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Kim BG, Choi HS, Choe YH, Jeon HM, Heo JY, Cheon YH, Kang KM, Lee SI, Jeong BK, Kim M. Low-Dose Radiotherapy Attenuates Experimental Autoimmune Arthritis by Inducing Apoptosis of Lymphocytes and Fibroblast-Like Synoviocytes. Immune Netw 2024; 24:e32. [PMID: 39246617 PMCID: PMC11377951 DOI: 10.4110/in.2024.24.e32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 07/24/2024] [Accepted: 07/31/2024] [Indexed: 09/10/2024] Open
Abstract
Low-dose radiotherapy (LDRT) has been explored as a treatment option for various inflammatory diseases; however, its application in the context of rheumatoid arthritis (RA) is lacking. This study aimed to elucidate the mechanism underlying LDRT-based treatment for RA and standardize it. LDRT reduced the total numbers of immune cells, but increased the apoptotic CD4+ T and B220+ B cells, in the draining lymph nodes of collagen induced arthritis and K/BxN models. In addition, it significantly reduced the severity of various pathological manifestations, including bone destruction, cartilage erosion, and swelling of hind limb ankle. Post-LDRT, the proportion of apoptotic CD4+ T and CD19+ B cells increased significantly in the PBMCs derived from human patients with RA. LDRT showed a similar effect in fibroblast-like synoviocytes as well. In conclusion, we report that LDRT induces apoptosis in immune cells and fibro-blast-like synoviocytes, contributing to attenuation of arthritis.
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Affiliation(s)
- Bo-Gyu Kim
- Division of Rheumatology, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju 52727, Korea
- Department of Convergence Medical Science, College of Medicine, Gyeongsang National University, Jinju 52727, Korea
| | - Hoon Sik Choi
- Department of Radiation Oncology, Gyeongsang National University Changwon Hospital, Changwon 51472, Korea
- Department of Radiation Oncology and Institute of Health Science, College of Medicine, Gyeongsang National University, Jinju 52727, Korea
| | - Yong-Ho Choe
- Division of Rheumatology, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju 52727, Korea
- Department of Veterinary Obstetrics, College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Korea
- Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN 55414, USA
| | - Hyun Min Jeon
- Division of Rheumatology, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju 52727, Korea
| | - Ji Yeon Heo
- Division of Rheumatology, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju 52727, Korea
| | - Yun-Hong Cheon
- Division of Rheumatology, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju 52727, Korea
- Department of Convergence Medical Science, College of Medicine, Gyeongsang National University, Jinju 52727, Korea
- Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju 52727, Korea
| | - Ki Mun Kang
- Department of Radiation Oncology, Gyeongsang National University Changwon Hospital, Changwon 51472, Korea
- Department of Radiation Oncology and Institute of Health Science, College of Medicine, Gyeongsang National University, Jinju 52727, Korea
| | - Sang-Il Lee
- Division of Rheumatology, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju 52727, Korea
- Department of Convergence Medical Science, College of Medicine, Gyeongsang National University, Jinju 52727, Korea
- Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju 52727, Korea
| | - Bae Kwon Jeong
- Department of Radiation Oncology and Institute of Health Science, College of Medicine, Gyeongsang National University, Jinju 52727, Korea
- Department of Radiation Oncology, Gyeongsang National University Hospital, Jinju 52727, Korea
| | - Mingyo Kim
- Division of Rheumatology, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju 52727, Korea
- Department of Convergence Medical Science, College of Medicine, Gyeongsang National University, Jinju 52727, Korea
- Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju 52727, Korea
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Wang J, Zhang J, Wen W, Wang F, Wu M, Chen D, Yu J. Exploring low-dose radiotherapy to overcome radio-immunotherapy resistance. Biochim Biophys Acta Mol Basis Dis 2023:166789. [PMID: 37302425 DOI: 10.1016/j.bbadis.2023.166789] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/29/2023] [Accepted: 06/07/2023] [Indexed: 06/13/2023]
Abstract
Immune checkpoint inhibitors (ICIs) have revolutionized the current treatment landscape for cancer, yet the response rates of ICIs remain unmet. Synergistic with immunotherapy, low-dose radiotherapy (LDRT) has been demonstrated to activate anti-tumor immunity - a transition from traditional radiation therapy geared toward local radical treatment to a type of immunological adjuvant. As such, studies utilizing LDRT to enhance the efficacy of immunotherapy have been increasing preclinically and clinically. This paper reviews the recent strategies of using LDRT to overcome the resistance of ICIs, as well as providing potential opportunities in cancer treatment. Despite the potential of LDRT in immunotherapy is recognized, the mechanisms behind this form of treatment remain largely elusive. Thus, we reviewed history, mechanisms and challenges associated with this form of treatment, as well as different modes of its application, to provide relatively accurate practice standards for LDRT as a sensitizing treatment when combined with immunotherapy or radio-immunotherapy.
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Affiliation(s)
- Juan Wang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, PR China; Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation Oncology, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, PR China
| | - Jingxin Zhang
- Shandong University Cancer Center, Jinan, Shandong 250117, PR China; Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation Oncology, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, PR China
| | - Weitao Wen
- Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation Oncology, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, PR China
| | - Fei Wang
- Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation Oncology, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, PR China
| | - Meng Wu
- Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation Oncology, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, PR China
| | - Dawei Chen
- Shandong University Cancer Center, Jinan, Shandong 250117, PR China; Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation Oncology, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, PR China.
| | - Jinming Yu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, PR China; Shandong University Cancer Center, Jinan, Shandong 250117, PR China; Department of Radiation Oncology and Shandong Provincial Key Laboratory of Radiation Oncology, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, PR China; Research Unit of Radiation Oncology, Chinese Academy of Medical Sciences, Jinan, Shandong 250117, PR China.
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3
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Dove AP, Cmelak A, Darrow K, McComas KN, Chowdhary M, Beckta J, Kirschner AN. The Use of Low-Dose Radiotherapy in Osteoarthritis: A Review. Int J Radiat Oncol Biol Phys 2022; 114:203-220. [DOI: 10.1016/j.ijrobp.2022.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/08/2022] [Accepted: 04/21/2022] [Indexed: 11/26/2022]
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Abdus-Salam AA, Olabumuyi AA, Jimoh MA, Folorunso SA, Orekoya AA. The role of radiation treatment in the management of inflammatory musculoskeletal conditions: a revisit. Radiat Oncol J 2020; 38:151-161. [PMID: 33012142 PMCID: PMC7533403 DOI: 10.3857/roj.2020.00178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/03/2020] [Indexed: 01/28/2023] Open
Abstract
Inflammatory musculoskeletal conditions are a common group of diseases among the elderly, worldwide. They are characterized by articular degenerative changes accompanied with often debilitating pain. Treatments often involve life-long analgesic therapy or joint replacement in extreme cases. The aim of this current review is to look at the role of radiation treatment with the hope of further study into the effectiveness of radiation treatment in reducing pain, eliminate or reduce the need for life-long analgesic therapy and thereby avoiding the analgesics’ side effects. Extensive literature search was done on PubMed and other available data base and the findings are presented and discussed. Literature showed that many countries in Europe, especially Germany use radiation routinely for the treatment of many degenerative disorders including osteoarthritis with good results and few side effects. A pilot study is therefore recommended with a view to establish the effectiveness or otherwise of this treatment method in patients.
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Affiliation(s)
| | | | - Mutiu Alani Jimoh
- Department of Radiation Oncology, University of Ibadan, Ibadan, Nigeria
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5
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Schaue D, McBride WH. Flying by the seat of our pants: is low dose radiation therapy for COVID-19 an option? Int J Radiat Biol 2020; 96:1219-1223. [PMID: 32401694 PMCID: PMC7725653 DOI: 10.1080/09553002.2020.1767314] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 04/30/2020] [Accepted: 05/05/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Dörthe Schaue
- Department of Radiation Oncology, University of California at Los Angeles (UCLA), Los Angeles, CA, USA
| | - William H McBride
- Department of Radiation Oncology, University of California at Los Angeles (UCLA), Los Angeles, CA, USA
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Hautmann MG, Rechner P, Neumaier U, Süß C, Dietl B, Putz FJ, Behr M, Kölbl O, Steger F. Radiotherapy for osteoarthritis—an analysis of 295 joints treated with a linear accelerator. Strahlenther Onkol 2019; 196:715-724. [DOI: 10.1007/s00066-019-01563-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/28/2019] [Indexed: 01/27/2023]
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Radiotherapy for osteoarthritis of the ankle and tarsal joints—analysis of 66 joints. Strahlenther Onkol 2019; 196:569-575. [DOI: 10.1007/s00066-019-01551-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/14/2019] [Indexed: 01/25/2023]
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8
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Hautmann MG, Rechner P, Hipp M, Neumaier U, Steger F, Pohl F, Weber M, Kölbl O, Süß C. Re-irradiation for osteoarthritis—retrospective analysis of 217 joints. Strahlenther Onkol 2019; 195:1060-1067. [DOI: 10.1007/s00066-019-01500-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/10/2019] [Indexed: 12/30/2022]
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9
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Reichl B, Block A, Schäfer U, Bert C, Müller R, Jung H, Rödel F. DEGRO practical guidelines for radiotherapy of non-malignant disorders. Strahlenther Onkol 2015; 191:701-9. [DOI: 10.1007/s00066-015-0865-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 06/03/2015] [Indexed: 11/29/2022]
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10
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Hong EH, Song JY, Lee SJ, Park IC, Um HD, Park JK, Lee KH, Nam SY, Hwang SG. Low-dose γ-radiation inhibits IL-1β-induced dedifferentiation and inflammation of articular chondrocytes via blockage of catenin signaling. IUBMB Life 2014; 66:128-37. [PMID: 24604706 PMCID: PMC4321059 DOI: 10.1002/iub.1248] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 01/24/2014] [Accepted: 01/31/2014] [Indexed: 12/26/2022]
Abstract
Although low-dose radiation (LDR) regulates a wide range of biological processes, limited information is available on the effects of LDR on the chondrocyte phenotype. Here, we found that LDR, at doses of 0.5–2 centiGray (cGy), inhibited interleukin (IL)-1β-induced chondrocyte destruction without causing side effects, such as cell death and senescence. IL-1β treatment induced an increase in the expression of α-, β-, and γ-catenin proteins in chondrocytes via Akt signaling, thereby promoting dedifferentiation through catenin-dependent suppression of Sox-9 transcription factor expression and induction of inflammation through activation of the NF-κB pathway. Notably, LDR blocked cartilage disorders by inhibiting IL-1β-induced catenin signaling and subsequent catenin-dependent suppression of the Sox-9 pathway and activation of the NF-κB pathway, without directly altering catenin expression. LDR also inhibited chondrocyte destruction through the catenin pathway induced by epidermal growth factor, phorbol 12-myristate 13-acetate, and retinoic acid. Collectively, these results identify the molecular mechanisms by which LDR suppresses pathophysiological processes and establish LDR as a potentially valuable therapeutic tool for patients with cytokine- or soluble factors-mediated cartilage disorders.
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Affiliation(s)
- Eun-Hee Hong
- Division of Radiation Cancer Biology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea; Department of Chemistry, College of Natural Sciences, Hanyang University, Seoul, Korea
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11
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Keller S, Müller K, Kortmann RD, Wolf U, Hildebrandt G, Liebmann A, Micke O, Flemming G, Baaske D. Efficacy of low-dose radiotherapy in painful gonarthritis: experiences from a retrospective East German bicenter study. Radiat Oncol 2013; 8:29. [PMID: 23369282 PMCID: PMC3582586 DOI: 10.1186/1748-717x-8-29] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 01/20/2013] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate the efficacy of low-dose radiotherapy in painful gonarthritis. METHODS We assessed the medical records of 1037 patients with painful gonarthritis who had undergone low-dose radiotherapy between 1981 and 2008. The subjective patient perception of the response to irradiation as graded immediately or up to two months after the completion of a radiotherapy series was evaluated and correlated with age, gender, radiological grading and the duration of symptoms before radiotherapy. Moreover, we performed a mail survey to obtain additional long-term follow-up information and received one hundred and six evaluable questionnaires. RESULTS We assessed 1659 series of radiotherapy in 1037 patients. In 79.3% of the cases the patients experienced a slight, marked or complete pain relief immediately or up to two months after the completion of radiotherapy. Gender, age and the duration of pain before radiotherapy did not have a significant influence on the response to irradiation. In contrast, severe signs of osteoarthritis were associated with more effective pain relief. In more than 50% of the patients who reported a positive response to irradiation a sustained period of symptomatic improvement was observed. CONCLUSIONS Our results confirm that low-dose radiotherapy is an effective treatment for painful osteoarthritis of the knee. In contrast to an earlier retrospective study, severe signs of osteoarthritis constituted a positive prognostic factor for the response to irradiation. A randomized trial is urgently required to compare radiotherapy with other treatment modalities.
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Affiliation(s)
- Stephanie Keller
- Department of Internal Medicine II- Gastroenterology / Hepatology /Oncology / Infectology / Tropical Medicine /Endocrinology / Diabetology, Klinikum Chemnitz gGmbH, Flemmingstraße 2, Chemnitz 09116, Germany
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12
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Calabrese EJ, Calabrese V. Reduction of arthritic symptoms by low dose radiation therapy (LD-RT) is associated with an anti-inflammatory phenotype. Int J Radiat Biol 2012; 89:278-86. [DOI: 10.3109/09553002.2013.752594] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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13
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Calabrese EJ, Calabrese V. Low dose radiation therapy (LD-RT) is effective in the treatment of arthritis: Animal model findings. Int J Radiat Biol 2012; 89:287-94. [DOI: 10.3109/09553002.2013.752595] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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14
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Rödel F, Frey B, Manda K, Hildebrandt G, Hehlgans S, Keilholz L, Seegenschmiedt MH, Gaipl US, Rödel C. Immunomodulatory properties and molecular effects in inflammatory diseases of low-dose x-irradiation. Front Oncol 2012; 2:120. [PMID: 23057008 PMCID: PMC3457026 DOI: 10.3389/fonc.2012.00120] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 09/03/2012] [Indexed: 01/12/2023] Open
Abstract
Inflammatory diseases are the result of complex and pathologically unbalanced multicellular interactions. For decades, low-dose X-irradiation therapy (LD-RT) has been clinically documented to exert an anti-inflammatory effect on benign diseases and chronic degenerative disorders. By contrast, experimental studies to confirm the effectiveness and to reveal underlying cellular and molecular mechanisms are still at their early stages. During the last decade, however, the modulation of a multitude of immunological processes by LD-RT has been explored in vitro and in vivo. These include leukocyte/endothelial cell adhesion, adhesion molecule and cytokine/chemokine expression, apoptosis induction, and mononuclear/polymorphonuclear cell metabolism and activity. Interestingly, these mechanisms display comparable dose dependences and dose-effect relationships with a maximum effect in the range between 0.3 and 0.7 Gy, already empirically identified to be most effective in the clinical routine. This review summarizes data and models exploring the mechanisms underlying the immunomodulatory properties of LD-RT that may serve as a prerequisite for further systematic analyses to optimize low-dose irradiation procedures in future clinical practice.
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Affiliation(s)
- Franz Rödel
- Department of Radiotherapy and Oncology, University Hospital of Frankfurt, Johann Wolfgang-Goethe Universität Frankfurt am Main, Germany
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Arenas M, Sabater S, Hernández V, Rovirosa A, Lara PC, Biete A, Panés J. Anti-inflammatory effects of low-dose radiotherapy. Indications, dose, and radiobiological mechanisms involved. Strahlenther Onkol 2012; 188:975-81. [PMID: 22907572 DOI: 10.1007/s00066-012-0170-8] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 06/13/2012] [Indexed: 12/24/2022]
Abstract
Low-dose radiotherapy (LD-RT) has been used for several benign diseases, including arthrodegenerative and inflammatory pathologies. Despite its effectiveness in clinical practice, little is known about the mechanisms through which LD-RT modulates the various phases of the inflammatory response and about the optimal dose fractionation. The objective of this review is to deepen knowledge about the most effective LD-RT treatment schedule and radiobiological mechanisms underlying the anti-inflammatory effects of LD-RT in various in vitro experiments, in vivo studies, and clinical studies.
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Affiliation(s)
- M Arenas
- Radiation Oncology Department. Hospital Universitari Sant Joan de Reus, Institut d'Investigacions Sanitàries Pere Virgili, Universitat Rovira i Virgili, C/Sant Joan, 43200, Reus, Spain.
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Kern PM, Keilholz L. Radio-immunological mechanisms of anti-inflammatory treatment: is there a way from the past into the future? Autoimmunity 2009; 42:337-9. [PMID: 19811294 DOI: 10.1080/08916930902831027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The anti-inflammatory efficiency of low-dose radiotherapy (LD-RT) for degenerative joint disorders was demonstrated over decades but had no explanation on a cellular or molecular level. As inflammatory diseases are the results of complex and pathologically unbalanced cellular and molecular interactions more recent in-vivo and in-vitro data will be discussed for possible explanation of the mechanism underlying ant-inflammatory LD-RT.2.
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Affiliation(s)
- P M Kern
- Department for Internal Medicine and Rheumatology, Capio Franz von Pruemmer Hospital, D-97769, Bad Brückenau, Germany
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Hildebrandt G, Radlingmayr A, Rosenthal S, Rothe R, Jahns J, Hindemith M, Rödel F, Kamprad F. Low‐dose radiotherapy (LD‐RT) and the modulation of iNOS expression in adjuvant‐induced arthritis in rats. Int J Radiat Biol 2009; 79:993-1001. [PMID: 14713577 DOI: 10.1080/09553000310001636639] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Low-dose radiotherapy (LD-RT) of arthritic joints applied during the peak of the acute inflammatory response improves the clinical and histomorphological development of adjuvant arthritis. The study was undertaken to investigate the cellular composition of the inflammatory infiltrate and the expression of the pro-inflammatory and anti-inflammatory enzymes, inducible nitric oxide synthase (iNOS), cyclo-oxygenase 2 (COX-2) and haem-oxygenase 1 (HO-1), in response to LD-RT. MATERIALS AND METHODS Adjuvant arthritis in female Lewis rats was induced by intradermal injection of heat-inactivated mycobacterium tuberculosis on day 0. Both arthritic hind paws were sham irradiated (group 1) or X-irradiated with either 5 x 1.0 Gy (group 2) or 5 x 0.5 Gy (group 3) from days 15 to 19 after induction (15 animals/group). On days 21 (n=12 joints/group) and 30 (n=18 joints/group), cryostat sections were analysed histologically and immunohistologically after specific staining for macrophages, iNOS, COX-2 and HO-1. RESULTS A total of 5 x 1.0 Gy or 5 x 0.5 Gy led to a significant reduction of clinical symptoms from days 21 to 29, and a highly significant reduction of cartilage and bone destruction on day 30. Macrophage-positive areas could be detected continuously throughout the periarticular infiltrate, and were slightly reduced after LD-RT on days 21 and 30. This reduction was more pronounced after 5 x 1.0 Gy. Following LD-RT, the iNOS score was reduced by about 45-50% on days 21 (p<0.05) and 30 (p<0.001). In contrast, the HO-1 score was increased by about 50% on days 21 (p=0.08) and 30 (p=0.03). CONCLUSIONS The clinically and histologically observed prevention of the progression of adjuvant arthritis after LD-RT given during the peak of the acute inflammatory response and the reduction of cartilage and bone destruction in the chronic phase appears to be related to the modulation of iNOS activity by low X-ray doses.
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Affiliation(s)
- G Hildebrandt
- Department of Radiotherapy and Radiooncology, University of Leipzig, Stephanstrasse 9a, D-04103 Leipzig, Germany.
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18
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Schaue D, Jahns J, Hildebrandt G, Trott KR. Radiation treatment of acute inflammation in mice. Int J Radiat Biol 2009; 81:657-67. [PMID: 16368644 DOI: 10.1080/09553000500385556] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Low-dose radiotherapy (RT) has often been used effectively for the treatment of a variety of benign diseases, particularly those with acute inflammatory features. Here we report findings on radiation treatment of acute inflammation using a murine carrageenin air pouch model. MATERIALS AND METHODS Air pouches raised on the dorsal surface of mice were injected with lambda carrageenin and were irradiated 6 h later with doses ranging from 0-5 Gy. Treatment success was evaluated at various times thereafter by volume of exudate and number of inflammatory cells, and levels of inflammation-related cytokines tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1beta) and transforming growth factor beta-1 (TGFbeta-1), and expression of inducible nitric oxide synthase (iNOS), heme oxygenase-1 (HO-1), cyclooxygenase-2 (COX-2) and inducible heat shock protein 70 (HSP70) as determined by enzyme-linked immunosorbent assay (ELISA) and Western blotting, respectively. RESULTS Crude inflammatory parameters such as the amount of exudates and number of inflammatory cells remained largely unaffected by radiation or were even a slightly and transiently increased. However, the expression of iNOS was attenuated by radiation concomitant with an increase in the levels of HO-1 and HSP70. Cytokine levels varied with the radiation dose and the time point. CONCLUSIONS Ionizing radiation, even at low doses, functionally modulates inflammatory cells. Our findings indicate possible mechanisms as to how low-dose radiation may exert anti-inflammatory effects and provide the first evidence that heat shock proteins may be involved in this response.
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Niewald M, Fleckenstein J, Naumann S, Ruebe C. Long-term results of radiotherapy for periarthritis of the shoulder: a retrospective evaluation. Radiat Oncol 2007; 2:34. [PMID: 17868446 PMCID: PMC2078592 DOI: 10.1186/1748-717x-2-34] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Accepted: 09/14/2007] [Indexed: 11/25/2022] Open
Abstract
Background To evaluate retrospectively the results of radiotherapy for periarthritis of the shoulder Methods In 1983–2004, 141 patients were treated, all had attended at least one follow-up examination. 19% had had pain for several weeks, 66% for months and 14% for years. Shoulder motility was impaired in 137/140 patients. Nearly all patients had taken oral analgesics, 81% had undergone physiotherapy, five patients had been operated on, and six had been irradiated. Radiotherapy was applied using regular anterior-posterior opposing portals and Co-60 gamma rays or 4 MV photons. 89% of the patients received a total dose of 6 Gy (dose/fraction of 1 Gy twice weekly, the others had total doses ranging from 4 to 8 Gy. The patients and the referring doctors were given written questionnaires in order to obtain long-term results. The mean duration of follow-up was 6.9 years [0–20 years]. Results During the first follow-up examination at the end of radiotherapy 56% of the patients reported pain relief and improvement of motility. After in median 4.5 months the values were 69 and 89%, after 3.9 years 73% and 73%, respectively. There were virtually no side effects. In the questionnaires, 69% of the patients reported pain relief directly after radiotherapy, 31% up to 12 weeks after radiotherapy. 56% of the patients stated that pain relief had lasted for "years", in further 12% at least for "months". Conclusion Low-dose radiotherapy for periarthropathy of the shoulder was highly effective and yielded long-lasting improvement of pain and motility without side effects.
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Affiliation(s)
- Marcus Niewald
- Dept. of Radiooncology, Saarland University Hospital, Kirrberger Str.1, D-66421, Homburg, Germany
| | - Jochen Fleckenstein
- Dept. of Radiooncology, Saarland University Hospital, Kirrberger Str.1, D-66421, Homburg, Germany
| | - Susanne Naumann
- Dept. of Radiooncology, Saarland University Hospital, Kirrberger Str.1, D-66421, Homburg, Germany
| | - Christian Ruebe
- Dept. of Radiooncology, Saarland University Hospital, Kirrberger Str.1, D-66421, Homburg, Germany
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Rödel F, Keilholz L, Herrmann M, Sauer R, Hildebrandt G. Radiobiological mechanisms in inflammatory diseases of low-dose radiation therapy. Int J Radiat Biol 2007; 83:357-66. [PMID: 17487675 DOI: 10.1080/09553000701317358] [Citation(s) in RCA: 145] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Whereas X-irradiation with high doses is established to exert pro-inflammatory effects, low-dose radiotherapy (LD-RT) with single fractions below 1.0 Gy and a total dose below 12 Gy is clinically well known to exert anti-inflammatory and analgesic effects on several inflammatory diseases and painful degenerative disorders. Experimental studies to confirm the effectiveness, the empirical dose and fractionation schemes, and the underlying radiobiological mechanisms are still fragmentary. METHOD The anti-inflammatory efficiency of LD-RT was confirmed in several experimental in vitro and in vivo models. RESULTS In vitro studies revealed a variety of mechanisms related to the anti-inflammatory effect, in particular the modulation of cytokine and adhesion molecule expression on activated endothelial cells and leukocytes, and of nitric oxide (NO) production and oxidative burst in activated macrophages and native granulocytes. CONCLUSION Inflammatory diseases are the result of complex and pathologically unbalanced multicellular interactions. It is, therefore, reasonable to assume that further molecular pathways and cellular components contribute to the anti-inflammatory effect of LD-RT. This review discusses data and models revealing aspects of the mechanisms underlying the anti-inflammation induced by low doses of X-irradiation and may serve as a basis for systematic analyses, necessary to optimize LD-RT in clinical practice.
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Affiliation(s)
- F Rödel
- Department of Radiotherapy, University of Erlangen-Nuremberg, Erlangen, Germany.
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Abstract
Radiotherapy with total doses of < or =6 Gy has been given as very effective and low risk treatment of painful degenerative joint diseases and other inflammatory processes. Recent radiobiological experiments in vitro and in vivo identified mechanisms which may be related to these anti-inflammatory radiation effects, in particular functional modulation of the adhesion of white blood cells to activated endothelial cells and modulation of the induction of nitric oxide synthase in activated macrophages.
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Affiliation(s)
- K R Trott
- Department of Radiation Biology, St. Bartholomew's and the Royal London School of Medicine and Dentistry, Queen Mary & Westfield College, London, UK
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