Bridging the gap

Translational medicine has been described as a “two-way street” between bench and bedside. Experimental findings and models in the basic laboratory can help to steer clinicians to increase the efficiency by which we use new therapeutic strategies in humans. Of equal importance is the feedback from clinicians to researchers on the effects of these treatments and potential for new pathways based on clinical observation, sometimes in other disease states. This feedback loop has been critical in the field of pulmonary vascular disease, as we have shifted focus over the past decades from finding the perfect “selective” pulmonary vasodilator to investigating therapies with anti-proliferative and anti-inflammatory properties. Clinicians frequently use the term “remodeling” of the pulmonary vascular bed, but without the ability to safely and routinely perform lung biopsies, we are dependent on the basic scientists to report the impact of novel therapies on the pulmonary vascular bed. Unfortunately, even the basic scientists struggle with less than perfect animal models for pulmonary vascular disease. These challenges highlight the importance of close communication among the basic scientists, clinical researchers, and clinicians in the field of pulmonary vascular disease.

In this issue, Jim White, MD, PhD, serves as guest editor and he and authors shed light on many of the complex pathways implicated in the pathogenesis of PAH and some of the novel therapies and strategies to target these pathways. The authors provide a comprehensive review and at times a “translation” of where the science is moving and how it may affect our clinical practice in the future. In the absence of a cure, we need to continue to bridge the gap between basic scientists and clinical researchers if we hope to uncover new targets for the treatment of pulmonary vascular disease. In this issue of Advances, authors eloquently provide the reader with some of the tools to start to bridge these gaps.