Department of Radiation Oncology, University of Florida, Gainesville, Florida.
School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York.
Radiat Res. 2024 Jul 1;202(1):70-79. doi: 10.1667/RADE-23-00159.1.
Optimal triage biodosimetry would include risk stratification within minutes, and it would provide useful triage despite heterogeneous dosimetry, cytokine therapy, mixed radiation quality, race, and age. For regulatory approval, the U.S. Food and Drug Administration (FDA) Biodosimetry Guidance requires suitability for purpose and a validated species-independent mechanism. Circulating cell-free DNA (cfDNA) concentration assays may provide such triage information. To test this hypothesis, cfDNA concentrations were measured in unprocessed monkey plasma using a branched DNA (bDNA) technique with a laboratory developed test. The cfDNA levels, along with hematopoietic parameters, were measured over a 7-day period in Rhesus macaques receiving total body radiation doses ranging from 1 to 6.5 Gy. Low-dose irradiation (0-2 Gy) was easily distinguished from high-dose whole-body exposures (5.5 and 6.5 Gy). Fold changes in cfDNA in the monkey model were comparable to those measured in a bone marrow transplant patient receiving a supralethal radiation dose, suggesting that the lethal threshold of cfDNA concentrations may be similar across species. Average cfDNA levels were 50 ± 40 ng/mL [±1 standard deviation (SD)] pre-irradiation, 120 ± 13 ng/mL at 1 Gy; 242 ± 71 ng/mL at 2 Gy; 607 ± 54 at 5.5 Gy; and 1585 ± 351 at 6.5 Gy (±1 SD). There was an exponential increase in cfDNA concentration with radiation dose. Comparison of the monkey model with the mouse model and the Guskova model, developed using Chernobyl responder data, further demonstrated correlation across species, supporting a similar mechanism of action. The test is available commercially in a Clinical Laboratory Improvement Amendments (CLIA) ready form in the U.S. and the European Union. The remaining challenges include developing methods for further simplification of specimen processing and assay evaluation, as well as more accurate calibration of the triage category with cfDNA concentration cutoffs.
最佳的分诊生物剂量测定应在数分钟内进行风险分层,并且即使在剂量测定不均匀、细胞因子治疗、混合辐射质量、种族和年龄存在差异的情况下,也能提供有用的分诊信息。为了获得监管部门批准,美国食品和药物管理局(FDA)的生物剂量测定指南要求该方法具有适用性和经过验证的与物种无关的机制。循环无细胞 DNA(cfDNA)浓度测定可能提供这种分诊信息。为了验证这一假设,使用实验室开发的检测方法,使用分支 DNA(bDNA)技术对未经处理的猴血浆中的 cfDNA 浓度进行了测量。在接受范围为 1 至 6.5 Gy 的全身照射的恒河猴中,在 7 天的时间内测量了 cfDNA 水平以及造血参数。低剂量照射(0-2 Gy)与高剂量全身照射(5.5 和 6.5 Gy)容易区分。在猴模型中 cfDNA 的变化倍数与接受超致死剂量辐射的骨髓移植患者测量的结果相似,这表明 cfDNA 浓度的致死阈值在不同物种中可能相似。照射前平均 cfDNA 水平为 50±40ng/mL[±1 标准差(SD)],1 Gy 时为 120±13ng/mL;2 Gy 时为 242±71ng/mL;5.5 Gy 时为 607±54ng/mL;6.5 Gy 时为 1585±351ng/mL(±1 SD)。cfDNA 浓度随辐射剂量呈指数增加。猴模型与小鼠模型和使用切尔诺贝利反应者数据开发的 Guskova 模型的比较进一步证明了种间相关性,支持了相似的作用机制。该检测方法已在美国和欧盟以临床实验室改进修正案(CLIA)就绪形式商业化。目前仍面临的挑战包括开发进一步简化标本处理和检测评估的方法,以及通过 cfDNA 浓度截止值更准确地校准分诊类别。