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Silverman TA, Shadiack AM, Hofmeyer KA, Cecere AE, Eisnor DL, Hoffman CM, Loelius SG, Patel A, Homer MJ. Blood product use for radiological/nuclear trauma: product development and US regulatory considerations. Trauma Surg Acute Care Open 2024; 9:e001123. [PMID: 38196926 PMCID: PMC10773416 DOI: 10.1136/tsaco-2023-001123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/03/2023] [Indexed: 01/11/2024] Open
Abstract
Blood products are likely to be critical components of the medical response to nuclear detonation, as the hematopoietic subsyndrome of acute radiation syndrome (H-ARS) includes depletion of platelets and red blood cells that can lead to lethal hemorrhage and anemia. There is, however, only limited clinical information on the use of blood products to treat H-ARS. As currently configured, the US blood supply cannot meet the predicted surge in blood product demand that is likely to occur short-term and possibly long-term in the event of a large nuclear detonation. As part of the Administration for Strategic Preparedness and Response within the US Department of Health and Human Services, the Biomedical Advanced Research and Development Authority (BARDA) is addressing this preparedness gap by supporting the development of novel blood products and devices with characteristics that improve blood product storage and use in austere operational environments. The US Food and Drug Administration's Center for Drug Evaluation and Research (CDER) recently issued draft guidance on the development of drugs and biologics regulated by CDER to prevent or treat Acute Radiation Syndrome under the provisions of the "Animal Rule." The commentary provided here discusses the unique regulatory scheme for transfusion components and blood products regulated as biological drugs by Center for Biologics Evaluation and Research, including the ambiguity surrounding the evidentiary requirements for their approval for H-ARS, and whether, under certain circumstances, a specific H-ARS indication is necessary if relevant commercial indications are approved.
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Affiliation(s)
- Toby A Silverman
- Tunnell Government Services, Bethesda, Maryland, USA
- Division of Chemical, Biological, Radiological, and Nuclear Medical Countermeasure, Biomedical Advanced Research and Development Authority, Washington, District of Columbia, USA
| | - Annette M Shadiack
- Tunnell Government Services, Bethesda, Maryland, USA
- Division of Chemical, Biological, Radiological, and Nuclear Medical Countermeasure, Biomedical Advanced Research and Development Authority, Washington, District of Columbia, USA
| | - Kimberly A Hofmeyer
- Biomedical Advanced Research and Development Authority, Washington, District of Columbia, USA
| | - Ashley E Cecere
- Biomedical Advanced Research and Development Authority, Washington, District of Columbia, USA
| | - Derek L Eisnor
- Division of Clinical Development, Biomedical Advanced Research and Development Authority, Washington, District of Columbia, USA
| | - Corey M Hoffman
- Division of Chemical, Biological, Radiological, and Nuclear Medical Countermeasure, Biomedical Advanced Research and Development Authority, Washington, District of Columbia, USA
| | - Shannon G Loelius
- Division of Chemical, Biological, Radiological, and Nuclear Medical Countermeasure, Biomedical Advanced Research and Development Authority, Washington, District of Columbia, USA
| | - Aditiben Patel
- Division of Regulatory and Quality Affairs, Biomedical Advanced Research and Development Authority, Washington, District of Columbia, USA
| | - Mary J Homer
- Division of Chemical, Biological, Radiological, and Nuclear Medical Countermeasure, Biomedical Advanced Research and Development Authority, Washington, District of Columbia, USA
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Satyamitra MM, Andres DK, Bergmann JN, Hoffman CM, Hogdahl T, Homer MJ, Hu TC, Rios CI, Yeung DT, DiCarlo AL. Overlapping Science in Radiation and Sulfur Mustard Exposures of Skin and Lung: Consideration of Models, Mechanisms, Organ Systems, and Medical Countermeasures: Overlapping science in radiation and sulfur mustard injuries to lung and skin. Disaster Med Public Health Prep 2023; 17:e552. [PMID: 37852927 PMCID: PMC10843005 DOI: 10.1017/dmp.2023.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
PURPOSE To summarize presentations and discussions from the 2022 trans-agency workshop titled "Overlapping science in radiation and sulfur mustard (SM) exposures of skin and lung: Consideration of models, mechanisms, organ systems, and medical countermeasures." METHODS Summary on topics includes: (1) an overview of the radiation and chemical countermeasure development programs and missions; (2) regulatory and industry perspectives for drugs and devices; 3) pathophysiology of skin and lung following radiation or SM exposure; 4) mechanisms of action/targets, biomarkers of injury; and 5) animal models that simulate anticipated clinical responses. RESULTS There are striking similarities between injuries caused by radiation and SM exposures. Primary outcomes from both types of exposure include acute injuries, while late complications comprise chronic inflammation, oxidative stress, and vascular dysfunction, which can culminate in fibrosis in both skin and lung organ systems. This workshop brought together academic and industrial researchers, medical practitioners, US Government program officials, and regulators to discuss lung-, and skin- specific animal models and biomarkers, novel pathways of injury and recovery, and paths to licensure for products to address radiation or SM injuries. CONCLUSIONS Regular communications between the radiological and chemical injury research communities can enhance the state-of-the-science, provide a unique perspective on novel therapeutic strategies, and improve overall US Government emergency preparedness.
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Affiliation(s)
- Merriline M. Satyamitra
- Radiation and Nuclear Countermeasures Program (RNCP), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH)
| | | | - Julie N. Bergmann
- Radiological/Nuclear Medical Countermeasures Program, Biomedical Advanced Research and Development Authority (BARDA)
| | - Corey M. Hoffman
- Radiological/Nuclear Medical Countermeasures Program, Biomedical Advanced Research and Development Authority (BARDA)
| | | | - Mary J. Homer
- Radiological/Nuclear Medical Countermeasures Program, Biomedical Advanced Research and Development Authority (BARDA)
| | - Tom C. Hu
- Chemical Medical Countermeasures Program, BARDA
| | - Carmen I. Rios
- Radiation and Nuclear Countermeasures Program (RNCP), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH)
| | - David T. Yeung
- Chemical Countermeasures Research Program (CCRP), NIAID, NIH
| | - Andrea L. DiCarlo
- Radiation and Nuclear Countermeasures Program (RNCP), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH)
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Systemic Bioavailability of Sublingual Atropine Ophthalmic Solution: a Phase I Study in Healthy Volunteers with Implications for Use as a Contingency Medical Countermeasure. J Med Toxicol 2022; 18:187-197. [PMID: 35312968 DOI: 10.1007/s13181-021-00873-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION Atropine sulfate is an FDA-approved medical countermeasure (MCM) for the treatment of organophosphorus nerve agent and organophosphate pesticide toxicity. Sufficient MCM supplies must be available in an incident involving a mass human exposure either from an accidental chemical release or a terrorist attack. METHODS We performed a randomized, 3-sequence, 3-period phase I crossover study to assess the bioavailability and pharmacokinetics (PK) of a single dose (0.5 mg and 1.0 mg) of 1% ophthalmic atropine sulfate solution administered sublingually to 15 healthy adult volunteers. The primary endpoint was evaluation of the bioavailability of each of the two sublingual doses against a 1.0 mg reference intravenous (IV) atropine dose. Secondary endpoints included the safety and tolerability (xerostomia scale) of atropine sulfate administered sublingually. RESULTS Sublingual atropine was safe (no severe AEs or SAEs were reported with either dose) and well tolerated, with a single subject reaching maximum xerostomia on a single dosing day. The geometric mean AUC∞ was 286.40, 493.81, and 816.47 min*ng/mL for the 0.5 mg and 1.0 mg sublingual doses, and the 1.0 mg IV dose, respectively. Compared to IV administration, the 1.0 mg sublingual dose produced 0.60 (90% CI: 0.55-0.66) of the overall concentration of atropine over time (AUC∞). CONCLUSION Sublingual atropine sulfate 1% ophthalmic solution may be an alternative formulation and route of administration combination which expands the capacity and dosing options of atropine as a nerve agent MCM.
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Calamai F, Derkenne C, Jost D, Travers S, Klein I, Bertho K, Dorandeu F, Bignand M, Prunet B. The chemical, biological, radiological and nuclear (CBRN) chain of survival: a new pragmatic and didactic tool used by Paris Fire Brigade. Crit Care 2019; 23:66. [PMID: 30808394 PMCID: PMC6390529 DOI: 10.1186/s13054-019-2364-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 02/17/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Franck Calamai
- Emergency Medical Department, Paris Fire Brigade, 1 Place Jules Renard, 75017 Paris, France
| | - Clément Derkenne
- Emergency Medical Department, Paris Fire Brigade, 1 Place Jules Renard, 75017 Paris, France
| | - Daniel Jost
- Emergency Medical Department, Paris Fire Brigade, 1 Place Jules Renard, 75017 Paris, France
- Sudden Death Expertise Center, 75015 Paris, France
| | - Stéphane Travers
- Villacoublay Military Health Center, 78129 Velizy, France
- Val-de-Grâce Military Health Academy, 1 Place Alphonse Laveran, 75005 Paris, France
| | - Isabelle Klein
- Emergency Medical Department, Paris Fire Brigade, 1 Place Jules Renard, 75017 Paris, France
| | - Kilian Bertho
- Emergency Medical Department, Paris Fire Brigade, 1 Place Jules Renard, 75017 Paris, France
| | - Frédéric Dorandeu
- Val-de-Grâce Military Health Academy, 1 Place Alphonse Laveran, 75005 Paris, France
- French Armed Biomedical Research Institute, 91220 Brétigny-sur-Orge, France
| | - Michel Bignand
- Emergency Medical Department, Paris Fire Brigade, 1 Place Jules Renard, 75017 Paris, France
| | - Bertrand Prunet
- Emergency Medical Department, Paris Fire Brigade, 1 Place Jules Renard, 75017 Paris, France
- Val-de-Grâce Military Health Academy, 1 Place Alphonse Laveran, 75005 Paris, France
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