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Recipients of the 2020 PhD Theses of the Year prizes at Sahlgrenska Academy

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Kristian Axelsson has been awarded the PhD Thesis of the Year prize at Sahlgrenska Academy. His studies show how healthcare can reduce the risk of repeated fractures in the elderly through structured and preventive efforts. Angela Molinaro receives the prize for PhD Thesis of the Year at the Institute of Medicine. She investigates how a specific group of proteins affects regulation of insulin and obesity.

When bone fractures afflict people with osteoporosis, they generally experience a decline in their ability to function, greater morbidity and higher mortality. Their risk of a new fracture is also four to five times higher in the first two years after the initial fracture. The human suffering is great, and Swedish healthcare efforts in the area cost an estimated tens of billions of kronor every year.

An 18 per cent reduction in risk

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Kristian Axelsson has been awarded the prize for the PhD Thesis of the Year at Sahlgrenska Academy.
Kristian Axelsson has been awarded the prize for the PhD Thesis of the Year at Sahlgrenska Academy.
Photo: Skaraborgs sjukhus

Fracture liaison services offer a new working method for healthcare. The method involves identifying patients, assessing their risk level and investigating and treating them immediately after the first fracture. The fracture coordinator overseeing the process usually works in the specialist clinics that care for fracture patients or treat the osteoporosis.

Kristian Axelsson defended his thesis in November 2020, but its substudies had already attracted a lot of attention when they were published. During his doctoral studies at the Department of Internal Medicine and Clinical Nutrition, he also served as a resident physician at the orthopaedic clinic at Skaraborg Hospital Skövde and was responsible for the fracture liaison services in Skaraborg. He now works as a resident physician in general medicine at the Norrmalm medical centre in Skövde.

His thesis currently provides the best evidence that fracture liaison services work. The studies show that the risk of repeated fracture was 18 per cent lower after the introduction of fracture liaison services. Among the very oldest fracture patients – those over 82 years of age – only 16 needed to be screened to prevent a new fracture within five years.

Impacts healthcare throughout Sweden

The thesis was nominated by his principal supervisor, Professor Mattias Lorentzon. He describes how Kristian Axelsson has worked in an exemplary way to spread the new knowledge he has contributed to society through educational events for the public, for politicians and for patient associations and, especially, within health care and medical services at the regional and national level. 

Since last year, fracture liaison services have been given high priority in the Swedish Board of Health and Welfare’s national guidelines. They have also been selected by the Swedish Association of Local Authorities and Regions for a person-centred and cohesive care process to be implemented in 2021. This means that the results of the thesis will soon be of great importance to many patients.

“I am most proud of the fact that the results may soon have clinical significance. This can lead to many patients receiving better care and having better health as a result,” says Axelsson.

Obesity is a global problem

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Angela Molinaro receives the prize for the PhD Thesis of the Year at the Institute of Medicine.
Angela Molinaro receives the prize for the PhD Thesis of the Year at the Institute of Medicine.
Photo: Privat

The percentage of overweight people is increasing in the world. Obesity is a global problem that currently affects 650 million people. It also constitutes the biggest risk factor for a number of serious chronic diseases, such as type 2 diabetes, cardiovascular disease, asthma and cancer. This underscores the importance of examining the mechanisms that govern the link between obesity and these chronic diseases.

In her thesis, which she defended in May 2020, Angelia Molinaro examined these particular issues. More specifically, she investigated a group of proteins called phosphatidylinositol 3-kinase (PI3K), class 1. These proteins have an important function in the body because they affect the immune system and how our insulin is regulated. They are also involved in tissue homeostasis, the process governing how cells stay healthy, age and die.

Discovered important pieces of the puzzle

Three studies conducted by Angela Molinaro and her colleagues have investigated how different variants of these proteins (PI3Kα, PI3Kβ, PI3Kδ and PI3Kγ) affect insulin regulation and obesity. 

In the first study, the researchers examined how PI3Kγ affects obesity and inflammation in blood stem cells. They were able to show that the protein increases inflammation in adipose tissue and promotes insulin resistance in cases of obesity. Insulin resistance means that the body’s cells cannot assimilate insulin, a condition that increases the risk of both type-2 diabetes and cardiovascular disease. 

In the second study, the researchers examined how PI3K affects insulin signalling in liver cells. The study resulted in a new and updated model for how different variants of PI3K control the regulation of insulin. The third study examined how insulin regulation differs in different types of liver cells.

In summary, the thesis shows how a certain type of inhibitor could be used in an optimal way in future treatments for several diseases.

“We have shown that isoform-specific inhibitors that differentiate between PI3Kα and PI3Kβ should be used in lower doses to avoid increasing the level of insulin in the blood. These inhibitors could then be used in an optimal way to treat obesity, insulin resistance and cancer.”

Surprised and thrilled

Angela Molinaro was a little surprised to be awarded the prize for best thesis at the Institute of Medicine because she thinks that so many high-quality theses are written within Sahlgrenska Academy, but the prize means a lot to her.

“It shows appreciation for the hard work my colleagues and I have put in over these years. Above all, it increases the visibility of our results, which are important for research in obesity, insulin regulation and cancer.”

Molinaro is originally from Italy, but she has chosen to stay at Sahlgrenska Academy after her thesis. She currently works as a postdoctoral researcher in the Department of Laboratory Medicine at the Institute of Biomedicine. She takes most pride in the results of the second study in her thesis.

“It was my main project, which I worked on throughout my doctoral studies, and it represents what science is for me: development, challenge and knowledge.”

Annual prize supported by donation

The “PhD Thesis of the Year at Sahlgrenska Academy” prize has been awarded since 2009 and is funded by Dr. Amt Vestby’s Research Foundation. In addition to the PhD Thesis of the Year at Sahlgrenska Academy, a prize-winner is also chosen for each of the faculty’s six departments.

Due to the pandemic, there will be no award ceremony this year. In addition to the prize amount, the prize-winners receive diplomas and floral bouquets.

TEXT: ELIN LINDSTRÖM AND KARIN ALLANDER
PHOTO: SKARABORG HOSPITAL, PRIVATE PHOTO

Additional reading: 

The entire theses: