Jama media briefing on opportunities for medical research in the 21st century
Imagine this: The year is 2025Alzheimers and osteoporosis are now preventable; many cancers are considered curable; Parkinsons and arthritis have been brought under control; and "designer" antibiotics have revolutionized the treatment of resistant infections.
Does it sound too good to be true? Not according to the forecasts of the scientists gathered at a media briefing entitled "Opportunities for Medical Research in the 21st Century," a collaboration between the Albert & Mary Lasker Foundation and the Journal of the American Medical Association. The briefing coincided with the publication of the Feb. 7 issue of JAMA, which includes 24 articles examining in detail the promise of medical research over the next 25 years with respect to a specific disease or category.
"The magnitude of advances in medical science at this time and over the next generation is unprecedented and revolutionary," said Catherine DeAngelis, M.D., editor of JAMA. "The impact of this scientific force on the health of all humankind will be extraordinary." These sentiments were echoed by her fellow scientists, who offered a fascinating glimpse into what the future might hold for discoveries and progress in biomedical science.
The consensus was that there is something fundamentally new about 21st-century biomedical research. In the latter half of the 20th century, we have learned that the behavioror misbehaviorof human genes is at the root of disease in one way or another and that the interaction of these genes and the environment results in complex diseases. The individuality of each persons distinctive complement of genes has made some people more susceptible to one disorder than another. In order to prevent or cure disease, it is necessary to know how these genes work and how they interact with other genes in the body as well as with factors in the environment. The first step in achieving this goal has been the sequencing of the human genome. The scientists concurred that obtaining the sequence of the human genome is "the end of the beginning." A daunting challenge awaits them: to apply this information to identify the particular genes that play a significant role in the hereditary contribution to common disease.
Revolutionizing the search for drug targets are genomic information and bioinformatics, the science of interpreting sets of data too large for the human brain to compute. "Target identification is essentially routine with the power of these technologies," said August M. Watanabe, M.D., co-author of the JAMA article on drug discovery. "The selection of the right targets remains the key strategic challenge." He predicted that as research intensifies, it is likely that disease "platforms" will emerge where pathways will be prioritized for complex diseases and multiple targets for therapy will be identified.
Linda G. Griffith, Ph.D., and Alan J. Grodzinsky, Sc.D., of the Massachusetts Institute of Technology, focused on projections for the future of biomedical engineering. "Either by looking for single-signature molecules [e.g., cancer antigens] or by using appropriate algorithms to derive relationships between interacting molecules," the authors wrote, "early prediction of onset of disease may be possible. New drugs developed with the aid of molecular and cellular engineering will likely be available to combat disease progression. For osteoarthritis, these advances would obviate the need for joint replacement surgery . For Alzheimers disease the impact of bioengineering will be extraordinary," they concluded.
Ronald G. Crystal, M.D., Weill Medical College of Cornell University, New York, examined the advances being made in the treatment of lung disease and the promise of the future. Among the advances that may be on the horizon are gene therapy to cure hereditary lung disorders, new treatments for asthma, and "designer" antibiotics. "Progress should come in the development of new generations of antibiotics, including designer peptide antibiotics," he wrote. "Administration of anti-infectives by the aerosol route will gain popularity, and vaccine development will become a major aspect of research in this area, particularly in gene-based vaccines."
With new and reemerging infectious agents posing serious threat, the need for research directed toward development of new antibiotics has never been greater. This area was explored by Gail H. Cassell, Ph.D., infectious disease research and clinical investigation, Eli Lilly & Co., and John Mekalanos, Ph.D., department of microbiology and molecular genetics, Harvard Medical School. "The elucidation of the human genome sequence and the genomic sequences of the most important bacterial and fungal pathogens should aid rational design against infectious agents," they said.
The authors noted that evidence now supports the theory that infectious agents cause or contribute to many cancers and chronic diseases that were previously thought to be caused by environmental or lifestyle factors. "There are estimates that as much as 15% of cancers could be avoided by preventing the infectious diseases associated with them, including more than 50% of stomach cancers [due to H. pylori] and cervical cancers [due to human papillomavirus] and 80% of liver cancers [due to hepatitis B and C]."
The application of functional genomics and integrative biological technologies should help to clarify the etiologic agents and pathogenic mechanisms involved in chronic diseases and cancers.
Tammy Chernin. Scientists look into future of medical research field.