1
|
McDiarmid MA, Hines S, Cloeren M, Gucer P, Condon M, Oliver M, Roth T, Lewin-Smith MR, Strathmann F, Velez-Quinones MA, Gaitens JM. The Department of Veterans' Affairs Depleted Uranium Cohort in the Time of COVID-19: Translating a Traditional Surveillance Protocol to a Telehealth Platform. J Occup Environ Med 2023; 65:670-676. [PMID: 37167933 PMCID: PMC10417219 DOI: 10.1097/jom.0000000000002875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE In 2021, 37 members of a cohort of depleted uranium-exposed Gulf War I veterans were evaluated using a protocol tailored to accommodate COVID-19 safety practices on a telehealth platform. METHODS Individual elements of the legacy protocol were reviewed for urgency and feasibility of inclusion in a modified, telehealth platform. RESULTS The redesigned protocol included a participant readiness for telehealth assessment, nurse and physician telehealth visits, collection of usual health questionnaires, and urine collections for exposure monitoring for uranium and other fragment-related metal measures. CONCLUSIONS Despite some limitations in scope, the telehealth platform permitted a visual "visit" with surveillance participants who expressed a high comfort level with the format. The telehealth platform has apparent utility for occupational surveillance and should be explored as a standard approach for surveillance outside of public health emergencies.
Collapse
|
2
|
Bajaj AO, Parker R, Farnsworth C, Law C, Johnson-Davis KL. Method validation of multi-element panel in whole blood by inductively coupled plasma mass spectrometry (ICP-MS). J Mass Spectrom Adv Clin Lab 2022; 27:33-39. [PMID: 36593911 PMCID: PMC9803809 DOI: 10.1016/j.jmsacl.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Background Analytical methods to measure trace and toxic elements are essential to evaluate exposure and nutritional status. A ten-element panel was developed and validated for clinical testing in whole blood. Retrospective data analysis was conducted on patient samples performed at ARUP Laboratories. Methods A method was developed and validated to quantify ten elements in whole blood by ICP-MS. Fifty microliters of sample were extracted with 950 μL of diluent containing 1 % ammonium hydroxide, 0.1 % Triton X-100, 1.75 % EDTA along with spiked internal standards. Four calibrators were used for each element and prepared in goat blood to match the patient specimen matrix. Samples were analyzed with an Agilent 7700 ICP-MS with a Cetac MVX 7100 μL Workstation autosampler. Results The assay was linear for all elements with inter- and intra-assay imprecision less than or equal to 11% CV at the low end of the analytical measurement range (AMR) and less than or equal to 4% CV at the upper end of the AMR for all elements. Accuracy was checked with a minimum of 40 repeat patient samples, proficiency testing samples, and matrix-matched spikes. The linear slopes for the ten elements ranged from 0.94 to 1.03 with intercepts below the AMR and R2 ranging from 0.97 to 1.00. Conclusions The multi-element panel was developed to analyze ten elements in whole blood to unify the sample preparation and increase batch run efficiency. The improved analytical method utilized matrix-matched calibrators for accurate quantification to meet regulatory requirements. The assay was validated according to guidelines for CLIA-certified clinical laboratories and was suitable for clinical testing to assess nutritional status and toxic exposure.
Collapse
Key Words
- AAPCC, American Association of Poison Control Centers
- AMR, Analytical measurement range
- As, arsenic
- Bi, bismuth
- CLIA, Clinical Laboratory Improvement Amendments
- CLRW, Clinical Laboratory Reagent Water
- Cd, cadmium
- Co, cobalt
- Hg, mercury
- ICP-MS
- ICP-MS, Inductively coupled plasma-mass spectrometry
- IRB, institutional review board
- KED, kinetic energy discrimination
- LOB, limit of the blank
- LOD, limit of detection
- LOQ, limit of quantitation
- Method validation
- Mn, manganese
- NH4OH, ammonium hydroxide
- Pb, lead
- SD, standard deviation
- Sb, antimony
- Tl, thallium
- Toxic elements
- Trace elements
- ULOQ, upper limit of quantification
- WB, Whole blood
- Whole blood
- Zn, zinc
Collapse
Affiliation(s)
- Amol O. Bajaj
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, United States,ARUP Laboratories, Salt Lake City, UT, United States,Corresponding authors at: ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, United States.
| | | | | | - Christian Law
- ARUP Laboratories, Salt Lake City, UT, United States
| | - Kamisha L. Johnson-Davis
- Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, UT, United States,ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, United States,Corresponding authors at: ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, United States.
| |
Collapse
|
3
|
Vechetti IJ, Wen Y, Hoffman JF, Alimov AP, Vergara VB, Kalinich JF, Gaitens JM, Hines SE, McDiarmid MA, McCarthy JJ, Peterson CA. Urine miRNAs as potential biomarkers for systemic reactions induced by exposure to embedded metal. Biomark Med 2021; 15:1397-1410. [PMID: 34541869 DOI: 10.2217/bmm-2021-0120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Aim: Explore the potential of urine microRNAs as biomarkers that may reflect the biological responses to pure metals embedded in skeletal muscle over time. Materials & methods: We tested a panel of military-relevant metals embedded in the gastrocnemius muscles of 3-month-old, male, Sprague-Dawley rats (n = 8/group) for a duration of 1, 3, 6 and 12 months, and performed small RNA-sequencing on the urine samples. Results: Results provide potential tissue targets affected by metal exposure and a list of unique or common urine microRNA biomarkers indicative of exposure to various metals, highlighting a complex systemic response. Conclusion: We have identified a panel of miRNAs as potential urine biomarkers to reflect the complex systemic response to embedded metal exposure.
Collapse
Affiliation(s)
- Ivan J Vechetti
- Department of Nutrition & Health Sciences, College of Education & Human Sciences, University of Nebraska-Lincoln, Lincoln, NE 68583, USA
| | - Yuan Wen
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY 40536, USA
- Center for Muscle Biology, University of Kentucky, Lexington, KY 40536, USA
| | - Jessica F Hoffman
- Internal Contamination & Metal Toxicity Program, Armed Forces Radiobiology Research Institute, Uniformed Services University, Bethesda, MD 20814, USA
| | - Alexander P Alimov
- Center for Muscle Biology, University of Kentucky, Lexington, KY 40536, USA
- Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY 40536, USA
| | - Vernieda B Vergara
- Internal Contamination & Metal Toxicity Program, Armed Forces Radiobiology Research Institute, Uniformed Services University, Bethesda, MD 20814, USA
| | - John F Kalinich
- Internal Contamination & Metal Toxicity Program, Armed Forces Radiobiology Research Institute, Uniformed Services University, Bethesda, MD 20814, USA
| | - Joanna M Gaitens
- Department of Veterans Affairs Medical Center Baltimore, Baltimore, MD 21201, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Stella E Hines
- Department of Veterans Affairs Medical Center Baltimore, Baltimore, MD 21201, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Melissa A McDiarmid
- Department of Veterans Affairs Medical Center Baltimore, Baltimore, MD 21201, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - John J McCarthy
- Center for Muscle Biology, University of Kentucky, Lexington, KY 40536, USA
- Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY 40536, USA
| | - Charlotte A Peterson
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY 40536, USA
- Center for Muscle Biology, University of Kentucky, Lexington, KY 40536, USA
| |
Collapse
|
4
|
McDiarmid MA, Gaitens JM, Hines S, Cloeren M, Breyer R, Condon M, Oliver M, Roth T, Gucer P, Kaup B, Brown L, Brown CH, Dux M, Glick D, Lewin-Smith MR, Strathmann F, Xu H, Velez-Quinones MA, Streeten E. Surveillance of Depleted Uranium-exposed Gulf War Veterans: More Evidence for Bone Effects. HEALTH PHYSICS 2021; 120:671-682. [PMID: 33867437 DOI: 10.1097/hp.0000000000001395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
ABSTRACT Gulf War I veterans who were victims of depleted uranium (DU) "friendly-fire" incidents have undergone longitudinal health surveillance since 1994. During the spring of 2019, 36 members of the cohort were evaluated with a monitoring protocol including exposure assessment for total and isotopic uranium concentrations in urine and a comprehensive review of health outcomes, including measures of bone metabolism and bone mineral density (BMD) determination. Elevated urine U concentrations were observed in cohort members with retained depleted uranium (DU) shrapnel fragments. In addition, a measure of bone resorption, N-telopeptide, showed a statistically significant increase in those in the high DU subgroup, a finding consistent with a statistically significant decrease in bone mass also observed in this high DU subgroup compared to the low DU subgroup. After more than 25 y since first exposure to DU, an aging cohort of military veterans continues to show few U-related health effects in known target organs of U toxicity. The new finding of impaired BMD in the high DU subgroup has now been detected in two consecutive surveillance visits. While this is a biologically plausible uranium effect, it is not reflected in other measures of bone metabolism in the full cohort, which have largely been within normal limits. However, ongoing accrual of the U burden from fragment absorption over time and the effect of aging further impairing BMD suggest the need for future surveillance assessments of this cohort.
Collapse
Affiliation(s)
| | | | | | | | - Richard Breyer
- Department of Veterans Affairs Medical Center Baltimore, MD
| | - Marian Condon
- Department of Veterans Affairs Medical Center Baltimore, MD
| | | | | | | | - Bruce Kaup
- Department of Veterans Affairs Medical Center Baltimore, MD
| | | | - Clayton H Brown
- Biophysical Toxicology, The Joint Pathology Center, Silver Spring, MD
| | - Moira Dux
- Department of Veterans Affairs Medical Center Baltimore, MD
| | - Danielle Glick
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Michael R Lewin-Smith
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 655 W Baltimore S, Baltimore, MD 21201
| | - Frederick Strathmann
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 655 W Baltimore S, Baltimore, MD 21201
| | - Hanna Xu
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 655 W Baltimore S, Baltimore, MD 21201
| | - Maria A Velez-Quinones
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 655 W Baltimore S, Baltimore, MD 21201
| | - Elizabeth Streeten
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| |
Collapse
|
5
|
Gaitens JM, Brown CH, Strathmann FG, Xu H, Lewin-Smith MR, Velez-Quinones MA, McDiarmid MA. The Utility of Spot vs 24-Hour Urine Samples for Metal Determination in Veterans With Retained Fragments. Am J Clin Pathol 2021; 155:428-434. [PMID: 33083816 DOI: 10.1093/ajcp/aqaa144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The objective of this investigation is to explore the utility of using a spot urine sample in lieu of a 24-hour collection in assessing fragment-related metal exposure in war-injured veterans. METHODS Twenty-four veterans collected each urine void over a 24-hour period in separate containers. Concentrations of 13 metals were measured in each void and in a pooled 24-hour sample using inductively coupled plasma mass spectrometry. To assess the reliability of spot sample measures over time, intraclass correlations (ICCs) were calculated across all spot samples. Lin's concordance correlation coefficient was used to assess agreement between a randomly selected spot urine sample and each corresponding 24-hour sample. RESULTS In total, 149 spot urine samples were collected. Ten of the 13 metals measured had ICCs more than 0.4, suggesting "fair to good" reliability. Concordance coefficients were more than 0.4 for all metals, suggesting "moderate" agreement between spot and 24-hour concentrations, and more than 0.6 for seven of the 13 metals, suggesting "good" agreement. CONCLUSIONS Our fair to good reliability findings, for most metals investigated, and moderate to good agreement findings for all metals, across the range of concentrations observed here, suggest the utility of spot urine samples to obtain valid estimates of exposure in the longitudinal surveillance of metal-exposed populations.
Collapse
Affiliation(s)
- Joanna M Gaitens
- Department of Veterans Affairs, Baltimore VA Medical Center, Baltimore, MD
- Department of Medicine, Division of Occupational and Environmental Medicine
| | - Clayton H Brown
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore
| | | | - Hanna Xu
- The Joint Pathology Center, Environmental Toxicology Laboratory, Silver Spring, MD
| | | | | | - Melissa A McDiarmid
- Department of Veterans Affairs, Baltimore VA Medical Center, Baltimore, MD
- Department of Medicine, Division of Occupational and Environmental Medicine
| |
Collapse
|