Each month, Look Who’s Talking features voices from across the Brigham answering the same question. This month, we ask members of the Brigham community to tell us about a big ‘breakthrough’ in science or medicine that they anticipate for 2019. If you would like to add your voice to the conversation, please submit a comment at the bottom of the page.

Charles Jennings

“One area that’s especially exciting right now is the development of ‘cell atlases’ that will map the cellular and molecular complexity of the human body with unprecedented detail. I’m especially interested in the brain; we still don’t know how many cell types it contains, but thanks to some amazing advances in genomics and microscopy, we are now positioned to discover not just the parts list, but also how all those parts fit together. It will be like Google Maps for the brain, and once it’s finished, it will have a huge impact on how we understand biology and disease.”

– Charles Jennings, PhD, Executive Director of the Ann Romney Center for Neurologic Diseases and Program for Interdisciplinary Neuroscience

Kathryn Rexrode

“The biggest breakthrough in 2019 will be the recognition of sex and gender as the first elements of precision medicine. New research is quantifying the impact of sex and gender on biology, health and disease. Bringing these specific insights to clinical care will transform the care of all of our patients.”

– Kathryn Rexrode, MD, MPH, Chief of the Division of Women’s Health in the Department of Medicine; Director of the Office for Women’s Careers in the Center for Diversity and Inclusion

Khalid Shah

“The human immune system, which is highly variable between individuals, is going to play a major role in how each individual’s diseases, particularly cancer, are treated. As there are specific factors that shape one’s immune system, understanding when and how these factors have an influence will be key to understanding our immunological health and broadening our knowledge of the risk of immune-mediated diseases.”

– Khalid Shah, MS, PhD, Vice Chair of Research, Department of Neurosurgery; Director, Center for Stem Cell Therapeutics and Imaging; Director, Center of Excellence for Biomedicine

Julie Silver

“Keep an eye on the research and expanding clinical implementation of multi-modal prehabilitation protocols. Particularly in aging populations with multiple co-morbidities, there is a growing interest in prehabilitation before elective surgeries. Newly diagnosed cancer patients may also benefit from getting stronger and healthier prior to surgery or the start of other oncology-directed therapies. Cancer prehabilitation research has been rapidly increasing and may provide opportunities to lower the surgical risk for elderly or frail patients and help them tolerate other treatments such as chemotherapy.”

-Julie K. Silver, MD, Associate Chair, and Director of Cancer Rehabilitation, Department of Physical Medicine and Rehabilitation

Clemens Scherzer

“I think the biggest breakthrough in the year ahead will be in our understanding of progression genes. The main determinant of patient wellbeing is not genetic susceptibility, but the course of disease progression. I expect a transformative shift from understanding the genetics of susceptibility to the genetics of prognosis. Instead of waiting for disease complications to occur, this completely new type of genetics will help predict and prevent disease progression.”

– Clemens Scherzer, MD, Director of the Center for Advanced Parkinson’s Disease Research; Director of the Brigham’s Precision Neurology Program

Marie McDonnell

“I think we will soon see the new era of precision medicine come to fruition in diabetes. On the heels of recent studies identifying unique benefits of certain therapies in those with type 2 diabetes and heart disease, we look forward to the results of the GRADE study, which randomized participants with type 2 diabetes to multiple treatment strategies for the sole purpose of determining which path is best, for which patients, and why. Beyond the primary outcome, we are hopeful that the study will shed light on applying genomics and unique patient characteristics to both diagnosis and treatment. For type 1 diabetes, we will see new technologies that come closer than ever before to the “artificial pancreas,” and hopefully more biosimilar insulins on the market will lower the price of insulin on a global scale so more can access it when they need it.  Telemedicine will also take a new leap this year. I think BWH Diabetes researcher and GRADE investigator Vanita Aroda, MD, stated it well: ‘Individualization at all levels’ will make a huge impact over the next few years.

– Marie McDonnell, MD, Director, Brigham Diabetes Program

David Walt

“In 2019, I expect we will see the first diagnostic tests showing it is possible to detect diseases at a much earlier stage than is presently possible. Examples include some types of cancer, neurological disorders and infectious diseases. Whatever comes out in 2019 will be only the beginning, as I expect new genetic, proteomic and metabolomic technologies to start making a dent in one disease after another. Ideally, this capability will enable us to treat patients earlier and even prevent the development of symptoms.”

– David Walt, PhD, Professor of Pathology, Department of Pathology

Lynn Bry

“Several Massachusetts-based microbiome companies will be completing Phase II and III studies for the use of live bacteriotherapeutics in diseases such as recurrent C. difficile colitis and for inflammatory bowel diseases. Breakthroughs to look out for will be the successful use of these novel therapeutics, particularly as the field moves to using defined species as opposed to unfractionated communities as in fecal microbiota transplant for C. difficile colitis. More broadly, as we move to getting organisms in hand and identifying the microbial genes and products that mediate effects in health and disease, we can expect to see targeted, small-molecule therapeutics that leverage your microbiota as a druggable target.”

– Lynn Bry, MD, PhD, Associate Medical Director of Clinical Microbiology in the Pathology Department