1
|
Dinakar K, Jakka MK, Vemannagari PKR, Mohan A, Subramanian BV, Bodagala VD, Bhuma V, Das P, Bonala SR, Vutukuru VR. Efficacy of low-dose lung radiotherapy in the management of COVID-19 patients: a randomised, open-label study. Br J Radiol 2023; 96:20230022. [PMID: 37751170 PMCID: PMC10646638 DOI: 10.1259/bjr.20230022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE Evaluate role of low-dose radiotherapy (LDRT) in COVID-19 pneumonia. METHODS Sixty-five patients 40 years or older tested positive for COVID-19 reverse transcriptase-polymerase chain reaction with mild to moderate acute respiratory distress syndrome (ARDS), were randomised 1:1, from 4 June 2021, to either best standard of care (control arm) according to the Indian Council of Medical Research guidelines or a single dose of LDRT (LDRT-0.5Gy) to both lungs along with best standard of care (experimental arm). The primary outcome was either progression to severe disease (PaO2/FiO2 ratio <100 mmHg) within 28 days of randomisation or all-cause mortality at 28 days. If the primary outcome could have been prevented, it was considered "favourable"; if not, it was considered "unfavourable." RESULTS Thirty-three patients were allocated to experimental arm, 32 to control arm. An intention to treat analysis was performed. Unfavourable outcome was seen in 5 (15.2%) patients in experimental arm, vs , 12 (37.5%) patients in control arm, odds of an unfavourable outcome in experimental arm were 0.3, 95% CI 0.09-0.97; two-sided p = 0.04. Four and five patients died in experimental and control arm, respectively. No radiation-induced toxicity was observed. CONCLUSION LDRT reduced the number of patients with unfavourable outcome at 28 days. ADVANCES IN KNOWLEDGE One of the few randomised studies showing reduced unfavourable outcome in mild to moderate ARDS COVID-19 patients receiving LDRT.CTRI/2021/06/034001, Clinical Trials Registry - India (ICMR-NIMS).
Collapse
Affiliation(s)
- Kootala Dinakar
- Department of Radiation Oncology, Government Medical College, Ananthapur, Andhra Pradesh, India
| | - Mohan Krishna Jakka
- Department of Radiation Oncology, Sri Venkateswara Institute of Medical Sciences, SVIMS Cancer Centre, Tirupati, Andhra Pradesh, India
| | - Pavan Kumar Reddy Vemannagari
- Department of Radiation Oncology, Sri Venkateswara Institute of Medical Sciences, SVIMS Cancer Centre, Tirupati, Andhra Pradesh, India
| | - Alladi Mohan
- Department of Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Bala Venkat Subramanian
- Department of Radiation Oncology, Sri Venkateswara Institute of Medical Sciences, SVIMS Cancer Centre, Tirupati, Andhra Pradesh, India
| | | | - Vengamma Bhuma
- Department of Neurology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Pranabandhu Das
- Department of Radiation Oncology, Sri Venkateswara Institute of Medical Sciences, SVIMS Cancer Centre, Tirupati, Andhra Pradesh, India
| | - Sreenivasa Rao Bonala
- Department of Radiation Oncology, Sri Venkateswara Institute of Medical Sciences, SVIMS Cancer Centre, Tirupati, Andhra Pradesh, India
| | | |
Collapse
|
2
|
Ahsan T, Shoily SS, Ahmed T, Sajib AA. Role of the redox state of the Pirin-bound cofactor on interaction with the master regulators of inflammation and other pathways. PLoS One 2023; 18:e0289158. [PMID: 38033031 PMCID: PMC10688961 DOI: 10.1371/journal.pone.0289158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/10/2023] [Indexed: 12/02/2023] Open
Abstract
Persistent cellular stress induced perpetuation and uncontrolled amplification of inflammatory response results in a shift from tissue repair toward collateral damage, significant alterations of tissue functions, and derangements of homeostasis which in turn can lead to a large number of acute and chronic pathological conditions, such as chronic heart failure, atherosclerosis, myocardial infarction, neurodegenerative diseases, diabetes, rheumatoid arthritis, and cancer. Keeping the vital role of balanced inflammation in maintaining tissue integrity in mind, the way to combating inflammatory diseases may be through identification and characterization of mediators of inflammation that can be targeted without hampering normal body function. Pirin (PIR) is a non-heme iron containing protein having two different conformations depending on the oxidation state of the iron. Through exploration of the Pirin interactome and using molecular docking approaches, we identified that the Fe2+-bound Pirin directly interacts with BCL3, NFKBIA, NFIX and SMAD9 with more resemblance to the native binding pose and higher affinity than the Fe3+-bound form. In addition, Pirin appears to have a function in the regulation of inflammation, the transition between the canonical and non-canonical NF-κB pathways, and the remodeling of the actin cytoskeleton. Moreover, Pirin signaling appears to have a critical role in tumor invasion and metastasis, as well as metabolic and neuro-pathological complications. There are regulatory variants in PIR that can influence expression of not only PIR but also other genes, including VEGFD and ACE2. Disparity exists between South Asian and European populations in the frequencies of variant alleles at some of these regulatory loci that may lead to differential occurrence of Pirin-mediated pathogenic conditions.
Collapse
Affiliation(s)
- Tamim Ahsan
- Molecular Biotechnology Division, National Institute of Biotechnology, Savar, Dhaka, Bangladesh
| | - Sabrina Samad Shoily
- Department of Genetic Engineering & Biotechnology, University of Dhaka, Dhaka, Bangladesh
| | - Tasnim Ahmed
- Department of Genetic Engineering & Biotechnology, University of Dhaka, Dhaka, Bangladesh
| | - Abu Ashfaqur Sajib
- Department of Genetic Engineering & Biotechnology, University of Dhaka, Dhaka, Bangladesh
| |
Collapse
|
3
|
Wang Y, Ma J, Jiang Y. Transcription factor Nrf2 as a potential therapeutic target for COVID-19. Cell Stress Chaperones 2023; 28:11-20. [PMID: 36417098 PMCID: PMC9685020 DOI: 10.1007/s12192-022-01296-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 08/08/2022] [Accepted: 09/09/2022] [Indexed: 11/24/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) is caused by a novel severe acute respiratory syndrome (SARS)-like coronavirus (SARS-CoV-2). Critically ill patients with SARS-COV-2 infection frequently exhibit signs of high oxidative stress and systemic inflammation, which accounts for most of the mortality. Antiviral strategies to inhibit the pathogenic consequences of COVID-19 are urgently required. The nuclear factor erythroid 2-related transcription factor (Nrf2) is a transcription factor that is involved in antioxidant and anti-inflammatory defense in several tissues and cells. This review tries to present an overview of the role of Nrf2 in the treatment of COVID-19.
Collapse
Affiliation(s)
- Yifan Wang
- Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Jing Ma
- Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Yongfang Jiang
- Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha, 410011, China.
| |
Collapse
|
4
|
Labarrere CA, Kassab GS. Glutathione deficiency in the pathogenesis of SARS-CoV-2 infection and its effects upon the host immune response in severe COVID-19 disease. Front Microbiol 2022; 13:979719. [PMID: 36274722 PMCID: PMC9582773 DOI: 10.3389/fmicb.2022.979719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/14/2022] [Indexed: 01/08/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 19 (COVID-19) has numerous risk factors leading to severe disease with high mortality rate. Oxidative stress with excessive production of reactive oxygen species (ROS) that lower glutathione (GSH) levels seems to be a common pathway associated with the high COVID-19 mortality. GSH is a unique small but powerful molecule paramount for life. It sustains adequate redox cell signaling since a physiologic level of oxidative stress is fundamental for controlling life processes via redox signaling, but excessive oxidation causes cell and tissue damage. The water-soluble GSH tripeptide (γ-L-glutamyl-L-cysteinyl-glycine) is present in the cytoplasm of all cells. GSH is at 1-10 mM concentrations in all mammalian tissues (highest concentration in liver) as the most abundant non-protein thiol that protects against excessive oxidative stress. Oxidative stress also activates the Kelch-like ECH-associated protein 1 (Keap1)-Nuclear factor erythroid 2-related factor 2 (Nrf2)-antioxidant response element (ARE) redox regulator pathway, releasing Nrf2 to regulate the expression of genes that control antioxidant, inflammatory and immune system responses, facilitating GSH activity. GSH exists in the thiol-reduced and disulfide-oxidized (GSSG) forms. Reduced GSH is the prevailing form accounting for >98% of total GSH. The concentrations of GSH and GSSG and their molar ratio are indicators of the functionality of the cell and its alteration is related to various human pathological processes including COVID-19. Oxidative stress plays a prominent role in SARS-CoV-2 infection following recognition of the viral S-protein by angiotensin converting enzyme-2 receptor and pattern recognition receptors like toll-like receptors 2 and 4, and activation of transcription factors like nuclear factor kappa B, that subsequently activate nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (NOX) expression succeeded by ROS production. GSH depletion may have a fundamental role in COVID-19 pathophysiology, host immune response and disease severity and mortality. Therapies enhancing GSH could become a cornerstone to reduce severity and fatal outcomes of COVID-19 disease and increasing GSH levels may prevent and subdue the disease. The life value of GSH makes for a paramount research field in biology and medicine and may be key against SARS-CoV-2 infection and COVID-19 disease.
Collapse
|
5
|
Kolahdouzan K, Chavoshi M, Bayani R, Darzikolaee NM. Low-Dose Whole Lung Irradiation for Treatment of COVID-19 Pneumonia: A Systematic Review and Meta-Analysis. Int J Radiat Oncol Biol Phys 2022; 113:946-959. [PMID: 35537577 PMCID: PMC9077801 DOI: 10.1016/j.ijrobp.2022.04.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 02/09/2023]
Abstract
PURPOSE Studies dating back to a century ago have reported using low-dose radiation therapy for the treatment of viral and bacterial pneumonia. In the modern era, since the COVID-19 pandemic began, several groups worldwide have researched the applicability of whole lung irradiation (WLI) for the treatment of COVID-19. We aimed to bring together the results of these experimental studies. METHODS AND MATERIALS We performed a systematic review and meta-analysis searching PubMed and Scopus databases for clinical trials incorporating WLI for the treatment of patients with COVID-19. Required data were extracted from each study. Using the random-effects model, the overall pooled day 28 survival rate, survival hazard ratio, and intubation-free days within 15 days after WLI were calculated, and forest plots were produced. RESULTS Ten studies were identified, and eventually, 5 were included for meta-analysis. The overall survival hazard ratio was calculated to be 0.85 (0.46-1.57). The pooled mean difference of intubation-free days within 15 days after WLI was 1.87, favoring the WLI group (95% confidence interval, -0.02 to 3.76). The overall day 28 survival rate of patients receiving WLI for the 9 studies with adequate follow-up data was 74% (95% confidence interval, 61-87). Except for 2 studies, the other 8 studies were assessed to have moderate to high risk of bias, and there were many differences among the designs of the studies, included patients, primary endpoints, outcome measurement methods, and reporting of the results. CONCLUSIONS Despite a mild improvement in intubation-free days, WLI had no significant effect on patients' overall survival. Currently, we cannot recommend routine use of WLI for the treatment of patients with moderate-to-severe COVID-19.
Collapse
Affiliation(s)
- Kasra Kolahdouzan
- Department of Radiation Oncology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran,Radiation Oncology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Chavoshi
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reyhaneh Bayani
- Radiation Oncology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran,Department of Radiation Oncology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Nima Mousavi Darzikolaee
- Department of Radiation Oncology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran,Radiation Oncology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran,Cancer Institute, Imam Khomeini Hospital Complex, Tehran, Iran,Corresponding author: Nima Mousavi Darzikolaee, MD
| |
Collapse
|
6
|
Little MP, Zhang W, van Dusen R, Hamada N, Bugden M, Cao M, Thomas K, Li D, Wang Y, Chandrashekhar M, Khan MK, Coleman CN. Low-dose radiotherapy for COVID-19 pneumonia and cancer: summary of a recent symposium and future perspectives. Int J Radiat Biol 2022; 99:357-371. [PMID: 35511152 PMCID: PMC11270648 DOI: 10.1080/09553002.2022.2074165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/28/2022] [Accepted: 04/24/2022] [Indexed: 02/03/2023]
Abstract
The lessons learned from the Coronavirus Disease 2019 (COVID-19) pandemic are numerous. Low dose radiotherapy (LDRT) was used in the pre-antibiotic era as treatment for bacterially/virally associated pneumonia. Motivated in part by these historic clinical and radiobiological data, LDRT for treatment of COVID-19-associated pneumonia was proposed in early 2020. Although there is a large body of epidemiological and experimental data pointing to effects such as cancer at low doses, there is some evidence of beneficial health effects at low doses. It has been hypothesized that low dose radiation could be combined with immune checkpoint therapy to treat cancer. We shall review here some of these old radiobiological and epidemiological data, as well as the newer data on low dose radiation and stimulated immune response and other relevant emerging data. The paper includes a summary of several oral presentations given in a Symposium on "Low dose RT for COVID and other inflammatory diseases" as part of the 67th Annual Meeting of the Radiation Research Society, held virtually 3-6 October 2021.
Collapse
Affiliation(s)
- Mark P Little
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Rockville, MD 20892-9778, USA
| | - Wei Zhang
- Radiation Effects Department, UK Health Security Agency (UKHSA), Chilton, Didcot, OX11 0RQ, UK
| | - Roy van Dusen
- Information Management Services, Silver Spring, MD 20904, USA
| | - Nobuyuki Hamada
- Radiation Safety Unit, Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), 2-11-1 Iwado-kita, Komae, Tokyo 201-8511, Japan
| | - Michelle Bugden
- Radiobiology and Health Branch, Canadian Nuclear Laboratories, 286 Plant Road, Chalk River, K0J 1J0, Ontario, Canada
| | - Meiyun Cao
- Radiobiology and Health Branch, Canadian Nuclear Laboratories, 286 Plant Road, Chalk River, K0J 1J0, Ontario, Canada
| | - Kiersten Thomas
- Radiobiology and Health Branch, Canadian Nuclear Laboratories, 286 Plant Road, Chalk River, K0J 1J0, Ontario, Canada
| | - Deyang Li
- Radiobiology and Health Branch, Canadian Nuclear Laboratories, 286 Plant Road, Chalk River, K0J 1J0, Ontario, Canada
| | - Yi Wang
- Radiobiology and Health Branch, Canadian Nuclear Laboratories, 286 Plant Road, Chalk River, K0J 1J0, Ontario, Canada
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, K1H 8M5, Ontario, Canada
| | - Megha Chandrashekhar
- Radiobiology and Health Branch, Canadian Nuclear Laboratories, 286 Plant Road, Chalk River, K0J 1J0, Ontario, Canada
| | - Mohammad K Khan
- Department of Radiation Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA 30345, USA
| | - C. Norman Coleman
- Radiation Research Program, Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Rockville, MD 20892-9727, Rockville, MD, USA
| |
Collapse
|
7
|
Høilund-Carlsen PF, Revheim ME, Alavi A. Alzheimer’s Disease at a Crossroad: Time to Part from Amyloid to More Promising Aspects— Atherosclerosis for a Start. J Alzheimers Dis 2022; 88:455-458. [DOI: 10.3233/jad-220190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Three decades with the amyloid hypothesis, nearly two with amyloid-PET imaging, and one with testing of anti-amyloid therapy have not yielded benefits to patients with Alzheimer’s disease (AD). It is time to focus on more promising options, e.g., infection, low dose radiation, and atherosclerosis. The relevance of the latter in managing AD has fluctuated from being significant to insignificant. Current methodologies for detecting cerebral atherosclerosis reflect advanced changes in only major arteries. In contrast, 18F-sodium fluoride PET imaging assessing early-stage cerebral atherosclerosis regionally or in the entire vascular bed may provide new insight in this age-related process in dementia.
Collapse
Affiliation(s)
- Poul F. Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mona-Elisabeth Revheim
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Norway
- Institute of Clinical Medicine, University of Oslo, Norway
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
8
|
Agathokleous E. The hormetic response of heart rate of fish embryos to contaminants - Implications for research and policy. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 815:152911. [PMID: 34999064 DOI: 10.1016/j.scitotenv.2021.152911] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/31/2021] [Accepted: 12/31/2021] [Indexed: 06/14/2023]
Abstract
Evidence of contaminant-induced hormesis is rapidly accumulating, while the underlying mechanisms of hormesis are becoming increasingly understood. Recent developments in this research area, and especially the emergence of the nuclear factor-erythroid factor 2-related factor 2 (Nrf2) as the master mechanism, suggest that contaminants can induce cardiac hormetic responses. This paper collates significant evidence of hormetic response of the heart rate of fish embryos to contaminants, in particular antibiotics, microplastics, and herbicides, characterized by a low-dose increase (tachycardia) and a high-dose decrease (bradycardia). The increase often occurs at doses about 100-800 times smaller than the no-observed-adverse-effect-level (NOAEL). There are also indications for even triphasic responses, which include a sub-hormetic decrease of the heart rate by doses over 106 times smaller than the NOAEL. Such sub-NOAEL effects cannot be captured by linear-no-threshold (LNT) and threshold models, raising concerns about environmental health and highlighting the pressing need to consider hormetic responses in the ecological risk assessment. A visionary way forward is proposed, but addressing this research bottleneck would require improved research designs with enhanced ability and statistical power to study diphasic and triphasic responses of heart rate.
Collapse
Affiliation(s)
- Evgenios Agathokleous
- School of Applied Meteorology, Nanjing University of Information Science & Technology (NUIST), 219 Ningliu Rd., Nanjing 210044, China.
| |
Collapse
|
9
|
Ozyurek Y, Sari SY, Hurmuz P. Comments on “Whole lung irradiation as a novel treatment for COVID-19: Final results of the prospective randomized trial (WINCOVID trial)”. Radiother Oncol 2022; 170:244-245. [PMID: 35259417 PMCID: PMC8897284 DOI: 10.1016/j.radonc.2022.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/28/2022] [Indexed: 11/27/2022]
|
10
|
|
11
|
Pandey SR, Adhikari Yadav S, Gautam S, Giri K, Devkota A, Shrestha S, Bhandari S, Baniya S, Adhikari B, Adhikari B, Neupane S, Bhandari J. Effectiveness of low-dose radiation therapy in COVID-19 patients globally: A systematic review. F1000Res 2022; 11:62. [PMID: 35186275 PMCID: PMC8825648 DOI: 10.12688/f1000research.74558.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Novel Corona Virus Disease 2019 (COVID-19) can affect multiple organs, including the lungs, resulting in pneumonia. Apart from steroids, other anti-COVID drugs that have been studied appear to have little or no effect on COVID-19 pneumonia. There is a well-known history of inflammatory disease, including pneumonia, treated with low-dose radiation therapy (LDRT). It reduces the production of proinflammatory cytokines, Interleukin-1a (IL-1a), and leukocyte recruitment. Methods: A comprehensive literature search was conducted using PubMed, Scopus, Embase, CINAHL, and Google Scholar, with keywords such as "radiotherapy," "low-dose radiation therapy," "low-dose irradiation," "covid-19 pneumonia," "SARS-CoV-2 pneumonia," and "covid pneumonia." with additional filters for human studies and customized articles in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We reviewed randomized controlled trials, quasi-experimental studies, cohort, case-control, and cross-sectional studies with a clearly defined intervention, including low-dose radiotherapy alone or in combination with any therapy to treat COVID-19 pneumonia from December 2019 to May 2021. Patients receiving standard or high-dose radiotherapy, including for other diseases, were excluded. Zotero software was used to collect and organize research from various databases, remove duplicates, extract relevant data, and record decisions. Participants' demographics and baseline status were obtained from the full-text articles along with the intervention's outcome/effect on patient status. Results: Four studies with 61 participants that met the inclusion criteria were included. One was a double-blind randomized controlled trial, one a non-randomized trial, while the other two were single-arm clinical trials. Low-dose radiation therapy did not show any significant improvement in COVID-19 patients. Conclusion: Only two studies included in this review demonstrated an improvement in inflammatory markers; however, patients were also given steroids or other drugs. Therefore, the confounding effects must be considered before drawing conclusions. This systematic review does not support mortality benefit, clinical course improvement, or imaging changes with LDRT.
Collapse
Affiliation(s)
- Sirish Raj Pandey
- Medical Oncology, Nepal Cancer Hospital and Research Center, Lalitpur, Province 3, 44700, Nepal
| | | | | | - Kalpana Giri
- B.P. Koirala Cancer Hospital, Chitwan, 44204, Nepal
| | | | - Shipra Shrestha
- Shahid Gangalal National Heart Center, Kathmandu, 44600, Nepal
| | - Shreya Bhandari
- Shahid Gangalal National Heart Center, Kathmandu, 44600, Nepal
| | | | | | - Bibek Adhikari
- Medical Oncology, Nepal Cancer Hospital and Research Center, Lalitpur, Province 3, 44700, Nepal
| | - Shila Neupane
- Patan Academy of Health Sciences School of Medicine, Kathmandu, 44600, Nepal
| | - Jenish Bhandari
- All Nepal College of Medical Education, Kathmandu, 44600, Nepal
| |
Collapse
|
12
|
Abstract
PURPOSE Low dose radiation therapy (LDRT) using doses in the range of 30-150 cGy has been proposed as a means of mitigating the pneumonia associated with COVID-19. However, preliminary results from ongoing clinical trials have been mixed. The aim of this work is to develop a mathematical model of the viral infection and associated systemic inflammation in a patient based on the time evolution of the viral load. The model further proposes an immunomodulatory response to LDRT based on available data. Inflammation kinetics are then explored and compared to clinical results. METHODS The time evolution of a viral infection, inflammatory signaling factors, and inflammatory response are modeled by a set of coupled differential equations. Adjustable parameters are taken from the literature where available and otherwise iteratively adjusted to fit relevant data. Simple functions modeling both the suppression of pro-inflammatory signal factors and the enhancement of anti-inflammatory factors in response to low doses of radiation are developed. The inflammation response is benchmarked against C-reactive protein (CRP) levels measured for cohorts of patients with severe COVID-19. RESULTS The model fit the time-evolution of viral load data, cytokine data, and inflammation (CRP) data. When LDRT was applied early, the model predicted a reduction in peak inflammation consistent with the difference between the non-surviving and surviving cohorts. This reduction of peak inflammation diminished as the application of LDRT was delayed. CONCLUSION The model tracks the available data on viral load, cytokine levels, and inflammatory biomarkers well. An LDRT effect is large enough in principle to provide a life-saving immunomodulatory effect, though patients treated with LDRT already near the peak of their inflammation trajectory are unlikely to see drastic reductions in that peak. This result potentially explains some discrepancies in the preliminary clinical trial data.
Collapse
Affiliation(s)
- Charles Kirkby
- Department of Medical Physics, Jack Ady Cancer Centre, Lethbridge, Alberta, Canada.,Department of Oncology, University of Calgary, Calgary, Alberta, Canada.,Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
13
|
Bardallo RG, Panisello‐Roselló A, Sanchez‐Nuno S, Alva N, Roselló‐Catafau J, Carbonell T. Nrf2 and Oxidative Stress in liver Ischemia/Reperfusion Injury. FEBS J 2021; 289:5463-5479. [PMID: 34967991 DOI: 10.1111/febs.16336] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/18/2021] [Accepted: 12/29/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Raquel G. Bardallo
- Department of Cell Biology, Physiology and Immunology Universitat de Barcelona Spain
| | - Arnau Panisello‐Roselló
- Experimental Pathology Department Institute of Biomedical Research of Barcelona (IIBB) CSIC‐IDIBAPS Barcelona Spain
| | - Sergio Sanchez‐Nuno
- Department of Cell Biology, Physiology and Immunology Universitat de Barcelona Spain
| | - Norma Alva
- Department of Cell Biology, Physiology and Immunology Universitat de Barcelona Spain
| | - Joan Roselló‐Catafau
- Experimental Pathology Department Institute of Biomedical Research of Barcelona (IIBB) CSIC‐IDIBAPS Barcelona Spain
| | - Teresa Carbonell
- Department of Cell Biology, Physiology and Immunology Universitat de Barcelona Spain
| |
Collapse
|
14
|
Ganesan G, Ponniah S, Sundaram V, Kumar Marimuthu P, Pitchaikannu V, Chandrasekaran M, Thangarasu J, Kannupaiyan G, Ramamoorthy P, Thangaraj B, Sasipriya Govindaraj H, Vaishnavi Raguram S. Whole lung Irradiation as a Novel treatment for COVID-19: Final Results of the Prospective Randomized trial (WINCOVID trial). Radiother Oncol 2021; 167:133-142. [PMID: 34958809 PMCID: PMC8709793 DOI: 10.1016/j.radonc.2021.12.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 12/14/2022]
Abstract
Background and purpose The ability of low dose radiotherapy (LDRT) to control the unprecedented cytokine release associated with COVID-19 pathogenesis has been an area of widespread research since the COVID pandemic. It has not been studied adequately whether the anti-inflammatory effect of LDRT provides additional benefit when used concurrently with steroids amongst other standard pharmacologic therapy. Material and methods 51 RT-PCR positive COVID-19 patients were recruited between November 2020 and July 2021. 34 patients were allotted to receive 0.5 Gy single session LDRT along with standard pharmacologic therapy while 17 patients received standard pharmacologic therapy alone. All had SpO2 <94% on room air, respiratory frequency >24/min and SpO2/FiO2 (SF) ratio between >89 but <357. All patients underwent a baseline CT scan. They were followed up for 28 days during when serial SF ratio, blood biomarkers (CRP, Serum ferritin, IL-6), Absolute lymphocyte count (ALC), repeat CT scan were performed at pre-defined time points. Results LDRT showed a statistically significant early improvement in oxygenation, an early time to clinical recovery, early hospital discharge and better radiological resolution compared to control group. There was no statistically significant difference between the two groups with respect to ALC or blood biomarkers at any of the measured time points. The 28-day mortality rate did not show statistically significant difference between the two groups. Conclusion LDRT can be considered for selected oxygen-dependent moderate to severe COVID-19 patients for rapid relief of respiratory distress. It can be safely combined with standard pharmacologic treatment in such patients for added clinical benefit.
Collapse
Affiliation(s)
- Govindaraj Ganesan
- Harshamitra Super-Specialty Cancer Centre and Research Institute, Trichy, Tamilnadu, India.
| | - Sasipriya Ponniah
- Harshamitra Super-Specialty Cancer Centre and Research Institute, Trichy, Tamilnadu, India
| | | | | | | | | | | | | | - Prabhu Ramamoorthy
- Harshamitra Super-Specialty Cancer Centre and Research Institute, Trichy, Tamilnadu, India
| | - Brindha Thangaraj
- Harshamitra Super-Specialty Cancer Centre and Research Institute, Trichy, Tamilnadu, India
| | | | | |
Collapse
|
15
|
Sharma DN, Welsh J, Kumar R. Can low-dose radiation therapy reduce the risk of mucormycosis in COVID-19 patients? J Cancer Res Ther 2021; 17:1294-1296. [PMID: 34916356 DOI: 10.4103/jcrt.jcrt_2011_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Daya Nand Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - James Welsh
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University, Chicago; Department of Radiation Oncology, Edward Hines Jr VA Hospital, Hines, Illinois, USA
| | - Rishabh Kumar
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
16
|
Alam MS, Czajkowsky DM. SARS-CoV-2 infection and oxidative stress: Pathophysiological insight into thrombosis and therapeutic opportunities. Cytokine Growth Factor Rev 2021; 63:44-57. [PMID: 34836751 PMCID: PMC8591899 DOI: 10.1016/j.cytogfr.2021.11.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 01/08/2023]
Abstract
The current coronavirus disease 2019 (COVID-19) pandemic has presented unprecedented challenges to global health. Although the majority of COVID-19 patients exhibit mild-to-no symptoms, many patients develop severe disease and need immediate hospitalization, with most severe infections associated with a dysregulated immune response attributed to a cytokine storm. Epidemiological studies suggest that overall COVID-19 severity and morbidity correlate with underlying comorbidities, including diabetes, obesity, cardiovascular diseases, and immunosuppressive conditions. Patients with such comorbidities exhibit elevated levels of reactive oxygen species (ROS) and oxidative stress caused by an increased accumulation of angiotensin II and by activation of the NADPH oxidase pathway. Moreover, accumulating evidence suggests that oxidative stress coupled with the cytokine storm contribute to COVID-19 pathogenesis and immunopathogenesis by causing endotheliitis and endothelial cell dysfunction and by activating the blood clotting cascade that results in blood coagulation and microvascular thrombosis. In this review, we survey the mechanisms of how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces oxidative stress and the consequences of this stress on patient health. We further shed light on aspects of the host immunity that are crucial to prevent the disease during the early phase of infection. A better understanding of the disease pathophysiology as well as preventive measures aimed at lowering ROS levels may pave the way to mitigate SARS-CoV-2-induced complications and decrease mortality.
Collapse
Affiliation(s)
- Mohammad Shah Alam
- Department of Anatomy and Histology, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur 1706, Bangladesh.
| | - Daniel M Czajkowsky
- Bio-ID Centre, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| |
Collapse
|
17
|
Abdel-Aziz N, Elkady AA, Elgazzar EM. Effect of Low-Dose Gamma Radiation and Lipoic Acid on High- Radiation-Dose Induced Rat Brain Injuries. Dose Response 2021; 19:15593258211044845. [PMID: 34759786 PMCID: PMC8573698 DOI: 10.1177/15593258211044845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 08/17/2021] [Indexed: 12/04/2022] Open
Abstract
Aim This work aims to investigate the possible radio-adaptive mechanisms induced by low-dose (LD) whole-body γ-irradiation alone or combined with alpha-lipoic acid (ALA) administration in modulating high-dose (HD) head irradiation–induced brain injury in rats. Materials and Methods Rats were irradiated with LD (.25 Gy) 24 hours prior HD (20 Gy), and subjected to ALA (100 mg/kg/day) 5 minutes after HD and continued for 10 days. At the end of the experiment, animals were sacrificed and brain samples were dissected for biochemical and histopathological examinations. Results HD irradiation-induced brain injury as manifested by elevation of oxidative stress, DNA damage, apoptotic, and inflammatory markers in brain tissue. Histological examination of brain sections showed marked alterations. However, LD alone or combined with ALA ameliorated the changes induced by HD. Conclusion Under the present experimental conditions, LD whole-body irradiation exhibited neuroprotective activity against detrimental effects of a subsequent HD head irradiation. This effect might be due to the adaptive response induced by LD that activated the anti-oxidative, anti-apoptotic, and anti-inflammatory mechanisms in the affected animals making them able to cope with the subsequent high-dose exposure. However, the combined LD exposure and ALA supplementation produced a further modulating effect in the HD-irradiated rats.
Collapse
Affiliation(s)
- Nahed Abdel-Aziz
- Radiation Biology Research Department, National Centre for Radiation Research and Technology (NCRRT), Egyptian Atomic Energy Authority (EAEA), Cairo, Egypt
| | - Ahmed A Elkady
- Ahmed A. Elkady: Health Radiation Research Department, National Centre for Radiation Research and Technology (NCRRT), Egyptian Atomic Energy Authority (EAEA), Cairo, Egypt
| | - Eman M Elgazzar
- Ahmed A. Elkady: Health Radiation Research Department, National Centre for Radiation Research and Technology (NCRRT), Egyptian Atomic Energy Authority (EAEA), Cairo, Egypt
| |
Collapse
|
18
|
Kapoor R, Welsh JS, Dhawan V, Javadinia SA, Calabrese EJ, Dhawan G. Low-dose radiation therapy (LDRT) for COVID-19 and its deadlier variants. Arch Toxicol 2021; 95:3425-3432. [PMID: 34302492 PMCID: PMC8308081 DOI: 10.1007/s00204-021-03124-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/20/2021] [Indexed: 12/11/2022]
Abstract
Coronavirus variants are gaining strongholds throughout the globe. Despite early signals that SARS-CoV-2 coronavirus case numbers are easing up in the United States and during the middle of a (not so easy) vaccination roll out, the country has passed a grim landmark of 600,000 deaths. We contend that these numbers would have been much lower if the medical community undertook serious investigations into the potential of low doses of radiation (LDRT) as a mainstream treatment modality for COVID-19 pneumonia. LDRT has been posited to manifest anti-infectious and anti-inflammatory properties at doses of 0.3-1.0 Gy via the activation of the Nrf-2 pathway. Although some researchers are conducting well-designed clinical trials on the potential of LDRT, the deep-rooted, blind, and flawed acceptance of the Linear No-Threshold (LNT) model for ionizing radiation has led to sidelining of this promising therapy and thus unimaginable numbers of deaths in the United States.
Collapse
Affiliation(s)
- Rachna Kapoor
- Saint Francis Hospital and Medical Center, Hartford, CT USA
| | - James S. Welsh
- Edward Hines Jr VA Hospital, Hines, IL USA
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL USA
| | - Vikas Dhawan
- COVID 19 Facilities, Command Hospital (Western Command), Chandimandir, Panchkula, Haryana India
| | - Seyed Alireza Javadinia
- Clinical Research Development Unit, Hospital Research Development Committee, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Edward J. Calabrese
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA USA
| | - Gaurav Dhawan
- Sri Guru Ram Das University of Health Sciences, Amritsar, India
| |
Collapse
|
19
|
Cuttler JM, Calabrese EJ. What Would Become of Nuclear Risk if Governments Changed Their Regulations to Recognize the Evidence of Radiation's Beneficial Health Effects for Exposures That Are Below the Thresholds for Detrimental Effects? Dose Response 2021; 19:15593258211059317. [PMID: 34880717 PMCID: PMC8647278 DOI: 10.1177/15593258211059317] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The 1953 Atoms for Peace Speech to the United Nations proposed applying nuclear energy to essential needs, including abundant electrical energy. The widespread fear of ionizing radiation from nuclear facilities and medical procedures began after the United States National Academy of Sciences performed a study of radiation dangers to the human genome. This study, initiated and managed by an oil industry benefactor, recommended in 1956 that the risk of radiation-induced mutations be assessed using the linear no-threshold dose-response model instead of the threshold model. It was followed by a study that wrongly linked low radiation to cancer among the atomic bomb survivors. The ensuing controversy resulted in a compromise. The National Committee on Radiation Protection adopted the precautionary principle policy in 1959, justified by fear of cancer and lack of knowledge. The United States and all other countries followed this recommendation, which remains unchanged 62 years later. Its impact on nuclear energy and medicine has been profound. Many costly regulations have been enacted to prevent very unlikely human or equipment failures-failures that would lead to radiation exposures that are below the dose thresholds for lasting harmful effects. Potential low-dose radiation therapies, against inflammation, cancer, autoimmune, and neurodegenerative diseases, are shunned.
Collapse
Affiliation(s)
| | - Edward J. Calabrese
- Department of Environmental Health
Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| |
Collapse
|
20
|
Dunlap NE, van Berkel V, Cai L. COVID-19 and low-dose radiation therapy. RADIATION MEDICINE AND PROTECTION 2021; 2:139-145. [PMID: 34522905 PMCID: PMC8429076 DOI: 10.1016/j.radmp.2021.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 02/06/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative pathogen of the coronavirus disease 2019 (COVID-19), has caused more than 179 million infections and 3.8 million deaths worldwide. Global health authorities working on the COVID-19 outbreak continue to explore methods to reduce the rate of its transmission to healthy individuals. Treatment protocols thus far have focused on social distancing and masking, treatment with antivirals early in infection, and steroids to reduce the inflammatory response. An alternative approach is therapy with low dose radiation (LDR), which has several advantages compared to the current drugs and medicines. To date more than 10 case reports and pilot clinical trial preliminary outcome are available from different countries. These reports cover a wide range of patient conditions and LDR treatment strategies. Although one report showed the failure to observe the improvement of COVID-19 patients after LDR therapy, the majority showed some clinical improvement, and demonstrated the safety of LDR for COVID-19 patients, particularly with 0.5 Gy. This review aims to summarize the potential rationales and mechanisms of LDR therapy for COVID-19 patients, and its current clinical status and potential use.
Collapse
Affiliation(s)
- Neal E Dunlap
- Department of Radiation Oncology, University of Louisville School of Medicine, Louisville, KY, 40202, USA
| | - Victor van Berkel
- Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, KY, 40204, USA
| | - Lu Cai
- Department of Radiation Oncology, University of Louisville School of Medicine, Louisville, KY, 40202, USA.,Pediatric Research Institute, Departments of Pediatrics, Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY, 40202, USA
| |
Collapse
|
21
|
de Melo GD, Lazarini F, Larrous F, Feige L, Kornobis E, Levallois S, Marchio A, Kergoat L, Hardy D, Cokelaer T, Pineau P, Lecuit M, Lledo P, Changeux J, Bourhy H. Attenuation of clinical and immunological outcomes during SARS-CoV-2 infection by ivermectin. EMBO Mol Med 2021; 13:e14122. [PMID: 34170074 PMCID: PMC8350903 DOI: 10.15252/emmm.202114122] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 12/12/2022] Open
Abstract
The devastating pandemic due to SARS-CoV-2 and the emergence of antigenic variants that jeopardize the efficacy of current vaccines create an urgent need for a comprehensive understanding of the pathophysiology of COVID-19, including the contribution of inflammation to disease. It also warrants for the search of immunomodulatory drugs that could improve disease outcome. Here, we show that standard doses of ivermectin (IVM), an anti-parasitic drug with potential immunomodulatory activities through the cholinergic anti-inflammatory pathway, prevent clinical deterioration, reduce olfactory deficit, and limit the inflammation of the upper and lower respiratory tracts in SARS-CoV-2-infected hamsters. Whereas it has no effect on viral load in the airways of infected animals, transcriptomic analyses of infected lungs reveal that IVM dampens type I interferon responses and modulates several other inflammatory pathways. In particular, IVM dramatically reduces the Il-6/Il-10 ratio in lung tissue and promotes macrophage M2 polarization, which might account for the more favorable clinical presentation of IVM-treated animals. Altogether, this study supports the use of immunomodulatory drugs such as IVM, to improve the clinical condition of SARS-CoV-2-infected patients.
Collapse
Affiliation(s)
| | | | - Florence Larrous
- Lyssavirus Epidemiology and Neuropathology UnitInstitut PasteurParisFrance
| | - Lena Feige
- Lyssavirus Epidemiology and Neuropathology UnitInstitut PasteurParisFrance
| | - Etienne Kornobis
- Biomics Technological PlatformCenter for Technological Resources and Research (C2RT)Institut PasteurParisFrance
- Bioinformatics and Biostatistics HubComputational Biology DepartmentInstitut PasteurParisFrance
| | | | - Agnès Marchio
- Nuclear Organization and Oncogenesis UnitInstitut PasteurParisFrance
| | - Lauriane Kergoat
- Lyssavirus Epidemiology and Neuropathology UnitInstitut PasteurParisFrance
| | - David Hardy
- Experimental Neuropathology UnitInstitut PasteurParisFrance
| | - Thomas Cokelaer
- Biomics Technological PlatformCenter for Technological Resources and Research (C2RT)Institut PasteurParisFrance
- Bioinformatics and Biostatistics HubComputational Biology DepartmentInstitut PasteurParisFrance
| | - Pascal Pineau
- Nuclear Organization and Oncogenesis UnitInstitut PasteurParisFrance
| | - Marc Lecuit
- Biology of Infection UnitInstitut PasteurInserm U1117ParisFrance
- Division of Infectious Diseases and Tropical MedicineInstitut ImagineUniversité de ParisNecker‐Enfants Malades University HospitalAP‐HPParisFrance
| | | | | | - Hervé Bourhy
- Lyssavirus Epidemiology and Neuropathology UnitInstitut PasteurParisFrance
| |
Collapse
|
22
|
An Update on the Role of Nrf2 in Respiratory Disease: Molecular Mechanisms and Therapeutic Approaches. Int J Mol Sci 2021; 22:ijms22168406. [PMID: 34445113 PMCID: PMC8395144 DOI: 10.3390/ijms22168406] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/29/2021] [Accepted: 08/03/2021] [Indexed: 12/17/2022] Open
Abstract
Nuclear factor erythroid 2-related factor (Nrf2) is a transcriptional activator of the cell protection gene that binds to the antioxidant response element (ARE). Therefore, Nrf2 protects cells and tissues from oxidative stress. Normally, Kelch-like ECH-associated protein 1 (Keap1) inhibits the activation of Nrf2 by binding to Nrf2 and contributes to Nrf2 break down by ubiquitin proteasomes. In moderate oxidative stress, Keap1 is inhibited, allowing Nrf2 to be translocated to the nucleus, which acts as an antioxidant. However, under unusually severe oxidative stress, the Keap1-Nrf2 mechanism becomes disrupted and results in cell and tissue damage. Oxide-containing atmospheric environment generally contributes to the development of respiratory diseases, possibly leading to the failure of the Keap1-Nrf2 pathway. Until now, several studies have identified changes in Keap1-Nrf2 signaling in models of respiratory diseases, such as acute respiratory distress syndrome (ARDS)/acute lung injury (ALI), chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), and asthma. These studies have confirmed that several Nrf2 activators can alleviate symptoms of respiratory diseases. Thus, this review describes how the expression of Keap1-Nrf2 functions in different respiratory diseases and explains the protective effects of reversing this expression.
Collapse
|
23
|
Javadinia SA, Nazeminezhad N, Ghahramani-Asl R, Soroosh D, Fazilat-Panah D, PeyroShabany B, Saberhosseini SN, Mehrabian A, Taghizadeh-Hesary F, Nematshahi M, Dhawan G, Welsh JS, Calabrese EJ, Kapoor R. Low-dose radiation therapy for osteoarthritis and enthesopathies: a review of current data. Int J Radiat Biol 2021; 97:1352-1367. [PMID: 34259615 DOI: 10.1080/09553002.2021.1956000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Osteoarthritis (OA), the most common degenerative joint disease, is associated with severe functional limitation and impairment of quality of life. Numerous reports have documented the clinical efficacy of low-dose radiotherapy (LD-RT) in the management of various inflammatory disorders, including OA. In this paper, we assessed the clinical literature involving the use of LD-RT in the treatment of OA, its dose-response features, possible underlying mechanistic features, and optimal therapeutic dose range. METHODS We carried out a systematic review based on the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statements and evaluated articles meeting the inclusion criteria for this review. RESULTS A total of 361 articles were identified from databases, such as Scopus, PubMed, Embase, and Science Direct out of which 224 articles were duplicates and were discarded. Of the remaining 137 articles, 74 articles were un-related, 27 articles were review articles, eight were conference abstracts, three were letters, two were editorials, two were notes, and one was a book chapter. Finally, 20 articles met all the inclusion criteria and were included in this systematic review. DISCUSSION Several single-arm retrospective/prospective studies showed advantages for LD-RT in the management of OA in terms of pain relief, improvement of mobility and function, and showed minimal side effects. Mechanistic considerations involve positive subcellular effects mediated by the activation of a nuclear factor erythroid 2-related transcription factor (Nrf2) mediated antioxidant response. Further research on both the short- and long-term effects of LD-RT on OA and other inflammatory disorders is recommended.
Collapse
Affiliation(s)
- Seyed Alireza Javadinia
- Clinical Research Development Unit, Hospital Research Development Committee, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | | | - Ruhollah Ghahramani-Asl
- Clinical Research Development Unit, Hospital Research Development Committee, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Davood Soroosh
- Clinical Research Development Unit, Hospital Research Development Committee, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | | | - Babak PeyroShabany
- Department of Internal Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | | | - Arezoo Mehrabian
- Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Nematshahi
- Department of Anesthesiology and Critical Care, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Gaurav Dhawan
- Sri Guru Ram Das University of Health Sciences, Amritsar, India
| | - James S Welsh
- Edward Hines Jr. VA Hospital, Loyola University Chicago Stritch School of Medicine, Chicago, IL, USA
| | - Edward J Calabrese
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Rachna Kapoor
- Saint Francis Hospital and Medical Center, Hartford, CT, USA
| |
Collapse
|
24
|
Emanuele S, Celesia A, D’Anneo A, Lauricella M, Carlisi D, De Blasio A, Giuliano M. The Good and Bad of Nrf2: An Update in Cancer and New Perspectives in COVID-19. Int J Mol Sci 2021; 22:7963. [PMID: 34360732 PMCID: PMC8348506 DOI: 10.3390/ijms22157963] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/23/2021] [Accepted: 07/24/2021] [Indexed: 01/08/2023] Open
Abstract
Nuclear factor erythroid 2-related factor 2 (Nrf2) is a well-known transcription factor best recognised as one of the main regulators of the oxidative stress response. Beyond playing a crucial role in cell defence by transactivating cytoprotective genes encoding antioxidant and detoxifying enzymes, Nrf2 is also implicated in a wide network regulating anti-inflammatory response and metabolic reprogramming. Such a broad spectrum of actions renders the factor a key regulator of cell fate and a strategic player in the control of cell transformation and response to viral infections. The Nrf2 protective roles in normal cells account for its anti-tumour and anti-viral functions. However, Nrf2 overstimulation often occurs in tumour cells and a complex correlation of Nrf2 with cancer initiation and progression has been widely described. Therefore, if on one hand, Nrf2 has a dual role in cancer, on the other hand, the factor seems to display a univocal function in preventing inflammation and cytokine storm that occur under viral infections, specifically in coronavirus disease 19 (COVID-19). In such a variegate context, the present review aims to dissect the roles of Nrf2 in both cancer and COVID-19, two widespread diseases that represent a cause of major concern today. In particular, the review describes the molecular aspects of Nrf2 signalling in both pathological situations and the most recent findings about the advantages of Nrf2 inhibition or activation as possible strategies for cancer and COVID-19 treatment respectively.
Collapse
Affiliation(s)
- Sonia Emanuele
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (BIND), University of Palermo, Via del Vespro 129, 90127 Palermo, Italy; (A.C.); (M.L.); (D.C.)
| | - Adriana Celesia
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (BIND), University of Palermo, Via del Vespro 129, 90127 Palermo, Italy; (A.C.); (M.L.); (D.C.)
| | - Antonella D’Anneo
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), Biochemistry Building, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy; (A.D.); (A.D.B.); (M.G.)
| | - Marianna Lauricella
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (BIND), University of Palermo, Via del Vespro 129, 90127 Palermo, Italy; (A.C.); (M.L.); (D.C.)
| | - Daniela Carlisi
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (BIND), University of Palermo, Via del Vespro 129, 90127 Palermo, Italy; (A.C.); (M.L.); (D.C.)
| | - Anna De Blasio
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), Biochemistry Building, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy; (A.D.); (A.D.B.); (M.G.)
| | - Michela Giuliano
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), Biochemistry Building, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy; (A.D.); (A.D.B.); (M.G.)
| |
Collapse
|
25
|
Mandal A, Singh P, Samaddar A, Singh D, Verma M, Rakesh A, Ranjan R. Vaccination of cancer patients against COVID-19: towards the end of a dilemma. Med Oncol 2021; 38:92. [PMID: 34235592 PMCID: PMC8263320 DOI: 10.1007/s12032-021-01540-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/25/2021] [Indexed: 12/12/2022]
Abstract
With the emergence of second wave of COVID-19 infection globally, particularly in India in March-April 2021, protection by massive vaccination drive has become the need of the hour. Vaccines have been proved to reduce the risk of developing severe illness and are emerging as vital tools in the battle against COVID-19. As per the GLOBOCAN database, nearly 19.3 million new cancer cases have been reported in 2020 globally, which posed a significant challenge to health care providers to protect such large number of 'vulnerable' patients from COVID-19. Nevertheless, a considerable degree of doubt, hesitancy and misconceptions are noted regarding the administration of vaccines particularly during active immuno-suppressant treatment. This review article highlights the added vulnerability of cancer patients to the COVID-19 infection and has explored the immunological challenges associated with malignancy, anticancer treatment and COVID-19 vaccination.
Collapse
Affiliation(s)
- Avik Mandal
- Department of Radiation Oncology, All India Institute of Medical Sciences, Aurangabad Road, Phulwari Sharif, Patna, Bihar, 801507, India.
| | - Pritanjali Singh
- Department of Radiation Oncology, All India Institute of Medical Sciences, Aurangabad Road, Phulwari Sharif, Patna, Bihar, 801507, India
| | - Arghadip Samaddar
- Depratment of Neuromicrobiology, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Dharmendra Singh
- Department of Radiation Oncology, All India Institute of Medical Sciences, Aurangabad Road, Phulwari Sharif, Patna, Bihar, 801507, India
| | - Manika Verma
- Department of Radiation Oncology, All India Institute of Medical Sciences, Aurangabad Road, Phulwari Sharif, Patna, Bihar, 801507, India
| | - Amrita Rakesh
- Department of Radiation Oncology, All India Institute of Medical Sciences, Aurangabad Road, Phulwari Sharif, Patna, Bihar, 801507, India
| | - Rakesh Ranjan
- Department of Radiation Oncology, All India Institute of Medical Sciences, Aurangabad Road, Phulwari Sharif, Patna, Bihar, 801507, India
| |
Collapse
|
26
|
Oakley PA, Betz JW, Harrison DE, Siskin LA, Hirsh DW. Radiophobia Overreaction: College of Chiropractors of British Columbia Revoke Full X-Ray Rights Based on Flawed Study and Radiation Fear-Mongering. Dose Response 2021; 19:15593258211033142. [PMID: 34421439 PMCID: PMC8375354 DOI: 10.1177/15593258211033142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 01/11/2023] Open
Abstract
Fears over radiation have created irrational pressures to dissuade radiography use within chiropractic. Recently, the regulatory body for chiropractors practicing in British Columbia, Canada, the College of Chiropractors of British Columbia (CCBC), contracted Pierre Côté to review the clinical use of X-rays within the chiropractic profession. A "rapid review" was performed and published quickly and included only 9 papers, the most recent dating from 2005; they concluded, "Given the inherent risks of radiation, we recommend that chiropractors do not use radiographs for the routine and repeat evaluation of the structure and function of the spine." The CCBC then launched an immediate review of the use of X-rays by chiropractors in their jurisdiction. Member and public opinion were gathered but not presented to their members. On February 4, 2021, the College announced amendments to their Professional Conduct Handbook that revoked X-ray rights for routine/repeat assessment and management of patients with spine disorders. Here, we highlight current and historical evidence that substantiates that X-rays are not a public health threat. We also point out critical and insurmountable flaws in the single paper used to support irrational and unscientific policy that discriminates against chiropractors who practice certain forms of evidence-based X-ray-guided methods.
Collapse
Affiliation(s)
| | | | | | | | | | - International Chiropractors Association Rapid Response Research Review Subcommittee
- Private Practice, Newmarket, ON, Canada
- Private Practice, Boise, ID, USA
- CBP NonProfit, Inc, Eagle, ID, USA
- Private Practice, Green Brook, NJ, USA
- Private Practice, Laurel, MD, USA
| |
Collapse
|