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Sleiman A, Miller KB, Flores D, Kuan J, Altwasser K, Smith BJ, Kozbenko T, Hocking R, Wood SJ, Huff J, Adam-Guillermin C, Hamada N, Yauk C, Wilkins R, Chauhan V. AOP report: Development of an adverse outcome pathway for deposition of energy leading to learning and memory impairment. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2024. [PMID: 39228295 DOI: 10.1002/em.22622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Accepted: 08/14/2024] [Indexed: 09/05/2024]
Abstract
Understanding radiation-induced non-cancer effects on the central nervous system (CNS) is essential for the risk assessment of medical (e.g., radiotherapy) and occupational (e.g., nuclear workers and astronauts) exposures. Herein, the adverse outcome pathway (AOP) approach was used to consolidate relevant studies in the area of cognitive decline for identification of research gaps, countermeasure development, and for eventual use in risk assessments. AOPs are an analytical construct describing critical events to an adverse outcome (AO) in a simplified form beginning with a molecular initiating event (MIE). An AOP was constructed utilizing mechanistic information to build empirical support for the key event relationships (KERs) between the MIE of deposition of energy to the AO of learning and memory impairment through multiple key events (KEs). The evidence for the AOP was acquired through a documented scoping review of the literature. In this AOP, the MIE is connected to the AO via six KEs: increased oxidative stress, increased deoxyribonucleic acid (DNA) strand breaks, altered stress response signaling, tissue resident cell activation, increased pro-inflammatory mediators, and abnormal neural remodeling that encompasses atypical structural and functional alterations of neural cells and surrounding environment. Deposition of energy directly leads to oxidative stress, increased DNA strand breaks, an increase of pro-inflammatory mediators and tissue resident cell activation. These KEs, which are themselves interconnected, can lead to abnormal neural remodeling impacting learning and memory processes. Identified knowledge gaps include improving quantitative understanding of the AOP across several KERs and additional testing of proposed modulating factors through experimental work. Broadly, it is envisioned that the outcome of these efforts could be extended to other cognitive disorders and complement ongoing work by international radiation governing bodies in their review of the system of radiological protection.
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Affiliation(s)
- Ahmad Sleiman
- Institut de Radioprotection et de Sûreté Nucléaire, St. Paul Lez Durance, Provence, France
| | - Kathleen B Miller
- Department of Health and Exercise Science, Morrison College Family of Health, University of St. Thomas, Saint Paul, Minnesota, USA
| | - Danicia Flores
- Consumer and Clinical Radiation Protection Bureau, Environmental and Radiation Health Sciences Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Jaqueline Kuan
- Consumer and Clinical Radiation Protection Bureau, Environmental and Radiation Health Sciences Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Kaitlyn Altwasser
- Consumer and Clinical Radiation Protection Bureau, Environmental and Radiation Health Sciences Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Benjamin J Smith
- Consumer and Clinical Radiation Protection Bureau, Environmental and Radiation Health Sciences Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Tatiana Kozbenko
- Consumer and Clinical Radiation Protection Bureau, Environmental and Radiation Health Sciences Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Robyn Hocking
- Consumer and Clinical Radiation Protection Bureau, Environmental and Radiation Health Sciences Directorate, Health Canada, Ottawa, Ontario, Canada
| | | | - Janice Huff
- NASA Langley Research Center, Hampton, Virginia, USA
| | | | - Nobuyuki Hamada
- Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Chiba, Japan
| | - Carole Yauk
- Department of Biology, University of Ottawa, Ottawa, Ontario, Canada
| | - Ruth Wilkins
- Consumer and Clinical Radiation Protection Bureau, Environmental and Radiation Health Sciences Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Vinita Chauhan
- Consumer and Clinical Radiation Protection Bureau, Environmental and Radiation Health Sciences Directorate, Health Canada, Ottawa, Ontario, Canada
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Little MP, Bazyka D, de Gonzalez AB, Brenner AV, Chumak VV, Cullings HM, Daniels RD, French B, Grant E, Hamada N, Hauptmann M, Kendall GM, Laurier D, Lee C, Lee WJ, Linet MS, Mabuchi K, Morton LM, Muirhead CR, Preston DL, Rajaraman P, Richardson DB, Sakata R, Samet JM, Simon SL, Sugiyama H, Wakeford R, Zablotska LB. A Historical Survey of Key Epidemiological Studies of Ionizing Radiation Exposure. Radiat Res 2024; 202:432-487. [PMID: 39021204 PMCID: PMC11316622 DOI: 10.1667/rade-24-00021.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/23/2024] [Indexed: 07/20/2024]
Abstract
In this article we review the history of key epidemiological studies of populations exposed to ionizing radiation. We highlight historical and recent findings regarding radiation-associated risks for incidence and mortality of cancer and non-cancer outcomes with emphasis on study design and methods of exposure assessment and dose estimation along with brief consideration of sources of bias for a few of the more important studies. We examine the findings from the epidemiological studies of the Japanese atomic bomb survivors, persons exposed to radiation for diagnostic or therapeutic purposes, those exposed to environmental sources including Chornobyl and other reactor accidents, and occupationally exposed cohorts. We also summarize results of pooled studies. These summaries are necessarily brief, but we provide references to more detailed information. We discuss possible future directions of study, to include assessment of susceptible populations, and possible new populations, data sources, study designs and methods of analysis.
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Affiliation(s)
- Mark P. Little
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
- Faculty of Health and Life Sciences, Oxford Brookes University, Headington Campus, Oxford, OX3 0BP, UK
| | - Dimitry Bazyka
- National Research Center for Radiation Medicine, Hematology and Oncology, 53 Melnikov Street, Kyiv 04050, Ukraine
| | | | - Alina V. Brenner
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Vadim V. Chumak
- National Research Center for Radiation Medicine, Hematology and Oncology, 53 Melnikov Street, Kyiv 04050, Ukraine
| | - Harry M. Cullings
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Robert D. Daniels
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Benjamin French
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric Grant
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Nobuyuki Hamada
- Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), 1646 Abiko, Chiba 270-1194, Japan
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
| | - Gerald M. Kendall
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Dominique Laurier
- Institute for Radiological Protection and Nuclear Safety, Fontenay aux Roses France
| | - Choonsik Lee
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Martha S. Linet
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Kiyohiko Mabuchi
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Lindsay M. Morton
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | | | | | - Preetha Rajaraman
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - David B. Richardson
- Environmental and Occupational Health, 653 East Peltason, University California, Irvine, Irvine, CA 92697-3957 USA
| | - Ritsu Sakata
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Jonathan M. Samet
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Steven L. Simon
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Hiromi Sugiyama
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Richard Wakeford
- Centre for Occupational and Environmental Health, The University of Manchester, Ellen Wilkinson Building, Oxford Road, Manchester, M13 9PL, UK
| | - Lydia B. Zablotska
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, 550 16 Street, 2 floor, San Francisco, CA 94143, USA
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3
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Wilson C, Adams GG, Patel P, Windham K, Ennis C, Caffrey E. A Review of Recent Low-dose Research and Recommendations for Moving Forward. HEALTH PHYSICS 2024; 126:386-396. [PMID: 38568156 DOI: 10.1097/hp.0000000000001808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
ABSTRACT The linear no-threshold (LNT) model has been the regulatory "law of the land" for decades. Despite the long-standing use of LNT, there is significant ongoing scientific disagreement on the applicability of LNT to low-dose radiation risk. A review of the low-dose risk literature of the last 10 y does not provide a clear answer, but rather the body of literature seems to be split between LNT, non-linear risk functions (e.g., supra- or sub-linear), and hormetic models. Furthermore, recent studies have started to explore whether radiation can play a role in the development of several non-cancer effects, such as heart disease, Parkinson's disease, and diabetes, the mechanisms of which are still being explored. Based on this review, there is insufficient evidence to replace LNT as the regulatory model despite the fact that it contributes to public radiophobia, unpreparedness in radiation emergency response, and extreme cleanup costs both following radiological or nuclear incidents and for routine decommissioning of nuclear power plants. Rather, additional research is needed to further understand the implications of low doses of radiation. The authors present an approach to meaningfully contribute to the science of low-dose research that incorporates machine learning and Edisonian approaches to data analysis.
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Affiliation(s)
- Charles Wilson
- University of Alabama at Birmingham, School of Health Professions, Clinical and Diagnostic Sciences, Health Physics Program
| | - Grace G Adams
- Gryphon Scientific, LLC, 6930 Carrol Ave., Suite 810, Takoma Park, MD 20912
| | - Pooja Patel
- University of Alabama at Birmingham, School of Health Professions, Clinical and Diagnostic Sciences, Health Physics Program
| | - Kiran Windham
- University of Alabama at Birmingham, School of Health Professions, Clinical and Diagnostic Sciences, Health Physics Program
| | - Colby Ennis
- University of Alabama at Birmingham, School of Health Professions, Clinical and Diagnostic Sciences, Health Physics Program
| | - Emily Caffrey
- University of Alabama at Birmingham, School of Health Professions, Clinical and Diagnostic Sciences, Health Physics Program
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Dauer LT, Walsh L, Mumma MT, Cohen SS, Golden AP, Howard SC, Roemer GE, Boice JD. Moon, Mars and Minds: Evaluating Parkinson's disease mortality among U.S. radiation workers and veterans in the million person study of low-dose effects. Z Med Phys 2024; 34:100-110. [PMID: 37537100 PMCID: PMC10919963 DOI: 10.1016/j.zemedi.2023.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Radiation is one of the most important stressors related to missions in space beyond Earth's orbit. Epidemiologic studies of exposed workers have reported elevated rates of Parkinson's disease. The importance of cognitive dysfunction related to low-dose rate radiation in humans is not defined. A meta-analysis was conducted of six cohorts in the Million Person Study (MPS) of low-dose health effects to learn whether there is consistent evidence that Parkinson's disease is associated with radiation dose to brain. MATERIALS AND METHODS The MPS evaluates all causes of death among U.S. radiation workers and veterans, including Parkinson's disease. Systematic and consistent methods are applied to study all categories of workers including medical radiation workers, industrial radiographers, nuclear power plant workers, atomic veterans, and Manhattan Projects workers at the Los Alamos National Laboratory and at Rocky Flats. Consistent methods for all cohorts are used to estimate organ-specific doses and to obtain vital status and cause of death. RESULTS The meta-analysis include 6 cohorts within the MPS, consisting of 517,608 workers and 17,219,001 person-years of observation. The mean dose to brain ranged from 6.9 to 47.6 mGy and the maximum dose from 0.76 to 2.7 Gy. Five of the 6 cohorts revealed positive associations with Parkinson's disease. The overall summary estimate from the meta-analysis was statistically significant based on 1573 deaths due to Parkinson's disease. The summary excess relative risk at 100 mGy was 0.17 (95% CI: 0.05; 0.29). CONCLUSIONS Parkinson's disease was positively associated with radiation in the MPS cohorts indicating the need for careful evaluation as to causality in other studies, delineation of possible mechanisms, and assessing possible implications for space travel as well as radiation protection guidance for terrestrial workers.
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Affiliation(s)
- Lawrence T Dauer
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Linda Walsh
- Department of Physics, University of Zürich, Zürich, Switzerland
| | - Michael T Mumma
- Vanderbilt University Medical Center's International Epidemiology Field Station, Rockville, MD, USA
| | | | - Ashley P Golden
- ORISE Health Studies Program, Oak Ridge Associated Universities, Oak Ridge, TN, USA
| | - Sara C Howard
- ORISE Health Studies Program, Oak Ridge Associated Universities, Oak Ridge, TN, USA
| | - Grace E Roemer
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John D Boice
- National Council on Radiation Protection and Measurements, Bethesda, MD, USA; Vanderbilt University School of Medicine, Nashville, TN, USA
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5
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Thariat J, Little MP, Zablotska LB, Samson P, O’Banion MK, Leuraud K, Bergom C, Girault G, Azimzadeh O, Bouffler S, Hamada N. Radiotherapy for non-cancer diseases: benefits and long-term risks. Int J Radiat Biol 2024; 100:505-526. [PMID: 38180039 PMCID: PMC11039429 DOI: 10.1080/09553002.2023.2295966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE The discovery of X-rays was followed by a variety of attempts to treat infectious diseases and various other non-cancer diseases with ionizing radiation, in addition to cancer. There has been a recent resurgence of interest in the use of such radiotherapy for non-cancer diseases. Non-cancer diseases for which use of radiotherapy has currently been proposed include refractory ventricular tachycardia, neurodegenerative diseases (e.g. Alzheimer's disease and dementia), and Coronavirus Disease 2019 (COVID-19) pneumonia, all with ongoing clinical studies that deliver radiation doses of 0.5-25 Gy in a single fraction or in multiple daily fractions. In addition to such non-cancer effects, historical indications predominantly used in some countries (e.g. Germany) include osteoarthritis and degenerative diseases of the bones and joints. This narrative review gives an overview of the biological rationale and ongoing preclinical and clinical studies for radiotherapy proposed for various non-cancer diseases, discusses the plausibility of the proposed biological rationale, and considers the long-term radiation risks of cancer and non-cancer diseases. CONCLUSIONS A growing body of evidence has suggested that radiation represents a double-edged sword, not only for cancer, but also for non-cancer diseases. At present, clinical evidence has shown some beneficial effects of radiotherapy for ventricular tachycardia, but there is little or no such evidence of radiotherapy for other newly proposed non-cancer diseases (e.g. Alzheimer's disease, COVID-19 pneumonia). Patients with ventricular tachycardia and COVID-19 pneumonia have thus far been treated with radiotherapy when they are an urgent life threat with no efficient alternative treatment, but some survivors may encounter a paradoxical situation where patients were rescued by radiotherapy but then get harmed by radiotherapy. Further studies are needed to justify the clinical use of radiotherapy for non-cancer diseases, and optimize dose to diseased tissue while minimizing dose to healthy tissue.
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Affiliation(s)
- Juliette Thariat
- Department of Radiation Oncology, Comprehensive Cancer Centre François Baclesse, Caen, France
- Laboratoire de Physique Corpusculaire IN2P3, ENSICAEN/CNRS UMR 6534, Normandie Université, Caen, France
| | - Mark P. Little
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Lydia B. Zablotska
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Pamela Samson
- Department of Radiation Oncology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - M. Kerry O’Banion
- Department of Neuroscience, Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Klervi Leuraud
- Research Department on Biological and Health Effects of Ionizing Radiation (SESANE), Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - Carmen Bergom
- Department of Radiation Oncology, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
- Cardio-Oncology Center of Excellence, Washington University, St. Louis, Missouri, USA
| | - Gilles Girault
- Comprehensive Cancer Centre François Baclesse, Medical Library, Caen, France
| | - Omid Azimzadeh
- Federal Office for Radiation Protection (BfS), Section Radiation Biology, Neuherberg, Germany
| | - Simon Bouffler
- Radiation Protection Sciences Division, UK Health Security Agency (UKHSA), Chilton, Didcot, UK
| | - Nobuyuki Hamada
- Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Abiko, Chiba, Japan
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6
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Vellingiri B. A deeper understanding about the role of uranium toxicity in neurodegeneration. ENVIRONMENTAL RESEARCH 2023; 233:116430. [PMID: 37329943 DOI: 10.1016/j.envres.2023.116430] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/01/2023] [Accepted: 06/14/2023] [Indexed: 06/19/2023]
Abstract
Natural deposits and human-caused releases of uranium have led to its contamination in the nature. Toxic environmental contaminants such as uranium that harm cerebral processes specifically target the brain. Numerous experimental researches have shown that occupational and environmental uranium exposure can result in a wide range of health issues. According to the recent experimental research, uranium can enter the brain after exposure and cause neurobehavioral problems such as elevated motion related activity, disruption of the sleep-wake cycle, poor memory, and elevated anxiety. However, the exact mechanism behind the factor for neurotoxicity by uranium is still uncertain. This review primarily aims on a brief overview of uranium, its route of exposure to the central nervous system, and the likely mechanism of uranium in neurological diseases including oxidative stress, epigenetic modification, and neuronal inflammation has been described, which could present the probable state-of-the-art status of uranium in neurotoxicity. Finally, we offer some preventative strategies to workers who are exposed to uranium at work. In closing, this study highlights the knowledge of uranium's health dangers and underlying toxicological mechanisms is still in its infancy, and there is still more to learn about many contentious discoveries.
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Affiliation(s)
- Balachandar Vellingiri
- Cytogenetics and Stem Cell Laboratory, Department of Zoology, School of Basic Sciences, Central University of Punjab, Bathinda, 151401, Punjab, India.
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7
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Hamada N. Noncancer Effects of Ionizing Radiation Exposure on the Eye, the Circulatory System and beyond: Developments made since the 2011 ICRP Statement on Tissue Reactions. Radiat Res 2023; 200:188-216. [PMID: 37410098 DOI: 10.1667/rade-23-00030.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/13/2023] [Indexed: 07/07/2023]
Abstract
For radiation protection purposes, noncancer effects with a threshold-type dose-response relationship have been classified as tissue reactions (formerly called nonstochastic or deterministic effects), and equivalent dose limits aim to prevent occurrence of such tissue reactions. Accumulating evidence demonstrates increased risks for several late occurring noncancer effects at doses and dose rates much lower than previously considered. In 2011, the International Commission on Radiological Protection (ICRP) issued a statement on tissue reactions to recommend a threshold of 0.5 Gy to the lens of the eye for cataracts and to the heart and brain for diseases of the circulatory system (DCS), independent of dose rate. Literature published thereafter continues to provide updated knowledge. Increased risks for cataracts below 0.5 Gy have been reported in several cohorts (e.g., including in those receiving protracted or chronic exposures). A dose threshold for cataracts is less evident with longer follow-up, with limited evidence available for risk of cataract removal surgery. There is emerging evidence for risk of normal-tension glaucoma and diabetic retinopathy, but the long-held tenet that the lens represents among the most radiosensitive tissues in the eye and in the body seems to remain unchanged. For DCS, increased risks have been reported in various cohorts, but the existence or otherwise of a dose threshold is unclear. The level of risk is less uncertain at lower dose and lower dose rate, with the possibility that risk per unit dose is greater at lower doses and dose rates. Target organs and tissues for DCS are also unknown, but may include heart, large blood vessels and kidneys. Identification of potential factors (e.g., sex, age, lifestyle factors, coexposures, comorbidities, genetics and epigenetics) that may modify radiation risk of cataracts and DCS would be important. Other noncancer effects on the radar include neurological effects (e.g., Parkinson's disease, Alzheimer's disease and dementia) of which elevated risk has increasingly been reported. These late occurring noncancer effects tend to deviate from the definition of tissue reactions, necessitating more scientific developments to reconsider the radiation effect classification system and risk management. This paper gives an overview of historical developments made in ICRP prior to the 2011 statement and an update on relevant developments made since the 2011 ICRP statement.
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Affiliation(s)
- Nobuyuki Hamada
- Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Chiba, Japan
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8
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Faerman A, Clark JB, Sutton JP. Neuropsychological considerations for long-duration deep spaceflight. Front Physiol 2023; 14:1146096. [PMID: 37275233 PMCID: PMC10235498 DOI: 10.3389/fphys.2023.1146096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/09/2023] [Indexed: 06/07/2023] Open
Abstract
The deep space environment far beyond low-Earth orbit (LEO) introduces multiple and simultaneous risks for the functioning and health of the central nervous system (CNS), which may impair astronauts' performance and wellbeing. As future deep space missions to Mars, moons, or asteroids will also exceed current LEO stay durations and are estimated to require up to 3 years, we review recent evidence with contemporary and historic spaceflight case studies addressing implications for long-duration missions. To highlight the need for specific further investigations, we provide neuropsychological considerations integrating cognitive and motor functions, neuroimaging, neurological biomarkers, behavior changes, and mood and affect to construct a multifactorial profile to explain performance variability, subjective experience, and potential risks. We discuss the importance of adopting a neuropsychological approach to long-duration deep spaceflight (LDDS) missions and draw specific recommendations for future research in space neuropsychology.
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Affiliation(s)
- Afik Faerman
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Jonathan B. Clark
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, United States
- Department of Neurology, Baylor College of Medicine, Houston, TX, United States
| | - Jeffrey P. Sutton
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, United States
- Translational Research Institute for Space Health, Baylor College of Medicine, Houston, TX, United States
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
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9
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Srivastava T, Chirikova E, Birk S, Xiong F, Benzouak T, Liu JY, Villeneuve PJ, Zablotska LB. Exposure to Ionizing Radiation and Risk of Dementia: A Systematic Review and Meta-Analysis. Radiat Res 2023; 199:490-505. [PMID: 37293601 PMCID: PMC10249679 DOI: 10.1667/rade-22-00153.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The number of people living with dementia is rising globally as life expectancy increases. Dementia is a multifactorial disease. Due to the ubiquity of radiation exposure in medical and occupational settings, the potential association between radiation and dementia, and its subtypes (Alzheimer's and Parkinson's disease), is of particular importance. There has also been an increased interest in studying radiation induced dementia risks in connection with the long-term manned space travel proposed by The National Aeronautics and Space Administration (NASA). Our aim was to systematically review the literature on this topic, and use meta-analysis to generate a summary measure of association, assess publication bias and explore sources of heterogeneity across studies. We identified five types of exposed populations for this review: 1. survivors of atomic bombings in Japan; 2. patients treated with radiation therapy for cancer or other diseases; 3. occupationally exposed workers; 4. those exposed to environmental radiation; and 5. patients exposed to radiation from diagnostic radiation imaging procedures. We included studies that considered incident or mortality outcomes for dementia and its subtypes. Following PRISMA guidelines, we systematically searched the published literature indexed in PubMed between 2001 and 2022. We then abstracted the relevant articles, conducted a risk-of-bias assessment, and fit random effects models using the published risk estimates. After we applied our eligibility criteria, 18 studies were identified for review and retained for meta-analysis. For dementia (all subtypes), the summary relative risk was 1.11 (95% CI: 1.04, 1.18; P = 0.001) comparing individuals receiving 100 mSv of radiation to those with no exposure. The corresponding summary relative risk for Parkinson's disease incidence and mortality was 1.12 (95% CI 1.07, 1.17; P <0.001). Our results provide evidence that exposure to ionizing radiation increases the risk of dementia. However, our findings should be interpreted with caution due to the small number of included studies. Longitudinal studies with improved exposure characterization, incident outcomes, larger sample size, and the ability to adjust for effects of potential confounders are needed to better assess the possible causal link between ionizing radiation and dementia.
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Affiliation(s)
- Tanvi Srivastava
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California 94143
| | - Ekaterina Chirikova
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California 94143
| | - Sapriya Birk
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada K1S 5B6
| | - Fanxiu Xiong
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California 94143
| | - Tarek Benzouak
- Department of Psychology, Carleton University, Ottawa, ON, Canada K1S 5B6
| | - Jane Y. Liu
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California 94143
| | - Paul J. Villeneuve
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada K1S 5B6
| | - Lydia B. Zablotska
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California 94143
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10
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Zablotska LB, Zupunski L, Leuraud K, Lopes J, Hinkle J, Pugeda T, Delgado T, Olschowka J, Williams J, O’Banion MK, Boice JD, Cohen SS, Mumma MT, Dauer LT, Britten RA, Stephenson S. Radiation and CNS effects: summary of evidence from a recent symposium of the Radiation Research Society. Int J Radiat Biol 2022; 99:1332-1342. [PMID: 36318723 PMCID: PMC10759179 DOI: 10.1080/09553002.2023.2142984] [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: 07/22/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/13/2022]
Abstract
This article summarizes a Symposium on 'Radiation risks of the central nervous system' held virtually at the 67th Annual Meeting of the Radiation Research Society, 3-6 October 2021. Repeated low-dose radiation exposure over a certain period could lead to reduced neuronal proliferation, altered neurogenesis, neuroinflammation and various neurological complications, including psychological consequences, necessitating further research in these areas. Four speakers from radiation biology, genetics and epidemiology presented the latest data from their studies seeking insights into this important topic. This symposium highlighted new and important directions for further research on mental health disorders, neurodegenerative conditions and cognitive impairment. Future studies will examine risks of mental and behavioral disorders and neurodegenerative diseases following protracted radiation exposures to better understand risks of occupational exposures as well as provide insights into risks from exposures to galactic cosmic rays.
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Affiliation(s)
- Lydia B. Zablotska
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Ljubica Zupunski
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Klervi Leuraud
- Laboratory of Epidemiology (LEPID), Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - Julie Lopes
- Laboratory of Epidemiology (LEPID), Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - Joshua Hinkle
- Department of Neuroscience, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
- Del Monte Institute for Neuroscience, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
| | - Tyler Pugeda
- Department of Neuroscience, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
- Del Monte Institute for Neuroscience, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
| | - Thomas Delgado
- Department of Neuroscience, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
- Del Monte Institute for Neuroscience, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
| | - John Olschowka
- Department of Neuroscience, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
- Del Monte Institute for Neuroscience, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
| | - Jacqueline Williams
- Department of Environmental Medicine, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
- Wilmot Cancer Center, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
| | - M. Kerry O’Banion
- Department of Neuroscience, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
- Del Monte Institute for Neuroscience, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
- Wilmot Cancer Center, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
- Department of Neurology, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
| | - John D. Boice
- National Council on Radiation Protection and Measurements, Bethesda, MD, USA
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah S. Cohen
- Vanderbilt University Medical Center, Nashville, TN, USA
- EpidStrategies, Cary, NC, USA
| | - Michael T. Mumma
- Vanderbilt University Medical Center, Nashville, TN, USA
- International Epidemiology Institute, Rockville, MD, USA
| | | | - Richard A. Britten
- Department of Radiation Oncology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Samuel Stephenson
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
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11
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Miller KB, Mi KL, Nelson GA, Norman RB, Patel ZS, Huff JL. Ionizing radiation, cerebrovascular disease, and consequent dementia: A review and proposed framework relevant to space radiation exposure. Front Physiol 2022; 13:1008640. [PMID: 36388106 PMCID: PMC9640983 DOI: 10.3389/fphys.2022.1008640] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/29/2022] [Indexed: 09/05/2023] Open
Abstract
Space exploration requires the characterization and management or mitigation of a variety of human health risks. Exposure to space radiation is one of the main health concerns because it has the potential to increase the risk of cancer, cardiovascular disease, and both acute and late neurodegeneration. Space radiation-induced decrements to the vascular system may impact the risk for cerebrovascular disease and consequent dementia. These risks may be independent or synergistic with direct damage to central nervous system tissues. The purpose of this work is to review epidemiological and experimental data regarding the impact of low-to-moderate dose ionizing radiation on the central nervous system and the cerebrovascular system. A proposed framework outlines how space radiation-induced effects on the vasculature may increase risk for both cerebrovascular dysfunction and neural and cognitive adverse outcomes. The results of this work suggest that there are multiple processes by which ionizing radiation exposure may impact cerebrovascular function including increases in oxidative stress, neuroinflammation, endothelial cell dysfunction, arterial stiffening, atherosclerosis, and cerebral amyloid angiopathy. Cerebrovascular adverse outcomes may also promote neural and cognitive adverse outcomes. However, there are many gaps in both the human and preclinical evidence base regarding the long-term impact of ionizing radiation exposure on brain health due to heterogeneity in both exposures and outcomes. The unique composition of the space radiation environment makes the translation of the evidence base from terrestrial exposures to space exposures difficult. Additional investigation and understanding of the impact of low-to-moderate doses of ionizing radiation including high (H) atomic number (Z) and energy (E) (HZE) ions on the cerebrovascular system is needed. Furthermore, investigation of how decrements in vascular systems may contribute to development of neurodegenerative diseases in independent or synergistic pathways is important for protecting the long-term health of astronauts.
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Affiliation(s)
| | | | - Gregory A. Nelson
- Department of Basic Sciences, Division of Biomedical Engineering Sciences, Loma Linda University, Loma Linda, CA, United States
- NASA Johnson Space Center, Houston, TX, United States
- KBR Inc., Houston, TX, United States
| | - Ryan B. Norman
- NASA Langley Research Center, Hampton, VA, United States
| | - Zarana S. Patel
- NASA Johnson Space Center, Houston, TX, United States
- KBR Inc., Houston, TX, United States
| | - Janice L. Huff
- NASA Langley Research Center, Hampton, VA, United States
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12
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Lopes J, Baudin C, Leuraud K, Klokov D, Bernier MO. Ionizing radiation exposure during adulthood and risk of developing central nervous system tumors: systematic review and meta-analysis. Sci Rep 2022; 12:16209. [PMID: 36171442 PMCID: PMC9519546 DOI: 10.1038/s41598-022-20462-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 09/13/2022] [Indexed: 11/24/2022] Open
Abstract
Many studies on ionizing radiation (IR) exposure during childhood have shown deleterious effects on the central nervous system (CNS), however results regarding adult exposure are inconsistent, and no systematic reviews have been performed. The objectives are to synthesize the findings and draw evidence-based conclusions from epidemiological studies on the risk of benign and malignant brain and CNS tumors in humans exposed to low-to-moderate doses (< 0.5 Gy) of IR during adulthood/young adulthood. A systematic literature search of four electronic databases, supplemented by a hand search, was performed to retrieve relevant epidemiological studies published from 2000 to 2022. Pooled excess relative risk (ERRpooled) was estimated using a random effect model. Eighteen publications were included in the systematic review and twelve out of them were included in a meta-analysis. The following IR sources were considered: atomic bombs, occupational, and environmental exposures. No significant dose-risk association was found for brain/CNS tumors (ERRpooled at 100 mGy = - 0.01; 95% CI: - 0.05, 0.04). Our systematic review and meta-analysis did not show any association between exposure to low-to-moderate doses of IR and risk of CNS tumors. Further studies with histological information and precise dose assessment are needed.
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Affiliation(s)
- Julie Lopes
- Laboratory of Epidemiology (LEPID) - Institute for Radiological Protection and Nuclear Safety (IRSN), 92262, Fontenay-aux-Roses, France.
| | - Clémence Baudin
- Laboratory of Epidemiology (LEPID) - Institute for Radiological Protection and Nuclear Safety (IRSN), 92262, Fontenay-aux-Roses, France
| | - Klervi Leuraud
- Laboratory of Epidemiology (LEPID) - Institute for Radiological Protection and Nuclear Safety (IRSN), 92262, Fontenay-aux-Roses, France
| | - Dmitry Klokov
- Laboratory of Radiobiology and Radiotoxicology (LRTOX) - Institute for Radiological Protection and Nuclear Safety (IRSN), 92262, Fontenay-aux-Roses, France
| | - Marie-Odile Bernier
- Laboratory of Epidemiology (LEPID) - Institute for Radiological Protection and Nuclear Safety (IRSN), 92262, Fontenay-aux-Roses, France
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