INAUGURATION OF NEW PROFESSORS. As a cataract surgeon she can help blind patients to see again, and as a researcher she tries to understand how cataracts occur. Meet Madeleine Zetterberg, who was one of 16 new professors at the Sahlgrenska Academy during the last year, on the occasion of the University’s installation on May 13.
Madeleine Zetterberg has been a new Professor of Ophthalmology for half a year now, with a focus on the anterior segment of the eye. She is an expert on cataract.
“We know quite a lot about the risk factors for cataracts, but nowhere near as much about the exact mechanisms by which the lens becomes cloudy. By investigating these mechanisms we may find ways to prevent this illness and perhaps find a better treatment”, says Madeleine, who is also a specialist doctor at Sahlgrenska University Hospital in Mölndal.
Already when she was in medical school she was fascinated by the eye and by the physiology of vision – how light is transformed into nerve signals and how complex the interpretation of visual information is.
“Eyes are so beautiful. I also thought that it would be fun to work surgically, because I have always liked things that are a little finicky,” says Madeline, and asserts that she has never regretted her choice of speciality.
“Vision is vitally important for people and there are therapies that are available for many conditions. In my work as a cataract surgeon I feel that I am doing something that is really of benefit. Even if most of the patients who come to us with cataracts have a moderate visual impairment, it happens that patients who are blind as a result of cataracts attain perfect vision after surgery. There are few interventions in the medical world where you can in principle go from zero function to full function.”
Cataracts are very common among older people, and it is likely that half of Sweden’s population will need to be operated on for cataract during their lives. Both genetic factors and environmental factors such as UV light and smoking affect the risk of developing cataracts.
In addition to operating on cataracts, Madeleine Zetterberg also sees patients who have damaged their eyes through accidents or other trauma, or who have developed severe eye infections.
A part of the puzzle of aging
Madeleine Zetterberg did her doctoral work in histology, as it then was, and her dissertation dealt with how damaged proteins in the lens of the eye were broken down by proteolytic enzymes. She is now continuing to look for an answer as to how cataracts occur. Her experimental research now deals with oxidation damage, with protein quality control and with the so-called ubiquitin proteasome system which is an important system for cleansing cells of damaged proteins which would otherwise risk accumulating. In the case of the lens, this can lead to the formation of light scattering aggregates.
“What happens in the lens when cataracts develop is part of normal aging, and it is exciting since what happens in the lens is also what happens in other parts of the body. In that way, knowledge from one field of research can also be of use for other age-related illnesses,” Madeleine says.
She is working with cell and molecular biological methods, such as protein chemistry and enzyme determinants, and will in addition also utilize more proteomics so as to analyze protein modifications in lenses from people:
“We are doing the greater part of our experimental work on human lens tissue which we obtain from patients in conjunction with cataract surgery. It is good to have a close collaboration between health care and the academy! We also have a newly-started project in which we instead use transgenic mice which overexpress a regulatory subunit in the proteasome.”
Cataracts from several viewpoints
She has been able to show, among other things, that a calcium-dependent enzyme, calpain, is elevated in conjunction with the most common types of cataract, and that oxidational stress increases that enzyme. During her time as a post-doctoral fellow in Boston, she was also able to show that proteins which are coupled with glutathione are more susceptible to breakdown via the ubiquitin-proteasome-system.
Her research is not just experimental, but is also both epidemiological and clinical. In collaboration with other researchers at the Sahlgrenska Academy, she is conducting studies at a population level on visual function and ophthalmic illnesses in older people, as well as on the connection between the exposure that different types of occupation entail and the risk of developing cataracts. She is also studying how cataract patients are optimally treated, among other things how to diminish the risk of complications and how they are to be dealt with when they nonetheless occur.
As to the question what she struggles most with in her research, she replies that it can be a challenge to get the logistics to function properly in newly-started projects:
“We are collecting biological tissue in conjunction with cataract operations and corneal transplants, and we are also pushing to kickstart a clinical trial to evaluate which lens prosthesis produces the least intraocular inflammation. What is involved is finding efficient ways to collaborate and to provide clear information to all the personnel categories that are working on a project which involves both health care and the university.”
The reciprocal learning process
Madeleine Zetterberg also devotes a great deal of time to teaching. She is in charge of the courses in ophthalmic training in the doctoral program and also participates in teaching residents and in specialist training. Sometimes she is a student herself, for instance when she is learning a new surgical procedure.
“It is just this creative, knowledge-intensive environment, characterized by a continuous and reciprocal learning process, that I think is so fantastic!”
She tells how, in a single day, she can sometimes perform operations in the morning with students whom she is teaching clinically, and then in the afternoon lecture, supervise PhD students, and have meetings on various research projects.
“There is an enormous variety in my work which I enjoy immensely! I think that precisely this integration of the clinic, research and teaching is vitally important both for developing good research that addresses relevant questions and for attracting coworkers who want to work in a university clinic,” Madeleine says, but adds that she sometimes wishes there were more hours in the day.
Ophthalmic research with a tail wind
In addition to cataract, pediatric ophthalmology is a major research area in Gothenburg, and in both of these areas there are large research groups which are conducting translational research in which laboratory research is combined with projects that are closer to the patients. Ophthalmic research in Gothenburg is moving forward, Madeleine Zetterberg asserts:
“There is great interest among coworkers in ophthalmic health care to begin research studies, but at the same time we do not have enough of the more senior researchers who can supervise younger colleagues. Older colleagues who have completed their theses seldom continue to do research, which may depend in part on the difficulties of combining work in the clinic with research.”
She herself thinks that the overlap of combining the clinic and research works well.
“It is fantastic fun to be able to combine clinical work with research and it is in the cross-fertilization between these environments that I get ideas and inspiration in the clinical workday that I can carry with me over into the research.”
Sahlgrenska Academy’s 16 new professors in 2015:
Inger Gjertsson, Professor of rheumatology
Kristina Jakobsson, Professor of Clinical Environmental Medicine
Turgut Tatlisumak, Professor of Neurology
Kjell Olmarker, Professor of Anatomy
Kaisa Mannerkorpi, Professor of Physiotherapy with a focus on pain and on organs which support movement
Mikael Svensson, Professor of Applied Health Care Finance with a focus on register-based research
Silvana Naredi, Professor of Anesthesiology and Intensive Care
Ann-Marie Wennerberg, Professor of Dermatology and Sexually Transmitted Diseases
Jan Sunnegårdh, Professor of Juvenile Cardiology
Kate Abrahamsson, Professor of Juvenile Surgery
Jonas Nilsson, Professor of Experimental Cancer Surgery
Anna Rudin, Professor of Rheumatology and Inflammation Research
Madeleine Zetterberg, Professor of Ophthalmology with a focus on the forward segment of the eye
Thomas Nyström, Professor of Microbiology
Mats Börjesson, Professor of Sports Physiology with a focus on sports cardiology and community health
Johan Bylund, Professor of Oral Microbiology
