Why does pre-clinical success in cardioprotection fail at the bedside?

This editorial refers to ‘Translational failure of anti-inflammatory compounds for myocardial infarction: a meta-analysis of large animal models’ by G.P.J. van Hout et al. , pp. 240–248. Translating findings from experimental studies into effective treatments for patients is never an easy task. Hurdles are particularly high when one tries to reproduce at the bedside the positive effects of cardioprotective interventions obtained in animal models of ischaemia/reperfusion injury. Despite the wealth of successful cardioprotective interventions in animals, none of the subsequent clinical trials has yet fulfilled this goal or changed clinical practice. Some small ‘proof-of-concept’ clinical studies have shown encouraging results, only to be negated later by larger trials.1Controversy and frustration are evident in the reviews2,3 and position papers4–6 that have been written on this topic; however, these documents have done little to allay doubts. One possible explanation for the difficulty in translating pre-clinical findings into clinically useful therapies may have to do with the design of experimental studies. Van Hout et al .7 address this matter by undertaking a meta-analysis of the experimental studies, i.e. by carrying out a systematic review of the available evidence as it is typically done in the clinical settings. By using this approach, they point out some potential weaknesses …