Research moves 'bench to bedside'

This is the second in a series of articles examining current research trends, nationwide and at Duke.

The face of science research is quickly evolving beyond the laboratory bench, as researchers increasingly approach basic science questions in terms of clinical applicability. At Duke University Medical Center, researchers have embraced this controversial trend toward translational research, the recently coined term to describe such application-based studies.

"In the past, academicians were solely interested in pure, exploratory science," said Donald McDonnell, professor of pharmacology and cancer biology. "Now it's completely changed. Translational research is about getting medicine into people quickly. This is a relatively new focus for academic research."

Ross McKinney, vice dean of research in the School of Medicine, said this "bench to bedside" approach to science research has existed as a concept for many years, but there are still few scientists who grasp both the basic science and clinical aspects of research. As a result, translational research as a term has only recently entered the scientific jargon.

As an example, McDonnell pointed to one of his studies that investigates steroid hormone receptors that could lead to the development of new drugs for contraception, hormone replacement therapy, breast and prostate cancer, osteoporosis and endometriosis. Past research projects he has led have already reached the early stages of drug commercialization.

"Through a direct or indirect way, my research is going to impact the delivery of drugs and positively affect the health of people in the future," he said.

Dr. Rebecca Buckley, professor of pediatrics and immunology, has also been involved with translational research on genetically determined immunodeficiency diseases. She credits her pioneering clinical work on the infamous Bubble Boy Disease, which afflicts people born with no immune system, to prior in vitro and animal research.

"We had a lot of patients at Duke who would come in with Bubble Boy Disease, but no matter what we did, they would all die," she said. "If it were not for a breakthrough that had developed through animal studies, they would still be dying."

Buckley, who completed her undergraduate degree and later her residency at Duke, noted that the University has increasingly provided opportunities for scientists to do translational research over the years.

Patrick Casey, James B. Duke professor of pharmacology and cancer biology, said Duke in the early '90s was slow in supporting translational studies. Since 1998, however, new application-oriented research programs have been developed. He pointed in particular to the Comprehensive Cancer Center, the Institute for Genome Sciences and Policy and other grassroots efforts in engineering, medicine, statistics, computer science and chemistry.

"Opportunities exist now to do translational research, and there are lots of young scientists that want to do this," said James Siedow, vice provost for research.

The increased emphasis on translational research is a result of a recent appeal by Dr. Elias Zerhouni, director of the National Institutes of Health, for researchers to begin to think in terms of "Big Science"--collaborative efforts by scientists to tackle large medical problems such as SARS, AIDS and cancer.

"[The NIH is] asking us to now justify our research in terms of how it can advance human health," McDonnell said. "And they're justifying the funding they give us based on how our research will have a positive impact on human health in the future."

Some scientists, however, are not pleased with the new trend toward applied research. They argue that the emphasis on translational research prevents scientists from being able to do research for the sake of research because the funding opportunities for basic science are diminishing.

"The whole face of [science] is changing," Casey said. "We can do things that we couldn't do 10 years ago in terms of Big Science--and [scientists] are scared. I was scared that I was going to become a dinosaur in 10 years."

Observers have noted a growing chasm between supporters of translational research and those who oppose it. "This is a view that is not adopted by everyone," McDonnell said.

McKinney admitted that basic scientists are having trouble receiving NIH grants, but also said that they still have the potential to be successful in the future.

"The critics [of translational research] are correct, but the pendulum will swing back," he said. "Putting all their money in applied research won't get you anywhere if you've got no ideas to apply it to."

Buckley, who in the past has chaired NIH committees that review grant proposals, stressed the need for balancing funding among basic and clinical research projects. "Basic science is crucial in that what we learn from them allows us to hypothesize in terms of people and then do a clinical investigation," she said.