The Center for Molecular Medicine, CMM, is one of the most successful Swedish research institutions. The center was built in 1997 to develop the medical research at the Karolinska University Hospital in Stockholm with the goal to reach and to give relief or cure.
CMM is located in the middle of the Karolinska University Hospital area in Solna, just north of Stockholm. It is an island of research among all the clinics and it only takes a physician 5 minutes to walk from the patients to the laboratory, where they can continue to seek the answer to the questions that arise when they treat their patients. Today it seems quite natural to have the research separated into one common place, but it has not always been this way.
The Karolinska Hospital was built in the 1930ies and officially inaugurated in 1940. It has a modular layout with separate buildings for different clinical specialties. Research was given priority in the sense that laboratories were located in proximity to and run by each clinic. This arrangement was instrumental in bringing researchers close to clinical realities, but hardly optimal in terms of efficient use of research resources. In the 1990ies great advances in molecular and cellular biology were made, culminating with the complete sequence of the human genome in 2000. During that same period the treatments of many of the common diseases, such as psoriasis, rheumatoid arthritis, heart- and lung diseases and multiple sclerosis (MS), experienced a lack of major advances. The doctors could do little but ease the symptoms and felt great frustration regarding these therapeutic failures.
– The research laboratories were small and their activities not much coordinated. The research was concentrated on the competence of each laboratory, such as physiology or chemistry, says Göran Holm, professor emeritus in Medicine and deputy president of research at Karolinska Institutet (KI) 1988-95.
How to create a new center
Modern molecular research was mainly performed at the Karolinska Institutet (KI), not in the hospital laboratories, and the knowledge created elsewhere brought a new insight to the clinical researchers – that molecular mechanisms between different diseases, such as rheumatism and MS, were surprisingly similar. They started to realize that one common denominator behind several diseases is inflammation and that different inflammatory processes can be explained by an overly active immune defense system. Similarly, diseases in the metabolic and central nervous system showed surprising commonalities. Thus the vision started to create a laboratory where molecular methods, cell biology, neurobiology and immunology could merge to face clinical questions; a laboratory where physicians could meet and interact with both clinical and basic researchers, to solve the riddle behind many common diseases. The methods could be the same although the diseases battled were different.
– The human being is not made up by independent pieces. We are organisms made up by numerous systems linked together in ways not fully understood. To able to face the complexity of the diseases studied, we needed to gather independent research groups with different foci to work for a common goal, says Lars Terenius, Professor in Experimental Alcohol and Drug Dependence Research, founder and CEO of CMM 1995-2008.
The idea of one building accommodating several different research groups also allowing an attractive environment for new recruitments, took shape. But where should this new laboratory be created? The knowledge in molecular biology lacking at the hospital site was available at KI, just across the road. A building there would however not be easily accessible from the clinics and would then not be integrated in the daily activities of the clinical researchers. Thus, the new laboratories had to be situated on the hospital grounds, a decision that created difficulties when it came to financing. The hospital were at the time not able or interested in funding a research building and the government owned KI could not fund a new building on grounds owned by the Stockholm County Council. To solve this problem, the CMM Foundation was instituted in 1995, under the auspices of the County Administrative Board of Stockholm and with the purpose to raise financial support to a new research building.
In creating a foundation, CMM acquired an independent status. It would not be under the guidance of The County Council, otherwise responsible for surrounding hospital buildings. On the other hand, the hospital agreed to enter a long-term lease on the building. In an agreement with the County Council, the CMM Foundation would raise at least 50% of the total capital by donations and cover remaining costs with a bank loan. Fundraising was, by ardent work, successful. Donors such as the Knut and Alice Wallenberg SEK 90 million, which covered over 60% of the total cost of the building and by November 1996 the cornerstone was laid. After a swift planning and building period, the first laboratories were occupied and running in February 1997. The CMM building was officially opened on May 22, 1997, with laboratories and offices for 200 researchers.
The need for research laboratories close to the hospital clinics was however underestimated and over time CMM has expanded. Today our building hosts over close to 500 staff members from all over the world. Network analyses shows that CMM is very well connected with virtually every clinic at the academic hospitals. A similar analysis on connections within Sweden and international connections with the EU countries and USA also point to a very substantial network of collaboration and common projects. Different evaluations also show that the reserach performed is in many cases world leading.
– One underlying factor is that we have a flat structure of our organization. There are almost no superior hierarchic structures. We have a culture where everyone wants to engage in reserach. Research is the most important issue, it is number one, says Lars Terenius.
Ever since the start, CMM has turned into a substantial contributor to many international reserach collaborations, which recently have revolutionized the diagnosis and treatment of many common diseases, such as rheumatiod arthritis, psoriasis, MS and preventive treatments for hereditary colon cancer. Rheumatic patients that previously were almost invalids have regained most of their mobility, psoriasis patients with red scaling skin can see the patches dissappear and MS patients have less relapses.
Even though not unheard of, this kind of organization, with basic research on the hospital grounds, is unusual and attractive, also for international scientists. One of the most recent international recruitments is Thomas Renné from Germany, who chose to move his research on anti-coagulants and thrombosis to CMM. The possibility to work in the CMM environment and collaborate with the cardiovascular research groups here made the move to Sweden worth the risk of receiving lower salaries and funding then in Germany.
Another attraction for foreign researchers is the unique patient registers in Sweden,e.g. the Cancer register and the Twin register enabling us to follow individual patients during decades. i.e. epidemiology.
– Epidemiology has been one of the foremost areas of research in Sweden. In the USA the patients are spread in numerous different insurance systems, which makes it impossible to follow them during extended periods of time. This is also the case in many other European countries, says Lars Klareskog, Professor in Rheumatology and director of CMM since 2008.
Researchers are now using the Swedish registers to follow the development of different diseases. By investigating the individual genetic disposition of the patients and how they are responding to the treatments, the researchers can learn more how to design personalized treatment. By using several registers and making cross references, it is also possible to find common risk factors between different diseases, which means preventive measures can be taken to maximize the well being of the patients.
So, even though several steps have been made to improve the quality of life, there is still a lot to do. The goal of CMM is to make common diseases less common and chronic diseases less chronic and since several diseases are still lacking a long lasting cure, more work remains to be done. That is why we will continue to put the patients' need in focus and strive to stay as leading contributor to the international research, both now and in the future.