MCW Center for Medical Countermeasures against Radiation

Before September 11, 2001, most of us didn't spend much time brooding over dirty bombs, weapons of mass destruction, or the fine points of preparing anthrax spores to infect the greatest number of people.

But some individuals have worked behind the scenes for years - in research laboratories, academic institutions, hospitals, government agencies, and privately-owned corporations - to find the best ways of protecting people in the event of a nuclear, biological, or radiological attack.

At the Medical College of Wisconsin, the studies of three researchers have been brought to the forefront by the search for ways to minimize the health effects of radiation, specifically those to the kidneys, gut, and lungs.

Medical Countermeasures against Radiation
The Medical College was recently selected to receive a five-year, $18.5-million contract from the National Institute of Allergy and Infectious Diseases (NIAID) to establish a Center for Medical Countermeasures against Radiation (CMCR), one of eight such centers being created nationally. These Centers will focus on applied research to develop new products for measuring radiation exposure, to protect against exposure, and to minimize its effects.

"The primary goal of the Centers is to develop new medical products that would be needed in the event of radiation released in a terrorist attack. We are asking the centers to develop biodosimetry products to measure radiation exposure, therapeutics to treat short-term and long-term symptoms of radiation exposure, as well as products that can prevent or mitigate the effects of radiation exposure," says NIAID program officer Narayani Ramakrishnan, PhD.

Each Center will be led by a principal investigator and may include a consortium of other research institutions.

At the Medical College, John Moulder, PhD, Professor of Radiation Oncology, serves as Principal Investigator of the new CMCR and focuses on kidney injury, while Mary Otterson, MD, Professor of Gastrointestinal Surgery, acts as Associate Director of the Center and leads the gut injury project, and Meetha Medhora, PhD, Associate Professor of Pulmonary and Critical Care Medicine, directs the lung project.

Dr. Moulder's investigation in this area began years ago. "I have been studying the biology of radiation-induced tissue injury for decades," he says. "I began this work because such injuries limit the use of radiation to cure cancer, and it is only by understanding the biological basis for the injury that we can hope to prevent it."

Radiological Terrorism Defined
Dr. Moulder describes radiological terrorism as "the use of radioactive material to scare people, to kill people, or to contaminate the environment."

Possible terrorist events involving radiation could include introducing radioactive material into the food or water supply, using dirty bombs that make use of explosives such as dynamite to scatter radioactive materials, bombing or destroying a nuclear facility, or exploding a small nuclear device.

One of the goals of the CMCR program is to provide expertise in case of such a national emergency. Terrorists could use "a stolen radioactive source or nuclear weapon, or stage a physical attack on a nuclear reactor or a radioactive waste depository," says Dr. Moulder. In addition, it is possible to create "a home-made nuclear weapon."

Materials that could be used to create devices for radiological terrorism are abundant. Radioactive substances are used in facilities worldwide for a variety of purposes, notes Dr. Moulder:

• In hospitals, they are used to diagnose diseases and treat cancer
• In medical laboratories, they are used for research
• In nuclear plants, they are used to create and supply power
• In heavy industry, they are used for quality control
• In food and medical facilities, they are used for product sterilization
• In oil exploration, they are used to obtain geological information
• In the military, they are used as weapons and power sources
• In the space program, they are used as power sources

Despite measures being taken to protect these materials from being stolen and used for the wrong purposes, some countries have been less than successful at preventing such an event, says Dr. Moulder: "In this country security precautions for these sources has always been high and it is now getting much higher. In some other countries security has been poor and radioactive material has been stolen."

Cesium-137 is the material considered most likely to be used to create a "dirty bomb," since it is widely available and its particles are the right size for inhalation or ingestion. Everyone is exposed to very small amounts of cesium-137 in soil and water as a result of atmospheric fallout from nuclear reactor waste and accidental releases such as the 1986 incident in Chernobyl. But when cesium-137 enters the body in large amounts, it can result in radiation exposure to the soft tissues, causing both immediate and chronic health consequences.

Short- and Long-Term Health Effects
On the most basic level, radiation affects the human body by disrupting cell structure. "At a lower dose, radiation can mutate cells, which might lead to cancer. If the radiation dose is high enough it can kill cells," explains Dr. Moulder.

"The Medical College CMCR will be focusing on the short- and medium-term (days to months) health crises of those exposed. Cancer will be a risk only if people exposed to radiation survive the first days and months after an incident."

"We are most concerned about the short-term effects of radiation," Dr. Moulder says. "Our work is focused on drugs that can be given after irradiation to prevent or decrease radiation-induced injury to the gut, lung, kidneys and brain."

To this end, the Medical College researchers are working to develop tools for detection of radiation injury and medications or other substances that will mitigate injuries that do occur.

Although it is hoped that the Centers will find valuable methods for preventing and treating radiological injuries that occur under any circumstances, there is no question that the program has its roots in the potential for terrorist attacks in the US.

"The program is a direct result of the 9/11 attacks," says Dr. Moulder. Asked about the likelihood of a radiological attack occurring, he says, "Personally I cannot judge that. Certain people that I have talked to in Washington seem to be surprised that it has not already happened." But "the greatest tool that terrorists have is fear," says Dr. Moulder, and the work of the CMCR is grounded in the hope that its discoveries will eventually be used to promote health, not to prevent terrorist-based injury and death.

Being prepared for any eventuality makes sense, but the prospects for constructive results are a more likely outcome of the current research.

Eileen Early, BA, BSN, RN
HealthLink Editor

This article includes information from the National Institute of Allergy and Infectious Diseases, the US Department of Health and Human Services, and the Centers for Disease Control and Prevention Office of Emergency Preparedness & Response.

For more information on this topic, see Part 2 of this article, Preventing, Mitigating, and Treating Radiological Injuries, appearing in the June 1, 2006 issue of HealthLink.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.