Environmental Advances (Jul 2022)
Diagnostics for radiation injuries in large scale radio-nuclear accidents: Recent developments for a medical-management focused approach
Abstract
During radiological or nuclear scenarios, a few to several tens of thousands of people can be affected. In a situation like that, it is essential identifying unexposed (to avoid absorbance of limited clinical resources), low exposed (not requiring immediate care but in need of surveillance for later developing health effects), and highly exposed individuals who will suffer from life-threatening acute health effects summarized into the acute radiation syndrome/sickness (ARS). An early hospitalization and early treatment will have a high impact on the ARS outcome. Hence, early and high-throughput diagnostics in specialized facilities, as well as point of care diagnostics, are required. Several approaches dealing with the support of medical management are known. Those comprise physical, clinical, and biological dosimetry. None of these approaches alone is ideal, and only a combination will cover different scenarios and different requirements. In this situation, it is useful revisiting the core task - Medical Management of irradiated individuals. Different layers of complexity/challenges have to be considered. They start with radiation exposure followed by radiation-induced biological alterations. These biological changes might convert into useful biomarkers located downstream of the exposure on a time scale closer to the effect (the ARS). As a final layer of complexity, these biomarkers of effect prediction have to be converted into clinically relevant information to facilitate patients’ treatment by clinicians understanding the prediction. The Bundeswehr Institute of Radiobiology (BIR) established two biomarker tools, which seem to integrate radiation exposure and biological processes for predicting clinical outcomes (hematological ARS, H-ARS severity). These tools bridge the gap and provide clinicians with comprehensive information for the treatment of potentially irradiated individuals. We, herein, describe the four layers of complexity and introduce the two tools, namely, the H-Module and a suggested gene expression combination for H-ARS prediction.
