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Current Drug Research Reviews

Editor-in-Chief

ISSN (Print): 2589-9775
ISSN (Online): 2589-9783

Research Article

Protective Effect of Metformin, Resveratrol and Alpha-lipoic Acid on Radiation- Induced Pneumonitis and Fibrosis: A Histopathological Study

Author(s): Rasoul Yahyapour, Peyman Amini, Hana Saffar, Elahe Motevaseli, Bagher Farhood, Vahid Pooladvand, Dheyauldeen Shabeeb, Ahmed Eleojo Musa and Masoud Najafi*

Volume 11, Issue 2, 2019

Page: [111 - 117] Pages: 7

DOI: 10.2174/2589977511666191018180758

Abstract

Background: Radiation-induced pneumonitis and fibrosis are the most common side effects of chest radiotherapy. They result from massive and chronic production of Reactive Oxygen Species (ROS), inhibition of antioxidant enzymes as well as the release of several inflammatory mediators. In this study, we aimed to detect the radioprotective effects of metformin (as inhibitor of mitochondrial ROS), resveratrol (as stimulator of antioxidant defense enzymes) and alpha-lipoic acid (as direct antioxidant) for alleviating radiation-induced pneumonitis and fibrosis.

Methods: 80 Male Mice were randomly allotted to eight groups which include G1: control; G2: resveratrol; G3: alpha-lipoic acid; G4: metformin; G5: radiation; G6: radiation plus resveratrol; G7: radiation plus alpha-lipoic acid; G8: radiation plus metformin. Drugs’ doses were as follows: 100 mg/kg metformin, 200 mg/kg resveratrol and 200 mg/kg alpha-lipoic acid. Irradiation with a single radiation dose of 18 Gy was performed using a cobalt-60 (60Co) gamma-ray source. After 80 days, all mice were sacrificed and their lung tissues evaluated for morphological changes using histopathological markers.

Results: Irradiation led to acute pneumonitis including infiltration of inflammatory cells and damages to alveolar and vascular, as well as mild fibrosis. Metformin, alpha-lipoic acid and resveratrol were able to reduce pneumonitis and overcome radiation-induced fibrosis.

Conclusion: All agents could protect against radiation-induced lung injury moderately. It is possible that administering higher doses of these drugs over a long period of time could give better radioprotection of the lung.

Keywords: Radiation, lung, fibrosis, metformin, alpha-lipoic acid, resveratrol.

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[1]
Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin 2017; 67(1): 7-30.
[http://dx.doi.org/10.3322/caac.21387] [PMID: 28055103]
[2]
Ayres BE, Sooriakumaran P. Future prospects, who is the patient who still dies of prostate cancer following local treatment of high-risk prostate cancer? Can we prolong their lives using modern treatment approaches? Curr Opin Urol 2013; 23(4): 372-6.
[http://dx.doi.org/10.1097/MOU.0b013e328361ebea] [PMID: 23665741]
[3]
Jiang W, Chan CK, Weissman IL, Kim BYS, Hahn SM. Immune priming of the tumor microenvironment by radiation. Trends Cancer 2016; 2(11): 638-45.
[http://dx.doi.org/10.1016/j.trecan.2016.09.007] [PMID: 28741502]
[4]
Abdollahi H. Probiotic-based protection of normal tissues during radiotherapy. Nutrition 2014; 30(4): 495-6.
[http://dx.doi.org/10.1016/j.nut.2013.09.006] [PMID: 24607309]
[5]
Razzaghdoust A, Mozdarani H, Mofid B. Famotidine as a radioprotector for rectal mucosa in prostate cancer patients treated with radiotherapy. Phase I/II randomized placebo-controlled trial. Strahlenther Onkol 2014; 190(8): 739-44.
[http://dx.doi.org/10.1007/s00066-014-0602-8] [PMID: 24619016]
[6]
Saadipoor A, Razzaghdoust A, Simforoosh N, et al. Randomized, double-blind, placebo-controlled phase II trial of nanocurcumin in prostate cancer patients undergoing radiotherapy. Phytother Res 2019; 33(2): 370-8.
[PMID: 30427093]
[7]
Deas SD, Huprikar N, Skabelund A. Radiation exposure and lung disease in today’s nuclear world. Curr Opin Pulm Med 2017; 23(2): 167-72.
[http://dx.doi.org/10.1097/MCP.0000000000000349] [PMID: 27906856]
[8]
Barjaktarovic Z, Schmaltz D, Shyla A, et al. Radiation-induced signaling results in mitochondrial impairment in mouse heart at 4 weeks after exposure to X-rays. PLoS One 2011; 6(12)e27811
[http://dx.doi.org/10.1371/journal.pone.0027811] [PMID: 22174747]
[9]
Kim GJ, Fiskum GM, Morgan WF. A role for mitochondrial dysfunction in perpetuating radiation-induced genomic instability. Cancer Res 2006; 66(21): 10377-83.
[http://dx.doi.org/10.1158/0008-5472.CAN-05-3036] [PMID: 17079457]
[10]
Edvardsen H, Landmark-Høyvik H, Reinertsen KV, et al. SNP in TXNRD2 associated with radiation-induced fibrosis, a study of genetic variation in reactive oxygen species metabolism and signaling. Int J Radiat Oncol Biol Phys 2013; 86(4): 791-9.
[http://dx.doi.org/10.1016/j.ijrobp.2013.02.025] [PMID: 23597419]
[11]
Citrin D, Cotrim AP, Hyodo F, Baum BJ, Krishna MC, Mitchell JB. Radioprotectors and mitigators of radiation-induced normal tissue injury. Oncologist 2010; 15(4): 360-71.
[http://dx.doi.org/10.1634/theoncologist.2009-S104] [PMID: 20413641]
[12]
Brizel DM, Wasserman TH, Henke M, et al. Phase III randomized trial of amifostine as a radioprotector in head and neck cancer. J Clin Oncol 2000; 18(19): 3339-45.
[http://dx.doi.org/10.1200/JCO.2000.18.19.3339] [PMID: 11013273]
[13]
Koritzinsky M. Metformin: A novel biological modifier of tumor response to radiation therapy. Int J Radiat Oncol Biol Phys 2015; 93(2): 454-64.
[http://dx.doi.org/10.1016/j.ijrobp.2015.06.003] [PMID: 26383681]
[14]
Nna VU, Abu Bakar AB, Md Lazin MRML, Mohamed M. Antioxidant, anti-inflammatory and synergistic anti-hyperglycemic effects of Malaysian propolis and metformin in streptozotocin-induced diabetic rats. Food Chem Toxicol 2018; 120: 305-20.
[http://dx.doi.org/10.1016/j.fct.2018.07.028] [PMID: 30026088]
[15]
Kim JH, Kim KM, Jung MH, et al. Protective effects of alpha lipoic acid on radiation-induced salivary gland injury in rats. Oncotarget 2016; 7(20): 29143-53.
[http://dx.doi.org/10.18632/oncotarget.8661] [PMID: 27072584]
[16]
Jimoh A, Tanko Y, Ahmed A, Mohammed A, Ayo JO. Resveratrol prevents high-fat diet-induced obesity and oxidative stress in rabbits. Pathophysiology 2018; 25(4): 359-64.
[http://dx.doi.org/10.1016/j.pathophys.2018.07.003] [PMID: 30017743]
[17]
Shay KP, Moreau RF, Smith EJ, Smith AR, Hagen TM. Alpha-lipoic acid as a dietary supplement, molecular mechanisms and therapeutic potential. Biochim Biophys Acta 2009; 1790(10): 1149-60.
[http://dx.doi.org/10.1016/j.bbagen.2009.07.026] [PMID: 19664690]
[18]
Zannella VE, Dal Pra A, Muaddi H, et al. Reprogramming metabolism with metformin improves tumor oxygenation and radiotherapy response. Clin Cancer Res 2013; 19(24): 6741-50.
[http://dx.doi.org/10.1158/1078-0432.CCR-13-1787] [PMID: 24141625]
[19]
Kma L. Synergistic effect of resveratrol and radiotherapy in control of cancers. Asian Pac J Cancer Prev 2013; 14(11): 6197-208.
[http://dx.doi.org/10.7314/APJCP.2013.14.11.6197] [PMID: 24377505]
[20]
Fang Y, DeMarco VG, Nicholl MB. Resveratrol enhances radiation sensitivity in prostate cancer by inhibiting cell proliferation and promoting cell senescence and apoptosis. Cancer Sci 2012; 103(6): 1090-8.
[http://dx.doi.org/10.1111/j.1349-7006.2012.02272.x] [PMID: 22417066]
[21]
Ryu SH, Park EY, Kwak S, et al. Protective effect of α-lipoic acid against radiation-induced fibrosis in mice. Oncotarget 2016; 7(13): 15554-65.
[http://dx.doi.org/10.18632/oncotarget.6952] [PMID: 26799284]
[22]
Dozio E, Ruscica M, Passafaro L, et al. The natural antioxidant alpha-lipoic acid induces p27(Kip1)-dependent cell cycle arrest and apoptosis in MCF-7 human breast cancer cells. Eur J Pharmacol 2010; 641(1): 29-34.
[http://dx.doi.org/10.1016/j.ejphar.2010.05.009] [PMID: 20580704]
[23]
Roy S, Sannigrahi S, Majumdar S, Ghosh B, Sarkar B. Resveratrol regulates antioxidant status, inhibits cytokine expression and restricts apoptosis in carbon tetrachloride induced rat hepatic injury. Oxid Med Cell Longev 2011; 2011703676
[http://dx.doi.org/10.1155/2011/703676] [PMID: 22013498]
[24]
Jia J, Gong X, Zhao Y, et al. autophagy enhancing contributes to the organ protective effect of alpha-lipoic acid in Septic Rats. Front Immunol 2019; 10: 1491.
[http://dx.doi.org/10.3389/fimmu.2019.01491] [PMID: 31333648]
[25]
Cadirci E, Altunkaynak BZ, Halici Z, et al. Alpha-lipoic acid as a potential target for the treatment of lung injury caused by cecal ligation and puncture-induced sepsis model in rats. Shock 2010; 33(5): 479-84.
[PMID: 19823117]
[26]
Kim JM, Yoo H, Kim JY, et al. metformin alleviates radiation-induced skin fibrosis via the downregulation of FOXO3. Cell Physiol Biochem 2018; 48(3): 959-70.
[http://dx.doi.org/10.1159/000491964] [PMID: 30036874]
[27]
Azmoonfar R, Amini P, Saffar H, et al. Metformin protects against radiation-induced pneumonitis and fibrosis and attenuates upregulation of dual oxidase genes expression. Adv Pharm Bull 2018; 8(4): 697-704.
[http://dx.doi.org/10.15171/apb.2018.078] [PMID: 30607342]
[28]
Kubiak BD, Albert SP, Gatto LA, et al. Peritoneal negative pressure therapy prevents multiple organ injury in a chronic porcine sepsis and ischemia/reperfusion model. Shock 2010; 34(5): 525-34.
[http://dx.doi.org/10.1097/SHK.0b013e3181e14cd2] [PMID: 20823698]
[29]
Carver JR, Shapiro CL, Ng A, et al. American society of clinical oncology clinical evidence review on the ongoing care of adult cancer survivors: Cardiac and pulmonary late effects. J Clin Oncol 2007; 25(25): 3991-4008.
[http://dx.doi.org/10.1200/JCO.2007.10.9777] [PMID: 17577017]
[30]
Bahig H, Filion E, Vu T, et al. Severe radiation pneumonitis after lung stereotactic ablative radiation therapy in patients with interstitial lung disease. Pract Radiat Oncol 2016; 6(5): 367-74.
[http://dx.doi.org/10.1016/j.prro.2016.01.009] [PMID: 27068780]
[31]
Szabo S, Ghosh SN, Fish BL, et al. Cellular inflammatory infiltrate in pneumonitis induced by a single moderate dose of thoracic x radiation in rats. Radiat Res 2010; 173(4): 545-56.
[http://dx.doi.org/10.1667/RR1753.1] [PMID: 20334527]
[32]
Westbury CB, Haviland J, Davies S, et al. Cytokine levels as biomarkers of radiation fibrosis in patients treated with breast radiotherapy. Radiat Oncol 2014; 9: 103.
[http://dx.doi.org/10.1186/1748-717X-9-103] [PMID: 24885397]
[33]
Rahman I, Biswas SK, Kirkham PA. Regulation of inflammation and redox signaling by dietary polyphenols. Biochem Pharmacol 2006; 72(11): 1439-52.
[http://dx.doi.org/10.1016/j.bcp.2006.07.004] [PMID: 16920072]
[34]
Robbins ME, Zhao W. Chronic oxidative stress and radiation-induced late normal tissue injury, a review. Int J Radiat Biol 2004; 80(4): 251-9.
[http://dx.doi.org/10.1080/09553000410001692726] [PMID: 15204702]
[35]
Zhao W, Robbins ME. Inflammation and chronic oxidative stress in radiation-induced late normal tissue injury: Therapeutic implications. Curr Med Chem 2009; 16(2): 130-43.
[http://dx.doi.org/10.2174/092986709787002790] [PMID: 19149566]
[36]
Chen C, Yang S, Zhang M, et al. Triptolide mitigates radiation-induced pulmonary fibrosis via inhibition of axis of alveolar macrophages-noxes-ROS-myofibroblasts. Cancer Biol Ther 2016; 17(4): 381-9.
[http://dx.doi.org/10.1080/15384047.2016.1139229] [PMID: 27003327]
[37]
Choi SH, Kim M, Lee HJ, Kim EH, Kim CH, Lee YJ. Effects of NOX1 on fibroblastic changes of endothelial cells in radiation-induced pulmonary fibrosis. Mol Med Rep 2016; 13(5): 4135-42.
[http://dx.doi.org/10.3892/mmr.2016.5090] [PMID: 27053172]
[38]
Büttner C, Skupin A, Reimann T, et al. Local production of interleukin-4 during radiation-induced pneumonitis and pulmonary fibrosis in rats: Macrophages as a prominent source of interleukin-4. Am J Respir Cell Mol Biol 1997; 17(3): 315-25.
[http://dx.doi.org/10.1165/ajrcmb.17.3.2279] [PMID: 9308918]
[39]
Xu G, Wu H, Zhang J, et al. Metformin ameliorates ionizing irradiation-induced long-term hematopoietic stem cell injury in mice. Free Radic Biol Med 2015; 87: 15-25.
[http://dx.doi.org/10.1016/j.freeradbiomed.2015.05.045] [PMID: 26086617]
[40]
Sato N, Takasaka N, Yoshida M, et al. Metformin attenuates lung fibrosis development via NOX4 suppression. Respir Res 2016; 17(1): 107.
[http://dx.doi.org/10.1186/s12931-016-0420-x] [PMID: 27576730]
[41]
Zhang H, Zhai Z, Wang Y, et al. Resveratrol ameliorates ionizing irradiation-induced long-term hematopoietic stem cell injury in mice. Free Radic Biol Med 2013; 54: 40-50.
[http://dx.doi.org/10.1016/j.freeradbiomed.2012.10.530] [PMID: 23124026]
[42]
Li D, Tian Z, Tang W, et al. The protective effects of 5-methoxytryptamine-α-lipoic acid on ionizing radiation-induced hematopoietic injury. Int J Mol Sci 2016; 17(6): 935.
[http://dx.doi.org/10.3390/ijms17060935] [PMID: 27314327]
[43]
Zhang H, Yan H, Zhou X, et al. The protective effects of resveratrol against radiation-induced intestinal injury. BMC Complement Altern Med 2017; 17(1): 410.
[http://dx.doi.org/10.1186/s12906-017-1915-9] [PMID: 28814292]
[44]
Jeong BK, Song JH, Jeong H, et al. Effect of alpha-lipoic acid on radiation-induced small intestine injury in mice. Oncotarget 2016; 7(12): 15105-17.
[http://dx.doi.org/10.18632/oncotarget.7874] [PMID: 26943777]

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