Protein biomarkers for enhancement of radiation dose and injury assessment in nonhuman primate total-body irradiation model

Development and validation of early-response radiation injury biomarkers are critical for effective triage and medical management of irradiated individuals. Plasma protein and haematological profiles were evaluated using multivariate linear-regression analysis to provide dose-response calibration curves for photon-radiation dose assessment in 30 rhesus macaques total-body-irradiated to 1-8.5 Gy with (60)Co gamma rays (0.55 Gy min(-1)). Equations for radiation dose received were established based on different combinations of protein biomarkers [i.e. C-reactive protein (CRP), serum amyloid A (SAA), interleukin 6 (IL-6) and Flt3 Ligand (Flt3L)] at samples collection time-points 6 h, 1, 2, 3, 4 and 7 d post-total-body irradiation. Dynamic changes in the levels of CRP, SAA, IL-6 and Flt3L may function as prognostic indicators of the time course and severity of acute radiation sickness (ARS). The combination of protein biomarkers provides greater accuracy for early radiation assessment than any one biomarker alone.

DNA repair and cell cycle biomarkers of radiation exposure and inflammation stress in human blood

DNA damage and repair are hallmarks of cellular responses to ionizing radiation. We hypothesized that monitoring the expression of DNA repair-associated genes would enhance the detection of individuals exposed to radiation versus other forms of physiological stress. We employed the human blood ex vivo radiation model to investigate the expression responses of DNA repair genes in repeated blood samples from healthy, non-smoking men and women exposed to 2 Gy of X-rays in the context of inflammation stress mimicked by the bacterial endotoxin lipopolysaccharide (LPS). Radiation exposure significantly modulated the transcript expression of 12 genes of 40 tested (2.2E-06<p<0.03), of which 8 showed no overlap between unirradiated and irradiated samples (CDKN1A, FDXR, BBC3, PCNA, GADD45a, XPC, POLH and DDB2). This panel demonstrated excellent dose response discrimination (0.5 to 8 Gy) in an independent human blood ex vivo dataset, and 100% accuracy for discriminating patients who received total body radiation. Three genes of this panel (CDKN1A, FDXR and BBC3) were also highly sensitive to LPS treatment in the absence of radiation exposure, and LPS co-treatment significantly affected their radiation responses. At the protein level, BAX and pCHK2-thr68 were elevated after radiation exposure, but the pCHK2-thr68 response was significantly decreased in the presence of LPS. Our combined panel yields an estimated 4-group accuracy of ∼90% to discriminate between radiation alone, inflammation alone, or combined exposures. Our findings suggest that DNA repair gene expression may be helpful to identify biodosimeters of exposure to radiation, especially within high-complexity exposure scenarios.

Radiation metabolomics. 5. Identification of urinary biomarkers of ionizing radiation exposure in nonhuman primates by mass spectrometry-based metabolomics

Mass spectrometry-based metabolomics has previously demonstrated utility for identifying biomarkers of ionizing radiation exposure in cellular, mouse and rat in vivo radiation models. To provide a valuable link from small laboratory rodents to humans, γ-radiation-induced urinary biomarkers were investigated using a nonhuman primate total-body-irradiation model. Mass spectrometry-based metabolomics approaches were applied to determine whether biomarkers could be identified, as well as the previously discovered rodent biomarkers of γ radiation. Ultra-performance liquid chromatography-electrospray ionization quadrupole time-of-flight mass spectrometry analysis was carried out on a time course of clean-catch urine samples collected from nonhuman primates (n = 6 per cohort) exposed to sham, 1.0, 3.5, 6.5 or 8.5 Gy doses of (60)Co γ ray (∼0.55 Gy/min) ionizing radiation. By multivariate data analysis, 13 biomarkers of radiation were discovered: N-acetyltaurine, isethionic acid, taurine, xanthine, hypoxanthine, uric acid, creatine, creatinine, tyrosol sulfate, 3-hydroxytyrosol sulfate, tyramine sulfate, N-acetylserotonin sulfate, and adipic acid. N-Acetyltaurine, isethionic acid, and taurine had previously been identified in rats, and taurine and xanthine in mice after ionizing radiation exposure. Mass spectrometry-based metabolomics has thus successfully revealed and verified urinary biomarkers of ionizing radiation exposure in the nonhuman primate for the first time, which indicates possible mechanisms for ionizing radiation injury.

Q(γ-H2AX), an analysis method for partial-body radiation exposure using γ-H2AX in nonhuman primate lymphocytes

We previously used the γ-H2AX assay as a biodosimeter for total-body-irradiation (TBI) exposure (γ-rays) in a rhesus macaque (Macaca mulatta) model. Utilizing peripheral blood lymphocytes and plucked hairs, we obtained statistically significant γ-H2AX responses days after total-body exposure to 1-8.5 Gy ((60)Co γ-rays at 55 cGy min(-1)). Here, we introduce a partial-body exposure analysis method, Q(γ-H2AX), which is based on the number of γ-H2AX foci per damaged cells as evident by having one or more γ-H2AX foci per cell. Results from the rhesus monkey - TBI study were used to establish Q(γ-H2AX) dose-response calibration curves to assess acute partial-body exposures. γ-H2AX foci were detected in plucked hairs for several days after in vivo irradiation demonstrating this assay's utility for dose assessment in various body regions. The quantitation of γ-H2AX may provide a robust biodosimeter for analyzing partial body exposures to ionizing radiation in humans.

The use of gamma-H2AX as a biodosimeter for total-body radiation exposure in non-human primates

Background

There is a crucial shortage of methods capable of determining the extent of accidental exposures of human beings to ionizing radiation. However, knowledge of individual exposures is essential for early triage during radiological incidents to provide optimum possible life-sparing medical procedures to each person.

Methods and Findings

We evaluated immunocytofluorescence-based quantitation of γ-H2AX foci as a biodosimeter of total-body radiation exposure (⁶⁰Co γ-rays) in a rhesus macaque (Macaca mulatta) model. Peripheral blood lymphocytes and plucked hairs were collected from 4 cohorts of macaques receiving total body irradiation doses ranging from 1 Gy to 8.5 Gy. Each cohort consisted of 6 experimental and 2 control animals. Numbers of residual γ-H2AX foci were proportional to initial irradiation doses and statistically significant responses were obtained until 1 day after 1 Gy, 4 days after 3.5 and 6.5 Gy, and 14 days after 8.5 Gy in lymphocytes and until 1 day after 1 Gy, at least 2 days after 3.5 and 6.5 Gy, and 9 days after 8.5 Gy in plucked hairs.

Conclusion

These findings indicate that quantitation of γ-H2AX foci may make a robust biodosimeter for analyzing total-body exposure to ionizing radiation in humans. This tool would help clinicians prescribe appropriate types of medical intervention for optimal individual outcome. These results also demonstrate that the use of a high throughput γ-H2AX biodosimeter would be useful for days post-exposure in applications like large-scale radiological events or radiation therapy. In addition, this study validates a possibility to use plucked hair in future clinical trials investigating genotoxic effects of drugs and radiation treatments.

Biodosimetry medical recording-use of the Biodosimetry Assessment Tool

Effective and dynamic recording of radiation exposure and medical diagnostic information for individuals suspected or known to have been exposed to ionizing radiation contributes to appropriate formulation of medical treatment strategies and radiation protection management. The objectives of this article are to report the database entry templates or screens, provide general use guidelines, and discuss the application to selected radiation exposure scenarios for the Armed Forces Radiobiology Research Institute's software application, Biodosimetry Assessment Tool (BAT). BAT data entry screens were developed based on consensus generic guidance and organized into discrete categories (i.e., physical dosimetry, contamination, prodromal symptoms, hematology, lymphocyte cytogenetics, erythema/wound, and infection) to facilitate its practical use during the early-phase response for radiological incidents. The summary report provides a concise output of information on radiation exposure, radionuclide contamination, dose assessment based on biological indicators (i.e., cytogenetic chromosome aberration bioassays, time to onset of vomiting, lymphocyte cell counts or depletion kinetics), and relevant clinical signs and symptoms. The BAT report template is compliant with NATO and international guidance for recording ionizing radiation exposures for medical purposes.

Biodosimetry Assessment Tool (BAT) software-dose prediction algorithms

PURPOSE

Medical management of suspected radiation casualties requires use of multiparameter biodosimetry because no single biodosimetric measurement is sufficiently robust. This report describes the design and algorithms used in a radiation exposure assessment software application that serves as a diagnostic utility for triage and medical treatment formulation, as well as to convey psychological reassurance, for early-phase assessment of radiation exposures, and for surge response assessment for mass radiological casualties.

METHODS

The Armed Forces Radiobiology Research Institute's Biological Dosimetry Research Program developed the integrated multiparameter Biodosimetry Assessment Tool computer program using Microsoft Visual Basic 6 with various second party plug-ins and add-ons. Dose-predicting algorithms were adopted by analyzing data from merged databases of human radiation exposure incidents and normal controls (non-irradiated) volunteers. The results are summarized in user-friendly screens.

SUMMARY

BAT algorithms are presented and compared to other previously published dose assessment algorithms based on biological indicators (i.e., onset of vomiting, lymphocyte depletion kinetics). These new algorithms are incorporated into a computer-based program that assists responders and medical providers in recording relevant diagnostic information and assessing significant radiation exposures. It promotes early-phase (<10 d) data collection after a radiation exposure incident and provides data templates for entry of diagnostic information using multiparameter indices. It allows for recording of relevant clinical information and summarizes diagnostic information such as estimated multiparameter doses. Data can be printed and archived in accordance with civilian and military guidelines.

Multiple parameter radiation injury assessment using a nonhuman primate radiation model-biodosimetry applications

There are urgent needs to establish capability to rapidly assess radiation injury in mass casualty and population monitoring scenarios. This study's objective was to evaluate several currently available biomarkers that can provide early diagnostic triage information after radiation exposure. Hematology and blood chemistry measurements were performed on samples derived from a nonhuman primate (Macaca mulatta; n = 8) total-body irradiation (TBI) model (6.5-Gy Co gamma rays at 0.6 Gy min). The results from this study demonstrate: a) time course for changes in C-reactive protein (CRP) (-2 d to 15 d after TBI); b) time-dependent (-2 d, 1-4 d after TBI) changes in blood cell counts [i.e., lymphocytes decrease to 5-8% of pre-study levels at 1 to 4 d after TBI; ratio of neutrophil to lymphocytes increases by 44 +/- 18 (p = 0.016), 12 +/- 4 (p = 0.001), 8 +/- 2 (p = 0.0020), and 5.0 +/- 2 (p = 0.002) fold at 1, 2, 3, and 4 days after TBI, respectively]; and c) 4.5 +/- 0.8 (p = 0.002)-fold increases in serum amylase activity 1 d after TBI. Plasma CRP levels at 1 d after exposure were 22 +/- 13 (p = 0.0005) (females) and 44 +/- 11 (p = 0.0004) (males)-fold elevated above baseline levels. One hundred percent successful separation of samples from exposed macaques (24 h after TBI) vs. samples from the same macaque taken before irradiation using a discriminant analysis based on four biomarkers (i.e., lymphocytes, neutrophils, ratio of neutrophils to lymphocytes, and serum amylase activity) was demonstrated. These results demonstrate the practical use of multiple parameter biomarkers to enhance the discrimination of exposed vs. non-exposed individuals and justify a follow-on rhesus macaque dose-response study.

Synopsis of partial-body radiation diagnostic biomarkers and medical management of radiation injury workshop

Radiation exposures from accidents, nuclear detonations or terrorist incidents are unlikely to be homogeneous; however, current biodosimetric approaches are developed and validated primarily in whole-body irradiation models. A workshop was held at the Armed Forces Radiobiology Research Institute in May 2008 to draw attention to the need for partial-body biodosimetry, to discuss current knowledge, and to identify the gaps to be filled. A panel of international experts and the workshop attendees discussed the requirements and concepts for a path forward. This report addresses eight key areas identified by the Workshop Program Committee for future focus: (1) improved cytogenetics, (2) clinical signs and symptoms, (3) cutaneous bioindicators, (4) organ-specific biomarkers, (5) biophysical markers of dose, (6) integrated diagnostic approaches, (7) confounding factors, and (8) requirements for post-event medical follow-up. For each area, the status, advantages and limitations of existing approaches and suggestions for new directions are presented.

Combined approach of hematological biomarkers and plasma protein SAA for improvement of radiation dose assessment triage in biodosimetry applications

Early treatment of populations exposed to ionizing radiation requires accurate and rapid biodosimetry with a precision as high as possible to determine an individual's exposure level and risk for morbidity and mortality. The purpose of this study was to evaluate the utility of multiple blood biomarkers for early-response assessment of radiation exposure using a murine (BALB/c, males) in vivo radiation model. Present results for mice exposed to whole-body Co gamma-rays (0.1 Gy min) over a broad dose range (0-7 Gy) demonstrate at 24 h after exposure: 1) dose-dependent increase in the acute phase protein serum amyloid A or SAA; 2) dose-dependent changes in blood cell counts (lymphocytes, neutrophils, and ratio of neutrophils to lymphocytes); 3) SAA results coupled with peripheral blood cell counts analyzed with use of multivariate discriminant analysis established very successful separation of irradiated animals; 4) an enhanced separation as the number of biomarkers increased. These results also demonstrate proof-in-concept that plasma protein SAA shows promise as a complimentary approach to conventional biodosimetry for early assessment of radiation exposures and, coupled with peripheral blood cell counts, provides early diagnostic information to effectively manage radiation casualty incidents.

Overview of hazard assessment and emergency planning software of use to RN first responders

There are numerous software tools available for field deployment, reach-back, training and planning use in the event of a radiological or nuclear terrorist event. Specialized software tools used by CBRNe responders can increase information available and the speed and accuracy of the response, thereby ensuring that radiation doses to responders, receivers, and the general public are kept as low as reasonably achievable. Software designed to provide health care providers with assistance in selecting appropriate countermeasures or therapeutic interventions in a timely fashion can improve the potential for positive patient outcome. This paper reviews various software applications of relevance to radiological and nuclear events that are currently in use by first responders, emergency planners, medical receivers, and criminal investigators.

Multiple blood-proteins approach for early-response exposure assessment using an in vivo murine radiation model

PURPOSE

The aim was to evaluate the utility of multiple blood-protein biomarkers for early-response assessment of radiation exposure using a murine radiation model system.

MATERIAL AND METHODS

BALB/c male mice (8-10 weeks old) were exposed to whole-body 60Co gamma-rays (10 cGy min(-1)) over a broad dose range (0-7 Gy). Blood protein biomarkers (i.e., Growth Arrest and DNA Damage Inducible Gene 45 or GADD45alpha, interleukin 6 or IL-6, and serum amyloid A or SAA) were measured by enzyme linked immunosorbent assay (ELISA) at 4, 24, 48, and 72 h after total-body irradiation (TBI).

RESULTS

Time- and dose-dependent increases in the protein targets were observed. The use of multiple protein targets was evaluated using multiple linear regression analysis to provide dose-response calibration curves for dose assessment. Multivariate discriminant analysis demonstrated enhanced dose-dependent separation of irradiated animals from control as the number of biomarkers increased.

CONCLUSIONS

Results from this study represent a proof-of-concept for multiple blood-proteins biodosimetry approach. It was demonstrated for the first time that protein expression profile could be developed not only to assess radiation exposure in male BALB/c mice but also to distinguish the level of radiation exposure, ranging from 1-7 Gy.

NASA Radiation Biomarker Workshop, September 27-28, 2007

A summary is provided of presentations and discussions at the NASA Radiation Biomarker Workshop held September 27-28, 2007 at NASA Ames Research Center in Mountain View, CA. Invited speakers were distinguished scientists representing key sectors of the radiation research community. Speakers addressed recent developments in the biomarker and biotechnology fields that may provide new opportunities for health-related assessment of radiation-exposed individuals, including those exposed during long-duration space travel. Topics discussed included the space radiation environment, biomarkers of radiation sensitivity and individual susceptibility, molecular signatures of low-dose responses, multivariate analysis of gene expression, biomarkers in biodefense, biomarkers in radiation oncology, biomarkers and triage after large-scale radiological incidents, integrated and multiple biomarker approaches, advances in whole-genome tiling arrays, advances in mass spectrometry proteomics, radiation biodosimetry for estimation of cancer risk in a rat skin model, and confounding factors. A summary of conclusions is provided at the end of the report.

Sample Tracking in an Automated Cytogenetic Biodosimetry Laboratory for Radiation Mass Casualties

Chromosome aberration-based dicentric assay is expected to be used after mass casualty life-threatening radiation exposures to assess radiation dose to individuals. This will require processing of a large number of samples for individual dose assessment and clinical triage to aid treatment decisions. We have established an automated, high-throughput, cytogenetic biodosimetry laboratory to process a large number of samples for conducting the dicentric assay using peripheral blood from exposed individuals according to internationally accepted laboratory protocols (i.e., within days following radiation exposures). The components of an automated cytogenetic biodosimetry laboratory include blood collection kits for sample shipment, a cell viability analyzer, a robotic liquid handler, an automated metaphase harvester, a metaphase spreader, high-throughput slide stainer and coverslipper, a high-throughput metaphase finder, multiple satellite chromosome-aberration analysis systems, and a computerized sample tracking system. Laboratory automation using commercially available, off-the-shelf technologies, customized technology integration, and implementation of a laboratory information management system (LIMS) for cytogenetic analysis will significantly increase throughput.This paper focuses on our efforts to eliminate data transcription errors, increase efficiency, and maintain samples' positive chain-of-custody by sample tracking during sample processing and data analysis. This sample tracking system represents a "beta" version, which can be modeled elsewhere in a cytogenetic biodosimetry laboratory, and includes a customized LIMS with a central server, personal computer workstations, barcode printers, fixed station and wireless hand-held devices to scan barcodes at various critical steps, and data transmission over a private intra-laboratory computer network. Our studies will improve diagnostic biodosimetry response, aid confirmation of clinical triage, and medical management of radiation exposed individuals.

Use of a centrifuge-based automated blood cell counter for radiation dose assessment

Hematological changes create early-response biomarkers for assessing radiation doses. Existing dose-prediction models are based on serial blood lymphocyte counts after acute whole-body exposure to gamma-radiation. Measurements of lymphocyte-depletion kinetics after possible exposures are useful for triaging patients and managing medical resources. The small-footprint QBC Autoread Plus System provides cost-effective hematological analyses with reproducibility, accuracy, and a broad dynamic range. QBC analysis measures centrifugally packed, whole blood cells in microhematocrit tubes and reports pooled lymphocyte and monocyte counts. Our objective was to modify this procedure to report pure lymphocyte counts for radiation biodosimetry applications. The CD14 antigen is strongly expressed on most human monocytes. Using anti-CD14-coated Dynabeads, we have devised a rapid method for depleting monocytes from whole blood without altering the lymphocyte viability or count. This simple dry procedure provides reliable lymphocyte counts for results that fall within the normal lymphocyte count range (1-4 x 10(9) cells per L) for radiation exposure assessment using lymphocyte-depletion kinetics.

Early-response biological dosimetry--recommended countermeasure enhancements for mass-casualty radiological incidents and terrorism

The effective medical management of a suspected acute radiation overexposure incident necessitates recording dynamic medical data, measuring appropriate radiation bioassays, and estimating dose from dosimeters and radioactivity assessments in order to provide diagnostic information to the treating physician and a dose assessment for personnel radiation protection records. The accepted generic multiparameter and early-response approach includes measuring radioactivity and monitoring the exposed individual; observing and recording prodromal signs/symptoms and erythema; obtaining complete blood counts with white blood cell differential; sampling blood for the chromosome-aberration cytogenetic bioassay using the "gold standard" dicentric assay (translocation assay for long times after exposure) for dose assessment; bioassay sampling, if appropriate, to determine radioactivity contamination; and using other available dosimetry approaches. In the event of a radiological mass-casualty incident, current national resources need to be enhanced to provide suitable dose assessment and medical triage and diagnoses. This capability should be broadly based and include stockpiling reagents and devices; establishing deployable (i.e., hematology and biodosimetry) laboratories and reference (i.e., cytogenetic biodosimetry, radiation bioassay) laboratories; networking qualified reference radioactivity-counting bioassay laboratories, cytogenetic biodosimetry, and deployable hematology laboratories with the medical responder community and national radiation protection program; and researching efforts to identify novel radiation biomarkers and develop applied biological dosimetry assays monitored with clinical, deployable, and hand-held analytical systems. These research and applied science efforts should ultimately contribute towards approved, regulated biodosimetry devices or diagnostic tests integrated into a national radioprotection program.

Quantification of total mitochondrial DNA and the 4977-bp common deletion in Pearson's syndrome lymphoblasts using a fluorogenic 5'-nuclease (TaqMan) real-time polymerase chain reaction assay and plasmid external calibration standards

This study describes a multiplex real-time polymerase chain reaction (PCR) assay that quantifies total mitochondrial DNA (mtDNA(total)) and mtDNA bearing the 4977-base pair 'common deletion' (deltamtDNA4977) in lymphoblasts derived from an individual diagnosed with Pearson's syndrome. The method is unique in its use of plasmids as external quantification standards and its use of multiplex conditions. Standards are validated by comparison with purified mtDNA amplification curves and by the fact that curves are largely unaffected by nuclear DNA (nucDNA). Finally, slopes of standard curves and unknowns are shown to be similar to each other and to theoretical predictions. From these data, mtDNA(total) in these cells is calculated to be 3258 (+723/-592) copies per cell while deltamtDNA4977 averages 232 (+136/-86) copies per cell or 7% (+4.65/-2.81).

Premature chromosome condensation in human resting peripheral blood lymphocytes for chromosome aberration analysis using specific whole-chromosome DNA hybridization probes

This paper describes a unique, simple, and rapid method for inducing premature chromosome condensation (PCC) in "resting" human peripheral blood lymphocytes (HPBLs) and also explains an approach to studying numerical changes and/or structural aberrations involving specific chromosomes. HPBLs are isolated from whole blood on a density gradient and, to induce PCC, are incubated at 37 degrees C in cell culture medium supplemented with a phosphatase inhibitor (okadaic acid or calyculin A), adenosine triphosphate (ATP), and p34cdc2/cyclin B kinase (an essential component of mitosis-promoting factor [MPF]). PCC spreads are prepared on glass slides after a brief hypotonic treatment of cells and fixing in acetic acid/methanol fixative. Aberrations involving specific chromosomes are analyzed after in situ hybridization and chromosome painting by fluorescence microscopy. Normal (undamaged) cells display two fluorescent spots per chromosome, whereas aneuploid cells, or cells with a structural aberration involving the specific chromosome corresponding to the painting probe, may show more than two spots. This method may be used in many biological and toxicological fields that require analysis of numerical and structural aberrations involving specific chromosomes.

Medical management of the acute radiation syndrome: recommendations of the Strategic National Stockpile Radiation Working Group

Physicians, hospitals, and other health care facilities will assume the responsibility for aiding individuals injured by a terrorist act involving radioactive material. Scenarios have been developed for such acts that include a range of exposures resulting in few to many casualties. This consensus document was developed by the Strategic National Stockpile Radiation Working Group to provide a framework for physicians in internal medicine and the medical subspecialties to evaluate and manage large-scale radiation injuries. Individual radiation dose is assessed by determining the time to onset and severity of nausea and vomiting, decline in absolute lymphocyte count over several hours or days after exposure, and appearance of chromosome aberrations (including dicentrics and ring forms) in peripheral blood lymphocytes. Documentation of clinical signs and symptoms (affecting the hematopoietic, gastrointestinal, cerebrovascular, and cutaneous systems) over time is essential for triage of victims, selection of therapy, and assignment of prognosis. Recommendations based on radiation dose and physiologic response are made for treatment of the hematopoietic syndrome. Therapy includes treatment with hematopoietic cytokines; blood transfusion; and, in selected cases, stem-cell transplantation. Additional medical management based on the evolution of clinical signs and symptoms includes the use of antimicrobial agents (quinolones, antiviral therapy, and antifungal agents), antiemetic agents, and analgesic agents. Because of the strong psychological impact of a possible radiation exposure, psychosocial support will be required for those exposed, regardless of the dose, as well as for family and friends. Treatment of pregnant women must account for risk to the fetus. For terrorist or accidental events involving exposure to radioiodines, prophylaxis against malignant disease of the thyroid is also recommended, particularly for children and adolescents.