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Draeger E, Roberts K, Decker RD, Bahar N, Wilson LD, Contessa J, Husain Z, Williams BB, Flood AB, Swartz HM, Carlson DJ. In Vivo Verification of Electron Paramagnetic Resonance Biodosimetry Using Patients Undergoing Radiation Therapy Treatment. Int J Radiat Oncol Biol Phys 2024; 119:292-301. [PMID: 38072322 DOI: 10.1016/j.ijrobp.2023.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/28/2023] [Accepted: 11/19/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE Electron paramagnetic resonance (EPR) biodosimetry, used to triage large numbers of individuals incidentally exposed to unknown doses of ionizing radiation, is based on detecting a stable physical response in the body that is subject to quantifiable variation after exposure. In vivo measurement is essential to fully characterize the radiation response relevant to a living tooth measured in situ. The purpose of this study was to verify EPR spectroscopy in vivo by estimating the radiation dose received in participants' teeth. METHODS AND MATERIALS A continuous wave L-band spectrometer was used for EPR measurements. Participants included healthy volunteers and patients undergoing head and neck and total body irradiation treatments. Healthy volunteers completed 1 measurement each, and patients underwent measurement before starting treatment and between subsequent fractions. Optically stimulated luminescent dosimeters and diodes were used to determine the dose delivered to the teeth to validate EPR measurements. RESULTS Seventy measurements were acquired from 4 total body irradiation and 6 head and neck patients over 15 months. Patient data showed a linear increase of EPR signal with delivered dose across the dose range tested. A linear least-squares weighted fit of the data gave a statistically significant correlation between EPR signal and absorbed dose (P < .0001). The standard error of inverse prediction (SEIP), used to assess the usefulness of fits, was 1.92 Gy for the dose range most relevant for immediate triage (≤7 Gy). Correcting for natural background radiation based on patient age reduced the SEIP to 1.51 Gy. CONCLUSIONS This study demonstrated the feasibility of using spectroscopic measurements from radiation therapy patients to validate in vivo EPR biodosimetry. The data illustrated a statistically significant correlation between the magnitude of EPR signals and absorbed dose. The SEIP of 1.51 Gy, obtained under clinical conditions, indicates the potential value of this technique in response to large radiation events.
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Affiliation(s)
- Emily Draeger
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut.
| | - Kenneth Roberts
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Roy D Decker
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Nina Bahar
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Lynn D Wilson
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Joseph Contessa
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Zain Husain
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Benjamin B Williams
- Department of Radiology & EPR Center, Geisel Medical School at Dartmouth, Hanover, New Hampshire
| | - Ann Barry Flood
- Department of Radiology & EPR Center, Geisel Medical School at Dartmouth, Hanover, New Hampshire
| | - Harold M Swartz
- Department of Radiology & EPR Center, Geisel Medical School at Dartmouth, Hanover, New Hampshire
| | - David J Carlson
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut.
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Swartz HM, Flood AB. Re-examining What the Results of "a Measurement of Oxygen Level in Tissues" Really Mean. Mol Imaging Biol 2024:10.1007/s11307-023-01887-6. [PMID: 38177616 DOI: 10.1007/s11307-023-01887-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024]
Abstract
Within this special issue, many eminent investigators report on measurements of oxygen (O2) levels in tissues. Given the complexities of spatial and temporal heterogeneities of O2 in tissues and its many sources, this commentary draws attention to what such measurements do and do not actually assess regarding O2 levels in tissues. Given this limitation, it also discusses how these results can be used most effectively. To provide a convenient mechanism to discuss these issues more fully, this analysis focuses on measurements using EPR oximetry, but these considerations apply to all other techniques. The nature of the delivery of O2 to tissues and the mechanisms by which O2 is consumed necessarily result in very different levels of O2 within the volume of each voxel of a measurement. Better spatial resolution cannot fully resolve the problem because the variations include O2 gradients within each cell. Improved resolution of the time-dependent variation in O2 is also very challenging because O2 levels within tissues can have fluctuations of O2 levels in the range of milliseconds, while most methods require longer times to acquire the data from each voxel. Based on these issues, we argue that the values obtained inevitably are complex aggregates of averages of O2 levels across space and time in the tissue. These complexities arise from the complex physiology of tissues and are compounded by the limitations of the technique and its ability to acquire data. However, one often can obtain very meaningful and useful results if these complexities and limitations are taken into account. We illustrate this, using results obtained with in vivo EPR oximetry, especially utilizing its capacity to make repeated measurements to follow changes in O2 levels that occur with interventions and/or over time.
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Affiliation(s)
- Harold M Swartz
- Dept. of Radiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
- Clin-EPR, LLC, Lyme, NH, USA
| | - Ann Barry Flood
- Dept. of Radiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.
- Clin-EPR, LLC, Lyme, NH, USA.
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Thomas W, Sunnerberg J, Reed M, Gladstone DJ, Zhang R, Harms J, Swartz HM, Pogue BW. Proton and Electron Ultrahigh-Dose-Rate Isodose Irradiations Produce Differences in Reactive Oxygen Species Yields. Int J Radiat Oncol Biol Phys 2024; 118:262-267. [PMID: 37558097 PMCID: PMC10843497 DOI: 10.1016/j.ijrobp.2023.07.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/10/2023] [Accepted: 07/29/2023] [Indexed: 08/11/2023]
Abstract
Purpose: Investigations into ultra-high dose rate (UHDR) radiotherapy have dramatically risen because of the observed normal tissue sparing FLASH effect without sacrificing tumor control. The purpose of this study was to provide a direct beamline comparison of protons and electrons to determine where UHDR to conventional dose rates (CDR) changes affect the resultant radiochemistry. Methods and Materials: We used well characterized assays of reactive oxygen species (ROS) and oxygen consumption to assess the radiolysis in protein solutions. Three optical reporters related to ROS (CellROX Deep Red, reflects highly reactive radicals; Amplex Red reflects H2O2; and Oxyphor reflects partial pressure loss (ΔpO2)). A Varian ProBeam proton cyclotron and a converted Varian Trilogy electron linac were used for irradiation at both their CDR and UHDR capable level, to assess the assay change per unit dose. Results: For both protons and electrons an expected reduction in ROS was noted going from CDR to UHDR, and results interpreted as a reduction in the ratio of UHDR/CDR yield. The CellROX assay showed no difference between beamlines, each showing ~80% reduction in ROS from CDR to UHDR. The Amplex assay showed the largest inter-beamline difference, with ~5% loss using protons vs ~69% loss with electrons, in protein solution. The Oxyphor assay of ΔpO2 showed a small difference in CDR to UHDR with a 23% loss with protons and 43% loss with electrons. Conclusion: Interpretation of ROS assays and oxygen consumption is notoriously challenging. These assays might be interpreted by their most activating species’ lifetime. The assay for highly reactive OH●, appeared independent of beamline, whereas the assays for the longer lived H2O2 species and ΔpO2 assay showed differences between beamlines via the UHDR/CDR ratio. This work can be used for FLASH hypothesis testing by comparing these assays to isodose biological FLASH effects in vivo.
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Affiliation(s)
- William Thomas
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jacob Sunnerberg
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Matthew Reed
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin
| | - David J Gladstone
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire; Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Rongxiao Zhang
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire; Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Joseph Harms
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Harold M Swartz
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire; Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Brian W Pogue
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin; Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire.
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Swartz HM, Flood AB. EPR biodosimetry: challenges and opportunities. Radiat Prot Dosimetry 2023; 199:1441-1449. [PMID: 37721062 DOI: 10.1093/rpd/ncad009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/27/2022] [Accepted: 01/10/2023] [Indexed: 09/19/2023]
Abstract
This paper briefly examines electron paramagnetic resonance (EPR) techniques to measure dose from exposure to external radiation, assessing their current status, potential future uses and the challenges impacting their progress. We conclude the uses and potential value of different EPR techniques depend on the number of victims and whether they characterize short- or long-term risks from exposure. For large populations, EPR biodosimetry based on in vivo measurements or using co-located inanimate objects offer the greatest promise for assessing acute, life-threatening risk and the magnitude and extent of such risk. To assess long-term risk, ex vivo EPR methods using concentrated enamel from exfoliated teeth are most impactful. For small groups, ex vivo EPR biodosimetry based on available samples of teeth, nails and/or bones are most useful. The most important challenges are common to all approaches: improve the technique's technical capabilities and advance recognition by planning groups of the relative strengths EPR techniques offer for each population size. The most useful applications are likely to be for triage and medical guidance in large events and for radiation epidemiology to evaluate long-term risks.
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Affiliation(s)
- Harold M Swartz
- Radiology Department, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Clin-EPR, LLC, Lyme, NH, USA
| | - Ann Barry Flood
- Radiology Department, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Clin-EPR, LLC, Lyme, NH, USA
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Flood AB, Sidabras JW, Swarts SG, Buehler PW, Schreiber W, Grinberg O, Swartz HM. Benefits and challenges of in vivo EPR nail biodosimetry in a second tier of medical triage in response to a large radiation event. Radiat Prot Dosimetry 2023; 199:1539-1550. [PMID: 37721065 PMCID: PMC10505939 DOI: 10.1093/rpd/ncad022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 09/19/2023]
Abstract
Following large-scale radiation events, an overwhelming number of people will potentially need mitigators or treatment for radiation-induced injuries. This necessitates having methods to triage people based on their dose and its likely distribution, so life-saving treatment is directed only to people who can benefit from such care. Using estimates of victims following an improvised nuclear device striking a major city, we illustrate a two-tier approach to triage. At the second tier, after first removing most who would not benefit from care, biodosimetry should provide accurate dose estimates and determine whether the dose was heterogeneous. We illustrate the value of using in vivo electron paramagnetic resonance nail biodosimetry to rapidly assess dose and determine its heterogeneity using independent measurements of nails from the hands and feet. Having previously established its feasibility, we review the benefits and challenges of potential improvements of this method that would make it particularly suitable for tier 2 triage. Improvements, guided by a user-centered approach to design and development, include expanding its capability to make simultaneous, independent measurements and improving its precision and universality.
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Affiliation(s)
- Ann Barry Flood
- Radiology Department, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, USA
- Clin-EPR, LLC, Lyme, NH, USA
| | - Jason W Sidabras
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Steven G Swarts
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - Paul W Buehler
- Department of Pathology, University of Maryland, Baltimore, MD, USA
| | | | | | - Harold M Swartz
- Radiology Department, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, USA
- Clin-EPR, LLC, Lyme, NH, USA
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6
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Swarts SG, Flood AB, Swartz HM. Implications of "flash" radiotherapy for biodosimetry. Radiat Prot Dosimetry 2023; 199:1450-1459. [PMID: 37721059 DOI: 10.1093/rpd/ncad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 09/19/2023]
Abstract
Extremely high dose rate radiation delivery (FLASH) for cancer treatment has been shown to produce less damage to normal tissues while having the same radiotoxic effect on tumor tissue (referred to as the FLASH effect). Research on the FLASH effect has two very pertinent implications for the field of biodosimetry: (1) FLASH is a good model to simulate delivery of prompt radiation from the initial moments after detonating a nuclear weapon and (2) the FLASH effect elucidates how dose rate impacts the biological mechanisms that underlie most types of biological biodosimetry. The impact of dose rate will likely differ for different types of biodosimetry, depending on the specific underlying mechanisms. The greatest impact of FLASH effects is likely to occur for assays based on biological responses to radiation damage, but the consequences of differential effects of dose rates on the accuracy of dose estimates has not been taken into account.
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Affiliation(s)
- Steven G Swarts
- Department of Radiation Oncology, University of Florida, Gainesville, FL 32610, United States
| | - Ann Barry Flood
- Department of Radiology, Geisel School of Medicine at Dartmouth College, Hanover, NH 03755, United States
- Clin-EPR, LLC, Lyme, NH 03769, United States
| | - Harold M Swartz
- Department of Radiology, Geisel School of Medicine at Dartmouth College, Hanover, NH 03755, United States
- Clin-EPR, LLC, Lyme, NH 03769, United States
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7
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Duval KEA, Aulwes E, Zhang R, Rahman M, Ashraf MR, Sloop A, Sunnerberg J, Williams BB, Cao X, Bruza P, Kheirollah A, Tavakkoli A, Jarvis LA, Schaner PE, Swartz HM, Gladstone DJ, Pogue BW, Hoopes PJ. Comparison of Tumor Control and Skin Damage in a Mouse Model after Ultra-High Dose Rate Irradiation and Conventional Irradiation. Radiat Res 2023; 200:223-231. [PMID: 37590482 PMCID: PMC10551764 DOI: 10.1667/rade-23-00057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/07/2023] [Indexed: 08/19/2023]
Abstract
Recent studies suggest ultra-high dose rate radiation treatment (UHDR-RT) reduces normal tissue damage compared to conventional radiation treatment (CONV-RT) at the same dose. In this study, we compared first, the kinetics and degree of skin damage in wild-type C57BL/6 mice, and second, tumor treatment efficacy in GL261 and B16F10 dermal tumor models, at the same UHDR-RT and CONV-RT doses. Flank skin of wild-type mice received UHDR-RT or CONV-RT at 25 Gy and 30 Gy. Normal skin damage was tracked by clinical observation to determine the time to moist desquamation, an endpoint which was verified by histopathology. Tumors were inoculated on the right flank of the mice, then received UHDR-RT or CONV-RT at 1 × 11 Gy, 1 × 15, 1 × 25, 3 × 6 and 3 × 8 Gy, and time to tumor tripling volume was determined. Tumors also received 1 × 11, 1 × 15, 3 × 6 and 3 × 8 Gy doses for assessment of CD8+/CD4+ tumor infiltrate and genetic expression 96 h postirradiation. All irradiations of the mouse tumor or flank skin were performed with megavoltage electron beams (10 MeV, 270 Gy/s for UHDR-RT and 9 MeV, 0.12 Gy/s for CONV-RT) delivered via a clinical linear accelerator. Tumor control was statistically equal for similar doses of UHDR-RT and CONV-RT in B16F10 and GL261 murine tumors. There were variable qualitative differences in genetic expression of immune and cell damage-associated pathways between UHDR and CONV irradiated B16F10 tumors. Compared to CONV-RT, UHDR-RT resulted in an increased latent period to skin desquamation after a single 25 Gy dose (7 days longer). Time to moist skin desquamation did not significantly differ between UHDR-RT and CONV-RT after a 30 Gy dose. The histomorphological characteristics of skin damage were similar for UHDR-RT and CONV-RT. These studies demonstrated similar tumor control responses for equivalent single and fractionated radiation doses, with variable difference in expression of tumor progression and immune related gene pathways. There was a modest UHDR-RT skin sparing effect after a 1 × 25 Gy dose but not after a 1 × 30 Gy dose.
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Affiliation(s)
- Kayla E. A. Duval
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Ethan Aulwes
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Rongxiao Zhang
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Mahbubur Rahman
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - M. Ramish Ashraf
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Austin Sloop
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Jacob Sunnerberg
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Benjamin B. Williams
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Xu Cao
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Petr Bruza
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | | | - Armin Tavakkoli
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Lesley A. Jarvis
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Philip E. Schaner
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Harold M. Swartz
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - David J. Gladstone
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Brian W. Pogue
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin
| | - P. Jack Hoopes
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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8
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Sunnerberg JP, Zhang R, Gladstone DJ, Swartz HM, Gui J, Pogue BW. Mean dose rate in ultra-high dose rate electron irradiation is a significant predictor for O 2consumption and H 2O 2yield. Phys Med Biol 2023; 68:165014. [PMID: 37463588 PMCID: PMC10405361 DOI: 10.1088/1361-6560/ace877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/27/2023] [Accepted: 07/18/2023] [Indexed: 07/20/2023]
Abstract
Objective. The objective of this study was to investigate the impact of mean and instantaneous dose rates on the production of reactive oxygen species (ROS) during ultra-high dose rate (UHDR) radiotherapy. The study aimed to determine whether either dose rate type plays a role in driving the FLASH effect, a phenomenon where UHDR radiotherapy reduces damage to normal tissues while maintaining tumor control.Approach. Assays of hydrogen peroxide (H2O2) production and oxygen consumption (ΔpO2) were conducted using UHDR electron irradiation. Aqueous solutions of 4% albumin were utilized as the experimental medium. The study compared the effects of varying mean dose rates and instantaneous dose rates on ROS yields. Instantaneous dose rate was varied by changing the source-to-surface distance (SSD), resulting in instantaneous dose rates ranging from 102to 106Gy s-1. Mean dose rate was manipulated by altering the pulse frequency of the linear accelerator (linac) and by changing the SSD, ranging from 0.14 to 1500 Gy s-1.Main results. The study found that both ΔH2O2and ΔpO2decreased as the mean dose rate increased. Multivariate analysis indicated that instantaneous dose rates also contributed to this effect. The variation in ΔpO2was dependent on the initial oxygen concentration in the solution. Based on the analysis of dose rate variation, the study estimated that 7.51 moles of H2O2were produced for every mole of O2consumed.Significance. The results highlight the significance of mean dose rate as a predictor of ROS production during UHDR radiotherapy. As the mean dose rate increased, there was a decrease in oxygen consumption and in H2O2production. These findings have implications for understanding the FLASH effect and its potential optimization. The study sheds light on the role of dose rate parameters and their impact on radiochemical outcomes, contributing to the advancement of UHDR radiotherapy techniques.
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Affiliation(s)
- Jacob P Sunnerberg
- Thayer School of Engineering at Dartmouth College, Hanover, NH, United States of America
| | - Rongxiao Zhang
- Thayer School of Engineering at Dartmouth College, Hanover, NH, United States of America
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States of America
| | - David J Gladstone
- Thayer School of Engineering at Dartmouth College, Hanover, NH, United States of America
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States of America
| | - Harold M Swartz
- Geisel School of Medicine at Dartmouth College, Hanover, NH, United States of America
| | - Jiang Gui
- Geisel School of Medicine at Dartmouth College, Hanover, NH, United States of America
| | - Brian W Pogue
- Thayer School of Engineering at Dartmouth College, Hanover, NH, United States of America
- University of Wisconsin—Madison, Madison, WI, United States of America
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9
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Swartz HM, Vaupel P, Flood AB. A Critical Analysis of Possible Mechanisms for the Oxygen Effect in Radiation Therapy with FLASH. Adv Exp Med Biol 2023; 1438:127-133. [PMID: 37845451 DOI: 10.1007/978-3-031-42003-0_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
The aim of this review is to stimulate readers to undertake appropriate investigations of the mechanism for a possible oxygen effect in FLASH. FLASH is a method of delivery of radiation that empirically, in animal models, appears to decrease the impact of radiation on normal tissues while retaining full effect on tumors. This has the potential for achieving a significantly increased effectiveness of radiation therapy. The mechanism is not known but, especially in view of the prominent role that oxygen has in the effects of radiation, investigations of mechanisms of FLASH have often focused on impacts of FLASH on oxygen levels. We and others have previously shown that simple differential depletion of oxygen directly changing the response to radiation is not a likely mechanism. In this review we consider how time-varying changes in oxygen levels could account for the FLASH effect by changing oxygen-dependent signaling in cells. While the methods of delivering FLASH are still evolving, current approaches for FLASH can differ from conventional irradiation in several ways that can impact the pattern of oxygen consumption: the rate of delivery of the radiation (40 Gy/s vs. 0.1 Gy/s), the time over which each fraction is delivered (e.g., <0.5 s. vs. 300 s), the delivery in pulses, the number of fractions, the size of the fractions, and the total duration of treatment. Taking these differences into account and recognizing that cell signaling is an intrinsic component of the need for cells to maintain steady-state conditions and, therefore, is activated by small changes in the environment, we delineate the potential time dependent changes in oxygen consumption and overview the cell signaling pathways whose differential activation by FLASH could account for the observed biological effects of FLASH. We speculate that the most likely pathways are those involved in repair of damaged DNA.
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Affiliation(s)
- Harold M Swartz
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA.
| | - Peter Vaupel
- Department of Radiation Oncology, University Medical Center, University of Freiburg/Brsg., Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ann Barry Flood
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Viswakarma N, Siddiqui E, Patel S, Hameed S, Schreiber W, Swartz HM, Epel B, Kotecha M. In Vivo Partial Oxygen Pressure Assessment in Subcutaneous and Intraperitoneal Sites Using Imaging of Solid Oxygen Probe. Tissue Eng Part C Methods 2022; 28:264-271. [PMID: 35509263 DOI: 10.1089/ten.tec.2022.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The purpose of this study was to assess the natural partial oxygen pressure (pO2) of subcutaneous (SC) and intraperitoneal (IP) sites in mice to determine their relative suitability as sites for placement of implants. The pO2 measurements were performed using oxygen imaging of solid probes using lithium phthalocyanine (LiPc) as the oxygen sensitive material. LiPc is a water-insoluble crystalline probe whose spin-lattice and spin-spin relaxation rates (R1 and R2) are sensitive to the local oxygen concentration. To facilitate direct in vivo oxygen imaging, we prepared a solid probe containing encapsulated LiPc crystals in polydimethylsiloxane (PDMS), an oxygen-permeable and bioinert polymer. Although LiPc-PDMS or similar probes have been used in repeated spectroscopic or average oxygen measurements using continuous wave electron paramagnetic resonance (EPR) since the late 1990s and now have advanced to clinical applications, they have not been used for pulse EPR oxygen imaging. One LiPc-PDMS probe of 2 mm diameter and 10 mm length was implanted in SC or IP sites (left or right side) in each animal. The pO2 imaging of implanted LiPc-PDMS probes was performed weekly for 6 weeks using O2M preclinical 25 mT oxygen imager, JIVA-25™, using the pulse inversion recovery electron spin echo method. At week 6, the probes were recovered, and histological examinations were performed. We report in this study, first-ever solid probe oxygen imaging of implanted devices and pO2 assessment of SC and IP sites.
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Affiliation(s)
- Navin Viswakarma
- Oxygen Measurement Core, O2M Technologies, LLC, Chicago, Illinois, USA
| | - Eliyas Siddiqui
- Oxygen Measurement Core, O2M Technologies, LLC, Chicago, Illinois, USA
| | - Sonny Patel
- Oxygen Measurement Core, O2M Technologies, LLC, Chicago, Illinois, USA
| | - Safa Hameed
- Oxygen Measurement Core, O2M Technologies, LLC, Chicago, Illinois, USA
| | | | | | - Boris Epel
- Oxygen Measurement Core, O2M Technologies, LLC, Chicago, Illinois, USA.,Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois, USA
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Holzer P, Chang EJ, Lu D, Adkins J, Rogers K, Man A, Chang K, Wicks J, Ko DSC, Schulz JT, Kaiser RA, Swartz HM, Cetrulo CL, Monroy R, Goverman J. 90 Efficacy of Porcine Skin Xenotransplants Indistinguishable from Allograft in First-in-human Clinical Evaluation. J Burn Care Res 2022. [PMCID: PMC8946259 DOI: 10.1093/jbcr/irac012.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Introduction Human cadaver allograft (HCA) is the current standard of care for temporary wound closure of large burns, but a critical need for high-quality alternatives exists. Porcine skin shares many similarities with human skin, and hyperacute rejection is prevented via a single genetic modification. Like human skin, non-terminally sterilized porcine skin contains viable dermal and epidermal cells and intact vasculature that enables restoration of barrier function. These characteristics are distinct from those of traditional, terminally sterilized “xenografts” and may offer greater therapeutic capability. We report here key efficacy outcomes specific to severe burn care from a first-in-human clinical trial to assess the capability of genetically engineered porcine skin xenotransplants to provide temporary wound closure for severe and extensive deep-partial and full-thickness burn wounds, compared to HCA. Methods Split-thickness skin containing epidermal and dermal layers was harvested from Designated Pathogen Free, GalT-KO, porcine donors, cGMP processed to achieve USP< 71 > sterility and cryopreserved to retain >70% cell viability. These were transplanted side by side with HCA on debrided full-thickness burn wounds in six human subjects. Temporary wound closure, incidence of complete wound closure following autografting, and quality of healing, including scarring, contour, and feel of healed skin, normalization of skin markings or pigmentation, were independently assessed. Results Across all patients and assessment time points, adherence, vascularity, and overall appearance were indistinguishable between porcine skin xenotransplants and HCA control. After surgical removal, wound beds treated with each type of dressing were perfused and otherwise appeared equivalent and clinically suitable for autografting. Long-term outcomes were comparable between wound sites treated with porcine skin or HCA with no discernable differences in scarring or cosmesis. Conclusions Skin xenotransplants effectively provided temporary wound closure and restoration of barrier function via intact native vasculature, active cells, decreased antigenicity, and high-quality tissue architecture unimpacted by cryopreservation and thawing. These results show clinical promise as an interchangeable alternative to HCA in the treatment of severe burns. Expanded clinical evaluation is ongoing.
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Affiliation(s)
- Paul Holzer
- Johns Hopkins University, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; StageBio, Frederick, Maryland; Rhode Island Hospital, Th
| | - Elizabeth J Chang
- Johns Hopkins University, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; StageBio, Frederick, Maryland; Rhode Island Hospital, Th
| | - Diana Lu
- Johns Hopkins University, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; StageBio, Frederick, Maryland; Rhode Island Hospital, Th
| | - Jon Adkins
- Johns Hopkins University, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; StageBio, Frederick, Maryland; Rhode Island Hospital, Th
| | - Kaitlyn Rogers
- Johns Hopkins University, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; StageBio, Frederick, Maryland; Rhode Island Hospital, Th
| | - Angela Man
- Johns Hopkins University, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; StageBio, Frederick, Maryland; Rhode Island Hospital, Th
| | - Kristina Chang
- Johns Hopkins University, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; StageBio, Frederick, Maryland; Rhode Island Hospital, Th
| | - Joan Wicks
- Johns Hopkins University, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; StageBio, Frederick, Maryland; Rhode Island Hospital, Th
| | - Dicken S C Ko
- Johns Hopkins University, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; StageBio, Frederick, Maryland; Rhode Island Hospital, Th
| | - John T Schulz
- Johns Hopkins University, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; StageBio, Frederick, Maryland; Rhode Island Hospital, Th
| | - Robert A Kaiser
- Johns Hopkins University, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; StageBio, Frederick, Maryland; Rhode Island Hospital, Th
| | - Harold M Swartz
- Johns Hopkins University, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; StageBio, Frederick, Maryland; Rhode Island Hospital, Th
| | - Curtis L Cetrulo
- Johns Hopkins University, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; StageBio, Frederick, Maryland; Rhode Island Hospital, Th
| | - Rod Monroy
- Johns Hopkins University, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; StageBio, Frederick, Maryland; Rhode Island Hospital, Th
| | - Jeremy Goverman
- Johns Hopkins University, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; XenoTherapeutics, Inc, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; StageBio, Frederick, Maryland; Rhode Island Hospital, Th
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12
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Swartz HM, Hoopes PJ, Gladstone DJ, Demidov V, Vaupel P, Flood AB, Williams BB, Zhang R, Pogue BW. A Radiation Biological Analysis of the Oxygen Effect as a Possible Mechanism in FLASH. Adv Exp Med Biol 2022; 1395:315-321. [PMID: 36527655 PMCID: PMC10653672 DOI: 10.1007/978-3-031-14190-4_51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The delivery of radiation at an ultra-high dose rate (FLASH) is an important new approach to radiotherapy (RT) that appears to be able to improve the therapeutic ratio by diminishing damage to normal tissues. While the mechanisms by which FLASH improves outcomes have not been established, a role involving molecular oxygen (O2) is frequently mentioned. In order to effectively determine if the protective effect of FLASH RT occurs via a differential direct depletion of O2 (compared to conventional radiation), it is essential to consider the known role of O2 in modifying the response of cells and tissues to ionising radiation (known as 'the oxygen effect'). Considerations include: (1) The pertinent reaction involves an unstable intermediate of radiation-damaged DNA, which either undergoes chemical repair to restore the DNA or reacts with O2, resulting in an unrepairable lesion in the DNA, (2) These reactions occur in the nuclear DNA, which can be used to estimate the distance needed for O2 to diffuse through the cell to reach the intermediates, (3) The longest lifetime that the reactive site of the DNA is available to react with O2 is 1-10 μsec, (4) Using these lifetime estimates and known diffusion rates in different cell media, the maximal distance that O2 could travel in the cytosol to reach the site of the DNA (i.e., the nucleus) in time to react are 60-185 nm. This calculation defines the volume of oxygen that is pertinent for the direct oxygen effect, (5) Therefore, direct measurements of oxygen to determine if FLASH RT operates through differential radiochemical depletion of oxygen will require the ability to measure oxygen selectively in a sphere of <200 nm, with a time resolution of the duration of the delivery of FLASH, (6) It also is possible that alterations of oxygen levels by FLASH could occur more indirectly by affecting oxygen-dependent cell signalling and/or cellular repair.
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Affiliation(s)
- Harold M Swartz
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Centre, Lebanon, NH, USA.
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA.
| | - P Jack Hoopes
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Centre, Lebanon, NH, USA
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - David J Gladstone
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Centre, Lebanon, NH, USA
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | | | - Peter Vaupel
- Department of Radiation Oncology, University Medical Center, Freiburg, Germany
| | - Ann Barry Flood
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Centre, Lebanon, NH, USA
| | - Benjamin B Williams
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Centre, Lebanon, NH, USA
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Rongxiao Zhang
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Centre, Lebanon, NH, USA
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Brian W Pogue
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Centre, Lebanon, NH, USA
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
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Swartz HM, Wilkins RC, Ainsbury E, Port M, Barry Flood A, Trompier F, Roy L, Swarts SG. What if a major radiation incident happened during a pandemic? - Considerations of the impact on biodosimetry. Int J Radiat Biol 2021; 98:825-830. [PMID: 34730484 DOI: 10.1080/09553002.2021.2000659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Harold M Swartz
- Radiology Department, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Ruth C Wilkins
- Consumer and Clinical Radiation Protection Bureau, Health Canada, Ottawa, Canada
| | - Elizabeth Ainsbury
- Public Health England Centre for Radiation, Chemical and Environmental Hazards, Oxford, UK
| | - Matthias Port
- Bundeswehr Institute of Radiobiology, Affiliated to the University of Ulm, Munich, Germany
| | - Ann Barry Flood
- Radiology Department, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - François Trompier
- Department for Research on Dosimetry, IRSN, Fontenay-aux-roses, France
| | - Laurence Roy
- Department for Research on the Biological and Health Effects of Ionising Radiation, IRSN, Fontenay-aux-roses, France
| | - Steven G Swarts
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
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14
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Schaner PE, Williams BB, Chen EY, Pettus JR, Schreiber WA, Kmiec MM, Jarvis LA, Pastel DA, Zuurbier RA, DiFlorio-Alexander RM, Paydarfar JA, Gosselin BJ, Barth RJ, Rosenkranz KM, Petryakov SV, Hou H, Tse D, Pletnev A, Flood AB, Wood VA, Hebert KA, Mosher RE, Demidenko E, Swartz HM, Kuppusamy P. First-In-Human Study in Cancer Patients Establishing the Feasibility of Oxygen Measurements in Tumors Using Electron Paramagnetic Resonance With the OxyChip. Front Oncol 2021; 11:743256. [PMID: 34660306 PMCID: PMC8517507 DOI: 10.3389/fonc.2021.743256] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 09/07/2021] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE The overall objective of this clinical study was to validate an implantable oxygen sensor, called the 'OxyChip', as a clinically feasible technology that would allow individualized tumor-oxygen assessments in cancer patients prior to and during hypoxia-modification interventions such as hyperoxygen breathing. METHODS Patients with any solid tumor at ≤3-cm depth from the skin-surface scheduled to undergo surgical resection (with or without neoadjuvant therapy) were considered eligible for the study. The OxyChip was implanted in the tumor and subsequently removed during standard-of-care surgery. Partial pressure of oxygen (pO2) at the implant location was assessed using electron paramagnetic resonance (EPR) oximetry. RESULTS Twenty-three cancer patients underwent OxyChip implantation in their tumors. Six patients received neoadjuvant therapy while the OxyChip was implanted. Median implant duration was 30 days (range 4-128 days). Forty-five successful oxygen measurements were made in 15 patients. Baseline pO2 values were variable with overall median 15.7 mmHg (range 0.6-73.1 mmHg); 33% of the values were below 10 mmHg. After hyperoxygenation, the overall median pO2 was 31.8 mmHg (range 1.5-144.6 mmHg). In 83% of the measurements, there was a statistically significant (p ≤ 0.05) response to hyperoxygenation. CONCLUSIONS Measurement of baseline pO2 and response to hyperoxygenation using EPR oximetry with the OxyChip is clinically feasible in a variety of tumor types. Tumor oxygen at baseline differed significantly among patients. Although most tumors responded to a hyperoxygenation intervention, some were non-responders. These data demonstrated the need for individualized assessment of tumor oxygenation in the context of planned hyperoxygenation interventions to optimize clinical outcomes.
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Affiliation(s)
- Philip E. Schaner
- Department of Medicine, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth College, and Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Benjamin B. Williams
- Department of Medicine, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth College, and Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Department of Radiology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth College, and Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Eunice Y. Chen
- Department of Surgery, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth College, and Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Jason R. Pettus
- Department of Pathology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth College, and Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Wilson A. Schreiber
- Department of Radiology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth College, and Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Maciej M. Kmiec
- Department of Radiology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth College, and Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Lesley A. Jarvis
- Department of Medicine, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth College, and Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - David A. Pastel
- Department of Radiology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth College, and Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Rebecca A. Zuurbier
- Department of Radiology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth College, and Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Roberta M. DiFlorio-Alexander
- Department of Radiology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth College, and Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Joseph A. Paydarfar
- Department of Surgery, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth College, and Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Benoit J. Gosselin
- Department of Surgery, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth College, and Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Richard J. Barth
- Department of Surgery, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth College, and Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Kari M. Rosenkranz
- Department of Surgery, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth College, and Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Sergey V. Petryakov
- Department of Radiology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth College, and Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Huagang Hou
- Department of Radiology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth College, and Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Dan Tse
- Department of Radiology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth College, and Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Alexandre Pletnev
- Department of Chemistry, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth College, and Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Ann Barry Flood
- Department of Radiology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth College, and Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Victoria A. Wood
- Department of Radiology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth College, and Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Kendra A. Hebert
- Department of Radiology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth College, and Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Robyn E. Mosher
- Department of Radiology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth College, and Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Eugene Demidenko
- Department of Biomedical Data Science, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth College, and Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Harold M. Swartz
- Department of Radiology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth College, and Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Periannan Kuppusamy
- Department of Medicine, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth College, and Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Department of Radiology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth College, and Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Department of Chemistry, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth College, and Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
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Subczynski WK, Widomska J, Stein N, Swartz HM. Factors determining barrier properties to oxygen transport across model and cell plasma membranes based on EPR spin-label oximetry. Appl Magn Reson 2021; 52:1237-1260. [PMID: 36267674 PMCID: PMC9581439 DOI: 10.1007/s00723-021-01412-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 07/23/2021] [Accepted: 08/04/2021] [Indexed: 06/01/2023]
Abstract
This review is motivated by the exciting new area of radiation therapy using a phenomenon termed FLASH in which oxygen is thought to have a central role. Well-established principles of radiation biology and physics suggest that if oxygen has a strong role, it should be the level at the DNA. The key aspect discussed is the rate of oxygen diffusion. If oxygen freely diffuses into cells and rapidly equilibrates, then measurements in the extracellular compartment would enable FLASH to be investigated using existing methodologies that can readily measure oxygen in the extracellular compartment. EPR spin-label oximetry allows evaluation of the oxygen permeability coefficient across lipid bilayer membranes. It is established that simple fluid phase lipid bilayers are not barriers to oxygen transport. However, further investigations indicate that many physical and chemical (compositional) factor can significantly decrease this permeation. In biological cell plasma membranes, the lipid bilayer forms the matrix in which integral membrane proteins are immersed, changing organization and properties of the lipid matrix. To evaluate oxygen permeability coefficients across these complex membranes, oxygen permeation across all membrane domains and components must be considered. In this review, we consider many of the factors that affect (decrease) oxygen permeation across cell plasma membranes. Finally, we address the question, can the plasma membrane of the cell form a barrier to the free diffusion of oxygen into the cell interior? If there is a barrier then this must be considered in the investigations of the role of oxygen in FLASH.
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Affiliation(s)
- Witold K. Subczynski
- Department of Biophysics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Justyna Widomska
- Department of Biophysics, Medical University of Lublin, Jaczewskiego 4, Lublin, Poland
| | - Natalia Stein
- Department of Biophysics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Harold M. Swartz
- Department of Radiology, The Geisel School of Medicine at Dartmouth, Lebanon, NH 03766, USA
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16
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Chen EY, Tse D, Hou H, Schreiber WA, Schaner PE, Kmiec MM, Hebert KA, Kuppusamy P, Swartz HM, Williams BB. Evaluation of a Refined Implantable Resonator for Deep-Tissue EPR Oximetry in the Clinic. Appl Magn Reson 2021; 52:1321-1342. [PMID: 34744319 PMCID: PMC8570533 DOI: 10.1007/s00723-021-01376-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 05/04/2023]
Abstract
OBJECTIVES (1) Summarize revisions made to the implantable resonator (IR) design and results of testing to characterize biocompatibility;(2) Demonstrate safety of implantation and feasibility of deep tissue oxygenation measurement using electron paramagnetic resonance (EPR) oximetry. STUDY DESIGN In vitro testing of the revised IR and in vivo implantation in rabbit brain and leg tissues. METHODS Revised IRs were fabricated with 1-4 OxyChips with a thin wire encapsulated with two biocompatible coatings. Biocompatibility and chemical characterization tests were performed. Rabbits were implanted with either an IR with 2 oxygen sensors or a biocompatible-control sample in both the brain and hind leg. The rabbits were implanted with IRs using a catheter-based, minimally invasive surgical procedure. EPR oximetry was performed for rabbits with IRs. Cohorts of rabbits were euthanized and tissues were obtained at 1 week, 3 months, and 9 months after implantation and examined for tissue reaction. RESULTS Biocompatibility and toxicity testing of the revised IRs demonstrated no abnormal reactions. EPR oximetry from brain and leg tissues were successfully executed. Blood work and histopathological evaluations showed no significant difference between the IR and control groups. CONCLUSIONS IRs were functional for up to 9 months after implantation and provided deep tissue oxygen measurements using EPR oximetry. Tissues surrounding the IRs showed no more tissue reaction than tissues surrounding the control samples. This pre-clinical study demonstrates that the IRs can be safely implanted in brain and leg tissues and that repeated, non-invasive, deep-tissue oxygen measurements can be obtained using in vivo EPR oximetry.
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Affiliation(s)
- Eunice Y. Chen
- Section of Otolaryngology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States and Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Dan Tse
- Department of Radiology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Huagang Hou
- Department of Radiology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Wilson A. Schreiber
- Department of Radiology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Philip E. Schaner
- Section of Radiation Oncology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States and Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Maciej M. Kmiec
- Department of Radiology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Kendra A. Hebert
- Department of Radiology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Periannan Kuppusamy
- Department of Radiology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Harold M. Swartz
- Department of Radiology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
- Section of Radiation Oncology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States and Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Benjamin B. Williams
- Department of Radiology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
- Section of Radiation Oncology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States and Geisel School of Medicine at Dartmouth, Hanover, NH
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Cao X, Zhang R, Esipova TV, Allu SR, Ashraf R, Rahman M, Gunn JR, Bruza P, Gladstone DJ, Williams BB, Swartz HM, Hoopes PJ, Vinogradov SA, Pogue BW. Quantification of Oxygen Depletion During FLASH Irradiation In Vitro and In Vivo. Int J Radiat Oncol Biol Phys 2021; 111:240-248. [PMID: 33845146 PMCID: PMC8338745 DOI: 10.1016/j.ijrobp.2021.03.056] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/28/2021] [Accepted: 03/31/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE Delivery of radiation at ultrahigh dose rates (UHDRs), known as FLASH, has recently been shown to preferentially spare normal tissues from radiation damage compared with tumor tissues. However, the underlying mechanism of this phenomenon remains unknown, with one of the most widely considered hypotheses being that the effect is related to substantial oxygen depletion upon FLASH, thereby altering the radiochemical damage during irradiation, leading to different radiation responses of normal and tumor cells. Testing of this hypothesis would be advanced by direct measurement of tissue oxygen in vivo during and after FLASH irradiation. METHODS AND MATERIALS Oxygen measurements were performed in vitro and in vivo using the phosphorescence quenching method and a water-soluble molecular probe Oxyphor 2P. The changes in oxygen per unit dose (G-values) were quantified in response to irradiation by 10 MeV electron beam at either UHDR reaching 300 Gy/s or conventional radiation therapy dose rates of 0.1 Gy/s. RESULTS In vitro experiments with 5% bovine serum albumin solutions at 23°C resulted in G-values for oxygen consumption of 0.19 to 0.21 mm Hg/Gy (0.34-0.37 μM/Gy) for conventional irradiation and 0.16 to 0.17 mm Hg/Gy (0.28-0.30 μM/Gy) for UHDR irradiation. In vivo, the total decrease in oxygen after a single fraction of 20 Gy FLASH irradiation was 2.3 ± 0.3 mm Hg in normal tissue and 1.0 ± 0.2 mm Hg in tumor tissue (P < .00001), whereas no decrease in oxygen was observed from a single fraction of 20 Gy applied in conventional mode. CONCLUSIONS Our observations suggest that oxygen depletion to radiologically relevant levels of hypoxia is unlikely to occur in bulk tissue under FLASH irradiation. For the same dose, FLASH irradiation induces less oxygen consumption than conventional irradiation in vitro, which may be related to the FLASH sparing effect. However, the difference in oxygen depletion between FLASH and conventional irradiation could not be quantified in vivo because measurements of oxygen depletion under conventional irradiation are hampered by resupply of oxygen from the blood.
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Affiliation(s)
- Xu Cao
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire; Engineering Research Center of Molecular and Neuro Imaging of the Ministry of Education & School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, China
| | - Rongxiao Zhang
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Tatiana V Esipova
- Department of Biochemistry and Biophysics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Chemistry, School or Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Srinivasa Rao Allu
- Department of Biochemistry and Biophysics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Chemistry, School or Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ramish Ashraf
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Mahbubur Rahman
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Jason R Gunn
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Petr Bruza
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - David J Gladstone
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Benjamin B Williams
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Harold M Swartz
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - P Jack Hoopes
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Surgery, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Sergei A Vinogradov
- Department of Biochemistry and Biophysics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Chemistry, School or Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Surgery, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.
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18
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Schaner PE, Tran LBA, Zaki BI, Swartz HM, Demidenko E, Williams BB, Siegel A, Kuppusamy P, Flood AB, Gallez B. The impact of particulate electron paramagnetic resonance oxygen sensors on fluorodeoxyglucose imaging characteristics detected via positron emission tomography. Sci Rep 2021; 11:4422. [PMID: 33627688 PMCID: PMC7904945 DOI: 10.1038/s41598-021-82754-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/25/2021] [Indexed: 11/08/2022] Open
Abstract
During a first-in-humans clinical trial investigating electron paramagnetic resonance tumor oximetry, a patient injected with the particulate oxygen sensor Printex ink was found to have unexpected fluorodeoxyglucose (FDG) uptake in a dermal nodule via positron emission tomography (PET). This nodule co-localized with the Printex ink injection; biopsy of the area, due to concern for malignancy, revealed findings consistent with ink and an associated inflammatory reaction. Investigations were subsequently performed to assess the impact of oxygen sensors on FDG-PET/CT imaging. A retrospective analysis of three clinical tumor oximetry trials involving two oxygen sensors (charcoal particulates and LiNc-BuO microcrystals) in 22 patients was performed to evaluate FDG imaging characteristics. The impact of clinically used oxygen sensors (carbon black, charcoal particulates, LiNc-BuO microcrystals) on FDG-PET/CT imaging after implantation in rat muscle (n = 12) was investigated. The retrospective review revealed no other patients with FDG avidity associated with particulate sensors. The preclinical investigation found no injected oxygen sensor whose mean standard uptake values differed significantly from sham injections. The risk of a false-positive FDG-PET/CT scan due to oxygen sensors appears low. However, in the right clinical context the potential exists that an associated inflammatory reaction may confound interpretation.
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Affiliation(s)
- Philip E Schaner
- Department of Medicine Section of Radiation Oncology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Ly-Binh-An Tran
- Biomedical Magnetic Resonance, Louvain Drug Research Institute, Universite Catholique du Louvain, Brussels, Belgium
| | - Bassem I Zaki
- Department of Medicine Section of Radiation Oncology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Harold M Swartz
- Department of Medicine Section of Radiation Oncology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA
- Department of Radiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Eugene Demidenko
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Benjamin B Williams
- Department of Medicine Section of Radiation Oncology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA
- Department of Radiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Alan Siegel
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Periannan Kuppusamy
- Department of Medicine Section of Radiation Oncology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA
- Department of Radiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Ann Barry Flood
- Department of Radiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Bernard Gallez
- Biomedical Magnetic Resonance, Louvain Drug Research Institute, Universite Catholique du Louvain, Brussels, Belgium
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19
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Park JI, Choi K, Koo CU, Oh J, Hirata H, Swartz HM, Ye SJ. Dependence of Radiation-induced Signals on Geometry of Tooth Enamel Using a 1.15 GHz Electron Paramagnetic Resonance Spectrometer: Improvement of Dosimetric Accuracy. Health Phys 2021; 120:152-162. [PMID: 32701613 DOI: 10.1097/hp.0000000000001292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We aim to improve the accuracy of electron paramagnetic resonance (EPR)-based in vivo tooth dosimetry using the relationship between tooth geometry and radiation-induced signals (RIS). A homebuilt EPR spectrometer at L-band frequency of 1.15 GHz originally designed for non-invasive and in vivo measurements of intact teeth was used to measure the RIS of extracted human teeth. Twenty human central incisors were scanned by microCT and irradiated by 220 kVp x-rays. The RISs of the samples were measured by the EPR spectrometer as well as simulated by using the finite element analysis of the electromagnetic field. A linear relationship between simulated RISs and tooth geometric dimensions, such as enamel area, enamel volume, and labial enamel volume, was confirmed. The dose sensitivity was quantified as a slope of the calibration curve (i.e., RIS vs. dose) for each tooth sample. The linear regression of these dose sensitivities was established for each of three tooth geometric dimensions. Based on these findings, a method for the geometry correction was developed by use of expected dose sensitivity of a certain tooth for one of the tooth geometric dimensions. Using upper incisors, the mean absolute deviation (MAD) without correction was 1.48 Gy from an estimated dose of 10 Gy; however, the MAD corrected by enamel area, volume, and labial volume was reduced to 1.04 Gy, 0.77 Gy, and 0.83 Gy, respectively. In general, the method corrected by enamel volume showed the best accuracy in this study. This homebuilt EPR spectrometer for the purpose of non-invasive and in vivo tooth dosimetry was successfully tested for achieving measurements in situ. We demonstrated that the developed correction method could reduce dosimetric uncertainties resulting from the variations in tooth geometric dimensions.
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Affiliation(s)
| | | | | | - Jeonghun Oh
- Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, 08826, Republic of Korea
| | - Hiroshi Hirata
- Division of Bioengineering and Bioinformatics, Graduate School of Information Science and Technology, Hokkaido University, Sapporo, 060-0814, Japan
| | - Harold M Swartz
- Geisel School of Medicine, HB 7785 Dartmouth College, Hanover, NH 03755
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20
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Buehler PW, Flood AB, Swartz HM. Measurement of Tissue Oxygen as a Novel Approach to Optimizing Red Blood Cell Quality Assessment. Adv Exp Med Biol 2021; 1269:379-386. [PMID: 33966246 DOI: 10.1007/978-3-030-48238-1_60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The effectiveness of blood transfusions can be impacted by storage and extensive processing techniques that involve treatment of red blood cells (RBCs) with pathogen reduction technologies (e.g., UV-light and chemical treatment), ex vivo stem cell derivation/maturation methods, and bioengineering of RBCs using nanotechnology. Therefore, there is a need to have methods that assess the evaluation of the effectiveness of transfusions to achieve their intended purpose: to increase oxygenation of critical tissues. Consequently, there has been intense interest in the development of techniques targeted at optimizing the assessment of RBC quality in preclinical and clinical settings. We provide a critical assessment of the ability of currently used methods to provide unambiguous information on oxygen levels in tissues and conclude that they cannot do this. This is because they are based on surrogates for the true goal of transfusion, which is to increase oxygenation of critical organs. This does not mean that they are valueless, but it does indicate that other methods are needed to provide direct measurements of oxygen in tissues. We report here on the initial results of a method that can provide direct assessment of the impact of the transfusion on tissue oxygen: EPR oximetry. It has the potential to provide such information in both preclinical and clinical settings for the assessment of blood quality posttransfusion.
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Affiliation(s)
- Paul W Buehler
- Department of Pathology, Department of Pediatrics, Center for Blood Oxygen Transport and Hemostasis, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Ann Barry Flood
- Radiology, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Harold M Swartz
- Radiology, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA.,Radiation Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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21
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Schaner PE, Pettus JR, Flood AB, Williams BB, Jarvis LA, Chen EY, Pastel DA, Zuurbier RA, diFlorio-Alexander RM, Swartz HM, Kuppusamy P. OxyChip Implantation and Subsequent Electron Paramagnetic Resonance Oximetry in Human Tumors Is Safe and Feasible: First Experience in 24 Patients. Front Oncol 2020; 10:572060. [PMID: 33194670 PMCID: PMC7653093 DOI: 10.3389/fonc.2020.572060] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/21/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction: Tumor hypoxia confers both a poor prognosis and increased resistance to oncologic therapies, and therefore, hypoxia modification with reliable oxygen profiling during anticancer treatment is desirable. The OxyChip is an implantable oxygen sensor that can detect tumor oxygen levels using electron paramagnetic resonance (EPR) oximetry. We report initial safety and feasibility outcomes after OxyChip implantation in a first-in-humans clinical trial (NCT02706197, www.clinicaltrials.gov). Materials and Methods: Twenty-four patients were enrolled. Eligible patients had a tumor ≤ 3 cm from the skin surface with planned surgical resection as part of standard-of-care therapy. Most patients had a squamous cell carcinoma of the skin (33%) or a breast malignancy (33%). After an initial cohort of six patients who received surgery alone, eligibility was expanded to patients receiving either chemotherapy or radiotherapy prior to surgical resection. The OxyChip was implanted into the tumor using an 18-G needle; a subset of patients had ultrasound-guided implantation. Electron paramagnetic resonance oximetry was carried out using a custom-built clinical EPR scanner. Patients were evaluated for associated toxicity using the Common Terminology Criteria for Adverse Events (CTCAE); evaluations started immediately after OxyChip placement, occurred during every EPR oximetry measurement, and continued periodically after removal. The OxyChip was removed during standard-of-care surgery, and pathologic analysis of the tissue surrounding the OxyChip was performed. Results: Eighteen patients received surgery alone, while five underwent chemotherapy and one underwent radiotherapy prior to surgery. No unanticipated serious adverse device events occurred. The maximum severity of any adverse event as graded by the CTCAE was 1 (least severe), and all were related to events typically associated with implantation. After surgical resection, 45% of the patients had no histopathologic findings specifically associated with the OxyChip. All tissue pathology was "anticipated" excepting a patient with greater than expected inflammatory findings, which was assessed to be related to the tumor as opposed to the OxyChip. Conclusion: This report of the first-in-humans trial of OxyChip implantation and EPR oximetry demonstrated no significant clinical pathology or unanticipated serious adverse device events. Use of the OxyChip in the clinic was thus safe and feasible.
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Affiliation(s)
- Philip E Schaner
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States.,Geisel School of Medicine, Dartmouth College, Hanover, NH, United States.,Norris Cotton Cancer Center, Lebanon, NH, United States
| | - Jason R Pettus
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States.,Geisel School of Medicine, Dartmouth College, Hanover, NH, United States.,Norris Cotton Cancer Center, Lebanon, NH, United States.,Department of Pathology, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
| | - Ann Barry Flood
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States.,Norris Cotton Cancer Center, Lebanon, NH, United States.,Department of Radiology, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
| | - Benjamin B Williams
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States.,Geisel School of Medicine, Dartmouth College, Hanover, NH, United States.,Norris Cotton Cancer Center, Lebanon, NH, United States.,Department of Radiology, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
| | - Lesley A Jarvis
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States.,Geisel School of Medicine, Dartmouth College, Hanover, NH, United States.,Norris Cotton Cancer Center, Lebanon, NH, United States
| | - Eunice Y Chen
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States.,Norris Cotton Cancer Center, Lebanon, NH, United States.,Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
| | - David A Pastel
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States.,Norris Cotton Cancer Center, Lebanon, NH, United States.,Department of Radiology, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
| | - Rebecca A Zuurbier
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States.,Norris Cotton Cancer Center, Lebanon, NH, United States.,Department of Radiology, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
| | - Roberta M diFlorio-Alexander
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States.,Norris Cotton Cancer Center, Lebanon, NH, United States.,Department of Radiology, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
| | - Harold M Swartz
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States.,Geisel School of Medicine, Dartmouth College, Hanover, NH, United States.,Norris Cotton Cancer Center, Lebanon, NH, United States.,Department of Radiology, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
| | - Periannan Kuppusamy
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States.,Geisel School of Medicine, Dartmouth College, Hanover, NH, United States.,Norris Cotton Cancer Center, Lebanon, NH, United States.,Department of Radiology, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
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22
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Swartz HM, Flood AB, Schaner PE, Halpern H, Williams BB, Pogue BW, Gallez B, Vaupel P. How best to interpret measures of levels of oxygen in tissues to make them effective clinical tools for care of patients with cancer and other oxygen-dependent pathologies. Physiol Rep 2020; 8:e14541. [PMID: 32786045 PMCID: PMC7422807 DOI: 10.14814/phy2.14541] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 02/07/2023] Open
Abstract
It is well understood that the level of molecular oxygen (O2 ) in tissue is a very important factor impacting both physiology and pathological processes as well as responsiveness to some treatments. Data on O2 in tissue could be effectively utilized to enhance precision medicine. However, the nature of the data that can be obtained using existing clinically applicable techniques is often misunderstood, and this can confound the effective use of the information. Attempts to make clinical measurements of O2 in tissues will inevitably provide data that are aggregated over time and space and therefore will not fully represent the inherent heterogeneity of O2 in tissues. Additionally, the nature of existing techniques to measure O2 may result in uneven sampling of the volume of interest and therefore may not provide accurate information on the "average" O2 in the measured volume. By recognizing the potential limitations of the O2 measurements, one can focus on the important and useful information that can be obtained from these techniques. The most valuable clinical characterizations of oxygen are likely to be derived from a series of measurements that provide data about factors that can change levels of O2 , which then can be exploited both diagnostically and therapeutically. The clinical utility of such data ultimately needs to be verified by careful studies of outcomes related to the measured changes in levels of O2 .
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Affiliation(s)
- Harold M Swartz
- Department of Radiology, Dartmouth Medical School, Hanover, NH, USA
- Department of Medicine, Section of Radiation Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Ann Barry Flood
- Department of Radiology, Dartmouth Medical School, Hanover, NH, USA
| | - Philip E Schaner
- Department of Medicine, Section of Radiation Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Howard Halpern
- Department Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
| | - Benjamin B Williams
- Department of Radiology, Dartmouth Medical School, Hanover, NH, USA
- Department of Medicine, Section of Radiation Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Bernard Gallez
- Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Peter Vaupel
- Department Radiation Oncology, University Medical Center, University of Freiburg, Freiburg, Germany
- German Cancer Center Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
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23
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Swartz HM, Flood AB, Singh VK, Swarts SG. Scientific and Logistical Considerations When Screening for Radiation Risks by Using Biodosimetry Based on Biological Effects of Radiation Rather than Dose: The Need for Prior Measurements of Homogeneity and Distribution of Dose. Health Phys 2020; 119:72-82. [PMID: 32175928 PMCID: PMC7269859 DOI: 10.1097/hp.0000000000001244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
An effective medical response to a large-scale radiation event requires prompt and effective initial triage so that appropriate care can be provided to individuals with significant risk for severe acute radiation injury. Arguably, it would be advantageous to use injury rather than radiation dose for the initial assessment; i.e., use bioassays of biological damage. Such assays would be based on changes in intrinsic biological response elements; e.g., up- or down-regulation of genes, proteins, metabolites, blood cell counts, chromosomal aberrations, micronuclei, micro-RNA, cytokines, or transcriptomes. Using a framework to evaluate the feasibility of biodosimetry for triaging up to a million people in less than a week following a major radiation event, Part 1 analyzes the logistical feasibility and clinical needs for ensuring that biomarkers of organ-specific injury could be effectively used in this context. We conclude that the decision to use biomarkers of organ-specific injury would greatly benefit by first having independent knowledge of whether the person's exposure was heterogeneous and, if so, what was the dose distribution (to determine which organs were exposed to high doses). In Part 2, we describe how these two essential needs for prior information (heterogeneity and dose distribution) could be obtained by using in vivo nail dosimetry. This novel physical biodosimetry method can also meet the needs for initial triage, providing non-invasive, point-of-care measurements made by non-experts with immediate dose estimates for four separate anatomical sites. Additionally, it uniquely provides immediate information as to whether the exposure was homogeneous and, if not, it can estimate the dose distribution. We conclude that combining the capability of methods such as in vivo EPR nail dosimetry with bioassays to predict organ-specific damage would allow effective use of medical resources to save lives.
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Affiliation(s)
- Harold M. Swartz
- Dept of Radiology, Geisel School of Medicine at Dartmouth College, Hanover, NH USA
- Dept of Medicine/Radiation Oncology, Geisel School of Medicine at Dartmouth College, Hanover, NH USA
| | - Ann Barry Flood
- Dept of Radiology, Geisel School of Medicine at Dartmouth College, Hanover, NH USA
| | - Vijay K. Singh
- Dept. Pharmacology & Molecular Therapeutics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Steven G. Swarts
- Dept of Radiation Oncology, University of Florida, Gainesville, FL, USA
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Swartz HM, Vaupel P, Williams BB, Schaner PE, Gallez B, Schreiber W, Ali A, Flood AB. 'Oxygen Level in a Tissue' - What Do Available Measurements Really Report? Adv Exp Med Biol 2020; 1232:145-153. [PMID: 31893405 DOI: 10.1007/978-3-030-34461-0_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The aim of the paper is to discuss what currently is feasible clinically to measure the level of oxygen and how that measurement can be clinically useful. Because oxygen in tissues is quite heterogeneous and all methods of measurement can only provide an average across heterogeneities at some spatial and temporal resolution, the values that are obtained may have limitations on their clinical utility. However, even if such limitations are significant, if one utilizes repeated measurements and focuses on changes in the measured levels, rather than 'absolute levels', it may be possible to obtain very useful clinical information. While these considerations are especially pertinent in cancer, they also pertain to most other types of pathology.
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Affiliation(s)
- H M Swartz
- Department Radiology, Dartmouth Medical School, Hanover, NH, USA. .,Section Radiation Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
| | - P Vaupel
- Department Radiation Oncology, University Medical Center, Mainz, Germany
| | - B B Williams
- Department Radiology, Dartmouth Medical School, Hanover, NH, USA.,Section Radiation Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - P E Schaner
- Section Radiation Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - B Gallez
- Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - W Schreiber
- Department Radiology, Dartmouth Medical School, Hanover, NH, USA
| | - A Ali
- Department Radiation Oncology, Emory School of Medicine, Atlanta, GA, USA
| | - A B Flood
- Department Radiology, Dartmouth Medical School, Hanover, NH, USA
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25
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Kobayashi K, Dong R, Nicolalde RJ, Calderon P, Du G, Williams BB, Lee MCI, Swartz HM, Flood AB. Development of a novel mouth model as an alternative tool to test the effectiveness of an in vivo EPR dosimetry system. Phys Med Biol 2018; 63:165002. [PMID: 30033935 DOI: 10.1088/1361-6560/aad518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In a large-scale radiation event, thousands may be exposed to unknown amounts of radiation, some of which may be life-threatening without immediate attention. In such situations, a method to quickly and reliably estimate dose would help medical responders triage victims to receive life-saving care. We developed such a method using electron paramagnetic resonance (EPR) to make in vivo measurements of the maxillary incisors. This report provides evidence that the use of in vitro studies can provide data that are fully representative of the measurements made in vivo. This is necessary because, in order to systematically test and improve the reliability and accuracy of the dose estimates made with our EPR dosimetry system, it is important to conduct controlled studies in vitro using irradiated human teeth. Therefore, it is imperative to validate whether our in vitro models adequately simulate the measurements made in vivo, which are intended to help guide decisions on triage after a radiation event. Using a healthy volunteer with a dentition gap that allows using a partial denture, human teeth were serially irradiated in vitro and then, using a partial denture, placed in the volunteer's mouth for measurements. We compared dose estimates made using in vivo measurements made in the volunteer's mouth to measurements made on the same teeth in our complex mouth model that simulates electromagnetic and anatomic properties of the mouth. Our results demonstrate that this mouth model can be used in in vitro studies to develop the system because these measurements appropriately model in vivo conditions.
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Affiliation(s)
- Kyo Kobayashi
- EPR Center for the Study of Viable Systems, Radiology Department, Geisel School of Medicine at Dartmouth, HB 7785, Williamson Translational Research Bldg, Lebanon, NH, United States of America
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26
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Swarts SG, Sidabras JW, Grinberg O, Tipikin DS, Kmiec M, Petryakov S, Schreiber W, Wood VA, Williams BB, Flood AB, Swartz HM. Developments in Biodosimetry Methods for Triage With a Focus on X-band Electron Paramagnetic Resonance In Vivo Fingernail Dosimetry. Health Phys 2018; 115:140-150. [PMID: 29787440 PMCID: PMC5967651 DOI: 10.1097/hp.0000000000000874] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Instrumentation and application methodologies for rapidly and accurately estimating individual ionizing radiation dose are needed for on-site triage in a radiological/nuclear event. One such methodology is an in vivo X-band, electron paramagnetic resonance, physically based dosimetry method to directly measure the radiation-induced signal in fingernails. The primary components under development are key instrument features, such as resonators with unique geometries that allow for large sampling volumes but limit radiation-induced signal measurements to the nail plate, and methodological approaches for addressing interfering signals in the nail and for calibrating dose from radiation-induced signal measurements. One resonator development highlighted here is a surface resonator array designed to reduce signal detection losses due to the soft tissues underlying the nail plate. Several surface resonator array geometries, along with ergonomic features to stabilize fingernail placement, have been tested in tissue-equivalent nail models and in vivo nail measurements of healthy volunteers using simulated radiation-induced signals in their fingernails. These studies demonstrated radiation-induced signal detection sensitivities and quantitation limits approaching the clinically relevant range of ≤ 10 Gy. Studies of the capabilities of the current instrument suggest that a reduction in the variability in radiation-induced signal measurements can be obtained with refinements to the surface resonator array and ergonomic features of the human interface to the instrument. Additional studies are required before the quantitative limits of the assay can be determined for triage decisions in a field application of dosimetry. These include expanded in vivo nail studies and associated ex vivo nail studies to provide informed approaches to accommodate for a potential interfering native signal in the nails when calculating the radiation-induced signal from the nail plate spectral measurements and to provide a method for calibrating dose estimates from the radiation-induced signal measurements based on quantifying experiments in patients undergoing total-body irradiation or total-skin electron therapy.
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Affiliation(s)
- Steven G. Swarts
- Department of Radiation Oncology, University of Florida, Gainesville, Florida 32618
| | - Jason W. Sidabras
- Max Planck for Chemical Energy Conversion, Biophysical Chemistry, Mülheim, Germany
| | - Oleg Grinberg
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, 03755
| | | | - Maciej Kmiec
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, 03755
| | - Sergey Petryakov
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, 03755
| | - Wilson Schreiber
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, 03755
| | - Victoria A. Wood
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, 03755
| | | | - Ann Barry Flood
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, 03755
| | - Harold M. Swartz
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, 03755
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Abstract
Current methods for the study of bone marrow to evaluate possible primary or metastatic cancers are reviewed. Bone marrow biopsy, radionuclide scan, computed tomography and magnetic resonance imaging (MRI) are analyzed with regard to their clinical usefulness at the time of diagnosis and during the course of the disease. Bone marrow biopsy is still the examination of choice not only in hematologic malignancies but also for tumors that metastasize into the marrow. Radionuclide scans are indicated for screening for skeletal metastases, except for those from thyroid carcinoma and multiple myeloma. Computed tomography is useful for cortical bone evaluation. MRI shows a high sensitivity in finding occult sites of disease in the marrow but its use has been restricted by high cost and limited availability. However, the future of MRI in bone marrow evaluation seems assured. MRI is already the method of choice for diagnosis of multiple myeloma, when radiography is negative, and for quantitative evaluation of lymphoma when a crucial therapeutic decision (i.e. bone marrow transplantation) must be made. Finally, methods are being developed that will enhance the sensitivity and specificity of MRI studies of bone marrow.
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Affiliation(s)
- M Federico
- Divisione di Oncologia, Università di Modena, Italy
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28
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Flood AB, Wood VA, Schreiber W, Williams BB, Gallez B, Swartz HM. Guidance to Transfer 'Bench-Ready' Medical Technology into Usual Clinical Practice: Case Study - Sensors and Spectrometer Used in EPR Oximetry. Adv Exp Med Biol 2018; 1072:233-239. [PMID: 30178351 DOI: 10.1007/978-3-319-91287-5_37] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This paper considers the critical role that academics can have in the development of clinical innovations and especially how their impact can be optimized. The focus should be on establishing the safety and efficacy of new approaches while also incorporating human factors and human use considerations into the inventions. It is very advantageous to work in concert with the end-users (operators and clinicians) to help ensure that the innovation will be useful and feasible to be incorporated into actual clinical practice as intended. This strategy enables developments to tackle real clinical needs by providing novel strategies to improve patient care while using solutions that fit into clinical practice and that are welcomed by patients and clinical staff. These principles are illustrated by a case study of the development of clinical in vivo EPR oximetry.
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Affiliation(s)
- Ann Barry Flood
- Radiology, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA.
| | - Victoria A Wood
- Radiology, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Wilson Schreiber
- Radiology, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | | | - Bernard Gallez
- Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Harold M Swartz
- Radiology, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA.,Radiation Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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29
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Vostal JG, Buehler PW, Gelderman MP, Alayash AI, Doctor A, Zimring JC, Glynn SA, Hess JR, Klein H, Acker JP, Spinella PC, D'Alessandro A, Palsson B, Raife TJ, Busch MP, McMahon TJ, Intaglietta M, Swartz HM, Dubick MA, Cardin S, Patel RP, Natanson C, Weisel JW, Muszynski JA, Norris PJ, Ness PM. Proceedings of the Food and Drug Administration's public workshop on new red blood cell product regulatory science 2016. Transfusion 2017; 58:255-266. [PMID: 29243830 DOI: 10.1111/trf.14435] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 09/11/2017] [Accepted: 09/13/2017] [Indexed: 01/28/2023]
Abstract
The US Food and Drug Administration (FDA) held a workshop on red blood cell (RBC) product regulatory science on October 6 and 7, 2016, at the Natcher Conference Center on the National Institutes of Health (NIH) Campus in Bethesda, Maryland. The workshop was supported by the National Heart, Lung, and Blood Institute, NIH; the Department of Defense; the Office of the Assistant Secretary for Health, Department of Health and Human Services; and the Center for Biologics Evaluation and Research, FDA. The workshop reviewed the status and scientific basis of the current regulatory framework and the available scientific tools to expand it to evaluate innovative and future RBC transfusion products. A full record of the proceedings is available on the FDA website (http://www.fda.gov/BiologicsBloodVaccines/NewsEvents/WorkshopsMeetingsConferences/ucm507890.htm). The contents of the summary are the authors' opinions and do not represent agency policy.
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Affiliation(s)
- Jaroslav G Vostal
- Division of Blood Components and Devices, OBRR, CBER, Food and Drug Administration, Silver Spring, Maryland
| | - Paul W Buehler
- Division of Blood Components and Devices, OBRR, CBER, Food and Drug Administration, Silver Spring, Maryland
| | - Monique P Gelderman
- Division of Blood Components and Devices, OBRR, CBER, Food and Drug Administration, Silver Spring, Maryland
| | - Abdu I Alayash
- Division of Blood Components and Devices, OBRR, CBER, Food and Drug Administration, Silver Spring, Maryland
| | - Alan Doctor
- Department of Pediatric Critical Care, St Louis Children's Hospital, St Louis, Missouri
| | | | - Simone A Glynn
- Division of Blood Diseases and Resources, NHLBI, NIH, Bethesda, Maryland
| | - John R Hess
- Department of Laboratory Medicine and Hematology, University of Washington, School of Medicine, Seattle, Washington
| | - Harvey Klein
- Department of Transfusion Medicine, National Institutes of Health, Clinical Center, Bethesda, Maryland
| | - Jason P Acker
- Department of Research & Development, Canadian Blood Services, Edmonton, Alberta, Canada
| | - Philip C Spinella
- Department of Pediatric Critical Care, Washington University School of Medicine, St Louis, Missouri
| | - Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado-Anschutz Medical Campus, Denver, Colorado
| | - Bernhard Palsson
- Center for Systems Biology, University of Iceland, Reykjavik, Iceland
| | - Thomas J Raife
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Timothy J McMahon
- Department of Medicine, Pulmonary, Allergy, & Critical Care Medicine, Duke University Medical Center, and the Durham VA Medical Center, Durham, North Carolina
| | - Marcos Intaglietta
- Department of Bioengineering, University of California at San Diego, San Diego, California
| | - Harold M Swartz
- Department of Radiology, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire
| | | | - Sylvain Cardin
- Naval Medical Research Unit-San Antonio, San Antonio, Texas
| | - Rakesh P Patel
- Center for Free Radical Biology and Translational and Molecular Sciences Certificate Program, University of Alabama, Birmingham, Alabama
| | | | - John W Weisel
- Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer A Muszynski
- Division of Critical Care Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Philip J Norris
- Blood Systems Research Institute, Blood Systems, Inc., San Francisco, California
| | - Paul M Ness
- Division of Transfusion Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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30
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Umakoshi M, Yamaguchi I, Hirata H, Kunugita N, Williams BB, Swartz HM, Miyake M. In Vivo Electron Paramagnetic Resonance Tooth Dosimetry: Dependence of Radiation-Induced Signal Amplitude on the Enamel Thickness and Surface Area of Ex Vivo Human Teeth. Health Phys 2017; 113:262-270. [PMID: 28796750 DOI: 10.1097/hp.0000000000000698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In vivo L-band electron paramagnetic resonance tooth dosimetry is a newly developed and very promising method for retrospective biodosimetry in individuals who may have been exposed to significant levels of ionizing radiation. The present study aimed to determine the relationships among enamel thickness, enamel area, and measured electron paramagnetic resonance signal amplitude with a view to improve the quantitative accuracy of the dosimetry technique. Ten isolated incisors were irradiated using well-characterized doses, and their radiation-induced electron paramagnetic resonance signals were measured. Following the measurements, the enamel thickness and area of each tooth were measured using micro-focus computed tomography. Linear regression showed that the enamel area at each measurement position significantly affected the radiation-induced electron paramagnetic resonance signal amplitude (p < 0.001). Simulation data agreed well with this result. These results indicate that it is essential to properly consider enamel thickness and area when interpreting electron paramagnetic resonance tooth dosimetry measurements to optimize the accuracy of dose estimation.
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Affiliation(s)
- Michitaka Umakoshi
- *Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Kagawa University, Kagawa,761-0793, Japan; †Department of Environmental Health, National Institute of Public Health, Wako, 351-0197, Japan; ‡Division of Bioengineering and Bioinformatics, Graduate School of Information Science and Technology, Hokkaido University, Sapporo, 060-0814, Japan; §EPR Center for the Study of Viable Systems, Department of Radiology, The Geisel School of Medicine at Dartmouth, Lebanon, NH 03766
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31
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Caston RM, Schreiber W, Hou H, Williams BB, Chen EY, Schaner PE, Jarvis LA, Flood AB, Petryakov SV, Kmiec MM, Kuppusamy P, Swartz HM. Development of the Implantable Resonator System for Clinical EPR Oximetry. Cell Biochem Biophys 2017; 75:275-283. [PMID: 28687906 DOI: 10.1007/s12013-017-0809-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 06/06/2017] [Indexed: 11/24/2022]
Abstract
Hypoxic tumors are more resistant to radiotherapy and chemotherapy, which decreases the efficacy of these common forms of treatment. We have been developing implantable paramagnetic particulates to measure oxygen in vivo using electron paramagnetic resonance. Once implanted, oxygen can be measured repeatedly and non-invasively in superficial tissues (<3 cm deep), using an electron paramagnetic resonance spectrometer and an external surface-loop resonator. To significantly extend the clinical applications of electron paramagnetic resonance oximetry, we developed an implantable resonator system to obtain measurements at deeper sites. This system has been used to successfully obtain oxygen measurements in animal studies for several years. We report here on recent developments needed to meet the regulatory requirements to make this technology available for clinical use. radio frequency heating is discussed and magnetic resonance compatibility testing of the device has been carried out by a Good Laboratory Practice-certified laboratory. The geometry of the implantable resonator has been modified to meet our focused goal of verifying safety and efficacy for the proposed use of intracranial measurements and also for future use in tissue sites other than the brain. We have encapsulated the device within a smooth cylindrical-shaped silicone elastomer to prevent tissues from adhering to the device and to limit perturbation of tissue during implantation and removal. We have modified the configuration for simultaneously measuring oxygen at multiple sites by developing a linear array of oxygen sensing probes, which each provide independent measurements. If positive results are obtained in additional studies which evaluate biocompatibility and chemical characterization, we believe the implantable resonator will be at a suitable stage for initial testing in human subjects.
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Affiliation(s)
- Rose M Caston
- EPR Center for the Study of Viable Systems at Dartmouth College, Hanover, USA.
| | - Wilson Schreiber
- EPR Center for the Study of Viable Systems at Dartmouth College, Hanover, USA
| | - Huagang Hou
- EPR Center for the Study of Viable Systems at Dartmouth College, Hanover, USA
| | - Benjamin B Williams
- EPR Center for the Study of Viable Systems at Dartmouth College, Hanover, USA
| | - Eunice Y Chen
- EPR Center for the Study of Viable Systems at Dartmouth College, Hanover, USA
| | - Philip E Schaner
- EPR Center for the Study of Viable Systems at Dartmouth College, Hanover, USA
| | - Lesley A Jarvis
- EPR Center for the Study of Viable Systems at Dartmouth College, Hanover, USA
| | - Ann Barry Flood
- EPR Center for the Study of Viable Systems at Dartmouth College, Hanover, USA
| | - Sergey V Petryakov
- EPR Center for the Study of Viable Systems at Dartmouth College, Hanover, USA
| | - Maciej M Kmiec
- EPR Center for the Study of Viable Systems at Dartmouth College, Hanover, USA
| | - Periannan Kuppusamy
- EPR Center for the Study of Viable Systems at Dartmouth College, Hanover, USA
| | - Harold M Swartz
- EPR Center for the Study of Viable Systems at Dartmouth College, Hanover, USA
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32
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Hou H, Khan N, Gohain S, Eskey CJ, Moodie KL, Maurer KJ, Swartz HM, Kuppusamy P. Dynamic EPR Oximetry of Changes in Intracerebral Oxygen Tension During Induced Thromboembolism. Cell Biochem Biophys 2017; 75:285-294. [PMID: 28434138 DOI: 10.1007/s12013-017-0798-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 04/12/2017] [Indexed: 12/19/2022]
Abstract
Cerebral tissue oxygenation (oxygen tension, pO2) is a critical parameter that is closely linked to brain metabolism, function, and pathophysiology. In this work, we have used electron paramagnetic resonance oximetry with a deep-tissue multi-site oxygen-sensing probe, called implantable resonator, to monitor temporal changes in cerebral pO2 simultaneously at four sites in a rabbit model of ischemic stroke induced by embolic clot. The pO2 values in healthy brain were not significantly different among the four sites measured over a period of 4 weeks. During exposure to 15% O2 (hypoxia), a sudden and significant decrease in pO2 was observed in all four sites. On the other hand, brief exposure to breathing carbogen gas (95% O2 + 5% CO2) showed a significant increase in the cerebral pO2 from baseline value. During ischemic stroke, induced by embolic clot in the left brain, a significant decline in the pO2 of the left cortex (ischemic core) was observed without any change in the contralateral sites. While the pO2 in the non-infarct regions returned to baseline at 24-h post-stroke, pO2 in the infarct core was consistently lower compared to the baseline and other regions of the brain. The results demonstrated that electron paramagnetic resonance oximetry with the implantable resonator can repeatedly and simultaneously report temporal changes in cerebral pO2 at multiple sites. This oximetry approach can be used to develop interventions to rescue hypoxic/ischemic tissue by modulating cerebral pO2 during hypoxic and stroke injury.
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Affiliation(s)
- Huagang Hou
- Department of Radiology, The Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive,, Lebanon, 03756, NH, USA
| | - Nadeem Khan
- Department of Radiology, The Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive,, Lebanon, 03756, NH, USA
| | - Sangeeta Gohain
- Department of Radiology, The Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive,, Lebanon, 03756, NH, USA
| | - Clifford J Eskey
- Department of Radiology, The Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive,, Lebanon, 03756, NH, USA
| | - Karen L Moodie
- Center for Comparative Medicine and Research, Dartmouth College, 1 Medical Center Drive,, Lebanon, 03756, NH, USA
| | - Kirk J Maurer
- Center for Comparative Medicine and Research, Dartmouth College, 1 Medical Center Drive,, Lebanon, 03756, NH, USA
| | - Harold M Swartz
- Department of Radiology, The Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive,, Lebanon, 03756, NH, USA
| | - Periannan Kuppusamy
- Department of Radiology, The Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive,, Lebanon, 03756, NH, USA.
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Miyake M, Nakai Y, Yamaguchi I, Hirata H, Kunugita N, Williams BB, Swartz HM. IN-VIVO RADIATION DOSIMETRY USING PORTABLE L BAND EPR: ON-SITE MEASUREMENT OF VOLUNTEERS IN FUKUSHIMA PREFECTURE, JAPAN. Radiat Prot Dosimetry 2016; 172:248-253. [PMID: 27522046 PMCID: PMC5225973 DOI: 10.1093/rpd/ncw214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The aim of this study was to make direct measurements of the possible radiation-induced EPR signals in the teeth of volunteers who were residents in Fukushima within 80 km distance from the Fukushima Nuclear Power plant at the time of the disaster, and continued to live there for at least 3 month after the disaster. Thirty four volunteers were enrolled in this study. These measurements were made using a portable L-band EPR spectrometer, which was originally developed in the EPR Center at Dartmouth. All measurements were performed using surface loop resonators that have been specifically designed for the upper incisor teeth. Potentially these signals include not only radiation-induced signals induced by the incident but also background signals including those from prior radiation exposure from the environment and medical exposure. We demonstrated that it is feasible to transport the dosimeter to the measurement site and make valid measurements. The intensity of the signals that were obtained was not significantly above those seen in volunteers who had not had potential radiation exposures at Fukushima.
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Affiliation(s)
- Minoru Miyake
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Kagawa University, 750-1 Ikenobe, Miki-cho, Kita-gun , Kagawa Prefecture 761-0793, Japan
| | - Yasuhiro Nakai
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Kagawa University, 750-1 Ikenobe, Miki-cho, Kita-gun , Kagawa Prefecture 761-0793, Japan
| | - Ichiro Yamaguchi
- Department of Environmental Health, NIPH (National Institute of Public Health ), 2-3-6 Minami, Wako-shi , Saitama 351-0197, Japan
| | - Hiroshi Hirata
- EPR group in the Division of Bioengineering and Bioinformatics, Hokkaido University, Kita 14, Nishi 9, Kita-ku, Sapporo, Hokkaido 060-0814, Japan
| | - Naoki Kunugita
- Department of Environmental Health, NIPH (National Institute of Public Health ), 2-3-6 Minami, Wako-shi , Saitama 351-0197, Japan
| | - Benjamin B Williams
- Dartmouth EPR Center, Department of Radiology, The Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
| | - Harold M Swartz
- Dartmouth EPR Center, Department of Radiology, The Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
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34
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Swartz HM. Using Stable Free Radicals to Obtain Unique and Clinically Useful Data In Vivo in Human Subjects. Radiat Prot Dosimetry 2016; 172:3-15. [PMID: 27886997 PMCID: PMC6061194 DOI: 10.1093/rpd/ncw323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/30/2016] [Indexed: 06/06/2023]
Abstract
This paper attempts to: (1) provide a critical overview of the challenges and opportunities to extend electron paramagnetic resonance (EPR) into practical applications in human subjects, based on EPR measurements made in vivo; (2) summarize the clinical applications of EPR for improving treatments in cancer, wound healing and diabetic care, emphasizing EPR's unique capability to measure tissue oxygen repeatedly and with particular sensitivity to hypoxia and (3) summarize the capabilities of in vivo EPR to measure radiation dose for triage and medical guidance after a large-scale radiation exposure. The conclusion is that while still at a relatively early stage of its development and availability, clinical applications of EPR already have demonstrated significant value and the field is likely to grow in both the extent of its applications and its impact on significant problems.
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Affiliation(s)
- Harold M Swartz
- EPR Center for the Study of Viable Systems at Dartmouth, Department of Radiology, Geisel School of Medicine at Dartmouth, HB 7785 One Medical Center Drive, Lebanon, NH 03756, USA
- Division of Radiation Oncology, Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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Kobayashi K, Dong R, Nicolalde RJ, Williams BB, Du G, Swartz HM, Flood AB. Evolution and Optimization of Tooth Models for Testing In Vivo EPR Tooth Dosimetry. Radiat Prot Dosimetry 2016; 172:152-160. [PMID: 27555657 PMCID: PMC5225979 DOI: 10.1093/rpd/ncw215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Testing and verification are an integral part of any cycle to design, manufacture and improve a novel device intended for use in humans. In the case of testing Dartmouth's electron paramagnetic resonance (EPR) in vivo tooth dosimetry device, in vitro studies are needed throughout its development to test its performance, i.e. to verify its current capability for assessing dose in individuals potentially exposed to ionizing radiation. Since the EPR device uses the enamel of human teeth to assess dose, models that include human teeth have been an integral mechanism to carry out in vitro studies during development and testing its ability to meet performance standards for its ultimate intended in vivo use. As the instrument improves over time, new demands for in vitro studies change as well. This paper describes the tooth models used to perform in vitro studies and their evolution to meet the changing demands for testing in vivo EPR tooth dosimetry.
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Affiliation(s)
- Kyo Kobayashi
- EPR Center for the Study of Viable Systems, Radiology Department, Geisel School of Medicine at Dartmouth, HB 7785, Williamson Translational Research Bldg. Lebanon, NH, USA
| | - Ruhong Dong
- EPR Center for the Study of Viable Systems, Radiology Department, Geisel School of Medicine at Dartmouth, HB 7785, Williamson Translational Research Bldg. Lebanon, NH, USA
| | | | - Benjamin B Williams
- EPR Center for the Study of Viable Systems, Radiology Department, Geisel School of Medicine at Dartmouth, HB 7785, Williamson Translational Research Bldg. Lebanon, NH, USA
- Division of Radiation Oncology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Gaixin Du
- EPR Center for the Study of Viable Systems, Radiology Department, Geisel School of Medicine at Dartmouth, HB 7785, Williamson Translational Research Bldg. Lebanon, NH, USA
| | - Harold M Swartz
- EPR Center for the Study of Viable Systems, Radiology Department, Geisel School of Medicine at Dartmouth, HB 7785, Williamson Translational Research Bldg. Lebanon, NH, USA
- Division of Radiation Oncology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Ann Barry Flood
- EPR Center for the Study of Viable Systems, Radiology Department, Geisel School of Medicine at Dartmouth, HB 7785, Williamson Translational Research Bldg. Lebanon, NH, USA
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36
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Abstract
Receiver operating characteristic (ROC) analysis is a fundamental tool used for the evaluation and comparison of diagnostic systems that provides estimates of the combinations of sensitivity and specificity that can be achieved with a given technique. Along with critical considerations of practical limitations, such as throughput and time to availability of results, ROC analyses can be applied to provide meaningful assessments and comparisons of available biodosimetry methods. Accordingly, guidance from the Food and Drug Administration to evaluate biodosimetry devices recommends using ROC analysis. However, the existing literature for the numerous biodosimetry methods that have been developed to address the needs for triage either do not contain ROC analyses or present ROC analyses where the dose distributions of the study samples are not representative of the populations to be screened. The use of non-representative sample populations can result in a significant spectrum bias, where estimated performance metrics do not accurately characterize the true performance under real-world conditions. Particularly, in scenarios where a large group of people is screened because they were potentially exposed in a large-scale radiation event, directly measured population data do not exist. However, a number of complex simulations have been performed and reported in the literature that provide estimates of the required dose distributions. Based on these simulations and reported data about the output and uncertainties of biodosimetry assays, we illustrate how ROC curves can be generated that incorporate a realistic representative sample. A technique to generate ROC curves for biodosimetry data is presented along with representative ROC curves, summary statistics and discussion based on published data for triage-ready electron paramagnetic resonance in vivo tooth dosimetry, the dicentric chromosome assay and quantitative polymerase chain reaction assay. We argue that this methodology should be adopted generally to evaluate the performance of radiation biodosimetry screening assays so that they can be compared in the context of their intended use.
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Affiliation(s)
- Benjamin B Williams
- Department of Medicine, Section of Radiation Oncology, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
- Department of Radiology, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - Ann Barry Flood
- Department of Radiology, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - Eugene Demidenko
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - Harold M Swartz
- Department of Medicine, Section of Radiation Oncology, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
- Department of Radiology, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
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37
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Schreiber W, Petryakov SV, Kmiec MM, Feldman MA, Meaney PM, Wood VA, Boyle HK, Flood AB, Williams BB, Swartz HM. FLEXIBLE, WIRELESS, INDUCTIVELY COUPLED SURFACE COIL RESONATOR FOR EPR TOOTH DOSIMETRY. Radiat Prot Dosimetry 2016; 172:87-95. [PMID: 27421470 PMCID: PMC6287419 DOI: 10.1093/rpd/ncw153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Managing radiation injuries following a catastrophic event where large numbers of people may have been exposed to life-threatening doses of ionizing radiation relies on the availability of biodosimetry to assess whether individuals need to be triaged for care. Electron Paramagnetic Resonance (EPR) tooth dosimetry is a viable method to accurately estimate the amount of ionizing radiation to which an individual has been exposed. In the intended measurement conditions and scenario, it is essential that the measurement process be fast, straightforward and provides meaningful and accurate dose estimations for individuals in the expected measurement conditions. The sensing component of a conventional L-band EPR spectrometer used for tooth dosimetry typically consists of a surface coil resonator that is rigidly, physically attached to the coupler. This design can result in cumbersome operation, limitations in teeth geometries that may be measured and hinder the overall utility of the dosimeter. A novel surface coil resonator has been developed for the currently existing L-band (1.15 GHz) EPR tooth dosimeter for the intended use as a point of care device by minimally trained operators. This resonator development provides further utility to the dosimeter, and increases the usability of the dosimeter by non-expert operators in the intended use scenario.
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Affiliation(s)
- Wilson Schreiber
- Department of Radiology, EPR Center for the Study of Viable Systems, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - Sergey V Petryakov
- Department of Radiology, EPR Center for the Study of Viable Systems, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - Maciej M Kmiec
- Department of Radiology, EPR Center for the Study of Viable Systems, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - Matthew A Feldman
- Department of Radiology, EPR Center for the Study of Viable Systems, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - Paul M Meaney
- Department of Radiology, EPR Center for the Study of Viable Systems, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
- Thayer School of Engineering at Dartmouth, Hanover, NH 03755, USA
| | - Victoria A Wood
- Department of Radiology, EPR Center for the Study of Viable Systems, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - Holly K Boyle
- Department of Radiology, EPR Center for the Study of Viable Systems, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - Ann Barry Flood
- Department of Radiology, EPR Center for the Study of Viable Systems, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - Benjamin B Williams
- Department of Radiology, EPR Center for the Study of Viable Systems, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - Harold M Swartz
- Department of Radiology, EPR Center for the Study of Viable Systems, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
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Grinberg O, Sidabras JW, Tipikin DS, Krymov V, Mariani M, Feldman MM, Kmiec MM, Petryakov SV, Brugger S, Carr B, Schreiber W, Swarts SG, Swartz HM. Dielectric-Backed Aperture Resonators for X-Band in vivo EPR Nail Dosimetry. Radiat Prot Dosimetry 2016; 172:121-126. [PMID: 27412507 PMCID: PMC5225980 DOI: 10.1093/rpd/ncw163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A new resonator for X-band in vivo EPR nail dosimetry, the dielectric-backed aperture resonator (DAR), is developed based on rectangular TE102 geometry. This novel geometry for surface spectroscopy improves at least a factor of 20 compared to a traditional non-backed aperture resonator. Such an increase in EPR sensitivity is achieved by using a non-resonant dielectric slab, placed on the aperture inside the cavity. The dielectric slab provides an increased magnetic field at the aperture and sample, while minimizing sensitive aperture resonance conditions. This work also introduces a DAR semi-spherical (SS)-TE011 geometry. The SS-TE011 geometry is attractive due to having twice the incident magnetic field at the aperture for a fixed input power. It has been shown that DAR provides sufficient sensitivity to make biologically relevant measurements both in vitro and in vivo Although in vivo tests have shown some effects of physiological motions that suggest the necessity of a more robust finger holder, equivalent dosimetry sensitivity of approximately 1.4 Gy has been demonstrated.
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Affiliation(s)
- Oleg Grinberg
- Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - Jason W Sidabras
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, WI 53211, USA
| | | | - Vladimir Krymov
- Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - Michael Mariani
- Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | | | - Maciej M Kmiec
- Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | | | - Spencer Brugger
- Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - Brandon Carr
- Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | | | - Steven G Swarts
- Department of Radiation Oncology, University of Florida, Gainesville, FL 32610, USA
| | - Harold M Swartz
- Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
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Tipikin DS, Swarts SG, Sidabras JW, Trompier F, Swartz HM. POSSIBLE NATURE OF THE RADIATION-INDUCED SIGNAL IN NAILS: HIGH-FIELD EPR, CONFIRMING CHEMICAL SYNTHESIS, AND QUANTUM CHEMICAL CALCULATIONS. Radiat Prot Dosimetry 2016; 172:112-120. [PMID: 27522053 PMCID: PMC5225972 DOI: 10.1093/rpd/ncw216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Exposure of finger- and toe-nails to ionizing radiation generates an Electron Paramagnetic Resonance (EPR) signal whose intensity is dose dependent and stable at room temperature for several days. The dependency of the radiation-induced signal (RIS) on the received dose may be used as the basis for retrospective dosimetry of an individual's fortuitous exposure to ionizing radiation. Two radiation-induced signals, a quasi-stable (RIS2) and stable signal (RIS5), have been identified in nails irradiated up to a dose of 50 Gy. Using X-band EPR, both RIS signals exhibit a singlet line shape with a line width around 1.0 mT and an apparent g-value of 2.0044. In this work, we seek information on the exact chemical nature of the radiation-induced free radicals underlying the signal. This knowledge may provide insights into the reason for the discrepancy in the stabilities of the two RIS signals and help develop strategies for stabilizing the radicals in nails or devising methods for restoring the radicals after decay. In this work an analysis of high field (94 GHz and 240 GHz) EPR spectra of the RIS using quantum chemical calculations, the oxidation-reduction properties and the pH dependence of the signal intensities are used to show that spectroscopic and chemical properties of the RIS are consistent with a semiquinone-type radical underlying the RIS. It has been suggested that semiquinone radicals formed on trace amounts of melanin in nails are the basis for the RIS signals. However, based on the quantum chemical calculations and chemical properties of the RIS, it is likely that the radicals underlying this signal are generated from the radiolysis of L-3,4-dihydroxyphenylalanine (DOPA) amino acids in the keratin proteins. These DOPA amino acids are likely formed from the exogenous oxidation of tyrosine in keratin by the oxygen from the air prior to irradiation. We show that these DOPA amino acids can work as radical traps, capturing the highly reactive and unstable sulfur-based radicals and/or alkyl radicals generated during the radiation event and are converted to the more stable o-semiquinone anion-radicals. From this understanding of the oxidation-reduction properties of the RIS, it may be possible to regenerate the unstable RIS2 following its decay through treatment of nail clippings. However, the treatment used to recover the RIS2 also has the ability to recover an interfering, mechanically-induced signal (MIS) formed when the nail is clipped. Therefore, to use the recovered (regenerated) RIS2 to increase the detection limits and precision of the RIS measurements and, therefore, the dose estimates calculated from the RIS signal amplitudes, will require the application of methods to differentiate the RIS2 from the recovered MIS signal.
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Affiliation(s)
- Dmitriy S Tipikin
- EPR Center at Dartmouth, Department of Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH 03766, USA
| | - Steven G Swarts
- Department of Radiation Oncology, University of Florida, Gainesville, FL 32610, USA
| | - Jason W Sidabras
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - François Trompier
- Institut de Radioprotection et de Sûreté Nucléaire, BP 17, F-92265 Fontenay-aux-roses, France
| | - Harold M Swartz
- EPR Center at Dartmouth, Department of Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH 03766, USA
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Petryakov SV, Schreiber W, Kmiec MM, Williams BB, Swartz HM. Surface Dielectric Resonators for X-band EPR Spectroscopy. Radiat Prot Dosimetry 2016; 172:127-132. [PMID: 27421472 PMCID: PMC8444672 DOI: 10.1093/rpd/ncw167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A new resonator for X-band electron paramagnetic resonance (EPR) spectroscopy, which utilizes the unique resonance properties of dielectric substrates, has been developed using a single crystal of titanium dioxide. As a result of the dielectric properties of the crystal(s) chosen, this novel resonator provides the ability to make in vivo EPR spectroscopy surface measurements in the presence of lossy tissues at X-band frequencies (up to 10 GHz). A double-loop coupling device is used to transmit and receive microwave power to/from the resonator. This coupler has been developed and optimized for coupling to the resonator in the presence of lossy tissues to further enable in vivo measurements, such as in vivo EPR spectroscopy of human fingernails or teeth to measure the dose of ionizing radiation that a given individual has been exposed to. An advantage of this resonator for surface measurements is that the magnetic fields generated by the resonator are inherently shallow, which is desirable for in vivo nail dosimetry.
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Affiliation(s)
- Sergey V Petryakov
- Department of Radiology, EPR Center for the Study of Viable Systems, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Wilson Schreiber
- Department of Radiology, EPR Center for the Study of Viable Systems, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Maciej M Kmiec
- Department of Radiology, EPR Center for the Study of Viable Systems, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Benjamin B Williams
- Department of Radiology, EPR Center for the Study of Viable Systems, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Division of Radiation Oncology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Harold M Swartz
- Department of Radiology, EPR Center for the Study of Viable Systems, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Division of Radiation Oncology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Ivannikov AI, Khailov AM, Orlenko SP, Skvortsov VG, Stepanenko VF, Zhumadilov KS, Williams BB, Flood AB, Swartz HM. Determination of the Average Native Background and the Light-Induced EPR Signals and their Variation in the Teeth Enamel Based on Large-Scale Survey of the Population. Radiat Prot Dosimetry 2016; 172:265-274. [PMID: 27412516 PMCID: PMC5225970 DOI: 10.1093/rpd/ncw150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The aim of the study is to determine the average intensity and variation of the native background signal amplitude (NSA) and of the solar light-induced signal amplitude (LSA) in electron paramagnetic resonance (EPR) spectra of tooth enamel for different kinds of teeth and different groups of people. These values are necessary for determination of the intensity of the radiation-induced signal amplitude (RSA) by subtraction of the expected NSA and LSA from the total signal amplitude measured in L-band for in vivo EPR dosimetry. Variation of these signals should be taken into account when estimating the uncertainty of the estimated RSA. A new analysis of several hundred EPR spectra that were measured earlier at X-band in a large-scale examination of the population of the Central Russia was performed. Based on this analysis, the average values and the variation (standard deviation, SD) of the amplitude of the NSA for the teeth from different positions, as well as LSA in outer enamel of the front teeth for different population groups, were determined. To convert data acquired at X-band to values corresponding to the conditions of measurement at L-band, the experimental dependencies of the intensities of the RSA, LSA and NSA on the m.w. power, measured at both X and L-band, were analysed. For the two central upper incisors, which are mainly used in in vivo dosimetry, the mean LSA annual rate induced only in the outer side enamel and its variation were obtained as 10 ± 2 (SD = 8) mGy y-1, the same for X- and L-bands (results are presented as the mean ± error of mean). Mean NSA in enamel and its variation for the upper incisors was calculated at 2.0 ± 0.2 (SD = 0.5) Gy, relative to the calibrated RSA dose-response to gamma radiation measured under non-power saturation conditions at X-band. Assuming the same value for L-band under non-power saturating conditions, then for in vivo measurements at L-band at 25 mW (power saturation conditions), a mean NSA and its variation correspond to 4.0 ± 0.4 (SD = 1.0) Gy.
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Affiliation(s)
| | - Artem M Khailov
- A.F. Tsyb Medical Radiological Research Center, Obninsk, Russia
| | | | | | | | | | | | - Ann B Flood
- Geisel School of Medicine at Dartmouth, New Hampshire, USA
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Flood AB, Williams BB, Schreiber W, Du G, Wood VA, Kmiec MM, Petryakov SV, Demidenko E, Swartz HM. Advances in in vivo EPR Tooth BIOdosimetry: Meeting the targets for initial triage following a large-scale radiation event. Radiat Prot Dosimetry 2016; 172:72-80. [PMID: 27421468 PMCID: PMC5225975 DOI: 10.1093/rpd/ncw165] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Several important recent advances in the development and evolution of in vivo Tooth Biodosimetry using Electron Paramagnetic Resonance (EPR) allow its performance to meet or exceed the U.S. targeted requirements for accuracy and ease of operation and throughput in a large-scale radiation event. Ergonomically based changes to the magnet, coupled with the development of rotation of the magnet and advanced software to automate collection of data, have made it easier and faster to make a measurement. From start to finish, measurements require a total elapsed time of 5 min, with data acquisition taking place in less than 3 min. At the same time, the accuracy of the data for triage of large populations has improved, as indicated using the metrics of sensitivity, specificity and area under the ROC curve. Applying these standards to the intended population, EPR in vivo Tooth Biodosimetry has approximately the same diagnostic accuracy as the purported 'gold standard' (dicentric chromosome assay). Other improvements include miniaturisation of the spectrometer, leading to the creation of a significantly lighter and more compact prototype that is suitable for transporting for Point of Care (POC) operation and that can be operated off a single standard power outlet. Additional advancements in the resonator, including use of a disposable sensing loop attached to the incisor tooth, have resulted in a biodosimetry method where measurements can be made quickly with a simple 5-step workflow and by people needing only a few minutes of training (which can be built into the instrument as a training video). In sum, recent advancements allow this prototype to meet or exceed the US Federal Government's recommended targets for POC biodosimetry in large-scale events.
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Affiliation(s)
- Ann Barry Flood
- EPR Center for the Study of Viable Systems at Dartmouth, Radiology Dept., Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Benjamin B Williams
- EPR Center for the Study of Viable Systems at Dartmouth, Radiology Dept., Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Division of Radiation Oncology, Dept. of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Wilson Schreiber
- EPR Center for the Study of Viable Systems at Dartmouth, Radiology Dept., Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Gaixin Du
- EPR Center for the Study of Viable Systems at Dartmouth, Radiology Dept., Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Victoria A Wood
- EPR Center for the Study of Viable Systems at Dartmouth, Radiology Dept., Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Maciej M Kmiec
- EPR Center for the Study of Viable Systems at Dartmouth, Radiology Dept., Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Sergey V Petryakov
- EPR Center for the Study of Viable Systems at Dartmouth, Radiology Dept., Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Eugene Demidenko
- Dept. of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Harold M Swartz
- EPR Center for the Study of Viable Systems at Dartmouth, Radiology Dept., Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Division of Radiation Oncology, Dept. of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Abstract
The effect of hyperoxygenation with carbogen (95% O2 + 5% CO2) and 100% oxygen inhalation on partial pressure of oxygen (pO2) of radiation-induced fibrosarcoma (RIF-1) tumor was investigated. RIF-1 tumors were innoculated in C3H mice, and aggregates of oximetry probe, lithium phthalocyanine (LiPc), was implanted in each tumor. A baseline tumor pO2 was measured by electron paramagnetic resonance (EPR) oximetry for 20 minutes in anesthetized mice breathing 30% O2 and then the gas was switched to carbogen or 100 % oxygen for 60 minutes. These experiments were repeated for 10 days. RIF-1 tumors were hypoxic with a baseline tissue pO2 of 6.2–8.3 mmHg in mice breathing 30% O2. Carbogen and 100% oxygen significantly increased tumor pO2 on days 1 to 5, with a maximal increase at approximately 32–45 minutes on each day. However, the extent of increase in pO2 from the baseline declined significantly on day 5 and day 10. The results provide quantitative information on the effect of hyperoxic gas inhalation on tumor pO2 over the course of 10 days. EPR oximetry can be effectively used to repeatedly monitor tumor pO2 and test hyperoxic methods for potential clinical applications.
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Affiliation(s)
- Hua-Gang Hou
- EPR Center for Viable Systems, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Nadeem Khan
- EPR Center for Viable Systems, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Gai-Xin Du
- EPR Center for Viable Systems, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Sassan Hodge
- Department of Genetics, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Harold M Swartz
- EPR Center for Viable Systems, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Flood AB, Ali AN, Boyle HK, Du G, Satinsky VA, Swarts SG, Williams BB, Demidenko E, Schreiber W, Swartz HM. Evaluating the Special Needs of The Military for Radiation Biodosimetry for Tactical Warfare Against Deployed Troops: Comparing Military to Civilian Needs for Biodosimetry Methods. Health Phys 2016; 111:169-82. [PMID: 27356061 PMCID: PMC4930006 DOI: 10.1097/hp.0000000000000538] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The aim of this paper is to delineate characteristics of biodosimetry most suitable for assessing individuals who have potentially been exposed to significant radiation from a nuclear device explosion when the primary population targeted by the explosion and needing rapid assessment for triage is civilians vs. deployed military personnel. The authors first carry out a systematic analysis of the requirements for biodosimetry to meet the military's needs to assess deployed troops in a warfare situation, which include accomplishing the military mission. Then the military's special capabilities to respond and carry out biodosimetry for deployed troops in warfare are compared and contrasted systematically, in contrast to those available to respond and conduct biodosimetry for civilians who have been targeted by terrorists, for example. Then the effectiveness of different biodosimetry methods to address military vs. civilian needs and capabilities in these scenarios was compared and, using five representative types of biodosimetry with sufficient published data to be useful for the simulations, the number of individuals are estimated who could be assessed by military vs. civilian responders within the timeframe needed for triage decisions. Analyses based on these scenarios indicate that, in comparison to responses for a civilian population, a wartime military response for deployed troops has both more complex requirements for and greater capabilities to use different types of biodosimetry to evaluate radiation exposure in a very short timeframe after the exposure occurs. Greater complexity for the deployed military is based on factors such as a greater likelihood of partial or whole body exposure, conditions that include exposure to neutrons, and a greater likelihood of combined injury. These simulations showed, for both the military and civilian response, that a very fast rate of initiating the processing (24,000 d) is needed to have at least some methods capable of completing the assessment of 50,000 people within a 2- or 6-d timeframe following exposure. This in turn suggests a very high capacity (i.e., laboratories, devices, supplies and expertise) would be necessary to achieve these rates. These simulations also demonstrated the practical importance of the military's superior capacity to minimize time to transport samples to offsite facilities and use the results to carry out triage quickly. Assuming sufficient resources and the fastest daily rate to initiate processing victims, the military scenario revealed that two biodosimetry methods could achieve the necessary throughput to triage 50,000 victims in 2 d (i.e., the timeframe needed for injured victims), and all five achieved the targeted throughput within 6 d. In contrast, simulations based on the civilian scenario revealed that no method could process 50,000 people in 2 d and only two could succeed within 6 d.
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Affiliation(s)
- Ann Barry Flood
- EPR Center for the Study of Viable Systems, Radiology Department, Geisel School of Medicine at Dartmouth, Hanover, NH 03755
| | - Arif N. Ali
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA
| | - Holly K. Boyle
- EPR Center for the Study of Viable Systems, Radiology Department, Geisel School of Medicine at Dartmouth, Hanover, NH 03755
| | - Gaixin Du
- EPR Center for the Study of Viable Systems, Radiology Department, Geisel School of Medicine at Dartmouth, Hanover, NH 03755
| | | | - Steven G. Swarts
- Department of Radiation Oncology, College of Medicine, University of Florida, Gainesville, FL
| | - Benjamin B. Williams
- EPR Center for the Study of Viable Systems, Radiology Department, Geisel School of Medicine at Dartmouth, Hanover, NH 03755
- Radiation Oncology Division, Geisel School of Medicine at Dartmouth, Hanover, NH 03755
| | - Eugene Demidenko
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, NH 03755
| | - Wilson Schreiber
- EPR Center for the Study of Viable Systems, Radiology Department, Geisel School of Medicine at Dartmouth, Hanover, NH 03755
| | - Harold M. Swartz
- EPR Center for the Study of Viable Systems, Radiology Department, Geisel School of Medicine at Dartmouth, Hanover, NH 03755
- Radiation Oncology Division, Geisel School of Medicine at Dartmouth, Hanover, NH 03755
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Hou H, Khan N, Nagane M, Gohain S, Chen EY, Jarvis LA, Schaner PE, Williams BB, Flood AB, Swartz HM, Kuppusamy P. Skeletal Muscle Oxygenation Measured by EPR Oximetry Using a Highly Sensitive Polymer-Encapsulated Paramagnetic Sensor. Adv Exp Med Biol 2016; 923:351-357. [PMID: 27526163 DOI: 10.1007/978-3-319-38810-6_46] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We have incorporated LiNc-BuO, an oxygen-sensing paramagnetic material, in polydimethylsiloxane (PDMS), which is an oxygen-permeable, biocompatible, and stable polymer. We fabricated implantable and retrievable oxygen-sensing chips (40 % LiNc-BuO in PDMS) using a 20-G Teflon tubing to mold the chips into variable shapes and sizes for in vivo studies in rats. In vitro EPR measurements were used to test the chip's oxygen response. Oxygen induced linear and reproducible line broadening with increasing partial pressure (pO2). The oxygen response was similar to that of bare (unencapsulated) crystals and did not change significantly on sterilization by autoclaving. The chips were implanted in rat femoris muscle and EPR oximetry was performed repeatedly (weekly) for 12 weeks post-implantation. The measurements showed good reliability and reproducibility over the period of testing. These results demonstrated that the new formulation of OxyChip with 40 % LiNc-BuO will enable the applicability of EPR oximetry for long-term measurement of oxygen concentration in tissues and has the potential for clinical applications.
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Affiliation(s)
- H Hou
- Department of Radiology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA.
| | - N Khan
- Department of Radiology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA
| | - M Nagane
- Department of Radiology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA
| | - S Gohain
- Department of Radiology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA
| | - E Y Chen
- Department of Surgery, Geisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA
| | - L A Jarvis
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA
| | - P E Schaner
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA
| | - B B Williams
- Department of Radiology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA.,Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA
| | - A B Flood
- Department of Radiology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA
| | - H M Swartz
- Department of Radiology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA.,Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA
| | - P Kuppusamy
- Department of Radiology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA. .,Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA. .,Department of Radiology, EPR Center for the Study of Viable Systems, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH, 03766, USA.
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Williams BB, Hou H, Coombs R, Swartz HM. EPR Oximetry for Investigation of Hyperbaric O2 Pre-treatment for Tumor Radiosensitization. Adv Exp Med Biol 2016; 923:367-374. [PMID: 27526165 DOI: 10.1007/978-3-319-38810-6_48] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
A number of studies have reported benefits associated with the application of hyperbaric oxygen treatment (HBO) delivered immediately prior to radiation therapy. While these studies provide evidence that pre-treatment with HBO may be beneficial, no measurements of intratumoral pO2 were carried out and they do not directly link the apparent benefits to decreased hypoxic fractions at the time of radiation therapy. While there is empirical evidence and some theoretical basis for HBO to enhance radiation therapy, without direct and repeated measurements of its effects on pO2, it is unlikely that the use of HBO can be understood and optimized for clinical applications. In vivo EPR oximetry is a technique uniquely capable of providing repeated direct measurements of pO2 through a non-invasive procedure in both animal models and human patients. In order to evaluate the ability of pretreatment with HBO to elevate tumor pO2, a novel small animal hyperbaric chamber system was constructed that allows simultaneous in vivo EPR oximetry. This chamber can be placed within the EPR magnet and is equipped with a variety of ports for multiplace gas delivery, thermoregulation, delivery of anesthesia, physiologic monitoring, and EPR detection. Initial measurements were performed in a subcutaneous RIF-1 tumor model in C3H/HeJ mice. The mean baseline pO2 value was 6.0 ± 1.2 mmHg (N = 7) and responses to two atmospheres absolute pressure HBO varied considerably across subjects, within tumors, and over time. When an increase in pO2 was observed, the effect was transient in all but one case, with durations lasting from 5 min to over 20 min, and returned to baseline levels during HBO administration. These results indicate that without direct measurements of pO2 in the tissue of interest, it is likely to be difficult to know the effects of HBO on actual tissue pO2.
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Affiliation(s)
- Benjamin B Williams
- Dartmouth EPR Center, Geisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA.
| | - Huagang Hou
- Dartmouth EPR Center, Geisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA
| | - Rachel Coombs
- Dartmouth EPR Center, Geisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA
| | - Harold M Swartz
- Dartmouth EPR Center, Geisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA
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Swartz HM, Williams BB, Hou H, Khan N, Jarvis LA, Chen EY, Schaner PE, Ali A, Gallez B, Kuppusamy P, Flood AB. Direct and Repeated Clinical Measurements of pO2 for Enhancing Cancer Therapy and Other Applications. Adv Exp Med Biol 2016; 923:95-104. [PMID: 27526130 PMCID: PMC5989722 DOI: 10.1007/978-3-319-38810-6_13] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
The first systematic multi-center study of the clinical use of EPR oximetry has begun, with funding as a PPG from the NCI. Using particulate oxygen sensitive EPR, materials in three complementary forms (India Ink, "OxyChips", and implantable resonators) the clinical value of the technique will be evaluated. The aims include using repeated measurement of tumor pO2 to monitor the effects of treatments on tumor pO2, to use the measurements to select suitable subjects for the type of treatment including the use of hyperoxic techniques, and to provide data that will enable existing clinical techniques which provide data relevant to tumor pO2 but which cannot directly measure it to be enhanced by determining circumstances where they can give dependable information about tumor pO2.
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Affiliation(s)
- Harold M Swartz
- Department of Radiology, Geisel School of Medicine at Dartmouth, One Medical Center Drive Lebanon, Lebanon, NH, USA.
- Department of Medicine, Geisel School of Medicine at Dartmouth, One Medical Center Drive Lebanon, Lebanon, NH, USA.
| | - Benjamin B Williams
- Department of Radiology, Geisel School of Medicine at Dartmouth, One Medical Center Drive Lebanon, Lebanon, NH, USA
- Department of Medicine, Geisel School of Medicine at Dartmouth, One Medical Center Drive Lebanon, Lebanon, NH, USA
| | - Huagang Hou
- Department of Radiology, Geisel School of Medicine at Dartmouth, One Medical Center Drive Lebanon, Lebanon, NH, USA
| | - Nadeem Khan
- Department of Radiology, Geisel School of Medicine at Dartmouth, One Medical Center Drive Lebanon, Lebanon, NH, USA
| | - Lesley A Jarvis
- Department of Medicine, Geisel School of Medicine at Dartmouth, One Medical Center Drive Lebanon, Lebanon, NH, USA
| | - Eunice Y Chen
- Department of Surgery, Geisel School of Medicine at Dartmouth, One Medical Center Drive Lebanon, Lebanon, NH, USA
| | - Philip E Schaner
- Department of Medicine, Geisel School of Medicine at Dartmouth, One Medical Center Drive Lebanon, Lebanon, NH, USA
| | - Arif Ali
- Department of Radiation Oncology, Emory Medical School, Atlanta, GA, USA
| | - Bernard Gallez
- Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Periannan Kuppusamy
- Department of Radiology, Geisel School of Medicine at Dartmouth, One Medical Center Drive Lebanon, Lebanon, NH, USA
- Department of Medicine, Geisel School of Medicine at Dartmouth, One Medical Center Drive Lebanon, Lebanon, NH, USA
| | - Ann B Flood
- Department of Radiology, Geisel School of Medicine at Dartmouth, One Medical Center Drive Lebanon, Lebanon, NH, USA
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Constantinou C, Apidianakis Y, Psychogios N, Righi V, Mindrinos MN, Khan N, Swartz HM, Szeto HH, Tompkins RG, Rahme LG, Tzika AA. In vivo high-resolution magic angle spinning magnetic and electron paramagnetic resonance spectroscopic analysis of mitochondria-targeted peptide in Drosophila melanogaster with trauma-induced thoracic injury. Int J Mol Med 2015; 37:299-308. [PMID: 26648055 PMCID: PMC4716799 DOI: 10.3892/ijmm.2015.2426] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/29/2015] [Indexed: 01/01/2023] Open
Abstract
Trauma is the most common cause of mortality among individuals aged between 1 and 44 years and the third leading cause of mortality overall in the US. In this study, we examined the effects of trauma on the expression of genes in Drosophila melanogaster, a useful model for investigating genetics and physiology. After trauma was induced by a non-lethal needle puncture of the thorax, we observed the differential expression of genes encoding for mitochondrial uncoupling proteins, as well as those encoding for apoptosis-related and insulin signaling-related proteins, thus indicating muscle functional dysregulation. These results prompted us to examine the link between insulin signaling and mitochondrial dysfunction using in vivo nuclear magnetic resonance (NMR) with complementary electron paramagnetic resonance (EPR) spectroscopy. Trauma significantly increased insulin resistance biomarkers, and the NMR spectral profile of the aged flies with trauma-induced thoracic injury resembled that of insulin-resistant chico mutant flies. In addition, the mitochondrial redox status, as measured by EPR, was significantly altered following trauma, indicating mitochondrial uncoupling. A mitochondria-targeted compound, Szeto-Schiller (SS)-31 that promotes adenosine triphosphate (ATP) synthesis normalized the NMR spectral profile, as well as the mitochondrial redox status of the flies with trauma-induced thoracic injury, as assessed by EPR. Based on these findings, we propose a molecular mechanism responsible for trauma-related mortality and also propose that trauma sequelae in aging are linked to insulin signaling and mitochondrial dysfunction. Our findings further suggest that SS-31 attenuates trauma-associated pathological changes.
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Affiliation(s)
- Caterina Constantinou
- NMR Surgical Laboratory, Department of Surgery, Massachusetts General Hospital and Shriners Burns Institute, Harvard Medical School, Boston, MA, USA
| | - Yiorgos Apidianakis
- Molecular Surgery Laboratory, Center for Surgery, Innovation and Bioengineering, Department of Surgery, Massachusetts General Hospital and Shriners Burns Institute, Harvard Medical School, Boston, MA, USA
| | - Nikolaos Psychogios
- NMR Surgical Laboratory, Department of Surgery, Massachusetts General Hospital and Shriners Burns Institute, Harvard Medical School, Boston, MA, USA
| | - Valeria Righi
- NMR Surgical Laboratory, Department of Surgery, Massachusetts General Hospital and Shriners Burns Institute, Harvard Medical School, Boston, MA, USA
| | - Michael N Mindrinos
- Department of Biochemistry, Stanford University School of Medicine, Stanford, CA, USA
| | - Nadeem Khan
- EPR Center for Viable Systems, Department of Diagnostic Radiology, The Geisel School of Medicine, Lebanon, NH, USA
| | - Harold M Swartz
- EPR Center for Viable Systems, Department of Diagnostic Radiology, The Geisel School of Medicine, Lebanon, NH, USA
| | - Hazel H Szeto
- Department of Pharmacology, Joan and Sanford I. Weill Medical College of Cornell University, New York, NY, USA
| | - Ronald G Tompkins
- Center for Surgery, Innovation and Bioengineering, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Laurence G Rahme
- Molecular Surgery Laboratory, Center for Surgery, Innovation and Bioengineering, Department of Surgery, Massachusetts General Hospital and Shriners Burns Institute, Harvard Medical School, Boston, MA, USA
| | - A Aria Tzika
- NMR Surgical Laboratory, Department of Surgery, Massachusetts General Hospital and Shriners Burns Institute, Harvard Medical School, Boston, MA, USA
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Brenner DJ, Chao NJ, Greenberger JS, Guha C, McBride WH, Swartz HM, Williams JP. Are We Ready for a Radiological Terrorist Attack Yet? Report From the Centers for Medical Countermeasures Against Radiation Network. Int J Radiat Oncol Biol Phys 2015; 92:504-5. [PMID: 26068482 DOI: 10.1016/j.ijrobp.2015.02.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 02/23/2015] [Indexed: 01/30/2023]
Affiliation(s)
- David J Brenner
- Center for Radiological Research, Columbia University Medical Center, New York, New York
| | - Nelson J Chao
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Joel S Greenberger
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Chandan Guha
- Department of Radiation Oncology, Albert Einstein College of Medicine, New York, New York
| | - William H McBride
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California
| | - Harold M Swartz
- Department of Radiology, The Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Jacqueline P Williams
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, New York.
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Abstract
Low level of oxygen (hypoxia) is a critical factor that defines the pathological consequence of several pathophysiologies, particularly ischemia, that usually occur following the blockage of a blood vessel in vital organs, such as brain and heart, or abnormalities in the microvasculature, such as peripheral vascular disease. Therefore, methods that can directly and repeatedly quantify oxygen levels in the brain and heart will significantly improve our understanding of ischemic pathologies. Importantly, such oximetry capability will facilitate the development of strategies to counteract low levels of oxygen and thereby improve outcome following stroke or myocardial infarction. In vivo electron paramagnetic resonance (EPR) oximetry has the capability to monitor tissue oxygen levels in real time. The method has largely been tested and used in experimental animals, although some clinical measurements have been performed. In this chapter, a brief overview of the methodology to repeatedly quantify oxygen levels in the brain and heart of experimental animal models, ranging from mice to swine, is presented. EPR oximetry requires a one-time placement of an oxygen-sensitive probe in the tissue of interest, while the rest of the procedure for reliable, accurate, and repeated measurements of pO2 (partial pressure of oxygen) is noninvasive and can be repeated as often as desired. A multisite oximetry approach can be used to monitor pO2 at many sites simultaneously. Building on significant advances in the application of EPR oximetry in experimental animal models, spectrometers have been developed for use in human subjects. Initial feasibility of pO2 measurement in solid tumors of patients has been successfully demonstrated.
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Affiliation(s)
- Nadeem Khan
- Department of Radiology, EPR Center for the Study of Viable Systems, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Huagang Hou
- Department of Radiology, EPR Center for the Study of Viable Systems, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Harold M Swartz
- Department of Radiology, EPR Center for the Study of Viable Systems, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Periannan Kuppusamy
- Department of Radiology, EPR Center for the Study of Viable Systems, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
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