Research is fascinating!

My research focuses on the role of the immune system in brain tumours, particularly glioblastoma. It is the most aggressive brain tumour in adults, and unfortunately the survival rate for patients remains very low. The standard treatment begins with surgery, followed by a combination of radiotherapy and chemotherapy. However, a real breakthrough in treatment has yet to be achieved.

One promising approach is immunotherapy, in which the body's own immune cells are used to attack the tumour. This already works well for certain cancers, such as malignant melanoma. So far, however, this breakthrough has not been achieved for glioblastoma.

Exactly. Led by Dr Celia Dobersalske, our research group discovered that immune cells capable of fighting the tumour accumulate within the skull bone. We refer to this as an immune cell niche. What's particularly exciting is that these cells are not located in the tumour itself but in the bone marrow of the skull. They develop in response to the tumour, carry receptors that enable them to recognise it, but are unable to reach the tumour and attack it effectively.

My MD/PhD supervisor, Professor Björn Scheffler, who heads the DKTK Translational Neuro-Oncology research group at the West German Cancer Centre, always says: “The strength of our cells lies in the fact that they recognise the tumour without actually being inside it.” And that's exactly the challenge.

Yes. Originally, we used small bone fragments that are sometimes removed during routine tumour surgery. These fragments are only taken when they are already required as part of the procedure—for example, if the surgical opening to the brain needs to be enlarged.

My goal was to use material that is produced during every operation anyway, regardless of whether research is being carried out. And I was determined to find a way of isolating immune cells from that material as well.

When surgeons drill through the skull, a fine material is produced—known as bone dust—rather like drilling dust. Normally, it is immediately suctioned away and discarded. In other words, it is a waste product generated during every operation. That's what I use for my research.

To do this, I developed a new protocol—a new method for isolating the cells from the bone dust. At first, however, we didn't know whether the cells would remain intact after being exposed to the heat generated during drilling and the irrigation used during surgery.

No. It was essentially a coin toss. We had no idea whether the cells would survive or whether they would be destroyed during the process. But that's exactly what research is about: trying something that might not work—and sometimes discovering something entirely new as a result. Those are the moments that make research so exciting.

It gives us much easier access to the immune cell niche. With this new method, we can obtain samples during surgery much more easily, more precisely, and with considerably less effort.

Above all, it opens up new possibilities for understanding the immune cell niche in much greater detail. We hope that, in the future, we may be able to use these cells therapeutically—for example, by introducing them into the tumour so that they can actively fight it.

Ideally, pre-operative imaging could allow us to identify where these immune cells are most concentrated. Surgeons could then decide more precisely where to place the first burr hole in the skull in order to obtain material with the greatest therapeutic potential.

Most patients are very open to it because the material is generated during surgery anyway. It doesn't require any additional procedure or pose any extra risk. On the contrary, many are pleased that they can contribute to research.

It's something very special. I put my heart and soul into this work every single day. I can collect the samples myself and take them straight to the laboratory. My MD/PhD project may only be one piece of the puzzle, but it's a pretty exciting piece of a much larger project.

That research is a process. You move forward step by step, sometimes without seeing any obvious progress—and then suddenly you discover something that nobody has seen before. It's exactly this combination that makes research so fascinating to me.

Why Felix is so passionate about combining clinical medicine and research: Research inspires! “My heart belongs to the brain!”

Felix Maximilian Gerach, Translational Neuro-Oncology, Felix.Gerach@uk-essen.de

Editorial: Janina Balzer, janina.balzer@uni-due.de