THE KAROLINSKA INSTITUTE INNOVATION ECOSYSTEM FOR CANCER STARTUPS: LESSONS LEARNED AND BEST PRACTICES *

. The Karolinska Institute's cancer startup innovation ecosystem is a dynamic network of stakeholders who collaborate to develop and commercialise innovative ideas and technologies in cancer research and treatment. This ecosystem has been successful in cultivating an environment of innovation and entrepreneurship, producing several successful startups in the cancer research and treatment space. This paper aims to provide a systematic review of the lessons learned and best practices from the Karolinska Institute innovation ecosystem for cancer startups. The review includes a comprehensive SWOT analysis, as well as insights from interviews with stakeholders from academia, industry, and government. The SWOT analysis identified several key strengths of the Karolinska Institute innovation ecosystem for cancer startups. The interview methodology for this study involved a semi-structured approach, with open questions designed to elicit detailed and nuanced responses from the participants. The Interviews and SWOT analysis identified several key of success of the Karolinska Institute innovation ecosystem for cancer startups is due to a number of key factors, including strong leadership, collaboration, funding mechanisms, supportive policies, and infrastructure. Effective leadership is required to guide the ecosystem and foster an innovation culture. Collaboration among stakeholders is critical for knowledge sharing, resource allocation, and coordination. Funding mechanisms and infrastructure are critical for supporting R&D activities and providing startups with the resources they need to grow and succeed. To protect and incentivize innovation, supportive policies such as intellectual property laws and regulatory frameworks are required. In addition, the paper discovered that incubation programmes are critical to the success of cancer startups in the Karolinska Institute innovation ecosystem. These programmes connect startups with resources, mentorship, and networks that are critical to their growth and development.


Innovation ecosystem and its importance
The literature on innovation ecosystem focuses mostly on the concept and importance which has been widely used, often with different qualifiers such as national innovation systems (Lundvall, 1992) or sectoral innovation systems (Breschi and Malerba, 1997).The term "innovation ecosystem" refers to a diverse group of players who work together to produce innovations that add value ( Adner, 2006;de Vasconcelos Gomes et al., 2018), The innovation ecosystem is characterized as a network of interrelated organizations, centered around a core firm or platform, that includes both producers and users, and is dedicated to the creation of novel value through innovation (Autio and Thomas, 2014).In recent years, the idea of an innovation ecosystem has drawn more and more attention as a means of comprehending the complex and dynamic connections between the various actors participating in the innovation process.
Further, the literature analyses the primary goal of an innovation ecosystem, which is described as a network of interconnected businesses focused on a central company or platform and including both production and use-side actors (de Vasconcelos Gomes et al., 2018).The main goal of an innovation ecosystem is to promote collaboration and exchange among its members to speed up innovation and generate economic value.Innovation plays a critical role in the success and growth of organizations across various industries.It is widely recognized as a key driver of economic development, as it enables firms to create new products, services, and processes that improve efficiency, increase productivity, and enhance customer satisfaction (Dutta and Bilbao-Osorio, 2012).The importance of an innovation ecosystem lies in its ability to create an environment that supports and encourages innovation.By bringing together a diverse set of actors, an innovation ecosystem provides access to resources, knowledge, and expertise that may not be available to individual actors.Through collaboration and knowledge transfer, the ecosystem can help to break down silos and foster innovation across different sectors and disciplines.There is a growing body of academic literature on the concept of innovative ecosystems and their importance for driving economic growth and innovation.One (Cooke, 2001).
There are indeed studies that emphasize the role of open innovation and the importance of knowledge spillovers in innovation ecosystems.(Chesbrough, 2003).Innovation is no longer confined within the boundaries of individual firms, but rather is distributed across a network of actors who collaborate and exchange knowledge to create new products and services.More recently, scholars have focused on the role of digital technologies and platforms in innovation ecosystems.They have argued that digital platforms can facilitate collaboration and exchange by connecting actors across different geographies and sectors.They have also highlighted the importance of data and analytics in creating new opportunities for innovation and economic value creation.Overall, the academic literature on innovation ecosystems underscores the importance of collaboration, exchange, and openness for driving innovation and economic growth.

Karolinska Institute innovation and incubator system
A Swedish medical university Karolinska Institute (KI) has been developing its own innovation-supporting system since the late 1990s (Stone and Frank, 2001).The Karolinska Institute is known for its innovative research in various fields of medicine and health sciences.This system consists of a highly integrated group of organisations that select medical discoveries from the Nordic countries and turn them into spin-offs that KI's incubator directly controls and finances for up to 10-15 years with significant funds, in addition to offering business support services to the incubated businesses (Baraldi & Ingemansson Havenvid, 2016), KI's incubator also offers highly specialised drug discovery services (Baraldi et al., 2014).
A programme for entrepreneurship at the Karolinska Institute helps researchers and students turn their ideas into profitable businesses.The initiative helps researchers and students launch their own businesses by offering mentoring, training, and money.The Karolinska Institute is home to a number of incubators and innovation hubs that offer resources and assistance to early-stage businesses.One of the key ways that the Karolinska Institute supports startups is through its incubation programs.The Karolinska Institutet Innovations AB (KIAB) incubator, for example, provides startups with access to office and laboratory space, as well as business development support, mentorship, and networking opportunities.The incubator also offers access to funding sources and access to the Karolinska Institute's network of researchers and clinicians (KI Innovations, 2022).These resources include access to equipment, money, mentorship, and networking opportunities in addition to lab space (KI Innovations, 2022).KI's incubator combines elements of numerous models due to its excessive focus on science and a particular industry (biomedical), maximum intervention in start-ups, and rigorous emphasis on picking winning ideas (Bergek & Norrman, 2008).Furthermore, KI's incubator includes activities that go beyond those of a normal incubator, such as actual product development and international operations (Baraldi & Ingemansson Havenvid, 2016).The Karolinska Institute has contributed to the development of a number of cancer startups with a focus on the invention of cutting-edge technologies and cancer treatments to enhance patient care.These firms, many of which are founded on research from the Karolinska Institute, demonstrate the institute's dedication to cancer care innovation.DRIVE is a life science incubator program run by KI Innovations, a subsidiary of Karolinska Institutet.The program is designed to support early-stage life science companies and accelerate the development of innovative healthcare products and services.Cancer startups are companies that are focused on developing innovative technologies and treatments to improve cancer diagnosis, treatment, and patient outcomes.These startups are often founded by researchers or entrepreneurs who have identified a need or opportunity in the cancer space and are working to develop a solution.
The Karolinska cancer startups ecosystem is one example of how these principles can be applied to a specific domain, with the goal of improving patient outcomes and creating economic value.In the case of the Karolinska cancer startups ecosystem, the objective is to improve cancer treatment and patient outcomes.By providing funding mechanisms, research partnerships, knowledge transfer, and networking opportunities, the ecosystem supports the development of innovative solutions to address the complex challenges of cancer research and treatment.The ecosystem also has the potential to attract and retain talent, create new jobs, and drive economic growth in the region.The innovation ecosystem has a relational perspective in which internal and external environment exchange inputs and outputs, feedback each other and collaboratively design innovative solutions (Torres Valdés et al., 2018).In business, the ecosystem may be formed around a product, service, process, customer, industry, and platform (Kumar et al., 2015).Health care and life science incubators are highly specialized and have close ties to academia (Schwartz and Hornych, 20, Schwartz and Hornych, 2010).Even though there are many "bio-incubators" in Europe (Ehret et al.,201), there isn't much study that specifically focuses on The Karolinska cancer incubator.

Examples of successful startups that have emerged from the Karolinska cancer ecosystem.
The Karolinska Institute plays a vital role in incubating and supporting startups in the field of cancer research and treatment.The institute provides a range of resources and programs to help entrepreneurs and researchers develop and commercialize their innovative ideas.The Karolinska cancer startups ecosystem has produced several successful startups that have made significant contributions to cancer research and treatment Table (1).

Research Methodology
A comprehensive literature review was conducted to gather information on the concept of innovation ecosystems, their importance, and factors contributing to their success.Sources used included academic articles, research reports, and online resources from reputable organizations.Additionally, interviews were conducted with key stakeholders involved in the Karolinska cancer startups ecosystem, including representatives from Karolinska Institute and Karolinska University Hospital, as well as entrepreneurs and investors.The insights gathered from these interviews provided valuable firsthand perspectives on the innovation ecosystem and its impact on cancer research and treatment.
the study employed a SWOT analysis to identify the ecosystem's strengths, weaknesses, opportunities, and threats.The analysis considered the findings from the literature review, interviews, and survey to identify the ecosystem's internal and external factors that impact its success.The SWOT analysis provided a comprehensive understanding of the ecosystem's current status and identified areas for improvement.
In addition to the SWOT analysis, a semi-structured interview, with open questions designed to elicit detailed and nuanced responses from the participants were conducted with key stakeholders involved in the Karolinska cancer startups ecosystem.Participants were chosen based on their experience, knowledge, and involvement in the ecosystem.These stakeholders included representatives from Karolinska Institute and Karolinska University Hospital, as well as entrepreneurs and investors.
The questions were designed to be broad and non-leading, allowing participants to express their thoughts and ideas freely, the survey including the following questions: Overall, the research methodology for this paper involved a combination of interviews and SWOT analysis, the combination of these methods allowed for a comprehensive analysis of the Karolinska Institute innovation ecosystem for cancer startups, drawing on both academic literature and stakeholder insights.The findings and best practices identified in this study can provide valuable guidance for policymakers, entrepreneurs, and other stakeholders seeking to promote innovation and drive economic growth in the field of cancer research and treatment.

Innovation ecosystem of Karolinska Innovation cancer startups
The innovation ecosystem of Karolinska cancer startups is a collaborative network of researchers, entrepreneurs, investors, and industry partners focused on developing innovative technologies and solutions to improve cancer care.This ecosystem is supported by the Karolinska Institute, Karolinska University Hospital, and the Swedish Cancer Society, among others.Karolinska Institutet (KI) KI has a strong focus on cancer research, with a number of world-renowned research groups and centers dedicated to studying cancer biology, diagnosis, and treatment, the Karolinska cancer startups ecosystem is a complex network of individuals, organizations, and institutions that are involved in the creation, development, and commercialization of new cancer-related technologies.The ecosystem comprises various components that work together to foster innovation, collaboration, and entrepreneurship.Some of the key components of the ecosystem of The Karolinska Institute that supports innovation and entrepreneurship in the cancer include: 1. Karolinska Institute: The Karolinska Institute is a world-renowned medical university that is at the center of the ecosystem.It provides expertise, resources, and infrastructure for researchers, entrepreneurs, and clinicians to develop new cancer-related technologies and therapies.The Karolinska Institute also plays a crucial role in training the next generation of cancer researchers and clinicians (Stone & Frank, 2001).More than 350 research groups are part of the larger umbrella organization Cancer Research KI at Karolinska Institutet.By bringing together leading cancer researchers from many fields, the goal is to merge cancer research and clinical oncology to contribute to the development of novel scientific findings that may be swiftly applied to clinical practice for the benefit of patients and society.

A business incubator (Drive):
The Karolinska Innovation Incubator provides early-stage cancer startups with access to office space, mentorship, and funding (Incubator DRIVE -KI Innovations, 2022).Karolinska Innovation offers incubation facilities for cancer startups at the Karolinska Institute campus in Stockholm, Sweden.These facilities provide resources and support to startups and early-stage companies developing new technologies and treatments for cancer care that match with the incubators provide place which is both physical and organizational (Smith & Zhang, 2012)) and provides logistical support to start-ups as well as the opportunity to collaborate with other organizations (Oakey, 2012: 68).
3. The Proof-of-Concept program (POC): Karolinska Innovation offers funding opportunities for cancer startups through its grant programs the Proof-of-Concept program (POC).The PoC program provides funding of up to SEK 500,000 (approximately USD 60,000) to support the development of a proof of concept or prototype for a novel product, technology, or service in the life sciences.These programs provide funding for early-stage development of cancer innovations.
4. Swedish public funds (Vinnova & Almi) the two most significant Swedish enterprises that are sources of financing for innovation projects and new companies are Vinnova and Almi.Vinnova, Sweden's innovation agency, has a large number of grants and programmes available for new companies and ideas that are developed from academia.Vinnova provides funding for evaluation/verification of business ideas and projects.Almi provides various forms of grants, loans and venture capital for companies in the start-up phase.Almi is a governmental financing body represented throughout Sweden via regional subsidiaries.Almi provides consultation, mentorship and different forms of financing (Innovation financing, 2023).

Karolinska University Hospital:
The Karolinska University Hospital is a leading cancer treatment center that provides access to state-of-the-art cancer care and expertise.It collaborates closely with researchers and entrepreneurs to develop new cancer-related technologies and therapies and to improve patient outcomes (Kihlander & Gravenius, 2022).

SWOT analysis of innovation ecosystem of Karolinska cancer startups
The innovation ecosystem of Karolinska cancer startups is a dynamic, multifaceted system that encourages the development of innovative treatments for cancer.Some of the key participants in this ecosystem include researchers, physicians, industrial partners, regulatory and legal experts, development specialists, and Karolinska Innovation and Karolinska Development.
In this case, a SWOT analysis can be used to help identify the advantages, disadvantages, opportunities, and threats of the innovation ecosystem.
The SWOT analysis of Karolinska cancer startups' innovation environment indicates numerous critical strengths, weaknesses, opportunities, and threats that impact cancer entrepreneurs' capacity to develop and commercialize innovative approaches.
The report shows Karolinska Institutet's world-class research capabilities as well as the supportive ecosystem that gives access to funds, business partnerships, and specialised manpower.However, the investigation reveals a number of problems, such as limited resources, strong competition, and lengthy regulatory approval.
Emerging technology, increasing markets, and personalized medicine are among the opportunities indicated in the SWOT analysis.However, the report identifies several threats, including as legislative changes and cybersecurity issues.
Overall, the SWOT analysis emphasizes the complex and dynamic character of the Karolinska cancer startups' innovation environment.While there are numerous strengths and opportunities to encourage innovation and growth, there are also numerous challenges and risks that must be addressed for cancer entrepreneurs to succeed.
Cancer startups can maximize their ability to produce innovative approaches that improve cancer outcomes and reduce disparities in cancer incidence and mortality rates by recognizing these aspects and devising strategies to address them.See Table 2 below.

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Telemedicine systems and mobile health apps, for example, provide tremendous prospects for innovation in cancer care delivery and patient involvement (Haleem et al., 2021).
Weakness  Karolinska cancer startups may suffer resource limits, especially in the early stages of development, and may face strong competition from other startups and established corporations.

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The cancer treatment market in Sweden is relatively small, making it difficult for Karolinska cancer startups to scale and profit, and the startups may face difficulties expanding into international markets, particularly in regions with different regulatory environments and healthcare systems (Kanavos & Sullivan, 2010).

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The regulatory approval procedure for new cancer treatments can be lengthy and difficult, causing innovative technology to be delayed in commercialization.

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Cancer startups may have limited access to realworld data on cancer patients, making it harder to develop and refine innovative treatments.They may also face difficulties getting clinical expertise and partnering with other organizations (Penberthy et al., 2021).(Shinwari et al., 2018).

Factors contributing to the success of the innovation ecosystem
The success of the Karolinska cancer startups innovation ecosystem can be attributed to several factors: Social Factors regarding population and awareness: Sweden has one of the highest life expectancies in the world, and the population is rapidly aging.According to Statistics Sweden, in 2020, around 20% of the population was aged 65 or older, and this proportion is expected to increase to 25% by 2030.Between 2018 and 2022, the life expectancy for men and women was 81.05 and 84.56 years, respectively.In 2022, Sweden had one of the highest life expectancy levels worldwide (Statista, 2023).The aging population in Sweden creates a high demand for cancer treatments.According to the Swedish Cancer Society, the number of cancer cases is expected to increase by 40% by 2030, which creates an opportunity for Karolinska cancer startups to develop new treatments that cater to this demographic (Globocan, 2020).See Figure 2 below.The Strong public awareness and support for cancer research and treatment in Sweden creates a favorable environment for Karolinska cancer startups to raise funds and attract talent.For example, thirteen researchers at Karolinska Institutet have been awarded 54.9 million Swedish kronor from the Swedish Cancer Society.The foundation is distributing a total of SEK 124.3 million to 31 cancer researchers in Sweden (Swedish Cancer Society, 2023).In addition, patient-centered treatment is becoming more popular, emphasizing the value of patient outcomes and experience.Karolinska cancer companies can create therapies that give patients' demands top priority and enhance results.

Support from Karolinska Institutet and Karolinska University Hospital:
The support provided by Karolinska Institutet and Karolinska University Hospital is a crucial factor contributing to the success of the innovation ecosystem for Karolinska cancer startups.These institutions provide a wealth of resources, expertise, and funding to support the development of new technologies and products.Karolinska Institutet is a world-renowned medical university that is focused on research and education in the field of medicine and health sciences.The institute has a long history of innovation and has been responsible for several important medical breakthroughs, including the discovery of the structure of the nerve impulse and the development of the first pacemaker.Karolinska Institutet has a strong commitment to fostering innovation and entrepreneurship and has established a number of programs and initiatives to support the development of new technologies and products.Karolinska University Hospital is a leading academic medical center that is focused on providing high-quality patient care, education, and research.The hospital is closely affiliated with Karolinska Institutet, and many of its staff members are also affiliated with the institute.This close collaboration between the hospital and the university creates a fertile environment for innovation and entrepreneurship, as researchers and clinicians work together to develop new technologies and products that can improve patient outcomes.
Collaboration between researchers, clinicians, and entrepreneurs: Collaboration between researchers, physicians, and entrepreneurs is a critical aspect in the success of the Karolinska cancer startups' innovation ecosystem.The ecosystem brings together people from many backgrounds and disciplines, offering a productive platform for collaboration and knowledge sharing.Entrepreneurs provide financial acumen and a focus on commercialization, while researchers and clinicians bring expertise in cancer biology and therapy.This collaboration is made possible through a variety of means, including joint research initiatives, networking events, and mentorship programmes (Blevins et al., 2010).Karolinska Institutet Innovation AB, for example, offers frequent seminars and workshops where researchers, physicians, and entrepreneurs can discuss ideas and network.
In addition, the organization offers mentorship and coaching to startups, assisting them in navigating the challenging process of bringing a new product or service to market.
Researchers and clinicians can obtain a greater understanding of the commercial potential of their study through these relationships, while entrepreneurs can receive access to the most recent scientific and medical expertise.This collaboration can also serve to hasten the translation of basic research into clinical practise, which will benefit patients and the larger community in the long run.
Access to funding and resources: Another crucial component contributing to the development of the Karolinska cancer startups ecosystem is access to finance and resources.Life sciences startups frequently require considerable expenditures to support R&D, clinical trials, regulatory approvals, and commercialization.Access to capital is therefore important for the development and growth of businesses in this industry.The Karolinska cancer startups ecosystem offers a variety of funding options to help entrepreneurs at various stages of development.KI Innovations, for example, gives seed finance to early-stage entrepreneurs, whereas Karolinska Development AB provides venture capital to more developed enterprises.Furthermore, the Swedish government and the European Union fund companies through programmes such as Horizon 2020 and the European Innovation Council.
Aside from investment, the ecosystem provides a variety of resources to assist entrepreneurs.KI Innovations, for instance, provides lab and office space, as well as equipment and services to support research and development.The ecosystem's incubators and accelerators also offer mentorship, training, and networking opportunities to help entrepreneurs succeed and develop.In general, startup success in the Karolinska cancer startups ecosystem is dependent on access to finance and resources.The ecosystem offers a variety of funding sources and resources to assist companies at various stages of growth in overcoming financial barriers and succeeding in their individual fields of innovation.

Conclusion
The Karolinska Cancer Startups ecosystem has become a model for other institutions looking to support cancer startups and advance cancer research.One of the key lessons learned from this ecosystem is the importance of collaboration and partnerships.By bringing together experts from different fields and institutions, the Karolinska Cancer Startups ecosystem has created a network that supports startups throughout their development process.This collaboration has also led to the development of new technologies and approaches to cancer treatment.Another best practice from the Karolinska Cancer Startups ecosystem is the emphasis on personalized medicine.By tailoring treatments to individual patients' needs, startups can improve treatment outcomes and reduce side effects.This focus on personalized medicine has been a driving force behind the development of new technologies and therapies in the field of cancer research.
The Karolinska Cancer Startups ecosystem also places a strong emphasis on mentorship and support for startups.Through programs like the Karolinska Institutet Innovations AB (KIAB) and the Karolinska Venture, startups receive guidance and resources to help them navigate the complex process of bringing new products and services to market.This support has been instrumental in the success of many startups in the ecosystem.Karolinska Cancer Startups has a robust innovation ecosystem that plays a critical role in driving innovation in cancer research and treatment.The ecosystem includes a network of experts, resources, and funding opportunities that support startups in the field of cancer research and help them bring new products and services to market.The importance of this ecosystem cannot be overstated, as it provides startups with the resources and support needed to accelerate their growth and success.With access to the latest research, cutting-edge technologies, and a network of experienced professionals, startups in the Karolinska Cancer Startups ecosystem are well-positioned to make significant strides in cancer research and treatment.
Looking to the future, there is enormous potential for continued innovation and success in the field of cancer research.With ongoing advancements in technology and an increased focus on personalized medicine, there are many opportunities for startups to develop new and innovative approaches to cancer treatment.
Overall, the Karolinska Cancer Startups ecosystem is an excellent example of how collaboration, innovation, and strategic partnerships can drive progress in cancer research and help bring new treatments and cures to patients in need.Overall, the Karolinska Cancer Startups ecosystem shows how collaboration, personalised medicine, and mentorship can encourage cancer research and treatment innovation.Other universities seeking to help cancer entrepreneurs can draw from the best practises and lessons learnt from the Karolinska Cancer entrepreneur's ecosystem in order to build their own successful innovation ecosystems.
1. What is your role within the Karolinska cancer startups ecosystem?2. Do you think the ecosystem plays an important role in driving innovation in cancer research and treatment?3. Have you seen any examples of successful products or services developed within the ecosystem?4. Does the ecosystem facilitate collaboration between different stakeholders?INSIGHTS INTO REGIONAL DEVELOPMENT ISSN 2669-0195 (online) https://jssidoi.org/ird/2023 Volume 5 Number 2 (June) http://doi.org/10.9770/IRD.2023.5.2(1) 14 5. Do you think the ecosystem has the potential for future innovation and success?6. Have you faced any challenges or obstacles within the ecosystem?7. Do you see the ecosystem evolving in the coming years?8. Would you recommend the ecosystem to other entrepreneurs looking to start a business in the field of cancer research and treatment?9. Do you think the ecosystem provides valuable resources and support for startups in the field of cancer research and treatment?10.Do you believe the ecosystem has contributed to the advancement of cancer research and treatment?
6. Karolinska Development AB: is a Swedish life sciences investment company focused on developing and commercializing innovative medical products.The company was founded in 2003 and is headquartered in Stockholm, Sweden.The company is focused on investing in early-stage life science companies with high potential for commercial success, including those developing innovative cancer therapies.In addition to providing funding, Karolinska Development offers startups access to its extensive network of experts in various areas of cancer research and development, including clinical trials, regulatory affairs, and business development (Karolinska Development, 2023); see Figure 1 below.

Figure 1 .
Figure 1.Overview of the innovation ecosystem of Karolinska cancer startups

Figure 2 .
Figure 2. Number of new cases in 2020, both sexes, all ages

Table 1 .
Examples of successful startups that have emerged from the Karolinska

Table 2 .
SWOT analysis of innovation ecosystem of Karolinska cancer startups