From the International Journal of Radiation Medicine 2001, 3

							               Consultative Exercise on Radiation Risks of Internal Emitters
                                        (CERRIE)
             ________________________________________________________________________
 th
4 Meeting, June 6 2002                                                                  INFO 4-G
Conference Room 6
DEFRA, Ashdown House
123 Victoria Street
London SW1E 6DE


      Abstracts by Dr Bandazhevsky and Dr Nesterenko on Cs-137 Effects after Chernobyl

1. Attached for the Committee’s information are six abstracts of articles by Dr Bandazhevsky and Dr Nesterenko from
Minsk, Belarus on Cs-137 concentrations, effects and pathologies following the Chernobyl accident. In particular,
attention is drawn to the reported doubling of Cs-137 concentrations in thyroid compared to skeletal muscle tissue,
and the reported sixfold increase in Cs-137 concentrations in thyroid in children compared to adults.

IF/May 21
From the International Journal of Radiation Medicine 2001, 3 (1-2)

INCORPORATED CAESIUM AND CARDIOVASCULAR PATHOLOGY
Bandazhevsky YuJ., Bandazhevskala G. Institute of Radiation Safety, Minsk, Belarus .

Abstract
Incidence of cardiovascular diseases, the first cause of death in Belarus, increases since decades. Where radiocaesium is
omnipresent, new cardiac diseases appeared with hypertension, even in younger subjects. GorAel Medical Institute's
collaborators undertook experimental, anatomo-pathological, and clinical studies on the pathogenesis of these
cardiovascular diseases. 1) Experimental trials. The consequences of 1.17Cs-137 cardiac accumulation were assessed
in rats' fed with contaminated cereals. 63.35 Bq/kg/body-weight and 445.7 Bq/kg/heart were measured 10 days later.
Alkaline phosphatase and CPK decreased, whereas AST increased significantly, reflecting major cardiac metabolic
dysfunction. Histology showed destruction in cardiomyocytes, and other highly differentiated cells, e.g.: kidney, thyroid.
The electron microscopy shows the damages at the mitochondrion level. 2) Patho-morphology and histology: Autopsies
were performed in persons who lived and died in contaminated regions. Average ' 37Cs level was 26.1 Bq - kg' cardiac
muscle in 285 subjects died from sudden-death Cardiac dilatation and congestive heart failure was commonly en-
countered not only in adults but also in young children. Coronary obstruction with ischemic damage of the myocardium
was rare in this group. Histology showed degenerative heart alterations in 98.63 of 285 cases, with atrophic or
hypertrophic cardiomyocytes, loss of striation, myocytolysis, pycnotic nuclei, cell death, with focal cellular accumulation,
and generalised interstitial oedema without infiltrAtions. Other organs showed similar degenerative cellular dystrophy, e.g.:
kidney, responsible for hypertension in several cases, thyroid which interfere also in cardiac function. 3) Clinical findings:
                                                                                                    137
School-children from villages from Grodno, Vetka, Minsk to Gomel areas, with different levels of Cs contamination, had
usually a satisfactory nutritional status. However, many reacted to moderate physical efforts with tachycardia, arrhythmia,
unstable blood pressure, abnormal fatigue. Anorganic systolic murmurs were frequent, in some cases the first cardiac
sound was abnormally soft, the second split. In such children, ECG showed e.g. atrio-ventricular block and repolarisation
anomalies. ECG changes were directly proportional to the measured Cs-137 incorporated in the organism: In adults,
137
   Cs levels of over 20-30 Bq/kg body-weight, reduced the adaptive cardiac response: functional impairment after
moderate stress, such as physical efforts, infectious diseases.

Conclusion: Chronic Cs-137 levels over 30 Bq/kg body weight is often associated with serious cardiovascular diseases. In
children, these changes remain reversible, when uncontaminated food, holidays in clean regions or pectin treatment are
prescribed

Cs-137MEASURES AND PUBLIC HEALTH
Bandazhevsky Yu J., Nesterenko V.B. Institute of Radiation Safety, Minsk, Belarus

Abstract
Chernobyl released enormous quantities of radionuclides in atmosphere, especially 131-I,137-Cs and Sr-90. Cs-137, with
a half-life of 30 years, continues to affect the health of people living in contaminated regions. 15 years after the
catastrophe, it is still incorporated in the organisms with contaminated food, and concentrates in several organs and
systems. At levels of 30-50 Bq/kg body-weight, Cs-137 impairs highly differentiated cells of heart, brain, immune and en-
docrine systems, liver, and kidneys, which has a negative impact on health (Bandazhevsky, 2000). In order to protect
                                                                                                  137
inhabitants of the contaminated regions, it is necessary to measure the level of incorporated Cs-137 in food and in the
organism of individual subjects. This allows to monitor. their health, to evacuate or treat them, and to understand much
better the role of this radionuclide in the pathogenesis under certain pathological conditions. For the last 10 years, Institute
for Radiation Protection *Belrad* has performed more than 94,000 measures of the incorporation level of gamma-emitting
radionuclides, especially Cs-137 in the organism of children and adults, and 320,000 similar measures in food samples.
In villages, contamination of individuals with Cs-137 can vary between negligible and unacceptable, with highly toxic
doses. In the latter cases, medical examinations show functional alterations or anomalies of different organs or systems,
especially the cardiovascular system, with a severity directly proportional to the Cs-137 level measured: Differences in Cs-
137 contamination depend upon eating habits, type of work, age, sex and some other factors. In order to protect those
subjects, precautionary measures must be adapted to each individual case. Human radiometry allows for the timely detec-
tion of persons at risk, the prevention of the worsening of their health. It makes possible to discuss with them the cause of
their constant recontamination, to suggest changes of habits, especially alimentary, to order cures in clean regions, or
treatments with adsorbents. Public health measures should no more be based on theoretical calculations, basing on
average estimations of local or regional contamination. Human radiometry must also complement clinical and laboratory
examinations in those regions, in order to monitor diseases, and learn their pathogenesis and assess the efficacy of the
treatment.


Address : Prof. V.B. Nesterenko Institut de Radioprotection "Belrad" V. Khorushei 31 a ; 220002 Minsk, Belarus
RADIOPROTECTIVE MEASURES FOR THE BELARUSIAN POPULATION AFTER THE CHERNOBYL ACCIDENT
Nesterenko V.B. Institute for Radioprotection "Belrad”, Minsk, Belarus

Abstract
The Institute for Radioprotection “Belrad”, established a strategy to protect the population after the Chernobyl
catastrophe which provoked massive radioactive fallout on 23% of Belarus. 2 million persons, including
500.000 children, still live there. For Belarus, the costs of the catastrophe represent US$235 billion, i.e. 32
1985-annual budget. Long lived radionuclides remain in the upper part of soils; they are recycled in plants
and animals, especially agricultural products, and represent the principal source of radioactive con tamination
of humans through oral contamination. Economic crisis and poverty render the production of clean food for
everyone impossible. This requires specific fertilisation of pastures and fields. Milk -producing cows should
receive adsorbents to avoid Cs-137contaminated milk; a major source of Cs-137 uptake. Belrad's radio-
protective strategy is based on the following range of projects, which were implemented:

             Establishment of a training center for teacher-ecologists for. 911 schools, for the education of
              teachers and children on basic knowledge of individual and collective protection, i.e. of the
              products responsible for human contamination.
             Creation of another training centre within a convalescence centre for teaching parents and chil-
              dren during the course of their treatment.
             Programs of intermittent intakes of food additives containing pectine, which protect t he
              organism from radionuclides and heavy metals.
             Establishment of a network of centres for radioactivity control in food samples, established in
              schools, dispensaries, where the population is taught how to use and cook local products.
             Organization of 15 mobile laboratories with SRH (human radiometry) to measure the
              radionuclide load in children, to monitor the efficiency of protective measures, especially the
              response to pectin intake.
             Establishment of a facility for the production of pectin food additive in Minsk.
             Creation of international centre of international projects on monitoring, radiation and medical
              diagnostics of children.

NGOs from Ireland, Germany, Austria, Norway, Switzerland, Italy, Belgium, France and the USA participate
in those projects, confirming the validity of the protective measures set up by “Belrad”, to reduce radio-
contamination in children.

MONITORING OF CAESIUM CONTAMINATION IN CHILDREN OF BELARUS AFTER CHERNOBYL.
RADIOPROTECTION WITH PECTIN
Nesterenko V.B., Babenko VJ., Erkovitch TV., Derfugo VA., Babenko I.V., Nesterenko I.E. Institute for
Radioprotection ”Belrad”, Minsk, Belarus

Abstract
Spectrometry of Human Radiation (SHR) is used in Russia and in Western countries. The Institute for
Radioprotection <Belrad> selected the SHR <Skrinner-3Wof the Institute of Human Ecology in Ukraine, which
is highly sensitive, well adapted for field studies and not too ex pensive to equip its mobile monitoring teams in
contaminated regions of Belarus. The Institute <Belrad> established an international project to measure with
SHR the Cs-137load in the organism of children and to monitor this contamination after holidays in foreign
countries or in other Belarus regions where pectin as food additive and other preventive measures were
taken. This programme was presented for the first time in the European Parliament on the 17th April, 1996 in
Strasbourg at the conference on the Consequences of Chernobyl on the Belarus po pulation. Since 1996, 7
mobile laboratories with SHR plus gamma-spectometry are being used to assess the contamination of people
and food. The spectrometers were built by <Belrad> as part of an international project with support from
NGOs in Ireland, Germany, Norway and the USA. In 1999, as part of an international project with an Austrian
NGO, 1000 children received 3 to 4 cures per year of pectin food additives. The Cs -137 load was measured
before and after the pectin intake in several villages: Beliavka , Doublin, Kirov, Demidov, Polessie in the
Gomel region, Sivitza in the Minsk region, as well as in children from Gomel, Mozir, and Svetlogorsk. Pec tin
tablets were easily accepted and well tolerated. With food additives containing pectin for 4 weeks the reduc-
tion of the Cs-137 load was 61% in Beliaevka, 59% in Doublin, 46% in Kirov, 36% in Demidov, 50% in
Polessie, 83% in Sivitsa. The average Cs-137 levels measured dropped from 108.4 Bq per kg down to 18.6
Bq per kg body weight at the end of the year. The results of our SHR measurements show that 3 to 4 one-
month per year cures with a food additive containing pectin, reduce the whole body caesium load by a factor 2
to 3 in children.


Address : Prof. V.B. Nesterenko Institut de Radioprotection "Belrad" V. Khorushei 31 a ; 220002 Minsk, Belarus
INCORPORATED Cs-137 AND PATHOLOGY OF THE THYROID GLAND
Bandazhevsky Yu.l. Institute of Radiation Safety, Minsk, Belarus

Abstract
The incidence of thyroid diseases has increased after the Chernobyl catastrophe. It is generally.accepted that the
enormous release of 131-I, a short-lived radionuclide, had a determinant role for initiating such a processes. It
                                                       137
appears to be necessary to investigate the role of        Cs, a long-lived (30 years) omnipresent radionuclide, in the
pathogenesis of auto-immune and neoplastic processes of the thyroid. Researchers of the Gomel Medical Institute
            137
measured Cs content of thyroid glands, muscle and spleen of 52 children born after the Chernobyl accident and 71
adults living in the contaminated regions. No thyroid disease was detected before death in these subjects. Post-
mortem histology of all thyroid glands was undertaken. In children, the average 137-Cs load in the thyroid gland
                                  -
reached 2,053.7±288.3 Bq • kg ' compared to 373.9 ± 53.7 Bq • kg ' in adults. These values were much higher than
                                                                                                               -
those measured in the skeletal muscle: 901.9±237.7 Bq per kg in children compared to 19.5 ±32.3 Bq • kg ' in adults.
The thyroid concentrates significantly more 137-Cs than muscle. Histological examination of all thyroids showed
dystrophy, necrosis of follicular cells, the connective tissue around the follicles showed infiltration with lymphocytes
and histiocytes, with vascular changes, spotty fibrosis or diffuse sclerosis. Those important alterations may contribute
                                                                  137
to functional disorders, neoplasms and autoimmune reactions. Cs in the epithelial cells alters metabolic processes,
especially at mitochondrion level, inducing dystrophy and necrosis of these highly differentiated cells, and reduced
secretion. This radionuclide also alters the DNA of the thyroid cells, precipitating evolution toward neoplasm, in cells
altered with I-131, with inhibiting repair mechanisms. The largest T-lymphocytes reservoir, the spleen had very high
           37
average 1 -Cs, concentrations: 608.2±109.1 Bq per kg spleen in children and 195.5 ± 24.7 Bq per kg in adults. T-
Lymphocytes are not homogeneously affected with gamma rays: the suppressor T-lymphocytes are the most
susceptible. The loss of suppressor T-lymphocytes favours auto-immune reactions to thyroid antigens, released from
137-Cs damaged cells; the risk of autoimmune thyroiditis increases. Thus, incorporated 137-Cs contributes to the
pathogenesis of auto-immune and neoplastic thyroid diseases, in patients affected with Chernobyl fallout, even in
children born some years later the massive fallout of radioactive isotopes of iodine.
                                           -
Average 137-Cs concentrations (Bq • kg ') in post-mortem tissues in Belarus
                                                 Children                                       Adult
thyroid                                        2,053.7±288.3                                 373.9 ± 53.7
muscle                                          901.9±237.7                                   19.5 ±32.3
spleen                                          608.2±109.1                                  195.5 ± 24.7


RADIOCAESIUM AND CONGENITAL MALFORMATIONS
Bandazhevsky Yu.l. Institute of Radiation Safety, Minsk, Belarus

Abstract
After Chernobyl, the incidence of congenital malformations increased: those of the central nervous system, heart,
face, limbs and fingers increased in Belarus. This increase was significantly higher in the more than in the less
contaminated zones (Botshkov et al. 1996). Clinical and experimental work performed by the research teams at the
Medical Institute in Gomel showed the negative impact of even low levels of incorporated 137-Cs on the human
organism. Levels of 137-Cs above 50 Bq • kg' body-weight impair the cellular metabolism, especially the synthesis of
proteins. This occurs also during pregnancy, with high levels of incorporated 137-Cs in the maternal organism.
Foetuses with central nervous system malformations show higher average levels of 137-Cs in the placenta compared
                                                 137
with foetuses with other deformities. Levels of     Cs, superior to 200 Bq per kg body-weight induce hormonal
disorders in mother and foetus, with imbalances of thyroid, sex and adrenal hormones: cortisone values triple. In
addition to these findings, laboratory experiments were conducted in pregnant Syrian hamsters, a species with a
short gestation period. The hamster genome has similarities to the human genome. It has also a predisposition to
multifactorial congenital malformations.
                                                   -
Method: 1 ml of pure Cs-137 solution (100 Bq • ml ') was injected intraperitoneally on days 6 and 8 of pregnancy. The
control group received likewise 1 ml of physiological saline solution.
                                      137
Results: On day 10, the average Cs level was of 246±20.1 Bq•kg' body weight in the treated females, compared
with 12.4±1.7 Bq•kg' in the controls. The cereals of standard feed are not totally free of Cs-137 in Gomel. Foetuses
were examined for congenital deformities on day 15, i.e. shortly before birth. 137-Cs levels of more than 200 Bq • kg'
body-weight in females induce either teratogenic or even embryolethal effects (death of all foetuses of a female).
59% of the surviving foetuses in the 137-Cs treated group show malformations of multifactorial origin, compared with
20% in the control group, which shows in any case no total embryolethal effect at all. These differences are
statistically significant. Our results show the role of Cs-137 for the pathogenesis of congenital malformations, in the
presence of a genetic predisposition.

Address : Prof. V.B. Nesterenko Institut de Radioprotection "Belrad" V. Khorushei 31 a ; 220002 Minsk, Belarus