Bench to bedside: A journey of basic science to clinical research

After finishing my 6 years of postdoctoral training in Internal Medicine here at UT Southwestern, I was at a crossroads. My next step initially began as a research scientist, yet I was still unsure whether to pursue this career.

As a child I was very fascinated by the research my dad did as an endocrinologist. His work taught me that scientific research is of critical importance when trying to understand and treat a disease. As a basic scientist I have always loved my job and enjoyed doing research. A basic scientist tries to answer fundamental questions of biology and that often translates to how a disease impacts a living organism.  By validating the underlying mechanism, one could possibly find a cure for a specific disease. I had many colleagues that worked directly with patients every day to save lives. I on the other hand, worked on genes involved in cellular pathways of a disease and was often questioned by friends and family if that would ever have an impact in medical field. I would simply explain that, “Basic science is the foundation for clinical research. Treating patients directly is more like building a house on that foundation.” In the absence of all the information obtained from basic research, it would be very difficult to predict any future in the treatment of a disease.

I earned a Ph.D. in environmental toxicology, and my thesis focused on using plant derived phytoestrogens to treat breast cancer cells and investigate the underlying mechanism that could treat the disease. As a postdoc at UT Southwestern I shifted my attention to lipid research and treatment of diabetes in knockout mice. Though the research focus was to specifically understand the molecular mechanism of breast cancer or diabetes, the end goal was development of therapeutics. In some ways, these experiences have even helped me better appreciate how clinical science builds on knowledge from basic animal research. The pre-clinical research provides the backbone for clinical research.

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To improve human health, scientific discoveries need to be translated into real world applications. Such discoveries usually begin at the bench with basic research, where scientists study the mechanisms and pathogenesis of a disease at a molecular or cellular level. The obtained results are then translated to the clinical level or the patient’s bedside. This bench-to-bedside approach of translational research is a two-way street. It’s not just the basic scientists delivering newer tools to examine patients, but also the clinicians making novel observations about the progression and impact of a disease, which can further stimulate basic research. For instance, to understand a drug’s mechanism of action, basic scientists use animal studies to determine how well it is absorbed into the body, how it is distributed to target tissues, how effective it is, and how likely it may cause any side effects. When the new drug passes animal trials, the clinicians then use the preliminary data to test the efficacy in humans. This clinical data is relayed back to the basic scientists if further improvements are needed.

Generally, basic science involves answering some very fundamental questions, which help establish future research. By identifying key molecules that lead to a specific disease, drugs can be developed to specifically target critical pathways. In contrast, clinical research involves human subjects with the main objective of understanding the history of a disease along with the possible treatment options and diagnostic tools. Though many basic scientists around the world provide an overwhelming amount of data, at the end of the day not all of this work directly translates to clinical usage. Consequently, basic research rarely comes to the attention of the general public, makes the headlines of a newspaper, or gets cited as a medical breakthrough, yet it is no less important compared to clinical data. Even though for patients the importance of clinical research might be more obvious, it would be wrong to neglect the importance of basic science research. Both basic and clinical research play crucial roles in understanding and treating disease.

My studies had always sought to improve patient treatment through the search of novel therapeutics or by elucidating the underlying mechanism of disease. To this extent, I had a change of heart as a basic research scientist and began looking for clinical positions, hoping to transfer my expertise at the bench in order to provide a new perspective in the clinic. Luckily I came across a clinical coordinator position in Neurology. Transitioning into clinical research was a great challenge as it involved human interaction, thus requiring more scrutiny. Initially, I felt it was too late in my career to make such a big change, but if driven by interest and curiosity, one can always find opportunities to pursue a new avenue. Furthermore, one doesn’t need an M.D. to become involved in clinical research, my basic science career has proven to be essential to move into a clinical position and so has my broader research experiences. For example, my teaching assistantship for an undergraduate laboratory during graduate school has helped me to improve my communication skills. Similarly, attending and presenting my work at departmental and scientific conferences has helped me with networking, and also provided some exposure to different areas of research. These skills are imperative for a clinical coordinator who must communicate intelligibly to patients in order to bridge the knowledge gap and obtain consent. Lastly, had I not previously been in research, it would have been very difficult to understand any of the clinical language. Based on my experience so far I can say that it is possible to move between the bench and clinical research, and the transition can be very smooth for an individual with basic research experience.

Image was adapted from: Zerhouni EA. 2007. Translational research: moving discovery to practice. Clinical Pharmacology and Therapeutics 81:126-128.

Editor: Chase Melick

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