Anecdotal experience with nuclear accident victims has shown that with superior supportive care, individuals may survive the acute radiation syndromes (hematopoietic and gastrointestinal syndromes), but ultimately succumb to respiratory distress due to radiation pneumonitis/fibrosis as a delayed effect. At this time there s no FDA approved treatment for radiation pneumonitis/fibrosis. Therefore, the goal of this project is to finalize the development of a safe, effective, practical, and widely available medical countermeasure to mitigate and/or treat radiation-induced pulmonary injury by utilizing a Nrf2 activator, trifluoromethyl-2'-methoxychalone (TMC) developed at Johns Hopkins University (JHU). The rationale for Nrf2 activator as a medical countermeasure arises from a decade of research demonstrating that augmenting Nrf2 signaling will inhibit oxidative stress, apoptosis, aberrant immune response, and inflammation (the 4 key pathologic processes involved in radiation-induced pulmonary injury) by upregulating a broad spectrum of cytoprotective defenses including nearly all cellular antioxidants. The studies proposed here will be focused on further development of TCM. The objective of this proposal is to bring TMC towards pivotal efficacy studies under GLP guidelines in rodent and non-human primates for Investigational New Drug (IND) application and FDA approval under the Animal Rule. The proposal comprises seven specific Milestones and defines benchmarks for determining their success. Specifically, the studies are designed to determine the maximum tolerated dose (MTD), tissue and plasma PK, establish a pharmacodynamics assay based on the mechanism of the compound, and to define the optimal dose, treatment duration, and window of opportunity for initiation of TMC treatment to optimize therapeutic efficacy and maximally improve survival.

Public Health Relevance

Lung is one of the most vulnerable organs to radiation toxicity. Lung failure might lead to mass casualties after accidental or deliberate radiation exposure. A new drug has been developed to activate an important cell protective molecule, Nrf2, which is key to suppressing the inflammatory processes leading to radiation lung injury. Preliminary studies demonstrate the potential of this new compound to prevent development of lung toxicity when given after lethal radiation exposure. Studies are designed to determine the optimal treatment schedule to achieve maximum effect in lung protection. If successful this will provide a safe and effective deliverable that can be stockpiled and made widely available in the event of a nuclear or radiological attack or accidental radiation exposure.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Research Project--Cooperative Agreements (U01)
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Special Emphasis Panel (ZAI1)
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Dicarlo-Cohen, Andrea L
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University of Maryland Baltimore
Schools of Medicine
United States
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Antonic, Vlado; Jackson, Isabel L; Ganga, Gurung et al. (2017) Development of A Novel Murine Model of Combined Radiation and Peripheral Tissue Trauma Injuries. Radiat Res 187:241-250
Kim, Jung-Hyun; Thimmulappa, Rajesh K; Kumar, Vineet et al. (2014) NRF2-mediated Notch pathway activation enhances hematopoietic reconstitution following myelosuppressive radiation. J Clin Invest 124:730-41