(09/22/21) Through its research fellowship program and the Walter Benjamin Program, the DFG supports junior scientists in their academic careers by funding an independent research project abroad and, since 2019, in Germany too. A large proportion of these fellowships are awarded in the USA and to a lesser extent in Canada, reflecting the belief still prevalent in many disciplines that for a career in research it is helpful to have “been in America.” In this series of talks, we aim to give you an impression of the wide range of DFG funding recipients. In this edition, we take a look at who is behind funding number MO 3694.

DFG: Dr. Mossakowski, many thanks for taking the time to talk to us. You were born in Toruń, Poland – the birthplace of Nicolaus Copernicus. Wouldn’t a career as an astronomer have been the more obvious choice?

Agata Mossakowski (AM): There's more to that question than you might think. But before answering it, I’d first like to thank the DFG for the research grant that has enabled me to work for two years now in Davis, California, as a member of one of the world’s leading research groups in the area of muscle physiology. I also very much appreciate the opportunity to talk to you, and as a funding recipient, I’m more than happy to contribute my perspective as part of your series. Now back to your question. I was even born in the same month as Copernicus and if my parents had stayed in Poland, I might have studied at the Nicolaus Copernicus University in Toruń. But that probably wouldn’t have been enough to set me on course for a career in astronomy. And although Copernicus became famous for his insights in astronomy, he was actually more of a universal scholar – as was perhaps more common and indeed more possible at that time than today – so his knowledge extended to medicine as well, of course.

DFG: Medicine – a natural choice for you, of course: you obtained outstanding results in your school-leaving exams and your father is a doctor. Might you have opted for a different path?

AM: Even without a control group, I would still say on a personal level that life is more interesting if you keep a few conflicts unresolved. One of those is certainly my decision to opt for medicine and not to pursue writing, painting and the stage – interests I duly assigned to the limited realm of my hobbies. Why limited? Well, if you want to work as a doctor and at the same time feelthe need to scientifically evaluate the issues you come across in practice – and a day still only has 24 hours – then you simply don’t have the time to give your hobbies the attention they might deserve.

DFG: The situation was probably different before you embarked on your current dual career as a research neurologist – even if back then a day still only had 24 hours, no?

AM: Yes, that’s true – you certainly go through phases. The very first of these was immortalized in my primary school poetry journal. Under the heading “When I grow up...”, I wrote in my very best handwriting: “I will have a farmhouse with a research lab in the basement.” As such, the idea of achieving a combination of “something useful” and "research" was established very early on. But before I get into trouble with the medical profession and research, let me add that in my eyes as a child, to be a doctor was mainly something of practical use, and I believed it would be a good thing to have a laboratory installed one floor below a farmhouse kitchen. But my eyes also lit up when my paternal grandmother took me to rehearsals for stage productions on visits to Poland. She was one of the better known actresses in Toruń and really loved to fascinate me with a little stage magic. Of course that means I was virtually predestined to join the school theatre club, and during my studies I was in the cabaret ensemble at the Charité, too.

I pursued my journalistic inclinations as the organizer of a school newspaper during my secondary school years. But to be honest, I’d be far too friendly as a journalist – at least an investigative one – and I could never imagine myself looking for dirt under the carpet while getting help from those who swept it there. Research is where I much prefer to act on my investigative impulse.

That leaves music. After seven years of piano lessons, I could get through the first movement of the Moonlight Sonata almost without stumbling, and I still had friends after spending roughly the same amount of time learning the flute. But I probably couldn’t make the world a better place as a musician. I’ve always kept up my singing, however, and that’s given me great social contacts here in Davis in the university choir and chamber choir.

DFG: Why don’t you tell us about how you did finally go into medicine after ruling out all the possible alternatives?

AM: Gladly. The story here is mainly about the strong women in my life and my female role models. As I mentioned, the sense of wanting to do all kinds of things started very early on – and with regard to medicine, it probably began with my biology teacher at secondary school, the Gymnasium an der Gartenstrasse in Mönchengladbach. Wobine Crisp had a striking mane of red hair and a fascinating enthusiasm for spiders. It was she who encouraged me to take part in the Biology Olympics, and I did so well in the NRW state competition that I was invited to a selection seminar. There I was allowed to pipette my first polymerase chain reaction – and I could almost see myself in my dream basement laboratory. Ms. Crisp also nominated me for the Zonta International Young Women in Public Affairs Award – which I actually won.

While I was doing my doctorate, my supervisor Dr. Helena Radbruch gave me both inspiration and support. She is one of the brightest minds I have ever met. And she’s a master at reconciling clinical practice with research and a family in such a way that there is no imbalance. She also taught me how to navigate the political and personal rapids of a university using humility, integrity, magnanimity and also self-confidence as a guiding rudder. She was a phenomenal supervisor. I owe the quality and distinctions of my doctorate primarily to her and to my equally brilliant co-supervisors, Prof. Raluca Niesner and Prof. Anja Hauser.

During my time at the clinic it was – and still is – Dr. Katrin Hahn: she is efficient and well organized, always hits the nail on the head, and is always focused on the next step. She is consistently willing to share her time, however scarce it may be, as well as her advice and her knowledge, which is anything but scarce.

DFG: So all female influences, then?

AM: No, of course not – but I don't think the numerous twelve or sixteen-point stags in this field need me to help their antlers grow any more. They can manage just fine without me. However, I would like to single out my father – not least because he constantly undermines my belief that you can’t seriously cultivate hobbies as a good doctor. I’m extremely proud of him. He’s not only an excellent doctor and regularly available to me for brief brainstorming sessions on his neuro-pediatric cases, where I see just how much work and compassion he puts into each individual patient. He’s also on stage on the weekends with his band, gigging at small concert halls and pubs as the “rock doc” on the keyboards.

In fact I’m very proud of my parents in general. Before the Iron Curtain fell, they fled Poland in a cloak-and-dagger operation without telling their relatives or acquaintances. They were fed up with living under a repressive political system and intended to go to France, though they actually ended up in Mönchengladbach. They had nothing with them but a slim travel bag and their two-year-old daughter. At the reception camp they were given a woollen blanket, a few cooking pots and a hundred deutschmarks. The money was stolen from them the very first night. But my father had finished his medical training in Poland at that time and was very easily integrated into the German healthcare system. My mother was unable to continue her profession as a teacher and found a new vocation as a writer. They built a new life for themselves and for me, enabling me to try things out and learn about the world. We travelled a lot. Later on I took every opportunity I could to go abroad for internships. Maybe it's just the natural consequence of this urge to travel that I’ve been here in the US for more than two years now.

DFG: “Here in the US” means Davis in California, right?

AM: Yes, that’s right – it’s the agricultural and engineering department of the internationally much better known Berkeley campus of the University of California (UC). We’re a good hour’s drive east of Berkeley – the cows can roam about here, which would probably be a nuisance in Berkeley. We also have one of the oldest brewing science institutes in the US and a second-to-none Department for Viticulture and Enology. It actually gets very close to my poetry album image of a farmyard and a research lab, though that’s not why I came here.

DFG: Yes, it was put rather differently in your proposal for a research grant.

AM: The proposal is about exploring certain signalling and regulatory functions in inflammatory processes in muscle tissue, in particular in connection with muscle atrophy. Prof. Keith Baar’s group has an outstanding international reputation in this field and he works closely with Prof. Craig McDonald, Director of the Neuromuscular Disease Clinic (NDC) at UC Davis. Before I finished my doctorate, I was able to compare notes with Professor Baar in the summer of 2016 at the MyoGrad Summer School for Muscle Scientists Max Delbrück Center for Molecular Medicine in Berlin. He later offered me a postdoc position at his lab – which provides an ideal working environment for me, not least because of its connection with the NDC.

DFG: What are you doing at the moment?

AM: I have two main projects going on right now. One concerns the problem that muscles weaken as they age. The process of how this happens is not well understood – even though it is well understood by anyone over thirty in terms of first-hand personal experience. The loss of muscle mass, called sarcopenia, and the loss of muscle strength, which we call dynapenia, correlate closely with life expectancy and independence in old age. It’s the survival of the fittest, quite literally. My hypothesis is that muscle ageing is significantly influenced by a certain inflammatory signalling pathway and that this is derailed to a certain extent in old age. I’m looking into the influence of this signalling pathway on the muscle by triggering the “old” signalling pathway in young mice and the “young” signalling pathway in old mice.

While my first project is concerned with a topic that affects practically everyone, my second project started very specifically with one man. At 35, this individual was diagnosed with a rare, incurable genetic muscle disease – a desminopathy. Knowing full well that it would probably be too late for him, but wanting to give his children and future grandchildren a better chance of a therapy, he knocked on the door of universities and research groups to raise awareness of his condition. We realized that his disease is probably not as rare as was thought but is simply discovered far too infrequently; we also decided that there was a lot to be learned about other diseases from the mechanisms of this particular disease. There are amazing overlaps with diseases such as Alzheimer’s and amyotrophic lateral sclerosis as well as apoplexy and diabetes. Using CRISPR-Cas9 technology, we’ve developed rats that carry and inherit this mutation, allowing us to look at the disease in all its developmental stages and in all situations. In this way we hope to find a therapy that will help those suffering from desminopathy in the future.

DFG: Let’s take another step back. You studied medicine at the Charité on a kind of reformed degree program. What prompted you to do this?

AM: I was so impressed with the idea of the reformed program at the Charité that when I applied for a place through the ZVS at the time, I didn’t even include any other institutions on my wish list – there was just no alternative for me. I was lucky and I got in. Why did I want to go there so badly? Reform efforts are not infrequently ridiculed in medicine, apparently arousing associations with oat biscuits and carrot sticks, and triggering fears that this kind of training produces “barefoot” doctors rather than real ones. The model is in fact scientific and modern and is based on an approach that has been practiced at McMaster University in Canada since the late 1960s, undergoing further development on an ongoing basis. The focus is on small groups and a curriculum developed around patient cases – so-called “problem-based learning.” This significantly increases both the retention rate and understanding. Students are better at absorbing the material that is taught if it is more directly related to patient diagnosis and therapy. Otherwise you learn huge amounts of data for the preliminary exam or state exam, then regurgitate it again – and very little actually sticks. There’s that old joke about a phone book being given to various types of people to memorize, and the medical student simply asks, “By when?” The reformed course aimed to get away from the phone book method and crude memorization. At the same time, it sought to promote a scholarly mindset and empathic action – something I was more than happy to advocate myself. Ultimately, I became closely involved in the development of the new revised medical curriculum in which all students at the Charité have been enrolled since 2010. And with the exam now behind me, I still really enjoy teaching.

DFG: And you also went on to study design thinking, correct?

AM: At the D-School at the Hasso Plattner Institute in Potsdam, yes. I hope you’re not going to ask me to explain design thinking – it’s notoriously difficult and a classic case of “you had to be there.” Essentially, it’s a problem-solving technique in which the problem itself is called into question and the focus is on the user. But it may well be that much of what is behind design thinking is already being applied in other problem-solving techniques – such as problem-based learning as we know it from the new revised medical curriculum. We combined the two directly and remodelled them to create BioThinking at the Berlin-Brandenburg School for Regenerative Therapies. And before you grin and roll your eyes – it does actually work, despite the hip name.

DFG: You seem to have a certain sense of mission with regard to medical training in Germany. What is it you’re trying to do?

AM: The question is really where I’m trying to do it. Whether you want to change the course of a supertanker or a small ship, the best thing to do is to go to the helm.

DFG: And the way to the helm ...

AM: ... is via a post-doctoral lecturing qualification. There’s currently no other way in medicine in Germany. I’ll be going back to Berlin to the Charité in December to finish my neurology residency as part of the Clinician Scientist Program – essentially I'll be bringing back home everything I have learned scientifically in the US and building on it in Berlin. Before I start changing the course of any supertankers, I’d like to work as a doctor and researcher for quite a while, if possible in Berlin.

DFG: Isn’t Berlin a tough prospect right after California?

AM: It’s not for nothing that the city’s unofficial anthem includes the words “in winter it hurts…” In California, it’s no problem to watch hummingbirds in the garden all year round, enjoy the sun on the bike path to the lab and head out to the mountains at weekends. In Berlin it probably takes a few more months for the grey days to fade away. But I’m not worried about being able to make good use of those days.

DFG: If you can largely make do without mountains and hummingbirds, what is it that drives you as a doctor and a researcher?

AM: You mean combining the two? For me as a doctor, a scientific way of thinking is almost automatic, because the underlying principles of many things you come across in clinical practice have not yet been properly explained. In the case of rare diseases especially, there can be a lot of frustration, so the prospect of finding out more through academic research can be comforting to some extent. When I tell a patient they have been diagnosed with an illness that is incurable and add “but we are working on it,” I can cope with the situation better if I can include myself in that “we.”

DFG: In your contribution to the Science Slam at the recent annual meeting of the German Academic International Network (GAIN), you cited some statistics in your field of rare muscle diseases to compare frequency, such as how many people go to sleep at night with a stuffed animal. The number was amazingly high; it was a great way to get your audience’s attention. Was that just a trick for this purpose – or did the number actually come from a genuine source?

AM: I’m glad it worked – and no, I didn't make it up. Survey figures circulating on the internet show that 34% of all adults take a stuffed animal to bed with them. If you ask nursing staff at hospitals, they will confirm this, too – perhaps not as much as 34%, but to a much greater extent than you might imagine. I assume that you don’t take a stuffed animal to bed with you yourself.

DFG: No, but there’s a pennant of my favorite football team hanging over the bed, which brings me to my last question: Borussia Mönchengladbach lost 1:2 against Union Berlin on the second match day of the new season. How did you cope with this?

AM: Even though I’m surrounded by sports fans in my muscle lab here and live broadcasts of the Champions League regularly run on the lab computer, I must confess to you that my fascination with muscles is more academic in nature – sport itself is “not really my thing,” as they say. If you want to pin me down, I'll say: Gladbach before Union, Union before Hertha BSC. But I can get really excited about big matches, too.

DFG: Thank you very much for this very informative and entertaining interview. We wish you all the very best for your professional future, determination on your way to the helm of the ship, and the best of luck when you get there.