For patients treated with radiation therapy — and for anyone thinking about preparedness for a radiological or nuclear event — the story of radiation injury doesn’t end when treatment or exposure ends. Some of the most consequential effects show up months or years later, often in organs far from the original target. Understanding, predicting, and eventually intervening in these delayed effects is the driving question behind much of NSL’s work.
What is DEARE?
Delayed Effects of Acute Radiation Exposure (often referred to by the acronym DEARE) describes the injuries that emerge well after the initial acute radiation consequences have resolved. Where acute radiation injury tends to strike fast-turnover tissues like the gut lining and bone marrow within days to weeks, DEARE affects slower-responding organs, such as the heart, lungs, and kidneys. These impacts can take months or years to become clinically apparent. This distinction between clinically apparent and subclinical injury matters: a patient or exposed individual can look recovered by every early measure and still be at risk for organ injury that hasn’t yet declared itself.
The biology of radiation-induced heart injury — and what it means for care
The heart is a textbook example of a late-responding organ. Radiation exposure — whether from cancer treatment involving the chest, or from a radiological emergency — can quietly damage blood vessels over time, setting off a slow buildup of scar tissue (called fibrosis) in the heart muscle itself. Left unchecked, this scarring stiffens the heart and makes it harder to pump effectively. The trouble is that by the time this damage shows up on a standard scan or starts causing symptoms, the window for early intervention has often closed.
That’s the gap NSL is working to close: finding signals in blood and tissue that flag cardiac injury while it’s still developing, not after it’s already caused lasting damage.
Finding those signals: CardioWatch
CardioWatch is NSL’s blood test for radiation-induced heart injury. Rather than relying on a single measurement, it looks at a broad panel of blood-based markers, including metabolites, fats (lipids), and proteins, to catch signs of cardiac damage earlier than conventional tools allow. Developed through an SBIR-funded partnership with Dr. Amrita Cheema’s lab at Georgetown University, the panel is being tested and refined in animal studies, and increasingly in real patients undergoing radiation treatment for cancers in the chest.
Advancing the science through evidence and collaboration
None of this happens in isolation. NSL’s work on DEARE and radiation-induced cardiac disease is built on close collaboration with Georgetown University, Medical College of Wisconsin, University of Arkansas for Medical Sciences, and partners across the preclinical radiation research community. This work that was recently recognized with three accepted abstracts and travel awards at this year’s Radiation Research Society Annual Meeting. Together with a recent publication in iScience characterizing multi-organ effects of neutron radiation exposure, this research is steadily building the evidence base needed to move biomarker-guided cardiac risk prediction from the lab toward real clinical use.
Turning a hidden risk into an early signal
Radiation’s delayed effects have long been difficult to see coming. NSL’s goal is to change that — giving clinicians and researchers a clearer, earlier picture of who is at risk, so that care can be guided by biology rather than by hindsight.