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Mats Akerlund

August 14, 2011

Obstetrician and global authority on the way the womb works

Outside the US, atosiban is the most popular drug for suppressing the contractions of premature labour, still the leading cause of perinatal death. Mats Akerlund, who has died aged 66, was the obstetrician who was instrumental in developing it into one of the most widely used medicines in pregnancy. In the early 1980s Akerlund, working in Lund University in Sweden, was the world’s leading authority on myometrial physiology, the way the muscles of the womb work.

Together with the chemist Jerzy Trojnar and the pharmacologist Per Melin, both working for the pharmaceutical company Ferring, Akerlund studied a range of synthetic peptides in the hope that they might block or enhance the actions of similar peptide hormones released by the pituitary gland. He tested their effects on uterine muscle in vitro, in pregnant animals, and eventually in women.

RWJ 22164, later renamed atosiban, and according to myometrial legend the 17th drug Akerlund tested, turned out not only to block oxytocin, a hormone that makes the womb contract, but also to be safer than other options. It remains unique as the only new chemical entity ever to have been successfully developed specifically to treat a pregnancy disease, rather than to just end the pregnancy. Most pharmaceutical companies concentrate on other diseases because of the legal and regulatory risks, and only by chance do some drugs later turn out to work in pregnancy. Under the trade name Tractocile, atosiban has now been administered to many hundreds of thousands of women.

The second of three boys, Akerlund was the opposite of premature. He weighed 5kg when he was born at Leksand vicarage in Dalarna, in central-southern Sweden. He studied medicine in Lund from 1962 to 1968 and, apart from a short spell in general practice, worked at Lund university hospital for the rest of his life. He completed his doctoral thesis on uterine contractility and blood flow in 1976 under the mentorship of Lars Philip Bengtsson, and soon became a world authority on myometrial physiology. He later claimed he was lucky to have picked atosiban so early – pharmaceutical companies typically test thousands of compounds for every one that reaches clinical use – but this was false modesty. He had carefully chosen which peptides to test.

Akerlund was a brilliant scientist who also worked on drugs to help the uterus contract after delivery to prevent bleeding, to help the embryo implant after in vitro fertilisation and to treat menstrual cramps. He was a shrewd entrepreneur who founded a number of companies to market his discoveries. Although he never developed another drug with quite the impact of Tractocile, he contributed hugely to the speciality of obstetrics and gynaecology. He was also a dedicated doctor and an inspiring teacher, loved and admired by generations of patients and students.

Sadly, Tractocile was not the billion-dollar blockbuster that early enthusiasts hoped for. It was never licensed in the US, partly because the human trials were unable to prove for certain that the baby benefited from the extra time in the womb. None of the other options was ever proved to help the baby either, but Tractocile remains controversial.

Meanwhile Akerlund faced other troubles. In his 30s he had noticed numbness in his little finger and joked that he must have multiple sclerosis. He was correct. He started using a stick in the early 1990s and by the middle of that decade, required a motorised wheelchair. He continued to travel internationally, so frequently that he was recognised by the porters at Heathrow who met him from the aeroplane steps. His final years were complicated by a number of near-fatal chest infections. His recovery from an episode three years ago, after the family had assembled at his bedside to say farewell, occurred, appropriately, on Easter Day. Despite all this he continued working until a few days before he died. Earlier this year, he was awarded a SEK2.1m (£170,000) grant to continue his studies of oxytocin.

Akerlund held a private pilot’s licence and was a keen hunter. He owned a large tract of forest near Lake Siljan in Dalarna. He was a founder member of the Amanda male voice double quartet, specialising in the songs of the Nordic composers Jean Sibelius and Carl Nielsen. He is survived by his wife Eva, two daughters and a son. A few weeks before his death, he introduced himself to a sixth, as yet unborn, grandchild, through abdominal palpation.

• Mats Akerlund, obstetrician and gynaecologist, born 20 November 1942; died 30 March 2009

Jim Thornton. Reprinted from The Guardian, Thursday 28 May 2009

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