Modulation of accelerated repopulation in mouse skin during daily irradiation

Acute radiation dermatitis in breast cancer patients: challenges and solutions

Nearly all women who receive radiotherapy (RT) for breast cancer experience some degree of radiation dermatitis. However, evidence describing the appropriate management of radiation dermatitis is often lacking or contradictory. Here, we summarize the available literature regarding radiation dermatitis causes, the presentation and timing of symptoms, methods for dermatitis assessment and prevention, and review evidence-based management strategies.

Fibroblast growth factor-peptide improves barrier function and proliferation in human keratinocytes after radiation

PURPOSE

Epidermal keratinocytes, which can be severely damaged after ionizing radiation (IR), are rapid turnover cells that function as a barrier, protecting the host from pathogenic invasion and fluid loss. We tested fibroblast growth factor-peptide (FGF-P), a small peptide derived from the receptor-binding domain of FGF-2, as a potential mitigator of radiation effects via proliferation and the barrier function of keratinocytes.

METHODS AND MATERIALS

Keratinocytes isolated from neonatal foreskin were grown on transwells. After being exposed to 0, 5, or 10 Gy IR, the cells were treated with a vehicle or FGF-P. The permeability of IR cells was assessed by using transepithelial electrical resistance (TEER) and a paracellular tracer flux of fluorescein isothiocyanate-conjugated bovine serum albumin (FITC-BSA) with Ussing chambers. The cell proliferation was measured with yellow tetrazolium salt (MTT) and tritiated thymidine ([3H]-TdR) assays. The phosphorylation of extracellular signal-regulated kinases (ERK) was measured in an enzyme-linked immunosorbent (ELISA)-like assay, and the proteins related to tight junctions (TJ) and adherens junctions (AJ) were examined with Western blotting. We used a mouse model to assess the ability of FGF-P to promote the healing of skin β burns created with a strontium applicator.

RESULTS

We found (1) FGF-P reduced the permeability of irradiated keratinocytes, as evidenced by increased TEER and decreased diffusion of FITC-BSA, both associated with the regulation of different proteins and levels of TJ and AJ; and (2) FGF-P enhanced the proliferation of irradiated keratinocytes, as evidenced by increased MTT activity and [3H]-TdR incorporation, which was associated with activation of the ERK pathway; and (3) FGF-P promoted the healing of skin β burns.

CONCLUSIONS

FGF-P enhances the barrier function, including up-regulation of TJ proteins, increases proliferation of human keratinocytes, and accelerates the healing of skin β burns. FGF-P is a promising mitigator that improves the proliferation and barrier function of keratinocytes after IR.

Phototoxicity assessment of drugs and cosmetic products using E. coli

A gram negative bacteria Escherichia coli (Dh5alpha strain) was developed as an alternate test system of phototoxicity. Eight drugs (antibiotics) and cosmetic products (eight face creams) were examined for their phototoxicity using this test system. Five known phototoxic compounds were used to validate the test system. UVA-radiation induced phototoxicity of these compounds was tested by agar gel diffusion assay. Decrease in colony forming units (CFU) was taken as an end point of phototoxicity. The phototoxic compounds and antibiotics produced significant reduction in CFU (p<0.001) at 80 microg/ml concentrations under exposure to UVA-radiation (5.4-10.8 J/cm(2)). One face cream was found phototoxic and produced significant decrease in CFU of E. coli at 1.0mg/ml concentration under UVA exposure (10.8 J/cm(2)). The minimum effective concentration of tetracycline and dose of UVA-radiation were also determined by observing growth inhibition of E. coli through disc diffusion assay. The observations suggested that E. coli can be used as an alternative test system for phototoxicity evaluation of chemicals. A battery of test systems is required to conclude the toxic/phototoxic potential of a chemical agent. In view of the speed, easiness, sensitivity and low cost, E. coli is introduced as one of the alternate test system for phototoxicity studies in safety evaluation of various chemical ingredients or formulations used in cosmetics and drugs.

Effect of solar UV radiation on earthworm (Metaphire posthuma)

Human health risks like damage to the eyes, immune system, and skin are known to be associated with increasing ultraviolet radiation (UVR) in the environment. In this study, we evaluated the phototoxic effects of UVR in sunlight and its possible mechanism of action by using earthworm as an alternative model because earthworm skin contains several biomolecules (tetraene and triene sterol) similar to human beings. We studied the generation of reactive oxygen species (ROS), photooxidation of lipids, and histopathological changes in earthworm integument. It was observed that UVR-exposed earthworm skin homogenate produced a significant amount of singlet oxygen ((1)O(2)), superoxide anion (O(2)(*)(-)), hydroxyl radicals ((*)OH), and photooxidation of lipids. The production of ROS and lipid peroxidation product was found dependent on the dose of solar UVR in earthworm integument. Histological anomalies such as thickening, vacuolation, and hypertrophy of epidermal cells were observed when the animals were exposed for 1 to 2h, while a higher exposure period (3h) caused degeneration of circular and longitudinal muscles. Continuous sunlight exposure for more than 3h was found lethal to worms. These observations suggested that the current level of UVR in sunlight may produce significant phototoxic effects in the earthworms probably via the generation of ROS (photodynamic action). Possible increases in UVR in view of ozone depletion may be more detrimental to the biomolecules in the worm's skin. The earthworm thus turned out as a simple, sensitive, and cost-effective test organism for the assessment of the hazardous potential of solar radiation and also for planning safety measures for human beings.

Effect of UVB radiation on human erythrocytes in vitro

In order to evaluate the UVB radiation induced phototoxic effect, the human erythrocytes (RBCs) were used an alternate biological model and rate of photohaemolysis was assessed in vitro at various intensities of UVB radiation (0-2.0 mW/cm2) for an exposure period of 0-240 min. The alterations of biochemical activities in RBC membrane (ghosts), caused by its exposure under an average incident intensity of UVB radiation (0.5 mW/cm2) in sunlight at earth surface, were also determined to understand the possible mechanism of photohaemolysis. We observed UVB dose dependent lysis of erythrocytes by recording haemoglobin and methemoglobin (oxidized form of haemoglobin) in photohaemolysate. We also observed significant inhibition in ATPase, acetylcholinesterase, glucose-6-phosphate dehydrogenase activites and an increased amount of thiobarbituric acid-reactive substance (TBA-RS) in RBC ghosts exposed to UVB radiation (0.5 mW/cm2) for a period of 0-100 min (doses: 0, 0.33, 0.66, 1.0, 1.5 and 3.0 J). The changes were found UVB dose dependent. A decrease of glutathione content in RBC ghosts at low dose level of UVB exposure (0.33 J) was found to be recovered at higher dose levels (0.66-1.5 J). These observations suggested, UVB dose dependent toxicity to human erythrocytes in vitro. Thus the erythrocytes can be used for an assessment of UVB induced biological effects and to understand possible mechanism of the phototoxicity.

Ultraviolet radiation and the contact hypersensitivity reaction in mice

The article reviews the application of the contact hypersensitivity assay in mice to the science of photoimmunology. The contact hypersensitivity (CHS) reaction, which is suppressed by UV irradiation in mice similarly to their ability to respond immunologically to skin tumors, has been used very profitably to reveal many of the regulating factors that control photoimmunosuppression, such as the identity of the photoreceptors that initiate immunosuppression, the defects induced in the cutaneous antigen presenting pathway, the local cytokine imbalance, and the protective intervention by various molecules, drugs, or interacting UV wavebands. Technical hints to optimize the measurement of the CHS response are suggested, including information on UV radiation wavebands and dosages and sensitivities of different mouse strains.

Topical corticosteroid therapy for acute radiation dermatitis: a prospective, randomized, double-blind study

BACKGROUND

Radiation dermatitis is a common side-effect of radiation therapy, but there is no current consensus about its appropriate therapy.

OBJECTIVES

To compare treatment with topical 0.1% methylprednisolone vs. 0.5% dexpanthenol in a cohort of patients undergoing fractionated radiation therapy for breast cancer.

METHODS

In a randomized, double-blind design, treatment was initiated at the beginning of radiation therapy and continued for 2 weeks after termination of radiation. Outcomes were compared by three different measures: clinical (symptom score), functional (transepidermal water loss, TEWL) and subjective (quality of life, QOL).

RESULTS

In a preliminary cohort of untreated patients undergoing radiation therapy, clinical signs and TEWL levels increased progressively during radiation therapy, reaching highest values at 5 and 4 weeks, respectively. Although neither topical treatment reduced the incidence of radiation dermatitis, both delayed the emergence of greatest clinical and TEWL scores until approximately 6 and 5 weeks, respectively. With topical corticosteroids, clinical symptoms and TEWL were less pronounced than with dexpanthenol. Whereas general QOL improved after completion of radiation therapy, skin-related QOL declined. However, the skin-related QOL decline could be at least in part reversed by use of topical corticosteroid vs. dexpanthenol-containing emollient.

CONCLUSIONS

We provide evidence that prophylactic and ongoing use of topical therapy with either topical corticosteroid or a dexpanthenol-containing emollient ameliorates, but does not prevent radiation dermatitis. Our data suggest, but do not prove, a benefit of a topical corticosteroid vs. a dexpanthenol-containing emollient. Further controlled studies with larger cohorts will be needed to determine optimal forms of topical therapy for radiation dermatitis.

Radiation-induced changes in cellularity and proliferation in human oral mucosa

PURPOSE

To quantify the oral mucosal cell density and proliferation rate during conventional radiotherapy of head-and-neck tumors and to compare these parameters with clinical scoring of oral mucositis.

MATERIALS AND METHODS

Between 1996 and 1999, 22 patients were included in this study. Mucosal biopsies were taken before or during the radiotherapy course (5 x 2 Gy/wk). Biopsies were incubated in vitro with tritiated thymidine immediately after excision to label DNA-synthesizing cells.

RESULTS

Epithelial cell density followed a biphasic radiation response. A steep decrease to about 50% of the preirradiation value (1000 cells/mm epithelium) during Week 1 was followed by a more gradual loss to about 400 cells at the end of treatment. The initial phase was based on the depression of proliferation, with 5-10 labeled cells/mm at the end of Week 1 vs. 60 labeled cells/mm in controls. Subsequently, proliferation was partially restituted at 20 labeled cells/mm. A significant difference in cell numbers was seen between Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer Grade 0 (approximately 850 cell/mm) and Grade 2 (325/mm) or Grade 3 (370/mm). No significant differences were observed between reaction grades 1, 2, and 3.

CONCLUSION

Conventionally fractionated radiotherapy induces a rapid suppression in cell production in Week 1, which results in a prompt reduction in cell numbers. Subsequently, a partial restoration of proliferation significantly reduces the rate of cell loss. These processes clearly precede the clinical response. Regeneration, defined as restoration of cellularity, is already under way when the maximal clinical response is observed. Clinical reaction grading corresponds poorly to cellular density measures during conventional fractionation.