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Ceyzériat K, Jaques E, Gloria Y, Badina A, Millet P, Koutsouvelis N, Dipasquale G, Frisoni GB, Zilli T, Garibotto V, Tournier BB. Low-Dose Radiation Therapy Impacts Microglial Inflammatory Response without Modulating Amyloid Load in Female TgF344-AD Rats. J Alzheimers Dis 2024; 98:1001-1016. [PMID: 38489181 DOI: 10.3233/jad-231153] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
Background Low-dose radiation therapy (LD-RT) has demonstrated in preclinical and clinical studies interesting properties in the perspective of targeting Alzheimer's disease (AD), including anti-amyloid and anti-inflammatory effects. Nevertheless, studies were highly heterogenous with respect to total doses, fractionation protocols, sex, age at the time of treatment and delay post treatment. Recently, we demonstrated that LD-RT reduced amyloid peptides and inflammatory markers in 9-month-old TgF344-AD (TgAD) males. Objective As multiple studies demonstrated a sex effect in AD, we wanted to validate that LD-RT benefits are also observed in TgAD females analyzed at the same age. Methods Females were bilaterally treated with 2 Gy×5 daily fractions, 2 Gy×5 weekly fractions, or 10 fractions of 1 Gy delivered twice a week. The effect of each treatment on amyloid load and inflammation was evaluated using immunohistology and biochemistry. Results A daily treatment did not affect amyloid and reduced only microglial-mediated inflammation markers, the opposite of the results obtained in our previous male study. Moreover, altered fractionations (2 Gy×5 weekly fractions or 10 fractions of 1 Gy delivered twice a week) did not influence the amyloid load or neuroinflammatory response in females. Conclusions A daily treatment consequently appears to be the most efficient for AD. This study also shows that the anti-amyloid and anti-inflammatory response to LD-RT are, at least partly, two distinct mechanisms. It also emphasizes the necessity to assess the sex impact when evaluating responses in ongoing pilot clinical trials testing LD-RT against AD.
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Affiliation(s)
- Kelly Ceyzériat
- Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Faculty of Medicine, Geneva University, Geneva, Switzerland
- Diagnostic Department, Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals and NIMTLab, Faculty of Medicine, Geneva University, Geneva, Switzerland
- CIBM Center for BioMedical Imaging, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Emma Jaques
- Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Yesica Gloria
- Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Faculty of Medicine, Geneva University, Geneva, Switzerland
- Bertarelli Foundation Gene Therapy Platform, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
| | - Aurélien Badina
- Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Philippe Millet
- Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Nikolaos Koutsouvelis
- Department of Oncology, Division of Radiation Oncology, Geneva University Hospitals, Geneva, Switzerland
| | - Giovanna Dipasquale
- Department of Oncology, Division of Radiation Oncology, Geneva University Hospitals, Geneva, Switzerland
| | - Giovanni B Frisoni
- Faculty of Medicine, Geneva University, Geneva, Switzerland
- Diagnostic Department, Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals and NIMTLab, Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Thomas Zilli
- Faculty of Medicine, Geneva University, Geneva, Switzerland
- Department of Oncology, Division of Radiation Oncology, Geneva University Hospitals, Geneva, Switzerland
- Department of Radiation Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
- Facoltà di Scienze Biomediche, Università della Svizzera Italiana, Lugano, Switzerland
| | - Valentina Garibotto
- Faculty of Medicine, Geneva University, Geneva, Switzerland
- Diagnostic Department, Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals and NIMTLab, Faculty of Medicine, Geneva University, Geneva, Switzerland
- CIBM Center for BioMedical Imaging, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Benjamin B Tournier
- Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Faculty of Medicine, Geneva University, Geneva, Switzerland
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Song HY, Chen F, Park HR, Han JM, Ji HJ, Byun EB, Kwon Y, Kim MK, Ahn KB, Seo HS. Low-dose radiation therapy suppresses viral pneumonia by enhancing broad-spectrum anti-inflammatory responses via transforming growth factor-β production. Front Immunol 2023; 14:1182927. [PMID: 37304302 PMCID: PMC10248130 DOI: 10.3389/fimmu.2023.1182927] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/16/2023] [Indexed: 06/13/2023] Open
Abstract
Low-dose radiation therapy (LDRT) can suppress intractable inflammation, such as that in rheumatoid arthritis, and is used for treating more than 10,000 rheumatoid arthritis patients annually in Europe. Several recent clinical trials have reported that LDRT can effectively reduce the severity of coronavirus disease (COVID-19) and other cases of viral pneumonia. However, the therapeutic mechanism of LDRT remains unelucidated. Therefore, in the current study, we aimed to investigate the molecular mechanism underlying immunological alterations in influenza pneumonia after LDRT. Mice were irradiated to the whole lung 1 day post-infection. The changes in levels of inflammatory mediators (cytokines and chemokines) and immune cell populations in the bronchoalveolar lavage (BALF), lungs, and serum were examined. LDRT-treated mice displayed markedly increased survival rates and reduced lung edema and airway and vascular inflammation in the lung; however, the viral titers in the lungs were unaffected. Levels of primary inflammatory cytokines were reduced after LDRT, and transforming growth factor-β (TGF-β) levels increased significantly on day 1 following LDRT. Levels of chemokines increased from day 3 following LDRT. Additionally, M2 macrophage polarization or recruitment was increased following LDRT. We found that LDRT-induced TGF-β reduced the levels of cytokines and polarized M2 cells and blocked immune cell infiltration, including neutrophils, in BALF. LDRT-induced early TGF-β production was shown to be a key regulator involved in broad-spectrum anti-inflammatory activity in virus-infected lungs. Therefore, LDRT or TGF-β may be an alternative therapy for viral pneumonia.
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Affiliation(s)
- Ha-Yeon Song
- Research Division for Radiation Science, Advanced Radiation Technology Institute, Korea Atomic Energy Research Institute, Jeongeup, Republic of Korea
| | - Fengjia Chen
- Research Division for Radiation Science, Advanced Radiation Technology Institute, Korea Atomic Energy Research Institute, Jeongeup, Republic of Korea
| | - Hae Ran Park
- Research Division for Radiation Science, Advanced Radiation Technology Institute, Korea Atomic Energy Research Institute, Jeongeup, Republic of Korea
| | - Jeong Moo Han
- Research Division for Radiation Science, Advanced Radiation Technology Institute, Korea Atomic Energy Research Institute, Jeongeup, Republic of Korea
- Department of Biotechnology, College of Life Science and Biotechnology, Korea University, Seoul, Republic of Korea
| | - Hyun Jung Ji
- Research Division for Radiation Science, Advanced Radiation Technology Institute, Korea Atomic Energy Research Institute, Jeongeup, Republic of Korea
- Department of Oral Microbiology and Immunology, Dental Research Institute (DRI), and BK21 Plus Program, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Eui-Baek Byun
- Research Division for Radiation Science, Advanced Radiation Technology Institute, Korea Atomic Energy Research Institute, Jeongeup, Republic of Korea
| | - Yeongkag Kwon
- Research Division for Radiation Science, Advanced Radiation Technology Institute, Korea Atomic Energy Research Institute, Jeongeup, Republic of Korea
| | - Min-Kyu Kim
- Research Division for Radiation Science, Advanced Radiation Technology Institute, Korea Atomic Energy Research Institute, Jeongeup, Republic of Korea
| | - Ki Bum Ahn
- Research Division for Radiation Science, Advanced Radiation Technology Institute, Korea Atomic Energy Research Institute, Jeongeup, Republic of Korea
- Animal Production and Health Laboratory, Joint Food and Agricultural Organization/International Atomic Energy Agency (FAO/IAEA) Centre for Nuclear Applications in Food and Agriculture, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Seibersdorf, Austria
| | - Ho Seong Seo
- Research Division for Radiation Science, Advanced Radiation Technology Institute, Korea Atomic Energy Research Institute, Jeongeup, Republic of Korea
- Department of Radiation Science, University of Science and Technology, Daejeon, Republic of Korea
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Piqué B, Peña K, Riu F, Acosta JC, Torres-Royo L, Malave B, Araguas P, Benavides R, de Febrer G, Camps J, Joven J, Arenas M, Parada D. SARS-CoV-2 Serum Viral Load and Prognostic Markers Proposal for COVID-19 Pneumonia in Low-Dose Radiation Therapy Treated Patients. J Clin Med 2023; 12:jcm12030798. [PMID: 36769445 PMCID: PMC9918037 DOI: 10.3390/jcm12030798] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Several studies have shown that the plasma RNA of SARS-CoV-2 seems to be associated with a worse prognosis of COVID-19. In the present study, we investigated plasma RNA in COVID-19 patients treated with low-dose radiotherapy to determine its prognostic value. Data were collected from the IPACOVID prospective clinical trial (NCT04380818). The study included 46 patients with COVID-19 pneumonia treated with a whole-lung dose of 0.5 Gy. Clinical follow-up, as well as laboratory variables, and SARS-CoV-2 serum viral load, were analyzed before LDRT, at 24 h, and one week after treatment. The mean age of the patients was 85 years, and none received any of the SARS-CoV-2 vaccine doses. The mortality ratio during the course of treatment was 33%. RT-qPCR showed amplification in 23 patients. Higher mortality rate was associated with detectable viremia. Additionally, C-reactive protein, lactate dehydrogenase, and aspartate aminotransferase were significant risk factors associated with COVID-19 mortality. Our present findings show that detectable SARS-CoV-2 plasma viremia 24 h before LDRT is significantly associated with increased mortality rates post-treatment, thus downsizing the treatment success.
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Affiliation(s)
- Berta Piqué
- Molecular Pathology Unit, Department of Pathology, Hospital Universitari Sant Joan de Reus, Institut d’Investigació Sanitàri Pere Virgili, Universitat Rovira i Virgili, 43204 Tarragona, Spain
| | - Karla Peña
- Molecular Pathology Unit, Department of Pathology, Hospital Universitari Sant Joan de Reus, Institut d’Investigació Sanitàri Pere Virgili, Universitat Rovira i Virgili, 43204 Tarragona, Spain
| | - Francesc Riu
- Molecular Pathology Unit, Department of Pathology, Hospital Universitari Sant Joan de Reus, Institut d’Investigació Sanitàri Pere Virgili, Universitat Rovira i Virgili, 43204 Tarragona, Spain
| | - Johana C. Acosta
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d’Investigació Sanitàri Pere Virgili, Universitat Rovira i Virgili, 43204 Tarragona, Spain
| | - Laura Torres-Royo
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d’Investigació Sanitàri Pere Virgili, Universitat Rovira i Virgili, 43204 Tarragona, Spain
| | - Barbara Malave
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d’Investigació Sanitàri Pere Virgili, Universitat Rovira i Virgili, 43204 Tarragona, Spain
| | - Pablo Araguas
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d’Investigació Sanitàri Pere Virgili, Universitat Rovira i Virgili, 43204 Tarragona, Spain
| | - Rocío Benavides
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d’Investigació Sanitàri Pere Virgili, Universitat Rovira i Virgili, 43204 Tarragona, Spain
| | - Gabriel de Febrer
- Department of Geriatric and Palliative Care, Hospital Universitari Sant Joan de Reus, 43204 Tarragona, Spain
| | - Jordi Camps
- Unitat de Recerca Biomèdica, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43003 Tarragona, Spain
| | - Jorge Joven
- Unitat de Recerca Biomèdica, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43003 Tarragona, Spain
| | - Meritxell Arenas
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d’Investigació Sanitàri Pere Virgili, Universitat Rovira i Virgili, 43204 Tarragona, Spain
- Correspondence: (M.A.); (D.P.)
| | - David Parada
- Molecular Pathology Unit, Department of Pathology, Hospital Universitari Sant Joan de Reus, Institut d’Investigació Sanitàri Pere Virgili, Universitat Rovira i Virgili, 43204 Tarragona, Spain
- Correspondence: (M.A.); (D.P.)
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Kim DY, Kim JS, Seo YS, Park WY, Kim BH, Hong EH, Kim JY, Cho SJ, Rhee HY, Kim A, Kim KY, Oh DJ, Chung WK. Evaluation of Efficacy and Safety Using Low Dose Radiation Therapy with Alzheimer's Disease: A Protocol for Multicenter Phase II Clinical Trial. J Alzheimers Dis 2023; 95:1263-1272. [PMID: 37638435 PMCID: PMC10578208 DOI: 10.3233/jad-230241] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Alzheimer's disease (AD), the most common cause of dementia, is a neurodegenerative disease resulting from extracellular and intracellular deposits of amyloid-β (Aβ) and neurofibrillary tangles in the brain. Although many clinical studies evaluating pharmacological approaches have been conducted, most have shown disappointing results; thus, innovative strategies other than drugs have been actively attempted. OBJECTIVE This study aims to explore low-dose radiation therapy (LDRT) for the treatment of patients with AD based on preclinical evidence, case reports, and a small pilot trial in humans. METHODS This study is a phase II, multicenter, prospective, single-blinded, randomized controlled trial that will evaluate the efficacy and safety of LDRT to the whole brain using a linear accelerator in patients with mild AD. Sixty participants will be randomly assigned to three groups: experimental I (24 cGy/6 fractions), experimental II (300 cGy/6 fractions), or sham RT group (0 cGy/6 fractions). During LDRT and follow-up visits after LDRT, possible adverse events will be assessed by the physician's interview and neurological examinations. Furthermore, the effectiveness of LDRT will be measured using neurocognitive function tests and imaging tools at 6 and 12 months after LDRT. We will also monitor the alterations in cytokines, Aβ42/Aβ40 ratio, and tau levels in plasma. Our primary endpoint is the change in cognitive function test scores estimated by the Alzheimer's Disease Assessment Scale-Korea compared to baseline after 6 months of LDRT. CONCLUSIONS This study is registered at ClinicalTrials.gov [NCT05635968] and is currently recruiting patients. This study will provide evidence that LDRT is a new treatment strategy for AD.
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Affiliation(s)
- Dong-Yun Kim
- Department of Radiation Oncology, Kyunghee University Hospital at Gangdong, Seoul, Korea
| | - Jae Sik Kim
- Department of Radiation Oncology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Young-Seok Seo
- Department of Radiation Oncology, Chungbuk National University Hospital, Cheongju, Korea
| | - Woo-Yoon Park
- Department of Radiation Oncology, Chungbuk National University Hospital, Cheongju, Korea
| | - Byoung Hyuck Kim
- Department of Radiation Oncology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Eun-Hee Hong
- Radiation Health Research Institute, Korea Hydro & Nuclear Power Co Ltd., Seoul, Korea
| | - Ji Young Kim
- Radiation Health Research Institute, Korea Hydro & Nuclear Power Co Ltd., Seoul, Korea
| | - Seong-Jun Cho
- Radiation Health Research Institute, Korea Hydro & Nuclear Power Co Ltd., Seoul, Korea
| | - Hak Young Rhee
- Department of Neurology, Kyunghee University Hospital at Gangdong, Seoul, Korea
| | - Aryun Kim
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea
| | - Keun You Kim
- Department of Psychiatry, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Dae Jong Oh
- Workplace Mental Health Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Weon Kuu Chung
- Department of Radiation Oncology, Kyunghee University Hospital at Gangdong, Seoul, Korea
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Rodríguez-Tomàs E, Acosta JC, Torres-Royo L, De Febrer G, Baiges-Gaya G, Castañé H, Jiménez A, Vasco C, Araguas P, Gómez J, Malave B, Árquez M, Calderón D, Piqué B, Algara M, Montero Á, Simó JM, Gabaldó-Barrios X, Sabater S, Camps J, Joven J, Arenas M. Effect of Low-Dose Radiotherapy on the Circulating Levels of Paraoxonase-1-Related Variables and Markers of Inflammation in Patients with COVID-19 Pneumonia. Antioxidants (Basel) 2022; 11:antiox11061184. [PMID: 35740079 PMCID: PMC9220239 DOI: 10.3390/antiox11061184] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/04/2022] [Accepted: 06/10/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of our study was to investigate the changes produced by low-dose radiotherapy (LDRT) in the circulating levels of the antioxidant enzyme paraoxonase-1 (PON1) and inflammatory markers in patients with COVID-19 pneumonia treated with LDRT and their interactions with clinical and radiological changes. Data were collected from the IPACOVID prospective clinical trial (NCT04380818). The study included 30 patients treated with a whole-lung dose of 0.5 Gy. Clinical follow-up, as well as PON1-related variables, cytokines, and radiological parameters were analyzed before LDRT, at 24 h, and 1 week after treatment. Twenty-five patients (83.3%) survived 1 week after LDRT. Respiratory function and radiological images improved in survivors. Twenty-four hours after LDRT, PON1 concentration significantly decreased, while transforming growth factor beta 1 (TGF-β1) increased with respect to baseline. One week after LDRT, patients had increased PON1 activities and lower PON1 and TGF-β1 concentrations compared with 24 h after LDRT, PON1 specific activity increased, lactate dehydrogenase (LDH), and C-reactive protein (CRP) decreased, and CD4+ and CD8+ cells increased after one week. Our results highlight the benefit of LDRT in patients with COVID-19 pneumonia and it might be mediated, at least in part, by an increase in serum PON1 activity at one week and an increase in TGF-β1 concentrations at 24 h.
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Affiliation(s)
- Elisabet Rodríguez-Tomàs
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Tarragona, Spain; (E.R.-T.); (J.C.A.); (L.T.-R.); (P.A.); (J.G.); (B.M.); (M.Á.); (D.C.); (B.P.)
- Unitat de Recerca Biomèdica, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43003 Tarragona, Spain; (G.B.-G.); (H.C.); (A.J.); (J.C.); (J.J.)
| | - Johana C. Acosta
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Tarragona, Spain; (E.R.-T.); (J.C.A.); (L.T.-R.); (P.A.); (J.G.); (B.M.); (M.Á.); (D.C.); (B.P.)
| | - Laura Torres-Royo
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Tarragona, Spain; (E.R.-T.); (J.C.A.); (L.T.-R.); (P.A.); (J.G.); (B.M.); (M.Á.); (D.C.); (B.P.)
| | - Gabriel De Febrer
- Department of Geriatric and Palliative Care, Hospital Universitari Sant Joan de Reus, 43204 Tarragona, Spain; (G.D.F.); (C.V.)
| | - Gerard Baiges-Gaya
- Unitat de Recerca Biomèdica, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43003 Tarragona, Spain; (G.B.-G.); (H.C.); (A.J.); (J.C.); (J.J.)
| | - Helena Castañé
- Unitat de Recerca Biomèdica, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43003 Tarragona, Spain; (G.B.-G.); (H.C.); (A.J.); (J.C.); (J.J.)
| | - Andrea Jiménez
- Unitat de Recerca Biomèdica, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43003 Tarragona, Spain; (G.B.-G.); (H.C.); (A.J.); (J.C.); (J.J.)
| | - Carlos Vasco
- Department of Geriatric and Palliative Care, Hospital Universitari Sant Joan de Reus, 43204 Tarragona, Spain; (G.D.F.); (C.V.)
| | - Pablo Araguas
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Tarragona, Spain; (E.R.-T.); (J.C.A.); (L.T.-R.); (P.A.); (J.G.); (B.M.); (M.Á.); (D.C.); (B.P.)
| | - Junior Gómez
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Tarragona, Spain; (E.R.-T.); (J.C.A.); (L.T.-R.); (P.A.); (J.G.); (B.M.); (M.Á.); (D.C.); (B.P.)
| | - Bárbara Malave
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Tarragona, Spain; (E.R.-T.); (J.C.A.); (L.T.-R.); (P.A.); (J.G.); (B.M.); (M.Á.); (D.C.); (B.P.)
| | - Miguel Árquez
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Tarragona, Spain; (E.R.-T.); (J.C.A.); (L.T.-R.); (P.A.); (J.G.); (B.M.); (M.Á.); (D.C.); (B.P.)
| | - David Calderón
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Tarragona, Spain; (E.R.-T.); (J.C.A.); (L.T.-R.); (P.A.); (J.G.); (B.M.); (M.Á.); (D.C.); (B.P.)
| | - Berta Piqué
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Tarragona, Spain; (E.R.-T.); (J.C.A.); (L.T.-R.); (P.A.); (J.G.); (B.M.); (M.Á.); (D.C.); (B.P.)
- Department of Pathology, Hospital Universitari Sant Joan de Reus, 43204 Tarragona, Spain
| | - Manel Algara
- Department of Radiation Oncology, Institut d’Investigacions Mèdiques, Hospital del Mar, Autonomous University of Barcelona, 08193 Barcelona, Spain;
| | - Ángel Montero
- Department of Radiation Oncology, HM Hospitales, 28050 Madrid, Spain;
| | - Josep M. Simó
- Laboratori de Referència Sud, Hospital Universitari Sant Joan de Reus, 43204 Tarragona, Spain; (J.M.S.); (X.G.-B.)
| | - Xavier Gabaldó-Barrios
- Laboratori de Referència Sud, Hospital Universitari Sant Joan de Reus, 43204 Tarragona, Spain; (J.M.S.); (X.G.-B.)
| | - Sebastià Sabater
- Department of Radiation Oncology, Complejo Hospitalario de Albacete, 02006 Albacete, Spain;
| | - Jordi Camps
- Unitat de Recerca Biomèdica, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43003 Tarragona, Spain; (G.B.-G.); (H.C.); (A.J.); (J.C.); (J.J.)
| | - Jorge Joven
- Unitat de Recerca Biomèdica, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43003 Tarragona, Spain; (G.B.-G.); (H.C.); (A.J.); (J.C.); (J.J.)
| | - Meritxell Arenas
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Tarragona, Spain; (E.R.-T.); (J.C.A.); (L.T.-R.); (P.A.); (J.G.); (B.M.); (M.Á.); (D.C.); (B.P.)
- Correspondence:
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6
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Pandey SR, Adhikari Yadav S, Gautam S, Giri K, Devkota A, Shrestha S, Bhandari S, Baniya S, Adhikari B, Adhikari B, Neupane S, Bhandari J. Effectiveness of low-dose radiation therapy in COVID-19 patients globally: A systematic review. F1000Res 2022; 11:62. [PMID: 35186275 PMCID: PMC8825648 DOI: 10.12688/f1000research.74558.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Novel Corona Virus Disease 2019 (COVID-19) can affect multiple organs, including the lungs, resulting in pneumonia. Apart from steroids, other anti-COVID drugs that have been studied appear to have little or no effect on COVID-19 pneumonia. There is a well-known history of inflammatory disease, including pneumonia, treated with low-dose radiation therapy (LDRT). It reduces the production of proinflammatory cytokines, Interleukin-1a (IL-1a), and leukocyte recruitment. Methods: A comprehensive literature search was conducted using PubMed, Scopus, Embase, CINAHL, and Google Scholar, with keywords such as "radiotherapy," "low-dose radiation therapy," "low-dose irradiation," "covid-19 pneumonia," "SARS-CoV-2 pneumonia," and "covid pneumonia." with additional filters for human studies and customized articles in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We reviewed randomized controlled trials, quasi-experimental studies, cohort, case-control, and cross-sectional studies with a clearly defined intervention, including low-dose radiotherapy alone or in combination with any therapy to treat COVID-19 pneumonia from December 2019 to May 2021. Patients receiving standard or high-dose radiotherapy, including for other diseases, were excluded. Zotero software was used to collect and organize research from various databases, remove duplicates, extract relevant data, and record decisions. Participants' demographics and baseline status were obtained from the full-text articles along with the intervention's outcome/effect on patient status. Results: Four studies with 61 participants that met the inclusion criteria were included. One was a double-blind randomized controlled trial, one a non-randomized trial, while the other two were single-arm clinical trials. Low-dose radiation therapy did not show any significant improvement in COVID-19 patients. Conclusion: Only two studies included in this review demonstrated an improvement in inflammatory markers; however, patients were also given steroids or other drugs. Therefore, the confounding effects must be considered before drawing conclusions. This systematic review does not support mortality benefit, clinical course improvement, or imaging changes with LDRT.
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Affiliation(s)
- Sirish Raj Pandey
- Medical Oncology, Nepal Cancer Hospital and Research Center, Lalitpur, Province 3, 44700, Nepal
| | | | | | - Kalpana Giri
- B.P. Koirala Cancer Hospital, Chitwan, 44204, Nepal
| | | | - Shipra Shrestha
- Shahid Gangalal National Heart Center, Kathmandu, 44600, Nepal
| | - Shreya Bhandari
- Shahid Gangalal National Heart Center, Kathmandu, 44600, Nepal
| | | | | | - Bibek Adhikari
- Medical Oncology, Nepal Cancer Hospital and Research Center, Lalitpur, Province 3, 44700, Nepal
| | - Shila Neupane
- Patan Academy of Health Sciences School of Medicine, Kathmandu, 44600, Nepal
| | - Jenish Bhandari
- All Nepal College of Medical Education, Kathmandu, 44600, Nepal
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7
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Pandey BN. Low-dose radiation therapy for coronavirus disease-2019 pneumonia: Is it time to look beyond apprehensions? Ann Thorac Med 2020; 15:199-207. [PMID: 33381234 PMCID: PMC7720738 DOI: 10.4103/atm.atm_433_20] [Citation(s) in RCA: 5] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/15/2020] [Indexed: 11/11/2022] Open
Abstract
Coronavirus disease-2019 (COVID-19) has become a global health crisis. Mortality associated with COVID-19 is characterized mainly by acute respiratory distress syndrome (ARDS), sepsis, pneumonia, and respiratory failure. The pathogenesis of the disease is known to be associated with pro-inflammatory processes after virus infection. Hence, various therapeutic strategies are being developed to control the inflammation and cytokine storm in COVID-19 patients. Recently, low-dose radiation therapy (LDRT) has been suggested for the treatment of pneumonia/ADRS in COVID-19 patients through irradiation of lungs by gamma/X-ray. In this direction, a few clinical trials have also been initiated. However, a few recent publications have raised some concerns regarding LDRT, especially about possibilities of activation/aggressiveness of virus (severe acute respiratory syndrome coronavirus 2 in case of COVID-19), lung injury and risk of second cancer after low-dose therapy. The present manuscript is an attempt to analyze these apprehensions based on cited references and other available literature, including some from our laboratory. At this point, LDRT may be not the first line of therapy. However, based on existing anti-inflammatory evidence of LDRT, it needs encouragement as an adjuvant therapy and for more multi-centric clinical trials. In addition, it would be worth combining LDRT with other anti-inflammatory therapies, which would open avenues for multi-modal therapy of pneumonia/ARDS in COVID-19 patients. The mode of irradiation (local lung irradiation or whole-body irradiation) and the window period after infection of the virus, need to be optimized using suitable animal studies for effective clinical outcomes of LDRT. However, considering ample evidence, it is time to look beyond the apprehensions if a low dose of radiation could be exploited for better management of COVID-19 patients.
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Affiliation(s)
- Badri Narain Pandey
- Radiation Biology and Health Sciences Division, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
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8
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Donaubauer AJ, Zhou JG, Ott OJ, Putz F, Fietkau R, Keilholz L, Gaipl US, Frey B, Weissmann T. Low Dose Radiation Therapy, Particularly with 0.5 Gy, Improves Pain in Degenerative Joint Disease of the Fingers: Results of a Retrospective Analysis. Int J Mol Sci 2020; 21:ijms21165854. [PMID: 32824064 PMCID: PMC7461565 DOI: 10.3390/ijms21165854] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/27/2020] [Accepted: 08/12/2020] [Indexed: 01/07/2023] Open
Abstract
Low-dose radiation therapy (LDRT) has been successfully established for decades as an alternative analgesic treatment option for patients suffering from chronic degenerative and inflammatory diseases. In this study, 483 patients were undergoing LDRT for degenerative joint disease of the fingers and thumb at the University Hospital Erlangen between 2004 and 2019. Radiotherapy was applied according to the German guidelines for LDRT. Several impact factors on therapeutic success, such as the age and gender, the number of affected fingers, the single and cumulative dose, as well as the number of series, were investigated. In summary, 70% of the patients showed an improvement of their pain following LDRT. No significant impact was found for the factors age, gender, the number of series or the cumulative dosage. Patients with an involvement of the thumb showed a significantly worse outcome compared to patients with an isolated affection of the fingers. In this cohort, patients receiving a single dose of 0.5 Gy reported a significantly better outcome than patients receiving 1.0 Gy, strongly suggesting a reduction in the total dose. In summary, LDRT is a good alternative treatment option for patients suffering from degenerative and inflammatory joint disease of the fingers.
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Affiliation(s)
- Anna-Jasmina Donaubauer
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.-J.D.); (J.-G.Z.); (O.J.O.); (F.P.); (R.F.); (U.S.G.); (B.F.)
| | - Jian-Guo Zhou
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.-J.D.); (J.-G.Z.); (O.J.O.); (F.P.); (R.F.); (U.S.G.); (B.F.)
- Department of Oncology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China
| | - Oliver J. Ott
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.-J.D.); (J.-G.Z.); (O.J.O.); (F.P.); (R.F.); (U.S.G.); (B.F.)
| | - Florian Putz
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.-J.D.); (J.-G.Z.); (O.J.O.); (F.P.); (R.F.); (U.S.G.); (B.F.)
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.-J.D.); (J.-G.Z.); (O.J.O.); (F.P.); (R.F.); (U.S.G.); (B.F.)
| | - Ludwig Keilholz
- Department of Radiotherapy, Clinical Center Bayreuth, 95447 Bayreuth, Germany;
| | - Udo S. Gaipl
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.-J.D.); (J.-G.Z.); (O.J.O.); (F.P.); (R.F.); (U.S.G.); (B.F.)
| | - Benjamin Frey
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.-J.D.); (J.-G.Z.); (O.J.O.); (F.P.); (R.F.); (U.S.G.); (B.F.)
| | - Thomas Weissmann
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.-J.D.); (J.-G.Z.); (O.J.O.); (F.P.); (R.F.); (U.S.G.); (B.F.)
- Correspondence: ; Tel.: +49-(0)9131-85-44209
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Kato H, Nakamura M, Oda T, Morita A. Effectiveness of combined low-dose radiotherapy and pazopanib for controlling the local manifestations of taxane-resistant recurrent angiosarcoma of the head. JAAD Case Rep 2020; 6:713-715. [PMID: 32715058 PMCID: PMC7369525 DOI: 10.1016/j.jdcr.2020.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Hiroshi Kato
- Correspondence to: Hiroshi Kato, MD, PhD, Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
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Affiliation(s)
- Adrianna Henson Masters
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Ryan T Hughes
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Lindsay Strowd
- Department of Dermatology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Zanetta Lamar
- Department of Hematology and Oncology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Karen Marie Winkfield
- Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
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11
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Rödel F, Fournier C, Wiedemann J, Merz F, Gaipl US, Frey B, Keilholz L, Seegenschmiedt MH, Rödel C, Hehlgans S. Basics of Radiation Biology When Treating Hyperproliferative Benign Diseases. Front Immunol 2017; 8:519. [PMID: 28515727 PMCID: PMC5413517 DOI: 10.3389/fimmu.2017.00519] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 01/10/2017] [Accepted: 04/18/2017] [Indexed: 01/08/2023] Open
Abstract
For decades, low- and moderate-dose radiation therapy (RT) has been shown to exert a beneficial therapeutic effect in a multitude of non-malignant conditions including painful degenerative muscoloskeletal and hyperproliferative disorders. Dupuytren and Ledderhose diseases are benign fibroproliferative diseases of the hand/foot with fibrotic nodules and fascial cords, which determine debilitating contractures and deformities of fingers/toes, while keloids are exuberant scar formations following burn damage, surgery, and trauma. Although RT has become an established and effective option in the management of these diseases, experimental studies to illustrate cellular composites and factors involved remain to be elucidated. More recent findings, however, indicate the involvement of radiation-sensitive targets like mitotic fibroblasts/myofibroblasts as well as inflammatory cells. Radiation-related molecular mechanisms affecting these target cells include the production of free radicals to hamper proliferative activity and interference with growth factors and cytokines. Moreover, an impairment of activated immune cells involved in both myofibroblast proliferative and inflammatory processes may further contribute to the clinical effects. We here aim at briefly describing mechanisms contributing to a modulation of proliferative and inflammatory processes and to summarize current concepts of treating hyperproliferative diseases by low and moderate doses of ionizing radiation.
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Affiliation(s)
- Franz Rödel
- Department of Radiotherapy and Oncology, University Hospital of Frankfurt, Goethe-Universität, Frankfurt am Main, Germany
| | - Claudia Fournier
- Department of Biophysics, GSI Helmholtz Centre for Heavy Ion Research, Darmstadt, Germany
| | - Julia Wiedemann
- Department of Biophysics, GSI Helmholtz Centre for Heavy Ion Research, Darmstadt, Germany
| | - Felicitas Merz
- Department of Biophysics, GSI Helmholtz Centre for Heavy Ion Research, Darmstadt, Germany
| | - Udo S Gaipl
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Benjamin Frey
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Ludwig Keilholz
- Department of Radiotherapy, Clinical Center Bayreuth, Bayreuth, Germany
| | | | - Claus Rödel
- Department of Radiotherapy and Oncology, University Hospital of Frankfurt, Goethe-Universität, Frankfurt am Main, Germany
| | - Stephanie Hehlgans
- Department of Radiotherapy and Oncology, University Hospital of Frankfurt, Goethe-Universität, Frankfurt am Main, Germany
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12
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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] [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: 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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