A tenacious researcher.
Text: Irène Dietschi
Mirjam Christ-Crain is setting new standards. Her motto? “Never give up.” The endocrinologist is even making advances in fields beyond her own – and always for the benefit of patients.
As a young assistant physician at the University Hospital Basel, Mirjam Christ-Crain would sometimes get to witness the “water deprivation test.” Practiced in the field of endocrinology, this test involved preventing a patient from drinking for 17 hours. The door would be locked from the outside, the faucets inside the room removed.
The aim was to identify a potential deficiency in vasopressin, a hormone released by the pituitary gland that regulates the body’s water balance. It helps to restrict urinary excretion if the body isn’t getting enough fluids; in this case, the urine turns a dark yellow color.
If a person is deficient in vasopressin, this mechanism fails, and they have to drink up to 15 liters of water every day to stop themselves from dying of thirst. Their urine remains clear, regardless of how little fluid is added from the outside, a disorder formerly known as diabetes insipidus.
Driven to do better.
“For decades, clinics used this as an indirect way of identifying vasopressin deficiencies,” says Christ-Crain. “But it was torture for the patients.” And that’s not all: The test was so imprecise that it returned the wrong result in a third of cases. For Christ-Crain, this was an incentive to find a better approach.
She has since earned her Habilitation (associate professorship) and developed a new test to diagnose vasopressin deficiency using copeptin, a peptide that is co-excreted in parallel with vasopressin by the pituitary gland. “But in contrast to vasopressin, the copeptin in the blood can be reliably measured,” she explains. “It’s now much easier to diagnose a vasopressin deficiency, with more than 96-percent accuracy.” The method is now being used for the benefit of patients around the world.
Intellect instead of craft.
Christ-Crain is explaining the various steps to this research in her office on the ground floor of the University Hospital at Petersgraben 4 in Basel. It’s a hot afternoon in the middle of August, and noise from a construction site is drifting in through the windows. But she doesn’t allow herself to be distracted. As Deputy Chief Physician at the Endocrinology, Diabetology and Metabolism Clinic, she sits at her desk with her back straight and her dark hair tied up in a bun – focused, friendly, and approachable.
Christ-Crain has had a remarkable career. Even as a student, she knew that she was most interested in endocrinology, the science of hormones: “It’s a holistic and intellectual field that demands a lot of logical thought,” she says, adding that she is less gifted with manual skills: “I wouldn’t have made a good surgeon.”
Instead, she became an excellent researcher: Christ-Crain dedicates around 50 percent of her working hours to her studies. She has received many awards, including the renowned Latsis Prize in 2009 for her research on stress hormones, and last year the equally prestigious Otto Naegeli Award, which normally honors basic research. Christ-Crain is the first person to receive the award for application-oriented clinical research.
Combine and discover new things.
“She’s very open to new, interdisciplinary approaches, and that’s how her true innovations come about,” says Matthias Liechti, a clinical pharmacologist who works with Christ-Crain at the University Hospital Basel and the University of Basel. Liechti explains that, while clinical research can be very laborious, requires a lot of money and is highly regulated, Christ-Crain doesn’t allow these obstacles to get in her way: “I’ve rarely met anyone who pursues their goals with such determination,” he says.
Christ-Crain herself says that her “thing” is to network with great minds from other disciplines to come up with new ideas. This is how the vasopressin story moved onto a new chapter – one that focuses on oxytocin, the “love hormone”, which is also released by the pituitary gland: “During our consultation hour, we realized that people with a vasopressin deficiency often have other symptoms too: They are frequently anxious, a little gloomy, socially withdrawn.” This led us to suspect that those affected with vasopressin deficiency could also be lacking oxytocin.
Testing with ecstasy.
Just like vasopressin, oxytocin deficiency cannot be measured directly in the blood – the system also has to be stimulated. In this case, it was stimulated using MDMA – otherwise known as ecstasy. In a pilot study conducted with Liechti and de Quervain, Christ-Crain was able to show that many people with a vasopressin deficiency don’t adequately release oxytocin either: While healthy test participants saw their hormone levels increase eightfold after being given MDMA, the patients’ hormone levels remained the same and they did not experience the typical subjective MDMA effects. “This proves they are lacking in oxytocin.”
A larger-scale study is now examining whether oxytocin treatment can help these patients with their psychological symptoms. Recruitment has been underway since the start of January, and 120 patients from all over Europe are set to be included. “There has been great interest,” says Christ-Crain.
This approach might even open up a whole new field of research: “It’s possible that some people who suffer from anxiety disorders, post-traumatic stress disorders or depression may have an oxytocin deficiency – with or without a simultaneous vasopressin deficiency – and the MDMA test enables us to identify this deficiency,” she says. One day, it might be possible to use these findings to develop a treatment for this cohort of psychiatric patients. “That’s still a long way off though,” says Christ-Crain. Nevertheless, her indefatigable drive to research may soon be taking her to new horizons in psychiatric diagnostics.
Mirjam Christ-Crain was born in Basel in 1974 to an American father and a Swiss mother. In her youth, she competed in middle-distance running (800 meters). After studying medicine, she trained as an endocrinologist in Basel and London. In 2007, aged just 33, she became the youngest Habilitation candidate at the University of Basel. For ten years now, she has been Professor of Endocrinology and Clinical Research at the University of Basel and Deputy Chief Physician at the Endocrinology, Diabetology and Metabolism Clinic, University Hospital Basel. She is married and has three teenage children.
More articles in this issue of UNI NOVA (November 2024).