Molecular markers of radiation-related normal tissue toxicity

Okunieff, Paul; Chen, Yuhchyau; Maguire, David; Huser, Amy K.

doi:10.1007/s10555-008-9138-7

Cited by 85 publications

(50 citation statements)

References 75 publications

(86 reference statements)

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“…To address the molecular changes that potentially could drive the differential toxic response, we subjected the isolated tissues to immunohistochemical (IHC) staining using the wellknown radiotherapy marker TGF-b 16 ( Fig. 2).…”

Section: Resultsmentioning

confidence: 99%

Tissue TGF-β expression following conventional radiotherapy and pulsed low-dose-rate radiation

et al. 2017

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The release of inflammatory cytokines has been implicated in the toxicity of conventional radiotherapy (CRT). Transforming growth factor b (TGF-b) has been suggested to be a risk marker for pulmonary toxicity following radiotherapy. Pulsed low-dose rate radiotherapy (PLDR) is a technique that involves spreading out a conventional radiotherapy dose into short pulses of dose with breaks in between to reduce toxicities. We hypothesized that the more tolerable toxicity profile of PLDR compared with CRT may be related to differential expression of inflammatory cytokines such as TGF-b in normal tissues. To address this, we analyzed tissues from mice that had been subjected to lethal doses of CRT and PLDR by histology and immunohistochemistry (IHC). Equivalent physical doses of CRT triggered more cellular atrophy in the bone marrow, intestine, and pancreas when compared with PLDR as indicated by hematoxylin and eosin staining. IHC data indicates that TGF-b expression is increased in the bone marrow, intestine, and lungs of mice subjected to CRT as compared with tissues from mice subjected to PLDR. Our in vivo data suggest that differential expression of inflammatory cytokines such as TGF-b may play a role in the more favorable normal tissue late response following treatment with PLDR.

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Section: Resultsmentioning

confidence: 99%

Tissue TGF-β expression following conventional radiotherapy and pulsed low-dose-rate radiation

et al. 2017

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“…tumor response and survival (2). Clinically, the acute toxicity of prostate cancer radiotherapy manifest as gastrointestinal and genitourinary symptoms based on validated scoring criteria, [e.g., Common Terminology Criteria for Adverse Events (CTC-AE); ref .…”

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confidence: 99%

Longitudinal Cytokine Expression during IMRT for Prostate Cancer and Acute Treatment Toxicity

Christensen

Pintilie

Evans

et al. 2009

Clinical Cancer Research

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Purpose: Proteomic profiling of patients undergoing intensity-modulated radiotherapy (IMRT) for prostate cancer can identify unique biomarkers that reflect acute toxicity in normal tissues. Our objectives were to measure inflammatory cytokine proteins during IMRT and assess the variability of individual proteomic signatures. Experimental Design: Forty-two patients with intermediate-risk prostate cancer were recruited as follows: group 1, definitive IMRT (78 Gy in 39 fractions, n = 22), and group 2, IMRT postprostatectomy (66 Gy in 33 fractions, n = 20). Blood/urine samples were collected at baseline and weekly during IMRT. Acute toxicity was graded weekly during radiotherapy using CTC-AE v3.0 criteria. Multiplexed immunoassays were used to quantify cytokines including granulocyte macrophage colony-stimulating factor, IFN-γ, tumor necrosis factor-α, interleukin (IL)-1α, IL-2, IL6, IL-8, IL-10, and IL-12p70. Results: We observed positive correlations between cytokine expression between serum and plasma, but not between serum/plasma and urine. The Mann-Whitney test showed a significant increase in IFN-γ and IL-6 during IMRT (P = 0.0077, 0.0035). Increasing IL-2 and IL-1 expression were associated with increased probability of acute gastrointestinal and genitourinary toxicity, respectively. Conclusions: Determination of radiation-response signatures is feasible using multiplexed immunoassays and is a promising predictive early biomarker of toxicity outcomes. (Clin Cancer Res 2009;15(17):5576-83) Cellular damage caused by ionizing radiation induces specific proteins involved in DNA repair, cell death, inflammation, and other pathophysiologic responses (1). The majority of biomarker studies in radiation oncology have focused on predicting tumor response and survival (2). Clinically, the acute toxicity of prostate cancer radiotherapy manifest as gastrointestinal and genitourinary symptoms based on validated scoring criteria, [e.g., Common Terminology Criteria for Adverse Events (CTC-AE); ref. 3]. Radiotherapy dose escalation using intensity-modulated radiotherapy (IMRT) is associated with improved biochemical tumor control, yet still has radiation-induced toxicity. Dose-dependent markers of acute normal toxicity could help predict individuals at increased risk of radiotherapy-related injury and help to maximize the therapeutic ratio for individual patients.Rubin and colleagues were among the first to describe the role of cytokines (small glycoproteins involved in intercellular signaling) in mediating radiation toxicity (4). They showed in preclinical and clinical lung studies that levels of interleukin (IL)-1, transforming growth factor (TGF)-β, and tumor necrosis factor (TNF)-α were increased immediately after radiation exposure, and that chronically elevated TGF-β levels were associated with increased risk of pulmonary fibrosis. The link between radiation toxicity and cytokine expression is supported by studies showing that prolonged cytokine expression postradiotherapy is correlated to specific lung radi...

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“…A number of clinical studies have also shown that cytokines are elevated during and after Radiotherapy for a variety of malignancies. 10,[18][19] Using this as a feasibility study, we measured the cytokines protein levels of p53, PCNA and p21 in human breast skin cells after receiving post-mastectomy radiotherapy treatment regimens as biomarkers for radiation response. The radiation response of cytokines within a controlled population with the same dose but in different fraction size has never been studied before.…”

Section: Discussionmentioning

confidence: 99%

Human epidermal keratinocytes death and expression of protein markers of apoptosis after ionizing radiation exposure

Wong

Chor

Moorthy

et al. 2013

Int J Cancer Ther Oncol

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Purpose: Knowledge of the pathophysiology of the irradiated skin is important to understand the tolerance and cosmetic response of the human skin to radiation. There are limited studies on the effect of radiotherapy dosage and fraction size in inducing apoptotic cell death in human skin. The expression of apoptotic biomarkers within a controlled population in different fractionation schemes has also never been studied. This study aims to investigate radiation induced apoptotic cell death in human skin cells after fractionated radiation exposure and the expression of unique biomarkers that reflect cell death or biology using multiplexed immunoassays. Methods: Breast skin biopsies were obtained from a single individual and divided into small pieces. Each piece was irradiated under different radiotherapy treatment fractionation schedules to a total dose of 50Gy. The irradiated skin tissues were analysed using Tunnel, immunohistochemistry and Western blot assays for expression of apoptotic keratinocytes and biomarkers (p53, p21, and PCNA). Haematoxylin and eosin (H&E) immunostaining was performed to study the morphological changes in the skin cells. Results: Radiation is mostly absorbed by the epidermal layers and observed to damage the epidermal keratinocytes leading to the activation of apoptotic proteins. Apoptotic proteins (p53, p21 and PCNA) were confirmed to be up-regulated in radiation exposed skin cells as compared to normal skin cells with no radiation. There is strong correlation of apoptotic protein expressions with increased radiation dosage and dose fractionation. Statistical analysis with ANOVA revealed a significant increase of PCNA and p21 expression with increased radiation dosage and dose fractionation (p < 0.05). Immunohistochemically, 14 % (range 10.71% to 17.29%) of the keratinocytes were positive for PCNA and 22.5% (range 18.28% to 27.2%) for p21 after 2Gy of irradiation. The most widespread, intense and uniform staining for PCNA and p21 was observed in skin that had received 50Gy of irradiation. The maximum expression of p53 (range 37.09% to 50.91%) was reached at 10Gy. Conclusion: Findings from this study will assist clinicians in predicting radiation induced skin toxicity with the current changes in radiation fractionation protocols.Keywords: Apoptosis; Fractionated radiation therapy; Immunohistochemistry; Skin IntroductionRadiation therapy (RT) is a commonly utilized modality for the treatment of breast cancer. It is routinely employed in breast conservation therapy. Its role as adjuvant therapy in selected patients undergoing mastectomy for stages I and II disease is currently evolving, and has become an essential component of the combined modality approach for stage III disease. Postmastectomy Radiotherapy (PMRT) to the chest wall and to the regional lymphatics has shown to decrease locoregional recurrence and increase survival for women with large tumors and/or node-positive disease. 1-2 However, the risk of toxicity to skin and cosmesis must be weighed against local and regional...

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Molecular markers of radiation-related normal tissue toxicity

Cited by 85 publications

References 75 publications

Tissue TGF-β expression following conventional radiotherapy and pulsed low-dose-rate radiation

Tissue TGF-β expression following conventional radiotherapy and pulsed low-dose-rate radiation

Longitudinal Cytokine Expression during IMRT for Prostate Cancer and Acute Treatment Toxicity

Human epidermal keratinocytes death and expression of protein markers of apoptosis after ionizing radiation exposure

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