Exposure Biomarkers in DoD Deployments

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Exposure Biomarkersin DoD Deployments
Captain Lisa M. May, BSC, USAFR Uniformed
Services University of the Health Sciences Joint
Environmental Surveillance Working Group 26 Apr 00
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Exposure Biomarkersin DoD Deployments

• Shifting Paradigm
• Use of Biomarkers in DoD Deployments
• Project Funding - Grant Application
• Project Description
• Collaborators
• Summary

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Exposure Biomarkersin DoD Deployments

• Kenneth Olden, NIEHS Director,

Human exposure assessment is often the weakest
link in risk assessment. Adverse health
outcome is a function of toxicity and exposure,
both duration and intensity. Environmental
monitoring, which determines whats in air,
soil, food, and water, is not equivalent to
individual exposure.
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Exposure Biomarkersin DoD Deployments

• Paradigm Shift from

Internal Dose
External Dose
Internalization
Release
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Exposure Biomarkersin DoD Deployments

• Traditionally, environmental risk has been
  assessed by chemical residue determination in
  samples of environmental media
• Internalization of a contaminated media, via
  inhalation, ingestion, or dermal absorption,
  results in an internal dose
• Disadvantages Not easy, Bioavailability not
  quantified

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Exposure Biomarkersin DoD Deployments

• Paradigm Shift to

Disease State
Internal Dose
Reversible or Irreversible Alteration
Delivery to Critical Site
Exposure
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Exposure Biomarkersin DoD Deployments

• What are Biomarkers?
• The National Academy of Sciences defines a
  biomarker as a xenobiotically induced alteration
  in cellular or biochemical components or
  processes, structures, or functions that is
  measurable in a biological system or sample.
• Two types Exposure Effect (ATSDR)

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Exposure Biomarkersin DoD Deployments

• What are Exposure Biomarkers?
• Classified as the presence of a xenobiotic
  substance or its metabolite(s) or the product of
  an interaction between a xenobiotic agent and
  some target molecule or cell that is measured
  within a compartment of an organism
• ATSDR, 1994

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Exposure Biomarkersin DoD Deployments

• Biomarker Based Approach
• Chemical residue analysis of tissues from
  biological receptors
• Provides direct measure of toxicant effects in
  the affected species
• Disadvantages
• Cost
• Ethics

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Exposure Biomarkersin DoD Deployments

• Examples of Studies Using Biomarkers
• Operation Ranch Hand (Michalek, 1992)
• Exposure of U.S. Population to Lead (Pirkle,
  1998)
• Serum Dioxin in Relation to Diabetes Mellitus
  (Longnecker, 1999)
• NHANES II Background (Pirkle, 1999)

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Exposure Biomarkersin DoD Deployments

• Hypothesis For Use in DoD Deployments
• Feasible for Pre, During, and Post
• Cost Effective
• Sensitive and Specific
• Concurrent with Environmental Monitoring
• Policy

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Exposure Biomarkersin DoD Deployments

• Project Outline
• Grant Application IRB Approval
• Information Gathering (Aug 00 - Jul 01)
• Literature Review, Site Selection, Questionnaire
• Data Gathering (Aug 01 - Aug 02)
• Pilot Study with CDC, AFIP, AFRRI
• Questionnaire
• Data Analysis (Sep 02 - Jan 03)
• Publications (Jan 03 - Sep 03)

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Exposure Biomarkersin DoD Deployments

• Data Gathering Detail
• CDC
• 100 samples analyzed for VOCs (10 ml blood)
• 50 samples Chemical Weapon Screen (urine)
• AFRRI
• CBRE Database test, Human Blood Counts
• AFIP
• 1000 samples analyzed for Depleted Uranium
• Questionnaire to Assess Troop Demographics and
  Perceptions of Biomarkers

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Exposure Biomarkersin DoD Deployments

• Funding CHPPM, CDC, AFIP, AFRRI
• Grant Proposal to U.S. Army Medical Research and
  Material Command
• Request for Gulf War Illness Research
  Biochemical and Physiological Markers to Assess
  Toxic Chemical Exposures and Health Effects in
  Deployed Military Personnel
• Cost Estimated at 625,000

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Exposure Biomarkersin DoD Deployments

• Collaborators
• AFRRI Dr. William Blakely, PhD
• CHPPM Dr. Jack Heller, PhD
• AFIP Dr. Victor Kalasinsky, PhD
• USUHS Dr. Arthur Lee, LTC, USA, PE, PhD
• CDC Dr. James Pirkle, MD, PhD
• National Center for Environmental Health

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Exposure Biomarkersin DoD Deployments

• Summary
• Shifting Paradigm
• Use of Exposure Biomarkers in DoD Deployments
• Project Funding - Grant Application
• Project Description
• Collaborators

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Exposure Biomarkersin DoD Deployments

• Questions or Potential Collaboration
• Contact Lisa May at (301)-879-5855,
  lmay_at_usuhs.mil
• or LTC Arthur Lee at (301)-295-9776,
  alee_at_usuhs.mil
• Thank You

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Exposure Biomarkersin DoD Deployments

• George Lucier, director of NIEHSs Environmental
  Toxicology Program,

a new paradigm to link human exposure
assessment to disease is crystallizing.