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Surveillance of Depleted Uranium Exposed Gulf War Veterans: Health Effects Observed in an Enlarged “Friendly Fire” Cohort

McDiarmid, Melissa A. MD, MPH; Squibb, Katherine PhD; Engelhardt, Susan RN, MN; Oliver, Marc RN, MPH; Gucer, Patricia PhD; Wilson, P. David PhD; Kane, Robert PhD; Kabat, Michael PhD; Kaup, Bruce MD, MPH; Anderson, Larry PhD; Hoover, Dennis PhD; Brown, Lawrence MD; Jacobson-Kram, David PhD, DABT; Depleted Uranium Follow-Up Program

Journal of Occupational & Environmental Medicine: December 2001 - Volume 43 - Issue 12 - pp 991-1000
Original Articles

To determine clinical health effects in a small group of US Gulf War veterans (n = 50) who were victims of depleted uranium (DU) “friendly fire,” we performed periodic medical surveillance examinations. We obtained urine uranium determinations, clinical laboratory values, reproductive health measures, neurocognitive assessments, and genotoxicity measures. DU-exposed Gulf War veterans with retained metal shrapnel fragments were excreting elevated levels of urine uranium 8 years after their first exposure (range, 0.018 to 39.1 μg/g creatinine for DU-exposed Gulf War veterans with retained fragments vs 0.002 to 0.231 μg/g creatinine in DU exposed but without fragments). The persistence of the elevated urine uranium suggests ongoing mobilization from the DU fragments and results in chronic systemic exposure. Clinical laboratory outcomes, including renal functioning, were essentially normal. Neurocognitive measures showing subtle differences between high and low uranium exposure groups, seen previously, have since diminished. Sister chromatid exchange frequency, a measure of mutation in peripheral lymphocytes, was related to urine uranium level (6.35 sister chromatid exchanges/cell in the high uranium exposure group vs 5.52 sister chromatid exchanges/cell in the low uranium exposure group;P = 0.03). Observed health effects were related to subtle but biologically plausible perturbations in central nervous system function and a general measure of mutagen exposure. The findings related to uranium’s chemical rather than radiologic toxicity. Observations in this group of veterans prompt speculation about the health effects of DU in other exposure scenarios.

From the Department of Veterans Affairs Medical Center, Baltimore (Dr Kane, Dr Kabat, Dr Kaup, Dr Brown, Ms Engelhardt); the Departments of Medicine (Dr McDiarmid, Dr Gucer, Mr Oliver), Epidemiology and Preventive Medicine (Dr Wilson), Psychiatry (Dr Kane, Dr Kabat, Dr Kaup), Pathology (Dr Squibb, Dr Brown), Anatomy, and Neurobiology, and the Program of Human Health and the Environment (Dr Anderson, Dr Hoover), University of Maryland School of Medicine, Baltimore; and BioReliance Corporation, Rockville (Dr Jacobson-Kram).

Address correspondence to: Dr Melissa A. McDiarmid, University of Maryland School of Medicine, 405 W. Redwood Street, Baltimore, MD 21201; mmcdiarm@medicine.umaryland.edu.

This work was supported by the Department of Veterans Affairs which has funded the Depleted Uranium Follow-Up Program at the Veterans Administration Maryland Health Care System/Baltimore Division since 1993.

Informed consent was obtained from all before any assessment activity. All protocols were also administered with approval of the University of Maryland Institutional Review Board.

© 2001 Lippincott Williams & Wilkins, Inc.