A New Day for PAH
 Starting with this issue of Advances in Pulmonary Hypertension, I am delighted to assume the editor-in-chief position. I am extremely grateful to Ron Oudiz for his productive tenure and his guidance through the process of creating and producing a quality journal. The feedback we have received during Ron’s time in charge has been almost uniformly glowing, a testament to his calm leadership. I will do my best to maintain the quality of the journal and provide similar (although possibly less calm) guidance.
The mission of Advances has always been to provide, for practicing physicians, cutting edge updates on all aspects of pulmonary hypertension (PH). The journal has, we hope, been accessible and understandable to the diverse readers, including nurses, pharmacists, internists, rheumatologists, pulmonologists, and cardiologists. We have, thus, avoided including primary, original research papers or articles with too narrow a focus.
The overall tenor of Advances will continue, unchanged under my editorship. However, I am excited to introduce several new features that we believe will enhance the variety and accessibility of the journal. These 4 new sections will debut in the Summer 2009 issue:
Article Reviews (Section Editors: Drs Todd Bull and Francisco Soto): Brief summaries of recently published papers related to pulmonary vascular disease.
Pulmonary Hypertension Resource Network Corner (Section Editor: Glenna Traiger, RN, MSN): Topics of particular interest to allied health personnel involved in PH, such as nutrition, insurance issues, etc…
Ask the Expert (Section Editor: Dr Myung Park) We will solicit questions related to any aspect of pulmonary vascular disease. The questions will be addressed by an assigned expert and the answers published, as space allows. (See page 48 for details on how to be involved with this new section.)
Clinical Trials Update (Section Editors: Drs Fernando Torres and Deborah Levine): A rundown of ongoing clinical trials, top line results, and planned trials.
In this current issue of Advances, Drs Jim White and Bob Schilz have tackled the area of new therapeutics. Although we already have several effective pulmonary arterial hypertension (PAH) therapies, the field of PAH treatment continues to move forward rapidly. New therapeutic targets and new ways to give existing therapies are being studied. With more therapies on the market, however, the feasibility and ethics of randomized controlled trials has changed. These important issues have been addressed in a Roundtable discussion that I hope you will find as lively as I did!
Richard N. Channick, MD
Editor-in-Chief
When the editorial board first considered an issue devoted to recent clinical trial results, clinicians had 6 FDA approved drugs to treat pulmonary arterial hypertension (PAH). We now have 7, and it seems conceivable that we might have an 8th before the end of 2009. With collaborative, international efforts, the pace of progress has quickened in the last 5 years, and indeed, a “New Day is Dawning” on treatment options for our patients.
In this issue, Bob Schilz and I wanted to provide an authoritative update on recent clinical trials and to highlight therapies that have “graduated” from bench science to bedside investigation. An author on the pivotal epoprostenol report, David Langleben has a long perspective and remains committed to bench research on mechanisms of vascular dysfunction in PAH. His article highlights Phases I and II trial data that have been reported only in abstract form at international meetings in the last 2 years. He also invites readers to consider an important question about whether our current therapies address fundamental disease mechanisms. I think readers will especially appreciate the figure illustrating how cicletanine, riociguat, and phospho-diesterase inhibitors are related in the nitric oxide-cyclic GMP signaling pathway.
Murali Chakinala’s information-packed article summarizes key data from recently published or presented combination trials including PACES (adding sildenafil), TRIUMPH (adding inhaled treprostinil), and PHIRST (adding tadalafil). A useful table in the paper shows trends in the baseline characteristics of patients over the last decade, and his thoughtful analysis on endpoints highlights the limitations of our current approach in drug development and invites us to “Raise the bar” for future investigations
Finally, I reviewed the progress toward a highly effective oral prostanoid; unfortunately, I had to conclude that we as investigators have endured a large amount of backsliding down a steep learning curve. We still have a mountain to master! Scott Halpern has a research interest in the ethics of clinical research. We invited him to moderate a round table discussion with 3 leaders in clinical drug development over the last 20 years: Mike McGoon, David Badesch, and Myung Park. The questions were provocative, and I think you’ll really learn from the lively dialogue among these authorities with very different perspectives.
Bob Schilz and I enjoyed planning this issue, and we hope that it will serve as a valuable reference point for readers who wish to update their knowledge about the drugs (and cells!) that will heavily influence therapeutic approaches now and in the next 5 years.
R. James White, MD, PhD
Guest Editor
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