Interviews with Norwegian Scientists: Stein Bergan

Created: Friday, 08 September 2023 12:48

Last Updated: Friday, 08 September 2023 13:03

Written by Jana Stojanova

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As we approach the Oslo congress, we have one final interview in the Norwegian Scientists series, this time with congress Chair, Stein Bergan. It’s great to hear from Stein, whose perspective adds to the picture painted in earlier interviews of Norway being a vibrant hub for the implementation of innovations in pharmacology, always for the benefit of patients. Stein traces developments since the days when PCR was understood to mean ‘Partido Comunista Revolucionario’ (!), and a mass spectrometer required several engineers to analyze a handful of samples per week. Though we’ve come a long way, Stein highlights some areas where there is room to learn and improve, a number of which will have dedicated sessions at the upcoming congress.   If you are still sitting on the fence about joining us all in Oslo, I strongly recommend our recent podcast episode with Stein, Anders and Ida where we take a deep dive into the program. Our earlier interviews with Anders, Kristine and Nils will also undoubtedly inspire you to come see the amazing work from Norway, as well as colleagues from around the world. Click on the link below to read more!   Stein Bergan Group leader Precision Pharmacotherapy research group Pharmacology Department, Oslo University Hospital Oslo, Norway   Professor Department of Pharmacy University of Oslo Oslo, Norway

Can you tell us a little bit about your respective roles? What is a typical day like for you?

My training as an MSci in pharmacy was in the 70s at the Oslo University, and I did my PhD in the Oslo University Hospital where I have been working since 1990. I also have a 20% position as professor at the University. My tasks and duties have changed over these years. In the early years I did hands-on establishing assays in the lab. As the lab for TDM and pharmacogenetics, our activities, staff and clinical service have expanded, my job increasingly focus on interpretation and commenting on individual results, dose recommendations and communication between lab and the clinicians. I am also leading the research team of our lab, supervising master and PhD students plus teaching at the University as part of my professorate.

Arriving early in the morning I will normally have a little bit of time to respond to the most urgent emails. There are internal meetings in our group and I regularly attend pre-rounds in some of the clinics. Remaining time of the day I will spend on commenting etc as mentioned, and in-between there are projects, both scientific and administrative. Requests that may need some update and literature search in order to respond adequately to. To find time for writing and reading, learning and supervising, I need to spend evening hours at my job several times per week. Recently much of this time has been occupied by preparations for the IATDMCT congress (as expected and intended) - which also increasingly extends into weekends.

Is there anything that is done at your centre that you would consider innovative?

We were early to see the potential benefits in microsampling for our quantitative analyses, especially for follow-up of transplant recipients (in Norway all organ transplants are performed at this hospital). Which means we have contributed to the rapid expansion, development and validation in collaboration with device manufacturers. In a longer perspective, I know that our service around busulfan conditioning and thiopurines and TPMT genotyping have made a difference for individual patients. This was also something we established already in the nineties, based on my own thesis and later further developed in the lab.

What technological innovations have entered into use during your career that have permitted a change, or evolution, in practice?

By now the reader realizes how long I have been around. When I graduated there were hardly any sub-division of lymphocyte categories, "PCR" was the abbreviation for the Partido Comunista Revolucionario (in Argentina), and if you purchased a mass spectrometer, you would need a couple of engineers merely to keep the instrument going, and at best running a few samples per week. Now everyone knows what these developments have meant for our understanding of immunosuppression, pharmacogenetics and to run a TDM lab with many analytes with high throughput.

How did you become interested in your area of expertise?

Already when I did my master, I was intrigued by the ideas around what is currently personalized pharmacotherapy, thinking that this was a field where one might also see the results on an individual basis immediately. Early in my career as a hospital pharmacist at a county hospital, which was small but with a bunch of clever and enthusiastic clinicians, I found inspiration to pursue this which eventually lead to the position in my current lab.

Is there anything that you’ve seen or heard about recently and thought “I’d like to incorporate that idea at my center”?

Mass spectrometry imaging (MSI) is a fascinating technique which seems to have a great potential for studies of distribution and metabolism of drugs. Not sure whether this will enter any kind of clinical routine applications directly, but for research and to increase our understanding of kinetics and dynamics it seems revolutionary from what I have read. And I am happy to highlight a presentation on this topic by Christian Janfelt at the upcoming IATDMCT congress in Oslo.

What sort of research do you have on the horizon that you think might influence clinical practice in the future?

For a while now, pharmacogenetics/pharmacogenomics has gone through the standard phases like more or less enthusiasm/ skepticism/ hype/ disillusionment/ consolidation/ evidentiation /implementation, and is finding its place in clinical application. This relates mostly to drug metabolism and somewhat to distribution. I still feel that there must be much more to explore with respect to individual variability in drug response related to targets, i.e. gene variants in receptors etc. Not sure, but I hope for progress here, and that it may prove helpful to explain more of the irregular drug responses that we frequently see.

What do you consider is the future for TDM and CT? What are you excited about? What are the challenges we face?

With the revived attention and interest in personalized medicine/pharmacotherapy, I find that it is now more than ever up to us to grasp the opportunities to disseminate the message on how the available tools – TDM, PGx, MIPD – can contribute to improving outcomes for patients.

As I see it, one major challenge remains. That is to provide evidence by clinical trials of sufficient power and design to document the benefits of personalized treatment in terms of robust endpoints. The collaboration needed to obtain such results can be facilitated by the IATDMCT.