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Kiang JG, Cannon G, Singh VK. An Overview of Radiation Countermeasure Development in Radiation Research from 1954 to 2024. Radiat Res 2024; 202:420-431. [PMID: 38964743 PMCID: PMC11385179 DOI: 10.1667/rade-24-00036.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/21/2024] [Indexed: 07/06/2024]
Abstract
Preparation for medical responses to major radiation accidents, further driven by increases in the threat of nuclear warfare, has led to a pressing need to understand the underlying mechanisms of radiation injury (RI) alone or in combination with other trauma (combined injury, CI). The identification of these mechanisms suggests molecules and signaling pathways that can be targeted to develop radiation medical countermeasures. Thus far, the United States Food and Drug Administration (U.S. FDA) has approved seven countermeasures to mitigate hematopoietic acute radiation syndrome (H-ARS), but no drugs are available for prophylaxis and no agents have been approved to combat the other sub-syndromes of ARS, let alone delayed effects of acute radiation exposure or the effects of combined injury. From its inception, Radiation Research has significantly contributed to the understanding of the underlying mechanisms of radiation injury and combined injury, and to the development of radiation medical countermeasures for these indications through the publication of peer-reviewed research and review articles.
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Affiliation(s)
- Juliann G Kiang
- Scientific Research Department, Armed Forces Radiobiology Research Institute
- Department of Pharmacology and Molecular Therapeutics, School of Medicine
- Department of Medicine, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Georgetta Cannon
- Scientific Research Department, Armed Forces Radiobiology Research Institute
| | - Vijay K Singh
- Scientific Research Department, Armed Forces Radiobiology Research Institute
- Department of Pharmacology and Molecular Therapeutics, School of Medicine
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2
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Rios CI, Garcia EE, Hogdahl TS, Homer MJ, Iyer NV, Laney JW, Loelius SG, Satyamitra MM, DiCarlo AL. Radiation and Chemical Program Research for Multi-Utility and Repurposed Countermeasures: A US Department of Health and Human Services Agencies Perspective. Disaster Med Public Health Prep 2024; 18:e35. [PMID: 38384183 PMCID: PMC10948027 DOI: 10.1017/dmp.2023.226] [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: 02/23/2024]
Abstract
Although chemical and radiological agents cause toxicity through different mechanisms, the multiorgan injuries caused by these threats share similarities that convene on the level of basic biological responses. This publication will discuss these areas of convergence and explore "multi-utility" approaches that could be leveraged to address common injury mechanisms underlying actions of chemical and radiological agents in a threat-agnostic manner. In addition, we will provide an overview of the current state of radiological and chemical threat research, discuss the US Government's efforts toward medical preparedness, and identify potential areas for collaboration geared toward enhancing preparedness and response against radiological and chemical threats. We also will discuss previous regulatory experience to provide insight on how to navigate regulatory paths for US Food and Drug Administration (FDA) approval/licensure/clearance for products addressing chemical or radiological/nuclear threats. This publication follows a 2022 trans-agency meeting titled, "Overlapping Science in Radiation and Sulfur Mustard Exposures of Skin and Lung: Consideration of Models, Mechanisms, Organ Systems, and Medical Countermeasures," sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), a part of the National Institutes of Health (NIH). Discussions from this meeting explored the overlapping nature of radiation and chemical injury and spurred increased interest in how preparedness for one threat leads to preparedness for the other. Herein, subject matter experts from the NIAID and the Biomedical Advanced Research and Development Authority (BARDA), a part of the Administration for Strategic Preparedness and Response (ASPR), summarize the knowledge gained from recently funded biomedical research, as well as insights from the 2022 meeting. These topics include identification of common areas for collaboration, potential use of biomarkers of injury to identify injuries caused by both hazards, and common and widely available treatments that could treat damage caused by radiological or chemical threats.
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Affiliation(s)
- Carmen I. Rios
- Radiation and Nuclear Countermeasures Program (RNCP), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), US Department of Health and Human Services (HHS), Washington, DC, USA
| | - Efrain E. Garcia
- Chemical Medical Countermeasures (MCM) Program, Biomedical Advanced Research and Development Authority (BARDA), Administration for Strategic Preparedness and Response (ASPR), Washington, DC, USA
| | - Thomas S. Hogdahl
- Burn/Blast MCM Program, Biomedical Advanced Research and Development Authority (BARDA), Administration for Strategic Preparedness and Response (ASPR), Washington, DC, USA
| | - Mary J. Homer
- Radiological/Nuclear MCM Program, Division of Chemical, Biological, Radiological, and Nuclear Medical Countermeasures, Biomedical Advanced Research and Development Authority (BARDA), Administration for Strategic Preparedness and Response (ASPR), HHS, Washington, DC, USA
| | - Narayan V. Iyer
- Burn/Blast MCM Program, Biomedical Advanced Research and Development Authority (BARDA), Administration for Strategic Preparedness and Response (ASPR), Washington, DC, USA
| | - Judith W. Laney
- Chemical Medical Countermeasures (MCM) Program, Biomedical Advanced Research and Development Authority (BARDA), Administration for Strategic Preparedness and Response (ASPR), Washington, DC, USA
| | - Shannon G. Loelius
- Radiological/Nuclear MCM Program, Division of Chemical, Biological, Radiological, and Nuclear Medical Countermeasures, Biomedical Advanced Research and Development Authority (BARDA), Administration for Strategic Preparedness and Response (ASPR), HHS, Washington, DC, USA
| | - Merriline M. Satyamitra
- Radiation and Nuclear Countermeasures Program (RNCP), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), US Department of Health and Human Services (HHS), Washington, DC, USA
| | - Andrea L. DiCarlo
- Radiation and Nuclear Countermeasures Program (RNCP), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), US Department of Health and Human Services (HHS), Washington, DC, USA
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Ancel L, Gabillot O, Szurewsky C, Granger R, Sache A, Voyer F, Gruel G, Illiano S, Benderitter M, Le Guen B, Souidi M, Benadjaoud MA, Flamant S. microRNA blood signature for localized radiation injury. Sci Rep 2024; 14:2681. [PMID: 38302506 PMCID: PMC10834964 DOI: 10.1038/s41598-024-52258-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024] Open
Abstract
A radiological accident, whether from industrial, medical, or malicious origin, may result in localized exposure to high doses of ionizing radiations, leading to the development of local radiation injury (LRI), that may evolve toward deep ulceration and necrosis of the skin and underlying tissues. Early diagnosis is therefore crucial to facilitate identification and management of LRI victims. Circulating microRNAs (miRNA) have been studied as potential diagnostic biomarkers of several diseases including hematological defects following whole-body irradiation (WBI). This study aims to identify a blood miRNA signature associated with LRI in a preclinical C57BL/6J mouse model of hindlimb irradiation using different 10-MV X-ray doses that lead to injuries of different severities. To this end, we first performed broad-spectrum plasma miRNA profiling, followed by a targeted validation step, on two independent animal cohorts. Using a multivariate sparse partial least square discriminant analysis, we identified a panel of eight circulating miRNAs able to segregate mice according to LRI severity. Interestingly, these miRNAs were previously associated with WBI (miR-150-5p, miR-342-3p, miR-146a-5p), inflammation (miR-18a-5p, miR-148b-3p, miR-532-5p) and skin diseases (miR-139-5p, miR-195-5p). Our results suggest the use of circulating miRNAs as suitable molecular biomarkers for LRI prognosis and diagnosis.
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Affiliation(s)
- Lucie Ancel
- Radiobiology and Regenerative Medicine Research Service, Radiobiology of Accidental Exposure Laboratory, IRSN PSE-SANTE/SERAMED/LRAcc, 31 av de la Division Leclerc, 92260, Fontenay-aux-Roses, France
| | - Olivier Gabillot
- Radiobiology and Regenerative Medicine Research Service, Radiobiology of Accidental Exposure Laboratory, IRSN PSE-SANTE/SERAMED/LRAcc, 31 av de la Division Leclerc, 92260, Fontenay-aux-Roses, France
| | - Chloé Szurewsky
- Radiobiology and Regenerative Medicine Research Service, Radiobiology of Accidental Exposure Laboratory, IRSN PSE-SANTE/SERAMED/LRAcc, 31 av de la Division Leclerc, 92260, Fontenay-aux-Roses, France
| | - Romain Granger
- Ionizing Radiations Biological and Sanitary Effects Research Service, Support Group for Research and Animal Ethic, IRSN PSE-SANTE, Fontenay-aux-Roses, France
| | - Amandine Sache
- Ionizing Radiations Biological and Sanitary Effects Research Service, Support Group for Research and Animal Ethic, IRSN PSE-SANTE, Fontenay-aux-Roses, France
| | - Frédéric Voyer
- Ionizing Radiations Biological and Sanitary Effects Research Service, Support Group for Research and Animal Ethic, IRSN PSE-SANTE, Fontenay-aux-Roses, France
| | - Gaëtan Gruel
- Radiobiology and Regenerative Medicine Research Service, Radiobiology of Accidental Exposure Laboratory, IRSN PSE-SANTE/SERAMED/LRAcc, 31 av de la Division Leclerc, 92260, Fontenay-aux-Roses, France
| | - Stéphane Illiano
- Radiobiology and Regenerative Medicine Research Service, IRSN PSE-SANTE, Fontenay-aux-Roses, France
| | - Marc Benderitter
- Radiobiology and Regenerative Medicine Research Service, IRSN PSE-SANTE, Fontenay-aux-Roses, France
| | | | - Maâmar Souidi
- Radiobiology and Regenerative Medicine Research Service, Radiobiology of Accidental Exposure Laboratory, IRSN PSE-SANTE/SERAMED/LRAcc, 31 av de la Division Leclerc, 92260, Fontenay-aux-Roses, France
| | - Mohamed Amine Benadjaoud
- Radiobiology and Regenerative Medicine Research Service, IRSN PSE-SANTE, Fontenay-aux-Roses, France
| | - Stéphane Flamant
- Radiobiology and Regenerative Medicine Research Service, Radiobiology of Accidental Exposure Laboratory, IRSN PSE-SANTE/SERAMED/LRAcc, 31 av de la Division Leclerc, 92260, Fontenay-aux-Roses, France.
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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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Iddins CJ, DiCarlo AL, Ervin MD, Herrera-Reyes E, Goans RE. Cutaneous and local radiation injuries. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:10.1088/1361-6498/ac241a. [PMID: 34488201 PMCID: PMC8785213 DOI: 10.1088/1361-6498/ac241a] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/06/2021] [Indexed: 06/13/2023]
Abstract
The threat of a large-scale radiological or nuclear (R/N) incident looms in the present-day climate, as noted most recently in an editorial in Scientific American (March 2021). These large-scale incidents are infrequent but affect large numbers of people. Smaller-scale R/N incidents occur more often, affecting smaller numbers of people. There is more awareness of acute radiation syndrome (ARS) in the medical community; however, ionising radiation-induced injuries to the skin are much less understood. This article will provide an overview of radiation-induced injuries to the skin, deeper tissues, and organs. The history and nomenclature; types and causes of injuries; pathophysiology; evaluation and diagnosis; current medical management; and current research of the evaluation and management are presented. Cutaneous radiation injuries (CRI) or local radiation injuries (LRI) may lead to cutaneous radiation syndrome, a sub-syndrome of ARS. These injuries may occur from exposure to radioactive particles suspended in the environment (air, soil, water) after a nuclear detonation or an improvised nuclear detonation (IND), a nuclear power plant incident, or an encounter with a radioactive dispersal or exposure device. These incidents may also result in a radiation-combined injury; a chemical, thermal, or traumatic injury, with radiation exposure. Skin injuries from medical diagnostic and therapeutic imaging, medical misadministration of nuclear medicine or radiotherapy, occupational exposures (including research) to radioactive sources are more common but are not the focus of this manuscript. Diagnosis and evaluation of injuries are based on the scenario, clinical picture, and dosimetry, and may be assisted through advanced imaging techniques. Research-based multidisciplinary therapies, both in the laboratory and clinical trial environments, hold promise for future medical management. Great progress is being made in recognising the extent of injuries, understanding their pathophysiology, as well as diagnosis and management; however, research gaps still exist.
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Affiliation(s)
- Carol J Iddins
- Radiation Emergency Assistance Center/Training Site (REAC/TS), Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, United States of America
| | - Andrea L DiCarlo
- Radiation and Nuclear Countermeasures Program (RNCP), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States of America
| | - Mark D Ervin
- Radiation Emergency Assistance Center/Training Site (REAC/TS), Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, United States of America
| | | | - Ronald E Goans
- Radiation Emergency Assistance Center/Training Site (REAC/TS), Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, United States of America
- MJW Corporation, Buffalo, NY, United States of America
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Rios CI, DiCarlo AL, Marzella L. Cutaneous Radiation Injuries: Models, Assessment and Treatments. Radiat Res 2020; 194:310-313. [PMID: 32857847 DOI: 10.1667/rade-20-00132.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/11/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Carmen I Rios
- 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
| | - Andrea L DiCarlo
- 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
| | - Libero Marzella
- Division of Imaging and Radiation Medicine, Center for Drug Evaluation and Research, United States Food and Drug Administration (FDA), White Oak, Maryland
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DiCarlo AL, Bandremer AC, Hollingsworth BA, Kasim S, Laniyonu A, Todd NF, Wang SJ, Wertheimer ER, Rios CI. Cutaneous Radiation Injuries: Models, Assessment and Treatments. Radiat Res 2020; 194:315-344. [PMID: 32857831 PMCID: PMC7525796 DOI: 10.1667/rade-20-00120.1] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/11/2020] [Indexed: 12/16/2022]
Abstract
Many cases of human exposures to high-dose radiation have been documented, including individuals exposed during the detonation of atomic bombs in Hiroshima and Nagasaki, nuclear power plant disasters (e.g., Chernobyl), as well as industrial and medical accidents. For many of these exposures, injuries to the skin have been present and have played a significant role in the progression of the injuries and survivability from the radiation exposure. There are also instances of radiation-induced skin complications in routine clinical radiotherapy and radiation diagnostic imaging procedures. In response to the threat of a radiological or nuclear mass casualty incident, 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, including those to the skin. To appropriately assess the severity of radiation-induced skin injuries and determine efficacy of different approaches to mitigate/treat them, it is necessary to develop animal models that appropriately simulate what is seen in humans who have been exposed. In addition, it is important to understand the techniques that are used in other clinical indications (e.g., thermal burns, diabetic ulcers, etc.) to accurately assess the extent of skin injury and progression of healing. For these reasons, the NIAID partnered with two other U.S. Government funding and regulatory agencies, the Biomedical Advanced Research and Development Authority (BARDA) and the Food and Drug Administration (FDA), to identify state-of-the-art methods in assessment of skin injuries, explore animal models to better understand radiation-induced cutaneous damage and investigate treatment approaches. A two-day workshop was convened in May 2019 highlighting talks from 28 subject matter experts across five scientific sessions. This report provides an overview of information that was presented and the subsequent guided discussions.
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Affiliation(s)
- Andrea L. DiCarlo
- 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
| | - Aaron C. Bandremer
- Biomedical Advanced Research and Development Authority (BARDA), Department of Health and Human Services (HHS), Washington, DC
| | - Brynn A. Hollingsworth
- 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
| | - Suhail Kasim
- U.S. Food and Drug Administration (FDA), White Oak, Maryland
| | | | - Nushin F. Todd
- U.S. Food and Drug Administration (FDA), White Oak, Maryland
| | - Sue-Jane Wang
- U.S. Food and Drug Administration (FDA), White Oak, Maryland
| | | | - Carmen I. Rios
- 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
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