1
|
Zhang D, Li Y, Pan J, Zheng Y, Xu X. Copper homeostasis and cuproptosis in radiation-induced injury. Biomed Pharmacother 2024; 178:117150. [PMID: 39047417 DOI: 10.1016/j.biopha.2024.117150] [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: 05/01/2024] [Revised: 07/10/2024] [Accepted: 07/12/2024] [Indexed: 07/27/2024] Open
Abstract
Radiation therapy for cancer treatment brings about a series of radiation injuries to normal tissues. In recent years, the discovery of copper-regulated cell death, cuproptosis, a novel form of programmed cell death, has attracted widespread attention and exploration in various biological functions and pathological mechanisms of copper metabolism and cuproptosis. Understanding its role in the process of radiation injury may open up new avenues and directions for exploration in radiation biology and radiation oncology, thereby improving tumor response and mitigating adverse reactions to radiotherapy. This review provides an overview of copper metabolism, the characteristics of cuproptosis, and their potential regulatory mechanisms in radiation injury.
Collapse
Affiliation(s)
- Daoming Zhang
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Yuan Li
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Jinghui Pan
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Yongfa Zheng
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan 430060, China.
| | - Ximing Xu
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan 430060, China.
| |
Collapse
|
2
|
Lv X, Zhao N, Long S, Wang G, Ran X, Gao J, Wang J, Wang T. 3D skin bioprinting as promising therapeutic strategy for radiation-associated skin injuries. Wound Repair Regen 2024; 32:217-228. [PMID: 38602068 DOI: 10.1111/wrr.13181] [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: 10/29/2023] [Revised: 02/16/2024] [Accepted: 04/01/2024] [Indexed: 04/12/2024]
Abstract
Both cutaneous radiation injury and radiation combined injury (RCI) could have serious skin traumas, which are collectively referred to as radiation-associated skin injuries in this paper. These two types of skin injuries require special managements of wounds, and the therapeutic effects still need to be further improved. Cutaneous radiation injuries are common in both radiotherapy patients and victims of radioactive source accidents, which could lead to skin necrosis and ulcers in serious conditions. At present, there are still many challenges in management of cutaneous radiation injuries including early diagnosis, lesion assessment, and treatment prognosis. Radiation combined injuries are special and important issues in severe nuclear accidents, which often accompanied by serious skin traumas. Mass victims of RCI would be the focus of public health concern. Three-dimensional (3D) bioprinting, as a versatile and favourable technique, offers effective approaches to fabricate biomimetic architectures with bioactivity, which provides potentials for resolve the challenges in treating radiation-associated skin injuries. Combining with the cutting-edge advances in 3D skin bioprinting, the authors analyse the damage characteristics of skin wounds in both cutaneous radiation injury and RCI and look forward to the potential value of 3D skin bioprinting for the treatments of radiation-associated skin injuries.
Collapse
Affiliation(s)
- Xiaofan Lv
- State Key Laboratory of Trauma and Chemical Poisoning, Institute of Combined Injury, School of Preventive Military Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Na Zhao
- State Key Laboratory of Trauma and Chemical Poisoning, Institute of Combined Injury, School of Preventive Military Medicine, Army Medical University (Third Military Medical University), Chongqing, China
- Institute of Materia Medica and Department of Pharmaceutics, College of Pharmacy, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shuang Long
- State Key Laboratory of Trauma and Chemical Poisoning, Institute of Combined Injury, School of Preventive Military Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Guojian Wang
- State Key Laboratory of Trauma and Chemical Poisoning, Institute of Combined Injury, School of Preventive Military Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xinze Ran
- State Key Laboratory of Trauma and Chemical Poisoning, Institute of Combined Injury, School of Preventive Military Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jining Gao
- State Key Laboratory of Trauma and Chemical Poisoning, Institute of Combined Injury, School of Preventive Military Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Junping Wang
- State Key Laboratory of Trauma and Chemical Poisoning, Institute of Combined Injury, School of Preventive Military Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Tao Wang
- State Key Laboratory of Trauma and Chemical Poisoning, Institute of Combined Injury, School of Preventive Military Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| |
Collapse
|
3
|
Wang Y, Chen S, Bao S, Yao L, Wen Z, Xu L, Chen X, Guo S, Pang H, Zhou Y, Zhou P. Deciphering the fibrotic process: mechanism of chronic radiation skin injury fibrosis. Front Immunol 2024; 15:1338922. [PMID: 38426100 PMCID: PMC10902513 DOI: 10.3389/fimmu.2024.1338922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
This review explores the mechanisms of chronic radiation-induced skin injury fibrosis, focusing on the transition from acute radiation damage to a chronic fibrotic state. It reviewed the cellular and molecular responses of the skin to radiation, highlighting the role of myofibroblasts and the significant impact of Transforming Growth Factor-beta (TGF-β) in promoting fibroblast-to-myofibroblast transformation. The review delves into the epigenetic regulation of fibrotic gene expression, the contribution of extracellular matrix proteins to the fibrotic microenvironment, and the regulation of the immune system in the context of fibrosis. Additionally, it discusses the potential of biomaterials and artificial intelligence in medical research to advance the understanding and treatment of radiation-induced skin fibrosis, suggesting future directions involving bioinformatics and personalized therapeutic strategies to enhance patient quality of life.
Collapse
Affiliation(s)
- Yiren Wang
- School of Nursing, Southwest Medical University, Luzhou, China
- Wound Healing Basic Research and Clinical Application Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China
| | - Shouying Chen
- School of Nursing, Southwest Medical University, Luzhou, China
- Wound Healing Basic Research and Clinical Application Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China
| | - Shuilan Bao
- School of Nursing, Southwest Medical University, Luzhou, China
- Wound Healing Basic Research and Clinical Application Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China
| | - Li Yao
- School of Nursing, Southwest Medical University, Luzhou, China
- Wound Healing Basic Research and Clinical Application Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China
| | - Zhongjian Wen
- School of Nursing, Southwest Medical University, Luzhou, China
- Wound Healing Basic Research and Clinical Application Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China
| | - Lixia Xu
- School of Nursing, Southwest Medical University, Luzhou, China
| | - Xiaoman Chen
- School of Nursing, Southwest Medical University, Luzhou, China
| | - Shengmin Guo
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Haowen Pang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yun Zhou
- School of Medical Information and Engineering, Southwest Medical University, Luzhou, China
| | - Ping Zhou
- Wound Healing Basic Research and Clinical Application Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| |
Collapse
|
4
|
Kurian AG, Singh RK, Sagar V, Lee JH, Kim HW. Nanozyme-Engineered Hydrogels for Anti-Inflammation and Skin Regeneration. NANO-MICRO LETTERS 2024; 16:110. [PMID: 38321242 PMCID: PMC10847086 DOI: 10.1007/s40820-024-01323-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/24/2023] [Indexed: 02/08/2024]
Abstract
Inflammatory skin disorders can cause chronic scarring and functional impairments, posing a significant burden on patients and the healthcare system. Conventional therapies, such as corticosteroids and nonsteroidal anti-inflammatory drugs, are limited in efficacy and associated with adverse effects. Recently, nanozyme (NZ)-based hydrogels have shown great promise in addressing these challenges. NZ-based hydrogels possess unique therapeutic abilities by combining the therapeutic benefits of redox nanomaterials with enzymatic activity and the water-retaining capacity of hydrogels. The multifaceted therapeutic effects of these hydrogels include scavenging reactive oxygen species and other inflammatory mediators modulating immune responses toward a pro-regenerative environment and enhancing regenerative potential by triggering cell migration and differentiation. This review highlights the current state of the art in NZ-engineered hydrogels (NZ@hydrogels) for anti-inflammatory and skin regeneration applications. It also discusses the underlying chemo-mechano-biological mechanisms behind their effectiveness. Additionally, the challenges and future directions in this ground, particularly their clinical translation, are addressed. The insights provided in this review can aid in the design and engineering of novel NZ-based hydrogels, offering new possibilities for targeted and personalized skin-care therapies.
Collapse
Affiliation(s)
- Amal George Kurian
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, 31116, Republic of Korea
- Department of Nanobiomedical Science & BK21 NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan, 31116, Republic of Korea
| | - Rajendra K Singh
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, 31116, Republic of Korea
- Department of Nanobiomedical Science & BK21 NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan, 31116, Republic of Korea
| | - Varsha Sagar
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, 31116, Republic of Korea
- Department of Nanobiomedical Science & BK21 NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan, 31116, Republic of Korea
| | - Jung-Hwan Lee
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, 31116, Republic of Korea
- Department of Nanobiomedical Science & BK21 NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan, 31116, Republic of Korea
- Department of Biomaterials Science, School of Dentistry, Dankook University, Cheonan, 31116, Republic of Korea
- UCL Eastman-Korea Dental Medicine Innovation Centre, Dankook University, Cheonan, 31116, Republic of Korea
- Cell and Matter Institute, Dankook University, Cheonan, 31116, Republic of Korea
- Mechanobiology Dental Medicine Research Center, Dankook University, Cheonan, 31116, Republic of Korea
| | - Hae-Won Kim
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, 31116, Republic of Korea.
- Department of Nanobiomedical Science & BK21 NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan, 31116, Republic of Korea.
- Department of Biomaterials Science, School of Dentistry, Dankook University, Cheonan, 31116, Republic of Korea.
- UCL Eastman-Korea Dental Medicine Innovation Centre, Dankook University, Cheonan, 31116, Republic of Korea.
- Cell and Matter Institute, Dankook University, Cheonan, 31116, Republic of Korea.
- Mechanobiology Dental Medicine Research Center, Dankook University, Cheonan, 31116, Republic of Korea.
| |
Collapse
|
5
|
Binici S, Güven M, Özdemir A, İlik ZA, Demirhan B, Uygur S, İliklerden ÜH. Addressing radiotherapy-induced fibrosis: the potential of platelet-rich plasma and infliximab for improved breast cancer management. Histochem Cell Biol 2024:10.1007/s00418-024-02267-z. [PMID: 38282055 DOI: 10.1007/s00418-024-02267-z] [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: 01/09/2024] [Indexed: 01/30/2024]
Abstract
Breast cancer treatment encompasses various therapeutic modalities, including surgery, radiotherapy, and chemotherapy. Breast-conserving surgery has been an integral part of breast cancer management. However, radiotherapy, an important component of breast cancer management, can lead to complications, particularly fibrosis, affecting reconstructive surgery outcomes. We conducted an in vivo study using 48 female Wistar Albino rats, employing segmental mastectomy and radiotherapy to simulate post-mastectomy conditions. The rats were divided into six groups: control, mastectomy, mastectomy + radiotherapy, mastectomy + platelet-rich plasma (PRP) + radiotherapy, mastectomy + infliximab + radiotherapy, and mastectomy + infliximab + PRP + radiotherapy. Edema, hyperemia, inflammation, and fibrosis were assessed as indicators of tissue response. Histopathological analysis revealed that mastectomy + infliximab and mastectomy + infliximab + PRP groups showed significant reductions in fibrosis compared to other groups. Edema, hyperemia, and inflammation were also less severe in these groups compared to the control group. Radiotherapy-induced fibrosis is a major concern in breast reconstruction. Our study suggests that local PRP application and systemic infliximab administration, either alone or in combination, could mitigate the adverse effects of radiotherapy. This approach has the potential to improve reconstructive outcomes in patients undergoing or having the possibility to undergo radiotherapy. This is the first study showing the effectiveness of infliximab and PRP combination on wound healing. The provided experimental rat model might offer guidance for further research. This study provides insights into optimizing outcomes in reconstructive breast surgery, paving the way for further research and clinical studies.
Collapse
Affiliation(s)
- Serhat Binici
- General Surgery Department, Şırnak State Hospital, Şırnak, Turkey.
| | - Mustafa Güven
- Faculty of Medicine, Van Yuzuncu Yıl University, Van, Turkey
| | - Abdulselam Özdemir
- Faculty of Medicine, Department of General Surgery, Van Yuzuncu Yıl University, Van, Turkey
| | - Zehra Akman İlik
- Department of Pathology, Van Education and Research Hospital, Van, Turkey
| | - Birhan Demirhan
- Faculty of Medicine, Department of Radiation Oncology, Van Yuzuncu Yıl University, Van, Turkey
| | - Serhat Uygur
- Faculty of Medicine, Van Yuzuncu Yıl University, Van, Turkey
| | - Ümit Haluk İliklerden
- Faculty of Medicine, Department of General Surgery, Van Yuzuncu Yıl University, Van, Turkey
| |
Collapse
|
6
|
Hassan AM, Asaad M, Morris N, Kumar S, Liu J, Mitchell MP, Shuck JW, Clemens MW, Butler CE, Selber JC. Subpectoral Implant Placement Is Not Protective against Postmastectomy Radiotherapy-Related Complications Compared to Prepectoral Placement. Plast Reconstr Surg 2024; 153:24-33. [PMID: 37010459 DOI: 10.1097/prs.0000000000010489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
BACKGROUND Postmastectomy radiotherapy (PMRT) is associated with altered cosmetic outcomes and higher complication rates in implant-based breast reconstruction (IBR). Conventional wisdom suggests that muscle coverage is somewhat protective against PMRT-related complications. In this study, the authors compared surgical outcomes in patients who underwent two-stage prepectoral versus subpectoral IBR in the setting of PMRT. METHODS The authors performed a retrospective cohort study of patients who underwent mastectomy and PMRT with two-stage IBR from 2016 to 2019. The primary outcome was breast-related complications, including device infection; the secondary outcome was device explantation. RESULTS The authors identified 179 reconstructions (101 prepectoral and 78 subpectoral) in 172 patients with a mean follow-up time of 39.7 ± 14.4 months. There were no differences between the prepectoral and subpectoral reconstructions in rates of breast-related complications (26.7% and 21.8%, respectively; P = 0.274), device infection (18.8% and 15.4%, respectively; P = 0.307), skin flap necrosis (5.0% and 1.3%, respectively; P = 0.232), or device explantation (20.8% and 14.1%, respectively; P = 0.117). In adjusted models, compared with prepectoral device placement, subpectoral device placement was not associated with a lower risk of breast-related complications [hazard ratio (HR), 0.75; 95% confidence interval (CI), 0.41 to 1.36], device infection (HR, 0.73; 95% CI, 0.35 to 1.49), or device explantation (HR, 0.58; 95% CI, 0.28 to 1.19). CONCLUSIONS Device placement plane was not predictive of complication rates in IBR in the setting of PMRT. Two-stage prepectoral IBR provides safe long-term outcomes with acceptable postoperative complication rates comparable to those with subpectoral IBR, even in the setting of PMRT. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
Collapse
Affiliation(s)
- Abbas M Hassan
- From the Departments of Plastic and Reconstructive Surgery
| | - Malke Asaad
- From the Departments of Plastic and Reconstructive Surgery
| | | | | | - Jun Liu
- From the Departments of Plastic and Reconstructive Surgery
| | | | - John W Shuck
- From the Departments of Plastic and Reconstructive Surgery
| | - Mark W Clemens
- From the Departments of Plastic and Reconstructive Surgery
| | | | - Jesse C Selber
- From the Departments of Plastic and Reconstructive Surgery
| |
Collapse
|
7
|
Wang X, Lu Y, Cheng X, Zhu X, Li D, Duan H, Hu S, Xiao F, Du L, Zhang Q. Local Multiple-site Injections of a Plasmid Encoding Human MnSOD Mitigate Radiation-induced Skin Injury by Inhibiting Ferroptosis. Curr Drug Deliv 2024; 21:763-774. [PMID: 37157191 DOI: 10.2174/1567201820666230508120720] [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: 09/24/2022] [Revised: 03/04/2023] [Accepted: 03/22/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Most patients who undergo radiotherapy develop radiation skin injury, for which effective treatment is urgently needed. MnSOD defends against reactive oxygen species (ROS) damage and may be valuable for treating radiation-induced injury. Here, we (i) investigated the therapeutic and preventive effects of local multiple-site injections of a plasmid, encoding human MnSOD, on radiation-induced skin injury in rats and (ii) explored the mechanism underlying the protective effects of pMnSOD. METHODS The recombinant plasmid (pMnSOD) was constructed with human cytomegalovirus (CMV) promoter and pUC-ori. The protective effects of pMnSOD against 20-Gy X-ray irradiation were evaluated in human keratinocytes (HaCaT cells) by determining cell viability, ROS levels, and ferroptosisrelated gene expression. In therapeutic treatment, rats received local multiple-site injections of pMnSOD on days 12, 19, and 21 after 40-Gy γ-ray irradiation. In preventive treatment, rats received pMnSOD injections on day -3 pre-irradiation and on day 4 post-irradiation. The skin injuries were evaluated based on the injury score and pathological examination, and ferroptosis-related gene expression was determined. RESULTS In irradiated HaCaT cells, pMnSOD transfection resulted in an increased SOD2 expression, reduced intracellular ROS levels, and increased cell viability. Moreover, GPX4 and SLC7A11 expression was significantly upregulated, and erastin-induced ferroptosis was inhibited in HaCaT cells. In the therapeutic and prevention treatment experiments, pMnSOD administration produced local SOD protein expression and evidently promoted the healing of radiation-induced skin injury. In the therapeutic treatment experiments, the injury score in the high-dose pMnSOD group was significantly lower than in the PBS group on day 33 post-irradiation (1.50 vs. 2.80, P < 0.05). In the prevention treatment experiments, the skin injury scores were much lower in the pMnSOD administration groups than in the PBS group from day 21 to day 34. GPX4, SLC7A11, and Bcl-2 were upregulated in irradiated skin tissues after pMnSOD treatment, while ACSL4 was downregulated. CONCLUSION The present study provides evidence that the protective effects of MnSOD in irradiated HaCaT cells may be related to the inhibition of ferroptosis. The multi-site injections of pMnSOD had clear therapeutic and preventive effects on radiation-induced skin injury in rats. pMnSOD may have therapeutic value for the treatment of radiation-induced skin injury.
Collapse
Affiliation(s)
- Xiaoying Wang
- College of Chemistry and Environmental Sciences, Hebei University, Baoding, Hebei, China
- Beijing Institute of Radiation Medicine, Beijing, China
| | - Yuxin Lu
- Beijing Institute of Radiation Medicine, Beijing, China
| | | | - Xuefeng Zhu
- Beijing Institute of Radiation Medicine, Beijing, China
| | - Dujuan Li
- Beijing Institute of Radiation Medicine, Beijing, China
| | - Haiying Duan
- Beijing Institute of Radiation Medicine, Beijing, China
| | - Shenhui Hu
- Beijing Institute of Radiation Medicine, Beijing, China
| | - Fengjun Xiao
- Beijing Institute of Radiation Medicine, Beijing, China
| | - Li Du
- Beijing Institute of Radiation Medicine, Beijing, China
| | - Qinglin Zhang
- Beijing Institute of Radiation Medicine, Beijing, China
| |
Collapse
|
8
|
Dong J, Ren B, Tian Y, Peng G, Zhai H, Meng Z, Gu R, Gan H, Wu Z, Sun Y, Dou G, Liu S. Effects of Radiation-Induced Skin Injury on Hyaluronan Degradation and Its Underlying Mechanisms. Molecules 2023; 28:7449. [PMID: 37959868 PMCID: PMC10647323 DOI: 10.3390/molecules28217449] [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: 09/21/2023] [Revised: 10/28/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
Radiation-induced skin injury (RISI) is a frequent and severe complication with a complex pathogenesis that often occurs during radiation therapy, nuclear incidents, and nuclear war, for which there is no effective treatment. Hyaluronan (HA) plays an overwhelming role in the skin, and it has been shown that UVB irradiation induces increased HA expression. Nevertheless, to the best of our knowledge, there has been no study regarding the biological correlation between RISI and HA degradation and its underlying mechanisms. Therefore, in our study, we investigated low-molecular-weight HA content using an enzyme-linked immunosorbent assay and changes in the expression of HA-related metabolic enzymes using real-time quantitative polymerase chain reaction and a Western blotting assay. The oxidative stress level of the RISI model was assessed using sodium dismutase, malondialdehyde, and reactive oxygen species assays. We demonstrated that low-molecular-weight HA content was significantly upregulated in skin tissues during the late phase of irradiation exposure in the RISI model and that HA-related metabolic enzymes, oxidative stress levels, the MEK5/ERK5 pathway, and inflammatory factors were consistent with changes in low-molecular-weight HA content. These findings prove that HA degradation is biologically relevant to RISI development and that the HA degradation mechanisms are related to HA-related metabolic enzymes, oxidative stress, and inflammatory factors. The MEK5/ERK5 pathway represents a potential mechanism of HA degradation. In conclusion, we aimed to investigate changes in HA content and preliminarily investigate the HA degradation mechanism in a RISI model under γ-ray irradiation, to consider HA as a new target for RISI and provide ideas for novel drug development.
Collapse
Affiliation(s)
- Jiahui Dong
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China; (J.D.); (B.R.); (Z.M.); (R.G.); (H.G.); (Z.W.); (Y.S.)
| | - Boyuan Ren
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China; (J.D.); (B.R.); (Z.M.); (R.G.); (H.G.); (Z.W.); (Y.S.)
| | - Yunfei Tian
- School of Pharmacy, Henan University, Kaifeng 475004, China; (Y.T.); (H.Z.)
| | - Guanqun Peng
- College of Life Science, Hebei University, Baoding 071002, China;
| | - Huiting Zhai
- School of Pharmacy, Henan University, Kaifeng 475004, China; (Y.T.); (H.Z.)
| | - Zhiyun Meng
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China; (J.D.); (B.R.); (Z.M.); (R.G.); (H.G.); (Z.W.); (Y.S.)
| | - Ruolan Gu
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China; (J.D.); (B.R.); (Z.M.); (R.G.); (H.G.); (Z.W.); (Y.S.)
| | - Hui Gan
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China; (J.D.); (B.R.); (Z.M.); (R.G.); (H.G.); (Z.W.); (Y.S.)
| | - Zhuona Wu
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China; (J.D.); (B.R.); (Z.M.); (R.G.); (H.G.); (Z.W.); (Y.S.)
| | - Yunbo Sun
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China; (J.D.); (B.R.); (Z.M.); (R.G.); (H.G.); (Z.W.); (Y.S.)
| | - Guifang Dou
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China; (J.D.); (B.R.); (Z.M.); (R.G.); (H.G.); (Z.W.); (Y.S.)
| | - Shuchen Liu
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China; (J.D.); (B.R.); (Z.M.); (R.G.); (H.G.); (Z.W.); (Y.S.)
| |
Collapse
|
9
|
Sörgel CA, Cai A, Schmid R, Horch RE. Perspectives on the Current State of Bioprinted Skin Substitutes for Wound Healing. Biomedicines 2023; 11:2678. [PMID: 37893053 PMCID: PMC10604151 DOI: 10.3390/biomedicines11102678] [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: 08/09/2023] [Revised: 09/22/2023] [Accepted: 09/23/2023] [Indexed: 10/29/2023] Open
Abstract
Human skin is particularly vulnerable to external damaging influences such as irradiation, extreme temperatures, chemical trauma, and certain systemic diseases, which reduce the skin's capacity for regeneration and restoration and can possibly lead to large-scale skin defects. To restore skin continuity in severe cases, surgical interventions such as the transplantation of autologous tissue are needed. Nevertheless, the coverage of larger skin defects caused by severe third-grade burns or extensive irradiation therapy is limited due to the depletion of uninjured autologous tissue. In such cases, many of the patient's epidermal cells can become available using biofabricated skin grafts, thereby restoring the skin's vital functions. Given the limited availability of autologous skin grafts for restoring integrity in large-scale defects, using bioprinted constructs as skin graft substitutes could offer an encouraging therapeutic alternative to conventional therapies for large-scale wounds, such as the transplantation of autologous tissue. Using layer-by-layer aggregation or volumetric bioprinting, inkjet bioprinting, laser-assisted bioprinting, or extrusion-based bioprinting, skin cells are deposited in a desired pattern. The resulting constructs may be used as skin graft substitutes to accelerate wound healing and reconstitute the physiological functions of the skin. In this review, we aimed to elucidate the current state of bioprinting within the context of skin tissue engineering and introduce and discuss different bioprinting techniques, possible approaches and materials, commonly used cell types, and strategies for graft vascularization for the production of bioprinted constructs for use as skin graft substitutes.
Collapse
|
10
|
Ahmed SF, Saafan AM, Rasmy AH, Bakr MA. Histomorphometric Analysis of the Healing Capacity of Low-Level Laser on Thermally Induced Tongue Ulcers for Gamma-Irradiated Rats. Photobiomodul Photomed Laser Surg 2023; 41:467-474. [PMID: 37738367 DOI: 10.1089/photob.2023.0017] [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] [Indexed: 09/24/2023] Open
Abstract
Objective: This study aimed to assess the efficacy of low-level laser therapy (LLLT) for treating thermal tongue ulcers in gamma-irradiated rats. Background: Postradiotherapeutic trauma may cause cell death, tissue damage, organ dysfunction, and loss of hematological components. Materials and methods: Thermal ulcers were induced on the dorsal surfaces of tongues of gamma-irradiated rats (15 Gy). Rats were divided into three groups, group 1 received no treatment, group 2 was subjected to a single dose of diode laser 807 nm with energy density 4 J/cm2, and group 3 was subjected to the same dose of LLLT but fractionated into three sessions at days 1, 3, and 5 after ulcers induction. Ulcers were assessed clinically for their areas and healing percentage. Specimens were examined for the quality of ulcer closure and expression of IL-1β and TGF-β1. Results: Results revealed significant improvement of ulcer healing clinically and histologically in both treatment groups compared to control. Moreover, IL-1β and TGF-β1 expression in both treatment groups was high at the earlier stage of healing then declined by time to reach a normal level. However, untreated group showed higher expression of IL-1β and TGF-β1 compared to treatment groups. In addition, IL-1β expression decreased by time but still of high level and TGF-β1 expression increased then declined. Conclusions: We concluded that gamma radiation-impaired mucosal healing could be related to the over expression of IL-1β and TGF-β1. LLLT, whether one session or fractionated, could be an effective treatment for postradiotherapeutic ulcers. The healing power of LLLT might be due to modulation of IL-1β and TGF-β1. Clinical Trial Registration number is 25A122.
Collapse
Affiliation(s)
- Salwa Farid Ahmed
- Health Radiation Research Department, National Center for Radiation Research and Technology, Egyptian Atomic Energy Authority, Cairo, Egypt
| | - Ali Mohamed Saafan
- Medical Laser Applications Department, National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt
| | - Amr H Rasmy
- Health Radiation Research Department, National Center for Radiation Research and Technology, Egyptian Atomic Energy Authority, Cairo, Egypt
| | - Mostafa A Bakr
- Health Radiation Research Department, National Center for Radiation Research and Technology, Egyptian Atomic Energy Authority, Cairo, Egypt
| |
Collapse
|
11
|
Chen X, Qin W, Wang L, Jin Y, Tu J, Yuan X. Autophagy gene Atg7 regulates the development of radiation-induced skin injury and fibrosis of skin. Skin Res Technol 2023; 29:e13337. [PMID: 37357660 PMCID: PMC10230157 DOI: 10.1111/srt.13337] [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: 01/09/2023] [Accepted: 04/17/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Radiation-induced skin injury, which may progress to fibrosis, is a severe side effect of radiotherapy in patients with cancer. However, currently, there is a lack of preventive or curative treatments for this injury. Meanwhile, the mechanisms underlying this injury remain poorly understood. Here, we elucidated whether autophagy is essential for the development of radiation-induced skin injury and the potential molecular pathways and mechanisms involved. METHODS AND RESULTS We used the myofibroblast-specific Atg7 knockout (namely, conditional Atg7 knockout) mice irradiated with a single electron beam irradiation dose of 30 Gy. Vaseline-based 0.2% rapamycin ointment was topically applied once daily from the day of irradiation for 30 days. On day 30 post irradiation, skin tissues were harvested for further analysis. In vitro, human foreskin fibroblast cells were treated with rapamycin (100 nM) for 24 h and pretreated with 3-MA (5 mM) for 12 h. Macroscopic skin manifestations, histological changes, and fibrosis markers at the mRNA and protein expression levels were measured. Post irradiation, the myofibroblast-specific autophagy-deficient (Atg7Flox/Flox Cre+ ) mice had increased fibrosis marker (COL1A1, CTGF, TGF-β1, and α-SMA) levels in the irradiated area and had more severe macroscopic skin manifestations than the control group (Atg7Flox/Flox Cre- ) mice. Treatment with an autophagy agonist rapamycin attenuated macroscopic skin injury scores and skin fibrosis marker levels with decreased epidermal thickness and dermal collagen deposition in Atg7Flox/Flox Cre+ mice compared with the vehicle control. Moreover, in vitro experiment results were consistent with the in vivo results. Together with studies at the molecular level, we found that these changes involved the Akt/mTOR pathway. In addition, this phenomenon might also relate to Nrf2-autophagy signaling pathway under oxidative stress conditions. CONCLUSION In conclusion, Atg7 and autophagy-related mechanisms confer radioprotection, and reactivation of the autophagy process can be a novel therapeutic strategy to reduce and prevent the occurrence of radiodermatitis, particularly skin fibrosis, in patients with cancer.
Collapse
Affiliation(s)
- Xinyi Chen
- Department of OncologyTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
| | - Wan Qin
- Department of OncologyTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
| | - Lu Wang
- Department of OncologyTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
| | - Yu Jin
- Department of OncologyTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
| | - Jingyao Tu
- Department of OncologyTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
| | - Xianglin Yuan
- Department of OncologyTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
| |
Collapse
|
12
|
Ma L, Chen Y, Gong Q, Cheng Z, Ran C, Liu K, Shi C. Cold atmospheric plasma alleviates radiation-induced skin injury by suppressing inflammation and promoting repair. Free Radic Biol Med 2023; 204:184-194. [PMID: 37172912 DOI: 10.1016/j.freeradbiomed.2023.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/29/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023]
Abstract
Currently, there is no effective treatment for chronic skin radiation injury, which burdens patients significantly. Previous studies have shown that cold atmospheric plasma has an apparent therapeutic effect on acute and chronic skin injuries in clinical. However, whether CAP is effective for radiation-induced skin injury has not been reported. We created 35Gy X-ray radiation exposure within 3 * 3 cm2 region of the left leg of rats and applied CAP to the wound bed. Wound healing, cell proliferation and apoptosis were examined in vivo or vitro. CAP alleviated radiation-induced skin injury by enhancing proliferation and migration and cellular antioxidant stress and promoting DNA damage repair through regulated nuclear translocation of NRF2. In addition, CAP inhibited the proinflammatory factors' expression of IL-1β, TNF-α and temporarily increased the pro repair factor's expression of IL-6 in irradiated tissues. At the same time, CAP also changed the polarity of macrophages to a repair-promoting phenotype. Our finding suggested that CAP ameliorated radiation-induced skin injury by activating NRF2 and ameliorating the inflammatory response. Our work provided a preliminary theoretical foundation for the clinical administration of CAP in high-dose irradiated skin injury.
Collapse
Affiliation(s)
- Le Ma
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
| | - Yan Chen
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
| | - Qiang Gong
- Department of Hematology, Southwest Hospital, First Affiliated Hospital of the Army Medical University, Chongqing, 400038, China.
| | - Zhuo Cheng
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
| | - Congfu Ran
- The State Key Laboratory of Power Transmission Equipment & System Security and New Technology, Chongqing University, Chongqing, China.
| | - Kun Liu
- The State Key Laboratory of Power Transmission Equipment & System Security and New Technology, Chongqing University, Chongqing, China.
| | - Chunmeng Shi
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
| |
Collapse
|
13
|
Wilson B, Shah R, Menzer C, Aleisa A, Rossi A. Laser therapy as a treatment for chronic radiation fibrosis. Lasers Surg Med 2023; 55:82-88. [PMID: 36349748 PMCID: PMC10099494 DOI: 10.1002/lsm.23617] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chronic radiation fibrosis (CRF) is a long-term sequala of radiation therapy that has a significant impact on patient quality of life. There is no standard of care or single therapeutic modality that has been found to be consistently effective. OBJECTIVE To describe our experience using fractional 10,600 nm carbon dioxide (CO2 ) laser therapy and vascular laser therapy in a series of patients with CRF. METHODS Patients presenting to the dermatology service for CRF were evaluated for laser therapy eligibility. Patients were eligible if they had a clinical diagnosis of CRF confirmed by physical examination. RESULTS We identified five patients with CRF treated with fractional ablative CO2 laser and vascular laser. Patients were a median age of 57 years old, and the amount of time between the initiation of radiotherapy and laser treatment ranged between 3 months and 40 years. The satisfactory response was achieved in all cases. LIMITATIONS Lack of standardized laser protocol, small sample size, lack of a control group, different anatomical locations CONCLUSION: Fractional ablative and vascular laser therapy may serve as an additional treatment for CRF, leading to functional improvements.
Collapse
Affiliation(s)
- Britney Wilson
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Rohan Shah
- Department of Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Christian Menzer
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Abdullah Aleisa
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Anthony Rossi
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Dermatology, Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
14
|
Feng Z, Zhang Y, Yang C, Liu X, Huangfu Y, Zhang C, Huang P, Dong A, Liu J, Liu J, Kong D, Wang W. Bioinspired and Inflammation-Modulatory Glycopeptide Hydrogels for Radiation-Induced Chronic Skin Injury Repair. Adv Healthc Mater 2023; 12:e2201671. [PMID: 36183357 DOI: 10.1002/adhm.202201671] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/19/2022] [Indexed: 02/03/2023]
Abstract
Clinical wound management of radiation-induced skin injury (RSI) remains a great challenge due to acute injuries induced by excessive reactive oxygen species (ROS), and the concomitant repetitive inflammatory microenvironment caused by an imbalance in macrophage homeostasis. Herein, a cutaneous extracellular matrix (ECM)-inspired glycopeptide hydrogel (GK@TAgel ) is rationally designed for accelerating wound healing through modulating the chronic inflammation in RSI. The glycopeptide hydrogel not only replicates ECM-like glycoprotein components and nanofibrous architecture, but also displays effective ROS scavenging and radioprotective capability that can reduce the acute injuries after exposure to irradiation. Importantly, the mannose receptor (MR) in GK@TAgel exhibits high affinity and bioactivity to drive the M2 macrophage polarization, thereby overcoming the persistent inflammatory microenvironment in chronic RSI. The repair of RSI in mice demonstrates that GK@TAgel significantly reduces the hyperplasia of epithelial, promotes appendage regeneration and angiogenesis, and decreased the proinflammatory cytokine expression, which is superior to the treatment of commercial radioprotective drug amifostine. Collectively, the ECM-mimetic hydrogel dressing can protect the tissue from irradiation and heal the chronic wound in RSI, holding great potential in clinical wound management and tissue regeneration.
Collapse
Affiliation(s)
- Zujian Feng
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300192, China
| | - Yumin Zhang
- Key Laboratory of Radiopharmacokinetics for Innovative Drugs, Chinese Academy of Medical Sciences, and Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300192, China
| | - Chunfang Yang
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300192, China
| | - Xiang Liu
- Department of Polymer Science and Engineering, Key Laboratory of Systems Bioengineering (Ministry of Education), School of Chemical Engineering and Technology, Tianjin University, Tianjin, 300072, China
| | - Yini Huangfu
- Department of Polymer Science and Engineering, Key Laboratory of Systems Bioengineering (Ministry of Education), School of Chemical Engineering and Technology, Tianjin University, Tianjin, 300072, China
| | - Chuangnian Zhang
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300192, China
| | - Pingsheng Huang
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300192, China
| | - Anjie Dong
- Department of Polymer Science and Engineering, Key Laboratory of Systems Bioengineering (Ministry of Education), School of Chemical Engineering and Technology, Tianjin University, Tianjin, 300072, China
| | - Jinjian Liu
- Key Laboratory of Radiopharmacokinetics for Innovative Drugs, Chinese Academy of Medical Sciences, and Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300192, China
| | - Jianfeng Liu
- Key Laboratory of Radiopharmacokinetics for Innovative Drugs, Chinese Academy of Medical Sciences, and Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300192, China
| | - Deling Kong
- State Key Laboratory of Medicinal Chemical Biology, College of Life Sciences, Nankai University, Tianjin, 300071, China
| | - Weiwei Wang
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300192, China.,Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, Beijing, 100144, China
| |
Collapse
|
15
|
Zhang L, Du W, Li X, Ling G, Zhang P. Dissolving microneedles based on polysaccharide for dermatological diseases therapy. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
16
|
Park HR, Lee JH, Ji HJ, Lim S, Ahn KB, Seo HS. Radioprotection of deinococcal exopolysaccharide BRD125 by regenerating hematopoietic stem cells. Front Oncol 2022; 12:898185. [PMID: 36226052 PMCID: PMC9549790 DOI: 10.3389/fonc.2022.898185] [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: 03/17/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
There is a substantial need for the development of biomaterials for protecting hematopoietic stem cells and enhancing hematopoiesis after radiation damage. Bacterial exopolysaccharide (EPS) has been shown to be very attractive to researchers as a radioprotectant owing to its high antioxidant, anti-cancer, and limited adverse effects. In the present study, we isolated EPS from a novel strain, Deinococcus radiodurans BRD125, which produces EPS in high abundance, and investigated its applicability as a radioprotective biomaterial. We found that EPS isolated from EPS-rich D. radiodurans BRD125 (DeinoPol-BRD125) had an excellent free-radical scavenging effect and reduced irradiation-induced apoptosis. In addition, bone-marrow and spleen-cell apoptosis in irradiated mice were significantly reduced by DeinoPol-BRD125 administration. DeinoPol-BRD125 enhanced the expression of hematopoiesis-related cytokines such as GM-CSF, G-GSF, M-CSF, and SCF, thereby enhancing hematopoietic stem cells protection and regeneration. Taken together, our findings are the first to report the immunological mechanism of a novel radioprotectant, DeinoPol-BRD125, which might constitute an ideal radioprotective and radiation mitigating agent as a supplement drug during radiotherapy.
Collapse
Affiliation(s)
- Hae Ran Park
- Research Division for Radiation Science, Korea Atomic Energy Research Institute, Jeongeup, South Korea
- *Correspondence: Ho Seong Seo, ; Hae Ran Park,
| | - Ji Hee Lee
- Research Division for Radiation Science, Korea Atomic Energy Research Institute, Jeongeup, South Korea
- Division of Pathogen Resource Management, Center for Public Vaccine Development Support, National Institute of Infectious Diseases, National Institute of Health (NIH), Korea Disease Control and Prevention Agency, Cheongju, South Korea
| | - Hyun Jung Ji
- Research Division for Radiation Science, Korea Atomic Energy Research Institute, Jeongeup, South Korea
- Department of Oral Microbiology and Immunology, DRI, and BK21 Plus Program, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Sangyong Lim
- Research Division for Radiation Science, Korea Atomic Energy Research Institute, Jeongeup, South Korea
- Department of Radiation Science, University of Science and Technology, Daejeon, South Korea
| | - Ki Bum Ahn
- Research Division for Radiation Science, Korea Atomic Energy Research Institute, Jeongeup, South Korea
| | - Ho Seong Seo
- Research Division for Radiation Science, Korea Atomic Energy Research Institute, Jeongeup, South Korea
- Department of Radiation Science, University of Science and Technology, Daejeon, South Korea
- *Correspondence: Ho Seong Seo, ; Hae Ran Park,
| |
Collapse
|
17
|
Transcriptomics of Wet Skin Biopsies Predict Early Radiation-Induced Hematological Damage in a Mouse Model. Genes (Basel) 2022; 13:genes13030538. [PMID: 35328091 PMCID: PMC8952434 DOI: 10.3390/genes13030538] [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: 02/02/2022] [Revised: 02/28/2022] [Accepted: 03/16/2022] [Indexed: 12/04/2022] Open
Abstract
The lack of an easy and fast radiation-exposure testing method with a dosimetric ability complicates triage and treatment in response to a nuclear detonation, radioactive material release, or clandestine exposure. The potential of transcriptomics in radiation diagnosis and prognosis were assessed here using wet skin (blood/skin) biopsies obtained at hour 2 and days 4, 7, 21, and 28 from a mouse radiation model. Analysis of significantly differentially transcribed genes (SDTG; p ≤ 0.05 and FC ≥ 2) during the first post-exposure week identified the glycoprotein 6 (GP-VI) signaling, the dendritic cell maturation, and the intrinsic prothrombin activation pathways as the top modulated pathways with stable inactivation after lethal exposures (20 Gy) and intermittent activation after sublethal (1, 3, 6 Gy) exposure time points (TPs). Interestingly, these pathways were inactivated in the late TPs after sublethal exposure in concordance with a delayed deleterious effect. Modulated transcription of a variety of collagen types, laminin, and peptidase genes underlay the modulated functions of these hematologically important pathways. Several other SDTGs related to platelet and leukocyte development and functions were identified. These results outlined genetic determinants that were crucial to clinically documented radiation-induced hematological and skin damage with potential countermeasure applications.
Collapse
|
18
|
Min K, Jeon DN, Han HH, Kim EK, Eom JS. Inframammary Fold Approach for Second-stage Operation in Expander-Implant Breast Reconstruction. Ann Plast Surg 2021; 87:501-505. [PMID: 33346535 DOI: 10.1097/sap.0000000000002629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite expander-based breast reconstruction being used as a reliable reconstruction method, implant removal due to wound dehiscence and infection still occurs in 0.5% to 15% of cases. This study aimed to compare the outcomes of the new inframammary fold (IMF) incision approach with previous incision in second-stage operation of expander-based 2-stage breast reconstruction. METHODS Patients who underwent expander-based 2-stage breast reconstruction between February 2014 and May 2019 were included. After expander inflation, patients undergoing second-stage reconstruction were divided into the previous incision and IMF incision groups and their outcomes were compared. Propensity score matching analysis was performed to compare postoperative 1-year results. RESULTS The previous incision and IMF incision groups comprised 79 and 31 patients, respectively. There were no intergroup differences in general demographics or intraoperative data, except for total inflation volume (426.87 ± 102.63 mL in the previous incision group and 375.48 ± 94.10 mL in the IMF incision group, P = 0.017). Wound dehiscence occurred in 12 and 0 cases in the previous and IMF incision groups, respectively (P = 0.018). Implant removal was performed due to dehiscence in 9 cases (8.18%) and 0 cases (0%) in the previous and IMF incision groups, respectively (P = 0.049). In 1-to-1 propensity score matching analysis, the IMF incision group showed better results at 1-year follow-up (odds ratio: 0, 95% confidence interval: 0-1.09; P = 0.063). CONCLUSIONS The IMF approach is a safe method for replacing the expander with an implant, with lower incidence of wound dehiscence and implant explantation.
Collapse
Affiliation(s)
- Kyunghyun Min
- From the Department of Plastic Surgery, Asan Medical Center, University of Ulsan, School of Medicine, Seoul, Republic of Korea
| | | | | | | | | |
Collapse
|
19
|
Deleon NMD, Adem S, Lavin CV, Abbas DB, Griffin M, King ME, Borrelli MR, Patel RA, Fahy EJ, Lee D, Shen AH, Momeni A, Longaker MT, Wan DC. Angiogenic CD34+CD146+ adipose-derived stromal cells augment recovery of soft tissue after radiotherapy. J Tissue Eng Regen Med 2021; 15:1105-1117. [PMID: 34582109 DOI: 10.1002/term.3253] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/26/2021] [Accepted: 08/31/2021] [Indexed: 12/12/2022]
Abstract
Radiation therapy is effective for cancer treatment but may also result in collateral soft tissue contracture, contour deformities, and non-healing wounds. Autologous fat transfer has been described to improve tissue architecture and function of radiation-induced fibrosis and these effects may be augmented by enrichment with specific adipose-derived stromal cells (ASCs) with enhanced angiogenic potential. CD34+CD146+, CD34+CD146-, or CD34+ unfractionated human ASCs were isolated by flow cytometry and used to supplement human lipoaspirate placed beneath the scalp of irradiated mice. Volume retention was followed radiographically and fat grafts as well as overlying soft tissue were harvested after eight weeks for histologic and biomechanical analyses. Radiographic evaluation revealed the highest volume retention in fat grafts supplemented with CD34+CD146+ ASCs, and these grafts were also found to have greater histologic integrity than other groups. Irradiated skin overlying CD34+CD146+ ASC-enriched grafts was significantly more vascularized than other treatment groups, had significantly less dermal thickness and collagen deposition, and the greatest improvement in fibrillin staining and return of elasticity. Radiation therapy obliterates vascularity and contributes to scarring and loss of tissue function. ASC-enrichment of fat grafts with CD34+CD146+ ASCs not only enhances fat graft vascularization and retention, but also significantly promotes improvement in overlying radiation-injured soft tissue. This regenerative effect on skin is highly promising for patients with impaired wound healing and deformities following radiotherapy.
Collapse
Affiliation(s)
- Nestor M Diaz Deleon
- Department of Surgery, Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Sandeep Adem
- Department of Surgery, Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Christopher V Lavin
- Department of Surgery, Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Darren B Abbas
- Department of Surgery, Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Michelle Griffin
- Department of Surgery, Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Megan E King
- Department of Surgery, Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Mimi R Borrelli
- Department of Surgery, Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Ronak A Patel
- Department of Surgery, Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Evan J Fahy
- Department of Surgery, Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Daniel Lee
- Department of Surgery, Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Abra H Shen
- Department of Surgery, Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Arash Momeni
- Department of Surgery, Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Michael T Longaker
- Department of Surgery, Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA.,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Derrick C Wan
- Department of Surgery, Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
20
|
Xue J, Yu C, Tang Y, Mo W, Tang Z, Sheng W, Jiao Y, Zhu W, Cao J. NF-E2-Related Factor 2 (Nrf2) Ameliorates Radiation-Induced Skin Injury. Front Oncol 2021; 11:680058. [PMID: 34568011 PMCID: PMC8461566 DOI: 10.3389/fonc.2021.680058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/30/2021] [Indexed: 11/13/2022] Open
Abstract
Radiation-induced skin injury (RISI) commonly occur in cancer patients who received radiotherapy and is one of the first clinical symptoms after suffering from nuclear exposure. Oxidative damage is the major causes of RISI. Nuclear factor erythroid 2-related factor 2 (Nrf2) is considered as a key mediator of the cellular antioxidant response. However, whether Nrf2 can alleviate RISI after high-dose irradiation remains unknown. In this study, we demonstrated that Nrf2-deficient (Nrf2-/-) mice were susceptible to high-dose irradiation and adenovirus-mediated overexpression of Nrf2 (ad-Nrf2) protected against radiation in skin cells. Overexpression of Nrf2 attenuated the severity of skin injury after high-dose electron beam irradiation. To uncover the mechanisms of Nrf2 involved in RISI, mRNA sequencing technology was performed to analyze the mRNA expression profiles of Ad-Nrf2 skin cells following radiation. The results revealed that a total of 127 genes were significantly changed, 55 genes were upregulated, and 72 genes were downregulated after Nrf2 overexpression. GSEA showed that Nrf2 was associated with positive regulation of genes involved in the reactive oxygen species pathway after radiation. Taken together, this study illustrated the role of Nrf2 in RISI and provided potentially strategies for ameliorating RISI.
Collapse
Affiliation(s)
- Jiao Xue
- State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, China.,Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China.,School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, China
| | - Chenxiao Yu
- State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, China.,School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, China.,Department of Radiotherapy and Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, China.,Institute of Radiation Oncology, Soochow University, Suzhou, China
| | - Yiting Tang
- State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, China.,School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, China
| | - Wei Mo
- State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, China.,School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, China
| | - Zhicheng Tang
- State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, China.,School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, China
| | - Wenjiong Sheng
- State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, China.,School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, China
| | - Yang Jiao
- State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, China.,School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, China
| | - Wei Zhu
- State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, China.,School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, China
| | - Jianping Cao
- State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, China.,School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, China
| |
Collapse
|
21
|
Zhao M, Wang C, Xie J, Ji C, Gu Z. Eco-Friendly and Scalable Synthesis of Fullerenols with High Free Radical Scavenging Ability for Skin Radioprotection. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2021; 17:e2102035. [PMID: 34337863 DOI: 10.1002/smll.202102035] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/26/2021] [Indexed: 06/13/2023]
Abstract
Radiation dermatitis is a common but torturous side effect during radiotherapy, which greatly decreases the life quality of patients and potentially results in detrimental cessation of tumor treatment. Fullerenol, known as "free radical sponge," is a great choice for skin radioprotection because of its broad-spectrum free radical scavenging performance, good chemical stability, and biosafety. In this work, a facile scalable and eco-friendly synthetic method of fullerenols by catalyst assistant mechanical chemistry strategy is provided. As no organic solvent or high concentration of acid and alkali is introduced to this synthetic system, large-scale (>20 g) production of fullerenols with high yield (>95%) is obtained and no complicated purification is required. Then, the skin radioprotective performance of fullerenols is systematically explored for the first time. In vitro results indicate that fullerenols significantly block the reactive oxygen species-induced damage and enhance the viability of irradiated human keratinocyte cells. In vivo experiments suggest that medical sodium hyaluronate hydrogels loaded with fullerenols are suitable for skin administration and powerfully mitigate radiodermatitis via effectively protecting epidermal stem cells. The work not only provides an efficient gram-scale and eco-friendly synthetic method of fullerenols, but also promotes the development of fullerenols as potential skin radioprotectors.
Collapse
Affiliation(s)
- Maoru Zhao
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100049, China
- Center of Materials Science and Optoelectronics Engineering, College of Materials Science and Optoelectronic Technology, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Chengyan Wang
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100049, China
- Center of Materials Science and Optoelectronics Engineering, College of Materials Science and Optoelectronic Technology, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Jiani Xie
- College of Pharmacy and Biological Engineering, Chengdu University, Chengdu, 610106, China
| | - Chao Ji
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100049, China
| | - Zhanjun Gu
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100049, China
- Center of Materials Science and Optoelectronics Engineering, College of Materials Science and Optoelectronic Technology, University of Chinese Academy of Sciences, Beijing, 100049, China
- GBA Research Innovation Institute for Nanotechnology, Guangdong, 510700, China
| |
Collapse
|
22
|
Fat Grafting in Radiation-Induced Soft-Tissue Injury: A Narrative Review of the Clinical Evidence and Implications for Future Studies. Plast Reconstr Surg 2021; 147:819-838. [PMID: 33776031 DOI: 10.1097/prs.0000000000007705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
SUMMARY Radiation-induced changes in skin and soft tissue result in significant cosmetic and functional impairment with subsequent decrease in quality of life. Fat grafting has emerged as a therapy for radiation-induced soft-tissue injury, and this narrative review aims to evaluate the current clinical evidence regarding its efficacy. A review was conducted to examine the current clinical evidence of fat grafting as a therapy for radiation-induced injury to the skin and soft tissue and to outline the clinical outcomes that can be used to more consistently quantify chronic radiation-induced injury in future clinical studies. The current clinical evidence regarding the efficacy of fat grafting to treat radiation-induced injury of the skin and soft tissue suggests that fat grafting increases skin softness and pliability, induces volume restoration, improves hair growth in areas of alopecia, reduces pain, and improves cosmetic and functional outcomes. However, literature in this field is far from robust and mired by the retrospective nature of the studies, lack of adequate controls, and inherent limitations of small case series and cohorts. A series of actions have been identified to strengthen future clinical data, including the need for physical examination using a validated scale, appropriate imaging, skin biomechanics and microcirculation testing, and histologic analysis. In conclusion, radiation-induced soft-tissue injury is a significant health burden that can lead to severe functional and aesthetic sequelae. Although still in a preliminary research phase, there is promising clinical evidence demonstrating the benefits of fat grafting to treat chronic changes after radiation therapy. Future clinical studies will require larger cohorts, adequate controls, and consistent use of objective measurements.
Collapse
|
23
|
Mesenchymal Stem Cells for Mitigating Radiotherapy Side Effects. Cells 2021; 10:cells10020294. [PMID: 33535574 PMCID: PMC7912747 DOI: 10.3390/cells10020294] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/19/2021] [Accepted: 01/29/2021] [Indexed: 12/14/2022] Open
Abstract
Radiation therapy for cancers also damages healthy cells and causes side effects. Depending on the dosage and exposure region, radiotherapy may induce severe and irreversible injuries to various tissues or organs, especially the skin, intestine, brain, lung, liver, and heart. Therefore, promising treatment strategies to mitigate radiation injury is in pressing need. Recently, stem cell-based therapy generates great attention in clinical care. Among these, mesenchymal stem cells are extensively applied because it is easy to access and capable of mesodermal differentiation, immunomodulation, and paracrine secretion. Here, we summarize the current attempts and discuss the future perspectives about mesenchymal stem cells (MSCs) for mitigating radiotherapy side effects.
Collapse
|
24
|
Mansouri V, Arjmand B, Rezaei Tavirani M, Razzaghi M, Rostami-Nejad M, Hamdieh M. Evaluation of Efficacy of Low-Level Laser Therapy. J Lasers Med Sci 2021; 11:369-380. [PMID: 33425286 DOI: 10.34172/jlms.2020.60] [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] [Indexed: 01/07/2023]
Abstract
Introduction: Given the inconsistencies in the literature regarding laser performance in non-surgical treatments, this study investigated the available literature to determine the advantages and disadvantages of low-power lasers in treating non-surgical complications and diseases. Methods: Authentic information from articles was extracted and evaluated to assess low-power laser performance for non-surgical treatments. A systematic search of studies on low-level laser therapy (LLLT) for non-surgical treatments was conducted mainly in PubMed and google scholar articles. Results: Four categories of diseases, including brain-related diseases, skin-related diseases, cancers, and bone-related disorders, which were treated by LLLT were identified and introduced. The various types of LLLT regarding the studied diseases were discussed. Conclusion: Positive aspects of LLLT versus a few disadvantages of its application imply more investigation to find better and efficient new methods.
Collapse
Affiliation(s)
- Vahid Mansouri
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Arjmand
- Cell Therapy and Regenerative Medicine Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Rezaei Tavirani
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Razzaghi
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Rostami-Nejad
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mostafa Hamdieh
- Department of Psychosomatic, Taleghani Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
25
|
Song SY, Chang JS, Fan KL, Kim MJ, Chang HP, Lew DH, Roh TS, Roh H, Kim YB, Lee DW. Hypofractionated Radiotherapy With Volumetric Modulated Arc Therapy Decreases Postoperative Complications in Prosthetic Breast Reconstructions: A Clinicopathologic Study. Front Oncol 2020; 10:577136. [PMID: 33282731 PMCID: PMC7705232 DOI: 10.3389/fonc.2020.577136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/20/2020] [Indexed: 11/13/2022] Open
Abstract
Background Emerging radiation technologies are expected to provide a positive impact on the reduction in postoperative complications in patients receiving prosthetic breast reconstruction. This study aimed to determine whether hypofractionated radiation therapy(RT) with volumetric modulated arc therapy(VMAT) is superior to conventional RT in the setting of prosthetic reconstruction. Methods From retrospective data collections, postoperative complications were compared for all patients with mastectomy and staged prosthetic reconstruction without RT, with hypofractionation using 40 Gy in 15 fractions with VMAT (Hypo-VMAT) or conventional RT (50 Gy over 5 weeks). After harvesting subpectoral capsules from patients with informed consents, histologic analysis including immunohistochemistry and immunofluorescence for collagen type I, α-smooth muscle actin, CD34 and CD31 expression was performed. Results A total of 288 reconstructions without RT, 55 reconstructions with Hypo-VMAT, and 29 reconstructions with conventional RT were examined. During average follow-up period of 34.8 months, rates of overall complications were 6.3% in the no-radiation group, 18.2% in Hypo-VMAT group and 44.8% in conventional-RT group with significant differences (no-RT vs Hypo-VMAT: p=0.006; Hypo-VMAT vs conventional-RT: p=0.012). Levels of myofibroblasts and tissue fibrosis were lower in the Hypo-VMAT group than in conventional-RT group (p=0.016 and p=0.040, respectively), while those of progenitor cells and microvessel density were higher in the Hypo-VMAT group than in conventional-RT group (p<0.001 and p<0.001, respectively). Conclusion We demonstrated that hypofractionated RT with VMAT served to reduce radiation-related morbidities in prosthetic reconstruction from a clinicopathologic perspective, compared to conventional RT. It may offer a practical strategy to mitigate radiation-related complications in clinical settings.
Collapse
Affiliation(s)
- Seung Yong Song
- Department of Plastic & Reconstructive Surgery and Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, South Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kenneth L Fan
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington DC, United States
| | - Mi Jung Kim
- Department of Plastic & Reconstructive Surgery and Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, South Korea
| | - Hsien Pin Chang
- Department of Plastic & Reconstructive Surgery and Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, South Korea
| | - Dae Hyun Lew
- Department of Plastic & Reconstructive Surgery and Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, South Korea
| | - Tai Suk Roh
- Department of Plastic & Reconstructive Surgery and Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyun Roh
- Department of Plastic & Reconstructive Surgery and Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Won Lee
- Department of Plastic & Reconstructive Surgery and Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, South Korea
| |
Collapse
|
26
|
Kulshrestha S, Chawla R, Singh S, Yadav P, Sharma N, Goel R, Ojha H, Kumar V, Adhikari J. Protection of sildenafil citrate hydrogel against radiation-induced skin wounds. Burns 2020; 46:1157-1169. [DOI: 10.1016/j.burns.2019.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 10/18/2019] [Accepted: 11/23/2019] [Indexed: 12/23/2022]
|
27
|
Cao J, Zhu W, Yu D, Pan L, Zhong L, Xiao Y, Gao Y, Jiao Y, Zhang Q, Ji J, Yang H, Zhang S, Cao J. The Involvement of SDF-1α/CXCR4 Axis in Radiation-Induced Acute Injury and Fibrosis of Skin. Radiat Res 2019; 192:410-421. [PMID: 31390312 DOI: 10.1667/rr15384.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Radiation-induced acute skin injury and consequent fibrosis are common complications of cancer radiotherapy and radiation accidents. Stromal cell-derived factor-1α (SDF-1α) and its receptor, CXC chemokine receptor 4 (CXCR4) have been shown to be involved in multiple cellular events. However, the role of SDF-1α/CXCR4 axis in radiation-induced acute injury and fibrosis of skin has not been reported. In this study, we found that the expression of SDF-1α and CXCR4 was significantly increased in irradiated skin tissues of humans, monkeys and rats, compared to their nonirradiated counterparts. Mice with keratinocyte-specific ablation of CXCR4 showed less severe skin damage than wild-type mice after receiving a 35 Gy dose of radiation. Consistently, subcutaneous injection of AMD3100, an FDA approved SDF-1α/CXCR4 inhibitor, attenuated skin injury and fibrosis induced by exposure to radiation in a rat model. Mechanically, the SDF-1α/CXCR4 axis promotes pro-fibrotic TGF-b/Smad signaling through the PI3K-MAPK signaling cascade in human keratinocyte HaCaT cells and skin fibroblast WS1 cells. AMD3100 inhibited Smad2 nuclear translocation and transcriptional activity of Smad2/3 induced by radiation, which suppressed the pro-fibrotic TGF-b/Smad signaling pathway activated by exposure. Taken together, these findings demonstrate the involvement of SDF-1α/CXCR4 axis in radiation-induced acute injury and fibrosis of skin, and indicate that AMD3100 would be an effective countermeasure against these diseases.
Collapse
Affiliation(s)
- Jinming Cao
- School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou 215123, China.,State Key Laboratory of Radiation Medicine and Protection, Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou 215123, China
| | - Wei Zhu
- School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou 215123, China.,State Key Laboratory of Radiation Medicine and Protection, Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou 215123, China
| | - Daojiang Yu
- State Key Laboratory of Radiation Medicine and Protection, Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou 215123, China.,Departments of Plastic Surgery
| | - Lu Pan
- School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou 215123, China.,State Key Laboratory of Radiation Medicine and Protection, Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou 215123, China
| | - Li Zhong
- School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou 215123, China.,State Key Laboratory of Radiation Medicine and Protection, Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou 215123, China
| | - Yuji Xiao
- School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou 215123, China.,State Key Laboratory of Radiation Medicine and Protection, Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou 215123, China
| | - Yiying Gao
- School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou 215123, China.,State Key Laboratory of Radiation Medicine and Protection, Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou 215123, China
| | - Yang Jiao
- School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou 215123, China.,State Key Laboratory of Radiation Medicine and Protection, Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou 215123, China
| | - Qi Zhang
- School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou 215123, China.,State Key Laboratory of Radiation Medicine and Protection, Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou 215123, China
| | - Jiang Ji
- Departments of Dermatology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Hongying Yang
- School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou 215123, China.,State Key Laboratory of Radiation Medicine and Protection, Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou 215123, China
| | - Shuyu Zhang
- State Key Laboratory of Radiation Medicine and Protection, Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou 215123, China.,Department of Oncology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou 213100, China.,Department of Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu 610051, China
| | - Jianping Cao
- School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou 215123, China.,State Key Laboratory of Radiation Medicine and Protection, Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou 215123, China
| |
Collapse
|
28
|
Sheng X, Zhou Y, Wang H, Shen Y, Liao Q, Rao Z, Deng F, Xie L, Yao C, Mao H, Liu Z, Peng M, Long Y, Zeng Y, Xue L, Gao N, Kong Y, Zhou X. Establishment and characterization of a radiation-induced dermatitis rat model. J Cell Mol Med 2019; 23:3178-3189. [PMID: 30821089 PMCID: PMC6484338 DOI: 10.1111/jcmm.14174] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/27/2018] [Accepted: 12/28/2018] [Indexed: 12/18/2022] Open
Abstract
Radiation‐induced dermatitis is a common and serious side effect after radiotherapy. Current clinical treatments cannot efficiently or fully prevent the occurrence of post‐irradiation dermatitis, which remains a significant clinical problem. Resolving this challenge requires gaining a better understanding of the precise pathophysiology, which in turn requires establishment of a suitable animal model that mimics the clinical condition, and can also be used to investigate the mechanism and explore effective treatment options. In this study, a single dose of 90 Gy irradiation to rats resulted in ulceration, dermal thickening, inflammation, hair follicle loss, and sebaceous glands loss, indicating successful establishment of the model. Few hair follicle cells migrated to form epidermal cells, and both the severity of skin fibrosis and hydroxyproline levels increased with time post‐irradiation. Radiation damaged the mitochondria and induced both apoptosis and autophagy of the skin cells. Therefore, irradiation of 90 Gy can be used to successfully establish a rat model of radiation‐induced dermatitis. This model will be helpful for developing new treatments and gaining a better understanding of the pathological mechanism of radiation‐induced dermatitis. Specifically, our results suggest autophagy regulation as a potentially effective therapeutic target.
Collapse
Affiliation(s)
- Xiaowu Sheng
- Hunan Branch Center, National Tissue Engineering Center of China, Translational Medical Center, Central Laboratory, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
| | - Yue Zhou
- Department of Radiation Oncology, Key Laboratory of Translational Radiation Oncology, Changsha, Hunan Province, China.,Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China.,Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
| | - Hui Wang
- Department of Radiation Oncology, Key Laboratory of Translational Radiation Oncology, Changsha, Hunan Province, China.,Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
| | - Yongyi Shen
- Nursing Department, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan Province, China
| | - Qianjin Liao
- Hunan Branch Center, National Tissue Engineering Center of China, Translational Medical Center, Central Laboratory, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
| | - Zhen Rao
- Department of Head and Neck Surgery, The First People's Hospital of Changde City, Changsha, Hunan Province, China
| | - Feiyan Deng
- University of South China, Hengyang, Hunan Province, China.,Department of Head and Neck Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan Province, China
| | - Luyuan Xie
- University of South China, Hengyang, Hunan Province, China.,Department of Head and Neck Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan Province, China
| | - Chaoling Yao
- Department of Head and Neck Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan Province, China
| | - Huangxing Mao
- Department of Head and Neck Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan Province, China
| | - Zhiyan Liu
- Department of Head and Neck Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan Province, China
| | - Mingjing Peng
- Hunan Branch Center, National Tissue Engineering Center of China, Translational Medical Center, Central Laboratory, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
| | - Ying Long
- Hunan Branch Center, National Tissue Engineering Center of China, Translational Medical Center, Central Laboratory, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
| | - Yong Zeng
- Hunan Branch Center, National Tissue Engineering Center of China, Translational Medical Center, Central Laboratory, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
| | - Lei Xue
- Pathology Department, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan Province, China
| | - Nina Gao
- Pathology Department, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan Province, China
| | - Yu Kong
- Institute of Neuroscience, Chinese Academy of Sciences, Shanghai, China
| | - Xiao Zhou
- Hunan Branch Center, National Tissue Engineering Center of China, Translational Medical Center, Central Laboratory, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China.,Department of Head and Neck Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan Province, China
| |
Collapse
|
29
|
Zhou P, Lin B, Wang P, Pan T, Wang S, Chen W, Cheng S, Liu S. The healing effect of hydrogen-rich water on acute radiation-induced skin injury in rats. JOURNAL OF RADIATION RESEARCH 2019; 60:17-22. [PMID: 30260398 PMCID: PMC6373674 DOI: 10.1093/jrr/rry074] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Indexed: 05/09/2023]
Abstract
This study aimed to determine the healing effect of hydrogen-rich water (HRW) on radiotherapy-induced skin injury. Rats were irradiated with a 6 MeV electron beam from a Varian linear accelerator. After skin wound formation, rats were individually administrated with distilled water, HRW (1.0 ppm) or HRW (2.0 ppm). We measured the healing time and observed the healing rate of the wounded surface. After irradiation, the malondialdehyde (MDA) content and the superoxide dismutase (SOD) activity in the wounded tissues were evaluated, as determined using an MDA and SOD assay kit. Interleukin-6 (IL-6) and epidermal growth factor (EGF) levels were assessed by enzyme-linked immunosorbent assay (ELISA). Models of skin damage were successfully established using a 44 Gy electronic beam. The healing time was shortened in the two HRW-treated groups (P < 0.05). Furthermore, interventions of HRW resulted in a marked reduction in the MDA (P < 0.05) and IL-6 levels (P < 0.01). Additionally, the SOD activity in the two HRW-treated groups was higher than that in the distilled water group at the end of the 1st, 2nd and 3rd weeks (P < 0.001). The EGF level was also significantly increased at the end of the 1st and 2nd weeks (P < 0.05). Compared with the HRW (1.0 ppm) group, the healing rate was higher and the healing time was reduced in the HRW (2.0 ppm) group. A significant decrease was observed in the IL-6 level at the end of the 1st, 3rd and 4th weeks (P < 0.05) and in the EGF content at the end of the 1 week after the HRW administration (P < 0.01). Collectively, our data indicate that HRW accelerates wound healing of radiation-induced skin lesions through anti-oxidative and anti-inflammatory effects, suggesting that HRW has a healing effect on acute radiation-mediated skin injury, and that this is dependent on the concentration of the hydrogen.
Collapse
Affiliation(s)
- Ping Zhou
- Department of Radiotherapy, The First Affiliated Hospital, Hainan Medical University, #33 Longhua Road, Longhua District, Haikou, Hainan Province, PR China
| | - Bing Lin
- Department of Radiotherapy, The First Affiliated Hospital, Hainan Medical University, #33 Longhua Road, Longhua District, Haikou, Hainan Province, PR China
| | - Peng Wang
- Department of Radiotherapy, The First Affiliated Hospital, Hainan Medical University, #33 Longhua Road, Longhua District, Haikou, Hainan Province, PR China
| | - Tao Pan
- Department of Radiotherapy, The First Affiliated Hospital, Hainan Medical University, #33 Longhua Road, Longhua District, Haikou, Hainan Province, PR China
| | - Shun Wang
- Department of Radiotherapy, The First Affiliated Hospital, Hainan Medical University, #33 Longhua Road, Longhua District, Haikou, Hainan Province, PR China
| | - Weisi Chen
- Department of Radiation Physics Center, The First Affiliated Hospital, Hainan Medical University, #33 Longhua Road, Longhua District, Haikou, Hainan Province, PR China
| | - Shaowen Cheng
- Department of Trauma Center, The First Affiliated Hospital, Hainan Medical University, #33 Longhua Road, Longhua District, Haikou, Hainan Province, PR China
| | - Sha Liu
- Department of Radiotherapy, The First Affiliated Hospital, Hainan Medical University, #33 Longhua Road, Longhua District, Haikou, Hainan Province, PR China
- Corresponding author. Department of Radiotherapy, The First Affiliated Hospital, Hainan Medical University, #33 Longhua Road, Longhua District, Haikou 570000, Hainan Province, PR China. Tel: +86-0898-6652-8040; Fax: +86-0898-6652-8040;
| |
Collapse
|
30
|
Fallah M, Shen Y, Brodén J, Bäckman A, Lundskog B, Johansson M, Blomquist M, Liu K, Wilczynska M, Ny T. Plasminogen activation is required for the development of radiation-induced dermatitis. Cell Death Dis 2018; 9:1051. [PMID: 30323258 PMCID: PMC6189099 DOI: 10.1038/s41419-018-1106-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 09/11/2018] [Accepted: 09/26/2018] [Indexed: 12/20/2022]
Abstract
Skin damage caused by radiation therapy (radiodermatitis) is a severe side effect of radiotherapy in cancer patients, and there is currently a lack of effective strategies to prevent or treat such skin damage. In this work, we show with several lines of evidence that plasminogen, a pro-inflammatory factor, is key for the development of radiodermatitis. After skin irradiation in wild-type (plg+/+) mice, the plasminogen level increased in the irradiated area, leading to severe skin damage such as ulcer formation. However, plasminogen-deficient (plg-/-) mice and mice lacking plasminogen activators were mostly resistant to radiodermatitis. Moreover, treatment with a plasminogen inhibitor, tranexamic acid, decreased radiodermatitis in plg+/+ mice and prevented radiodermatitis in plg+/- mice. Together with studies at the molecular level, we report that plasmin is required for the induction of inflammation after irradiation that leads to radiodermatitis, and we propose that inhibition of plasminogen activation can be a novel treatment strategy to reduce and prevent the occurrence of radiodermatitis in patients.
Collapse
Affiliation(s)
- Mahsa Fallah
- Department of Medical Biochemistry and Biophysics, Umeå University, 901-87, Umeå, Sweden
| | - Yue Shen
- Department of Medical Biochemistry and Biophysics, Umeå University, 901-87, Umeå, Sweden
| | | | | | - Bertil Lundskog
- Department of Medical Biosciences, Pathology, Umeå University, 901-87, Umeå, Sweden
| | - Michael Johansson
- Department of Radiation Sciences, Umeå University, 901-87, Umeå, Sweden
| | - Michael Blomquist
- Department of Radiation Sciences, Umeå University, 901-87, Umeå, Sweden
| | - Kui Liu
- Omnio AB, Tvistevägen 48, 907-36, Umeå, Sweden
| | - Malgorzata Wilczynska
- Department of Medical Biochemistry and Biophysics, Umeå University, 901-87, Umeå, Sweden
| | - Tor Ny
- Department of Medical Biochemistry and Biophysics, Umeå University, 901-87, Umeå, Sweden.
| |
Collapse
|
31
|
Petersen H, Walshe P, Glynn F, McMahon R, Fitzgerald C, Thapa J, Simoes-Franklin C, Viani L. Occurrence of major complications after cochlear implant surgery in Ireland. Cochlear Implants Int 2018; 19:297-306. [DOI: 10.1080/14670100.2018.1513386] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Hannes Petersen
- National Cochlear Implant Programme, Beaumont Hospital, Dublin, Ireland
| | - Peter Walshe
- National Cochlear Implant Programme, Beaumont Hospital, Dublin, Ireland
| | - Fergal Glynn
- National Cochlear Implant Programme, Beaumont Hospital, Dublin, Ireland
| | - Rosemary McMahon
- National Cochlear Implant Programme, Beaumont Hospital, Dublin, Ireland
| | - Conall Fitzgerald
- National Cochlear Implant Programme, Beaumont Hospital, Dublin, Ireland
| | - Jyoti Thapa
- National Cochlear Implant Programme, Beaumont Hospital, Dublin, Ireland
| | - Cristina Simoes-Franklin
- National Cochlear Implant Programme, Beaumont Hospital, Dublin, Ireland
- Trinity Centre for Bioengineering, Trinity College Dublin, Ireland
- School of Medicine, Trinity College Dublin, Ireland
| | - Laura Viani
- National Cochlear Implant Programme, Beaumont Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Ireland
- Royal College of Surgeons Ireland, Dublin, Ireland
| |
Collapse
|
32
|
Photobiomodulation or low-level laser therapy in the management of cancer therapy-induced mucositis, dermatitis and lymphedema. Curr Opin Oncol 2018; 30:226-232. [DOI: 10.1097/cco.0000000000000452] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
33
|
Mashiko T, Takada H, Wu SH, Kanayama K, Feng J, Tashiro K, Asahi R, Sunaga A, Hoshi K, Kurisaki A, Takato T, Yoshimura K. Therapeutic effects of a recombinant human collagen peptide bioscaffold with human adipose-derived stem cells on impaired wound healing after radiotherapy. J Tissue Eng Regen Med 2018; 12:1186-1194. [PMID: 29377539 DOI: 10.1002/term.2647] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 11/26/2017] [Accepted: 01/16/2018] [Indexed: 12/11/2022]
Abstract
Chronic changes following radiotherapy include alterations in tissue-resident stem cells and vasculatures, which can lead to impaired wound healing. In this study, novel recombinant human collagen peptide (rhCP) scaffolds were evaluated as a biomaterial carrier for cellular regenerative therapy. Human adipose-derived stem cells (hASCs) were successfully cultured on rhCP scaffolds. By hASC culture on rhCP, microarray assay indicated that expression of genes related to cell proliferation and extracellular matrix production was upregulated. Pathway analyses revealed that signaling pathways related to inflammatory suppression and cell growth promotion were activated as well as signaling pathways consistent with some growth factors including vascular endothelial growth factor, hepatocyte growth factor, and transforming growth factor beta, although gene expression of these growth factors was not upregulated. These findings suggest the rhCP scaffold showed similar biological actions to cytokines regulating cell growth and immunity. In subsequent impaired wound healing experiments using a locally irradiated (20 Gray) mouse, wound treatment with rhCP sponges combined with cultured hASCs and human umbilical vein endothelial cells accelerated wound closure compared with wounds treated with rhCP with hASCs alone, rhCP only, and control (dressing alone), with better healing observed according to this order. These results indicating the therapeutic value of rhCP scaffolds as a topical biomaterial dressing and a biocarrier of stem cells and vascular endothelial cells for regenerating therapies. The combination of rhCP and functional cells was suggested to be a potential tool for revitalizing stem cell-depleted conditions such as radiation tissue damage.
Collapse
Affiliation(s)
- Takanobu Mashiko
- Department of Plastic Surgery, Jichi Medical University, Tochigi, Japan.,Department of Plastic Surgery, University of Tokyo, School of Medicine, Tokyo, Japan
| | - Hitomi Takada
- Stem Cell Technologies lab, Graduate School of Biological Sciences, Nara Institute of Science and Technology, Nara, Japan
| | - Szu-Hsien Wu
- Department of Plastic Surgery, University of Tokyo, School of Medicine, Tokyo, Japan
| | - Koji Kanayama
- Department of Plastic Surgery, Jichi Medical University, Tochigi, Japan.,Department of Plastic Surgery, University of Tokyo, School of Medicine, Tokyo, Japan
| | - Jingwei Feng
- Department of Plastic Surgery, University of Tokyo, School of Medicine, Tokyo, Japan
| | - Kensuke Tashiro
- Department of Plastic Surgery, University of Tokyo, School of Medicine, Tokyo, Japan
| | - Rintaro Asahi
- Department of Plastic Surgery, Jichi Medical University, Tochigi, Japan
| | - Ataru Sunaga
- Department of Plastic Surgery, Jichi Medical University, Tochigi, Japan
| | - Kazuto Hoshi
- Department of Oral Surgery, University of Tokyo, School of Medicine, Tokyo, Japan
| | - Akira Kurisaki
- Stem Cell Technologies lab, Graduate School of Biological Sciences, Nara Institute of Science and Technology, Nara, Japan
| | - Tsuyoshi Takato
- Department of Oral Surgery, University of Tokyo, School of Medicine, Tokyo, Japan
| | - Kotaro Yoshimura
- Department of Plastic Surgery, Jichi Medical University, Tochigi, Japan.,Department of Plastic Surgery, University of Tokyo, School of Medicine, Tokyo, Japan
| |
Collapse
|
34
|
Kwon JW, Hong SE, Kang SR, Park BY. Effect of Human Placental Extract Treatment on Random-Pattern Skin Flap Survival in Rats. J INVEST SURG 2018; 32:304-313. [PMID: 29431531 DOI: 10.1080/08941939.2017.1417518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: Human placental extract (HPE), prepared from the placentas of healthy, postpartum females, displays various physiological activities, including antioxidative properties. In this study, a dorsal skin flap model was used to investigate the effect of HPE on flap viability in rats. Materials and methods: Forty male Sprague-Dawley rats underwent random-pattern skin flap surgeries. The animals were randomly divided among a control group and three treatment groups (localized injection (LI), 10 mg/kg/d localized HPE injections; low-dose treatment (LT), 10 mg/kg/d systemic HPE injections; high-dose treatment (HT), 40 mg/kg/d systemic HPE injections). Surviving skin flap areas were measured 7 days after surgery and tissue samples were stained with hematoxylin and eosin; vascular endothelial growth factor expression was determined immunohistochemically. To evaluate the antioxidant and antiapoptotic effects of HPE, malondialdehyde, glutathione peroxidase, and caspase-3 levels were examined. Results: Seven days after surgery, HPE-treated animals had significantly reduced necrotic areas, rats receiving the highest HPE dose demonstrated the greatest flap survival. In the HPE groups, the histopathological scores were lower than for the control group. Immunohistochemistry showed markedly more numerous vascular endothelial growth factor-positive cells in the HT group than in the C group. Malondialdehyde levels were significantly lower and glutathione peroxidase levels were higher in the HT group than in the C group. HPE treatment significantly inhibited apoptosis by lowering caspase-3 activity. Conclusions: HPE treatment yielded positive effects on flap survival, due to its antioxidant and antiapoptotic properties. These results suggest a new therapeutic approach for enhancing flap viability and accelerating wound repair.
Collapse
Affiliation(s)
- Jung Woo Kwon
- a Department of Plastic and Reconstructive Surgery , College of Medicine, Ewha Womans University Mokdong Hospital , Seoul , South Korea
| | - Seung Eun Hong
- a Department of Plastic and Reconstructive Surgery , College of Medicine, Ewha Womans University Mokdong Hospital , Seoul , South Korea
| | - So Ra Kang
- a Department of Plastic and Reconstructive Surgery , College of Medicine, Ewha Womans University Mokdong Hospital , Seoul , South Korea
| | - Bo Young Park
- a Department of Plastic and Reconstructive Surgery , College of Medicine, Ewha Womans University Mokdong Hospital , Seoul , South Korea
| |
Collapse
|
35
|
Khan AA, Paget JT, McLaughlin M, Kyula JN, Wilkinson MJ, Pencavel T, Mansfield D, Roulstone V, Seth R, Halle M, Somaiah N, Boult JKR, Robinson SP, Pandha HS, Vile RG, Melcher AA, Harris PA, Harrington KJ. Genetically modified lentiviruses that preserve microvascular function protect against late radiation damage in normal tissues. Sci Transl Med 2018; 10:eaar2041. [PMID: 29367346 PMCID: PMC6020074 DOI: 10.1126/scitranslmed.aar2041] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 10/15/2017] [Accepted: 11/08/2017] [Indexed: 12/25/2022]
Abstract
Improvements in cancer survival mean that long-term toxicities, which contribute to the morbidity of cancer survivorship, are being increasingly recognized. Late adverse effects (LAEs) in normal tissues after radiotherapy (RT) are characterized by vascular dysfunction and fibrosis causing volume loss and tissue contracture, for example, in the free flaps used for immediate breast reconstruction after mastectomy. We evaluated the efficacy of lentivirally delivered superoxide dismutase 2 (SOD2) overexpression and connective tissue growth factor (CTGF) knockdown by short hairpin RNA in reducing the severity of LAEs in an animal model of free flap LAEs. Vectors were delivered by intra-arterial injection, ex vivo, to target the vascular compartment. LVSOD2 and LVshCTGF monotherapy before irradiation resulted in preservation of flap volume or reduction in skin contracture, respectively. Flaps transduced with combination therapy experienced improvements in both volume loss and skin contracture. Both therapies reduced the fibrotic burden after irradiation. LAEs were associated with impaired vascular perfusion, loss of endothelial permeability, and stromal hypoxia, which were all reversed in the treatment model. Using a tumor recurrence model, we showed that SOD2 overexpression in normal tissues did not compromise the efficacy of RT against tumor cells but appeared to enhance it. LVSOD2 and LVshCTGF combination therapy by targeted, intravascular delivery reduced LAE severities in normal tissues without compromising the efficacy of RT and warrants translational evaluation as a free flap-targeted gene therapy.
Collapse
Affiliation(s)
- Aadil A Khan
- Targeted Therapy Team, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SW3 6JB, UK
- Department of Plastic Surgery, The Royal Marsden Hospital, London SW3 6JJ, UK
| | - James T Paget
- Targeted Therapy Team, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SW3 6JB, UK
- Department of Plastic Surgery, The Royal Marsden Hospital, London SW3 6JJ, UK
| | - Martin McLaughlin
- Targeted Therapy Team, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SW3 6JB, UK
| | - Joan N Kyula
- Targeted Therapy Team, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SW3 6JB, UK
| | - Michelle J Wilkinson
- Targeted Therapy Team, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SW3 6JB, UK
| | - Timothy Pencavel
- Targeted Therapy Team, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SW3 6JB, UK
| | - David Mansfield
- Targeted Therapy Team, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SW3 6JB, UK
| | - Victoria Roulstone
- Targeted Therapy Team, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SW3 6JB, UK
| | - Rohit Seth
- Targeted Therapy Team, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SW3 6JB, UK
| | - Martin Halle
- Department of Molecular Medicine and Surgery, Section of Plastic Surgery, Karolinska Institute, Stockholm 17176, Sweden
- Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm 17176, Sweden
| | - Navita Somaiah
- Targeted Therapy Team, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SW3 6JB, UK
| | - Jessica K R Boult
- Magnetic Resonance Team, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SM2 5NG, UK
| | - Simon P Robinson
- Magnetic Resonance Team, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SM2 5NG, UK
| | - Hardev S Pandha
- Postgraduate Medical School, University of Surrey, Guildford GU2 7XH, UK
| | - Richard G Vile
- Molecular Medicine Program, Mayo Clinic, Rochester, MN 55905, USA
| | - Alan A Melcher
- Translational Immunotherapy Team, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, SW3 6JB, UK
| | - Paul A Harris
- Department of Plastic Surgery, The Royal Marsden Hospital, London SW3 6JJ, UK
| | - Kevin J Harrington
- Targeted Therapy Team, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SW3 6JB, UK.
| |
Collapse
|
36
|
Jacobson LK, Johnson MB, Dedhia RD, Niknam-Bienia S, Wong AK. Impaired wound healing after radiation therapy: A systematic review of pathogenesis and treatment. JPRAS Open 2017. [DOI: 10.1016/j.jpra.2017.04.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
|
37
|
Tomita K, Yano K, Nishibayashi A, Seike S, Hosokawa K. Aesthetic outcomes of inframammary fold recreation in two-stage, implant-based, breast reconstruction. SPRINGERPLUS 2016; 5:1656. [PMID: 27730018 PMCID: PMC5037096 DOI: 10.1186/s40064-016-3331-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 09/19/2016] [Indexed: 11/10/2022]
Abstract
Background When the inframammary fold (IMF) is excised in mastectomy procedures for oncologic reasons, it must be recreated to restore a natural breast shape. Despite refinements in surgical techniques, postoperative loss of a well-defined IMF can occur. This study aimed to assess the outcomes of IMF recreation after two-stage, implant-based breast reconstruction. Methods We retrospectively reviewed 75 consecutive patients who underwent unilateral, two-stage, implant-based breast reconstruction between 2013 and 2015 at the authors’ institution. Among them, IMF recreation was performed in 37 patients through a modified Nava’s internal method. Aesthetic outcomes of the recreated IMFs were evaluated by observer assessment of two criteria, and critical factors affecting IMF outcomes were also analyzed. Results We found that contralateral breast ptosis (p < 0.05) and lack of postmastectomy radiotherapy (PMRT, p < 0.01) were significant predictors of better IMF outcomes. Nipple-sparing mastectomy and skin-sparing mastectomy resulted in better IMF outcomes, as compared with non-skin-sparing mastectomy (p < 0.05 for each), while no significant difference was observed between them in patients who did not undergo PMRT (p = 0.19). Similarly, larger implant volume, but not projection of implant, was a predictor of better IMF outcomes when limited to patients who did not undergo PMRT (p < 0.05). Age, body mass index, timing of reconstruction, and extent of overexpansion had no significant effect on IMF outcomes. Conclusions Based on these critical factors, the shape of the reconstructed breast and the need for reshaping the contralateral breast can be predicted. Special attention should be paid to patients with non-skin-sparing mastectomy and PMRT. When these patients desire a medium- to large-sized ptotic breast, conversion to autologous reconstruction can achieve symmetrical breast reconstruction.
Collapse
Affiliation(s)
- Koichi Tomita
- Department of Plastic Surgery and Reconstructive Surgery, Osaka University Graduate School of Medicine, 2-2 C11 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Kenji Yano
- Department of Plastic Surgery and Reconstructive Surgery, Osaka University Graduate School of Medicine, 2-2 C11 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Akimitsu Nishibayashi
- Department of Plastic Surgery and Reconstructive Surgery, Osaka University Graduate School of Medicine, 2-2 C11 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Shien Seike
- Department of Plastic Surgery and Reconstructive Surgery, Osaka University Graduate School of Medicine, 2-2 C11 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Ko Hosokawa
- Department of Plastic Surgery and Reconstructive Surgery, Osaka University Graduate School of Medicine, 2-2 C11 Yamadaoka, Suita, Osaka 565-0871 Japan
| |
Collapse
|
38
|
Yu D, Li S, Wang S, Li X, Zhu M, Huang S, Sun L, Zhang Y, Liu Y, Wang S. Development and Characterization of VEGF165-Chitosan Nanoparticles for the Treatment of Radiation-Induced Skin Injury in Rats. Mar Drugs 2016; 14:md14100182. [PMID: 27727163 PMCID: PMC5082330 DOI: 10.3390/md14100182] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 08/30/2016] [Accepted: 08/31/2016] [Indexed: 12/20/2022] Open
Abstract
Radiation-induced skin injury, which remains a serious concern in radiation therapy, is currently believed to be the result of vascular endothelial cell injury and apoptosis. Here, we established a model of acute radiation-induced skin injury and compared the effect of different vascular growth factors on skin healing by observing the changes of microcirculation and cell apoptosis. Vascular endothelial growth factor (VEGF) was more effective at inhibiting apoptosis and preventing injury progression than other factors. A new strategy for improving the bioavailability of vascular growth factors was developed by loading VEGF with chitosan nanoparticles. The VEGF-chitosan nanoparticles showed a protective effect on vascular endothelial cells, improved the local microcirculation, and delayed the development of radioactive skin damage.
Collapse
Affiliation(s)
- Daojiang Yu
- Department of Plastic Surgery, the Second Affiliated Hospital, Soochow University, Suzhou 215004, China.
- Department of Pathology, School of Biology & Basic Medical Sciences, Soochow University, Suzhou 215123, China.
| | - Shan Li
- College of Pharmaceutical Science, Soochow University, Suzhou 215123, China.
| | - Shuai Wang
- Department of Plastic Surgery, the Second Affiliated Hospital, Soochow University, Suzhou 215004, China.
| | - Xiujie Li
- Department of Plastic Surgery, the Second Affiliated Hospital, Soochow University, Suzhou 215004, China.
| | - Minsheng Zhu
- Department of Pathology, School of Biology & Basic Medical Sciences, Soochow University, Suzhou 215123, China.
| | - Shai Huang
- Department of Pathology, School of Biology & Basic Medical Sciences, Soochow University, Suzhou 215123, China.
| | - Li Sun
- Department of Pathology, School of Biology & Basic Medical Sciences, Soochow University, Suzhou 215123, China.
| | - Yongsheng Zhang
- Department of Pathology, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China.
| | - Yanli Liu
- College of Pharmaceutical Science, Soochow University, Suzhou 215123, China.
| | - Shouli Wang
- Department of Pathology, School of Biology & Basic Medical Sciences, Soochow University, Suzhou 215123, China.
- Institute of Radiology & Oncology, Soochow University, Suzhou 215006, China.
- Suzhou Key Laboratory of Tumor Microenvironment Pathology, Suzhou 215123, China.
| |
Collapse
|
39
|
Nakagami Y, Masuda K. A novel Nrf2 activator from microbial transformation inhibits radiation-induced dermatitis in mice. JOURNAL OF RADIATION RESEARCH 2016; 57:567-571. [PMID: 27242339 PMCID: PMC5045074 DOI: 10.1093/jrr/rrw039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 02/16/2016] [Accepted: 03/04/2016] [Indexed: 06/05/2023]
Abstract
Nuclear factor erythroid 2-related factor 2 (Nrf2) is a transcriptional factor that regulates many antioxidants, and we have recently succeeded in obtaining a novel Nrf2 activator, RS9, from microbial transformation. RS9 is categorized as a triterpenoid, and well-known triterpenoids such as RTA 402 (bardoxolone methyl) and RTA 408 have been tested in clinical trials. RTA 408 lotion is currently being tested in patients at risk for radiation dermatitis. This prompted us to study the profiles of RS9 in the skin. All the above triterpenoids increased the level of an Nrf2-targeted gene, NADPH:quinone oxidoreductase-1, in normal human epidermal keratinocytes. Among them, the activity of RS9 was prominent; furthermore, the cellular toxicity was less compared with RTA compounds. BALB/c mice were irradiated with 30 Gy/day on Day 0, and compounds were topically applied on the back once daily from Day 1 to Day 30. Dermatitis scores peaked on Day 18, with a score of 2.6 in vehicle-treated mice, and topical applications of 0.1% RTA 402, RTA 408 and RS9 reduced the scores to 1.8, 2.0 and 1.4, respectively. Moreover, the percentage of animals with scores ≥2 was analyzed, and 0.1% RS9 suppressed the percentage from 100% to 47%. These results imply that RS9 has potential efficacy for treating radiation dermatitis.
Collapse
Affiliation(s)
- Yasuhiro Nakagami
- Daiichi Sankyo Co., Ltd, 1-2-58, Hiromachi, Shinagawa-ku, Tokyo 140-8710, Japan Asubio Pharma Co, Ltd, 6-4-3 Minatojima-minamimachi, Chuo-ku, Kobe-shi, Hyogo 650-0047, Japan
| | - Kayoko Masuda
- Daiichi Sankyo RD Novare Co., Ltd, 1-16-13, Kitakasai, Edogawa-ku, Tokyo 134-8630, Japan
| |
Collapse
|
40
|
Portas M, Mansilla E, Drago H, Dubner D, Radl A, Coppola A, Di Giorgio M. Use of Human Cadaveric Mesenchymal Stem Cells for Cell Therapy of a Chronic Radiation-Induced Skin Lesion: A Case Report. RADIATION PROTECTION DOSIMETRY 2016; 171:99-106. [PMID: 27574323 DOI: 10.1093/rpd/ncw206] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Acute and late radiation-induced injury on skin and subcutaneous tissues are associated with substantial morbidity in radiation therapy, interventional procedures and also are of concern in the context of nuclear or radiological accidents. Pathogenesis is initiated by depletion of acutely responding epithelial tissues and damage to vascular endothelial microvessels. Efforts for medical management of severe radiation-induced lesions have been made. Nevertheless, the development of strategies to promote wound healing, including stem cell therapy, is required. From 1997 to 2014, over 248 patients were referred to the Radiopathology Committee of Hospital de Quemados del Gobierno de la Ciudad de Buenos Aires (Burns Hospital) for the diagnosis and therapy of radiation-induced localized lesions. As part of the strategies for the management of severe cases, there is an ongoing research and development protocol on 'Translational Clinical Trial phases I/II to evaluate the safety and efficacy of adult mesenchymal stem cells from bone marrow for the treatment of large burns and radiological lesions'. The object of this work was to describe the actions carried out by the Radiopathology Committee of the Burns Hospital in a chronic case with more than 30 years of evolution without positive response to conventional treatments. The approach involved the evaluation of the tissular compromise of the lesion, the prognosis and the personalized treatment, including regenerative therapy.
Collapse
Affiliation(s)
- M Portas
- Hospital de Quemados del Gobierno de la Ciudad de Buenos Aires, Buenos Aires, Argentina
| | - E Mansilla
- Servicio de Ingeniería Tisular, Medicina Regenerativa y Terapias Celulares del Centro Único de Ablación e Implantes de la provincia de Buenos Aires (CUCAIBA), Buenos Aires, Argentina
| | - H Drago
- Hospital de Quemados del Gobierno de la Ciudad de Buenos Aires, Buenos Aires, Argentina Servicio de Ingeniería Tisular, Medicina Regenerativa y Terapias Celulares del Centro Único de Ablación e Implantes de la provincia de Buenos Aires (CUCAIBA), Buenos Aires, Argentina
| | - D Dubner
- Autoridad Regulatoria Nuclear, Buenos Aires, Argentina
| | - A Radl
- Autoridad Regulatoria Nuclear, Buenos Aires, Argentina
| | - A Coppola
- Hospital de Quemados del Gobierno de la Ciudad de Buenos Aires, Buenos Aires, Argentina
| | - M Di Giorgio
- Autoridad Regulatoria Nuclear, Buenos Aires, Argentina
| |
Collapse
|
41
|
Singh M, Alavi A, Wong R, Akita S. Radiodermatitis: A Review of Our Current Understanding. Am J Clin Dermatol 2016; 17:277-92. [PMID: 27021652 DOI: 10.1007/s40257-016-0186-4] [Citation(s) in RCA: 187] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Radiodermatitis (radiation dermatitis, radiation-induced skin reactions, or radiation injury) is a significant side effect of ionizing radiation delivered to the skin during cancer treatment as well as a result of nuclear attacks and disasters, such as that which occurred in Fukushima in 2011. More specifically, 95 % of cancer patients receiving radiation therapy will develop some form of radiodermatitis, including erythema, dry desquamation, and moist desquamation. These radiation skin reactions result in a myriad of complications, including delays in treatment, diminished aesthetic appeal, and reduced quality of life. Recent technological advancements and novel treatment regimens have only been successful in partly ameliorating these adverse side effects. This article examines the current knowledge surrounding the pathogenesis, clinical manifestations, differential diagnoses, prevention, and management of radiodermatitis. Future research should examine therapies that incorporate the current understanding of the pathophysiology of radiodermatitis while measuring effectiveness using objective and universal outcome measures.
Collapse
|
42
|
Zecha JAEM, Raber-Durlacher JE, Nair RG, Epstein JB, Elad S, Hamblin MR, Barasch A, Migliorati CA, Milstein DMJ, Genot MT, Lansaat L, van der Brink R, Arnabat-Dominguez J, van der Molen L, Jacobi I, van Diessen J, de Lange J, Smeele LE, Schubert MM, Bensadoun RJ. Low-level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: part 2: proposed applications and treatment protocols. Support Care Cancer 2016; 24:2793-805. [PMID: 26984249 DOI: 10.1007/s00520-016-3153-y] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 03/07/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE There is a large body of evidence supporting the efficacy of low-level laser therapy (LLLT), more recently termed photobiomodulation (PBM) for the management of oral mucositis (OM) in patients undergoing radiotherapy for head and neck cancer (HNC). Recent advances in PBM technology, together with a better understanding of mechanisms involved and dosimetric parameters may lead to the management of a broader range of complications associated with HNC treatment. This could enhance patient adherence to cancer therapy, and improve quality of life and treatment outcomes. The mechanisms of action, dosimetric, and safety considerations for PBM have been reviewed in part 1. Part 2 discusses the head and neck treatment side effects for which PBM may prove to be effective. In addition, PBM parameters for each of these complications are suggested and future research directions are discussed. METHODS Narrative review and presentation of PBM parameters are based on current evidence and expert opinion. RESULTS PBM may have potential applications in the management of a broad range of side effects of (chemo)radiation therapy (CRT) in patients being treated for HNC. For OM management, optimal PBM parameters identified were as follows: wavelength, typically between 633 and 685 nm or 780-830 nm; energy density, laser or light-emitting diode (LED) output between 10 and 150 mW; dose, 2-3 J (J/cm(2)), and no more than 6 J/cm(2) on the tissue surface treated; treatment schedule, two to three times a week up to daily; emission type, pulsed (<100 Hz); and route of delivery, intraorally and/or transcutaneously. To facilitate further studies, we propose potentially effective PBM parameters for prophylactic and therapeutic use in supportive care for dermatitis, dysphagia, dry mouth, dysgeusia, trismus, necrosis, lymphedema, and voice/speech alterations. CONCLUSION PBM may have a role in supportive care for a broad range of complications associated with the treatment of HNC with CRT. The suggested PBM irradiation and dosimetric parameters, which are potentially effective for these complications, are intended to provide guidance for well-designed future studies. It is imperative that such studies include elucidating the effects of PBM on oncology treatment outcomes.
Collapse
Affiliation(s)
- Judith A E M Zecha
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Judith E Raber-Durlacher
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.,Department of Medical Dental Interaction and Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, P.O. Box 22660 1100 DD, Amsterdam, the Netherlands
| | - Raj G Nair
- Oral Medicine Oral Pathology and Human Diseases, Menzies Health Institute Queensland and Oral Medicine Consultant, Department of Haematology and Oncology/Cancer Services, Gold Coast University Hospital, Queensland Health, Queensland, Australia
| | - Joel B Epstein
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.,Division of Otolaryngology and Head and Neck Surgery, City of Hope, Duarte, CA, 91010, USA
| | - Sharon Elad
- Division of Oral Medicine, Eastman Institute for Oral Health, and Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, 14620, USA
| | - Michael R Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, 02114, USA.,Department of Dermatology, Harvard Medical School, Boston, MA, 02115, USA.,Harvard-MIT Division of Health Science and Technology, Cambridge, MA, 02139, USA
| | - Andrei Barasch
- Division of Oncology, Weill Cornell Medical Center, New York, NY, USA
| | - Cesar A Migliorati
- Department of Diagnostic Sciences and Oral Medicine, Director of Oral Medicine, College of Dentistry, University of Tennessee Health Science Center, 875 Union Ave. Suite N231, Memphis, TN, 38163, USA
| | - Dan M J Milstein
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Marie-Thérèse Genot
- Laser Therapy Unit, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles, Brussels, Belgium
| | - Liset Lansaat
- Antoni van Leeuwenhoek Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ron van der Brink
- Division of Otolaryngology and Head and Neck Surgery, City of Hope, Duarte, CA, 91010, USA
| | | | - Lisette van der Molen
- Antoni van Leeuwenhoek Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Irene Jacobi
- Antoni van Leeuwenhoek Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Judi van Diessen
- Antoni van Leeuwenhoek Department of Radiation Oncology, Amsterdam, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Ludi E Smeele
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.,Antoni van Leeuwenhoek Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Mark M Schubert
- Seattle Cancer Care Alliance (SCCA), Oral Medicine, 825 Eastlake Ave E Ste G6900, Seattle, WA, 98109, USA
| | - René-Jean Bensadoun
- World Association for Laser Therapy (WALT) Scientific Secretary, Centre de Haute Energie (CHE), 10 Bd Pasteur, 06000, Nice, France.
| |
Collapse
|
43
|
Wright JL, Takita C, Reis IM, Zhao W, Lee E, Nelson OL, Hu JJ. Prospective evaluation of radiation-induced skin toxicity in a race/ethnically diverse breast cancer population. Cancer Med 2016; 5:454-64. [PMID: 26763411 PMCID: PMC4799959 DOI: 10.1002/cam4.608] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 11/18/2015] [Indexed: 01/08/2023] Open
Abstract
We evaluated predictors of radiation‐induced skin toxicity in a prospective study of a tri‐racial/ethnic breast cancer population. We evaluated patient demographics, tumor characteristics, and treatment variables in the first 392 patients in a prospective study assessing radiation‐induced skin toxicity. Logistic regression analyses were conducted to evaluate potential predictors of skin toxicity. The study consists of 59 non‐Hispanic whites (NHW; 15%), 241 Hispanic Whites (HW; 62%), 79 black or African Americans (AA; 20%), and 13 others (3%). Overall, 48% developed grade 0–1 skin toxicity, 49.8% grade 2, and 2.2% grade 3 by the National Cancer Institute's Common Toxicity Criteria for Adverse Events (CTCAE) scale. Twenty‐one percent developed moist desquamation. In multivariate analysis, higher body mass index (BMI; OR = 2.09; 95%CI = 1.15, 3.82), higher disease stage (OR = 1.82; 95%CI = 1.06, 3.11), ER‐positive/PR‐negative status (OR = 2.74; 95%CI = 1.26, 5.98), and conventionally fractionated regimens (OR = 3.25; 95%CI = 1.76, 6.01) were significantly associated with higher skin toxicity grade after adjustment for age, race, ethnicity, ER status, and breast volume. BMI specifically predicted for moist desquamation, but not degree of erythema. In this racially and ethnically diverse cohort of breast cancer patients receiving radiation to the intact breast, risk factors including BMI, disease stage, and conventionally fractionated radiation predicted for higher skin toxicity grade, whereas age, race, ethnicity, and breast volume did not. BMI specifically predicted for moist desquamation, suggesting that preventive measures to address this particular outcome should be investigated.
Collapse
Affiliation(s)
- Jean L Wright
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Cristiane Takita
- Department of Radiation Oncology, University of Miami School of Medicine, Miami, Florida
| | - Isildinha M Reis
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, Florida
| | - Wei Zhao
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, Florida
| | - Eunkyung Lee
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida
| | - Omar L Nelson
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, Florida
| | - Jennifer J Hu
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, Florida
| |
Collapse
|
44
|
Luan A, Duscher D, Whittam AJ, Paik KJ, Zielins ER, Brett EA, Atashroo DA, Hu MS, Lee GK, Gurtner GC, Longaker MT, Wan DC. Cell-Assisted Lipotransfer Improves Volume Retention in Irradiated Recipient Sites and Rescues Radiation-Induced Skin Changes. Stem Cells 2016; 34:668-73. [PMID: 26661694 DOI: 10.1002/stem.2256] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 10/11/2015] [Indexed: 01/09/2023]
Abstract
Radiation therapy is not only a mainstay in the treatment of many malignancies but also results in collateral obliteration of microvasculature and dermal/subcutaneous fibrosis. Soft tissue reconstruction of hypovascular, irradiated recipient sites through fat grafting remains challenging; however, a coincident improvement in surrounding skin quality has been noted. Cell-assisted lipotransfer (CAL), the enrichment of fat with additional adipose-derived stem cells (ASCs) from the stromal vascular fraction, has been shown to improve fat volume retention, and enhanced outcomes may also be achieved with CAL at irradiated sites. Supplementing fat grafts with additional ASCs may also augment the regenerative effect on radiation-damaged skin. In this study, we demonstrate the ability for CAL to enhance fat graft volume retention when placed beneath the irradiated scalps of immunocompromised mice. Histologic metrics of fat graft survival were also appreciated, with improved structural qualities and vascularity. Finally, rehabilitation of radiation-induced soft tissue changes were also noted, as enhanced amelioration of dermal thickness, collagen content, skin vascularity, and biomechanical measures were all observed with CAL compared to unsupplemented fat grafts. Supplementation of fat grafts with ASCs therefore shows promise for reconstruction of complex soft tissue defects following adjuvant radiotherapy.
Collapse
Affiliation(s)
- Anna Luan
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine
| | - Dominik Duscher
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine
| | - Alexander J Whittam
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine
| | - Kevin J Paik
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine
| | - Elizabeth R Zielins
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine
| | - Elizabeth A Brett
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine
| | - David A Atashroo
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine
| | - Michael S Hu
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine
| | - Gordon K Lee
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine
| | - Geoffrey C Gurtner
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine
| | - Michael T Longaker
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine.,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, California, USA
| | - Derrick C Wan
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine
| |
Collapse
|
45
|
Chen T, Wang L, Chen K, Qiu S, Cen X, Li H, Hu C. Evaluation of gamma ray-induced gastrointestinal tract morphological and proliferative activity changes in rhesus monkeys. Hum Exp Toxicol 2015; 35:1133-44. [PMID: 26699188 DOI: 10.1177/0960327115622259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To provide support for future pharmacology and preclinical studies, we have established a stable nonhuman primate animal model to demonstrate the histopathological changes in the gastrointestinal tract following gamma ray irradiation. In this study, 12 healthy rhesus monkeys were divided into 2 groups (control and radiation groups). Animals in the radiation group were exposed to gamma rays (cobalt 60 source) at a dose level of 6.5 Gy total body irradiation bilaterally (i.e. 3.25 Gy on each side). Control animals were sham exposed using identical procedures. After a 5-day in-life observation period, gastrointestinal tract tissues (esophagus, stomach, duodenum, jejunum, ileum, colon, and rectum) were collected and fixed in 10% neutral-buffered formalin for subsequent hematoxylin and eosin and 5-bromo-2-deoxyuridine (BrdU) immunohistochemistry processing. The results showed that the esophagus was undergoing degeneration without obvious inflammatory changes, while the stomach and duodenum exhibited both degeneration and inflammation. From the jejunum to the rectum, late-stage inflammation with glandular regeneration, as well as a high-level BrdU labeling index, was present.
Collapse
Affiliation(s)
- T Chen
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China National Chengdu Center for Safety Evaluation of Drugs, Chengdu, China
| | - L Wang
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China National Chengdu Center for Safety Evaluation of Drugs, Chengdu, China
| | - K Chen
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China National Chengdu Center for Safety Evaluation of Drugs, Chengdu, China
| | - S Qiu
- National Chengdu Center for Safety Evaluation of Drugs, Chengdu, China
| | - X Cen
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China National Chengdu Center for Safety Evaluation of Drugs, Chengdu, China
| | - H Li
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China National Chengdu Center for Safety Evaluation of Drugs, Chengdu, China
| | - C Hu
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China National Chengdu Center for Safety Evaluation of Drugs, Chengdu, China
| |
Collapse
|
46
|
Adipose-Derived Stem Cells Improve Survival of Random Pattern Cutaneous Flaps in Radiation Damaged Skin. J Craniofac Surg 2015; 26:1450-5. [DOI: 10.1097/scs.0000000000001852] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
47
|
Yoo H, Kang JW, Lee DW, Oh SH, Lee YS, Lee EJ, Cho J. Pyruvate metabolism: A therapeutic opportunity in radiation-induced skin injury. Biochem Biophys Res Commun 2015; 460:504-10. [PMID: 25797627 DOI: 10.1016/j.bbrc.2015.03.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 03/11/2015] [Indexed: 11/18/2022]
Abstract
Ionizing radiation is used to treat a range of cancers. Despite recent technological progress, radiation therapy can damage the skin at the administration site. The specific molecular mechanisms involved in this effect have not been fully characterized. In this study, the effects of pyruvate, on radiation-induced skin injury were investigated, including the role of the pyruvate dehydrogenase kinase 2 (PDK2) signaling pathway. Next generation sequencing (NGS) identified a wide range of gene expression differences between the control and irradiated mice, including reduced expression of PDK2. This was confirmed using Q-PCR. Cell culture studies demonstrated that PDK2 overexpression and a high cellular pyruvate concentration inhibited radiation-induced cytokine expression. Immunohistochemical studies demonstrated radiation-induced skin thickening and gene expression changes. Oral pyruvate treatment markedly downregulated radiation-induced changes in skin thickness and inflammatory cytokine expression. These findings indicated that regulation of the pyruvate metabolic pathway could provide an effective approach to the control of radiation-induced skin damage.
Collapse
Affiliation(s)
- Hyun Yoo
- Department of Radiation Oncology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
| | - Jeong Wook Kang
- Department of Radiation Oncology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
| | - Dong Won Lee
- Department of Plastic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
| | - Sang Ho Oh
- Department of Dermatology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
| | - Yun-Sil Lee
- College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewah Womans University, Seoul 120-750, South Korea
| | - Eun-Jung Lee
- Department of Radiation Oncology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
| | - Jaeho Cho
- Department of Radiation Oncology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea.
| |
Collapse
|
48
|
Efficacy of Synbiotics to Reduce Acute Radiation Proctitis Symptoms and Improve Quality of Life: A Randomized, Double-Blind, Placebo-Controlled Pilot Trial. Int J Radiat Oncol Biol Phys 2014; 90:289-95. [DOI: 10.1016/j.ijrobp.2014.05.049] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/23/2014] [Accepted: 05/27/2014] [Indexed: 01/01/2023]
|
49
|
De Langhe S, Mulliez T, Veldeman L, Remouchamps V, van Greveling A, Gilsoul M, De Schepper E, De Ruyck K, De Neve W, Thierens H. Factors modifying the risk for developing acute skin toxicity after whole-breast intensity modulated radiotherapy. BMC Cancer 2014; 14:711. [PMID: 25252713 PMCID: PMC4192342 DOI: 10.1186/1471-2407-14-711] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 09/18/2014] [Indexed: 11/29/2022] Open
Abstract
Background After breast-conserving radiation therapy most patients experience acute skin toxicity to some degree. This may impair patients’ quality of life, cause pain and discomfort. In this study, we investigated treatment and patient-related factors, including genetic polymorphisms, that can modify the risk for severe radiation-induced skin toxicity in breast cancer patients. Methods We studied 377 patients treated at Ghent University Hospital and at ST.-Elisabeth Clinic and Maternity in Namur, with adjuvant intensity modulated radiotherapy (IMRT) after breast-conserving surgery for breast cancer. Women were treated in a prone or supine position with normofractionated (25 × 2 Gy) or hypofractionated (15 × 2.67 Gy) IMRT alone or in combination with other adjuvant therapies. Patient- and treatment-related factors and genetic markers in regulatory regions of radioresponsive genes and in LIG3, MLH1 and XRCC3 genes were considered as variables. Acute dermatitis was scored using the CTCAEv3.0 scoring system. Desquamation was scored separately on a 3-point scale (0-none, 1-dry, 2-moist). Results Two-hundred and twenty patients (58%) developed G2+ dermatitis whereas moist desquamation occurred in 56 patients (15%). Normofractionation (both p < 0.001), high body mass index (BMI) (p = 0.003 and p < 0.001), bra cup size ≥ D (p = 0.001 and p = 0.043) and concurrent hormone therapy (p = 0.001 and p = 0.037) were significantly associated with occurrence of acute dermatitis and moist desquamation, respectively. Additional factors associated with an increased risk of acute dermatitis were the genetic variation in MLH1 rs1800734 (p=0.008), smoking during RT (p = 0.010) and supine IMRT (p = 0.004). Patients receiving trastuzumab showed decreased risk of acute dermatitis (p < 0.001). Conclusions The normofractionation schedule, supine IMRT, concomitant hormone treatment and patient related factors (high BMI, large breast, smoking during treatment and the genetic variation in MLH1 rs1800734) were associated with increased acute skin toxicity in patients receiving radiation therapy after breast-conserving surgery. Trastuzumab seemed to be protective.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Hubert Thierens
- Department of Basic Medical Sciences, Ghent University, Proeftuinstraat 86, 9000 Ghent, Belgium.
| |
Collapse
|
50
|
Kim JH, Jenrow KA, Brown SL. Mechanisms of radiation-induced normal tissue toxicity and implications for future clinical trials. Radiat Oncol J 2014; 32:103-15. [PMID: 25324981 PMCID: PMC4194292 DOI: 10.3857/roj.2014.32.3.103] [Citation(s) in RCA: 186] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 08/18/2014] [Indexed: 01/10/2023] Open
Abstract
To summarize current knowledge regarding mechanisms of radiation-induced normal tissue injury and medical countermeasures available to reduce its severity. Advances in radiation delivery using megavoltage and intensity-modulated radiation therapy have permitted delivery of higher doses of radiation to well-defined tumor target tissues. Injury to critical normal tissues and organs, however, poses substantial risks in the curative treatment of cancers, especially when radiation is administered in combination with chemotherapy. The principal pathogenesis is initiated by depletion of tissue stem cells and progenitor cells and damage to vascular endothelial microvessels. Emerging concepts of radiation-induced normal tissue toxicity suggest that the recovery and repopulation of stromal stem cells remain chronically impaired by long-lived free radicals, reactive oxygen species, and pro-inflammatory cytokines/chemokines resulting in progressive damage after radiation exposure. Better understanding the mechanisms mediating interactions among excessive generation of reactive oxygen species, production of pro-inflammatory cytokines and activated macrophages, and role of bone marrow-derived progenitor and stem cells may provide novel insight on the pathogenesis of radiation-induced injury of tissues. Further understanding the molecular signaling pathways of cytokines and chemokines would reveal novel targets for protecting or mitigating radiation injury of tissues and organs.
Collapse
Affiliation(s)
- Jae Ho Kim
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
| | - Kenneth A. Jenrow
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
| | - Stephen L. Brown
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
| |
Collapse
|