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Perspectives on Translational Research in Healthcare Settings by Prof Eva Bezak

In the latest edition of the AFOMP newsletter (Jan 2021), ACPSEM member Prof Eva Bezak and AFOMP Vice-President was invited by AFOMP to write an article on 'Perspectives on Translational Research in Healthcare Settings'. The article can be found below:

I have been asked to write a few words about translational research in healthcare for the current issue of the AFOMP newsletter. It has turned out to be not such a simple task as there is ample excellent literature available on what translational research is – using various nuances of its definition. It is interesting to note that the term translational research initially emerged mostly in cancer care in the 1990s and then was more broadly adopted into healthcare research in the last 15- 20 years.

So what are the different types of research that lead to research translation? Let's start from the beginning, defining basic and clinical research first.

According to the National Institute of Health (NIH), USA, basic health research is defined as : “Basic science research helps us understand the principles, mechanisms and processes that underlie living organisms. Through basic research, scientists try to answer fundamental questions about how life works. For example, they may examine how cells talk to each other, how proteins fold or how gene activity is controlled. The knowledge gained from this work serves as the foundation for biomedical advances that help protect and improve human health. It can be difficult to predict how a basic research study will lead to human health benefits. The line between discovery and medical application can be long and hard to trace. The fundamental knowledge gained through basic science often leads to unanticipated breakthroughs in how to predict, prevent, diagnose and treat disease. Research into specific disease targets, called translational or applied research, depends on a broad and diverse scientific research portfolio to create the foundation that makes further scientific discovery possible.” (https://www.nih.gov/news-events/basic-research-digital-media-kit#overview)

Clinical research, on the other hand, is defined by NIH as :

“Clinical research aims to advance medical knowledge by studying people, either through direct interaction or through the collection and analysis of blood, tissues, or other samples. A clinical trial involves research participants. It follows a pre-defined plan or protocol to evaluate the effects of a medical or behavioural intervention on health outcomes. By taking part in clinical trials, participants not only play a more active role in their own health care, but they also can access experimental treatments and help others by contributing to medical research.”(https://www.nichd.nih.gov/health/clinical-research)

While the definitions above, in regard to basic and clinical research may be fairly clear and standard, more variation exists when defining the translational research. I will present a few of the definitions that can be found in literature:

  1. NIH [3]: Translational research includes two areas of translation. One is the process of applying discoveries generated during research in the laboratory, and in preclinical studies, to the development of trials and studies in humans. The second area of translation concerns research aimed at enhancing the adoption of best practices in the community. Cost-e55ectiveness of prevention and treatment strategies is also an important part of translational science. (http://grants.nih.gov/grants/guide/rfa-files/RFA-RM-07-007.html.)
  1. According to Rubio et al : Translational research fosters the multidirectional integration of basic research, patient-oriented research, and population-based research, with the long-term aim of improving the health of the public. T1 research expedites the movement between basic research and patient-oriented research that leads to new or improved scientific understanding or standards of care. T2 research facilitates the movement between patient-oriented research and population-based research that leads to better patient outcomes, the implementation of best practices, and improved health status in communities. T3 research promotes interaction between laboratory-based research and population-based research to stimulate a robust scientific understanding of human health and disease.
  2. Or Wikipedia : Translational research – a term often used interchangeably with translational medicine or translational science or bench to bedside – is an effort to build on basic scientiffic research to create new therapies, medical procedures, or diagnostics. Basic biomedical research is based on studies of disease processes using, for example, cell cultures or animal models. The adjective "translational" refers to the "translation" (the term derives from the Latin for "carrying over") of basic scientific fi1ndings in a labatory setting into potential treatments for disease . (https://en.wikipedia.org/wiki/Translational_research)
  3. A slightly different aspect is discussed by Ganon : “The common justification for much research funding is that the outcomes will move from the laboratory to the clinic and patient care, or be converted into jobs and money. The term “translational research” is widely used in this context by medical research institutes and an increasing number of university departments to convey the message to politicians and taxpayers that research activities ultimately serve the public.”

Pomeroy and Sanfilippo discuss two categories of translational research: a) basic to clinical and b) clinical to population. The individual steps include: 1) Basic biomedical research, 2) Clinical translation, 3) Demonstration of efficacy (e.g. of a novel cancer therapy), 4) Translation to practice, and where applicable, 5) Translation to broader populations (e.g. everyone in the world implementing the intensity modulated radiation therapy). Research results from steps 1, 2 and 3 impact policies related to bringing new diagnostic and therapeutic tools through clinical trials, while research findings from steps 4 and 5 inform policy at a higher level, e.g. in regards to guidelines development or financing of health care delivery in various populations .

Figure 1 schematically shows the main steps of basic and clinical research translation into clinical practice and guideline development. Step T1 aims to transition the research knowledge from basic/laboratory phase to a clinical environment. Step T2 is to advance clinical research to clinical practice and step T3 is a practice based research focused on implementation and dissemination of results based on high level clinical evidence - such as that obtained from Phase 3 and 4 clinical trials.

Figure 1. Schematic of inter-relation of basic, clinical and translational research. Practical adoption of this schema should allow for faster translation of research into clinical practice. Courtesy Westfall et al .

Translational research depends on active collaboration and communication between scientists and clinicians from multiple disciplines and is supported by the establishment of teaching-research-clinical practice centres. Novel training models and methods of communications may need to be implemented to ensure preparedness of scientists and clinicians to work in the translational research space . This means that health research at universities or research centers must be informed by clinical needs, and at the same time health providers must support and/or create an environment in hospitals/clinics that is inclusive of research. Table 1 below from Rubio at al , shows an excellent summary on training (inputs and outcomes) in translational research.

Table 1. Logic model for training in translational research (courtesy Rubio et al ).

You may ask, why all this effort? What are the benefi1ts of translational research? Without going into too much detail, they include: faster implementation of novel healthcare technologies into clinical practice; faster dissemination of clinical data and experiences; stronger collaboration between researchers/universities, clinicians/hospitals and industry; more focused potential for investment and commercialisation of medical innovations; and ultimately better therapy and diagnosis for communities around the world.

Wishing you all the very best Eva Bezak

Vice-President, AFOMP

References:

  1. https://www.nih.gov/news-events/basic-research-digital-media-kit#overview. 12/12/2020].
  1. https://www.nichd.nih.gov/health/clinical-research. 12/12/2020].
  1. http://grants.nih.gov/grants/guide/rfa-fi1les/RFA-RM-07-007.html. 12/12/2020].
  1. Rubio, D.M., et al., Defining translational research: implications for training. Acad Med, 2010. 85(3): p. 470-5.
  1. https://en.wikipedia.org/wiki/Translational_research. 12/12/2020].
  1. Gannon, F., The steps from translatable to translational research. EMBO Rep, 2014. 15(11): p. 1107-8.
  1. Pomeroy, C. and F. Sanfilippo, How Research Can and Should Inform Public Policy, in The Transformation of Academic Health Centers Meeting the Challenges of Healthcare's Changing Landscape. 2015, Academic Press. p. 179-191.
  1. Westfall, J.M., J. Mold, and L. Fagnan, Practice-based research - "Blue Highways" on the NIH roadmap. Jama-Journal of the American Medical Association, 2007. 297(4): p. 403-406.
  1. Trochim, W., et al., Evaluating translational research: a process marker model. Clin Transl Sci, 2011. 4(3): p. 153-62.
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