Low dose ionizing radiation and the immune response: what is the role of non-targeted effects?

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.

Eliminating the stigma: A systematic review of the health effects of low-dose radiation within the diagnostic imaging department and its implications for the future of medical radiation

BACKGROUND

Low-dose radiation exposure to Canadians is exponentially increasing due to the influx of diagnostic imaging and medical procedures that utilize radiation. Despite the use of medical radiation since 1896, the standardized acceptable dose for the Canadian public is still debated. The current annual dose limit for the public is set at 1 millisievert (mSv). This set dose limit intrinsically restricts the use of medical radiation for diagnosis due to concerns of public health.

METHODS

This systematic review is in the form of a retrospective meta-analysis of previous experimental studies and observational reviews of low-dose radiation health effects. A database search using PubMed and Medscape identified 1,296 articles using the terms "low-dose radiation", "radiation hormesis", "radiation safety", "dose exposure", and "medical radiation". Full text articles were excluded for the following reasons: radiation dose level not <100mSv, results of radiation effects not included, or no inclusion of biologic effects on living tissue. After screening, 15 studies were selected for inclusion.

RESULTS

The concerns of radiation exposure are based on epidemiological and experimental studies that have indicated that high-dose ionizing radiation has toxic effects and increases cancer risk. In contrast, low-dose radiation has experimentally demonstrated various beneficial effects through a combination of molecular and cohort studies, randomized control trials, and observational analysis. The limitation of radiation in medical imaging is founded on the assumption that low-dose radiation health risks are a linear extrapolation of high-dose radiation.

DISCUSSION/CONCLUSIONS

Through a systematic review of research, it is proposed that the current dose-response extrapolation for radiation-related health risks cannot be linearly based on the effects at high doses. By altering this knowledge, we could effectively improve patient diagnosis and public health by redefining the restrictions of current radiation limits within diagnostic imaging.

Hormesis and radiation safety norms: Comments for an update

Hormesis can be explained by evolutionary adaptation to the current level of a factor present in the natural environment or to some average from the past. This pertains also to ionizing radiation as the natural background has been decreasing during the time of the life existence. DNA damage and repair are normally in a dynamic balance. The conservative nature of the DNA repair suggests that cells may have retained some capability to repair damage from higher radiation levels than that existing today. According to this concept, the harm caused by radioactive contamination would tend to zero with a dose rate tending to a wide range level of the natural radiation background. Existing evidence in favor of hormesis is substantial, experimental data being partly at variance with results of epidemiological studies. Potential bias, systematic errors, and motives to exaggerate risks from low-dose low-rate ionizing radiation are discussed here. In conclusion, current radiation safety norms are exceedingly restrictive and should be revised on the basis of scientific evidence. Elevation of the limits must be accompanied by measures guaranteeing their observance.

Hormetic use of stress in gerontological interventions requires a cautious approach

Hormesis as a general principle is conceivable only for factors that are present in the natural environment. For such factors, existence of an optimal level can be assumed, which would correspond to the current environmental level or some average of historic levels. Theoretic basis of some hormetic mechanisms has been discussed within the scope of stress response pathways. Impacts of multiple stressing agents may produce combined effects larger than those expected from isolated impacts i.e. act synergistically. Adding the effect of a damaging stress to another damaging stress would possibly augment the damage; but if two mild stresses have positive hormetic effects, their combination can have additive positive effects. Potential adverse effects of excessive doses of hormetic agents should be pointed out particularly for senile age or a state close to decompensation when minor stimuli might be damaging. In conclusion, a hormetic use of stress in gerontological interventions requires a cautious approach.

Depleted uranium instead of lead in munitions: the lesser evil

Uranium has many similarities to lead in its exposure mechanisms, metabolism and target organs. However, lead is more toxic, which is reflected in the threshold limit values. The main potential hazard associated with depleted uranium is inhalation of the aerosols created when a projectile hits an armoured target. A person can be exposed to lead in similar ways. Accidental dangerous exposures can result from contact with both substances. Encountering uranium fragments is of minor significance because of the low penetration depth of alpha particles emitted by uranium: they are unable to penetrate even the superficial keratin layer of human skin. An additional cancer risk attributable to the uranium exposure might be significant only in case of prolonged contact of the contaminant with susceptible tissues. Lead intoxication can be observed in the wounded, in workers manufacturing munitions etc; moreover, lead has been documented to have a negative impact on the intellectual function of children at very low blood concentrations. It is concluded on the basis of the literature overview that replacement of lead by depleted uranium in munitions would be environmentally beneficial or largely insignificant because both lead and uranium are present in the environment.