Myocardial protection at a crossroads: The need for translation into clinical therapy

Roberto Bolli, Lance Becker, Garrett Gross, Robert Mentzer, David Balshaw, David A. Lathrop

Research output: Contribution to journalReview article

Abstract

Over the past 30 years, hundreds of experimental interventions (both pharmacologic and nonpharmacologic) have been reported to protect the ischemic myocardium in experimental animals; however, with the exception of early reperfusion, none has been translated into clinical practice. The National Heart, Lung, and Blood Institute convened a working group to discuss the reasons for the failure to translate potential therapies for protecting the heart from ischemia and reperfusion and to recommend new approaches to accomplish this goal. The Working Group concluded that cardioprotection in the setting of acute myocardial infarction, cardiac surgery, and cardiac arrest is at a crossroads. Present basic research approaches to identify cardioprotective therapies are inefficient and counterproductive. For 3 decades, significant resources have been invested in single-center studies that have often yielded inconclusive results. A new paradigm is needed to obviate many of the difficulties associated with translation of basic science findings. The Working Group urged a new focus on translational research that emphasizes efficacy and clinically relevant outcomes, and recommended the establishment of a system for rigorous preclinical testing of promising cardioprotective agents with clinical trial-like approaches (ie, blinded, randomized, multicenter, and adequately powered studies using standardized methods). A national preclinical research consortium would enable rational translation of important basic science findings into clinical use. The Working Group recommended that the National Institutes of Health proactively intervene to remedy current problems that impede translation of cardioprotective therapies. Their specific recommendations include the establishment of a preclinical consortium and the performance of 2 clinical studies that are likely to demonstrate effectiveness (phase III clinical trials of adenosine in acute myocardial infarction and cardiac surgery).

Original languageEnglish (US)
Pages (from-to)125-134
Number of pages10
JournalCirculation research
Volume95
Issue number2
DOIs
StatePublished - Jul 23 2004

Keywords

  • Basic science
  • Cardiac surgery
  • Cardioprotection
  • Ischemic heart disease
  • Myocardial ischemia
  • Reperfusion injury
  • Research translation

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

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  • Cite this

    Bolli, R., Becker, L., Gross, G., Mentzer, R., Balshaw, D., & Lathrop, D. A. (2004). Myocardial protection at a crossroads: The need for translation into clinical therapy. Circulation research, 95(2), 125-134. https://doi.org/10.1161/01.RES.0000137171.97172.d7