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The Emerging Breast Imaging Standard

Many breast imaging centers have launched high risk screening clinics to augment their existing services. This has already become the new standard, as organizations look for justification to expand patient services, recommend breast MRI screening exams, and provide referrals for genetic counseling.  Offering a service dedicated to screening patients for high risk, without the proper tools, can put more stress on the breast imaging workflow.

The problem is that many systems are not set up to function on this plane. Subsequently, some sites resort to manual data entry on risk model websites to calculate each score individually. Calculated risk models, such as Tyrer-Cuzick and the Gail Model, are simply not built into the RIS mammography tracking module, mammography information system, or EMR module.

Some programs offer standalone, web-based risk platforms only, although this method adds to system fragmentation, redundancy, and increased room for error. This is especially true when the reader wants to add the risk score to their finding report, or if the site wants to include risk-related information in the patient notification letter.

Tyrer-Cuzick version 8 has 25 elements and family history factors alone, so the time required to enter this for every patient, every study, and every day adds up fast. In most cases, the facility is already required to enter this information into their existing mammography tracking solution and, in order to generate the risk score, that same information has to be re-entered into an online calculator.

MagView, however, has considered this workflow and incorporated several breast cancer risk models into their base program. They offer automated calculations for all available risk models, such as Tyrer-Cuzick, Gail, BRCAPro, and Claus. In their program, patients can enter breast cancer risk factors in advance of the appointment using a patient history portal, saving the facility staff countless hours a day. The patients can also use the patient history tablet module for electronic submission to the breast center and MagView system.

These factors are saved from year to year, so the patient only needs to modify any changes in the previous history on subsequent visits. The calculators are built into the program, so no external websites or third-party programs are needed. The data is then used in the automatic risk calculation, and the radiologists can see the score in real-time, affecting their decision on follow-up recommendation. Scores can automatically be included in the finding reports, saving the readers additional time, and patients can be notified with automated text inserted into the letter based on their score.

Evidence has shown that including risk information in both the finding reports and patient letters has increased awareness along all fronts, especially when qualifying patients for additional imaging, like breast MRIs. One site reported a 100% increase in breast MRI referrals from their previous workflow using their RIS mammography tracking module as a reporting tool.

The bottom line is, increased high risk screening has improved the detection of cancers by ensuring patients who are at a high risk receive the care and additional imaging they need. In a recent study of BRCA mutation carriers and women of 20% or higher lifetime risk for breast cancer, sensitivity for breast cancer detection was 90.0% using MRI versus 37.5% for mammography and 37.5% for ultrasound (Source: Journal of Clinical Oncology. 2015;33(10):1128-35).

Reprint by permission of PRNewswire; Image courtesy of Ed Uthman via flickr CC 2.0

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Hong Kong Dept of Health Approves Biktarvy® for HIV, following FDA and EC

In Phase 3 Clinical Trials, Biktarvy® Demonstrated High Efficacy and Zero Resistance Through 48 Weeks

The triple-combination, single-tablet therapy combines the potency of the novel integrase strand transfer inhibitor (INSTI) bictegravir, with the demonstrated safety and efficacy profile of a guideline recommended dual nucleoside reverse transcriptase inhibitor (NRTI) backbone – Descovy® (emtricitabine 200 mg/tenofovir alafenamide 25 mg; FTC/TAF). BIC/FTC/TAF provides a convenient once-daily dosing STR without regards to food. Furthermore, BIC/FTC/TAF’s use is not restricted by the patient’s baseline viral load, CD4 cell count or HLA-B 5701 status.

“Safety and resistance profiles are important considerations for HIV patients, as the disease requires long-term care. In addition, potent treatments with convenient dosing can potentially improve adherence and outcomes for patients,” said Dr Chan Kai Ming, Specialist in Infectious Disease, Consultant in Internal Medicine, Union Hospital, Hong Kong.

The Hong Kong Dept of Health has approved Biktarvy® (bictegravir 50mg/emtricitabine 200 mg/tenofovir alafenamide 25 mg; BIC/FTC/TAF), a once-daily single tablet regimen (STR) for the treatment of HIV-1 infection in adults*. Hong Kong is the first market in Asia to approve Biktarvy. BIC/FTC/TAF was approved by the U.S. Food and Drug Administration (FDA) on February 7, 2018 and the European Commission on June 21, 2018.

The approval was based upon data from four ongoing Phase 3 studies: Studies 1489 and 1490 in treatment-naive HIV-1 infected adults, and Studies 1844 and 1878 in virologically suppressed adults. The trials are comprised of a population of 2,414 participants, and BIC/FTC/TAF met its primary efficacy objective at 48 weeks in all four studies, with no participants in any of the four BIC/FTC/TAF studies developing treatment-emergent virologic resistance. There were no cases of renal discontinuation, proximal renal tubulopathy or Fanconi syndrome in the BIC/FTC/TAF arms at 48 weeks. Additional ongoing studies not included in the marketing authorization application involve dedicated studies in women, adolescents and children.

“We welcome the timely approval of BIC/FTC/TAF in Hong Kong, a novel treatment option for people living with HIV,” said Andrew Hexter, Vice President and GM for Gilead Sciences Asia. “We are committed to serving the needs of HIV patients and medical communities in Asia, and are working with public health authorities to make the treatment available in this region.”

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September is Blood Cancer Awareness Month

September was designated as National Blood Cancer Awareness Month in 2010 by the United States Congress. Approximately every 3 minutes one person in the United States is diagnosed with a blood cancer. That means that during September, Blood Cancer Awareness Month, more than 14,000 people will be informed that they have one of these terrible diseases.

Blood cancers are a group of diseases that affect the production and function of blood cells. The three main types are leukemia (found in blood and bone marrow), lymphoma (affects the body’s lymphatic system) and myeloma (impacts plasma cells). Nearly 172,000 people in the U.S. are living with a blood cancer, according to Kevin Radelet, executive director, Leukemia Research Foundation.

In recognition of Blood Cancer Awareness Month, the Leukemia Research Foundation is conducting a social media initiative called The Heroes Among Us to increase awareness about ALL blood cancers, including leukemia, lymphoma, multiple myeloma, and myelodysplastic syndromes.

The LRF Facebook?and Instagram pages will highlight Heroes through uplifting stories. You will have the opportunity to share, mention and comment on posts on Twitter, YouTube, and LinkedIn too.

Several buildings in downtown Chicago — LRF is located in Northfield, IL — will “light up orange” in recognition of Blood Cancer Awareness Month. Click here for details.

Here’s how you can participate:
? Share on social media channels online using hashtags: #LRFHeroes?and/or #HeroesWearOrange
? Share the link to the heroes stories with friends, family members and colleagues
? Buy a bag of orange ribbons and share them!?Send an email?to request ribbons
? Please donate today?to help LRF continue to raise awareness and funding for research and patient programs.
? For other ways to get involved, sign up for events, or volunteer, please click here.

Headquartered in Northfield, IL., the Leukemia Research Foundation is dedicated to conquering all blood cancers by funding research into their causes and cures and enriching the quality of life of those touched by these diseases. For more information, visit www.allbloodcancers.org or call 847-424-0600.

Copy reprinted by permission of LRF.org; excerpt by permission of PRnewswire

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A Phase 2/3 Clinical Trial of Trigriluzole for Alzheimer’s Disease

The first patient has been enrolled in a Phase 2/3 clinical trial of trigriluzole (BHV-4157), a novel glutamate modulator for the treatment of mild-to-moderate Alzheimer’s disease (AD). The trial is a randomized, double-blind, placebo-controlled trial evaluating the efficacy and safety of trigriluzole in patients diagnosed with AD of mild-to-moderate severity (Mini-Mental State Examination scores of 14-24 at screening), and is being conducted in collaboration with the Alzheimer’s Disease Cooperative Study (ADCS) at sites throughout the USA.Howard Feldman, MD, FRCP, Director of the ADCS and Professor of Neurosciences at University of California San Diego School of Medicine added, “The preclinical evidence for the active metabolite of trigriluzole to modulate glutamate and confer neuroprotective effects in patients with AD is compelling, and the new formulation of trigriluzole should improve its pharmaceutical properties with potential for efficacy in AD.”

Alzheimer’s disease is a progressive, fatal neurodegenerative dementia that accounts for 60 ? 80 percent of dementia cases. Alzheimer’s disease currently has no cure. Although there are FDA-approved medications for symptomatic treatment of AD, their clinical benefits are generally limited. Novel therapeutic approaches aimed at normalizing synaptic and extra-synaptic glutamate levels, such as trigriluzole, may offer the potential for symptomatic benefit in AD by improving cognitive function, as well as the potential for disease modification by preventing the loss of synapses.

The Phase 2/3 clinical trial (clinicaltrials.gov identifier NCT03605667) is a randomized, double-blind, placebo-controlled trial evaluating the efficacy and safety of trigriluzole in patients diagnosed with AD of mild-to-moderate severity (Mini-Mental State Examination scores of 14-24 at screening). Patients who have been taking stable doses of FDA-approved AD medications (AchEI also known as acetylcholinesterase inhibitors and/or memantine) for a minimum of three months prior to screening and who are willing to remain on the same regimen for the duration of the trial may be eligible to participate. Approximately 292 patients will be randomized on a 1:1 basis to receive 280 mg of trigriluzole or placebo, taken orally at bedtime. Duration of treatment will be 48 weeks.

About Trigriluzole
Trigriluzole is a third-generation prodrug and new chemical entity that modulates glutamate, the most abundant excitatory neurotransmitter in the human body. Trigriluzole has a wide range of pharmacological actions, including interactions with several types of ion channels, cellular signaling mechanisms and facilitation of glutamate reuptake. Some potential targets related to trigriluzole’s mechanism of action include (1) reducing presynaptic glutamate release through actions at the voltage-gated ion channels, (2) facilitating glutamate uptake via EAATs located on glial cells, (3) enhancing transmission through synaptic AMPA receptors, (4) altering GABAergic neurotransmission, and (5) effecting neurotrophic agents such as BDNF. Several of these targets of trigriluzole balance abnormalities observed in human AD post-mortem tissue as well as in AD animal models. As such, trigriluzole potentially offers neuroprotective effects at the level of the synapse as well as improved synaptic functioning, mechanisms that could exert both symptomatic and disease-modifying effects in AD.

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Finding New Treatments for Breast Cancer with Brain Metastases

As if Breast Cancer or Brain Cancer alone were not enough to combat — patients with both now?have new hope in light of fledgling research that is showing progress.

Once breast cancer metastasizes into other areas of the body, particularly the brain, it becomes much more dangerous. And while the National Cancer Institute spends more than $500 million dollars per year on breast cancer research, only two to five percent of this funding goes to study how the disease spreads.

A clinical trial is open nationwide through the Academic Breast Cancer Consortium (ABRCC), giving access to an exciting novel drug therapy combination. The tucatinib, palbocilib and letrozole trial is coordinated by ABRCC and currently open for enrollment at the University of Colorado Cancer Center; University of Texas Health and Science Center in San Antonio, TX; Stony Brook University, NY; University of Arizona, Tucson, AZ; and University of New Mexico, Albuquerque, NM and will also be accruing patients at Northwestern University, Chicago, IL.

There are three well-established predictive markers of breast cancer. They are estrogen receptors (ER), progesterone receptors (PR), and the growth factor receptor HER2, these receptors may be blocked with targeted drugs to stop cancer growth. Breast cancers lacking these three markers are referred to as ?triple-negative? but clinicians and scientists are quickly learning more about cancers that have all three receptors, which are often called ?triple-positive.? There are treatments against each target individually, but when multiple drivers are present, as in ?triple-positive? breast cancer, blocking one often results in cancer nimbly switching to driving its growth with the other two.

The study combines tucatinib, which inhibits HER2, with letrozole targeting ER and PR hormone receptors, and the drug palbociclib, which targets CDK proteins that help cancer cells rush through the process of replication. The three had not been tried together until Elena Shagisultanova, MD, PhD, a breast cancer specialist at UCH, hypothesized there could be a way to target all three drivers at the same time with better results than targeting combinations of any two.

?When metastatic cancer spreads to the brain, it can be especially challenging,? says Dr Peter Kabos, the National Medical Director of the Academic Breast Cancer Consortium (ABRCC) and the Kabos Research Lab for Breast Cancer at UC Denver. ?Many medications aren?t effective in the brain, but exciting early clinical trial data for tucatinib shows that it may be one of the drugs that can penetrate the blood-brain barrier to combat brain metastases.

The trial is funded by the Pfizer ASPIRE Award in Breast Cancer Research. Cascadian Therapeutics and Pfizer are providing the study drugs tucatinib and palbociclib. For more information about trial eligibility and participation, contact brad.mackay@ucdenver.edu or emily.berens@ucdenver.edu

Article excerpted with permission from the University of Colorado Cancer Center blog — for the complete story, click here.

LANTERN-2 Clinical Trial Aims at Reducing Use of Opioids

Bonti announced it has initiated dosing in its LANTERN-2 clinical trial, a Phase II clinical trial under Bonti?s LANTERN (Long-Acting NeuroToxin-E Relief, Non-opioid) clinical program aimed at treating focal muscle pain and reducing use of rescue medications, including opioids.

LANTERN-2 is a randomized, placebo-controlled, ascending dose, double-blind clinical trial to evaluate the safety and efficacy of intramuscular (IM) injections of Bonti?s therapeutic product candidate, EB-001T, in subjects undergoing elective abdominoplasty (tummy tuck) surgery. The primary endpoint in this trial will be reduction of post-operative pain at rest as measured by the Numeric Pain Rating Scale (NPRS) over the first 96 hours. Secondary endpoints include NPRS during activity and patient use of rescue medications, including opioids, to address unrelieved pain.

LANTERN-2 trial was based on favorable safety results from the recently completed LANTERN-1 clinical trial, which was Bonti?s first trial in the LANTERN program. EB-001T showed favorable safety in a wide dose range and was well tolerated, and in which the maximum tolerated dose was not reached. Learn more about EB-001T?at Bonti’s website.

Displayed with permission of Centerwatch Clinical Trial News

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CRISPR Tech for Eye Disease Moves Closer to Reality

A study published in the journal of the American Academy of Ophthalmology shows that a CRISPR-based treatment can restore retinal function in mice.

Researchers from Columbia University have developed a new technique for the powerful gene editing tool CRISPR to restore retinal function in mice afflicted by a degenerative retinal disease, retinitis pigmentosa. This is the first time researchers have successfully applied CRISPR technology to a type of inherited disease known as a dominant disorder. This same tool might work in hundreds of diseases, including Huntington’s disease, Marfan syndrome, and corneal dystrophies. Their study was published online today in Ophthalmology, the journal of the American Academy of Ophthalmology.

Stephen H. Tsang, M.D., Ph.D., and his colleagues sought to create a more agile CRISPR tool so it can treat more patients, regardless of their individual genetic profile. Dr. Tsang calls the technique genome surgery because it cuts out the bad gene and replaces it with a normal, functioning gene. Dr. Tsang said he expects human trials to begin in three years. “Genome surgery is coming,” Dr. Tsang said. “Ophthalmology will be the first to see genome surgery before the rest of medicine.”

Retinitis pigmentosa is a group of rare inherited genetic disorders caused by one of more than 70 genes. It involves the breakdown and loss of cells in the retina, the light sensitive tissue that lines the back of the eye. It typically strikes in childhood and progresses slowly, affecting peripheral vision and the ability to see at night. Most will lose much of their sight by early adulthood and become legally blind by age 40. There is no cure. It is estimated to affect roughly 1 in 4,000 people worldwide.

Since it was introduced in 2012, the gene editing technology known as CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats) has revolutionized the speed and scope with which scientists can modify the DNA of living cells. Scientists have used it on a wide range of applications, from engineering plants (seedless tomatoes) to producing animals (extra lean piglets). But as incredible as genome surgery is, CRISPR has some flaws to overcome before it can live up to its hype of curing disease in humans by simply cutting out bad genes and sewing in good ones.

Typically, CRISPR researchers design a short sequence of code called guide RNA that matches the bit they want to replace. They attach the guide RNA to a protein called Cas9, and together they roam the cell’s nucleus until they find a matching piece of DNA. Cas9 unzips the DNA and pushes in the guide RNA. It then snips out the bad code and coaxes the cell to accept the good code, using the cell’s natural gene repair machinery.

Diseases like autosomal dominant retinitis pigmentosa present a special challenge to researchers. In autosomal dominant disorders, the person inherits only one copy of a mutated gene from their parents and one normal gene on a pair of autosomal chromosomes. So, the challenge for CRISPR-wielding scientists is to edit only the mutant copy without altering the healthy one. In contrast, people with autosomal recessive disorders inherit two copies of the mutant gene. When two copies of the gene are mutated, treatment involves a more straightforward, one-step approach of simply replacing the defective gene. Dr. Tsang and colleagues have come up with a better strategy to treat autosomal dominant disease. It allowed them to cut out the old gene and replace it with a good gene, without affecting its normal function.

Instead of using one guide RNA, Dr. Tsang designed two guide RNAs to treat autosomal dominant retinitis pigmentosa caused by variations in the rhodopsin gene. Rhodopsin is an important therapeutic target because mutations in it cause about 30 percent of autosomal dominant retinitis pigmentosa and 15 percent of all inherited retinal dystrophies.

This technique allowed for a larger deletion of genetic code that permanently destroyed the targeted gene. Dr. Tsang found that using two guide RNAs instead of one increased the chance of disrupting the bad gene from 30 percent to 90 percent. They combined this genome surgery tool with a gene replacement technique using an adeno-associated virus to carry a healthy version of the gene into the retina. Another advantage is that this technique can be used in non-dividing cells, which means that it could enable gene therapies that focus on nondividing adult cells, such as cells of the eye, brain, or heart. Up until now, CRISPR has been applied more efficiently in dividing cells than non-dividing cells.

Dr. Tsang used an objective vision test to evaluate the mice after treatment to show a significant improvement in retinal function. An electroretinogram is typically used to evaluate retinal health in humans. It tests the health of the retina much like an electrocardiogram (EKG) tests the health of the heart. Previous CRISPR studies for retinal diseases have relied on a less objective measure that involves evaluating how often the mouse turns its head in the direction of a light source. Dr. Tsang used electroretinography to show that retinal degeneration slowed in treated eyes compared with untreated eyes.

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Orphan Drug Designation for Treatment of ALS – Amyotrophic Lateral Sclerosis

On March 29, 2018 the U.S. Food and Drug Administration (FDA) Office of Orphan Products Development granted Orphan Drug Designation (ODD) to experimental therapeutic EH301 for the treatment of amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s Disease.

The Orphan Drug Designation submission included data from a 2017 double-blind placebo-controlled European pilot study in humans. To expand on the results of the pilot study, Elysium Health expects to initiate a placebo-controlled study in collaboration with Mayo Clinic to evaluate EH301 in up to 150 adults with ALS by the fourth quarter of 2018. The granting of ODD to EH301 does not alter the standard regulatory requirement through adequate and well-controlled studies to support FDA approval, and there is no guarantee EH301 will be approved for the treatment of ALS by FDA.

Elysium Health Chief Scientist Dr. Leonard Guarente remarked that “There is a great deal of work to be done to address the need for continued research to better understand and to treat all neurodegenerative diseases. We believe that the FDA’s granting of Orphan Drug Designation for EH301 for ALS underscores the need for novel treatments for this rare condition.”

ALS is a rare neurodegenerative disease that affects nerve cells that control voluntary muscles throughout the body to produce movements including talking, eating, walking, and breathing. ALS is progressive, meaning it gets worse over time. As the nerves lose the ability to control muscles, the muscles become weak and eventually lead to paralysis. Most people with ALS succumb to respiratory failure, usually within three to five years from when symptoms first appear. Please visit the ALS website for more information.

The FDA’s ODD program provides orphan status to drugs intended for the safe and effective treatment, diagnosis, or prevention of rare diseases or disorders that affect fewer than 200,000 people in the United States. It is estimated that there are approximately 15,000-20,000 Americans with ALS. Please see the NIH ALS Fact Sheet for details.

Additional information can be found on the Christopher & Dana Reeve Foundation website regarding current therapies and disease trends.

Disclosure: Mayo Clinic has a financial interest in Elysium Health. All revenue Mayo Clinic receives will be used to fund its not-for-profit mission in medical research and education.

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Beneficial Skin Bacteria Protect Against Skin Cancer

Science continues to peel away layers of the skin microbiome to reveal its protective properties.? Researchers now report on a potential new role for some bacteria on the skin: protecting against cancer.

“We have identified a strain of Staphylococcus epidermidis, common on healthy human skin, that exerts a selective ability to inhibit the growth of some cancers,” said Richard Gallo, MD, PhD, Distinguished Professor and chair of the Department of Dermatology at UC San Diego School of Medicine. “This unique strain of skin bacteria produces a chemical that kills several types of cancer cells but does not appear to be toxic to normal cells.”

The team discovered the S. epidermidis strain produces the chemical compound 6-N-hydroxyaminopurine (6-HAP). Mice with S. epidermidis on their skin that did not make 6-HAP had many skin tumors after being exposed to cancer-causing ultraviolet rays (UV), but mice with the S. epidermidis strain producing 6-HAP did not.? 6-HAP is a molecule that impairs the creation of DNA, known as DNA synthesis, and prevents the spread of transformed tumor cells as well as the potential to suppress development of UV-induced skin tumors.

Mice that received intravenous injections of 6-HAP every 48 hours over a two-week period experienced no apparent toxic effects, but when transplanted with melanoma cells, their tumor size was suppressed by more than 50 percent compared to controls.

“There is increasing evidence that the skin microbiome is an important element of human health. In fact, we previously reported that some bacteria on our skin produce antimicrobial peptides that defend against pathogenic bacteria such as, Staph aureus,” said Gallo.

In the case of S. epidermidis, it appears to also be adding a layer of protection against some forms of cancer, said Gallo. Further studies are needed to understand how 6-HAP is produced, if it can be used for prevention of cancer or if loss of 6-HAP increases cancer risk, said Gallo.

More than 1 million cases of skin cancer are diagnosed in the United States each year. More than 95 percent of these are non-melanoma skin cancer, which is typically caused by overexposure to the sun’s UV rays. Melanoma is the most serious form of skin cancer that starts in the pigment-producing skin cells, called melanocytes.

Displayed with permission from FARS News Agency via RePubHub

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Huntington’s Disease Molecule Can Kill Cancer Cells

Scientists have destroyed numerous types of human cancer cells with a toxic molecule characteristic of fatal genetic illness Huntington?s disease.

The researchers hailed the molecule?which has killed both human and mouse ovarian, breast, prostate, liver, brain, lung, skin and colon cancer cell lines in mice?as a ?super assassin.? Their results were published in the journal EMBO Reports.

Huntington?s disease is a progressive illness caused by an excess of a specific repeating RNA sequence in the Huntington gene, which is present in every cell. The defect causes the death of brain cells, and gradually worsens a person?s physical and mental abilities. The disease has no cure.

Researchers believe that the defect may be even more powerful against cancer cells than nerve cells in the brain, and the team hopes it can be harnessed to kill cancer cells without causing Huntington?s symptoms.? ?This molecule is a super assassin against all tumor cells,? said senior author Marcus Peter, a professor of cancer metabolism at Northwestern University Feinberg School of Medicine, Chicago, in a press statement. ?We?ve never seen anything this powerful.?

Peter collaborated with Feinberg colleague Shad Thaxton, associate professor of urology, to deliver the molecule in the form of nanoparticles to mice with human ovarian cancer. The targeted molecule decreased tumor growth with no toxicity to the mice.

First author Andrea Murmann, a research assistant professor who discovered the cancer-killing mechanism, used the molecule to kill numerous other human and mouse cancer cell lines. Building on previous research into a cancer ?kill switch?, Murmann looked to diseases associated with low rates of cancer and a suspected RNA link.? ?I thought maybe there is a situation where this kill switch is overactive in certain people, and where it could cause loss of tissues,? Murmann said in the statement. ?These patients would not only have a disease with an RNA component, but they also had to have less cancer.?

There is up to 80 percent less cancer in people with Huntington?s disease than the general population.? Murmann recognised similarities between the kill switch and the toxic Huntington?s disease RNA sequences.? Based on their results, the team believe the ?super assassin? molecule could be used to fight cancer in humans. ?We believe a short-term treatment cancer therapy for a few weeks might be possible, where we could treat a patient to kill the cancer cells without causing the neurological issues that Huntington?s patients suffer from,? Peter said.? The scientists next aim to refine the molecule?s delivery method to improve tumor targeting, and to stabilize the nanoparticles for storage.

By Katherine Hignett – Displayed with permission from Newsweek via RePubHub License; Cancer Cells courtesy of PixaBay FREE LIC CC0?

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