Thermal enhancement of the radiation damage in the mouse foot at different heat and radiation dose: influence of thermotolerance

We studied the reaction of the mouse foot after combined X-irradiation and heat treatment. Acute reactions after heat differ from those after irradiation, however, after healing of the lesions, the same symptoms of deformity of the mouse foot remain. Prior heat treatment, 30 min at 43 degrees C, of the foot led to thermotolerance and this thermotolerance resulted in resistance to combined irradiation-heat treatments and hence to a decreased thermal enhancement of radiation effects. Resistance could be observed up to 168 h after prior heat treatment. The development of resistance to combined treatment at higher irradiation dose (15 or 20 Gy) and less severe heating was slower than at lower irradiation dose (10 Gy) and more severe heating. Thermal enhancement was confirmed to be dependent on the sequence of, and the interval between irradiation and heat treatment. When the mouse foot was made thermotolerant by prior heat treatment, thermal enhancement was always reduced, regardless of the sequence, when the combined heat and radiation treatments were given with an interval of less than 12 h. Thermotolerance led to an apparent decrease in the effective temperature employed in a combined treatment equivalent to approximately 1.0 degrees C, at temperatures above 43 degrees C in a 1 h heat treatment.     

The individual and combined effects of X-irradiation and hyperthermia on early somite mouse embryos in culture.

The effects of 1) X-irradiation and 2) hyperthermia at a temperature of 43 degrees C individually and in combination have been investigated using cultured 8-day mouse embryos. B6C3F1 embryos were exposed to 0.3-2.0 Gy of X-rays, 5-20 min of heating, or 5 min of heating and irradiation at 0.3, 0.6, and 0.9 Gy. Irradiation alone at 0.3 Gy showed no apparent effect on embryonic development, but irradiation at 0.6-2.0 Gy caused a dose-dependent increase in malformed embryos. Heating alone for 5 min produced no malformed embryos, while heating for 10-20 min caused malformations as a function of heating time. Combined treatments produced higher frequencies (22.2-100%) of malformations than those of the sum of the separate treatments (0-41.7%). Malformations observed were primarily microphthalmia, microcephaly, and open neural tubes. The results indicate that in cultured mouse embryos irradiation combined with a "nonteratogenic dose" of hyperthermia directly exerts an additive effect on formation of the malformed embryos. In addition, a single occurrence of left-sided tail was produced by hyperthermia alone, while four occurrences were produced in combination with radiation.     

Assay of premorbid murine jejunal fibrosis based on mechanical changes after X irradiation and hyperthermia

Preparative surgery immobilized 15 mm of functional jejunum against the peritoneal surface of the ventral abdominal wall in C3H/HeJ mice. The surgery allowed subsequent treatments with single fractions of 44 degrees C hyperthermia and X irradiation to be selective to this portion of small intestine. With each doubling of time since treatment, 1 through 70 weeks, a sample of mice was killed and specimens of their intestines were excised and radially stretched in a tensile-testing apparatus that measured tension as a continuous function of circumference. Preconditioning with repeated cycles of stretch and relaxation before specimens were irreversibly stretched enabled measurement of the limit collagen placed on the extensibility of the intestinal wall by physiologic forces and the stiffness of the intestinal collagen once that limit was exceeded. Both kinds of measurements made possible dose-response characterization of radiation fibrosis for treatments that killed no mice. Response increased linearly with X-ray dose above a threshold. After X rays alone the threshold remained constant at 9.7 +/- 0.6 Gy for the assays at 1 through 8 weeks and subsequently decreased to about 6 Gy by 35 weeks. With adjuvant hyperthermia of 15 min at 44 degrees C beginning 10 min after X irradiation, the threshold of approximately 5 Gy at 2-4 weeks decreased to about 2 Gy by 17 weeks; the thermal enhancement ratio as calculated from slope-ratio analysis of the dose-response curves was 1.50 +/- 0.08 at 2-4 weeks post-treatment and 1.96 +/- 0.05 at 17-70 weeks post-treatment. Up to 20 min at 44 degrees C by itself was without effect. From comparisons of these data with results of crypt microcolony assays, it was concluded that intestinal fibrosis was both a chronic sequela of acute mucosal injury and a late effect of X irradiation. Adjuvant hyperthermia both hastened the expression of the late effect and increased its severity beyond that predicted from the acute injury.     

Thermotherapy of VX2 rabbit carcinoma. I. Augmentation by irradiation

An induction-type radiofrequency generator was used to heat thigh implants of the VX2 rabbit carcinoma. The tumor temperature could be easily raised to over 50 degrees C, while the temperature of normal adjacent muscle generally remained at about 43 degrees C. The marked hypovascularity of the tumor, as demonstrated angiographically, probably explains this disproportionate hyperthermic reaction to administered heat. Twenty-five untreated rabbits succumbed to their tumors after a mean interval of 38 days. Of 24 rabbits with tumors heated to between 48 and 50 degrees C for 30 to 45 min, 5 (21%) were permanently cured. Of 10 rabbits treated with 1000 R in a single dose, none were cured. Of 12 rabbits treated with 1000 R, followed after 3.5 hr with 30 min of heating to 48-49 degrees C, 11 were locally cured. Thus a synergistic effect between hyperthermia and irradiation was demonstrated.     

The effect of hyperthermia on radiation-induced carcinogenesis

Ten groups of mice were exposed to either a single (30 Gy) or multiple (six fractions of 6 Gy) X-ray doses to the leg. Eight of these groups had the irradiated leg made hyperthermic for 45 min immediately following the X irradiation to temperatures of 37 to 43 degrees C. Eight control groups had their legs made hyperthermic with a single exposure or six exposures to heat as the only treatment. In mice exposed to radiation only, the postexposure subcutaneous temperature was 36.0 +/- 1.1 degrees C. Hyperthermia alone was not carcinogenic. At none of the hyperthermic temperatures was the incidence of tumors in the treated leg different from that induced by X rays alone. The incidence of tumors developing in anatomic sites other than the treated leg was decreased in mice where the leg was exposed to hyperthermia compared to mice where the leg was irradiated. A systemic effect of local hyperthermia is suggested to account for this observation. In mice given single X-ray doses and hyperthermia, temperatures of 37, 39, or 41 degrees C did not influence radiation damage as measured by the acute skin reactions. A hyperthermic temperature of 43 degrees C potentiated the acute radiation reaction (thermal enhancement factor 1.1). In the group subjected to hyperthermic temperatures of 37 or 39 degrees C and X rays given in six fractions, the skin reaction was no different from that of the group receiving X rays alone. Hyperthermic temperatures of 41 and 43 degrees C resulted in a thermal enhancement of 1.16 and 1.36 for the acute skin reactions. From Day 50 to Day 600 after treatment, the skin reactions showed regular fluctuations with a 150-day periodicity. Following a fractionated schedule of combined hyperthermia and X rays, late damage to the leg was less than that following X irradiation alone. Mice subjected to X rays and hyperthermic temperatures of 41 and 43 degrees C had a lower median survival time than the mice treated with hyperthermia alone. This effect was not associated with tumor incidence.     

Influence of hyperthermia on gamma-ray-induced mutation in V79 cells

Asynchronously growing V79 cells were assayed for mutation induction following exposure to hyperthermia either immediately before or after being irradiated with 60Co gamma rays. Hyperthermia exposures consisted of either 43.5 degrees C for 30 min or 45 degrees C for 10 min. Each of these heat treatments resulted in a survival level of 42%. For all sequences of combined treatment with hyperthermia and radiation, cell killing by gamma rays was enhanced. Mutation induction by gamma rays was enhanced when heat preceded gamma irradiation, but no increase was observed when heat was given after gamma exposures. Treatment at 45 degrees C for 10 min gave a higher yield in mutants at all gamma doses studied compared to treatment at 43.5 degrees C for 30 min. When heat-treated cells were incubated for different periods before being exposed to gamma rays, thermal enhancement of radiation killing was lost after 24 h. In contrast, only 5-6 h incubation was needed for loss of mutation induction enhancement.     

DNA lesions in hyperthermic cell killing: effects of thermotolerance, procaine, and erythritol

When HeLa S3 cells were subjected to 45 degrees C hyperthermia, DNA lesions were detected by the use of the alkaline unwinding/hydroxylapatite method. The number of lesions formed was not affected when the cells were made thermotolerant by either an acute (15 min 44 degrees C + 5 h 37 degrees C) or a chronic (5 h 42 degrees C) pretreatment before 45 degrees C hyperthermia. The presence of 10 mM procaine (heat sensitizer) or 0.5 M erythritol (heat protector) during hyperthermia also had no effect on the rate of formation of heat-induced alkali labile DNA lesions. These observations do not support a concept where DNA lesions are considered to be the ultimate cause of hyperthermic cell killing. Both drugs, however, influenced the rate of repair of radiation-induced strand breaks when present during preirradiation heat treatment. We conclude that the initial number of heat-induced alkali labile DNA lesions is not directly related to cell survival. It cannot be excluded, however, that differences in posthyperthermic repair of these lesions may lead to a positive correlation between residual DNA damage and survival after the different experimental conditions.     

An unexpected effect of hyperthermia on the expression of X-ray damage in mouse skin

The interaction between hyperthermia and X irradiation in the expression of injury to skin was investigated in the tail of adult mice. The X-ray treatments when given alone resulted in skin reactions which ranged in severity from "no observable gross injury" to "moist desquamation over most of the tail," the peak reaction occurring at approximately 20 days. When hyperthermia was given alone, the maximal reaction observed was "foci of moist desquamation, accompanied by severe erythema and edema" which, in contrast to the radiation response, peaked 1 to 2 days after treatment. For the combined treatments, hyperthermia at a temperature between 43.0 and 44.5 degrees C for 30 min was given either 3, 6, 9, or 10 days after X irradiation. When the interval was 3 days, there appeared to be no interaction between the treatments. As the interval was lengthened, so that hyperthermia was given 6 or more days after irradiation, i.e., within 7 days of the time of appearance of gross radiation injury, the severity of the observed skin reaction was greater than the individual responses following either treatment given alone. Using a 9-day interval, it could be seen that both the thermal and radiation reactions were enhanced in a dose-dependent manner. The peak times for each reaction were not significantly altered by the additional treatment. The results are discussed with reference to possible modes of interaction between X irradiation and hyperthermia in an in vivo system.     

Effect of thermotolerance on thermal radiosensitization in hepatoma cells

The interaction between hyperthermia and X irradiation was determined in cultured Reuber H35 hepatoma cells with different states of thermosensitivity. Incubation at 41 degrees C followed by 4-Gy X rays resulted after 2 hr in a stabilization of cell survival for heat or plus X rays, with a maximum synergism factor of 1.6. Thermotolerance did not develop during incubation at 41.7 or 42.5 degrees C. When heat treatment of cells was followed by irradiation, the synergism factor for thermal radiosensitization increased with both the amount of thermal cell killing and the amount of X-ray cell killing; the influence of thermal exposure on the synergism factor was greater than that of the X-ray dose. Cells were made thermotolerant either by incubation at 42.5 degrees C for 30 or 60 min followed by an interval at 37 degrees C, or by continuous incubation at 41 degrees C. In both cases thermotolerance was measured by incubation at 42.5 degrees C. No difference was observed between the maximum thermotolerance achieved with both methods. When cells were irradiated in addition to the second heat treatment, thermal radiosensitization was strongly reduced concomitant with the decreased sensitivity to killing by heat.     

The response of previously irradiated skin to combinations of X radiation and ultrasound-induced hyperthermia

Areas of skin approximately 1.5 cm in diameter on the legs of mice were made hyperthermic (30 min at 42.7 degrees C) by exposure to an ultrasound beam (780 kHz), a single dose of X irradiation (2000 rad), or a combination of these treatments. After 35 days, when the acute reaction had reached a steady state, the same tissue was given a second treatment by either hyperthermia, irradiation, or a combination of hyperthermia and irradiation. When the first treatment was irradiation and the second treatment was either irradiation or a combination of hyperthermia and irradiation, the acute skin reactions were similar to those of skin not previously irradiated, indicating a large proportion of recovery from the first irradiation. When irradiation was the first treatment, a comparison of second treatments by hyperthermia plus irradiation with irradiation alone showed a thermal enhancement of 1.45. When the first treatment was hyperthermia plus irradiation, a comparison of second treatments by hyperthermia plus irradiation with irradiation also showed an enhancement factor of 1.45 for the combined treatment.     

Modification of radiation damage in the canine kidney by hyperthermia: a histologic and functional study

The purpose of this study was to evaluate the effect of hyperthermia on the histologic and functional response of the canine kidney, a late-responding normal tissue, to irradiation. Both kidneys were irradiated. Radiation was delivered in single doses of 0, 10, or 15 Gy. Whole-body hyperthermia was used to produce renal kidney temperatures approximating 42.0 degrees C for 60 min. Thirty-six beagles were placed randomly in the following six treatment groups: control, whole-body hyperthermia alone, 10 Gy alone, 10 Gy + whole-body hyperthermia, 15 Gy alone, and 15 Gy + whole-body hyperthermia. Renal histologic and functional changes were assessed at 1 to 9 months after therapy. No changes were seen in glomerular filtration rate or renal tissue volumes in control or hyperthermia alone groups. Renal vascular and glomerular volumes were not affected significantly by any combination of hyperthermia and/or radiation. In all groups receiving radiation, glomerular filtration rate decreased, percentage renal tubular volume decreased, and interstitial volume increased significantly after therapy. The magnitude of these changes in the functional and histologic response of the kidney and the latent period before expression of this damage were dependent on radiation dose. However, hyperthermia did not modify expression of radiation damage in the kidney based on glomerular filtration rate and histologic quantification of renal tissue components.     

Enhancement of cell killing by induction of apoptosis after treatment with mild hyperthermia at 42 degrees C and cisplatin.

Ohtsubo, T., Igawa, H., Saito, T., Matsumoto, H., Park, H. J., Song, C. W., Kano, E. and Saito, H. Enhancement of Cell Killing by Induction of Apoptosis after Treatment with Mild Hyperthermia at 42 degrees C and Cisplatin. Radiat. Res. 156, 103-109 (2001).We examined the interactive effects of cisplatin (1.0 microg/ml) combined with hyperthermia on cell killing and on the induction of apoptosis in IMC-3 human maxillary carcinoma cells. The cytotoxic effects of hyperthermia on IMC-3 cells at 44 degrees C were greater than at 42 degrees C, as has been reported for many other cells. The induction of apoptosis, DNA fragmentation and poly(ADP-ribose) polymerase cleavage were greater after hyperthermia at 44 degrees C for 30 min compared with treatment at 42 degrees C for 105 min, even though both of these heat doses were isoeffective in reducing cell survival to 50%. Treatment with cisplatin at 37 degrees C for up to 120 min did not result in cytotoxicity or the induction of apoptosis. The enhancement ratio for treatment with cisplatin at 42 degrees C was greater than that at 44 degrees C. More apoptosis was induced after the treatment with cisplatin at 42 degrees C compared to treatment with cisplatin at 44 degrees C. Taking these findings together, the combination of cisplatin and hyperthermia at 42 degrees C appeared to be more effective than cisplatin with hyperthermia at 44 degrees C for the induction of apoptosis in IMC-3 cells.     

The differential response of the skin in young and old rats to a combination of X-rays and 'wet' or 'dry' hyperthermia

The left hind feet of groups of female rats aged 7, 14 and 52 weeks were irradiated at three dose levels of X-rays (20, 25 or 30 Gy). Hyperthermia (42.5 degrees C for 1 h) was carried out immediately following irradiation using either 'wet' or 'dry' heat, achieved by immersion in either water or fluorocarbon liquid. The results demonstrated that 'wet' heat produced a consistently greater enhancement of the irradiation damage than 'dry' heat. The thermal enhancement ratio for irradiation plus 'wet' heat was approximately 1.5 and for irradiation plus 'dry' heat it was in the range 1.17 to 1.39. Immersion of the feet in fluorocarbon liquid at 37 degrees C did not significantly modify the irradiation response of the skin. The lower thermal enhancement ratios obtained using immersion in fluorocarbon liquid at 42.5 degrees C are close to those obtained in large animal studies and also similar to the limited amount of data from clinical studies where microwave or ultrasound heating techniques were used. It has been demonstrated that there are large age-related differences in the response of the rat foot skin to irradiation alone. It has also been shown in the present study, using rats of the same age, that the response to irradiation plus hyperthermia was less age dependent. This finding may reflect the differing methods by which damage occurs in tissue after irradiation or hyperthermia.     

Effects of hyperthermia and photodynamic therapy on BALB/c mice bearing subcutaneous tumors

The therapeutic effects of photodynamic therapy and hyperthermia on mice bearing subcutaneous tumors were investigated. Ehrlich ascites tumor cells (1 x 10(7)) were implanted subcutaneously into the femoral area of BALB/c mice. A total of 134 tumor-bearing mice were treated with photodynamic therapy, i.e., administration of laser irradiation (514.5 nm, 112.5 mW/cm2 for 11.12 min with a total energy 75 J/cm2) after injection (i.p.) of hematoporphyrin derivative (HPD, 7.5 and 10.0 mg/kg body weight) and/or hyperthermia (by electric heating needles to 44 and 45 degrees C for 30 min) once a day for three successive days. The results revealed that the therapeutic effects of the combination of photodynamic therapy and hyperthermia were improved when compared with photodynamic therapy or hyperthermia alone. A combination of photodynamic therapy (10.0 mg HPD/kg body weight and 75 J/cm2 of total laser irradiation energy) and hyperthermia (44 degrees C for 30 min) had the best therapeutic effect, indicating that the mortality rate within 120 days (MR120) was 12.5% and the mean survival time (MST120) was 113.8 days.     

Early changes in intracellular ATP concentration after 5 Gy irradiation by routine regimen and regimen modified by low doses (0.1+4.9 Gy)]

Comparative studies were made of immediate (within the first minutes) changes in intracellular ATP concentration after irradiation by different regimens. ATP concentration in cells at a stationary phase of growth increased immediately after irradiation with a dose of 5 Gy, reaching its maximum within 30-40 min. Irradiation with the same total dose, by the regimen of 0.1 + 4.9 Gy at a 3-minute interval between the doses, did not cause alterations in the ATP content in cells. It is concluded that the absence of the increase in the parameter under study (ATP) after irradiation by the latter regimen indicates that preirradiation at a dose of 0.1 Gy inhibits the adequate development of an early response to irradiation with a dose of 4.9 Gy.     

Hyperthermia in a differentiating murine erythroleukaemia cell line: II. Effect of heat on haem induction by radiation

Friend erythroleukaemia cells (FELC) were induced to a haem-producing state by X-rays. The percentage of haem positive cells was maximum for doses between 10 and 15 Gy. Heat treatment at 42.0 degrees C or 45.0 degrees C during or after irradiation inhibited haem induction whereas heating before irradiation enhanced it. Incubation at 37 degrees C between heating and irradiation resulted in a decline in induction levels, indicating repair of heat damage that interacts with X-ray damage. Incubation at 37 degrees C between irradiation and heating did not result in changed haem induction levels, indicating a lack of repair of radiation damage that could interact with subsequent damage produced by heating.     

Growth delay in 9L rat brain tumor spheroids after irradiation with single and split doses of X rays

The response of 9L spheroids to irradiation with single and split doses of X rays has been investigated. Irradiation with single doses caused a dose-dependent decrease in spheroid growth rate, which eventually returned to the growth rate for unirradiated spheroids. This delay appeared to be related to cell survival. When spheroids were irradiated with two 4-Gy doses of X rays separated by various times the amount of growth delay was intermediate between that observed with single doses of 4 and 8 Gy. For relatively short times (15-90 min), recovery probably resulted from repair processes, but for longer times (up to 24 hr), recovery also appeared to depend on cellular redistribution and repopulation effects.     

Differences in heat-induced cell killing as determined in three mammalian cell lines do not correspond with the extent of heat radiosensitization

Three different cell lines, Ehrlich ascites tumour (EAT) cells, HeLa S3 cells and LM mouse fibroblasts, were used to investigate whether or not the extent of heat killing (44 degrees C) and heat radio-sensitization (44 degrees C before 0-6 Gy X-irradiation) are related. Although HeLa cells were the most heat-resistant cell line and showed the least heat radiosensitization, we found that the most heat-sensitive EAT cells (D0, EAT = 8.0 min; D0, LM = 10.0 min; D0, HeLa = 12.5 min) showed less radiosensitization than the more heat-resistant LM fibroblasts (TERHeLa less than TEREAT less than TERLM). Therefore, it is concluded that the routes leading to heat-induced cell death are not identical to those determining heat radiosensitization. Furthermore the inactivation of DNA polymerase alpha and beta activities by heat seemed not to correlate with heat survival alone but showed a positive relationship to heat radiosensitization. The possibility of these enzymes being a determinant in heat radiosensitization is discussed.     

Correlation between cellular survival and potassium loss in mouse fibroblasts after hyperthermia alone and after a combined treatment with X rays

Mouse fibroblast LM cells have been heated at 44 degrees C for different periods. Potassium content of the cells was measured at certain intervals during the postheating period at 37 degrees C for up to 24 hr. The level of K+ decreased gradually in time starting within some hours after the heat treatment. The rate of K+ loss as well as the ultimate level reached was heat-dose dependent. When the potassium content of the cell population was determined 16 hr after the heat treatment, a correlation was observed between the concentration of potassium and the level of cell survival. When X irradiation was applied immediately after hyperthermia, radiosensitization on the level of cell survival was obtained as expected, the extent being dependent on the severity of heat treatments. No added K+ loss was observed, however, when hyperthermia was combined with radiation. It is suggested that plasma membrane related functions are disturbed by the heat treatment. This points to membranes as possible candidates for primary targets in the case of cell inactivation by heat alone, and not with respect to the radiosensitization by hyperthermia.     

Structural changes in plasma membranes prepared from irradiated Chinese hamster V79 cells as revealed by Raman spectroscopy

The effect of gamma irradiation on the integrity of plasma membranes isolated from Chinese hamster V79 cells was investigated by Raman spectroscopy. Plasma membranes of control V79 cells show transitions between (-) 10 and 5 degrees C (low-temperature transition), 10 and 22 degrees C (middle-temperature transition), and 32 and 40 degrees C (high-temperature transition). Irradiation (5 Gy) alters these transitions markedly. First, the low-temperature transition shifts to higher temperature (onset and completion temperatures 4 and 14 degrees C). Second, the middle-temperature transition shifts up to the range of about 20-32 degrees C, but the width remains unchanged. Third, the higher temperature transition broadens markedly and shifts to the range of about 15-40 degrees C. Protein secondary structure as determined by least-squares analysis of the amide I bands shows 36% total helix, 55% total beta-strand, and 9% turn plus undefined for control plasma membrane proteins. Plasma membrane proteins of irradiated V79 cells show an increase in total helix (40 and 45% at 5 and 10 Gy, respectively) and a decrease in the total beta-strand (48 and 44% at 5 and 10 Gy, respectively) structures. The qualitative analysis of the Raman features of plasma membranes and model compounds in the 1600 cm-1 region, assigned to tyrosine groups, revealed that irradiation alters the microenvironment of these groups. We conclude that the radiation dose used in the survival range of Chinese hamster V79 cells can cause damage to plasma membrane proteins without detectable lipid peroxidation, and that the altered proteins react differently with lipids, yielding a shift in the thermal transition properties.