From heart failure to transplantation: genes, miRNAs, and biomarkers

Over the past three decades, lifespan has increased by 8 years, to which cardiology has contributed at least 6 years.1 Among the therapeutic measures introduced, effective drugs contributed the most to this success, as reflected again in the most recent ESC Guidelines on prevention2 and heart failure management.3 Drug development traditionally focuses on only one specific indication, and other possible applications are often left aside. In a Current Opinion ‘ Reincarnated medicines: using out dated drugs for novel indications ’, Roberto Ferrari from the Azienda Ospedaliero-Universitaria di Ferrara in Italy reminds us that the development of new drugs has become a very challenging, as well as a lengthy and costly process.4 Of note, the majority of development programmes with new compounds have had to be stopped prematurely due to futility.5 For every drug that makes it through the discovery and development process and finally to market, thousands of candidates have failed and huge investments have dissipated: currently the overall costs to develop a new molecule range somewhere around US$1 billion. The development process encompasses 10–15 years from target selection to approval, with an overall failure rate now approaching 95%.6 Thus, novel indications for approved drugs may offer hidden opportunities. There are numerous examples of compounds that eventually were tested in other indications and provided novel treatment options that have been previously overlooked. A condition in which drugs are of particular importance is heart failure.3 In their clinical review ‘ Biomarkers of renal injury and function: diagnostic, prognostic , and therapeutic implications in heart failure ’ Dirk J. van Veldhuisen and colleagues from the University Hospital …