Karolinska Institutet (KI) is a comprehensive medical university covering biomedical, clinical, epidemiological and nursing research in virtually all medical disciplines. Cancer Center Karolinska is a translational cancer research structure linked to the oncology clinic where 29 research groups have their laboratories that span preclinical to clinical research.
Karolinska Institutet has 7000 students in undergraduate programs and 2200 in postdoctoral programs and consists of 22 departments, 6 in basic biomedicine and the rest at the clinic. The clinical part of research and training is the Karolinska University Hospital, which has two sites (the former Karolinska Hospital northern site, and Huddinge Hospital southern site) including collaboration with three community hospitals. A new hospital building, New Karolinska Solna, is gradually employed during 2017 and 2018. Basic preclinical research is located at the Karolinska Institutet Campus and some institutions at the Huddinge site. Clinical research regarding solid tumors and paediatric oncology is located at the northern site. Haematology is represented at both University Hospital sites. Overall, Karolinska Institutet has 16 programs to train medical and paramedical staff; apart from medicine and odontology, this also includes nursing, physiotherapy, biomedicine, toxicology, as well as other disciplines. Altogether 140 research groups with more than 800 members in twelve of the twenty-two departments are active in cancer research.
The KICancer researchers network promotes translational research as its main mission with 800 members from 140 research groups. StratCan – the Strategic Cancer Initiative at KI – is a government funded organisation which brings together cancer research at KI by providing strategic grants, supporting infrastructure and recruitment of young and senior investigators. KICancer and StratCan are collaborating intimately in order to join with the University Hospitals new organization Theme Cancer. Together KICancer and StratCan organize meeting places for the KICancer community, interactive retreats, diagnosis based networks, young cancer leader programs and international collaborations (http://ki.se/en/stratcan/startpage ). KICancer/StratCan is also organizing the formal PhD-training program providing 15-20 one to two week courses per year that are open to MD/PhD-students. KICancer also initiated a National Clinical Research School for clinical cancer researchers in training, called NatiOn, which now also is jointly supported with StratCan. each program runs for three years with two months of full time teaching per year providing the tools for good clinical research and cutting-edge know-how in tumor biology.
Personalized cancer medicine and clinical trials
KICancer started a program in 2014 to develop translational and close-to-patient research building upon existing infrastructures to mobilizing the institute around its Personalized Cancer Medicine initiative, which now also includes StratCan and is supported by some initial funding.
There is an increasing interest within the cancer profession and Swedish funding bodies to organize and support cancer research for development of a Personalized Cancer Medicine program. Of special importance are several strategies initiated to strengthen specific research areas and coordinate cancer research towards personalized cancer medicine. With the large number of different basic and preclinical research activities there are efforts to balance the early clinical trial activities to improve translation into clinical research. Thre are exceptional possibilities to expand late translational cancer research involving clinical validation and outcomes research, both in terms of clinical effectiveness and cost-effectiveness assessment, as there are decades of experience in prospectively building clinical registries and population-based patient cohorts. This is important since next-generation clinical trials should be linked to late translation in order to make drug development more effective.
Molecular diagnostics, genomics and proteomics
Three years ago a new facility was built, Science for Life Laboratory (SciLife), with both cutting edge research in 'omics, live imaging, and broad service platforms including the new Clinical Genomics facility and mass spectrometry proteomics facility which is now being integrated with the Personalized Cancer Medicine program.
SciLife has a strong critical mass in bioinformatics with some 170 bioinformaticians doing research or providing support through the Wabi and BILS-programs. SciLife houses both national facilities for biology as a whole as well as regional units belonging to the three major universities in Stockholm - Karolinska Institutet, the Royal School of Technology (KTH) and the Stockholm University. It is developing into a great meeting place for technology and biomedical driven research and it is well funded by the government. The ongoing work to link SciLife to the clinical pathology will offer a unique molecular diagnostic platform for development of personalized cancer medicine.
The Pathology Department includes biopsies via fine needle aspiration; this technology was developed in Stockholm and is very useful when repeated biopsies are part of adaptive clinical trials. More than 100 specific diagnostic measures are used for routine diagnosis, including expression analyses with antibodies or FISH, and mutational analyses with specific probes. In addition, in-depth molecular genetic analysis is pursued at the Department of Clinical Genetics, with a strong focus on familial cancer and cancer risks.
Imaging in the clinical setting
Imaging has a strong tradition in Karolinska Institutet and its hospitals, based on several early inventions. Developmental programs in imaging mainly focus on MRI. Projects include multimodal MRI in prostate cancer with projects on preoperative imaging versus PAD, MRI for fusion biopsy guidance (MRI/Ultrasound), and MRI with IVIM DWI (perfusion imaging with the DWI technique). In rectal and cervical cancer, potential prognostic factors are identified as well as technologies for treatment response evaluation. Involving imaging technologies within clinical trials, one of the strategic goals of the Personalized Cancer Medicine program, will be an important step forward.
A facility for mouse tumor models has been set up including a live imaging facility with PET/CT and MRI as well as ultrasound. Innovative research using this equipment involves neuroscience and various surgical disciplines, but this infrastructure is a great asset for preclinical cancer research.
For experimental purposes there is atomic force microscopy, electron microscopy, a confocal microscope facility and several STED-based techniques. Multicolor FACS-sorting and FCM are also high-quality. These facilities are not centralized, but instead disseminated throughout different departments.
An experimental technique has been developed for high-throughput imaging for in vitro screening of primary tumor treatments, called the hexascope. Similar techniques have been developed for phenotypic screening of new small molecule target drugs within the medicinal chemistry unit.
Clinical Data Management
Karolinska Institutet has centralized management of its IT systems supporting basic and preclinical research. Clinical registries going back to 1976 cover most cancer diagnoses; these registries are linked to the Regional Cancer Registry meaning that population based patient cohorts are available for practically all diagnoses. The clinical registries contain data on patients, diagnostic procedures, tumors, primary treatment and follow-up. Sweden has a unique way to follow all patients even if they move within the country, thereby helping to provide extensive data for clinical epidemiology.