Archambeau John O, Tovmasyan Artak, Pearlstein Robert D, Crapo James D, Batinic-Haberle Ines
Department of Radiation Medicine, Loma Linda University, Loma Linda, CA, USA.
Department of Radiation Oncology, Duke University School of Medicine, Durham, NC 27710, USA.
Redox Biol. 2013 Oct 25;1(1):599-607. doi: 10.1016/j.redox.2013.10.002. eCollection 2013.
Radiation proctitis, an inflammation and damage to the lower part of colon, is a common adverse event of the radiotherapy of tumors in the abdominal and pelvic region (colon, prostate, cervical). Several Mn(III) porphyrin-based superoxide dismutase mimics have been synthesized and successfully evaluated in preclinical models as radioprotectants. Here we report for the first time the remarkable rectal radioprotection of frequently explored Mn(III) meso-tetrakis(N-ethylpyridinium-2-yl)porphyrin, MnTE-2-PyP(5+). A batch prepared in compliance with good manufacturing practice (GMP), which has good safety/toxicity profile, was used for this study. MnTE-2-PyP(5+) was given subcutaneously at 5 mg/kg, either 1 h before or 1 h after irradiation, with additional drug administered at weekly intervals thereafter. MnTE-2-PyP(5+) ameliorated both acute and chronic radiation proctitis in male Sprague-Dawley rats irradiated with 20-30 Gy protons delivered to 2.5 cm span of rectum using spread-out Bragg peak of a proton treatment beam. Focal irradiation of the rectum produced acute proctitis, which healed, followed by chronic rectal dilation and symptomatic proctitis. MnTE-2-PyP(5+) protected rectal mucosa from radiation-induced crypt loss measured 10 days post-irradiation. Significant effects were observed with both pre- and post-treatment regimens. However, only MnTE-2-PyP(5+) pre-treatment, but not post-treatment, prevented the development of rectal dilation, indicating that proper dosing regimen is critical for radioprotection. The pre-treatment also prevented or delayed the development of chronic proctitis depending on the radiation dose. Further work aimed at developing MnTE-2-PyP(5+) and similar drugs as adjunctive agents for radiotherapy of pelvic tumors is warranted. The present study substantiates the prospects of employing this and similar analogs in preserving normal tissue during cancer radiation as well as any other radiation exposure.
放射性直肠炎是结肠下部的一种炎症和损伤,是腹部和盆腔区域(结肠、前列腺、子宫颈)肿瘤放射治疗的常见不良事件。几种基于锰(III)卟啉的超氧化物歧化酶模拟物已被合成,并在临床前模型中作为辐射防护剂成功进行了评估。在此,我们首次报告了常用的中-四(N-乙基吡啶-2-基)锰(III)卟啉(MnTE-2-PyP(5+))对直肠具有显著的辐射防护作用。本研究使用了一批按照药品生产质量管理规范(GMP)制备的、具有良好安全性/毒性特征的产品。MnTE-2-PyP(5+)以5mg/kg的剂量皮下注射,在照射前1小时或照射后1小时给药,此后每周间隔给药一次。使用质子治疗束的扩展布拉格峰,对雄性Sprague-Dawley大鼠的直肠进行20 - 30Gy质子照射,照射范围为2.5cm,MnTE-2-PyP(5+)可改善急性和慢性放射性直肠炎。直肠局部照射会产生急性直肠炎,随后愈合,接着出现慢性直肠扩张和症状性直肠炎。MnTE-2-PyP(5+)可保护直肠黏膜免受照射后10天测量的辐射诱导的隐窝丢失。在治疗前和治疗后方案中均观察到显著效果。然而,只有MnTE-2-PyP(5+)预处理而非后处理可预防直肠扩张的发生,这表明适当的给药方案对辐射防护至关重要。预处理还可根据辐射剂量预防或延迟慢性直肠炎的发展。有必要进一步开展工作,将MnTE-2-PyP(5+)及类似药物开发为盆腔肿瘤放射治疗的辅助药物。本研究证实了在癌症放疗及任何其他辐射暴露期间使用这种及类似类似物保护正常组织的前景。