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Al-Rubaiey S, Senger C, Bukatz J, Krantchev K, Janas A, Eitner C, Nieminen-Kelhä M, Brandenburg S, Zips D, Vajkoczy P, Acker G. Determinants of cerebral radionecrosis in animal models: A systematic review. Radiother Oncol 2024; 199:110444. [PMID: 39067705 DOI: 10.1016/j.radonc.2024.110444] [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: 11/26/2023] [Revised: 06/13/2024] [Accepted: 07/11/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Radionecrosis is a common complication in radiation oncology, while mechanisms and risk factors have yet to be fully explored. We therefore conducted a systematic review to understand the pathogenesis and identify factors that significantly affect the development. METHODS We performed a systematic literature search based on the PRISMA guidelines using PubMed, Ovid, and Web of Science databases. The complete search strategy can be found as a preregistered protocol on PROSPERO (CRD42023361662). RESULTS We included 83 studies, most involving healthy animals (n = 72, 86.75 %). High doses of hemispherical irradiation of 30 Gy in rats and 50 Gy in mice led repeatedly to radionecrosis among different studies and set-ups. Higher dose and larger irradiated volume were associated with earlier onset. Fractionated schedules showed limited effectiveness in the prevention of radionecrosis. Distinct anatomical brain structures respond to irradiation in various ways. White matter appears to be more vulnerable than gray matter. Younger age, more evolved animal species, and genetic background were also significant factors, whereas sex was irrelevant. Only 13.25 % of the studies were performed on primary brain tumor bearing animals, no studies on brain metastases are currently available. CONCLUSION This systematic review identified various factors that significantly affect the induction of radionecrosis. The current state of research neglects the utilization of animal models of brain tumors, even though patients with brain malignancies constitute the largest group receiving brain irradiation. This latter aspect should be primarily addressed when developing an experimental radionecrosis model for translational implementation.
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Affiliation(s)
- Sanaria Al-Rubaiey
- Department of Neurosurgery, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1 10117, Berlin, Germany; Department of Radiation Oncology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Augustenburger Platz 1 13353, Berlin, Germany.
| | - Carolin Senger
- Department of Radiation Oncology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Augustenburger Platz 1 13353, Berlin, Germany.
| | - Jan Bukatz
- Department of Neurosurgery, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1 10117, Berlin, Germany; Department of Radiation Oncology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Augustenburger Platz 1 13353, Berlin, Germany.
| | - Kiril Krantchev
- Department of Neurosurgery, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1 10117, Berlin, Germany.
| | - Anastasia Janas
- Department of Neurosurgery, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1 10117, Berlin, Germany; Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Charitéplatz 1 10117, Berlin, Germany.
| | - Chiara Eitner
- Department of Neurosurgery, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1 10117, Berlin, Germany.
| | - Melina Nieminen-Kelhä
- Department of Neurosurgery, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1 10117, Berlin, Germany.
| | - Susan Brandenburg
- Department of Neurosurgery, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1 10117, Berlin, Germany.
| | - Daniel Zips
- Department of Radiation Oncology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Augustenburger Platz 1 13353, Berlin, Germany.
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1 10117, Berlin, Germany.
| | - Güliz Acker
- Department of Neurosurgery, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1 10117, Berlin, Germany; Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Charitéplatz 1 10117, Berlin, Germany; Department of Radiation Oncology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Augustenburger Platz 1 13353, Berlin, Germany.
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Ocaña-Tienda B, León-Triana O, Pérez-Beteta J, Jiménez-Sánchez J, Pérez-García VM. Radiation necrosis after radiation therapy treatment of brain metastases: A computational approach. PLoS Comput Biol 2024; 20:e1011400. [PMID: 38289964 PMCID: PMC10857744 DOI: 10.1371/journal.pcbi.1011400] [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: 07/31/2023] [Revised: 02/09/2024] [Accepted: 01/21/2024] [Indexed: 02/01/2024] Open
Abstract
Metastasis is the process through which cancer cells break away from a primary tumor, travel through the blood or lymph system, and form new tumors in distant tissues. One of the preferred sites for metastatic dissemination is the brain, affecting more than 20% of all cancer patients. This figure is increasing steadily due to improvements in treatments of primary tumors. Stereotactic radiosurgery (SRS) is one of the main treatment options for patients with a small or moderate number of brain metastases (BMs). A frequent adverse event of SRS is radiation necrosis (RN), an inflammatory condition caused by late normal tissue cell death. A major diagnostic problem is that RNs are difficult to distinguish from BM recurrences, due to their similarities on standard magnetic resonance images (MRIs). However, this distinction is key to choosing the best therapeutic approach since RNs resolve often without further interventions, while relapsing BMs may require open brain surgery. Recent research has shown that RNs have a faster growth dynamics than recurrent BMs, providing a way to differentiate the two entities, but no mechanistic explanation has been provided for those observations. In this study, computational frameworks were developed based on mathematical models of increasing complexity, providing mechanistic explanations for the differential growth dynamics of BMs relapse versus RN events and explaining the observed clinical phenomenology. Simulated tumor relapses were found to have growth exponents substantially smaller than the group in which there was inflammation due to damage induced by SRS to normal brain tissue adjacent to the BMs, thus leading to RN. ROC curves with the synthetic data had an optimal threshold that maximized the sensitivity and specificity values for a growth exponent β* = 1.05, very close to that observed in patient datasets.
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Affiliation(s)
- Beatriz Ocaña-Tienda
- Mathematical Oncology Laboratory, Universidad de Castilla-La Mancha, Ciudad Real, Spain
| | | | - Julián Pérez-Beteta
- Mathematical Oncology Laboratory, Universidad de Castilla-La Mancha, Ciudad Real, Spain
| | - Juan Jiménez-Sánchez
- Mathematical Oncology Laboratory, Universidad de Castilla-La Mancha, Ciudad Real, Spain
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Otluoglu GD, Yılmaz B, Ekinci G, Bayri Y, Bozkurt SU, Dağçınar A. Pentoxifylline and Vitamin E Can Restrict Radiation Necrosis via Vascular Pathways, Experimental Study in an Animal Model. World Neurosurg 2023; 179:e530-e538. [PMID: 37689362 DOI: 10.1016/j.wneu.2023.08.135] [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: 06/07/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVE Radiation necrosis (RN) is a long-term side effect of Gamma Knife stereotactic radiosurgery that may require surgical intervention. Pentoxifylline and vitamin E have previously been shown to be effective in the treatment of RN in the published literature, but there are no data on the prophylactic use of these molecules or, more importantly, whether prophylaxis is required. METHODS The iatrogenic RN model included 50 Sprague-Dawley rats of both sexes. There were 7 treatment subgroups established. Gamma-Plan 8.32 was used to plan after magnetic resonance scans were performed in a specially designed frame. The injection doses used in the treatment groups were vitamin E (30 mg/kg/day in a single dose) and pentoxifylline (50 mg/kg/day in 2 doses). Control magnetic resonance scans were performed at the end of a 16-week treatment, and the subjects were decapitated for pathological evaluations. RESULTS The intensity of hypoxia - inducible factor 1α immunoreactivity is statistically significantly lower in the therapeutic vitamin E, prophylactic pentoxifylline and vitamin E, and therapeutic pentoxifylline and vitamin E groups than in the other groups. Similarly, the intensity of vascular endothelial growth factor immunoreactivity was reduced in the therapeutic vitamin E and prophylactic pentoxifylline and vitamin E treatment modality groups. When compared with other groups, the therapeutic pentoxifylline group had significantly fewer vascular endothelial growth factor-immunoreactive cells in the perinecrotic area, with an accompanying decreased contrast enhancement pattern. CONCLUSIONS Both vitamin E and pentoxifylline are effective for the treatment and/or restriction of RN, either alone or in combination. The use of these molecules as a preventive measure did not outperform the therapeutic treatment.
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Affiliation(s)
| | - Baran Yılmaz
- Department of Neurosurgery, Bahçeşehir University School of Medicine, Istanbul, Turkey
| | - Gazanfer Ekinci
- Department of Radiology, Yeditepe University School Of Medicine, Istanbul, Turkey
| | - Yaşar Bayri
- Department of Neurosurgery, Acibadem Healthcare, Istanbul, Turkey
| | - Süheyla Uyar Bozkurt
- Department of Pathology, Marmara University School of Medicine, Istanbul, Turkey
| | - Adnan Dağçınar
- Department of Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey
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4
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Romano A, Moltoni G, Blandino A, Palizzi S, Romano A, de Rosa G, De Blasi Palma L, Monopoli C, Guarnera A, Minniti G, Bozzao A. Radiosurgery for Brain Metastases: Challenges in Imaging Interpretation after Treatment. Cancers (Basel) 2023; 15:5092. [PMID: 37894459 PMCID: PMC10605307 DOI: 10.3390/cancers15205092] [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: 09/01/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
Stereotactic radiosurgery (SRS) has transformed the management of brain metastases by achieving local tumor control, reducing toxicity, and minimizing the need for whole-brain radiation therapy (WBRT). This review specifically investigates radiation-induced changes in patients treated for metastasis, highlighting the crucial role of magnetic resonance imaging (MRI) in the evaluation of treatment response, both at very early and late stages. The primary objective of the review is to evaluate the most effective imaging techniques for assessing radiation-induced changes and distinguishing them from tumor growth. The limitations of conventional imaging methods, which rely on size measurements, dimensional criteria, and contrast enhancement patterns, are critically evaluated. In addition, it has been investigated the potential of advanced imaging modalities to offer a more precise and comprehensive evaluation of treatment response. Finally, an overview of the relevant literature concerning the interpretation of brain changes in patients undergoing immunotherapies is provided.
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Affiliation(s)
- Andrea Romano
- NESMOS Department, U.O.C. Neuroradiology “Sant’Andrea” University Hospital, 00189 Rome, Italy; (A.R.); (G.M.); (A.B.); (S.P.); (A.R.); (G.d.R.); (L.D.B.P.); (C.M.); (A.G.); (A.B.)
| | - Giulia Moltoni
- NESMOS Department, U.O.C. Neuroradiology “Sant’Andrea” University Hospital, 00189 Rome, Italy; (A.R.); (G.M.); (A.B.); (S.P.); (A.R.); (G.d.R.); (L.D.B.P.); (C.M.); (A.G.); (A.B.)
| | - Antonella Blandino
- NESMOS Department, U.O.C. Neuroradiology “Sant’Andrea” University Hospital, 00189 Rome, Italy; (A.R.); (G.M.); (A.B.); (S.P.); (A.R.); (G.d.R.); (L.D.B.P.); (C.M.); (A.G.); (A.B.)
| | - Serena Palizzi
- NESMOS Department, U.O.C. Neuroradiology “Sant’Andrea” University Hospital, 00189 Rome, Italy; (A.R.); (G.M.); (A.B.); (S.P.); (A.R.); (G.d.R.); (L.D.B.P.); (C.M.); (A.G.); (A.B.)
| | - Allegra Romano
- NESMOS Department, U.O.C. Neuroradiology “Sant’Andrea” University Hospital, 00189 Rome, Italy; (A.R.); (G.M.); (A.B.); (S.P.); (A.R.); (G.d.R.); (L.D.B.P.); (C.M.); (A.G.); (A.B.)
| | - Giulia de Rosa
- NESMOS Department, U.O.C. Neuroradiology “Sant’Andrea” University Hospital, 00189 Rome, Italy; (A.R.); (G.M.); (A.B.); (S.P.); (A.R.); (G.d.R.); (L.D.B.P.); (C.M.); (A.G.); (A.B.)
| | - Lara De Blasi Palma
- NESMOS Department, U.O.C. Neuroradiology “Sant’Andrea” University Hospital, 00189 Rome, Italy; (A.R.); (G.M.); (A.B.); (S.P.); (A.R.); (G.d.R.); (L.D.B.P.); (C.M.); (A.G.); (A.B.)
| | - Cristiana Monopoli
- NESMOS Department, U.O.C. Neuroradiology “Sant’Andrea” University Hospital, 00189 Rome, Italy; (A.R.); (G.M.); (A.B.); (S.P.); (A.R.); (G.d.R.); (L.D.B.P.); (C.M.); (A.G.); (A.B.)
| | - Alessia Guarnera
- NESMOS Department, U.O.C. Neuroradiology “Sant’Andrea” University Hospital, 00189 Rome, Italy; (A.R.); (G.M.); (A.B.); (S.P.); (A.R.); (G.d.R.); (L.D.B.P.); (C.M.); (A.G.); (A.B.)
| | - Giuseppe Minniti
- Department of Radiological, Oncological and Pathological Sciences, “Sapienza” University of Rome, 00138 Rome, Italy
- IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Alessandro Bozzao
- NESMOS Department, U.O.C. Neuroradiology “Sant’Andrea” University Hospital, 00189 Rome, Italy; (A.R.); (G.M.); (A.B.); (S.P.); (A.R.); (G.d.R.); (L.D.B.P.); (C.M.); (A.G.); (A.B.)
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5
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Zhang Y, Lu L, Chen C, Field RW, D'Alton M, Kahe K. Does protracted radon exposure play a role in the development of dementia? ENVIRONMENTAL RESEARCH 2022; 210:112980. [PMID: 35189101 PMCID: PMC9081166 DOI: 10.1016/j.envres.2022.112980] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/17/2022] [Accepted: 02/17/2022] [Indexed: 06/10/2023]
Abstract
Radon is a ubiquitous radioactive gas that decays into a series of solid radioactive decay products. Radon, and its decay products, enter the human body primarily through inhalation and can be delivered to various tissues including the brain through systemic circulation. It can also reach the brain by neuronal pathways via the olfactory system. While ionizing radiation has been suggested as a risk factor of dementia for decades, studies exploring the possible role of radon exposure in the development of Alzheimer's Diseases (AD) and other dementias are sparse. We systematically reviewed the literature and found several lines of evidence suggesting that radon decay products (RDPs) disproportionally deposit in the brain of AD patients with selective accumulation within the protein fractions. Ecologic study findings also indicate a significant positive correlation between geographic-level radon distribution and AD mortality in the US. Additionally, pathologic studies of radon shed light on the potential pathways of radon decay product induced proinflammation and oxidative stress that may result in the development of dementia. In summary, there are plausible underlying biological mechanisms linking radon exposure to the risk of dementia. Since randomized clinical trials on radon exposure are not feasible, well-designed individual-level epidemiologic studies are urgently needed to elucidate the possible association between radon (i.e., RDPs) exposure and the onset of dementia.
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Affiliation(s)
- Yijia Zhang
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, 10032, USA; Department of Epidemiology, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Liping Lu
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, 10032, USA; Department of Epidemiology, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Cheng Chen
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, 10032, USA; Department of Epidemiology, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - R William Field
- Department of Occupational and Environmental Health and Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, 52242, USA
| | - Mary D'Alton
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Ka Kahe
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, 10032, USA; Department of Epidemiology, Columbia University Irving Medical Center, New York, NY, 10032, USA.
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6
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Treatment of Radiation-Induced Brain Necrosis. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2021:4793517. [PMID: 34976300 PMCID: PMC8720020 DOI: 10.1155/2021/4793517] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 11/25/2021] [Accepted: 12/08/2021] [Indexed: 02/07/2023]
Abstract
Radiation-induced brain necrosis (RBN) is a serious complication of intracranial as well as skull base tumors after radiotherapy. In the past, due to the lack of effective treatment, radiation brain necrosis was considered to be progressive and irreversible. With better understanding in histopathology and neuroimaging, the occurrence and development of RBN have been gradually clarified, and new treatment methods are constantly emerging. In recent years, some scholars have tried to treat RBN with bevacizumab, nerve growth factor, and gangliosides and have achieved similar results. Some cases of brain necrosis can be repairable and reversible. We aimed to summarize the incidence, pathogenesis, and treatment of RBN.
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7
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Choi S, Hong A, Wang T, Lo S, Chen B, Silva I, Kapoor R, Hsiao E, Fogarty GB, Carlino MS, Menzies AM, Long GV, Shivalingam BS. Risk of radiation necrosis after stereotactic radiosurgery for melanoma brain metastasis by anatomical location. Strahlenther Onkol 2021; 197:1104-1112. [PMID: 34114045 DOI: 10.1007/s00066-021-01798-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/03/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE In this retrospective study, we have explored the anatomical factors that lead to the development of radiation necrosis (RN) in the setting of stereotactic radiosurgery (SRS) for melanoma brain metastases (MBM). METHODS Between 2014 and 2018, 137 patients underwent SRS for 311 MBM. Lesions were assessed according to anatomical zones: zone 1-peripheral grey-white matter junction and cortical mantle, zone 2-deep white matter, including tumours located at base of sulci, zone 3-tumours adjacent to ependymal lining or in deep locations such as brainstem, basal ganglia and thalamus. Other anatomical factors including lobes, medial-peripheral, supra or infratentorial locations were also recorded. RESULTS In all, 12.4% (n = 17) of patients and 6.1% (n = 20) of lesions developed RN, actuarial incidence of RN at 12 and 24 months was 10% and 14.2% respectively. Zone 2 lesions recorded the highest rate of development of RN (n = 7/19; 36%), zone 3 (N = 4/24; 16%) and zone 1 (n = 9/268; 3%). Five of 17 patients developed symptomatic RN and 7/17 patients underwent surgery for RN. CONCLUSION This study raises awareness of the increased likelihood of deep lesions particularly in white matter structures to develop RN after SRS. Further studies including larger cohorts would be useful in identifying statistical differences in the rate of development of RN in different anatomical zones.
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Affiliation(s)
- Siujoon Choi
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
| | - Angela Hong
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Chris O'Brien Lifehouse, Camperdown, NSW, Australia.,Melanoma Institute Australia, North Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Tim Wang
- Melanoma Institute Australia, North Sydney, NSW, Australia.,Crown Princess Mary Cancer Centre, Westmead, NSW, Australia.,Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Seringe Lo
- Melanoma Institute Australia, North Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Bi Chen
- Melanoma Institute Australia, North Sydney, NSW, Australia
| | - Ines Silva
- Melanoma Institute Australia, North Sydney, NSW, Australia
| | - Rony Kapoor
- Melanoma Institute Australia, North Sydney, NSW, Australia.,Mater Hospital, North Sydney, NSW, Australia
| | - Edward Hsiao
- Melanoma Institute Australia, North Sydney, NSW, Australia.,Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Gerald B Fogarty
- Melanoma Institute Australia, North Sydney, NSW, Australia.,Mater Hospital, North Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Matteo S Carlino
- Melanoma Institute Australia, North Sydney, NSW, Australia.,Crown Princess Mary Cancer Centre, Westmead, NSW, Australia.,Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, North Sydney, NSW, Australia.,Mater Hospital, North Sydney, NSW, Australia.,Royal North Shore Hospital, St Leonards, NSW, Australia.,Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Georgina V Long
- Melanoma Institute Australia, North Sydney, NSW, Australia.,Mater Hospital, North Sydney, NSW, Australia.,Royal North Shore Hospital, St Leonards, NSW, Australia.,Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Brindha S Shivalingam
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Chris O'Brien Lifehouse, Camperdown, NSW, Australia.,Melanoma Institute Australia, North Sydney, NSW, Australia.,Mater Hospital, North Sydney, NSW, Australia
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8
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Chu C, Gao Y, Lan X, Lin J, Thomas AM, Li S. Stem-Cell Therapy as a Potential Strategy for Radiation-Induced Brain Injury. Stem Cell Rev Rep 2021; 16:639-649. [PMID: 32418118 DOI: 10.1007/s12015-020-09984-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Radiation therapy is a standard and effective non-surgical treatment for primary brain tumors and metastases. However, this strategy inevitably results in damage of normal brain tissue, causing severe complications, especially the late-delayed cognitive impairment. Due to the multifactorial and complex pathological effects of radiation, there is a lack of effective preventative and restorative treatments for the irradiated brain. Stem-cell therapy has held considerable promise for decades in the treatment of central nervous system (CNS) disorders because of its unique capacity for tissue repair and functional integrity. Currently, there is growing interest in using stem cells as a novel option to attenuate the adverse effects of irradiation. In the present review, we discuss recent studies evaluating stem-cell therapies for the irradiated brain and their therapeutic effects on ameliorating radiation-related brain injury as well as their potential challenges in clinical applications. We discuss these works in context of the pathogenesis of radiation-induced injury to CNS tissue in an attempt to elucidate the potential mechanisms of engrafted stem cells to reverse radiation-induced degenerative processes.
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Affiliation(s)
- Chengyan Chu
- Department of Neurology, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, No. 826 Xinan Road, Shahekou District Dalian, Dalian, Liaoning, 116033, China
| | - Yue Gao
- Department of Neurology, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, No. 826 Xinan Road, Shahekou District Dalian, Dalian, Liaoning, 116033, China
| | - Xiaoyan Lan
- Department of Neurology, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, No. 826 Xinan Road, Shahekou District Dalian, Dalian, Liaoning, 116033, China
| | - Jianwen Lin
- Department of Neurology, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, No. 826 Xinan Road, Shahekou District Dalian, Dalian, Liaoning, 116033, China
| | - Aline M Thomas
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shen Li
- Department of Neurology, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, No. 826 Xinan Road, Shahekou District Dalian, Dalian, Liaoning, 116033, China.
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Hibernation as a Tool for Radiation Protection in Space Exploration. Life (Basel) 2021; 11:life11010054. [PMID: 33466717 PMCID: PMC7828799 DOI: 10.3390/life11010054] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/29/2020] [Accepted: 01/11/2021] [Indexed: 02/08/2023] Open
Abstract
With new and advanced technology, human exploration has reached outside of the Earth's boundaries. There are plans for reaching Mars and the satellites of Jupiter and Saturn, and even to build a permanent base on the Moon. However, human beings have evolved on Earth with levels of gravity and radiation that are very different from those that we have to face in space. These issues seem to pose a significant limitation on exploration. Although there are plausible solutions for problems related to the lack of gravity, it is still unclear how to address the radiation problem. Several solutions have been proposed, such as passive or active shielding or the use of specific drugs that could reduce the effects of radiation. Recently, a method that reproduces a mechanism similar to hibernation or torpor, known as synthetic torpor, has started to become possible. Several studies show that hibernators are resistant to acute high-dose-rate radiation exposure. However, the underlying mechanism of how this occurs remains unclear, and further investigation is needed. Whether synthetic hibernation will also protect from the deleterious effects of chronic low-dose-rate radiation exposure is currently unknown. Hibernators can modulate their neuronal firing, adjust their cardiovascular function, regulate their body temperature, preserve their muscles during prolonged inactivity, regulate their immune system, and most importantly, increase their radioresistance during the inactive period. According to recent studies, synthetic hibernation, just like natural hibernation, could mitigate radiation-induced toxicity. In this review, we see what artificial hibernation is and how it could help the next generation of astronauts in future interplanetary missions.
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Bálentová S, Adamkov M. Pathological changes in the central nervous system following exposure to ionizing radiation. Physiol Res 2020; 69:389-404. [PMID: 32469226 PMCID: PMC8648310 DOI: 10.33549/physiolres.934309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 03/03/2020] [Indexed: 12/19/2022] Open
Abstract
Experimental studies in animals provide relevant knowledge about pathogenesis of radiation-induced injury to the central nervous system. Radiation-induced injury can alter neuronal, glial cell population, brain vasculature and may lead to molecular, cellular and functional consequences. Regarding to its fundamental role in the formation of new memories, spatial navigation and adult neurogenesis, the majority of studies have focused on the hippocampus. Most recent findings in cranial radiotherapy revealed that hippocampal avoidance prevents radiation-induced cognitive impairment of patients with brain primary tumors and metastases. However, numerous preclinical studies have shown that this problem is more complex. Regarding the fact, that the radiation-induced cognitive impairment reflects hippocampal and non-hippocampal compartments, it is highly important to investigate molecular, cellular and functional changes in different brain regions and their integration at clinically relevant doses and schedules. Here, we provide a literature review in order support the translation of preclinical findings to clinical practice and improve the physical and mental status of patients with brain tumors.
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Affiliation(s)
- S Bálentová
- Institute of Histology and Embryology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic.
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Cerebral Radiation Necrosis: Incidence, Pathogenesis, Diagnostic Challenges, and Future Opportunities. Curr Oncol Rep 2019; 21:66. [PMID: 31218455 DOI: 10.1007/s11912-019-0818-y] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Cerebral radiation necrosis (CRN) is a major dose-limiting adverse event of radiotherapy. The incidence rate of RN varies with the radiotherapy modality, total dose, dose fractionation, and the nature of the lesion being targeted. In addition to these known and controllable features, there is a stochastic component to the occurrence of CRN-the genetic profile of the host or the lesion and their role in the development of CRN. RECENT FINDINGS Recent studies provide some insight into the genetic mechanisms underlying radiation-induced brain injury. In addition to these incompletely understood host factors, the diagnostic criteria for CRN using structural and functional imaging are also not clear, though multiple structural and functional imaging modalities exist, a combination of which may prove to be the ideal diagnostic imaging approach. As the utilization of novel molecular therapies and immunotherapy increases, the incidence of CNR is expected to increase and its diagnosis will become more challenging. Tissue biopsies can be insensitive and suffer from sampling biases and procedural risks. Liquid biopsies represent a promising, accurate, and non-invasive diagnostic strategy, though this modality is currently in its infancy. A better understanding of the pathogenesis of CRN will expand and optimize the diagnosis and management of CRN by better utilizing existing treatment options including bevacizumab, pentoxifylline, hyperbaric oxygen therapy, and laser interstitial thermal therapy.
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Yoshida Y, Sejimo Y, Kurachi M, Ishizaki Y, Nakano T, Takahashi A. X-ray irradiation induces disruption of the blood–brain barrier with localized changes in claudin-5 and activation of microglia in the mouse brain. Neurochem Int 2018; 119:199-206. [DOI: 10.1016/j.neuint.2018.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 02/24/2018] [Accepted: 03/08/2018] [Indexed: 10/17/2022]
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Saeed Y, Xie B, Xu J, Rehman A, Hong M, Hong Q, Deng Y. Glial U87 cells protect neuronal SH-SY5Y cells from indirect effect of radiation by reducing oxidative stress and apoptosis. Acta Biochim Biophys Sin (Shanghai) 2015; 47:250-7. [PMID: 25724352 DOI: 10.1093/abbs/gmv004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Recent studies have demonstrated the role of indirect effect of radiation in neurodegeneration. However, the role of glial cells in neuroprotection against indirect effect of radiation is still not clear, although they are known to protect neurons under stress conditions in central nervous system. Our study showed that indirect effect of radiation increased the oxidative stress that further enhances the expression of key apoptotic proteins and leads to neuronal cell death. We also investigated the indirect effect of radiation on neuronal cells in the presence of glial cells in a transwell co-culture system, while our analysis was focused on neuronal cells. Irradiated cell-conditioned medium (ICCM) was used as source of indirect radiation and neuroprotective effect was analyzed by various endpoints. It was observed that ICCM-induced reactive oxidative species level was significantly reduced in SH-SY5Y cells co-cultured with glial U87 cells, which might help to maintain the integrity of mitochondrial membrane potential. Increased levels of antioxidant enzyme superoxide dismutase and antioxidant glutathione were observed in SH-SY5Y cells co-cultured with glial U87 cells. Moreover, it was also observed that co-culture with glial cells inhibits the expression of ICCM-induced apoptotic proteins, i.e. Bax, cytochrome c, and caspase-3 in SH-SY5Y cells. Hence, it can be speculated that in co-culture system glial cells may protect the neuronal SH-SY5Y cells by reducing the ICCM-induced oxidative stress and apoptotic death.
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Affiliation(s)
- Yasmeen Saeed
- School of Life Sciences, Beijing Institute of Technology, Beijing 100086, China
| | - Bingjie Xie
- School of Life Sciences, Beijing Institute of Technology, Beijing 100086, China
| | - Jin Xu
- School of Life Sciences, Beijing Institute of Technology, Beijing 100086, China
| | - Abdur Rehman
- School of Life Sciences, Beijing Institute of Technology, Beijing 100086, China
| | - Ma Hong
- School of Life Sciences, Beijing Institute of Technology, Beijing 100086, China
| | - Qing Hong
- School of Life Sciences, Beijing Institute of Technology, Beijing 100086, China
| | - Yulin Deng
- School of Life Sciences, Beijing Institute of Technology, Beijing 100086, China
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