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Biochemical approach to prediction of multiple organ dysfunction syndrome

Institut de Radioprotection et de Sûreté Nucléaire, BP 17, F-92262 Fontenay-aux-Roses Cedex, France

Correspondence: Laurence Roy, IRSN/DRPH/SRBE, BP 17, 92262 Fontenay-aux roses Cedex, France. E-mail: Laurence.roy@irsn.fr

Variation in many biological parameters can be directly measured in different tissues following radiation exposure. These biological parameters are a useful complement to the sometimes non-existent clinical symptomatology and to the often incomplete physical reconstruction of the accidental radiation exposure situation. For many years, the scoring of unstable chromosome aberrations in peripheral blood lymphocytes was stated as an accurate reference in cases of acute, whole body and homogeneous irradiation. However, most radiation overexposures are heterogeneous, fractionated or their evaluation delayed. New methods were thus added to the conventional cytogenetic ones to set up a multiparametric panel of biological dosimetry. These methods have been developed in the cytogenetic area (translocations, micronuclei, prematurely condensed chromosomes, Qdr, Dolphin) on circulating lymphocytes as well as on resident cells, in order to assess the dose received locally. The dose itself is not sufficient to predict multiple organ dysfunction syndrome (MODS). In fact, at the level of the organ, biological dosimetric indicators should be complemented by bioindicators of prognosis and diagnosis. Some of these indicators appear promising and are presented here in this paper (Flt-3, citrulline, oxysterols); they refer to either structural or functional alterations. The final purpose should be to establish a cartography of the dose received by various organs and to assess damage as soon as possible to predict MODS leading to eventual multiple organ failure.