Translational medicine

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Introduction

There is no clear definition of translational medicine; it means different things to different people. Here, we define translational medicine (also referred to as translational science) as a rapidly growing discipline in biomedical research that aims to expedite the discovery of new diagnostic tools and treatments by using a multi-disciplinary, highly collaborative approach.

Often described as the practice of transferring scientific knowledge “from bench to bedside“ (B2B), translational medicine builds on basic research advances – studies of biological processes using cell cultures, for example, or animal models – and uses them to develop new therapies or medical procedures

There are different views of the concept of translational medicine:

Barry S. Coller from the Rockefeller University, NY defines translational medicine as: “The application of the scientific method to address a health need.”

He holds that, in contrast to basic research, which has the generation of new knowledge as its primary goal, the primary goal of translational science is improvement in human health.

John Hutton from the Cincinnati Children’s Hospital Medical Centre, describes that a perfectly reasonable, “official” definition of translational medicine should be: “Translational medicine transforms scientific discoveries arising from laboratory, clinical or population studies into new clinical tools and applications that improve human health by reducing disease incidence, morbidity and mortality”.

This definition has been taken and adapted from “Transforming Translation – Harnessing Discovery for Patient and Public Benefit” (Report of the Translational Research Working Group of the National Cancer Advisory Board, US NIH, 2007).

Core concept

Translational medicine converts promising laboratory discoveries into clinical applications and attempts to answer clinical questions with the use of bench work to facilitate prediction, prevention, diagnosis, and treatment of diseases. In other words, translational medicine transforms the basic investigational achievements of medical biology into practical theory, technology, and methods that will bridge laboratory and clinical practice.

Translational medicine is focused on ensuring that proven strategies for disease treatment and prevention are eventually implemented within a patient population.

Translational medicine: a bi-directional concept

Translational medicine will encourage the flow of information from the laboratory to the clinic, and in the same way, it should be encouraged from the clinic back to the laboratory. This means that translational medicine, as a concept, is a bi-directional concept, encompassing:

  • bench-to-bedside factors, which aim to increase the efficiency by which new therapeutic strategies developed through research are tested clinically, and
  • bedside-to-bench factors, which provide feedback about the applications of new treatments and how they can be improved.

Currently, advances in the understanding of biologic systems and the development of powerful new tools that can be applied at both the bench and the bedside – offer unprecedented prospects for advancing knowledge of human disorders in this bi-directional translational context.

Translational medicine seeks to coordinate the use of new knowledge in clinical practice and to incorporate clinical observations and questions into scientific hypotheses in the laboratory. It also facilitates the characterisation of disease processes and the generation of novel hypotheses based on direct human observation.

Patients and patient organisations play a very important role in ensuring continuous feedback and communication among the diverse stakeholders in this field, which are essential for success.

History of translational medicine

The term translational medicine was introduced in the 1990s but only gained wide usage in the early 2000s. Originally, translational medical research emerged from the concept of bench-to-bedside (B2B), as a class of medical research aiming to eliminate the barriers between laboratory and clinical research.

In 2003, the Institute of Medicine Clinical Research Roundtable described the current terminology and model of translational research as a two-phase process of research, progressing from:

The most current translation model in the literature is the 4 T’s model:

  • T1: basic scientific discovery (basic knowledge) to potential clinical application (theoretical knowledge) to
  • T2: evidence-based guidelines (efficacy knowledge) to
  • T3: clinical care or intervention (applied knowledge) to
  • T4: the health of a community or population (public health knowledge)

The need for translational medicine

Independently of the definition, what remains clear is the enormous need for translational medicine, mostly due to:

  • The rapidly growing life expectancy in most world populations has resulted in an increased prevalence of chronic disease. Treatments can be costly and prolonged.
  • The continued rise in prevalence has resulted in a projected growth of health care spending.
  • Improved diagnosis has increased the requirements for treatments for newly identified, often rare, diseases.

A final goal of translational medicine is to help patients with a more rapid development of new diagnostics, medicinal products, and new medical knowledge for treating diseases, giving access to care for people at reasonable costs.

Opportunities and challenges for translational medicine

This type of medicine has helped to translate the remarkable scientific innovations that occurred in the last years into health gains for the general population. This has been accomplished by:

  • Using advances in physics and materials science which offer new approaches to study or diagnose medical conditions
  • Helping in expediting the incorporation of novel endpoints into clinical testing, thereby shortening the duration of clinical trials
  • Facilitating the transfer of testable agents into the clinic, thereby leading to more rapid validation of new products and reducing costs associated with non-clinical testing

However, there are many challenges still for this type of medicine, as it has to translate in a manner that will enable public health models for disease prevention or treatment even in low-resource settings to be realistically and successfully implemented. This is possible by identifying the means to create a supportive environment for translational medicine and to develop novel methods for diagnosis, prognosis, and therapy for urgent and unmet global needs.

Knowledge of many fundamental aspects of biology in health and disease is still insufficient to automatically translate current findings reliably into new and more effective prevention and treatment – the goals of translational medicine can be attained only through continuous investment and advances in basic biomedical and behavioural discovery coupled with efficient translational science. Fulfilling the unmet need of disseminating new knowledge in clinical and translational medicine can lead to a better clinical practice.

Achievements of translational medicine

Translational medicine, in enhancing the efficiency of biomedical discovery and application, rather than attempting to modify existing processes within disciplines, has come to serve as a unifying concept in the increasingly complex, specialised, and fragmented field of biomedical research. It has emerged based on the synthesis of information gained from multiple investigative sources. Thanks to this approach, human biology and diseases are better understood and therapies more rapidly identified and tested, which together result in improved patient treatment and outcomes.

However, there is the need to stimulate the development of a clearer vision for translational and clinical research, to ensure that these disciplines remain powerful engines of creativity.

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