He plays the whole board

How do you win a war? By knowing your enemy—knowing who and where your enemy is. Professor Frank Aarestrup has devoted his life to winning the war against the microorganisms that make people ill and, in worst case scenarios, actually lead to their deaths. He has drawn his battle strategy from books such as Julius Ceasar’s De Bello Gallico, and Tolstoy’s epic War and Peace. Because not only is he a veterinarian, a microbiologist and one of the fathers of the Danish programme to combat antimicrobial resistance, but he is also extremely well-read and well versed in the history of the world.

Frank Aarestrup is always reading at least one work of fiction, and he is currently reading four: Poor Folk by Fyodor Dostoevsky, The Picture of Dorian Grey by Oscar Wilde, The Italian by Ann Radcliffe and The Nigger of the Narcissus by Joseph Conrad. However, he usually packs a few more when he heads off on his travels —which he does increasingly often these days.

Travel did not otherwise play a major role in his childhood. Based on the Danish island of Mors, his family did not have the money to fritter away on such extravagances, so Frank turned to books as his source of information about the outside world. And his travels in fiction continue to this day.

“My dear wife has an MA in Comparative Literature and Ancient Greek, but I think I’ve read more than she has. And I do it purely for the pleasure of reading. I’ve never been taken by her personal favourite, Euripides, and I found the Iliad really, really boring. The Odyssey, however, is magnificent and funny ... I may well read it again soon,” says Frank Aarestrup with characteristic enthusiasm and glibness.

Veterinarian is a solid profession
Frank originally wanted to be a chemical engineer, but he was afraid that it might be too boring and involve too much sitting behind a desk. So he chose to become a veterinarian instead. “That’s viewed as a solid profession here in Jutland, and the study programme gave me a chance to get back out into the country,” he says.

He never returned to his home turf, however, because after completing his MSc thesis on diseases in cattle, he was asked whether he would be interested in writing a PhD about the bacteria that lead to mastitis. This marked the point where he was diverted from his original interest in genetic resistance to disease, and where he found employment at Statens Veterinære Serumlaboratorium (The Danish State Veterinary Serum Laboratory, which later became The Danish Institute for Food and Veterinary Research) in Copenhagen.

In the 1990s, the first reports concerning antimicrobial-resistant bacteria began to emerge from abroad, and it transpired that antimicrobial agents were being used as growth boosters in Denmark as well—and that resistant bacteria had already been identified in the country. This made a deep impression on the young PhD student, and he soon allowed his name to be added to a project that would be unthinkable today: in just eight weeks, the Danish Minister for Agriculture wanted scientific documentation of the scope of the problem in preparation for a proposal to prohibit the practice in the EU. Frank was handed responsibility for all the laboratory work, and successfully applied to have the date of his PhD submission postponed. He found the work highly enjoyable, and subsequently took it upon himself to draw up a protocol for monitoring resistance in future.

He readily admits that the protocol would never be rubber stamped today, but it functioned at the time and served as the starting point for the Danmap report that has been published every year since 1996—and has also been used as the model for monitoring programmes in other countries. In fact, his work in this field is so highly acclaimed that Frank Aarestrup received official recognition from the Queen of Denmark in May this year.

“Yes ... that’s probably why I was knighted.  You can argue back and forth about whether the honour was merited, but the work was exciting, and the monitoring programme has actually made a difference at global level. However, I think it’s about time the programme was updated, and I have an idea about how to do it,” says Frank.

Complete sequencing opened up a host of new opportunities
Personally, he has set his sights on an even higher goal, namely to create a global disease monitoring system based in Denmark.

“As a vet, you tend to be almost brainwashed into thinking in terms of disease control and prevention. That’s probably why I got to thinking that in order to be able to combat illness, you have to know what you’re facing at all times. At the same time, it’s obvious that Denmark doesn't exist in isolation—the country is open to infection via imports and international travel.”

The idea about building up knowledge about diseases at global level was also given a boost by the fact that technology and equipment for sequencing entire genomes was becoming cheaper and more readily accessible.

“Gene sequencing is actually quite simple today, compared with the old methods, where people had all kinds of different ways of writing the word ‘salmonella’. The DNA code is a universal language, and everyone can send data by email. So I came up with the idea of setting up a service where we could receive sequencing results of samples from sick people that small laboratories in developing countries had prepared, have our bioinformaticians analyse them and then send the answers back within just a few hours. This would also allow us to ‘skim off the cream’ by saving the data we received—and all of a sudden, we’d have a global illness monitoring system.”

The whole world as the playing field
His idea arose around the time that the Danish Institute for Food and Veterinary Research merged with DTU, so it was an obvious step to involve the Centre for Biological Sequence Analysis at DTU Systems Biology. And even though he could not promise more than a five per cent chance of success, Frank was awarded funding from the Danish Council for Strategic Research to test the idea—which subsequently proved viable. It is a very long way from there to launching a truly global system, however; much longer, in fact, than Frank originally envisioned.

One of the problems is actually sharing data, which is a sensitive area for both individuals and national authorities. This conundrum led Frank Aarestrup to start thinking of alternative approaches. Rather than examining pathogenic microorganisms in individual patients, it should be possible to search for them in these people’s ‘waste products’, and to test out his idea he applied for funding for an experiment involving wastewater from Herlev Hospital.

Then one day, he and his partner, Professor Thomas Sicheritz-Pontén from the  Centre for Biological Sequence Analysis, happened to start discussing how pertinent it would be to analyse the wastewater at airports, where people from all parts of the world meet on their travels.

“We can’t quite agree on who it was made the next logical leap and came up with the idea of taking samples directly from the aircraft; we both think it was each other. But we quickly decided to run an experiment,” relates Frank.

Their experiment proved that it is possible to draw valuable information from such samples, but it is, of course, necessary to collect a great many samples over a protracted period before it becomes clear whether it is worth devoting money to predicting the spread of illness by analysing the contents of aircraft toilets.

Frank would like to see someone pick up the ball and run with it, but he himself continues to struggle to overcome the numerous practical and legal obstacles on the path towards his global illness monitoring system.

“There’s no merit in it for me as a researcher, but as a university man, I feel it is essential to interact with society as a whole. It would be easier simply to study your E.coli samples with a single PhD student, but if you have the whole world as your playing field, you have to run a bit harder and farther. This is something you have to accept. The idea alone won’t do the work for you; you have to spend time out in the real world and devote time to it. Research is a means to an end, not an end in itself.”

Frank Aarestrup’s goal is to establish a global illness monitoring system—he’d consider anything less a personal failure. And on the day it works, he’ll hang up his lab coat and retire.

CV

Frank Møller Aarestrup was born on 11 January 1966. He lives in Gentofte with his wife and three children aged 6, 9 and 10. May 2015: receives a knighthood (Ridderkorset) 2013: Member of the Danish Academy of Technical Sciences (ATV). 2010: Professor at DTU 2009: Receives the ‘EliteForsk’ award presented by Danish Ministry of Higher Education and Science 2002: Research Professor at the Danish Institute for Food and Veterinary Research 1992–2002: Employed at Statens Veterinære Serumlaboratorium (The Danish State Veterinary Serum Laboratory) 2000: MD from the Danish Royal Veterinary and Agricultural University (KVL) 1996: PhD from KVL 1992: MSc from KVL