Despite being very different diseases, ALS and some forms of cancer have shared characteristics: complex genetics, mostly frequently adult onset, followed by rapid disease progression (see related news story). These shared features led Ammar Al-Chalabi at King’s College London and Neil Pierce at the London School of Hygiene and Tropical Medicine together with an international team of researchers to adapt mathematical models from cancer for modeling ALS. In the October 7 Lancet Neurology, the researchers apply a multistep model of ALS to epidemiological data from five different European registries, and conclude that ALS is caused by a sequence of six steps. The accumulation of these steps over a lifetime, one of which can be an inherited mutation, ultimately ends in disease. Although the precise stages remain to be elucidated, this thought-provoking approach provides further support for the contribution of environmental risk factors to ALS.
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