DiCarlo Andrea L, Tamarat Radia, Rios Carmen I, Benderitter Marc, Czarniecki Christine W, Allio Theresa C, Macchiarini Francesca, Maidment Bert W, Jourdain Jean-Rene
a 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.
b Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Fontenay-aux-Roses, France.
Radiat Res. 2017 Aug;188(2):e54-e75. doi: 10.1667/RR14810.1. Epub 2017 Jun 12.
In recent years, there has been increasing concern over the possibility of a radiological or nuclear incident occurring somewhere in the world. Intelligence agencies frequently report that terrorist groups and rogue nations are seeking to obtain radiological or nuclear weapons of mass destruction. In addition, there exists the real possibility that safety of nuclear power reactors could be compromised by natural (such as the tsunami and subsequent Fukushima accident in Japan in March, 2011) or accidental (Three Mile Island, 1979 and Chernobyl, 1986) events. Although progress has been made by governments around the world to prepare for these events, including the stockpiling of radiation countermeasures, there are still challenges concerning care of patients injured during a radiation incident. Because the deleterious and pathological effects of radiation are so broad, it is desirable to identify medical countermeasures that can have a beneficial impact on several tissues and organ systems. Cellular therapies have the potential to impact recovery and tissue/organ regeneration for both early and late complications of radiation exposure. These therapies, which could include stem or blood progenitor cells, mesenchymal stromal cells (MSCs) or cells derived from other tissues (e.g., endothelium or placenta), have shown great promise in treating other nonradiation injuries to and diseases of the bone marrow, skin, gastrointestinal tract, brain, lung and heart. To explore the potential use of these therapies in the treatment of victims after acute radiation exposure, the National Institute of Allergy and Infectious Diseases co-sponsored an international workshop in July, 2015 in Paris, France with the Institut de Radioprotection et de Sûreté Nucléaire. The workshop included discussions of data available from testing in preclinical models of radiation injury to different organs, logistics associated with the practical use of cellular therapies for a mass casualty incident, as well as international regulatory requirements for authorizing such drug products to be legally and readily used in such incidents. This report reviews the data presented, as well as key discussion points from the meeting.
近年来，全球各地对发生放射性或核事故的可能性日益关注。情报机构经常报告称，恐怖组织和流氓国家正试图获取放射性或核武器等大规模杀伤性武器。此外，核电反应堆的安全确实有可能因自然事件（如2011年3月日本的海啸及随后的福岛事故）或意外事件（1979年的三里岛事故和1986年的切尔诺贝利事故）而受到影响。尽管世界各国政府在为应对这些事件做准备方面取得了进展，包括储备辐射应对措施，但在辐射事故中受伤患者的救治方面仍存在挑战。由于辐射的有害和病理影响范围广泛，因此需要确定能够对多个组织和器官系统产生有益影响的医学应对措施。细胞疗法有可能对辐射暴露的早期和晚期并发症的恢复以及组织/器官再生产生影响。这些疗法可能包括干细胞或血液祖细胞、间充质基质细胞（MSC）或源自其他组织（如内皮或胎盘）的细胞，在治疗骨髓、皮肤、胃肠道、脑、肺和心脏的其他非辐射性损伤及疾病方面已显示出巨大潜力。为了探索这些疗法在急性辐射暴露后受害者治疗中的潜在用途，美国国立过敏与传染病研究所于2015年7月在法国巴黎与法国辐射防护与核安全研究所共同主办了一次国际研讨会。该研讨会讨论了不同器官辐射损伤临床前模型测试中可得的数据、大规模伤亡事件中细胞疗法实际应用的相关后勤问题，以及授权此类药品在这类事件中合法且可随时使用的国际监管要求。本报告回顾了会上展示的数据以及关键讨论要点。
