Our bodies are made up of billions of cells. Each cell is a tiny world of its own, where molecules are continuously produced, used, cleared away and recycled.
Understanding how these processes fit together lies at the heart of basic research.
"Basic research is about understanding how nature works, right down to the level of cells and molecules," says Professor and cancer researcher Anne Simonsen.
"We do not always know how new knowledge will be used when we discover it, and the outcomes can be difficult to predict. But that is precisely why basic research can lead to breakthroughs and insights that ultimately result in new treatments for patients."
Simonsen is this year's recipient of the University of Oslo Research Prize. She is deputy director of CanCell, a Centre of Excellence at the University of Oslo and Oslo University Hospital.
Researchers must first understand the healthy cell
For almost three decades, Simonsen has sought to explain what happens when healthy cells develop into cancer cells. She also studies why failures in cells' clean-up mechanisms can contribute to neurological diseases such as Huntington's and Parkinson's.
"If you want to repair a car, you first need to understand its parts and how they work together. The same applies when we want to repair a body affected by disease," Simonsen explains.
"To understand disease, we must first understand how the body functions normally. Then we need to find out what goes wrong when disease develops."
For Simonsen, basic research is like putting together a jigsaw puzzle: every discovery may represent one small piece. On its own, it is not always obvious what that piece might be used for. But as more pieces fall into place, the overall picture becomes clearer.
The cell's own recycling system
Simonsen's work focuses on autophagy, which is the cell's internal waste-disposal and recycling system.
Cells, like cities, generate waste. Molecules and cellular components can become damaged, worn out or no longer needed. If they are allowed to accumulate, they may harm the cell.
Autophagy is the process through which cells identify this waste and transport it to the appropriate recycling station where it is broken down for reuse.
"It is a fundamental and essential process that helps keep cells healthy," Simonsen says. "Autophagy takes place in all our cells throughout life."
When that process fails, the consequences can be serious. Impaired autophagy has been linked to a range of conditions, including cancer and neurodegenerative diseases such as Huntington's and Parkinson's.
In the laboratory, scientists can suppress or disable autophagy using genetic techniques. Studies in model organisms have offered striking evidence of its importance. Fruit flies with impaired autophagy have shortened lifespan, while mice lacking autophagy in the brain have been shown to die from neurodegeneration within months.
The reverse may also be true: increasing autophagy can, in some contexts, extend lifespan and help prevent disease development.
But when it comes to cancer, there is a complication.
A double-edged sword in cancer
At first glance, it might seem obvious that boosting autophagy would always be beneficial. If the process keeps cells clean and healthy, surely more of it must be better?
Not necessarily.
"In cancer, autophagy is a double-edged sword," Simonsen says.
In healthy cells, autophagy can protect against cancer by clearing damaged components and preventing cellular dysfunction. But once a tumour has formed, cancer cells may use the same process to their advantage.
Tumours often grow in hostile conditions, with limited oxygen and nutrients. Autophagy can help cancer cells survive these shortages, allowing them to continue growing when normal cells might struggle.
That means researchers cannot simply decide that autophagy should always be increased or always be blocked. They need to understand precisely what role it is playing in a particular cancer and at a particular stage of the disease.
"We need more basic research before we can use autophagy in a targeted way in cancer treatment", Simonsen says.
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Looking at early cancer development
Simonsen and her colleagues are now finalists in a competition to establish a new Centre of Excellence. Their ambition is to investigate the earliest stages of cancer development: the gradual transition from a normal, healthy cell to a cancer cell.
They want to know why autophagy matters during this early period. What kinds of cellular waste are important? Which processes are controlled by autophagy? And do the decisive changes take place inside emerging cancer cells, or in the surrounding tissue environment?
The answers could eventually open new possibilities for both diagnosis and treatment.
Hoping to detect cancer earlier
Cancer medicine is increasingly moving towards personalised care. Two people with the same named cancer may have tumours with very different biological characteristics and may respond differently to the same treatment.
"The more we understand about the fundamental processes, the greater the opportunity to find the right treatment for the right patient," Simonsen says.
The work could also contribute to earlier diagnosis. Researchers hope that a deeper understanding of autophagy may help identify new biomarkers - measurable signals in blood or urine that indicate disease, or an increased risk of developing it.
If a particular molecule is found in high quantities at an early stage of cancer development, it could one day become a useful biomarker. In principle, that might allow blood or urine tests to detect cancer earlier than is currently possible.
Simonsen stresses that this remains an ambition rather than a clinical reality. But it is precisely the kind of future application that basic research can make possible.
Building the puzzle, piece by piece
The journey from a discovery in a cell to a treatment available to patients can be long. It requires patience, investment and a willingness to support research without demanding an immediate payoff.
For Simonsen, basic research is like assembling a puzzle. At first, each new finding may appear to be only a small and isolated piece. But as more pieces are added, the wider picture starts to emerge.
"No one can see the whole picture from the beginning," she says. "But every new piece can make it a little clearer."
In a decade's time, she hopes her team will have supplied some of those missing pieces, solid discoveries that others can build on.
"And of course," she adds, "I hope that some of what we do can benefit cancer patients."
