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Abstract
PURPOSE:
Radiotherapy for head and neck cancer may result in serious side effects, such as hyposalivation, impairing the patient's quality of life. Modern radiotherapy techniques attempt to reduce the dose to salivary glands, which, however, results in low-dose irradiation of the tissue stem cells. Here we assess the low-dose sensitivity of tissue stem cells and the consequences for tissue function.

EXPERIMENTAL DESIGN:
Postirradiation rat salivary gland secretory function was determined after pilocarpine induction. Murine and patient-derived salivary gland and thyroid gland organoids were irradiated and clonogenic survival was assessed. The DNA damage response (DDR) was analyzed in organoids and modulated using different radiation modalities, chemical inhibition, and genetic modification.

RESULTS:
Relative low-dose irradiation to the high-density stem cell region of rat salivary gland disproportionally impaired function. Hyper-radiosensitivity at doses <1 Gy, followed by relative radioresistance at doses ≥1 Gy, was observed in salivary gland and thyroid gland organoid cultures. DDR modulation resulted in diminished, or even abrogated, relative radioresistance. Furthermore, inhibition of the DDR protein ATM impaired DNA repair after 1 Gy, but not 0.25 Gy. Irradiation of patient-derived salivary gland organoid cells showed similar responses, whereas a single 1 Gy dose to salivary gland-derived stem cells resulted in greater survival than clinically relevant fractionated doses of 4 × 0.25 Gy.

CONCLUSIONS:
We show that murine and human glandular tissue stem cells exhibit a dose threshold in DDR activation, resulting in low-dose hyper-radiosensitivity, with clinical implications in radiotherapy treatment planning. Furthermore, our results from patient-derived organoids highlight the potential of organoids to study normal tissue responses to radiation.

Author information

Nagle PW1,2, Hosper NA1,2, Barazzuol L1,2, Jellema AL1,2, Baanstra M1,2, van Goethem MJ1,3, Brandenburg S3, Giesen U4, Langendijk JA1, van Luijk P1, Coppes RP5,2.
1
Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
2
Department of Cell Biology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
3
KVI Center for Advanced Radiation Technology, University of Groningen, Groningen, the Netherlands.
4
Physikalisch-Technische Bundesanstalt (PTB), Braunschweig, Germany.
5
Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. r.p.coppes@umcg.nl.