The Gulf War Depleted Uranium Cohort at 20 years

Abstract

During the 1991 GulfWar, U.S. service members were exposed to depleted uranium (DU) through friendly-fire incidents involving DU munitions and vehicles protected by DU armor. Routes of exposure to DU involved inhalation of soluble and insoluble DU oxide particles, wound contamination, and retained embedded DU metal fragments that continue to oxidize in situ and release DU to the systemic circulation. A biennial health surveillance program established for this group of Veterans by the U.S. Department of Veterans Affairs has shown continuously elevated urine DU concentrations in the subset of veterans with embedded fragments for over 20 years. While the 2011 assessment was comprehensive, few clinically significant U-related health effects were observed. This report is focused on health outcomes associated with two primary target organs of concern for long term effects of this combat-related exposure to DU. Renal biomarkers showed minimal DU-related effects on proximal tubule function and cytotoxicity, but significant biomarker results were observed when urine concentrations of multiple metals also found in fragments were examined together. Pulmonary tests and questionnaire results indicate that pulmonary function after 20 y remains within the clinical normal range. Imaging of DU embedded fragment-associated tissue for signs of inflammatory or proliferative reactions possibly associated with foreign body transformation or with local alpha emissions from DU was also conducted using PET-CT and ultrasound. These imaging tools may be helpful in guiding decisions regarding removal of fragments.

The management of embedded metal fragment patients and the role of chelation Therapy: A workshop of the Department of Veterans Affairs—Walter Reed National Medical Center

“…The radiopaque specks are embedded fragments from the blast 386 | fragment burden. 23,[73][74][75] Although the uU concentrations are several orders of magnitude higher than those of the general population, they fall below acceptable limits set for occupationally uraniumexposed populations. 76 To date, no clinically significant uraniumrelated adverse health effects have been found in the veterans who have an elevated urine uranium concentration compared to veterans in the cohort who do not.…”

“…These fragments possess both radiologic and chemical metal toxicity and the surveillance protocols were designed to assess for both local and systemic health effects. 23 This DU-exposed cohort has been evaluated on a biennial basis at the Baltimore VA Medical Center. The clinical surveillance protocol includes the determination of urine uranium concentrations, used as an exposure metric.…”

“…17,18 Systemic metal exposure has also been documented for many other types of metal ions absorbed from tissue depots of metal fragments, observed in both animals implanted with metal fragments and in DU-exposed veterans. [19][20][21][22][23] This systemic mobilization makes organ systems at a distance from the soft tissue fragment vulnerable to the circulating metal's toxicity.…”

Renal Effects and Carcinogenicity of Occupational Exposure to Uranium: A Meta-Analysis

“…Over the years 2000-2013, McDiarmid et al [ 11 , 12 , 13 , 14 , 15 , 16 , 17 ] published seven different cross-sectional studies of a large cohort of approximately 70 US Gulf War veterans with retained uranium shrapnel fragments. We pooled the results of these seven publications and used it as one clinical study for the biomarker meta-analysis.…”

Toxicity of Metals Released from Implanted Medical Devices

“…acceptable daily intake, reference dose) for the compounds of interest. McDiarmid et al, 2013;Squibb et al, 2012) may be useful for the design of postapproval studies of implanted metallic medical devices. A significant challenge from a risk assessment perspective is to calculate the dose of a metal released from a device, based on data on the concentration of the metal in blood or urine over time.…”