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Providing tailor-made treatment for rheumatism

Centre for Personalized Immunotherapy wants to develop personalised treatment for rheumatoid arthritis and other inflammatory rheumatic diseases. This will improve treatment and could save the Norwegian health care budget millions of Norwegian kroner.

Bottle of medicines, showing the bottle tipped over with pills in various colours. Used to illustrate article about the Centre for Personalized Immunotherapy at University of Bergen.
RHEUMATISM REVOLUTION: Researchers at the University of Bergen (UiB) are heading a new centre working to create personalised treatment for patients who suffer from inflammatory diseases.
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About one per cent of Norway’s population have inflammatory rheumatic disorders. Over the past 10 to 15 years there has been a quiet revolution with new biological medicines.

However, some patients experience little or no effect in highly disabling diseases. Additionally, biological treatment comes at a steep price to the Norwegian national health care budget: two billion Norwegian kroner (NOK) a year is spent on patients inflammatory rheumatic diseases.

“We would make treatment more targeted and individualised. This entails a more efficient, profitable and careful treatment for many patients,” says Professor Roland Jonsson at the Department of Clinical Science at the University of Bergen (UiB).
Jonsson is head of the Broegelmann Research Laboratory (BRL) at UiB, and coordinator of the project Centre for Personalized Immunotherapy (CPI), which has applied for status as a Centre for Research-based Innovation (SFI) from the Research Council of Norway.

Targeted immunotherapy

In addition to developing tailored use of biological medicines, CPI aims to provide clinical testing of new biological lower cost therapy, which the health care system is currently promoting for Norwegian patients.
CPI will be a centre for personal immunotherapy. Patients are treated with therapeutic antibodies that are injected and attach to the cells that are believed to be pathogenic. The antibodies locate and block the disease-causing substances in the cells.
“In the case of arthritis there is pathogenic tissue in joints that cause inflammation. In which case the antibodies locate the diseased cells and neutralise these,” says Jonsson.

“We want these products to be more reasonably targeted by tailoring the use of the medications. That way we can avoid unnecessary trial and error, which is both stressful for the patients and expensive for the national health care system. You get better treatment and less side effects.”

Analysing individual cells

The CPI researchers will employ a method that involves analysing individual cell communication at the molecular level. One purpose is to obtain information about what proteins are being secreted by the diseased cells, so-called biomarkers. Another purpose is to determine the difference between diseased cells and cells from healthy individuals. Researchers will study what happens to these cellular signalling systems during treatment and hope to establish a pattern for the cells’ behaviour.
The goal is to create individualised medicine. If you have arthritis, the doctors are then able to take blood samples and find out what medicine to provide, without trial and error. All based on knowledge of how inflammation is caused by a particular type of signal, as opposed to the different signals emitted by healthy cells. As things are today, many patients have to use many different types of medication before arriving at the best solution.

“In addition to current medicines causing problems and side effects, our hope is that new forms of treatment can also provide patients with faster treatment,” says Jonsson.

A disabling disease

Rheumatoid arthritis can be extremely disabling for the patient.

“Some patients with prolonged arthritis experience deformations of the joints and may even have difficulties in moving around or grabbing objects with their hands,” explains the professor of medicine. “In addition to targeted treatment we are also keen to find out more about the underlying mechanisms of the disease.”
To carry out planned research, the patients need to be monitored for a period of time. The centre will make use of its location at Haukeland University Hospital, where the UiB researchers already enjoy a long-lasting collaboration with the rheumatology department.

Patient participation is also of the essence, and the department has access to blood samples from around 1,000 patients, partaking in long-term monitoring. The collaboration between researchers and practising medical staff is at the heart of the SFI application.

“Over the next eight years, we hope to develop more targeted treatment fitting the individual patient. Perhaps we will even find unique biomarkers for inflammatory diseases to improve diagnostics; biomarkers that may guide selection of effective treatment for each patient,” says Jonsson, before adding. “Today, we use diagnostics that were developed maybe up to 70 years ago.”

EU-supported medical research

Until now, the BRL researchers have received EU funding for nine projects; three of which are still on-going.

Jonsson has a background as a postdoctoral fellow at the Rheumatology Arthritis Research Center at the University of Alabama at Birmingham (UAB) in the United States. He has participated in numerous international projects and has served on the editorial board of several academic journals, including Arthritis and Rheumatology as well as Annals of the Rheumatic Diseases, the two top-ranked rheumatology journals of today.

Read more about the other UiB centres applying for the SFI status.

(Translated from the Norwegian by Sverre Ole Drønen.)