Patrice Wendling

EDINBURGH – Physicians may want to avoid exposing their photosensitive patients to single-envelope compact fluorescent lamps. Better to use the double-envelope variety, Dr. Harry Moseley suggested.

“Ultraviolet emissions from single-envelope compact fluorescent lamps can be harmful to patients with light-sensitive skin disorders,” Dr. Moseley said at the 15th World Congress on Cancers of the Skin.

Patrice Wendling/Frontline Medical News

Compact fluorescent lamps (CFLs) contain small amounts of mercury that, when stimulated, produce ultraviolet radiation. Double-envelope CFLs encase the standard twisted CFL bulb in a glass or plastic shell, thereby lowering the UV risk.

Extensive testing of 280 lamps, including 106 single-envelope CFLs, by Dr. Moseley and others revealed sizable variations in emissions below the 400-nm threshold in the UVC (280-100 nm), UVB (280-315 nm), and UVA (315-400 nm) wavelengths.

The average UVC, UVB, UVA2, and UVA1 milliwatts per square meter from double-envelope CFLs was 0.02, 4, 11, and 408, respectively, compared with 2, 99, 81, and 989 milliwatts per square meter for single-envelope lamps (Photodermatol. Photoimmunol. Photomed. 2014;30:153-9; Br. J. Dermatol. 2013;169;910-5; Photochem. Photobiol. Sci. 2012;11:1346-55).

“So now we have something we can take to our photosensitive patients,” Dr. Moseley, head of scientific services at the photobiology unit, University of Dundee (Scotland), said.

Newer light-emitting diodes provide an even safer alternative, with no UV emissions detected below 380 nm in the lab, he added.

In its most recent 2011 report, the Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR) also acknowledged the benefits of LEDs to reduce UV radiation exposure.

A preliminary case report by Dr. Moseley involving just four patients with chronic actinic dermatitis (Br. J. Dermatol. 2009;160:659-664) prompted SCENIHR to issue its first warning about single-envelope CFLs in 2008 and recommend the use of double-envelope CFLs.

“The lighting industry said we were being too strict, and the patient pressure groups said we weren’t being strict enough, so I’m assuming we must have been about right,” he recalled.

Subsequent testing in 200 patients, 154 of whom were actively photosensitive, produced 32 positive responses to exposure from single-envelope CFLs at a distance of 5 cm.

Because CFLs don’t emit heat like old-fashioned incandescent bulbs, however, patients frequently place these lamps quite close to their face or hands when reading or doing intricate work, Dr. Moseley observed.

In the United States, the Food and Drug Administration has worked with the lighting industry to require a caution label on general-purpose lighting that exceeds the Illuminating Engineering Society of North America’s radiation emission standards. The FDA states that CFLs carry no such warning because UV levels fall “below the level of concern” when used at typical-use distances by healthy individuals.

“The problem is that when you’re buying these lamps, you don’t know how much UV is coming out of them because there is nothing on the packet that will tell you this kind of information you may be interested in,” he said at the meeting, sponsored by the Skin Cancer Foundation.

[email protected]

EDINBURGH – Physicians may want to avoid exposing their photosensitive patients to single-envelope compact fluorescent lamps. Better to use the double-envelope variety, Dr. Harry Moseley suggested.

“Ultraviolet emissions from single-envelope compact fluorescent lamps can be harmful to patients with light-sensitive skin disorders,” Dr. Moseley said at the 15th World Congress on Cancers of the Skin.

Patrice Wendling/Frontline Medical News

Compact fluorescent lamps (CFLs) contain small amounts of mercury that, when stimulated, produce ultraviolet radiation. Double-envelope CFLs encase the standard twisted CFL bulb in a glass or plastic shell, thereby lowering the UV risk.

Extensive testing of 280 lamps, including 106 single-envelope CFLs, by Dr. Moseley and others revealed sizable variations in emissions below the 400-nm threshold in the UVC (280-100 nm), UVB (280-315 nm), and UVA (315-400 nm) wavelengths.

The average UVC, UVB, UVA2, and UVA1 milliwatts per square meter from double-envelope CFLs was 0.02, 4, 11, and 408, respectively, compared with 2, 99, 81, and 989 milliwatts per square meter for single-envelope lamps (Photodermatol. Photoimmunol. Photomed. 2014;30:153-9; Br. J. Dermatol. 2013;169;910-5; Photochem. Photobiol. Sci. 2012;11:1346-55).

“So now we have something we can take to our photosensitive patients,” Dr. Moseley, head of scientific services at the photobiology unit, University of Dundee (Scotland), said.

Newer light-emitting diodes provide an even safer alternative, with no UV emissions detected below 380 nm in the lab, he added.

In its most recent 2011 report, the Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR) also acknowledged the benefits of LEDs to reduce UV radiation exposure.

A preliminary case report by Dr. Moseley involving just four patients with chronic actinic dermatitis (Br. J. Dermatol. 2009;160:659-664) prompted SCENIHR to issue its first warning about single-envelope CFLs in 2008 and recommend the use of double-envelope CFLs.

“The lighting industry said we were being too strict, and the patient pressure groups said we weren’t being strict enough, so I’m assuming we must have been about right,” he recalled.

Subsequent testing in 200 patients, 154 of whom were actively photosensitive, produced 32 positive responses to exposure from single-envelope CFLs at a distance of 5 cm.

Because CFLs don’t emit heat like old-fashioned incandescent bulbs, however, patients frequently place these lamps quite close to their face or hands when reading or doing intricate work, Dr. Moseley observed.

In the United States, the Food and Drug Administration has worked with the lighting industry to require a caution label on general-purpose lighting that exceeds the Illuminating Engineering Society of North America’s radiation emission standards. The FDA states that CFLs carry no such warning because UV levels fall “below the level of concern” when used at typical-use distances by healthy individuals.

“The problem is that when you’re buying these lamps, you don’t know how much UV is coming out of them because there is nothing on the packet that will tell you this kind of information you may be interested in,” he said at the meeting, sponsored by the Skin Cancer Foundation.

[email protected]

EDINBURGH – Physicians may want to avoid exposing their photosensitive patients to single-envelope compact fluorescent lamps. Better to use the double-envelope variety, Dr. Harry Moseley suggested.

“Ultraviolet emissions from single-envelope compact fluorescent lamps can be harmful to patients with light-sensitive skin disorders,” Dr. Moseley said at the 15th World Congress on Cancers of the Skin.

Patrice Wendling/Frontline Medical News

Compact fluorescent lamps (CFLs) contain small amounts of mercury that, when stimulated, produce ultraviolet radiation. Double-envelope CFLs encase the standard twisted CFL bulb in a glass or plastic shell, thereby lowering the UV risk.

Extensive testing of 280 lamps, including 106 single-envelope CFLs, by Dr. Moseley and others revealed sizable variations in emissions below the 400-nm threshold in the UVC (280-100 nm), UVB (280-315 nm), and UVA (315-400 nm) wavelengths.

The average UVC, UVB, UVA2, and UVA1 milliwatts per square meter from double-envelope CFLs was 0.02, 4, 11, and 408, respectively, compared with 2, 99, 81, and 989 milliwatts per square meter for single-envelope lamps (Photodermatol. Photoimmunol. Photomed. 2014;30:153-9; Br. J. Dermatol. 2013;169;910-5; Photochem. Photobiol. Sci. 2012;11:1346-55).

“So now we have something we can take to our photosensitive patients,” Dr. Moseley, head of scientific services at the photobiology unit, University of Dundee (Scotland), said.

Newer light-emitting diodes provide an even safer alternative, with no UV emissions detected below 380 nm in the lab, he added.

In its most recent 2011 report, the Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR) also acknowledged the benefits of LEDs to reduce UV radiation exposure.

A preliminary case report by Dr. Moseley involving just four patients with chronic actinic dermatitis (Br. J. Dermatol. 2009;160:659-664) prompted SCENIHR to issue its first warning about single-envelope CFLs in 2008 and recommend the use of double-envelope CFLs.

“The lighting industry said we were being too strict, and the patient pressure groups said we weren’t being strict enough, so I’m assuming we must have been about right,” he recalled.

Subsequent testing in 200 patients, 154 of whom were actively photosensitive, produced 32 positive responses to exposure from single-envelope CFLs at a distance of 5 cm.

Because CFLs don’t emit heat like old-fashioned incandescent bulbs, however, patients frequently place these lamps quite close to their face or hands when reading or doing intricate work, Dr. Moseley observed.

In the United States, the Food and Drug Administration has worked with the lighting industry to require a caution label on general-purpose lighting that exceeds the Illuminating Engineering Society of North America’s radiation emission standards. The FDA states that CFLs carry no such warning because UV levels fall “below the level of concern” when used at typical-use distances by healthy individuals.

“The problem is that when you’re buying these lamps, you don’t know how much UV is coming out of them because there is nothing on the packet that will tell you this kind of information you may be interested in,” he said at the meeting, sponsored by the Skin Cancer Foundation.

[email protected]

EDINBURGH –Kinase fusions have been well described in hematologic malignancies and are the newest genetic aberration to be identified in Spitz tumors.

Kinase fusions are actually quite common in Spitzoid neoplasms, with 51% of Spitzoid tumors and melanomas harboring a kinase fusion in a recent analysis of 140 tumors (Nat. Commun. 2014;5:3116. doi:10.1038/ncommons4116 ).

The fusions were identified across the entire biological spectrum of Spitzoid neoplasms, including 55% of Spitz nevi, 56% of atypical Spitz tumors, and 39% of Spitzoid melanomas. Therefore, kinase fusions are not useful to distinguish benign from malignant tumors, study author Dr. Thomas Wiesner said at the 15^thWorld Congress on Cancers of the Skin.

However, the kinase fusions were mutually exclusive, meaning that only one fusion activates the oncogenic pathway in a tumor. Small molecule kinase inhibitors have become mainstays of modern oncologic therapy in recent years and thus may be useful in Spitz tumors, which typically affect the young.

“These genetic aberrations represent targets for therapeutic interventions and offer investigational treatment options for patients with metastatic disease,” said Dr. Wiesner, a research associate at Memorial Sloan-Kettering Cancer Center in New York City.

ROS1 (c-ros oncogene 1) fusions were the most frequent in the series at 17% and have been shown in mouse models to respond to crizotinib (Xalkori). ALK fusions, present in 10% of tumors, are also sensitive to this drug.

“I think Spitzoid melanoma that is metastatic should be stained for ROS1 or ALK fusions because crizotinib might help these patients,” he said. “We have good evidence that it helps, at least in lung cancer and lymphoma.”

Other drugs target NTRK1 (neurotrophic tyrosine kinase receptor type 1) fusions, which were identified in 16% of Spitzoid tumors, and are in preclinical trials.

The researchers have also published a description of the morphological features that point to the underlying genetic aberrations (Am. J. Surg. Pathol. Jul 2014;38:925-33)). The study, involving 17 patients, aged 2 to 35 years, indicates that BAP1 loss and BRAF mutations are common in epithelioid Spitz tumors, HRAS mutations and gains of 11p are seen in desmoplastic Spitz nevi, while ALK fusions usually point to plexiform Spitz tumors, Dr. Wiesner said.

Clinicians can use the morphological features along with basic immunohistochemistry to identify the distinct subsets of tumors with BAP1 loss or ALK, NTRK1, or ROS1 fusions.

BAP1 loss Spitz tumors are important to identify because they are associated with a hereditary tumor syndrome very similar to Peutz-Jeghers or Muir-Torre syndrome, Dr. Wiesner said.

“When we see multiple epithelioid Spitz tumors in one patient, we have to think about a hereditary tumor syndrome,” he said at the meeting, sponsored by the Skin Cancer Foundation.

EDINBURGH –Kinase fusions have been well described in hematologic malignancies and are the newest genetic aberration to be identified in Spitz tumors.

Kinase fusions are actually quite common in Spitzoid neoplasms, with 51% of Spitzoid tumors and melanomas harboring a kinase fusion in a recent analysis of 140 tumors (Nat. Commun. 2014;5:3116. doi:10.1038/ncommons4116 ).

The fusions were identified across the entire biological spectrum of Spitzoid neoplasms, including 55% of Spitz nevi, 56% of atypical Spitz tumors, and 39% of Spitzoid melanomas. Therefore, kinase fusions are not useful to distinguish benign from malignant tumors, study author Dr. Thomas Wiesner said at the 15^thWorld Congress on Cancers of the Skin.

However, the kinase fusions were mutually exclusive, meaning that only one fusion activates the oncogenic pathway in a tumor. Small molecule kinase inhibitors have become mainstays of modern oncologic therapy in recent years and thus may be useful in Spitz tumors, which typically affect the young.

“These genetic aberrations represent targets for therapeutic interventions and offer investigational treatment options for patients with metastatic disease,” said Dr. Wiesner, a research associate at Memorial Sloan-Kettering Cancer Center in New York City.

ROS1 (c-ros oncogene 1) fusions were the most frequent in the series at 17% and have been shown in mouse models to respond to crizotinib (Xalkori). ALK fusions, present in 10% of tumors, are also sensitive to this drug.

“I think Spitzoid melanoma that is metastatic should be stained for ROS1 or ALK fusions because crizotinib might help these patients,” he said. “We have good evidence that it helps, at least in lung cancer and lymphoma.”

Other drugs target NTRK1 (neurotrophic tyrosine kinase receptor type 1) fusions, which were identified in 16% of Spitzoid tumors, and are in preclinical trials.

The researchers have also published a description of the morphological features that point to the underlying genetic aberrations (Am. J. Surg. Pathol. Jul 2014;38:925-33)). The study, involving 17 patients, aged 2 to 35 years, indicates that BAP1 loss and BRAF mutations are common in epithelioid Spitz tumors, HRAS mutations and gains of 11p are seen in desmoplastic Spitz nevi, while ALK fusions usually point to plexiform Spitz tumors, Dr. Wiesner said.

Clinicians can use the morphological features along with basic immunohistochemistry to identify the distinct subsets of tumors with BAP1 loss or ALK, NTRK1, or ROS1 fusions.

BAP1 loss Spitz tumors are important to identify because they are associated with a hereditary tumor syndrome very similar to Peutz-Jeghers or Muir-Torre syndrome, Dr. Wiesner said.

“When we see multiple epithelioid Spitz tumors in one patient, we have to think about a hereditary tumor syndrome,” he said at the meeting, sponsored by the Skin Cancer Foundation.

EDINBURGH –Kinase fusions have been well described in hematologic malignancies and are the newest genetic aberration to be identified in Spitz tumors.

Kinase fusions are actually quite common in Spitzoid neoplasms, with 51% of Spitzoid tumors and melanomas harboring a kinase fusion in a recent analysis of 140 tumors (Nat. Commun. 2014;5:3116. doi:10.1038/ncommons4116 ).

The fusions were identified across the entire biological spectrum of Spitzoid neoplasms, including 55% of Spitz nevi, 56% of atypical Spitz tumors, and 39% of Spitzoid melanomas. Therefore, kinase fusions are not useful to distinguish benign from malignant tumors, study author Dr. Thomas Wiesner said at the 15^thWorld Congress on Cancers of the Skin.

However, the kinase fusions were mutually exclusive, meaning that only one fusion activates the oncogenic pathway in a tumor. Small molecule kinase inhibitors have become mainstays of modern oncologic therapy in recent years and thus may be useful in Spitz tumors, which typically affect the young.

“These genetic aberrations represent targets for therapeutic interventions and offer investigational treatment options for patients with metastatic disease,” said Dr. Wiesner, a research associate at Memorial Sloan-Kettering Cancer Center in New York City.

ROS1 (c-ros oncogene 1) fusions were the most frequent in the series at 17% and have been shown in mouse models to respond to crizotinib (Xalkori). ALK fusions, present in 10% of tumors, are also sensitive to this drug.

“I think Spitzoid melanoma that is metastatic should be stained for ROS1 or ALK fusions because crizotinib might help these patients,” he said. “We have good evidence that it helps, at least in lung cancer and lymphoma.”

Other drugs target NTRK1 (neurotrophic tyrosine kinase receptor type 1) fusions, which were identified in 16% of Spitzoid tumors, and are in preclinical trials.

The researchers have also published a description of the morphological features that point to the underlying genetic aberrations (Am. J. Surg. Pathol. Jul 2014;38:925-33)). The study, involving 17 patients, aged 2 to 35 years, indicates that BAP1 loss and BRAF mutations are common in epithelioid Spitz tumors, HRAS mutations and gains of 11p are seen in desmoplastic Spitz nevi, while ALK fusions usually point to plexiform Spitz tumors, Dr. Wiesner said.

Clinicians can use the morphological features along with basic immunohistochemistry to identify the distinct subsets of tumors with BAP1 loss or ALK, NTRK1, or ROS1 fusions.

BAP1 loss Spitz tumors are important to identify because they are associated with a hereditary tumor syndrome very similar to Peutz-Jeghers or Muir-Torre syndrome, Dr. Wiesner said.

“When we see multiple epithelioid Spitz tumors in one patient, we have to think about a hereditary tumor syndrome,” he said at the meeting, sponsored by the Skin Cancer Foundation.

CHICAGO – Adding epinephrine to a specific formulation of hyaluronic acid already mixed with lidocaine failed to reduce the severity of adverse events following correction of perioral lines in a blinded study.

"Our results using split-face comparison did not reveal a large difference in bruising and pain scores," Dr. Azadeh Shirazi of Scripps Clinic in La Jolla, Calif., reported at the American Academy of Dermatology summer meeting.

Three groups of 10 women with mild to severe lip wrinkles were treated with 1.0 mL of cohesive polydensified matrix hyaluronic acid (CPMHA) alone; CPMHA plus 0.3 mL of lidocaine HCl 1%; or CPMHA plus lidocaine and epinephrine 1:100,000. The volumes in each syringe were adjusted to 1 mL in total.

All injections were performed in the dermis, using serial punctures and linear threading techniques. An entire syringe of one mixture was used on one side, followed by injection of a different mixture on the contralateral side.

Outside evaluators, physician investigators, and patients were blinded to treatment. Bruising was assessed on a 4-point, nonvalidated scale, with 0 being "no visible bruising" and 3 "severe" bruising.

On day 1 post procedure, outside evaluators gave the lowest bruising score to CPMHA alone at about 1.375, followed by CPMHA plus lidocaine and epinephrine at about 1.4, and CPMHA plus lidocaine at about 1.45.

Physicians favored the hyaluronic acid with both pain medications, while patients rated the lidocaine formulation as causing the least bruising.

By day 7, bruising was lower in all groups. The outside evaluators again rated CPMHA alone as causing the least bruising on day 7, while patients and physicians perceived less bruising with the CPMHA-lidocaine formulation. Pain scores followed a similar pattern.

Although not a variable in the study, short-lived edema also was noted in most patients.

It’s possible that there was not enough time for the epinephrine to take full effect as a vasoconstrictor to decrease bruising, Dr. Shirazi said in an interview.

Larger studies are warranted to determine differences between the different formulations, the Dr. Shirazi and her colleagues concluded in the poster.

The study was supported by Merz North America, makers of the CPMHA formulation. Dr. Shirazi has served as an investigator for Allergan, Medicis, and Merz, and as an advisory board member for several pharmaceutical and device companies.

[email protected]

CHICAGO – Adding epinephrine to a specific formulation of hyaluronic acid already mixed with lidocaine failed to reduce the severity of adverse events following correction of perioral lines in a blinded study.

"Our results using split-face comparison did not reveal a large difference in bruising and pain scores," Dr. Azadeh Shirazi of Scripps Clinic in La Jolla, Calif., reported at the American Academy of Dermatology summer meeting.

Three groups of 10 women with mild to severe lip wrinkles were treated with 1.0 mL of cohesive polydensified matrix hyaluronic acid (CPMHA) alone; CPMHA plus 0.3 mL of lidocaine HCl 1%; or CPMHA plus lidocaine and epinephrine 1:100,000. The volumes in each syringe were adjusted to 1 mL in total.

All injections were performed in the dermis, using serial punctures and linear threading techniques. An entire syringe of one mixture was used on one side, followed by injection of a different mixture on the contralateral side.

Outside evaluators, physician investigators, and patients were blinded to treatment. Bruising was assessed on a 4-point, nonvalidated scale, with 0 being "no visible bruising" and 3 "severe" bruising.

On day 1 post procedure, outside evaluators gave the lowest bruising score to CPMHA alone at about 1.375, followed by CPMHA plus lidocaine and epinephrine at about 1.4, and CPMHA plus lidocaine at about 1.45.

Physicians favored the hyaluronic acid with both pain medications, while patients rated the lidocaine formulation as causing the least bruising.

By day 7, bruising was lower in all groups. The outside evaluators again rated CPMHA alone as causing the least bruising on day 7, while patients and physicians perceived less bruising with the CPMHA-lidocaine formulation. Pain scores followed a similar pattern.

Although not a variable in the study, short-lived edema also was noted in most patients.

It’s possible that there was not enough time for the epinephrine to take full effect as a vasoconstrictor to decrease bruising, Dr. Shirazi said in an interview.

Larger studies are warranted to determine differences between the different formulations, the Dr. Shirazi and her colleagues concluded in the poster.

The study was supported by Merz North America, makers of the CPMHA formulation. Dr. Shirazi has served as an investigator for Allergan, Medicis, and Merz, and as an advisory board member for several pharmaceutical and device companies.

[email protected]

CHICAGO – Adding epinephrine to a specific formulation of hyaluronic acid already mixed with lidocaine failed to reduce the severity of adverse events following correction of perioral lines in a blinded study.

"Our results using split-face comparison did not reveal a large difference in bruising and pain scores," Dr. Azadeh Shirazi of Scripps Clinic in La Jolla, Calif., reported at the American Academy of Dermatology summer meeting.

Three groups of 10 women with mild to severe lip wrinkles were treated with 1.0 mL of cohesive polydensified matrix hyaluronic acid (CPMHA) alone; CPMHA plus 0.3 mL of lidocaine HCl 1%; or CPMHA plus lidocaine and epinephrine 1:100,000. The volumes in each syringe were adjusted to 1 mL in total.

All injections were performed in the dermis, using serial punctures and linear threading techniques. An entire syringe of one mixture was used on one side, followed by injection of a different mixture on the contralateral side.

Outside evaluators, physician investigators, and patients were blinded to treatment. Bruising was assessed on a 4-point, nonvalidated scale, with 0 being "no visible bruising" and 3 "severe" bruising.

On day 1 post procedure, outside evaluators gave the lowest bruising score to CPMHA alone at about 1.375, followed by CPMHA plus lidocaine and epinephrine at about 1.4, and CPMHA plus lidocaine at about 1.45.

Physicians favored the hyaluronic acid with both pain medications, while patients rated the lidocaine formulation as causing the least bruising.

By day 7, bruising was lower in all groups. The outside evaluators again rated CPMHA alone as causing the least bruising on day 7, while patients and physicians perceived less bruising with the CPMHA-lidocaine formulation. Pain scores followed a similar pattern.

Although not a variable in the study, short-lived edema also was noted in most patients.

It’s possible that there was not enough time for the epinephrine to take full effect as a vasoconstrictor to decrease bruising, Dr. Shirazi said in an interview.

Larger studies are warranted to determine differences between the different formulations, the Dr. Shirazi and her colleagues concluded in the poster.

The study was supported by Merz North America, makers of the CPMHA formulation. Dr. Shirazi has served as an investigator for Allergan, Medicis, and Merz, and as an advisory board member for several pharmaceutical and device companies.

[email protected]

EDINBURGH – Mobile phone apps that provide real-time, personalized sun risk and protection information are gaining ground in the fight against skin cancer.

The SunSmart app uses geolocation to alert iPhone, Android, and Samsung phones users in Australia when the UV Index reaches 3 or more and protection is required.

"The great advantage of a smartphone app for communicating the UV Index is that it can really communicate very directly to individuals based on their location," Craig Sinclair said at the 15th World Congress on Cancers of the Skin.

The SunSmart app also provides precise information related to the UV index and behavior prompts associated with it. It can, for example, calculate how much sunscreen should be applied based on the user’s height, weight, and choice of clothing; provide reminders to reapply sunscreen every 2 hours; and track whether a user is getting enough vitamin D based on their skin type, time spent outdoors, and clothing choices, said Mr. Sinclair of the Cancer Council Australia, Victoria, developer of the app.

The World UV app, created by the British Association of Dermatologists (BAD) and the United Kingdom’s Met Office (national weather service), takes sun protection one step further by providing a guide to the Fitzpatrick skin classification scale so users can determine the effects of the current UV rating on their specific skin type.

The app uses simple icons to relay the current UV index in real time and whether skin protection is required. Separate tabs allow access to more information on their Fitzpatrick skin type, what type of protection is required, and sun protection tips.

The app uses geolocation to pinpoint users but also allows them to select from more than 10,000 locations worldwide – making it a truly global app, Nina Goad, head of communications at BAD, said at the meeting.

Since its informal launch in 2012, more than 150,000 people in 200 countries have downloaded the free World UV app. The app has been most popular in the United States, United Kingdom, Belgium, Spain, and Australia, she said.

The launch of the SunSmart app in late 2010 has prompted roughly 130,000 Australians to download the free app. An online survey of 78 users in February 2011 showed that 85% felt it was easy to use and 87% said it met or exceeded expectations, Mr. Sinclair said at the meeting, which was sponsored by the Skin Cancer Foundation.

A follow-up survey of 380 persons revealed that 72% "agreed" or "strongly agreed" that using the app improved their sun protection that summer.

Another 86% said that it made them more aware of the times of day when sun protection is required and 81% said they were able to recognize the difference between UV level and temperature, which is "always a difficult issue to communicate," Mr. Sinclair said.

"These are self-reports, so there is undoubtedly some bias associated with them, but nonetheless, showing reasonably promising results," he added.

Both Mr. Sinclair and Ms. Goad said the apps will continue to be refined to increase downloads and return visits but noted that their respective nonprofits do not have the funding for large-scale advertising campaigns.

EDINBURGH – Mobile phone apps that provide real-time, personalized sun risk and protection information are gaining ground in the fight against skin cancer.

The SunSmart app uses geolocation to alert iPhone, Android, and Samsung phones users in Australia when the UV Index reaches 3 or more and protection is required.

"The great advantage of a smartphone app for communicating the UV Index is that it can really communicate very directly to individuals based on their location," Craig Sinclair said at the 15th World Congress on Cancers of the Skin.

The SunSmart app also provides precise information related to the UV index and behavior prompts associated with it. It can, for example, calculate how much sunscreen should be applied based on the user’s height, weight, and choice of clothing; provide reminders to reapply sunscreen every 2 hours; and track whether a user is getting enough vitamin D based on their skin type, time spent outdoors, and clothing choices, said Mr. Sinclair of the Cancer Council Australia, Victoria, developer of the app.

The World UV app, created by the British Association of Dermatologists (BAD) and the United Kingdom’s Met Office (national weather service), takes sun protection one step further by providing a guide to the Fitzpatrick skin classification scale so users can determine the effects of the current UV rating on their specific skin type.

The app uses simple icons to relay the current UV index in real time and whether skin protection is required. Separate tabs allow access to more information on their Fitzpatrick skin type, what type of protection is required, and sun protection tips.

The app uses geolocation to pinpoint users but also allows them to select from more than 10,000 locations worldwide – making it a truly global app, Nina Goad, head of communications at BAD, said at the meeting.

Since its informal launch in 2012, more than 150,000 people in 200 countries have downloaded the free World UV app. The app has been most popular in the United States, United Kingdom, Belgium, Spain, and Australia, she said.

The launch of the SunSmart app in late 2010 has prompted roughly 130,000 Australians to download the free app. An online survey of 78 users in February 2011 showed that 85% felt it was easy to use and 87% said it met or exceeded expectations, Mr. Sinclair said at the meeting, which was sponsored by the Skin Cancer Foundation.

A follow-up survey of 380 persons revealed that 72% "agreed" or "strongly agreed" that using the app improved their sun protection that summer.

Another 86% said that it made them more aware of the times of day when sun protection is required and 81% said they were able to recognize the difference between UV level and temperature, which is "always a difficult issue to communicate," Mr. Sinclair said.

"These are self-reports, so there is undoubtedly some bias associated with them, but nonetheless, showing reasonably promising results," he added.

Both Mr. Sinclair and Ms. Goad said the apps will continue to be refined to increase downloads and return visits but noted that their respective nonprofits do not have the funding for large-scale advertising campaigns.

EDINBURGH – Mobile phone apps that provide real-time, personalized sun risk and protection information are gaining ground in the fight against skin cancer.

The SunSmart app uses geolocation to alert iPhone, Android, and Samsung phones users in Australia when the UV Index reaches 3 or more and protection is required.

"The great advantage of a smartphone app for communicating the UV Index is that it can really communicate very directly to individuals based on their location," Craig Sinclair said at the 15th World Congress on Cancers of the Skin.

The SunSmart app also provides precise information related to the UV index and behavior prompts associated with it. It can, for example, calculate how much sunscreen should be applied based on the user’s height, weight, and choice of clothing; provide reminders to reapply sunscreen every 2 hours; and track whether a user is getting enough vitamin D based on their skin type, time spent outdoors, and clothing choices, said Mr. Sinclair of the Cancer Council Australia, Victoria, developer of the app.

The World UV app, created by the British Association of Dermatologists (BAD) and the United Kingdom’s Met Office (national weather service), takes sun protection one step further by providing a guide to the Fitzpatrick skin classification scale so users can determine the effects of the current UV rating on their specific skin type.

The app uses simple icons to relay the current UV index in real time and whether skin protection is required. Separate tabs allow access to more information on their Fitzpatrick skin type, what type of protection is required, and sun protection tips.

The app uses geolocation to pinpoint users but also allows them to select from more than 10,000 locations worldwide – making it a truly global app, Nina Goad, head of communications at BAD, said at the meeting.

Since its informal launch in 2012, more than 150,000 people in 200 countries have downloaded the free World UV app. The app has been most popular in the United States, United Kingdom, Belgium, Spain, and Australia, she said.

The launch of the SunSmart app in late 2010 has prompted roughly 130,000 Australians to download the free app. An online survey of 78 users in February 2011 showed that 85% felt it was easy to use and 87% said it met or exceeded expectations, Mr. Sinclair said at the meeting, which was sponsored by the Skin Cancer Foundation.

A follow-up survey of 380 persons revealed that 72% "agreed" or "strongly agreed" that using the app improved their sun protection that summer.

Another 86% said that it made them more aware of the times of day when sun protection is required and 81% said they were able to recognize the difference between UV level and temperature, which is "always a difficult issue to communicate," Mr. Sinclair said.

"These are self-reports, so there is undoubtedly some bias associated with them, but nonetheless, showing reasonably promising results," he added.

Both Mr. Sinclair and Ms. Goad said the apps will continue to be refined to increase downloads and return visits but noted that their respective nonprofits do not have the funding for large-scale advertising campaigns.

EDINBURGH – Mobile phone apps that provide real-time, personalized sun risk and protection information are gaining ground in the fight against skin cancer.

The SunSmart app uses geolocation to alert iPhone, Android, and Samsung phones users in Australia when the UV Index reaches 3 or more and protection is required.

Patrice Wendling/Frontline Medical News

"The great advantage of a smartphone app for communicating the UV Index is that it can really communicate very directly to individuals based on their location," Craig Sinclair said at the 15th World Congress on Cancers of the Skin.

The SunSmart app also provides precise information related to the UV index and behavior prompts associated with it. It can, for example, calculate how much sunscreen should be applied based on the user’s height, weight, and choice of clothing; provide reminders to reapply sunscreen every 2 hours; and track whether a user is getting enough vitamin D based on their skin type, time spent outdoors, and clothing choices, said Mr. Sinclair of the Cancer Council Australia, Victoria, developer of the app.

The World UV app, created by the British Association of Dermatologists (BAD) and the United Kingdom’s Met Office (national weather service), takes sun protection one step further by providing a guide to the Fitzpatrick skin classification scale so users can determine the effects of the current UV rating on their specific skin type.

The app uses simple icons to relay the current UV index in real time and whether skin protection is required. Separate tabs allow access to more information on their Fitzpatrick skin type, what type of protection is required, and sun protection tips.

The app uses geolocation to pinpoint users but also allows them to select from more than 10,000 locations worldwide – making it a truly global app, Nina Goad, head of communications at BAD, said at the meeting.

Since its informal launch in 2012, more than 150,000 people in 200 countries have downloaded the free World UV app. The app has been most popular in the United States, United Kingdom, Belgium, Spain, and Australia, she said.

The launch of the SunSmart app in late 2010 has prompted roughly 130,000 Australians to download the free app. An online survey of 78 users in February 2011 showed that 85% felt it was easy to use and 87% said it met or exceeded expectations, Mr. Sinclair said at the meeting, which was sponsored by the Skin Cancer Foundation.

Patrice Wendling/Frontline Medical News

A follow-up survey of 380 persons revealed that 72% "agreed" or "strongly agreed" that using the app improved their sun protection that summer.

Another 86% said that it made them more aware of the times of day when sun protection is required and 81% said they were able to recognize the difference between UV level and temperature, which is "always a difficult issue to communicate," Mr. Sinclair said.

"These are self-reports, so there is undoubtedly some bias associated with them, but nonetheless, showing reasonably promising results," he added.

Both Mr. Sinclair and Ms. Goad said the apps will continue to be refined to increase downloads and return visits but noted that their respective nonprofits do not have the funding for large-scale advertising campaigns.

[email protected]

EDINBURGH – Mobile phone apps that provide real-time, personalized sun risk and protection information are gaining ground in the fight against skin cancer.

The SunSmart app uses geolocation to alert iPhone, Android, and Samsung phones users in Australia when the UV Index reaches 3 or more and protection is required.

Patrice Wendling/Frontline Medical News

"The great advantage of a smartphone app for communicating the UV Index is that it can really communicate very directly to individuals based on their location," Craig Sinclair said at the 15th World Congress on Cancers of the Skin.

The SunSmart app also provides precise information related to the UV index and behavior prompts associated with it. It can, for example, calculate how much sunscreen should be applied based on the user’s height, weight, and choice of clothing; provide reminders to reapply sunscreen every 2 hours; and track whether a user is getting enough vitamin D based on their skin type, time spent outdoors, and clothing choices, said Mr. Sinclair of the Cancer Council Australia, Victoria, developer of the app.

The World UV app, created by the British Association of Dermatologists (BAD) and the United Kingdom’s Met Office (national weather service), takes sun protection one step further by providing a guide to the Fitzpatrick skin classification scale so users can determine the effects of the current UV rating on their specific skin type.

The app uses simple icons to relay the current UV index in real time and whether skin protection is required. Separate tabs allow access to more information on their Fitzpatrick skin type, what type of protection is required, and sun protection tips.

The app uses geolocation to pinpoint users but also allows them to select from more than 10,000 locations worldwide – making it a truly global app, Nina Goad, head of communications at BAD, said at the meeting.

Since its informal launch in 2012, more than 150,000 people in 200 countries have downloaded the free World UV app. The app has been most popular in the United States, United Kingdom, Belgium, Spain, and Australia, she said.

The launch of the SunSmart app in late 2010 has prompted roughly 130,000 Australians to download the free app. An online survey of 78 users in February 2011 showed that 85% felt it was easy to use and 87% said it met or exceeded expectations, Mr. Sinclair said at the meeting, which was sponsored by the Skin Cancer Foundation.

Patrice Wendling/Frontline Medical News

A follow-up survey of 380 persons revealed that 72% "agreed" or "strongly agreed" that using the app improved their sun protection that summer.

Another 86% said that it made them more aware of the times of day when sun protection is required and 81% said they were able to recognize the difference between UV level and temperature, which is "always a difficult issue to communicate," Mr. Sinclair said.

"These are self-reports, so there is undoubtedly some bias associated with them, but nonetheless, showing reasonably promising results," he added.

Both Mr. Sinclair and Ms. Goad said the apps will continue to be refined to increase downloads and return visits but noted that their respective nonprofits do not have the funding for large-scale advertising campaigns.

[email protected]

EDINBURGH – Mobile phone apps that provide real-time, personalized sun risk and protection information are gaining ground in the fight against skin cancer.

The SunSmart app uses geolocation to alert iPhone, Android, and Samsung phones users in Australia when the UV Index reaches 3 or more and protection is required.

Patrice Wendling/Frontline Medical News

"The great advantage of a smartphone app for communicating the UV Index is that it can really communicate very directly to individuals based on their location," Craig Sinclair said at the 15th World Congress on Cancers of the Skin.

The SunSmart app also provides precise information related to the UV index and behavior prompts associated with it. It can, for example, calculate how much sunscreen should be applied based on the user’s height, weight, and choice of clothing; provide reminders to reapply sunscreen every 2 hours; and track whether a user is getting enough vitamin D based on their skin type, time spent outdoors, and clothing choices, said Mr. Sinclair of the Cancer Council Australia, Victoria, developer of the app.

The World UV app, created by the British Association of Dermatologists (BAD) and the United Kingdom’s Met Office (national weather service), takes sun protection one step further by providing a guide to the Fitzpatrick skin classification scale so users can determine the effects of the current UV rating on their specific skin type.

The app uses simple icons to relay the current UV index in real time and whether skin protection is required. Separate tabs allow access to more information on their Fitzpatrick skin type, what type of protection is required, and sun protection tips.

The app uses geolocation to pinpoint users but also allows them to select from more than 10,000 locations worldwide – making it a truly global app, Nina Goad, head of communications at BAD, said at the meeting.

Since its informal launch in 2012, more than 150,000 people in 200 countries have downloaded the free World UV app. The app has been most popular in the United States, United Kingdom, Belgium, Spain, and Australia, she said.

The launch of the SunSmart app in late 2010 has prompted roughly 130,000 Australians to download the free app. An online survey of 78 users in February 2011 showed that 85% felt it was easy to use and 87% said it met or exceeded expectations, Mr. Sinclair said at the meeting, which was sponsored by the Skin Cancer Foundation.

Patrice Wendling/Frontline Medical News

A follow-up survey of 380 persons revealed that 72% "agreed" or "strongly agreed" that using the app improved their sun protection that summer.

Another 86% said that it made them more aware of the times of day when sun protection is required and 81% said they were able to recognize the difference between UV level and temperature, which is "always a difficult issue to communicate," Mr. Sinclair said.

"These are self-reports, so there is undoubtedly some bias associated with them, but nonetheless, showing reasonably promising results," he added.

Both Mr. Sinclair and Ms. Goad said the apps will continue to be refined to increase downloads and return visits but noted that their respective nonprofits do not have the funding for large-scale advertising campaigns.

[email protected]

CHICAGO – Health care is going to change more in this decade than in the past 45 years, according to health futurist and medical economist Jeffrey Bauer, Ph.D.

"We’re going to go through an incredible period of disequilibrium and readjustment," he said in a plenary session at the American Academy of Dermatology summer meeting. "It’s going to be several years of real ups and downs."

Dr. Bauer’s forecast for 2015 through 2019 is far less bullish than most, giving just a 20% chance that national health spending will increase as a percentage of gross domestic product. The potential for stagnation is 35% and for decline is 45%.

Over the same time period, 35% of health care providers will cease to exist as currently organized, 40% will continue as organized, although precariously, and 25% will thrive by reinventing the way health care is delivered, said the nationally recognized author and management consultant.

Dr. Bauer made the following recommendations for improving the odds of success in the changing health care system:

• Manage the transition in core function from acute care to disease management.

The one-size-fits-all clinical paradigm is fast disappearing as a result of the ongoing revolution in medical science that is making medicine more precise. Cost-effective care will be achieved through personalized, preventive medicine that matches therapies to each patient’s specific disease characteristics.

• Those who build care teams will do better.

The site of care will continue to shift from hospital to clinic, pharmacy, worksite, and home, and care teams that extend physicians’ reach with nonphysician practitioners will become the best-practices delivery model. "The real key, if you want to be the 40% that survives or the 25% that thrives, is to recognize the value of care teams," Dr. Bauer said.

• Physicians need to position themselves to transition from fee-for-service reimbursement to bundled and value-based payment.

Patients simply don’t have the disposable income to pay more for care, forcing providers to rationalize pricing. Embrace the concept that future successes will be based on multi-stakeholder partnerships comprised of purchasers, payers, practitioners, and providers.

• Work to reform how health care is delivered.

"It’s important that we reform health care delivery so that people can get to you when they need to, but I am just as fervently of the belief that the Affordable Care Act doesn’t do that," he said. "We’ve got to find another way there."

Many of the tools needed to fix the way health care is delivered are already in physicians’ hands. They include advocacy through professional societies, utilization of advanced data analytics to demonstrate value and eliminate unexplained variation from objective performance standards, and adoption of performance improvement tools such as Six Sigma or Lean to ensure that care is delivered correctly all the time and as inexpensively as possible.

Dr. Bauer disclosed no conflicts of interest. He is the author of the just-released book: "Paradox and Imperatives in Health Care: Redirecting Reform for Efficiency and Effectiveness" (CRC Press, 2014).

[email protected]

CHICAGO – Health care is going to change more in this decade than in the past 45 years, according to health futurist and medical economist Jeffrey Bauer, Ph.D.

"We’re going to go through an incredible period of disequilibrium and readjustment," he said in a plenary session at the American Academy of Dermatology summer meeting. "It’s going to be several years of real ups and downs."

Dr. Bauer’s forecast for 2015 through 2019 is far less bullish than most, giving just a 20% chance that national health spending will increase as a percentage of gross domestic product. The potential for stagnation is 35% and for decline is 45%.

Over the same time period, 35% of health care providers will cease to exist as currently organized, 40% will continue as organized, although precariously, and 25% will thrive by reinventing the way health care is delivered, said the nationally recognized author and management consultant.

Dr. Bauer made the following recommendations for improving the odds of success in the changing health care system:

• Manage the transition in core function from acute care to disease management.

The one-size-fits-all clinical paradigm is fast disappearing as a result of the ongoing revolution in medical science that is making medicine more precise. Cost-effective care will be achieved through personalized, preventive medicine that matches therapies to each patient’s specific disease characteristics.

• Those who build care teams will do better.

The site of care will continue to shift from hospital to clinic, pharmacy, worksite, and home, and care teams that extend physicians’ reach with nonphysician practitioners will become the best-practices delivery model. "The real key, if you want to be the 40% that survives or the 25% that thrives, is to recognize the value of care teams," Dr. Bauer said.

• Physicians need to position themselves to transition from fee-for-service reimbursement to bundled and value-based payment.

Patients simply don’t have the disposable income to pay more for care, forcing providers to rationalize pricing. Embrace the concept that future successes will be based on multi-stakeholder partnerships comprised of purchasers, payers, practitioners, and providers.

• Work to reform how health care is delivered.

"It’s important that we reform health care delivery so that people can get to you when they need to, but I am just as fervently of the belief that the Affordable Care Act doesn’t do that," he said. "We’ve got to find another way there."

Many of the tools needed to fix the way health care is delivered are already in physicians’ hands. They include advocacy through professional societies, utilization of advanced data analytics to demonstrate value and eliminate unexplained variation from objective performance standards, and adoption of performance improvement tools such as Six Sigma or Lean to ensure that care is delivered correctly all the time and as inexpensively as possible.

Dr. Bauer disclosed no conflicts of interest. He is the author of the just-released book: "Paradox and Imperatives in Health Care: Redirecting Reform for Efficiency and Effectiveness" (CRC Press, 2014).

[email protected]

CHICAGO – Health care is going to change more in this decade than in the past 45 years, according to health futurist and medical economist Jeffrey Bauer, Ph.D.

"We’re going to go through an incredible period of disequilibrium and readjustment," he said in a plenary session at the American Academy of Dermatology summer meeting. "It’s going to be several years of real ups and downs."

Dr. Bauer’s forecast for 2015 through 2019 is far less bullish than most, giving just a 20% chance that national health spending will increase as a percentage of gross domestic product. The potential for stagnation is 35% and for decline is 45%.

Over the same time period, 35% of health care providers will cease to exist as currently organized, 40% will continue as organized, although precariously, and 25% will thrive by reinventing the way health care is delivered, said the nationally recognized author and management consultant.

Dr. Bauer made the following recommendations for improving the odds of success in the changing health care system:

• Manage the transition in core function from acute care to disease management.

The one-size-fits-all clinical paradigm is fast disappearing as a result of the ongoing revolution in medical science that is making medicine more precise. Cost-effective care will be achieved through personalized, preventive medicine that matches therapies to each patient’s specific disease characteristics.

• Those who build care teams will do better.

The site of care will continue to shift from hospital to clinic, pharmacy, worksite, and home, and care teams that extend physicians’ reach with nonphysician practitioners will become the best-practices delivery model. "The real key, if you want to be the 40% that survives or the 25% that thrives, is to recognize the value of care teams," Dr. Bauer said.

• Physicians need to position themselves to transition from fee-for-service reimbursement to bundled and value-based payment.

Patients simply don’t have the disposable income to pay more for care, forcing providers to rationalize pricing. Embrace the concept that future successes will be based on multi-stakeholder partnerships comprised of purchasers, payers, practitioners, and providers.

• Work to reform how health care is delivered.

"It’s important that we reform health care delivery so that people can get to you when they need to, but I am just as fervently of the belief that the Affordable Care Act doesn’t do that," he said. "We’ve got to find another way there."

Many of the tools needed to fix the way health care is delivered are already in physicians’ hands. They include advocacy through professional societies, utilization of advanced data analytics to demonstrate value and eliminate unexplained variation from objective performance standards, and adoption of performance improvement tools such as Six Sigma or Lean to ensure that care is delivered correctly all the time and as inexpensively as possible.

Dr. Bauer disclosed no conflicts of interest. He is the author of the just-released book: "Paradox and Imperatives in Health Care: Redirecting Reform for Efficiency and Effectiveness" (CRC Press, 2014).

[email protected]

For the first time, a novel antiviral treatment has saved the lives of primates when given in the late stage of infection with the Marburg virus, a lethal filovirus closely related to the Ebola virus.

Seven daily doses of the lipid-encapsulated small interfering RNA (siRNA) treatment started 3 days after exposure to a lethal dose of Marburg virus–Angola hemorrhagic fever (MARV-Angola) resulted in 100% protection in 16 rhesus macaques already showing clinical signs of the disease.

All untreated animals died; most died early on day 8 after infection, according to results reported in the Aug. 20 issue of Science Translational Medicine.

Delaying treatment until day 3 is clinically significant because this is the earliest time at which viremia can be detected, "showing real-world utility of this technology," study coauthor Thomas Geisbert, Ph.D., professor of microbiology and immunology at the University of Texas Medical Branch, Galveston, said during a press briefing.

The anti-MARV nucleoprotein-targeting siRNAs have been designed to protect against all known strains of Marburg virus, but will not protect against the Ebola virus.

A previous study, however, showed that the same technology completely protected rhesus monkeys exposed to the Zaire Ebola virus, the same species involved in the current outbreak, he said. That study examined treatment given only shortly after exposure, not when the signs of illness were already present, which is crucial to outbreak control (Lancet 2010;375:1896-905).

Still, the siRNA Ebola treatment could be used on a compassionate-use basis in the current Ebola outbreak, he added.

Recently two cases of MARV were imported to the United States and Europe, raising concerns about the public health threat posed by this virus.

There are no approved vaccines or drugs for humans infected with MARV-Angola. It has been associated with the highest case fatality rates of any strain or species of filovirus, causing 90% mortality in man in the largest Marburg outbreak in 2005 in Angola, Dr. Geisbert observed.

A phase I human study has been started with the Ebola siRNA product, but funding is needed before a trial evaluating the Marburg siRNA product can be launched in humans.

The antiviral strategy is based on siRNAs or double-stranded molecules that cause messenger RNA to be broken down after transcription. Thus, there is no translation of the Marburg virus proteins. The siRNAs are packaged in a proprietary lipid nanoparticle that serves as the delivery vehicle (Tekmira Pharmaceuticals, Burnaby, British Columbia).

Future work will examine how much further out treatment can be delayed in MARV-Angola as well as in Ebola hemorrhagic fever, Dr. Geisbert said.

So far, only one other strategy combining monoclonal antibodies and adenovirus vector expressing interferon-alpha has been shown to confer complete protection to macaques when given 3 days after infection (Sci. Transl. Med. 2013 Oct 16;5:207ra143. doi: 10.1126/scitranslmed.3006605), he said.

The National Institutes of Health provided up to $26 million in grant funding this March to UTMB, Tekmira, Profectus, and Vanderbilt University to allow researchers to evaluate both strategies and whether combining antibodies and siRNAs will further enhance the benefits, he said.

Treatment dosing has yet to be optimized. So far, no serious safety concerns have been identified in primates given the Marburg siRNA product or in humans dosed with the siRNA Ebola product, he added.

[email protected]

For the first time, a novel antiviral treatment has saved the lives of primates when given in the late stage of infection with the Marburg virus, a lethal filovirus closely related to the Ebola virus.

Seven daily doses of the lipid-encapsulated small interfering RNA (siRNA) treatment started 3 days after exposure to a lethal dose of Marburg virus–Angola hemorrhagic fever (MARV-Angola) resulted in 100% protection in 16 rhesus macaques already showing clinical signs of the disease.

All untreated animals died; most died early on day 8 after infection, according to results reported in the Aug. 20 issue of Science Translational Medicine.

Delaying treatment until day 3 is clinically significant because this is the earliest time at which viremia can be detected, "showing real-world utility of this technology," study coauthor Thomas Geisbert, Ph.D., professor of microbiology and immunology at the University of Texas Medical Branch, Galveston, said during a press briefing.

The anti-MARV nucleoprotein-targeting siRNAs have been designed to protect against all known strains of Marburg virus, but will not protect against the Ebola virus.

A previous study, however, showed that the same technology completely protected rhesus monkeys exposed to the Zaire Ebola virus, the same species involved in the current outbreak, he said. That study examined treatment given only shortly after exposure, not when the signs of illness were already present, which is crucial to outbreak control (Lancet 2010;375:1896-905).

Still, the siRNA Ebola treatment could be used on a compassionate-use basis in the current Ebola outbreak, he added.

Recently two cases of MARV were imported to the United States and Europe, raising concerns about the public health threat posed by this virus.

There are no approved vaccines or drugs for humans infected with MARV-Angola. It has been associated with the highest case fatality rates of any strain or species of filovirus, causing 90% mortality in man in the largest Marburg outbreak in 2005 in Angola, Dr. Geisbert observed.

A phase I human study has been started with the Ebola siRNA product, but funding is needed before a trial evaluating the Marburg siRNA product can be launched in humans.

The antiviral strategy is based on siRNAs or double-stranded molecules that cause messenger RNA to be broken down after transcription. Thus, there is no translation of the Marburg virus proteins. The siRNAs are packaged in a proprietary lipid nanoparticle that serves as the delivery vehicle (Tekmira Pharmaceuticals, Burnaby, British Columbia).

Future work will examine how much further out treatment can be delayed in MARV-Angola as well as in Ebola hemorrhagic fever, Dr. Geisbert said.

So far, only one other strategy combining monoclonal antibodies and adenovirus vector expressing interferon-alpha has been shown to confer complete protection to macaques when given 3 days after infection (Sci. Transl. Med. 2013 Oct 16;5:207ra143. doi: 10.1126/scitranslmed.3006605), he said.

The National Institutes of Health provided up to $26 million in grant funding this March to UTMB, Tekmira, Profectus, and Vanderbilt University to allow researchers to evaluate both strategies and whether combining antibodies and siRNAs will further enhance the benefits, he said.

Treatment dosing has yet to be optimized. So far, no serious safety concerns have been identified in primates given the Marburg siRNA product or in humans dosed with the siRNA Ebola product, he added.

[email protected]

For the first time, a novel antiviral treatment has saved the lives of primates when given in the late stage of infection with the Marburg virus, a lethal filovirus closely related to the Ebola virus.

Seven daily doses of the lipid-encapsulated small interfering RNA (siRNA) treatment started 3 days after exposure to a lethal dose of Marburg virus–Angola hemorrhagic fever (MARV-Angola) resulted in 100% protection in 16 rhesus macaques already showing clinical signs of the disease.

All untreated animals died; most died early on day 8 after infection, according to results reported in the Aug. 20 issue of Science Translational Medicine.

Delaying treatment until day 3 is clinically significant because this is the earliest time at which viremia can be detected, "showing real-world utility of this technology," study coauthor Thomas Geisbert, Ph.D., professor of microbiology and immunology at the University of Texas Medical Branch, Galveston, said during a press briefing.

The anti-MARV nucleoprotein-targeting siRNAs have been designed to protect against all known strains of Marburg virus, but will not protect against the Ebola virus.

A previous study, however, showed that the same technology completely protected rhesus monkeys exposed to the Zaire Ebola virus, the same species involved in the current outbreak, he said. That study examined treatment given only shortly after exposure, not when the signs of illness were already present, which is crucial to outbreak control (Lancet 2010;375:1896-905).

Still, the siRNA Ebola treatment could be used on a compassionate-use basis in the current Ebola outbreak, he added.

Recently two cases of MARV were imported to the United States and Europe, raising concerns about the public health threat posed by this virus.

There are no approved vaccines or drugs for humans infected with MARV-Angola. It has been associated with the highest case fatality rates of any strain or species of filovirus, causing 90% mortality in man in the largest Marburg outbreak in 2005 in Angola, Dr. Geisbert observed.

A phase I human study has been started with the Ebola siRNA product, but funding is needed before a trial evaluating the Marburg siRNA product can be launched in humans.

The antiviral strategy is based on siRNAs or double-stranded molecules that cause messenger RNA to be broken down after transcription. Thus, there is no translation of the Marburg virus proteins. The siRNAs are packaged in a proprietary lipid nanoparticle that serves as the delivery vehicle (Tekmira Pharmaceuticals, Burnaby, British Columbia).

Future work will examine how much further out treatment can be delayed in MARV-Angola as well as in Ebola hemorrhagic fever, Dr. Geisbert said.

So far, only one other strategy combining monoclonal antibodies and adenovirus vector expressing interferon-alpha has been shown to confer complete protection to macaques when given 3 days after infection (Sci. Transl. Med. 2013 Oct 16;5:207ra143. doi: 10.1126/scitranslmed.3006605), he said.

The National Institutes of Health provided up to $26 million in grant funding this March to UTMB, Tekmira, Profectus, and Vanderbilt University to allow researchers to evaluate both strategies and whether combining antibodies and siRNAs will further enhance the benefits, he said.

Treatment dosing has yet to be optimized. So far, no serious safety concerns have been identified in primates given the Marburg siRNA product or in humans dosed with the siRNA Ebola product, he added.

[email protected]