Interview with Prof Hans Kollberg
Years ago, while working in Germany, I met Emeritus Professor Hans Kollberg, a globe-trotting Swedish Paediatrician who works at University Hospital, Uppsala. I know him as a knowledgeable and approachable physician who is primarily focused on his patients, but he is also a pioneer.

Though chastised by some colleagues for 'torturing his patients" he established a marathon-running club for people with Cystic Fibrosis in Sweden. This arose from his earlier work in the USA with a martial arts instructor who believed his sport would offer optimal training for CF sufferers. Back in Sweden, he managed to recruit Grete Waitz, Norway's multi-world record marathon record holder, as patron for the CF Marathon Club. The practical experience is that sport helps maintain lung function and builds reserves.

He has also written a CF cook book. This arose from concerns that many CF sufferers turn to junk food and chocolate as a way of maintaining weight. However, these addictive foods also make people with CF more prone to diabetes and other auto-immune conditions. His book emphasized the role of fats as an energy source instead of carbs.

More recently, he has pioneered a unique egg-based IgY-antibody gargle to prevent Pseudomonas aeruginosa infections in people with CF. I had the opportunity to meet him again when he attended a European Cystic Fibrosis Society Conference in Dublin in 2012.

Peter Conry (PC): Professor Kollberg, your particular area of expertise is Cystic Fibrosis. But you've done many things in different countries over the course of your career. You’ve also been a great innovator in CF care. Do you think the variety helped you?
Hans Kollberg (HK): Yes, indeed. In 1966 when I took a residency for a year in USA, there was no real treatment for Cystic fibrosis (CF) in Sweden. I learned about the up-to-date treatment for CF in the US during that year with Dr Herman Lipow as teacher. He had learned his skill and knowledge from the legendary Dr. Harry Shwachman.

The ideas about physical activity as therapy for CF-patients were mainly a result of thorough discussions with my Norwegian colleagues, Dag Skyberg and Johan Stanghelle.

My half year at the Pasteur Institute in Paris working together with Dr Peter Hösli gave me insight into research about the basic defect in CF. My three years in Kuwait helped me to think in new ways about both teaching and caring for patients. I also learned that CF is probably as common in Arabic populations as in Caucasians. Finally, my cooperation with Tromsö, Norway, in telemedicine helped me to understand that telemedicine is a good help for consultation between CF-doctors and those CF-patients who have a long distance to travel in order to get help from specialists in the disease.

PC: In Ireland, we have reputedly the highest incidence of CF in the world. Is it common in Sweden?
HK: The incidence in Ireland is really one of the highest in the world - around 1 in 800 newborns. In Sweden the incidence is around 1 in 4500 newborns, which is about the same as in most European countries and in Caucasians in the USA.

PC: For years, people with CF in Ireland have been advocating separate treatment units for CF sufferers. These are in place in Dublin, at least. Is there any alternative to separatism? I ask this as a friend with CF told me at the time that liked the facilities but hated the isolation.
HK: In Sweden we started with special CF-centres in 1968 with the first centre in my hometown - Uppsala. I do believe that CF-patients need to visit a specialised centre at least once a year and that they need to have a check-up every three months. At these check-ups they should have a chance to meet a doctor, a nurse, a physical therapist and often also a nutritionist and sometimes also a social worker or a psychologist.

PC: Your practical and holistic view of healthcare is striking. You advocate therapy in the form of diet and exercise for CF sufferers rather than medical treatment alone. You’ve even written a cook book for CF. So, firstly, do diet and exercise make a difference? And secondly, as CF automatically impacts on the ability to freely eat and exercise, is it practical?

HK: Getting rid of the thick sputum that CF-patients have is the single most important part of CF-therapy. The best ways to do this are breathing exercises and regular training to get a healthy body that can do all kinds of activities to help the sputum come up – running, jumping, swimming, horse riding, playing soccer or other ball games. This takes time - but it is a must! The patients can choose whichever activity they like best. The alternative of passively getting percussions and vibrations over the chest walls takes more time and is not as efficient as activity. In fact, most patients enjoy the active type of treatment much better than passivity.

It is very good to have a physiotherapist available to regularly help the patients with activity and exercise.

To your second question, diet is also very important. CF-patients have difficulties to absorb all the food that they take in - even if the extra pancreatic enzymes that they take with every meal now are much better than they were some years ago. The patients need to eat a diet with lots of calories - i.e. contains a lot of fat. In addition, CF-patients need more vitamins, especially those that are fat-soluble -A, D, E and K. To ensure that the CF-patients get enough calories and vitamins, it is good to have regular help from a dietician.

PC: You are currently pioneering a therapy so simple, it is revolutionary. You are using antibodies from hen’s eggs to protect CF sufferers from some of the most common, debilitating and, for sufferers, annoying infections. Can you tell me a bit more about it?

HK: CF-patients have thick sputum which is difficult to get out of the lungs. This sputum catches bacteria, which give rise to lung infections. The most common bacteria in CF-patients is called Pseudomonas aeruginosa. CF-patients who have got infections with these bacteria deteriorate quickly and these infections are the most common cause of death for CF-patients.

My approach to this problem is to give the patients passive protection by administration of antibodies. We vaccinate hens with the bacteria (Pseudomonas aeruginosa). The hens then produce antibodies against these bacteria, and the hens pass the antibodies through to the egg yolk. From the egg yolk we then make a watery solution with which the patients gargle every night. The solution contains nothing except egg-yolk and water and is completely free from any side effects except for those who are allergic to eggs. It is called Anti-pseudomonas IgY.

Our studies have shown that CF-patients who take Anti-pseudomonas IgY get statistically significantly longer times between infections with pseudomonas infections, and they need much less antibiotics.

PC: I’ve looked at traditional medicine in Ireland, and in earlier centuries milk was used as the carrier for most herbal medicines. When you think about it, (unpasteurized) milk contained antibodies as well as billions of probiotic bacteria. Is there any tradition of medical treatment with raw eggs in Sweden?
HK: No, we do not have any such tradition. But there was a traditional belief (and possibly tradition) among peasants in earlier times to give ‘horses eggs’ to cure diarrhoea. You can guess what that means. This is a form of probiotic treatment. Milk itself contains some antibodies, especially the first milk after the cow has delivered a calf.

PC: How do you standardize and quality-control the antibody preparations? Do they have a short shelf-life, like eggs?
HK: The eggs come from a farm that is controlled for any disease by the Swedish Agriculture Department, the Swedish Medical Products agency and the American FDA. The product is controlled for activity, for microbial contamination and for shelf-life. At present we have 1 year shelf-life for the product when it is stored in a freezer (-18◦ C)

PC: Pharmacoeconomics – which effectively means rationing – has become a key component of healthcare. In the UK, there is NICE, and in Ireland we have a Pharmaceconomic Unit in St. James’s Hospital which advises on State reimbursement schemes. Have you done any estimates of the pharmaco-economic benefits of using IgY antibodies?

HK: The Swedish control-centre for pricing medical drugs has given us the right to sell it for around 40€ per dose (i.e. per day). This cost is about the same as if you treat the patient with antibiotics. The economic benefits are that the patients who are treated with Anti-pseudomonas IgY need far fewer days of hospitalization.

P: Do you think the fact that you are using a (albeit pharmaceutically standardized) food for treatment means that it is more difficult to gain acceptance?
No. I think that the main problem for me is to find a company that is ready to invest in all the new equipment that is needed to start a completely new way of making drugs.

P: Looking beyond CF patients, who are clearly dear to your heart, do you think this type of treatment is applicable in other fields?
HK: Yes, indeed. I have tried it on children with leukaemia, who are immunologically depressed, to prevent infection with candida albicans (a fungus) with good results. And also on newborns who got diarrhoea because of Enterobacter. We had an endemic outbreak in our hospital which was stopped with Anti-enterobacter IgY. There are many animal studies showing that IgY can cure Salmonella, rotavirus, and other infections in the gastro-intestinal tract. In fact, I think that specific IgY can cure all infections in the gastro-intestinal tract, if the hens have been vaccinated with the proper microbes.

P: Thank you.

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