Early peroxidizing effects of myocardial damage in rats after gamma-irradiation and farmorubicin (4'-epidoxorubicin) treatment

Murine models of radiation cardiotoxicity: A systematic review and recommendations for future studies

BACKGROUND AND PURPOSE

The effects of radiation on the heart are dependent on dose, fractionation, overall treatment time, and pre-existing cardiovascular pathology. Murine models have played a central role in improving our understanding of the radiation response of the heart yet a wide range of exposure parameters have been used. We evaluated the study design of published murine cardiac irradiation experiments to assess gaps in the literature and to suggest guidance for the harmonisation of future study reporting.

METHODS AND MATERIALS

A systematic review of mouse/rat studies published 1981-2021 that examined the effect of radiation on the heart was performed. The protocol was published on PROSPERO (CRD42021238921) and the findings were reported in accordance with the PRISMA guidance. Risk of bias was assessed using the SYRCLE checklist.

RESULTS

159 relevant full-text original articles were reviewed. The heart only was the target volume in 67% of the studies and simulation details were unavailable for 44% studies. Dosimetry methods were reported in 31% studies. The pulmonary effects of whole and partial heart irradiation were reported in 13% studies. Seventy-eight unique dose-fractionation schedules were evaluated. Large heterogeneity was observed in the endpoints measured, and the reporting standards were highly variable.

CONCLUSIONS

Current murine models of radiation cardiotoxicity cover a wide range of irradiation configurations and latency periods. There is a lack of evidence describing clinically relevant dose-fractionations, circulating biomarkers and radioprotectants. Recommendations for the consistent reporting of methods and results of in vivo cardiac irradiation studies are made to increase their suitability for informing the design of clinical studies.

Effects of melatonin and vitamin E on oxidative-antioxidative status in rats exposed to irradiation

Bone marrow is known to be particularly susceptible to radiation. In this study, the effects of treatment with Vitamin E and melatonin and irradiation-induced lipid peroxidation and its association with antioxidant enzymes in the total bone (bone and bone marrow) and skeletal muscle of rats subjected to total body irradiation was investigated. Wistar-Albino rats were intraperitoneally treated with 100mg/kg Vitamin E or melatonin before exposure to 720cGy irradiation. Control, irradiation, Vitamin E plus irradiation, melatonin plus irradiation groups were sacrificed by decapitation under ether anaesthesia on the 10th day after irradiation exposure. Application of total body irradiation elevated malondialdehyde (MDA) levels in rat skeletal muscle (p<0.001), but glutathione peroxidase (GSH-Px) and catalase activities remained unchanged. Application of Vitamin E with irradiation or melatonin decreased the MDA levels in skeletal muscle (p<0.01), but did not affect the GSH-Px and catalase activity. MDA levels were found elevated in total bone (p<0.001), GSH-Px activity decreased (p<0.001) and catalase activity remained unchanged in the group treated with irradiation. Application of Vitamin E with irradiation increased the GSH-Px activity in total bone (p<0.01), but the activity of MDA and catalase remained unchanged. Treatment of the animals with melatonin concurrent with total body irradiation reduced the degree of lipid peroxidation and elevation in antioxidant enzymes in total bone (p<0.01). We conclude that melatonin may protect the total bone from the damaging effects of irradiation exposure, and its actions protect total bone from oxidative stress. However, protective effects of Vitamin E were not observed in this study.

A Case-Control Study of Diet and the Risk of Ovarian Cancer

Epidemiologic studies have suggested that some dietary factors may play a role in the etiology of ovarian cancer, but the findings have been inconsistent. We assessed the association of ovarian cancer with dietary factors in a population-based case-control study in Canada. Diet information was collected on 442 incident cases of ovarian cancer diagnosed in 1994 to 1997 and 2,135 population controls via a self-administered questionnaire. Compared with women in the lowest quartile of cholesterol intake, those in the second, third, and fourth quartiles had a multivariate adjusted odds ratio [OR; 95% confidence interval (95% CI)] of 1.12 (0.81–1.56), 1.20 (0.85–1.68), and 1.42 (1.03–1.97), respectively (P for trend = 0.031). Higher egg consumption was also associated with a nonsignificant increase in ovarian cancer risk. The ORs (95% CIs) for ovarian cancer were 0.77 (0.60–1.04) and 0.76 (0.56–0.99) among women in the highest quartile of total vegetable and cruciferous vegetable intake as compared with women in the lowest quartile. Women who took supplements of vitamin E, β-carotene, and B-complex vitamins for ≥10 years had ORs (95% CIs) of 0.49 (0.30–0.81), 0.31 (0.11–0.91), and 0.61 (0.36–1.05), respectively. However, we did not observe an association of ovarian cancer risk with dietary fat intake, including saturated, monounsaturated, and polyunsaturated fatty acids, protein, carbohydrate, dietary fiber, fruit, dairy products, meat products, fish, chicken, grain products, nut products, baked desserts, margarine, butter, mayonnaise, and supplement of multiple vitamins, vitamin A, vitamin C, calcium, iron, zinc, and selenium. Our findings suggested that ovarian cancer risk was positively associated with higher consumption of dietary cholesterol and eggs and inversely associated with higher intake of total vegetables and cruciferous vegetables and supplementation of vitamin E, β-carotene, and B-complex vitamins.

Radiation-induced cardiomyopathy as a function of radiation beam gating to the cardiac cycle

Portions of the heart are often unavoidably included in the primary treatment volume during thoracic radiotherapy, and radiation-induced heart disease has been observed as a treatment-related complication. Such complications have been observed in humans following radiation therapy for Hodgkin's disease and treatment of the left breast for carcinoma. Recent attempts have been made to prevent re-stenosis following angioplasty procedures using external beam irradiation. These attempts were not successful, however, due to the large volume of heart included in the treatment field and subsequent cardiac morbidity. We suggest a mechanism for sparing the heart from radiation damage by synchronizing the radiation beam with the cardiac cycle and delivering radiation only when the heart is in a relatively hypoxic state. We present data from a rat model testing this hypothesis and show that radiation damage to the heart can be altered by synchronizing the radiation beam with the cardiac cycle. This technique may be useful in reducing radiation damage to the heart secondary to treatment for diseases such as Hodgkin's disease and breast cancer.

Adequate intakes of vitamin E and protein prevent increases of oxidative damage to DNA, lipids, and protein induced by total body irradiation in mice

We examined the influence of the level of dietary protein or vitamin E (VE) on oxidative damage to DNA, lipids, and protein in the liver after total body irradiation (TBI) with X-rays at 1 or 4 Gy. Levels of 8-hydroxydeoxyguanosine, thiobarbituric acid-reactive substances, and protein carbonyls in the liver did not differ among the groups that did not receive TBI. However, oxidative damage to lipids and protein was increased by TBI only in the 1% protein group. DNA damage, lipid peroxidation, or protein oxidation in the liver was increased by TBI in a dose-dependent manner, and the damage was consistently higher in the 1% than in the 20% protein group. In the 1% protein group, a greater decrease in relative spleen weight by TBI was also observed. Concentrations of antioxidants (vitamins C and E and glutathione) in the liver were lower and the concentration of nonheme iron in the liver was higher in the 1% than in the 20% protein group. Mice fed a 1% protein diet became susceptible to TBI-induced oxidative damage, and decreases in antioxidant levels and an increase in iron level were involved in the mechanism of this susceptibility. These results suggest that dietary VE and protein can prevent oxidative damage to DNA, lipid, and protein in mice subjected to TBI. Consumption of a VE-free diet significantly increased 8-hydroxydeoxyguanosine levels in DNA from mice fed the 1% protein diet with TBI, but such changes were not detected in DNA from mice fed the 20% protein diet.

Different onsets of oxidative damage to DNA and lipids in bone marrow and liver in rats given total body irradiation

We examined time-dependent changes in antioxidant vitamins and oxidative damage to DNA and lipids in the bone marrow, liver, and plasma of rats given total body irradiation (TBI) with X-rays at 3 Gy. The oxidative damage to DNA and lipids was evaluated by measuring increases of 8-hydroxydeoxyguanosine (8OHdG) in DNA and 4-hydroxy-2-nonenal (HNE), respectively. After the TBI, marked increases in 8OHdG and HNE were detected at 3 to 5 h in the bone marrow, while gradual increases in these parameters were detected after a few days in the liver. These changes in 8OHdG and HNE were well correlated within each tissue. In the bone marrow, levels of both vitamin C and vitamin E were decreased by the TBI; however, the changes in vitamin C were earlier and greater than those in vitamin E. In the liver, the level of vitamin C did not decrease, but that of vitamin E decreased due to the TBI. Changes in HNE, vitamin C, and vitamin E in the plasma were similar to those in the liver. Within each tissue, the time of decrease in antioxidants was almost the same as that of the increase in oxidative damage. An increase in total iron due to the TBI was also detected in these tissues. In particular, the total iron in the bone marrow was markedly increased at a few hours after the TBI, with a slight increase in transferrin and no increase in ferritin. Exposure studies performed on cells or isolated DNA showed that an increase in 8OHdG was detected immediately after irradiation at more than 100 Gy in bone marrow cells and at less than 10 Gy in isolated DNA, suggesting that an increase in 8OHdG is undetectable even in bone marrow immediately after the TBI at 3 Gy. These results indicate that the onset of oxidative damage to DNA and lipids was delayed after TBI at 3 Gy, that it was quite different in the bone marrow and the liver, and that an increase in iron and decrease in antioxidant vitamins were involved in the mechanism of oxidative damage.

Effects of combined irradiation and doxorubicin treatment on cardiac function and antioxidant defenses in the rat

Combined radiotherapy and chemotherapy have represented a major advance in the therapeutic management of cancer therapy. However, the combination of doxorubicin (DXR) and cardiac irradiation (IRR) could precipitate the unexpected expression of congestive heart failure. Oxidative lesions induced by IRR and DXR could represent one of the pathogenic factors of myocardial dysfunction. Our investigations were performed to evaluate in the rat: 1) cardiac functional changes, 2) cardiac and plasma peroxidative damage and antioxidant defenses variations, that occur 24 h (acute effects) and 30 d (middle term effects) following DXR treatment 1 mg/kg(-1)/day(-1) IP for 10 d and a 1 x 20 Gy cardiac gamma-irradiation. Our results showed that DXR affected heart reactivity as early as the end of its administration, although irradiation exerted no detectable effect. Antioxidant defenses disturbances in hearts of DXR treated rats were characterized by vitamins C and E decreases, catalase activity induction and an increase in lipid peroxidation. Moreover, plasma vitamin C consumption and the lower level of plasma lipid peroxidation attested to the efficient solicitation of antioxidant defenses that probably contributed to the preservation of cardiac function at 24 h. After 30 d, cardiac dysfunction became symptomatic at rest, resulting from DXR cardiac toxicity. In spite of the persistent activation of cardiac catalase activity, antioxidant deficiency and increased plasma and cardiac lipid peroxidation highlighted defenses overtaken. Thus, different physiopathological mechanisms are involved in heart disturbance at acute and middle terms, IRR and DXR acting on distinct targets without disclosing synergistic effects. After 30 d, cardiac and plasma biochemical abnormalities were emphasized by the combined DXR+IRR therapy, pointing out the severity of the damage. Oxidative damage to the heart induced both by irradiation and DXR, may be one of the pathogenic factors of myocardial dysfunction. There is the possibility that the deleterious effects might be limited by the use of pharmacologic antioxidant agents.

Activity of creatine kinase MB-isoenzyme in rat serum after heart irradiation and/or farmorubicin (4'-epidoxorubicin) treatment

Activity of creatine kinase (CK, EC 2.7.3.2) and its CK-MB isoenzyme were evaluated in rat serum after external irradiation of the heart with 20 Gy given as A single dose or 4 x 5 Gy and also after treating the animals with farmorubicin 10 mg/kg in a single dose of 4 x 2.5 mg/kg. Fractionated irradiation or repeated injection of farmorubicin induced high five-fold transient increment of CK-MB isoenzyme activity in rat serum. Combined treatment (4 x 5 Gy heart irradiation, week 1, after 2 days pause 4 x 2.5 mg/kg farmorubicin, week 2) showed increase of MB isoenzyme activity in serum roughly comparable with that measured in animals treated with farmorubicin alone. The behaviour of MB isoenzyme activity after single doses of radiation 1 x 20 Gy or farmorubicin 1 x 10 mg/kg was dissimilar to that after repeated doses and was generally lower. Specially, a high single dose of farmorubicin led at first to suppression of CK-MB isoenzyme activity and then to an increase, however, slower than after fractionated treatment. Generally, elevation of CK-MB isoenzyme activity in rat serum after heart irradiation and farmorubicin injection (scheme independent) was many times higher than the total CK activity increment. Results suggest that estimation of CK-MB isoenzyme activity in serum is more sensitive and definitive evidence of early cardiac damage exerted by gamma-rays and/or farmorubicin than total CK activity.