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The road ahead: nine destinations.

Article Excerpt
The Reverend Dr. Martin Luther King, Jr., once observed (in a different context), "We ain't what we ought to be. We ain't what we could be. We ain't what we're gonna be, but thank God we ain't what we were!" The old civil rights analysis fits the MS movement very well. Anyone who was diagnosed before the 1990s can attest to what a different place the world of MS is today, even if some advances have come too late to be of personal use.

What needs to be done now?

In 2001, the Institute of Medicine (IOM, the independent nonprofit agency created by the federal government to advise on science and technology) issued a special study commissioned by the National MS Society. The Society asked IOM to identify the most promising research directions in MS. In response, the IOM advisors created a "roadmap"--or more properly, according to Dr. John Richert, executive vice president for Research and Clinical Programs at the Society, "a list of essential destinations."

"Our priorities are in accord with these destinations," Dr. Richert said. "But priorities are not the same as a sequence. Completing number five doesn't require completing one through four first. In fact, these destinations cannot be listed in order of importance, in part because no one knows all the things that could result from reaching any one of them. We do know that some emerging answers are likely to change or even eliminate other questions. One thing is certain: funding for research in all these areas is of compelling importance."

The list of destinations starts (arbitrarily) with basic questions about human biology.

1 Unravel the genetic basis for susceptibility to MS

It is already established that MS is not a single-gene disorder. It involves multiple genes interacting with an environmental trigger or triggers. Research points toward infections rather than something toxic in air, water, or food as a triggering agent, though recent evidence hints that lack of sun exposure, leading to lower vitamin D levels, may play a role.

The search for genes involves scanning for patterns in the human genome and processing mind-numbing numbers of potential combinations. But the genetics of MS is likely to provide a key to accurate prognosis and a sound rationale for selecting treatments for an individual. Genetics will also identify biological molecules active in MS that will be attractive targets for new therapies. And finally, knowing which genes do what will help define and describe the disease itself.

"There could...

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