The Future of Cardiovascular Biomedicine

Abstract

Not since Osler have such powerful currents of change been evident in biomedicine. As the scale of the biomedical enterprise has grown to represent some 20% of the US economy, so the pressures to remodel almost every facet of the so-called medical-industrial complex have become irresistible. New contributors to the discipline and accelerating technological innovations will affect biomedicine in predictable and unpredictable ways, but the radical pace of some of the evolving change is already making the future more uncertain for the field than at any time since the postwar era. Although financial exigencies are driving the entry of many nontraditional participants into the biomedical arena, several other global scientific and secular trends are contributing importantly to the sense of imminent transformation. The enthusiasm for molecular medicine that began almost 20 years ago as disease genes were cloned, combined with the new mechanistic insights that this effort spurred, is finally being applied to the clinical arena. Early successes in the diagnosis and therapy of cancer and the rapid commoditization of sequencing and other technologies are illuminating strategies to bring similar transformation to nonclonal chronic disease. There have also been remarkable developments in many other areas of fundamental and translational science. For example, the discovery of cellular reprogramming to pluripotency and the feasibility of recreating in vitro from patient-derived samples all the cell autonomous components of disease have opened new approaches to mechanistic modeling and drug discovery. The ease of generating recombinant proteins, humanized monoclonal antibodies, and stable forms of the full repertoire of RNAs has revolutionized our ability to manipulate disease pathways therapeutically, whereas gene-editing technologies also promise to affect every field. The translation of numerous other innovations, such as nanotechnology or single-cell analysis, is imminent, but perhaps the largest impact will come from the long overdue penetration of computation …