Abstract

ABSTRACTMolecular mechanisms underlying development of acute pneumonitis and/or late fibrosis following thoracic irradiation remain poorly understood. Here, we hypothesize that heterogeneity in disease progression and phenotypic expression of radiation-induced lung disease (RILD) across murine strains presents an opportunity to better elucidate mechanisms driving tissue response toward pneumonitis and/or fibrosis. Distinct differences in disease progression were observed in age- and sex-matched CBA/J, C57L/J and C57BL/6J mice over 1 year after graded doses of whole-thorax lung irradiation (WTLI). Separately, comparison of gene expression profiles in lung tissue 24 h post-exposure demonstrated >5000 genes to be differentially expressed (P<0.01; >twofold change) between strains with early versus late onset of disease. An immediate divergence in early tissue response between radiation-sensitive and -resistant strains was observed. In pneumonitis-prone C57L/J mice, differentially expressed genes were enriched in proinflammatory pathways, whereas in fibrosis-prone C57BL/6J mice, genes were enriched in pathways involved in purine and pyrimidine synthesis, DNA replication and cell division. At 24 h post-WTLI, different patterns of cellular damage were observed at the ultrastructural level among strains but microscopic damage was not yet evident under light microscopy. These data point toward a fundamental difference in patterns of early pulmonary tissue response to WTLI, consistent with the macroscopic expression of injury manifesting weeks to months after exposure. Understanding the mechanisms underlying development of RILD might lead to more rational selection of therapeutic interventions to mitigate healthy tissue damage.

Highlights

  • Radiation-induced lung disease (RILD) remains the most common healthy tissue complication associated with radiation treatment of thoracic tumors

  • We previously reported on the dose­-response relationship and pathophysiological comparability of RILD in three murine strains (CBA/J, C57BL/6J and C57L/J), nonhuman primates (NHPs), and humans over the first 180 days after exposure (Jackson et al, 2014)

  • Elucidating the pathophysiological mechanisms that orchestrate the divergence of tissue response toward acute pneumonitis and/or fibrosis and identifying new therapeutic interventions requires well-designed, well-controlled preclinical studies with a stable and reproducible relationship between radiation dose and development of RILD

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Summary

INTRODUCTION

Radiation-induced lung disease (RILD) remains the most common healthy tissue complication associated with radiation treatment of thoracic tumors. Radiation pneumonitis affects 5-15% of patients undergoing thoracic radiotherapy It is defined as an early, transient phase that occurs between 1 and 7 months after exposure, with a peak incidence at 3-4 months. No U.S Food and Drug Administration-approved therapies are available to prevent, mitigate, and/or treat radiation pneumonitis and/or fibrosis; nor do well-defined biological markers predict individual risk for development of disease. This is, in part, a result of the biological complexity of RILD, in which injurious mechanisms begin at the time of exposure and progress through a clinically latent period before overt onset of pneumonitis and/or fibrosis (Bentzen, 2006). We report the importance of appropriate strain selection, control over biological variables, and sufficient follow-up time to accurately identifying new therapeutic targets and testing of new medical interventions

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