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About the Institute

Profile of Maarten Egeler

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Dr. Maarten Egeler

 By: Hannah Sunderani

Dr. Maarten Egeler MD, PhD

  • Section Head, Stem Cell Transplantation, Haematology/Oncology
  • Senior Associate Scientist, Developmental & Stem Cell Biology
  • Professor, Paediatrics, University of Toronto

1. Where are you from?/Where did you study?
I was born in the Netherlands and grew up there, but I was always looking over the borders. From early on I was interested in moving to Canada, Australia or New Zealand because they are spacious and rich with nature. I graduated in 1985 from the University of Leiden Medical School, The Netherlands. Medical school in the Netherlands is different than in Canada. It is a seven year education that requires five years of studying theory followed by a two year internship. Following this I decided that I wanted to be a paediatrician, and in the Netherlands this requires five more years of studying Paediatrics; and so this is what I did at the University of Amsterdam. Subsequently I did my research fellowship in histiocytoses funded by the Royal Dutch Academy of Arts and Sciences at the University of Minnesota in the U.S., well known for their hematopoietic stem cell transplantation program. While I was there I was awarded the best fellow research award, which the division considered a great accomplishment.

When my training was done I joined the Division of Pediatric Hematology and Oncology at the Erasmus University Rotterdam in The Netherlands. After that I moved to Canada to be an Associate Professor of Oncology and Pediatrics at the Southern Alberta Children's Cancer Program at the University of Calgary. I had caught the North American fever whilst undergoing my fellowship in Minnesota and so I was very excited to move to Canada for this opportunity.

After three years in Calgary, I was appointed Director of the Division of Pediatric Immunology, Hematology, Oncology, Bone Marrow Transplantation and Auto-immune disease in 2000 to the Leiden University Medical Center, which took me back to the Netherlands. This was both a good career move and a good personal move for me at the time as my children were young and I wanted to be closer to them because they are my world. They have since grown up and I returned to Canada to take on my current role at SickKids. I really enjoy working at SickKids because I am able to work directly with patients, families and staff. 

2. What are you researching right now?
I have three major topics of interest that I am currently researching.

My main interest and expertise lies in the field of hematopoietic stem cell transplantation (HSCT). HSCT is transplantation of stem cells that is performed on patients with certain cancers of the blood or bone marrow such as high risk or relapsing leukemia. (Originally it was called bone marrow transplantation as the bone marrow was the only source of collecting stem cells). HSCT can also be a form of treatment for certain patients with immune deficiencies, bone marrow failure, inborn errors of metabolism and in certain instances, for patients with haemoglobinopathies. Performing HSCT can lead to debilitating side-effects including something called Graft-versus-Host-Disease (GvHD). In GvHD the new cells of the donor (the graft) do not recognize the patient (the host) as their own and start to attack the patient’s organs, like skin, gut, liver and lungs. This is truly a devastating side effect and I often refer to it as an immunologic war in the body. In the lab I look specifically at GvHD in experimental models. Our goal is to explore the pathophysiology and find therapies to heal our experimental models from GvHD. I started this research over a year ago. I am currently conducting the research in Dr. Armand Keating’s lab at Princess Margaret Hospital with my own small research group. However, when the new Peter Gilgan Centre for Research and Learning opens I will have my own lab. Currently I am working hard to make stem cell transplantation a more popular field of research in Toronto because it is not as big of a research focus here as it is in the Netherlands. Stem cell research in Toronto is among the best in the world, now it is up to us to make the connections to stem cell transplantation research. I am looking forward to having our own research lab and to attract interested scientists to help move our HSCT research forward.

My second research interest is dedicated to the immunologic aspect of dendritic cells particularly in relation to Langerhans cell histiocytoses (LCH), which is a rare disease that occurs when Langerhans cells accumulate and expand abnormally. Langerhans cells are a sort of white blood cell that helps the body in fighting infections. These dendritic cells are normally present in tissues, such as the skin, and have more or less direct contact with the external environment. Langerhans cells are the gatekeepers of our immune system. In simple terms; when you get something on your skin the Langerhans cells pick it up and bring it to your lymph nodes where other cells will destroy it. However, when the Langerhans cells start to grow abnormally, often in organs where they should not be such as the bone, one gets a disease called Langerhans cell histiocytosis. I am working in the lab to find out what triggers LCH and how we can improve the treatment of this disease. I have written many articles and contributed to several book chapters about this disease to move research forward. Together with Dr. Sheila Weitzman, who also works at SickKids, we edited a book entitled, Histiocytic Disorders of Children and Adults. Compared to HSCT the LCH-field is a much smaller field of research and subsequently there are less physicians and scientist in the world who are studying it. Some of the top physicians specializing in this disease are at SickKids, and I have worked with many of them on LCH before joining the hospital.

My third research interest is in the field of biology, pathophysiology and immunotherapy of bone tumours. Generally, tumour research is a major research focus for the genetics field. However, I believe that whilst genetics plays a vital role in understanding the cause of tumours, our immunological background also plays an important role in whether a patient can be cured of the tumour. I am interested in looking at why some patients respond well to chemotherapy treatment while others do not; and how the immunological background of the tumour affects the patient’s ability to respond to treatment.

3. Who is your all-time favourite scientist and why?
This is a very difficult question to answer, but if I had to pick one scientist I would say that it is Dr. Ralph Steinman. He was a great friend and mentor to me and his research had a profound impact on my research interests.

Dr. Steinman was the first person to describe dendritic cells in 1973, and he was awarded a Nobel Prize for this finding in 2011. As I discussed earlier, dendritic cells are the gate keepers of our immune system, which appear in the skin as Langerhans cells. When they detect something on the skin they migrate to your lymph nodes to destroy it. Steinman’s finding has profoundly influenced the development of medicine in the last decade.

Dr. Steinman and I became friends at a yearly think-tank that I host in Athens, Greece on Langerhans cell histiocytosisn (LCH). For the past twenty years I’ve organized this yearly think-tank to discuss different research topics and ideas focusing on LCH. One year, I invited Steinman to discuss the topic of the development of dendritic cells and whether there might be a dysfunction in their development leading to LCH. At the think-tank we asked him if he wanted to join our steering committee; fortunately he said yes and we became good friends. We would talk about our research interests and how to improve my research in stem cell transplantation, histiocytosis and bone tumours with the dendritic cell. We had wonderful discussions and he often advised me on my research papers with the goal to get them accepted into excellent journals.

Sadly, Steinman died of cancer just two days before he was recognized by the Nobel Committee for his dendritic cell research and was awarded a Nobel Prize. I still hold him very dear to my heart, and I think about his influence often. Not only was he a great researcher, but he was always willing to listen to others’ research interests and give his advice and insight. He had valuable characteristics that I admire in a scientist. Although I really work on a much lower level and combine research with a lot of clinical care, I try to practice these same qualities with my students, who are the upcoming generation of researchers.

4. What in your opinion is the most important scientific breakthrough and why?
One of the most important scientific breakthroughs in my opinion was the discovery of HLA-typing (Human Leukocyte Antigen), because it was so very significant to my field of research in understanding bone marrow transplantation. In our bone marrow and blood system, we have red blood cells, platelets and white blood cells. HLA-typing is found in our white blood-cells and it plays a major role in determining how our bodies will accept or reject a bone marrow transplant. The ideal bone marrow transplant will be between a donor and a recipient that have a matching HLA type, like a fully matched brother or sister who have inherited the same HLA-antigens from their mother and father. In 25 per cent of siblings this is the case; and no mismatch means there is a very small chance for developing GvHD.

If we think about red blood cells we know that a person can be one of four types; O positive, A positive, B positive or AB positive; people can also be all these types but with a negative rhesus factor. When a person needs a blood transfusion the recipient requires a donor of the same blood type. The same is more or less true for white blood cells due to HLA-typing, (although, HLA typing is much more complicated because there are over 10,000 different types).

This discovery of HLA typing was discovered by Professor Dr. Jon van Rood at my former institute, the Leiden University Medical Center in The Netherlands. With his discovery he proved that matching the HLA-type of the donor to recipient and it was the initiation of HSCT. This finding extended our ability to give successful bone marrow transplants. When the HLA-types match, the body is more likely to accept the bone marrow transplant. When the HLA-types do not match then the recipient is at risk of developing the earlier mentioned GvHD. This is because the recipient of the transplant’s immune system will not recognize the host as their own and it will start to attack. The better the HLA-type match, the less chance that the recipient will develop this complication.

5. What are your major interests outside the lab?
Apart from working in the lab I am also the Chair of the Cell Therapy Committee within the North American Pediatric Blood and Marrow Transplantation Consortium (PBMTC). Cell therapy is a very specific form of treatment with HSCT as a platform. My role as the Chair is to find ways to get the very specialized treatment to every patient that needs it. Our goal is to get new studies out of the lab and into day-to-day care.

Outside of my work I like to spend time with my three sons and my partner Sonja. My sons are grown up now and they live in Amsterdam. The eldest is working towards becoming a lawyer, my second child is pursuing a career in diplomacy and my third child is still unsure of what the future holds. When we are together we like to hang out and make music. Both my eldest son and my youngest play the piano and the guitar, and they are nice singers. My middle child prefers drama and he is active in student theatre. If there is a piano around my boys cannot resist sitting behind it to play and I really enjoy listening to them. I also like to sing with them. My eldest son and I once performed for Prime Minister Balkenende of the Netherlands for a fundraiser. We played Golden Slumbers by The Beatles; he was behind the piano and I sang the lyrics. Although, I’d rather give a lecture to 1,000 people than to ever sing for an audience again!

I am very passionate about the arts and I would love to be able to play the piano or guitar. I feel that this is something I missed out on growing up because I came from background where sports were deemed the most important hobby. Sports played a major role in my life growing up; I was a fanatic mountaineer and I spent every summer in the beautiful Alps. During the school year I played rugby. However, I think of myself as a softer person and I wish I that had spent more of my time involved in the arts of music. Regardless, I still engage in artistic expression through music. I enjoy listening to The Beatles, Pink Floyd, Queen, the Red Hot Chili Peppers and Coldplay. Last year my youngest son and I enjoyed a Coldplay performance at the Air Canada Centre. Love of my Life, by Freddy Mercury and Queen is still one of my favourite songs, and it gives me chills to listen to. The live version is spectacular. I relate to this song because I see my work as the love of my life. I also enjoy going to the opera. The Spanish opera Carmen, performed by the Teatro Colon in Beunos Aires, Argentina, is still one of my favourites. I would highly recommend going if you ever get the chance to see it. It is absolutely breath taking.

6. Why science?
I enjoy contributing to the vision of improving childhood cancer. My research helps to improve treatment regimes and benefit children with cancer and that is a wonderful feeling. I am very passionate about my work and it runs through my veins. I love to study, write, teach and dream about the pathophysiology and immunology of childhood cancer because this is how we can improve outcomes. You could call me up in the middle of the night to ask about hematopoietic stem cell transplantation (HSCT), or dendritic cell biology and I could talk for hours. Yes, I am a little crazy!

We are doing well in the field of research for childhood cancer, but there is still a long way to go. I am particularly interested in the children that don’t respond to the common treatment methods because this is the key to advancements in the field. I am constantly trying to find ways to improve and to help in our conquest to end childhood cancer. If I can contribute to this then I will retire a very happy person.

7. Why SickKids?
When I think of SickKids I think, ‘global impact’. The Netherlands is very small, and I wanted to work in a place where I could make a bigger impact in childhood cancer on a larger scale. Here we perform paediatric HSCT for the whole of Ontario and for Newfoundland and Nova Scotia. In fact, SickKids is responsible for 50 per cent of all HSCT in children performed in Canada. I am hoping that the volume of patients and translational research opportunities will help me and my team to move our research field forward and open doors to develop the next breakthroughs and the next protocols. SickKids is supporting me in this mission as best they can, and I am very thankful for that.

8. What is the most controversial question in your field right now?
The most controversial question in my field of research is how to cope with the side-effects of HSCT. As discussed earlier, there are major side-effects to treating patients through this transplantation. Our goal with this process is to wipe out the cancer cells in the bone marrow, but as a result we also wipe out cells that the body requires to remain healthy. This includes things like red blood cells, which provides the body with oxygen; platelets, which are cells that are needed to form blood clots to stop wounds from bleeding; and white blood cells, which help to fight infection. Fortunately we can replenish the body with blood cells and platelets through transfusions, but we cannot supply the body with new white blood cells. When we have low white blood cell count then our body is much more prone to infection. Unfortunately, there is a long period of time that the patient’s immunity is compromised and we sometimes lose patients in that period due to bacterial, viral and/or fungal infections.

My field is currently working on research in cell therapy to reduce the number of side-effects the patient experiences post-transplant. It is a research topic I am very interested in. If we can find ways to help boost the immune system and restore the immune system faster, or if we can provide ways to help the body’s immune system to target cancer cells then this could have major benefits. We all make cancer cells every day at every moment, but our immune system often copes with that. One of the cells responsible for this coping is the Natural Killer Cells (NK cells). Boosting the NK cells following HSCT to further improve the outcome by diminishing relapse is an exciting and innovative idea. This research is currently being done in the Netherlands and here in North America. We are looking into this as well at SickKids. It is still in its early stages, but this kind of research looks very promising. At the moment only a handful of patients are being treated with cell therapies like these. This kind of research indeed is keeping me busy.

9. What are you reading right now?
I like to read page turners when I am not reading for work. I enjoy books about crime, particularly those written by Baldacci, Grisham and Conelly. I also really like to watch crime shows on TV, like NCIS. I find crime mysteries very similar to my work. We are both trying to solve the mystery. In my field of cancer research I am looking for the reason behind the cancer, and how I can solve it. I am trying to put the clues together and find the missing pieces to the puzzle. These types of books and movies allow my brain to relax a little, and it helps to recharge my batteries. My partner Sonja is a detective with the police on major crimes, and she teases me when I watch crime shows because crimes can’t get solved in one hour.

10. If you could give one piece of advice to someone considering a research career, what would it be?
Being a scientist is a way of life, so ask yourself if this is something you are passionate about. It is an amazing feeling to know that your contribution can help benefit patients around the world and that you are raising the bar for treating certain diseases. Working in paediatric oncology and transplantation research is a wonderful field to be a part of because we are a small group, which makes us closely-knit and supportive of one another. In essence, we are all working for the same goal.

On the other hand, there is a lot of blood, sweat and tears in research and you need to be prepared for this. It is an extremely competitive field and it can be difficult to get your research papers accepted and your grant proposals awarded. You must be willing to carry on in times of failure. Research is also a never ending process; we are always looking ahead to the next problem, and we are always asking new questions. Solving one problem often generates at least three new questions. As a result, there isn’t always a lot of time for rest. If you are motivated by this type of lifestyle then being a researcher is a good career path. The biggest advice I can give is to follow your heart, if your passion lies in research then best of luck to you.

11. What does the Peter Gilgan Centre for Research and Learning mean to you?
I am very excited to work in the Peter Gilgan Centre for Research and Learning (PGCRL). I think the new PGCRL makes a tremendous statement to the world that SickKids recognizes the significance of paediatric research to improving child health outcomes worldwide. I also think it will help to bring the best and brightest future researchers to our front doors, who are eager to contribute to our vision of improving child health worldwide.   

September 2013