SERCA Pharmaceuticals signed an agreement with the Indian company Cadila Pharmaceuticals on the development of a unique cardiac treatment. Photo: Ken Rosendal, Inven2

The treatment of heart attacks often leads to damage to the heart’s muscle tissue. It simply dies because it has been deprived of oxygen for too long, and then experiences an intense influx when the blocked blood vessels are re-opened. There was no treatment for such reperfusion injury, until now.

Based on 20 years of research, the Norwegian start-up SERCA Pharmaceuticals will develop a pharmacological treatment that they think could solve this problem.

In connection with Prime Minister Erna Solberg’s official state visit to India, SERCA signed an agreement with the Indian company Cadila Pharmaceuticals on the development of the treatment.

“SERCA Pharmaceuticals is based on groundbreaking Norwegian research. It’s very pleasing to land such a good agreement with a major pharmaceutical company just months after the company was established,” says Kristin Sandereid, Executive Fund & Business Developer in Inven2.

The company was established in 2018 on the basis of preclinical research on a potential pharmacological treatment for damage arising from the treatment of heart attacks. The research behind the company has been conducted over the past 20 years by Professor Kjetil Taskén’s research group at the University of Oslo.

Unique treatment

The treatment that SERCA Pharmaceuticals and Indian company Cadila Pharmaceuticals are set to develop together is based on Norwegian research and is unique and not currently available.

“This contract means a great deal to SERCA Pharmaceuticals. Landing this agreement with a major pharmaceutical company after such a short time on the development of the treatment we have discovered is very promising. The contract is also good and ensures that the product development will be more cost efficient,” says Kjetil Hestdal, CEO of SERCA Pharmaceuticals. Hestdal has extensive experience of biotech and the development of medical products based on research through his position as CEO of Photocure.

As part of the agreement, Cadila Pharmaceuticals will use its development organisation to conduct some of the work of developing a new treatment for heart attack patients, which SERCA Pharmaceuticals can then bring to the global market. The new pharmaceutical is based on an invention made by Kjetil Taskén and colleagues at the University of Oslo and Oslo University Hospital, and SERCA Pharmaceuticals was founded by Inven2.

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3D model of NORSAT‐1, with m‐NLP’s cantilever system visible. With the extension of the license agreement between EIDEL and UiO, EIDEL will now start commercialisation of this version of m‐NLP, in addition to the ESA version Eidel delivered in April. Photo: Trond Abrahamsen.

Norwegians are obsessed by the weather, but the weather in outer space is not normally part of small talk between friends and acquaintances. The weather in space, more specifically the outer layers of the atmosphere called the ionosphere, nonetheless has a great impact on most of us, without us knowing it. There are often big gusts of wind and turbulence there, which lead to interruptions to GPS measurements and satellite communication on Earth.

An extensive and long standing collaboration between the Department of Physics at UiO, the company EIDEL, which was started by a Swede in a garage in Eidsvoll in the 1960s, and Inven2 may, in time, lead to an outer space weather forecast service similar to that of YR. A weather forecast for space of this kind can, in turn, lead to a new way of flying, thereby forming the basis for a billion kroner industry in Norway.

Space-certified probe in 2018

The basis for the whole project is a unique instrument called the multi-Needle Langmuir Probe, or m-NLP for short. It is this instrument that can form the core of the space weather forecast, which will enable secure use of GPS.

“The theoretical basis for m-NLP, the measurement principle itself, was designed by the student Knut Stanley Jacobsen from the Department of Physics on assignment for Jøran Idar Moen in the summer of 2007. I have worked on implementing the system, with electronics, a cantilever system and probes, through both by master’s and PhD degrees, and this work is the basis for my now being employed at EIDEL,” says Tore André Bekkeng.

In April 2018, the m-NLP instrument in EIDEL’s radiation tolerant version was certified by the European Space Agency (ESA) for use in space. The UiO version of the instrument is currently flying on the Norwegian satellite Norsat-1 and Norway thereby has its first space weather satellite in orbit. m-NLP will now be launched on a number of satellites and further developed to, among other things, be reduced in size enabling it to also be used on small satellites.

But what is so groundbreaking about the instrument with the complicated name?

Measures distances in space in real time

The brilliant thing about m-NLP is that it can measure electron density in the ionosphere much more accurately and with much greater spatial resolution than other corresponding instruments. This is all Greek to most of us, but these simple facts explain it a bit better: Before m-NLP was developed, it was only possible to do one or two measurements of electron density per second. However, m-NLP manages 5,000–10,000 measurements a second.

“This means that the resolution changes from kilometre-based to metre-based, and that we can observe and forecast any interruptions to the radio signal between the satellite and user on Earth,” explains Bekkeng.

Professor Jøran Moen is head of the Department of Physics and has spent his Easter holiday in Silicon Valley to become even more inspired. Moen understood early on that m-NLP could become extremely important. He is now making strategic and long-term efforts to position Norway as a key player in the development of a space weather forecast service and an industry that can produce m-NLP on a large scale.

“If you assemble m-NLP instruments on a fleet of satellites, we can both measure and forecast the weather in space around the globe,” says Moen.

“This means that aircraft can completely trust GPS signals and fly the shortest distances from A to B, which could revolutionise air traffic. Today, aeroplanes need radio signals from the ground to fly safely. They therefore fly from point to point where they have contact with a radio tower on the ground, rather than taking the shortest route. By reducing dependency on radio towers, the aircraft will save fuel and time on each flight, and they can use a bigger area in which to fly, thereby avoiding traffic build-ups in narrow air corridors,” says Moen.

Inven2 decisive for the project

Jøran Moen firmly believes that Inven2 has played a decisive role in the development of the m-NLP system’s innovation potential.

“Inven2 meant that we succeeded in achieving industry cooperation. My main idea has continuously been to engage a Norwegian business to develop m-NLP for commercial use, since this will help to improve Norway’s position in European space operations. m-NLP is now certified for use by European satellites, and this gives Norway and EIDEL a major competitive advantage over other European corporations,” says Moen.

“The collaboration with EIDEL is absolutely essential to us succeeding in getting m-NLP into the commercial market for global space weather services.”

The fact that EIDEL, which is a small company with 11 employees, has received an ESA-commissioned project means a lot to the further development of the business in Eidsvoll. If EIDEL succeeds in selling the instruments, it will also generate income to UiO.

“EIDEL has been awarded the license for m-NLP, and we entered into a smart agreement back in 2011 that ensures a good return on this license for the university and Jøran’s group,” says Bjarne Tvete, who is business developer at Inven2.

Along with his colleague Elin Melby, he has worked closely with Professor Moen and EIDEL for a number of years.

Moen says he will use Inven2’s competence in the project’s further development.

“What I appreciate most about the collaboration with Inven2 is that they have helped to focus my ideas. I had no previous competence in commercialisation, so Inven2 has been an important factor in realising the innovation potential of my group’s research. Elin and Bjarne have challenged me all the way, which has been great. Inven2 is also very good in terms of protecting the rights to the ideas, and has ensured good contracts where all parties benefit from the collaboration,” says Moen.

Creating jobs and increased competitiveness

Although on a day-to-day basis, Professor Moen and his research group and students are interested in advanced basic research on the causes of turbulence in the ionosphere, the idea of actually using the knowledge is always present.

With Moen, there is no culture for putting projects on the back burner. Here, it is about taking advantage of the downstream opportunities, as he puts it. The downstream opportunities in the short and long term are spin-off companies related to the development of a space weather forecast service, large-scale production of m-NLPs and, not least, customer support. Moen estimates that the production and support of m-NLP in a global market for space weather forecasts can create at least 200 jobs, and he hopes that as many of these as possible will be in Norway.

“I am very conscious of the fact that our work and research is based on funds that stem from the tax payers. This means that we need to give back to society where we can. In the same way, it is also important to me that my students are able to contribute to developing the industry after completing their studies,” says Moen.

Bekkeng, who has taken his master’s and PhD degree in Moen’s group, explains that ESA’s condition for EIDEL receiving the project on certification of m-NLP in 2013 was that he joined forces with EIDEL.

Truls Andersen, managing director of EIDEL, is very satisfied with this. He believes that the collaboration with UiO and Inven2 has given the business he manages a leg up in a global market.

“We achieve an exchange of competence, technology and experience through our collaboration with UiO. This means that EIDEL becomes competitive in a very competitive market when we can present results from basic research and develop them into commercial products together,” says Andersen.

“We would not have had this access to basic research had it not been for such a collaboration. The initiatives we are currently working on will form the basis for further growth in the business. It is also important to us to be able to give back to UiO so that they can continue their research. This is where Inven2 enters the stage and does a great job in balancing these needs, as well as seeing the needs of both parties,” he adds.

So in just a few years from now, when planes are hopefully flying in a straight line from A to B, we can offer a thought to Norwegian innovation spurred by curiosity and a synergistic collaboration between basic research and industry.

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Photo: Hanne Kristine Fjellheim, SopraSteria

Microsoft launched the HoloLens glasses in 2016. These are far from ordinary glasses, in that they are in fact a wireless computer that enables the user to see an ‘extended reality’. This could be a hologram of the liver shown in the right position on the patient’s body, or another organ that appears to hover in the air, and that can be turned and rotated or taken to pieces and observed from the inside out.

These glasses currently play a major, but not the main, role in nine projects in Inven2’s portfolio. Some of the projects involve developing better tools for surgeons who operate cancer patients on a daily basis or who perform complicated operations, from cardiovascular to hip joint surgery. A number of skilled professionals play the main roles in these projects.

One of these is Ola Wiig, an orthopaedist at the Oslo University Hospital Rikshospitalet. He explains how the HoloLens technology can give the surgeons a kind of virtual X-ray vision:

“If we manage to do this, it will be the greatest innovation in the field of medicine since X-radiation was discovered back in 1895. And Norway is at the international forefront in terms of developing the use of this technology,” says Wiig.

Among other things, the HoloLens technology makes it possible for surgeons to see three-dimensional holograms of the individual organs of the patient they are going to operate. Before complicated operations, a number of surgeons can plan the operation together by looking at the same hologram, thereby achieving an entirely different shared spatial understanding of what they are going to do, and where to place the incision, than by looking at two-dimensional CT images.

But how did we get here? 

From endoscopic surgery to holograms

Let’s journey back in time, to 1996. The Intervention Centre at Rikshospitalet in Oslo is established and will contribute to the development of new treatments and treatment strategies. Surgeon Bjørn Edwin is another of the main players here. He needs better operating tools for removing cancerous tumours in the liver. Since we only have one liver, it is important not to remove too much healthy tissue around the tumour, in case it becomes necessary to operate again to remove a new tumour. At the same time, it is important to remove enough so that no cancer cells remain that can form a new tumour.

At this time, endoscopic surgery was in its initial stages and still very experimental. How were the surgeons supposed to see what they were doing inside the body without opening it up, and be sure that they did not cut vital blood vessels that would lead to major blood loss from the patient?

At this time, Ole Jakob Elle, another of the main players, started at the Intervention Centre. He has a background in robotics and navigation and, together with Edwin and other colleagues, develops increasingly better models of the body’s organs with particular focus on the liver.

“The purpose has always been to create an anatomical map of the individual patient’s insides that is as complete as possible, but it must be completely precise or things could go terribly wrong,” explains Elle. He is head of the Medical Robotics, Visualisation and Navigation group at the Intervention Centre.

In 2004–2008, the Intervention Centre in cooperation with other parties is granted the prestigious EU project ARISER, which stands for ‘Augmented Reality in Surgery’. In the project, the scientists experiment with several different head-mounted screens that show 3D models of the liver, but they are not good enough.

At this point, the work stagnates for a period until it is given a boost through several rounds of funding from the South-Eastern Norway Regional Health Authority and more EU projects. One of these is HiPerNav, or ‘High Performance soft-tissue Navigation’, which is an ongoing EU project coordinated by the Intervention Centre.

“Just before the HoloLens glasses became a reality, we had already developed a 3D model for use in liver surgery,” explains Elle.

When his developers become aware of the glasses, they are unable to get hold of them, as they were not yet on the market. The time of writing is now 2015. In 2016, Sopra Steria contacts them. As a close partner of Microsoft, they have now gained access to the new HoloLens glasses and wish to cooperate with the Intervention Centre. A new chapter starts and things start moving quickly.

International innovation award

Sopra Steria are technology consultants and among the first in Europe to be given the HoloLens glasses to use.

“We contacted the Innovation Centre after Norway Health Tech tipped us off that they had been working on the technology for some time. Just 48 hours after this, we were under way with the first project on liver cancer,” says John Berland, Innovation Director of Sopra Steria Scandinavia.

The project progresses very smoothly. The developers from Sopra Steria as good as move into the Intervention Centre and work closely with the clinicians and technologists there. Shortly afterwards, they present the liver project at a global conference in the USA. Here, the interdisciplinary team comprising members from both the private and public sector receive an innovation award, major international attention and praise from Microsoft’s chief medical officer from the stage.

In 2018, just two years afterwards, Inven2 has as many as nine ongoing projects that use HoloLens in different ways in medical treatment. A number of these projects collaborate under the umbrella ‘HoloCare’.

HoloCare is the world’s first innovation centre for the use of “Mixed Reality”, which is a combination of the virtual and real world, in the health field. It was established at the Intervention Centre.

Can see children’s hearts before surgery

Meet another of the main players in the development of HoloLens use: Henrik Brun. Henrik Brun is a paediatric cardiologist who has specialised in planning operations of children with serious heart conditions.

“We have worked with 3D modelling for a long time. Children who need heart surgery often have such serious heart conditions that deciding where to start is a complex matter. When we use HoloLens in the surgery planning process, we can almost go into the heart together with the surgeons who are going to operate, and point out, explain and reach a proper common understanding of what we need to do to optimise the heart’s functioning,” says Brun.

He says that the start-up phase in the use of HoloLens went very smoothly, since they were already familiar with 3D modelling and 3D printing.

“The use of holograms has revolutionised the use of 3D in the planning phase. The next step for us is to use this during surgery and not just for planning, so it’s going to be exciting,” says Brun.

He has presented the technology at several international heart congresses where he has received much attention.

“Many are amazed when they see what we are doing, even experts in the fields of imaging, i.e. advanced and digital use of images in medicine, so this shows that Norway really is at the forefront here,” says Brun.

He is clear that the technology will make cardiovascular surgery better and safer for the simple reason that holograms are closer to reality than an image you see on a screen or on paper.

“The holograms leave less to the imagination and linguistic reproduction of pathology. Everyone involved sees the same thing and can be sure that there is a common understanding of what the organic heart disease looks like and what should be done,” says Brun.

Must utilise the health industry

John Berland of Sopra Steria believes that Norway must commercially exploit the advantage we have from the HoloLens technology.

“We have an advantage now over the rest of the world, and we should be smart and utilise it both commercially and in terms of research. This has been a team effort among interdisciplinary professional groups since the start and it has enormous potential,” says Berland.

Elin Melby is responsible for technology projects at Inven2. She is the project manager for all commercialisation projects that involve HoloLens at Oslo University Hospital and Akershus University Hospital, and is in complete agreement with Berland in relation to commercial exploitation.

“We are currently looking into the possibility of starting a company that encompasses all applications developed by the researchers and clinics relating to HoloLens. There is great potential here. It is exciting that Norway is so far ahead in an area that can revolutionise surgical practice,” says Melby. She is closely cooperating on this work with Bjarne Tvete, who is a business developer at Inven2.

The HoloLens projects have received significant funding from the South-Eastern Norway Regional Health Authority and Oslo University Hospital, which has played a vital role in developing the use of the technology. The projects are also expanding from Norway and applying for international funding and EU partners.

Ole Jakob Elle is delighted to see how vastly the use of HoloLens has grown in just a few years, and supports Berland and Melby in their view that Norway now has a unique advantage.

“The scope of use we and others are now investigating is big. HoloLens is being tested for use for everything from wound healing at Sunnaas Hospital and colon cancer at Ahus to the treatment of people with severe mental health conditions at Ullevål Hospital. As of now, I do not know of any other technology that provides this type of visualisation and depth vision, and it will be exciting to be a part of the leap from use in the planning phase to use during surgery,” says Elle.

Revolutionising surgery

Back to Ola Wiig. Wiig is an orthopaedist at Rikshospitalet University Hospital and primarily works with children’s joints and hips. He is working intensely on developing HoloLens for use on this group of patients.

“The HoloLens technology is particularly well-suited to skeletal surgery and I believe it will be a simple matter to develop it for this purpose,” he says.

He believes he will be able to start using HoloLens in hip operations already in a year’s time, but they are dependent on funding to develop a number of software applications that are necessary for optimal use.

He has previously used 3D printing of patients’ skeletons, but constantly repeats that HoloLens will revolutionise the way in which surgeons work and will lead to major ripple effects.

“They will make fewer mistakes, the results will be better and the length of patients’ hospital stays can be significantly reduced. For the surgeons, it’s like having virtual X-ray vision, which will be the greatest innovation in the field of medicine since X-radiation was discovered back in 1895. This is big. There’s no doubt about that. And Norway is at the international forefront in terms of developing the use of this technology,” says Wiig.

Read more about Holocare: https://holocare.org/ 

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