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Interview

„Engineers will change medicine“

Although his specialty is actually structural engineering, Professor Bernhard Schrefler is currently researching how to improve cancer patients’ chances for recovery. In our interview he talks about the similarities between human tissue and concrete, and why engineers 
will soon be working in operating rooms.

Interview Tino Scholz  Photos Dirk Bruniecki

Professor Schrefler, you say that the human body can be compared to concrete. What do you mean?

Concrete, like human tissue, is a porous structure—meaning a solid object with pores in which gases and fluids move. This means that certain standard models for studying such structures can be transposed from one material onto the other. It is merely the respective exchange processes that change.

 

How did you reach this conclusion?

By looking beyond the horizon of my own discipline. Americans call this thinking outside the box. In 2010, when I was working at the University of Texas at Austin, colleagues of mine from the Medical School showed me a new model for prostate tumors. I told them: I’ve been solving the equations of your model for twenty years.

 

What were you thinking at the moment?

Eureka! I’ve got it! I knew straightaway that my path was going to take me into medicine now. Shortly thereafter, I went to Houston and met the director of the Houston Methodist Research Institute—and I promised him that I would improve his research. He believed me and hired me.

Since then you’ve been researching the extent to which the behaviors of fluid materials in physics can be transferred to the flow behaviors of compounds to treat cancer.

One of the things that is critical for successful treatment is that the medications arrive exactly where they are needed. In my project, I’ve been working closely with Professor Wolfgang Wall from the Institute for Computational Mechanics at the Technical University of Munich. He is currently putting together a model of the currents in the blood vessels, the bio-distribution, that is more precise than before. With the assistance of this type of general model, we can then calculate how a medication spreads throughout the body.

 

And this basic model will then be combined with your results?

Exactly, that’s when we add the concrete to it, so to speak. We’re very familiar with its flow properties. We’re attempting to simulate how much of a drug actually arrives at a tumor in the end and, for instance, how much gets lost due to the immune system or from diffusion in the tumor’s immediate vicinity. This is the step that connects engineering mechanics and medicine—a step into the future.

 

You will be celebrating your seventy-fifth birthday in just a few months. What do you find appealing about breaking new ground with basic research at an age where most people would have long since retired?

Precisely because I’m getting older, I’m very pleased when I can advance something that benefits humankind. Aside from which, it’s always wonderful to investigate a field of application in a way that wasn’t previously possible.

 

You actually conduct research at the University of Padova, but are also at the Technical University of Munich. Your residence there as part of the Hans Fischer Senior Fellowship has been made possible by the TÜV SÜD Foundation. What does this Visiting Fellowship mean for you?

The fellowship sponsored by the TÜV SÜD Foundation gives me the freedom to continue researching. As I said, you have to think outside the box, meet new, young people, experience new influences—that’s what the fellowship offers me. In addition, I can attend many interesting and important conferences around the world. All of these things make it easier for me and are a great support. I enjoy being in Munich three months out of the year. The interaction and communication undoubtedly advance the colleagues here just as much as at my university in Italy.

Photos: Dirk Bruniecki

PERSONALIA

Curiosity, the lure of the strange, the drive to understand how certain aspects of nature work—that is what drives Professor Bernhard Schrefler. He was born 74 years ago in South Tyrol and speaks several languages, having completed his pre-university studies at a German-
language school in Bolzano, Italy. Over the long course of his career, he has been particularly focused on the flow behavior of physical materials, concrete in particular.

Since 2014 Schrefler has been Professor Emeritus at the University of Padova, in Italy, at the School for Engineering Sciences, and since 2012 a Full Affiliate Member at the Houston Methodist Research Institute, where he focuses on his cancer research. “To be able to advance into a new specialist subject, to work with living material, doing something that can be of direct help to my fellow humans, that is something special,” he says. In 2017, Bernhard Schrefler will also be teaching in Munich, with the support of the TÜV SÜD Foundation. The foundation’s goal is to promote technical safety in all fields.

How far along is your research at the moment?

The theoretical model is completed. Now we just have to apply it while observing how it interacts with medications, in order to be able to determine its actual efficacy in fighting cancer.

 

What is, in your opinion, the ultimate goal?

Eventually, a patient-specific model should be available. That means a therapy customized to each patient for the best possible treatment.

 

What is the difference between your approach and traditional medical research?

Medicine still has a very experimental orientation; that is to say, you usually look to see how a therapy is working. If it doesn’t work as planned, modifications must be made. But this approach takes a lot of time, time that patients don’t always have. In the future, our computer model can quickly adjust parameters and recalculate much more quickly than would be possible in a laboratory.

 

Your goal is to increase the amount of medication that actually arrives where it is needed from 0.1 to 1 percent. Is that much really lost?

Yes, unfortunately. An increase to one percent would be a huge success. To achieve this, we want to pair our model with the use of nanoparticles. The current problem is that the chemotherapy drugs spread throughout the entire body. Nanoparticles wouldn’t scatter so widely since they flow much more directly to the tumor and can thereby deliver a higher concentration of active ingredients. This is also about quality of life for cancer patients. One example: we have cases of children being treated whose hair doesn’t fall out and who can continue attending kindergarten.

 

Is there already evidence or estimates as to how much more likely it is for a patient to recover when your model is used?

No, it’s still too early for that. We can calculate how much active ingredient gets to the tumor and how that ingredient operates. Using our model and with the help of a good computer, you can find the right medication within thirty to sixty minutes.

 

When can your model be more widely used?

It is already being used in specialized research centers. But widespread availability will still take some time, certainly several years.

 

Will there be engineers in operating rooms then?

You’re probably referring to a provocative statement I made, trying to hammer home just how much we engineers can already support medicine. At a conference in California, I recently experienced a very interesting example of this: based on a problem a patient was having, four cardiologists were asked to say how they would proceed with respect to an opera tion. A computer simulation put together by engineers ran through the four operations and calculated that the patient’s condition would worsen in two cases, and would remain the same in one case.

 

So only one of the cardiologists could have actually helped the patient?

Exactly. That’s why I hope that we’ll soon be at the point where computer-supported models can predict the results of an operation. This is thanks to the work of engineers. I think that you can go so far as to say: engineers are capable of changing medicine. That actually would be revolutionary.


Pumps and Pipes

Along with Prof. Bernhard Schrefler’s use of engineering techniques in medicine, there are additional parallels between industrial and biological processes that could be conducive to research. One example is blood circulation. Blood vessels are like pipes, and right now, in Houston, there is plenty of research being conducted in this area, with a lot of emphasis on crude oil and natural gas. There’s an annual conference in the city where engineers from the oil and chemical sector meet with doctors. It’s called Pumps and Pipes.

In a cross-comparison, once again it’s basically the same physical equations that link the flow of crude oil through pipelines and the circulation of blood through veins and arteries. This carryover can, for instance, lead to inferences about calcifications that can become problematic. This knowledge transfer can help to better understand why these happen and how they can be prevented.

“These interdisciplinary transfers are very important,” Prof. Schrefler says. “We’ve been conducting research in the fight against cancer for a long time, but the successes could be greater. That’s why it’s important to strengthen these connections. Physics, mathematics and evolutionary biology belong to the scientific disciplines that can provide cancer research with new perspectives and therapeutic approaches.”