REDDSTAR Dissemination Officer Danielle Nicholson interviewed Martin Ridderstråle: Vice President, Head of Clinic at Steno Diabetes Center in Copenhagen, Denmark to discuss his work and diabetes care in the context of REDDSTAR | Repair of Diabetic Damage by Stromal Cell Administration.
It must be very exciting to be part of a team that is improving patient outcomes and human health for people with diabetes. What sparked your interest in diabetes research?
I started out doing preclinical research on insulin and growth hormone signalling during medical school. I guess one thing led to another.
What do you like best about your role within Steno Diabetes Center?
At Steno we have the privilege of being allowed to focus on what we like and do best: delivering and developing diabetes care. As Head of Clinic I am blessed with colleagues and co-workers with a very high level of “change-literacy”.
In your practice and experience, is there a low perception of the seriousness of diabetes? If so, what can be done to address this better?
Well, this really depends on context. Among patients and relatives of patients I should say no. If there is it might be part of the psychology of having a chronic condition. Among health care professionals (HCPs), again no but here there is lack of knowledge of what to do sometimes, one’s proper role and function, what we call alignment or having a common standard and goal.
What does a typical diabetes education course look like at Steno/ in Denmark?
At Steno, is new, specific information created to educate and inform patients and their carers about experimental medical interventions, including for example the expectations and structure of each clinical study? If so, what is the most effective form for this information to take?
A large proportion of our patients participate in clinical trials, or R&D projects. They are informed via the web. But more importantly, inquire themselves as they visit the clinic and are actively contacted by our CRU (Clinical Research Unit) once they have consented to this.
Interesting question! We just had a meeting with patient advocates yesterday and we will do this more actively in the future. But the field of diabetes research is wide and it does not apply everywhere.
I hear a lot about the pros and cons of medical tourism and get quite a few queries from patients who want to be involved in clinical studies abroad. At Steno, are only local patients recruited for involvement in a clinical study, or do you involve and treat patients from far afield?
We are working on opening up for this possibility. This year we are establishing an “International Clinic”, but this is more directed to international patients living around Copenhagen.
If patients want to be involved in experimental new treatments, what steps would you advise them to take?
Contact us, or any other HCP. There are lists of interest, but also keep actively interested and informed!
In the context of REDDSTAR, it would seem that diabetic wounds respond well to the standard of care offered at the Steno Diabetes Foot clinic, are there common characteristics among those patients and wounds that do not typically respond to what’s currently offered? If so, please explain. In your opinion what can we all be doing better to help offset these outcomes?
Yes, indeed we have good results! But, you know what, apart from applying the most efficient medication, ointment, debridement, off-loading, cask or mix of stem cells, you need to come to treatment before it becomes efficient. What do I mean? Well, at Steno we offer 9 out of 10 patients who contact us because of a foot wound an appointment in our Foot Clinic within 24 hours. But it turns out that the median time to take advantage of that opportunity is 8 days with a spread of 0 to 100 days. Please! Contact us early and let us help you. These issues, as you realise, are much more low-practical than high tech solutions, but no less important.
This is a novel study for Steno in that it involves the topical application of a ‘live cell therapy’, Orbcel-M™. I was fascinated by your presentation at our last meeting in Porto. There are so many variables to work out in order to design the trial protocol for delivery, such as patients demographics, the target size and location of wounds, parameters of acceptable blood glucose or HbA1c, presence/ absence of other complications of diabetes, number of cells administered, numbers of doses of cells, can one patient with multiple wounds be treated for all of them or just one; how many patients to recruit. Is the patients’ current medication regime and compliance track record also factored into consideration?
Specifically to your questions, no and this is a good thing. Even a good thing is not good enough if it does not work in the context where it will be implemented. Meanwhile, patients who participate in studies tend to be very compliant both to current treatment and study protocols.
There are so many steps to be performed to make REDDSTAR’s diabetes wound therapy: creating medical grade cells under perfect conditions in Leiden (LUMC), transporting and storing the live cells for treating the patients, designing/finding the right sterile vessel to mix the Orbcel-M™ with the Excellagen® collagen matrix just before administration- just to name a few. What do you think will be the greatest challenge in the REDDSTAR clinical study?
When it comes to wound healing I believe that the challenge is in the interaction between people. But it is also there you find the rewards. The logistics are minor barriers.
Will patients and/or their carers be contacted by telephone between visits to gauge effects and reaction?
We have a 24-hour telephone service for all of our patients and the HCPs manning the service are informed on on-going trials.
How do patients and their doctors learn that and when a new, novel treatment is available?
At Steno this is secured by our “raison d’être”, i.e. delivering AND developing top diabetes care. In brief for everyone else; the internet!
Do mechanisms exist for medical doctors to find out about newly approved treatment options, or are conferences and publications still the best way to disseminate translational findings?
What happens if a clinical study’s outcomes are not entirely clear?
To my mind they are always “clear” in the scientific sense that they are positive, negative, or not. When they are not, they might need more research.
Once the study data is locked and analysed, how does Steno typically communicate the outcomes of trials?
We use all available communication channels from scientific publications and conferences to patient and participant info meetings.
To wrap up, I see you are a ‘serial academic’: PhD, MD and MBA and Professor. What do you like to do in your free time? (Do you have any?!)
I am fortunate enough to have three interests; family, garden, and biking – I hope that neither of them feels neglected on account on the other! For me, they all contribute to the benefit of the other; much the same as I view my different past experiences contribute to develop new ones.
Thanks very much for your time and insight. We look forward to hearing about the progress of the trial once the information is widely available.
Find out more:
REDDSTAR project website www.reddstar.eu
Follow Martin Ridderstråle on Twitter @MRidderstrale
Steno Diabetes Center films on Vimeo https://vimeo.com/stenodiabetes
REDDSTAR Factsheet on Diabetic wound healing and foot ulcers http://www.reddstar.eu/wp-content/uploads/2014/09/wound-healing.pdf