In October 2017 Prof. dr. Louis Vermeulen became
the youngest professor ever at the AMC. He received a lot of media attention from outlets such as Medisch Contact, RTL and many others. Meanwhile,
he is still in training to become a specialist in internal medicine. We were keen in interviewing the just 33-year-old professor about his success in research, his view on the medical curriculum and the future of medicine in general. But of course, we had to ask one question first:
How does it feel to be professor but still in training?
I do not feel any different since my new appointment and I collaborate with all my colleagues just the same. It is true that I know quite a lot about one particular area in molecular medicine, but there are so many more areas, and it is a privilege to be educated by experts in those fields.
Did you always plan to become a doctor or researcher and what interested you during your studies? Can you elaborate on why you wanted to do both?
I have always been interested in science and medicine, but the field I chose was also partly due to coincidence. During the first year of my studies I tried to combine physics and medicine and although that did not work out too well, I knew I was fascinated by science just as much as clinical medicine. I vividly remember Marcel Levi standing in front of the lecture hall asking who of us were interested in research upon which I decided send him an e-mail. Quite naively, I wrote that both cancer and HIV interested me. Hereupon he referred me to Prof. dr. Richel, head of medical oncology back then. As you might understand, I had no knowledge
of the research group and specific topics they were into, it could just as well have been someone else. Then I might have been into HIV research right now! I do believe however, that virtually all fields of research become more interesting and fun as you delve deeper and learn more on specific topics and so they motivate you to continue your efforts. Right now, I am very pleased that oncology was my choice all those years ago.
Do you remember any life experiences or role models during your studies that inspired you to pursue your current goals in your clinical career and in research?
I have never had any specific role model, but I have always been inspired when I met very skilled researchers or skilled clinicians as they always made the most difficult tasks seem easy. Of course, there are many such people, so I would say I have been inspired by lots of them. I do believe, however, that being too much in awe of any professor or clinician only limits you as no one is perfect, and no one was born with all their skill or knowledge. Understanding that these people have had to learn and improve is ultimately what makes you more critical of how you can improve yourself without underestimating your talents.
What is your area of expertise? Why does this specialism or field of study interest you?
My field of interest is the molecular oncology, specifically the characterization and treatment of colon cancer. My research ranges from stem cells to classification of different molecular subtypes within colon cancer for personalized treatment. This field interests me due to its central role within oncology. Despite the impression that molecular oncology might be a subdivision or a rather small field within cancer medicine, I believe we are truly at the forefront of oncology and our studies influence therapies and diagnostics across the field. In addition, it motivates me that we are privileged to help answer societal dilemmas such as the issues on cancer prevention and the rising costs of drugs.
What are your current research interests?
Within my research I mainly focus on two matters as I mentioned, cancer stem cells and cancer heterogeneity. In stem cells we are mainly interested in the process that turns healthy stem cells into cancer stem cells and which molecular signals affect their development towards such cells and towards ‘regular’, differentiated cancer cells. When these cells are fully differentiated they become sensitive to therapy, so we want to influence this process and find out which factors could be enhanced or inhibited to improve current therapies. As for cancer heterogeneity, in my research group we are very focused on classifying tumors in groups to be able to predict treatment response despite all the patient differences. To do so, we have generated gene expression profiles of many colon cancers. Using a computer algorithm, these profiles were then clustered into different groups. These subtypes we have now studied in detail to determine why these groups are different, genetically, functionally and why these cancers respond differentially to therapies. We now aim to improve therapies and develop biomarkers to use the subtype classification in clinical practice.
Prof. dr. L. Vermeulen
What is the scientific finding or publication you are most proud of?
That is a difficult question as your best publication should always be yet to come! Also, it depends how you classify this, as certain publications were a huge effort for me but have found relatively little interest, while others have become hugely cited while their efforts have been less. I am however very proud of the subtypes that we have been able to find within colon cancer as I mentioned earlier. This is a finding that is often cited and I am convinced that this strategy is becoming more relevant in clinical practice as we speak. Secondly, I am proud that we have been able to discover stem cells within tumors, and that we have shown how they are heavily influenced by the tumor environment. It was often believed that these stem cells were so capable by themselves, but we have been able to show how these cells were just as much dependent upon their microenvironment.
What is your opinion on the usefulness of fundamental versus clinical research?
I believe this debate is important due to the attention and funding towards ever more clinically useful research. In doing so we are in fact limiting ourselves in the long-term. Although clinical research is of course more relevant in the shortterm, it should be noted that one cannot do without the other and that there is no actual ‘versus’ or rivalry between fundamental and clinical research. It is much more a continuous spectrum and you will never meet a fundamental researcher who is
simply interested in doing major fundamental discoveries without implementing their discovery in practice. The challenge is this major step to implementation, which has become rare; however once you succeed you will be set for the rest of your career. We should therefore judge fundamental research and clinical research in different terms as the long-term output of fundamental research is much more difficult to assess.
If you had to choose either career what would it be: Clinical care or research?
That is an absurd question! I would be unable to choose either because I believe that, especially in oncology, research and clinical care are connected. To me, it would be like asking a chef to choose between desserts or main dishes while both are required for a proper meal.
What would you advise to students interested in doing research abroad?
I think there are multiple ways to work out something since there are often research groups here with contacts all over the world. When you are interested you could just inquire and come across the opportunity to learn new techniques elsewhere during internships and implement them here at the VUmc or AMC. I contacted a research group after I had attained a fund from the KWF, which gave me a lot of freedom in deciding what I wanted to study while I stayed in Cambridge. Usually, you would need to apply for a vacancy but by attaining your own funds you are in fact your own boss. There are multiple such funds right now so my best recommendation would be to acquire such funding if you would want to study elsewhere, especially if you would like to study at top research institutes, where vacancies are in high demand.
What is your opinion on publication pressure and how do you believe the necessity of research for getting into residency programs affects the value of the research published?
I believe this is a very difficult question, multiple questions actually. I absolutely do not believe that a PhD is mandatory to succeed in clinical care, nor do I believe that being involved in research is required to be a good medical specialist. Instead it should be done by students who enjoy research or are gifted in research, while others can excel at their own talents; so that teams and specialties are well-rounded.
As for the publication pressure, I think this is largely intrinsic to research since writing articles and publishing on your findings is a main task for researchers. A good example is how the IAS, the Institute for Advanced Study, was founded in Princeton almost a century ago with the very top researchers around the globe who were given unlimited funds but went on to achieve little. To me this proves how even the best researchers need a challenge to perform. Of course, too much pressure is not the answer! I would advocate a limited number of high-quality publications for researchers rather than a large volume. Also, we need to rethink how we should value the contributions of individuals in large research teams.
What do you think of current developments in the medical curriculum such as the sidetracks from biomedical sciences to medicine, the combined bachelors of medicine and biomedicine and the general intention of such developments to bring together clinical medicine and research?
I believe that these developments are very useful as these subjects very much complement one another. For students interested in both these subjects such combinations present them with a great opportunity. Meanwhile, I also believe that if you are interested in subjects such as molecular oncology that these subjects are not mandatory to study a master. I have never followed such courses and have learned such skills on the job. I would never discourage any student going into research because they lack such experiences if they are motivated. Similarly, I believe that specializing on a certain topic too early is a waste, as you will lack different, more creative, views and knowledge, which might allow you to standout in a research field. Studying immunology before going into oncology for example, despite the relatively small step, already gives many new insights that might come useful sooner or later.
What do you think oncology will look like in 10 years? Will cancer be a curable disease?
I believe that the biggest changes in 10 years have already been set in motion. The biggest development will be in how much smarter we become in the integration of all the -omics fields (blood tests, imaging, genetics). After all, we are already able to generate huge databases of data, which are now difficult to analyze and integrate per patient. In the future smarter algorithms will be able to integrate such information to decide therapeutic combination strategies, not just single therapies, during treatment. In doing so we will be able to recognize resistant cancer cell clones much faster, by blood samples or imaging. Such information might even allow us to keep certain cell lines or clones alive and in competition with other clones to direct therapy even more meticulously and to indeed make cancer a more chronic disease.
2002 Graduation high school
2010 PhD thesis: cancer stem cells in colon cancer
2011 Graduation medicine, AMC
2011 Post-doc AMC / Cambridge University (Wolfson College)
2014 Principal investigator, AMC
2015 AIOS (internist-oncologist), AMC
2017 Professor of molecular oncology (colorectal cancer), AMC
Current position: internal medicine resident at AMC.