When research is the subject, you have certainly heard the words “translational research” or “from bench to bedside”.
What do these words mean?
They point towards a leaner, targeted and result-oriented research meant to tackle unsolved issues. You could ask why this would deserve a special wording, isn’t this the normal way research gets translated to applied science, in our case medicine?
The answer is that it does deserve an own description because this is not the “normal mainstream case”.
What would be the usual path? Normally basic researchers, who try to understand and describe natural or pathological processes, do so by following a research plan conceived to bring them there in the most efficient way.
Let’s hypothesize you worked on a research project on stem cells and their interaction with inflammatory processes. Your research plan would foresee the development of immunological techniques for identifying activated inflammatory cells and stem cells, as well as of an appropriate in vitro and / or in vivo model. Should you yield scientifically sound and reproducible results, you would write and publish a paper in a peer reviewed scientific journal and present the results in a conference, listen to critiques from colleagues and try to improve your project accordingly. This is how basic research goes. Sometimes a clinical application emerges but this happens post hoc, i.e. when the results are out and someone identifies a potential use.
At the other end, a farsighted clinician (physician, surgeon) would identify an unmet clinical need or would not accept a complication prompting him/her to seek a solution.
He/she can contact as many people as possible for ideas or can see if something can already be found, which could contribute to the desired solution.
What happens if this research does not bring any usable results? Accept the situation or get more active! The latter option would make the clinician contact a suitable research lab and explain to the researchers the nature of the issue to be solved. They would start together a creative process, so called brainstorming, trying to find ideas and approaches towards a possible solution (Fig. 1). This can be a long journey, it could require to involve more people from other labs, deeper study of the available literature and eventually some trial-and-error approaches.
Fig. 1: Mindmap after brainstorming to tackle a clinically relevant issue through translational research in cardiovascular engineering.
A new research project is now born, initiated by the clinician’s desire / request, i.e. with a clear final target. At the very end of this project, a possible solution is developed and in the best case applied “at the bedside”. This is what is called translational research. Its main characteristic is that it is initiated by a clinical need and conducted with the (applicable) solution to this need in mind.
Clinical application of the result of a research project (the final step of the translation, i.e. the bedside) is not as simple as it may sound! Now a new term comes in, “knowledge transfer”, meaning that the result of the translational research is transferred to healthcare practice. The physiological result of a translational research project is a product. A product can either be a diagnostic or therapeutic method, a medical device, a substance and in any case it is an intellectual property (scientifically presented and / or patented). The usual channels to bring all this to clinical practice are spin-off or start-up companies; alternatively, working prototypes can be licensed to private companies.
A new substance (“pharmacon”) needs to be producible on a large scale, to undergo thorough animal and later clinical testing to certify first safety and later efficacy. Larger and very expensive clinical trials are later needed before the new substance finds its way to the pharmacy. Almost the same path is foreseen for medical devices, implantable (more complex procedure) or temporarily usable for diagnostic or therapeutic purposes.
In another post in this blog we will discuss the complexity of the procedure of studying and certifying medical devices, which in the last years got unreasonably complex, complicated and very expensive.
In sum, there is a substantial conceptual difference between basic and translational research, the latter one being initiated by an unmet clinical need. A major requirement for the translational research is the intellectual curiosity and open mindedness of clinicians, who seek an effective interaction with researchers and researchers who appreciate and understand their clinical counterparts and the issues brought by them. Embedding researchers in the clinical practice and clinicians in the lab can create a magical interaction, which frequently enough generates winning ideas and produces great and applicable results. Succeeding in establishing such an environment is not simple; on the contrary, it is a rare privilege.
On a personal note, I count myself among those having this privilege with our lab of cardiovascular engineering led by PD Dr. Stijn Vandenberghe, PhD. In cardiac surgery, as in many other disciplines at the edge of medical and technological progress in general, this kind of translational and creative stimulation is, in my humble opinion, absolutely essential for the continuous improvement of the continuous improvement of the healthcare we provide our patients.