Translational Cardiovascular Research:
The Good, the Bad and the Role of the ISACB
The 20th century saw enormous progress in health and lifespan in both the developed and the developing world, especially from reductions in rates of death from heart disease and stroke. Of the six-year increase in life expectancy realized in the United States between 1970 and 2000, nearly two-thirds is attributed to reductions in mortality from heart disease and stroke.1 Approximately one half of that gain is attributable to primary and secondary prevention through reductions in major risk factors and one-half from improved therapeutic drugs, procedures and cardiovascular medical devices.2, 3 These statistics clearly emphasize the power of research applied to healthcare needs, especially investigation related to cardiovascular disease.
So what is the problem?
Nevertheless, there is widespread agreement that the maximal return on the nearly $250 billion invested by this country in the National Institutes of Health (NIH), the major source of biomedical funding in the U.S., has not been realized and that present and past scientific discoveries are not being translated as efficiently as possible into tangible human benefit.4, 5 Indeed, health and longevity in the US would be improved if we did a better job of applying what we have learned through research; specific cardiovascular health needs have been emphasized.6 Moreover, the translation of basic science discoveries into clinical studies and of clinical studies into medical practice and health decision making in systems of care is increasingly encumbered by high costs, slow results, lack of funding, regulatory burdens, fragmented infrastructure, incompatible databases, and a shortage of qualified investigators and willing human subjects, thus engendering "translational blocks".7
NIH Director, Dr. Elias Zerhouni, has eloquently articulated the challenge "The current practice of medicine needs to change radically over the next few decades. Biological research data will need to encompass more quantitative, spatial, and temporal elements, in addition to variables at the molecular, cellular, tissue, and organ levels, if scientists are to understand the complex interactions that drive biological systems toward health or disease. ... Effective scientific teams of the future will require closer working relationships among basic, translational, and clinical scientists. Traditional disciplinary, departmental, and other artificial organizational barriers will have to be breeched in an era of scientific convergence in which basic life processes have been shown to be common across disease conditions, chronic multisystemic diseases are the norm rather than the exception, and research tactics and strategies have become very similar across diseases." 8 To accomplish this goal, in 2003 the NIH embarked on the NIH Roadmap for Medical Research, which aimed to identify and support cross-cutting research needs that are beyond the scope of any single NIH component and to bolster the development and availability of modern scientific tools and information resources, foster novel methods of research collaboration beyond the confines of individual disciplines, and explore new organizational models for team science.
Concurrently, many biomedical researchers feel seriously threatened by an increasing difficulty in obtaining new and renewal NIH grants, owing to a flattening of the NIH budget over the past several years that followed a virtual doubling of the NIH budget in the years 1998 to 2003. Many excellent investigators, accomplished in both translational contributions and mentoring of young translational scientists, are profoundly worried about the future of their work and scrambling for "bridge" funding.9, 10
What are the solutions:
Facilitate the recruitment, training and retention of translational investigators. This should include scientists and engineers with interest in applying their expertise to problems of human health, physicians who view the hospital as a "problem-rich" environment, and physician-scientists, particularly in the early parts of their careers and at critical transition points.11, 12, 13, 14 The NIH has addressed this need, in part, by the development of new models for support of training, changes in the structure of study sections, and increases.
Show and emphasize how translational research and the development and implementation of appropriate technology are cost effective. Economic models that calculate the impact of the use of beta-blockers following myocardial infarction, cholesterol lowering, the use of percutaneous coronary intervention bare metal or drug-eluting stents, percutaneous valve repair and replacement and personalized approaches to specific diseases where pertinent genetic data are available, among many others, need to be constructed. They should be used in the allocation of research funding and reimbursement for patient care. The insurance companies, health maintenance organizations and industries that develop and manufacture, as well as directly benefit from the application of these technologies should fund some of this research.
Facilitate the creation of, and reward for, new collaborative models in which clinical "pull" and technology "push" work hand-in-hand to engender a "culture of innovation" in academic medical centers and facilitate technology development and implementation. An excellent example of this approach is the Center for Integration of Medicine and Innovative Technology (CIMIT). A non-profit consortium of Boston area teaching hospitals and engineering schools, CIMIT (www.cimit.org) provides innovators with resources to explore, develop and implement novel technological solutions for today's key healthcare needs. CIMIT facilitates research through funding of peer-reviewed grants and career development awards, and providing expertise in human and animal research guideline compliance and intellectual property issues. Moreover, CIMIT fosters and nurtures interdisciplinary collaboration among world-class experts in medicine, science and engineering, in concert with industry and government, to rapidly improve patient care. In the nine years since its initiation, CIMIT has demonstrated the power of connecting creative minds from diverse areas of expertise, proving that actively catalyzing the collaborative process accelerates progress in applying new technologies.
ISACB is also a powerful force for extending this paradigm across disciplines, institutions, and nations.
Why is the ISACB so important to progress in translational research in cardiovascular disease?
ISACB provides a forum for collaboration in bedside-to-bench-to-bedside discovery, development and implementation. The opportunity to truly impact issues of translation through effective face-to-face communication is enormous and ISACB has been a pioneering society in this regard. ISACB uniquely nurtures a strong and effective alliance among academic scientists, clinicians and industry-based scientists, who collectively have the expertise to understand and translate basic biological mechanisms into treatment strategies. Toward this end, ISACB continues to be an integral forum for discussion of solutions to difficult clinical, scientific and technical challenges demanded by integrative and translational studies. ISACB members and meeting participants use techniques ranging among molecular and biochemical analysis, imaging and pathological evaluation; they are developing and validating the efficacy and safety of diagnostic imaging and laboratory tests, and therapeutic techniques, procedures and devices, including advanced biomaterials, endovascular techniques, and innovative cardiovascular devices.ISACB has hosted biennial scientific meetings since the inception of the society in 1987. Basic, translational and clinical researchers, clinicians, and representatives from the biotechnology, pharmaceutical and cardiovascular device industries have enthusiastically attended these meetings. Vascular surgeons were instrumental in the founding of the Society in 1987, and they, cardiothoracic surgeons, and interventional cardiologists also attend ISACB meetings. Through a generous corporate contribution, ISACB has recently reorganized its web site (www.isacb.org) where additional information can be found about the organization and its programs.
ISACB's 11th Biennial Meeting to be held in Bordeaux, France on September 13-15, 2008 will once again focus on these issues. The overall theme of the meeting will be "Translation of Applied Biology to the Treatment of Cardiovascular Disease". The technical core of the meeting will be five half-day sessions involving approximately 20 leading scientists, engineers and clinicians as invited speakers. Proffered papers and posters on original research, selected by a rigorous peer-review process, will supplement these presentations and there will be a vibrant social program to facilitate informal discussion (in a spectacular venue).
As President of the ISACB, and on behalf of its leadership, I hope to see you there. I look forward to discussing with you the most vexing challenges in cardiovascular disease today and the most innovative approaches to solve them!
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11. Moskowitz J, Thompson JN. Enhancing the clinical research pipeline. Training approaches for a new century. Acad Med 76:307, 2001.
12. Nathan DG. Careers in translational clinical research–Historical perspectives, future challenges. JAMA 287:2424, 2002.
13. Snyderman R. The clinical researcher–An "emerging" species. JAMA 291:882, 2004.
14. Ley TJ, Rosenberg LE. The physician-scientist career pipeline in 2005–Build it and they will come. JAMA 294:1343, 2005.
Frederick J. Schoen MD, PhD
President, ISACB
