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Livingston GK, Ryan TL, Escalona MB, Foster AE, Balajee AS. Retrospective Evaluation of Cytogenetic Effects Induced by Internal Radioiodine Exposure: A 27-Year Follow-Up Study. Cytogenet Genome Res 2023; 163:154-162. [PMID: 37573786 DOI: 10.1159/000533396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023] Open
Abstract
Radioiodine (131I) is widely used in the treatment of hyperthyroidism and as an effective ablative therapy for differentiated thyroid cancer. Radioiodine (131I) constitutes 90% of the currently used therapies in the field of nuclear medicine. Here, we report the cytogenetic findings of a long-term follow-up study of 27 years on a male patient who received two rounds of radioiodine treatment within a span of 26 months between 1992 and 1994 for his papillary thyroid cancer. A comprehensive cytogenetic follow-up study utilizing cytokinesis blocked micronucleus assay, dicentric chromosome assay, genome wide translocations and inversions was initiated on this patient since the first administration of radioiodine in 1992. Frequencies of micronuclei (0.006/cell) and dicentric chromosomes (0.008/cell) detected in the current study were grossly similar to that reported earlier in 2019. The mFISH analysis detected chromosome aberrations in 8.6% of the cells in the form of both unbalanced and balanced translocations. Additionally, a clonal translocation involving chromosomes 14p; 15q was observed in 2 of the 500 cells analyzed. Out of the 500 cells examined, one cell showed a complex translocation (involving chromosomes 9, 10, and 16) besides 5 other chromosome rearrangements. Collectively, our study indicates that the past radioiodine exposure results in long-lasting chromosome damage and that the persistence of translocations can be useful for both retrospective biodosimetry and for monitoring chromosome instability in the lymphocytes of radioiodine exposed individuals.
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Affiliation(s)
- Gordon K Livingston
- Cytogenetic Biodosimetry Laboratory, Radiation Emergency Assistance Center/Training Site, Oak Ridge Institute for Science and Education, Oak Ridge Associated Universities, Oak Ridge, Tennessee, USA
| | - Terri L Ryan
- Cytogenetic Biodosimetry Laboratory, Radiation Emergency Assistance Center/Training Site, Oak Ridge Institute for Science and Education, Oak Ridge Associated Universities, Oak Ridge, Tennessee, USA
| | - Maria B Escalona
- Cytogenetic Biodosimetry Laboratory, Radiation Emergency Assistance Center/Training Site, Oak Ridge Institute for Science and Education, Oak Ridge Associated Universities, Oak Ridge, Tennessee, USA
| | - Alvis E Foster
- Indiana University Health, Ball Memorial Hospital, Muncie, Indiana, USA
| | - Adayabalam S Balajee
- Cytogenetic Biodosimetry Laboratory, Radiation Emergency Assistance Center/Training Site, Oak Ridge Institute for Science and Education, Oak Ridge Associated Universities, Oak Ridge, Tennessee, USA
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Khvostunov IK, Nasonova E, Krylov V, Rodichev A, Kochetova T, Shepel N, Korovchuk O, Kutsalo P, Shegai P, Kaprin A. Cytogenetic Damage Induced by Radioiodine Therapy: A Follow-Up Case Study. Int J Mol Sci 2023; 24:ijms24065128. [PMID: 36982202 PMCID: PMC10049272 DOI: 10.3390/ijms24065128] [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: 02/02/2023] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/30/2023] Open
Abstract
The risk of toxicity attributable to radioiodine therapy (RIT) remains a subject of ongoing research, with a whole-body dose of 2 Gy proposed as a safe limit. This article evaluates the RIT-induced cytogenetic damage in two rare differentiated thyroid cancer (DTC) cases, including the first follow-up study of a pediatric DTC patient. Chromosome damage in the patient's peripheral blood lymphocytes (PBL) was examined using conventional metaphase assay, painting of chromosomes 2, 4, and 12 (FISH), and multiplex fluorescence in situ hybridization (mFISH). Patient 1 (female, 1.6 y.o.) received four RIT courses over 1.1 years. Patient 2 (female, 49 y.o.) received 12 courses over 6.4 years, the last two of which were examined. Blood samples were collected before and 3-4 days after the treatment. Chromosome aberrations (CA) analyzed by conventional and FISH methods were converted to a whole-body dose accounting for the dose rate effect. The mFISH method showed an increase in total aberrant cell frequency following each RIT course, while cells carrying unstable aberrations predominated in the yield. The proportion of cells containing stable CA associated with long-term cytogenetic risk remained mostly unchanged during follow-up for both patients. A one-time administration of RIT was safe, as the threshold of 2 Gy for the whole-body dose was not exceeded. The risk of side effects projected from RIT-attributable cytogenetic damage was low, suggesting a good long-term prognosis. In rare cases, such as the ones reviewed in this study, individual planning based on cytogenetic biodosimetry is strongly recommended.
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Affiliation(s)
- Igor K Khvostunov
- A.F. Tsyb Medical Radiological Research Center (MRRC)-Branch of the National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, 4 Koroliova St., 249036 Obninsk, Russia
| | - Elena Nasonova
- Joint Institute for Nuclear Research (JINR), 6 Joliot-Curie St., 141980 Dubna, Russia
| | - Valeriy Krylov
- A.F. Tsyb Medical Radiological Research Center (MRRC)-Branch of the National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, 4 Koroliova St., 249036 Obninsk, Russia
| | - Andrei Rodichev
- A.F. Tsyb Medical Radiological Research Center (MRRC)-Branch of the National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, 4 Koroliova St., 249036 Obninsk, Russia
| | - Tatiana Kochetova
- A.F. Tsyb Medical Radiological Research Center (MRRC)-Branch of the National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, 4 Koroliova St., 249036 Obninsk, Russia
| | - Natalia Shepel
- A.F. Tsyb Medical Radiological Research Center (MRRC)-Branch of the National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, 4 Koroliova St., 249036 Obninsk, Russia
| | - Olga Korovchuk
- A.F. Tsyb Medical Radiological Research Center (MRRC)-Branch of the National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, 4 Koroliova St., 249036 Obninsk, Russia
| | - Polina Kutsalo
- Joint Institute for Nuclear Research (JINR), 6 Joliot-Curie St., 141980 Dubna, Russia
| | - Petr Shegai
- Federal State Budgetary Institution, National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, 2 Botkinskiy Proezd, 125284 Moscow, Russia
| | - Andrei Kaprin
- Federal State Budgetary Institution, National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, 2 Botkinskiy Proezd, 125284 Moscow, Russia
- Federal State Autonomous Educational Institution of Higher Professional Education, Department of Oncology and Radiology Named after N.P. Kharchenko, Medical Institute, Peoples' Friendship University of Russia, 117198 Moscow, Russia
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Vinnikov V, Belyakov O. Clinical Applications of Biological Dosimetry in Patients Exposed to Low Dose Radiation Due to Radiological, Imaging or Nuclear Medicine Procedures. Semin Nucl Med 2021; 52:114-139. [PMID: 34879905 DOI: 10.1053/j.semnuclmed.2021.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Radiation dosimetric biomarkers have found applications beyond radiation protection area and now are actively introduced into clinical practice. Cytogenetic assays appeared to be a valuable tool for individualized quantifying radiation effects in patients, with high capability for assessing genotoxicity of various medical exposure modalities and providing meaningful radiation dose estimates for prognoses of radiation-related cancer risk. This review summarized current data on the use of biological dosimetry methods in patients undergoing various medical irradiations to low doses. The highlighted topics include basic aspects of biological dosimetry and its limitations in the range of low radiation doses, and main patterns of in vivo induction of radiation biomarkers in clinical exposure scenarios, occurring in X-ray diagnostics, computed tomography, interventional radiology, low dose radiotherapy, and nuclear medicine (internally administered 131I and other radiopharmaceuticals). Additionally, several specific issues, examined by biodosimetry techniques, are analysed, such as contrast media effect, radiation response in pediatric patients, impact of magnetic resonance imaging, evaluation of radioprotectors, detection of patients' abnormal intrinsic radiosensitivity and dose estimation in persons involved in medical radiation incidents. A prognosis of possible directions for further improvements in this area includes the automation of cytogenetic analysis, introduction of molecular biodosimeters and development of multiparametric biodosimetry platforms. A potential approach to the advanced biodosimetry of internal exposure and/or low dose external irradiation is suggested; this can be a multiparametric platform based on the combination of the γ-H2AX foci, dicentric, and translocation assays, each applied in the optimum postexposure time range, with the amalgamation of the dose estimates. The study revealed the necessity of further research, which might clarify medical radiation safety concerns for patients via using stringent biodosimetry methodology.
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Affiliation(s)
- Volodymyr Vinnikov
- International Atomic Energy Agency (IAEA), Vienna, Austria; Grigoriev Institute for Medical Radiology and Oncology (GIMRO), Kharkiv, Ukraine.
| | - Oleg Belyakov
- International Atomic Energy Agency (IAEA), Vienna, Austria
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Balajee AS, Livingston GK, Escalona MB, Ryan TL, Goans RE, Iddins CJ. Cytogenetic follow-up studies on humans with internal and external exposure to ionizing radiation. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:S578-S601. [PMID: 34233319 DOI: 10.1088/1361-6498/ac125a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/07/2021] [Indexed: 06/13/2023]
Abstract
Cells exposed to ionizing radiation have a wide spectrum of DNA lesions that include DNA single-strand breaks, DNA double-strand breaks (DSBs), oxidative base damage and DNA-protein crosslinks. Among them, DSB is the most critical lesion, which when mis-repaired leads to unstable and stable chromosome aberrations. Currently, chromosome aberration analysis is the preferred method for biological monitoring of radiation-exposed humans. Stable chromosome aberrations, such as inversions and balanced translocations, persist in the peripheral blood lymphocytes of radiation-exposed humans for several years and, therefore, are potentially useful tools to prognosticate the health risks of radiation exposure, particularly in the hematopoietic system. In this review, we summarize the cytogenetic follow-up studies performed by REAC/TS (Radiation Emergency Assistance Center/Training site, Oak Ridge, USA) on humans exposed to internal and external radiation. In the light of our observations as well as the data existing in the literature, this review attempts to highlight the importance of follow-up studies for predicting the extent of genomic instability and its impact on delayed health risks in radiation-exposed victims.
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Affiliation(s)
- Adayabalam S Balajee
- Cytogenetic Biodosimetry Laboratory, Radiation Emergency Assistance Centre/Training Site, Oak Ridge Institute for Science and Education, Oak Ridge Associated Universities, Oak Ridge, TN, United States of America
| | - Gordon K Livingston
- Cytogenetic Biodosimetry Laboratory, Radiation Emergency Assistance Centre/Training Site, Oak Ridge Institute for Science and Education, Oak Ridge Associated Universities, Oak Ridge, TN, United States of America
| | - Maria B Escalona
- Cytogenetic Biodosimetry Laboratory, Radiation Emergency Assistance Centre/Training Site, Oak Ridge Institute for Science and Education, Oak Ridge Associated Universities, Oak Ridge, TN, United States of America
| | - Terri L Ryan
- Cytogenetic Biodosimetry Laboratory, Radiation Emergency Assistance Centre/Training Site, Oak Ridge Institute for Science and Education, Oak Ridge Associated Universities, Oak Ridge, TN, United States of America
| | - Ronald E Goans
- Cytogenetic Biodosimetry Laboratory, Radiation Emergency Assistance Centre/Training Site, Oak Ridge Institute for Science and Education, Oak Ridge Associated Universities, Oak Ridge, TN, United States of America
| | - Carol J Iddins
- Cytogenetic Biodosimetry Laboratory, Radiation Emergency Assistance Centre/Training Site, Oak Ridge Institute for Science and Education, Oak Ridge Associated Universities, Oak Ridge, TN, United States of America
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Chimeno JM, Sebastià N, Torres-Espallardo I, Balaguer J, Candela-Juan C, Loaiza JL, Adria M, Ibanez-Rosello B, Cañete A, Martí-Bonmatí L, Montoro A. Assessment of the dicentric chromosome assay as a biodosimetry tool for more personalized medicine in a case of a high risk neuroblastoma 131I-mIBG treatment. Int J Radiat Biol 2018; 95:314-320. [PMID: 30496023 DOI: 10.1080/09553002.2019.1549755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE The aims of this study were to estimate the whole - body absorbed - dose with the Dicentric Chromosome Assay (DCA) (biodosimetry) for 131I - metaiodobenzylguanidine (131I - mIBG) therapy for high - risk neuroblastoma, and to obtain an initial correlation with the physical dosimetry calculated as described by the Medical Internal Radiation Dosimetry formalism (MIRD). Together both objectives will aid the optimization of personalized targeted radionuclide therapies. MATERIAL AND METHODS A 12 year-old child with relapsed high-risk neuroblastoma was treated with 131I-mIBG: a first administration with activity <444 MBq/kg was used as a tracer in order to calculate the activity needed in a second administration to achieve a whole body prescribed dose of ∼4 Gy. Blood samples were obtained before and seven days after each administration to analyze the frequency of dicentrics. Moreover, consequent estimations of retained activity were done every few hours from equivalent dose rate measurements at a fixed position, two meters away from the patient, in order to apply the MIRD procedure. Blood samples were also drawn every 2- to -3 days to assess bone marrow toxicity. RESULTS For a total activity of 22,867 MBq administered over two phases, both biological and physical dosimetries were performed. The former estimated a whole-body cumulated dose of 3.53 (2.58-4.41) Gy and the latter a total whole-body absorbed dose of 2.32 ± 0.48 Gy. The patient developed thrombocytopenia grade 3 after both infusions and neutropenia grade 3 and grade 4 (based on CTCAE 4.0) during respective phases. CONCLUSION The results indicate a possible correlation between biodosimetry and standard physical dosimetry in 131I-mIBG treatment for high-risk neuroblastoma. A larger cohort and refinement of the DCA for internal irradiation are needed to define the role of biodosimetry in clinical situations.
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Affiliation(s)
- Jose Maria Chimeno
- a Radiation Protection Service , Hospital Universitario y Politécnico La Fe , Valencia , Spain
| | - Natividad Sebastià
- a Radiation Protection Service , Hospital Universitario y Politécnico La Fe , Valencia , Spain.,b Mixed Unity of Nanomedicine and Sensors , Instituto de Investigación Sanitaria La Fe Valencia , Spain
| | - Irene Torres-Espallardo
- c Department of Nuclear Medicine , Hospital Universitario y Politécnico La Fe , Valencia , Spain
| | - Julia Balaguer
- d Department of Pediatric Oncology , Hospital Universitario y Politécnico La Fe , Valencia , Spain
| | - Cristian Candela-Juan
- e Centro Nacional de Dosimetría (CND) , Instituto Nacional de Gestión Sanitaria , Valencia , Spain
| | - Jose Luis Loaiza
- c Department of Nuclear Medicine , Hospital Universitario y Politécnico La Fe , Valencia , Spain
| | - Mar Adria
- c Department of Nuclear Medicine , Hospital Universitario y Politécnico La Fe , Valencia , Spain
| | - Blanca Ibanez-Rosello
- c Department of Nuclear Medicine , Hospital Universitario y Politécnico La Fe , Valencia , Spain
| | - Adela Cañete
- d Department of Pediatric Oncology , Hospital Universitario y Politécnico La Fe , Valencia , Spain
| | - Luis Martí-Bonmatí
- f Department of Radiology , Hospital Universitario y Politécnico La Fe and Instituto de Investigación Sanitaria la Fe , Valencia , Spain.,g Biomedical Imaging Research Group GIBI230 , Instituto de Investigación Sanitaria la Fe , Spain
| | - Alegría Montoro
- a Radiation Protection Service , Hospital Universitario y Politécnico La Fe , Valencia , Spain.,g Biomedical Imaging Research Group GIBI230 , Instituto de Investigación Sanitaria la Fe , Spain
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Balajee AS, Hande MP. History and evolution of cytogenetic techniques: Current and future applications in basic and clinical research. MUTATION RESEARCH-GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2018; 836:3-12. [PMID: 30389159 DOI: 10.1016/j.mrgentox.2018.08.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/23/2018] [Accepted: 08/23/2018] [Indexed: 12/13/2022]
Abstract
Chromosomes are the vehicles of genes, which are the functional units of a cell's nucleus. In humans, there are more than 20,000 genes that are distributed among 46 chromosomes in somatic cells. The study of chromosome structure and function is known as cytogenetics which is historically a field of hybrid science encompassing cytology and genetics. The field of cytogenetics has undergone rapid developments over the last several decades from classical Giemsa staining of chromosomes to 3-dimensional spatial organization of chromosomes with a high resolution mapping of gene structure at the nucleotide level. Improved molecular cytogenetic techniques have opened up exciting possibilities for understanding the chromosomal/molecular basis of various human diseases including cancer and tissue degeneration. This review summaries the history and evolution of various cytogenetic techniques and their current and future applications in diverse areas of basic research and medical diagnostics.
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Affiliation(s)
- Adayabalam S Balajee
- Cytogenetics Biodosimetry Laboratory, Radiation Emergency Assistance Center and Training Site, Oak Ridge Institute for Science and Education, Oak Ridge Associated Universities, 1299, Bethel Valley Road, Oak Ridge, TN 37830, USA.
| | - M Prakash Hande
- Department of Physiology, Yong Loo Lin School of Medicine and Tembusu College, National University of Singapore, 117593, Singapore.
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Livingston GK, Escalona M, Foster A, Balajee AS. Persistent in vivo cytogenetic effects of radioiodine therapy: a 21-year follow-up study using multicolor FISH. JOURNAL OF RADIATION RESEARCH 2018; 59:10-17. [PMID: 29036595 PMCID: PMC5778502 DOI: 10.1093/jrr/rrx049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 07/28/2017] [Indexed: 06/07/2023]
Abstract
Our previous studies demonstrated the cytogenetic effects in the peripheral blood lymphocytes of a 34-year-old male patient who received ablative radioactive 131iodine therapy (RIT) on two different occasions in 1992 and 1994. Assessment of RIT-induced chromosomal damage by the cytokinesis-blocked micronucleus assay (CBMN) showed the persistence of elevated micronucleus frequency in this patient for more than two decades since the first RIT. Subsequent cytogenetic analysis performed in 2012 revealed both stable and unstable aberrations, whose frequencies were higher than the baseline reported in the literature. Here, we report the findings of our recent cytogenetic analysis peformed in 2015 on this patient using the multicolor fluorescence in situ hybridization (mFISH) technique. Our results showed that both reciprocal and non-reciprocal translocations persisted at higher frequencies in the patient than those reported in 2012. Persistence of structural aberrations for more than two decades indicate that these aberrations might have originated from long-lived T-lymphocytes or hematopoietic stem cells. Our study suggests that the long-term persistence of chromosome translocations in circulating lymphocytes can be useful for monitoring the extent of RIT-induced chromosomal instability several years after exposure and for estimating the cumulative absorbed dose after multiple RITs for retrospective biodosimetry purposes. This is perhaps the first and longest follow-up study documenting the persistence of cytogenetic damage for 21 years after internal radiation exposure.
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Affiliation(s)
- Gordon K Livingston
- Radiation Emergency Assistance Center and Training Site, Cytogenetic Biodosimetry Laboratory, Oak Ridge Associated Universities, Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830, USA
| | - Maria Escalona
- Radiation Emergency Assistance Center and Training Site, Cytogenetic Biodosimetry Laboratory, Oak Ridge Associated Universities, Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830, USA
| | - Alvis Foster
- Indiana University Health, Ball Memorial Hospital, 2401 West University Avenue, Muncie, IN 47303, USA
| | - Adayabalam S Balajee
- Radiation Emergency Assistance Center and Training Site, Cytogenetic Biodosimetry Laboratory, Oak Ridge Associated Universities, Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830, USA
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