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Blakely WF, Port M, Abend M. Early-response multiple-parameter biodosimetry and dosimetry: risk predictions. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:R152-R175. [PMID: 34280908 DOI: 10.1088/1361-6498/ac15df] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/19/2021] [Indexed: 06/13/2023]
Abstract
The accepted generic multiple-parameter and early-response biodosimetry and dosimetry assessment approach for suspected high-dose radiation (i.e. life-threatening) exposure includes measuring radioactivity associated with the exposed individual (if appropriate); observing and recording prodromal signs/symptoms; obtaining serial complete blood counts with white-blood-cell differential; sampling blood for the chromosome-aberration cytogenetic bioassay using the 'gold standard' dicentric assay (premature chromosome condensation assay for exposures >5 Gy photon acute doses equivalent), measurement of proteomic biomarkers and gene expression assays for dose assessment; bioassay sampling, if appropriate, to determine radioactive internal contamination; physical dose reconstruction, and using other available opportunistic dosimetry approaches. Biodosimetry and dosimetry resources are identified and should be setup in advance along with agreements to access additional national, regional, and international resources. This multifaceted capability needs to be integrated into a biodosimetry/dosimetry 'concept of operations' for use in a radiological emergency. The combined use of traditional biological-, clinical-, and physical-dosimetry should be use in an integrated approach to provide: (a) early-phase diagnostics to guide the development of initial medical-management strategy, and (b) intermediate and definitive assessment of radiation dose and injury. Use of early-phase (a) clinical signs and symptoms, (b) blood chemistry biomarkers, and (c) triage cytogenetics shows diagnostic utility to predict acute radiation injury severity.
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Affiliation(s)
- William F Blakely
- Scientific Research Department, Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
| | - Matthias Port
- Bundeswehr Institute of Radiobiology affiliated to the University of Ulm, Munich, Germany
| | - Michael Abend
- Bundeswehr Institute of Radiobiology affiliated to the University of Ulm, Munich, Germany
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2
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Lamkowski A, Combs SE, Abend M, Port M. Training of clinical triage of acute radiation casualties: a performance comparison of on-siteversus onlinetraining due to the covid-19 pandemic. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:S540-S560. [PMID: 34256358 DOI: 10.1088/1361-6498/ac13c2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
A collection of powerful diagnostic tools have been developed under the umbrellas of NATO for ionising radiation dose assessment (BAT, WinFRAT) and estimate of acute health effects in humans (WinFRAT, H-Module). We assembled a database of 191 ARS cases using the medical treatment protocols for radiation accident victims (n= 167) and the system for evaluation and archiving of radiation accidents based on case histories (n= 24) for training purposes of medical personnel. From 2016 to 2019, we trained 39 participants comprising MSc level radiobiology students in an on-site teaching class. Enforced by the covid-19 pandemic in 2020 for the first time, an online teaching of nine MSc radiobiology students replaced the on-site teaching. We found that: (a) limitations of correct diagnostic decision-making based on clinical signs and symptoms were experienced unrelated to the teaching format. (b) A significant performance decrease concerning online (first number in parenthesis) versus on-site teaching (reference and second number in parenthesis) was seen regarding the estimate time (31 vs 61 cases per hour, two-fold decrease,p= 0.005). Also, the accurate assessment of response categories (89.9% vs 96.9%,p= 0.001), ARS (92.4% vs 96.7%,p= 0.002) and hospitalisation (93.5% vs 97.0%,p= 0.002) decreased by around 3%-7%. The performances of the online attendees were mainly distributed within the lower quartile performance of on-site participants and the 25%-75% interquartile range increased 3-7-fold. (c) Comparison of dose estimates performed by training participants with hematologic acute radiation syndrome (HARS) severity mirrored the known limitations of dose alone as a surrogate parameter for HARS severity at doses less than 1.5 Gy, but demonstrated correct determination of HARS 2-4 and support for clinical decision making at dose estimates >1.5 Gy, regardless of teaching format. (d) Overall, one-third of the online participants showed substantial misapprehension and insecurities of elementary course content that did not occur after the on-site teaching.
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Affiliation(s)
- Andreas Lamkowski
- Bundeswehr Institute of Radiobiology affiliated to the University Ulm, Neuherbergstrasse 11, Munich 80937, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, 81675 Munich, Germany
- Institute of Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Zentrum München (HMGU), Ingolstaedter Landstr. 1 85764 Neuherberg, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site, Munich, Germany
| | - Michael Abend
- Bundeswehr Institute of Radiobiology affiliated to the University Ulm, Neuherbergstrasse 11, Munich 80937, Germany
| | - Matthias Port
- Bundeswehr Institute of Radiobiology affiliated to the University Ulm, Neuherbergstrasse 11, Munich 80937, Germany
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3
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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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4
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Bene BJ, Blakely WF, Burmeister DM, Cary L, Chhetri SJ, Davis CM, Ghosh SP, Holmes-Hampton GP, Iordanskiy S, Kalinich JF, Kiang JG, Kumar VP, Lowy RJ, Miller A, Naeem M, Schauer DA, Senchak L, Singh VK, Stewart AJ, Velazquez EM, Xiao M. Celebrating 60 Years of Accomplishments of the Armed Forces Radiobiology Research Institute1. Radiat Res 2021; 196:129-146. [PMID: 33979439 DOI: 10.1667/21-00064.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/20/2021] [Indexed: 11/03/2022]
Abstract
Chartered by the U.S. Congress in 1961, the Armed Forces Radiobiology Research Institute (AFRRI) is a Joint Department of Defense (DoD) entity with the mission of carrying out the Medical Radiological Defense Research Program in support of our military forces around the globe. In the last 60 years, the investigators at AFRRI have conducted exploratory and developmental research with broad application to the field of radiation sciences. As the only DoD facility dedicated to radiation research, AFRRI's Medical Radiobiology Advisory Team provides deployable medical and radiobiological subject matter expertise, advising commanders in the response to a U.S. nuclear weapon incident and other nuclear or radiological material incidents. AFRRI received the DoD Joint Meritorious Unit Award on February 17, 2004, for its exceptionally meritorious achievements from September 11, 2001 to June 20, 2003, in response to acts of terrorism and nuclear/radiological threats at home and abroad. In August 2009, the American Nuclear Society designated the institute a nuclear historic landmark as the U.S.'s primary source of medical nuclear and radiological research, preparedness and training. Since then, research has continued, and core areas of study include prevention, assessment and treatment of radiological injuries that may occur from exposure to a wide range of doses (low to high). AFRRI collaborates with other government entities, academic institutions, civilian laboratories and other countries to research the biological effects of ionizing radiation. Notable early research contributions were the establishment of dose limits for major acute radiation syndromes in primates, applicable to human exposures, followed by the subsequent evolution of radiobiology concepts, particularly the importance of immune collapse and combined injury. In this century, the program has been essential in the development and validation of prophylactic and therapeutic drugs, such as Amifostine, Neupogen®, Neulasta®, Nplate® and Leukine®, all of which are used to prevent and treat radiation injuries. Moreover, AFRRI has helped develop rapid, high-precision, biodosimetry tools ranging from novel assays to software decision support. New drug candidates and biological dose assessment technologies are currently being developed. Such efforts are supported by unique and unmatched radiation sources and generators that allow for comprehensive analyses across the various types and qualities of radiation. These include but are not limited to both 60Co facilities, a TRIGA® reactor providing variable mixed neutron and γ-ray fields, a clinical linear accelerator, and a small animal radiation research platform with low-energy photons. There are five major research areas at AFRRI that encompass the prevention, assessment and treatment of injuries resulting from the effects of ionizing radiation: 1. biodosimetry; 2. low-level and low-dose-rate radiation; 3. internal contamination and metal toxicity; 4. radiation combined injury; and 5. radiation medical countermeasures. These research areas are bolstered by an educational component to broadcast and increase awareness of the medical effects of ionizing radiation, in the mass-casualty scenario after a nuclear detonation or radiological accidents. This work provides a description of the military medical operations as well as the radiation facilities and capabilities present at AFRRI, followed by a review and discussion of each of the research areas.
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Affiliation(s)
| | | | | | - Lynnette Cary
- Scientific Research Department.,Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Catherine M Davis
- Scientific Research Department.,Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Sanchita P Ghosh
- Scientific Research Department.,Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Gregory P Holmes-Hampton
- Scientific Research Department.,Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Sergey Iordanskiy
- Scientific Research Department.,Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Juliann G Kiang
- Scientific Research Department.,Medicine.,Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | | | | | | | - David A Schauer
- Radiation Sciences Department, Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Vijay K Singh
- Scientific Research Department.,Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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5
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Giovanetti A, Marconi R, Awad N, Abuzied H, Agamy N, Barakat M, Bartoleschi C, Bossi G, Canfora M, Elsaid AA, Ioannilli L, Ismail HM, Issa YA, Novelli F, Pardini MC, Pioli C, Pinnarò P, Sanguineti G, Tahoun MM, Turchi R, Strigari L. Validation of a biomarker tool capable of measuring the absorbed dose soon after exposure to ionizing radiation. Sci Rep 2021; 11:8118. [PMID: 33854097 PMCID: PMC8047015 DOI: 10.1038/s41598-021-87173-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 03/19/2021] [Indexed: 01/17/2023] Open
Abstract
A radiological or nuclear attack could involve such a large number of subjects as to overwhelm the emergency facilities in charge. Resources should therefore be focused on those subjects needing immediate medical attention and care. In such a scenario, for the triage management by first responders, it is necessary to count on efficient biological dosimetry tools capable of early detection of the absorbed dose. At present the validated assays for measuring the absorbed dose are dicentric chromosomes and micronuclei counts, which require more than 2–3 days to obtain results. To overcome this limitation the NATO SPS Programme funded an Italian–Egyptian collaborative project aimed at validating a fast, accurate and feasible tool for assessing the absorbed dose early after radiation exposure. Biomarkers as complete blood cell counts, DNA breaks and radio-inducible proteins were investigated on blood samples collected before and 3 h after the first fraction of radiotherapy in patients treated in specific target areas with doses/fraction of about: 2, 3.5 or > 5 Gy and compared with the reference micronuclei count. Based on univariate and multivariate multiple linear regression correlation, our results identify five early biomarkers potentially useful for detecting the extent of the absorbed dose 3 h after the exposure.
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Affiliation(s)
- Anna Giovanetti
- Division of Health Protection Technologies, ENEA-Italian National Agency for New Technologies, Energy and Sustainable Economic Development, 00123, Rome, Italy.
| | - Raffaella Marconi
- Scientific Direction, National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, 00149, Rome, Italy
| | - Noha Awad
- Epidemiology Department, High Institute of Public Health, Alexandria University, Alexandria, 21561, Egypt
| | - Hala Abuzied
- Alexandria University Cancer Research Cluster, Alexandria, 21561, Egypt
| | - Neveen Agamy
- Nutrition Department, High Institute of Public Health, Alexandria University, Alexandria, 21561, Egypt
| | - Mohamed Barakat
- Alexandria University Cancer Research Cluster, Alexandria, 21561, Egypt
| | - Cecilia Bartoleschi
- Division of Health Protection Technologies, ENEA-Italian National Agency for New Technologies, Energy and Sustainable Economic Development, 00123, Rome, Italy
| | - Gianluca Bossi
- Oncogenomic and Epigenetic Unit, Department of Diagnostic Research and Technological Innovation, IRCCS - Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Marco Canfora
- Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Amr A Elsaid
- Oncology Department, Faculty of Medicine, Alexandria University, Alexandria, 21561, Egypt
| | - Laura Ioannilli
- Department of Biology, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Horeya M Ismail
- Alexandria University Cancer Research Cluster, Alexandria, 21561, Egypt
| | - Yasmine Amr Issa
- Medical Biochemistry Department, Faculty of Medicine, University of Alexandria, Alexandria, 21561, Egypt
| | - Flavia Novelli
- Division of Health Protection Technologies, ENEA-Italian National Agency for New Technologies, Energy and Sustainable Economic Development, 00123, Rome, Italy
| | - Maria Chiara Pardini
- Division of Health Protection Technologies, ENEA-Italian National Agency for New Technologies, Energy and Sustainable Economic Development, 00123, Rome, Italy
| | - Claudio Pioli
- Division of Health Protection Technologies, ENEA-Italian National Agency for New Technologies, Energy and Sustainable Economic Development, 00123, Rome, Italy
| | - Paola Pinnarò
- Departments of Radiation Oncology, IRCCS - Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Giuseppe Sanguineti
- Departments of Radiation Oncology, IRCCS - Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Mohamed M Tahoun
- Epidemiology Department, High Institute of Public Health, Alexandria University, Alexandria, 21561, Egypt
| | - Riccardo Turchi
- Department of Biology, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Lidia Strigari
- IRCCS Azienda Ospedaliera Universitaria di Bologna, 40138, Bologna, Italy
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6
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Port M, Haupt J, Ostheim P, Majewski M, Combs SE, Atkinson M, Abend M. Software Tools for the Evaluation of Clinical Signs and Symptoms in the Medical Management of Acute Radiation Syndrome-A Five-year Experience. HEALTH PHYSICS 2021; 120:400-409. [PMID: 33315652 DOI: 10.1097/hp.0000000000001353] [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
A suite of software tools has been developed for dose estimation (BAT, WinFRAT) and prediction of acute health effects (WinFRAT, H-Module) using clinical symptoms and/or changes in blood cell counts. We constructed a database of 191 ARS cases using the METREPOL (n = 167) and the SEARCH-database (n = 24). The cases ranged from unexposed (RC0), to mild (RC1), moderate (RC2), severe (RC3), and lethal ARS (RC4). From 2015-2019, radiobiology students and participants of two NATO meetings predicted clinical outcomes (RC, H-ARS, and hospitalization) based on clinical symptoms. We evaluated the prediction outcomes using the same input datasets with a total of 32 teams and 94 participants. We found that: (1) unexposed (RC0) and mildly exposed individuals (RC1) could not be discriminated; (2) the severity of RC2 and RC3 were systematically overestimated, but almost all lethal cases (RC4) were correctly predicted; (3) introducing a prior education component for non-physicians significantly increased the correct predictions of RC, ARS, and hospitalization by around 10% (p<0.005) with a threefold reduction in variance and a halving of the evaluation time per case; (4) correct outcome prediction was independent of the software tools used; and (5) comparing the dose estimates generated by the teams with H-ARS severity reflected known limitations of dose alone as a surrogate for H-ARS severity. We found inexperienced personnel can use software tools to make accurate diagnostic and treatment recommendations with up to 98% accuracy. Educational training improved the quality of decision making and enabled participants lacking a medical background to perform comparably to experts.
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Affiliation(s)
- Matthias Port
- Bundeswehr Institute of Radiobiology affiliated to the University Ulm, Neuherbergstraße 11, 80937, Munich, Germany
| | - Julian Haupt
- Bundeswehr Institute of Radiobiology affiliated to the University Ulm, Neuherbergstraße 11, 80937, Munich, Germany
| | - Patrick Ostheim
- Bundeswehr Institute of Radiobiology affiliated to the University Ulm, Neuherbergstraße 11, 80937, Munich, Germany
| | | | | | - Mike Atkinson
- Department of Radiation Sciences (DRS), Institute of Radiation Biology, Helmholtz Zentrum München, Oberschleißheim, Germany
| | - Michael Abend
- Bundeswehr Institute of Radiobiology affiliated to the University Ulm, Neuherbergstraße 11, 80937, Munich, Germany
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Shuryak I, Ghandhi SA, Turner HC, Weber W, Melo D, Amundson SA, Brenner DJ. Dose and Dose-Rate Effects in a Mouse Model of Internal Exposure from 137Cs. Part 2: Integration of Gamma-H2AX and Gene Expression Biomarkers for Retrospective Radiation Biodosimetry. Radiat Res 2020; 196:491-500. [PMID: 33064820 PMCID: PMC8944909 DOI: 10.1667/rade-20-00042.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 08/13/2020] [Indexed: 11/03/2022]
Abstract
Inhalation and ingestion of 137Cs and other long-lived radionuclides can occur after large-scale accidental or malicious radioactive contamination incidents, resulting in a complex temporal pattern of radiation dose/dose rate, influenced by radionuclide pharmacokinetics and chemical properties. High-throughput radiation biodosimetry techniques for such internal exposure are needed to assess potential risks of short-term toxicity and delayed effects (e.g., carcinogenesis) for exposed individuals. Previously, we used γ-H2AX to reconstruct injected 137Cs activity in experimentally-exposed mice, and converted activity values into radiation doses based on time since injection and 137Cs-elimination kinetics. In the current study, we sought to assess the feasibility and possible advantages of combining γ-H2AX with transcriptomics to improve 137Cs activity reconstructions. We selected five genes (Atf5, Hist2h2aa2, Olfr358, Psrc1, Hist2h2ac) with strong statistically-significant Spearman's correlations with injected activity and stable expression over time after 137Cs injection. The geometric mean of log-transformed signals of these five genes, combined with γ-H2AX fluorescence, were used as predictors in a nonlinear model for reconstructing injected 137Cs activity. The coefficient of determination (R2) comparing actual and reconstructed activities was 0.91 and root mean squared error (RMSE) was 0.95 MBq. These metrics remained stable when the model was fitted to a randomly-selected half of the data and tested on the other half, repeated 100 times. Model performance was significantly better when compared to our previous analysis using γ-H2AX alone, and when compared to an analysis where genes are used without γ-H2AX, suggesting that integrating γ-H2AX with gene expression provides an important advantage. Our findings show a proof of principle that integration of radiation-responsive biomarkers from different fields is promising for radiation biodosimetry of internal emitters.
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Affiliation(s)
- Igor Shuryak
- Center for Radiological Research, Columbia University Irving Medical Center, New York, New York 10032
| | - Shanaz A. Ghandhi
- Center for Radiological Research, Columbia University Irving Medical Center, New York, New York 10032
| | - Helen C. Turner
- Center for Radiological Research, Columbia University Irving Medical Center, New York, New York 10032
| | - Waylon Weber
- Lovelace Biomedical, Albuquerque, New Mexico, 87108
| | | | - Sally A. Amundson
- Center for Radiological Research, Columbia University Irving Medical Center, New York, New York 10032
| | - David J. Brenner
- Center for Radiological Research, Columbia University Irving Medical Center, New York, New York 10032
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Bryden DW, Tilghman JI, Hinds SR. Blast-Related Traumatic Brain Injury: Current Concepts and Research Considerations. J Exp Neurosci 2019; 13:1179069519872213. [PMID: 31548796 PMCID: PMC6743194 DOI: 10.1177/1179069519872213] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/02/2019] [Indexed: 01/12/2023] Open
Abstract
Traumatic brain injury (TBI) is a well-known consequence of participation in activities such as military combat or collision sports. But the wide variability in eliciting circumstances and injury severities makes the study of TBI as a uniform disease state impossible. Military Service members are under additional, unique threats such as exposure to explosive blast and its unique effects on the body. This review is aimed toward TBI researchers, as it covers important concepts and considerations for studying blast-induced head trauma. These include the comparability of blast-induced head trauma to other mechanisms of TBI, whether blast overpressure induces measureable biomarkers, and whether a biodosimeter can link blast exposure to health outcomes, using acute radiation exposure as a corollary. This examination is contextualized by the understanding of concussive events and their psychological effects throughout the past century's wars, as well as the variables that predict sustaining a TBI and those that precipitate or exacerbate psychological conditions. Disclaimer: The views expressed in this article are solely the views of the authors and not those of the Department of Defense Blast Injury Research Coordinating Office, US Army Medical Research and Development Command, US Army Futures Command, US Army, or the Department of Defense.
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Affiliation(s)
- Daniel W Bryden
- Booz Allen Hamilton, contract support to
DoD Blast Injury Research Coordinating Office, US Army Medical Research and
Development Command, Fort Detrick, MD, USA
| | - Jessica I Tilghman
- Booz Allen Hamilton, contract support to
DoD Blast Injury Research Coordinating Office, US Army Medical Research and
Development Command, Fort Detrick, MD, USA
| | - Sidney R Hinds
- DoD Blast Injury Research Coordinating
Office, US Army Medical Research and Development Command, Fort Detrick, MD,
USA
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Port M, Pieper B, Knie T, Dörr H, Ganser A, Graessle D, Meineke V, Abend M. Rapid Prediction of Hematologic Acute Radiation Syndrome in Radiation Injury Patients Using Peripheral Blood Cell Counts. Radiat Res 2017; 188:156-168. [DOI: 10.1667/rr14612.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- M. Port
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - B. Pieper
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - T. Knie
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - H. Dörr
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - A. Ganser
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Germany
| | - D. Graessle
- Bundeswehr Institute of Radiobiology, Munich, Germany
- Radiation Medicine Research Group of the Faculty of Medicine, University of Ulm, Ulm, Germany and World Health Organization Liaison Institute for Radiation Emergency Preparedness, Munich, Germany
| | - V. Meineke
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - M. Abend
- Bundeswehr Institute of Radiobiology, Munich, Germany
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10
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Proposed "Exposure And Symptom Triage" (EAST) Tool to Assess Radiation Exposure After a Nuclear Detonation. Disaster Med Public Health Prep 2017; 12:386-395. [PMID: 29911522 DOI: 10.1017/dmp.2017.86] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTOne of the biggest medical challenges after the detonation of a nuclear device will be implementing a strategy to assess the severity of radiation exposure among survivors and to triage them appropriately. Those found to be at significant risk for radiation injury can be prioritized to receive potentially lifesaving myeloid cytokines and to be evacuated to other communities with intact health care infrastructure prior to the onset of severe complications of bone marrow suppression. Currently, the most efficient and accessible triage method is the use of sequential complete blood counts to assess lymphocyte depletion kinetics that correlate with estimated whole-body dose radiation exposure. However, even this simple test will likely not be available initially on the scale required to assess the at-risk population. Additional variables such as geographic location of exposure, sheltering, and signs and symptoms may be useful for initial sorting. An interdisciplinary working group composed of federal, state, and local public health experts proposes an Exposure And Symptom Triage (EAST) tool combining estimates of exposure from maps with clinical assessments and single lymphocyte counts if available. The proposed tool may help sort survivors efficiently at assembly centers near the damage and fallout zones and enable rapid prioritization for appropriate treatment and transport. (Disaster Med Public Health Preparedness. 2018; 12: 386-395).
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11
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Hu S, Blakely WF, Cucinotta FA. HEMODOSE: A Biodosimetry Tool Based on Multi-type Blood Cell Counts. HEALTH PHYSICS 2015; 109:54-68. [PMID: 26011498 PMCID: PMC4482456 DOI: 10.1097/hp.0000000000000295] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Peripheral blood cell counts are important biomarkers of radiation exposure. In this work, a simplified compartmental modeling approach is applied to simulate the perturbation of the hematopoiesis system in humans after radiation exposure, and HemoDose software is reported to estimate individuals' absorbed doses based on multi-type blood cell counts. Testing with patient data in some historical accidents indicates that either single or serial granulocyte, lymphocyte, leukocyte, and platelet counts after exposure can be robust indicators of the absorbed doses. In addition, such correlation exists not only in the early time window (1 or 2 d) but also in the late phase (up to 4 wk) after exposure, when the four types of cell counts are combined for analysis. These demonstrate the capability of HemoDose as a rapid point-of-care diagnostic or centralized high-throughput assay system for personnel exposed to unintended high doses of radiation, especially in large-scale nuclear/radiological disaster scenarios involving mass casualties.
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Affiliation(s)
- Shaowen Hu
- *Wyle Laboratories, NASA Johnson Space Center, Houston, TX 77058; †Scientific Research Department, Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, MD 20889; ‡University of Nevada, Las Vegas, NV 89154
| | - William F. Blakely
- *Wyle Laboratories, NASA Johnson Space Center, Houston, TX 77058; †Scientific Research Department, Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, MD 20889; ‡University of Nevada, Las Vegas, NV 89154
| | - Francis A. Cucinotta
- *Wyle Laboratories, NASA Johnson Space Center, Houston, TX 77058; †Scientific Research Department, Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, MD 20889; ‡University of Nevada, Las Vegas, NV 89154
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Sullivan JM, Prasanna PGS, Grace MB, Wathen L, Wallace RL, Koerner JF, Coleman CN. Assessment of biodosimetry methods for a mass-casualty radiological incident: medical response and management considerations. HEALTH PHYSICS 2013; 105:540-54. [PMID: 24162058 PMCID: PMC3810609 DOI: 10.1097/hp.0b013e31829cf221] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Following a mass-casualty nuclear disaster, effective medical triage has the potential to save tens of thousands of lives. In order to best use the available scarce resources, there is an urgent need for biodosimetry tools to determine an individual's radiation dose. Initial triage for radiation exposure will include location during the incident, symptoms, and physical examination. Stepwise triage will include point of care assessment of less than or greater than 2 Gy, followed by secondary assessment, possibly with high throughput screening, to further define an individual's dose. Given the multisystem nature of radiation injury, it is unlikely that any single biodosimetry assay can be used as a standalone tool to meet the surge in capacity with the timeliness and accuracy needed. As part of the national preparedness and planning for a nuclear or radiological incident, the authors reviewed the primary literature to determine the capabilities and limitations of a number of biodosimetry assays currently available or under development for use in the initial and secondary triage of patients. Understanding the requirements from a response standpoint and the capability and logistics for the various assays will help inform future biodosimetry technology development and acquisition. Factors considered include: type of sample required, dose detection limit, time interval when the assay is feasible biologically, time for sample preparation and analysis, ease of use, logistical requirements, potential throughput, point-of-care capability, and the ability to support patient diagnosis and treatment within a therapeutically relevant time point.
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Affiliation(s)
- Julie M. Sullivan
- Office of Preparedness and Emergency Operations, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC
- AAAS Science and Technology Policy Fellow, Washington DC
| | - Pataje G. S. Prasanna
- Radia on Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - Marcy B. Grace
- Biomedical Advanced Research & Development Authority, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC
| | - Lynne Wathen
- Biomedical Advanced Research & Development Authority, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC
| | - Rodney L. Wallace
- Biomedical Advanced Research & Development Authority, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC
| | - John F. Koerner
- Office of Preparedness and Emergency Operations, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC
| | - C. Norman Coleman
- Office of Preparedness and Emergency Operations, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC
- Radia on Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
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Romm H, Barnard S, Boulay-Greene H, De Amicis A, De Sanctis S, Franco M, Herodin F, Jones A, Kulka U, Lista F, Martigne P, Moquet J, Oestreicher U, Rothkamm K, Thierens H, Valente M, Vandersickel V, Vral A, Braselmann H, Meineke V, Abend M, Beinke C. Laboratory Intercomparison of the Cytokinesis-Block Micronucleus Assay. Radiat Res 2013; 180:120-8. [DOI: 10.1667/rr3234.1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hu S, Smirnova OA, Cucinotta FA. A biomathematical model of lymphopoiesis following severe radiation accidents--potential use for dose assessment. HEALTH PHYSICS 2012; 102:425-436. [PMID: 22378204 DOI: 10.1097/hp.0b013e318240593d] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A biomathematical model of lymphopoiesis is described and used to analyze the lymphocyte changes observed in the blood of exposed victims in radiation accidents. The coarse-grained architecture of cellular replication and production and implicit cellular regulation mechanisms used in this model make it straightforward to incorporate various radiation conditions. Model simulations with reported absorbed doses as inputs are shown to qualitatively and quantitatively describe a wide range of accidental data in vastly different scenarios. In addition, the absolute lymphocyte counts and the depletion rate constants calculated by this model show good correlation with two widely recognized empirical methods for early dose assessment. This demonstrates the potential to use the biophysical model as an alternative method for the assessment of radiation injury in the case of large-scale radiation disaster. The physiological assumptions underlying the model are also discussed, which may provide a putative mechanism for some biodosimetric tools that use the peripheral blood cell counts as markers of radiation impairment.
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Affiliation(s)
- Shaowen Hu
- Division of Space Life Sciences, Universities Space Research Association, Houston, TX 77058, USA
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