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. 2022 May-Jun;36(3):1485-1490.
doi: 10.21873/invivo.12855.

Prospective Exploratory Study of the Relationship Between Radiation Pneumonitis and TGF-β1 in Exhaled Breath Condensate

Shigeo Takahashi  1 , Masahide Anada  2 , Toshifumi Kinoshita  2 , Takamasa Nishide  2 , Toru Shibata  2
Affiliations

Prospective Exploratory Study of the Relationship Between Radiation Pneumonitis and TGF-β1 in Exhaled Breath Condensate

Shigeo Takahashi et al. In Vivo. 2022 May-Jun.

Abstract

Background/aim: We conducted a prospective exploratory study to investigate the relationship between radiation pneumonitis (RP) and transforming growth factor-β1 (TGF-β1) in exhaled breath condensate (EBC).

Patients and methods: The inclusion criteria were: patients who 1) received thoracic radiotherapy (RT) for lung cancer, 2) were aged ≥20 years, and 3) provided written informed consent. EBC was collected before and 1 month after RT. TGF-β1 levels in EBC were measured using an enzyme-linked immunosorbent assay. We evaluated RP using the Common Terminology Criteria for Adverse Events v4 and analyzed the relationship between grade (G) 2 RP and TGF-β1 levels in EBC.

Results: Ten patients were enrolled [median age, 75 years (range=60-81 years)], and none of them had interstitial lung disease. Conventional fractionation, accelerated hyperfractionation, hypofractionation, and stereotactic ablative fractionation were used in four, one, two, and three patients, respectively. G1 and G2 RP were observed in five patients each; no G3-G5 RP occurred. The median TGF-β1 levels in EBC before and 1 month after RT were 79.1 pg/ml (0.1-563.7 pg/ml) and 286.9 pg/ml (33.7-661.3 pg/ml), respectively. Of the seven patients with increased TGF-β1 levels in EBC 1 month after RT than before RT, five (71%) experienced G2 RP, whereas the remaining three patients with decreased TGF-β1 levels had G1 RP (p=0.083, one-sided Fisher's exact test).

Conclusion: Increased TGF-β1 levels in EBC 1 month after RT might be promising for the detection of G2 RP.

Keywords: Radiation pneumonitis; exhaled breath condensate; radiation therapy; transforming growth factor-β1.

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Conflict of interest statement

The Authors have no conflicts of interest regarding this study.

Figures

Figure 1
Figure 1. A method of the exhaled breath condensate (EBC) collection. 1) After inserting a collection device in the patients’ mouth, they were instructed to inhale naturally (dotted line). 2) Patients were then instructed to exhale naturally (broken line). 3) The exhaled breath passes through a one-way valve (bold line). 4) The exhaled breath is then chilled by a cooling sleeve, which covers a collection device (gray bar). 5) The EBC attaches to an inner wall of a collection device (gray drop). Patients were instructed to breathe naturally to a collection device for 10 min. After that, we collected the EBC within the collection device.
Figure 2
Figure 2. Changes in transforming growth factor-β1 (TGF-β1) levels in exhaled breath condensate from before radiotherapy (RT) to 1 month after RT. Gray solid lines indicate patients with grade (G) 2 radiation pneumonitis (RP) alone. Gray broken lines indicate patients with both G2 RP and early tumor progression. Black broken lines indicate patients with early tumor progression alone. Black solid lines indicate patients without these events.
See this image and copyright information in PMC

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