Karin Scharffetter-Kochanek is a full professor and the Medical Director of the Department of Dermatology and Allergology at Ulm University Medical Center. She is also the Chair of Dermatology and Allergology at the University of Ulm. 

She studied Medicine at the Rheinisch-Westfälische Technische Hochschule in Aachen, Germany, and at the University of Vienna, Austria. She trained in research at the Department of Dermatology, Ludwig-Maximilians-Universität in Munich, at the National Institutes of Health in Bethesda, and as a Heisenberg Fellow at the Institute for Human and Molecular Genetics at Baylor College of Medicine, Houston, USA. 

She is a dermatologist and a physician-scientist. Her research focuses on inflammatory skin diseases such as psoriasis and the complex processes involved in skin regeneration and wound healing disorders. An example is “open legs” (ulcus cruris venosum) disease, for which she contributed important findings for new therapies. Together with her team, she developed mouse models for studying psoriasis and identified several gene mutations involved in the disease. Influenced by her clinical work, she takes a systemic approach to understanding the skin and its related diseases, with a keen eye on its interplay with other organs. 

In recent years, she has been increasingly interested in the process of cellular aging. On this topic, she is a principal investigator and the Deputy Coordinator in the German Collaborative Research Center 1506 “Aging at Interfaces”. As part of this interdisciplinary consortium, she is studying how senescent skin fibroblasts enforce skin decline and possibly aging of other organs and exploring new approaches to reverse or prevent skin and other organ aging and age- associated morbidities. 

She has been an elected member of the German National Academy of Sciences Leopoldina since 2008. 

Keywords: Skin diseases, autoimmune diseases, psoriasis, wound healing disorders, aging processes of the skin, diagnostics, skin, prevention, molecular mechanisms.

Ulm – September 21st, 2023 

How did you (decide to) become a scientist?

My journey started with curiosity. Initially, I studied Medicine and wished to become a doctor in Internal Medicine, but they rejected me, stating that they had enough doctors at that time. So, I switched to Pathology because it allowed me to understand how organs function together by examining them macroscopically and histologically. I found it very interesting to clarify why people died. I also gained a lot of respect for pathologists. They act as the consciousness of clinicians, often finding things that clinicians may have overlooked. My work in Pathology was very fruitful, and I even published my first papers on vessel disease, while working with Professor Christian Mittermeier in Aachen.

However, while working in Pathology I had not enough time to concentrate on science. The research work, according to my impression, still did not reach the depth of understanding I would have wished.  So, I transitioned to Dermatology. I met a mentor, who advised me to separate clinical work and research during the years of research training. 

I got inspired by science because in research you dig into something that is pretty much unknown and gradually uncover its secrets step by step. This led me to stay in science and pursue five years of education in molecular and cell biology. Eventually, I combined this with my clinical training to complete my residency. Inspired by Professor Thomas Krieg, I approached the German Research Foundation to fund me as a faculty member and they supported me with a Heisenberg Stipend. I first went to the National Institute of Health in the USA and then to the Baylor College of Medicine in the Department of Genetics. During that period, researchers established methods to disable (knock out) molecules and study their effect on the whole organism, particularly how specific molecules were involved in diseases, and I contributed to this field with my research.  Eventually, I was recruited as a professor and established my group. 

I was always interested in aging. I wanted to understand how tissues decline and also how wounds heal because I felt if one could understand wound healing and the mechanisms of aging, one could attenuate or reverse aging or make the wound heal without scars and stop the tissue decline. Certainly, research in this field has been very slow. However, in the scientific community, there has been a real advancement in our understanding of various cells, including fibroblasts (a type of cell in the connective tissue, that supports and connects different tissues in organs in the body) and hematopoietic (blood-forming) stem cells, and their aging process. As these cells age (senesce) – they stop dividing and change their phenotype. Senescent cells start the production of inflammatory soluble proteins, which are released and influence neighboring cells. This process involves the release of pro-inflammatory chemokines, cytokines, and matrix-degrading metalloproteases, and their metabolism, with the decrease of insulin growth factor1. All this impacts the cellular environment, and the result is the depletion of stem cells in their stem cell  niches, a decline in regenerative capacity, degradation of the structural proteins, with a severe loss of the regenerative capacity and the tensile strength of the skin of old adults.  While this concept is not originally mine, my idea is to intervene in this process (senescence). If you could get specifically rid of senescent fibroblasts by senolytics (a class of drugs under basic research to determine if they can selectively clear senescent cells) or genetically, you could stop the tissue decline, as has been demonstrated in mice. In the dermis, a type of connective tissue, the fibroblasts cannot die because of their anti-apoptotic program, contributing to inflammation, often referred to as “inflammaging”. That is the reason why I think that removing senescent fibroblasts could be beneficial for different organs´ functions and would  overall  enforce people’s health. This concept is also true for macrophages and other cell of the innate immune system. I believe that some organs or systems drive these inflammatory processes and others respond to them I also think that the connective tissue, which is found in all organs, is crucial. My view is that connective tissue, skin, and bones act as driver organs of “inflammaging by secreting inflammatory products that can potentially affect the entire body, including the brain. I’m confident that we make deeper discoveries in this field, and it’s truly fascinating.

What is your drive and excitement in science and in doing what you do now?

I think that Medicine is interesting and fulfilling but if clinicians do not engage in research, there will be limited progress going beyond tradition. In science, I like I’m forced to think critically and maintain a strong focus, and this is critical to success. In medicine, you’re reactive to patients’ needs which is a value in itself. In science, you can sit down and say “I want to solve this problem, which steps do I have to do?”. I like this type of contemplative approach in science, it allows you to accomplish things, to make meaningful progress, even if it doesn’t result in the Nobel prize. 

I like also to interact with young people, hungry people, who have some glow in their eyes because they’re fascinated by something and are motivated to accomplish something meaningful. So, I’m very happy to pursue research, even though it sometimes requires long hours to manage it all. I have to balance the administration, and the medical responsibility for patients and training of residents, and I have the research, so it’s extensive but it doesn’t make me unhappy. The research and the clinical work are equally important. Research allows us to educate others to think in a structured way. As clinicians, we need to look at symptoms, connect them to diagnosis, think about what to do in the laboratory to support diagnosis, and explore different possibilities for therapy.

If every day would be the same fourteen-hour routine, then you get bored. However, if you have the opportunity to work on a problem for many years, it’s a privilege. While sometimes you have to give up if a research line doesn’t yield good results, you can inquire or investigate things and you often find answers, and even more questions. So, it never gets boring.  

Dealing with frustration is part of the scientific journey because nature and science do not unveil their beauty instantly. You have to unfold it. This is not always easy. However, you’ve to deal with frustration anyhow in human life, so research is a good path for practice. When you finally achieve something, that makes you more than happy. For my wellbeing. I would not want to do every day the same; I like the process of developing something, which looks like a stairway to find the solution.  We need the foundation of a structured routine, but we need also creative, sometimes a little bit crazy minds to help us innovate and define our direction for advancement of knowledge. This journey may be very slow, but it’s a good path. Young people should have better chances to go through it more often.

Would you have one word to give as a gift to other women and more in general to young aspiring scientists, women, or men?

I think science is an attitude. It takes years to cultivate it and be trained in it. It involves learning to observe and think critically, understand how you can make changes, unveil hidden processes, and then ask how it’s all related to disease. I think it’s extremely fulfilling. For those with open minds who pursue science, it can be particularly fulfilling. 

You need a mentor initially. Most people get frustrated because science is not easy, you cannot gamble. You have to work hard because nature does not say to us, “You are intelligent, here is the secret of life”. Hardworking and intelligence help us, but you cannot do research just by sitting in front of a computer, you need to listen to nature. I’ve helped some students to become professors and find their way, and some are on their way. I’ve also initiated some Medical Doctors on the double-track clinical and research work. 

For young people, especially those pursuing a career in medicine, it can be challenging to balance their wish for creativity and for doing meaningful work with the demands of the healthcare system that pushes them to earn money with medicine. My advice to them would be, “Continue your medical and scientific journey, but try not to do everything simultaneously”. Instead, try a sequential approach where you can integrate both science and clinical practice. “Connect with people who can help secure funding so that you have the opportunity to spend a few months each year doing research. This approach allows you to grow in both fields”.  This advice is more relevant to medical doctors (MDs). For those pursuing a PhD in science, the dynamics are different. The beauty in scientists often lies in their attitude to life. 

Young people should be encouraged to establish confidence in research. I’ve observed them and I know they have beautiful brains and a scientific attitude. Students who enter the clinic have beautiful brains too. However, they are very young, and they can easily become frustrated by the system, so they don’t want to do research. It’s very difficult in the clinic to recruit people, who want to do both clinical work and research, just as I do. Many of them believe that completing their residency in four years or even less is the ultimate goal to pursue. They are not familiar with the laboratory work or have a clear understanding of natural sciences and the purpose of pursuing a Ph.D. because they don’t learn this in their training in the German system. I prefer the system in other countries, where medical doctors are required to spend obligatory time in the laboratory, to allow them to become acquainted with the process of scientific thinking. In our system, this exposure is lacking, and as the saying goes, “What you don’t know, you don’t want”. That’s a pity.