title: The Gulf War depleted uranium cohort at 20 years: bioassay results and novel approaches to fragment surveillance.
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.
authors: Department of Veterans Affairs Medical Center Baltimore, MD, USA.
authors: Melissa A
authors: MA
authors: McDiarmid
authors: Joanna M
authors: JM
authors: Gaitens
authors: Stella
authors: S
authors: Hines
authors: Richard
authors: R
authors: Breyer
authors: Jade J
authors: JJ
authors: Wong-You-Cheong
authors: Susan M
authors: SM
authors: Engelhardt
authors: Marc
authors: M
authors: Oliver
authors: Patricia
authors: P
authors: Gucer
authors: Robert
authors: R
authors: Kane
authors: Alison
authors: A
authors: Cernich
authors: Bruce
authors: B
authors: Kaup
authors: Dennis
authors: D
authors: Hoover
authors: Anthony A
authors: AA
authors: Gaspari
authors: Juan
authors: J
authors: Liu
authors: Erin
authors: E
authors: Harberts
authors: Lawrence
authors: L
authors: Brown
authors: Jose A
authors: JA
authors: Centeno
authors: Patrick J
authors: PJ
authors: Gray
authors: Hanna
authors: H
authors: Xu
authors: Katherine S
authors: KS
authors: Squibb
mesh_terms: D015415:Biomarkers / Q000652:urine*; D015331:Cohort Studies; D003952:Diagnostic Imaging; D047830:Gulf War; D006801:Humans; D007107:Immune System; D007677:Kidney Function Tests; D008297:Male; D008670:Metals / Q000652:urine*; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D012129:Respiratory Function Tests; D014501:Uranium / Q000633:toxicity* / Q000652:urine; D014728:Veterans
chemical_list: D015415:Biomarkers; D008670:Metals; D014501:Uranium