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Background: 223Ra is currently used for treatment of metastatic castration resistant prostate cancer patients (mCRPC) bone metastases with fixed standard activity. Individualized treatments, based on adsorbed dose (AD) in target and non-target tissue, are absolutely needed to optimize efficacy while reducing toxicity of α-emitter targeted therapy. This is a pilot first in human clinical trial aimed to correlate dosimetry, clinical response and biological side effects to personalize 223Ra treatment. Methods: Out of 20 mCRPC patients who underwent standard 223Ra treatment and dosimetry, in a subset of 5 patients the AD to target and non-target tissues was correlated with clinical effects and radiation-induced chromosome damages. Before each 223Ra administrations, haematological parameters, PSA and ALP values were evaluated. Additional blood samples were obtained baseline (T0), at 7 days (T7), 30 days (T30) and 180 days (T180) to evaluate chromosome damage. After administration WB planar 223Ra images were obtained at 2–4 and 18–24 h. Treatment response and toxicity were monitored with clinical evaluation, bone scan, 18F-choline-PET/CT, PSA value and ALP while haematological parameters were evaluated weekly after 223Ra injection and 2 months after last cycle. Results: 1. a correlation between AD to target and clinical response was evidenced with threshold of 20 Gy as a cut-off to obtain tumor control; 2. the AD to red marrow was lower than 2 Gy in all the patients with no apparently correlation between dosimetry and clinical toxicity. 3. a high dose dependent increase of the number of dicentrics and micronuclei during the course of 223Ra therapy was observed and a linear correlation has been found between blood AD (BAD) and number of dicentrics. Conclusions: This study provides some interesting preliminary evidence to be further investigated: dosimetry may be useful to identify a more appropriate 223Ra administered activity predicting AD to target tissue; a dose dependent complex chromosome damage occurs during 223Ra administration and this injury is more evident in heavily pre-treated patients; dosimetry could be used for radioprotection purpose. Trial registration: The pilot study has been approved from the Ethics Committee of Regina Elena National Cancer Institute (N:RS1083/18–2111). [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study is to correlate the physical dose to non-target tissues to the radiation-induced chromosome damage in terms of the dicentrics and micronuclei (MN) in peripheral blood lymphocytes (PBL) after radium-223 chloride (223RaCl2) therapy in patients with bone metastasis derived from prostate cancer [1] . Methods Four patients undergoing 223RaCl2 therapy for skeletal diseases have been enrolled in this prospective clinical study. The effective dose to non-target tissues per injected activity was calculated considering the alpha, beta and gamma emission of Ra-223 and considering a standard man weight of 70 kg. PBL cultures for dicentric assay and micronuclei induction were performed before treatment (T0), 6 days (T1) and 30 days (T2) after the first cycle of treatment. Haematological toxicity parameters (blood cell count) have been monitored during therapy and analysed along with doses to blood and non-target tissues. Results The administration of 223RaCl2 produces a high dose dependent increase of radiation-induced chromosome damage in terms of dicentrics and micronuclei observed in the circulating lymphocytes (non target-tissue). Surprisingly, this increase of chromosome damage observed is not due to an 223RaCl2 addition dose, suggesting that circulating lymphocytes were exposed to an extra dose by the emissions from the target organs. In addition, clinical monitoring during the treatment showed a progressive increasing fatigue, leucopenia and anemia with a partial recovery after some months after the end of therapy. Conclusions The cytogenetic data seem to suggest a persistence of the radiation emission from the target tissue to non-target ones and seem to be correlated to the observed haematological toxicity, highlighting possible adverse effects related to this therapy. These data need further investigation in order to evaluate the potential side effects to normal, non-target tissue in patients treated with alpha emitters. [ABSTRACT FROM AUTHOR]

The article presents a study conducted to determine the seven novel mutations in the ABCD1 gene on chromosome Xq28 that are said to cause the peroxisomal disorder called X-linked adrenoleukodystrophy (X-ALD). A molecular screening was conducted through the use of denaturing high-performance liquid chromatography (DHPLC)-based protocol. X-ALD is characterized with progressive demyelination of the central nervous system (CNS), as well as the deterioration of the mental, motor and visual functions, and hypoadrenalism.

Biological dosimetry is an essential tool for estimating radiation doses received from individuals when the physical dosimetry is not available or inadequate. Early knowledge about the absorbed dose levels in radiation accidents is of paramount importance for selecting the unaffected subjects from those individuals requiring medical evaluation and intervention. A lesson learned from many radiological incidents is the importance to identify the "worried well."Several assays are useful for biological dosimetry approaches, since no one single assay is sufficiently robust for all potential radiation scenarios including early-phase acute exposures, partial-body exposures, and biosampling years after exposure or in case of suspected mixed exposures (radiological and chemicals).The most commonly used biodosimetry methods are based on the evaluation of the radiation-specific dicentric chromosomes (Dic) and micronuclei (MN) in exposed individuals' peripheral blood lymphocytes (PBL).The present chapter does not claim to make an exhaustive and complete picture on the complex world of biodosimetry, to which a large number of specific guidelines for performing laboratory services by the International Organization for Standardization (ISO) are dedicated, but it aims to support the reader in understanding the application of two cytogenetic methods in the individual ionizing radiation dose assessment, suggesting some appropriate scientific sources to consult for each case.

Purpose: The RENEB accident exercise was carried out in order to train the RENEB participants in coordinating and managing potentially large data sets that would be generated in case of a major radiological event., Materials and Methods: Each participant was offered the possibility to activate the network by sending an alerting email about a simulated radiation emergency. The same participant had to collect, compile and report capacity, triage categorization and exposure scenario results obtained from all other participants. The exercise was performed over 27 weeks and involved the network consisting of 28 institutes: 21 RENEB members, four candidates and three non-RENEB partners., Results: The duration of a single exercise never exceeded 10 days, while the response from the assisting laboratories never came later than within half a day. During each week of the exercise, around 4500 samples were reported by all service laboratories (SL) to be examined and 54 scenarios were coherently estimated by all laboratories (the standard deviation from the mean of all SL answers for a given scenario category and a set of data was not larger than 3 patient codes)., Conclusions: Each participant received training in both the role of a reference laboratory (activating the network) and of a service laboratory (responding to an activation request). The procedures in the case of radiological event were successfully established and tested.

Purpose: A European network was initiated in 2012 by 23 partners from 16 European countries with the aim to significantly increase individualized dose reconstruction in case of large-scale radiological emergency scenarios., Results: The network was built on three complementary pillars: (1) an operational basis with seven biological and physical dosimetric assays in ready-to-use mode, (2) a basis for education, training and quality assurance, and (3) a basis for further network development regarding new techniques and members. Techniques for individual dose estimation based on biological samples and/or inert personalized devices as mobile phones or smart phones were optimized to support rapid categorization of many potential victims according to the received dose to the blood or personal devices. Communication and cross-border collaboration were also standardized. To assure long-term sustainability of the network, cooperation with national and international emergency preparedness organizations was initiated and links to radiation protection and research platforms have been developed. A legal framework, based on a Memorandum of Understanding, was established and signed by 27 organizations by the end of 2015., Conclusions: RENEB is a European Network of biological and physical-retrospective dosimetry, with the capacity and capability to perform large-scale rapid individualized dose estimation. Specialized to handle large numbers of samples, RENEB is able to contribute to radiological emergency preparedness and wider large-scale research projects.

Purpose: RENEB, 'Realising the European Network of Biodosimetry and Physical Retrospective Dosimetry,' is a network for research and emergency response mutual assistance in biodosimetry within the EU. Within this extremely active network, a number of new dosimetry methods have recently been proposed or developed. There is a requirement to test and/or validate these candidate techniques and inter-comparison exercises are a well-established method for such validation., Materials and Methods: The authors present details of inter-comparisons of four such new methods: dicentric chromosome analysis including telomere and centromere staining; the gene expression assay carried out in whole blood; Raman spectroscopy on blood lymphocytes, and detection of radiation-induced thermoluminescent signals in glass screens taken from mobile phones., Results: In general the results show good agreement between the laboratories and methods within the expected levels of uncertainty, and thus demonstrate that there is a lot of potential for each of the candidate techniques., Conclusions: Further work is required before the new methods can be included within the suite of reliable dosimetry methods for use by RENEB partners and others in routine and emergency response scenarios.

We set up a new denaturing high-performance liquid chromatography (DHPLC)-based protocol to screen patients with autosomal dominant hereditary spastic paraplegia (AD-HSP) for mutations in SPG4. Six patients had a complicated form and 49 a pure HSP phenotype. We also analyzed 19 unrelated patients presenting with an HSP phenotype (pure in 17 and complicated in two subjects) but no clear family history, as such patients may be cases of dominant inheritance with low penetrance. The overall frequency of SPG4 mutations in our study of HSP (in which prior linkage data were unavailable) was 32.4%, rising to 46.9% when only pure AD-HSP patients were considered. This figure falls well within the range reported in different populations. Rather as expected, the clinical data available for the patients did not support an easy genotype-phenotype correlation. Moreover, the clinical picture was not influenced by the length of the predicted residual gene product. As well as identifying novel variants in SPG4, this study constitutes the molecular characterization of the largest cohort of Italian AD-HSP patients studied to date. In addition, it provided an efficient, cost-effective, and reliable detection protocol for mutational screening of SPG4, which might facilitate medical genetic counseling.

Lower limb muscle chronic hyperactivity in hereditary spastic paraplegia (HSP) is the consequence of motor corticospinal tract involvement, which in turn has been hypothesized to be of mitochondrial origin. In order to assess skeletal muscle aerobic metabolism and sympathetic response during exercise in 10 HSP patients, we evaluated their blood lactate and catecholamine levels during an incremental workload bicycle exercise. Lactate, but not epinephrine or norepinephrine, levels were significantly higher in the HSP patients than in control subjects, in both resting conditions and during exercise. In the patients, the anaerobic lactate threshold was reached prematurely (at 50% of the predicted normal maximal power output) when compared to normal controls. This finding was not related to any specific muscle morphology or histochemical activity. Although other factors, including chronic spasticity and muscle deconditioning, have to be considered in the interpretation of our data, our results suggest the possible involvement of a mitochondrial mechanism, independently of sympathetic system overactivation, in exercising skeletal muscle of HSP patients.