Last week, as tens of thousands of US and South Korean soldiers gathered at a base in Iwakuni, Japan for an annual joint military exercise, North Korea fired four ballistic missiles from Pyongyang into the sea off Japan’s northwest coast. In a world where the US is headed by a Twigger-happy political neophyte and the risk of a Cold War reboot looms larger with each Wikileaks disclosure, this demonstration wasn’t just an empty display of dictatorial propaganda. It was a reminder that the nuclear threat is still alive and well.
But even if you’ve taken a decades-long break from stocking your fallout shelter, the federal government hasn’t. Over the last ten years the US has poured millions of dollars into technologies and treatments it hopes to never have to use, but could, in the event of a nuclear catastrophe. From assays that measure radiation exposure to cell therapies that restore dwindling blood cells to liquid spray skin grafts, government officials are now far better equipped to deal with diagnosing and treating people if the unthinkable were to happen. And the next generation of treatments are being funded right now.
In 2006, the Department of Health and Human Services established the Public Health Emergency Medical Countermeasures Enterprise to coordinate federal solutions to large-scale public health threats, including the nuclear one. Pretty much every agency you can think of is involved---CDC, NIH, FDA, DoD, DHS, USDA, VA, and OEM, among others. But in terms of nuclear countermeasures, three programs nested within HHS do the bulk of the heavy lifting.
The NIH’s National Institute of Allergy and Infectious Disease is the first stop; it runs clinical and preclinical trials for promising technologies. Then there’s the Biomedical Advanced Research and Development Authority---Barda---which is basically a taxpayer-backed investment firm that develops these potential drugs, vaccines, treatments, and supplies and ushers them through FDA approval. Finally there’s Project BioShield, which Barda uses to contract with companies when their products are almost ready, ensuring a national market. To date, the program has acquired 12 products related to a nuclear blast or reactor meltdown, some FDA-approved, some still in late stage development, but all destined for the Strategic National Stockpile, the CDC-managed backup supply of drugs and medical supplies for use in a public health emergency. And each class of products addresses a different part of the threat.
The first is diagnosis. When a person is exposed to high levels of radiation, unpaired electrons careen around their cellular machinery, breaking DNA and causing damage to every organ, including the bone marrow. This means you can’t generate new red blood cells, white blood cells, and platelets, so you can’t fight off infections or coagulate your blood. People usually don’t start feeling the effects of acute radiation syndrome for 24 to 48 hours, but damage to their cells’ DNA starts almost immediately. Which is why you need a reliable diagnostic device; following a nuclear event, people who feel well might actually be in danger, and people who weren’t exposed will want treatment just to be safe.
So using Project BioShield, Barda has acquired two diagnostic devices, known as biodosimeters, to tell the difference. One works by measuring gene expression, the other by visually analyzing cell nuclei. “In the event of a nuclear event, the countermeasures we’ve procured will be precious resources,” says Joe Larsen, acting director of Barda's division of chemical, biological, radiological, and nuclear medical countermeasures. “We’re going to end up with a lot of worried well demanding treatment, and we can only afford to treat people that need it.”
That treatment, at least right now, consists of injections of immune-boosting cytokines, developed for cancer patients to restore depleted white blood cells lost during radiation treatments or chemotherapy. Project BioShield has acquired three such cytokine treatments---but, Larsen notes, they won’t work for about 20 percent of people. For them, the only option will be bone marrow or cord blood transplants, which come with the extra obstacle of having to be matched with a donor. So Barda is now looking for cellular therapies that don’t require any donor matching to their portfolio---a universal treatment. “That could shore up gaps in our initial capability to treat radiation.” And they’ve got at a few promising options coming down the pipeline.
Barda recently signed a $188 million contract to develop a stem cell therapy produced by California-based Cellerant Therapeutics, which restores white blood cells in leukemia patients who've had theirs taken out by chemotherapy. The cells are cryopreserved and shelf-stable, important features for a stockpile item. But the treatment is focused on white blood cells, and radiation exposure doesn't limit itself to the immune system's front-line fighters.
To that end, NIAID is funding clinical trials for a placenta-derived stem cell treatment developed by an Israeli company, Pluristem, that has shown the ability to restore all three blood cell lines---red and white blood cells, as well as platelets---in animal models. Like Cellerant's, the treatment comes cryogenically frozen along with a thawing device to deploy it easily in the field. The cells stay viable on liquid nitrogen inside their canisters, so you don’t have to worry about losing them if the power goes out. From their injection site, the placental stem cells sense stress signals in bone marrow tissues, and send more than 20 signaling molecules to repair and restore their functions. The company isn’t testing efficacy in humans, for obvious reasons. But Pluristem says their animal studies showed close to 100 percent survival rates with the treatment, compared to 30 percent without.
Arik Eisenkraft, who began working on an ARS application for Pluristem’s technology following the Fukushima disaster, isn't surprised that a potential solution to nuclear radiation would come out of a place like Israel. “We live in a world of imminent threats, not theoretical ones,” he said. “Even though we don’t have the same budgets and the same scope of institutes, what we do have is a real sense of urgency.”
Neither Barda nor Pluristem could confirm whether or not a contract is somewhere in their future. But the agency did say it was looking at all the options. And with Barda’s budget cut by $160 million last year and an uncertain future for disaster preparedness funds in a Trump administration, there’s no time like the present for some urgency of their own.
