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Hamada N. Noncancer Effects of Ionizing Radiation Exposure on the Eye, the Circulatory System and beyond: Developments made since the 2011 ICRP Statement on Tissue Reactions. Radiat Res 2023; 200:188-216. [PMID: 37410098 DOI: 10.1667/rade-23-00030.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/13/2023] [Indexed: 07/07/2023]
Abstract
For radiation protection purposes, noncancer effects with a threshold-type dose-response relationship have been classified as tissue reactions (formerly called nonstochastic or deterministic effects), and equivalent dose limits aim to prevent occurrence of such tissue reactions. Accumulating evidence demonstrates increased risks for several late occurring noncancer effects at doses and dose rates much lower than previously considered. In 2011, the International Commission on Radiological Protection (ICRP) issued a statement on tissue reactions to recommend a threshold of 0.5 Gy to the lens of the eye for cataracts and to the heart and brain for diseases of the circulatory system (DCS), independent of dose rate. Literature published thereafter continues to provide updated knowledge. Increased risks for cataracts below 0.5 Gy have been reported in several cohorts (e.g., including in those receiving protracted or chronic exposures). A dose threshold for cataracts is less evident with longer follow-up, with limited evidence available for risk of cataract removal surgery. There is emerging evidence for risk of normal-tension glaucoma and diabetic retinopathy, but the long-held tenet that the lens represents among the most radiosensitive tissues in the eye and in the body seems to remain unchanged. For DCS, increased risks have been reported in various cohorts, but the existence or otherwise of a dose threshold is unclear. The level of risk is less uncertain at lower dose and lower dose rate, with the possibility that risk per unit dose is greater at lower doses and dose rates. Target organs and tissues for DCS are also unknown, but may include heart, large blood vessels and kidneys. Identification of potential factors (e.g., sex, age, lifestyle factors, coexposures, comorbidities, genetics and epigenetics) that may modify radiation risk of cataracts and DCS would be important. Other noncancer effects on the radar include neurological effects (e.g., Parkinson's disease, Alzheimer's disease and dementia) of which elevated risk has increasingly been reported. These late occurring noncancer effects tend to deviate from the definition of tissue reactions, necessitating more scientific developments to reconsider the radiation effect classification system and risk management. This paper gives an overview of historical developments made in ICRP prior to the 2011 statement and an update on relevant developments made since the 2011 ICRP statement.
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Affiliation(s)
- Nobuyuki Hamada
- Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Chiba, Japan
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Wakeford R. Risk of diseases of the circulatory system after low-level radiation exposure-an assessment of evidence from occupational exposures. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:020201. [PMID: 35575612 DOI: 10.1088/1361-6498/ac6275] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/30/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Richard Wakeford
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester M13 9PL, United Kingdom
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Babini G, Baiocco G, Barbieri S, Morini J, Sangsuwan T, Haghdoost S, Yentrapalli R, Azimzadeh O, Rombouts C, Aerts A, Quintens R, Ebrahimian T, Benotmane MA, Ramadan R, Baatout S, Tapio S, Harms-Ringdahl M, Ottolenghi A. A systems radiation biology approach to unravel the role of chronic low-dose-rate gamma-irradiation in inducing premature senescence in endothelial cells. PLoS One 2022; 17:e0265281. [PMID: 35286349 PMCID: PMC8920222 DOI: 10.1371/journal.pone.0265281] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/24/2022] [Indexed: 12/13/2022] Open
Abstract
Purpose The aim of this study was to explore the effects of chronic low-dose-rate gamma-radiation at a multi-scale level. The specific objective was to obtain an overall view of the endothelial cell response, by integrating previously published data on different cellular endpoints and highlighting possible different mechanisms underpinning radiation-induced senescence. Materials and methods Different datasets were collected regarding experiments on human umbilical vein endothelial cells (HUVECs) which were chronically exposed to low dose rates (0, 1.4, 2.1 and 4.1 mGy/h) of gamma-rays until cell replication was arrested. Such exposed cells were analyzed for different complementary endpoints at distinct time points (up to several weeks), investigating cellular functions such as proliferation, senescence and angiogenic properties, as well as using transcriptomics and proteomics profiling. A mathematical model was proposed to describe proliferation and senescence. Results Simultaneous ceasing of cell proliferation and senescence onset as a function of time were well reproduced by the logistic growth curve, conveying shared equilibria between the two endpoints. The combination of all the different endpoints investigated highlighted a dose-dependence for prematurely induced senescence. However, the underpinning molecular mechanisms appeared to be dissimilar for the different dose rates, thus suggesting a more complex scenario. Conclusions This study was conducted integrating different datasets, focusing on their temporal dynamics, and using a systems biology approach. Results of our analysis highlight that different dose rates have different effects in inducing premature senescence, and that the total cumulative absorbed dose also plays an important role in accelerating endothelial cell senescence.
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Affiliation(s)
| | | | - Sofia Barbieri
- Physics Department, University of Pavia, Pavia, Italy
- Faculty of Medicine, Department of Cellular Physiology and Metabolism, University of Geneva, Geneva, Switzerland
| | - Jacopo Morini
- Physics Department, University of Pavia, Pavia, Italy
| | - Traimate Sangsuwan
- Department of Molecular Bioscience, Centre for Radiation Protection Research, Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| | - Siamak Haghdoost
- Department of Molecular Bioscience, Centre for Radiation Protection Research, Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
- ARIA Laboratory, University of Caen Normandy, CIMAP-GANIL, 14076, Caen, France
| | - Ramesh Yentrapalli
- Institute of Radiation Biology, Helmholtz Zentrum Muenchen—German Research Centre for Environmental Health, Neuherberg, Germany
| | - Omid Azimzadeh
- Institute of Radiation Biology, Helmholtz Zentrum Muenchen—German Research Centre for Environmental Health, Neuherberg, Germany
- Section Radiation Biology, Federal Office for Radiation Protection, Munich, Germany
| | - Charlotte Rombouts
- Radiobiology Unit, Belgian Nuclear Research Centre, SCK CEN, Boeretang, Belgium
- Department of Molecular Biotechnology, Ghent University, Ghent, Belgium
| | - An Aerts
- Radiobiology Unit, Belgian Nuclear Research Centre, SCK CEN, Boeretang, Belgium
| | - Roel Quintens
- Radiobiology Unit, Belgian Nuclear Research Centre, SCK CEN, Boeretang, Belgium
| | - Teni Ebrahimian
- Laboratoire de Radiobiologie et RadioToxicologie expérimentale, Service de recherche des effets biologiques et sanitaires des rayonnements ionisants, Pôle santé, F-92262, Fontenay-aux-Roses, France
| | | | - Raghda Ramadan
- Radiobiology Unit, Belgian Nuclear Research Centre, SCK CEN, Boeretang, Belgium
- * E-mail:
| | - Sarah Baatout
- Radiobiology Unit, Belgian Nuclear Research Centre, SCK CEN, Boeretang, Belgium
- Department of Molecular Biotechnology, Ghent University, Ghent, Belgium
| | - Soile Tapio
- Institute of Radiation Biology, Helmholtz Zentrum Muenchen—German Research Centre for Environmental Health, Neuherberg, Germany
| | - Mats Harms-Ringdahl
- Department of Molecular Bioscience, Centre for Radiation Protection Research, Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
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Simonetto C, Heier M, Peters A, Kaiser JC, Rospleszcz S. From Atherosclerosis to Myocardial Infarction: A Process-Oriented Model Investigating the Role of Risk Factors. Am J Epidemiol 2022; 191:1766-1775. [PMID: 35231928 PMCID: PMC9535448 DOI: 10.1093/aje/kwac038] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 01/14/2022] [Accepted: 02/24/2022] [Indexed: 01/29/2023] Open
Abstract
Mathematical models are able to reflect biological processes and to capture epidemiologic data. Thus, they may help elucidate roles of risk factors in disease progression. We propose to account for smoking, hypertension, and dyslipidemia in a previously published process-oriented model that describes the development of atherosclerotic lesions resulting in myocardial infarction (MI). The model is sex-specific and incorporates individual heterogeneity. It was applied to population-based individual risk factors and MI rates (Cooperative Health Research in the Region of Augsburg (KORA) study) together with subclinical atherosclerotic lesion data (Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study). Different model variants were evaluated, testing the association of risk factors with different disease processes. Best fits were obtained for smoking affecting a late-stage disease process, suggesting a thrombogenic role. Hypertension was mainly related to complicated, vulnerable lesions. Dyslipidemia was consistent with increasing the number of initial lesions. By accounting for heterogeneity, individual hazard ratios differ from the population average. The mean individual hazard ratio for smoking was twice the population-based hazard ratio for men and even more for women. Atherosclerotic lesion progression and MI incidence data can be related in a mathematical model to illuminate how risk factors affect different phases of this pathological process.
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Affiliation(s)
- Cristoforo Simonetto
- Correspondence to Dr. Cristoforo Simonetto, Institute of Radiation Medicine, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstraße 1, D-85764 Neuherberg, Germany (e-mail: )
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Mc Auley MT. Modeling cholesterol metabolism and atherosclerosis. WIREs Mech Dis 2021; 14:e1546. [PMID: 34931487 DOI: 10.1002/wsbm.1546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 10/11/2021] [Accepted: 10/14/2021] [Indexed: 12/19/2022]
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality among Western populations. Many risk factors have been identified for ASCVD; however, elevated low-density lipoprotein cholesterol (LDL-C) remains the gold standard. Cholesterol metabolism at the cellular and whole-body level is maintained by an array of interacting components. These regulatory mechanisms have complex behavior. Likewise, the mechanisms which underpin atherogenesis are nontrivial and multifaceted. To help overcome the challenge of investigating these processes mathematical modeling, which is a core constituent of the systems biology paradigm has played a pivotal role in deciphering their dynamics. In so doing models have revealed new insights about the key drivers of ASCVD. The aim of this review is fourfold; to provide an overview of cholesterol metabolism and atherosclerosis, to briefly introduce mathematical approaches used in this field, to critically discuss models of cholesterol metabolism and atherosclerosis, and to highlight areas where mathematical modeling could help to investigate in the future. This article is categorized under: Cardiovascular Diseases > Computational Models.
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Simonetto C, Rospleszcz S, Heier M, Meisinger C, Peters A, Kaiser JC. Simulating the dynamics of atherosclerosis to the incidence of myocardial infarction, applied to the KORA population. Stat Med 2021; 40:3299-3312. [PMID: 34008245 DOI: 10.1002/sim.8951] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/08/2021] [Accepted: 02/28/2021] [Indexed: 11/11/2022]
Abstract
Analyzing epidemiological data with simplified mathematical models of disease development provides a link between the time-course of incidence and the underlying biological processes. Here we point out that considerable modeling flexibility is gained if the model is solved by simulation only. To this aim, a model of atherosclerosis is proposed: a Markov Chain with continuous state space which represents the coronary artery intimal surface area involved with atherosclerotic lesions of increasing severity. Myocardial infarction rates are assumed to be proportional to the area of most severe lesions. The model can be fitted simultaneously to infarction incidence rates observed in the KORA registry, and to the age-dependent prevalence and extent of atherosclerotic lesions in the PDAY study. Moreover, the simulation approach allows for non-linear transition rates, and to consider at the same time randomness and inter-individual heterogeneity. Interestingly, the fit revealed significant age dependence of parameters in females around the age of menopause, qualitatively reproducing the known vascular effects of female sex hormones. For males, the incidence curve flattens for higher ages. According to the model, frailty explains this flattening only partially, and saturation of the disease process plays also an important role. This study shows the feasibility of simulating subclinical and epidemiological data with the same mathematical model. The approach is very general and may be extended to investigate the effects of risk factors or interventions. Moreover, it offers an interface to integrate quantitative individual health data as assessed, for example, by imaging.
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Affiliation(s)
- Cristoforo Simonetto
- Institute of Radiation Medicine, Helmholtz Zentrum München German Research Center for Environmental Health (GmbH), Munich, Germany
| | - Susanne Rospleszcz
- Institute of Epidemiology, Helmholtz Zentrum München German Research Center for Environmental Health (GmbH), Munich, Germany.,Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Cardiovascular Disease (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Margit Heier
- Institute of Epidemiology, Helmholtz Zentrum München German Research Center for Environmental Health (GmbH), Munich, Germany.,KORA Study Centre, University Hospital of Augsburg, Augsburg, Germany
| | - Christa Meisinger
- MONICA/KORA Myocardial Infarction Registry, University Hospital of Augsburg, Augsburg, Germany.,Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T, Munich, Germany.,Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München German Research Center for Environmental Health (GmbH), Munich, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München German Research Center for Environmental Health (GmbH), Munich, Germany.,Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Cardiovascular Disease (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Jan Christian Kaiser
- Institute of Radiation Medicine, Helmholtz Zentrum München German Research Center for Environmental Health (GmbH), Munich, Germany
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Simonetto C, Heier M, Rospleszcz S, Meisinger C, Then C, Seißler J, Peters A, Kaiser JC. Risk for cardiovascular events responds nonlinearly to carotid intima-media thickness in the KORA F4 study. Atherosclerosis 2020; 296:32-39. [PMID: 32005003 DOI: 10.1016/j.atherosclerosis.2020.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/02/2019] [Accepted: 01/15/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIMS Risk assessment studies on the impact of carotid intima-media thickness (CIMT) on cardiovascular events (CVEs) often apply a linear relationship in Cox models of proportional hazards. However, CVEs are mostly induced through rupture of plaques driven by nonlinear mechanical properties of the arterial wall. Hence, the risk response might be nonlinear as well and should be detectable in CVE incidence data when associated with CIMT as surrogate variable for atherosclerotic wall degeneration. METHODS To test this hypothesis, we investigate the KORA F4 study comprising 2580 participants with CIMT measurements and 153 first CVEs (86 strokes and 67 myocardial infarctions). CIMT is only a moderate predictor of CVE risk due to confounding by attained age. Biological evidence suggests that age-related CIMT growth is not entirely connected with atherosclerosis. To explore the complex relations between age, CIMT and CVE risk, we apply linear and nonlinear models of both CIMT and dnCIMT, defined as deviation from a sex and age-adjusted normal value. RESULTS Based on goodness-of-fit and biological plausibility, threshold and logistic step models clearly reveal nonlinear risk response relations for vascular covariables CIMT and dnCIMT. The effect is more pronounced for models involving dnCIMT as novel risk factor, which is not correlated with age. CONCLUSIONS Compared to the standard approach of risk assessment with linear models involving CIMT, the application of excess dnCIMT with nonlinear risk responses leads to a more precise identification of asymptomatic high risk patients, especially at younger age.
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Affiliation(s)
- Cristoforo Simonetto
- Helmholtz Zentrum München, Institute of Radiation Medicine, 85764, Oberschleißheim, Germany
| | - Margit Heier
- Helmholtz Zentrum München, Institute of Epidemiology, 85764, Oberschleißheim, Germany
| | - Susanne Rospleszcz
- Helmholtz Zentrum München, Institute of Epidemiology, 85764, Oberschleißheim, Germany
| | - Christa Meisinger
- Helmholtz Zentrum München, Institute of Epidemiology, 85764, Oberschleißheim, Germany; Chair of Epidemiology, Ludwig-Maximilians-University München, UNIKA-T Augsburg, Augsburg, Germany
| | - Cornelia Then
- Diabetes Centre, Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Clinical Cooperation Group Diabetes, Ludwig-Maximilians-Universität München and Helmholtz Zentrum München, Munich, Germany
| | - Jochen Seißler
- Diabetes Centre, Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany; Clinical Cooperation Group Diabetes, Ludwig-Maximilians-Universität München and Helmholtz Zentrum München, Munich, Germany
| | - Annette Peters
- Helmholtz Zentrum München, Institute of Epidemiology, 85764, Oberschleißheim, Germany; Chair of Epidemiology, Ludwig-Maximilians-University München, Munich, Germany
| | - Jan Christian Kaiser
- Helmholtz Zentrum München, Institute of Radiation Medicine, 85764, Oberschleißheim, Germany.
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Vaiserman A, Koliada A, Zabuga O, Socol Y. Health Impacts of Low-Dose Ionizing Radiation: Current Scientific Debates and Regulatory Issues. Dose Response 2018; 16:1559325818796331. [PMID: 30263019 PMCID: PMC6149023 DOI: 10.1177/1559325818796331] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 12/31/2022] Open
Abstract
Health impacts of low-dose ionizing radiation are significant in important fields such as X-ray imaging, radiation therapy, nuclear power, and others. However, all existing and potential applications are currently challenged by public concerns and regulatory restrictions. We aimed to assess the validity of the linear no-threshold (LNT) model of radiation damage, which is the basis of current regulation, and to assess the justification for this regulation. We have conducted an extensive search in PubMed. Special attention has been given to papers cited in comprehensive reviews of the United States (2006) and French (2005) Academies of Sciences and in the United Nations Scientific Committee on Atomic Radiation 2016 report. Epidemiological data provide essentially no evidence for detrimental health effects below 100 mSv, and several studies suggest beneficial (hormetic) effects. Equally significant, many studies with in vitro and in animal models demonstrate that several mechanisms initiated by low-dose radiation have beneficial effects. Overall, although probably not yet proven to be untrue, LNT has certainly not been proven to be true. At this point, taking into account the high price tag (in both economic and human terms) borne by the LNT-inspired regulation, there is little doubt that the present regulatory burden should be reduced.
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