Efficacy of radioprotective agents in preventing small and large bowel radiation injury

Radio-protective efficacy of Gymnema sylvestre on Pangasius sutchi against gamma (60Co) irradiation

PURPOSE

Freshwater fish Pangasius sutchi was used in this study as a vertebrate model. We evaluated the induction of certain antioxidant enzymes in various vital organs. The radioprotective efficacy of Gymnema sylvestre leaves extract (GS) [25 mg/kg Body Weight (B.W)] and its bioactive compound Gymnemagenin (GG) [0.3 mg/kg B.W] was compared with Amifostine (Ami), the only radioprotector clinically approved by the US-FDA [Ami- 83.3 mg/kg B.W] against different doses of gamma radiation - ⁶⁰Co (Lethal Dose: LD₃₀-9.2 Gy, LD₅₀-10.2 Gy and LD₇₀-11.4 Gy).

MATERIALS AND METHODS

This study was done via stress marker enzymes, cell cycle analysis (CCA) and DNA damage assay prediction with molecular docking, which are reported here for the first time. The results indicate an elevated LPO level and decreased level of CAT, SOD and GSH due to oxidative stress initiation by ⁶⁰Co Ionizing Radiation (IR) on 4th day and slightly reduced on 32nd day while the reverse observed when the fishes were pretreated with Ami, GS and GG. Similarly, CCA and dead/live cells counts were conducted with pretreatment of Ami, GS and GG against ⁶⁰Co IR dose (LD₅₀-10.2 Gy).

RESULTS

In CCA, G0/G1 phase was observed to be the highest in Ami and lowest in GG, against ⁶⁰Co IR doses 10.2 Gy which was 51.76 ± 7.55. The dead cells range observed in pretreated group of Ami, GS and GG was lowest in Ami and highest in GG and live cells (highest in Ami and lowest in GG) as compared to ⁶⁰Co IR group (86.43 ± 3.42 and 8.77 ± 5.95). Thus, antioxidant profile improvement by oxidative stress reduction and gradual progression of different phases of cell cycle except the apoptotic phase along with the live cells counts indicates that the radio-protective efficacy of GS is similar to Ami.

CONCLUSION

Predictive assessment was carried out by docking of Ami, various components of GS with p53, NF-κβ cells and Rad51 proteins structures responsible for CCA, apoptosis and repair mechanism. These structural proteins were docked with other structural proteins like USP7, TNF-α and partner and localizer of BRCA2 associated (PALB2/BRCA2) complex which made us perform these systemic efforts to find the functional activity of these known radio-protectants.

Protective effects of apocynin against ionizing radiation-induced hepatotoxicity in rats

Radiation hepatotoxicity is thought to be due to free oxygen radicals. We investigated the protective effects of apocynin (APO) against ionizing radiation induced oxidative stress in liver tissue following whole body ionizing radiation. We divided rats into four groups. The control group was injected intraperitoneally (i.p.) with saline for five consecutive days. A second group was injected i.p. with saline for 5 days and after 24 h, a single-dose of radiation (800 cGy) was administered to the whole abdomen. A third group was injected i.p. with 20 mg/kg APO for 5 days. A fourth group was injected i.p. with APO for 5 days and after 24 h, the rats were exposed to radiation. Ionizing radiation induced hepatotoxicity was demonstrated biochemically by significant changes in oxidative and antioxidant parameters. Our findings suggest that APO treatment may be protective against radiation induced hepatic injury by decreasing oxidative stress and increasing antioxidant activity.

Radioprotective effect of lycopene on the gastrointestinal tract after high-dose radioiodine administration in rat models

PURPOSE

The aim of this study was to evaluate the effect of lycopene against radioactive iodine (RAI)-related gastrointestinal tract acute damage in a rat model as a novel radioprotective agent.

MATERIALS AND METHODS

Twenty Wistar albino rats were divided into two equal groups: group 1 was administered only RAI and group 2 was administered RAI and lycopene. All rats were killed 24 h after the last administration of the agents and the gastrointestinal tract organs were removed surgically for histopathological examination.

RESULT

The presence of lamina propria edema in the duodenum (P=0.003) and ileum (P=0.02), ulcer in the duodenum (P=0.033), mucosal erosion in the stomach (P=0.001), mucosal degeneration in stomach (P=0.02) and colon (P=0.02), necrosis in all tissues (P value for stomach=0.005, duodenum=0.001, ileum=0.001, colon=0.001), inflammation in those tissues (P value for; stomach=0.003, duodenum=0.02, ileum=0.011, colon=0.033), and fibrosis in those tissues (P value for; stomach=0.02, duodenum=0.003, ileum=0.003, colon=0.001) were statistically less frequently observed in the lycopene group compared with the RAI group.

CONCLUSION

As a first study assessing the protective effect of lycopene on gastrointestinal tract organs in a rat model after RAI, these preliminary basic research findings suggest that lycopene appears to exert radioprotective effects against RAI-induced acute gastrointestinal tract damage.

Therapeutic improvement of colonic anastomotic healing under complicated conditions: A systematic review

AIM: To identify therapeutic agents for the prophylaxis of gastrointestinal anastomotic leakage (AL) under complicated conditions.

METHODS: The PubMed and EMBASE databases were searched for English articles published between January 1975 and September 2014. Studies with the primary purpose of improving anastomotic healing in the colon or rectum under complicated preoperative and/or intraoperative conditions were included. We excluded studies investigating the adverse effects or risk assessment of an active intervention. Furthermore, investigations of biophysical materials, sealants, electrical stimulation and nutrients were excluded. The primary study outcome was biomechanical anastomotic strength or AL. The meta-analysis focused on therapeutic agents that were investigated in one animal model using the same outcome by at least three independent research groups.

RESULTS: The 65 studies included were divided into 7 different complicated animal models: Bowel ischemia, ischemia/reperfusion, bowel obstruction, obstructive jaundice, peritonitis, chemotherapy and radiotherapy. In total, 48 different therapeutic compounds were examined. The majority of investigated agents (65%) were reported as beneficial for anastomotic healing. Twelve of the agents (25%) were tested more than once in the same model, whereas 13 (27%) of the agents were tested in two or more models of complicated healing. Two therapeutic agents met our inclusion criteria for the meta-analysis. Postoperative hyperbaric oxygen therapy significantly increased anastomotic bursting pressure in ischemic colon anastomoses by a mean of 28 mmHg (95%CI: 17 to 39 mmHg, P < 0.00001). Granulocyte macrophage-colony stimulating factor failed to show a significant increase in anastomotic bursting pressure (95%CI: -20 to 21 mmHg, P = 0.97) vs controls in experimental chemotherapeutic models.

CONCLUSION: This systematic review identified potential therapeutic agents, but more studies are needed before concluding that any of these are useful for AL prophylaxis.

The protective effects of apocynin on ionizing radiation-induced intestinal damage in rats

BACKGROUND AND AIMS

Radiation colitis typically emerges during radiotherapy of intra-abdominal malignancies. While the underlying mechanism remains unclear, it is considered that free oxygen radicals act like cellular mediators to cause colonic damage. Apocynin (APO) prevents oxidative stress and apoptotic cell death by inhibiting NADPH oxidase, and preventing the formation of free oxygen radicals. The aim of the present study was to investigate the protective effect of APO, a strong antioxidant and antiinflammatory agent, on radiation induced colonic oxidative damage in rats.

MATERIALS AND METHODS

Rats were randomly divided into four groups (n = 8/group). Group I (control group); Group II (Group RAD) received a single dose of 800 cGy ionizing radiation to the whole abdomen with a linear accelerator (LINAC); Group III (Group APO) received a single dose of 20 mg/kg of APO intraperitoneally for five days; Group IV (Group APO+RAD) received APO for five days before radiation exposure (similar to Group III), (similar to Group II).

RESULTS

APO treatment prior to radiation led to protection in the biochemical and histopathological parameters.

CONCLUSIONS

Our study shows that APO treatment before radiation improves radiation induced colonic injury in rats, by decreasing oxidative stress and apoptosis.

ICRP publication 118: ICRP statement on tissue reactions and early and late effects of radiation in normal tissues and organs--threshold doses for tissue reactions in a radiation protection context

This report provides a review of early and late effects of radiation in normal tissues and organs with respect to radiation protection. It was instigated following a recommendation in Publication 103 (ICRP, 2007), and it provides updated estimates of 'practical' threshold doses for tissue injury defined at the level of 1% incidence. Estimates are given for morbidity and mortality endpoints in all organ systems following acute, fractionated, or chronic exposure. The organ systems comprise the haematopoietic, immune, reproductive, circulatory, respiratory, musculoskeletal, endocrine, and nervous systems; the digestive and urinary tracts; the skin; and the eye. Particular attention is paid to circulatory disease and cataracts because of recent evidence of higher incidences of injury than expected after lower doses; hence, threshold doses appear to be lower than previously considered. This is largely because of the increasing incidences with increasing times after exposure. In the context of protection, it is the threshold doses for very long follow-up times that are the most relevant for workers and the public; for example, the atomic bomb survivors with 40-50years of follow-up. Radiotherapy data generally apply for shorter follow-up times because of competing causes of death in cancer patients, and hence the risks of radiation-induced circulatory disease at those earlier times are lower. A variety of biological response modifiers have been used to help reduce late reactions in many tissues. These include antioxidants, radical scavengers, inhibitors of apoptosis, anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, growth factors, and cytokines. In many cases, these give dose modification factors of 1.1-1.2, and in a few cases 1.5-2, indicating the potential for increasing threshold doses in known exposure cases. In contrast, there are agents that enhance radiation responses, notably other cytotoxic agents such as antimetabolites, alkylating agents, anti-angiogenic drugs, and antibiotics, as well as genetic and comorbidity factors. Most tissues show a sparing effect of dose fractionation, so that total doses for a given endpoint are higher if the dose is fractionated rather than when given as a single dose. However, for reactions manifesting very late after low total doses, particularly for cataracts and circulatory disease, it appears that the rate of dose delivery does not modify the low incidence. This implies that the injury in these cases and at these low dose levels is caused by single-hit irreparable-type events. For these two tissues, a threshold dose of 0.5Gy is proposed herein for practical purposes, irrespective of the rate of dose delivery, and future studies may elucidate this judgement further.

L-arginine and glycine supplementation in the repair of the irradiated colonic wall of rats

PURPOSE

Radiotherapy is widely used for cancer treatment but has harmful effects. This study aimed to assess the effects of L-arginine and glycine supplementation on the colon wall of rats submitted to abdominal irradiation.

METHODS

Forty male Wistar rats were randomly divided into four groups: I-healthy, II-irradiated with no amino acid supplementation, III-irradiated and supplemented with L-arginine, and IV-irradiated and supplemented with glycine. The animals received supplementation for 14 days, with irradiation being applied on the eighth day of the experiment. All animals underwent laparotomy on the 15th day for resection of a colonic segment for stereologic analysis. Parametric and nonparametric tests were used for statistical analysis, with the level of significance set at p ≤0.05.

RESULTS

Stereologic analysis showed that irradiation induced a reduction of the total volume of the colon wall of group II and III animals compared to healthy controls, but not of group IV animals supplemented with glycine. The mucosal layer of the irradiated animals of all groups was reduced compared to healthy group I animals, but supplementation with L-arginine and glycine was effective in maintaining the epithelial surface of the mucosal layer.

CONCLUSION

The present results suggest that glycine supplementation had a superior effect on the irradiated colon wall compared to L-arginine supplementation since it was able to maintain the thickness of the wall and the epithelial surface of the mucosa, whereas L-arginine maintained the partial volume of the epithelium and the epithelial surface, but not the total volume of the intestinal wall.

Models for Evaluating Agents Intended for the Prophylaxis, Mitigation and Treatment of Radiation Injuries Report of an NCI Workshop, December 3–4, 2003

To develop approaches to prophylaxis/protection, mitigation and treatment of radiation injuries, appropriate models are needed that integrate the complex events that occur in the radiation-exposed organism. While the spectrum of agents in clinical use or preclinical development is limited, new research findings promise improvements in survival after whole-body irradiation and reductions in the risk of adverse effects of radiotherapy. Approaches include agents that act on the initial radiochemical events, agents that prevent or reduce progression of radiation damage, and agents that facilitate recovery from radiation injuries. While the mechanisms of action for most of the agents with known efficacy are yet to be fully determined, many seem to be operating at the tissue, organ or whole animal level as well as the cellular level. Thus research on prophylaxis/protection, mitigation and treatment of radiation injuries will require studies in whole animal models. Discovery, development and delivery of effective radiation modulators will also require collaboration among researchers in diverse fields such as radiation biology, inflammation, physiology, toxicology, immunology, tissue injury, drug development and radiation oncology. Additional investment in training more scientists in radiation biology and in the research portfolio addressing radiological and nuclear terrorism would benefit the general population in case of a radiological terrorism event or a large-scale accidental event as well as benefit patients treated with radiation.

Estudo morfológico do efeito radioprotetor da vitamina E (dl-alfa-tocoferil) na reparação tecidual em ratos

Esta pesquisa teve por finalidade avaliar a ação da vitamina E como radioprotetora no processo de reparação tecidual em ratos, após sofrerem um procedimento cirúrgico, que consistiu da produção de uma ferida na região dorsal anterior. Os animais foram divididos em cinco grupos: grupo CO (controle) - constituído de animais em que foi produzida somente a ferida; grupo VE - pré-tratamento com vitamina E (90 UI); grupo IR - irradiação três dias após a cirurgia; grupo VEIR - pré-tratamento com 90 UI de vitamina E e irradiação de suas bordas três dias após a cirurgia; grupo OIR - pré-tratamento com óleo de oliva e irradiação de suas bordas três dias após a cirurgia. A ação radioprotetora da vitamina E foi avaliada pela coloração por hematoxilina-eosina para análise morfológica do tecido de granulação, aos 4, 7, 14 e 21 dias após a cirurgia. A análise dos resultados mostrou que o retardo no processo de reparação tecidual causado por 6 Gy de radiação de elétrons com feixe de 6 MeV não ocorreu no grupo de animais que recebeu vitamina E, mostrando-se esta substância efetiva como radioprotetora.

Trophic and cytoprotective nutrition for intestinal adaptation, mucosal repair, and barrier function

Intestinal epithelial cell turnover (proliferation, migration, differentiation, and apoptosis) and gut barrier functions are dynamic processes that are markedly affected by nutritional status, the route of feeding, and the adequacy of specific nutrients in the diet. Emerging studies are defining potential therapeutic roles for specific nutrients and diet-derived compounds (including arginine, glutamate, glutamine, glutathione, glycine, vitamin A, zinc, and specific lipids) in gut mucosal turnover, repair, adaptation after massive bowel resection, and barrier function. The role and regulation of endogenous bowel flora in generating short-chain fatty acids from diet-derived fiber and other diet-derived compounds and the effects of these agents on gut function are increasingly being elucidated. Results of these investigations should define new nutritional methods for trophic and cytoprotective effects on the intestine in conditions such as inflammatory bowel disease, malnutrition, and short bowel syndrome.

The “Pro-drug” RibCys Decreases the Mutagenicity of High-LET Radiation in Cultured Mammalian Cells

We are carrying out studies aimed at reducing the mutagenic effects of high-LET 56Fe ions and 12C ions (56Fe ions, 143 keV/microm; 12C ions, 100 keV/microm) with certain drugs, including RibCys [2-(R,S)-D-ribo-(1',2',3',4'-tetrahydroxybutyl)-thiazolidine-4(R)-carboxylic acid]. RibCys, formed by condensation of L-cysteine with D-ribose, is designed so that the sulfhydryl amino acid L-cysteine is released intracellularly through nonenzymatic ring opening and hydrolysis leading to increased levels of glutathione (GSH). RibCys (4 or 10 mM), which was present during irradiation and for a few hours after, significantly decreased the yield of CD59- mutants induced by radiation in AL human-hamster hybrid cells. RibCys did not affect the clonogenic survival of irradiated cells, nor was it mutagenic itself. These results, together with the minimal side effects reported in mice and pigs, indicate that RibCys may be useful, perhaps even when used prophylactically, in reducing the mutation load created by high-LET radiation in astronauts or other exposed individuals.

New opportunities in chemoprevention research

The importance of prevention in reducing the morbidity and mortality from cancer has been widely recognized. With the demonstration of tamoxifen's ability to prevent breast cancer in women, the feasibility of cancer chemoprevention in humans is now established. Future clinical chemoprevention studies should focus on phytochemicals, cancer preventive compounds in fruits, vegetables and other plants. Many phytochemicals are excellent potential chemopreventive agents, because, in addition to their cancer preventive effects, they are relatively non-toxic and inexpensive, they can be taken orally and some of them have other health benefits as well. New opportunities in clinical chemoprevention research include investigating chemopreventive effects of phytochemicals and conducting studies in patients with cancer. There is also a great need to investigate potential benefits and risks of administering phytochemicals before, during or after conventional therapies, such as surgery, chemotherapy, radiation or hormonal therapy. In addition, administration of chemopreventive agents prior to surgery provides an opportunity to investigate the modulation of genetic and epigenetic pathways by putative cancer preventive compounds and nutrients.

Radiation damage to the rectum and anus: pathophysiology, clinical features and surgical implications

Radiation kills cancer cells by inducing various degrees of deoxyribonucleic acid fragmentation and disruption of intracellular membranes that lead to either immediate or delayed cell death. Although radiation can be effective in destroying cancer, its usefulness is limited by damage to normal tissues that surround the target tumour or those in the path of the radiation beam. The rectum and anus are damaged frequently during radiotherapy for abdominopelvic malignancy, including preresection therapy for rectal cancer. Such damage is often associated with lesions in the perineal skin, genitourinary tract, colon, and small intestine. Surgical intervention often is required for the most severe forms of these complications.

Acute nutritional and intestinal changes after pelvic radiation

OBJECTIVE

Pelvic radiotherapy induces acute small bowel injury but its effects on nutritional status are unknown. The objective of this study was to prospectively evaluate nutritional, functional and morphologic intestinal changes, after radiotherapy.

METHODS

Fifteen patients were studied before and after pelvic irradiation. A clinical, nutritional and routine clinical laboratory assessment was performed. Nutritional parameters included dietary recall, subjective global assessment, anthropometric measurements (body mass index, skinfold thickness at four sites and circumferences of arm, waist and hip), hand grip strength, indirect calorimetry and Dual Energy X-ray absortiometry (DEXA). Intestinal parameters included permeabilty to sugars (assessed by lactulose and mannitol urinary excretion), intestinal transit time (measured by hydrogen breath test after ingestion of lactulose) and jejunal biopsies.

RESULTS

Thirteen patients presented diarrhea during radiation therapy. After five weeks, intestinal permeability increased, while intestinal transit time decreased. The second biopsy showed hypertrophy of villae and crypts. Simultaneously, patients lost weight at the expense of fat free mass. Resting energy expenditure was elevated prior to treatment and declined after five weeks. Changes in caloric ingestion were not significant.

CONCLUSIONS

Our results indicate that pelvic radiation induces a loss of fat free mass along with intestinal morphologic and functional changes.

Administration of Lactobacillus plantarum 299v reduces side-effects of external radiation on colon anastomotic healing in an experimental model

OBJECTIVE

Preoperative radiotherapy of patients with rectal carcinoma is frequently used to reduce the incidence of local recurrence. However, the radiation therapy is associated with several complications, including diarrhea, retarded anastomotic healing and mucosal atrophy. Exogenous administration of lactobacilli has been demonstrated to be effective in stimulating intestinal mucosal growth and reduce mucosal inflammation. The objective of this study was to examine the effects of Lactobacillus plantarum 299v administration on external radiation injury in colon anastomotic healing at different time points.

MATERIAL AND METHODS

Sprague-Dawley rats were treated with Lb. plantarum 299v or saline as control and received external radiation of the lower abdomen (10 Gy/day) on day 3 and 7 of the experiment. After 4 days, a colonic resection with anastomosis was performed. Animals were sacrificed on 4th, 7th and 11th day postoperatively. Body weight, white blood cell (WBC) count, mucosal myeloperoxidase (MPO) activity, hydroxyproline, nucleotide, DNA and RNA content, colonic bacterial microflora, bacterial translocation and histology were evaluated.

RESULTS

On the 4th postoperative day body weight, WBC and MPO decreased significantly after radiation. On the 7th postoperative day MPO decreased after radiation. In the two irradiated groups it decreased significantly in the Lb. plantarum group compared to the radiated group without treatment. Collagen concentration on the 7th postoperative day was significantly higher in Lb. plantarum group without radiation compared to the group with radiation without Lb. plantarum. On the 11th postoperative day MPO was significantly higher in irradiated rats without treatment compared to Lb. plantarum treatment. The collagen concentration increased significantly in the irradiated Lb. plantarum group compared to the other two groups.

CONCLUSION

The collagen content decreased and MPO activity increased significantly of the colonic anastomosis in irradiated rats without treatment compared to those treated with Lb. plantarum. It therefore seems that administration of Lactobacillus plantarum 299v reduces the intestinal injury and inflammation following external radiation and improves the colonic anastomotic healing.

The effect of selenium and/or vitamin E treatments on radiation-induced intestinal injury in rats

Cytotoxic effects of ionizing radiation on gastrointestinal epithelium may be related to oxidative stress. In this study, we wanted to investigate the effects of selenium, vitamin E and selenium plus vitamin E pretreatments prior to whole abdominal irradiation on intestinal injury. Irradiation caused increased lipid peroxide and decreased GSH levels in the intestine. Intestinal superoxide dismutase and glutathione peroxidase activities were increased, but glutathione transferase activity decreased following irradiation. Selenium and/or vitamin E pretreatments ameliorated these disturbances in prooxidant-antioxidant balance. This amelioriation has been verified with histopathological findings. These results indicate that antioxidant pretreatments prior to irradiation may have some beneficial effects against irradiation-induced intestinal injury.