Fellows announced during Lof der Geneeskunst

Each year, the fellows are announced during the event Lof der Geneeskunst. This year the fellows are Casper Rokx of Internal Medical Microbiology & Infectious Diseases, Joshua White of Neuroscience, Mohsen Ghanbari of Epidemiology and Rintje Agricola of Orthopedics and Sports Medicine. Over the next four years, they will be conducting their research, with support from their departments and Erasmus MC.

Casper Rokx: Curing HIV

When Casper Rokx worked in Africa as part of his medical training, he saw how devastating infectious diseases can be. During his medical specialization as an internist – infectious diseases specialist, he devoted himself to the treatment of HIV and AIDS. His holy grail? ‘To cure HIV completely.’

Casper Rokx eventually wants to be able to say, ‘This patient is female, she is 60 years old and has had HIV for 12 years. The best treatment for her would be to take drug A in combination with drug B.’ Rokx calls it ‘finding the right drug for the right patient’. In order to do so he will dive into the lab to test promising drugs on the cells of various patient groups. What characteristics do these patients have that makes treatment successful or unsuccessful? Finally, he will select the most effective drugs to further study them in clinical trial.

Lifelong medication

HIV can currently be effectively suppressed with medication. The virus then hides in cells in the body and goes into hibernation. A reservoir of inactive virus particles remains. However, this means that someone with HIV must continue to take medication throughout their entire live. If the patient stops taking the medication, HIV could multiply. That person could become infectious once again and develop AIDS. This is a risk to their health and their surroundings.

Everyone is different

Taking medication for an entire lifetime costs energy and money and can cause side effects. Despite the treatment, people with HIV continue to run a higher risk of diseases such as cardiovascular disease, infections and cancer. The key for Rokx is therefore to gain control over the reservoir of cells that the virus is hiding in: “There are various medications or substances that we know to act on the reservoir. We have tested this in the lab. But the tricky thing is that every person, and every virus reservoir, is different. In the very first clinical trial, it turned out that not every combination of patient and drug was equally effective. Gender, age, treatment status, it all matters.’

Joshua White: How does the brain control smooth movement?

Many movements you make, are done subconsciously without thinking. Neuroscientist Joshua White wants to know what the physical process behind this is. What molecules in the brain lead to movement? ‘The brain is just a fascinating puzzle.’

Neuroscientist Joshua White began studying economics in the United States because he wanted to understand human behavior. However, he wasn’t particularly interested in money. Eventually, his interests led him to the ultimate study of behavior: neuroscience. “Everything you do and say is the result of a clump of cells.

Molecular pathway

With the fellowship, White will try to figure out how that clump of cells causes people to make movements they don’t have to think about. ‘Smooth movements’ he calls them: ‘I’d like to know what molecular pathway in the brain causes me to put one foot in front of the other during a walk.’

Brain puzzle

By looking at brain disorders in which people cannot make these kinds of smooth movements, White hopes to solve the brain puzzle. We know the genetic cause of some brain disorders, but not exactly what the molecular effect is in the brain. If we can find that out, science can work towards a solution for these kinds of brain disorders.’ In this way, White hopes to eventually bring his fundamental research into clinical practice: ‘Nothing more exciting.’

Mohsen Ghanbari: Understanding and predicting age-related diseases

Age-related diseases are a growing social and medical problem in ageing societies. Molecular epidemiologist Mohsen Ghanbari is looking for a solution: ‘We need to tackle these kinds of common but complex diseases at an earlier stage.’

As a general practitioner in Iran, Mohsen Ghanbari noticed that many of his patients suffered from age-related diseases such as dementia, diabetes and cardiovascular disease. He wanted to get to the root of the problem. So after working in the hospital, he studied until the wee hours. This is how he managed to secure a place abroad. 10 years ago, he started his PhD program in genetic and molecular epidemiology in the Netherlands: “I’m filling in the gap between molecular biology and epidemiology.

Blood samples

By combining the two lines of research, Ghanbari wants to better understand and predict age-related diseases. To this end, he uses data from the Rotterdam study. This is a study in which scientists have followed 18,000 participants for 30 years and screened them for age-related diseases. Data is collected on the participants every 3 to 5 years. Examples of data collection include but are not limited to: conduction of interviews, CT scans and blood withdrawal.

Ghanbari explains how he will use the Rotterdam study during his fellowship: ‘I will look at the molecular pathways behind the diseases of old age. What role does non-coding RNA play in this? In the blood samples I will be looking for biomarkers: can I see from certain substances in the blood which people have developed a disease of old age in the last 30 years? If we have these molecular clues, we can better predict or even prevent certain diseases for each individual.’

Rintje Agricola: A personalized prediction of hip arthrosis

Osteoarthritis is a major worldwide problem. In the Netherlands alone, approximately 1.5 million people suffer from osteoarthritis and this number will only increase in the coming years. It is even expected that it will be the most common disease in the Netherlands in 2040.

Orthopedic surgeon Rintje Agricola believes the time has come for a personalized approach to osteoarthritis. ‘We still don’t know enough about how osteoarthritis develops, we don’t know how to prevent it and treatments are still too general. We can recommend physical therapy, advise someone to lose weight or undergo surgery, but we can’t give personalized tailored advice.’ As a result, there might be patients who lose weight to treat their osteoarthritis, while their excess weight was not the cause of the disease. Losing weight won’t work for them, but a different approach might.

All available data

Determining which treatment will be effective for each individual requires an awful lot of data. That is why Agricola will use all available data on hip osteoarthritis. In total, data has been collected from 40,000 people. Artificial intelligence (AI) will be unleashed on X-rays to analyze them automatically. The findings in the x-rays will then be combined with data from blood samples, pain symptoms, medication use, genetics and other data. In this way, Agricola hopes to predict the risk of hip osteoarthritis for each patient and determine what factors have caused the osteoarthritis. Ultimately, this will be used to see if hip osteoarthritis can be prevented and if personalized treatments work better.