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From bench to bedside to bench

The term translational medicine does not always refer to the concept “from bench to bedside and back”, and indeed is often used to refer to many other, somewhat distant, concepts. However, the new translation centres and translational research consortia do correspond to the original meaning. These new centres and consortia have become effective structures in health research in Germany whose goal is the continuous improvement of the diagnostic and therapeutic treatment of patients.

Translational research is often related to medical applications. In the 1990s, the term was infrequently used in the USA to describe the transfer of research results into practical clinical application. By the beginning of the 21st century, the term started to suffer from over-use. Not long after, this more frequent usage also began to occur in Germany. The slogan “from bench to bedside” appears to have been used for the first time in 1996 by the American cardiologist Spencer King. In May 2011, googling the term leads to around 10.5 million hits.

Abbreviated slogans

The oft-used abbreviated slogan “from bench to bedside” is missing part of King’s original quote “from bench to bedside to bench” (frequently quoted as “from bench to bedside and back”). The omission of the last two words makes it difficult to properly understand the concept of translational medicine, namely the rapid transfer of findings from laboratory research into practical application on patients, and the subsequent use of the experiences and knowledge gained by doctors with their patients for laboratory research and the development of diagnostics and therapeutics. Mutual feedback between basic research and clinical application is an important criterion of translational medicine.

Prof. Dr. Otmar D. Wiestler, Chairman of the DKFZ (German Cancer Research Center) management board. © DKFZ

With a slight trace of irony, one could say that a new research branch can be seen as established when journals or scientific associations in the relevant area emerge. This was in fact the case with translational medicine: the “Journal of Translational Medicine” has been available as an online journal since 2003, and in 2009, the most prestigious American science magazine “Science” started a new series entitled “Science Translational Medicine”. The “Translational Medicine Society” and the “International Society for Translational Medicine” associations were established not long after.

The new building of the National Center for Tumour Diseases on the campus of Heidelberg University Hospital © NCT

The idea of building bridges between laboratories and clinical application is not that new. Many research institutions and work groups in medical faculties aim to associate laboratory research with clinical application. Large-scale research centres run by the Helmholtz Association such as the German Cancer Research Center (DKFZ) are tasked with combining strategically and programmatically oriented top research with innovative applications for solving existing social (in this case health) problems. The term translational medicine is used in this article to refer to the transfer of basic biomedical research into clinical application, which leads to the establishment of appropriate infrastructure and close strategic alliances.

A translational oncology centre par excellence

An excellent example of translational medicine in the field of cancer medicine and research is the National Centre for Tumour Diseases (NCT) in Heidelberg, established by the University Hospital of Heidelberg, the Heidelberg Thorax Hospital and the German Cancer Aid (see BIOPRO article published 20th January 2007: “National Centre for Tumour Diseases (NCT) in Heidelberg”) and modelled on the American Comprehensive Cancer Center.

The new NCT building on the University Hospital Heidelberg campus was opened around six months ago to bring together clinical application and research under one roof, thereby enabling a comprehensive interdisciplinary approach that takes all aspects of cancer treatment into account. This modern oncology centre offers the facilities to turn new research findings into innovative methods for the diagnosis, treatment and prevention of cancer as quickly as possible as well as facilities for clinical studies and testing. Patients therefore benefit at early stages from treatment that is not yet available elsewhere. Doctors from all relevant disciplines meet in expert meetings – so-called tumour boards – in the interdisciplinary tumour outpatient hospital of the NCT to jointly work out individual therapy plans for patients. Many directors and department heads at the NCT are also active researchers at the DKFZ and the University Hospital in Heidelberg.

Coordination centres for clinical trials

As controlled clinical trials are key elements in the translation of medical research results into progress in the diagnosis and therapy of patients, twelve coordination centres for clinical trials have been set up at German university hospitals, including centres at the hospitals of Tübingen, Freiburg and Heidelberg. Funds have been provided by the German Federal Ministry of Education and Research (BMBF). The coordination centres in Freiburg and Heidelberg along with four other German coordination centres, have a paediatrics module, which means that they fulfil the strict conditions required for carrying out clinical trials involving children. The establishment of coordination centres has also led to the creation of instruments that offer medical researchers comprehensive advice and support in the planning, execution and analysis of clinical trials. They also provide local support to multi-centre trials in a Germany-wide network. Clinical trials not only assess new therapeutic and diagnostic procedures, they also provide information about the causes and progression of diseases that feed back into research and drive forward experimental research.

Since their establishment, the twelve coordination centres have already run hundreds of clinical trials involving many thousands of people. Highly trained investigators and study assistants are a prerequisite for such trials, which is why the education and training of the doctors involved is of key importance. The clinical coordination centres follow internationally valid standards and regulations and have a centralised quality management structure.

A national consortium for translational cancer research

Prof. Dr. Annette Schavan, German Federal Minister of Education and Research © German Government

“Every year in Germany around 436,000 people are diagnosed with cancer and around 210,000 die of the disease, so it is important to ensure that results from cancer research are transferred into patient treatment even more rapidly than before. Rapid knowledge transfer can save lives,” explained Federal Research Minister Annette Schavan presenting the “National Consortium for Translational Cancer Research” together with Professor Dr. Otmar D. Wiestler, scientific director of the DKFZ, and Friedrich Carl Janssen, chairman of the German Cancer Aid board.

The consortium was established on the initiative of the BMBF, with the DKFZ as core centre, closely supported by university hospital research units, which give researchers access to patients, samples and an excellent clinical treatment apparatus. “In return, the research units have access to the DKFZ’s research programmes,” emphasized Schavan. Professor Wiestler pointed out that the establishment of the NCT at the DKFZ has led to a unique expertise based on close cooperation between basic researchers and clinicians, thereby creating excellent conditions for “our centre to coordinate and advance translational cancer research in Germany”.

Thomas Rachel, MdB, Parliamentary State Secretary in the BMBF © German Government

The National Consortium for Translational Cancer Research is not the only centre in Germany that aims to bring research and clinical application closer together. It is one of six inter-institutional centres in Germany that were established under the BMBF programme “German Centres for Health Research” and which focus on the research and treatment of important medical problems in Germany. In addition to the German Cancer Research Center, German centres for lung research, cardiovascular research, infectious disease research, dementia research and diabetes research are currently being established. “The funding of translational centres is a unique way of putting into practice the German government’s high-tech strategy concept,” explained Thomas Rachel, Parliamentary Secretary of State in the BMBF. “In joint approaches worked on and pursued by clinics, scientists and companies, the German high-tech strategy is aiming to turn future technologies created in Germany into international leaders. This means that we need to create excellent conditions for top talent.” The health-related and social challenges brought about by widespread diseases – their diagnosis, therapy and prevention – require new creative ideas and innovative as well as unconventional approaches that need to be advanced and implemented in a sustainable way and in a meaningful way in terms of health economics.

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