A cytogenetic follow-up study of thyroid cancer patients treated with 131I

Radionuclide 131I-labeled albumin-indocyanine green nanoparticles for synergistic combined radio-photothermal therapy of anaplastic thyroid cancer

Objectives

Anaplastic thyroid cancer (ATC) cells cannot retain the radionuclide iodine 131 (¹³¹I) for treatment due to the inability to uptake iodine. This study investigated the feasibility of combining radionuclides with photothermal agents in the diagnosis and treatment of ATC.

Methods

¹³¹I was labeled on human serum albumin (HSA) by the standard chloramine T method. ¹³¹I-HSA and indocyanine green (ICG) were non-covalently bound by a simple stirring to obtain ¹³¹I-HSA-ICG nanoparticles. Characterizations were performed in vitro. The cytotoxicity and imaging ability were investigated by cell/in vivo experiments. The radio-photothermal therapy efficacy of the nanoparticles was evaluated at the cellular and in vivo levels.

Results

The synthesized nanoparticles had a suitable size (25–45 nm) and objective biosafety. Under the irradiation of near-IR light, the photothermal conversion efficiency of the nanoparticles could reach 24.25%. In vivo fluorescence imaging and single-photon emission CT (SPECT)/CT imaging in small animals confirmed that I-HSA-ICG/¹³¹I-HSA-ICG nanoparticles could stay in tumor tissues for 4–6 days. Compared with other control groups, ¹³¹I-HSA-ICG nanoparticles had the most significant ablation effect on tumor cells under the irradiation of an 808-nm laser.

Conclusions

In summary, ¹³¹I-HSA-ICG nanoparticles could successfully perform dual-modality imaging and treatment of ATC, which provides a new direction for the future treatment of iodine-refractory thyroid cancer.

Clinical Applications of Biological Dosimetry in Patients Exposed to Low Dose Radiation Due to Radiological, Imaging or Nuclear Medicine Procedures

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.

Cytogenetic biodosimetry and dose-rate effect after radioiodine therapy for thyroid cancer

This study set out to investigate chromosomal damage in peripheral blood lymphocytes of thyroid cancer patients receiving ¹³¹I for thyroid remnant ablation or treatment of metastatic disease. The observed chromosomal damage was further converted to the estimates of whole-body dose to project the adverse side effects. Chromosomal aberration analysis was performed in 24 patients treated for the first time or after multiple courses. Blood samples were collected before treatment and 3 or 4 days after administration of 2-4 GBq of ¹³¹I. Both conventional cytogenetic and chromosome 2, 4 and 12 painting assays were used. To account for dose-rate effect, a dose-protraction factor was applied to calculate the whole-body dose. The mean dose was 0.62 Gy (95% CI: 0.44-0.77 Gy) in the subgroup of patients treated one time and 0.67 Gy (95% CI: 0.03-1.00 Gy) in re-treated patients. These dose estimates are about 1.7-fold higher than those disregarding the effect of exposure duration. In re-treated patients, the neglected dose-rate effect can result in underestimation of the cumulative whole-body dose by the factor ranging from 2.6 to 6.8. Elevated frequency of chromosomal aberrations observed in re-treated patients before radioiodine therapy allows estimation of a cumulative dose received from all previous treatments.

Study of cytogenetic toxicity of low-dose radioiodine therapy in hyperthyroid patients using a micronuclei assay

OBJECTIVE

Radioiodine, in low doses, has been used as a treatment modality for hyperthyroidism worldwide for a long time. However, there is little information available on the severity of cytotoxicity of radioiodine at these low doses. The present investigation aimed to study the cytogenetic toxicity of low-dose radioiodine in hyperthyroid patients using a cytokinesis-blocked micronuclei (MN) assay.

MATERIALS AND METHODOLOGY

All of the patients received radioiodine in the form of sodium iodine (oral form). Blood samples of these patients were collected before therapy and 3 months after therapy, and lymphocytes were analysed for MN assay.

RESULTS

Peripheral blood lymphocytes were analysed in 74 hyperthyroid patients (52 men, 22 women). The results indicated a positive relationship between age and the frequency of MN. However, there was no statistically significant difference in MN frequency at 3 months after therapy in comparison with that before therapy.

CONCLUSION

This study showed that the cytogenetic damage produced by low-dose radioiodine was transient and reversible. Thus, patients can be motivated to undergo this safe and easy procedure as a modality of treatment for hyperthyroidism.

Correlation between micronuclei frequency in peripheral blood lymphocytes and retention of 131-I in thyroid cancer patients

Differentiated thyroid cancers (DTCs) derive from thyroid follicular cells and include papillary and follicular cancers. In patients with DTCs, the initial treatment includes thyroidectomy and radioactive iodine (131-I) therapy. The objective of this study was to examine whether the intensity of DNA damage in peripheral blood lymphocytes (PBLs) of DTC patients depends on the amount of 131-I retained in the selected regions of interest (thyroid and abdominal region) as well as in the whole-body 72 hours after therapy. In addition, the possible influence of other factors that may affect micronuclei (MN) frequency, such as age, gender, smoking habits, and histological type of tumour was analyzed. The study population consisted of 22 DTC patients and 20 healthy donors. Data on the distribution of 131-I were obtained from the whole-body scans. MN frequency and cytokinesis-block proliferation index (CBPI) were measured using cytokinesis-block micronucleus assay. 131-I therapy significantly increased the MN frequency (19.50±6.90 vs. 27.10±19.50 MN) and significantly decreased the CBPI (1.52±0.20 vs. 1.38±0.17) in patients' lymphocytes. There was a clear correlation between the increased MN frequency and 131-I accumulation in the thyroid region in patients without metastases. The MN values did not differ in relation to the factors that could affect MN, such as age, gender, smoking habits, and histological type of tumour. In conclusion, the MN frequency in PBLs of DTC patients without metastases depends on the accumulation of 131-I in the thyroid region and does not depend on the other factors examined.

Basal and induced micronucleus frequencies in human lymphocytes with different GST and NAT2 genetic backgrounds

Basal and induced frequencies of genetic damage can be modulated by different host factors, including genes involved in phase II metabolism. Since polymorphic variants in the glutathione S-transferase (GST) and N-acetyl transferase (NAT) genes have been associated with cancer risk, we explored the possible links between GSTM1, GSTP1, GSTT1 and NAT2 variants and the frequency of micronuclei (MN) in human lymphocytes. This exploratory study was carried out in 30 thyroid cancer patients, before and after receiving an average dose of 109.9+/-1.3 mCi radioactive iodine as a co-adjuvant therapy. The results indicate that none of the polymorphisms studied show any kind of association with the basal level of micronuclei. When the same patients were followed after radioiodine exposure, a significant increase in the frequency of MN was observed in practically all of them (28/30), indicating the genotoxic activity of the ionising radiation exposure. The increase in MN frequency was not associated with any of the GST polymorphisms evaluated. Nevertheless, the presence of slow acetylator phenotypes and, in particular, the presence of the NAT2*7 allele was significantly associated with a lower increase of the MN frequency after radioiodine treatment.

Formation of micronuclei and of clastogenic factor(s) in patients receiving therapeutic doses of iodine-131

The micronucleus (MN) assay in peripheral blood lymphocytes was applied to assess the genotoxic potential of a single dose of iodine-131 (131I) given to six patients for ablation of thyroid remnants after total thyroidectomy. Lymphocytes were taken at various times after 131I therapy (from 2 to 180 days), and evaluated for the presence of MN in the binucleated cells identified after blocking cytokynesis with cytochalasin B. The presence of ultrafiltered, low-molecular weight, clastogenic factor(s) (CFs) in the plasma of 11 patient undergoing 131I therapy was also sequentially assessed.A significantly increased MN frequency was observed in lymphocytes of patients as soon as the first sampling time (2 days after 131I therapy), multifactor analysis of variance (MANOVA): P<0.0001, peaking at day 7 at almost four-fold the spontaneous frequency observed in the pre-therapy samples. MN frequency slowly declined thereafter, reaching the baseline levels at the 180-day time point. When tested against peripheral blood lymphocytes from a healthy donor, the ultrafiltered CFs obtained from 11 patient's plasma induced a significant increase of the MN frequency peaking at day 15. Thereafter, a slow MN frequency decline was observed and the baseline frequency was reached after 180 days. A significant relationship was found between the MN frequency observed in lymphocytes of patients after 131I therapy and the genotoxic CFs activity present in their plasma (P=0.019). These findings suggest that 131I induces a significant increase in the MN frequency of peripheral blood lymphocytes, as well as the formation of transferable CFs which persist for at least 60 days after administration of the radionuclide. The presence of these CFs might be responsible of chromosome aberrations often observed in cultured lymphocytes following X-ray exposure. The possibility of reducing the genotoxic activity of radionuclide therapy by chemoprevention of CFs with antioxidant drugs remains to be explored.

Follow-up in the micronucleus frequencies and its subsets in human population with chronic low-dose gamma-irradiation exposure

Forty-eight individuals, who received protracted low-dose rate gamma-irradiation from radioactive environments for 2-10 years, have been evaluated repetitively for cytogenetic damage by the cytochalasin-B micronuclei assay (CBMN) after they relocated from radioactive buildings. These subjects were shown to have a significant decrease in the CBMN frequencies during 26.2+/-8.4 months of follow-up. By the mixed effect multiple linear regression analysis, the CBMN frequencies in these 48 subjects during repetitive measurements were significantly associated with the relocation duration since leaving the radioactive environments (relocation time or RT in months; estimate -0.47, standard error 0. 0016, p value 0.0074). The alteration rate in the proportions of binucleates carrying a single micronucleus and those with multiple micronuclei was further compared among 26 of these exposed individuals. The proportions of binucleates with multi-micronuclei were shown to decline significantly faster than those with a mono-micronucleus between these two repetitive assays (proportional Z-test, p value 0.003). Moreover, some of the exposed subjects were shown to have a persistent increase in the total micronuclei frequencies or carrying multi-micronuclei in the binuclei even 3-4 years post-cessation of exposure. This suggests potential genomic instability in stem cells of the exposed individuals and the phenomenon deserves further closer monitoring. Understanding the dynamics of micronucleus expression in lymphocytes in subjects with previous mutagenic exposure would be of significant importance for human population monitoring.

Micronucleus frequency in Gomel (Belarus) children affected and not affected by thyroid cancer

Cytogenetic monitoring was carried out on a group of children from Gomel (Belarus), one of the areas most severely affected by radioactive contamination following the accident at the Chernobyl nuclear power plant, in 1986. We performed the micronucleus test (MN) in binucleated lymphocytes of 42 children (mean age: 11+/-2.34 years), 16 of whom were affected by thyroid gland tumor. Thirty healthy children living in Pisa (mean age: 14.96+/-2.17 years) were enrolled in the study as controls. Thyroid tumor affected children living in Gomel showed a statistically significant increase in the frequency of micronucleated cells as compared with the healthy children from Pisa. Moreover, a significant correlation was found between MN frequency and both the presence of tumor and higher 137Cs contamination. In addition, higher 137Cs contamination was more frequently observed in tumor affected children. These results suggest that the increased MN frequency is attributable more to 137Cs contamination rather than to the presence of the tumor itself.

Micronuclei induction by 131I exposure: study in hyperthyroidism patients

To evaluate the eventual genetic damage induced by therapeutic exposure to 131I, we have studied the presence of micronuclei (MN) in binucleated peripheral blood lymphocytes from a group of 28 hyperthyroidism patients who received 131I sodium iodide, via oral administration. The study was conducted over time and blood samples were obtained before the treatment, and 1 week, 1 month and 3 months after it. The results obtained indicate a positive relationship between dose and BNMN frequency as calculated by the linear regression coefficient, showing significant increases in the frequency of MN and BNMN (binucleated cells with MN) in the subgroup of patients that received more than 500 MBq. Taking into account that the patients studied were treated with relatively low doses of 131I, our positive results support the view that the MN assay is sensitive enough to monitor the chromosome damage resulting from the exposure.