Together we work on research 
for the medicine of the future

Welcome to the Medical Research Centre in Zurich!

Willkommen_Forschungsplattform_UMZH_BRUEDERLI_ENG_141221.mp4

To date, Professor Thomas M. Kessler has been tilting at windmills, a struggle that has often left him feeling miserable and helpless. He is the Senior Physician in Neuro-Urology at Balgrist University Hospital and a professor in the Faculty of Medicine at the University of Zurich. In his clinic, he sees patients every day who are suffering from painful, dangerous urinary tract infections. Until now, there has been virtually only one treatment: antibiotics. But antibiotic resistance is growing and the disadvantage of antibiotics is that they also kill the «good» bacteria in the gut flora. New therapies are urgently required.

«Antibiotic resistance is a huge problem throughout the world. We desperately need alternatives,» stresses Kessler. He has launched the interdisciplinary ImmunoPhage research project that is taking a fundamentally new approach to treating UTIs. The initial results are highly promising. They are based on a study that Kessler’s team took part in in Georgia. The ImmunoPhage project is the only one of its kind in the world.

Balgrist University Hospital traditionally treats patients who have developed complex neurological problems following an illness or accident. These include sufferers of Parkinson’s disease and multiple sclerosis, paraplegics, and stroke victims. Thomas M. Kessler and his team also treat people who are essentially healthy but who suffer from recurring UTIs and bladder infections that have a serious impact on their quality of life. «Apart from symptoms such as pain and the frequent need to pass urine, these infections can also be harmful to patients’ overall health if they spread to the kidneys. But the pathogens often do not respond to antibiotics,» explains Kessler. The physician suffers along with his patients: «This is a major motivation for me to investigate new types of treatment.»

Viruses that strengthen the immune system

He is concentrating on bacteriophages as an alternative to antibiotics and these are the central focus of the ImmunoPhage project. Bacteriophages are viruses that infect bacteria and reprogram them with their genetic material. The bacteriophages then multiply and destroy more and more bacteria. In the ImmunoPhage project, these bacteria-killers or bacteria-eaters are being used to combat UTIs. In the future, this method could also help in the treatment of other chronic conditions such as lung and middle ear infections.

Professor Thomas M. Kessler from Balgrist University Hospital is working closely with the research team led by Professor Martin J. Loessner from ETH Zurich and the group headed by Professor Onur Boyman from the University of Zurich. Loessner and his team are among the world’s leading specialists in bacteriophages. The molecular biologists and geneticists are responsible for the engineering activities. They isolate the naturally occurring bacteriophages and propagate them. In the laboratory, genetic information is added to these «designer» bacteriophages, which are then used to attack specific bacteria that cause infections in the urinary tract. 

Shawna McCallin and her team examine phage activity against a patient's bacterial isolate in a petri dish (from left to right: Sonja Milek, research assistant; Shawna McCallin, project leader; Jonas van Belleghem, postdoctoral researcher; Swenja Lassen, PhD student)

The sample is spinned at 78'2000 x the force of gravity for 18h in order to separate phage from bacterial contaminants. As many as 1'000'000'000'000 phages are within that thin white line. This process is an essential step in preparing immune cell testing and therapies. 

Soon available for the treatment of patients

«The network of specialists from different disciplines is essential to the project,» explains Professor Loessner from ETH Zurich. «We are the experts in bacteriophages, but we also need scientists who specialize in the immune system.» This is why the research group headed by Professor Onur Boyman is on board. He is the Director of the Department of Immunology at University Hospital Zurich and a professor in the Faculty of Medicine at the University of Zurich. Under the leadership of his team, chemical messengers are added to the bacteriophages which will stimulate the immune system. The aim of strengthening the immune system in this way is to enable it to fight off new infections in the future. Speaking about the project, Boyman says: «We are experts in the body’s defense system. I find it fascinating to work with colleagues who specialize in totally different areas.»

If everything goes to plan, the first designer bacteriophages could be used in clinical trials in Switzerland sometime in the next two years. The plan is to administer the bacteria-killers directly into patients’ bladders in liquid form via a catheter. The initiator of the ImmunoPhage project Thomas M. Kessler is confident about its prospects: «I hope that in five to ten years we will have an effective alternative to antibiotics.»

Interdisciplinary collaboration for cutting-edge research: The core research group «ImmunoPhage» with Lukas Heeb, Jochen Klumpp, Samuel Kilcher (top row, from left to right), Vera Neumeier, Hendrick Koliwer-Brandl, Matthew Dunne, Aleksandra Svorjova (second row, from left to right), Martin J. Loessner, Lorenz Leitner, Susanne Meile, Jiemin Du, Jonas van Belleghem (third row, from left to right), Thomas M. Kessler, Swenja Lassen, Shawna McCallin, Sonja Milek, Onur Boyman (bottom row, from left to right). 

Professor Onur Boyman MD is the Director of the Department of Immunology at University Hospital Zurich and a professor in the Faculty of Medicine at the University of Zurich.

UMZH Immunophage Onur Boymann USZ Audio neu.MP3

«I find it fascinating to transfer research findings into everyday clinical practice»

Professor Martin J. Loessner is Professor of Food Microbiology at the Institute of Food, Nutrition and Health at ETH Zurich.

Martin J. Loessner (Audio file in German)

UMZH Immunophage Martin Loessner ETH Audio 2.MP3

«Antibiotic resistance is jeopardizing conventional treatments»

Professor Thomas M. Kessler MD is the Senior Physician in Neuro-Urology at Balgrist University Hospital and a professor in the Faculty of Medicine at the University of Zurich.

UMZH Immunophage Thomas Kessler BAL Audio 2.MP3

«A revolutionary therapy that is long-lasting and has almost no side effects»

Bladder infection?
Clinic at Balgrist University Hospital
Diagnosis and treatment at University Hospital Zurich

Bladder infection (UTI, cystitis): 
The urinary tract and urine itself normally contain no bacteria. When bacteria are present in the urinary tract and trigger an inflammatory reaction there and this causes problems for the person affected, it is described as a urinary tract infection (UTI). For anatomical reasons, small children and women are most likely to suffer from UTIs. Among men, the risk increases with age.

Bacteriophages: 
Viruses that infect bacteria and reprogram them with their genetic material. The viruses then reproduce and destroy the bacteria.

Immunophages:
Bacteriophages are enriched in the laboratory with messenger substances that support the body’s immune response. In other words, the specific antimicrobial activity is combined with immunomodulatory properties.

Neuro-urology:
This discipline covers diseases of the lower urinary tract and the sexual organs after damage has been caused to the nerves that supply them.

Immunology:
This is the study of the biological and biochemical principles of the body’s defense against pathogens, such as bacteria, viruses and fungi, and other foreign substances.

Who is co-financing this project? (in CHF millions)

Text and audio: Rebekka Haefeli
Pictures: Frank Brüderli
University of Zurich: Onur Boyman, Hendrik Koliwer-Brandl
Balgrist University Hospital: Thomas M. Kessler, Shawna McCallin, Lorenz Leitner, Sonja Milek, Swenja Lassen, Vera Neumeier 
University Hospital Zurich: Onur Boyman, Jonas Van Belleghem, Lukas Heeb
ETH Zurich:  Martin J. Loessner, Matthew Dunne, Samuel Kilcher, Jochen Klumpp, Aleksandra Svorjova, Susanne Meile, Jiemin Du
Hochschulmedizin Zürich: Corina Schütt

Antibiotic resistance is becoming an increasing problem in the treatment of urinary tract infections (UTIs) and alternative therapies are urgently needed. This is where the ImmunoPhage project comes in. It aims to develop therapeutic bacteriophages that will cure UTIs.

Antibiotics

Immune system

Urology

Bladder infection

Neuro-urology

Immunophages

Bacteriophages

Bacteria-eaters combat bladder infections
Antibiotic resistance is becoming an increasing problem in the treatment of urinary tract infections (UTIs) and alternative therapies are urgently needed. This is where the ImmunoPhage project comes in. It aims to develop therapeutic bacteriophages that will cure UTIs.

Bacteria-eaters combat bladder infections

More precise treatments for aggressive forms of blood cancer

When Professor Thorsten Zenz returns to his office on floor D of the main building after his daily visit to University Hospital Zurich, he is full of a mixture of emotions. Some patients who have undergone chemotherapy can be discharged from the hospital with a good prognosis. In some cases, however, the Chief of Service for Hematology has to tell patients that their chances of a cure are slim.

Giving patients bad news is a difficult and distressing job for Zenz. Hopes are destroyed and dreams burst like soap bubbles. As he explains: «The blood cancer patients have often undergone several cycles of intensive and unpleasant treatment. In many cases this is successful for a certain period, but unfortunately we know that, if the cancer returns, the prognosis is sometimes very poor.»

The UMZH INTeRCePT project, run by a research consortium headed by Professor Zenz, aims to change this. It focuses on children and adults with aggressive blood cancers, such as lymphomas, which are caused by abnormal cells in the lymph nodes or bone marrow. Patients with acute lymphoblastic leukemia, which is particularly common in children up to the age of five, are also at the heart of the project.

Exploiting the potential for improvements

«We already have a wide range of new cell therapies at our disposal, including genetically modified ones,» explains Zenz, «and we are making use of the whole spectrum.» This is a positive development, but the physician believes that there is clear potential for improvement. The research group would like to gain a better understanding of which drugs are most effective for which disease. Their goal is to establish rules for the use of therapies that will significantly improve patients’ chances of recovery. The system needs to take into account the specific circumstances of each individual, making it a prime example of precision medicine. The aim is to increase the proportion of patients who respond to drugs by 50 percent.

The INTeRCePT project is intended to last for five years. The first three years will be spent carrying out research into the basic principles before starting a clinical trial. Initially, tissue and blood samples will be studied in the laboratory and used to test different drugs. The analysis will take place at an extremely high resolution down to the level of individual cells, with the aim of enabling the researchers to discover exactly how the cells react to the individual active ingredients.

Biomarkers will predict whether a patient will respond to a therapy

The partners in the INTeRCePT project include University Hospital Zurich, the University of Zurich and ETH Zurich, plus University Children’s Hospital Zurich and the European Molecular Biology Laboratory (EMBL) in Heidelberg. The pediatric oncologist Professor Jean-Pierre Bourquin from the children’s hospital is confronted with the same problems as Zenz every day. When the treatments available for a child with cancer run out, this has a huge impact on the whole family. Younger doctors such as Marco Roncador, a resident physician in the field of hematology who works with Thorsten Zenz, are also faced with sad realities of this kind with their adult patients. As he explains: «No doctor can rest while there are still patients that cannot be helped.»

Tobias Wertheimer is another physician who works at the Institute of Experimental Immunology at the University of Zurich. The team of immunologists investigates the interactions between immune cells and cancer cells with and without drugs in the laboratory. The researchers aim to identify biomarkers that will allow them to predict whether a certain patient will respond to a therapy.

Data that can help other cancer sufferers

A bioinformatics team from ETH Zurich will be responsible for collecting and analyzing the data. This is a very important aspect of the work because patients suffering from other forms of cancer will also be able to benefit from the results of the INTeRCePT project in the future.

Professor Thorsten Zenz MD is Chief of Service at the Department of Medical Oncology and Hematology at University Hospital Zurich and a professor in the Faculty of Medicine at the University of Zurich.

UMZH Intercept Thorsten Zenz UZH+USZ Audio.MP3

«Our understanding of why certain drugs do not work in the same way for all patients is constantly improving» 

Dr. Marco Roncador MD is a Resident Physician in Hematology at University Hospital Zurich.

UMZH Intercept Marco Roncador USZ Audio.MP3

«The key feature of the project is the cooperation between the different institutions and the opportunity to share experiences»

Dr. Tobias Wertheimer is a postdoctoral researcher at the Institute of Experimental Immunology at the University of Zurich.

UMZH Intercept Tobias Wertheimer UZH Audio.MP3

«We want to open up new options for patients with a recurrence of a cancer that is difficult to treat»

Would you like a second opinion?
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Precision medicine (previously known as personalized medicine):
Every person is different. The ways in which we become ill and recover also differ. Alongside our genetic predisposition, factors such as environmental influences, lifestyle, age, gender, and other illnesses also play a role. Precision medicine combines genetic analyses with other technologies from molecular and cell biology, imaging, computing, and data analysis to generate and analyze a full range of patient data. This makes it possible to give a much more accurate diagnosis and to find treatments that are tailor-made for the patient.

Hematology:
The study of blood and its components.

Blood cancer:
Blood cancer is a disease of the blood-forming system that can affect the blood itself, the bone marrow, or the lymphatic system. There are different types of cancer and disease progression.

Leukemia:
This is a type of blood cancer and a collective term for different types of cancer of the blood-forming system and the bone marrow. Precursors of different types of blood cells fail to reach maturity. The uncontrolled accumulation of immature blood cells prevents the healthy blood cells from functioning.

Recurrence:
The reappearance of a disease after a temporary recovery

Biomarkers:
Biomarkers are medically measurable parameters of biological processes that have prognostic or diagnostic significance and are therefore used as indicators for certain diseases, for example. They are characteristic biological features that can be measured objectively and can point to a normal biological or a pathological process In the body. Biomarkers may be cells, genes, gene products or certain molecules such as enzymes or hormones.

Text and audio: Rebekka Haefeli
Pictures: Frank Brüderli
University of Zurich: Thorsten Zenz, Tobias Wertheimer
ETH: Nora Toussaint
University Hospital Zurich: Thorsten Zenz, Marco Roncador 
University Children’s Hospital Zurich,: Jean-Pierre Bourquin
The LOOP Zurich - Medical Research Center: Jens Selige

The INTeRCePT project focuses on children and adults who are suffering from aggressive forms of blood cancer. The research consortium headed by Thorsten Zenz develops forms of treatment that are designed to match the individual characteristics of the patients. Using precision medicine, the aim is to increase the proportion of people who respond to drugs by 50 percent.

Precision medicine

Cancer

Oncology

Blood cancer: Precision medicine for children and adults. The INTeRCePT project focuses on children and adults who are suffering from aggressive forms of blood cancer. The research consortium headed by Thorsten Zenz develops forms of treatment that are designed to match the individual characteristics of the patients. Using precision medicine, the aim is to increase the proportion of people who respond to drugs by 50 percent.

Precision medicine for children and adults with blood cancer

In the laboratory wing of building Y44 on the Irchel campus of the University of Zurich, the mood was cheerful. There was a sense of relief among the members of the team headed by Professor Burkhard Becher at the Institute of Experimental Immunology. The group had been under immense pressure during the preceding months, working almost day and night. Now the researchers at the University of Zurich have discovered that all their hard work has more than paid off. In a very short period of time, they have made a major contribution to combating COVID-19 and their achievement is of international importance.

Together with researchers from Tübingen, Toulouse, and Nantes, the team identified a biomarker in the blood of COVID-19 patients that allows the progression of the disease to be predicted. The doctors can already tell on the patient’s first day in hospital whether the person will become seriously ill and need intensive care or whether they will have a mild case of the disease and will soon be able to return home.

Stefanie Kreutmair is heading the research project. She is a specialist in internal medicine, hematology, and oncology and moved to Zurich in February 2020 to start carrying out research at the University of Zurich. «Only one month later it all kicked off and the coronavirus arrived almost overnight,» she recalls. Before her move, she worked as a physician at the university hospital in Freiburg im Breisgau. She heard from her former colleagues that the emergency rooms and ICUs were quickly filling up. «People were talking about a shortage of doctors and I wondered whether I wouldn’t be more useful in the hospital than I was here.» But when she and her team were approached about the biomarker project, she was immediately fully committed to it. «I’m pleased that I can put my heart and soul into the research project and do something useful to combat the pandemic.»

Where everything began at the start of 2020.

Other ongoing projects in the research group led by Professor Burkhard Becher, for example concerning blood cancer, were initially put on hold. In the months that followed, the team headed by Stefanie Kreutmair focused entirely on the biomarkers and COVID-19. They looked for partner institutions and held joint discussions to determine the goal of the project. Kreutmair was able to contribute her experience as a physician. Because of the system of rotations at the hospital, she had worked in both the emergency room and the intensive care unit.

It was clear to everyone involved that if they succeeded in developing a simple measurement method for predicting how seriously ill a patient would become, this would represent a major breakthrough. Targeted drug treatments could be started early and transfers to the ICU planned more effectively. The researchers began studying the blood of COVID-19 patients at different stages in the progression of the disease. They compared it with the blood of patients suffering from serious lung infections where the pathogen was not the coronavirus. They analyzed the complete immune response of the patients, described it, and searched for differences. Among other things, they succeeded in identifying a specific type of white blood cell: the biomarker that is characteristic of the immune response to COVID-19.

The process that led to the identification of this biomarker is highly complex and the datasets produced are enormous. As Stefanie Kreutmair explains: «Now the method needs to be validated and it must also undergo testing in large-scale clinical trials. In the future, it could be widely used in clinical practice.»

Burkhard Becher with his team in the break room of the research lab on the Irchel Campus In Zurich (from left to right: Burkhard Becher, Donatella De Feo, Susanne Unger, Stefanie Kreutmair, Nicolás Gonzalo Núñez, Chiara Alberti, Ekaterina Friebel, Sinduya Krishnarajah. Not present: Florian Ingelfinger, Manuel Kauffmann).

Professor Burkhard Becher is a professor at the Institute of Experimental Immunology at the University of Zurich.

UMZH Biomarker Covid-19 Burkard Becher Audio.MP3

«We have succeeded in identifying the targets for treatment»

Dr. Stefanie Kreutmair is a specialist in internal medicine, hematology, and oncology at University Hospital Zurich and is heading the research project at the Institute of Experimental Immunology at the University of Zurich.

Stefanie Kreutmair (Audio file in German)

UMZH Biomarker Covid-19 Stefanie Kreutzmair Audio 2.MP3

«I wanted to contribute to the fight against the pandemic»

Dr. Chiara Alberti is a postdoctoral researcher at the Institute of Experimental Immunology at the University of Zurich.

UMZH Biomarker Covid-19 Chiara Alberti Audio.MP3

«Our results show how important it is to tailor the treatment to each individual patient»

Dr. Nico Nunez is a postdoctoral researcher at the Institute of Experimental Immunology at the University of Zurich.

UMZH Biomarker Covid-19 Nico Nunez Audio.MP3

«We have worked with patient samples from various European countries»

Dr. Susanne Unger is a postdoctoral researcher at the Institute of Experimental Immunology at the University of Zurich.

UMZH Biomarker Covid-19 Susanne Unger Audio.MP3

«We wanted to be able to predict serious cases of COVID-19 from blood samples»

University Hospital Zurich: Coronavirus testing and vaccination
University Children’s Hospital Zurich: Coronavirus testing and COVID-19 vaccination

Biomarkers:
These are measurable parameters of biological processes that can be used for prognostic or diagnostic purposes and therefore function as indicators of diseases, for example. They are characteristic biological features that can be measured objectively and can indicate a normal biological process or a disease in the body. Biomarkers can be cells, genes, gene products, or specific molecules, such as enzymes or hormones.

SARS-CoV-2:
The coronaviruses are a family of viruses that can cause various diseases. Seven different coronaviruses have so far been identified in humans. The current coronavirus is officially known as SARS-CoV-2. The illness caused by a SARS-CoV-2 infection is called COVID-19.

Hematology:
The study of blood and its components.. 


Text and audio: Rebekka Haefeli
Pictures: Frank Brüderli
University of Zurich: Stefanie Kreutmair, Burkhard Becher, Chiara Alberti, Nicolás Gonzalo Núñez, Susanne Unger, Donatella De Feo, Ekaterina Friebel, Sinduya Krishnarajah, Florian Ingelfinger, Manuel Kauffmann
The LOOP Zurich - Medical Research Center: Jens Selige

Serious cases of COVID-19 can be discovered at an early stage. Burkhard Becher and his research team have identified the first biomarker that enables reliable predictions to be made. This provides important evidence for physicians. On the day when a patient comes into hospital, they can find out whether this person will become seriously ill or whether they will suffer from a mild case of the disease and will be able to return home quickly.

Biomarker

COVID-19

Lung infections

SARS-CoV-2

COVID-19:
How a biomarker can predict the progression 

Tragic moments and rays of hope in the ICU

«We have seen many heartbreaking cases. A number of patients spent several months in intensive care.» Philipp Bühler, ICU physician at University Hospital Zurich, also speaks for his colleagues in the medical and care teams when he says: «The tragic cases where we fought for a long time to save the lives of patients, ultimately without success, hit us very hard.» But during the course of the pandemic, there have also been rays of hope. Patients who spent a long time on a ventilator have recovered. The treatments available were continuously refined and improved and have had a positive impact.

The research into the disease, which began very early on, has also helped in this respect. As early as the spring of 2020, critical care doctors and infectiologists at the university hospital began building up a biodatabase of blood samples. They soon started working closely with the research group headed by SNSF Professor Cathérine Gebhard from the University of Zurich. A specialist in gender medicine and cardiology, she is investigating the gender-specific differences in COVID-19 infections. The study has already produced initial results which indicate that to date, women have been at greater risk than men of suffering the long-term effects of COVID-19, i.e. symptoms of long COVID. The gender of the patient therefore has an influence on the development of the long-term consequences. On the other hand, men were more likely to become acutely ill and more frequently died from COVID-19 infections.

The team headed by SNSF Professor Cathérine Gebhard was able to make use of the biodatabase set up by the ICU physicians, who not only took regular blood samples from the patients, but also collected bodily secretions, for example from the lungs, during the patients’ stay in intensive care. The levels of sex and stress hormones in the blood were measured, among other things. Together with personal information about the people affected, such as details of pre-existing conditions, the analysis of the samples allowed a comprehensive picture to be built up. «We made use of synergies and all benefited from the different perspectives of the various disciplines,» explains intensive care physician Philipp Bühler.

As well as gathering patients’ clinical data, the research group headed by the gender medicine specialist Cathérine Gebhard carried out a survey of almost 6000 people who had fallen ill with COVID-19 to varying degrees. Between six and nine months after the acute infection, they answered around 70 questions, including some about the long-term consequences. The questions also covered sociocultural factors, such as the need to carry out household tasks and the resulting stress, which are areas that tend to affect men and women differently.

Gender has an influence on the development of long-term consequences. Cathérine Gebhard's team examines blood samples and measures sex and stress hormones, among other things.

«Typical female roles involve more domestic work and childcare and this apparently presents a risk of developing long COVID symptoms,» says Cathérine Gebhard, summing up the results. «The finding of our study that surprised me most was that pregnancy and other care-related tasks that are perceived positively were more likely to provide protection against long COVID.» How can this knowledge be used in a clinical context? Gebhard and Bühler hope that it will primarily have a preventive effect. The ICU physician explains that, because the risk factors are now known, this will allow patients who are particularly at risk to be identified quickly. «For example, it would be possible to increase the number of diagnostic tests for these patients and monitor them more closely at an early stage.»

Several centers are involved in the study including the University of Zurich, University Hospital Zurich, and the university hospitals in Bern and Basel. In addition, a research group from the Institute of Pharmaceutical Sciences at ETH Zurich and the Paul Scherrer Institute is also taking part under the leadership of Professor Roger Schibli. His team specializes in nuclear medicine and develops radioactive substances for diagnosing diseases. For example, radioactive materials used in imaging processes can make tumors visible.

This technology will also be used in the future to identify COVID-19 patients who are at particular risk and to monitor the progression of the disease. The researchers aim to use radioactive substances to mark the receptors in cells that the coronavirus binds to so that it can penetrate the cells. The results could then be investigated to identify gender differences. The researchers are currently evaluating the basic principles, including with experiments on mice. Schibli says: «No other groups in Switzerland have the same expertise in this area or the same infrastructure as we do.» 

A preprint of this study is available from this link.

Professor Cathérine Gebhard MD is attending physician in the Department of Nuclear Medicine and SNSF Professor of Cardiovascular Gender Medicine and Cardiac Imaging at the University of Zurich.

Cathérine Gebhard (Audio file in German)

UMZH Gender Covid-19 Cathérine Gebhard Audio.MP3

«An interdisciplinary study team is highly important»

Dr. Karl Philipp Bühler is attending physician and deputy head of the intensive care unit at University Hospital Zurich.

Karl Philipp Bühler (Audio file in German)

UMZH Gender Covid-19 Karl Philipp Bühler USZ Audio.MP3

«Stress factors in everyday life increase the risk of long COVID among women»

Professor Roger Schibli is a professor at the Institute of Pharmaceutical Sciences at ETH Zurich.

UMZH Gender Covid-19 Roger Schibli ETH Audio.MP3

«If we can identify the entry route of the virus, we can develop customized medicines» 

Long COVID clinic at University Hospital Zurich
Coronavirus center of the University of Zurich
Coronavirus testing at University Hospital Zurich 
Coronavirus vaccination at University Hospital Zurich

COVID-19 and SARS-CoV-2:
The coronaviruses are a family of viruses that can cause various diseases. Seven different coronaviruses have so far been identified in humans. The current coronavirus is officially known as SARS-CoV-2. The illness caused by a SARS-CoV-2 infection is called COVID-19.

Long COVID:
Some patients only recover very slowly from a COVID-19 infection and experience long-lasting symptoms such as breathing difficulties, coughing, chest pain, and fatigue even after the acute phase of the disease is over. Taken together, these symptoms are known as long COVID. Women are more likely to be affected.

Nuclear medicine:
This involves the development of radioactive substances for the purpose of diagnosing diseases. For example, radioactive materials used in imaging processes can make tumors visible.

Biobank:
A collection of substances, such as bodily fluids and tissue samples, with associated data that are managed in databases.

Gender medicine:
Biological and sociocultural gender has an impact on the presentation, progression, treatment, and diagnosis of diseases. However, gender-specific differences are often ignored in the medical world. This is where gender medicine – a form of medicine that takes into account precisely these differences – comes into play. In one of the first initiatives of its kind in Switzerland, the Faculty of Medicine of the University of Zurich has committed to incorporating gender-specific medicine into research, clinical practice, and teaching. 

Text and audio: Rebekka Haefeli
Pictures: Frank Brüderli
University of Zurich: Cathérine Gebhard
University Hospital Zurich: Karl Philipp Bühler, Cathérine Gebhard
ETH Zurich: Roger Schibli
The LOOP Zurich - Medical Research Center: Jens Selige

Women are at greater risk of suffering from the symptoms of long COVID, while men are more likely to become acutely ill and will more often die from a COVID-19 infection. This was the finding reached by the research team headed by Cathérine Gebhard after evaluating clinical patient data and survey responses from more than 6000 people who suffered from COVID-19 with varying degrees of severity.

Gender medicine

Gender

Long COVID

Biobank

COVID-19: Different disease progression in women and men. Women are at greater risk of suffering from the symptoms of long COVID, while men are more likely to become acutely ill and will more often die from a COVID-19 infection. This was the finding reached by the research team headed by Cathérine Gebhard after evaluating clinical patient data and survey responses from more than 6000 people who suffered from COVID-19 with varying degrees of severity.

COVID-19:
Different disease progression
in women and men

Free, independent movement is synonymous with a good quality of life

What constitutes a good quality of life? The answer that most people would give to this question is the freedom to move about independently. Many patients who have suffered a stroke or have Parkinson’s disease have lost this freedom. They may have difficulty walking or be at severe risk of falling. Moving about is an exhausting and laborious process for them. Stroke specialist and Chief of Service Andreas Luft from the Department of Neurology at University Hospital Zurich (USZ) treats patients of all ages who have had a stroke. «Many patients still find walking very difficult even after long periods of rehabilitation,» explains Professor Luft. «They are too unsteady to walk about outside or move too slowly to be able to cross a road. Many of them are isolated in their own homes and find it almost impossible to even go from one room to another. They lose their jobs and their social lives.»

Parkinson’s sufferers often also have difficulty walking, although the causes of this are different. Professor Luft and his colleague, Parkinson’s specialist Christian Baumann from USZ, are now working with other research partners of UMZH on a project to improve the treatments for both these groups. The project is set to begin in the summer of 2022. Until then, around 50 stroke and Parkinson’s patients will take part in two studies.

StimuLOOP is a perfect example of precision medicine    

The StimuLOOP project aims to revolutionize patients’ prospects and improve their everyday mobility and quality of life. Andreas Luft explains: «We want to personalize the treatment. StimuLOOP is a perfect example of precision medicine.» The first stage of the StimuLOOP project involves measuring patients’ gait. Detailed recordings will be made of participants’ movements in a laboratory. The measurements will include, for example, the angle of the individual joints and the symmetry of the walking movement. The researchers also want to find out how good the patients’ balance is, what forces their legs exert on the ground and what their muscle activity is like. «Combined with measurements taken in patients’ everyday lives by sensors on their arms and legs, this gives us a complete individual picture of their gait,» says Andreas Luft.

Then comes the therapy. During training sessions lasting between one and two hours, the patients are helped to improve the way they walk. They are given direct feedback which can be in visual form, for example a laughing face on a screen when they make a movement correctly. Feedback can also be provided by sensors that vibrate when a patient successfully compensates for a deficit.

In the next step, what the patients have learned is reinforced. This consolidation process takes place during sleep. The brain can be helped to store information by influencing its activity while the person is asleep. During phases of deep sleep, rhythmic sequences of sounds are played through headphones that the stroke patients have been given.

The movements of a study participant are recorded in detail in the gait analysis lab.

Regulating brain activity using your own imagination 

The situation for Parkinson’s patients is somewhat different. Many of them have had electrodes implanted in their brains to help improve their symptoms. These electrodes are used in the process of walking training. During the training sessions, the study participants watch on the computer the nerve signals that are sent by the electrodes. They learn to regulate their brain activity using their own imagination in such a way that their ability to walk improves. Scents are used to consolidate patients’ learning while they sleep. These are administered via a tiny tube in the patient’s nose during daytime training and then again overnight to reinforce the learning effect. The patients spend three consecutive nights in hospital.

The clinical and pure research being carried out in the StimuLOOP project involves University Hospital Zurich, the University of Zurich, and also University Children's Hospital Zurich. Professor Reto Huber from the Department of Developmental Pediatrics was responsible for developing the sleep interventions. ETH Zurich is also making an important contribution to the project in the form of the teams led by Roger Gassert, Professor of Rehabilitation Engineering, and Professor William Taylor from the Institute for Biomechanics. Some of the measurements are carried out in the ETH gait analysis lab. In addition, the team headed by Professor Julia Vogt at ETH will take responsibility for the data management.

As stroke specialist Andreas Luft explains: «My main motivation is to improve patients’ situation. Currently, we cannot offer some of them any further treatment after the rehabilitation has ended. Our goal is to enable them to live an independent life again.»

Professor Andreas Luft MD is Chief of Service at the Department of Neurology of University Hospital Zurich, Head of the Stroke Team at the Stroke Center Zurich, and a professor in the Faculty of Medicine at the University of Zurich.

UMZH StimuLoop Andreas Luft USZ Audio.MP3

«My central goal is to be able to offer patients new forms of therapy»

Virtual reality in the gait analysis lab: The patient on the treadmill receives targeted feedback so that she can learn to normalize her movements.

StimuLoop_Bruederli_1080p_final.mp4

Would you like to take part in the study?
Contact Professor Andreas Luft MD

Stroke and Parkinson’s clinics:
Stroke Center Zurich
Center for Movement Disorders USZ

Ischemic stroke:
A blood vessel in the brain becomes blocked and this more or less cuts off the tissue that is connected to it from the flow of blood. As a result, there is no longer an adequate supply of oxygen and sugar to this part of the brain. If this situation continues for some length of time, the brain cells in this area will die.

Hemorrhagic stroke:
The most common cause of this type of stroke is high blood pressure. The excessive pressure puts strain on the blood vessels over time and can cause them to burst. If this happens in the brain, it causes a brain hemorrhage. The blood leaving the blood vessel applies mechanical pressure to the surrounding tissue and kills off the nerve cells.

Parkinson’s disease:
This is one of the most common chronic medical conditions affecting the nervous system. Around 15’000 people in Switzerland suffer from it, with men being affected slightly more often than women. Most people are over the age of 60 when they are diagnosed. Parkinson’s sufferers have increasing difficulty with everyday movement such as walking, writing, and fine motor skills. Although research into the disease is being carried out all over the world, its cause remains unknown and no cure is available. What many people are unaware of, however, is that new therapies can significantly improve sufferers’ quality of life.

Text and audio: Rebekka Haefeli
Pictures: Frank Brüderli
University of Zurich: Andreas Luft, Reto Huber
University Hospital Zurich: Andreas Luft
University Children’s Hospital Zurich, Department of Developmental Pediatrics: Reto Huber
ETH Zurich: Roger Gassert, William Taylor
The LOOP Zurich - Medical Research Center: Jens Selige

The StimuLOOP project will study around 50 stroke and Parkinson’s patients from the summer of 2022 onward. The aim of the project is to treat the walking difficulties that result from both conditions and to improve the quality of life of the people affected. The research team, headed by Professor Andreas Luft, will measure patients’ gait and provide subsequent training. The patients will then be able to consolidate what they have learned during phases of deep sleep.

Sleep intervention

Parkinson’s

Stroke

Mobility

Improved Mobility for stroke and Parkinson’s patients. The aim of the project is to treat the walking difficulties that result from both conditions and to improve the quality of life of the people affected. The research team, headed by Professor Andreas Luft, will measure patients’ gait and provide subsequent training. The patients will then be able to consolidate what they have learned during phases of deep sleep.

Mobility for stroke and Parkinson’s patients

Augmented reality in the operating theater

Professor Mazda Farshad’s eyes light up when he talks about the first three patients he operated on as part of a clinical trial in the UMZH SURGENT project. Farshad is a spinal specialist and Medical Director of Balgrist University Hospital and a professor in the Faculty of Medicine at the University of Zurich. «All three patients are doing well,» he says, sitting in his office at the hospital and starting up his laptop to demonstrate the new technology in the operating theater using a computer animation. Farshad himself carries out around 300 to 400 spinal operations each year. In total, 1,200 of these operations are performed annually at Balgrist University Hospital.

Before surgery, the three patients he mentioned suffered from spinal degeneration, chronic pain, and sensory disturbances in their legs. Their quality of life had deteriorated and they were sometimes unable to sleep because of the pain. The physicians had already exhausted all the conventional treatments such as painkillers, cortisone injections, physiotherapy, and back training. The final option was an operation. Farshad and his team inserted screws and rods into specific parts of the patients’ spines to brace them and in the process they used a brand-new technology.

Driven by the thirst for knowledge and the stories of suffering

The detailed evaluation of the three interventions has not yet been completed and the SURGENT project is only in its early stages. However, Farshad, who is leading the trial, has great hopes for it: «This is potentially an important evolutionary step in the planning and implementation of surgical interventions,» he says. Professor Mazda Farshad is driven by his thirst for knowledge and by the stories of suffering that he hears from the patients in his clinic. For some people with back pain, he is the first port of call, but others have already been operated on more than a dozen times without providing a lasting cure.

Augmented reality supplements the human senses

The technological world innovation that Farshad is helping to develop in a research network consisting of Balgrist University Hospital, the University of Zurich, University Hospital Zurich and ETH Zurich is based on augmented reality. SURGENT stands for Surgeon Enhancing Technologies. The augmented reality supplements the surgeons’ own senses, giving them abilities that enhance their existing expertise and experience. As Farshad explains: «The goal is to be able to plan and implement the operations on a more individual basis with greater precision and therefore more successfully, which will benefit the patients. We want to improve their quality of life on a long-term basis.»

Professor Mazda Farshad carries out around 300 to 400 spinal operations himself each year. In total, 1,200 of these operations are performed annually at Balgrist University Hospital.

The SURGENT project, a flagship project of «Hochschulmedizin Zurich», is divided into two parts. The first relates to planning surgical interventions on the spine. In the future, patients’ individual characteristics will be given greater emphasis in the planning process. During the preparatory phase, MRI and CT scans and X-rays will be used as before, but the surgeons will also take into consideration other factors which are different for every individual. Wearable sensors will measure the patients’ movement patterns and this data will be included in the operation planning. The angle at which the surgeon inserts screws into the bone will be determined by the patient’s individual anatomy. A range of basic principles have already been identified for this part of the project and an application for a clinical trial will be submitted soon.

The second part of the SURGENT project focuses on the implementation of spinal operations. The clinical trial for this part is already underway. During the operation, the surgeon wears a special augmented reality headset that shows additional visual information. Images that have been individually generated for the patient in question are overlaid on the real-life view of the wound, the tissue, the nerves, or the bones. These images show the surgeons the direction for inserting the screws, for example. Another possible enhancement is the use of audible information that will help the surgeon to carry out the individual steps in the operation in a highly precise and targeted way.

The team led by Mirko Meboldt, Professor of Product Development at ETH Zurich, plays an important role in the research network. His group works on the human-machine interface. «The collaboration is both exciting and challenging,» says Meboldt. Also involved in the development is Philipp Fürnstahl, head of the ROCS team at Balgrist University Hospital. ROCS stands for Research in Orthopedic Computer Science. Fürnstahl is also Professor of Orthopedic Research specializing in the application of computer technologies at the University of Zurich. He explains: «We are combining technology and surgery and we need everyone to be involved. The surgeons contribute their clinical knowledge and the technical experts put into practice the methods that will help the surgeons.»

Collaboration within the UMZH network ensures efficiency

Mazda Farshad emphasizes the fact that the efficiency of the collaboration within the Academic Medicine Zurich (UMZH) network is internationally unique. He does not want to commit to a date when he thinks the SURGENT project might be completed and the technology will become part of standard surgical practice. He simply says: «It could be sooner than we think!»

Professor Mazda Farshad MD is Senior Physician for Spinal Surgery and Orthopedics, Director of the Spine Center at Balgrist University Hospital, and professor in the Faculty of Medicine of the University of Zurich.

UMZH Surgent Mazda Farshad BAL+UZH Audio.MP3

«The technology allows us to personalize our treatments»

Professor Mirko Meboldt is Professor of Product Development and Design at ETH Zurich.

UMZH Surgent Mirko Meboldt ETH Audio.MP3

«Our job is to improve the interaction between human and machine»

Professor Philipp Fürnstahl is Professor of Orthopedic Research specializing in the application of computer technologies and head of the ROCS team at Balgrist University Hospital.

Philipp Fürnstahl (Audio file in German)

UMZH Surgent Philipp Fürnstahl UZH+BAL Audio.MP3

«We are giving the surgeons X-ray vision»

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Highly innovative technology revolutionizes spinal operations

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Bacteria-eaters combat bladder infections

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Precision medicine for children and adults with blood cancer

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COVID-19: Different disease progression in women and men

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