Translating research into practice: An epilogue

Authors


We are witnessing a rapid transformation of clinical practice as more of what we do in medicine becomes informed by an increasingly accelerated application of scientific knowledge derived from basic science research. This process represents the essence of what is now termed clinical translational research, which entails the infusion of sound scientific knowledge, wherever appropriate, into clinical practice. The ultimate aim of clinical translational research centres is advancing our understanding of the mechanisms of disease and improving targeted therapeutics and approaches to make meaningful improvements in patient outcomes. In order to achieve this, the collaborative efforts of investigators and practitioners upon which such research is based would benefit from reviewing the progress achieved in linking scientific evidence to clinical experience so as to chart future research goals and directions.1

Based on this premise, we planned a series of invited reviews published over the last year or so in Respirology on ‘Translating research into practice’. The series identified leading translational experts who span broad areas of respiratory medicine that include topics of diagnostic and predictive biomarkers, respiratory physiology in terms of lung function testing, basic pathophysiology of sleep-related breathing disorders, and respiratory infections. Our authors provided advanced and evidence-based reviews on their areas of expertise.

Despite the recent publication of a revised version of the Global Initiative on Obstructive Lung Diseases guidelines, a variety of areas in chronic obstructive pulmonary disease (COPD) deserve further research and discussion, such as COPD in non-smokers, COPD staging, the multi-system nature of COPD and assessing the severity of exacerbations. Piera Boschetto and colleagues reviewed the relationship of COPD with one of its most important comorbidities, namely cardiovascular diseases.2 GuangQiao Zeng and colleagues contributed a concise review on non-smoking COPD,3 an emerging area of concern in the areas of COPD and asthma.

Understanding the anatomical structure of the respiratory system provides a critical foundation for advancing respiratory research. George Washko and colleagues gave a comprehensive review on research in computed tomography and magnetic resonance imaging both for the lung parenchyma and the airways, with examples of the application of advanced imaging to specific disorders, such as interstitial lung disease, asthma and COPD.4

Hiroshi Kubo reviewed current developments in pulmonary tissue engineering and regeneration, which represent key areas of basic research in pulmonary and stem cell research,5 and gave insights into potential areas for further research and development.

Respiratory physiology provides paramount insights into understanding lung function that are essential for advancing both clinical research and respiratory care. BinMiao Liang and colleagues revisited various aspects of lung function testing, offering a forward-looking perspective on areas ripe for new test development.6

Keishi Ohtani and colleagues reviewed futuristic bronchoscopic imaging techniques that included autofluorescence imaging, optical coherence tomography, confocal endomicroscopy and Raman spectroscopy, and their clinical and research applications in respiratory medicine.7 Kasia Czarnecka and Kazuhiro Yasufuku reviewed recent advances in interventional pulmonology, with a focus on diagnostic tools like endobronchial ultrasonography, pleuroscopy and navigational bronchoscopy.8

The challenges of pulmonary infections were approached by Jeannina Smith and Carol Kauffman, who contributed an overview of fungal lung infections that included cryptococcosis, aspergillosis and histoplasmosis, along with recent advances in clinical care.9 With the emergence of multi-drug-resistant tuberculosis and extended drug-resistant tuberculosis, Nicholas Walter and colleagues authored a timely review on the epidemiology, diagnosis and treatment of these highly resistant and increasingly lethal pathogens.10 S. Rodrigo Burguete and colleagues reviewed pulmonary infections that occur in patients undergoing lung transplantation.11

The new staging system for lung cancer was released by the International Society for the Study of Lung Cancer and is now widely adopted by clinicians engaged in the management of lung cancer patients. It is essential to have a thorough understanding of the rationale behind the various modifications of the new staging system. Henry Marshall and colleagues accepted the complex task of reviewing the scientific evidence in support of the recommendations proposed by the new staging system.12

With advances in the understanding of the pathobiology of lung adenocarcinoma, the International Society for the Study of Lung Cancer committee has also revised the classification of pulmonary adenocarcinoma recently. Humam Kadara and colleagues provided a timely review on how this classification evolved into its present form.13 HsuanYu Chen and colleagues reviewed recently expanded knowledge of biomarkers and transcriptomic profiling of lung cancer and resulting opportunities for further research in this area.14

The availability of targeted therapy for patients with lung cancer over the past decade has transformed the management of this persistently lethal disease, moving clinicians from rigid protocols into personalized treatment. David Lam reviewed the current applications of molecular testing that have ushered in personalized care for lung cancer, including testing for the epidermal growth factor receptor gene mutations and the anaplastic lymphoma kinase gene rearrangement.15

Screening for lung cancer remains an area of continued debate, even though recent screening trials provide support for computed tomography screening in selected populations. Stephen Spiro and Neal Navani provided a comprehensive review on the current progress of various screening studies in lung cancer.16 Mitsuo Sato and colleagues selected a frontier area of scientific research in lung cancer—epithelial mesenchymal transition—for review.17

Recent research into sleep-related breathing disorders has provided extensive data in support of translational knowledge. Romola Bucks and colleagues authored an in-depth review on our current understanding of neurocognitive aspects of obstructive sleep apnoea.18 Macy Lui and colleagues discussed the importance of endothelial dysfunction in obstructive sleep apnoea.19 Fang Han reviewed a sometimes neglected yet important area of sleep medicine research,20 namely narcolepsy and cataplexy, helping physicians develop practical approaches to these increasingly recognized clinical problems. Francoise Roux reviewed yet another often under-diagnosed sleep-related breathing disorder, that is, restless leg syndrome.21

The aforementioned topics represent only a small sliver of the translational clinical research that is increasingly informing our broad field of respiratory medicine. Conditions left out include interstitial lung disease, bronchiectasis and cystic fibrosis to name but a few. The manuscripts published in this series, however, create a clear image of the new landscape for research and clinical practice that is moving knowledge from the bench to the clinic along a remarkably streamlined trajectory. We hope to revisit this topic in future editions of Respirology to catch up on how other respiratory conditions have benefited from translational research as well. In the meantime, we thank the authors of the present series for sharing their expertise and setting us off on a course towards a more rapid translation of science to improved patient care.