Bridging the Gap Between Translational Research and Clinical Practice

Bill Damsky, MD, PhD

In recent years, dermatology has undergone a significant transformation, largely driven by advancements in translational research. Despite this progress, a gap persists between laboratory discoveries and their application in clinical practice. Bill Damsky, MD, PhD, assistant professor of dermatology at Yale School of Medicine in New Haven, Connecticut, is at the forefront of efforts to bridge this divide. His research focuses on inflammatory skin diseases such as atopic dermatitis and psoriasis, aiming to develop molecular diagnostic tools that enhance treatment precision.

The Challenge: Research to Practice

Damsky highlighted a critical issue in the field: Although research has led to groundbreaking insights, these discoveries often remain confined to laboratories. “As someone who thinks a lot about translational research and immunology, we realize that there is a practice gap between what’s possible in the research laboratory,” he explained in a recent interview with Dermatology Times. “There’s so much neat stuff that can happen, but there’s a gap between that and clinical medicine.”

This gap is particularly evident in the diagnosis and treatment of inflammatory skin diseases. Traditionally, clinicians rely on biopsy samples, which are examined morphologically under a microscope. However, this approach lacks the ability to incorporate molecular insights that could personalize and optimize treatment. “We also know there’s disease heterogeneity,” Damsky said. “One patient with atopic dermatitis may not be clinically, histologically, or immunologically identical to the next.”

A Molecular Approach to Diagnosing Skin Diseases

To address these limitations, Damsky and his team have developed a novel diagnostic test leveraging RNA in situ hybridization (ISH). This technique allows for precise molecular analysis of inflammatory skin diseases while seamlessly integrating into existing clinical workflows. “We tried to validate about 10 biomarkers, and we settled on 4. And those seem to be working very well for us,” he stated.

This method offers several advantages over traditional immunohistochemistry (IHC). “For secreted molecules like cytokines, which are really important in disease pathogenesis, IHC didn’t work that well, so we settled upon ISH,” Damsky explained. The RNA-based approach preserves tissue morphology, provides clear signals, and aligns with automated staining techniques commonly used in dermatology.

Practical Implementation in Clinical Settings

One of the most significant aspects of Damsky’s work is its practicality. Unlike research-based diagnostic methods that require specialized tissue handling or extensive turnaround times, his approach is designed for everyday clinical practice. “What’s great about this is the clinician doesn’t need to do anything different,” he emphasized. “They just do a biopsy, as they always would.”

The process is efficient and can be applied to both new and archival biopsies. “A clinician tells us they want this test either on an old biopsy or a new biopsy [sample], and we set it up on the stainer, run it overnight, and we get it back the next morning,” Damsky said. This rapid turnaround time is a major advantage compared with other molecular tests that often take weeks to deliver results.

Implications for Personalized Treatment

A key benefit of this molecular approach is its potential to refine treatment selection for inflammatory skin diseases. The current landscape of psoriasis and atopic dermatitis treatments includes multiple FDA-approved therapies with distinct mechanisms of action. However, choosing the most effective treatment for a given patient remains a challenge. “As a practicing dermatologist, there’s not clear guidance in terms of what medication is the best for the patient in front of you,” Damsky noted. By identifying molecular markers that correlate with treatment response, this diagnostic tool can help guide therapeutic decisions, leading to better patient outcomes.

The Future of Dermatological Biomarkers

Looking ahead, Damsky sees vast potential for biomarker-driven dermatology. His team is actively investigating additional inflammatory skin diseases beyond psoriasis and atopic dermatitis, with a focus on conditions that currently lack FDA-approved therapies. “A lot of the biomarkers that we’re looking at are cytokines that are targeted by approved approaches,” he said.

This research has already yielded success stories, particularly for patients with rare or severe skin diseases. “We’ve used the biomarker panel that we have to look for these cytokines, where we know we can block them with an FDA-approved drug, and take patients with rare skin diseases—sometimes kids, sometimes patients with genetic disorders—where their skin disease is significant and dictates their life and nominate therapies based on our biomarker profiles,” Damsky shared.

Conclusion: A Transformational Era in Dermatology

The integration of translational research into clinical dermatology is not just a theoretical concept—it is becoming a reality. By leveraging molecular diagnostics, Damsky and his team are pioneering a new era in personalized dermatologic care. “Dermatology, especially inflammatory skin disease, is in this translational revolution, where there’s so much that’s been discovered in the laboratory, and it’s being translated to new therapies,” he stated.

Although there is still much to uncover, the progress made in bridging the gap between research and clinical practice is promising. The development of rapid, accessible, and clinically relevant molecular tests represents a major step forward, offering hope for more precise diagnoses and effective treatments for patients with inflammatory skin diseases.

As this field continues to evolve, one thing remains clear: The future of dermatology lies in harnessing the power of molecular insights to improve patient care. Damsky’s work is a testament to the potential of translational research to revolutionize clinical dermatology, making advanced, personalized treatments a standard part of patient care.