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1 : inter leukin - 1 (IL - 1 ) inter leukin - 6 (IL - 6), *,, * * * * * * * * * * * * * =A b s t r a c t = A s tu dy f or t im e s e q u e n ti al e x p re s s i on of IL - 1 a n d IL - 6 af te r irr a di at io n o n r at lu n g Kw ang Yul Chang M.D., Choon Hee Son, M.D. *, Doo Kyung Yang, M.D. *, Ki Hyun Kim, M.D. *, Hyuk Lee, M.D. *, Seon Min Youn, M.D.*, Kw ang Mo Yang, M.D. *, Won Joo Hur, M.D. *, Mee Sook Roh, M.D. *, Jin Sook Jeong, M.D. *, Jin Yeong Han, M.D. *, Ki- Nam Lee, M.D. *, Pill Jo Choi, M.D. *, Soo Keol Lee, M.D. *, Ik Soo Choi, M.D. and Soon Kew P ark, M.D. Y oung-d o H osp ital P usan K orea; Dong-A University College of M edicine *, P usan K orea; Sam - Seon H osp ital P usan K orea; Department of Internal M edicine, Pusan N ational University College of M edicine, Pusan, K orea B ackg round : One of the limitation during the irradiation of malignant tumor is hazard to normal tissue although it is important and effective tool for treating malignant tumor. We studied the role of interleukin- 1 alpha (IL- 1 ) and interleukin-6 (IL-6) in the radiation- induced lung injury especially on fibrosis. Meth ods : We irradiated right- side lungs of thirty Sprague- Dawley rats with single fraction of 20 Gy and then sacrificed the animals until 20th week at intervals of two weeks. Both irradiated and unirradiated lung tissues were stained hematoxilin and eosin, Masson trichrome, reticulin and immunohistochemical staining for IL- 1 and IL- 6. T he degree of the staining for IL- 1 and IL- 6 were examined semiquantitatively. Res ult s : T wo weeks after irradiation interstitial edema and capillary congestion appeared, followed by increase of the monocytes infiltration and proteinaceous material during 4th and 8th week. After eight weeks of irradiation, collagen and reticulin fibers were detected along alveolar wall. 12th to 20th week, fibrosis in interstitium, decreased number of alveoli and thickening of bronchial wall were observed. The degree of immunohistochemical staining for IL- 1 and IL- 6 was increased rapidly during the first three week and then decreased slowly, but remain incresed until 20th week. Conclus ion : Our Study demonstrate the early and persistent elevation of cytokines IL- 1 and IL- 6 by immunohistochemical stain in rat lung following pulmonary irradiation. We think cytokines are produced immediately after irradiation, make collagen genes turn on and perisist until the expression of late effects become apparent pathologically and clinically.(korean J Med 62: , 2002) Key W ords : Radiation, Pneumonia, Interleukin- 1, Interleukin- 6 : : :, 3 ( ) E -m ail : ch a.ac.kr

2 Korean Journal of Medicine : Vol. 62, No. 4, 2002,..,,, (interleukin- 1 alpha, IL- 1 ) 1), - 6 (interleukin, IL- 6),, 2 ). IL- 1 IL- 1 mrna 3). IL-6. IL- 1 IL g (Sprague- Dawley rat) ketamine 67.5 mg/ kg., 4 2 cm 6 MV X- ray (CLINAC 1800 Varian Co., U.S.A.), 20 Gy , 2, 3, 4, 6, 8, 12, 16, 18, ) 10% (neutral buffered formalin). 2) (1) - (hematoxylin and eosin, HE), (Masson's trichrome). (2) ABC (avidin- biotinyl peroxidase complex method). 4 um 100% 10 2, 95% peroxidase 1% 10. phosphate buffered saline (PBS) 10 mm sodium citrate buffer (ph 6.0) 95 5, ph 2.5, 0.01 N 0.1% pepsin :100 1 (IL- 1, IL- 6 : Santa- Cruz Inc. SC, California, U.S.A.) PBS 3,

Kwang Yul Chang, et al : A study for time sequential expression of IL- 1 and IL- 6 after irradiation on rat lung 1:100

4.., 5% (0), 5 25% 1, 25 Figure 1A Figure 1B Figure 1C Figure 1D F ig ure 1.

A Focal consolidation and collapse of the right upper lung field with mild nodularity and congestion of the left lung.

right side. Also noted mild consolidation and hemorrhage at the left lung.

3 Kwang Yul Chang, et al : A study for time sequential expression of IL- 1 and IL- 6 after irradiation on rat lung 1:100 biotin 2 45 PBS 3. avidin- biotinyl peroxidase complex 30 PBS aminoethycarbazole (AEC, Vector Lab, U.S.A.) Mayer hematoxylin 3 crystal mount. 4.., 5% (0), 5 25% 1, 25 Figure 1A Figure 1B Figure 1C Figure 1D F ig ure 1. Gross findings of the rat lungs after irradiation (A; 3rd week, B; 8th week, C; 12th week, D; 16th week). A Focal consolidation and collapse of the right upper lung field with mild nodularity and congestion of the left lung. B More advanced consolidation of the upper and mid lung field with emphysematous changes of the lower lung field at the right side. Also noted mild consolidation and hemorrhage at the left lung. C : Nearly collapsed right lung with diffuse consolidation, hemorrhage and focal emphysematous change of the left lung. D : Diffuse firm consolidation with focal emphysematous change of both lungs

: 62 4 500 2002 50% 2, 51 75% 3, 75% 4, 1, 3, 2. 0 12. (adjacent alveoli), F ig ure 2.

4 : % 2, 51 75% 3, 75% 4, 1, 3, (adjacent alveoli), F ig ure 2. Microscopic findings of the right lung (A, B : 1st week, C, D : 3rd week, E, F : 8th week, G, H : 20th week; A, C, E, G : hematoxiln and eosin stain, B, D, F, H : Masson trichrome stain; A, B, C, D, G, H : 40, E, F : 100). Diffuse congestion in the 1st week (A, B) followed by interstitial widening with infiltration of neutrophils and mononuclear leukocytes at 3rd week (C, D) and progressed later (E, G). In the area of the pulmonary fibrosis young fibroblasts porliferate and traverse alveoli through alveolar ducts (E, F ). Honeycombing lesion is noted later (G, H)

5 15 : interleukin- 1 (IL- 1 ) interleukin- 6 (IL-6) (bronchus), (vessel) (consolidation). 1. 1) 2 2, 3 4, , 2, ) (1) 3., ( 1A). 8 1/ 3 ( 1B). 12 1/ 4. ( 1C) / 2. ( 1D) , 3. (2) H & E 3,, ( 2A, B). 6 8.,,,.. 8 ( 2C, G) ,,.,., 16, (reticulin fiber).. 20,,, (foamy histiocyte) ( 3D, H)... (3 ) IL- 1 IL ,, ( 3A)., ( 3B),.. 4 8,. 8,

Korean Journal of Medicine : Vol. 62, No.

Immunohistochemical staining for IL- 1 (A, 2nd week; B, 3rd week; C, 8th week; D, 20th

Strong reaction on the vascular endothelial cells, bronchial epithelial cells,

Increased number of stained cells with more strong reaction in intensity at 3rd week

6 Korean Journal of Medicine : Vol. 62, No. 4, 2002 Figure 3A Figure 3 B Figure 3C Figure 3 D F ig ure 3. Immunohistochemical staining for IL- 1 (A, 2nd week; B, 3rd week; C, 8th week; D, 20th week, 200). Strong reaction on the vascular endothelial cells, bronchial epithelial cells, subepithelial and interstitial mononuclear cells (A). Increased number of stained cells with more strong reaction in intensity at 3rd week (B). Decreased number of staing cell with weak reaction in the fibrotic area (C), even though mononuclear cells and fibroblasts show still strong reaction (D).., ( 3C) ,,. ( 3D). IL , 6 6, ( 5A) (4) IL- 6 IL- 6 1, ( 4A),, ,

Kwang Yul Chang, et al : A study for time sequential expression of IL- 1 and IL- 6 after irradiation on rat lung Figure 4A Figure 4 B Fig ure 5.

B: IL- 6 increased at 2nd week, rised to peak level at 3rd week, remained elevated until 20th week. (Alveolar.:Adjacent alveolar, Consol.:consolidation) Fig ure 4C ig ure 4.

Infiltrating mononulcear cells and bronchial epithelial cells show strong cytoplasmic reaction in 2nd week (A).

7 Kwang Yul Chang, et al : A study for time sequential expression of IL- 1 and IL- 6 after irradiation on rat lung Figure 4A Figure 4 B Fig ure 5. Semiqantitative level of IL- 1 and IL- 6 in the after irradiation. A: IL- 1 increased at 1st week, rised to peak level at 3rd week, remained elevated until 20th week. B: IL- 6 increased at 2nd week, rised to peak level at 3rd week, remained elevated until 20th week. (Alveolar.:Adjacent alveolar, Consol.:consolidation) Fig ure 4C ig ure 4. Immunohistochemical staining for IL- 6 (A, 2nd week; B, 6th week; C, 20th week 200). Infiltrating mononulcear cells and bronchial epithelial cells show strong cytoplasmic reaction in 2nd week (A). Markedly increased number of mononuclear cells with moderate intense staining in consolidation area at 6th week (B). Vascular endothelial cells show moderate degree of reaction, infiltrating mononuclear cells in fibrotic area show mild to moderate degree at 20th week (C).,,. 6, ( 4B) IL- 1, ( 4C) IL- 6, 1 1.2, 2 5.7, , ,

: 62 4 500 2002 Fig ure 6. Intercelluar communication by cytokine model. Modified from Aggarwal and Pocsik 15 ). 2 4, 20 5.75 ( 5B).,. 1 34%, 13 100% 4-7).,,,,. 27 1,911 7.8%, 43% 8 ).

8 : Fig ure 6. Intercelluar communication by cytokine model. Modified from Aggarwal and Pocsik 15 ). 2 4, ( 5B).,. 1 34%, % 4-7).,,,,. 27 1, %, 43% 8 ) ,,, )..,. II (surfactant) 10). 1 II (lamellar body), 24 II 11). 1 3 II (compensatory hypertrophy) 12 ),,,,,. 6,, II 13 ). 9, II,. Rubin 14 ) (cascade of cytokines)

9 15 : interleukin- 1 (IL- 1 ) interleukin- 6 (IL-6), (proinflammatory cytokines) (adhesion molecules) (chemokines). Aggarwal Pocsik 15) ( 6), 2,,,.. Piguet 16 ) IL- 1, - (tranforming growth factorbeta, T GF - ), (platelet derived growth factor, PDGF), - (tumor necrosis factor- alpha, T NF - ) (fibroblast growth factor, FGF ).. IL- 1 17, 18 ), (collagen) 19). Rubin 20 ) IL- 1 mrna 2 2, 26 (cascade of cytokines) IL- 1, 3 ) T NF -, IL- 1 mrna IL- 1 T NF -, IL- 1, IL- 1. IL , ( 5A). IL- 6 T. IL- 6. IL- 6 (lipid polysaccharide, LPS) T NF - 2 1), IL- 1 T NF - IL- 6 (monocyte colony stimulating factor, M- CSF) 22 ), IL- 6 B 2). Chen Y 23 ) IL- 6, IL- 6 IL- 6. IL- 6 3 ( 5B). IL- 6 IL- 1..,., ). Roswit White 24). Morgan Breit 25 ) (classic radiation pneumonitis) (sporadic radiation pneumonitis).,,. IL- 1 IL

10 Korean Journal of Medicine : Vol. 62, No. 4, 2002,,. T GF T GF 28, 29 ), IL- 1 IL-6.. Libshitz Southard 1) 40 Gy ) 20 Gy 4, 12. Moosavi 12 ) 2 4, 3 6, IL- 1 IL- 6 20, 23) IL- 6 ( 5B). IL- 1 ( 5A) Rubin 20 ) IL- 1 IL- 6., 2 (target cell) ( 6)., (autocrine), (paracrine) (endocrine),,,. :. interleukin- 1 alpha (IL- 6 ) interleukin- 6 (IL- 6). : Gy,

11 Kwang Yul Chang, et al : A study for time sequential expression of IL- 1 and IL- 6 after irradiation on rat lung IL- 1 IL- 6. : 1 2,. 4, IL- 1 IL- 6 3.,,, IL- 1 IL : IL- 1 IL- 6. R E F E R E N C E S 1) Libshitz HI, Southard ME. Comp lications of radiation therapy : the thorax. Semin R oentgenol 9:41-49, ) Kishimoto T. T he biology of interleukin- 6. B lood 74:1-10, ) Johnston CJ, Piedboeuf B, Rubin P, Williams JP, Baggs R, Finkelstein JN. Earl and p ersistent alterations in the exp ression of interleukin- 1, interleukin- 1 and tum or necrosis factor mr N A levels in f ibrosis- resistant and sensitive m ice af ter thoracic irradiation. R adiat R es 145: , ) Chu F C, Phillips R, Nickson JJ. P neum onitis f ollowing radiation therapy of cancer of the breast by tang ential technique. R adiology 64: , ) Rotstein S, Lax I, Svane G. I nf luence of radiation therapy on the lung - tissue in breast cancer patients: CT - assessed density changes and associated symp toms. Int J R adiat Oncol B iol P hys 18: , ) Lingos T I, Recht A, Vicini F, Abner A, Silver B, Harris JR. R adiation pneumonits in breast cancer patients treated with conservative surgery and radiation therapy. Int J R adiat Oncol B iol P hys 21: , ) Maasilta P. D eterioration in lung f unction f ollowing hem ithorax irradiation f or p leural m esothelioma. I nt J R adiat Oncol B iol P hys 20: , ) Roach M 3rd, Gandara DR, Yuo HS, Swift PS, Kroll S, Shrieve DC, W ara WM, Margolis L, Philips T L. R adiation p neum onitis f ollowing com - bined m odality therapy f or lung cancer: analysis of p rognostic factors. J Clin Oncol 13: , ) Movsas B, Raffin T A, Epstein AH, Link CJ Jr. P ulm onary radiation inj ury. Chest 111: , ) Rubin P, Shapiro DL, Finklestein JN, Penney DP. T he early release of surfactant f ollowing lung irradiation of alveolar typ e II cells. Int J R adiat Oncol B iol P hys 6:75-77, ) Penney DP, Rubin P. Sp ecif ic early f ine structural changes in the lung irradiation. I nt J R adiat Oncol B iol P hys 2: , ) Moosavi H, McDonald S, Rubin P, Cooper R, Stuard ID, Penney D. Early radiation doseresp onse in lung: an ultrastructural study. Int J R adiat Oncol B iol P hys 2: , ) T s 'ao CH, W ard WF, Port CD. R adiation inj ury in rat lung : I. p rostacyclin (P GI2) p roduction, arterial p erf usion and ultrastructure. R adiat R es 96: , ) Rubin P, Finkelstein J, Shapiro D. M olecular biology m echanism s in the radiation induction of p ulm onary inj ury syndrom es: interrelationship between the alveolar macrop hage and the sep tal f ibroblast. I nt J R adiat Oncol B iol P hys 24:93-101, ) Aggarw al BB, Pocsik E. Cy tokines: f rom clone to clinic. A rch B iochem B iop hys 292: , ) Piguet PF. Cytokines involved in p ulm onary f ibrosis. Int R ev Exp Pathol 34: , ) Schmidt JA, Mizel SB, Cohen D, Green I. Interleukin 1, a p otential reg ulator of f ibroblast p rolif eration. J I mm unol 128: ,

12 : ) T hornton SC, Por SB, W alsh BJ, Penny R, Breit SN. Interaction of im m une and connective tissue cells: I. the eff ect of lymp hokines and m onokines on f ibroblast g rowth. J L eukoc B iol 47: , ) Postlethw aite AE, Lachman LB, Mainardi CL, Kang AH. I nterleukin 1 stim ulation of collag enase p roduction by cultured f ibroblasts. J Exp M ed 157: , ) Rubin P, Johnston CJ, Williams JP, McDonald S, Finkelstein JN. A p erp etual cascade of cytokines p ost-irradiation leads to p ulm onary f ibrosis. I nt J R adiat Oncol B iol P hys 33:99-109, ) Aderka D, Le JM, Vilcek J. IL - 6 inhibits lip op olysaccharide- induced tum or necrosis factor p roduction in cultured human m onocy tes, U937 cells, and in m ice. J Im m unol 143: , ) Mantovani L, Henschler R, Brach MA, Mertelsmann RH, Herrmann F. R eg ulation of gene exp ression of macrop hag e- colony stim ulating factor in human f ibroblasts by the acute p hase resp onse m ediatros interleukin(il ) - 1 beta, tum or necrosis factoralp ha and IL - 6. FEB S L ett 280:97-102, ) Chen Y, Rubin P, Williams J, Hernady E, Smudzin T, Okunieff P. Circulating IL - 6 as a p redictor of radiation p neum onitis. I nt J R adiat Oncol B iol P hys 49: , ) Roswit B, White DC. Severe radiation inj uries of the lung. A JR 129: , ) Morgan GW, Breit SN. R adiation and the lung : a reevaluation of the m echanism s m ediating p ulm onary inj ury. I nt J R adiat Oncol B iol R hys 31: , ),,.. 17: ,

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歯 PDF X- : Captopril : captopril captopril TNF-TGF- : Sprague-Dawley 30, captopril 10 Gy, 20 Gy, 30 Gy 12, 11 captopril (captopril 500 mg/l )11 (fibrotic period) : 12 11 captopril captopril TNF-, TGF- (12 )

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歯62-4.PDF