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Pappas G, Karantanis W, Ayeni FE, Edirimanne S. Does Prior Breast Irradiation Increase Complications of Subsequent Reduction Surgery in Breast Cancer Patients? A systematic Review and Meta-Analysis. Aesthetic Plast Surg 2024:10.1007/s00266-024-04038-6. [PMID: 38658406 DOI: 10.1007/s00266-024-04038-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 03/28/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Reduction mammoplasty and mastopexy are potentially complicated by prior breast irradiation as part of breast conserving therapy. Associated tissue changes with therapeutic irradiation have led to surgeons deciding the risks may outweigh potential benefit for those patients. A systematic review of the existing literature was performed to explore surgical outcomes of patients undergoing delayed bilateral reduction mammoplasty or mastopexy following unilateral breast irradiation as part of breast conserving therapy. METHODS Medline, PubMed and EMBASE were searched from 1990 to 2023 according to PRISMA guidelines. Studies were combined by the generic inverse variance method on the natural logarithms of rate ratios (RR) using a random effect model in Review manager 5.4.1. RESULTS Fifteen studies reported outcomes in 188 patients who underwent breast reduction (BR) following unilateral breast conserving surgery and radiotherapy. The median age at BR was 51.5 years (range 39-60), and median time since radiotherapy was 48 months (range 11.7-86). We compared outcomes for irradiated breast (IB) versus non-irradiated breast (NIB). Pooled results showed higher rate of major complications in the IB (RR 2.52, 95%CI 0.96-6.63, p=0.06), but not statistically significant. However, rate of minor complications was significantly higher in the IB (RR 3.97 95%CI 1.86-8.50, p<0.0004). Incidence of fat necrosis as a discrete complication was 2× higher in IB (RR 2.14 95%CI 0.85-5.35, p-value 0.10) compared to the NIB, but not significant. CONCLUSION We found breast reduction to be safe with acceptable risk of major complications. However, the overall complication rate remains higher in IB compared to NIB. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- George Pappas
- Department of Surgery, Nepean Hospital, Derby Street, Kingswood, NSW, 2747, Australia
| | - William Karantanis
- Department of Surgery, Nepean Hospital, Derby Street, Kingswood, NSW, 2747, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Femi E Ayeni
- Nepean Institute of Academic Surgery, Nepean Clinical School, The University of Sydney, 62 Derby Street, Kingswood, NSW, 2747, Australia.
| | - Senarath Edirimanne
- Department of Surgery, Nepean Hospital, Derby Street, Kingswood, NSW, 2747, Australia
- Nepean Institute of Academic Surgery, Nepean Clinical School, The University of Sydney, 62 Derby Street, Kingswood, NSW, 2747, Australia
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Kameni LE, Januszyk M, Berry CE, Downer MA, Parker JB, Morgan AG, Valencia C, Griffin M, Li DJ, Liang NE, Momeni A, Longaker MT, Wan DC. A Review of Radiation-Induced Vascular Injury and Clinical Impact. Ann Plast Surg 2024; 92:181-185. [PMID: 37962260 DOI: 10.1097/sap.0000000000003723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
ABSTRACT The number of cancer survivors continues to increase because of advances in therapeutic modalities. Along with surgery and chemotherapy, radiotherapy is a commonly used treatment modality in roughly half of all cancer patients. It is particularly helpful in the oncologic treatment of patients with breast, head and neck, and prostate malignancies. Unfortunately, among patients receiving radiation therapy, long-term sequalae are often unavoidable, and there is accumulating clinical evidence suggesting significant radiation-related damage to the vascular endothelium. Ionizing radiation has been known to cause obliterative fibrosis and increased wall thickness in irradiated blood vessels. Clinically, these vascular changes induced by ionizing radiation can pose unique surgical challenges when operating in radiated fields. Here, we review the relevant literature on radiation-induced vascular damage focusing on mechanisms and signaling pathways involved and highlight microsurgical anastomotic outcomes after radiotherapy. In addition, we briefly comment on potential therapeutic strategies, which may have the ability to mitigate radiation injury to the vascular endothelium.
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Affiliation(s)
- Lionel E Kameni
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA
| | - Michael Januszyk
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA
| | | | - Mauricio A Downer
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA
| | - Jennifer B Parker
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA
| | - Annah G Morgan
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA
| | - Caleb Valencia
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA
| | - Michelle Griffin
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA
| | - Dayan J Li
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA
| | - Norah E Liang
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA
| | - Arash Momeni
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA
| | | | - Derrick C Wan
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA
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Bansal S, Bansal S, Fish BL, Li Y, Xu X, Fernandez JA, Griffin JH, Himburg HA, Boerma M, Medhora M, Cheema AK. Analysis of the urinary metabolic profiles in irradiated rats treated with Activated Protein C (APC), a potential mitigator of radiation toxicity. Int J Radiat Biol 2023; 99:1109-1118. [PMID: 36827630 PMCID: PMC10330346 DOI: 10.1080/09553002.2023.2182001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/13/2023] [Indexed: 02/26/2023]
Abstract
PURPOSE The goal of the current study was to identify longitudinal changes in urinary metabolites following IR exposure and to determine potential alleviation of radiation toxicities by administration of recombinant APC formulations. MATERIALS AND METHODS Female adult WAG/RijCmcr rats were irradiated with 13.0 Gy leg-out partial body X-rays; longitudinally collected urine samples were subject to LC-MS based metabolomic profiling. Sub-cohorts of rats were treated with three variants of recombinant APC namely, rat wildtype (WT) APC, rat 3K3A mutant form of APC, and human WT APC as two bolus injections at 24 and 48 hours post IR. RESULTS Radiation induced robust changes in the urinary profiles leading to oxidative stress, severe dyslipidemia, and altered biosynthesis of PUFAs, glycerophospholipids, sphingolipids, and steroids. Alterations were observed in multiple metabolic pathways related to energy metabolism, nucleotide biosynthesis and metabolism that were indicative of disrupted mitochondrial function and DNA damage. On the other hand, sub-cohorts of rats that were treated with rat wildtype-APC showed alleviation of radiation toxicities, in part, at the 90-day time point, while rat 3K3A-APC showed partial alleviation of radiation induced metabolic alterations 14 days after irradiation. CONCLUSIONS Taken together, these results show that augmenting the Protein C pathway and activity via administration of recombinant APC may be an effective approach for mitigation of radiation induced normal tissue toxicity.
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Affiliation(s)
- Shivani Bansal
- Department of Oncology, Georgetown University Medical Center, Washington DC, USA
| | - Sunil Bansal
- Department of Oncology, Georgetown University Medical Center, Washington DC, USA
| | - Brian L Fish
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Yaoxiang Li
- Department of Oncology, Georgetown University Medical Center, Washington DC, USA
| | - Xiao Xu
- Department of Molecular Medicine, Scripps Research Institute, La Jolla, CA, USA
| | - Jose A Fernandez
- Department of Molecular Medicine, Scripps Research Institute, La Jolla, CA, USA
| | - John H Griffin
- Department of Molecular Medicine, Scripps Research Institute, La Jolla, CA, USA
| | - Heather A Himburg
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Marjan Boerma
- Department of Pharmaceutical Sciences, Division of Radiation Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Meetha Medhora
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Amrita K Cheema
- Department of Oncology, Georgetown University Medical Center, Washington DC, USA
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University Medical Center, Washington DC, USA
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Singh R, Heaps CL, Muthuchamy M, Deveau MA, Stewart RH, Laine GA, Dongaonkar RM. Dichotomous effects of in vivo and in vitro ionizing radiation exposure on lymphatic function. Am J Physiol Heart Circ Physiol 2023; 324:H155-H171. [PMID: 36459446 DOI: 10.1152/ajpheart.00387.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
On the one hand, lymphatic dysfunction induces interstitial edema and inflammation. On the other hand, the formation of edema and inflammation induce lymphatic dysfunction. However, informed by the earlier reports of undetected apoptosis of irradiated lymphatic endothelial cells (LECs) in vivo, lymphatic vessels are commonly considered inconsequential to ionizing radiation (IR)-induced inflammatory injury to normal tissues. Primarily because of the lack of understanding of the acute effects of IR exposure on lymphatic function, acute edema and inflammation, common sequelae of IR exposure, have been ascribed solely to blood vessel damage. Therefore, in the present study, the lymphatic acute responses to IR exposure were quantified to evaluate the hypothesis that IR exposure impairs lymphatic pumping. Rat mesenteric lymphatic vessels were irradiated in vivo or in vitro, and changes in pumping were quantified in isolated vessels in vitro. Compared with sham-treated vessels, pumping was lowered in lymphatic vessels irradiated in vivo but increased in vessels irradiated in vitro. Furthermore, unlike in blood vessels, the acute effects of IR exposure in lymphatic vessels were not mediated by nitric oxide-dependent pathways in either in vivo or in vitro irradiated vessels. After cyclooxygenase blockade, pumping was partially restored in lymphatic vessels irradiated in vitro but not in vessels irradiated in vivo. Taken together, these findings demonstrated that lymphatic vessels are radiosensitive and LEC apoptosis alone may not account for all the effects of IR exposure on the lymphatic system.NEW & NOTEWORTHY Earlier studies leading to the common belief that lymphatic vessels are radioresistant either did not characterize lymphatic pumping, deemed necessary for the resolution of edema and inflammation, or did it in vivo. By characterizing pumping in vitro, the present study, for the first time, demonstrated that lymphatic pumping was impaired in vessels irradiated in vivo and enhanced in vessels irradiated in vitro. Furthermore, the pathways implicated in ionizing radiation-induced blood vessel damage did not mediate lymphatic responses.
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Affiliation(s)
- Reetu Singh
- Michael E. DeBakey Institute for Comparative Cardiovascular Science and Biomedical Devices, Department of Veterinary Physiology and Pharmacology, Texas A&M University, College Station, Texas
| | - Cristine L Heaps
- Michael E. DeBakey Institute for Comparative Cardiovascular Science and Biomedical Devices, Department of Veterinary Physiology and Pharmacology, Texas A&M University, College Station, Texas
| | | | - Michael A Deveau
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas
| | - Randolph H Stewart
- Michael E. DeBakey Institute for Comparative Cardiovascular Science and Biomedical Devices, Department of Veterinary Physiology and Pharmacology, Texas A&M University, College Station, Texas
| | - Glen A Laine
- Michael E. DeBakey Institute for Comparative Cardiovascular Science and Biomedical Devices, Department of Veterinary Physiology and Pharmacology, Texas A&M University, College Station, Texas
| | - Ranjeet M Dongaonkar
- Michael E. DeBakey Institute for Comparative Cardiovascular Science and Biomedical Devices, Department of Veterinary Physiology and Pharmacology, Texas A&M University, College Station, Texas
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Chopra S, Shankavaram U, Bylicky M, Dalo J, Scott K, Aryankalayil MJ, Coleman CN. Profiling mRNA, miRNA and lncRNA expression changes in endothelial cells in response to increasing doses of ionizing radiation. Sci Rep 2022; 12:19941. [PMID: 36402833 PMCID: PMC9675751 DOI: 10.1038/s41598-022-24051-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 11/09/2022] [Indexed: 11/21/2022] Open
Abstract
Recent and past research have highlighted the importance of the endothelium in the manifestation of radiation injury. Our primary focus is on medical triage and management following whole body or partial-body irradiation. Here we investigated the usability of endothelial cells' radiation response for biodosimetry applications. We profiled the transcriptome in cultured human endothelial cells treated with increasing doses of X-rays. mRNA expression changes were useful 24 h and 72 h post-radiation, microRNA and lncRNA expression changes were useful 72 h after radiation. More mRNA expressions were repressed than induced while more miRNA and lncRNA expressions were induced than repressed. These novel observations imply distinct radiation responsive regulatory mechanisms for coding and non-coding transcripts. It also follows how different RNA species should be explored as biomarkers for different time-points. Radiation-responsive markers which could classify no radiation (i.e., '0 Gy') and dose-differentiating markers were also predicted. IPA analysis showed growth arrest-related processes at 24 h but immune response coordination at the 72 h post-radiation. Collectively, these observations suggest that endothelial cells have a precise dose and time-dependent response to radiation. Further studies in the laboratory are examining if these differences could be captured in the extracellular vesicles released by irradiated endothelial cells.
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Affiliation(s)
- Sunita Chopra
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute (NCI), Bethesda, MD, 20892, USA
| | - Uma Shankavaram
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute (NCI), Bethesda, MD, 20892, USA
| | - Michelle Bylicky
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute (NCI), Bethesda, MD, 20892, USA
| | - Juan Dalo
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute (NCI), Bethesda, MD, 20892, USA
| | - Kevin Scott
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute (NCI), Bethesda, MD, 20892, USA
| | - Molykutty J Aryankalayil
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute (NCI), Bethesda, MD, 20892, USA.
| | - C Norman Coleman
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute (NCI), Bethesda, MD, 20892, USA.
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Liu Y, Li T, Fan Z, Li Y, Sun Z, Li S, Liang Y, Zhou C, Zhu Q, Zhang H, Liu X, Wang L, Wang Y. Image-Based Differentiation of Intracranial Metastasis From Glioblastoma Using Automated Machine Learning. Front Neurosci 2022; 16:855990. [PMID: 35645718 PMCID: PMC9133479 DOI: 10.3389/fnins.2022.855990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/28/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose The majority of solitary brain metastases appear similar to glioblastomas (GBMs) on magnetic resonance imaging (MRI). This study aimed to develop and validate an MRI-based model to differentiate intracranial metastases from GBMs using automated machine learning. Materials and Methods Radiomics features from 354 patients with brain metastases and 354 with GBMs were used to build prediction algorithms based on T2-weighted images, contrast-enhanced (CE) T1-weighted images, or both. The data of these subjects were subjected to a nested 10-fold split in the training and testing groups to build the best algorithms using the tree-based pipeline optimization tool (TPOT). The algorithms were independently validated using data from 124 institutional patients with solitary brain metastases and 103 patients with GBMs from the cancer genome atlas. Results Three groups of models were developed. The average areas under the receiver operating characteristic curve (AUCs) were 0.856 for CE T1-weighted images, 0.976 for T2-weighted images, and 0.988 for a combination in the testing groups, and the AUCs of the groups of models in the independent validation were 0.687, 0.831, and 0.867, respectively. A total of 149 radiomics features were considered as the most valuable features for the differential diagnosis of GBMs and metastases. Conclusion The models established by TPOT can distinguish glioblastoma from solitary brain metastases well, and its non-invasiveness, convenience, and robustness make it potentially useful for clinical applications.
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Affiliation(s)
- Yukun Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tianshi Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ziwen Fan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yiming Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhiyan Sun
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Shaowu Li
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yuchao Liang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chunyao Zhou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qiang Zhu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xing Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Lei Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Lei Wang,
| | - Yinyan Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
- *Correspondence: Yinyan Wang,
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Chen L, Shen Y, Huang X, Li H, Li J, Wei R, Yang W. MRI-Based Radiomics for Differentiating Orbital Cavernous Hemangioma and Orbital Schwannoma. Front Med (Lausanne) 2021; 8:795038. [PMID: 34977096 PMCID: PMC8716692 DOI: 10.3389/fmed.2021.795038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/29/2021] [Indexed: 01/05/2023] Open
Abstract
Aim: The purpose of this work was to develop and evaluate magnetic resonance imaging (MRI)-based radiomics for differentiation of orbital cavernous hemangioma (OCH) and orbital schwannoma (OSC). Methods: Fifty-eight patients (40 OCH and 18 OSC, confirmed pathohistologically) screened out from 216 consecutive patients who presented between 2015 and 2020 were divided into a training group (28 OCH and 12 OSC) and a validation group (12 OCH and 6 OSC). Radiomics features were extracted from T1-weighted imaging (T1WI) and T2-weighted imaging (T2WI). T-tests, the least absolute shrinkage and selection operator (LASSO), and principal components analysis (PCA) were used to select features for use in the classification models. A logistic regression (LR) model, support vector machine (SVM) model, decision tree (DT) model, and random forest (RF) model were constructed to differentiate OCH from OSC. The models were evaluated according to their accuracy and the area under the receiver operator characteristic (ROC) curve (AUC). Results: Six features from T1WI, five features from T2WI, and eight features from combined T1WI and T2WI were finally selected for building the classification models. The models using T2WI features showed superior performance on the validation data than those using T1WI features, especially the LR model and SVM model, which showed accuracy of 93% (85–100%) and 92%, respectively, The SVM model showed high accuracy of 93% (91–96%) on the combined feature group with an AUC of 98% (97–99%). The DT and RF models did not perform as well as the SVM model. Conclusion: Radiomics analysis using an SVM model achieved an accuracy of 93% for distinguishing OCH and OSC, which may be helpful for clinical diagnosis.
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Affiliation(s)
- Liang Chen
- Department of Ophthalmology, Shanghai Changzheng Hospital, Shanghai, China
| | - Ya Shen
- Department of Ophthalmology, Shanghai Changzheng Hospital, Shanghai, China
| | - Xiao Huang
- Department of Ophthalmology, Shanghai Changzheng Hospital, Shanghai, China
| | - Hua Li
- Department of Imaging, Shanghai Changzheng Hospital, Shanghai, China
| | - Jian Li
- Department of Ophthalmology, Shanghai Changzheng Hospital, Shanghai, China
| | - Ruili Wei
- Department of Ophthalmology, Shanghai Changzheng Hospital, Shanghai, China
- *Correspondence: Ruili Wei
| | - Weihua Yang
- Affiliated Eye Hospital, Nanjing Medical University, Nanjing, China
- Weihua Yang
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Therapeutic approach of adipose-derived mesenchymal stem cells in refractory peptic ulcer. Stem Cell Res Ther 2021; 12:515. [PMID: 34565461 PMCID: PMC8474857 DOI: 10.1186/s13287-021-02584-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/04/2021] [Indexed: 12/14/2022] Open
Abstract
Peptic ulcer is one of the most common gastrointestinal tract disorders worldwide, associated with challenges such as refractory morbidity, bleeding, interference with use of anticoagulants, and potential side effects associated with long-term use of proton pump inhibitors. A peptic ulcer is a defect in gastric or duodenal mucosa extending from muscularis mucosa to deeper layers of the stomach wall. In most cases, ulcers respond to standard treatments. However, in some people, peptic ulcer becomes resistant to conventional treatment or recurs after initially successful therapy. Therefore, new and safe treatments, including the use of stem cells, are highly favored for these patients. Adipose-derived mesenchymal stem cells are readily available in large quantities with minimal invasive intervention, and isolation of adipose-derived mesenchymal stromal stem cells (ASC) produces large amounts of stem cells, which are essential for cell-based and restorative therapies. These cells have high flexibility and can differentiate into several types of cells in vitro. This article will investigate the effects and possible mechanisms and signaling pathways of adipose tissue-derived mesenchymal stem cells in patients with refractory peptic ulcers.
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Karri J, Lachman L, Hanania A, Marathe A, Singh M, Zacharias N, Orhurhu V, Gulati A, Abd-Elsayed A. Radiotherapy-Specific Chronic Pain Syndromes in the Cancer Population: An Evidence-Based Narrative Review. Adv Ther 2021; 38:1425-1446. [PMID: 33570737 DOI: 10.1007/s12325-021-01640-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/27/2021] [Indexed: 12/25/2022]
Abstract
While radiation therapy is increasingly utilized in the treatment paradigm of many solid cancers, the chronic effects of radiation therapies are poorly characterized. Notably, understanding radiation-specific chronic pain syndromes is paramount given that the diagnosis and management of these conditions can serve to prevent long-standing functional impairments, optimize quality of life, and even allow for continued radiotherapy candidacy. These radiation-specific chronic pain phenomena include dermatitis, mucositis, enteritis, connective tissue fibrosis, lymphedema, and neuropathic pain syndromes. It is necessary to maintain a low threshold of suspicion for appropriately diagnosing these conditions as there exists a variance in when these symptoms arise after radiation. However, we present key epidemiological data delineating vulnerable cancer populations for each pain syndrome along with the available evidence for the management for each specific condition.
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Affiliation(s)
- Jay Karri
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Laura Lachman
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Alex Hanania
- Department of Radiation Oncology, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Anuj Marathe
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Mani Singh
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons, New York City, NY, USA
| | - Nicholas Zacharias
- Division of Pain Medicine, Department of Anesthesia, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Vwaire Orhurhu
- Division of Pain Medicine, Department of Anesthesia, University of Pittsburgh Medical Center, Susquehanna, Williamsport, PA, USA
| | - Amitabh Gulati
- Division of Pain Medicine, Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Alaa Abd-Elsayed
- Division of Pain Medicine, Department of Anesthesia, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
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Is radiation-induced arteriopathy in long-term breast cancer survivors an underdiagnosed situation?: Critical and pragmatic review of available literature. Radiother Oncol 2021; 157:163-174. [PMID: 33515666 DOI: 10.1016/j.radonc.2021.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 01/01/2021] [Accepted: 01/10/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Although considered exceptional, radiation-induced arteriopathy in long-term breast cancer survivors involves three main arterial domains in the irradiated volume, namely axillary-subclavian, coronary, and carotid. Stenosis of medium-large arteries is caused by "accelerated" atherosclerosis, particularly beyond 10 years after long-forgotten radiotherapy. The present review aims at summarizing what is known about arteriopathy, as well as the state of the art in terms of diagnosis and therapeutic management. DIAGNOSIS Pauci-symptomatic over years, the usual clinical presentation of arteriopathy involves arm pain with coldness due to subacute or critical ischemia (arterial occlusion), wrongly attributed to an exclusive neurological disorder, and more rarely transient ischemic accident or angina. Evaluation of the supra-aortic trunks by computed tomography and/or magnetic resonance angiography visualizes artery lesions, while Doppler ultrasonography in expert hands assesses diagnosis and downstream functional impact. In severe cases, more invasive angiography directly visualizes long irregular arterial stenosis (full-field radiotherapy), allowing accurate prognosis and treatment. MANAGEMENT Requires early diagnosis to enable initiation of medical treatment that increases blood flow (aspirin) as soon as moderate stenosis is detected, combined with correction of vascular risk factors. In intermediate cases, these therapeutic measures are completed by revascularization strategies using transluminal angioplasty-stenting (wall thickness). Antifibrotic treatment is useful in advanced cases with combined radiation injuries. CONCLUSION In follow-up of long-term breast cancer survivors with node irradiation, myocardial infarction is treated even if radiotherapy is forgotten, while recognition and diagnosis of chronic arm ischemia due to subclavian artery stenosis needs to be improved for appropriate therapeutic management.
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Le Fèvre C, Lhermitte B, Ahle G, Chambrelant I, Cebula H, Antoni D, Keller A, Schott R, Thiery A, Constans JM, Noël G. Pseudoprogression versus true progression in glioblastoma patients: A multiapproach literature review: Part 1 - Molecular, morphological and clinical features. Crit Rev Oncol Hematol 2020; 157:103188. [PMID: 33307200 DOI: 10.1016/j.critrevonc.2020.103188] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/12/2020] [Accepted: 11/23/2020] [Indexed: 01/04/2023] Open
Abstract
With new therapeutic protocols, more patients treated for glioblastoma have experienced a suspicious radiologic image of progression (pseudoprogression) during follow-up. Pseudoprogression should be differentiated from true progression because the disease management is completely different. In the case of pseudoprogression, the follow-up continues, and the patient is considered stable. In the case of true progression, a treatment adjustment is necessary. Presently, a pseudoprogression diagnosis certainly needs to be pathologically confirmed. Some important efforts in the radiological, histopathological, and genomic fields have been made to differentiate pseudoprogression from true progression, and the assessment of response criteria exists but remains limited. The aim of this paper is to highlight clinical and pathological markers to differentiate pseudoprogression from true progression through a literature review.
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Affiliation(s)
- Clara Le Fèvre
- Department of Radiotherapy, ICANS, Institut Cancérologie Strasbourg Europe, 17 Rue Albert Calmette, 67200, Strasbourg Cedex, France
| | - Benoît Lhermitte
- Département of Pathology, Hautepierre University Hospital, 1, Avenue Molière, 67200, Strasbourg, France
| | - Guido Ahle
- Departement of Neurology, Hôpitaux Civils de Colmar, 39 Avenue de la Liberté, 68024, Colmar, France
| | - Isabelle Chambrelant
- Department of Radiotherapy, ICANS, Institut Cancérologie Strasbourg Europe, 17 Rue Albert Calmette, 67200, Strasbourg Cedex, France
| | - Hélène Cebula
- Departement of Neurosurgery, Hautepierre University Hospital, 1, Avenue Molière, 67200, Strasbourg, France
| | - Delphine Antoni
- Department of Radiotherapy, ICANS, Institut Cancérologie Strasbourg Europe, 17 Rue Albert Calmette, 67200, Strasbourg Cedex, France
| | - Audrey Keller
- Department of Radiotherapy, ICANS, Institut Cancérologie Strasbourg Europe, 17 Rue Albert Calmette, 67200, Strasbourg Cedex, France
| | - Roland Schott
- Departement of Medical Oncology, ICANS, Institut Cancérologie Strasbourg Europe, 17 rue Albert Calmette, 67200, Strasbourg Cedex, France
| | - Alicia Thiery
- Department of Public Health, ICANS, Institut Cancérologie Strasbourg Europe, 17 rue Albert Calmette, 67200, Strasbourg Cedex, France
| | - Jean-Marc Constans
- Department of Radiology, Amiens-Pïcardie University Hospital, 1 rond point du Professeur Christian Cabrol, 80054 Amiens Cedex 1, France
| | - Georges Noël
- Department of Radiotherapy, ICANS, Institut Cancérologie Strasbourg Europe, 17 Rue Albert Calmette, 67200, Strasbourg Cedex, France.
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Gharzeddine K, Hatzoglou V, Holodny AI, Young RJ. MR Perfusion and MR Spectroscopy of Brain Neoplasms. Radiol Clin North Am 2019; 57:1177-1188. [PMID: 31582043 DOI: 10.1016/j.rcl.2019.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Advances in imaging techniques, such as MR perfusion and spectroscopy, are increasingly indispensable in the management and treatment plans of brain neoplasms: from diagnosing, molecular/genetic typing and grading neoplasms, augmenting biopsy results and improving accuracy, to ultimately directing and monitoring treatment and response. New developments in treatment methods have resulted in new diagnostic challenges for conventional MR imaging, such as pseudoprogression, where MR perfusion has the widest current application. MR spectroscopy is showing increasing promise in noninvasively determining genetic subtypes and, potentially, susceptibility to molecular targeted therapies.
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Affiliation(s)
- Karem Gharzeddine
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Vaios Hatzoglou
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, Weill Medical College of Cornell University, 1275 York Avenue, New York, NY 10065, USA
| | - Andrei I Holodny
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, Weill Medical College of Cornell University, Weill Cornell Graduate School of Medical Sciences, 1275 York Avenue, New York, NY 10065, USA.
| | - Robert J Young
- Brain Imaging, Neuroradiology Research, Neuroradiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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13
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Boulet J, Peña J, Hulten EA, Neilan TG, Dragomir A, Freeman C, Lambert C, Hijal T, Nadeau L, Brophy JM, Mousavi N. Statin Use and Risk of Vascular Events Among Cancer Patients After Radiotherapy to the Thorax, Head, and Neck. J Am Heart Assoc 2019; 8:e005996. [PMID: 31213106 PMCID: PMC6662340 DOI: 10.1161/jaha.117.005996] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background This study aimed to explore whether statins reduce radiation‐induced vascular complications in cancer patients postradiotherapy to the thorax, head, and neck. Methods and Results We conducted a retrospective cohort study within a provincial linked database of 5718 cardiac patients with thorax and head or neck cancer having undergone radiotherapy between 2000 and 2011. One thousand five hundred fifty‐two patients were identified as nonstatin users and 4166 as statin users. The primary outcome of interest was the composite of cerebrovascular (transient ischemic attack, and fatal or nonfatal stroke) or cardiovascular events (fatal or nonfatal myocardial infarction). Time‐dependent Cox proportional hazard analyses were performed. The crude event rate was 10.31% for nonusers and 9.03% for statin users (hazard ratio of 0.92 [95% CI 0.76–1.10, P=0.3451]), over a mean time to event/censoring of 534±687 days for nonusers and 594±706 days for the statin users. After adjusting for age, sex, prior history of stroke/transient ischemic attack or myocardial infarction, diabetes mellitus, dyslipidemia, atrial fibrillation, chronic kidney disease, heart failure, and hypertension, statin use postradiotherapy was associated with a nonsignificant 15% relative risk reduction, but a strong trend toward reducing the primary outcome (hazard ratio=0.85 95% CI 0.69–1.04, P=0.0811). The use of statins was associated with a significant reduction of 32% for the outcome of stroke alone (hazard ratio=0.68, 95% CI 0.48–0.98, P=0.0368). Conclusions Statin use post radiation therapy was associated with a significant reduction in stroke, with a trend toward significantly reducing cardiovascular and cerebrovascular events.
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Affiliation(s)
- Jacinthe Boulet
- 1 Department of Internal Medicine McGill University Health Centre Montreal Quebec Canada
| | - Jessica Peña
- 5 Dalio Institute of Cardiovascular Imaging Weill Cornell Medicine Weill Cornell University New York NY
| | - Edward A Hulten
- 6 Division of Cardiology Walter Reed National Military Medical Centre Washington DC
| | - Tomas G Neilan
- 7 Cardio-Oncology Program Division of Cardiology Massachusetts General Hospital Boston MA
| | - Alice Dragomir
- 2 Division of Urology Surgical Research McGill University Health Centre Montreal Quebec Canada
| | - Carolyn Freeman
- 3 Division of Radiation Oncology McGill University Health Centre Montreal Quebec Canada
| | - Christine Lambert
- 3 Division of Radiation Oncology McGill University Health Centre Montreal Quebec Canada
| | - Tarek Hijal
- 3 Division of Radiation Oncology McGill University Health Centre Montreal Quebec Canada
| | - Lyne Nadeau
- 4 Division of Clinical Epidemiology Department of Medicine McGill University Health Centre Montreal Quebec Canada
| | - James M Brophy
- 4 Division of Clinical Epidemiology Department of Medicine McGill University Health Centre Montreal Quebec Canada.,8 Departments of Cardiology and Epidemiology, Biostatistics and Occupational Health McGill University Montreal Quebec Canada
| | - Negareh Mousavi
- 4 Division of Clinical Epidemiology Department of Medicine McGill University Health Centre Montreal Quebec Canada
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Interval Change in Diffusion and Perfusion MRI Parameters for the Assessment of Pseudoprogression in Cerebral Metastases Treated With Stereotactic Radiation. AJR Am J Roentgenol 2018; 211:168-175. [DOI: 10.2214/ajr.17.18890] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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15
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Wang YL, Chen S, Xiao HF, Li Y, Wang Y, Liu G, Lou X, Ma L. Differentiation between radiation-induced brain injury and glioma recurrence using 3D pCASL and dynamic susceptibility contrast-enhanced perfusion-weighted imaging. Radiother Oncol 2018; 129:68-74. [PMID: 29398151 DOI: 10.1016/j.radonc.2018.01.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/11/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE This study was performed to validate the efficacy of three-dimensional pseudocontinuous arterial spin labeling (pCASL) compared with dynamic susceptibility contrast-enhanced perfusion-weighted imaging (DSC-PWI) in distinguishing radiation-induced brain injury from glioma recurrence in patients with glioma. METHODS Both 3D pCASL and DSC-PWI were performed using a 3.0 Tesla scanner in 69 patients with previously resected and irradiated glioma who displayed newly developed abnormal contrast-enhanced lesions. The included patients were classified into a radiation-induced brain injury group (n = 34) and a glioma recurrence group (n = 35) based on subsequent pathologic analysis or clinical-radiological follow-up. Lesion perfusion parameter values (CBF and nCBF on pCASL, nrCBV and nrCBF on DSC-PWI) were measured and compared between the two groups using Student's t test. Pearson correlation analysis was performed to evaluate the correlation between pCASL (CBF and nCBF) and DSC-PWI (nrCBV and nrCBF) values in the contrast-enhanced lesions and in the perifocal edema regions. RESULTS For the contrast-enhanced lesions, the CBF, nCBF, nrCBV, and nrCBF (29.46 ± 15.08 ml/100 g/min, 1.11 ± 0.50, 1.39 ± 1.15, and 1.30 ± 0.74) in the radiation-induced brain injury group were significantly lower than those (64.52 ± 33.92 ml/100 g/min, 2.73 ± 1.71, 3.39 ± 2.12, and 3.20 ± 1.95) in the glioma recurrence group (P < 0.001). The CBF and nCBF demonstrated strong correlation with nrCBV and nrCBF in the contrast-enhanced lesions. CONCLUSION Radiation-induced brain injury and glioma recurrence can be reliably distinguished using both 3D pCASL and DSC-PWI. Contrast-free 3D pCASL is a suitable alternative to DSC-PWI for long-term follow-up in glioma patients with postoperative radiotherapy.
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16
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Santos DA, Alseidi A, Shannon VR, Messick C, Song G, Ledet CR, Lee H, Ngo-Huang A, Francis GJ, Asher A. Management of surgical challenges in actively treated cancer patients. Curr Probl Surg 2017; 54:612-654. [DOI: 10.1067/j.cpsurg.2017.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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17
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Multiparametric MRI for Differentiation of Radiation Necrosis From Recurrent Tumor in Patients With Treated Glioblastoma. AJR Am J Roentgenol 2017; 210:18-23. [PMID: 28952810 DOI: 10.2214/ajr.17.18003] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Differentiation of radiation necrosis (RN) from recurrent tumor (RT) in treated patients with glioblastoma remains a diagnostic challenge. The purpose of this study is to evaluate the diagnostic performance of multiparametric MRI in distinguishing RN from RT in patients with glioblastoma, with the use of a combination of MR perfusion and diffusion parameters. MATERIALS AND METHODS Patients with glioblastoma who had a new enhancing mass develop after completing standard treatment were retrospectively evaluated. Apparent diffusion coefficient (ADC), volume transfer constant (Ktrans), and relative cerebral blood volume (rCBV) values were calculated from the MR images on which the enhancing lesions first appeared. Repeated measure of analysis, logistic regression, and ROC analysis were performed. RESULTS Of a total of 70 patients evaluated, 46 (34 with RT and 12 with RN) met our inclusion criteria. Patients with RT had significantly higher mean rCBV (p < 0.001) and Ktrans (p = 0.006) values and lower ADC values (p = 0.004), compared with patients with RN. The overall diagnostic accuracy was 85.8% for rCBV, 75.5% for Ktrans, and 71.3% for ADC values. The logistic regression model showed a significant contribution of rCBV (p = 0.024) and Ktrans (p = 0.040) as independent imaging classifiers for differentiation of RT from RN. Combined use of rCBV and Ktrans at threshold values of 2.2 and 0.08 min-1, respectively, improved the overall diagnostic accuracy to 92.8%. CONCLUSION In patients with treated glioblastoma, rCBV outperforms ADC and Ktrans as a single imaging classifier to predict recurrent tumor versus radiation necrosis; however, the combination of rCBV and Ktrans may be used to improve overall diagnostic accuracy.
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18
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Han YM, Park JM, Choi YS, Jin H, Lee YS, Han NY, Lee H, Hahm KB. The efficacy of human placenta-derived mesenchymal stem cells on radiation enteropathy along with proteomic biomarkers predicting a favorable response. Stem Cell Res Ther 2017; 8:105. [PMID: 28464953 PMCID: PMC5414323 DOI: 10.1186/s13287-017-0559-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/22/2017] [Accepted: 04/08/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Radiation enteropathy is a common complication in patients with abdominopelvic cancer, but no treatment has yet been established. Stem cell therapy may be a viable therapeutic option because intestinal stem cells are highly vulnerable to ionizing radiation (IR) and stem cell loss explains its intractability to general treatment. Here, we investigated either prophylactic or therapeutic efficacy of human placenta-derived mesenchymal stem cells (hPDSCs) against radiation enteropathy and could identify biomarkers predicting a favorable response to stem cell therapy. METHODS We challenged a radiation-induced enteropathy model with hPDSCs. After sacrifice, we checked the gross anatomy of small intestine, histology gross, and analyzed that, accompanied with molecular changes implicated in this model. RESULTS hPDSCs significantly improved the outcome of mice induced with either radiation enteropathy or lethal radiation syndrome (P < 0.01). hPDSCs exerted inhibitory actions on inflammatory cytokines, the re-establishment of epithelium homeostasis was completed with increasing endogenous restorative processes as assessed with increased levels of proliferative markers in the hPDSCs group, and a significant inhibition of IR-induced apoptosis. The preservation of cells expressing lysozyme, and Musashi-1 were significantly increased in the hPDSC treatment group. Both preventive and therapeutic efficacies of hPDSCs were noted against IR-induced enteropathy. Label-free quantification was used to identify biomarkers which predict favorable responses after hPDSC treatment, and finally glutathione S-transferase-mu type, interleukin-10, and peroxiredoxin-2 were validated as proteomic biomarkers predicting a favorable response to hPDSCs in radiation enteropathy. CONCLUSIONS hPDSCs may be a useful prophylactic and therapeutic cell therapy for radiation enteropathy.
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Affiliation(s)
- Young-Min Han
- CHA Cancer Prevention Research Center, CHA University, CHA Bio Complex, 335 Pangyo-ro, Bundang-ku, Seongnam, Kyunggi-do, 463-712, South Korea
| | - Jong-Min Park
- CHA Cancer Prevention Research Center, CHA University, CHA Bio Complex, 335 Pangyo-ro, Bundang-ku, Seongnam, Kyunggi-do, 463-712, South Korea
| | - Yong Soo Choi
- Department of Applied Bioscience, CHA University, Seongnam, South Korea
| | - Hee Jin
- Graduated School of Pharmaceutical Sciences, Ewha Womans University, Seoul, South Korea
| | - Yun-Sil Lee
- Graduated School of Pharmaceutical Sciences, Ewha Womans University, Seoul, South Korea
| | - Na-Young Han
- Lee Gil Ya Cancer and Diabetes Institute, College of Pharmacy, Gachon University, Incheon, South Korea
| | - Hookeun Lee
- Lee Gil Ya Cancer and Diabetes Institute, College of Pharmacy, Gachon University, Incheon, South Korea
| | - Ki Baik Hahm
- CHA Cancer Prevention Research Center, CHA University, CHA Bio Complex, 335 Pangyo-ro, Bundang-ku, Seongnam, Kyunggi-do, 463-712, South Korea. .,Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
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Pseudoprogression, radionecrosis, inflammation or true tumor progression? challenges associated with glioblastoma response assessment in an evolving therapeutic landscape. J Neurooncol 2017; 134:495-504. [PMID: 28382534 DOI: 10.1007/s11060-017-2375-2] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/13/2017] [Indexed: 01/24/2023]
Abstract
The wide variety of treatment options that exist for glioblastoma, including surgery, ionizing radiation, anti-neoplastic chemotherapies, anti-angiogenic therapies, and active or passive immunotherapies, all may alter aspects of vascular permeability within the tumor and/or normal parenchyma. These alterations manifest as changes in the degree of contrast enhancement or T2-weighted signal hyperintensity on standard anatomic MRI scans, posing a potential challenge for accurate radiographic response assessment for identifying anti-tumor effects. The current review highlights the challenges that remain in differentiating true disease progression from changes due to radiation therapy, including pseudoprogression and radionecrosis, as well as immune or inflammatory changes that may occur as either an undesired result of cytotoxic therapy or as a desired consequence of immunotherapies.
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Loinard C, Vilar J, Milliat F, Lévy B, Benderitter M. Monocytes/Macrophages Mobilization Orchestrate Neovascularization after Localized Colorectal Irradiation. Radiat Res 2017; 187:549-561. [PMID: 28319461 DOI: 10.1667/rr14398.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
In patients undergoing radiotherapy for cancer, radiation dose to healthy tissue can occur, causing microvascular damage. Monocytes that have been shown to promote tissue revascularization comprise the subsets: CD11b+Ly6G-7/4hi/monocyteshi and CD11b+Ly6G-7/4lo/monocyteslo. We hypothesized that monocytes were implicated in postirradiation blood vessel formation. C57Bl6 mice underwent localized colorectal irradiation and were sacrificed at different times after exposure. Bone marrow, spleen, blood and colon were collected. Fourteen days postirradiation, colons expressed proangiogenic actors and adhesion molecules. Monocyteshi, which were the main subset of infiltrating monocytes, mobilized to the blood from spleen and bone marrow, peaking at day 14 postirradiation, and were associated with lymphocyte Th1 polarization. At day 28 postirradiation, angiographic score and capillary density increased by ∼1.8-fold, and then returned to nonirradiated levels at day 60. Clodronate-mediated depletion of circulating monocytes prior to irradiation resulted in a ∼1.4-fold decrease in angiographic score and capillary density compared to the nontreated control. Histological analysis of the colon in clodronate-treated mice revealed a massive decrease of macrophage and lymphocyte infiltration as well as reduced collagen deposition in crypt area at day 21. However, late depletion of monocytes from day 25 postirradiation had no effect on fibrotic process. These findings demonstrate a central role for monocyte/macrophage activation in the orchestration of a neovascularization mechanism after localized colorectal irradiation.
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Affiliation(s)
- Céline Loinard
- a Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PRP-HOM, SRBE, L3R, Fontenay-aux-Roses, France
| | - José Vilar
- b Inserm UMR-U970, PARCC, Paris Research Cardiovascular Research Center, Paris, France
| | - Fabien Milliat
- a Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PRP-HOM, SRBE, L3R, Fontenay-aux-Roses, France
| | - Bernard Lévy
- c Institut des Vaisseaux et du Sang, Paris, France
| | - Marc Benderitter
- d Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PRP-HOM, SRBE, Fontenay-aux-Roses, France
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Tapio S. Pathology and biology of radiation-induced cardiac disease. JOURNAL OF RADIATION RESEARCH 2016; 57:439-448. [PMID: 27422929 PMCID: PMC5045085 DOI: 10.1093/jrr/rrw064] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 05/09/2016] [Indexed: 05/08/2023]
Abstract
Heart disease is the leading global cause of death. The risk for this disease is significantly increased in populations exposed to ionizing radiation, but the mechanisms are not fully elucidated yet. This review aims to gather and discuss the latest data about pathological and biological consequences in the radiation-exposed heart in a comprehensive manner. A better understanding of the molecular and cellular mechanisms underlying radiation-induced damage in heart tissue and cardiac vasculature will provide novel targets for therapeutic interventions. These may be valuable for individuals clinically or occupationally exposed to varying doses of ionizing radiation.
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Affiliation(s)
- Soile Tapio
- Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Institute of Radiation Biology, Ingolstaedter Landstrasse 1, 85764 Neuherberg, Germany
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22
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Differentiation between treatment-related changes and progressive disease in patients with high grade brain tumors using support vector machine classification based on DCE MRI. J Neurooncol 2016; 127:515-24. [DOI: 10.1007/s11060-016-2055-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 01/03/2016] [Indexed: 10/22/2022]
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Boerma M, Nelson GA, Sridharan V, Mao XW, Koturbash I, Hauer-Jensen M. Space radiation and cardiovascular disease risk. World J Cardiol 2015; 7:882-888. [PMID: 26730293 PMCID: PMC4691814 DOI: 10.4330/wjc.v7.i12.882] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/18/2015] [Accepted: 10/08/2015] [Indexed: 02/06/2023] Open
Abstract
Future long-distance space missions will be associated with significant exposures to ionizing radiation, and the health risks of these radiation exposures during manned missions need to be assessed. Recent Earth-based epidemiological studies in survivors of atomic bombs and after occupational and medical low dose radiation exposures have indicated that the cardiovascular system may be more sensitive to ionizing radiation than was previously thought. This has raised the concern of a cardiovascular disease risk from exposure to space radiation during long-distance space travel. Ground-based studies with animal and cell culture models play an important role in estimating health risks from space radiation exposure. Charged particle space radiation has dense ionization characteristics and may induce unique biological responses, appropriate simulation of the space radiation environment and careful consideration of the choice of the experimental model are critical. Recent studies have addressed cardiovascular effects of space radiation using such models and provided first results that aid in estimating cardiovascular disease risk, and several other studies are ongoing. Moreover, astronauts could potentially be administered pharmacological countermeasures against adverse effects of space radiation, and research is focused on the development of such compounds. Because the cardiovascular response to space radiation has not yet been clearly defined, the identification of potential pharmacological countermeasures against cardiovascular effects is still in its infancy.
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Dynamic contrast enhanced T1 MRI perfusion differentiates pseudoprogression from recurrent glioblastoma. J Neurooncol 2015; 125:183-90. [PMID: 26275367 DOI: 10.1007/s11060-015-1893-z] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/10/2015] [Indexed: 12/12/2022]
Abstract
Pseudoprogression may present as transient new or increasing enhancing lesions that mimic recurrent tumors in treated glioblastoma. The purpose of this study was to examine the utility of dynamic contrast enhanced T1 magnetic resonance imaging (DCE MRI) in differentiating between pseudoprogression and tumor progression and devise a cut-off value sensitive for pseudoprogression. We retrospectively examined 37 patients with glioblastoma treated with radiation and temozolomide after surgical resection that then developed new or increasing enhancing lesion(s) indeterminate for pseudoprogression versus progression. Volumetric plasma volume (Vp) and time-dependent leakage constant (Ktrans) maps were measured for the enhancing lesion and the mean and ninetieth percentile histogram values recorded. Lesion outcome was determined by clinical follow up with pseudoprogression defined as stable disease not requiring new treatment. Statistical analysis was performed with Wilcoxon rank-sum tests. Patients with pseudoprogression (n = 13) had Vp (mean) = 2.4 and Vp (90 %tile) = 3.2; and Ktrans (mean) = 3.5 and Ktrans (90 %tile) = 4.2. Patients with tumor progression (n = 24) had Vp (mean) = 5.3 and Vp (90 %tile) = 6.6; and Ktrans (mean) = 7.4 and Ktrans (90 %tile) = 9.1. Compared with tumor progression, pseudoprogression demonstrated lower Vp perfusion values (p = 0.0002) with a Vp (mean) cutoff <3.7 yielding 85% sensitivity and 79% specificity for pseudoprogression. Ktrans (mean) of >3.6 had a 69% sensitivity and 79% specificity for disease progression. DCE MRI shows lower plasma volume and time dependent leakage constant values in pseudoprogression than in tumor progression. A cut-off value with high sensitivity for pseudoprogression can be applied to aid in interpretation of DCE MRI.
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Gujral DM, Shah BN, Chahal NS, Bhattacharyya S, Senior R, Harrington KJ, Nutting CM. Arterial Stiffness as a Biomarker of Radiation-Induced Carotid Atherosclerosis. Angiology 2015; 67:266-71. [PMID: 26045515 DOI: 10.1177/0003319715589520] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Arterial stiffness is thought to be a precursor to atherosclerosis. Conventional arterial stiffness parameters as potential biomarkers of radiation-induced damage were investigated. Patients with head and neck cancer treated with radiotherapy ≥2 years previously to one side of the neck were included. The unirradiated side was the internal control. Beta stiffness index (B) and elastic modulus (Ep) were used to assess arterial stiffness and were measured in proximal, mid, and distal common carotid artery (CCA) and compared with the corresponding unirradiated segments. Fifty patients (68% male; median age 58 years; interquartile range 50-62) were included. Mean ± standard deviation maximum doses to irradiated and unirradiated arteries were 53 ± 13 and 1.9 ± 3.7 Gy, respectively. Differences in B were not significant. Significant differences in Ep were demonstrated-proximal CCA: 1301 ± 1223 versus 801 ± 492 (P < .0001), mid CCA: 1064 ± 818 versus 935.5 ± 793 (P < .0001), and distal CCA: 1267 ± 1084 versus 775.3 ± 551.9 (P < .0001). Surgery had no impact on arterial stiffness. Arterial stiffness is increased in irradiated arteries, in keeping with radiation-induced damage. Prospective data may show an association between arterial stiffness and atherosclerosis in this setting.
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Affiliation(s)
- Dorothy M Gujral
- Head and Neck Unit, The Royal Marsden Hospital, London, United Kingdom
| | - Benoy N Shah
- Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom
| | - Navtej S Chahal
- Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom
| | | | - Roxy Senior
- Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom
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Azimzadeh O, Sievert W, Sarioglu H, Merl-Pham J, Yentrapalli R, Bakshi MV, Janik D, Ueffing M, Atkinson MJ, Multhoff G, Tapio S. Integrative proteomics and targeted transcriptomics analyses in cardiac endothelial cells unravel mechanisms of long-term radiation-induced vascular dysfunction. J Proteome Res 2015; 14:1203-19. [PMID: 25590149 DOI: 10.1021/pr501141b] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Epidemiological data from radiotherapy patients show the damaging effect of ionizing radiation on heart and vasculature. The endothelium is the main target of radiation damage and contributes essentially to the development of cardiac injury. However, the molecular mechanisms behind the radiation-induced endothelial dysfunction are not fully understood. In the present study, 10-week-old C57Bl/6 mice received local X-ray heart doses of 8 or 16 Gy and were sacrificed after 16 weeks; the controls were sham-irradiated. The cardiac microvascular endothelial cells were isolated from the heart tissue using streptavidin-CD31-coated microbeads. The cells were lysed and proteins were labeled with duplex isotope-coded protein label methodology for quantification. All samples were analyzed by LC-ESI-MS/MS and Proteome Discoverer software. The proteomics data were further studied by bioinformatics tools and validated by targeted transcriptomics, immunoblotting, immunohistochemistry, and serum profiling. Radiation-induced endothelial dysfunction was characterized by impaired energy metabolism and perturbation of the insulin/IGF-PI3K-Akt signaling pathway. The data also strongly suggested premature endothelial senescence, increased oxidative stress, decreased NO availability, and enhanced inflammation as main causes of radiation-induced long-term vascular dysfunction. Detailed data on molecular mechanisms of radiation-induced vascular injury as compiled here are essential in developing radiotherapy strategies that minimize cardiovascular complications.
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Affiliation(s)
- Omid Azimzadeh
- Helmholtz Zentrum München - German Research Centre for Environmental Health, Institute of Radiation Biology , Ingolstaedter Landstrasse 1, D-85764 Neuherberg, Germany
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Prager AJ, Martinez N, Beal K, Omuro A, Zhang Z, Young RJ. Diffusion and perfusion MRI to differentiate treatment-related changes including pseudoprogression from recurrent tumors in high-grade gliomas with histopathologic evidence. AJNR Am J Neuroradiol 2015; 36:877-85. [PMID: 25593202 DOI: 10.3174/ajnr.a4218] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 10/20/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Treatment-related changes and recurrent tumors often have overlapping features on conventional MR imaging. The purpose of this study was to assess the utility of DWI and DSC perfusion imaging alone and in combination to differentiate treatment-related effects and recurrent high-grade gliomas. MATERIALS AND METHODS We retrospectively identified 68 consecutive patients with high-grade gliomas treated by surgical resection followed by radiation therapy and temozolomide, who then developed increasing enhancing mass lesions indeterminate for treatment-related changes versus recurrent tumor. All lesions were diagnosed by histopathology at repeat surgical resection. ROI analysis was performed of the enhancing lesion on the ADC and DSC maps. Measurements made by a 2D ROI of the enhancing lesion on a single slice were recorded as ADCLesion and rCBVLesion, and measurements made by the most abnormal small fixed diameter ROI as ADCROI and rCBVROI. Statistical analysis was performed with Wilcoxon rank sum tests with P = .05. RESULTS Ten of the 68 patients (14.7%) had treatment-related changes, while 58 patients (85.3%) had recurrent tumor only (n = 19) or recurrent tumor mixed with treatment effect (n = 39). DWI analysis showed higher ADCLesion in treatment-related changes than in recurrent tumor (P = .003). DSC analysis revealed lower relative cerebral blood volume (rCBV)Lesion and rCBVROI in treatment-related changes (P = .003 and P = .011, respectively). Subanalysis of patients with suspected pseudoprogression also revealed higher ADCLesion (P = .001) and lower rCBVLesion (P = .028) and rCBVROI (P = .032) in treatment-related changes. Applying a combined ADCLesion and rCBVLesion model did not outperform either the ADC or rCBV metric alone. CONCLUSIONS Treatment-related changes showed higher diffusion and lower perfusion than recurrent tumor. Similar correlations were found for patients with suspected pseudoprogression.
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Affiliation(s)
- A J Prager
- From the Departments of Radiology (A.J.P., R.J.Y.)
| | | | - K Beal
- Radiation Oncology (K.B.) the Brain Tumor Center (K.B., A.O., R.J.Y.), Memorial Sloan Kettering Cancer Center, New York, New York
| | - A Omuro
- Neurology (N.M., A.O.) the Brain Tumor Center (K.B., A.O., R.J.Y.), Memorial Sloan Kettering Cancer Center, New York, New York
| | - Z Zhang
- Epidemiology and Biostatistics (Z.Z.)
| | - R J Young
- From the Departments of Radiology (A.J.P., R.J.Y.) the Brain Tumor Center (K.B., A.O., R.J.Y.), Memorial Sloan Kettering Cancer Center, New York, New York.
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Yun TJ, Park CK, Kim TM, Lee SH, Kim JH, Sohn CH, Park SH, Kim IH, Choi SH. Glioblastoma treated with concurrent radiation therapy and temozolomide chemotherapy: differentiation of true progression from pseudoprogression with quantitative dynamic contrast-enhanced MR imaging. Radiology 2014; 274:830-40. [PMID: 25333475 DOI: 10.1148/radiol.14132632] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To explore the role of dynamic contrast material-enhanced magnetic resonance (MR) imaging in the differentiation of true progression from pseudoprogression in patients with glioblastoma on the basis of findings in entirely newly developed or enlarged enhancing lesions after concurrent radiation therapy and chemotherapy with temozolomide and to evaluate the diagnostic performance of the quantitative pharmacokinetic parameters obtained at dynamic contrast-enhanced MR imaging, such as the volume transfer constant (K(trans)), the extravascular extracellular space per unit volume of tissue(ve), and the blood plasma volume per unit volume of tissue(vp). MATERIALS AND METHODS This prospective study had institutional review board approval; written informed consent was obtained from all patients. Thirty-three patients with histopathologically proven glioblastoma who had undergone concurrent radiation therapy and chemotherapy with temozolomide were included. Dynamic contrast-enhanced MR imaging-derived pharmacokinetic parameters, including K(trans), ve, and vp, were calculated for newly developed or enlarged enhancing lesions. Pharmacokinetic parameters were compared between the true progression (n = 17) and pseudoprogression (n = 16) groups by using unpaired t tests and then multivariable analysis. RESULTS The mean K(trans) and ve were higher in the true progression group than in the pseudoprogression group (mean K(trans), 0.44 min(-1) ± 0.25 [standard deviation] and 0.23 min(-1) ± 0.10 for true progression and pseudoprogression groups, respectively, P = .004; and mean ve, 1.26 ± 0.78 and 0.75 ± 0.49 for true progression and pseudoprogression groups, respectively, P = .034). Multivariable analysis showed that mean K(trans) was the only independently differentiating variable (P = .004). CONCLUSION Dynamic contrast-enhanced MR imaging-derived pharmacokinetic parameters, including K(trans) and ve, in the entire newly developed or enlarged enhancing lesion may be useful objective diagnostic tools in the differentiation of true progression from pseudoprogression in patients with glioblastoma who have undergone concurrent radiation therapy and chemotherapy with temozolomide.
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Affiliation(s)
- Tae Jin Yun
- From the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (T.J.Y., J.H.K., C.H.S., S.H.C.); Department of Radiology (T.J.Y., J.H.K., C.H.S., S.H.C.), Department of Neurosurgery (C.K.P.), Department of Internal Medicine, Cancer Research Institute (T.M.K., S.H.L.), Department of Pathology (S.H.P.), and Department of Radiation Oncology, Cancer Research Institute (I.H.K.), Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Republic of Korea; Center for Nanoparticle Research, Institute for Basic Science, Seoul, Republic of Korea (S.H.C.); and School of Chemical and Biological Engineering, Seoul National University, Seoul, Republic of Korea (S.H.C.)
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Abstract
Radiation enteritis continues to be a major health concern in recipients of radiation therapy. The incidence of radiation enteritis is expected to continue to rise during the coming years paralleling the unprecedented use of radiotherapy in pelvic cancers. Radiation enteritis can present as either an acute or chronic syndrome. The acute form presents within hours to days of radiation exposure and typically resolves within few weeks. The chronic form may present as early as 2 months or as long as 30 years after exposure. Risk factors can be divided into patient and treatment-related factors. Chronic radiation enteritis is characterized by progressive obliterative endarteritis with exaggerated submucosal fibrosis and can manifest by stricturing, formation of fistulae, local abscesses, perforation, and bleeding. In the right clinical context, diagnosis can be confirmed by cross-sectional imaging, flexible or video capsule endoscopy. Present treatment strategies are directed primarily towards symptom relief and management of emerging complications. Recently, however, there has been a shift towards rational drug design based on improved understanding of the molecular basis of disease in an effort to limit the fibrotic process and prevent organ damage.
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Affiliation(s)
- Ali H Harb
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Rohleder NH, Flensberg S, Bauer F, Wagenpfeil S, Wales CJ, Koerdt S, Wolff KD, Hölzle F, Steiner T, Kesting MR. Can tissue spectrophotometry and laser Doppler flowmetry help to identify patients at risk for wound healing disorders after neck dissection? Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 117:302-11. [PMID: 24462344 DOI: 10.1016/j.oooo.2013.11.497] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 09/22/2013] [Accepted: 11/25/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Microcirculation and oxygen supply in cervical skin were measured with an optical, noninvasive method in patients with or without radiotherapy before neck dissection. The course of wound healing was monitored after the surgical procedure to identify predictive factors for postoperative wound healing disorders. STUDY DESIGN Tissue spectrophotometry and laser Doppler flowmetry were used to determine capillary oxygen saturation, hemoglobin concentration, blood flow, and blood velocity at 2-mm and 8-mm depths in the cervical skin of 91 patients before neck dissection in a maxillofacial unit of a university hospital in Munich, Germany. Parameters were evaluated for differences between patients with irradiation (24) and without (67) and patients with wound healing disorders (25) and without (66) (univariate or multivariate statistical analyses). RESULTS Velocity at 2 mm was lower in irradiated skin (P = .016). Flow at 2 mm was higher in patients with wound healing disorders (P = .018). CONCLUSIONS High flow values could help to identify patients at risk for cervical wound healing disorders.
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Affiliation(s)
- Nils H Rohleder
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Munich, Germany
| | - Sandra Flensberg
- Department of Anaesthesiology, Technische Universität München, Munich, Germany
| | - Florian Bauer
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Munich, Germany
| | - Stefan Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Homburg, Germany
| | - Craig J Wales
- Department of Oral and Maxillofacial Surgery, Southern General Hospital, Glasgow, Scotland
| | - Steffen Koerdt
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Munich, Germany
| | - Klaus D Wolff
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Munich, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University, Aachen, Germany
| | - Timm Steiner
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University, Aachen, Germany
| | - Marco R Kesting
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Munich, Germany.
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Abstract
OPINION STATEMENT Thoracic radiation remains an effective treatment for many types of neoplasms. The clinical benefit of radiation therapy on cancer mortality is counterbalanced by an increased risk of cardiovascular events in survivors. The long-term cardiovascular sequelae of thoracic radiation include premature coronary artery disease, valvular disease, pericardial disease, myocardial disease with systolic and especially diastolic dysfunction, and conduction system abnormalities. Radiation heart disease progresses over time and may manifest decades after the initial exposure. Since the risk of cardiac complications is significantly increased following chest irradiation, appropriate screening and long-term cardiac follow-up of these patients is essential. This article will summarize the pathophysiological features, clinical presentations, and current recommendations for screening and prevention of the wide spectrum of radiation induced cardiovascular disease.
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Affiliation(s)
- Negareh Mousavi
- Section of Cardiology, Department of Medicine, St. Joseph's Health Care Center, 30 The Queensway, Toronto, ON, Canada
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Vianello F, Cannella L, Coe D, Chai JG, Golshayan D, Marelli-Berg FM, Dazzi F. Enhanced and aberrant T cell trafficking following total body irradiation: a gateway to graft-versus-host disease? Br J Haematol 2013; 162:808-18. [PMID: 23855835 DOI: 10.1111/bjh.12472] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 06/12/2013] [Indexed: 01/01/2023]
Abstract
Pre-transplant conditioning regimens play a major role in triggering graft-versus-host disease (GVHD). This study investigated the effect of irradiation on donor T cell trafficking to lymphoid and non-lymphoid tissues by comparing the migration of carboxy-fluorescein diacetate succinimidyl ester-labelled, naïve donor T lymphocytes in vivo in irradiated and non-irradiated syngeneic mice recipients. Recruitment of adoptively transferred naïve T cells to secondary lymphoid organs was increased in irradiated mice and naïve T cells also aberrantly localized to non-lymphoid tissues. Irradiation also induced aberrant effector memory T cell migration into lymph nodes and their localization to homing-privileged non-lymphoid sites, such as the gut. The presence of a minor histocompatibility mismatch further enhanced the aberrant accumulation of T cells in both lymphoid and non-lymphoid tissue, whilst their migratory pattern was not modified as compared to fully matched irradiated recipients. These effects correlated with decreased permeability of, and the secretion of chemotactic factors by the endothelium. Our findings are consistent with the possibility that excessive, dysregulated extravasation of T cells induced by irradiation promotes the development of GVHD.
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Affiliation(s)
- Fabrizio Vianello
- Stem Cell Biology Section, Department of Haematology, Imperial College, London, UK
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Choi YJ, Kim HS, Jahng GH, Kim SJ, Suh DC. Pseudoprogression in patients with glioblastoma: added value of arterial spin labeling to dynamic susceptibility contrast perfusion MR imaging. Acta Radiol 2013; 54:448-54. [PMID: 23592805 DOI: 10.1177/0284185112474916] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pseudoprogression is a treatment-related reaction with an increase in contrast-enhancing lesion size, followed by subsequent improvement. Differentiating tumor recurrence from pseudoprogression remains a problem in neuro-oncology. PURPOSE To validate the added value of arterial spin labeling (ASL), compared with dynamic susceptibility contrast (DSC) perfusion magnetic resonance imaging (MRI) alone, in distinguishing early tumor progression from pseudoprogression in patients with newly diagnosed glioblastoma multiforme (GBM). MATERIAL AND METHODS We retrospectively evaluated 117 consecutive patients with newly diagnosed GBM who underwent surgical resection and concurrent chemoradiotherapy (CCRT) as standard treatment modality. Sixty-two patients who developed contrast-enhancing lesions were assessed by both ASL and DSC perfusion MRI and classified into groups of early tumor recurrence (n = 34) or pseudoprogression (n = 28) based on pathologic analysis or clinical-radiologic follow-up. We used a qualitative analysis and semi-quantitative grade system on the basis of the tumor perfusion signal intensity into those equal to white matter (grade I), gray matter (grade II), and blood vessels (grade III) on ASL imaging. ASL grade was correlated with histogram parameters derived from DSC perfusion MRI. RESULTS Pseudoprogression was observed in 15 (53.6%) patients with ASL grade I, 13 (46.4%) with grade II, and 0 (0%) with grade III, with early tumor progression observed in seven (20.6%) patients with ASL grade I, 11 (32.3%) with grade II, and 16 (47.1%) with grade III (P = 0.0022). DSC perfusion histogram parameters differed significantly among ASL grades. ASL grade was an independent predictor differentiating pseudoprogression from early tumor progression (odds ratio, 4.73; P = 0.0017). On qualitative review, adjunctive ASL produced eight (12.9%) more accurate results than DSC perfusion MRI alone. CONCLUSION ASL improves the diagnostic accuracy of DSC perfusion MRI in differentiating pseudoprogression from early tumor progression.
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Affiliation(s)
- Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul
| | - Geon-Ho Jahng
- Department of Radiology, Kyung Hee University Hospital-Gangdong, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Sang Joon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul
| | - Dae Chul Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul
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Shiroishi MS, Booker MT, Agarwal M, Jain N, Naghi I, Lerner A, Law M. Posttreatment evaluation of central nervous system gliomas. Magn Reson Imaging Clin N Am 2013; 21:241-68. [PMID: 23642552 DOI: 10.1016/j.mric.2013.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Although conventional contrast-enhanced MR imaging remains the standard-of-care imaging method in the posttreatment evaluation of gliomas, recent developments in therapeutic options such as chemoradiation and antiangiogenic agents have caused the neuro-oncology community to rethink traditional imaging criteria. This article highlights the latest recommendations. These recommendations should be viewed as works in progress. As more is learned about the pathophysiology of glioma treatment response, quantitative imaging biomarkers will be validated within this context. There will likely be further refinements to glioma response criteria, although the lack of technical standardization in image acquisition, postprocessing, and interpretation also need to be addressed.
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Affiliation(s)
- Mark S Shiroishi
- Division of Neuroradiology, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
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Kim M, Choi SH, Jin YB, Lee HJ, Ji YH, Kim J, Lee YS, Lee YJ. The effect of oxidized low-density lipoprotein (ox-LDL) on radiation-induced endothelial-to-mesenchymal transition. Int J Radiat Biol 2013; 89:356-63. [PMID: 23289363 DOI: 10.3109/09553002.2013.763193] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE Radiation-induced cardiovascular disease is a potentially severe side-effect of thoracic radiotherapy treatment. Clinically, this delayed side-effect presents as a form of accelerated atherosclerosis several years after irradiation. As general endothelial dysfunction is known to be an initiating event in radiation-induced vascular damage, we examined the effects of radiation on endothelial cells in radiation-induced atherosclerosis. MATERIALS AND METHODS The effects of radiation on human aortic endothelial cells (HAoEC) were assessed by immunoblotting and immunofluorescence assays. Radiation-induced phenotypic changes of endothelial cells (ECs) were examined using atherosclerotic tissues of irradiated apoprotein E null (ApoE(-/-)) mice. RESULTS Radiation induced the HAoEC to undergo phenotypic conversion to form fibroblast-like cells, called the endothelial-to-mesenchymal transition (EndMT), which leads to the upregulation of mesenchymal cell markers such as alpha-smooth muscle actin (α-SMA), fibroblast specific protein-1 (FSP-1), and vimentin, and downregulation of endothelial cell-specific markers such as CD31 and vascular endothelial (VE)-cadherin. Furthermore, compared with low-density lipoprotein (LDL), oxidized low-density lipoprotein (ox-LDL) significantly augmented radiation-induced EndMT in HAoEC. These fibrotic phenotypes of ECs were found in atherosclerotic tissues of irradiated ApoE(-/-) mice with increased levels of ox-LDL. CONCLUSIONS Taken together, these observations suggest that ox-LDL accelerates radiation-induced EndMT and subsequently contributes to radiation-induced atherosclerosis, providing a novel target for the prevention of radiation-induced atherosclerosis.
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Affiliation(s)
- Miseon Kim
- Division of Radiation Effects, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
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Bisdas S, Naegele T, Ritz R, Dimostheni A, Pfannenberg C, Reimold M, Koh TS, Ernemann U. Distinguishing recurrent high-grade gliomas from radiation injury: a pilot study using dynamic contrast-enhanced MR imaging. Acad Radiol 2011; 18:575-83. [PMID: 21419671 DOI: 10.1016/j.acra.2011.01.018] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Revised: 01/11/2011] [Accepted: 01/11/2011] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES The accurate delineation of tumor recurrence and its differentiation from radiation injury in the follow-up of adjuvantly treated high-grade gliomas presents a significant problem in neuro-oncology. The aim of this study was to investigate whether hemodynamic parameters derived from dynamic contrast-enhanced (DCE) T1-weighted magnetic resonance imaging (MRI) can be used to distinguish recurrent gliomas from radiation necrosis. MATERIALS AND METHODS Eighteen patients who were being treated for glial neoplasms underwent prospectively conventional and DCE-MRI using a 3T scanner. The pharmacokinetic modelling was based on a two-compartment model that allows for the calculation of K(trans) (transfer constant between intra- and extravascular, extracellular space), v(e) (extravascular, extracellular space), k(ep) (transfer constant from the extracellular, extravascular space into the plasma), and iAUC (initial area under the signal intensity-time curve). Regions of interest (ROIs) were drawn around the entire recurrence-suspected contrast-enhanced region. A definitive diagnosis was established at subsequent surgical resection or clinicoradiologic follow-up. The hemodynamic parameters in the contralateral normal white matter, the radiation injury sites, and the tumor recurrent lesions were compared using nonparametric tests. RESULTS The K(trans), v(e), k(ep), and iAUC values in the normal white matter were significantly different than those in the radiation necrosis and recurrent gliomas (0.01, <P < .0001). The only significantly different hemodynamic parameter between the recurrent tumor lesions and the radiation-induced necrotic sites were K(trans) and iAUC, which were significantly higher in the recurrent glioma group than in the radiation necrosis group (P ≤ .0184). A K(trans) cutoff value higher than 0.19 showed 100% sensitivity and 83% specificity for detecting the recurrent gliomas, whereas an iAUC cutoff value higher than 15.35 had 71% sensitivity and 71% specificity. The v(e) and k(ep) values in recurrent tumors were not significantly higher than those in radiation-induced necrotic lesions. CONCLUSIONS These findings suggest that DCE-MRI may be used to distinguish between recurrent gliomas and radiation injury and thus, assist in follow-up patient management strategy.
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Mechanisms underlying the radioprotective properties of γ-tocotrienol: comparative gene expression profiling in tocol-treated endothelial cells. GENES AND NUTRITION 2011; 7:75-81. [PMID: 21516479 DOI: 10.1007/s12263-011-0228-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 04/08/2011] [Indexed: 01/04/2023]
Abstract
Among the eight naturally occurring vitamin E analogs, γ-tocotrienol (GT3) is a particularly potent radioprophylactic agent in vivo. Moreover, GT3 protects endothelial cells from radiation injury not only by virtue of its antioxidant properties but also by inhibition of 3-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase and by improving the availability of the nitric oxide synthase cofactor tetrahydrobiopterin. Nevertheless, the precise mechanisms underlying the superior radioprotective properties of GT3 compared with other tocols are not known. This study, therefore, examined the differences in gene expression profiles between GT3 and its tocopherol counterpart, γ-tocopherol, as well as between GT3 and α-tocopherol in human endothelial cells. Cells were treated with vehicle or the appropriate tocol for 24 h, after which total RNA was isolated and genome-wide gene expression profiles were obtained using the Illumina platform. GT3 was far more potent in inducing gene-expression changes than α-tocopherol or γ-tocopherol. In particular, GT3 induced multiple changes in pathways known to be of importance in the cellular response to radiation exposure. Affected GO functional clusters included response to oxidative stress, response to DNA damage stimuli, cell cycle phase, regulation of cell death, regulation of cell proliferation, hematopoiesis, and blood vessel development. These results form the basis for further studies to determine the exact importance of differentially affected GO functional clusters in endothelial radioprotection by GT3.
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Boerma M, Hauer-Jensen M. Potential targets for intervention in radiation-induced heart disease. Curr Drug Targets 2011; 11:1405-12. [PMID: 20583977 DOI: 10.2174/1389450111009011405] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2010] [Accepted: 04/05/2010] [Indexed: 12/14/2022]
Abstract
Radiotherapy of thoracic and chest wall tumors, if all or part of the heart was included in the radiation field, can lead to radiation-induced heart disease (RIHD), a late and potentially severe side effect. RIHD presents clinically several years after irradiation and manifestations include accelerated atherosclerosis, pericardial and myocardial fibrosis, conduction abnormalities, and injury to cardiac valves. The pathogenesis of RIHD is largely unknown, and a treatment is not available. Hence, ongoing pre-clinical studies aim to elucidate molecular and cellular mechanisms of RIHD. Here, an overview of recent pre-clinical studies is given, and based on the results of these studies, potential targets for intervention in RIHD are discussed.
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Affiliation(s)
- M Boerma
- Department of Pharmaceutical Sciences, Division of Radiation Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
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Berbee M, Fu Q, Boerma M, Pathak R, Zhou D, Kumar KS, Hauer-Jensen M. Reduction of radiation-induced vascular nitrosative stress by the vitamin E analog γ-tocotrienol: evidence of a role for tetrahydrobiopterin. Int J Radiat Oncol Biol Phys 2011; 79:884-91. [PMID: 20950957 PMCID: PMC3023840 DOI: 10.1016/j.ijrobp.2010.08.032] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 08/19/2010] [Accepted: 08/20/2010] [Indexed: 01/13/2023]
Abstract
PURPOSE The vitamin E analog γ-tocotrienol (GT3) is a powerful radioprotector. GT3 reduces postradiation vascular peroxynitrite production, an effect dependent on inhibition of hydroxy-methylglutaryl-coenzyme A reductase. Hydroxy-methylglutaryl-coenzyme A reductase inhibitors mediate their pleiotropic effects via endothelial nitric oxide synthase that requires the cofactor tetrahydrobiopterin (BH4). This study investigated the effects of radiation on BH4 bioavailability and of GT3 on BH4 metabolism. METHODS AND MATERIALS Mice were exposed to 8.5 Gy of total body irradiation (TBI). Lung BH4 and total biopterin concentrations were measured 0, 3.5, 7, 14, and 21 days after TBI by use of differential oxidation followed by high-performance liquid chromatography. The effect of exogenous GT3 and BH4 treatment on postradiation vascular oxidative stress and bone marrow colony-forming units were assessed in vivo. The effect of GT3 on endothelial cell apoptosis and endothelial expression of guanosine triphosphate (GTP) cyclohydrolase 1 (GTPCH), GTPCH feedback regulatory protein (GFRP), GFRP transcription, GFRP protein levels, and GFRP-GTPCH protein binding was determined in vitro. RESULTS Compared with baseline levels, lung BH4 concentrations decreased by 24% at 3.5 days after TBI, an effect that was reversed by GT3. At 14 and 21 days after TBI, compensatory increases in BH4 (58% and 80%, respectively) were observed. Relative to vehicle-treated controls, both GT3 and BH4 supplementation reduced postirradiation vascular peroxynitrite production at 3.5 days (by 66% and 33%, respectively), and BH4 resulted in a 68% increase in bone marrow colony-forming units. GT3 ameliorated endothelial cell apoptosis and reduced endothelial GFRP protein levels and GFRP-GTPCH binding by decreasing transcription of the GFRP gene. CONCLUSIONS BH4 bioavailability is reduced in the early postradiation phase. Exogenous administration of BH4 reduces postirradiation vascular oxidative stress. GT3 potently reduces the expression of GFRP, one of the key regulatory proteins in the BH4 pathway, and may thus exert some of its beneficial effects on postradiation free radical production partly by counteracting the decrease in BH4.
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Affiliation(s)
- Maaike Berbee
- University of Arkansas for Medical Sciences, Little Rock, AR
| | - Qiang Fu
- University of Arkansas for Medical Sciences, Little Rock, AR
| | - Marjan Boerma
- University of Arkansas for Medical Sciences, Little Rock, AR
| | - Rupak Pathak
- University of Arkansas for Medical Sciences, Little Rock, AR
| | - Daohong Zhou
- University of Arkansas for Medical Sciences, Little Rock, AR
| | - K. Sree Kumar
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Martin Hauer-Jensen
- University of Arkansas for Medical Sciences, Little Rock, AR
- Central Arkansas Veterans Healthcare System, Little Rock, AR
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Boerma M, Hauer-Jensen M. Preclinical research into basic mechanisms of radiation-induced heart disease. Cardiol Res Pract 2010; 2011:858262. [PMID: 20953374 PMCID: PMC2952915 DOI: 10.4061/2011/858262] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 09/04/2010] [Indexed: 01/20/2023] Open
Abstract
Radiation-induced heart disease (RIHD) is a potentially severe side effect of radiotherapy of thoracic and chest wall tumors if all or part of the heart was included in the radiation field. RIHD presents clinically several years after irradiation and manifestations include accelerated atherosclerosis, pericardial and myocardial fibrosis, conduction abnormalities, and injury to cardiac valves. There is no method to prevent or reverse these injuries when the heart is exposed to ionizing radiation. This paper presents an overview of recent studies that address the role of microvascular injury, endothelial dysfunction, mast cells, and the renin angiotensin system in animal models of cardiac radiation injury. These insights into the basic mechanisms of RIHD may lead to the identification of targets for intervention in this late radiotherapy side effect.
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Affiliation(s)
- M. Boerma
- Division of Radiation Health, Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 522-10, Little Rock, AR 72205, USA
| | - M. Hauer-Jensen
- Division of Radiation Health, Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 522-10, Little Rock, AR 72205, USA
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Yarnold J, Brotons MCV. Pathogenetic mechanisms in radiation fibrosis. Radiother Oncol 2010; 97:149-61. [PMID: 20888056 DOI: 10.1016/j.radonc.2010.09.002] [Citation(s) in RCA: 447] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Revised: 07/07/2010] [Accepted: 09/02/2010] [Indexed: 12/19/2022]
Abstract
Deregulation of normal regenerative responses to physical, chemical and biological toxins in susceptible individuals leads to abnormal remodelling of extracellular matrix with pathological fibrosis. Processes deregulated after radiotherapy have much in common with processes associated with fibrotic diseases affecting the heart, skin, lungs, kidneys, gastro-intestinal tract and liver. Among the secreted factors driving fibrosis, transforming growth factor beta 1 (TGFβ1) produced by a wide range of inflammatory, mesenchymal and epithelial cells converts fibroblasts and other cell types into matrix-producing myofibroblasts. Even if required for the initiation of fibrosis, inflammation and the continued stimulus of TGFβ1 may not be needed to maintain it. After myofibroblast activation, collagen production can be perpetuated independently of TGFβ1 by autocrine induction of a cytokine called connective tissue growth factor. The role of inflammation, the origins and activation of myofibroblasts as biosynthetic cells and the downstream pathways of extracellular matrix synthesis in common fibrotic states are reviewed. Oxidative stress, hypoxia and microvascular damage are also considered, before examining the same processes in the context of radiotherapy. One of the main uncertainties is the relevance of very early events, including inflammatory responses in blood vessels, to fibrosis. Despite the power of animal models, including genetic systems, the potential contribution of research based on human tissue samples has never been greater. A closer interaction between scientists researching fibrosis and radiation oncologists holds enormous promise for therapeutic advances.
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Affiliation(s)
- John Yarnold
- Academic Radiotherapy Unit, Institute of Cancer Research and Royal Marsden Hospital, Sutton, Surrey, UK.
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Mao XW, Favre CJ, Fike JR, Kubinova L, Anderson E, Campbell-Beachler M, Jones T, Smith A, Rightnar S, Nelson GA. High-LET radiation-induced response of microvessels in the Hippocampus. Radiat Res 2010; 173:486-93. [PMID: 20334521 DOI: 10.1667/rr1728.1] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The hippocampus is critical for learning and memory, and injury to this structure is associated with cognitive deficits. The response of the hippocampal microvessels after a relatively low dose of high-LET radiation remains unclear. In this study, endothelial population changes in hippocampal microvessels exposed to (56)Fe ions at doses of 0, 0.5, 2 and 4 Gy were quantified using unbiased stereological techniques. Twelve months after exposure, mice that received 0.5 Gy or 2 Gy of iron ions showed a 34% or 29% loss of endothelial cells, respectively, in the hippocampal cornu ammonis region 1 (CA1) compared to age-matched controls or mice that received 4 Gy (P < 0.05). We suggest that this "U-shaped" dose response indicates a repopulation from a sensitive subset of endothelial cells that occurred after 4 Gy that was stimulated by an initial rapid loss of endothelial cells. In contrast to the CA1, in the dentate gyrus (DG), there was no significant difference in microvessel cell and length density between irradiated groups and age-matched controls. Vascular topology differences between CA1 and DG may account for the variation in dose response. The correlation between radiation-induced alterations in the hippocampal microvessels and their functional consequences must be investigated in further studies.
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Affiliation(s)
- Xiao Wen Mao
- Departments of Radiation Medicine, Molecular Radiation Biology Laboratories, Loma Linda University, Loma Linda, California 92350, USA.
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Abstract
BACKGROUND Postoperative infection in tissue expander breast reconstruction causes increased morbidity, cost, and suboptimal patient outcomes. To improve outcomes, it is important to preoperatively identify factors that might predispose to infection and minimize them when possible. It is hypothesized that certain patient characteristics are associated with an increased infection rate. METHODS A retrospective, 6-year, single-institution review of patient records was performed from 413 tissue expanders placed in 300 women for postmastectomy breast reconstruction. Infection was defined as any case where antibiotics were given in response to clinical signs of infection. Fourteen potential risk factors were analyzed. A generalized estimation equations approach was used to perform univariable and multivariable analyses. RESULTS Antibiotics were given to treat clinical infection in 68 of 413 expanders (16.5 percent), with a median time to diagnosis of 6.5 weeks (range, 1 to 52 weeks). Univariable analysis showed significant association with breast size larger than C cup (p < 0.001), previous irradiation (p = 0.007), repeated implant (p = 0.008), and delayed reconstruction (p = 0.04). All variables except delayed reconstruction remained significant (p < 0.002 for all) in a multivariable model. Additional significant covariates in this model included one surgical oncologist (p = 0.003) and contralateral surgery (p = 0.046). Given infection, one surgical oncologist was associated with an increased rate of mastectomy flap necrosis (p = 0.01). CONCLUSIONS Certain patient characteristics are associated with increased infection in tissue expansion breast reconstruction. Understanding how these predispose to infection requires additional study. Patients identified with these characteristics should be educated about these risks and other reconstructive options to optimize the success of their breast reconstruction.
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Barajas RF, Chang JS, Segal MR, Parsa AT, McDermott MW, Berger MS, Cha S. Differentiation of recurrent glioblastoma multiforme from radiation necrosis after external beam radiation therapy with dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging. Radiology 2009; 253:486-96. [PMID: 19789240 DOI: 10.1148/radiol.2532090007] [Citation(s) in RCA: 296] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate whether cerebral blood volume (CBV), peak height (PH), and percentage of signal intensity recovery (PSR) measurements derived from the results of T2-weighted dynamic susceptibility-weighted contrast material-enhanced (DSC) magnetic resonance (MR) imaging performed after external beam radiation therapy (EBRT) can be used to distinguish recurrent glioblastoma multiforme (GBM) from radiation necrosis. MATERIALS AND METHODS Fifty-seven patients were enrolled in this HIPAA-compliant institutional review board-approved retrospective study after they received a diagnosis of GBM, underwent EBRT, and were examined with DSC MR imaging, which revealed progressive contrast enhancement within the radiation field. A definitive diagnosis was established at subsequent surgical resection or clinicoradiologic follow-up. Regions of interest were retrospectively drawn around the entire contrast-enhanced region. This created T2-weighted signal intensity-time curves that produced three cerebral hemodynamic MR imaging measurements: CBV, PH, and PSR. Welch t tests were used to compare measurements between groups. RESULTS Mean, maximum, and minimum relative PH and relative CBV were significantly higher (P < .01) in patients with recurrent GBM than in patients with radiation necrosis. Mean, maximum, and minimum relative PSR values were significantly lower (P < .05) in patients with recurrent GBM than in patients with radiation necrosis. CONCLUSION These findings suggest that DSC perfusion MR imaging may be used to differentiate recurrent GBM from EBRT-induced radiation necrosis.
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Affiliation(s)
- Ramon F Barajas
- Department of Radiology, Neuroradiology Section, University of California, San Francisco, CA 94143, USA
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Radiation therapy. Prostate Cancer 2008. [DOI: 10.1017/cbo9780511551994.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Margulies BS, Damron TA, Allen MJ. The differential effects of the radioprotectant drugs amifostine and sodium selenite treatment in combination with radiation therapy on constituent bone cells, Ewing's sarcoma of bone tumor cells, and rhabdomyosarcoma tumor cells in vitro. J Orthop Res 2008; 26:1512-9. [PMID: 18473385 DOI: 10.1002/jor.20679] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to determine the differential effects of therapeutic X-radiation on constituent bone cells relative to the pediatric tumor cells: Ewing's sarcoma of bone and rhabdomyosarcoma. In addition, the radioprotectant drugs amifostine and sodium selenite were administered to constituent bone cells and the two tumor cells to determine if the radioprotectants differentially protect bone cells while not benefiting the tumor cells. These studies are a necessary first step in determining the potential clinical benefit of radioprotective therapy. An established in vitro cell culture model employing both constituent bone cells (osteoblasts, primary bone marrow monocytes, osteoclasts chondrocytes, and endothelial cells) and the tumor cells lines (Ewing's sarcoma of bone and rhabdomyosarcoma) were exposed to irradiation, amifostine, and sodium selenite. Cells were then assayed for changes in cell number, cytotoxicity, mineralization, bone resorption, cell attachment, osteocalcin, caspase-3 expression, clonogenic survival, and alkaline phosphatase expression. Radiation therapy differentially decreased cell number; with osteoblasts being shown to be the least sensitive to irradiation, the tumor cells had an intermediate sensitivity and monocytes were the most sensitive. Both amifostine and sodium selenite protected chondrocytes and osteoblasts from the negative effects of irradiation, while not protecting the tumor cells. The pediatric tumor cell lines were generally more radiosensitive than the bone cells examined. The radioprotectant drugs amifostine and sodium selenite provided significant radioprotection to constituent bone cells while not protecting the tumor cells. Finally, amifostine and sodium selenite therapy provided an additional benefit beyond radioprotection by increasing cytotoxicity in nonirradiated and irradiated tumor cells.
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Affiliation(s)
- Bryan S Margulies
- Department of Orthopedic Surgery, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, New York 13210, USA.
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Li XM, Hu Z, Jorgenson ML, Wingard JR, Slayton WB. Bone marrow sinusoidal endothelial cells undergo nonapoptotic cell death and are replaced by proliferating sinusoidal cells in situ to maintain the vascular niche following lethal irradiation. Exp Hematol 2008; 36:1143-1156. [PMID: 18718416 DOI: 10.1016/j.exphem.2008.06.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Revised: 06/11/2008] [Accepted: 06/18/2008] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Bone marrow sinusoids remain predominantly host-derived following bone marrow transplantation. Systematic analysis was conducted at the cellular level to investigate how the host sinusoidal structures survived after lethal irradiation. MATERIALS AND METHODS Apoptosis and cell proliferation assays were performed on bone marrow sections at various time points during the first 2 weeks postirradiation to study the extent of damage to sinusoidal endothelial cells from lethal irradiation and to determine whether cell proliferation contributes to the recovery of the sinusoidal system. RESULTS Phosphorylated H2AX was present in both hematopoietic and sinusoidal endothelial cells 3 hours after irradiation demonstrating DNA damage. Three days after irradiation, some sinusoidal endothelial cells became terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling -positive, but were caspase-3 and in situ oligo ligation -negative, suggesting nonapoptotic DNA fragmentation. Clusters of sinusoidal endothelial cells that expressed Ki67 appeared 3 days after irradiation, and increased through day 7. These Ki67-positive endothelial cells were host-derived. Bromodeoxyuridine-positive endothelial cells were present in the Ki67-positive areas confirming endothelial cell replication. Twenty percent of the sinusoidal endothelial cells were lost by day 3 after irradiation. The total number of endothelial cells remained relatively unchanged between day 3 and day 14. These results demonstrate that lethal irradiation resulted in limited, nonapoptotic sinusoidal endothelial cell loss, followed by proliferation of preexisting host-derived mature sinusoidal endothelial cells. Our data suggest that DNA repair mechanisms and proliferation of host endothelial cells within the sinusoids are involved in maintenance of the structural integrity of the bone marrow vascular niche following lethal irradiation.
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Affiliation(s)
- Xiao-Miao Li
- Department of Pediatrics, University of Florida, Gainesville, FL 32610, USA
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Gabryś D, Greco O, Patel G, Prise KM, Tozer GM, Kanthou C. Radiation Effects on the Cytoskeleton of Endothelial Cells and Endothelial Monolayer Permeability. Int J Radiat Oncol Biol Phys 2007; 69:1553-62. [DOI: 10.1016/j.ijrobp.2007.08.039] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Revised: 08/09/2007] [Accepted: 08/20/2007] [Indexed: 11/30/2022]
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