Will RA be curable in the future?
It should be possible to both cure and prevent rheumatoid arthritis in the future. This is what Vivianne Malmström, professor of rheumatological immunology at the Karolinska Institute, believes. One way forward is to turn off immune cells which would otherwise attack the tissue in the joints.
Who are you?
My name is Vivianne Malmström, Professor of Immunology and working at CMM, the Centre for Molecular Medicine at the Karolinska Institute. Many of us who work here have a personal experience of autoimmune diseases. I grew up in Boden, Norrbotten and in my close family, there have been people with severe allergies and diabetes, both of which are diseases where the immune system is overactivated.
How did you start working with RA?
I was a biology student in Uppsala when I met a person at an event who needed a master's student for a project that was about arthritis – joint inflammation – in mice. I thought it sounded exciting and decided to do my thesis in that research group. Then I stayed in that group and got my Ph.D. After spending eight years of my life researching arthritis, I felt I wanted to try something different so I moved to Oxford, England. There I started working with inflammatory bowel disease, IBD. The underlying immunological causes are similar to what I had worked with before, but it is another disease.
How did you become a professor in immunology?
After three years in Oxford, my partner and I moved back to Sweden. I met Lars Klareskog at KI who had heard I was on my way to Stockholm and asked if I wanted to start working here. I started in August 2000 and in the spring of 2014 I became a professor. It was both fun and challenging to change my research focus to study the human immune system through blood tests, joint fluid and patient biopsies. Because I had previously worked with studies in mice, I have been able to use the same techniques on material from people, and I built my research on it.
What does immunology mean?
The immune system can be divided into different parts. My special area is the white blood cells, lymphocytes. Here, an immunological memory is created after, for example, a vaccination or a viral infection like influenza. This means the immune system will react faster and more efficiently the next time you become infected.
My big interest is when the lymphocytes are overactivated in people with autoimmune disease. Instead of attacking, for example, a virus or bacteria, they think the body's own tissue is dangerous and foreign. In RA, this leads to the cartilage, bones and joints becoming inflamed.
Will RA be cured in the future?
Today, there are nice (and expensive) drugs that treat the symptoms of RA, but there is no cure yet. However, we believe that we will be able to cure RA. Not only that, but we are actually so sure of ourselves that we say we will be able to prevent RA. So preventive treatment. It is a huge question and not something an immunologist can solve on their own. It will require many professionals working together in large networks.
What does reverse vaccination mean?
Regular vaccination helps immune cells grow stronger and respond faster. Reverse immunization will work by turning off certain immune cells. Maybe the term Tolerating Therapy is a little better. But it opens up a whole new arena!
Who will be able to get this Tolerating Therapy
If a person has a combination of both joint pain and the presence of antibodies in a joint fluid test called Anti-CCP, there is an increased risk of them developing RA. This is exactly the group you would like to treat to prevent RA. My colleague and manager Anca Catrina is currently running an RA risk clinic.
What are you researching right now?
RA is a disease that comes and goes in flare-ups. Therefore we need to be able to show that tolerating therapy has really changed the immune system as we would like, not simply with a natural variation. Therefore, we develop various systems to measure, with the help of a blood test, if the treatment has been successful. It is also about being able to compare different treatments developed by many research groups around the world to see what works best.
We take a blood test where we look at whether the T cells, a type of lymphocyte, in the blood have changed if we have managed to turn them off.
In our research, we have been able to find antibodies in older blood samples in people who later developed RA. It is very interesting. Only about six months before a diagnosis, the number of antibodies in the body increases. We immunologists try to understand these antibodies. If they were there, for example, 15 years before a person becomes ill, should they have been ill before? Now we have also begun to understand that these antibodies look different over time.
RA patients simply have much more of these antibodies, although they may also be found in others. In healthy individuals, the antibodies disappear after a while but not with RA patients. Thus simply having these antibodies does not mean that you will get RA.
What is the most important thing you would say to someone with RA?
It is relatively common for researchers to discuss risk factors and behaviors, and that means it’s easy for people to think “This is my fault. I have put myself in this situation. " It is important for people to understand that this way of thinking is a huge simplification! Our bodies and systems are more complicated than that. Many factors interact.
Anyone with RA can do things that will help them feel better, such as staying physically active and quitting smoking. But it is important to understand that a lot of it is just about bad luck. It is a combination of genetic risk, environmental factors and then what we call the missing link - that is, luck.
How do you think Elsa can contribute in the future?
If we are to become even better at understanding RA, we must come at the problem from different angles and different perspectives. From a patient perspective, we can become more involved in their illness and more involved and involved in the treatment and change of their living habits. It gives patients a new perspective to be able to see their own data on how the disease and treatment have changed over time. How have I felt? How have I taken my medicine? How did I feel last year at this time? It can be about being able to more easily recognize when a flare-up is underway and simply getting better at managing their own disease. In addition, data from patients can help tailor treatment. By gathering a lot of data we could be able to group people and see which treatment actually suits each person best.