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The missing ingredient

Hundreds of tests on animals were soon completed with the new substance and with the same successful results. As news of their success spread, the pair realized that they lacked the right contacts to take their work to the next stage. All that changed one afternoon when the phone in the lab wouldn’t stop ringing. It was Rolf Zetterström, head of pediatrics at Sankt Göran’s Hospital in Stockholm.

“Rolf said that he’d heard great things about our tests, and that that day a baby had been born, extremely prematurely, who probably wouldn’t survive. Did we have some surfactant that he could use?”

Thanks to both parents and doctors granting their permission, and that it was a life or death situation, the substance could be used. But having conducted so many tests, their test-tubes were empty. They were also worried for another reason: what would happen if the baby didn’t make it?

“We looked at each other and realized that we could be accused of misconduct if the baby died. But at the same time we knew we had recorded some great results, and how careful we’d been with our documentation. So there was just one question left: would we make it in time?”

The first baby

Years later, in 2016, Curstedt was nominated for a Lifetime Achievement Award from the European Patent Office (EPO). Fellow nominees include Nobel laureates and leading innovators from all over the world.

Curstedt’s nomination was big news in Sweden, and the Curosurf story spread across the country. The following morning, messages of congratulation flooded Curstedt’s inbox. But there was one email that stood out. And it started with the sentence: “I was the first one!” The sender was one Patrik Svensson, born 1983.

“And when we counted back to that date, it was right. Patrik was the very first baby to receive our surfactant.”

That time, in 1983, they managed to purify just enough material to give the increasingly blue-looking boy a dose. And the results were extraordinary. Within an hour or so the boy’s normal colour had started to return and he could breathe unaided. “It was a dramatic moment. We didn’t manage to document it in any way at the time, but when I met Patrik later he told me what his parents had told him about that day.”

Clinical trials of the substance were launched in the 1980s. A dozen clinics throughout Europe participated. The study soon proved so successful that it was discontinued early to allow more patients to benefit from the prospective drug.

But when Curstedt and Rob- ertson approached Pharmacia to take the drug to market, they were turned down. The drug’s potential was considered too insignificant for the drug giant – an estimated SEK 200 million a year.

“We were pretty disappointed. Neither of us wanted to start our own business.”

Robertson was in contact with a doctor in Parma in Italy who heard about our difficulties. The doctor knew two brothers who ran a small drugs company named Chiesi. And they wasted no time in expressing their interest. “It was blind luck! Today, I’m glad that Pharmacia rejected us. Developing Curosurf in a smaller company prevented the product from getting lost in the crowd. This helped to position the drug better.”

Some 30 years later, Curstedt and Chiesi continue to work together. A conference call is scheduled just a couple of hours after our interview. Today, Curosurf accounts for approximately 12 per cent of Chiesi’s total sales, amounting to around EUR 218 million in 2018.

“We never would have enjoyed such long-term co-operation if we’d worked with a large company, which would have sold the product on in time.”

Next step: a synthetic version

Every year, around 300-500,000 premature babies all over the world are treated with Curosurf. But this number could be even higher, says Curstedt. Curosurf is still manufactured from animal lungs. Creating an entirely synthetic form of the drug would make it even more widely available.

“We knew this back in the 90s. And how to achieve it. But it wasn’t until 2012 we succeeded with the help of Jan Johansson at ̽����ѡ. We’re now conducting the last study prior to it being ready, but it’ll be 2023 before a new drug is registered.”

It’s easy to be optimistic when you see such good results in the lab, he says. “Optimism is great, but in my experience things take a lot longer than you think.” Despite his 73 years, Curstedt returns to the lab every day. Even though the synthetic variant of surfactant is ready, there is still room for improvement. Continuous improvement has always driven Curstedt.

“We’ve already made a number of changes that have made it even better. But this also means that we need to restart clinical trials again. And this means that we have at least another 10 years before we can launch a new drug.”

Curstedt has received extensive recognition for his work, such as being included on the Swedish king’s honours list; he has also received the ̽����ѡ Grand Silver Medal and Region Stockholm’s award for breakthroughs in clinical research.

“It would have been nice to have shared all the attention with Bengt, but he died in 2008. We won some awards together, but it would have been great if he’d still been with us today.”