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Cellular communication and bystander effects a critical review

Cellular communication and bystander effects a critical review
Cellular communication and bystander effects a critical review

Mutation Research 501(2002)1–12

Mini review

Cellular communication and bystander effects:a critical review

for modelling low-dose radiation action ?

Francesca Ballarini a ,d ,Marco Biaggi a ,d ,Andrea Ottolenghi b ,d ,?,Orazio Sapora c

a

Universitàdegli Studi di Milano,Dipartimento di Fisica,via Celoria 16,20133Milan,Italy b

Universitàdi Pavia,Dipartimento di Fisica Nucleare e Teorica,via U.Bassi 6,I-27100Pavia,Italy

c

Laboratorio di Tossicologia Comparata ed Ecotossicologia,Istituto Superiore di Sanità,viale Regina Elena 299,00161Rome,Italy

d INFN,sezion

e di Milano,via Celoria 16,20133Milan,Italy

Received 20July 2001;received in revised form 12December 2001;accepted 21December 2001

Abstract

Available data suggesting the occurrence of “bystander effects”(i.e.damage induction in cells not traversed by radiation)were collected and critically evaluated,in view of the development of low-dose risk models.Although the underlying mech-anisms are largely unknown,cellular communication seems to play a key role.In this context,the main features of cellular communication were summarised and a few representative studies on bystander effects were reported and discussed.Three main approaches were identi?ed:(1)conventional irradiation of cell cultures with very low doses of light ions;(2)irradiation of single cells with microbeam probes;(3)treatment with irradiated conditioned medium (ICM),i.e.feeding of unexposed cells with medium taken from irradiated cultures.Indication of different types of bystander damage (e.g.cell killing,gene mutations and modi?cations in gene expression)has been found in each of the three cases.The interpretations proposed by the investigators were discussed and possible biases introduced by speci?c experimental conditions were outlined.New arguments and experiments were suggested,with the main purpose of obtaining quantitative information to be included in models of low-dose radiation action.Implications in interpreting low-dose data and modelling low-dose effects at cellular and supra-cellular level,including cancer induction,were analysed.Possible synergism with other low-dose speci?c phenomena such as adaptive response (AR)(i.e.low-dose induced resistance to subsequent irradiation)was discussed.?2002Elsevier Science B.V .All rights reserved.

Keywords:Bystander effect;Adaptive response;Cellular communication;Low doses;Mechanistic models

1.Introduction

Estimates of the various damage types at sub-cel-lular,cellular and supra-cellular level induced by low

?Presented at Bystander Effect Workshop,Dublin,Ireland,December 2000.

?Corresponding author.Tel.:+39-02-5031-7655;fax:+39-02-5031-7630.

E-mail address:andrea.ottolenghi@mi.infn.it (A.Ottolenghi).

doses,where no experimental data are available,are generally based on linear back-extrapolations from data at higher doses.However,a large amount of data produced during the last decade seem to indicate higher damage yields than expected,possibly due to the so-called “bystander effect”(i.e.the induction of damage in cells that were not directly hit by radiation).One of the most intriguing aspects of these experi-ments relies in that bystander damage is observed even

0027-5107/02/$–see front matter ?2002Elsevier Science B.V .All rights reserved.PII:S 0027-5107(02)00010-6

2F.Ballarini et al./Mutation Research501(2002)1–12

at very low doses,down to the mGy level,and it does not signi?cantly increase with dose.No clear-cut con-clusions can be drawn on the mechanisms underlying bystander effect observations.Different pathways may be involved,depending on the speci?c conditions.In any case the various forms of cellular communication seem to play a key role,since damage in non directly hit cells may represent a response to signals coming from cells that were directly hit by radiation.If these ?ndings are con?rmed,radiobiology experiments may need to be re-interpreted and the models of low-dose radiation action may need to be revised.Furthermore, a signi?cant role of bystander effects in vivo would imply the re-evaluation of models of damage at tis-sue and organ level.A typical example is provided by low-dose cancer risk,which up to now has gener-ally been estimated by assuming a linear,no-threshold dose-response.

This scenario might be further complicated by the presence of other phenomena such as adaptive response(AR).The expression“AR”is used by dif-ferent investigators to indicate different effects also including hormesis,de?ned as a“stimulatory effect caused by low levels of toxic agents”[1],and increased radioresistance,i.e.sub-linear response at low doses.Strictly speaking,the term AR applies to protection provided by low-dose irradiation with respect to subsequent(higher-dose)irradiation[2]. Although the mechanisms underlying this effect are largely unknown,several similarities between AR and bystander effects can be found.In the framework of low-dose effect estimates,it has been inferred that AR might lead to a sub-linearity in cancer risk at low doses(e.g.[3]).If so,AR should be considered as a possible competing phenomenon with respect to bystander effects.

2.General features of cellular communication Cells possess complex systems—including recep-tors,kinases,phosphatases,GTP-binding proteins and several other molecules—that enable them to send or respond to signals to or from other cells.There exist three main forms of cell signalling:paracrine,synaptic and endocrine.Molecules secreted by a cell can be car-ried far apart to act on distant targets(synaptic and en-docrine signalling),or can act locally by affecting the cells in the close environment(paracrine signalling). By the same mechanisms,cells can send signals to other cells of the same type(autocrine signalling); it follows that they can send signals to themselves also.As can be de?ned from the currently available in vitro experiments,bystander effects are mainly a consequence of paracrine/autocrine signalling.In the literature there are several examples that can help in understanding these effects(for a review see[4]). The production and release of eicosanoids is an example of paracrine signalling.These molecules are continuously synthesised in cell membranes starting from20-carbon fatty acids with at least three dou-ble bonds.There exist four classes of eicosanoids: prostaglandines;prostacyclines;thromboxanes and leukotrienes.They mainly derive from arachidonic acid and they are involved in a wide variety of bio-logical activities,including in?ammatory responses. When cells are activated by damage induction or by chemical signalling,the rate of eicosanoid synthesis increases.The local levels of eicosanoids in?uence both the cells that produce them and their immediate neighbours.The?rst step of the synthesis is the release of the fatty acid cleaved from membrane phospho-lipids by phospholipases.This process can be triggered by low levels of oxidised poly-unsaturated fatty acids (PUFA)and can be ampli?ed by the action of phos-pholipases.The subsequent oxidation step involves the activity of cyclooxygenases and lipoxygenases. Other signalling molecules are also produced in response to oxidative stress induced by chemical and physical agents.Phospholipase C,produced in res-ponse to signals to plasma membrane growth-factor receptors,can catalyse the hydrolysis of phosphati-dylionsitol-4-5-bisphosphate(PIP2).The products of such hydrolysis,inositol(1,4,5)triphosphate(IP3)and diacylglycerol(DG),can cause a release of Ca2+ and an activation of phosphokinase C(PKC).PKC is a key enzyme representing a family of more than 11isoenzymes,dependent or not dependent on the presence of Ca2+.This family of enzymes can phos-phorylate various cellular proteins involved in cell proliferation control.

Also cyclic AMP(cAMP)can play a signi?cant role as a second messenger in cell proliferation con-trol.cAMP can also regulate PKC and the transcrip-tion of several genes.More than25years ago it has been shown that the intracellular levels of cAMP can

F.Ballarini et al./Mutation Research501(2002)1–123

be increased by treatment with prostaglandines E1, which can react with adenyl-cyclase receptors on the outer membrane leading to an increase of intracellular cAMP levels and,secondary,Ca2+levels.This treat-ment can in?uence the shape of survival curves of V79 cells irradiated with X-rays,mainly in the low-dose range[5].Finally,oxidative damage can produce a family of second messengers from membrane phos-pholipids.Oxidative products of linoleic and arachi-donic acid,such as the hydroperoxy-eicosatetraenoic acid(H-PETE),the hydroxy-2-nonenal(HNE)and the hydroxy-octadecadienoic acid(HODE),can be released by a cell and can react in neighbouring cells by activating signal cascade triggering repair pro-cesses or by activating cell death mechanisms.It has recently been reported that DNA damage induced by human mammary lipid extracts can be detected in breast epithelial cells[6].Interestingly,the authors showed that the most active lipid extracts were those obtained from donors whose cells contained the higher pre-existing DNA damage.

Intercellular communication through gap-junctions represents another way to co-ordinate the activities of neighbouring cells.These structures are specialised cell–cell junctions that can form between adjacent plasma membranes:gap-junctions directly connect the cytoplasms of neighbouring cells via narrow channels (≈2nm in diameter).Intercellular communication via gap-junctions allows the exchange of small molecules (<2000Da)such as Ca2+and cAMP,but not macro-molecules such as proteins and nucleic acids.Also compounds such as eicosanoids and lipid oxidative products can hardly diffuse trough gap-junctions,due to the high lipophylicity of these compounds and to the presence of water in gap-junction channels.

A clear general frame emerges from the available data:the different forms of cell signalling triggered by oxidative stress(ionising radiation acts mainly trough reactive oxygen species,ROS)are strictly correlated with cell proliferation and cell https://www.doczj.com/doc/a913412907.html,munication between damaged and undamaged cells has been sug-gested to lead to a general increase in genomic insta-bility.More speci?cally,it has been shown that factors secreted by UV-irradiated cells can increase muta-tion rates in unirradiated cells up to10-fold over?ve generations[7,8].Similar results have been obtained following irradiation with UV A rays in presence of psoralen,suggesting that the sensitisers may extend this response to long wavelengths.UV-irradiated skin

?broblasts can secrete at least two proteins,identi?ed

as interleukin-1and the basic?broblast growth factor

[9].Moreover,also interleukin-8and tumour necrosis

factor alpha(TNF-?)have been shown to be secreted

together with the already mentioned eicosanoids as a

consequence of in?ammation processes[10].

3.Bystander effects:experimental

approaches and indications

3.1.Treatment with irradiated conditioned

medium(ICM)

A large amount of data on bystander effects has

been obtained with the so-called“ICM treatment”

[11–14].This technique consists in replacing the

culture medium of non-irradiated cells with medium

taken from cell cultures previously exposed to radia-

tion.The main?nding of these studies relies in that

such treatment can reduce survival of unexposed cells.

This suggests that,as a result of a radiation insult,

certain cell types can release factors in the medium,

which therefore becomes potentially cytotoxic.

A detailed description of this approach can be

found in[11].The essential points will be summarised

herein.Non-irradiated human cell lines—including

normal keratinocytes,which are epithelial cells,and

normal?broblasts—seeded at cloning densities were

fed with medium taken from cultures of the same cell

type,previously irradiated as single cells with5Gy 60Co gamma-rays.Before being transferred to recip-ient?asks,the medium was?ltered to ensure that no

cells could still be present.This treatment was found to

reduce clonogenic survival of keratinocytes,whereas

no effect was observed for?broblasts.Furthermore,

medium taken from irradiated keratinocytes reduced

survival of unexposed?broblast,whereas medium

from irradiated?broblasts had no effect on unexposed

keratinocytes.Treatment with medium irradiated in

absence of cells had no effect on any of the cell lines,

indicating that a role of free radicals produced by

hydrolysis of medium components can be excluded.

Apoptotic?gures were also scored in ICM-treated ker-

atinocytes.No signi?cant dose-dependence was obser-

ved in the range0.5–10Gy.A signi?cant increase of

cell killing with the number of irradiated cells was

4F.Ballarini et al./Mutation Research501(2002)1–12

observed:medium taken from cultures of300,000 keratinocytes induced a response close to that of cells directly irradiated with5Gy.By transferring the medium at different post-irradiation times,the ICM toxicity was found to increase rapidly in the?rst few hours post-irradiation.Only a slow increase was ob-served in the range from3to60h.The time-response and the fact that an increased number of irradiated cells led to an increase in the medium toxicity were inter-preted as an indication that irradiated cells can release into the medium a factor able to in?uence survival of unexposed cells.In a subsequent work the authors hypothesised the secretion of a signalling molecule, rather than a factor toxic per se.Indeed the latter might be expected to provide a linear dose-response rather than a saturation-type effect[12].Furthermore, on the basis of heating/freezing tests,this signal was supposed to be protein-like:interleukin-8was consid-ered an“attractive candidate”.This protein,which is involved in in?ammatory responses(see Section2), has also been shown to be involved in a bystander in-crease of sister chromatid exchanges(SCEs)observed after conventional irradiation of human?broblasts with very low doses of alpha particles[15,16].

A possible role of the degree of cell-to-cell contact during irradiation was investigated[12]:medium was taken from normal human keratinocytes irradiated either as single cells,or microcolonies of three/four cells or con?uent monolayers.No signi?cant dif-ference was found between single cells and micro-colonies,whereas an increase in the medium toxicity was observed in the case of con?uent cultures.The authors concluded that the degree of cell–cell con-tact during irradiation was not signi?cant,whereas the number of irradiated cells is the only relevant parameter.Inhibition of gap-junction intercellular communication(GJIC)with the tumour promoter phorbol myristate acid(PMA)in con?uent cells led to a further increase in cell killing.The investigators provided no explanation for this phenomenon.On this subject,it is worthy remarking that the test for a possible role of GJIC is not consistent with the hy-pothesis of a protein-like signal,since the dimensions of gap-junction channels do not allow diffusion of proteins(see also Section2).By contrast,if smaller molecules were involved,the enhanced cell killing observed after GJIC inhibition might be explained as follows.If the signalling molecule is small enough to diffuse through gap-junction channels,it is likely that a fraction of the signal will be delivered to neigh-bouring cells rather than to the medium.Therefore, GJIC inhibition would lead to lower signal levels in neighbouring cells and thus higher signal levels in the medium,which would become more cytotoxic, consistent with the observed increase of cell killing. In a subsequent work the relative contributions of bystander and targeted cell killing were calculated after irradiation of human keratinocytes with60Co in the dose range between1and5Gy[14].Clonogenic survival was assumed to be a mixture of direct cell killing and bystander death.Direct cell death was calculated as the difference between total cell death (reduction in cloning ef?ciency of conventionally irradiated cells)and bystander cell death(reduction in cloning ef?ciency of unexposed cells treated with ICM).The data showed that below0.5Gy clonogenic cell death was due to bystander effects only,whereas after doses of0.5Gy and higher the curves were a combination between a dose-independent bystander effect and a non-bystander effect increasing with dose. Interestingly,a similar study on delayed cell death showed no signi?cant evidence for a non-bystander contribution below5Gy.

3.2.Conventional irradiation with low doses

of light ions

Evidence for some forms of bystander effect has been suggested also by conventional irradiation with low doses.One of the?rst studies in this?eld has showed a signi?cant,unexpected increase in the fre-quency of SCEs after exposure of Chinese hamster ovary(CHO)cells to very low doses of alpha particles, from0.03to0.25cGy[17].While about1%or less of the cells were actually traversed by a particle track, 30–45%of the individual cells showed increased levels of SCE.This suggests that genetic damage following exposure to very low doses of light ions may occur also in non directly-irradiated bystander cells.These?ndings,which have been ascribed to the generation of ROS outside of the nucleus,have been con?rmed by other research groups in the case of con?uent human?broblasts[15].The lowest dose delivered in the CHO cell experiment is almost10-fold lower than the annual exposure limit for the public indicated by the International Commission of Radi-

F.Ballarini et al./Mutation Research501(2002)1–125

ation Protection[18].This makes this study of great interest for its possible implications in the evaluation of the radiation action at very low doses.However, these results are of dif?cult interpretation in terms of health risks,since it is still not clear how SCE can be related to endpoints such as cell conversion to malignancy.

A few years later,the same group of authors has investigated a possible bystander modulation of the expression of speci?c genes following alpha particle irradiation[19].Normal human?broblasts synchro-nised in G0/G1phase were exposed to238Pu alpha particles in the dose range0.66–75cGy.The cells were then harvested for Western analysis of the expression of different genes including p53and p21, which are tumour suppressors involved in apoptosis and cell-cycle control.The fraction of cell nuclei tra-versed by an alpha particle was calculated by assum-ing that the average nuclear cross-section of a normal human?broblast is140?m2.This may represent a weak point for this study:a measurement of the actual dimensions of the cell nuclei would make the calcula-tion more accurate and reliable.Indeed the calculation of the fraction of actually traversed cells(generally based on the average number of particles and cells in a certain surface and on the average minimum energy deposited by each traversal)is one of the most critical points in bystander effect observations with low dose, charged-particle broad beams.Moreover,the role of intercellular communication might be overestimated, since a fraction of the effects ascribed to bystander mechanisms might be due to cytoplasmic irradiation. In any case,only a?ve-fold relative increase in the expression of p21was observed in correspondence to a16-fold increase in the fraction of traversed nuclei. This suggests that at0.66cGy a larger number of cells than those whose nuclei were actually traversed may contribute to the increase of p21levels[19].The extent of p53and p21modulation was signi?cantly reduced when cells were treated with lindane,which inhibits gap-junction intercellular communication via inhibition of connexin43,a major component of gap-junctions in skin?broblasts.The authors there-fore concluded that gap-junction-mediated communi-cation might be involved in the observed modulation of p53/p21expression in bystander cells.Seymour and Mothersill[13]commented that the role of gap-junctions suggested by Little and co-workers [19]disagrees with their results with ICM treatment. Indeed,by treating human keratinocytes with ICM [12],they found an increase(rather than the decrease that they expected)in the medium cytotoxicity after inhibiting gap-junctions with PMA.

However,it has to be taken into account that these two studies are completely different.In the experi-ment of Mothersill and Seymour(see also Section 3.1)each cell in the population would be exposed to photons and the endpoint of interest(i.e.cell death) was observed in non-exposed cells fed with medium taken from exposed cultures.By contrast,Little and co-workers directly irradiated a population of con-?uent cells(normal human?broblasts)with alpha particles.The doses were so low that only a small fraction of the cells were actually traversed by a parti-cle track.Therefore,the?ndings of these two studies can hardly be compared:different treatments(ICM treatment or direct radiation exposure),different doses (a few Gy or a few cGy)and also different,although probably correlated,endpoints(cell death or p53/p21 modulation).Indeed,when Mothersill and Seymour observed survival of human keratinocytes directly ir-radiated with60Co as single cells or microcolonies of different sizes(up to50cells),they did?nd a role of GJIC!In fact cell death was found to increase with the microcolony size.Moreover,GJIC inhibition dur-ing microcolony irradiation led to lower inactivation levels,similar to those observed with single cells[20]. Also a possible bystander induction of gene mu-tations,which are thought to have a major role in the initiation of radiation carcinogenesis,has been investigated with low-dose conventional irradiation [21].An unexpected increase of hprt gene mutations was observed in con?uent CHO cells exposed to very low?uences of238Pu alpha particles during the G1 phase of the cell cycle.The usual linear response was found over the range between5and1.2Gy.How-ever,mutation yields higher than those predicted by a linear back-extrapolation of higher dose data were measured below5cGy,where the mean number of traversals per nucleus was calculated to be in the range 0.05–0.3.This suggests the occurrence of mutations in non-irradiated bystander cells.On the basis of mi-crobeam experiments described in the literature[22], a role of cytoplasm irradiation was judged unlikely by the authors:indeed such experiments indicated that cytoplasm irradiation is much less effective than

6F.Ballarini et al./Mutation Research501(2002)1–12

nucleus irradiation in mutation induction.Further-more,it has to be taken into account that the volume occupied by the nucleus of CHO cells is very large with respect to the cytoplasmic volume.

The results reported by Nagasawa and Little might be of great interest for the estimate of health risks fol-lowing very low doses of alpha particles.It is worthy reminding that the estimation that as much as15%of lung cancers may be due to residential radon expo-sure[23]has been derived from linear,no-threshold back-extrapolations of data from underground miners exposed to higher doses.If the non-linearity found by Nagasawa and Little at low doses is con?rmed by further studies,also for in vivo exposure,data on cancer incidence may need to be re-interpreted and carcinogenesis models may need to be revised,at least at low doses.In this context it has to be taken into account a comment of Chadwick and Leenhouts[24], who re-examined the work described above by?tting a straight line to the complete set of mutation data, except the background point.The value of the back-ground mutation frequency resulting from this anal-ysis(0.41×10?5)was signi?cantly higher than the mutation yield measured in control cells by Nagasawa and Little(0.14×10?5).Chadwick and Leenhouts therefore concluded that this experiment provides no evidence for a bystander effect.However,Little and Nagasawa[25]responded that the measurement of the spontaneous mutation frequency was performed very carefully,and that there is no reason why the background value should be three-fold higher than the value that they actually measured.To support their interpretation,Little and Nagasawa outlined that their ?ndings are consistent with a published microbeam experiment,which showed mutation yields higher than expected after irradiation of mammalian cells with an alpha particle microbeam able to target indi-vidual cells[26].In any case it has to be pointed out that spontaneous mutation frequencies should be mea-sured in parallel to each dose value and then subtracted (taking also into account the propagation of errors), to minimise the risk of possible biases introduced by statistical?uctuations and biological variability.

3.3.Irradiation with microbeams

The studies discussed above strongly suggest a role of extranuclear-and possibly extracellular-targets in the propagation of certain damage types after irradia-tion with very low doses of light ions or treatment with ICM.Experiments allowing the identi?cation of spe-ci?c targets for such phenomena can be of great help to better understand the underlying mechanisms and to quantify the relative contributions of different targets. This kind of studies is now possible due to the increas-ing number of microbeam facilities(e.g.[27–37]).A few representative works will be discussed herein. At the Gray Laboratory(UK)human?broblasts in plateau phase were seeded into special dishes.Each dish was divided into four regions of5mm×5mm containing100–200cells and four targeted cells per dish(one per region)received?ve3MeV3He2+ particles through the centre of the nucleus[38]. Although only four cells had been directly traversed by radiation,80micronucleated and33apoptotic cells were observed over a total of3256scored cells.As a comparison,30micronucleated cells and no apoptotic cells were observed in a sham-irradiated control dish in which3076cells were scored.No signi?cant dif-ference was found by delivering to each targeted cell a higher number of particles(10or15).The authors explicitly stated that their data provide direct evidence for a cell-to-cell transmissible effect.Although they did not provide detailed suggestions for the underlying mechanisms,they judged more likely a medium-born effect with respect to gap-junction intercellular com-munication,since the targeted cells were irradiated as single units.Furthermore,on the basis of similarities with the instability phenotype observed by many in-vestigators(see,e.g.[39]),the authors suggested that the subcellular location of radiation may be a small component of the initial acute response,but may be-come more important in subsequent cell generations. The experiment described above has been re?ned later [40],when1–153He2+particles of105keV/?m were delivered through the centre of a human?broblast nu-cleus selected within600–800cells.A two–three-fold increase in the background frequency of micronucle-ated/apoptotic cells was found with respect to control dishes,where the same number of particles were deli-vered to a location outside a cell.The effect was observed also after a single particle traversal and no increase in the effect was observed by increasing the number of delivered particles.Since cell–cell contact was minimal and damaged cells appeared randomly distributed over the dish,the authors concluded that

F.Ballarini et al./Mutation Research501(2002)1–127

an extracellular factor was likely to be involved, although a possible role of gap-junctions could not be ruled out if cells were irradiated in close contact. In a subsequent work the3He2+microbeam has been used to irradiate a human epithelial tissue under in vivo-like conditions,where dividing and differen-tiated cells were present[41].Although the nuclei of only10cells from a primary uroepithelial explant were irradiated(with10particles),several thousand apoptotic and micronucleated cells were scored3days after irradiation.The higher effect observed with re-spect to the case of the?broblast experiment[38,40] was ascribed to the higher degree of cell-to-cell con-tact.Furthermore,irradiation of cells on the actively proliferating edge of the explant resulted in damaged cells mainly concentrated at the explant periphery. These?ndings are consistent with similar works available in the literature[42,43],in which an unusual response of human uroepithelium primary explants to low doses of60Co gamma-rays has been observed.To investigate whether similar bystander effects can oc-cur also after photon irradiation,a focused low-energy X-ray microprobe has recently been developed at the Gray Laboratory.This microbeam has a0.5?m diam-eter and is able to target speci?c regions of individual cells and to revisit both the irradiated and the unirra-diated cells—and their progeny—for scoring of dif-ferent damage types[44].This project is of particular interest because the irradiation of speci?c non-nuclear targets(such as mitochondria,which play a key role in modulating oxidative activity and apoptosis)can be of great help in elucidating the mechanisms underlying the various types of observable bystander effects.

A possible bystander induction of mutations has also been investigated with a microbeam[26].A randomly selected fraction(20%)of human–hamster hybrid cells in close contact was irradiated with20 alpha particles delivered by a microbeam targeting the cell nuclei.The cells were scored for mutations at the CD59locus of the human chromosome11and the ob-served mutant fraction was three-fold higher than the fraction predicted by assuming no bystander effect.No signi?cant difference was found by reducing the frac-tion of irradiated cells to10%.Pre-treatment of cells with the?OH scavenger DMSO had no signi?cant effect on mutation induction,whereas pre-treatment with lindane,which inhibits gap-junction intercellu-lar communication,led to a signi?cant decrease in the yield of mutants.This suggests a major role of cell-to-cell communication via gap-junctions with re-spect to free radicals.A signi?cant role of the culture medium was judged unlikely,since less than3?l of medium per dish were present at irradiation time.

In a previous work of the same group[22],the same endpoint has been investigated after targeted cytoplasmic irradiation.The treatment was found to be mutagenic at the CD59locus,but the toxicity was minimal.Moreover,most of the induced mutations were similar to spontaneous mutations and entirely different from mutations arising from irradiation of the cell nucleus.Experiments with radical scavengers suggested that the mutagenicity of cytoplasmic irra-diation might be mediated by the production of ROS.

4.Radiation-induced AR

Radiation-induced AR has been originally des-cribed more than15years ago in studies on chro-mosome aberration induction in human lymphocytes [45].Several experimental data have provided support for the occurrence of ARs in different cell systems.

A review can be found in[46,47].So far,this phe-nomenon has been observed both in vitro(human and animal,normal and tumour cell lines)and in vivo (mice)[48,49].AR can be expressed in different bio-logical endpoints including chromosome aberrations, gene mutations and cell survival[2].Adapting doses, i.e.doses that are effective at inducing AR,were found to be in the range5–20cGy for a single expo-sure to low LET radiation.ARs have been observed to decline with doses above20cGy and disappear with doses exceeding0.5Gy[50].

The biochemical and biological pathways involved in AR have not been clari?ed yet.The main hypothe-ses propose that low radiation doses can enhance DNA repair ability and antioxidant activity.Further-more,speci?c protective proteins might be produced ad hoc to compete with indirect damage induced by subsequent irradiation[51].An increase in apop-totic cell death has also been taken into account as a possible mechanism underlying AR[52].The most mentioned upside of AR is possible protection against radiation-induced tumours.However,it has to be taken into account that long-term AR might protect tumour masses against eradication by radiotherapy

8F.Ballarini et al./Mutation Research501(2002)1–12

[53].To what extent AR can decrease cancer risk and whether AR should affect current risk assessments is still an open question:opinion is split on this latter point.Some investigators have explicitly stated that the role of AR effects is so important that the lin-ear,no-threshold model has to be reconsidered(e.g. [2,3]).By contrast,others think that the current policy should not be changed until the mechanisms under-lying this phenomena are more clearly understood [54–56]:“(We)do not know enough about AR(or hormesis)to modify the entire set of guidelines”[56].

5.Possible implications for the estimate of

low-dose radiation action and the understanding of radiation carcinogenesis

“The understanding of the cellular basis of can-cer means being able to describe the biochemical of the regulated pathways between the cell surface and the nucleus that control cell growth”[57].This sen-tence summarises well what James Trosko named the “reductionalistic”view of carcinogenesis[58].On the other side,the“holistic”view of the problem is well represented by the approach of Potter[59],who has stated that“the cancer problem is not merely a cell problem,it is a problem of cell interaction,not only within tissues,but with distant cells in other tissues”. More generally,cancer can be viewed as a disease of homeostasis,i.e.the orchestration of speci?c cell/tissue/organ and organism functions such as cell proliferation,differentiation and ability to undergo apoptosis or adaptively respond.Indeed,a synthesis of these apparently con?icting approaches can be found only on the basis of deep mechanistic studies of the possible occurring events,taking into account possi-ble stochastic phenomena.In this context it has been hypothesised that the disruption of GJIC plays a major role in tumour promotion,starting from the working assumption that the“dysfunctional GJIC theory”can integrate all of the other carcinogenesis theories,since each of them is related to GJIC[58].The integration of the“initiation/promotion/progression theory”is worthy being reported as a paradigm of this approach, which led to a re-interpretation of the three classical steps(initiation,promotion and progression)of one of the most diffused carcinogenesis theory in terms of cell-to-cell communication.The?rst step was identi?ed with a stable alteration of a gene controlling terminal differentiation but not altering proliferation, leading to a certain number of non-terminally differ-entiated cells.Inhibition of GJIC in these“initiated”cells by endogenous factors or exogenous chemicals would then lead to clonal expansion,i.e.the forma-tion of a monoclonally-derived focus of benign cells (promotion).Finally,genomic inhibition of GJIC would lead to progression,i.e.the autonomous growth of the tumour mass.The thesis of a major role of gap-junctions in tumour promotion is supported by a series of experimental evidences:(a)GJIC is reduced in most neoplastic cells,which have fewer and smaller gap-junctions;(b)GJIC can be inhibited by growth stimuli such as carcinogens and oncogenes;(c)GJIC is stimulated by growth inhibitors such as retinoids and(d)growth of neoplastic cells can be inhibited by co-culture with normal cells,which possibly secrete growth inhibitors in the medium.It is worthy remind-ing that modulation of intercellular communication is the basis of gene therapy,which consists in intro-ducing active connexin genes in tumour cells.This treatment leads to an increase of gap-junction activity, which can help in increasing drug penetration in the tumour mass.Gene therapy itself can be viewed as a bystander effect,since many cells are killed although only a few cells are injected.

A non-linear response at low doses is one of the most interesting characteristics of bystander effect observations.If this feature is con?rmed also in vivo,cancer risk models at low doses,which are of interest for occupational exposures and also public exposures(e.g.inhalation of residential radon),may need to be re-evaluated.Low-dose cancer risk is gen-erally estimated on the basis of linear,no-threshold back-extrapolations of higher dose data from epi-demiological studies,such as the analyses on the atom-bomb survivors of Hiroshima and Nagasaki. However,a low-dose supra-linear response for end-points such as gene mutations,possibly due to by-stander effects,would lead to an increase in the number of“initiated”cells,and thus an increase of low-dose cancer risk.On the other side,bystander effects can enhance cell killing and this might act as a protective mechanism competing with the increase of non-lethal,potentially carcinogenic damage(e.g. mutations).Thus,the overall effect of bystander path-ways on low-dose radiation risk would be determined

F.Ballarini et al./Mutation Research501(2002)1–129

by the balance between these two contributions(cell

killing versus damage types such as mutations,which

generally do not affect cell proliferation but can initi-

ate carcinogenesis).A quantitative estimation of these

two contributions is therefore one of the main goals

in this?eld.Some experimental studies seem to sug-

gest that the contribution of bystander effects to cell

killing is signi?cantly higher than the contribution to

mutations.For instance33apoptotic cells were ob-

served after microbeam irradiation of four cells[38],

whereas only a?ve-fold increase of hprt mutations

in CHO cells was found[21].However,the scenario

might be much more complicated due to a possible

role of bystander-induced delayed effects,i.e.bio-

logical effects that appear only in the cell progenie.

Dose-response curves found in studies on bystander

effects are very similar to those found for genomic

instability,which includes both delayed cell death

and delayed non-lethal damage.Thus,it is likely that

at low doses genomic instability also can be induced

in non-irradiated bystander cells.This hypothesis is

supported by a work suggesting a role of GJIC in de-

layed death of human epithelial cells irradiated with 60Co[20].Interestingly,for initial clonogenic cell death a dose-dependent contribution of direct irradi-

ation appeared above0.5Gy,whereas no signi?cant

contribution of direct irradiation to delayed death

was observed in the dose range0–5Gy.This would

imply that the relative contributions of bystander ef-

fects to initial cell death and non-lethal damage may

not be suf?cient to re-evaluate low-dose cancer risk:

also the contributions of genomic instability should

be taken into account.Further complications would

arise by taking into account also a possible synergism

between bystander effects and AR,whose implica-

tions for low-dose risk have been discussed above.

Incidentally,some low-dose supra-linearity in cancer

incidence has been inferred by a re-evaluation of the

data provided by Japanese survivors[60].It is not

easy to assess the reliability of this analysis.However,

the following comment is worthy being reported:

“The linear non-threshold dose-response hypothe-

sis may be used as a simple,convenient method to

calculate numbers in radiation protection planning

but should not be mistaken as a stringent scienti?c

conclusion directly derived from the present state

of knowledge of the processes involved in radiation

carcinogenesis”[61].6.Discussion and conclusions

A few representative,and therefore non-exhaustive, experimental studies suggesting evidence for different radiation-induced bystander effects(e.g.cell killing and gene mutations)were discussed.Some general features were identi?ed:bystander effects are ob-served at very low doses(down to the order of the mGy),do not increase signi?cantly with dose and do not contribute signi?cantly to total damage at higher doses.The features of such phenomena seem to be strongly dependent on different factors,such as:(a) the way in which the radiation insult is delivered (conventional irradiation with low doses,irradiation with microbeams or treatment with ICM);(b)the cell type(normal or cancerous,human or animal,epithe-lial or?broblastic,etc.)and the cell-cycle stage;(c)in the case of direct irradiation,the degree of cell-to-cell contact;(d)in the case of ICM treatment,the number of irradiated cells and possibly the medium con-stituents and(e)the particular endpoint in study. Bystander effects have many aspects in common with AR,which might represent a competing phenomenon with respect to the determination of low-dose effects. Several models of the induction of different damage types following direct irradiation have been devel-oped(see, e.g.[62]for cell inactivation,[63]for chromosome aberrations,[64]for hprt mutations and [65]for free radical production).However,modelling bystander effects and/or AR would require a quanti?-cation of the role played by the factors outlined above. In the case of ICM treatment,killing of unex-posed cells has been ascribed to the secretion of a protein-like signal able to initiate apoptosis in cells fed with ICM.Interleukin-8has been proposed as a possible candidate.An alternative,equally attractive candidate is the TNF-?mentioned in Section2.This protein belongs to the cytokine family and can trigger apoptosis of keratinocytes via the receptor TNF-Rp55 (see[66]for a review on UV-induced apoptosis in keratinocytes).In fact while TNF-?can be produced by keratinocytes,TNF-Rp55,which is ubiquitously expressed and is thought to be involved in mediat-ing cytotoxicity and?broblast proliferation,has been shown to be implicated as the main mediator of apop-tosis in non-lymphoid cells.This is consistent with the observation that medium from irradiated keratinocytes can induce cell killing in unexposed?broblasts.The

10F.Ballarini et al./Mutation Research501(2002)1–12

fact that medium from irradiated keratinocytes is toxic to unexposed?broblasts is extremely intriguing, since it can be viewed as an in vitro reproduction of tissue-speci?c responses that can be observed in vivo:the skin response to UV irradiation is a typical example.A product of lipid oxydation may represent another candidate.To what extent the particular con-ditions of ICM treatments can reproduce the in vivo cellular environment,and thus to what extent these ?ndings can be applied to radiation carcinogenesis studies,has still to be clari?ed.

By contrast,in the case of direct exposure of cell cultures to radiation the degree of cell-to-cell contact seems to be a key parameter.If cells are in close contact,gap-junctions seem to have a major role, whereas if the degree of contact is poor,the culture medium also seems to be important.In fact inhibition of gap-junction activity in cells irradiated in close contact resulted in decreased levels of cell death[20], p53/p21induction[19]and gene mutations[26].On the other side,a microbeam experiment performed with minimal cell-to-cell contact resulted in a random distribution of damaged cells over the entire surface of the culture dish[40],suggesting a major role of an extracellular factor released in the medium,rather than gap-junctions.With respect to low-dose conven-tional irradiation,for which the fraction of traversed cells is estimated on the basis of the cell dimensions, microbeam techniques have the great advantage to allow targeting and monitoring of speci?c regions of individual cells.However,it cannot be neglected that some procedures of cell staining(for example UV ill-umination)might modify the experimental conditions and introduce a bias in these experiments. Microbeam irradiation of human cells harvested for both initial and delayed cell death and hprt muta-tions can be crucial experiments to better understand the mechanisms underlying bystander effects.From one side microbeam techniques would allow one to target and“follow up”individual cell nuclei,whereas on the other side radiation-induced hprt mutations are one of the most well known endpoints in radiobi-ology.As for concerns the identi?cation of possible signalling molecules,the hypothesis of a major role of TNF-?in cell-killing induction after ICM treat-ment of human keratinocytes(see Section4)might be tested by a treatment with an anti-TNF-?anti-body,which has been found to signi?cantly reduce UVB-induced apoptosis in keratinocytes.If this test is not successful,speci?c molecules might be identi?ed by comparison of gel electrophoresis bands obtained before and after irradiation:when a band of increased intensity appears,that band might be isolated and sequenced.More generally,a progressive separation of the different medium components might be of some help as a?rst approximation.Animal studies, together with microbeam irradiation of tissue cultures obtained with the primary explant growth technique, can be of great help in clarifying to what extent in vitro?ndings can be applied to the in vivo case. Acknowledgements

We are extremely grateful to Dr.Mario Faretta of the European Institute of Oncology(Milan,Italy)and Dr.Roberto Cherubini of the National Laboratories of Legnaro(Italy)for useful discussions and sug-gestions.This work was partially funded by the EC (contract no.FIGH-CT1999-00005,“Low dose risk models”)and the Italian Space Agency(ASI,contract no.I/R/090/00).

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两学一做当先锋改革强军显作为演讲稿

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