The need for translational research in respiratory medicine

Medical advances have failed to arrest the growing morbidity and mortality from lung diseases. COPD, lung cancer and pulmonary infections remain leading causes of death. More than any other time in human history, we need high quality, translatable, patient-focussed respiratory research that will improve clinical practice. Close teamwork of scientists and clinicians are essential. The results of these work need to be disseminated quickly and widely. The creation of an open access journal, such as Translational Respiratory Medicine, dedicated to translational respiratory research can help foster progress.

The path from the laboratory to the bedside is now far more complex than in past decades. The modern ethical framework for conducting research has created the necessary barriers to safeguard patient safety. Thankfully, no longer can clinicians simply take a drug under development and experiment it on patients, without evidence of its potential efficacy and safety data on its toxicology and teratogenicity.

The importance of full translational research in the workup of a therapeutic product is highlighted in the use of talc for pleurodesis [9, 10]. Millions of patients have received talc pleurodesis since the first report of talc poudrage in 1935 [11], even though talc has never been subjected to ‘proper’ laboratory workup and testing. Only half a century later was the observation made that talc could induce acute respiratory distress syndrome (ARDS). In subsequent studies, not only did researchers find impurities in many commercial talc preptions, they also discovered that talc particles were heterogenous in size within most products. Animal and human studies, including randomized trials, found that small talc particles are often systemically absorbed after their intrapleural delivery and induce lung inflammation and ARDS [12]. Talc-induced respiratory failure can affect up to 9% of patients, and caused death in 2.3% of the 482 patients undergoing talc pleurodesis in a multicenter study [13]. Clinical guidelines now recommend only the use of large particle size talc for pleurodesis [14].

On the other hand, there have been many significant successes in bringing laboratory discoveries to clinical care through proper translational research and regulatory channels. Conjugate pneumococcal vaccines, for example, have reduced the burden of disease in children and adults worldwide since their introduction [15]. Anti-human immunodeficiency virus agents have prolonged life expectancy in HIV patients by decades, and the discovery of EGFR mutations in lung cancer have led to new therapies for those harboring such mutations. Understanding the pathogenesis of cystic fibrosis (CF) has led to the first successful introduction of a modulator of CF transmembrane receptor, albeit only for patients with a G551D mutation [16].

“Research not published is as good as research never performed”. A journal dedicated to the field of translational respiratory research can only foster progress. Open access journals allow wider dissemination of information. The creation of Translational Respiratory Medicine is therefore an exciting and right step towards the above stated goals.

“Good beginning is half the success” as the famous Chinese saying states. We congratulate Professors Bai, Matthay and Wang for their effort in establishing the TRM journal. The other half of the success now depends on the support from researchers around the world to rally and support this opportunity of developing a unique and prestigious forum for translational respiratory medicine.

Professor Lee receives research grants from the Sir Charles Gairdner Research Advisory Committee, Westcare, the NSW Dust Disease Board and the Cancer Council of Western Australia. Professor Waterer is supported by a NH&MRC Career Development Fellowship.

Affiliations

1. School of Medicine & Pharmacology, University of Western Australia, Perth, Australia
   • YC Gary Lee
   •  & Grant W Waterer
2. Centre for Asthma, Allergy & Respiratory Research, University of Western Australia, Perth, Australia
   • YC Gary Lee
3. Respiratory Department, Sir Charles Gairdner Hospital, Perth, Australia
   • YC Gary Lee
4. Respiratory Department, Royal Perth Hospital, Perth, Australia
   • Grant W Waterer
5. University Department of Med, Sir Charles Gairdner Hospital, 4/F, G Block, Perth, WA, 6009, Australia
   • YC Gary Lee

Corresponding author

Correspondence to YC Gary Lee.

Competing interests

The authors have no conflicts of interest to disclose.

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