Hi Jan, one of the main "big things" at the moment is the treatment of a whole range of diseases by injection of a set of cells called "Mesenchymal Stromal Cells". There are currently > 200 clinical trials currently being performed on these cells (there are also hundreds of articles in the literature such as:

"Mesenchymal stem cells: environmentally responsive therapeutics for regenerative medicine", Murphy et al, Experimental & Molecular Medicine (2013) 45

Cells are generally harvested from a person's tissue (historically bone-marrow aspirate) and the MSC cells isolated and expanded in vitro to clinically useful levels.

These are the current "big thing" but the next big thing will be the characterisation and the use of the exosomes from these cells (time-line ~ 10-20 years).

Exosomes are small vesicles released from (almost all) cells that contain miRNA, signalling molecules etc. It is thought that the main beneficial effect of the MSC are from the exosomes they release. As injection of exosomes will probably be safer/require less stringent safety checks etc these will be the main treatments for a lot of diseases in the future (note: hMSC themselves are considered "immune-Privileged" meaning they do not invoke, or only weakly invoke, an immune response following injection in a donor - exosomes will probably provoke no  immune response at all and may be able to be artificially made in the future).

 I hope this helps,

Gary

ps. You might ant to look into tissue engineering in general - such as the decellularisation of organs which can then be re-seeded with cells from the patient to generate organs for transplant (this has been done with the trachea >10x now).

Thanks so much. This is a very good response and I value it. Which major diseases are currently being treated using "Mesenchymal Stromal Cells"? Cancers? (hey I can just read the papers you mentioned I guess!)

Gosh there a lots. They are a bit like snake oil right now - people are claiming they can cure/alleviate anything from Parkinson's to a bad back! Also MS, Chrones disease etc. are all being tested. If you perform a quick "Google" search you should find lots on this (use terms "mesenchymal" MSC, clinical trial, 2014 for example)

Because I'm charting an unknown future, Snake oil is just fine. I remember when I was a kid, seeing Sean Connery in James Bond, talking on a car-phone. It had a Bakerlite handset and a curly wire - just like home phones. I remember thinking that was snake oil too - how could a car phone possibly work? how could it connect to the telephone wires? Sketchy now just means a less distinct mark on my map.

Thanks again.

It depends on what you mean as a "breakthrough". And, too, the focus on health. There will be a range of technological advances in prosthetics (we are already seeing them) and orthotics. There will be and already are new avenues in the search for better methods of pain control (ten years ago nobody was discussing calcium-ion channels and drugs to target them. These are all breakthroughs and some are significant.

 In my area of infectious disease--endemic and epidemic--we will face increasing threats from bacterial and viral microbes. The questions are threefold. First, what is promoting the evolution of microbes that pose a distinct threat? Knowing those, can and then will we work to change the promoting environment. And when an isolated outbreak becomes an epidemic how may we best respond at the local, regional, and international levels.

This is somewhat back to the future but, as I've said in several posts, blogs, and papers probably the most significant health issue of our time. For a quick premier of this argument, see:

http://remedianetwork.net/2014/09/22/ebola-epidemics-pandemics-and-the-mapping-of-their-containment/ 

Hi Tom, do you foresee an increased use of bacteriophages for the treatment of infections? I heard some talk that they were generating bandages coated in phage (and I guess if this works other medical paraphernalia too).

Thanks,

Gary

Thanks Tom - and Gary again. Prosthetics is a really interesting area I hadn't considered, but of course it will have huge impacts as they get cheaper (just think what cheap cochlear implants would do?). I heard a great TED talk on the subject - Where Hugh Herr demonstrates better than real prosthetics: http://bit.ly/1ucB7gC.

I'll do some research on phage (whatever that is) and calcium ion targeting drugs to address pain.

The only thing I know about calcium ions is that dopamine phasis is triggered by it (according to Grace 2007), and that plays into an area of my research. To me it makes sense because (according to my working hypothesis, at least) dopamine mediates attention, and if phasic attention can be suppressed in a targeted way, we would have an incredible new approach to pain control. 

Hi Jan, bacteriophage are basically bacterial predators. A phage will infect and kill only one or two types of bacteria I think (rather than an antibiotic which may kill or supress a whole range of bacteria). Research on Phage has been on-going for almost a century (at least in the Eastern part of the world) and they have been shown to be fairly safe to humans. There was some talk of developing them/modulating their target specificities to include antibiotic resistant bacteria (such as MRSA etc). 

Your probably aware of personalised medicine which is also slated to be the "next big thing". This is generally though of as using data from a patient (such as a sequence of their genome or of their cancers genome) to tailor treatment (an example of this would be to treat a cancer patient with a drug, sequence the genome of the cancer they are suffering from and then modify the treatment if the cancer changes).

There has also been a recent break through in the treatment of ALL (acute lymphoid leukaemia, a particularly nasty form of leukaemia as the age of onset is usually very low ~ 2-4 years of age). This treatment uses modified T-cells from the patient to target  the cancer cells (not a new idea as I knew people working on something similar for melanoma ~ 20 years ago). The main problem then was the cancer(s) re-appeared in a process called "immune-escape" (where the characteristic of the cancer cells being targeted disappears due to the selective pressure of the treatment) although only ~ 3 patients in the trial I mentioned suffered from this (their cancer re-appeared but was now CD19 negative).

http://www.sciencedaily.com/releases/2014/10/141015190826.htm

This is a good example of the new "personalised medicine" I guess.

Anyway - back to work, if I think of anything else I will add it to the list.

Gary

Damn, you're interesting. I should really just move over and let you do this project!

Heh -  I'm a bit of a gypsy scientist (having worked in a variety of fields!), hence my knowledge is broad (if somewhat shallow). Anyway thanks for the kind remarks and have a good weekend!

Gary

I'm a bit of a gypsy too - but I don't know about that making my knowledge shallow. Perhaps in areas. I find that coming in as an outsider gives a very good perspective, and the ability to go deep fast. But perhaps you're modest Where are you based? UK?

Hey - does the Government (the one you work for, whoever that is) have a framework for spotting risks and targeting opportunities over the next century?

Sorry Jan, me again. I just thought of two more possible future treatments (although they are mid- to long term ~50 years in the future).

The first involves recent work on what is now being termed the "human bacteriome".

It's been known for a while now that the bacteria that reside on our skin or inside our intestines are more than just passive "parasites" and that they not only aid the digestion of food but ican also be considered an extended part of our immune system (as the harmless bacteria occupy an environmental niche in us that could otherwise be occupied by disease causing bacteria). In the last decade or so it has become apparent that some bacteria can harm us (pylori causes stomach ulcers for example). However even more recently it has been indicate that they can also influence the type of foods we crave (by stimulation of the vagus nerve of the enteric nervous system I think it was) which could have an effect on the chances of becoming obese/diabetes. I would have to check but I believe current thinking is that some other diseases (such as Chrone's disease) could be caused by a perturbation in the internal bacterial mix.

 Unfortunately around 60-90% of the bacterial species in the gut is still unknown (the "dark" genome" - I think Tom may have more details on this) but one can imagine a time when neonates are given a "bacterial shake" shortly after birth to "tune" the baby so that it won't be obese, or suffer from other diseases later in life (in utero a baby has no internal bacteria - these are picked up on the way through the birth canal).

The second involves the rapidly growing field of "epigenetics".

Epigenetics is alterations that occur either on our DNA (usually by the attachment of methyl groups to C residues) or at the protein level (acetylation of the histones that the DNA is wrapped around). Both forms of modification are not encoded at the DNA level but seem to occur due to environment. Evidence seems to be emerging that young animals can have their gene expression modified by their experiences (i.e. a badly treated child might get methylation of genes involved in the fight/flight response making them more aggressive in later life). Even more interesting this epigenetics seems to occur in the womb http://www.sciencedaily.com/releases/2014/09/140929105358.htm

(above link is very interesting). It seems that some of these "epigenetic" marks can be transmitted to offspring generations later.

In a way this is more lamarckian rather than Mendelian genetics (where the experience of the parents can affect their offspring). Even more interesting recent work in fruit flies seems to indicate there is an effect of previous mating on the offspring of female flies (http://www.sciencedaily.com/releases/2014/10/141001090238.htm)

One can image in a future where an individual can have his behaviour modified (eek!) at the DNA level by altering these epigenetic marks...

anyway back to work again!

Gary

Oh hi Jan - sorry our answers crossed!

I work at LGC and we are the NMI (National Measurement Institute) for chemistry and biology for the UK. We are a large company and do a lot of other things too (we work with both industry and academia). We also the largest private provider of forensic services in the world (not my area though). I'm afraid I can't speculate on LGC's long term assessment as that's well above my pay grade! (I am a humble worker ant).

My part of LGC is based in Teddington in SW London.

My personal background is from academia but I must admit I much prefer working here (a much nicer experience all round!)

Gary

Thanks again for another fruitful answer. 

Epigenetics is quite big in my area - people know that the urban environment is the biggest factor in the aetiology of schizophrenia, and so some (I should say the most prominent, like Jim Van Os) voices claim the urban environment causes genetic hysteriesis -. He gets his article sin Nature. I have to put up with rejection letters for 3 years!

Yes, if I would have been supported. - Now it might be too late then less and less people care zero about others. Ghost writers seem to have all the power, - this is scary. http://www.theatlantic.com/magazine/print/2010/11/lies-damned-lies-and-medical-science/308269/.

Yes I saw an article on the effects of the urban environment of schizophrenia - thought it was quite interesting (although schizophrenia is a highly complicated condition - I think I saw something recently that claimed up to 30 different Loci had a role to play in it's development).

Jouko - sorry I am a bit puzzled by your remarks, can you expand? (the link is interesting but also not sure what point you are making...?).

Also I'm afraid I don't really agree with the statement "less and less people care zero about others." ( I think you might have meant "more and more people care less about others" - which I also don't agree with!). I think the basic human psyche re: empathy etc hasn't really changed much in the last few centuries (since the development of the concept of the "self"). Anyway this is rather off topic.

Have a good weekend all.

Gary 

Less and less or more and more - there is indeed this difference! Pharmaceutical industry is extremely powerful, they are in business to make money - not to keep people healthy. - http://psychcentral.com/blog/archives/2008/06/16/cover-up-paxil-and-suicide-risk/

Gary - The article you saw on schizophrenia may have been mine. But I only identified 9 - but 9 categories. Once these are 'opened' you have thousands of targets. Especially when specific genetic factors are under the microscope. 

Golembiewski, Jan. (2013). Are diverse factors proxies for architectural influences? A case for architecture in the aetiology of schizophrenia. Curēus, 5(3), e106. doi: 10.7759/cureus.106 link: http://www.cureus.com/papers/Are-diverse-factors-proxies-for-architectural-influences-A-case-for-architecture-in-the-aetiology-of-schizophrenia/1986#.UUbMcFsd6dI

Jouko - thanks for your posts. The Atlantic article is interesting and I understand the concern. you'll be interested to hear that the tide is turning on big-pharma-centred research. It's early days, but a new website called 'www.patientslikeme.com' is ahead of the game. The site asks patients and human experiments to tell one another - and researchers what they experience, in their own language, and on their own terms. There is no hiding from this new body of data, because it's patient-led and generated, not top-down, researcher, research-grant, government policy or industry-led data. It's very interesting, I suggest you take a look.

The site does have a demographic bias (more women, possibly more internet-diagnosed-disorders and other somatoform disorders, younger people too)

The other article is about a something I know about, if only because a friend spearheads this research here in Australia. Dr. Yolande Lucire  is a psychiatrist who has been black-listed and scapegoated for trying to get patients off certain psychotropics. Some of her research shows that specific psychotropics affect different phenotypes differently. Look her up too.

http://www.cureus.com/papers/Are-diverse-factors-proxies-for-architectural-influences-A-case-for-architecture-in-the-aetiology-of-schizophrenia/1986#.UUbMcFsd6dI

Jan - thank you for the great link to Dr. Yolande Lucire and from there to Joanna Moncrieff. https://www.youtube.com/watch?v=IV1S5zw096U.

Jan

I know of two potentially major "breakthrough" projects that have been in existence for over a decade  and shown good promise but have not advanced so it's easy to expect they will take another few decades.

One is zolpidem for brain damage, all explained on this website : https://sites.google.com/site/zolpidemtherapy/home  A proportion of patients with brain damage of all causes respond with SPRCT scans showing new brain activity within infarctions plus clinical responses in stroke patients.  This is a unique effect since no other GABA agonist has this effect (such as zopiclone and zaleplon).

A second project is Colostrinin(R) which I suggest you search for by Google.  It is the only project that has worked well in several models of the pathology of Alzheimer's Dementia plus one placebo-controlled clinical trial.  There is a good review of its mechanisms of action by Boldogh and Kruzel in Journal of Alzheimer’s Disease 13 (2008) 303–321.  

Both these treatments are known to be safe. Both are available now at low cost, ie less than a UD dollar a day, so it is a huge tragedy that so many patients are not getting them.  The reasons for being stalled are many but lack of patents is a major one.  High cost of phase 3 type trials is another. Thirdly, investors see pharmaceuticals as very high risk.  Fourthly, academics in basic sciences see them as "old hat" or clinicans are constrained by health care budgets.  Your new breakthroughs will need to avoid all of these pitfalls, I think.

Cheers

Andy Sutton 

.

This is fascinating - and sounds like it has a great potential for rebuilding plasticity in mental illness also. Thanks for those tips.

J

I agree that both projects are important because their mechanisms of action are prime leads for further research. Zolpidem reversing infarctions means that they are not entirely dead areas but dormant.  Why?  We think GABA shuts down areas under hypoxic threat  and it locks them down to protect them. Zolpidem only has this effect at least 3 months after the stroke or trauma so we hypothesise that GABA molecules' hold weakens over time  and then when zolpidem competes for the receptor it manages to dislodge some of them. Zolpidem then has a weaker hold than GABA so it gets dislodged in its turn and the receptor is freed. 

The Alzheimer project is even more fascinating.  It is a filtrate of colostrum that nature produces for only about 48 hours after birth when the brain is assaulted by higher oxygen concentrations ( in air) than it is used to in the uterus.  The proline  and proline-rich-peptides have an extraordinary range of potentially important effects as listed in the review plus even effects like protection against the stress of drought in plants. I can only think it really does have  profound protective effects in the Alzheimer brain ... and maybe the immediate post-trauma brain too ??? 

Anyway. I'm glad that you liked my post.  Cheers again. Andy 

Again, thanks for this. I'm personally very interested in GABA function, as I've done a lot of work on the neuroscience of schizophrenia, and have found GABA to be pivotal for redressing negative signs - only it's very difficult to promote GABA-ergic activity without increasing other more florid psychosis. So this looks very promising. 

Fascinating - there is no better medicine than the preventive one. Today's medicine still is a lot of playing with costly symptom treatments that neither heal nor prevent. Breakthroughs are more than welcome.