From biology to therapy: a translational approach to breathlessness


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Richella Ryan1,2
1University of Cambridge, Cambridge, UK, 2Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

Abstract

Breathlessness is a complex symptom arising from the interaction between physiological, psychological, social and environmental factors1. There is a growing body of literature identifying the mechanisms underlying breathlessness genesis but much remains to be elucidated. A thorough understanding of the biological pathways involved is necessary in order to identify suitable therapeutic targets. A collaborative approach, involving basic scientists and clinical researchers, is likely to be necessary to achieve this.

My current work uses a collaborative translational approach, aiming to identify a new biological pathway in breathlessness which might be amenable to therapeutic manipulation. Due to the threatening nature of breathlessness, we hypothesise that the hypothalamic-pituitary-adrenal (HPA) axis (or stress system) is an important pathway in breathessness processing and that psychological approaches to breathlessness management operate along this biological pathway. We plan to test this using salivary diurnal cortisol profiles as a biomarker.

In this presentation, I will summarise the known mechanisms underlying breathlessness, along with the current and postulated therapeutic targets associated with these mechanisms. I will then describe the gaps in our current knowledge, along with the challenges of translating our current scientific knowledge to clinical practice. Finally, as an example of a translational approach to breathlessness research, I will describe my current work which tests the hypothesis that the HPA axis is an important biological pathway in breathlessness processing.

References

1. Meek PM, Schwartzstein RM, Adams L et al. American Journal of Respiratory and Critical Care Medicine 1999;159(1):321-40.