Nature Medicine asked leading experts to describe a research breakthrough they hope to see in the next year:

“The development of an AIDS vaccine has been one of the most difficult scientific challenges in biomedical research in decades. An AIDS vaccine is critical to a comprehensive prevention program to contain this devastating pandemic. My hope for 2009 is that we will witness a conceptual breakthrough in our ability to elicit broadly reacting neutralizing antibodies against HIV that would enable us to make a vaccine that would effectively protect against acquisition of HIV infection.

—Anthony Fauci Director, National Institute of Allergy and Infectious Diseases Bethesda, Maryland, USA

“I'd love to see a breakthrough in our understanding of bacterial cell death. Once we know more about the mechanisms and processes involved, we'll be in a far better position to develop therapies for tuberculosis that can dramatically shorten the duration of treatment, which currently takes six months.

—Valerie Mizrahi Director, Molecular Mycobacteriology Research Unit, University of the Witwatersrand Johannesburg, South Africa

“Now is the time to initiate the next generation of genetic association studies in which advances in stem cell research, cellular reprogramming, genomics and computational biology are combined to reveal the causal effects of naturally occurring human genetic variation on a wide range of molecular and cellular phenotypes. Efficient and cost-effective strategies should be developed to expand our knowledge of how the human genome functions in health and disease and to stimulate targeted therapies of molecular pathways that will undoubtedly cut across current disease classifications.

—Elizabeth Nabel Director, National Heart, Lung, and Blood Institute Bethesda, Maryland, USA

“In 2009, I would like to see progress toward solving a major problem that lies at the core of the mission of Harvard Medical School and other such institutions. We do not yet have an optimal approach to leveraging the enormous intellectual assets of researchers in the lab and clinic so as to most effectively bring transformative therapies that are safe and effective to the public. To achieve this goal may require creation of new academic models for therapeutic discovery, new models for relationships with industry that protect and enhance the values and needs of all parties and new approaches to regulation and public policy.

—Jeffrey Flier Dean of the Faculty of Medicine, Harvard Medical School Boston, Massachusetts, USA

“In 2009, I would most like to see some of the novel approaches that the entire field has begun to explore in Alzheimer's disease and schizophrenia provide results that open up a path to more effective treatments for these disabling disorders that, until now, have been so intractable. Every year, as our research progresses, I am more hopeful that we are getting closer to this goal.

—David Michelson Vice President, Clinical Neuroscience and Ophthalmology, Merck & Co. North Wales, Pennsylvania, USA

“Today, there is doubt that new molecular therapeutics are substantially changing cancer care and doubt that the fundamental genetic alterations and the unveiling of the molecular principles driving carcinogenesis will intersect with therapy. We have forgotten that efficacious therapy requires maximal target inhibition, that side effects can be ameliorated by scheduling and that personalized medicine includes personalized dosing. We have built a cumbersome system for finding incremental changes in patient benefit that does not enable the discovery of life-changing combinations. Nonetheless, the treatment of cancer is changing before us. When asked “can we cure cancer?” let us not retreat from the answer “yes, we can.”

—William Sellers Global Head of Oncology, Novartis Institutes for Biomedical Research Cambridge, Massachusetts, USA