Radiation induced toxicity in rectal epithelial stem cell contributes to acute radiation injury in rectum

Abstract

BackgroundRadiation induced rectal epithelial damage is a very common side effect of pelvic radiotherapy and often compromise the life quality and treatment outcome in patients with pelvic malignancies. Unlike small bowel and colon effect of radiation in rectal stem cells has not been explored extensively. Here we demonstrate that Lgr5 positive rectal stem cells are radiosensitive and organoid based transplantation of rectal stem cells mitigates radiation damage in rectum MethodsC57Bl6 male mice (JAX) at 24 h was exposed to pelvic irradiation (PIR) to determine the radiation effect in pelvic epithelium. Effect PIR on Lgr5-positive rectal stem cells (RSCs) was determined in Lgr5-EGFP-Cre-ERT2 mice exposed to PIR. Effect PIR or clinically relevant fractionated PIR on regenerative response of Lgr5-positive RSCs was examined by lineage tracing assay using Lgr5-eGFP-IRES-CreERT2; Rosa26-CAG-tdTomato mice with tamoxifen administration to activate Cre recombinase and thereby marking the ISC and their respective progeny. Ex vivo three-dimensional organoid cultures were developed from Lgr5-EGFP-Cre-ERT2 mice. Organoid growth was determined by quantifying the budding crypt/total crypt ratio. Organoids from Lgr5-EGFP-ires-CreERT2-TdT mice were transplanted in C57Bl6 male mice exposed to PIR. Engraftment and repopulation of Lgr5-positive RSCs were determined after tamoxifen administration to activate Cre recombinase in recipient mice. Statistical analysis was performed using Log-rank (Mantel-Cox) test and paired two-tail t test. ResultExposure to pelvic irradiation significantly damaged rectal epithelium with the loss of Lgr5+ve rectal stem cells. Radio-sensitivity of rectal epithelium was also observed with exposure to clinically relevant fractionated pelvic irradiation. Regenerative capacity of Lgr5+ve rectal stem cells were compromised in response to fractionated pelvic irradiation. Ex-vivo organoid study demonstrated that Lgr5+ve rectal stem cells are sensitive to both single and fractionated radiation. Organoid based transplantation of Lgr5+ve rectal stem cells promote repair and regeneration of rectal epithelium. ConclusionLgr5 positive rectal stem cells are radio-sensitive and contribute to radiation induced rectal epithelial toxicity. Transplantation of Lgr5 positive rectal stem cells mitigates radiation induced rectal injury and promote repair and regeneration process in rectum.