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Ionizing radiation and genetic risks XIV. Potential research directions in the post-genome era based on knowledge of repair of radiation-induced DNA double-strand breaks in mammalian somatic cells and the origin of deletions associated with human genomic disorders.

Recent estimates of genetic risks from exposure of human populations to ionizing radiation are those presented in the 2001 report of the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR). These estimates incorporate two important concepts, namely, the following: (1) most radiation-induced mutations are DNA deletions, often encompassing multiple genes, but only a small proportion of the induced deletions is compatible with offspring viability; and (2) the viability-compatible deletions induced in germ cells are more likely to manifest themselves as multi-system developmental anomalies rather than as single gene disorders. This paper: (a) pursues these concepts further in the light of knowledge of mechanisms of origin of deletions and other rearrangements from two fields of contemporary research: repair of radiation-induced DNA double-strand breaks (DSBs) in mammalian somatic cells and human molecular genetics; and (b) extends them to deletions induced in the germ cell stages of importance for radiation risk estimation, namely, stem cell spermatogonia in males and oocytes in females. DSB repair studies in somatic cells have elucidated the roles of two mechanistically distinct pathways, namely, homologous recombination repair (HRR) that utilizes extensive sequence homology and non-homologous end-joining (NHEJ) that requires little or no homology at the junctions. A third process, single-strand annealing (SSA), which utilizes short direct repeat sequences, is considered a variant of HRR. HRR is most efficient in late S and G2 phases of the cell cycle and is a high fidelity mechanism. NHEJ operates in all cell cycle phases, but is especially important in G1. In the context of radiation-induced DSBs, NHEJ is error-prone. SSA is also an error-prone mechanism and its role is presumably similar to that of HRR. Studies in human molecular genetics have demonstrated that the occurrence of large deletions, duplications or other rearrangements in certain regions of the genome is related to the presence of large segments of repetitive DNA called segmental duplications (also called duplicons or low copy repeats, LCRs) in such regions. The mechanism that is envisaged for the origin of deletions and other rearrangements involves misalignment of region-specific LCRs of homologous chromosomes in meiosis followed by unequal crossing-over (i.e., non-allelic homologous recombination, NAHR). We hypothesize that: (a) in spermatogonial stem cells, NHEJ is probably the principal mechanism underlying the origin of radiation-induced deletions, although SSA and NAHR may also be involved to some extent, especially at low doses; and (b) in irradiated oocytes, NAHR is likely to be the main mechanism for generating deletions. We suggest future research possibilities, including the development of models for identifying regions of the genome that are susceptible to radiation-induced deletions. Such efforts may have particular significance in the context of the estimation of genetic risks of radiation exposure of human females, a problem that is still with us.

Animals↗

[Radiation exposure of radiation-sensitive risk organs--ocular lens, parotid gland, thyroid gland--in dacryocystography and therapy].

PURPOSE: Evaluation of radiation dose to the radiosensitive head and neck organs and tissues-ocular lens, parotid and thyroid glands--during dacryocystography and fluoroscopy--guided dacryocystoplasty (DCP). METHOD: Radiation dose was determined in an Alderson Rando phantom and in 13 patients. Radiation dose was measured directly using Ca-F2-thermoluminescent dosimetry crystals (TLD) which were placed on each eyelid, parotid gland and thyroid gland. RESULTS: The mean radiation dose to the lens placed next to the path of radiation was 6.58 mGy in the Alderson-Rando phantom and 5.43 mGy in patients during DCP. The mean radiation dose to the contralateral lens was 1.37 mGy and 1.7 mGy to the parotid gland placed next to the x-ray tube. Radiation dose to the thyroid gland was max. 0.4 mGy during DCP. CONCLUSION: Radiation dose to the ocular lens, parotid gland and thyroid gland during fluoroscopy-guided DCP was 25 times higher than during diagnostic dacryocystography. The radiation dose to radiosensitive head and neck organs and tissues during fluoroscopy-guided DCP is much below the threshold dose for ocular lens cataract.

Dacryocystitis↗

Computer-based radiation safety training for hospital radiation workers.

Conducting a hospital-based radiation safety training class may lead to temporary technologist staffing shortages resulting in a reduction of patient services or even the cessation of all routine patient services. Use of an interactive computer-based radiation safety training software program may provide a practical alternative for hospital diagnostic and therapeutic radiation departments, as well as other hospital departments utilizing radiation sources, in meeting annual radiation safety training requirements for radiation workers. Medical radiation workers' participation in computer-based radiation safety training can make a positive impact on radiation safety awareness in the hospital, assist license holders in satisfying regulatory training requirements, ensure maximum participation of staff technologists, and reduce the burden of technologist staffing shortages caused by traditional methods of training.

Computer-Assisted Instruction↗

Evaluation of a radiation survey training video developed from a real-time video radiation detection system.

This project incorporates radiation survey training into a real-time video radiation detection system, thus providing a practical perspective for the radiation worker on efficient performance of radiation surveys. Regular surveys to evaluate radiation levels are necessary not only to recognize potential radiological hazards but also to keep the radiation exposure as low as reasonably achievable. By developing and implementing an instructional learning system using a real-time radiation survey training video showing specific categorization of work elements, radiation workers trained with this system demonstrated better radiation survey practice.

Health Physics↗

Evidence that DNA damage is a mediate in ultraviolet B radiation-induced inhibition of human gene expression: ultraviolet B radiation effects on intercellular adhesion molecule-1 (ICAM-1) expression.

Expression of intercellular adhesion molecule-1 (ICAM-1) is a prerequisite for the capacity of cells to physically interact with leukocytes. Ultraviolet B radiation previously was found to inhibit interferon gamma-induced ICAM-1 expression in human keratinocytes by suppressing interferon gamma-mediated upregulation of ICAM-1 mRNA levels. Because ultraviolet B radiation induces photoproducts in cellular DNA, the potential role of ultraviolet B radiation-induced DNA damage in this system was assessed. For this purpose, cells from a normal donor were compared with cells from patients with xeroderma pigmentosum from complementation groups C and D. Xeroderma pigmentosum cells are defective in the removal of ultraviolet B radiation-induced DNA lesions, and thus lower ultraviolet B radiation doses are required to retain equivalent numbers of DNA photoproducts at a given time point after irradiation. In the present study, ultraviolet B radiation inhibited interferon gamma-induced ICAM-1 mRNA expression in primary human skin fibroblasts in a manner identical to that previously observed for keratinocytes. Comparative studies employing normal versus xeroderma pigmentosum fibroblasts revealed that in xeroderma pigmentosum fibroblasts, two- to threefold lower ultraviolet B radiation doses were required to achieve inhibition equivalent to that observed in normal fibroblasts. In irradiated normal cells, inhibition of interferon gamma-induced ICAM-1 mRNA expression was transient and restored 12 h after ultraviolet B radiation exposure. In contrast, in xeroderma pigmentosum complementation group D cells, no restoration could be observed for up to 48 h, but responsiveness was restored in xeroderma pigmentosum complementation group C cells after 24 h. These studies indicate that ultraviolet B radiation-induced inhibition of interferon gamma-mediated ICAM-1 expression involves the generation of DNA photo-products.

Cell Adhesion Molecules↗

Dynamics of cytotoxic T lymphocyte precursors in vivo assessed by change in the radiation sensitivity. Evidence for development of radiation-sensitive memory cells without clonal expansion.

The dynamics of cytotoxic T lymphocyte precursors (CTL-p) in mice injected with allogeneic spleen cells (SC) was studied with special reference to changes in their radiation sensitivity. Whole-body 400 rad X-ray irradiation of allo-SC-primed and unprimed mice virtually abolished the capacity of their SC to proliferate and to generate CTL in primary or secondary mixed leucocyte culture (MLC). However, the impaired ability of SC to generate CTL in the primary MLC was restored by interleukin 2 (IL-2). This showed that helper cells whose activity was replaceable with IL-2 (IL-2-producing cells) were functionally more radiation-sensitive than CTL-p in unprimed mice. In contrast, the radiation-impaired activity in secondary MLC was not restored by IL-2, suggesting that memory CTL-p in allo-SC-primed mice were unexpectedly sensitive to radiation. The D37 values determined from the percentage of residual CTL-p activity of SC in bulk cultures 1 day after irradiation were 525 rad for virgin CTL-p and 75 rad for memory CTL-p. Further studies demonstrated that the radiation-sensitive memory CTL-p were generated from relatively radiation-resistant precursors, largely independent of radiation-sensitive IL-2-producing cells and of cellular proliferation. The mean frequency of CTL-p in SC measured by limiting dilution assay was not significantly increased by the priming. This supports our conclusion that the development of the memory CTL-p activity in allo-SC-primed mice did not depend on clonal expansion. Whole-body 400 rad-irradiation reduced the frequency of CTL-p in SC from unprimed mice to 1/2-1/3 and that in SC from allo-SC-primed mice to 1/8-1/15. This supports the view that the majority of radiation-resistant virgin CTL-p functionally mature to radiation-sensitive memory CTL-p without cellular proliferation in allo-SC-primed mice.

Animals↗

Studies about space radiation promote new fields in radiation biology.

Astronauts are constantly exposed to space radiation of various types of energy with a low dose-rate during long-term stays in space. Therefore, it is important to determine correctly the biological effects of space radiation on human health. Studies about biological the effects at a low dose and a low dose-rate include various aspects of microbeams, bystander effects, radioadaptive responses and hormesis which are important fields in radiation biology. In addition, space radiations contain high linear energy transfer (LET) particles. In particular, neutrons may cause reverse effectiveness at a low dose-rate in comparison to ionizing radiation. We are also interested in p53-centered signal transduction pathways involved in the cell cycle, DNA repair and apoptosis induced by space radiations. We must also study whether the relative biological effectiveness (RBE) of space radiation is affected by microgravity which is another typical component in space. To confirm this, we must prepare centrifuge systems in an International Space Station (ISS). In addition, we must prepare many types of equipment for space experiments in an ISS, because we cannot use conventional equipment from our laboratories. Furthermore, the research for space radiation might give us valuable information about the birth and evolution of life on the Earth. We can also realize the importance of preventing the ozone layer from depletion by the use of exposure equipment to sunlight in an ISS. For these reasons, we desire to educate space researchers of the next generation based on the consideration of the preservation of the Earth from research about space radiation.

Cosmic Radiation↗

Radiation injury of the lung after three-dimensional conformal radiation therapy.

OBJECTIVE: The objective of this study is to describe the CT patterns of radiation injury in the lungs of patients who have undergone three-dimensional (3D) conformal radiation therapy (CRT). MATERIALS AND METHODS: Over a 36-month period, the chest CT scans of 19 patients with non-small cell lung cancer who were treated with 3D CRT were reviewed. CT scans were evaluated for findings of radiation injury (ground-glass opacities, consolidation, bronchiectasis, and volume loss). The presence, extent, and distribution of these findings were reached by consensus. RESULTS: Radiation pneumonitis limited to a small area immediately around the tumor was present in all patients who were imaged within 3 months after completion of the treatment (n = 7). Radiation-induced fibrosis occurred in all patients (n = 19). Three distinct patterns of fibrosis were consistently present, and these were classified as modified conventional, masslike, and scarlike. Modified conventional fibrosis (consolidation, volume loss, and bronchiectasis similar to, but less extensive than, conventional radiation fibrosis) was seen in five patients. Masslike fibrosis (focal consolidation with traction bronchiectasis limited to the site of the original tumor) was seen in eight patients. Scarlike fibrosis (linear opacity in the region of the original tumor associated with moderate to severe volume loss) was seen in six patients. CONCLUSION: Three-dimensional conformal radiation therapy results in three patterns of radiation fibrosis that differ from the conventional radiation-induced lung injury. Knowledge of the full spectrum of these manifestations is useful in the correct interpretation of CT scans after 3D CRT.

Adult↗

Reduction of radiation cytotoxicity by human apurinic endonuclease in a radiation-sensitive Escherichia coli mutant.

Ionizing radiation produces a variety of DNA damage through active oxygen species such as the superoxide radical (O2.-), the hydroxyl radical (OH.), and hydrogen peroxide (H2O2). The removal of alkylation-induced apurinic (AP) sites and 3'-blocking deoxyribose fragments by exonuclease III (xth) and endonuclease IV (nfo) has been well demonstrated in E. coli. Very little information on the repair of radiation-induced DNA damage by human apurinic endonuclease is available. We examined the biological roles of the human AP endonuclease in the repair of radiation-induced DNA damage. An expression vector was constructed with human APE cDNA and transformed into radiation-sensitive E. coli mutants (xth- and nfo-). The radiation cytotoxicity was assayed by cell survival curves. Expression of human AP endonuclease in E. coli confirmed that AP endonuclease could complement exonuclease III functionally to diminish radiation cytotoxicity. In contrast, AP endonuclease was not able to increase resistance to H2O2, owing to a poor 3'-termini repair. We also tested whether AP endonuclease is a limiting factor for radiation cytotoxicity by using a plasmid nicking assay. Cell extracts from mutant cells with or without AP endonuclease expression were added to irradiated supercoiled plasmid DNA. The inability to convert supercoiled plasmid DNA to relaxed or linear forms suggested that there were large accumulations of AP sites in the mutant cell extracts. The AP endonuclease activities estimated from the plasmid nicking assays are 20-fold lower in the cell extracts of AP endonuclease-deficient mutant than in AP endonuclease-expressing cells. Therefore, AP endonuclease is a limiting step of base excision repair for the radiation-sensitive E. coli mutant, BW528. Our results conclude that AP endonuclease is responsible for the removal of AP sites from gamma-radiation-induced base damage in E. coli.

DNA Repair↗

[Estimation of radiation exposure and radiation risk for employees of a heart catheterization laboratory].

The staff at interventional radiological procedures is exposed to high levels of ionizing radiation. This applies especially to measures at cardiac catheterization laboratories. In this study the annual radiation exposure to the staff was estimated by measuring the dose rate under characteristic conditions. It could be shown that the resulting radiation exposure was strongly dependent on the radiation protection measures and is also dependent on the operation conditions of the x-ray-tube. The effective dose for the physician wearing a lead apron and thyroid shield was determined to about 1.7 mSv/a. Without a thyroid shield an effective dose of about 3.5 mSv/a resulted. This corresponds to approximately the natural background radiation of about 2.4 mSv/a in the Federal Republic of Germany. From the number of procedures performed we could derive an effective dose of approximately 1-2 microSv per application for the physician, averaged over all types of procedures. Further, it could be shown that the readings of the film badges, usually worn by the staff, underestimate the effective dose by approximately a factor of two. This is because the film badges do not include the contribution of the unshielded parts of the body to effective dose. From the estimated annual effective dose, a lifetime dose of 68 mSv was estimated for a 40-year working career. The corresponding lifetime risk for induced fatal cancer due to radiation exposure was determined to 0.3% applying the ICRP risk factor of 4 x 10(-2) Sv-1. Considering the NCRP recommendations for a safe occupation, working in a cardiac catheterization laboratory can be considered as safe when applying all radiation protection measures. However, changing the protection measures and modifying the parameters of the x-ray-tube can lead to strong changes of the radiation exposure and the resulting risk estimation.

Cardiac Catheterization↗

Intensity modulated radiation therapy (IMRT) decreases acute skin toxicity for women receiving radiation for breast cancer.

OBJECTIVE: To determine the clinically observed incidence and severity of acute skin toxicity with breast intensity modulated radiation therapy (IMRT), and compare the results with a matched cohort of patients treated by conventional radiation therapy. Our hypothesis is that measures to decrease dose inhomogeneity within the breast and skin with IMRT will improve acute skin toxicity. MATERIALS AND METHODS: The study population consists of 73 women with early stage breast cancer treated with breast-conserving surgery and IMRT. The IMRT technique involves an iteration method for optimization to generate the IMRT plan, Monte Carlo dose calculation, and a step-and-shoot technique using multileaf collimation for beam delivery. Other aspects of the technique including the clinical definition of the clinical target volume by the physician, patient positioning, tangential beam orientation, dose and field sizes were unchanged compared conventional tangential radiation. These patients were matched one-to-one to a control group of 60 women treated with conventional photon radiation by using their bra size and chest wall separation. The study end point was acute skin toxicity. RESULTS: There were no observed differences in the acute toxicity based upon common terminology criteria for adverse events (CTC) for acute radiation dermatitis. There was no desquamation in 42% of IMRT patients, dry desquamation in 37% and moist desquamation in 21%. The degree of desquamation was greater for conventional patients compared with IMRT patients -52% grade 0, 10% grade 1, and 38% grade 2 (P = 0.001). Subgroup analysis showed desquamation was significantly lower with IMRT for small (P = 0.038) and large breast sizes (P = 0.037), but not medium sizes (P = 0.454). For large breast sizes, the incidence of moist desquamation grade 2 was 48% with IMRT compared with 79% in controls. Significant predictors of moist desquamation on stepwise logistic regression were use of IMRT (P = 0.0011) and breast size (P < 0.0001). CONCLUSIONS: IMRT is associated with a decrease in severity of acute desquamation compared with a matched control group treated with conventional radiation therapy. As with conventional radiation, breast size remains the most important prognostic factor for acute skin toxicity. The CTC grading system for acute radiation dermatitis is not sensitive when applied to modern breast cancer treatment because of its dependence of subjective rating of erythema and inability to gauge variations in desquamation. Further study of patient symptoms, quality of life, and cosmesis is needed to evaluate the benefit of IMRT for breast cancer.

Breast Neoplasms↗