these yesterday, so it is vital that we have diligent researchers pondering them before the rest of us. And to have this multidisciplinary, interdisciplinary facility, MedTechLabs, constantly developing new equipment, thinking further ahead than we others, this is incredibly important to us all.”

“Because I’m sure we all have people close to us who are ill in various ways and, of course, we want them to have the very best care and the very best technical solutions. Clinical researchers and our researchers at KTH work together to build better diagnostics, something that is essential to reducing suffering and can even extend human life. So, our close collaboration with Karolinska Institutet and Region Stockholm is extraordinarily important. It has provided KTH researchers with a better, patient-centred understanding of the problems and how we need to work in order to solve them.”

“In turn, KTH has worked on the mathematics and physics of this machine. It is this that has made it possible to increase the precision, to increase the resolution. We contribute with biomedical imaging, machine learning and artificial intelligence, techniques that are also necessary to continue this development. Today, MedTechLabs is a well-established platform for cutting-edge medical technology initiatives and we are seeing more and more of these becoming clinical reality, in patient-centred healthcare. Today, we take the next step with this photon-counting imaging technology.”

On Friday 29 October, we inaugurated our new CT laboratory at BioClinicum, adjacent to Karolinska University Hospital in Solna. In addition to a tour of the laboratory and an ensuing reception, several speeches were given on the significance of the new CT laboratory. The following is an excerpt from the speech given by Ole Petter Ottersen, president of Karolinska Institutet.

“Events here today have significance far beyond the equipment and technique in question; in fact, beyond even the patients that they will help. Because this is an example of how this district, our dream team comprising the Region, KTH, KI – MedTechLabs – is on the frontline. And it is this that is so important. So, please allow me to congratulate you again because this has significance. All of our ambitions – whether that be the Region’s ambition to become a leading global life science cluster, KI’s ambition to conduct groundbreaking research or, of course, the ambitions of KTH and the hospital to be among the world’s best – are inextricably linked with this. But let me take you back to 1979, a big year for this technology, when Godfrey Hounsfield and Allan Cormack were awarded the Nobel Prize for their work on computerised tomography.”

“In his Nobel Lecture, Hounsfield explained that the first scan he performed took 10 days! Consider that. He makes no mention of how long the subsequent analysis took. Then there is a marvellously interesting section if his lecture: ‘What improvements should we expect to see in the future?’. Well, one of his greatest dreams was that it might one day be possible to look at the heart, a feat that was completely impossible at the time because, of course, the heart moves. However, when he spoke about how resolution could be improved, he never believed that we would have come as far as we have today. That was beyond his imagination. Now, with silicon-based detectors, we not only achieve much better resolution but we also obtain a great deal more important data from the equipment. Had he been with us today, Hounsfield would have been extremely impressed.”

On Friday 29 October, we inaugurated our new CT laboratory at BioClinicum, adjacent to Karolinska University Hospital in Solna. In addition to a tour of the laboratory and an ensuing reception, several speeches were given on the significance of the new CT laboratory. The following is an excerpt from the speech given by Irene Svenonius Irene Svenonius, regional chair for finance, Region Stockholm:

“We save people’s lives, just as Staffan Holmin says, using new technology the scope of application for which we can perhaps only imagine today. Now that you’re able to use it to help patients and develop it further, it will make a great difference, just as you have done with your treatment of stroke patients. Until now, who could have dreamed of this? It is quite astonishing and something else that you have developed together: Karolinska Institutet, Karolinska University Hospital and KTH. This is a dream partnership and, if I may say so as regional chair for finance at Region Stockholm, I am extremely proud that we as a region have committed to cofinancing MedTechLabs.

I can say that, in my opinion, every krona has been well spent; we are talking about the future of our patients. That said, I shall not disguise the fact that we have major strategic plans for the future of Hagastaden and Region Stockholm as a whole, which is that we intend to become one of the five leading regions for life science research in the world.

Investments like this, and the research that Mats Danielsson and his team have conducted in collaboration with Karolinska Institutet and Karolinska University Hospital, is precisely the cutting-edge knowledge we want the region to stand for and that will carry us forward. While this leads to solutions for patients, my hope is that it will also bring new businesses and new researchers to this unique place. Here, where we in the region together with Karolinska Institutet, and KTH Royal Institute of Technology, which is only a few bus stops away, have invested heavily in research infrastructure, which we of course want to come to use for the patients benefit.

So, on overall, I consider today to be a splendid example of what we wish to achieve in future.”

“From Quarks to Cancer Control – Science and Lessons Learned Bringing Photon-Counting Detectors to Spectral CT” was the headline when Mats Danielsson, professor in physics and program leader at MedTechLabs held a seminar lecture for Johns Hopkins Medical Engineering, May 18.

We asked Mats about his lecture and what he told the attendees, consisting of both faculty, management and students, about Swedish medtech research and development.

– The lecture focused on my experiences from translating research into use for the benefit of society. From my point of view, it is the application of good ideas from research into startups that it the fastest track to create value. I also took the chance of explaining that Sweden, though being a small country, always ranks very high for innovation in international comparison, that Forbes put Sweden on second place after the UK in their 2019 ranking of “Best countries for business”.
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One of the questions from the students was if they would need to choose between the academy or the industry. Mats’ answer was that it’s becoming more common for researchers to switch back and forth. And that KTH Royal Institute of Technology is generous in letting their researchers get leave long enough to create useful things outside the university.
 
– Also, I explained the Swedish “Teacher Exception”, letting researchers at the universities own the rights to their research and giving them the possibility to apply for patents. I promote this system even it other systems, which are common at US universities, can also work. The most important thing is probably that the researcher is present – in some way at least – all the way from the beginning and into the launch of the product.
 
Mats Danielssons work is a good example of strong interaction with industry, having built up several companies from his research at KTH. He has also seen an openness from investors towards researchers when it comes to making creative use of scientific results which may not have delivered on the original purpose.
 
– Sometimes it’s clear that what you were aiming for originally with the project, will not work. Today it’s possible to suggest a pivot, asking the investor to fund another angle. I myself did this with a project on stacked prism lens technology, where we shifted application from medical imaging to the use in telescopes for astronomy, which we later published in Nature Astronomy.
 
Mats is a firm believer in that researchers should build up a stack of ideas. If you wait five years, the idea might have become more relevant and the technology to develop the idea might have matured enough to move forward.
 
He also advised the students to learn enough mathematics and programming during their studies. If not, there is a clear risk that they cannot compete with students who have majored in these areas.
 
– Everybody needs to know some Matlab and Python.
 
Researchers such as Jeffrey Siewerdsen at Johns Hopkins acted as important advisors when MedTechLabs was formed. Today there is an ongoing dialogue between Johns Hopkins, KTH and the centre on additional collaboration, like the possibility for master student exchange.

On April 19, Koenraad H. Nieboer (Hans), Professor, MD, University Hospital Brussels held a speech on a MedTechLabs seminar. We asked him about his research and why Spectral CT is getting much attention.

Hi Hans, You just held a well visited seminar for MedTechLabs on clinical implementation of spectral imaging. Over 100 professionals signed up for the event! Why is this such a hot topic?

I think it is a hot topic because, at this moment, all prominent CT vendors finally have the opportunity to deliver high-quality spectral imaging with different techniques. Because they can provide these high-quality techniques, they put it to the attention of the radiologists. Nevertheless, spectral CT has been available for over ten years. Still, it takes a lot of time to go from first adaptors to general implementation. It has to fit in the radiologist’s workflow, and they have to see the benefit over time / financial investment. Nowadays, spectral CT can optimise image information and diagnostic accuracy, so we should use it and learn the radiological and medical community because it stays with a bright future in photon-counting CT.
 
What expectations do you have for your own research the coming year?

There are two topics in spectral imaging that have my particular interest: non-contrast brain IQ and contrast volume reduction in low keV reconstructions for vascular CT. But I keep my eyes and mind open for all possible diagnostic and technical evolutions.
 
You are a fellow and treasurer of the European Society of Emergency Radiology (ESER). What is the current scope of the organisation?

The ESER is a sub-society of the European Society of Radiology (ESR). The ESER’s primary goal is to advance and improve the radiologic aspects of emergent patient care and to advance the quality of diagnosis and treatment of acutely ill or injured patients by means of medical imaging and to enhance teaching and research in Emergency Radiology. This training includes new technologies like spectral CT. During this pandemic, it is challenging for younger societies, like ESER, to keep their financial balance because we can’t organise physical meetings. Like all societies, we have to make a difference in the online approach, but this is a big challenge. But we stay optimistic as always.

Meeting with the MedTechLabs researchers, what is your reflection of the centre?

This seminar was my first “physical” encounter with MedtechLabs, and it was an enjoyable experience. From my interests, I was, of course, well informed about the acquisition of Prismatic Sensors by GE Healthcare. I am curious how this cooperation will determine the future of (spectral) CT. Hopefully we are able to meet in person soon and have some more profound discussions!

Birgitta Janerot Sjöberg is Professor of Medical Technology at KI, the Department of Clinical Science, and member of the MedTechLabs Board. She is also one of the forces behind the joint KTH-KI PhD programme in Medical Technology and chairs the Programme Board.

What does it imply that the joint programme is renewed?

It’s really great that those in charge of the doctoral studies at both KI and KTH have chosen to support the existence of the programme. The programme is utterly important to minimise any negative sideffects from Stockholm having “One-faculty universities”, but also to make use of already successful initiatives deriving from the cooperation. The renewal will hopefully mean a boost for both supervisors, alumni, current and former doctoral students, as well as for the discipline as such. Medical Technology is developing fast, and the programme is spread across all the Schools and Institutions at KTH. We believe that an increased collaboration between the disciplines and universities also will favor the attractivity and the development of medical technology in the Stockholm region. That the students get to take with them two different university research cultures is something quite big. The following up of the Alumni is exciting!

What have been the drivers behind the programme and its’ renewal?

There is a strong tradition of collaboration within medical technology in the region. In the 1960s, KI was the first Swedish university to establish a Professor´s chair and Institution in Medical technology – a technological and natural science discipline to solve medical challenges. Early on there was a collaboration established with KTH where professors from KI taught biomedical engineers before medical technology became a separate programme at KTH. KI is still in charge of certain courses at the KTH programme.

When the “twin Professor chairs” within the discipline was established at KI and KTH in 2010, both of us newly appointed professors wanted to enhance and formalise the research collaboration, in order to contribute to the renewal of the discipline and the attractiveness of the region. Together we pursued the idea of a joint degree PhD programme and got support from the then existing School for Technology and Health at KTH and also CLINTEC at KI. Supported by enthusiastic colleagues , this eventually made it possible to start this programme, that leads to a medical doctoral exam from KI and a doctoral exam in biomedical engineering from KTH.

The evaluations were good, but administrative considerations, in combination with a diminished inflow of applications, lead to a pausing of the programme for a review after five years. However, the programme was sought after by both supervisors and students, and both KI and the hospitals saw an increasing demand for medical-technical competence. Now, with simplified and more coordinated administrative processes, the programme is once again ready to accept students.

Birgitta Janerot Sjöberg have been chairperson of the board since the formation and start of the programme, leading the work of two teachers from each university, appointed by the presidents, administrators and student representatives from each academy. Read more about the programme here.

(This interview text earlier had errors due to wrong translations).

Interview with Peder Olofsson. “It is fascinating that in the treatment of inflammation, it can be enough to send a few minute-long electrical pulses per day to achieve a long-term effect."

Peder Olofsson is a physician and researcher at the Department of Medicine, Solna, at Karolinska Institutet, and at MedTechLabs.

His research at MedTechLabs focuses primarily on mapping out the signal transfer between nerves and immune cells at the molecular level, and on finding out which parts of the large vagus nerve that communicate with the immune system.

Read the full article by Felicia Lindberg, first published in Swedish in the magazine Medicinsk Vetenskap No 2/2020.

Clara Hellner has been appointed new Chairperson for MedTechLabs. She entered the position as Director for Research and Innovation in Region Stockholm in June this year. Clara Hellner is an Adjunct Professor at the Institution for Clinical Neuroscience (CNS) at KI.

1. Hi Clara Hellner, congratulations to the new assignment. Why did You accept the position as new chairperson for MedTechLabs?
Thank You! Stockholm will be one of the world’s leading regions within life science, where medical technology is an important part. Being the R&D Director for Region Stockholm it is also natural for me to lead the work of MedTechLabs. The Centre is creating opportunities for researchers at KTH and KI to work close to the clinical operations within the healthcare, thus speeding up the pace for research results to benefit the patients. MedTechLabs also contributes to the regional ecosystem for start-ups and regions attractiveness for global corporations.

2. MedTechLabs is in a state of rapid growth. When and how will the results from the centre reach the patients?
The results from our first research program, Spectral CT-imaging and Endovascular Techniques, has continued to develop. Hopefully employees at the Karolinska University Hospital will soon provide patients suffering from acute stroke with finer diagnostics than ever before and better treatment. The technology is efficiently shared to other hospitals within Region Stockholm through the new online education “Acute stroke treatment within 24 h – decision making with perfusion”. Also, a new endovascular method for heart biopsy has been developed and is currently under clinical assessment in cooperation with the Sahlgrenska University Hospital Transplant Institute. Our second research program, “Breast Cancer Imaging powered by Artificial Intelligence Diagnostics”, has just started and a clinical study is under planning. Here AI and machine learning will be used that hopefully increases the accuracy within image diagnostics of breast cancer in a radical manner.

3. What will be your top priorities for MedTechLabs during the coming Year?
I would like to see that investments such as ScilifeLab and others within the region benefits from the collaboration that MedTechLabs is gradually starting with clinical operations. We are building the first model with Karolinska University Hospital at BioClincium, which then will be ready to spread to our other hospitals. It shall be easy for researcher and companies to conduct clinical studies as part of research projects. The coming year we will create the foundation for this infrastructure within MedTechLabs.

Three quick questions to Peta Sjölander.

1. How has the corona pandemic affected MedTechLabs?
– MedTechLabs carries on as normal – those of us who can are working from home. But the research, education and support activities continue as before.

2. What long term consequences can you see for the centre?
– Of course, no one wishes for this situation, but it has prompted collaboration opportunities across our three programmes. For instance, chest CT-imaging is of great importance in COVID-19 diagnosis, and AI solutions could improve early detection and therefore outcomes.

3. What do you do at MedTechLabs to keep up the energy?
– There is a lot of energy amongst scientists right now, worldwide. MedTechLabs has much to contribute.