Questions and AnswersProf. Jan Buer

At the University Hospital Essen you have had many patients who are being treated for the Swine (H1N1) flu. What impact has the epidemic had on your daily routine?
The first death in Germany attributed to the Swine flu was registered at our clinic, and the first case of Swine flu infection during pregnancy was also treated here. This of course led to a great deal of excitement and a media frenzy. Our Department for Virology is most involved with the Swine flu, but we – the microbiologists – are also in demand. You can imagine the situation: we have a patient with symptoms of an infectious disease. But that’s all the information we have. To rapidly determine exactly what it is, teamwork - involving the microbiologists just as much as the virologists – is required.

How can one picture your work: Do you stand at the bedside of patients every day?
No, it’s not really like that. In my Department there are senior physicians who attend to the hospital wards every day, who also look at patients and discuss treatment with the physicians there. However, most of our work takes place in the laboratory, where we characterize microbes in order to deliver the right therapy as soon as possible. The close proximity to the clinic is very important for our research. We can work with “real” cases, and that makes our research very effective.

And what exactly are you researching?
We are developing a new molecular diagnostic tool with which pathogens can be characterized. In addition, we are investigating host-pathogen interactions in order to find new targets for medications. This is an enormous and very important challenge, as only a small number of antibiotics can still be used for therapy. We therefore need to develop new strategies to fight pathogenic agents.

What kind of strategies?
One seminal field is the immune defense of the host, humans in the case of our research. We have to use – to activate - the mechanisms of our natural immune defense better. In order to be able to do this, we have to understand them better. There’s a long list of promising approaches, such as the defensins or the activation of secondary messengers. New strategies have become very important, because when it comes to development of antimicrobial drugs, the pharmaceutical industry has absolutely nothing in the pipelines.

What is the reason for this?
For one thing, the pharmaceutical companies are really lacking new approaches. However, companies also don’t view the development of new antibiotics as a particularly lucrative business. That’s why we – the research institutes – are even more needed. We can’t leave this work to the pharmaceutical giants, because combating infectious diseases is one of the biggest challenges that society will face over the coming decades.

What is the main problem: the emergence of new pathogens such as the Swine Flu or multidrug-resistant bugs?
Both. The problem is complex. Multidrug resistance is a global problem. For example, the sexually transmitted disease gonorrhea could be effectively treated with antibiotics a few years ago. However, in many areas of Asia, antibiotics can now be purchased at the corner store. Because of the abuse of antibiotics, some strains of gonorrhea have become antibiotic-resistant. At the same time, our increasing mobility means that pathogenic agents are distributed everywhere. In the hospital, multidrug-resistant pathogens are an enormous problem. Immunosuppressed patients such as HIV-positive individuals or transplant recipients are most likely to be affected, but people with chronic bronchitis are also at risk. The multidrug-resistant pathogens have become a real danger for patients, but it’s also a burden on the whole health care system, because the antibiotics required to treat resistant strains are very expensive. That’s why we also provide an “Antibiotic Service”. We give advice to our physicians as well as to other hospitals regarding how they can most sensibly use antibiotics. This saves a lot of money and is also beneficial to patients.

You manage a department with 100 co-workers. This probably means a lot of deskwork and little contact with patients. As a physician, do you miss the patients?
No. I find my work fascinating. And I originally didn’t want to be a physician at all, I wanted to become a pilot in the army. When I finished school, the movie Top Gun was just running, and we all wanted to be like Tom Cruise. It was actually my mother who pushed me into studying Medicine. And I’m very thankful for that because I enjoy research very much, and I also know that my work is meaningful.

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