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Characteristion and pharmacological modulation of radio-induced intestinal inflammation

Olivier GREMY, doctorate thesis of the Versailles Saint-Quentin-en-Yvelines university, defended on January 14, 2006


The use of radiation therapy to treat abdominal and pelvic malignancies inevitably involves exposure of healthy intestinal tissues which are very radiosensitive. As a result, most patients experience symptoms such as abdominal pain, nausea and diarrhoea. Such symptoms are associated with acute damage to intestine mucosa including radio-induced inflammatory processes. With a rat model of colorectal fractionated radiation, we have shown a gradual development of a colonic inflammation during radiation planning, without evident tissue injury. This radio-induced inflammation is characterized not only by the surexpressions of pro-inflammatory cytokines and chemokines, a NF-kB activation, but also by a repression of antiinflammatory cytokines and the nuclear receptors PPARa and RXRa, both involved in inflammation control. This early inflammation is associated with a discreet neutrophil recruitment and a macrophage accumulation. Macrophages are still abnormally numerous in tissue 27 weeks after the last day of irradiation. nflammatory process is the most often related to a specific immune profile, either a type Th1 leading to a cellular immune response, or a type Th2 for humorale immunity. According to our studies, a unique abdominal radiation in the rat induces an ileum inflammation and an immune imbalance resulting in a Th2-type profile. Inhibiting this profile is important as its persistence promotes chronic inflammation, predisposition to bacterial infections and fibrosis which is the main delayed side-effect of radiotherapy. The treatment of rats with an immunomodulator compound, the caffeic acid phenetyl ester (CAPE), have the potential to both reduce ileal mucosal inflammation and inhibit the radio-induced Th2 status. In order to search new therapeutic molecular target, we has been interested in the PPARg nuclear receptor involved in the maintenance of colon mucosal integrity. In our abdominal irradiation model, we have demonstrated that the prophylactic treatment with a PPARg synthetic ligand, the so-called 5-aminosalicylic acid (5-ASA), protects against the development of the acute mucosal colon inflammation. This pharmacological drug restrains radio-induced expression of proinflammatory molecular actors such as TNFa, MCP-1 and iNOS, it also limits the repression of nuclear receptors involved in inflammation control such as PPARg, and reduces the radio-induced accumulation of macrophages. These results could give some leads to find therapeutic drug to limit radio-induced early mucosal and consequently, to improve patients' comfort during and after the radiotherapy schedule.


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