Frangogiannis Nikolaos G
The Wilf Family Cardiovascular Research Institute, Department of Medicine (Cardiology), Albert Einstein College of Medicine, Bronx, NY 10461, USA.
J Cardiovasc Aging. 2022 Apr;2(2). doi: 10.20517/jca.2022.10. Epub 2022 Mar 31.
The development of novel therapies based on understanding the pathophysiologic basis of disease is a major goal of biomedical research. Despite an explosion in new knowledge on the molecular mechanisms of disease derived from animal model investigations, translation into effective treatment for human patients has been disappointingly slow. Several fundamental problems may explain the translational failures. First, the emphasis on novel and highly significant findings selectively rewards implausible, low-probability observations and high-magnitude effects, providing a biased perspective of the pathophysiology of disease that underappreciates the complexity and redundancy of biological systems. Second, even when a sound targetable mechanism is identified, animal models cannot recapitulate the pathophysiologic heterogeneity of the human disease, and are poor predictors of therapeutic success. Third, traditional classifications of most complex diseases are based primarily on clinical criteria and do not reflect the diverse pathophysiologic mechanisms that may be involved. The development of a flexible and dynamic conceptual paradigm that takes into account the totality of the evidence on the mechanisms of disease, and pathophysiologic stratification of patients to identify subpopulations with distinct pathogenetic mechanisms, are crucial for the development of new therapeutics.
基于对疾病病理生理基础的理解来开发新型疗法是生物医学研究的一个主要目标。尽管来自动物模型研究的关于疾病分子机制的新知识激增,但转化为对人类患者的有效治疗却一直令人失望地缓慢。几个基本问题可能解释了转化失败的原因。首先,对新颖且极具意义的发现的强调选择性地奖励了不可信、低概率的观察结果和高强度的效应,提供了一种对疾病病理生理学有偏差的观点,这种观点低估了生物系统的复杂性和冗余性。其次,即使确定了一个合理的可靶向机制,动物模型也无法重现人类疾病的病理生理异质性,并且对治疗成功的预测能力很差。第三,大多数复杂疾病的传统分类主要基于临床标准,并未反映可能涉及的多种病理生理机制。开发一种灵活且动态的概念范式,该范式考虑到关于疾病机制的全部证据,以及对患者进行病理生理分层以识别具有不同致病机制的亚群,对于开发新疗法至关重要。