Abstract
Colorectal cancer is among the three top cancer types for incidence and the second in terms of mortality, usually managed with surgery, chemotherapy and radiotherapy. In particular, radiotherapeutic concepts are crucial for the management of advanced rectal cancer, but patients’ survival remains poor, despite advances in treatment modalities. The use of well-characterized in vitro cell culture systems offers an important preclinical strategy to study mechanisms at the basis of cell response to therapeutic agents, including ionizing radiation, possibly leading to a better understanding of the in vivo response to the treatment. In this context, we present an integrated analysis of results obtained in an extensive measurement campaign of radiation effects on Caco-2 cells, derived from human colorectal adenocarcinoma. Cells were exposed to X-rays with doses up to 10 Gy from a radiotherapy accelerator. We measured a variety of endpoints at different post-irradiation times: clonogenic survival after ~ 2 weeks; cell cycle distribution, cell death, frequency of micronucleated cells and atypical mitoses, activation of matrix metalloproteases (MMPs) and of different proteins involved in DNA damage response and cell cycle regulation at earlier time points, up to 48 h post-exposure. Combined techniques of flow cytometry, immunofluorescence microscopy, gelatin zymography and western blotting were used. For selected endpoints, we also addressed the impact of the irradiation protocol, comparing results obtained when cells are plated before irradiation or first-irradiated and then re-plated. Caco-2 resistance to radiation, previously assessed up to 72 h post exposure in terms of cell viability, does not translate into a high clonogenic survival. Survival is not affected by the irradiation protocol, while endpoints measured on a shorter time frame are. Radiation mainly induces a G2-phase arrest, confirmed by associated molecular markers. The activation of death pathways is dose- and time-dependent, and correlates with a dose-dependent inhibition of MMPs. Genomic aberrations are also found to be dose-dependent. The phosphorylated forms of several proteins involved in cell cycle regulation increase following exposure; the key regulator FoxM1 appears to be downregulated, also leading to inhibition of MMP-2. A unified molecular model of the chain of events initiated by radiation is proposed to interpret all experimental results.
Highlights
According to data collected by the International Agency for Research on Cancer [available via the Global Cancer Observatory platform [1]], colorectal cancer (CRC) is the third most common cancer worldwide in terms of incidence, with a burden of 10.2% of the total ~18.1 million new cancer cases registered in 2018
The large data set presented in this work on colorectal adenocarcinoma Caco-2 cells exposed to X-ray doses up to 10 Gy offers the opportunity to conduct an integrated analysis of a variety of endpoints, measured with different techniques, to characterize the radiation response of this cell line, gaining molecular insight into underlying mechanisms elicited by radiation
As already noted in the description of results, differences observed for the sham condition can be mainly attributed to an overall “time-shift” between cell populations that is induced by differences in the two protocols
Summary
According to data collected by the International Agency for Research on Cancer [available via the Global Cancer Observatory platform [1]], colorectal cancer (CRC) is the third most common cancer worldwide in terms of incidence, with a burden of 10.2% of the total ~18.1 million new cancer cases (both sexes, all ages) registered in 2018. The choice of first-line treatment for CRC patients currently involves a multimodal approach that allows classifying patients in risk groups. This is done considering: tumor-related characteristics, as the presence of metastases (number and localization), stage of tumor progression, possible biochemical markers, etc.; and patient-related factors, such as co-morbidity, prognosis, etc. Different complementary strategies for neo-adjuvant therapies exist, in particular: a short-course radiotherapy with a 5 × 5 Gy scheme, or a long-course radiotherapy with normofractionated irradiation, for a total dose between 45 and 50.4 Gy, with simultaneous application of chemotherapy [4]. Radiotherapy can be used for palliation of symptoms, for colon cancer, either from primary lesions, or caused by distant metastases [3]
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