Professor von Kalle, you are the newly appointed BIH Chair for Clinical Translational Science. What does that mean? How would you define it?
Clinical translational science involves investigating what basic research findings can be rapidly translated into clinical applications.
That is precisely the BIH’s mission – translational medicine. How will you go about that practically?
It is a complex process that consists on the one hand in organizing clinical and preclinical research, and on the other in analyzing the research being carried out to determine which ideas can be accelerated or advanced further in this direction.
You are also founding director of the joint BIH and Charité Clinical Study Center. What are your plans here?
The Berlin life sciences scene has a great deal of expertise in organizing the different phases of clinical testing. I intend to create a consolidated structure here that encourages collaboration. New space needs to be created for this, too, so that we are brought closer to one another physically, thus hopefully ensuring that the productivity of the whole is greater than the sum of the parts.
You are coming to us from Heidelberg, where you helped establish and headed the National Center for Tumor Diseases (NCT). It is an institution that has also embraced the translation of research findings into clinical practice – in this case, in the field of cancer research and treatment. What experience from Heidelberg will you bring to the BIH in Berlin?
That was a situation in which we practically started in an empty room and over 13 years built up an entire institute – an institute that, through an alliance between the German Cancer Research Center (DKFZ) and Heidelberg University Hospital, has devoted itself to precisely this task in relation to cancer. Of course, it wasn’t always an easy process, but it was a very exciting one, because it coincided with the emergence of new molecular methods that allowed us, for example, to use genome sequencing for patient diagnostics in clinical trials. And I hope that here in Berlin we can achieve similar results, not only in oncology but in other fields as well.
Does that include using DNA sequencing data from patients for personalized therapies?
Yes, that has of course advanced a lot in the meantime. Research has delved deeply into the field of protein chemistry and immunological procedures and currently focuses strongly on single-cell diagnostics. Here there are groundbreaking programs in Berlin. And I would be very surprised if it weren’t possible to find something here that could be translated into improved patient care.
A translation center for oncology
But cancer is still probably close to your heart. Do you want to establish something like a Berlin NCT?
I think a translation center focused on oncology is a great idea. In this sense, I also think Berlin should have one. And I would gladly help my colleagues set up such a facility here.
Do you believe it is sensible for translation centers to specialize in a particular field? Or should translation be the purview of comprehensive systems medicine platforms?
I believe the two are not mutually exclusive, but the clinical reality is, of course, that patients are recruited mainly according to specific fields. At the same time, we should make sure that scientists do not remain hunkered down in their areas of specialty. That will be the trick. But it’s a great situation in Berlin, because there are so many possibilities and so many good institutes and people.
So you think Berlin is a good location for the life sciences and for translational medicine?
Absolutely. I hope it is, or will become, the best location. And I’m very excited about that.
You have devoted a lot of time to analyzing health data, not only data from DNA sequencing, but also clinical data that describe patients’ health condition. What role do such data play in patient care?
Data are important for patient care and, conversely, data gathered from patient care have become enormously important for research. We just talked about very data-intensive examinations that are clinically relevant for patients. Unfortunately, we still know very little about the outcomes of patients treated in different healthcare systems. And the prerequisite for learning from such data, i.e., for actually transforming the healthcare system into a truly learning system, is that the data collection method is well suited for this task. Compared to other countries, we in the German healthcare system still have some catching up to do here. On the other hand, we have good starting conditions because here things are done very systematically and thoroughly. And I believe we can make some progress in the next few years in implementing innovative ideas.
You have a very special definition of data protection, don’t you?
Yes, that’s right. When it comes to patients with serious or life-threatening diseases, I think data protection consists first and foremost of having the right to a proper data analysis, for the patients’ disease is the biggest problem they face. Of course, data security is also important, but here we had many situations in which the inability to competently process data was glossed over as data protection. And I hope in the future we can change that in many areas.
The data box as a data space that patients themselves control
What role should patients play with regard to their data?
I think it’s exceptionally important that patients become masters of their own data. Up until now, we’ve had a situation where mostly healthcare institutions or physicians gather data about patients. But the patients themselves have only indirect knowledge or no knowledge at all of such data gathering, and they also lack the technical wherewithal to take their own health data with them, unless they leave with a stack of papers under their arm or receive an occasional CD-ROM. And I believe that one of the essential requirements for implementing such a solution is a patient-focused electronic health record or a data space controlled by patients in which they can collect their health data and, very important, which they can administer themselves – i.e., can decide exactly – who can and cannot access the data. Today, we have wonderful technical possibilities for implementing such things. Health insurance companies are making valiant efforts to move forward on this issue. And I hope that we also make some progress on our own data box project in the next two years.
Could you tell us a little about the data box project?
With this project we want to create data spaces so that patients have sufficient memory on a computer system where they can collect their health data via an app or through a request to their general practitioner. They can then take this data with them when they visit another doctor or are admitted to a hospital. This ensures patients have direct access to their entire health records. In the future this may lead to other developments, such as accredited healthcare providers offering electronic services. Examples of such services include regularly trawling through the genome sequence, taking into account the latest findings; giving patients the opportunity to be notified of new studies about relevant diseases; or allowing patients to make their anonymized data available for research purposes, so-called data donation.
You are both a physician and a scientist – as well as an expert in gene therapy. Will you also conduct research in Berlin?
I will at least be intensively involved in research and would like to set up junior research groups in the field of gene therapy. The role described above is so wide-ranging that I will not initially do wet lab research and wield a pipette. I follow developments very closely and can imagine that we will team up with younger scientists to launch this or that gene therapy project.
The BIH is also active in the field of gene therapy, for example, at the BIH Center for Regenerative Therapies. Which area of medicine currently offers opportunities for gene therapy?
At the moment, a large number of gene therapy applications are being tested. This includes gene therapies for rare genetic disorders, in particular those of the hematopoietic system and of the liver. We currently see big opportunities in the field of CAR T cells, that is, in tumor immunotherapy. And I’m very pleased to see that this works quite well. We are involved in some of these tests through a small biotech spin-off, so we know what’s currently in the development pipeline. And I have the impression that in the field of cancer medicine, therapies targeting a number of tumor types are going to be developed in the next several years.
Closeness to patients is a vital part of translation
How do you assess the integration of the BIH as a third pillar of Charité?
Patient contact is an absolute necessity for realizing the BIH’s translational concept. I believe that the biggest factor is not the organizational formalities, but the willingness of both partners to actually create something new. Even the best of agreements is no substitute for this willingness. And I believe Charité and the BIH are well positioned in this regard.
There are plans for the BIH to have a role that extends beyond Berlin. Do you see this as an opportunity?
Yes, that is an opportunity. Here one must understand that federal funding comes with the requirement that the institution must do something that has relevance for the entire country. For that is the duty of the federal government and its ministries. But it is certainly a challenge that the Berlin location can meet. And there are opportunities to expand the BIH’s network across the entire country and to possibly initiate additional projects.
Advising Jens Spahn on digitalization in medicine
You serve as an adviser to Jens Spahn, the Federal Minister of Health. What are your responsibilities in this role?
For the next four years, I have the great honor of being a member of the Federal Ministry of Health’s Council of Experts. This council advises the Federal Minister of Health on fundamental issues of overuse, underuse, and misuse in the healthcare system. Over the coming months, the panel of experts will deal intensively with the topic of digitalization in medicine. And that is a process in which I can learn a great deal and which I’m very excited about.
For over a year now, you have held a position in Doha, the capital of Qatar, in addition to your responsibilities in Heidelberg. You serve there as chief research officer at the Institute for Women and Children’s Health. What experience have you gained there that you can bring to Berlin?
This is a role that takes me back to my early scientific activity in the fields of genetic diagnostics, gene therapy, and rare disease therapy. It is a monumental task. The aim here is to define the genetic background of the local population using a large-scale sequencing program involving both patients and healthy individuals, and thus find new therapeutic possibilities for genetic diseases that frequently occur due to traditional reasons. This means we are breaking new ground and can use a whole series of basic research-inspired molecular tests to directly help patients. As such it is a very nice project, and one that involves translation. I hope to implement and establish some ideas and organizational forms there so that this structure can actually develop into a translational hub in this field for the entire Middle East region.
Could this lead to a collaboration with Berlin?
For certain topics there will definitely be interest on both sides. The scientists working at the institute come from a whole host of countries. It is therefore a very international group featuring some very highly qualified people. And if there turns out to be thematic overlaps, it would surely be a great opportunity for collaboration.
Berlin is a great city
One last question: Are you also looking forward to what Berlin offers outside of work?
I have visited Berlin regularly and always enjoy my time there – it is of course a great city. My family and I are now very much looking forward to getting to know Berlin more deeply.
Dr. Stefanie Seltmann conducted the interview.