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DiCarlo AL. Scientific research and product development in the United States to address injuries from a radiation public health emergency. JOURNAL OF RADIATION RESEARCH 2021; 62:752-763. [PMID: 34308479 PMCID: PMC8438480 DOI: 10.1093/jrr/rrab064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/07/2021] [Indexed: 06/13/2023]
Abstract
The USA has experienced one large-scale nuclear incident in its history. Lessons learned during the Three-Mile Island nuclear accident provided government planners with insight into property damage resulting from a low-level release of radiation, and an awareness concerning how to prepare for future occurrences. However, if there is an incident resulting from detonation of an improvised nuclear device or state-sponsored device/weapon, resulting casualties and the need for medical treatment could overwhelm the nation's public health system. After the Cold War ended, government investments in radiation preparedness declined; however, the attacks on 9/11 led to re-establishment of research programs to plan for the possibility of a nuclear incident. Funding began in earnest in 2004, to address unmet research needs for radiation biomarkers, devices and products to triage and treat potentially large numbers of injured civilians. There are many biodosimetry approaches and medical countermeasures (MCMs) under study and in advanced development, including those to address radiation-induced injuries to organ systems including bone marrow, the gastrointestinal (GI) tract, lungs, skin, vasculature and kidneys. Biomarkers of interest in determining level of radiation exposure and susceptibility of injury include cytogenetic changes, 'omics' technologies and other approaches. Four drugs have been approved by the US Food and Drug Administration (FDA) for the treatment of acute radiation syndrome (ARS), with other licensures being sought; however, there are still no cleared devices to identify radiation-exposed individuals in need of treatment. Although many breakthroughs have been made in the efforts to expand availability of medical products, there is still work to be done.
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Affiliation(s)
- Andrea L DiCarlo
- Corresponding author. Radiation and Nuclear Countermeasures Program, Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 5601 Fishers Lane, Room 7B13, Rockville, MD, USA. Office Phone: 1-240-627-3492; Office Fax: 1-240-627-3113;
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Human Consequences of Multiple Nuclear Detonations in New Delhi (India): Interdisciplinary Requirements in Triage Management. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041740. [PMID: 33670135 PMCID: PMC7916841 DOI: 10.3390/ijerph18041740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 11/30/2022]
Abstract
The human casualties from simulated nuclear detonation scenarios in New Delhi, India are analyzed, with a focus on the distribution of casualties in urban environments and the theoretical application of a nuclear-specific triage system with significant innovation in interdisciplinary disaster management applicable generally to urban nuclear detonation medical response. Model estimates of nuclear war casualties employed ESRI’s ArcGIS 9.3, blast and prompt radiation were calculated using the Defense Nuclear Agency’s WE program, and fallout radiation was calculated using the Defense Threat Reduction Agency’s (DTRA’s) Hazard Prediction and Assessment Capability (HPAC) V404SP4, as well as custom GIS and database software applications. ESRI ArcGISTM programs were used to calculate affected populations from the Oak Ridge National Laboratory’s LandScanTM 2007 Global Population Dataset for areas affected by thermal, blast and radiation data. Trauma, thermal burn, and radiation casualties were thus estimated on a geographic basis for New Delhi, India for single and multiple (six) 25 kt detonations and a single 1 mt (1000 kt) detonation. Major issues related to the emergency management of a nuclear incident are discussed with specific recommendations for improvement. The consequences for health management of thermal burn and radiation patients is the worst, as burn patients require enormous resources to treat, and there will be little to no familiarity with the treatment of radiation victims. Of particular importance is the interdisciplinary cooperation necessary for such a large-scale emergency response event, which would be exemplified by efforts such as the application of a Nuclear Global Health Workforce.
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Serum Metabolomic Alterations Associated with Cesium-137 Internal Emitter Delivered in Various Dose Rates. Metabolites 2020; 10:metabo10070270. [PMID: 32629836 PMCID: PMC7407308 DOI: 10.3390/metabo10070270] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/24/2020] [Accepted: 06/29/2020] [Indexed: 01/08/2023] Open
Abstract
Our laboratory and others have use radiation metabolomics to assess responses in order to develop biomarkers reflecting exposure and level of injury. To expand the types of exposure and compare to previously published results, metabolomic analysis has been carried out using serum samples from mice exposed to 137Cs internal emitters. Animals were injected intraperitoneally with 137CsCl solutions of varying radioactivity, and the absorbed doses were calculated. To determine the dose rate effect, serum samples were collected at 2, 3, 5, 7, and 14 days after injection. Based on the time for each group receiving the cumulative dose of 4 Gy, the dose rate for each group was determined. The dose rates analyzed were 0.16 Gy/day (low), 0.69 Gy/day (medium), and 1.25 Gy/day (high). The results indicated that at a cumulative dose of 4 Gy, the low dose rate group had the least number of statistically significantly differential spectral features. Some identified metabolites showed common changes for different dose rates. For example, significantly altered levels of oleamide and sphingosine 1-phosphate were seen in all three groups. On the other hand, the intensity of three amino acids, Isoleucine, Phenylalanine and Arginine, significantly decreased only in the medium dose rate group. These findings have the potential to be used in assessing the exposure and the biological effects of internal emitters.
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Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNE) Science and the CBRNE Science Medical Operations Science Support Expert (CMOSSE). Disaster Med Public Health Prep 2020; 13:995-1010. [PMID: 31203830 DOI: 10.1017/dmp.2018.163] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.
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Dainiak N, Albanese J, Kaushik M, Balajee AS, Romanyukha A, Sharp TJ, Blakely WF. CONCEPTS OF OPERATIONS FOR A US DOSIMETRY AND BIODOSIMETRY NETWORK. RADIATION PROTECTION DOSIMETRY 2019; 186:130-138. [PMID: 30726970 DOI: 10.1093/rpd/ncy294] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/11/2018] [Accepted: 01/09/2019] [Indexed: 06/09/2023]
Abstract
The USA must be prepared to provide a prompt, coordinated and integrated response for radiation dose and injury assessment for suspected radiation exposure, whether it involves isolated cases or mass casualties. Dose estimation for radiation accidents typically necessitates a multiple parameter diagnostics approach that includes clinical, biological and physical dosimetry to provide an early-phase radiation dose. A US Individual Dosimetry and Biodosimetry Network (US-IDBN) will increase surge capacity for civilian and military populations in a large-scale incident. The network's goal is to leverage available resources and provide an integrated biodosimetry capability, using multiple parameter diagnostics. Initial operations will be to expand an existing functional integration of two cytogenetic biodosimetry laboratories by developing Standard Operating Procedures, cross-training laboratorians, developing common calibration curves, supporting inter-comparison exercises and obtaining certification to process clinical samples. Integration with certified commercial laboratories will increase surge capacity to meet the needs of a mass-casualty incident.
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Affiliation(s)
- Nicholas Dainiak
- Department of Therapeutic Radiology, Yale University School of Medicine, 333 Cedar Street, New Haven CT 06520, USA
| | - Joseph Albanese
- Department of Therapeutic Radiology, Yale University School of Medicine, 333 Cedar Street, New Haven CT 06520, USA
| | - Meetu Kaushik
- Department of Therapeutic Radiology, Yale University School of Medicine, 333 Cedar Street, New Haven CT 06520, USA
| | - Adayabalam S Balajee
- Radiation Emergency Assistance Center/Training Site, Oak Ridge Institute for Science and Education, PO Box 117, MS 39, Oak Ridge TN 37831, USA
| | | | - Thad J Sharp
- Naval Dosimetry Center, 8901 Wisconsin Avenue, Bethesda MD 20889, USA
| | - William F Blakely
- Uniformed Services University of the Health Sciences, Armed Forces Radiobiology Research Institute, 4555 South Palmer Road, Bldg. 42, Bethesda MD 20889-5648, USA
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DiCarlo AL, Horta ZP, Aldrich JT, Jakubowski AA, Skinner WK, Case CM. Use of Growth Factors and Other Cytokines for Treatment of Injuries During a Radiation Public Health Emergency. Radiat Res 2019; 192:99-120. [PMID: 31081742 DOI: 10.1667/rr15363.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Due to the threat of a radiological or nuclear incident that could impact citizens, 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. Given that the body's natural response to radiation exposure includes production of growth factors and cytokines, and that the only drugs approved by the U.S. Food and Drug Administration to treat acute radiation syndrome are growth factors targeting either the granulocyte (Neupogen® or Neulasta®) or granulocyte and macrophage (Leukine®) hematopoietic cell lineages, there is interest in understanding the role that these factors play in responding to and/or ameliorating radiation damage. Furthermore, in an environment where resources are scarce, such as what might be expected during a radiation public health emergency, availability of growth factor or other treatments may be limited. For these reasons, the NIAID partnered with the Radiation Injury Treatment Network (RITN), whose membership includes medical centers with expertise in the management of bone marrow failure, to explore the use of growth factors and other cytokines as MCMs to mitigate/treat radiation injuries. A workshop was convened that included government, industry and academic subject matter experts, with presentations covering the anticipated concept of operations during a mass casualty incident including triage and treatment, growth factors under development for a radiation indication, and how the practice of medicine can inform other potential approaches, as well as considerations for administration of these products to diverse civilian populations. This report reviews the information presented, and provides an overview of the discussions from a guided breakout session.
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Affiliation(s)
- Andrea L DiCarlo
- a Radiation and Nuclear Countermeasures Program (RNCP), Division of Allergy, Immunology and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rockville, Maryland
| | - Zulmarie Perez Horta
- a Radiation and Nuclear Countermeasures Program (RNCP), Division of Allergy, Immunology and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rockville, Maryland
| | | | - Ann A Jakubowski
- b Radiation Injury Treatment Network (RITN), Minneapolis, Minnesota.,c Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York
| | - William K Skinner
- d Uniformed Services University for Health Sciences (USUHS), Bethesda, Maryland
| | - Cullen M Case
- b Radiation Injury Treatment Network (RITN), Minneapolis, Minnesota
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Case C, Coleman CN, Bader JL, Hick J, Hanfling D. Guidance, Training and Exercises for Responding to an Improvised Nuclear Device: First Receivers, Public Health. HEALTH PHYSICS 2018; 114:165-172. [PMID: 30086007 DOI: 10.1097/hp.0000000000000759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
All large-scale emergencies and disaster incidents, including the detonation of an improvised nuclear device (IND), have life and death medical consequences. Responders must have realistic plans to save lives and reduce physical and psychological morbidity. Fifteen years after 9/11, considerable progress toward developing and implementing such plans has been made, but gaps in the management of response to an IND loom large. Another paper in this series reviewed gaps for first responders; this paper reviews gaps for first receivers and public health. Closing gaps requires the implementation of complex systems including.
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Koerner JF. Preparedness Is More Than a Plan: Medical Considerations for Radiation Response. HEALTH PHYSICS 2018; 114:128-135. [PMID: 30086001 DOI: 10.1097/hp.0000000000000755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The goals herein are to describe and discuss existing plans for the medical preparedness and response to a radiological incident/nuclear detonation, present the systems approach to nuclear response, introduce methods to assess operational capabilities, and posit suggestions for the way forward to implementation. This discussion seeks to review where these U.S. government efforts began 10 y ago, then moves through the collective National progress in preparedness planning for an improvised nuclear device detonation and differentiates between important preparedness planning efforts and the challenges of understanding national implementation. Finally, a way forward for the immediate future is suggested.
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Chauhan V, Duncan D, Wilkins RC. Radiological/Nuclear Human Monitoring Tabletop Exercise: Recommendations and Lessons Identified. HEALTH PHYSICS 2017; 112:580-586. [PMID: 28441289 DOI: 10.1097/hp.0000000000000678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Health Canada is the lead department for coordinating the federal response to a Canadian nuclear emergency event. The framework to manage a radiological consequence is outlined in the Federal Nuclear Emergency Plan (FNEP). In 2014, a full scale exercise (FSX) was held to test the capacity of the federal government to handle a nuclear facility emergency disaster in Canada. The FSX provided a means to demonstrate the integration of various departments and agencies in response to such an event, and although a number of task teams within FNEP were tested, the capacity to monitor humans for exposure post-event was not played out fully. To address this, a table top exercise (TTX) was held in 2015 that brought together experts from human monitoring groups (HMGs) in partnership with Provincial and Municipal emergency response organizations. The TTX took the form of a facilitated discussion centered around two types of radiological/nuclear (RN) emergency scenarios that commenced post-release. The purpose of the exercise was to integrate these communities and identify knowledge gaps in policies and concepts of operations pertaining to the human monitoring aspects of RN events including biodosimetry, bioassay, portal monitors, whole body counting, and the provision of personal dosimetry. It also tested the interoperability between first responders/receivers and Federal, Provincial, and Municipal emergency response organizations. The end outcome was the identification of clear knowledge gaps in existing and newly developed concepts of operation in the human population monitoring response to an RN emergency in Canada; these and possible recommendations are captured in this report.
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Affiliation(s)
- Vinita Chauhan
- *Consumer and Clinical Radiation Protection Bureau, Healthy Environment and Consumer Safety Branch, Health Canada, Ottawa, Ontario, Canada K1A 0K9; † International Safety Research, Ottawa, Ontario, Canada K2E 7J6
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Pannkuk EL, Fornace AJ, Laiakis EC. Metabolomic applications in radiation biodosimetry: exploring radiation effects through small molecules. Int J Radiat Biol 2017; 93:1151-1176. [PMID: 28067089 DOI: 10.1080/09553002.2016.1269218] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Exposure of the general population to ionizing radiation has increased in the past decades, primarily due to long distance travel and medical procedures. On the other hand, accidental exposures, nuclear accidents, and elevated threats of terrorism with the potential detonation of a radiological dispersal device or improvised nuclear device in a major city, all have led to increased needs for rapid biodosimetry and assessment of exposure to different radiation qualities and scenarios. Metabolomics, the qualitative and quantitative assessment of small molecules in a given biological specimen, has emerged as a promising technology to allow for rapid determination of an individual's exposure level and metabolic phenotype. Advancements in mass spectrometry techniques have led to untargeted (discovery phase, global assessment) and targeted (quantitative phase) methods not only to identify biomarkers of radiation exposure, but also to assess general perturbations of metabolism with potential long-term consequences, such as cancer, cardiovascular, and pulmonary disease. CONCLUSIONS Metabolomics of radiation exposure has provided a highly informative snapshot of metabolic dysregulation. Biomarkers in easily accessible biofluids and biospecimens (urine, blood, saliva, sebum, fecal material) from mouse, rat, and minipig models, to non-human primates and humans have provided the basis for determination of a radiation signature to assess the need for medical intervention. Here we provide a comprehensive description of the current status of radiation metabolomic studies for the purpose of rapid high-throughput radiation biodosimetry in easily accessible biofluids and discuss future directions of radiation metabolomics research.
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Affiliation(s)
- Evan L Pannkuk
- a Tumor Biology Program , Lombardi Comprehensive Cancer Center, Georgetown University , Washington DC , USA
| | - Albert J Fornace
- b Molecular Oncology , Lombardi Comprehensive Cancer Center, Georgetown University , Washington DC , USA.,c Department of Biochemistry and Molecular and Cellular Biology , Georgetown University , Washington DC , USA
| | - Evagelia C Laiakis
- c Department of Biochemistry and Molecular and Cellular Biology , Georgetown University , Washington DC , USA
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Gale SC, Shiroff AM, Donovan CM, Rhodes SC, Rhodes JS, Gracias VH. Medical Management at the Health Care Facility. Ann Emerg Med 2016; 69:S36-S45. [PMID: 27955761 DOI: 10.1016/j.annemergmed.2016.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
| | | | - Colleen M Donovan
- Department of Emergency Medicine, Rutgers, The State University of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ; University Center for Disaster Preparedness and Emergency Response at Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Stancie C Rhodes
- Department of Surgery, Rutgers, The State University of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - John S Rhodes
- Department of Surgery, Rutgers, The State University of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Vicente H Gracias
- Department of Surgery, Rutgers, The State University of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ; University Center for Disaster Preparedness and Emergency Response at Robert Wood Johnson University Hospital, New Brunswick, NJ
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Coleman CN, Koerner JF. Biodosimetry: Medicine, Science, and Systems to Support the Medical Decision-Maker Following a Large Scale Nuclear or Radiation Incident. RADIATION PROTECTION DOSIMETRY 2016; 172:38-46. [PMID: 27473694 PMCID: PMC6061193 DOI: 10.1093/rpd/ncw155] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The public health and medical response to a radiological or nuclear incident requires the capability to sort, assess, treat, triage and to ultimately discharge, refer or transport people to their next step in medical care. The size of the incident and scarcity of resources at the location of each medical decision point will determine how patients are triaged and treated. This will be a rapidly evolving situation impacting medical responders at regional, national and international levels. As capabilities, diagnostics and medical countermeasures improve, a dynamic system-based approach is needed to plan for and manage the incident, and to adapt effectively in real time. In that the concepts and terms can be unfamiliar and possibly confusing, resources and a concept of operations must be considered well in advance. An essential underlying tenet is that medical evaluation and care will be managed by healthcare professionals with biodosimetry assays providing critical supporting data.
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Affiliation(s)
- C Norman Coleman
- Chemical, Biological, Radiological, Nuclear and Explosive Branch, Office of Emergency Management, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC 20201, USA
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - John F Koerner
- Chemical, Biological, Radiological, Nuclear and Explosive Branch, Office of Emergency Management, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC 20201, USA
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Ossetrova NI, Blakely WF, Nagy V, McGann C, Ney PH, Christensen CL, Koch AL, Gulani J, Sigal GB, Glezer EN, Hieber KP. Non-human Primate Total-body Irradiation Model with Limited and Full Medical Supportive Care Including Filgrastim for Biodosimetry and Injury Assessment. RADIATION PROTECTION DOSIMETRY 2016; 172:174-191. [PMID: 27473690 DOI: 10.1093/rpd/ncw176] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
An assessment of multiple biomarkers from radiation casualties undergoing limited- or full-supportive care including treatment with filgrastim is critical to develop rapid and effective diagnostic triage strategies. The efficacy of filgrastim with full-supportive care was compared with results with limited-supportive care by analyzing survival, necropsy, histopathology and serial blood samples for hematological, serum chemistry and protein profiles in a non-human primate (Macaca mulatta, male and female) model during 60-d post-monitoring period following sham- and total-body irradiation with 6.5 Gy 60Co gamma-rays at 0.6 Gy min-1 Filgrastim (10 μg kg-1) was administered beginning on Day 1 post-exposure and continued daily until neutrophil counts were ≥2,000 μL-1 for two consecutive days. Filgrastim and full-supportive care significantly decreased the pancytopenia duration and resulted in improved animal survival and recovery compared to animals with a limited-supportive care. These findings also identified and validated a multiparametric biomarker panel to support radiation diagnostic device development.
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Affiliation(s)
- Natalia I Ossetrova
- Scientific Research Department, Armed Forces Radiobiology Research Institute (AFRRI), Uniformed Services University (USU) , 8901 Wisconsin Avenue, Bethesda, ML 20889, USA
| | - William F Blakely
- Scientific Research Department, Armed Forces Radiobiology Research Institute (AFRRI), Uniformed Services University (USU) , 8901 Wisconsin Avenue, Bethesda, ML 20889, USA
| | - Vitaly Nagy
- Scientific Research Department, Armed Forces Radiobiology Research Institute (AFRRI), Uniformed Services University (USU) , 8901 Wisconsin Avenue, Bethesda, ML 20889, USA
| | - Camille McGann
- Scientific Research Department, Armed Forces Radiobiology Research Institute (AFRRI), Uniformed Services University (USU) , 8901 Wisconsin Avenue, Bethesda, ML 20889, USA
| | - Patrick H Ney
- Scientific Research Department, Armed Forces Radiobiology Research Institute (AFRRI), Uniformed Services University (USU) , 8901 Wisconsin Avenue, Bethesda, ML 20889, USA
| | - Christine L Christensen
- Scientific Research Department, Armed Forces Radiobiology Research Institute (AFRRI), Uniformed Services University (USU) , 8901 Wisconsin Avenue, Bethesda, ML 20889, USA
- Tri-Service Research Laboratory (TRSL), 4141 Petroleum Road, JBSA-Fort Sam Houston, TX 78234, USA
| | - Amory L Koch
- Scientific Research Department, Armed Forces Radiobiology Research Institute (AFRRI), Uniformed Services University (USU) , 8901 Wisconsin Avenue, Bethesda, ML 20889, USA
- Tripler Army Medical Center, Honolulu, HI 96859, USA
| | - Jatinder Gulani
- Scientific Research Department, Armed Forces Radiobiology Research Institute (AFRRI), Uniformed Services University (USU) , 8901 Wisconsin Avenue, Bethesda, ML 20889, USA
| | - George B Sigal
- Meso Scale Diagnostics, LLC. (MSD), 1601 Research Boulevard, Rockville, MD 20850, USA
| | - Eli N Glezer
- Meso Scale Diagnostics, LLC. (MSD), 1601 Research Boulevard, Rockville, MD 20850, USA
| | - Kevin P Hieber
- Scientific Research Department, Armed Forces Radiobiology Research Institute (AFRRI), Uniformed Services University (USU) , 8901 Wisconsin Avenue, Bethesda, ML 20889, USA
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Blakely WF, Romanyukha A, Hayes SM, Reyes RA, Stewart HM, Hoefer MH, Williams A, Sharp T, Huff LA. U.S. Department of Defense Multiple-Parameter Biodosimetry Network. RADIATION PROTECTION DOSIMETRY 2016; 172:58-71. [PMID: 27886989 DOI: 10.1093/rpd/ncw295] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/12/2016] [Indexed: 06/06/2023]
Abstract
The U.S. Department of Defense (USDOD) service members are at risk of exposure to ionizing radiation due to radiation accidents, terrorist attacks and national defense activities. The use of biodosimetry is a standard of care for the triage and treatment of radiation injuries. Resources and procedures need to be established to implement a multiple-parameter biodosimetry system coupled with expert medial guidance to provide an integrated radiation diagnostic system to meet USDOD requirements. Current USDOD biodosimetry capabilities were identified and recommendations to fill the identified gaps are provided. A USDOD Multi-parametric Biodosimetry Network, based on the expertise that resides at the Armed Forces Radiobiology Research Institute and the Naval Dosimetry Center, was designed. This network based on the use of multiple biodosimetry modalities would provide diagnostic and triage capabilities needed to meet USDOD requirements. These are not available with sufficient capacity elsewhere but could be needed urgently after a major radiological/nuclear event.
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Affiliation(s)
- William F Blakely
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, 8901 Wisconsin Avenue, Bethesda, MD 20889-5603, USA
| | | | | | - Ricardo A Reyes
- Defense Health Agency, Walter Reed National Military Medical Command, Bethesda, MD 20889, USA
| | | | - Matthew H Hoefer
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, 8901 Wisconsin Avenue, Bethesda, MD 20889-5603, USA
| | | | - Thad Sharp
- Naval Dosimetry Center, Bethesda, MD 20889, USA
| | - L Andrew Huff
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, 8901 Wisconsin Avenue, Bethesda, MD 20889-5603, USA
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Sproull M, Camphausen K. State-of-the-Art Advances in Radiation Biodosimetry for Mass Casualty Events Involving Radiation Exposure. Radiat Res 2016; 186:423-435. [PMID: 27710702 DOI: 10.1667/rr14452.1] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
With the possibility of large-scale terrorist attacks around the world, the need for modeling and development of new medical countermeasures for potential future chemical, biological, radiological and nuclear (CBRN) has been well established. Project Bioshield, initiated in 2004, provided a framework to develop and expedite research in the field of CBRN exposures. To respond to large-scale population exposures from a nuclear event or radiation dispersal device (RDD), new methods for determining received dose using biological modeling became necessary. The field of biodosimetry has advanced significantly beyond this original initiative, with expansion into the fields of genomics, proteomics, metabolomics and transcriptomics. Studies are ongoing to evaluate the use of lymphocyte kinetics for dose assessment, as well as the development of field-deployable EPR technology. In addition, expansion of traditional cytogenetic assessment methods through the use of automated platforms and the development of laboratory surge capacity networks have helped to advance our biodefense preparedness. In this review of the latest advances in the field of biodosimetry we evaluate our progress and identify areas that still need to be addressed to achieve true field-deployment readiness.
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Affiliation(s)
- Mary Sproull
- Radiation Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Kevin Camphausen
- Radiation Oncology Branch, National Cancer Institute, Bethesda, Maryland
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Milner EE, Daxon EG, Anastasio MT, Nesler JT, Miller RL, Blakely WF. Concepts of Operations (CONOPS) for Biodosimetry Tools Employed in Operational Environments. HEALTH PHYSICS 2016; 110:370-379. [PMID: 26910029 DOI: 10.1097/hp.0000000000000470] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
It is essential to identify improved capabilities to accurately identify, confirm, and/or quantify radiological exposure and injury in order to inform critical triage, diagnosis, and treatment decisions. Herein the authors report characteristic requirements and potential Concepts of Operations (CONOPS) for biodosimetry tools employed in operational environments. While similar significant efforts have been completed in this area for the U.S. civilian sector, limited perspectives are published in the peer-reviewed literature regarding the use of radiological diagnostic technologies in deployed military medical treatment settings. Two radiological exposure scenarios were developed to clarify the diagnostic performance criteria and identify capability gaps. The emerging technology areas associated with radiation exposure diagnostics were reviewed and assessed to gauge their suitability in supporting triage, treatment, and return to duty decisions within the military medical support system.
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Affiliation(s)
- Erin E Milner
- *Medical Countermeasure Systems, Department of Defense, Ft. Detrick, MD, USA; †Battelle Memorial Institute, Medical Readiness and Response, Columbus, OH, USA; ‡Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Department of Defense, Bethesda, MD, USA
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Sproull M, Kramp T, Tandle A, Shankavaram U, Camphausen K. Serum Amyloid A as a Biomarker for Radiation Exposure. Radiat Res 2015; 184:14-23. [PMID: 26114330 DOI: 10.1667/rr13927.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There is a need for minimally invasive biomarkers that can accurately and quickly quantify radiation exposure. Radiation-responsive proteins have applications in clinical medicine and for mass population screenings after a nuclear or radiological incident where the level of radiation exposure and exposure pattern complicate medical triage for first responders. In this study, we evaluated the efficacy of the acute phase protein serum amyloid A (SAA) as a biomarker for radiation exposure using plasma from irradiated mice. Ten-week-old female C57BL6 mice received a 1-8 Gy single whole-body or partial-body dose from a Pantak X-ray source at a dose rate of 2.28 Gy/min. Plasma was collected by mandibular or cardiac puncture at 6, 24, 48 and 72 h or 1-3 weeks postirradiation. SAA levels were determined using a commercially available ELISA assay. Data was pooled to generate SAA μg/ml threshold values correlating plasma SAA levels with radiation dose. SAA levels were statistically significant over control at all exposures between 2 and 8 Gy at 24 h postirradiation but not at 6, 48 and 72 h or 1-3 weeks postirradiation. SAA levels at 1 Gy were not significantly elevated over control at all time points. Total-body-irradiated (TBI) SAA levels at 24 h were used to generate a dose prediction model that successfully differentiated TBI mice into dose received cohorts of control/1 Gy and ≥ 2 Gy groups with a high degree of accuracy in a blind study. Dose prediction of partial-body exposures based on the TBI model correlated increasing predictive accuracy with percentage of body exposure to radiation. Our findings indicate that plasma SAA levels might be a useful biomarker for radiation exposure in a variety of total- and partial-body irradiation settings.
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Affiliation(s)
- Mary Sproull
- Radiation Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Tamalee Kramp
- Radiation Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Anita Tandle
- Radiation Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Uma Shankavaram
- Radiation Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Kevin Camphausen
- Radiation Oncology Branch, National Cancer Institute, Bethesda, Maryland
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Recovery and resilience after a nuclear power plant disaster: a medical decision model for managing an effective, timely, and balanced response. Disaster Med Public Health Prep 2015; 7:136-45. [PMID: 24618164 DOI: 10.1017/dmp.2013.5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Resilience after a nuclear power plant or other radiation emergency requires response and recovery activities that are appropriately safe, timely, effective, and well organized. Timely informed decisions must be made, and the logic behind them communicated during the evolution of the incident before the final outcome is known. Based on our experiences in Tokyo responding to the Fukushima Daiichi nuclear power plant crisis, we propose a real-time, medical decision model by which to make key health-related decisions that are central drivers to the overall incident management. Using this approach, on-site decision makers empowered to make interim decisions can act without undue delay using readily available and high-level scientific, medical, communication, and policy expertise. Ongoing assessment, consultation, and adaption to the changing conditions and additional information are additional key features. Given the central role of health and medical issues in all disasters, we propose that this medical decision model, which is compatible with the existing US National Response Framework structure, be considered for effective management of complex, large-scale, and large-consequence incidents.
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Coleman CN, Sullivan JM, Bader JL, Murrain-Hill P, Koerner JF, Garrett AL, Weinstock DM, Case C, Hrdina C, Adams SA, Whitcomb RC, Graeden E, Shankman R, Lant T, Maidment BW, Hatchett RC. Public health and medical preparedness for a nuclear detonation: the nuclear incident medical enterprise. HEALTH PHYSICS 2015; 108:149-160. [PMID: 25551496 PMCID: PMC4295641 DOI: 10.1097/hp.0000000000000249] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Resilience and the ability to mitigate the consequences of a nuclear incident are enhanced by (1) effective planning, preparation and training; (2) ongoing interaction, formal exercises, and evaluation among the sectors involved; (3) effective and timely response and communication; and (4) continuous improvements based on new science, technology, experience, and ideas. Public health and medical planning require a complex, multi-faceted systematic approach involving federal, state, local, tribal, and territorial governments; private sector organizations; academia; industry; international partners; and individual experts and volunteers. The approach developed by the U.S. Department of Health and Human Services Nuclear Incident Medical Enterprise (NIME) is the result of efforts from government and nongovernment experts. It is a "bottom-up" systematic approach built on the available and emerging science that considers physical infrastructure damage, the spectrum of injuries, a scarce resources setting, the need for decision making in the face of a rapidly evolving situation with limited information early on, timely communication, and the need for tools and just-in-time information for responders who will likely be unfamiliar with radiation medicine and uncertain and overwhelmed in the face of the large number of casualties and the presence of radioactivity. The components of NIME can be used to support planning for, response to, and recovery from the effects of a nuclear incident. Recognizing that it is a continuous work-in-progress, the current status of the public health and medical preparedness and response for a nuclear incident is provided.
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Affiliation(s)
- C. Norman Coleman
- Office of Emergency Management, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, Telephone: (301) 496-5457, Fax: (301) 480-5439
| | - Julie M. Sullivan
- Office of Emergency Management, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC
| | - Judith L. Bader
- Office of Emergency Management, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC
| | - Paula Murrain-Hill
- Office of Emergency Management, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC
| | - John F. Koerner
- Office of Emergency Management, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC
| | - Andrew L. Garrett
- Office of Emergency Management, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC
| | - David M. Weinstock
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
- Radiation Injury Treatment Network, National Marrow Donor Program, Minneapolis, MN
| | - Cullen Case
- Radiation Injury Treatment Network, National Marrow Donor Program, Minneapolis, MN
| | - Chad Hrdina
- Office of Policy and Planning, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC
| | - Steven A. Adams
- Division of Strategic National Stockpile, Office of Public Health Preparedness and Response; Centers for Disease Control and Prevention, Atlanta, GA
| | - Robert C. Whitcomb
- Radiation Studies Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Robert Shankman
- Office of Emergency Management, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC
| | - Timothy Lant
- Biomedical Advanced Research & Development Authority, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC
| | - Bert W. Maidment
- Radiation/Nuclear Countermeasures Program, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Richard C. Hatchett
- Biomedical Advanced Research & Development Authority, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC
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Kearns RD, Cairns BA, Cairns CB. Surge Capacity and Capability. A Review of the History and Where the Science is Today Regarding Surge Capacity during a Mass Casualty Disaster. Front Public Health 2014; 2:29. [PMID: 24795873 PMCID: PMC4001022 DOI: 10.3389/fpubh.2014.00029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 03/27/2014] [Indexed: 11/15/2022] Open
Abstract
Disasters which include countless killed and many more injured, have occurred throughout recorded history. Many of the same reports of disaster also include numerous accounts of individuals attempting to rescue those in great peril and render aid to the injured and infirmed. The purpose of this paper is to briefly discuss the transition through several periods of time with managing a surge of many patients. This review will focus on the triggering event, injury and illness, location where the care is provided and specifically discuss where the science is today.
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Affiliation(s)
- Randy D Kearns
- Department of Surgery, University of North Carolina , Chapel Hill, NC , USA ; Department of Emergency Medicine, University of North Carolina , Chapel Hill, NC , USA
| | - Bruce A Cairns
- Department of Surgery, University of North Carolina , Chapel Hill, NC , USA
| | - Charles B Cairns
- Department of Emergency Medicine, University of North Carolina , Chapel Hill, NC , USA
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Bouville A, Linet MS, Hatch M, Mabuchi K, Simon SL. Guidelines for exposure assessment in health risk studies following a nuclear reactor accident. ENVIRONMENTAL HEALTH PERSPECTIVES 2014; 122:1-5. [PMID: 24184886 PMCID: PMC3888574 DOI: 10.1289/ehp.1307120] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 10/30/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Worldwide concerns regarding health effects after the Chernobyl and Fukushima nuclear power plant accidents indicate a clear need to identify short- and long-term health impacts that might result from accidents in the future. Fundamental to addressing this problem are reliable and accurate radiation dose estimates for the affected populations. The available guidance for activities following nuclear accidents is limited with regard to strategies for dose assessment in health risk studies. OBJECTIVES Here we propose a comprehensive systematic approach to estimating radiation doses for the evaluation of health risks resulting from a nuclear power plant accident, reflected in a set of seven guidelines. DISCUSSION Four major nuclear reactor accidents have occurred during the history of nuclear power production. The circumstances leading to these accidents were varied, as were the magnitude of the releases of radioactive materials, the pathways by which persons were exposed, the data collected afterward, and the lifestyle factors and dietary consumption that played an important role in the associated radiation exposure of the affected populations. Accidents involving nuclear reactors may occur in the future under a variety of conditions. The guidelines we recommend here are intended to facilitate obtaining reliable dose estimations for a range of different exposure conditions. We recognize that full implementation of the proposed approach may not always be feasible because of other priorities during the nuclear accident emergency and because of limited resources in manpower and equipment. CONCLUSIONS The proposed approach can serve as a basis to optimize the value of radiation dose reconstruction following a nuclear reactor accident.
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Affiliation(s)
- André Bouville
- National Cancer Institute (retired), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Rockville, Maryland, USA
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Correction. Biosecur Bioterror 2013. [DOI: 10.1089/bsp.2013.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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