We´ve seen the future of medicine-and it´s tough on the eyes. The secret to radically improved health care lies at the cellular level, ground zero for disease, where everything is roughly 1,000 times as small as the period at the end of this sentence. Dial out a decade or so, and doctors will wield molecular tools to switch genes on and off, taming
diabetes and obesity, among many ills. Researchers will
harness tiny proteins to ward off any strain of influenza.
Bye-bye bird flu. Precision-guided cancer killers will lay waste to tumors without so much as grazing the surrounding healthy tissue. No more chemotherapy side effects.

From a nano-sewing kit that mends severed nerves to a genetic switch that turns off fat genes, the future of molecular medicine looks bright. And that’s no small thing.


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The Genetic Slicer ‘N’ Dicer

A way to turn off the genes that are making us fat The Prescription: What if a simple injection could silence the genetic culprits that fuel weight gain, coercing cells to burn more fat and be more responsive to changing insulin levels? That´s precisely the sort of treatment now being developed by biochemist Michael Czech and his colleagues at the University of Massachusetts Medical School. The key to their approach is a technique called RNA interference, or RNAi, one of the body´s natural self-defense mechanisms. In broad strokes, when a virus, for instance, invades a cell, it passes on its genetic code through double-stranded RNA. The cell recognizes the RNA as an invader, dices it up into tiny pieces called short-interfering RNA, and attacks any genes that bind to it. In the past year, Czech has used RNAi to silence 1,000 genes in cultured adipose tissue, a.k.a. fat. The process would have taken them decades without RNAi-now they simply introduce bits of RNA that match the target genes, inducing the cells to shut the genes down. With certain key genes disabled, the researchers learned that the tissue can be more responsive to insulin levels, suck more glucose out of the blood, and actually burn fatty acids instead of storing them as new fat cells.
When?: 2010 or later.

Precision-Guided Tumor Killers

Little carbon bombs target cancer and spell the end of chemo’s sickening side effects The Prescription: Lay waste to cancerous growths while leaving bystander cells unscathed. The solution hinges on hollow spheres of carbon polymer, each 1,000 times as small as a pinpoint. Robert Langer of the Massachusetts Institute of Technology and Omid Farokhzad of Harvard University are infusing such spheres, known as nanoshells, with minuscule doses of chemotherapy drugs. To ensure that the particles strike only cancer cells, the researchers stud them with a string of molecules called aptamers that bind exclusively to proteins that sprout from cancerous tissue. â€The aptamers act like GPS in your car. They direct the delivery of the particles to the cancer cells,†Farokhzad says. Once the particles arrive at their preordained location, they deposit their anticancer cargo inside the culprit cells, killing them off-without killing healthy parts of the patient in the process.
When?: 2014. Langer and Farokhzad published data earlier this year showing that their nanoparticles destroy prostate tumors in mice, but at least three more years of animal studies are planned to confirm this finding. Testing in humans could take an additional five years or more. But it´s worth the wait-colleagues say the one-two punch of nanoparticles and aptamers is key to successful treatments.

Custom-Made Organs To Go

Never wait for a donor again-grow your own body parts instead The Prescription: Tissue engineer Anthony Atala of Wake Forest University Medical Center and his team made headlines in April when they announced the first custom-built human bladders to be successfully transplanted into people. A month later, they reported that they had used the same tissue-engineering technique to restore sexual function to rabbits with damaged penises, opening the door for radical new treatments for men with sexual dysfunction. Their next big challenge is to grow one of the most intricate organs in the human body: the kidney. Atala´s work on the bladder took off in 1999, when he harvested the cells of the first of seven patients suffering from bladder disease. He and his colleagues grew the cells in culture, implanted them in a biodegradable, bladder-shaped structure, and then grafted their creation onto the patient´s unhealthy organ. This spring, they wrote in a top medical journal that all the bladder recipients are healthy, marking a major milestone in tissue engineering.
When?: 2016. The group has already produced a section of kidney tissue that excretes a urine-like substance. The next big step is to grow the millions of nephrons, or urine-recycling ducts, necessary for a functional kidney.

Spinal Spark For Paralysis

There´s good news for those recently paralyzed by spinal-cord injuries. A small battery-powered device inserted beside the spinal column within 18 days of an injury can stimulate the regrowth of nerve tissue. The device, made by Cyberkinetics in Massachusetts, has helped both newly paralyzed dogs and humans regain some movement.

Kryptonite For Flu

A single-shot universal vaccine against any strain of influenza The Prescription: Immunologists are aiming at a fresh target: M2, a protein on the surface of viruses that appears almost unchanged in nearly every known strain of flu. An M2 vaccine, scientists say, could fight forms of the virus that haven´t even appeared yet. But unlike other vaccines, the M2 shot won´t actually stop infection. It works by kicking off a massive immune response that weakens the effects of flu, making it easier to survive potentially lethal symptoms like fever and dehydration. Immunologist Walter Gerhard of the Wistar Institute in Philadelphia says that spiking a standard flu shot with M2 could dramatically broaden its protective powers against epidemic influenza strains.
** When?:** Trials could begin next year.

The Nano-Knitters

A sewing kit to stitch severed nerve cells back together The Prescription: A team of scientists has developed a technique that allows nerve cells to regrow, bridging the gaps left by injury or illness. The procedure hinges on independent strings of amino acids about one thousandth the size of a red blood cell. Because the strings have different qualities-some are positively charged, others negative, some are attracted to water, others repelled by it-they self-assemble into chain-like structures. Injected into the injured area of a patient´s brain, millions of these nanocombs would form a kind of trellis along which nerve cells could grow. With the help of other therapies, such as a drug regimen that stimulates nerve-cell growth, their axons-the long fibers that carry electrical signals-would extend through and reconnect.
When?: 2010. Rutledge Ellis-Behnke of the Massachusetts Institute of Technology has tested the technique in animals. When he severed a tract in hamsters´ brains responsible for vision and added the nanothreads, he found that a striking 75 percent of the subjects regained sight. Ellis-Behnke hopes that nanoscaffolds will be used in brain surgery-healing areas injured by the surgeon´s scalpel-within five years.