A recent study could pave the way to treating a type of bone marrow cancer. The aim is to transform the cancer from being incurable to a disease that it is possible to live with. The research behind the study was conducted in Evren Alici’s group at Campus Flemingsberg.
“Welcome; would you like a coffee? Follow me!”
Alici begins the tour of the lab in Novum before I’ve even managed to take my gloves off. Room after room is bristling with advanced lab equipment and analysis tools. All mixed with small office places; generously filled with files, papers and screens. Before we get to the coffee room, we’re stopped twice by colleagues who need advice. Alici asks quick counter-questions and replies encouragingly:
“Good idea! Make a note of that immediately.”
At the coffee machine he books a meeting, at the same time as introducing me to his colleagues.
“There’s no hierarchy here: we have an open environment where everyone speaks to everyone. Everyone has their own niche, and we integrate between disciplines. The aim is that we complement each other to do the best possible research.”
Patience in short supply
When we sit down in a meeting room, Alici sighs over how quickly time has gone. In 2002, he started his doctorate studies at Karolinska Institutet. At that point, he had just arrived in Sweden having worked as a doctor in the Democratic Republic of Congo and the US. Raised and educated in Turkey, he found himself on Swedish soil one autumn day in September.
“I thought it was really cold. But I liked Sweden. My then wife was Swedish and encouraged the move. And she drilled the language into me right away, refusing to speak anything but Swedish with me at home,” he says, and laughs.
He soon realised that the fields that interested him most as a surgeon and orthopedist were too small in Sweden, and he wanted to do something else. But supervisor, Sirac Dilber, told him that he should take his doctorate and gave his name to professors Hans-Gustaf Ljunggren and Gösta Gahrton, and his career took an entirely different direction.
“They opened the door to the incredibly exciting area of cell and gene therapy. I was talking about viral vectors and plasmids, which were entirely new to me. It was a real challenge – just what I wanted. Even if the salary was catastrophically bad,” he says, with another infectious laugh.
He had planned his first year in Sweden to be a little more relaxed: learn the language and adapt to life here. But the tempo was the opposite. And it has hardly let up over the years, but that seems to mirror Alici as a person.
“I’m still basically a surgeon and therefore want to see results quickly: there should be a treatment based on my research before I retire.”
“Evren Alici is an extraordinarily determined and driven researcher in the anti-cancer immunotherapy field, with a strong focus on innovation and entrepreneurship. He is behind the emergence of several companies, including CellProtect Nordic Pharmaceuticals, which is based in Flemingsberg. He is a conscientious co-operation partner in a number of international research networks, and advisor to several international companies in the sector. For Flemingsberg to continue to develop, it needs more people with Evren’s qualities.” Hans-Gustaf Ljunggren, professor of infection medicine at the Department of Medicine, Karolinska Institutet
Driven by a patient-centric focus
The treatment he envisions is a new way to combat myeloma, a type of bone marrow cancer, with the help of advanced cell therapy. His research has had the aim of making use of a certain type of immune cells: so-called NK cells. They make up an important part of the immune system because they identify and kill cells that have altered in some way, for example due to being infected by a virus or that have mutated into tumor cells.
“After two years’ intensive work, together we found a way to expand and activate them so that they kill tumor cells.”
The focus on myeloma can partly be explained by his previous life as a doctor.
“These patients are extremely vulnerable to spinal fractures because they lose bone density. They can’t take any weight. I remember one patient, an older woman, who turned over in bed and broke all her ribs.
Conducting research close to patients is an important feature of the programme.
“Once you’ve worked with patients in a clinical setting, it changes the way you look at things. You have more empathy and you’re more solutions-orientated. It feels right that I focus on something that can help a patient even if it’s in the long term.”
Currently, a so-called Phase 1 trial is being conducted in which NK cells are given to patients with myeloma and the results are being reviewed in the Novum lab at Campus Flemingsberg. Publication of the results is planned for the new year.
“It looks as though it will work. Although this is only a Phase 1 trial, we’ve gained pointers for the way forward. And we’ve already decided to go ahead with a Phase 2 trial.
Born: 1975, in Izmir, Turkey.
Family: Married to Elizabeth Henry Alici, two daughters, Lilly 10 and Clara 13.
Lives in: Snättringe. His father is professor emeritus in orthopedics and has served as vice-chancellor of one of Turkey’s medical universities; his mother is a professor emeritus in microbiology.
Interests: Sailing, DIY, reading sci-fi.
Working environment is key to success
When Alici talks about his research, he mentions many names other than his. Two of these who have been already mentioned are Hans-Gustaf Ljunggren, professor of infection medicine; Gösta Gahrton, professor emeritus in hematology; and doctor Hareth Nahi.
“Hareth is one of the Nordic region’s leading myeloma doctors, and an unbelievably important person for the project. Amongst other things, he’s responsible for our clinical trials and manages all patient contact and follow-up.”
And the fact that Karolinska University Hospital Huddinge performs so many transplants has been key, he says.
“Nursing staff there, from nurses, research nurses to doctors, have extensive knowledge of cell therapy. Such as which side effects are most common, and how they can be best tackled. Their knowledge can be the single most important link in the entire process – without them, we’d never get anywhere.”
Even the infrastructure surrounding cell and gene therapy is unique to Flemingsberg, he says. The research project has been co-managed by Cellprotect Nordic Pharmaceuticals that has offices a few floors above the lab.
Cancer: a life-long disease
When the first clinical studies started, Alici realised that it was time to hand the work over to others.
“Instead, I went back to the lab to investigate how we could further increase the NK cells capacity to identify cancer cells.
He sold the patent for one Swedish krona and a pledge that Cellprotect would continue with the work. Commercialising the project is the natural way forward, he says.
“We need the business community because nobody else can conduct a Phase 3 trial. These cost millions of krona and is nothing that a research fund or public financier can provide.”
The future promises individualised drugs and therapies, he says. These approaches reduce the risk for side effects, extend life expectancy, and enhance the quality of life for patients.
“But I don’t think that we’ll be able to cure all cancers. What we can do, in time, is to transform many cancer conditions into chronic diseases, where patients enjoy a long life with improved quality of life. That would be a huge success. And that’s where we’re headed.”
You seem to love going to work.
“Yes! You’ll find me here from seven in the morning until nine at night. And I think it’s because I find the group’s positivity so infectious. When they show that they’re passionate about what they do, I’m passionate too.”
The NK cell – a Swedish discovery
NK cells were discovered at Karolinska Institutet in the mid-70s by Rolf Kiessling, Eva Klein, and Hans Wigzell. The cells’ ability to identify tumour cells was also discovered at KI, during the 80s, by researcher Klas Kärre and Hans-Gustaf Ljunggren.
Drug development takes place in phases
Phase 1 is the first time a drug is tested on humans. This is done on healthy or severely ill people depending on the type of drug. At this stage, focus is often on drug safety and how it is broken down in the body.
Phase 2 is conducted on a large group of patients that have an illness. The aim is to evaluate the effectiveness of the drug at treating the condition.
Phase 3 is a comparative study with trial and control groups, and involves a large number of patients
Phase 4 is a monitoring phase following the launch of the drug.