I am saddened by her loss, but the memory of her smile and her undiminished enthusiasm for life will stay with me always. And her consistently positive attitude while she was alive gives me reason to be hopeful, as well, about the trajectory of new research in ALS, which could potentially impact the lives of my other patients and their families.

Here are five promising areas of research that may ultimately point toward a cure, many of which are occurring because of greater collaboration between competing academic centers, patient organizations, and the pharmaceutical industry.

1. Preventing Spread of Prion-like Proteins
   It's well-established that ALS progresses from the place where it started (in some cases, muscles used for speech and swallowing are affected first) to other parts of the body. Some scientists hypothesize that progression occurs as misfolded proteins related to the disease spread from cell to cell similar to a prion protein. Scientists are working to develop very specific molecules to break down misfolded proteins and block their ability to penetrate neighboring cells. 
2. Discovering New Genes 
   For years, researchers had identified only one gene, the SOD1, as a possible cause of ALS, but it occurs in a tiny fraction of people with ALS. Now, they've singled out another gene, C9ORF72, which appears far more commonly in people with ALS. The gene is known to produce an abnormal protein that causes damage to the nerve cells that control muscle strength. Identifying new genes provides new targets for treatment and thus renewed hope of finding a cure for this devastating disease. 
3. Creating Designer Molecules 
   Scientists have developed designer molecules called antisense oligonucleotides (ASO) that specifically target, bind, and silence ALS genes and prevent the damaging proteins from forming. A recent trial showed that an infusion of these ASOs was safe in people who have ALS caused by the SOD1 gene. A larger trial is being designed to assess whether the ASOs can effectively inhibit the mutant gene.
4. Curing ALS in Dogs 
   Our canine brethren also get a form of ALS through a natural mutation in the SOD gene, which is why dogs provide a good model to study the disease. Scientists are working to find a cure or treatment in dogs with the hopes that it will translate to humans. For example, researchers are developing and testing canine-specific ASOs. Because they are a larger vertebrate model, dogs provide a better idea about the drug effects and metabolism than the mice models. 
5. Developing More Sensitive Tools to Identify Biomarkers 
   A new noninvasive technique called electrical impedance myography (EIM) applies a high-frequency, low-intensity electrical current to muscles to measure changes in composition and structure caused by ALS progression. Studies show that EIM is more sensitive in assessing disease progression than the ALS Functional Rating Scale (a questionnaire that measures changes in physical functioning) and muscle strength tests.
   
   These and many other recent developments in the field of ALS continue to offer hope to our patients and their families. Julie's smile and these recent promising research findings help lift my spirits while taking care of my patients.