1
|
Moloudi K, Azariasl S, Abrahamse H, George BP, Yasuda H. Expected role of photodynamic therapy to relieve skin damage in nuclear or radiological emergency: Review. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2024; 110:104517. [PMID: 39032581 DOI: 10.1016/j.etap.2024.104517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 07/02/2024] [Accepted: 07/17/2024] [Indexed: 07/23/2024]
Abstract
Nuclear and radiological accidents can occur due to poor management, in transportation, radiation therapy and nuclear wards in hospitals, leading to extreme radiation exposure and serious consequences for human health. Additionally, in many of previous radiological accidents, skin damage was observed in patients and survivors due to the high radiation exposure. However, as part of a medical countermeasures in a nuclear/radiological emergency, it is critical to plan for the treatment of radiation-induced skin damage. Hence, the new, non-invasive technology of photodynamic therapy (PDT) is projected to be more effectively used for treating skin damage caused by high-dose radiation. PDT plays an important role in treating, repairing skin damage and promoting wound healing as evidenced by research. This review, highlighted and recommended potential impacts of PDT to repair and decrease radiation-induced skin tissue damage. Moreover, we have suggested some photosensitizer (PS) agent as radio-mitigator drugs to decrease radiobiological effects.
Collapse
Affiliation(s)
- Kave Moloudi
- Laser Research Centre, Faculty of Health Science, Doornfontein Campus, University of Johannesburg, Johannesburg 2028, South Africa
| | - Samayeh Azariasl
- Department of Radiation Biophysics, Research Institute for Radiation Biology and Medicine, Hiroshima University, Kasumi, Minami-ku 734-8553, Japan
| | - Heidi Abrahamse
- Laser Research Centre, Faculty of Health Science, Doornfontein Campus, University of Johannesburg, Johannesburg 2028, South Africa
| | - Blassan P George
- Laser Research Centre, Faculty of Health Science, Doornfontein Campus, University of Johannesburg, Johannesburg 2028, South Africa.
| | - Hiroshi Yasuda
- Department of Radiation Biophysics, Research Institute for Radiation Biology and Medicine, Hiroshima University, Kasumi, Minami-ku 734-8553, Japan
| |
Collapse
|
2
|
Jackson TL, Desai R, Wafa HA, Wang Y, Peacock J, Peto T, Chakravarthy U, Dakin H, Wordsworth S, Lewis C, Clinch P, Ramazzotto L, Neffendorf JE, Lee CN, O'Sullivan JM, Reeves BC. Stereotactic radiotherapy for neovascular age-related macular degeneration (STAR): a pivotal, randomised, double-masked, sham-controlled device trial. Lancet 2024; 404:44-54. [PMID: 38876132 DOI: 10.1016/s0140-6736(24)00687-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/19/2024] [Accepted: 04/03/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Neovascular age-related macular degeneration (nAMD) is a leading cause of blindness. The first-line therapy is anti-vascular endothelial growth factor (anti-VEGF) agents delivered by intravitreal injection. Ionising radiation mitigates key pathogenic processes underlying nAMD, and therefore has therapeutic potential. STAR aimed to assess whether stereotactic radiotherapy (SRT) reduces the number of anti-VEGF injections required, without sacrificing visual acuity. METHODS This pivotal, randomised, double-masked, sham-controlled trial enrolled participants with pretreated chronic active nAMD from 30 UK hospitals. Participants were randomly allocated in a 2:1 ratio to 16-Gray (Gy) SRT delivered using a robotically controlled device or sham SRT, stratified by treatment centre. Eligible participants were aged 50 years or older and had chronic active nAMD, with at least three previous anti-VEGF injections, including at least one in the last 4 months. Participants and all trial and image reading centre staff were masked to treatment allocation, except one unmasked statistician. The primary outcome was the number of intravitreal ranibizumab injections required over 2 years, tested for superiority (fewer injections). The main secondary outcome was Early Treatment Diabetic Retinopathy Study visual acuity at two years, tested for non-inferiority (five-letter margin). The primary analysis used the intention-to-treat principle, and safety was analysed per-protocol on participants with available data. The study is registered with ClinicalTrials.gov (NCT02243878) and is closed for recruitment. FINDINGS 411 participants enrolled between Jan 1, 2015, and Dec 27, 2019, and 274 were randomly allocated to the 16-Gy SRT group and 137 to the sham SRT group. 240 (58%) of all participants were female, and 171 (42%) of all participants were male. 241 participants in the 16-Gy SRT group and 118 participants in the sham group were included in the final analysis, and 409 patients were treated and formed the safety population, of whom two patients allocated to sham treatment erroneously received 16-Gy SRT. The SRT group received a mean of 10·7 injections (SD 6·3) over 2 years versus 13·3 injections (5·8) with sham, a reduction of 2·9 injections after adjusting for treatment centre (95% CI -4·2 to -1·6, p<0·0001). The SRT group best-corrected visual acuity change was non-inferior to sham (adjusted mean letter loss difference between groups, -1·7 letters [95% CI -4·2 to 0·8]). Adverse event rates were similar across groups, but reading centre-detected microvascular abnormalities occurred in 77 SRT-treated eyes (35%) and 13 (12%) sham-treated eyes. Overall, eyes with microvascular abnormalities tended to have better best-corrected visual acuity than those without. Fewer ranibizumab injections offset the cost of SRT, saving a mean of £565 per participant (95% CI -332 to 1483). INTERPRETATION SRT can reduce ranibizumab treatment burden without compromising vision. FUNDING Medical Research Council and National Institute for Health and Care Research Efficacy and Mechanism Evaluation Programme.
Collapse
Affiliation(s)
- Timothy L Jackson
- King's Ophthalmology Research Unit (KORU), Department of Ophthalmology, King's College Hospital, London, UK; Faculty of Life Sciences and Medicine, King's College London, London, UK.
| | - Riti Desai
- King's Ophthalmology Research Unit (KORU), Department of Ophthalmology, King's College Hospital, London, UK; Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Hatem A Wafa
- Department of Population Health Sciences, King's College London, London, UK
| | - Yanzhong Wang
- Department of Population Health Sciences, King's College London, London, UK
| | - Janet Peacock
- Department of Population Health Sciences, King's College London, London, UK; Department of Epidemiology, Geisel School of Medicine at Dartmouth, Dartmouth College, NH, USA
| | - Tunde Peto
- Centre for Public Health, Queen's University Belfast, Belfast, UK; Network of Ophthalmic Reading Centres UK: London (Moorfields), Liverpool, and Belfast Ophthalmic Reading Centres, UK
| | | | - Helen Dakin
- Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Sarah Wordsworth
- Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Cornelius Lewis
- Medical Engineering and Physics, King's College Hospital, London, UK
| | - Patricia Clinch
- Medical Engineering and Physics, King's College Hospital, London, UK
| | - Lisa Ramazzotto
- King's Ophthalmology Research Unit (KORU), Department of Ophthalmology, King's College Hospital, London, UK; Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - James E Neffendorf
- King's Ophthalmology Research Unit (KORU), Department of Ophthalmology, King's College Hospital, London, UK; Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Chan Ning Lee
- King's Ophthalmology Research Unit (KORU), Department of Ophthalmology, King's College Hospital, London, UK; Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Joe M O'Sullivan
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | |
Collapse
|
3
|
Safini F, Amaoui B, Oqbani K, Abbaoui S, Semghouli S. Is Low-Dose Lung Radiotherapy for Severe COVID-19 Pneumonia a Therapeutic Alternative? Cureus 2024; 16:e65033. [PMID: 39165439 PMCID: PMC11334754 DOI: 10.7759/cureus.65033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2024] [Indexed: 08/22/2024] Open
Abstract
Low-dose radiotherapy (LD-RT) has historically been used to treat severe bacterial and viral pneumonia due to its immunomodulatory properties. However, this technique has been delayed since the advent of antibiotics and the carcinogenic risk associated with radiation therapy. Currently, it represents an alternative therapeutic in the SARS-CoV-2 pandemic which leads sometimes to fatal pneumonia, especially given the limited availability of effective treatments for severe forms of pneumonia. Numerous in vitro and in vivo studies have demonstrated the anti-inflammatory effect of LD-RT and have reported clinical and biological improvement in patients with severe pneumonia. In this literature review, we report the data and results of various published clinical trials.
Collapse
Affiliation(s)
- Fatima Safini
- Department of Radiation Therapy, Souss-Massa University Hospital, Agadir, MAR
- Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir, MAR
| | - Bouchra Amaoui
- Department of Radiation Therapy, Souss-Massa University Hospital, Agadir, MAR
- Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir, MAR
| | - Kenza Oqbani
- Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir, MAR
| | - Sanae Abbaoui
- Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir, MAR
| | - Slimane Semghouli
- Medical Physics, Higher Institute of Nursing Professions and Health Techniques, Agadir, MAR
| |
Collapse
|
4
|
Wang L, Rivas R, Wilson A, Park YM, Walls S, Yu T, Miller AC. Dose-Dependent Effects of Radiation on Mitochondrial Morphology and Clonogenic Cell Survival in Human Microvascular Endothelial Cells. Cells 2023; 13:39. [PMID: 38201243 PMCID: PMC10778067 DOI: 10.3390/cells13010039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
To better understand radiation-induced organ dysfunction at both high and low doses, it is critical to understand how endothelial cells (ECs) respond to radiation. The impact of irradiation (IR) on ECs varies depending on the dose administered. High doses can directly damage ECs, leading to EC impairment. In contrast, the effects of low doses on ECs are subtle but more complex. Low doses in this study refer to radiation exposure levels that are below those that cause immediate and necrotic damage. Mitochondria are the primary cellular components affected by IR, and this study explored their role in determining the effect of radiation on microvascular endothelial cells. Human dermal microvascular ECs (HMEC-1) were exposed to varying IR doses ranging from 0.1 Gy to 8 Gy (~0.4 Gy/min) in the AFRRI 60-Cobalt facility. Results indicated that high doses led to a dose-dependent reduction in cell survival, which can be attributed to factors such as DNA damage, oxidative stress, cell senescence, and mitochondrial dysfunction. However, low doses induced a small but significant increase in cell survival, and this was achieved without detectable DNA damage, oxidative stress, cell senescence, or mitochondrial dysfunction in HMEC-1. Moreover, the mitochondrial morphology was assessed, revealing that all doses increased the percentage of elongated mitochondria, with low doses (0.25 Gy and 0.5 Gy) having a greater effect than high doses. However, only high doses caused an increase in mitochondrial fragmentation/swelling. The study further revealed that low doses induced mitochondrial elongation, likely via an increase in mitochondrial fusion protein 1 (Mfn1), while high doses caused mitochondrial fragmentation via a decrease in optic atrophy protein 1 (Opa1). In conclusion, the study suggests, for the first time, that changes in mitochondrial morphology are likely involved in the mechanism for the radiation dose-dependent effect on the survival of microvascular endothelial cells. This research, by delineating the specific mechanisms through which radiation affects endothelial cells, offers invaluable insights into the potential impact of radiation exposure on cardiovascular health.
Collapse
Affiliation(s)
- Li Wang
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, MD 20889, USA; (L.W.); (R.R.); (A.W.); (S.W.)
- Department of Pathology, Uniformed Services University of the Health Sciences, Bethesda, MD 20889, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA; (Y.M.P.); (T.Y.)
| | - Rafael Rivas
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, MD 20889, USA; (L.W.); (R.R.); (A.W.); (S.W.)
| | - Angelo Wilson
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, MD 20889, USA; (L.W.); (R.R.); (A.W.); (S.W.)
- Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA; (Y.M.P.); (T.Y.)
| | - Yu Min Park
- Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA; (Y.M.P.); (T.Y.)
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Shannon Walls
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, MD 20889, USA; (L.W.); (R.R.); (A.W.); (S.W.)
| | - Tianzheng Yu
- Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA; (Y.M.P.); (T.Y.)
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Alexandra C. Miller
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, MD 20889, USA; (L.W.); (R.R.); (A.W.); (S.W.)
- Department of Radiation Science and Radiology, Uniformed Services University Health Sciences, Bethesda, MD 20889, USA
- Columbia University Irving Medical Center, Columbia University, New York, NY 10032, USA
| |
Collapse
|
5
|
Park M, Ha J, Lee Y, Choi HS, Kim BS, Jeong YK. Low-moderate dose whole-brain γ-ray irradiation modulates the expressions of glial fibrillary acidic protein and intercellular adhesion molecule-1 in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced Parkinson's disease mouse model. Neurobiol Aging 2023; 132:175-184. [PMID: 37837733 DOI: 10.1016/j.neurobiolaging.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/22/2023] [Accepted: 06/24/2023] [Indexed: 10/16/2023]
Abstract
The anti-inflammatory efficacy of radiation therapy (RT) with single fractions below 1.0 Gy has been demonstrated in Alzheimer's disease mouse models. As neuroinflammation is also a major pathological feature of Parkinson's disease (PD), RT may also be effective in PD treatment. Therefore, this study aimed to investigate the anti-inflammatory effect of low-moderate dose RT (LMDRT, 0.6 Gy/single dose, for 5 days) exposure in a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP; 30 mg/kg, intraperitoneally, for 5 consecutive days)-induced PD mouse model. Importantly, LMDRT reduced the levels of glial fibrillary acidic protein and intercellular adhesion molecule-1 (CD54) in the striatum region, which increased following MPTP administration. LMDRT also modulated inflammatory gene expression patterns in the substantia nigra region of the MPTP-treated mice. However, LMDRT had no direct effects on the severe loss of dopaminergic neurons and impaired motor behavior in the rotarod test. These results indicate that LMDRT has anti-inflammatory effects by modulating neuroinflammatory factors, including glial fibrillary acidic protein and intercellular adhesion molecule-1, but showed no behavioral improvements or neuroprotection in the MPTP-induced mouse model of PD.
Collapse
MESH Headings
- Animals
- Mice
- 1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine/metabolism
- 1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine/pharmacology
- 1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine/therapeutic use
- Brain/metabolism
- Brain/radiation effects
- Disease Models, Animal
- Dopaminergic Neurons/pathology
- Glial Fibrillary Acidic Protein/metabolism
- Intercellular Adhesion Molecule-1/metabolism
- Intercellular Adhesion Molecule-1/pharmacology
- Intercellular Adhesion Molecule-1/therapeutic use
- Mice, Inbred C57BL
- Parkinson Disease/metabolism
- Parkinson Disease/radiotherapy
- Substantia Nigra/metabolism
Collapse
Affiliation(s)
- Mijeong Park
- Radiological and Medical Support Center, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Jimin Ha
- Radiological and Medical Support Center, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea; Division of Pharmaceutical Sciences, College of Pharmacy, Ewha Womans University, Seoul, Republic of Korea
| | - Yuri Lee
- Radiological and Medical Support Center, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea; Division of Pharmaceutical Sciences, College of Pharmacy, Ewha Womans University, Seoul, Republic of Korea
| | - Hoon-Seong Choi
- Research Animal Resource Center, Korea Institute of Science and Technology, Seoul, Republic of Korea
| | - Byoung Soo Kim
- Division of Applied RI, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Youn Kyoung Jeong
- Radiological and Medical Support Center, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea.
| |
Collapse
|
6
|
Low-Dose Radiotherapy for Patients with Pneumonia Due to COVID-19: A Single-Institution Prospective Study. Biomedicines 2023; 11:biomedicines11030858. [PMID: 36979837 PMCID: PMC10045009 DOI: 10.3390/biomedicines11030858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 03/18/2023] Open
Abstract
Purpose: Results of the low-dose radiation therapy (LDRT) in patients with pneumonia due to COVID-19 has been presented. Methods: Fifteen patients received a single-fraction radiation dose of 1 Gy to the bilateral lungs due to pre-ARDS pneumonia in the course of COVID-19. Follow-up was performed on days 1, 3, 5, 7, 14 after LDRT. Results: Eleven patients (73%) were released up until day 28. Median hospitalization was 20 days; 28-day mortality was 13%. Median O2 saturation improved within 24 h after LDRT in 14/15, with median SpO2 values of 84.5% vs. 87.5% p = 0.016, respectively. At day 14 of hospitalization, 46% did not require oxygen supplementation. Significant decline in CRP and IL-6 was observed within 24 h post LDRT. No organ toxicities were noted. Conclusion: LDRT is feasible, well tolerated and may translate to early clinical recovery in patients with severe pneumonia. Further studies are needed to determine optimal candidate, time and dose of LDRT for COVID-19 patients with pneumonia.
Collapse
|
7
|
Low-Dose Radiation Therapy (LDRT) against Cancer and Inflammatory or Degenerative Diseases: Three Parallel Stories with a Common Molecular Mechanism Involving the Nucleoshuttling of the ATM Protein? Cancers (Basel) 2023; 15:cancers15051482. [PMID: 36900274 PMCID: PMC10000719 DOI: 10.3390/cancers15051482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/18/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023] Open
Abstract
Very early after their discovery, X-rays were used in multiple medical applications, such as treatments against cancer, inflammation and pain. Because of technological constraints, such applications involved X-ray doses lower than 1 Gy per session. Progressively, notably in oncology, the dose per session increased. However, the approach of delivering less than 1 Gy per session, now called low-dose radiation therapy (LDRT), was preserved and is still applied in very specific cases. More recently, LDRT has also been applied in some trials to protect against lung inflammation after COVID-19 infection or to treat degenerative syndromes such as Alzheimer's disease. LDRT illustrates well the discontinuity of the dose-response curve and the counterintuitive observation that a low dose may produce a biological effect higher than a certain higher dose. Even if further investigations are needed to document and optimize LDRT, the apparent paradox of some radiobiological effects specific to low dose may be explained by the same mechanistic model based on the radiation-induced nucleoshuttling of the ATM kinase, a protein involved in various stress response pathways.
Collapse
|
8
|
Hussien SM. The immunomodulatory properties of low-level ionizing radiation as a potential treatment for COVID-19's life-threatening symptoms. Eur J Med Res 2023; 28:73. [PMID: 36774511 PMCID: PMC9918814 DOI: 10.1186/s40001-023-00999-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 01/06/2023] [Indexed: 02/13/2023] Open
Abstract
Public health experts are looking into the current coronavirus outbreak to see if there are any ways to prevent potentially fatal symptoms. Low-Dose Radiotherapy (LD-RT) induces anti-inflammatory cytokine responses that act as a counterweight to pro-inflammatory cytokines, potentially providing therapeutic benefits for COVID-19-related diseases associated with significant morbidity and mortality. This study will look into positive immuno-radiological reactions to see if they are feasible, practicable, and effective in lowering the critical inflammatory condition of the crucial stage COVID-19. This study aims to investigate the use of low-dose lung radiation in bacterial and viral pneumonia, as well as to provide a treatment plan for COVID-19-associated pneumonia. This article discusses the evidence for and against LD-RT theories in COVID-19 patients. The use of LD-RT at various stages of COVID-19 appears to be beneficial, with fewer side effects than other currently being studied treatments.
Collapse
Affiliation(s)
- Soha M. Hussien
- grid.429648.50000 0000 9052 0245Radiation Safety Department, Nuclear and Radiological Safety Research Center, Egyptian Atomic Energy Authority, Cairo, Egypt
| |
Collapse
|
9
|
Deloch L, Rückert M, Weissmann T, Lettmaier S, Titova E, Wolff T, Weinrich F, Fietkau R, Gaipl US. The various functions and phenotypes of macrophages are also reflected in their responses to irradiation: A current overview. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2023; 376:99-120. [PMID: 36997271 DOI: 10.1016/bs.ircmb.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Macrophages are a vital part of the innate immune system that are involved in healthy biological processes but also in disease modulation and response to therapy. Ionizing radiation is commonly used in the treatment of cancer and, in a lower dose range, as additive therapy for inflammatory diseases. In general, lower doses of ionizing radiation are known to induce rather anti-inflammatory responses, while higher doses are utilized in cancer treatment where they result, next to tumor control, in rather inflammatory responses. Most experiments that have been carried out in ex vivo on macrophages find this to be true, however in vivo, tumor-associated macrophages, for example, show a contradictory response to the respective dose-range. While some knowledge in radiation-induced modulations of macrophages has been collected, many of the underlying mechanisms remain unclear. Due to their pivotal role in the human body, however, they are a great target in therapy and could potentially aid in better treatment outcome. We therefore summarized the current knowledge of macrophage mediated radiation responses.
Collapse
|
10
|
Hussien SM, Rashed ER. Immune system modulation by low-dose ionizing radiation-induced adaptive response. Int J Immunopathol Pharmacol 2023; 37:3946320231172080. [PMID: 37075331 PMCID: PMC10127215 DOI: 10.1177/03946320231172080] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVE Hormesis or low-dose ionizing radiation is known to induce various biological responses, a subcategory of which is the adaptive response, which has been reported to protect against higher radiation doses via multiple mechanisms. This study investigated the role of the cell-mediated immunological component of low-dose ionizing radiation-induced adaptive response. METHODS Herein, male albino rats were exposed to whole-body gamma radiation, using a Cs137 source with low-dose ionizing radiation doses of 0.25 and 0.5 Gray (Gy); 14 days later, another irradiation session at a dose level of 5 Gy was carried on. Four days post-irradiation at 5 Gy, rats were sacrificed. The low-dose ionizing radiation-induced immuno-radiological response has been assessed through the T-cell receptor (TCR) gene expression quantification. Also, the serum levels of each of interleukins-2 and -10 (IL-2, IL-10), transforming growth factor-beta (TGF-β), and 8-hydroxy-2'-deoxyguanosine (8-OHdG) were quantified. RESULTS Results indicated that priming low irradiation doses resulted in significant decrements in TCR gene expression and the serum levels of IL-2, TGF-β, and 8-OHdG with an increment in IL-10 expression compared to the irradiated group, which did not receive low priming doses. CONCLUSION The observed low-dose ionizing radiation-induced radio-adaptive response significantly protected against high irradiation dose injuries, through immune suppression, representing a promising pre-clinical protocol that would be applied to minimize radiotherapy side effects on normal but not against the tumor cells.
Collapse
Affiliation(s)
- Soha M Hussien
- Department of Radiation Safety, Nuclear and Radiological Safety Research Center, Egyptian Atomic Energy Authority, Cairo, Egypt
| | - Engy R Rashed
- Department of Drug Radiation Research, National Center for Radiation Research and Technology, Egyptian Atomic Energy Authority, Cairo, Egypt
| |
Collapse
|
11
|
Antony F, Chalissery JR, Gilvaz S. Radiotherapy for successful symptom control in recurrent refractory endometriosis: A case report. J Cancer Res Ther 2023; 19:S963-S966. [PMID: 38384091 DOI: 10.4103/jcrt.jcrt_561_22] [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: 03/09/2022] [Accepted: 07/25/2022] [Indexed: 02/23/2024]
Abstract
ABSTRACT Endometriosis is a benign gynecological condition which induces a chronic inflammatory process, characterized by the presence of endometrium-like tissue outside the uterus. Treatment options for endometriosis include medical, surgical, or both. Irrespective of the treatment approach, recurrence of symptoms is not rare. We report the use of radiotherapy in a patient with recurrent refractory endometriosis, not responding to conventional treatments. At lower doses, radiotherapy can modulate the inflammatory cascade and can also does ovarian ablation. She was treated using 6MV photons with a four-field box to a total dose of 30Gy in 10 fractions. The pelvic radiotherapy field also included the ovarian remnant. Her symptoms regressed within one week of radiation treatment and is now symptom free for six months, with good quality of life.
Collapse
Affiliation(s)
- Febin Antony
- Department of Radiation Oncology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
| | | | - Sareena Gilvaz
- Department of Obstetrics and Gynaecology, Jubilee, Mission Medical College and Research Institute, Thrissur, Kerala, India
| |
Collapse
|
12
|
Radiation as a Tool against Neurodegeneration-A Potential Treatment for Amyloidosis in the Central Nervous System. Int J Mol Sci 2022; 23:ijms232012265. [PMID: 36293118 PMCID: PMC9603404 DOI: 10.3390/ijms232012265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/07/2022] [Accepted: 10/12/2022] [Indexed: 11/20/2022] Open
Abstract
Radiotherapy (RT) is a relatively safe and established treatment for cancer, where the goal is to kill tumoral cells with the lowest toxicity to healthy tissues. Using it for disorders involving cell loss is counterintuitive. However, ionizing radiation has a hormetic nature: it can have deleterious or beneficial effects depending on how it is applied. Current evidence indicates that radiation could be a promising treatment for neurodegenerative disorders involving protein misfolding and amyloidogenesis, such as Alzheimer's or Parkinson's diseases. Low-dose RT can trigger antioxidant, anti-inflammatory and tissue regeneration responses. RT has been used to treat peripheral amyloidosis, which is very similar to other neurodegenerative disorders from a molecular perspective. Ionizing radiation prevents amyloid formation and other hallmarks in cell cultures, animal models and pilot clinical trials. Although some hypotheses have been formulated, the mechanism of action of RT on systemic amyloid deposits is still unclear, and uncertainty remains regarding its impact in the central nervous system. However, new RT modalities such as low-dose RT, FLASH, proton therapy or nanoparticle-enhanced RT could increase biological effects while reducing toxicity. Current evidence indicates that the potential of RT to treat neurodegeneration should be further explored.
Collapse
|
13
|
Kudo S, Miwa Y, Furuta H, Saigusa S. A Risk Comparison of Non-cancer Mortality between Lifestyle, Socioeconomic Status, and Radiation among Japanese Nuclear Workers (J-EPISODE). HEALTH PHYSICS 2022; 123:00004032-990000000-00039. [PMID: 36099426 PMCID: PMC9616597 DOI: 10.1097/hp.0000000000001613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
ABSTRACT Many epidemiological studies have been conducted to investigate the health effects of low-dose radiation. Most of these investigations have focused on cancer, and fewer studies have examined non-cancer topics than cancer subjects. The purpose of this study is to compare the relative risks of non-cancer mortality from low-dose radiation with lifestyle factors (such as smoking habits) and socioeconomic status (such as years of education). The cohort consisted of 43,692 males who responded to a lifestyle questionnaire survey conducted from 2003 to 2004 among nuclear workers in Japan. Missing questionnaire data were imputed by multiple imputation, each variable was categorized, and the relative risks for the reference group were calculated using Poisson regression. The total number of observed person-years was 300,000, and the mean age and dose were 55.2 y and 24.5 mSv (10-y lagged dose), respectively. For many of the causes of death in this analysis, significantly high risks existed for lifestyle differences, such as smoking, alcohol consumption, frequency of medical examination, breakfast intake, sleep, and BMI, but few for socioeconomic status. Radiation showed no significantly high risks. Taken together, the risk of non-cancer mortality from low-dose radiation is likely smaller than that from lifestyle factors.
Collapse
Affiliation(s)
- Shin’ichi Kudo
- Institute of Radiation Epidemiology, Radiation Effects Association
| | - Yoshie Miwa
- Institute of Radiation Epidemiology, Radiation Effects Association
| | - Hiroshige Furuta
- Institute of Radiation Epidemiology, Radiation Effects Association
| | - Shin Saigusa
- Institute of Radiation Epidemiology, Radiation Effects Association
| |
Collapse
|
14
|
Saleh M, Sharma K, Shah J, Karsan F, Waweru A, Musumbi M, Shah R, Sayed S, Abayo I, Karimi N, Gondi S, Rupani S, Kirathe G, Amariati H. A pilot phase Ib/II study of whole-lung low dose radiation therapy (LDRT) for the treatment of severe COVID-19 pneumonia: First experience from Africa. PLoS One 2022; 17:e0270594. [PMID: 35776736 PMCID: PMC9249221 DOI: 10.1371/journal.pone.0270594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 06/09/2022] [Indexed: 12/15/2022] Open
Abstract
Background Low dose radiation therapy (LDRT) has been used for non-malignant conditions since early 1900s based on the ability of single fractions between 50–150 cGy to inhibit cellular proliferation. Given scarcity of resources, poor access to vaccines and medical therapies within low and middle income countries, there is an urgent need to identify other cost-effective alternatives in management of COVID-19 pneumonia. We conducted a pilot phase Ib/II investigator-initiated clinical trial to assess the safety, feasibility, and toxicity of LDRT in patients with severe COVID-19 pneumonia at the Aga Khan University Hospital in Nairobi, Kenya. Additionally, we also assessed clinical benefit in terms of improvement in oxygenation at day 3 following LDRT and the ability to avoid mechanical ventilation at day 7 post LDRT. Methods Patients with both polymerase chain reaction (PCR) and high-resolution computer tomogram (HRCT) confirmed severe COVID-19 pneumonia, not improving on conventional therapy including Dexamethasone and with increasing oxygen requirement were enrolled in the study. Patients on mechanical ventilation were excluded. Eligible patients received a single 100cGy fraction to the whole lung. In the absence of any dose limiting toxicity the study proposed to treat a total of 10 patients. The primary endpoints were to assess the safety/feasibility, and toxicity within the first 24 hours post LDRT. The secondary endpoints were to assess efficacy of LDRT at Day 3, 7, 14 and 28 post LDRT. Results Ten patients were treated with LDRT. All (100%) of patients were able to complete LDRT without treatment related SAE within the first 24 hours post treatment. None of the patients treated with LDRT experienced any acute toxicity as defined by change in clinical and respiratory status at 24hr following LDRT. Majority (90%) of patients avoided mechanical ventilation within 7 days of LDRT. Four patients (40%) demonstrated at least 25% improvement in oxygen requirements within 3 days. Six patients (60%) were discharged and remained off oxygen, whereas four progressed and died (1 due to sepsis and 3 in cytokine storm). Median time to discharge (n = 6) was 16.5 days and median time to death (n = 4) was 11.0 days. Patients who ultimately died showed elevated inflammatory markers including Ferritin, CRP and D-dimers as compared to those who were discharged alive. Conclusion LDRT was feasible, safe and shows promise in the management of severe COVID-19 pneumonia including in patients progressing on conventional systemic treatment. Additional phase II trials are warranted to identify patients most likely to benefit from LDRT.
Collapse
Affiliation(s)
- Mansoor Saleh
- Clinical Research Unit, Aga Khan University Hospital, Nairobi, Kenya
- Department of Haematology and Oncology, Aga Khan University Hospital, Nairobi, Kenya
- * E-mail:
| | - Karishma Sharma
- Clinical Research Unit, Aga Khan University Hospital, Nairobi, Kenya
| | - Jasmit Shah
- Clinical Research Unit, Aga Khan University Hospital, Nairobi, Kenya
- Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya
| | - Farrok Karsan
- Department of Haematology and Oncology, Aga Khan University Hospital, Nairobi, Kenya
| | - Angela Waweru
- Department of Haematology and Oncology, Aga Khan University Hospital, Nairobi, Kenya
| | - Martin Musumbi
- Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya
| | - Reena Shah
- Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya
| | - Shahin Sayed
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - Innocent Abayo
- Clinical Research Unit, Aga Khan University Hospital, Nairobi, Kenya
| | - Noureen Karimi
- Clinical Research Unit, Aga Khan University Hospital, Nairobi, Kenya
| | - Stacey Gondi
- Clinical Research Unit, Aga Khan University Hospital, Nairobi, Kenya
| | - Sehrish Rupani
- Clinical Research Unit, Aga Khan University Hospital, Nairobi, Kenya
| | - Grace Kirathe
- Clinical Research Unit, Aga Khan University Hospital, Nairobi, Kenya
| | - Heldah Amariati
- Clinical Research Unit, Aga Khan University Hospital, Nairobi, Kenya
| |
Collapse
|
15
|
Chhablani J, Jager R, Ong J, Lohrenz R, Hamilton RJ, Stea B, Drew M, Kokame G. Two-year outcomes of episcleral brachytherapy adjunct to anti-VEGF therapy for treatment-resistant nAMD. Graefes Arch Clin Exp Ophthalmol 2022; 260:3791-3798. [PMID: 35713709 DOI: 10.1007/s00417-022-05736-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE This study was designed to demonstrate the safety and feasibility of episcleral brachytherapy (ESB) for the treatment of anti-vascular endothelial growth factor (anti-VEGF) resistant neovascular age-related macular degeneration (nAMD) in a 6-subject cohort adjunct to anti-VEGF therapy. METHODS Six eyes of six subjects with anti-VEGF resistant nAMD (persistent fluid or hemorrhage despite frequent anti-VEGF treatment) were treated with ESB between May 2018 and July 2018 as part of a larger early feasibility trial. Baseline and follow-up exams with multi-modal imaging were conducted. RESULTS In this analysis, six eyes were included. The mean age was 74.7 years; 33% were female; 67% had polypoidal choroidal vasculopathy. The mean number of lifetime anti-VEGF injections received prior to the study enrollment was 33.9 injections and 10 injections in the year prior to the study enrollment. In the first and second years following ESB, the mean number of injections was 8.5 and 8, respectively. No evidence of radiation-induced toxicity through 2 years following ESB was observed. The mean baseline VA was 55.3 letters. At 1 year, the mean VA increased by 3.2 letters and 1.7 letters at year 2. At 2 years, the mean change in vascular complex on ICGA was - 18%, - 43% on OCTA, and - 5% on FA. The subjects also experienced a mean decrease in CRT on OCT of 21% after 2 years. CONCLUSIONS The results from this six-subject cohort with 2-year data support additional investigations of ESB for nAMD, specifically those with persistent disease activity and treatment resistant nAMD.
Collapse
Affiliation(s)
- Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Rama Jager
- University Retina and Macula Associates, Oak Forest, IL, USA
- University of Illinois, Chicago, IL, USA
| | - Joshua Ong
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Russell J Hamilton
- Department of Radiation Oncology, University of Arizona, Tucson, AZ, USA
| | - Baldassare Stea
- Department of Radiation Oncology, University of Arizona, Tucson, AZ, USA
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | | | - Gregg Kokame
- Division of Ophthalmology, Department of Surgery, University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA
| |
Collapse
|
16
|
Yao J, Zhang J, Wang J, Lai Q, Yuan W, Liu Z, Cheng S, Feng Y, Jiang Z, Shi Y, Jiang S, Tu W. Transcriptome Profiling Unveils a Critical Role of IL-17 Signaling-Mediated Inflammation in Radiation-Induced Esophageal Injury in Rats. Dose Response 2022; 20:15593258221104609. [PMID: 35677348 PMCID: PMC9168911 DOI: 10.1177/15593258221104609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/29/2022] [Accepted: 05/13/2022] [Indexed: 02/05/2023] Open
Abstract
Elucidation of the molecular mechanisms involving the initiation and progression
of radiation-induced esophageal injury (RIEI) is important for prevention and
treatment. Despite ongoing advances, the underlying mechanisms controlling RIEI
remain largely unknown. In the present study, RNA-seq was performed to
characterize mRNA profiles of the irradiated rat esophagus exposed to 0, 25, or
35 Gy irradiation. Bioinformatics analyses including dose-dependent
differentially expressed genes (DEGs), Gene Ontology (GO), Kyoto Encyclopedia of
Gene and Genome (KEGG) pathway, protein-protein interaction (PPI) network, and
immune infiltration were performed. 134 DEGs were screened out with a
dose-dependent manner (35 Gy > 25 Gy > control, or 35 Gy < 25 Gy <
control). GO and KEGG analyses showed that the most significant mechanism was
IL-17 signaling-mediated inflammatory response. 5 hub genes, Ccl11, Cxcl3,
Il17a, S100a8, and S100a9, were identified through the intersection of the DEGs
involved in inflammatory response, IL-17 pathway, and PPI network. Additionally,
immune infiltration analysis showed the activation of macrophages, monocytes, T
cells, NKT cells, and neutrophils, among which macrophages, monocytes, and
neutrophils might be the main sources of S100a8 and S100a9. Thus, these findings
further our understanding on the molecular biology of RIEI and may help develop
more effective therapeutic strategies.
Collapse
Affiliation(s)
- Jia Yao
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jinkang Zhang
- Department of Nuclear Medicine, the Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
| | - Jinlong Wang
- Department of Nuclear Medicine, the Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
| | - Qian Lai
- Department of Nuclear Medicine, the Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
| | - Weijun Yuan
- Department of Nuclear Medicine, the Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
| | - Zhongyu Liu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Shuanghua Cheng
- School of Bioscience and Technology, Chengdu Medical College, Chengdu, China
| | - Yahui Feng
- School of Bioscience and Technology, Chengdu Medical College, Chengdu, China
| | - Zhiqiang Jiang
- School of Bioscience and Technology, Chengdu Medical College, Chengdu, China
| | - Yuhong Shi
- School of Bioscience and Technology, Chengdu Medical College, Chengdu, China
| | - Sheng Jiang
- School of Bioscience and Technology, Chengdu Medical College, Chengdu, China
| | - Wenling Tu
- Department of Nuclear Medicine, the Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
- School of Bioscience and Technology, Chengdu Medical College, Chengdu, China
| |
Collapse
|
17
|
Eckert D, Rapp F, Tsedeke AT, Kraft D, Wente I, Molendowska J, Basheer S, Langhans M, Meckel T, Friedrich T, Donaubauer AJ, Becker I, Frey B, Fournier C. Modulation of Differentiation and Bone Resorbing Activity of Human (Pre-) Osteoclasts After X-Ray Exposure. Front Immunol 2022; 13:817281. [PMID: 35603191 PMCID: PMC9116137 DOI: 10.3389/fimmu.2022.817281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
Low-dose radiotherapy (LD-RT) is a local treatment option for patients with chronic degenerative and inflammatory diseases, in particular musculoskeletal diseases. Despite reported analgesic and anti-inflammatory effects, cellular and molecular mechanisms related to osteoimmunological effects are still elusive. Here we test the hypothesis that X-irradiation inhibits the differentiation of precursor osteoclasts into mature osteoclasts (mOC) and their bone resorbing activity. Circulating monocytes from healthy donors were isolated and irradiated after attachment with single or fractionated X-ray doses, comparable to an LD-RT treatment scheme. Then monocytes underwent ex vivo differentiation into OC during cultivation up to 21 days, under conditions mimicking the physiological microenvironment of OC on bone. After irradiation, apoptotic frequencies were low, but the total number of OC precursors and mOC decreased up to the end of the cultivation period. On top, we observed an impairment of terminal differentiation, i.e. a smaller fraction of mOC, reduced resorbing activity on bone, and release of collagen fragments. We further analyzed the effect of X-irradiation on multinucleation, resulting from the fusion of precursor OC, which occurs late during OC differentiation. At 21 days after exposure, the observation of smaller cellular areas and a reduced number of nuclei per mOC suggest an impaired fusion of OC precursors to form mOC. Before, at 14 days, the nuclear translocation of Nuclear Factor Of Activated T Cells 1 (NFATc1), a master regulator of osteoclast differentiation and fusion, was decreased. In first results, obtained in the frame of a longitudinal LD-RT study, we previously reported a pain-relieving effect in patients. However, in a subgroup of patients suffering from Calcaneodynia or Achillodynia, we did not observe a consistent decrease of established blood markers for resorption and formation of bone, or modified T cell subtypes involved in regulating these processes. To assess the relevance of changes in bone metabolism for other diseases treated with LD-RT will be subject of further studies. Taken together, we observed that in vitro X-irradiation of monocytes results in an inhibition of the differentiation into bone-resorbing OC and a concomitant reduction of resorbing activity. The detected reduced NFATc1 signaling could be one underlying mechanism.
Collapse
Affiliation(s)
- Denise Eckert
- Department of Biophysics, Gesellschaft für Schwerionenforschung (GSI) Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Felicitas Rapp
- Department of Biophysics, Gesellschaft für Schwerionenforschung (GSI) Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Ayele Taddese Tsedeke
- Department of Biophysics, Gesellschaft für Schwerionenforschung (GSI) Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Daniela Kraft
- Department of Biophysics, Gesellschaft für Schwerionenforschung (GSI) Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Isabell Wente
- Department of Biophysics, Gesellschaft für Schwerionenforschung (GSI) Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Jessica Molendowska
- Department of Biophysics, Gesellschaft für Schwerionenforschung (GSI) Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Sidra Basheer
- Department of Biophysics, Gesellschaft für Schwerionenforschung (GSI) Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Markus Langhans
- Department of Macromolecular and Paper Chemistry and Membrane Dynamics, Technical University Darmstadt, Darmstadt, Germany
| | - Tobias Meckel
- Department of Macromolecular and Paper Chemistry and Membrane Dynamics, Technical University Darmstadt, Darmstadt, Germany
| | - Thomas Friedrich
- Department of Biophysics, Gesellschaft für Schwerionenforschung (GSI) Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Anna-Jasmina Donaubauer
- Translational Radiobiology, Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Ina Becker
- Translational Radiobiology, Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Benjamin Frey
- Translational Radiobiology, Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Claudia Fournier
- Department of Biophysics, Gesellschaft für Schwerionenforschung (GSI) Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| |
Collapse
|
18
|
Wen K, Bai C, Zhao H, Zhou P, Gao S, Guan H, Song M. Low dose radiation therapy attenuates ACE2 depression and inflammatory cytokines induction by COVID-19 viral spike protein in human bronchial epithelial cells. Int J Radiat Biol 2022; 98:1532-1541. [PMID: 35319335 DOI: 10.1080/09553002.2022.2055806] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Purpose: Low-dose radiation therapy (LDRT) is an evidence-based anti-inflammatory treatment. In anti-COVID-19, our study suggests that low to moderate dose radiation of < 1.5 Gy can inhibit the induction of inflammatory cytokine and attenuate the ACE2 depression induced by spike protein in human bronchial epithelial cells in COVID-19 infection. Our study provided further mechanistic evidence to support LDRT as a cost-effective treatment for COVID-19 to relieve the severe inflammatory reaction and lung injury. Methods and materials: A cellular model was created by treating human bronchial epithelial cells (BEP2D) with SARS-CoV-2 spike protein. We used the qRT-PCR and ELISA analysis to identify the production of inflammatory cytokines. The BEP2D control cells and the spike-treated cells were irradiated using a single low to moderate dose radiation of 0.5 Gy, 1 Gy, and 1.5 Gy. The inflammatory cytokines and ACE2 expression were detected at different time points. Results: The soluble SARS-CoV-2 spike protein stimulated the formation of inflammatory cytokines IL-6 and TNF-α while reducing the ACE2 protein expression in human bronchial epithelial cells. A single low to moderate dose exposure of 0.5 Gy, 1 Gy, and 1.5 Gy could attenuate the IL-6 and TNF-α induction and rescue the depression of ACE2 by spike protein. Moreover, the spike protein increased the proteolytic degradation of ACE2 protein by promoting NEDD4-mediated ubiquitination of ACE2. Conclusions: The low-dose radiation can attenuate ACE2 depression and inflammatory response produced in the targeted human bronchial epithelial cells by spike protein. This coordinating effect of LDRT may relieve the severe inflammatory reaction and lung injury in COVID-19 patients.
Collapse
Affiliation(s)
- Ke Wen
- Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Beijing, China
| | - Chenjun Bai
- Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Beijing, China
| | - Hongling Zhao
- Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Beijing, China
| | - Pingkun Zhou
- Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Beijing, China
| | - Shanshan Gao
- Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Beijing, China
| | - Hua Guan
- Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Beijing, China
| | - Man Song
- Beijing Key Laboratory for Radiobiology, Beijing Institute of Radiation Medicine, Beijing, China
| |
Collapse
|
19
|
Dove AP, Cmelak A, Darrow K, McComas KN, Chowdhary M, Beckta J, Kirschner AN. The Use of Low-Dose Radiotherapy in Osteoarthritis: A Review. Int J Radiat Oncol Biol Phys 2022; 114:203-220. [DOI: 10.1016/j.ijrobp.2022.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/08/2022] [Accepted: 04/21/2022] [Indexed: 11/26/2022]
|
20
|
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
|
21
|
Jackson MR, Stevenson K, Chahal SK, Curley E, Finney GE, Gutierrez-Quintana R, Onwubiko E, Rupp A, Strathdee K, Williams K, MacLeod MKL, McSharry C, Chalmers AJ. Low-Dose Lung Radiation Therapy for COVID-19 Lung Disease: A Preclinical Efficacy Study in a Bleomycin Model of Pneumonitis. Int J Radiat Oncol Biol Phys 2022; 112:197-211. [PMID: 34478832 PMCID: PMC8406661 DOI: 10.1016/j.ijrobp.2021.08.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/05/2021] [Accepted: 08/24/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE Low-dose whole lung radiation therapy (LDLR) has been proposed as a treatment for patients with acute respiratory distress syndrome associated with SARS-CoV-2 infection, and clinical trials are underway. There is an urgent need for preclinical evidence to justify this approach and inform dose, scheduling, and mechanisms of action. METHODS AND MATERIALS Female C57BL/6 mice were treated with intranasal bleomycin sulfate (7.5 or 11.25 units/kg, day 0) and then exposed to whole lung radiation therapy (0.5, 1.0, or 1.5 Gy, or sham; day 3). Bodyweight was measured daily, and lung tissue was harvested for histology and flow cytometry on day 10. Computed tomography lung imaging was performed before radiation (day 3) and pre-endpoint (day 10). RESULTS Bleomycin caused pneumonitis of variable severity, which correlated with weight loss. LDLR at 1.0 Gy was associated with a significant increase in the proportion of mice recovering to 98% of initial bodyweight, and a proportion of these mice exhibited less severe histopathologic lung changes. Mice experiencing moderate initial weight loss were more likely to respond to LDLR than those experiencing severe initial weight loss. In addition, LDLR (1.0 Gy) significantly reduced bleomycin-induced increases in interstitial macrophages, CD103+ dendritic cells (DCs), and neutrophil-DC hybrids. Overall, bleomycin-treated mice exhibited significantly higher percentages of nonaerated lung in left than right lungs, and LDLR (1.0 Gy) limited further reductions in aerated lung volume in right but not left lungs. LDLR at 0.5 and 1.5 Gy did not improve bodyweight, flow cytometric, or radiologic readouts of bleomycin-induced pneumonitis. CONCLUSIONS Our data support the concept that LDLR can ameliorate acute inflammatory lung injury, identify 1.0 Gy as the most effective dose, and provide evidence that it is more effective in the context of moderate than severe pneumonitis. Mechanistically, LDLR at 1.0 Gy significantly suppressed bleomycin-induced accumulation of pulmonary interstitial macrophages, CD103+ DCs, and neutrophil-DC hybrids.
Collapse
Affiliation(s)
- Mark R Jackson
- Institute of Cancer Sciences, University of Glasgow, United Kingdom
| | | | - Sandeep K Chahal
- Institute of Cancer Sciences, University of Glasgow, United Kingdom
| | - Emer Curley
- Cancer Research UK Beatson Institute, Glasgow, United Kingdom
| | - George E Finney
- Institute of Infection, Immunity and Inflammation, University of Glasgow, United Kingdom
| | - Rodrigo Gutierrez-Quintana
- Institute of Cancer Sciences, University of Glasgow, United Kingdom; School of Veterinary Medicine, University of Glasgow, United Kingdom
| | | | - Angie Rupp
- School of Veterinary Medicine, University of Glasgow, United Kingdom
| | - Karen Strathdee
- Institute of Cancer Sciences, University of Glasgow, United Kingdom
| | - Karin Williams
- Institute of Cancer Sciences, University of Glasgow, United Kingdom
| | - Megan K L MacLeod
- Institute of Infection, Immunity and Inflammation, University of Glasgow, United Kingdom
| | - Charles McSharry
- Institute of Infection, Immunity and Inflammation, University of Glasgow, United Kingdom
| | | |
Collapse
|
22
|
Ortiz CS, Hernández D, Trujillo C, Calderón D, Esqueda P, Calva F, Betancourt A, Ramírez M, Cervantes G, Souto MA, Celis JG, Nolazco LR, Olmos A. The clinical efficacy of low-dose whole-lung irradiation in moderate-to-severe COVID-19 pneumonia: RTMX-20 trial. Radiother Oncol 2022; 166:133-136. [PMID: 34838890 PMCID: PMC8613980 DOI: 10.1016/j.radonc.2021.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/26/2021] [Accepted: 11/16/2021] [Indexed: 11/02/2022]
Abstract
This is a paired prospective comparative cohort study with 58 patients, in order to analyze the clinical LD-WLI in patients with moderate or severe COVID19 pneumonia. The results of this study show that the Radiotherapy could be an option to improve the clinical response for patients with COVID-19.
Collapse
Affiliation(s)
- Cindy S Ortiz
- Radiation Oncology Department, UMAE 1, Speciality Hospital, Bajio National Medical Center, Instituto Mexicano del Seguro Social, Mexico
| | - Diana Hernández
- Internal Medicine Department, UMAE 1, Speciality Hospital, Bajio NationalMedical Center, Instituto Mexicano del Seguro Social, Mexico
| | - Cesar Trujillo
- Internal Medicine Department, UMAE 1, Speciality Hospital, Bajio NationalMedical Center, Instituto Mexicano del Seguro Social, Mexico
| | - David Calderón
- Radiation Oncology Department, UMAE 1, Speciality Hospital, Bajio National Medical Center, Instituto Mexicano del Seguro Social, Mexico
| | - Placido Esqueda
- Radiation Oncology Department, UMAE 1, Speciality Hospital, Bajio National Medical Center, Instituto Mexicano del Seguro Social, Mexico
| | - Flavio Calva
- Medical Physics Department, UMAE 1, Speciality Hospital, Bajio National Medical Center, Instituto Mexicano del Seguro Social, Mexico
| | - Arcadio Betancourt
- Medical Physics Department, UMAE 1, Speciality Hospital, Bajio National Medical Center, Instituto Mexicano del Seguro Social, Mexico
| | - Miriam Ramírez
- Radiation Oncology Department, UMAE 1, Speciality Hospital, Bajio National Medical Center, Instituto Mexicano del Seguro Social, Mexico
| | - Graciela Cervantes
- Radiation Oncology Department, UMAE 1, Speciality Hospital, Bajio National Medical Center, Instituto Mexicano del Seguro Social, Mexico
| | - Miguel A Souto
- Radiation Oncology Department, UMAE 25, Speciality Hospital, Instituto Mexicano del Seguro Social, Mexico
| | - Juan G Celis
- Direction, UMAE 1, Speciality Hospital, Bajio National Medical Center, Instituto Mexicano del Seguro Social, Mexico
| | - Luis R Nolazco
- Direction, UMAE 1, Speciality Hospital, Bajio National Medical Center, Instituto Mexicano del Seguro Social, Mexico
| | - Alejandro Olmos
- Radiation Oncology Department, UMAE 1, Speciality Hospital, Bajio National Medical Center, Instituto Mexicano del Seguro Social, Mexico.
| |
Collapse
|
23
|
Liu Y, Zhou X, Liu X, Jiang X. The immunology and immunotherapy for COVID-19. Expert Rev Mol Med 2021; 23:e24. [PMID: 34915958 PMCID: PMC8723987 DOI: 10.1017/erm.2021.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/26/2021] [Accepted: 12/13/2021] [Indexed: 12/15/2022]
Abstract
The ongoing global pandemic of coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and significantly impacts the world economy and daily life. Symptoms of COVID-19 range from asymptomatic to fever, dyspnoea, acute respiratory distress and multiple organ failure. Critical cases often occur in the elderly and patients with pre-existing conditions. By binding to the angiotensin-converting enzyme 2 receptor, SARS-CoV-2 can enter and replicate in the host cell, exerting a cytotoxic effect and causing local and systemic inflammation. Currently, there is no specific treatment for COVID-19, and immunotherapy has consistently attracted attention because of its essential role in boosting host immunity to the virus and reducing overwhelming inflammation. In this review, we summarise the immunopathogenic features of COVID-19 and highlight recent advances in immunotherapy to illuminate ideas for the development of new potential therapies.
Collapse
Affiliation(s)
- Yixin Liu
- Department of Immunology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Xinsheng Zhou
- Department of Immunology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xuan Liu
- Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaotao Jiang
- Department of Immunology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| |
Collapse
|
24
|
Mousavi Darzikolaee N, Kolahdouzan K, Abtahi H, Kazemizadeh H, Salehi M, Ghalehtaki R, Bayani R, Pestehei SK, Ghazanfari T, Ebrahiminasab F, Salarvand S, Haddad P, Kazemian A, Aghili M. Low-dose whole-lung irradiation in severe COVID-19 pneumonia: a controlled clinical trial. J Med Radiat Sci 2021; 68:396-406. [PMID: 34416084 PMCID: PMC8427095 DOI: 10.1002/jmrs.542] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/29/2021] [Accepted: 08/07/2021] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has caused significant morbidity and mortality thus far. Considering the historical uses of high-voltage X-ray beams for unresolvable pneumonia, we aimed to assess whether low-dose whole-lung irradiation (WLI) could provide any benefits for patients with refractory COVID-19 pneumonia. METHODS Eleven patients with refractory COVID-19 pneumonia were treated with WLI to a total dose of 1 Gy and compared to 11 patients in a matched control group from June to November 2020. The study's primary endpoint was improvement of chest X-ray severity score (CXRS), followed by changes in mean oxygen (O2) saturation and 28-day mortality as secondary endpoints. RESULTS The final CXRS was significantly lower in the WLI group (8.7 ± 2.5) compared to the control group (12.3 ± 3.3) (P: 0.016). Change of CXRS from the first to the last chest X-ray was -2.2 ± 3.1 for the WLI group and 0.7 ± 3.9 for the control group, which showed a trend for lower CXRS in the WLI group (U = 30, p: 0.085). Mean O2 saturation showed insignificant improvement in the first 24 hours after radiotherapy (mean difference: 2.5 ± 4.1, Z=-1.6, P value: 0.11). Overall survival after 28 days was 32% in the WLI group and 11% in the control group (P: 0.48). The reason for death in many patients was not merely respiratory failure, but also other adverse situations like pneumothorax, cardiogenic shock and pulmonary thromboembolism. CONCLUSIONS Low-dose WLI could improve the CXR severity score and O2 saturation in severely ill COVID-19 patients, but larger studies are required to determine its impact on mortality.
Collapse
Affiliation(s)
- Nima Mousavi Darzikolaee
- Radiation Oncology Department, Cancer InstituteImam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
- Radiation Oncology Research CenterCancer InstituteTehran University of Medical SciencesTehranIran
| | - Kasra Kolahdouzan
- Radiation Oncology Department, Cancer InstituteImam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
- Radiation Oncology Research CenterCancer InstituteTehran University of Medical SciencesTehranIran
| | - Hamidreza Abtahi
- Thoracic Research CenterImam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Hossein Kazemizadeh
- Thoracic Research CenterImam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
- Department of PulmonologyImam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Mohammadreza Salehi
- Department of Infectious Diseases and Tropical MedicinesImam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Reza Ghalehtaki
- Radiation Oncology Department, Cancer InstituteImam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
- Radiation Oncology Research CenterCancer InstituteTehran University of Medical SciencesTehranIran
| | - Reyhaneh Bayani
- Radiation Oncology Department, Cancer InstituteImam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
- Radiation Oncology Research CenterCancer InstituteTehran University of Medical SciencesTehranIran
| | | | | | - Fatemeh Ebrahiminasab
- Radiation Oncology Department, Cancer InstituteImam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Samaneh Salarvand
- Department of Clinical and Anatomical PathologyCancer InstituteTehran University of Medical SciencesTehranIran
| | - Peiman Haddad
- Radiation Oncology Research CenterCancer InstituteTehran University of Medical SciencesTehranIran
| | - Ali Kazemian
- Radiation Oncology Department, Cancer InstituteImam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
- Radiation Oncology Research CenterCancer InstituteTehran University of Medical SciencesTehranIran
| | - Mahdi Aghili
- Radiation Oncology Department, Cancer InstituteImam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
- Radiation Oncology Research CenterCancer InstituteTehran University of Medical SciencesTehranIran
| |
Collapse
|
25
|
Analgesic effects of low-dose radiotherapy in greater trochanteric pain syndrome: results in a clinical series of 155 patients with recurrent or refractory symptoms. Clin Transl Oncol 2021; 24:846-853. [PMID: 34807401 DOI: 10.1007/s12094-021-02730-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 10/30/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE This prospective study assessed the effects of low-dose radiotherapy in patients diagnosed with greater trochanteric pain syndrome (GTPS) with recurrent symptoms or refractory to previous conservative measures. METHODS We evaluated a total of 155 patients (90.3% women, mean age 69 years). Most patients (n = 136) received 10 Gy (1 Gy/day/3 fractions per week on alternate days), but after recommendations of DEGRO guidelines published in 2015, the remaining 19 patients (12.2%) received 6 Gy (1 Gy/day/3 fractions per week on alternate days). RESULTS At the pre-treatment visit, the mean (standard deviation, SD) visual analog scale (VAS) score was 8), which decreased to 5 (SD 2.2) after 1 month of the end of treatment and to 4 (SD 2.3) after 4 months. An objective symptom response with increased mobility, better sleep quality, and reduction of analgesic medication was found in 56% of patients at 1 month. In 129 patients (83.2%), there was a decrease of at least 1 point in the VAS score, and in 49 patients (29.0%), the VAS score was lower than 3. The mean length of follow-up was 45 months. The probability of maintaining the analgesic response estimated by the Kaplan-Meier method was 53% at 5 years. CONCLUSION Low dose radiotherapy effectively improved pain in the trochanteric area in most patients with recurrent or refractory GTPS, allowing a reduction in the need for analgesic medications and, more, importantly, better functioning and mobility. Further randomized studies in selected populations of GTPS are needed to define the treatment position of low-dose radiotherapy in this clinical setting.
Collapse
|
26
|
Yamazaki T, Young KH. Effects of radiation on tumor vasculature. Mol Carcinog 2021; 61:165-172. [PMID: 34644811 DOI: 10.1002/mc.23360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/08/2022]
Abstract
Radiation has been utilized as a direct cytotoxic tumorcidal modality, however, the effect of radiation on tumor vasculature influences response to anticancer therapies. Although numerous reports have demonstrated vascular changes in irradiated tumors, the findings and implications are extensive and at times contradictory depending on the radiation dose, timing, and models used. In this review, we focus on the radiation-mediated effects on tumor vasculature with respect to doses used, timing postradiation, vasculogenesis, adhesion molecule expression, permeability, and pericyte coverage, including the latest findings.
Collapse
Affiliation(s)
- Tomoko Yamazaki
- Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, Oregon, USA
| | - Kristina H Young
- Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, Oregon, USA.,Radiation Oncology Division, The Oregon Clinic, Portland, Oregon, USA
| |
Collapse
|
27
|
Sharma DN, Guleria R, Wig N, Mohan A, Rath G, Subramani V, Bhatnagar S, Mallick S, Sharma A, Patil P, Madan K, Soneja M, Thulkar S, Singh A, Singh S. Low-dose radiation therapy for COVID-19 pneumonia: a pilot study. Br J Radiol 2021; 94:20210187. [PMID: 34545760 PMCID: PMC9328067 DOI: 10.1259/bjr.20210187] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objectives: The World Health Organization (WHO) has declared coronavirus disease 2019 (COVID-19) as pandemic in March 2020. Currently there is no specific effective treatment for COVID-19. The major cause of death in COVID-19 is severe pneumonia leading to respiratory failure. Radiation in low doses (<100 cGy) has been known for its anti-inflammatory effect and therefore, low dose radiation therapy (LDRT) to lungs can potentially mitigate the severity of pneumonia and reduce mortality. We conducted a pilot trial to study the feasibility and clinical efficacy of LDRT to lungs in the management of patients with COVID-19. Methods: From June to Aug 2020, we enrolled 10 patients with COVID-19 having moderate to severe risk disease [National Early Warning Score (NEWS) of ≥5]. Patients were treated as per the standard COVID-19 management guidelines along with LDRT to both lungs with a dose of 70cGy in single fraction. Response assessment was done based on the clinical parameters using the NEWS. Results: All patients completed the prescribed treatment. Nine patients had complete clinical recovery mostly within a period ranging from 3 to 7 days. One patient, who was a known hypertensive, showed clinical deterioration and died 24 days after LDRT. No patients showed the signs of acute radiation toxicity. Conclusion: The results of our pilot study suggest that LDRT is feasible in COVID-19 patients having moderate to severe disease. Its clinical efficacy may be tested by conducting randomized controlled trials. Advances in knowledge: LDRT has shown promising results in COVID-19 pneumonia and should be researched further through randomized controlled trials.
Collapse
Affiliation(s)
- Daya Nand Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Goura Rath
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Vellaiyan Subramani
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Supriya Mallick
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Aman Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Pritee Patil
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Angel Singh
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Sheetal Singh
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
28
|
Álvarez B, Montero A, Alonso R, Valero J, López M, Ciérvide R, Sánchez E, Hernando O, García-Aranda M, Martí J, Prado A, Chen-Zhao X, Rubio C. Low-dose radiation therapy for hand osteoarthritis: shaking hands again? Clin Transl Oncol 2021; 24:532-539. [PMID: 34585316 DOI: 10.1007/s12094-021-02710-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hand osteoarthritis (HOA) is one of the most common causes of pain and functional disability in western countries and there is still no definitive cure. Low-dose radiation therapy (LDRT) has anti-inflammatory properties that have shown to be effective in the symptomatic relief of various degenerative musculoskeletal disorders. We designed a clinical protocol using LDRT for symptomatic HOA and present results and tolerance in the first 100 patients included. MATERIALS AND METHODS Between April 2015 and March 2021, 100 patients with a median age of 60 were treated. Fifty-seven patients suffering from proximal/distal interphalangeal joint pain, 40 patients with thumb arthritis, 2 patients with radiocarpal joint affection and 1 patient with metacarpophalangeal joint pain were enrolled. LDRT comprised of 6 fractions of 0.5-1 Gy on every other day up to a total dose of 3-6 Gy. Clinical response was evaluated according to the visual analog scale (VAS) for pain level and the von Pannewitz score (VPS) for joint functionality. Any patients not achieving subjective adequate pain relief after 8 weeks of treatment were offered a second identical LDRT course. RESULTS With a median follow-up of 10.5 months (range 7.55-12.45), 94% reported an improvement in the pain, with a significant reduction in the VAS level after 3, 6 and 12 months (p < 0.001). Sixty-three patients needed a second course of treatment at a median time interval of 12 weeks (range 9-14). The mean VAS score before treatment was 8 (range 3-10). After treatment, it was 5 (range 1-10). After 3, 6 and 12 months, the mean VAS scores were 4 (range 0-9), 3 (range 0-9) and 3.5 (range 0-9), respectively. Seventy patients reported functionality improvements after LDRT according to the von Pannewitz score. No acute or late complications were observed. CONCLUSION LDRT appears to be safe and useful for HOA and is associated with good rates of pain relief and functionality improvements. However, further studies are necessary to confirm these promising results.
Collapse
Affiliation(s)
- B Álvarez
- Department of Radiation Oncology, HM Hospitales, Calle Oña 10, 28050, Madrid, Spain
| | - A Montero
- Department of Radiation Oncology, HM Hospitales, Calle Oña 10, 28050, Madrid, Spain.
| | - R Alonso
- Department of Radiation Oncology, HM Hospitales, Calle Oña 10, 28050, Madrid, Spain
| | - J Valero
- Department of Radiation Oncology, HM Hospitales, Calle Oña 10, 28050, Madrid, Spain
| | - M López
- Department of Radiation Oncology, HM Hospitales, Calle Oña 10, 28050, Madrid, Spain
| | - R Ciérvide
- Department of Radiation Oncology, HM Hospitales, Calle Oña 10, 28050, Madrid, Spain
| | - E Sánchez
- Department of Radiation Oncology, HM Hospitales, Calle Oña 10, 28050, Madrid, Spain
| | - O Hernando
- Department of Radiation Oncology, HM Hospitales, Calle Oña 10, 28050, Madrid, Spain
| | - M García-Aranda
- Department of Radiation Oncology, HM Hospitales, Calle Oña 10, 28050, Madrid, Spain
| | - J Martí
- Department of Medical Physics, HM Hospitales, Madrid, Spain
| | - A Prado
- Department of Medical Physics, HM Hospitales, Madrid, Spain
| | - X Chen-Zhao
- Department of Radiation Oncology, HM Hospitales, Calle Oña 10, 28050, Madrid, Spain
| | - C Rubio
- Department of Radiation Oncology, HM Hospitales, Calle Oña 10, 28050, Madrid, Spain
| |
Collapse
|
29
|
Anand AK, Singh P, Kumar A, Bansal AK, Singh HM, Sharma T. Near complete resolution of COVID-19 pneumonia lesions in a patient of carcinoma lung treated with volumetric modulated arc therapy. BJR Case Rep 2021; 7:20210047. [PMID: 35136625 PMCID: PMC8803237 DOI: 10.1259/bjrcr.20210047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/28/2021] [Accepted: 07/15/2021] [Indexed: 11/21/2022] Open
Abstract
A 49-year-old male presented with non-small cell lung cancer in right upper lobe lung with solitary brain metastasis. He developed COVID-19 infection and received domiciliary treatment for 3 weeks. Three weeks after testing negative for RT-PCR test, he received stereotactic radiosurgery (SRS) to brain metastasis. He then presented in emergency with pain in the epigastrium and was detected with amoebic liver abscess. Subsequently, he developed recurrent hemoptysis for which he was planned for palliative radiation to right lung mass. Planning CT scan showed COVID-19 pneumonia lesions involving bilateral lungs in addition to right upper lobe tumour. Palliative radiation 8 Gy/1 fraction was delivered to lung tumour with VMAT technique. He showed near total resolution of COVID-19 lesions with low-dose scatter radiation and relief of haemoptysis.
Collapse
Affiliation(s)
- Anil Kumar Anand
- Department of Radiation Oncology, Max Institute of Cancer Care, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Priyanka Singh
- Department of Radiation Oncology, Max Institute of Cancer Care, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Amit Kumar
- Department of Imaging, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Anil Kumar Bansal
- Division of Medical Physics, Department of Radiation Oncology, Max Institute of Cancer Care, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Heigrujam Malhotra Singh
- Division of Medical Physics, Department of Radiation Oncology, Max Institute of Cancer Care, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Tarun Sharma
- Department of Pulmonology, Max Super Speciality Hospital, Saket, New Delhi, India
| |
Collapse
|
30
|
Abstract
The ongoing COVID-19 pandemic is of great concern for the whole world, and finding an effective treatment for the disease caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is, therefore, a global race. In particular, treatment options for elderly patients and patients with genetic risk factors with COVID-19-associated pneumonia are limited, and many patients die. Low-dose radiotherapy (LDRT) of lungs was used to treat pneumonia many decades ago. Since the first report on the potential efficacy of LDRT for COVID-19-associated pneumonia was published on 1 April, 2020, tens of papers have addressed the importance of this treatment. Moreover, the findings of less than 10 clinical trials conducted to date are now available. We performed a detailed search of PubMed/MEDLINE, Web of Science, Google Scholar, and Scopus and selected the nine most relevant articles. A review of these articles was conducted. The available data indicate that in oxygen-dependent elderly patients with COVID-19-associated pneumonia, whole-lung radiation at doses of 0.5–1.5 Gy can lead to accelerated recovery and progress in clinical status, encephalopathy, and radiographic consolidation without any detectable acute toxicity. Although data collected so far show that LDRT could be introduced as a treatment with promising efficacy, due to limitations such as lack of randomization in most studies, we need further large-scale randomized studies, especially for elderly patients who are at greater risk of mortality due to COVID-19. However, more preclinical work and clinical trials are needed before any clear conclusion can be made.
Collapse
|
31
|
Dawood A, Mothersill C, Seymour C. Low dose ionizing radiation and the immune response: what is the role of non-targeted effects? Int J Radiat Biol 2021; 97:1368-1382. [PMID: 34330196 DOI: 10.1080/09553002.2021.1962572] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This review aims to trace the historical narrative surrounding the low dose effects of radiation on the immune system and how our understanding has changed from the beginning of the 20th century to now. The particular focus is on the non-targeted effects (NTEs) of low dose ionizing radiation (LDIR) which are effects that occur when irradiated cells emit signals that cause effects in the nearby or distant non-irradiated cells known as radiation induced bystander effect (RIBE). Moreover, radiation induced genomic instability (RIGI) and abscopal effect (AE) also regarded as NTE. This was prompted by our recent discovery that ultraviolet A (UVA) photons are emitted by the irradiated cells and that these photons can trigger NTE such as the RIBE in unirradiated recipients of these photons. Given the well-known association between UV radiation and the immune response, where these biophotons may pose as bystander signals potentiating processes in deep tissues as a consequence of LDIR, it is timely to review the field with a fresh lens. Various pathways and immune components that contribute to the beneficial and adverse types of modulation induced by LDR will also be revisited. CONCLUSION There is limited evidence for LDIR induced immune effects by way of a non-targeted mechanism in biological tissue. The literature examining low to medium dose effects of ionizing radiation on the immune system and its components is complex and controversial. Early work was compromised by lack of good dosimetry while later work mainly looks at the involvement of immune response in radiotherapy. There is a lack of research in the LDIR/NTE field focusing on immune response although bone marrow stem cells and lineages were critical in the identification and characterization of NTE where effects like RIGI and RIBE were heavily researched. This may be in part, a result of the difficulty of isolating NTE in whole organisms which are essential for good immune response studies. Models involving inter organism transmission of NTE are a promising route to overcome these issues.
Collapse
Affiliation(s)
- Annum Dawood
- Department of Physics and Astronomy, McMaster University, Hamilton, Canada
| | | | - Colin Seymour
- Department of Biology, McMaster University, Hamilton, Canada
| |
Collapse
|
32
|
Low-dose radiotherapy for painful osteoarthritis of the elderly: A multicenter analysis of 970 patients with 1185 treated sites. Strahlenther Onkol 2021; 197:895-902. [PMID: 34342662 PMCID: PMC8458208 DOI: 10.1007/s00066-021-01816-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/01/2021] [Indexed: 10/25/2022]
Abstract
PURPOSE Painful osteoarthritis is common in elderly patients, and low-dose radiotherapy has been demonstrated to provide effective symptomatic treatment. We examined the analgesic effects of low-dose radiotherapy for osteoarthritis in the elderly aiming to reveal potential differences in the response rates relating to increasing age. METHODS A retrospective analysis was performed at two university hospitals including elderly patients (≥ 65 years) undergoing radiotherapy for osteoarthritis between 2008 and 2020. Pain intensity and response were quantified using the numerical rating scale (NRS) and the Pannewitz score. Age groups were defined for young old (65-74 years), older old (75-84 years), and oldest old patients (≥ 85 years). RESULTS In all, 970 patients with 1185 treated sites and a median age of 76 years were analyzed. Mean NRS was 66 at baseline (t0), 53 after radiotherapy (t1), and 44 at first follow-up (t2) (p < 0.001 for t0-t1, t1-t2, and t0-t2). At t1, 1.5% exhibited a Pannewitz score of 0 (no pain), 58.5% of 1-2 (less pain), 36.1% of 3 (equal pain), and 3.9% of 4 (worse pain), while at t2, pain response shifted towards 6.9% (0), 58.6% (1-2), 28.1% (3), and 6.3% (4). Pain response did not differ between age groups at t1 (p = 0.172) or t2 (p = 0.684). In addition, pain response after re-irradiation (n = 384 sites) was 61.0% and was comparable between age groups (p = 0.535). CONCLUSION Low-dose radiotherapy results in pain reduction in about two-thirds of treated sites with no difference relating to increasing age, showing that radiotherapy is an effective analgesic treatment for osteoarthritis even at advanced ages.
Collapse
|
33
|
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
|
34
|
Ceyzériat K, Zilli T, Fall AB, Millet P, Koutsouvelis N, Dipasquale G, Frisoni GB, Tournier BB, Garibotto V. Treatment by low-dose brain radiation therapy improves memory performances without changes of the amyloid load in the TgF344-AD rat model. Neurobiol Aging 2021; 103:117-127. [PMID: 33895629 DOI: 10.1016/j.neurobiolaging.2021.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/27/2021] [Accepted: 03/13/2021] [Indexed: 12/13/2022]
Abstract
Alzheimer's disease (AD) is a neurodegenerative condition affecting memory performance. This pathology is characterized by intracerebral amyloid plaques and tau tangles coupled with neuroinflammation. During the last century, numerous therapeutic trials unfortunately failed highlighting the need to find new therapeutic approaches. Low-dose brain radiotherapy (LD-RT) showed efficacy to reduce amyloid load and inflammation in patients with peripheral diseases. In this study, the therapeutic potential of 2 LD-RT schedules was tested on the TgF344-AD rat model of AD. Fifteen-month-old rats were irradiated with 5 fractions of 2 Gy delivered either daily or weekly. The daily treatment induced an improvement of memory performance in the Y-maze. In contrast, the weekly treatment increased the microglial reactivity in the hippocampus. A lack of effect of both regimens on amyloid pathology was unexpectedly observed. The positive effect on cognition encourages to further evaluate the LD-RT therapeutic potential and highlights the impact of the design choice of the LD-RT regimen.
Collapse
Affiliation(s)
- Kelly Ceyzériat
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland; Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, Geneva University Hospitals, and NimtLab, Faculty of Medicine, Geneva University, Geneva, Switzerland; Division of Radiation Oncology, Department of Oncology, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Thomas Zilli
- Division of Radiation Oncology, Department of Oncology, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Aïda B Fall
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Philippe Millet
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Nikolaos Koutsouvelis
- Division of Radiation Oncology, Department of Oncology, Geneva University Hospitals, Geneva, Switzerland
| | - Giovanna Dipasquale
- Division of Radiation Oncology, Department of Oncology, Geneva University Hospitals, Geneva, Switzerland
| | - Giovanni B Frisoni
- Memory Center, Geneva University Hospitals, and LANVIE, Faculty of Medicine, Geneva University, Geneva, Switzerland; IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Benjamin B Tournier
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, Geneva University Hospitals, and NimtLab, Faculty of Medicine, Geneva University, Geneva, Switzerland.
| |
Collapse
|
35
|
François S, Helissey C, Cavallero S, Drouet M, Libert N, Cosset JM, Deutsch E, Meziani L, Chargari C. COVID-19-Associated Pneumonia: Radiobiological Insights. Front Pharmacol 2021; 12:640040. [PMID: 34113249 PMCID: PMC8185272 DOI: 10.3389/fphar.2021.640040] [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: 12/10/2020] [Accepted: 03/04/2021] [Indexed: 12/15/2022] Open
Abstract
The evolution of SARS-CoV-2 pneumonia to acute respiratory distress syndrome is linked to a virus-induced “cytokine storm”, associated with systemic inflammation, coagulopathies, endothelial damage, thrombo-inflammation, immune system deregulation and disruption of angiotensin converting enzyme signaling pathways. To date, the most promising therapeutic approaches in COVID-19 pandemic are linked to the development of vaccines. However, the fight against COVID-19 pandemic in the short and mid-term cannot only rely on vaccines strategies, in particular given the growing proportion of more contagious and more lethal variants among exposed population (the English, South African and Brazilian variants). As long as collective immunity is still not acquired, some patients will have severe forms of the disease. Therapeutic perspectives also rely on the implementation of strategies for the prevention of secondary complications resulting from vascular endothelial damage and from immune system deregulation, which contributes to acute respiratory distress and potentially to long term irreversible tissue damage. While the anti-inflammatory effects of low dose irradiation have been exploited for a long time in the clinics, few recent physiopathological and experimental data suggested the possibility to modulate the inflammatory storm related to COVID-19 pulmonary infection by exposing patients to ionizing radiation at very low doses. Despite level of evidence is only preliminary, these preclinical findings open therapeutic perspectives and are discussed in this article.
Collapse
Affiliation(s)
- Sabine François
- Department of Radiation Biological Effects, French Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France
| | | | - Sophie Cavallero
- Department of Radiation Biological Effects, French Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France
| | - Michel Drouet
- Department of Radiation Biological Effects, French Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France
| | | | - Jean-Marc Cosset
- Centre de Radiothérapie Charlebourg/La Défense, Groupe Amethyst, La Garenne-Colombes, France
| | - Eric Deutsch
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France.,INSERM U1030, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Lydia Meziani
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France.,INSERM U1030, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Cyrus Chargari
- Department of Radiation Biological Effects, French Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France.,Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France.,INSERM U1030, Université Paris Saclay, Le Kremlin Bicêtre, France
| |
Collapse
|
36
|
Ceyzériat K, Tournier BB, Millet P, Frisoni GB, Garibotto V, Zilli T. Low-Dose Radiation Therapy: A New Treatment Strategy for Alzheimer's Disease? J Alzheimers Dis 2021; 74:411-419. [PMID: 32039848 DOI: 10.3233/jad-190984] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Alzheimer's disease (AD) is a neurodegenerative disease characterized by extracellular amyloid-β (Aβ) peptide aggregates, forming amyloid plaques, and intracellular deposits of phosphorylated tau. Neuroinflammation is now considered as the third hallmark of AD. The majority of clinical trials tested pharmacological strategies targeting amyloid, tau, and neuroinflammation, with disappointing results overall. In parallel, innovative strategies exploring other pathways and approaches are being tested. In this article, we focus on the rationale and preliminary preclinical evidence for a novel application to AD of a widely used therapeutic strategy for oncological and benign conditions: low-dose radiation therapy (LD-RT). LD-RT has shown to be effective against systemic amyloid deposits, as well as against chronic inflammatory diseases, and could thus be able to modulate amyloid load and neuroinflammation in AD. The anti-amyloid effect could be possibly mediated by the LD-RT action on the β-sheet structure of amyloid fibrils, by breaking H-bonds, and depolymerize glucoaminoglycans which are highly radiation-sensitive molecules associated with amyloid fibrils. The anti-inflammatory effect could be linked to the decrease of leukocytes-endothelial cells interactions and to the stimulation of the release of anti-inflammatory molecules. One preclinical study has observed a dramatic reduction of amyloid plaques 4 weeks post-RT, more important with fractionated protocols at low doses than hypofractionated single dose treatments, associated with modulation of inflammatory and anti-inflammatory cytokines and cognitive improvement. Ongoing Phase I clinical trials will test the ability of LD-RT to hold these promises.
Collapse
Affiliation(s)
- Kelly Ceyzériat
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland.,Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, Geneva University Hospitals, and NimtLab, Faculty of Medicine, Geneva University, Geneva, Switzerland.,Division of Radiation Oncology, Department of Oncology, Geneva University Hospitals and Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Benjamin B Tournier
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Philippe Millet
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Giovanni B Frisoni
- Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, Geneva University Hospitals, and NimtLab, Faculty of Medicine, Geneva University, Geneva, Switzerland.,IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, Geneva University Hospitals, and NimtLab, Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Thomas Zilli
- Division of Radiation Oncology, Department of Oncology, Geneva University Hospitals and Faculty of Medicine, Geneva University, Geneva, Switzerland
| |
Collapse
|
37
|
Miran C, Bonnet É, Allignet B, Clippe S, El Hedi Zouai M, Bosset M, Fleury B, Guy JB. [Low dose radiotherapy for COVID-19 pneumopathy: Biological rationale and literature review]. Cancer Radiother 2021; 25:494-501. [PMID: 33903009 PMCID: PMC8040522 DOI: 10.1016/j.canrad.2021.03.005] [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: 02/19/2021] [Revised: 03/19/2021] [Accepted: 03/29/2021] [Indexed: 01/08/2023]
Abstract
La pandémie de coronavirus disease 2019 (covid-19) due au severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) évolue depuis un peu plus d’un an. Si la majorité des formes est bénigne, des pneumopathies graves, voire mortelles, se développent chez certains patients plus à risque. De nombreuses pistes thérapeutiques ont été explorées avec cependant trop peu d’impact sur la mortalité. C’est dans ce contexte que Kirkby et Mackenzie ont rappelé en avril 2020 les propriétés anti-inflammatoires de la radiothérapie de faible dose (délivrant moins de 1 Gy) et son utilisation dans le traitement des pneumopathies bactériennes et virales avant l’ère des antibiotiques. En effet, de larges données in vitro et in vivo ont démontré le rationnel biologique à l’origine de la diminution de l’inflammation après une radiothérapie de faible dose dans de nombreuses pathologies. Depuis un an, trois essais cliniques de phase I/II ont été publiés ainsi qu’un essai randomisé, rapportant la faisabilité et l’amélioration clinique et biologique d’un traitement bipulmonaire par une dose 0,5 à 1 Gy. Treize autres études, dont une phase III randomisée, sont en cours dans le monde. Celles-ci pourront permettre de mieux apprécier les effets de la radiothérapie de faible dose pour la pneumonie à SARS-CoV-2. Cette revue s’attache à rappeler le rationnel biologique de l’utilisation de la radiothérapie de faible dose dans les pneumopathies, et de rapporter les résultats des essais publiés ou en cours sur son utilisation spécifique pour la pneumopathie à SARS-CoV-2.
Collapse
Affiliation(s)
- C Miran
- Centre de radiothérapie Marie-Curie, 159, boulevard Maréchal-Juin, 26000 Valence, France; Hospices civils de Lyon, 69000 Lyon, France
| | - É Bonnet
- Centre de radiothérapie Marie-Curie, 159, boulevard Maréchal-Juin, 26000 Valence, France
| | - B Allignet
- Hospices civils de Lyon, 69000 Lyon, France
| | - S Clippe
- Centre de radiothérapie Marie-Curie, 159, boulevard Maréchal-Juin, 26000 Valence, France
| | - M El Hedi Zouai
- Centre de radiothérapie Marie-Curie, 159, boulevard Maréchal-Juin, 26000 Valence, France
| | - M Bosset
- Centre de radiothérapie Marie-Curie, 159, boulevard Maréchal-Juin, 26000 Valence, France
| | - B Fleury
- Centre de radiothérapie Marie-Curie, 159, boulevard Maréchal-Juin, 26000 Valence, France
| | - J-B Guy
- Centre de radiothérapie Marie-Curie, 159, boulevard Maréchal-Juin, 26000 Valence, France.
| |
Collapse
|
38
|
COVID-19 pneumonia treated with ultra-low doses of radiotherapy (ULTRA-COVID study): a single institution report of two cases. Strahlenther Onkol 2021; 197:429-437. [PMID: 33502567 PMCID: PMC7839288 DOI: 10.1007/s00066-020-01743-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/31/2020] [Indexed: 12/31/2022]
Abstract
Introduction Since the outbreak of coronavirus disease 2019 (COVID-19) pandemic, healthcare systems have focused their efforts into finding a treatment to avoid the fatal outcomes of severe acute respiratory syndrome due to coronavirus‑2 (SARS-CoV-2). Benefits and risks of systemic treatments remain unclear, with multiple clinical trials still ongoing. Radiotherapy could play a role in reducing the inflammatory response in the lungs and relieve life-threatening symptoms. Methods We designed a prospective study of Ultra-Low Doses of Therapy with Radiation Applied to COVID-19 (ULTRA-COVID) for patients who suffer pneumonia, are not candidates for invasive mechanical ventilation and show no improvement with medical therapy. Results We present the preliminary results of two patients diagnosed with COVID-19 pneumonia treated with ULTRA-COVID. After one radiotherapy session, significant clinical response and a good radiological response was observed in both cases, resulting in both patients being discharged from hospital in less than 2 weeks after radiation treatment. Conclusion Preliminary clinical and radiological results suggest a potential benefit of treating COVID-19 pneumonia with ULTRA-COVID. ClinicalTrials.gov Identifier: NCT04394182
Collapse
|
39
|
Low-dose radiation therapy: a treatment for pneumonia resulting from COVID-19. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396920001089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Abstract
Background:
The Coronavirus disease 2019 (COVID-19) is spreading rapidly throughout the world. Lung is the primary organ which the COVID-19 virus affects and leads to pneumonia, an acute respiratory distress syndrome. COVID-19 infects the lower respiratory system, and the lung’s response to this infection is recruiting macrophages and monocytes leading to inflammation, this response causes widespread damage to the lung’s airways.
Aim:
The purpose of this study is to review studies of using low-dose radiation as a treatment for the inflammation of the tissue and pneumonia resulting from COVID-19. These studies were compared with the risk of developing lung cancer during performed dose for the treatment of COVID-19 in radiation therapy.
Materials and methods:
Our study focused on in vitro, in vivo and clinical reports of using low-dose radiation for the treatment of inflammation, pneumonia and COVID-19. The risk of lung cancer resulting from suggested dose in these studies was also evaluated.
Conclusion:
From the review of articles, we have found that low-dose radiation can lead to improvement in inflammation in different line cells and animals; in addition, it has been effective in treating inflammation and pneumonia caused by COVID-19 in human up to 80%. Since suggested doses do not remarkably increase the lung cancer risk, low-dose radiation can be an adjuvant treatment for COVID-19 patients.
Collapse
|
40
|
Kumar A, Dey AD, Behl T, Chadha S, Aggarwal V. Exploring the multifocal therapeutic approaches in COVID-19: A ray of hope. Int Immunopharmacol 2021; 90:107156. [PMID: 33189613 PMCID: PMC7608010 DOI: 10.1016/j.intimp.2020.107156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/24/2020] [Accepted: 10/21/2020] [Indexed: 12/28/2022]
Abstract
The ongoing global pandemic of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is marked as one of the most challenging infectious diseases in the history of mankind with affliction of ~29,737,453 confirmed cases globally. Looking at the present scenario where there is a parallel increment in curve with time, there is an utmost emergency to discover a perennial solution to this life-threatening virus which has led the Human race in an unusual state of affair. The entire health care fraternity is engaged in endeavouring an ultimate way out to hit this pandemic but no such research made till now has been approved yet, to have the potential to bring an end to this fatal situation. Although a few possible treatment choices exist at the moment yet the requirement to search for a still better therapeutic option remains persistent. Global laboratories are working day and night in search for an effective vaccine, many are undergoing clinical trials but their commercialization is no less than a year away. The present review highlights the current potential therapies viz., vaccines, immunotherapies, convulsant plasma therapies, corticosteroids, antithrombotic, intravenous immunoglobulins, nocturnal oxygen therapy etc. that may prove beneficial in attenuating the pandemic situation. However, comparison and presentation of collective data on the therapeutic advancements in mitigating the pandemic situation needs further clinical investigations in order to prove boon to mankind.
Collapse
Affiliation(s)
- Arun Kumar
- Chitkara College of Pharmacy, Chitkara University, Punjab, India.
| | - Asmita Deka Dey
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Tapan Behl
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Swati Chadha
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Vishal Aggarwal
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| |
Collapse
|
41
|
García-Hernández T, Romero-Expósito M, Sánchez-Nieto B. Low dose radiation therapy for COVID-19: Effective dose and estimation of cancer risk. Radiother Oncol 2020; 153:289-295. [PMID: 33065184 PMCID: PMC7553901 DOI: 10.1016/j.radonc.2020.09.051] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/16/2020] [Accepted: 09/27/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE The objective of this work is to evaluate the risk of carcinogenesis of low dose ionizing radiation therapy (LDRT), for treatment of immune-related pneumonia following COVID-19 infection, through the estimation of effective dose and the lifetime attributable risk of cancer (LAR). MATERIAL AND METHODS LDRT treatment was planned in male and female computational phantoms. Equivalent doses in organs were estimated using both treatment planning system calculations and a peripheral dose model (based on ionization chamber measurements). Skin dose was estimated using radiochromic films. Later, effective dose and LAR were calculated following radiation protection procedures. RESULTS Equivalent doses to organs per unit of prescription dose range from 10 mSv/cGy to 0.0051 mSv/cGy. Effective doses range from 204 mSv to 426 mSv, for prescription doses ranging from 50 cGy to 100 cGy. Total LAR for a prescription dose of 50 cGy ranges from 1.7 to 0.29% for male and from 4.9 to 0.54% for female, for ages ranging from 20 to 80 years old. CONCLUSIONS The organs that mainly contribute to risk are lung and breast. Risk for out-of-field organs is low, less than 0.06 cases per 10000. Female LAR is on average 2.2 times that of a male of the same age. Effective doses are of the same order of magnitude as the higher-dose interventional radiology techniques. For a 60 year-old male, LAR is 8 times that from a cardiac CT, when prescription dose is 50 cGy.
Collapse
Affiliation(s)
| | - Maite Romero-Expósito
- Área de Ciencias Básicas y Ambientales, Instituto Tecnológico de Santo Domingo (INTEC), P.O. Box 342-9/249-2, Santo Domingo, Dominican Republic
| | | |
Collapse
|
42
|
Sanmamed N, Alcantara P, Cerezo E, Gaztañaga M, Cabello N, Gómez S, Bustos A, Doval A, Corona J, Rodriguez G, Duffort M, Ortuño F, de Castro J, Fuentes ME, Sanz A, López A, Vazquez M. Low-Dose Radiation Therapy in the Management of Coronavirus Disease 2019 (COVID-19) Pneumonia (LOWRAD-Cov19): Preliminary Report. Int J Radiat Oncol Biol Phys 2020; 109:880-885. [PMID: 33249142 PMCID: PMC7690272 DOI: 10.1016/j.ijrobp.2020.11.049] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/19/2020] [Accepted: 11/19/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Low-dose radiation therapy (LD-RT) has been shown to have an anti-inflammatory effect, and preliminary results suggest it is feasible to treat patients with coronavirus disease 2019 (COVID-19) pneumonia. MATERIALS AND METHODS We conducted a prospective, single-arm, phase 1/2 clinical trial enrolling patients aged ≥50 years, who were coronavirus disease 2019 (COVID-19) positive, at phase 2 or 3 with lung involvement at imaging study and oxygen requirement. Patients received 100 cGy to total lungs in a single fraction. Primary outcome was radiologic response using severity and extension score on baseline computed tomography (CT), at days 3 and 7 after LD-RT. Secondary outcomes were toxicity using Common Terminology Criteria for Adverse Events v.5.0, duration of hospitalization, blood work evolution, and oxygen requirements using SatO2/FiO2 index (SAFI), at days 3 and 7 after LD-RT. RESULTS Nine patients were included. Median age was 66 (interquartile range, 57-77). Severity score was stable or decreased in the third CT but was not statistically significant (P = .28); however, there were statistically significant changes in the extension score (P = .03). SAFI index significantly improved 72 hours and 1 week after LD-RT (P = .01). Inflammatory blood parameters decreased 1 week after RT compared with baseline; only lactate dehydrogenase decreased significantly (P = .04). Two patients presented grade 2 lymphopenia after RT and another (with baseline grade 3) worsened to grade 4. Overall, the median number of days of hospitalization was 59 (range, 26-151). After RT the median number of days in the hospital was 13 (range, 4-77). With a median follow-up after RT of 112 days (range, 105-150), 7 patients were discharged and 2 patients died, 1 due to sepsis and the other with severe baseline chronic obstructive pulmonary disease from COVID-19 pneumonia. CONCLUSIONS Our preliminary results show that LD-RT was a feasible and well-tolerated treatment, with potential clinical improvement. Randomized trials are needed to establish whether LD-RT improves severe pneumonia.
Collapse
Affiliation(s)
- Noelia Sanmamed
- Radiation Oncology Department, Clinico San Carlos Hospital, Madrid, Spain.
| | - Pino Alcantara
- Radiation Oncology Department, Clinico San Carlos Hospital, Madrid, Spain; Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Elena Cerezo
- Radiation Oncology Department, Clinico San Carlos Hospital, Madrid, Spain
| | - Miren Gaztañaga
- Radiation Oncology Department, Clinico San Carlos Hospital, Madrid, Spain
| | - Noemi Cabello
- Internal Medicine Department, Clinico San Carlos Hospital, Madrid, Spain
| | - Sara Gómez
- Radiology Department, Clinico San Carlos Hospital, Madrid, Spain
| | - Ana Bustos
- Radiology Department, Clinico San Carlos Hospital, Madrid, Spain
| | - Anxela Doval
- Radiation Oncology Department, Clinico San Carlos Hospital, Madrid, Spain
| | - Juan Corona
- Radiation Oncology Department, Clinico San Carlos Hospital, Madrid, Spain; Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Gabriel Rodriguez
- Medical Physics Department, Clinico San Carlos Hospital, Madrid, Spain
| | - Mercedes Duffort
- Internal Medicine Department, Infanta Leonor Hospital, Madrid, Spain
| | | | | | - Manuel Enrique Fuentes
- Preventive Department, Clinico San Carlos Hospital, Madrid, Spain; Investigation Institute, Clinico San Carlos Hospital, Madrid, Spain
| | - Alvaro Sanz
- Medical Oncology Department, Rio Hortega Hospital, Valladolid, Spain
| | - Amanda López
- Investigation Institute, Clinico San Carlos Hospital, Madrid, Spain
| | - Manuel Vazquez
- Radiation Oncology Department, Clinico San Carlos Hospital, Madrid, Spain; Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| |
Collapse
|
43
|
Das IJ, Kalapurakal JA, Mittal BB. Caution warranted for low-dose radiation therapy for Covid-19. Br J Radiol 2020; 94:20200466. [PMID: 33112664 PMCID: PMC7774700 DOI: 10.1259/bjr.20200466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Covid-19 is a morbid respiratory disease that has caused desperate times on a global scale due to the lack of any effective medical treatment. Some in the radiation community are actively proposing low-dose radiation therapy (LDRT) for managing the viral pneumonia associated with Covid-19. This commentary provides a rationale for exercising caution against such a decision as the efficacy of LDRT for viral diseases is unknown, while its long-term adverse risks are well known.
Collapse
Affiliation(s)
- Indra J Das
- Department of Radiation Oncology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | | | | |
Collapse
|
44
|
Gil Marques F, Poli E, Malaquias J, Carvalho T, Portêlo A, Ramires A, Aldeia F, Ribeiro RM, Vitorino E, Diegues I, Costa L, Coutinho J, Pina F, Mareel M, Constantino Rosa Santos S. Low doses of ionizing radiation activate endothelial cells and induce angiogenesis in peritumoral tissues. Radiother Oncol 2020; 151:322-327. [PMID: 33004178 DOI: 10.1016/j.radonc.2020.06.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/24/2019] [Accepted: 06/27/2019] [Indexed: 10/23/2022]
Abstract
PURPOSE During radiotherapy the peritumoral tissues are daily exposed to subtherapeutic doses of ionizing radiation. Herein, the biological and molecular effects of doses lower than 0.8 Gy per fraction (LDIR), previously described as angiogenesis inducers, were assessed in human peritumoral tissues. MATERIAL AND METHODS Paired biopsies of preperitoneal adipose tissue were surgically collected from 16 patients diagnosed with locally advanced rectal cancer who underwent neo-adjuvant radiotherapy. One of the biopsies is located in the vicinity of the region where the tumor received the prescribed dose of radiation, and thus exposed to LDIR; the other specimen, outside all beam apertures, was used as an internal calibrator (IC). Microvessel density (MDV) was quantified by immunohistochemistry and the expression of angiogenic, pro-inflammatory, adhesion and oxidative stress genes was assessed by quantitative RT-PCR using exclusively endothelial cells (ECs) isolated by laser capture microdissection microscopy. RESULTS LDIR activated peritumoral ECs by significantly up-regulating the expression of several pro-angiogenic genes such as VEGFR1, VEGFR2, ANGPT2, TGFB2, VWF, FGF2, HGF and PDGFC and down-regulating the pro-inflammatory IL8 marker. Accordingly, the MVD was significantly increased in peritumoral tissues exposed to LDIR, compared to the IC. The patients that yielded a larger pro-angiogenic response, also showed the highest MVD. CONCLUSIONS LDIR activate ECs in peritumoral tissues that are associated with increased MVD. Although the technological advances in radiotherapy have contributed to reduce the damage to healthy tissues over the past years, the anatomical regions receiving LDIR should be taken into account in the treatment plan report for patient follow-up and in future studies to correlate these doses with tumor dissemination.
Collapse
Affiliation(s)
- Filipa Gil Marques
- Angiogenesis Laboratory, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Esmeralda Poli
- Radiotherapy Service, Centro Hospitalar Universitário Lisboa Norte, Portugal
| | - João Malaquias
- Department of Surgery, Centro Hospitalar Universitário Lisboa Norte, Portugal
| | - Tânia Carvalho
- Histology and Comparative Pathology Laboratory, Instituto de Medicina Molecular; Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Ana Portêlo
- Instituto de Medicina Molecular; Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Afonso Ramires
- Department of Surgery, Centro Hospitalar Universitário Lisboa Norte, Portugal
| | - Fernando Aldeia
- Department of Surgery, Centro Hospitalar Universitário Lisboa Norte, Portugal
| | - Ruy Miguel Ribeiro
- Biomathematics Laboratory, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Emília Vitorino
- Department of Pathology, Centro Hospitalar Universitário Lisboa Norte, Portugal
| | - Isabel Diegues
- Radiotherapy Service, Centro Hospitalar Universitário Lisboa Norte, Portugal
| | - Luís Costa
- Oncology Department, Centro Hospitalar Universitário Lisboa Norte; Instituto de Medicina Molecular; Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - João Coutinho
- Department of Surgery, Centro Hospitalar Universitário Lisboa Norte, Portugal
| | - Filomena Pina
- Radiotherapy Service, Centro Hospitalar Universitário Lisboa Norte, Portugal
| | - Marc Mareel
- Department of Radiotherapy and Laboratory of Experimental Cancer Research, Ghent University Hospital, Belgium
| | - Susana Constantino Rosa Santos
- Angiogenesis Laboratory, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Portugal.
| |
Collapse
|
45
|
Hertzog RG, Bicheru SN. Radiotherapy in the fight against pneumonia associated with SARS-CoV-2. Int J Radiat Biol 2020; 96:1319-1322. [PMID: 32931359 DOI: 10.1080/09553002.2020.1822560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
46
|
The Influence of Radiation on Bone and Bone Cells-Differential Effects on Osteoclasts and Osteoblasts. Int J Mol Sci 2020; 21:ijms21176377. [PMID: 32887421 PMCID: PMC7504528 DOI: 10.3390/ijms21176377] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
The bone is a complex organ that is dependent on a tight regulation between bone formation by osteoblasts (OBs) and bone resorption by osteoclasts (OCs). These processes can be influenced by environmental factors such as ionizing radiation (IR). In cancer therapy, IR is applied in high doses, leading to detrimental effects on bone, whereas radiation therapy with low doses of IR is applied for chronic degenerative and inflammatory diseases, with a positive impact especially on bone homeostasis. Moreover, the effects of IR are of particular interest in space travel, as astronauts suffer from bone loss due to space radiation and microgravity. This review summarizes the current state of knowledge on the effects of IR on bone with a special focus on the influence on OCs and OBs, as these cells are essential in bone remodeling. In addition, the influence of IR on the bone microenvironment is discussed. In summary, the effects of IR on bone and bone remodeling cells strongly depend on the applied radiation dose, as differential results are provided from in vivo as well as in vitro studies with varying doses of IR. Furthermore, the isolated effects of IR on a single cell type are difficult to determine, as the bone cells and bone microenvironment are building a tightly regulated network, influencing on one another. Therefore, future research is necessary in order to elucidate the influence of different bone cells on the overall radiation-induced effects on bone.
Collapse
|
47
|
Sasaki M, Kudo S, Furuta H. Effect of Radiation Dose Rate on Circulatory Disease Mortality among Nuclear Workers: Reanalysis of Hanford Data. HEALTH PHYSICS 2020; 119:280-288. [PMID: 32205716 DOI: 10.1097/hp.0000000000001230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The excess relative risk (ERR) of mortality for circulatory disease among nuclear workers was reanalyzed by taking into consideration the annual dose as the dose rate using publicly available epidemiological data of the Hanford site dedicated to the cohort study of nuclear workers in the US, the UK, and Canada. Values of the dose rate (cut-points) were chosen at 2 mSv y intervals from 2 to 40 mSv y, and risk estimates were made for 32,988 workers, considering the doses accumulated below and above each cut-point to have different effects. Similarly to that in the previous study for cancer by Sasaki et al., examinations of sensitivity analysis were also carried out for different risk models, lag periods, and impacts of adjusting the monitoring period to find the effect of the dose rate. As a result, emergence of a statistically significant difference between βL1, which is the ERR for the doses accumulated below the specified cut-point, and βH1, which is the ERR for that above the specified cut-point, was observed for cut-point of the dose rate of 4, 6, 34, 36, and 38 mSv y. While statistically negative values were estimated for βL1 (4 and 6 mSv y) and for βH1 (34, 36, and 38 mSv y), the overall relationship between the ERR and the cut-point of the dose rate was found to be similar to that obtained by the analysis of the mortality for all cancers excluding leukemia.
Collapse
Affiliation(s)
- Michiya Sasaki
- Radiation Safety Research Center, Nuclear Technology Research Laboratory, Central Research Institute of Electric Power Industry, 2-11-1 Iwado kita, Komae-shi, Tokyo 201-8511, Japan
| | - Shin'ichi Kudo
- Institute of Radiation Epidemiology, Radiation Effects Association, 1-9-16 Kajicho, Chiyoda-ku, Tokyo 101-0044, Japan
| | - Hiroshige Furuta
- Institute of Radiation Epidemiology, Radiation Effects Association, 1-9-16 Kajicho, Chiyoda-ku, Tokyo 101-0044, Japan
| |
Collapse
|
48
|
Kirkby C, Mackenzie M. Low dose lung radiation therapy for pneumonia: an examination of historical dose distributions. Phys Med Biol 2020; 65:155019. [PMID: 32554879 DOI: 10.1088/1361-6560/ab9e55] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The novel coronavirus, SARS-CoV-2, that causes the COVID-19 disease currently has healthcare systems around the world dealing with unprecedented numbers of critically ill patients. One of the primary concerns associated with this illness is acute respiratory distress syndrome (ARDS) and the pneumonia that accompanies it. Historical literature dating back to the 1940s and earlier contains many reports of successful treatment of pneumonias with ionizing radiation. Although these were not randomized controlled trials, they do suggest a potential avenue for further investigation. Technical details in these reports however were limited. In this work we review the literature and identify details including nominal kilovoltage ranges, filtration, and focus-skin distances (FSDs). Using a freely available and benchmarked code, we generated spectra and used these as sources for Monte Carlo simulations using the EGSnrc software package. The approximate sources were projected through a radiologically anthropomorphic phantom to provide detailed dose distributions within a targeted lung volume (approximate right middle lobe). After accounting for the reported exposure levels, mean lung doses fell in a relatively narrow range: 30-80 cGy. Variation in patient dimensions and other details are expected to result in an uncertainty on the order of ± 20%. This result is consistent with the dose range expected to induce anti-inflammatory effects.
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. Author to whom any correspondence should be addressed
| | | |
Collapse
|
49
|
Wilson GD, Mehta MP, Welsh JS, Chakravarti A, Rogers CL, Fontanesi J. Investigating Low-Dose Thoracic Radiation as a Treatment for COVID-19 Patients to Prevent Respiratory Failure. Radiat Res 2020; 194:1-8. [PMID: 32845978 DOI: 10.1667/rade-20-00108.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/05/2020] [Indexed: 11/03/2022]
Affiliation(s)
- George D Wilson
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan
| | - Minesh P Mehta
- Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | - James S Welsh
- Loyola University Chicago, Stritch School of Medicine, Department of Radiation Oncology, Maywood, Illinois
| | - Arnab Chakravarti
- Department of Radiation Oncology, Ohio State University, Columbus, Ohio
| | | | - James Fontanesi
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan
| |
Collapse
|
50
|
El-Hazek RMM, El-Sabbagh WA, El-Hazek RM, El-Gazzar MG. Anti-inflammatory and analgesic effect of LD-RT and some novel thiadiazole derivatives through COX-2 inhibition. Arch Pharm (Weinheim) 2020; 353:e2000094. [PMID: 32618021 DOI: 10.1002/ardp.202000094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/13/2020] [Accepted: 06/05/2020] [Indexed: 11/09/2022]
Abstract
Generally, highly selective COX-2 inhibitors cause cardiovascular side effects. Celecoxib is the highly marketed coxib, so there is still a need for the synthesis of COX-2 inhibitors with less adverse effects. Moreover, low-dose radiotherapy (LD-RT) is clinically used for the treatment of inflammatory diseases. The present study aimed to investigate the analgesic and anti-inflammatory activity of a novel series of 1,3,4-thiadiazole derivatives alone or combined with LD-RT with a single dose of 0.5 Gy. Initially, in vitro COX-1/COX-2 inhibition assays were performed, identifying the sulfonamide-containing compounds 5-10 as the most potent candidates, with IC50 values in the range of 0.32-0.37 µM and the highest selectivity indices. These compounds and celecoxib were subjected to in vivo examination after their safety was assessed through the acute toxicity test. Treatment with compounds 5-10 inhibited carrageenan-induced edema by nearly 47-56%, which was nearly equivalent to celecoxib. Compounds 7 and 8 and celecoxib showed an analgesic activity of 64.15%, 49.05%, and 84.90%, respectively, whereas compounds 5, 6, 9, and 10 did not show any analgesic activity unless combined with LD-RT. Ulcerogenic activity, histological paw examination, and docking studies were performed. Compounds 5-10 were nearly similar to celecoxib, showing normal histological features with no ulcerogenic activity.
Collapse
Affiliation(s)
- Reham M M El-Hazek
- Department of Drug Radiation Research, National Centre for Radiation Research & Technology (NCRRT), Egyptian Atomic Energy Authority (EAEA), Cairo, Egypt
| | - Walaa A El-Sabbagh
- Department of Drug Radiation Research, National Centre for Radiation Research & Technology (NCRRT), Egyptian Atomic Energy Authority (EAEA), Cairo, Egypt
| | - Rania M El-Hazek
- Department of Drug Radiation Research, National Centre for Radiation Research & Technology (NCRRT), Egyptian Atomic Energy Authority (EAEA), Cairo, Egypt
| | - Marwa G El-Gazzar
- Department of Drug Radiation Research, National Centre for Radiation Research & Technology (NCRRT), Egyptian Atomic Energy Authority (EAEA), Cairo, Egypt
| |
Collapse
|