Meet the Team

1. Could you tell us a little bit about your professional background?

I have a basic education in biochemistry (MSc. Engineering) and medicine (BSc. Medicine). I became docent in Physiological Chemistry 1977, was Lecturer in Physiological Chemistry 1977-1987 and acting Professor of Physiological Chemistry 1987-1996. In 1996 I became a professor in Molecular Toxicology and now I am Section head and research group leader in Pharmacogenetics at the Department of Physiology and Pharmacology, Karolinska Institutet since 2006.

I was a member of The Nobel Assembly at Karolinska Institutet 2008-2018, have about 520 original papers, 35,556 citations and H-index of 95 in WoS/Clarivate and 55,442 citations and H-index of 123 in Google Scholar. I have been assigned “Highly Cited Researcher” for 2014, 2015, 2016 and 2017, 2021, 2022 by Thomson & Reuters/Clarivate. Among the Awards are The Svedberg Prize 1999, The ISSX European Scientific Achievement Award 2003; The Bengt Danielsson Prize, The Swedish Academy of Pharmaceutical Sciences 2008; The John G Warner Pfizer Lectureship in Pharmaceutical Sciences, USA, 2011, BCPT Nordic Prize in Basic and Clinical Pharmacology and Toxicology 2018 and The ISSX RT Williams Scientific Achievement Award 2022.

I have been the main supervisor to a PhD degree for 33 postgraduate students and had postdoctoral training for 35 PhDs. I have a general competence in human genetics, molecular biology, cell biology. Specific competence in pharmacogenomics, drug metabolism, drug induced hepatotoxicity and in vitro models for liver disease. Recently we have published a lot of studies related to better drug psychiatric therapy based on pharmacogenomic knowledge, as summarized in Trends Pharmacol Sci. 2022;43:1055-1069. We are currently making much effort for functional characterization of genetic variants of importance for metabolism of CNS drugs and for identification of the bases for the missing heritability in pharmacogenomics, aimed at improving the genetic prediction of drug metabolism and response in collaboration with e.g., Marin Jukic and Espen Molden.

2. What is your role in PSY-PGx?

I have an advisory role for the project strategy and content with respect to genetic analyses. I am a member of the Management Support Team, a member of the Executive Steering Board, and partner in WP1 where we contribute with knowledge and resources for analyses of new and specific genotypes.

3.  Which aspect of your work do you enjoy the most, or you find particularly fascinating?

As I see it innovation and new thinking. The interpretation of the data and believing the data even though they seem to be wrong. In fact, a couple of our biggest discoveries have started with us discarding the data as due to contamination in the sample or as non-specific interactions. But a re-evaluation of the data based on the fact that you can really believe there is something in it resulted in two of the best findings we made. The genetic analyses are nice to work with since explaining variations which cause alteration in the individual's response to a drug or response is of great benefit. Over the years we have been active in the identification of 15 important genetic variants, which now are used as pharmacogenomic biomarkers, including all variants causing ultrarapid metabolism by CYP2C19 and CYP2D6. Our problem today is to find the origin of the missing heritability in drug metabolism and transport.

4. In an ideal world, how do you envision mental health care to look like?

I would like mental health care to be much more individualized as compared today. One major issue is the identification of the most important genetic variations influencing response and adverse drug reaction in pharmacotherapy of mental disease. Indeed, recently many high-powered studies and meta analyses indicate that pre-emptive genotyping can improve the antidepressant response to drugs by about 30%, based on different dosing to different patients based on the metabolic phenotypes/genotypes. However, there is still a pronounced interindividual variation in the drug metabolism within each defined genotype/phenotype group and the reasons behind must be elucidated before a true individualized drug treatment can be achieved. This includes to find novel haplotypes and novel types of genes influencing the action, transport and metabolism of drugs in psychiatry, but this also requires an intensified education of physicians and regulators. I think that the PSY-PGx project can indeed put forward harmonization and quality in psychiatric pharmacotherapy and it is my hope that the results can lead to more consensus and power of individually based pharmacogenomic assisted treatment of mental health.

1. Could you tell us a little bit about your professional background?

An MD since 1999 and I obtained my PhD in basic science at the Academic Medical Center in Amsterdam in 2005. I was offered a postdoc position in Sweden, but decided to go back to the clinics and spend 2,5 years working as Internal Medicine resident, after that I worked 2 years for the Dutch FDA (CBG) registered as a clinical pharmacologist in 2011 and as psychiatrist at the University medical Center in Amsterdam in 2013. My clinical pharmacology residency was partly at a big cancer hospital where pharmacogenetics was applied in colon carcinoma patient (DPYD gene to guide capecitabine treatment). I took this knowledge and started applying it in psychiatric patients since 2013 at the Erasmus medical Center. It turned out to direct towards more appropriate medicines for individual patients in more appropriate dosages and to reduce side effects in psychopharmaca use. Thereupon I took the initiative to develop a national guideline on implementation of pharmacogenetics in psychiatry, that was authorized by the Dutch Psychiatric Association in 2020. Also, I set-up an outpatient clinic on pharmacogenetics in 2017, which I have been running ever since. In 2018 I started working on what is now the PSY-PGx project, which is basically an international out roll of my outpatient clinic in RCT set-up. I am a member of the Dutch Pharmacogenetics Working Group, hold research positions at Maastricht University and King’s College UK, have teaching positions at Schola Medica and PsyFar to train psychiatrists and GPs in pharmacogenetics and psychopharmacology and see new patients every week at my outpatient clinic Pharmacogenetics in Amsterdam.

2. What is your role in PSY-PGx?

The initiator and Scientific Coordinator of PSY-PGx, Lead of the Data Management Work Package, Lead of the Project Management Work Package.

 3.  Which aspect of your work do you enjoy the most, or you find particularly fascinating?

1. Interaction with other people, especially patients but also other care providers and scientific colleagues.

2. Creating better treatments for patients, as we are doing in the PSY-PGx project. Getting everybody on board and having all actively involved is great. It is very similar to making music in a symphony orchestra, as I have been doing for some 40 years now, where I am part of a bigger creative process where every musician has a role and responsibility but the end result is a joint effort. 

4. In an ideal world, how do you envision mental health care to look like?

1. More prevention online and in communities for people with non-severe mental disorder before they enter the official psychiatric care systems and trying to prevent them getting worse symptoms

2. Finish treatment when possible, always have a clear treatment plan and evaluation with end of treatment (avoiding people getting dependent on care)

3. If this does not work another round of care, but also focussed and for a set period of time

4. Some patients need longer term care, but we should always strive to seek for opportunities to stop doing what is redundant and it should always be centered around the individual person’s needs

5. More emphasis on quality of life and daily activities, help with work, finances etc if necessary

6. More worldwide collaboration to increase knowledge on etiology of psychiatric disorders and enhance treatment options in general. Large data sets and AI can be of help here

7. More personalized treatment plan from the start, including more personalized treatment options e.g. by PGx guided psychopharmaca treatment and the algorithm that we will set-up

8. No mental health stigma and no stigma on psychopharmaca use

For my particular area, my ambition is to incorporate pharmacogenetics into psychopharmaca use in such a way that we reduce the trial-and-error period by reducing side effects and increase effect of our treatment as doctors around the globe for all patients using antidepressants or antipsychotics.

Of note: In general start of psychopharmaca in non-severe psychiatric disorders should not be advocated, but first focus on psycho-education, bibliography, activation, life style, physical exercise, financial problems etc.