Interview with Dr Markus Ketteler

Dr M. Ketteler Department of Nephrology University Hospital Aachen Aachen, Germany

Prof Zoccali: How did you become interested in renal disease and decide to pursue a career in nephrology?

Dr Ketteler: At first, this was actually due to the inspirational teaching by Prof. Peter Gross in Heidelberg (now Chief of Nephrology in Dresden) who led me through my doctoral thesis on the role of natriuretic factors in hyponatremia. A second major influence as a student was a clinical clerkship at Hammersmith Hospital in London, where I experienced the work of Drs. A. Rees, C. Pusey and C. Savage and others, which was quite exceptional.

Prof Zoccali: You  are  an investigator with a penchant for basic science research as well as being a clinician. Do you think that espousing the two roles will be more difficult in the years to come ?

Dr Ketteler: I hope and I am expecting the opposite: At least in Germany, authorities as well as faculties are starting to realize that flexibility in networks, as well as in local structures, much better enable successful combinations of basic and clinical science. In recent years, faculty-based interdisciplinary grant programmes have been  launched, and especially in Aachen such a core facility enabled our group to pursue both work in genetically manipulated animals and to participate in or launch clinical study approaches. However, tight budgets may again counteract such progress in the future.

Prof Zoccali: What aspect of clinical practice intrigues you most?

Dr Ketteler: Every step that improves survival, especially cardiovascular survival. And the benefits of renal transplantation are outstanding concerning the stringent cause-and-effect relationship between diagnosis and therapy and concerning quality of life aspects.

Prof Zoccali: At the moment what is the area of clinical nephrology that you consider as being the “hottest”?

Dr Ketteler: Well, I am probably “biased”, but I really think that the understanding of the biology of calcification processes has advanced tremendously in recent years. Here, we get ideas that will be both pathophysiologically and treatment relevant, e.g. in calciphylaxis, cardiovascular calcification prevention etc. But there are a number of other advancing fields such as the realizations that mild to moderate renal failure is an important mortality risk factor or that Epo-induced endothelial stem cells may be of use in vascular repair, just to mention a few areas.

Prof Zoccali: You are pursuing intriguing research projects in an area that goes beyond renal disease.  How do you perceive renal research in general at the moment, do you believe that it is still somewhat organ-restricted?

Dr Ketteler: No, I think that Nephrology is actually one of the broadest disciplines in internal medicine. A Nephrologist has to be in part a Cardiologist, a Diabetologist and Endocrinologist, a Rheumatologist, an Osteologist, an ICU specialist and so on. And this development is showing at the conferences where many contributions address the heart, the vessels, the bone, the immune system etc. “Organ-restriction”, if there were any in Nephrology, it is currently not very present.

Prof Zoccali: Vascular calcification mechanism(s) is a very successful theme and you have made relevant contributions here. Which is the research achievement that you perceive as  being very close to producing a clinical application?
 
Dr Ketteler: What we hope to identify are factors that quite selectively up-regulate endogenous hepatic synthesis of fetuin-A, a very potent systemic calcification inhibitor. But there may also be therapeutic potential in vitamin K-dependent processes of calcification regulation.

Prof Zoccali: What advice would you give to a young doctor entering training in nephrology?

Dr Ketteler: I would advise them to develop the same fascination with a complex and rewarding discipline such as Nephology just as I did when I started as an Intern 17 years ago. Once this clinical fascination has built up, the young doctor should look for a scientific mentor to gain  depth in a novel research area for 2 or 3 years, maybe abroad. And then, when the doctor is no longer so young, he should try to connect the science with clinical questions which yields, besides a lot a frustrations, many very rewarding experiences…

Prof Zoccali: Which is the paper, Congress lecture, communication or book that  influenced you most?

Dr Ketteler: I can’t say which single paper influenced me the most, there are many important ones. Two recent examples are papers from Murshed et al. who characterized the pivotal role of phosphate and matrix in calcification processes (Genes & Development 2005) and from Liu et al. who identified Toll-like receptor 1/2 dependent vitamin D production by macrophages as a central mechanism in tuberculosis defense (Science 2006). Among the key lectures I have heard I would rate Judah Folkman’s presentation of his work on angiopoetins very high. The most influential book? This was not a scientific one…

Prof Zoccali: How would you invest a 100.000.000 EU grant?

Dr Ketteler: I think the most reasonable way to invest this money would be to enable a number of important large clinical RCTs which otherwise would never take place because the industry would not be interested in sponsoring them. In Germany, there is good public potential for supporting basic research, but an almost complete lack of support for independent clinical research.

Prof Zoccali: Which is your favourite hobby?