A helper with foresight

Christoph Lange was recently appointed as Medical Director of the Research Center Borstel. From here, he substantially contributes to clinical tuberculosis research in Europe.

Prof. Christoph Lange

© FZ Borstel

Christoph Lange was recently appointed as Medical Director of the Research Center Borstel. From here, he substantially contributes to clinical tuberculosis research in Europe, also monitoring the development and treatment of multidrug-resistant cases. He is Professor of International Health/Infectious Diseases at the University of Lübeck and Head of the Clinical Tuberculosis Center at the DZIF and has dedicated himself to the field of personalised tuberculosis treatment worldwide.

A visit to the Research Center Borstel brings us to a small village in the middle of the state of Schleswig-Holstein. Without the renowned Leibniz Lung Center, Borstel would not have much to offer besides idyllic landscapes. However, Hamburg and Lübeck are within close reach and Kiel is also just an hour away. This played a role in Christoph Lange’s decision to take up a position as a physician in Borstel in 2001, after he had returned from a two-year research period in Ohio, USA. “Changing from a large university hospital in the USA to a small hospital in Borstel was quite a risk for me,” he admits quite frankly. However, the prospect of being able work in an HIV outpatient clinic was compelling. It was also easily commutable from Westensee (near Kiel), where he lived with his wife and child at the time. He became senior physician specialised in infectious disease medicine soon after.

Christoph Lange has never regretted his decision. Borstel still is very rural, but the Research Center is internationally renowned for its tuberculosis research which is, not least, due to Lange’s commitment. In 2006, he put into practice an idea he had been considering for a long time. He wanted to establish a European network of doctors and researchers through which clinical studies could be organised, similar to Eurosida which already existed for HIV at the time. Lange invited 44 researchers from 14 countries to Borstel and together they founded the Tuberculosis Network European Trialsgroup (TBNET), the largest multinational tuberculosis research organisation in Europe.

From botany to medicine

He discovered his interest in tuberculosis and other infectious diseases early on in his studies. In medical clerkships in South Africa, Christoph Lange worked with many children suffering from tuberculosis. “I was enthusiastic about the work,” he remembers. However, before his medical studies in Witten-Herdecke, he studied biology in Kiel and Freiburg with a major in botany and a minor in microbiology. “I thoroughly enjoyed my studies and was happy spending a year stalking through salt marshes to investigate indigenous plants for my diploma thesis. However, I missed the human side of things.” Consequently, after completing his degree in biology in 1988, he began his medical studies which he completed simultaneously with a PhD on antibiotics in lichens.

Following intensive years of teaching in internal medicine both in Cape Town, South Africa, and in Schleswig-Holstein, Lange and his wife, who is also a doctor, moved to the United States. A fellowship in Ohio finally brought him to the field of infectious disease medicine. “However, the position demanded practical clinical work from 8.00 am to 11.00 pm and research was simply not an option for me here. Consequently, at the age of 38, I still did not have a single publication.” Lange believes it was a stroke of luck that a senior physician invited him to a traditional Thanksgiving turkey dinner at that time, who then wanted to win him over as a research fellow for his HIV work. “Professor Michael Lederman fascinated me as a person and so I took up his offer,” he remembers. Perhaps luck played a role in this, but his perseverance and his feel for good teams certainly also always seem to be factors that bring him forward.

His intuition was correct. “Within one year I had everything together that I needed for my postdoctoral qualification,” says Lange, “I could not have had a better mentor.” In 2004, after having returned and worked at the Research Center Borstel for three years and being promoted to a senior physician position, Christoph Lange completed his postdoctoral qualification in internal medicine. His postdoctoral dissertation included work on immune reconstitution in HIV infection and was honoured by the Hector Foundation with a very valuable research prize. The Hector Foundation continued funding the physician generously. “This support came at exactly the right time and was pivotal for my scientific development,” he emphasises.

A bedside approach

Christoph Lange’s research work has always focused on the patient whether it involved HIV or his increasing focus on tuberculosis. First and foremost he is a physician with a core focus on correct diagnoses and treatment. Treating each patient individually is one of his objectives. He became chief senior physician in 2009, and subsequently Medical Director of Clinical Infectious Diseases in 2014. His particular focus is on treating patients with multidrug-resistant tuberculosis, the case numbers of which have been increasing worldwide over the past few years. Meanwhile, the Medical Clinic in Borstel has become one of the leading treatment centres for these patients in Western Europe.

Christoph Lange and colleagues

© Forschungszentrum Borstel

With the help of TBNET, which continues to be his hobbyhorse, Christoph Lange established a European database that provides comprehensive information on different treatment options for multidrug-resistant tuberculosis in Europe. “When I was offered to establish something on antibiotic resistance, I did not know much about the subject,” he remembers. Together with colleagues from 23 hospitals across 16 European countries, he monitored the courses of treatment of 380 patients with multidrug-resistant tuberculosis. Amongst other things, they discovered that particularly patients in East European countries received the worst care. “Here, we have a concrete need for action to help our European neighbours,” Lange reinforces. He received an honorary doctorate from the Moldavia State University for Medicine and Pharmacy in Chisinau in honour of his commitment across borders. In 2014, he received the “Society needs Science” Prize awarded by the German Stifterverband für die Deutsche Wissenschaft.

Lange and his colleagues were further able to show: the WHO’s definition of tuberculosis “cure” did not include the actual course of disease. In a current publication in Lancet Respiratory Medicine, Lange and other experts explain why they believe the WHO should review its criteria.

Germany and the world

The clinician scientist also sees the bigger picture at the DZIF: “The African Partner Institutions are a magnificent establishment but I believe we also need a network of study centres in Eastern Europe. Tuberculosis in Germany is under control, but the neighbouring EU countries Belarus, Moldavia and the Ukraine all have high incidences of multidrug-resistant tuberculosis,” he says. “We must draw on the possibilities we have here to develop new diagnostics and treatment methods and then implement them wherever they are needed,” he emphasises.

Lange sees the biggest potential in the advancement of personalised medicine. “Currently, we are pioneers in treating patients with tailored therapies,” he explains. “This is facilitated by the DZIF’s infrastructure and funding in particular.” He hopes that, in future, biomarkers obtained from simple blood and urine samples can be used to determine necessary durations of treatment. To this effect, a large project is underway at the DZIF, the results of which could benefit many tuberculosis patients, here and all over the world.