Cutaneous Radiation Injuries: Models, Assessment and Treatments

Abstract

Multiple cases of human exposure to radiation have been documented from the atomic bombings, nuclear power plant disasters and other industrial and medical accidents. Many of these exposures have led to pronounced cutaneous radiation injury (CRI), which played a significant role in the progression of damage and survivability of the radiation exposure and led to a lifetime of pain and scarring. Documentation of CRI from routine clinical radiotherapy and diagnostic procedures has also provided valuable information about the natural history of the injury. In response to the threat of a radiological or nuclear incident, the U.S. Department of Health and Human Services tasked the National Institute of Allergy and Infectious Diseases (NIAID) with identifying and funding early- to mid-stage medical countermeasure (MCM) development to treat radiation-induced injuries. Although there are now products to treat radiation-induced bone marrow damage, there are still no approved products specific for the treatment of CRI. To accurately assess severity of CRI and determine efficacy of different treatments, animal models must be developed that simulate what is seen in humans. It is also important to understand techniques used in other clinical indications to accurately assess the extent of skin injury and progression of healing. For these reasons, the NIAID partnered with the Food and Drug Administration (FDA)² and the Biomedical Advanced Research and Development Authority (BARDA) to identify state-of-the-art methods in assessment of skin injuries, explore animal models to better understand radiation-induced cutaneous damage and explore treatment approaches. A two-day workshop was convened in Rockville, MD on May 6 and 7, 2019, highlighting talks from 28 subject matter experts across five scientific sessions, and from this workshop a report was generated (1). This commentary provides a brief overview of the data presented at the workshop, and the key points that were considered during the discussion sessions that were held throughout the meeting. A more complete background and discussion of the workshop are available in the full report.