Induction of sister-chromatid exchanges in human lymphocytes exposed in vitro and in vivo to therapeutic ultrasound

Applications of Human Peripheral Blood Lymphocytes in Genotoxicity and Cytotoxicity

A number of features make peripheral blood lymphocytes an excellent system for studying both genotoxicity and cytotoxicity in humans. They are an abundant and readily accessible source of somatic cells, mostly in a non-proliferative state, but able to be stimulated by mitogens to enter the cell cycle. The blastocyte transformation of lymphocytes is a useful model for investigating the mechanisms which regulate cell-cycle progression in mammalian cells. By stimulating lymphocytes in vitro, it is possible to detect the genetic damages they have sustained in vivo, which become manifest as chromosomal aberrations, sister-chromatid exchanges or gene mutations. The metabolic properties of lymphocytes have been extensively studied, especially with reference to their characteristic collection of enzymes involved in nucleotide turnover, which makes them exquisitely sensitive to changes in intracellular levels of DNA precursors. The data collected on the ability of lymphocytes to metabolise xenobiotics show a marked quantitative difference between resting and proliferating lymphocytes, and minor qualitative differences between lymphocytes and other cell types, e.g. hepatocytes. An indirect approach to detect the metabolism of genotoxic xenobiotics by lymphocytes is the analysis of DNA adducts in their chromatin after in vivo or in vitro exposure. Lymphocytes can be employed to identify the (cyto)genetic consequences of in vivo genotoxic exposure and inter-individual variation in sensitivity to genotoxic agents. The analysis of mutations at the hgprt locus in lymphocytes is a promising approach for the study of somatic-cell mutations in humans and of the possible mechanisms of in vivo selection against mutants.

In the field of cytotoxicity, the applications of lymphocytes are, as yet, still few: the main effect measured is the impairment of the proliferative response to mitogens. But lymphocytes can be employed as primary human cells to be treated in vitro with mutagenic or toxic chemicals in standard genotoxicity and cytotoxicity assays, and offer the advantage of avoiding the problems of inter-species extrapolation of results by testing in a human system. Moreover, the (geno)toxic effects detected in lymphocytes after treatments in vitro may give information on the spontaneous or environmentally-determined susceptibility of the individual donors to xenobiotics.

Potential genotoxic effects of low-intensity ultrasound on fibroblasts, evaluated with the cytokinesis-block micronucleus assay

Although medical ultrasound offers compelling opportunities to improve therapy in principle, progress in the field has been limited because of an insufficient understanding of the potential genotoxic and cytotoxic effects of ultrasound on biological systems. This paper is mainly focused on an in vitro study of effects with respect to genotoxicity and viability induced by 1- and 3-MHz medical ultrasound in murine fibroblasts (NIH-3T3) at low-intensity exposure (spatial peak temporal average intensity Ita<0.1 W/cm(2)). The NIH-3T3 cells constitute a well-characterized in vitro cell model in which a genotoxic effect can be predicted by means of a reliable and precise murine cytokinesis-block micronucleus assay. A statistically significant increase in the incidence of micronuclei was observed in sonicated 3T3 cells. In particular, the effects were more evident at 1 MHz. Moreover, for each frequency investigated, the occurrence of micronuclei was comparatively more frequent with increasing time of exposure. The possible toxicological implications of the medical ultrasound employed herein deal with the existence of a window of exposure parameters (set well below the intensity of ultrasound cavitation) in which some genotoxic effects may occur without significant cytotoxicity. In this respect, they provide new insight toward the correct risk to benefit balancing of ultrasound-based treatments and for designing innovative therapeutic strategies.

Cardiac imaging: The biological effects of diagnostic cardiac ultrasound

Diagnostic cardiac ultrasounds are an environment-friendly and non-ionising imaging technology. However, ultrasounds are not biologically inert, and their use might have profound clinical impact. This paper summarizes the known effects of cardiac ultrasound--compared to other major imaging techniques--to exposed patients and to clinically exposed physicians practising ultrasound imaging. Furthermore, this review also provides an overview of the evidences on the biological effects of diagnostic ultrasound--which suggest that ultrasound with frequency, intensity and duration fully in the diagnostic range have significant molecular, cellular and organ effects. A better understanding of these effects may improve our understanding of the complex interactions between ultrasound and biological tissues and may open new avenues to therapeutic applications based on the ultrasound-modulated cell functions, such as membrane transduction, apoptosis, cell permeability and thrombolysis.

The biological effects of diagnostic cardiac imaging on chronically exposed physicians: the importance of being non-ionizing

Ultrasounds and ionizing radiation are extensively used for diagnostic applications in the cardiology clinical practice. This paper reviewed the available information on occupational risk of the cardiologists who perform, every day, cardiac imaging procedures. At the moment, there are no consistent evidence that exposure to medical ultrasound is capable of inducing genetic effects, and representing a serious health hazard for clinical staff. In contrast, exposure to ionizing radiation may result in adverse health effect on clinical cardiologists. Although the current risk estimates are clouded by approximations and extrapolations, most data from cytogenetic studies have reported a detrimental effect on somatic DNA of professionally exposed personnel to chronic low doses of ionizing radiation. Since interventional cardiologists and electro-physiologists have the highest radiation exposure among health professionals, a major awareness is crucial for improving occupational protection. Furthermore, the use of a biological dosimeter could be a reliable tool for the risk quantification on an individual basis.

Investigation of genotoxic effect of ultrasound in cases receiving therapeutic ultrasound by using micronucleus method

In 1991, reported that therapeutic ultrasound (US) did not induce sister chromatid exchanges (SCEs) in patients whereas, in 1984, reported that each of 10 patients exposed to therapeutic US had a statistically significant increase in SCEs. The present study was planned to investigate if there was chromosomal damage resulting from therapeutic US by using a micronucleus (MN) method, and to counter the lack of reports in this area over the past 10 years. A total of 20 female volunteers were included in the study; 10 of them with low back pain (mechanical low back pain and facet syndrome) were treated with US and 10 healthy cases constituted the control group. Patients with low back pain received 10 sessions of US therapy at an intensity of 2 W/cm(2) and a frequency of 1 MHz for 10 min and patients in the control group received sham US therapy for 10 min. Peripheral blood taken before and after the fifth and tenth applications of US therapy was cultured for MN frequencies both for the treatment and the control groups. The scores of MN assessed before the therapy were compared with those at the end of the fifth session and the end of the tenth session in the treatment and the control groups. Pretreatment, end of the fifth session and end of the tenth session MN frequencies were compared between the treatment and the control groups. There was no statistically significant difference in MN frequencies between pretreatment and fifth session or pretreatment and tenth session in both groups. Nor was there any significant difference in the MN frequencies of the treatment and control groups between pretreatment, fifth session and tenth session evaluations. In conclusion, we observed that therapeutic US did not induce increases in MN frequency, which are a sign of cytogenetic damage.

Effects of ultrasound on the growth and function of bone and periodontal ligament cells in vitro

The effects of therapeutic ultrasound (US) on tissue healing processes in vivo are likely to involve US-induced changes in key cellular functions. However, these have not yet been clearly delineated and the present study has, therefore, examined the effects of a single 5-min CW exposure of 3.00-MHz US on the growth and functional activity of a human osteoblast-like cell line (MG63 cells) and human periodontal ligament (PDL) cells in vitro. Although cell proliferation was found to be largely unaffected by spatial average intensity (I(SA)) values of between 140-990 mW/cm(2), flow cytometry (FCM) analysis showed that there were pronounced and differential effects on cell function. Thus, bone-associated proteins were down-regulated, whereas collagen type I (COL I) was unaffected and fibronectin (FN) was up-regulated at low intensities in MG63 cells. In contrast, bone protein expression was found to be dose-dependent, and FN and COL I were down-regulated in PDL cells. These results show that US has potentially important effects on the functional activities of connective tissue cells in vitro, which could markedly influence tissue repair and regeneration processes in vivo.

Cytogenetic monitoring of cardiology unit hospital workers exposed to Doppler ultrasound

We studied the effects of ultrasound on the peripheral blood lymphocytes of medical personnel from a cardiology unit working with colour Doppler ultrasonic equipment. Cytogenetic risks from ultrasound exposure were assessed by analysis of chromosome aberrations, sister chromatid exchanges (SCE), study of cell-cycle kinetics and micronucleus assay. We found significant increases (P < 0.001) in the total number of chromosome aberrations, mainly due to chromatid breaks and acentric fragments, increases in the total number of micronuclei and SCE and disturbances in cell-cycle kinetics in the exposed group compared to the control. In spite of their limitations, the results of the present investigation indicate that individuals occupationally exposed to ultrasound may experience an increased genotoxic risk and strongly emphasize the need for more research into the nature and extent of the biological consequences to medical personnel working with Doppler ultrasound.

Increased levels of sister chromatid exchanges in military aircraft pilots

Sister chromatid exchanges (SCEs) were scored in lymphocytes of nine high-performance pilots of alphajet aircrafts and of ten control individuals from the same air base. Statistical analysis of the mean SCE count per cell in the total number of cells analyzed as well as in those having 12 or more SCEs (high-frequency cells, HFCs) revealed a significant difference between pilots and controls, after adjusting for the effect of smoking. Analysis of the cell cycle kinetic data (replication and mitotic indices) revealed no significant differences either between pilots and controls or between smokers and nonsmokers. Previously, we reported an increase in the SCE levels in workers of the aeronautical industry exposed to noise and whole-body vibration. The present results corroborate those findings and indicate that noise and whole-body vibration may cause genotoxic effects in man.

Correlation of ultrasound-induced hemolysis with cavitation detector output in vitro

A 20-MHz passive acoustic detector was used to quantify the amount of transient acoustic cavitation occurring in a sample exposed to intense pulsed ultrasound. A dilute suspension of human erythrocytes with and without a microbubble echo-contrast agent was exposed in vitro to 500 W/cm2 (SPPA) ultrasound of center frequency 1 MHz and tone burst duration 20, 100, 200, 500 and 1000 microseconds at a pulse repetition frequency of 20 Hz. Inertial cavitation occurring within the sample, as measured by the temporal average of the detector output, correlated well with hemolysis, suggesting that violent bubble collapse is responsible for cell damage. The result also raises the prospect of cavitation monitoring as a possible predictor of adverse bioeffects when echo-contrast agents are used clinically.

Sister chromatid exchange analysis in workers exposed to noise and vibration

Workers chronically exposed to whole-body vibration and noise are known to develop pathophysiological and psychological disturbances. The frequencies of sister chromatid exchanges (SCEs) and of cells with high frequencies of SCEs (HFCs) were analyzed in lymphocytes of 50 workers occupationally exposed to vibration and noise and of 34 controls. The exposed group included: individuals operating hand-vibrating tools (group 1), 'test-cell operators' (group 2) and 'run-up' operators (group 3) from an air base and helicopter pilots (group 4). The statistical analysis of the mean SCE count per cell was carried out by multiple regression analysis, comparing various predictor variables: exposure group, duration of exposure, age and cigarette consumption. Only cigarette consumption and exposure group were found to be significantly correlated with the mean SCE frequency. After allowing for the effects of smoking, the analysis indicates that: (1) there was no significant difference between group 1 and controls (p > 0.05); (2) the differences between group 2 and group 0, group 3 and group 0 and group 4 and group 0 were all highly significant (p < 0.001); (3) there was no significant difference between groups 2 and 3 (p > 0.05), nor between groups 2 and 3 combined and group 4 (p > 0.05); (4) exposure groups 2, 3 and 4 combined, had a significantly elevated mean SCE frequency compared to the control group (p < 0.0001). Statistical analysis of the proportion of HFCs was consistent with these results. Our data suggest that chronic exposure to whole-body vibration and noise may lead to an increase in the level of SCEs in man. The observed effects may not reflect a direct action of these physical agents on DNA. Alternative explanations may include some of the whole-body vibration and noise-induced or stress-induced pathophysiological alterations which may indirectly induce SCE formation.

A review of in vitro bioeffects of inertial ultrasonic cavitation from a mechanistic perspective

This selective review of the biological effects of ultrasound presents a synopsis of our current understanding of how cells insonated in vitro are affected by inertial cavitation from the standpoint of physical and chemical mechanisms. The focus of this review is on the physical and chemical mechanisms of action of inertial cavitation which appear to be effective in causing biological effects. There are several fundamental conditions which must be satisfied before cavitation-related bioeffects may arise. First, bubbles must be created and then brought into proximity to cells. Exposure methods are critical in this regard, and simple procedures such as rotation of a vessel containing the cells during exposure can drastically alter the results. Second, once association is achieved between bubbles and cells, the former must interact with the latter to produce a bioeffect. It is not certain that the inertial event is the prime mechanism by which cells are lysed; there is evidence that the turbulence associated with bubble translation may cause lysis. Additionally, there appear to be chemical and other physical mechanisms by which inertial cavitation may affect cells; these include the generation of biologically effective sonochemicals and the apparent emission of ultraviolet (UV) and soft X-rays. The evidence for inertial cavitation occurring within cells is critically reviewed.

Cellular effects of image diagnostic ultrasound on murine spermatogenesis monitored by flow cytometry

A study has been carried out to evaluate the possible cellular effects induced by image diagnostic ultrasound on murine spermatogenetic cells. Exposure to ultrasound was carried out using a commercial diagnostic instrument that operates in B-mode. Male hybrid F1 mice, aged 8-10 weeks, were exposed to ultrasound for 30 min and observed from 7 to 35 days after treatment. Flow cytometric analysis has been used to monitor the relative frequency of the different types of spermatogenetic cells. This analytical approach showed changes in cell frequency in the compartment containing elongated spermatids which was used as an endpoint. A statistically significant decrease in the frequency of this cell type was observed 21, 28 and 35 days after exposure. These changes suggest that there may be a cytotoxic and/or cytostatic effect on spermatocytes and spermatogonia. These results showed that image diagnostic ultrasound induces effects on murine spermatogenesis at cellular level and that the flow cytometric approach makes it possible to identify quantitative cellular changes with reference to specific cell type.

Oxygen radical scavengers inhibit clastogenic activity induced by sonication of human serum

Clastogenic factors (CF) are diffusible molecules that damage DNA. They are generated within biological media by a variety of physical and chemical stimuli. Their nature and mechanism of action remain largely unknown. Clastogenic activity can be experimentally generated by pulsed ultrasound treatment of human serum. To investigate whether oxygen radicals are involved in the clastogenic activity induced by sonication of human serum, we examined the effects on such clastogenic activity of different oxygen radical scavengers added to human serum before and after sonication. Human serum was sonicated for 50 min at 24 microW/cm2 by pulsed ultrasound. The clastogenic activity of sonicated human serum was examined in the presence or absence of oxygen radical scavengers by measuring the amount of DNA damage induced in autologous human lymphocytes, assessed with the fluorometric analysis of DNA unwinding (FADU). Sonication of human serum generated significant DNA damage in autologous lymphocytes (DNA unwinding averaged 31.79% +/- 2.1 after sonication vs. 12.82% +/- 2.6 in the controls, p < 0.005). Superoxide dismutase (SOD; 500 I.U./ml), catalase (500 I.U./ml), mannitol (50 mM), and glutathione (50 mM) completely prevented DNA damage when added before serum sonication, whereas only mannitol (86%) and glutathione (90%) almost completely inhibited DNA damage when added after sonication. SOD and catalase had only a partial inhibitory effect when added after sonication (49% and 63%, respectively). The prevention of DNA damage was also obtained by an association of subliminal amounts of glutathione (20 mM) and vitamin E (1 I.U./ml). These results suggest that the clastogenic activity generated by sonication of human serum is mediated by oxygen radicals.

Cellular effects of diagnostic Doppler ultrasound on murine spermatogenic cells monitored by flow cytometry

A study has been carried out to investigate the possible effects caused by Doppler diagnostic ultrasound on murine spermatogenesis. The frequency of the different types of cells has been analyzed using flow cytometry. Exposure to ultrasound was carried out using a commercial device used in diagnostic conditions. Male hybrid mice were exposed to ultrasound for 30 min and observed from 7 to 35 days after treatment. Flow cytometrical analysis showed changes in the relative frequency of the elongated spermatids and this was used as an end-point. A statistically significant decrease in the frequency of this cell type was observed after 7 and 35 days with both pulsed and continuous ultrasound. With the former, a decrease was also seen in this compartment after 14 and 21 days. Our results have shown that diagnostic ultrasound used in the Doppler technique induces effects on specific cell types of murine spermatogenesis.

Sister chromatid exchanges in first-trimester chorionic villi after in vivo and in vitro exposure to diagnostic ultrasound

A study was done to evaluate the effects of diagnostic ultrasound on sister chromatid exchange (SCE) in first-trimester chorionic villi under controlled technical conditions. Chromosome analysis was performed by the direct method using spontaneous mitoses from the cytotrophoblast layer, and SCE visualization was accomplished by a 72 h treatment with 5-bromodeoxyuridine (BrdU) at a concentration of 10 micrograms/ml. The slides were stained with acridine orange. Immediately before first-trimester chorionic villus sampling, a group of ten pregnant women was exposed to diagnostic ultrasound for 20 min (in vivo exposure). This group of patients was compared with a control group who were not exposed. A mean value of SCE/cell frequency of 4.2 +/- 0.2 was found in the exposed pregnancies, while a value of 3.7 +/- 0.2 was observed in the control group. After in vitro exposure of chorionic villi obtained from elective abortions, the frequency of SCE/cell did not differ significantly among samples with different exposures (1, 2, and 3 h) and controls. The positive control (mitomycin C) yielded a significant increase in SCE frequency.

Factors that influence formation of sister chromatid exchanges in human blood lymphocytes

Sister chromatid exchange (SCE) reflects an interchange of DNA sequences between helices in a replicating chromosome. This was initially accomplished by Taylor and colleagues (1957) using tritiated thymidine incorporation followed by autoradiography. The development of an elegant technique for differential staining of sister chromatids by incorporating a thymidine analog, 5-bromodeoxyuridine (BrdU) has greatly simplified the detection of SCEs in metaphase chromosomes. In recent years, the analysis of SCE has been considered to be a highly sensitive and additional (i.e., with chromosome aberrations) end point for measuring mutagenic/carcinogenic potential of various environmental agents and is increasingly being used to detect and differentiate among chromosome fragility human diseases that predispose to neoplasia. Attention has been focused to see if the induction of SCEs in lymphocyte cultures can be used as a reliable "biological dosimeter" for genetic risk assessment and to monitor the exposed populations. Several physical or preparatory as well as biological factors that modify the response and formation of SCEs make the monitoring difficult. The purpose of this article is to review and analyze these factors to facilitate an effective development of a standard protocol for SCE testing and for appropriate evaluation of test results. This may also provide clues to understand the yet unknown molecular mechanism(s) and biological significance of SCE formation.

Sister-chromatid exchanges in human lymphocytes exposed in vitro to therapeutic ultrasound

Human lymphocytes were exposed in vitro to therapeutic levels of ultrasound (1 W/cm2, CW, 0.87 MHz, durations of 80 and 160 sec). There were no significant differences in sister-chromatid exchange frequencies between controls and ultrasound-exposed cells. Exposure of lymphocytes to the positive control (mitomycin C) resulted in a significant increase in sister-chromatid exchanges. The data do not verify a report by Stella et al. (Mutation Res., 138 (1984) 75-85) that such exposures result in increased frequencies of SCEs.

Lack of discernible effect of diagnostic ultrasound on the chromosomes of cord blood lymphocytes exposed in utero

The levels of either sister chromatid exchanges or chromosome breakage (as assayed by the frequency of micronuclei) in cord blood lymphocytes from a total of 62 babies were analysed. The exposure of these babies to ultrasound during gestation was determined retrospectively from medical records and the data reclassified accordingly. No correlation was seen between the levels of chromosome breakage, as measured by these two end-points, and exposure to ultrasound.

Cytogenetic damage in workers exposed to ethylene oxide

Sister-chromatid exchanges (SECs) and chromosomal aberrations (CAs) were detected in the peripheral lymphocytes of 41 sanitary workers exposed to ethylene oxide (EO) in the sterilizing units of 8 hospitals in the Venice Region. The first group (19 workers) was exposed to 10.7 +/- 4.9 ppm EO, expressed as the time-weighted average concentration for an 8-h working day (TWA/8 h conc.), and the second group (22 workers) to 0.35 +/- 0.12 ppm. Each exposed worker was paired with a control of similar age and smoking habits. A highly significant (P less than 0.001) increase in the mean frequency of SCEs was found in the higher exposure group, 14 (74%) exposed subjects having significantly increased levels of SCEs compared to their matched controls. In the lower exposure group, the increase in mean frequency of SCEs was lower, though still significant (P less than 0.05): 7 (33%) exposed subjects had higher and 1 (5%) had a lower SCE level than the matched controls. From the first group, 10 subjects, 7 of whom had increased SCE levels, were reanalysed 12-18 months after their exposure had been lowered or interrupted: in only 2 of them the SCE level was significantly decreased. A statistically significant correlation between SCE frequency and level of EO exposure (TWA/8 h conc.), as well as a multiple correlation between SCE level and EO exposure, smoking and age were found. However, no interaction could be detected between EO exposure and smoking in the induction of SCEs. In controls, SCE frequency was correlated with smoking and age. In the higher exposure group, the number of both chromatid- and chromosome-type aberrations, independent of gaps, was significantly increased, whereas in the lower exposure group only the frequency of chromosome-type aberrations, excluding gaps, was statistically higher than in controls. The level of CAs remained to a great extent unchanged in the 10 subjects re-examined at a later stage after lowering or halting exposure. Taking the group as a whole, the frequency of cells with total CAs was found to be weakly (P = 0.05) correlated with EO exposure, and was not correlated with smoking, age or SCE frequency.