1. 1
Role of MTH1 and MYH proteins
in genotoxic effects of radiation
Doctoral thesis in Molecular Genetics
Sara Shakeri Manesh
Centre for Radiation Protection Research
Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm
University, Sweden
Stockholm, 2015

2. 2
Abstract
Humans are constantly exposed to different types of radiations. It has been suggested that low
dose and low dose rate of γ-radiation as well as ultra violet A (UVA) radiation induce oxidative
stress in cells that may promote mutations. The mechanisms behind radiation-induced oxidative
stress and its relation to genotoxicity and cancer induction are not well understood.
Understanding these mechanisms may provide valuable information for radiation protection
research and cancer prevention. In the majority of investigations, the DNA molecule has been
studied as the only target for stress induced mutations, however the results obtained in our group
point out that DNA bases in the cytoplasm (dNTP) could also be a significant mutagenic target of
oxidative stress. The nucleotide pool sanitization enzyme, MTH1, and the base excision repair
protein, MYH, are two of the key components of the repair pathway that can prevent mutations
arising from the formation of oxidative DNA base in the cell. In this thesis, we investigated the
role of MTH1 and MYH in genotoxicity of UVA and low dose rates of γ-radiation (paper I, II
and IV). The adaptive response to low dose rates of γ-radiation was investigated in paper III. The
human lymphoblastoid TK6 cell line was stably transfected with shRNA directed against MTH1
and/or MYH. The clonogenic cell survival assay was performed to investigate the cytotoxicity of
UVA and γ-radiation. Mutant frequency and chromosomal aberration assays were applied to
study mutagenicity of radiation. Our results indicated that acute exposure to UVA or γ-radiation
affects cell survival and also significantly increases the frequency of mutants above the
background. The frequency of mutants in MTH1 deficient cells was significantly higher than that
in wild types after exposure to UVA. Following exposure to γ-radiation, a higher frequency of
mutants was observed in cells lacking the expression of both MYH and MTH1, in comparison to
cells lacking either MYH or MTH1 or to wild type cells. No dose rate effect of γ-radiation for
mutations and stable type aberrations was observed in TK6 cells. An adaptive response to γ-
radiation was observed at the level of mutation in MCF-10A cells but not at the survival level. In
summary, our results suggest that MYH and MTH1 proteins cooperatively protect cells against
genotoxic effects of chronic oxidative stress induced by γ-radiation applied at low dose rates. We
also suggest that MTH1 protein protects cells from UVA-induced mutations. We speculate that
very low dose rates of γ-radiation may induce an in vitro adaptive response at the mutation level.
The important finding in this thesis implies that there is no dose rate effect for γ-radiation at the
level of mutations.

3. 3
This thesis is based on the following papers:
1. Sara Shakeri Manesh, Marta Deperas-Kaminska, Asal Fotouhi, Traimate Sangsuwan,
Mats Harms-Ringdahl, Andrzej Wojcik, Siamak Haghdoost. Mutations and chromosomal
aberrations in hMTH1-transfected and non-transfected TK6 cells after exposure to low
dose rates of gamma radiation. Radiation and Environmental Biophysics 53:417–425,
2014
2. Sara Shakeri Manesh, Traimate Sangsuwan, Asal Fotouhi, Noushin S. Emami, Andrzej
Wojcik, Siamak Haghdoost. Cooperation of MTH1 and MYH proteins in response to
mutation induction by low dose rates of gamma radiation (submitted manuscript)
3. Sara Shakeri Manesh, Traimate Sangsuwan, Andrzej Wojcik, Siamak Haghdoost.
Adaptive response induced by different dose rates of gamma radiation in MCF-10A and
TK6 cells (manuscript)
4. Asal Fotouhi, Sara Skiöld, Sara Shakeri-Manesh, Siv Osterman-Golkar, Andrzej Wojcik,
Dag Jenssen, Mats Harms-Ringdahl, Siamak Haghdoost. Reduction of 8-oxodGTP in the
nucleotide pool by hMTH1 leads to reduction in mutations in the human lymphoblastoid
cell line TK6 exposed to UVA. Mutation Research 715:13-18, 2011
Publication not included in this thesis:
Li Dang, Halina Lisowska, Sara Shakeri Manesh, Alice Sollazzo, Marta Deperas-Kaminska,
Elina Staaf, Siamak Haghdoost, Karl Brehwens & Andrzej Wojcik. Radioprotective effect of
hypothermia on cells – a multiparametric approach to delineate the mechanisms.
International Journal of Radiation Biology 88: 507-514, 2012

4. 4
Table of Contents
ABBREVIATIONS..........................................................................................................................5
INTRODUCTION............................................................................................................................7
Radiation in human life .........................................................................................................................................7
Ionizing radiation..................................................................................................................................................7
Non-ionizing radiation ........................................................................................................................................11
Oxidative stress ...................................................................................................................................................12
Oxidative stress biomarkers ................................................................................................................................14
DNA damage and repair .....................................................................................................................................15
Adaptive response................................................................................................................................................19
Bystander effect...................................................................................................................................................20
Radiation and epigenetics ...................................................................................................................................20
AIM OF THE THESIS...................................................................................................................21
METHODOLOGY.........................................................................................................................21
RESULTS AND DISCUSSION ....................................................................................................27
Paper I.................................................................................................................................................................27
Paper II ...............................................................................................................................................................29
Paper III..............................................................................................................................................................31
Paper IV ..............................................................................................................................................................33
CONCLUDING REMARKS .........................................................................................................35
ONGOING AND FUTURE STUDIES..........................................................................................36
ACKNOWLEDGMENT................................................................................................................37
REFERENCES...............................................................................................................................39

5. 5
Abbreviations
8-oxo-dA 8-oxo-2'-deoxyadenosine
8-oxo-dG 8-oxo-7, 8-dihydro-2'-deoxyguanosine
8-oxo-dGTP 8-oxo-7, 8-dihydro-2'-deoxyguanosine 5´-triphosphate
8-oxo-dGMP 8-oxo-7, 8-dihydro-2'-deoxyguanosine 5´-monophosphate
2-OH-dATP 2-hydroxy-2´-deoxyadenosine 5´-triphosphate
AP site Apurinic/apyrmidinic site
BEIR VII Biological effects of ionizing radiation VII
BER Base excision repair
CA Chromosomal aberrations
CPD Cyclobutyl pyrimidine dimers
DAPI 4',6-diamidino-2-phenylindole
DDREF Dose and dose rate effectiveness factor
DNMT1,3a and 3b DNA (cytosine-5)-methyltransferase 1,3 alpha and 3 beta
dNTP Deoxyribonucleoside triphosphate
DSB Double strand break
Gy Gray
FITC Fluorescein isothiocyanate
γ-radiation Gamma radiation
HMOX1 Heme oxygenase-1
hMTH1 Human MutT homolog protein 1
hMYH Human MutY homolog protein
hNUDT1 Human nudix (nucleoside diphosphate linked moiety X)-type motif 1
hOGG1 Human MutM homolog protein
HPRT Hypoxanthine phosphoribosyltransferase
H2O2 Hydrogen peroxide
HR Homologous recombination
ICRP International commission on radiological protection
IR Ionizing radiation

6. 6
LET Linear energy transfer
LNT Linear non threshold
MCF-10A Human breast epithelial cell line
MnSOD Manganese superoxide dismutase
NADPH Nicotinamide adenine dinucleotide phosphate
NADH Nicotinamide adenine dinucleotide
NER Nucleotide excision repair
NHEJ Non homologous end joining
N-Tr Non-transfected
O2•-
Superoxide anion
1
O2 Singlet oxygen
•OH Hydroxyl radical
ROS Reactive oxygen species
shRNA Short hairpin RNA
SSB Single strand break
Sv Sievert
TFT Trifluorothymidine
TK Thymidine kinase
TK6 cells Human B lymphoblastoid cell line
Tr Transfected
TRITC Tetramethylrhodamine isothiocyanate
TXRND1 Thioredoxin reductase 1
UV Ultraviolet
UVA Ultraviolet A radiation, λ = 315-400 nm
UVB Ultraviolet B radiation, λ = 280-315 nm
UVC Ultraviolet C radiation, λ = 200-280 nm
WR Radiation weighting factor
6-4PPs Pyrimidine (6–4) pyrimidone photoproducts

7. 7
Introduction
Radiation in human life
Radiation is a part of our everyday environment. All humans are inevitably exposed to some level
of background radiation that originates from natural and artificial sources. Natural sources
comprise cosmic rays (sun and outer space rays), decay of various radionuclides in the Earth´s
crust and radioactive isotopes in the human body such as 14
C, 3
H and primarily 40
K [1]. Artificial
sources consist of medical diagnostic and therapeutic procedures, discharges of radioactive waste
from nuclear industries and fallout from nuclear weapons. The background level of radiation
varies in different parts of the world. For instance, there are areas in Brazil, China, India, and Iran
where the estimated annual effective dose to the population is several fold higher than the global
average level (2.4 mSv/year) [2]. Inhabitants of high background radiation areas do not show
signs of detrimental health effects compared to individuals living in the rest of the world, but this
is not surprising in view of their relative small number [3]. However, a better understanding of
the health effects of chronic background radiation is a challenge for radiation research.
Ionizing radiation
Ionizing radiation (IR) is able to ionize molecules in exposed matter and induce chemical
alterations. There are a few different radiation qualities that carry enough energy to cause
ionization, such as high energy photons (γ- and X-rays) or particles (electrons, protons, α-
particles, neutrons, and heavy charged ions) [4]. IR can be characterized based on its linear
energy transfer (LET) to matter, often expressed as keV/µm. Photons that sparsely deposit their
energy to the penetrated material are classified as low-LET and particles with dense energy
depositions are considered as high-LET type of radiation. The unit of absorbed energy of IR is
the Gy (1 Gy = 1 J/kg). Due to the differences in energy distribution for low- compared to high-
LET types of radiation, the consequences and biological effects for important target molecules
such as DNA per unit dose will be different [5]. This is considered in radiation protection
practices by introducing the equivalent dose Sievert (Sv) that will allow for risk estimates where
the exposure conditions consist of several different radiation qualities. The equivalent dose Sv is

8. 8
thus derived from the absorbed dose (Gy) by multiplying it with the radiation weighting factor
(WR); [Sv = WR x Gy] where WR are estimates of the biological effectiveness (cancer) of the
different radiation qualities, ranging from 1-20. Thus, 1 Sv of α-particles and γ-rays are
considered to produce the same risk (cancer) [4], although the absorbed dose of alpha particles is
20 times lower than that of γ-rays.
High dose versus low dose
According to ICRP (International Commission on Radiological Protection) recommendations,
publication 103, doses below 100 mSv are considered as low and doses above are considered as
moderate or high [6]. Dose rates below 0.1 mGy/min are considered to be low [7].
Biological effects of radiation, deterministic and stochastic effects, are dose dependent.
Deterministic effects which are lethal to cells and lead to functional loss in tissues or organs are
only induced at high doses. The severity of deterministic effects increases with dose and below a
certain threshold there is no such effect. The threshold dose varies for different organs, depending
on the organ sensitivity. According to ICRP recommendations, publication 103 and a review
published in 2008, 100 mSv is the threshold dose below which no deterministic effects are
induced [6, 8]. At low doses, stochastic effects such as mutations, cancer or hereditary disorders
are of main concern, although they will also be induced at high doses. Due to the lack of reliable
epidemiological data that permit estimates of the level of risk for low doses, the shape of the dose
response curve for stochastic effects at low doses is not known and may be described based on
several models. At present, ICRP accepts the linear non threshold (LNT) model and assumes it to
be the most appropriate way of extrapolating risk below 100 mSv. The model predicts linearity of
radiation-related cancer risk with dose down to very low doses, assuming that any dose has the
potential to induce cancer [9]. The LNT model is mainly based on epidemiological data obtained
from the life span studies of the atomic bomb survivors (figure 1).

9. 9
Figure 1: Schematic representation of different models for extrapolation of cancer risk following
exposure to low dose radiation. Curve a, linear extrapolation (LNT); curve b and c, nonlinear
dose response models that would result in overestimation and underestimation, respectively, of
risk if the LNT model is correct; curve d, threshold model; curve e, hormesis model (adapted
from [9]).
Dose rate effect
As mentioned earlier, most data on stochastic effects of radiation are from atomic bomb survivors
exposed to high dose rates while not enough data are available for health effects of protracted
exposures over long periods of time. Therefore, the study of dose rate effects, especially at low
dose rates, remains a high priority in radiation research. It is accepted that high dose rates induce
more malignancies and are more cytotoxic than low dose rates [10]. At low dose rates more time
is available for repair before the next hit is happening in juxtaposition of the first one, thus the
probability of interaction and formation of complex damage is lower. In other words, when the
dose rate is low the transient accumulation of damage will also be low and, subsequently, the
efficiency or fidelity of repair is high [11].

10. 10
For the purpose of radiation protection, a dose and dose-rate effectiveness factor (DDREF) is
defined as the factor by which the risk of causing stochastic effects induced by high acute doses
of low-LET IR should be reduced when the same dose is delivered at low dose rates.
At present, ICRP publication 103 recommends a DDREF of 2, meaning that the slope of the
dose-response at low doses or low dose-rates is half the slope compared to that for high doses and
high dose-rates [8, 12]. However, the BEIR (biological effects of ionizing radiation) VII
Committee of the National Academy of Sciences (USA) has come up with an even more
conservative policy and concludes that the best estimate of the DDREF is 1.5 [13]. In support for
the BEIR VII policy, recent studies of human populations provide evidence that cancer risks at
low dose rates (occupational exposures) are not lower than at high dose rates (atomic bomb
survivors) [14, 15]. More support comes from the studies for the risk of developing leukemia in
humans, as it is not reduced by exposure to protracted radiation [16]. On the other hand, a report
by Preston [15] suggests that the health effects of radiation may possibly be significantly reduced
after very low dose rate exposures compared to what is currently estimated. Therefore an accurate
estimation of DDREF for humans remains an open question.
For high-LET radiation, due to the lack of a dose rate effect [17], the DDREF is 1.
Action of ionizing radiation
The interaction of radiation with biological molecules occurs through direct and indirect means
(figure 2). Direct action involves direct ionization or excitation of the target molecule, initiating a
chain of reactions that leads to biological effects. This is the dominant mechanism of action for
high-LET radiation. For instance, direct and dense ionization from α-particles (high-LET) along a
path induces a high level of clustered DNA damage (at least two lesions within less than 10 base
pairs) [18]. Indirect action involves the interaction of radiation with other molecules (e.g. water)
to produce free radicals that ultimately interact with the target molecule and induce damage.
Interaction of ionizing radiation with water molecules gives rise to formation of reactive oxygen
species (ROS) and, consequently, to oxidative stress. Low-LET radiation interacts predominantly
(approximately 70%) through indirect action [4].

11. 11
Figure 2: A representation of direct and indirect action of ionizing radiation (modified
after [4]).
Non-ionizing radiation
Non-ionizing radiation refers to photons in the electromagnetic spectrum with wave lengths
longer than 200 nm. The energy of these photons is not sufficient to ionize molecules along their
path. Ultraviolet (UV), visible light, infra-red, etc. comprise different types of non-ionizing
radiation among which UV has the shortest wave lengths (200 to 400 nm) and has been studied in
this thesis. The main natural source of UV radiation is sunlight. However, the health effects of
exposure to artificial sources such as solariums are becoming in concern. UV radiation is
classified as UVA (320–400 nm), UVB (280–320 nm) and UVC (200–280 nm). The Earth’s
atmosphere filters UVC (completely) and UVB (mostly), therefore UVA is the main (95%) type
of UV radiation that reaches the Earth. Annual UV exposure to sunlight, in different parts of the
world, causes a total dose of 27 J/cm2
(United Kingdom) to 156 J/cm2
(Australia) to the human
skin [19]. The ability of UV radiation to penetrate the skin is proportional to the wavelength of
the rays, thus UVA can penetrate deep into the dermis of the skin whilst UVB is absorbed
superficially in the epidermis. Skin aging, development of skin cancers and immunosuppression
in humans are possible adverse effects of UVA exposure [20]. UVB is known to be a potent skin
cancer risk factor, responsible for erythema (sunburn) and immunosuppression. However, solar
UVB is essential for the synthesis of vitamin D, which may potentially reduce the risk of colon
[21], prostate and ovarian cancers [22, 23].

12. 12
Action of UV radiation
UV radiation can induce damage either directly (UVB and UVC) through the excitation of DNA
bases or indirectly (mainly UVA) through the excitation of endogenous photosensitizers and
further induction of ROS (figure 3), which leads to increased levels of oxidative stress. During
indirect actions, excited photosensitizers such as riboflavin and NADH−/NADPH transfer energy
to substrates as DNA without intermediates (type I) or via singlet oxygen (type II) [24].
Figure 3. Mechanisms of UV radiation action for the induction of DNA damage (modified after
[24, 25]).
Oxidative stress
Oxidative stress refers to an imbalance between the formation of reactive species and antioxidant
capacity of the cell. This imbalance may result from an increased induction of reactive species or
diminished levels of antioxidants. Reactive species are free radicals and their derivatives that can
be induced endogenously as a result of natural metabolism, or exogenously as an outcome of
radiation or a particular chemical exposure. Oxygen and nitrogen radicals and their derivatives
are the major types of these reactive species. In this thesis, reactive oxygen species (ROS) are
discussed. ROS include superoxide radical anion (O2•-
), hydroxyl radical (•OH), hydrogen
peroxide (H2O2) and singlet oxygen (1O2), among which •OH is the most reactive. •OH can react
with all molecules in a close proximity [26]. Singlet oxygen, preferentially, modifies guanine

13. 13
[27] while superoxide has too low of a reactivity to induce such damage at all [28]. The
predominant action of γ-radiation is via the •OH radical. In contrast, UVA mainly operates via
singlet oxygen [29].
The natural formation of ROS, in an aerobic organism, occurs in the mitochondrial respiratory
chain where O2 is reduced to H2O by the transfer of four electrons and two protons. In this
process, possible leakage of single electrons (1-2%) may lead to a partial reduction of O2 to O2•-.
Formation of O2•- could lead to the formation of other types of ROS, such as •OH (figure 4).
Besides the mitochondrial electron transport chain, some other endogenous sources such as
oxidase enzymes (NADPH in phagocytes and xanthine oxidases) and redox cycling can also
induce O2•-. It is suggested that accumulation of unfolded proteins in the endoplasmic reticulum may
lead to ROS production [30]. Also, dietary mineral deficiencies, such as deficiencies in Zn2+
,
Mg2+
, Fe2+
, and Cu2+
that are components of several antioxidant enzymes, can cause oxidative
stress [31-34].
It is estimated that about 1010
molecules of O2•- are produced in each human cell every day [35,
36]. This amount of endogenous ROS may, on average, induce about 106
DNA damage events
per cell per day [37]. The number of DNA double strand breaks (DSBs) induced by endogenous
ROS is approximately 103
times higher than that of radiogenic DSBs from background irradiation
[37, 38]. The number of ROS induced by 1Gy of γ-radiation is approximately 150 000 per cell
[39]. The magnitude of UVA-induced ROS per kJ/m2
, measured indirectly as a yield of damage
per kJ/m2
, is estimated to be less than what 1 Gy of γ-radiation induces [40].
Figure 4: Schematic representation of endogenous ROS formation (modified after [35, 41]).

14. 14
Excessive levels of ROS, and consequently the state of oxidative stress in many cells, have been
correlated with aging, neurodegenerative diseases, carcinogenesis, and many other disorders [42-
45]. Apart from deleterious effects, ROS could help cells by taking part in the enhancement of
signal transduction, sensing of oxygen tension and immunological responses to environmental
pathogens [45]. Moreover, elevated ROS concentrations activate antioxidant genes such as
manganese superoxide dismutase (MnSOD) in order to maintain the redox homeostasis in many
cells [45].
Oxidative stress biomarkers
Due to the short half-life of ROS, a direct and precise method of measuring the level of oxidative
stress is not available today. However, indirect approaches, often referred to as fingerprinting
methods, have been applied as useful alternatives. Fingerprinting methods measure the specific
end products that result from the interaction of ROS with biomolecules, such as DNA, proteins
and lipids. The detectable end products are known as biomarkers of oxidative stress and some
examples are listed below [46-48].
 8-oxo-7,8-dihydro-2′-deoxyguanosine (8-oxo-dG): biomarker for DNA base oxidation
 protein carbonyl groups: biomarker for protein oxidation
 malondialdehyde: biomarker for lipid peroxidation
Among these, oxidative DNA base biomarkers are of particular biological interest given that
DNA modifications can be genotoxic and also be transmitted over generations, which may result
in hereditary disorders. Guanine bases are found to be easily oxidized [49] due to their high redox
potential [50]. It is suggested that 8-oxo-dG is not metabolized in humans and its amount in urine
is unaffected by diet [51]. Therefore, 8-oxo-dG and 8-oxo-G have been used as sensitive markers
for oxidative stress in the nucleotide pool [52] and in the DNA, respectively.

15. 15
DNA damage and repair
Radiation induces a wide variety of DNA damage. For instance, 1 Gy of γ-radiation causes
approximately 20-40 double strand breaks (DSBs), 1000 single strand breaks (SSBs), 1000
oxidative base damages, and 0-3 chromosomal aberrations [5, 53] among which DSBs are the
most dangerous type of DNA damage. As a consequence of a DSB, two broken ends of a
chromosome may rejoin wrongly and generate chromosomal aberrations (CA). These
chromosome rearrangements may occur within a chromosome (intra-CA) such as deletions, rings
and inversions or between two or more chromosomes (inter-CA) such as translocations and
dicentrics (figure 5) [54]. Formation of dicentrics and rings are lethal to cells. Therefore, these
types of aberrations are considered as unstable aberrations and will probably be lost from a
proliferating cell population. On the other hand, symmetric translocations and small deletions that
persist during cell proliferation are considered as stable aberrations [4]. DSBs are repaired by two
main pathways; homologous recombination (HR) and non-homologous end-joining (NHEJ). HR
provides a high-fidelity repair mechanism that takes place in late S–G2 phase while NHEJ is an
error prone but fast repair mechanism that functions throughout the whole cell cycle [55].
UV radiation can produce DNA photoproducts and/or reactive oxygen species and induce
different types of DNA damage. The types of DNA damage induced by UVA radiation include
oxidative DNA damage [56], SSBs, abasic sites, and cyclobutyl pyrimidine dimers (CPDs) [20].
UVB radiation, through direct absorption by DNA, mainly gives rise to the formation of CPDs
and pyrimidine (6–4) pyrimidone photoproducts (6-4PPs) [57, 58] and to a lesser extent oxidative
damage [59]. Nucleotide excision repair (NER) repairs both CPDs and (6-4PPs) [60].

16. 16
Figure 5: Examples of chromosomal aberrations where the breaks and re-joins affect both sister-
chromatids (adapted from [61]).
Oxidative DNA damage and SSBs are repaired through the base excision repair (BER) pathway,
as described below.
Base excision repair (BER)
BER is the major repair pathway in mammalian cells that deals with oxidative DNA damage and
SSBs. This repair pathway is able to ensure the fidelity of base pairing via two general
mechanisms; short-patch and long-patch repair. The short-patch pathway results in the repair of a
single nucleotide while the long-patch leads to repair of at least two nucleotides. The core BER
pathway includes five enzymatic steps that remove damaged bases. In the first step, a DNA
glycosylase identifies and removes the damaged base, forming an apurinic or apyrimidinic site
(AP site). In the next step, a DNA AP endonuclease or a DNA AP lyase catalyzes the cleavage of
the DNA backbone. The endonucleases activity creates a single strand break which is filled in
(with a new nucleotide) by a DNA polymerase. DNA polymerase carries out two distinct
enzymatic activities in BER, which include DNA polymerase activity to fill in the gap, and 5´-
deoxyribophosphatase activity to cleave the 5´-phosphate forming an appropriate substrate for
efficient ligation. Ultimately, a DNA ligase restores the formation of phosphodiester bonds and
completes the repair [62]. The main BER proteins particularly involved in repair of 8-oxo-dG are
human MutY homolog (hMYH) and 8-oxoguanine DNA N-glycosylase 1 (hOGG1).

17. 17
MYH is an adenine-specific glycosylase that removes post-replicative mispaired adenines such as
A/8-oxo-G, A/G and A/C, although the enzymatic activity on A/C mismatches is weak [63, 64].
The hMYH gene is located on chromosome 1 and contains 16 exons [65]. The gene products
contain nuclear and mitochondrial signals [66]. The activity of the hMYH protein is cell cycle
dependent. It has been shown that the maximum level of hMYH expression is in the S phase [67].
The lack of hMYH activity leads to G:C to T:A transversions (figure 6) [68] which has been
found to be implicated in the inherited predisposition to colorectal tumors [69]. A tumor
formation suppressor activity is attributed to MYH due to its function in mutation prevention [70]
and programmed cell death under oxidative stress conditions [71]. Recently, a functional p53-
binding site has been discovered in the human MYH gene, proposing that MYH is
transcriptionally regulated by p53 and that the involvement of MYH in programmed cell death
under oxidative stress is mediated by p53 [72].
OGG1 is a DNA glycosylase that recognizes and excises 8-oxoG when it is paired with C, G, or
T but not with A [73]. Two forms of the nuclear and mitochondrial human OGG1 protein are
encoded by the hOGG1 gene which is located on chromosome 3 [74]. hOGG1 prevents G:C to
T:A transversions through the correction of 8-oxoG:C mispairs. There is evidence suggesting that
single nucleotide polymorphism in the hOGG1 gene has been a risk factor for breast cancer [75].
Nucleotide pool sanitization and the role of MTH1
Recently it has become clear that the nucleotide pool is an important target for ROS induced
deoxyribonucleoside triphosphate (dNTP) modification [76, 77]. Modified dNTPs, e.g., 8-oxo-
dGTP, can be incorporated into the DNA during replication and give rise to mutations. The
sanitization enzyme hMTH1 (human Mut T homolog 1) prevents the incorporation of 8-oxo-
dGTP into DNA in mammals, figure 6. hMTH1 also known as hNUDT1 is an 18 kDa protein
encoded by the hMTH1 gene and located on chromosome 7p22 [78]. The hMTH1 gene produces
seven types of mRNAs, such as types 1, 2A, 2B, 3A, 3B, 4A, and 4B by alternative splicing [79].
The hMTH1 protein, which is mainly localized in the cytoplasm, is able to hydrolyze 8-oxo-
dGTP to 8-oxo-dGMP (as well as 2-hydroxy-dATP to 2-hydroxy-dAMP), inhibiting 8-oxo-dGTP
incorporation from the nucleotide pool into DNA [80]. The 8-oxo-dGMP is further
dephosphorylated to 8-oxo-dG by the action of 8-oxo-dGMPase and then excreted to the cell

18. 18
exterior. Moreover, as mentioned earlier, excreted 8-oxo-dG into the extracellular milieu (in
urine, blood serum, cell culture medium) may be considered as a marker for oxidative stress.
Numerous evidences demonstrate that eliminating modified dNTPs from the nucleotide pool is
important for maintaining genomic integrity. As an example, the frequency of A:T to C:G
transversion has been found to be more predominant in bacteria deficient in Mut T than in wild
type [81]. The signaling processes that activates/regulate the expression of MTH1 are still
unclear.
Recently, the implication of MTH1 in tumor development as well as MTH1 suppression for
killing tumor cells have come into the focus for cancer biology research. For instance in mouse
studies, an increased number of tumors have been found in the lungs, liver, and stomach of
MTH1-deficient animals, as compared to wild-types [82]. In human studies, overexpression of
hMTH1 has been observed in brain [83] and lung [84] cancers. The role of hMTH1 in facilitating
RAS oncogene-induced non-small cell lung carcinoma has been explained as the ability of
hMTH1 to minimize the tumor-suppressive effects of ROS without entirely eliminating it [85]. In
gastric cancer patients, polymorphic variation of hMTH1 has more frequently been observed than
in healthy individuals and 20% of patients carried mutations in the p53 gene [86].
In contrast to normal cells, tumor cells undergo a high proliferative state and an active
metabolism possibly causing an increased level of oxidative stress. Hence, overexpression of
hMTH1 may be interpreted as a possible defensive mechanism for the survival of cancer cells.
Some recent studies have suggested that inhibition of hMTH1 could be lethal for cancer cells [87,
88]. As this thesis, paper I and II, indicates that hMTH1 cooperates with other proteins, namely
hMYH, in preventing oxidative damage, the hypothesis that suppression of MTH1 alone could
specifically kill cancer cells needs to be further investigated.

19. 19
Figure 6: Mutagenesis caused by 8-oxoguanine and mammalian defense systems, modified after
[89].
Most of these types of DNA damage, if not repaired, may lead to genomic instability which refers
to an increased rate of acquisition of alterations within the genome. These alterations involve a
wide variety of biological end points including chromosomal aberrations, gene mutations and
micronuclei formation [90].
Adaptive response
A phenomenon in which pre-exposure to a low adapting dose of radiation (or any other mutagen)
enhances cellular abilities to cope with the adverse effects of a subsequent challenging dose is
known as adaptive response [91, 92]. Exposure to a low adapting dose could hypothetically
decrease the risk for detrimental health effects of radiation by two principal types of mechanisms
that are described below. One is to increase repair capacity or other cellular defense systems that
could prevent and repair DNA damage resulting in cell survival and proper cellular functions.
The other type is to reduce genomic instability by eliminating damaged cells through induction of
apoptosis, differentiation and immune responses [38, 93, 94]. Adaptive response may develop
within a few hours after radiation exposure and may last for several weeks to months depending
on cell type or tissue [95, 96]. An improved understanding of the underlying mechanisms of

20. 20
adaptive response could shed light on the shape of the dose response curve for radiation-induced
cancer risk at low doses. This phenomenon is also of relevance for the clinical applications of
radiation in medicine. However, due to the variability of response depending on the different
cellular model systems, radiation conditions and endpoints, the phenomenon of adaptive response
is not universally accepted.
Bystander effect
Bystander effect is described as manifestation of radiation-induced cellular effects in non-
targeted cells neighboring targeted cells [97, 98]. These effects may result from signals generated
by irradiated cells secreted to non-irradiated cells or from molecules transported through cell-to-
cell gap junctions. Bystander effects could be beneficial (e.g. adaptive response) or detrimental
(e.g. transformation) to non-targeted cells. Although the mechanisms responsible for bystander
effect is not clearly understood and the effect is not universally accepted, generally, it appears to
be a low dose phenomenon [99]. Thus, a comprehensive understanding of radiation-induced
bystander effects could possibly have an impact on the cancer risk estimations at low doses.
Radiation and epigenetics
The classic definition of epigenetics describes stable heritable changes in gene expression
without alterations in the DNA sequence [100]. These changes may be induced through a number
of processes such as DNA methylation, histone modifications and non-coding RNA. Radiation
epigenetics is an emerging area of research that has been studied since 1980s and it may bring
insights into cellular responses to radiation. Epigenetic modifications have been found in various
human diseases including cancer and indeed studies of these changes have influenced the
understanding of radiation induced-carcinogenesis. DNA methylation is the most extensively
studied mechanism of epigenetics. A global DNA hypomethylation has mostly been observed
post-irradiation [101, 102] although hypermethylation in promoter regions of tumor-suppressor
genes has also been found to play a role in radiation-induced carcinogenesis. In addition, changes
in chromatin conformation, leading to a more open structure, and altered non-coding RNA
expression have been observed in response to radiation exposure [103]. However, epigenetic
changes can be highly dependent on tissue, sex, dose, and radiation quality [104, 105]. Although
the epigenetic effects of radiation and the underlying mechanisms need further investigations,
they may be considered as changes that have an impact on the late effects of radiation that drive

21. 21
or protect normal cells to/from cancer. The epigenetic alterations that protect cells from cancer
may be induced by low dose and dose rate low-LET radiation through e.g. activation of apoptosis
or tumor suppressor genes [106].
Aim of the thesis
The main aim of this thesis is to understand the mechanisms behind genotoxic effects of
radiation-induced oxidative stress and induction of adaptive response that could be used to better
understand the shape of the dose response curve for risk estimates at low doses and low dose
rates of γ-radiation. The hypothesis behind the study is that exposure to γ- (at low dose rates) or
UVA-radiation increases formation of endogenous free radicals in the cells, which may lead to
oxidation of dNTPs and the subsequent induction of mutations and cancer. Thus, investigating
the role of proteins engaged in repair of oxidative damage in vitro could possibly shed light on
cancer induction associated with an exposure scenario.
We established cells with normal and low capacity to handle oxidative stress by down-regulating
(shRNA transfection method) the expression levels of MTH1 and/or MYH proteins and exposed
them to γ- or UVA-radiation. The impact of γ-radiation at low dose rates on the induction of
chromosomal aberrations (paper I) and mutation at the TK locus (paper I and II) were
investigated in the transfected and non-transfected cells. The influence of acute exposure to UVA
radiation on the mutation and 8-oxo-dG induction were studied in paper IV. The adaptive
response induced by low dose rates of γ-radiation was studied in paper III.
Methodology
Cell types
TK6 is a human B lymphoblastoid cell line isolated from the spleen of a 5-year-old boy with
known hereditary spherocytosis [107]. In humans, TK6 cells are heterozygous at the thymidine
kinase (TK) locus [108] which is mapped on chromosome 17 [109]. TK+/-
heterozygotes are
suitable for mutation analysis. The function of P53 in TK6 cells is reported as normal [110].

22. 22
Based on our results observed in paper I, there is a stable translocation between one of the
chromosomes 14 and an unpainted fragment. TK6 cells were cultured in RPMI-1640 medium
supplemented with 10% defined bovine calf serum, 1% Pest and 10 mM HEPES at 37 o
C and 5%
CO2. The cell density was kept below 25 x 104
/ml during the experiments.
The MCF-10A cell line is derived from human fibrocystic mammary epithelial tissue and does
not exhibit a normal karyotype [111]. A balanced translocation t (3;9) has been presented in these
cells. The cell culture medium, DMEM/F12 Ham, was supplemented with 10% horse serum, 1%
Pest, 10 µg/ml insulin, 20 ng/ml epidermal growth factor (EGF), 0.5 μg/ml hydrocortisone and
0.1 µg/ml cholera toxin. The cells were grown at 37 o
C and 5% CO2. Experiments were
performed with 70% confluent cells (5 x 105
cells in 25 cm2
flasks flasks). 100% confluent cells
were sub-cultured after 5 days. Cells were detached from the flasks by 0.05% trypsin in EDTA
and washed with HBSS without calcium and magnesium.
Gene silencing
A stable silencing of the genes of interest was accomplished using short hairpin RNA (shRNA)
according to a standard protocol provided by Sigma-Aldrich. A lentiviral vector was used as a
tool to deliver shRNA into the cells. In order to increase the transfection efficiency,
hexadimethrine bromide was added to the cell culture medium. The shRNA was mixed with 3 x
104
TK6 cells in transfection medium, and after 20 hours puromycin was added to select the
transfected cells. After 5 days, the selected transfected cells were cultured in medium containing
low melting agarose gel and kept in a cell culture incubator for colony formation. Twenty
transfected colonies were picked up and expanded. In order to determine the expression levels of
transfected proteins, 1 x 105
cells from each colony were processed for western blot analysis. The
colonies that expressed the lowest level of transfected proteins were chosen for this study. The
transfection efficiency was also examined by using shRNA-producing GFP.

23. 23
Irradiation
Exposure to γ-radiation was carried out acutely or chronically. For chronic exposure of cells (1.4,
5.0, 15.0, or 30.0 mGy/h), two different cell culture incubators equipped with 137
Cs sources
(CRPR, Stockholm University) were used. The dose rates in one incubator were 5 to 30 mGy/h,
(figure 7A), and in the other incubator 1.4 mGy/h, (figure 7B). For acute exposure, a 137
Cs source
(Scanditronix, Uppsala, Sweden) with the dose rate of 24 Gy/h was used at room temperature,
(figure 7C). The non-exposed cells were incubated in a separate incubator and received a
background dose rate of 0.0005 mGy/h. During chronic radiation exposure, TK6 cells were sub-
cultured every second day, and MCF10-A cells every 5 days.
UVA exposure was performed using an Osram Ultramed device at 122 W/m2
irradiance
described in paper IV. Briefly, TK6 cells were cultured in RPMI-1640 medium without phenol
red supplemented with 10% defined bovine calf serum, 1% Pest and 10 mM HEPES at 37 o
C and
5% CO2 prior to the experiments. In order to irradiate approximately a monolayer of the cells, 0.5
×106
cells per 0.5 ml were placed on an 8.5 cm2
petri dish. Cells were irradiated on ice in petri
dishes without lids.

24. 24
Figure 7: γ-radiation exposure
facilities. Panel A and B show the
chronic exposure incubators equipped
with 137
Cs source 74 GBq (1993) and
137
Cs source 370 GBq (2007),
respectively. Panel C shows the acute
exposure 137
Cs source 33.3 TBq
(1985), (Scanditronix).

25. 25
Clonogenic survival
Clonogenic survival of the acutely exposed cells to γ- or UVA-radiation was assessed by the
colony formation assay. For TK6 cells, clonogenic survival was performed immediately after
radiation exposure by seeding different numbers (50 to 800) of cells into 6 well plates containing
low melting agarose gel prepared in RPMI medium. The plates were cooled down at 4 °C for 20
minutes in order to solidify the gel, followed by 10-14 days incubation period for colony
formation. The clonogenic survival of MCF-10A cells was assessed after seeding a defined
number of cells (20-100) into 6 well plates containing culture medium. After 11 days of
incubation, cells were stained with methylene blue and visible colonies were counted manually.
Mutation analysis
Mutation analysis was assessed as the frequency of mutants at TK or HPRT locus in TK6 and
MCF-10A cells, respectively.
Mutants at the TK locus were selected using trifluorothymidine (TFT), a thymidine analogue
[112]. Following treatments, TK6 cells were cultured at 37 o
C and 5% CO2 for 10 days in order to
allow mutants to express the mutated TK. During this time, cells were sub-cultured every second
day. After that, cells were seeded into 6 well plates containing low melting agarose gel mixed
with 2x concentrated RPMI medium and 5 μg/ml TFT. Cells resistant to TFT formed visible
colonies after a period of 10-14 days incubation at 37 o
C and 5% CO2.
MCF-10A mutants at HPRT locus were selected using 6-thioguanine. Following treatments cells
were cultured at 37 o
C and 5% CO2 for 11 days in order to allow the mutants to express the
mutated HPRT protein. Following the incubation time, cells were seeded into petri dishes
containing the culture medium (DMEM/F12 Ham) and 5 µg/ml 6-thioguanine. The cells were
incubated for 11 days to form colonies. Visible colonies were stained with methylene blue and
counted manually.
Mutant frequency (MF) at the TK or HPRT locus was calculated using the following formula: MF
= [(M/N) / CE] where M is the number of mutants, N is the number of total seeded cells in the

26. 26
selection medium and CE is the clonogenic efficiency, without 6-thioguane or TFT treatment.
The mutant frequency was expressed as mutants per 105
surviving cells.
Chromosomal aberrations
Chromosomal aberrations were analyzed in cells at metaphase with fluorescence in situ
hybridization (FISH) chromosome painting technique. Treatment with colcemid trapped cells in
metaphase. Chromosomal aberrations were identified in three chromosomes with different sizes
(2, 8 and 14) using specific FISH probes in MTH1-transfected and wild type cells following γ-
radiation exposure. Hybridization was carried out according to the protocol from the
manufacturer with some modifications (details are explained in paper I). Around 1000
metaphases were scored for each treatment group. Images were captured by a Cool Cube 1 CCD
camera coupled to a fluorescence microscope that was equipped with filters for DAPI, FITC and
TRITC. Aberrations were classified as dicentrics (2A, one- or two-way), translocations (2B, one-
and two-way) rings (centric and acentric) and acentric fragments. Dicentrics and translocations
included exchanges between the three painted chromosomes and, for 2A exchanges, between the
homologous chromosomes. The scoring of primary breaks was achieved by transforming all
aberrations to the simple form, by estimating the number of primary breaks necessary to create
the observed exchange aberration.
Determination of 8-oxo-dG and dG
The measurements of intra and extracellular levels of 8-oxo-dG, as a marker for oxidative stress,
was carried out according to a modified ELISA protocol developed at the Stockholm University
[113] for detection of 8-oxo-dG in the medium, blood serum and cytoplasm. Briefly, 1 ml
medium was filtered through a C18 bond elute column. The elute containing 8-oxo-dG was
freeze dried, re-solved in PBS and filtered again in order to remove compounds that interact with
the 8-oxo-dG primary antibody. The purified samples were resolved in PBS, mixed with 8-oxo-
dG antibody and added to a 96-well plate pre-coated with 8-oxo-dG. After incubation, the wells
were washes 3 times and treated with a secondary antibody. Thereafter, the plate was washed 3
times and staining solution was applied followed by 15 min incubation at room temperature.
Following incubation, phosphoric acid was added to each well and the intensity of the color was
measured at 450 nm using an ELISA plate reader. The dG quantification was performed by

27. 27
reversed phase HPLC with UV-detection, the details of the technique is explained by Osterman-
Golkar et al. [114].
Real-time PCR and PCR
The gene expression was investigated at mRNA level. Firstly, RNA was isolated from the cells
according to the standard protocol by Sigma-Aldrich, and further examined for the quality and
quantity. Secondly, the isolated RNA was transcribed to cDNA (Thermo Scientific) using PCR.
The kinetics of the cDNA amplification in the presence of the EvaGreen dye was monitored
using a LightCycler®
real-time PCR System provided by Roche. The experiments were
performed according to the protocols supplied by manufacturers.
Results and discussion
Paper I
Mutations and chromosomal aberrations in hMTH1-transfected and non-transfected TK6 cells
after exposure to low dose rates of gamma radiation
In this paper, the dose rate effects of γ- radiation and the role of hMTH1 protein against
radiation-induced oxidative stress were investigated in human lymphoblastoid TK6 cells. With
the tools of gene silencing, short hairpin RNA (shRNA), we stably transfected cells against
hMTH1. Transfection efficiency was validated with Western blot analysis, showing that the
expression level of hMTH1 in transfected cells was down regulated to 12%. The cells were
exposed to 0.5 and 1.0 Gy cumulative doses of γ-radiation at dose rates of 1.4, 5.0, 15.0, and 30.0
mGy/h as well as 24 Gy/h. After exposure, growth rate, clonogenic survival, mutant frequency,
and chromosomal aberrations were investigated in both wild type and hMTH1-transfected cells.
Growth rate was measured during chronic exposure to 0.0, 1.4, 5.0 or 15.0 mGy/h γ- radiation for
23 days, in both cell types. The results demonstrated that increasing dose rates, > 1.4 mGy/h,
reduced the growth rate in both wild type and hMTH1-transfected cells. Notably, the growth rate
in hMTH1- transfected cells was slightly, non-significantly, lower than that in non-transfected
cells. This pattern was observed at all dose rates. Clonogenic survival assay in cells exposed to

28. 28
acute doses of γ-radiation resulted in a non-significantly lower survival for transfected cells as
compared to wild type cells. The values for LD50 (the dose that results in 50% survival) were
0.33 Gy and 0.36 Gy for transfected and wild type cells, respectively. The frequency of mutants
were studied after chronic and acute exposures to γ-radiation at the accumulated doses of 0.5 and
1.0 Gy in both cell types. The results showed an overall dose dependent increase in mutation
induction while no significant dose rate effect. These patterns were seen in both transfected and
wild type cells. Comparing mutant frequencies between transfected and wild type cells, no
significant difference was observed. Moreover, the data indicated that radiation increased the
level of mutation significantly, almost 2- to 4-fold above the background level in both cell types.
Radiation-induced chromosomal aberrations were analyzed in chromosomes 2, 8 and 14 in both
transfected and wild type cells. The accumulated dose was 1 Gy administered at 1.4 to 30.0
mGy/h. A stable translocation was seen in both cell lines between chromosome 14 and an
unpainted fragment (not counted as an aberration). In control cells, no aberrations were detected
beside this stable translocation. Overall, when comparing exposed cells, no increase in stable
aberrations was seen with the dose rate. On the other hand, an inversed dose rate effect was
observed particularly for transfected cells. For unstable-type aberrations and primary breaks, a
clear increase was observed with increasing dose rates in both types of cells. A significant
difference between the two cell lines was only seen for primary breaks in the cells exposed at
15.0 mGy/h. However, this result must be interpreted with caution in view of the fact that a single
experiment was carried out.
The same response to γ-radiation-induced oxidative stress in hMTH1-transfected and wild type
cells could be explained in various ways; a) due to low yields of the oxidized dGTP under our
exposure conditions; b) due to up regulation of other pathways responsible for handling oxidative
stress. We may also speculate that the remaining expression of hMTH1 after transfection (12%)
has been sufficient to hydrolyze 8-oxo-dGTP in the nucleotide pool. The absence of a dose rate
effect in our study is in agreement with other´s data for TK6 cells [115, 116].

29. 29
Main findings in paper I:
 A dose rate effect was absent for mutations and stable-type aberrations in TK6 cells.
 Silencing the expression level of hMTH1 down to 12% had no influence on the cellular
response to γ-radiation-induced oxidative stress, with respect to survival, growth,
mutations, and chromosomal aberrations.
Paper II
Cooperation of MTH1 and MYH proteins in response to oxidative stress induced by chronic
gamma radiation
This study aimed at investigating the role of MYH and MTH1 proteins in response to γ-radiation-
induced oxidative stress. As in paper I, we found that down regulation of MTH1 does not
influence the sensitivity of TK6 cells to γ-radiation, thus it was interesting to investigate how
cells compensate this deficiency in the expression of MTH1. Therefore, in this study we focused
on the role of MYH and its cooperation with MTH1 in repair of oxidative damage. Using
shRNA, we established two cell lines differing in expression level of MYH and MTH1 proteins.
MYH expression was down regulated to 2.6% in one cell line and the levels of MTH1 and MYH
in the other cell line were simultaneously reduced to 14% and 22%, respectively. After the
exposure of cells to chronic and acute γ-radiation, the growth rate, clonogenic survival level and
mutant frequency were analyzed. The accumulated doses of 0.5 and 1.0 Gy were delivered at 1.4,
5.0, 15.0, and 30.0 mGy/h as well as an acute dose rate (24 Gy/h).
The clonogenic survival results did not show any significant differences among the three cell
types. The LD50 values for each cell line were as follows: wild type 0.61 Gy, MYH-Transfected

30. 30
0.61 Gy and MYH- and MTH1-transfected 0.51 Gy. However, the levels of cell survival and
growth (significant reductions at 5 and 15 mGy/h) were lower in cells lacking the complete
expression of both MTH1 and MYH in comparison to that in MYH deficient or wild type cells.
In contrast, MYH deficient cells did not show any higher sensitivity to radiation at the level of
survival and growth rate in comparison to wild type cells. The frequency of mutants in MYH and
MTH1 deficient cells was higher (in general) than that in MYH deficient or wild type cells.
However, for wild type and MYH deficient cells a similar level of mutant frequency was found
following acute and chronic exposures. Comparing MTH1 deficient cells (paper I) with cells
lacking the expression of both MTH1 and MYH, we found that later cells grow slower (at 5 and
15 mGy/h exposures), survive less (non-significantly) and have higher mutant frequency than
MTH1 deficient cells when exposed to γ-radiation.
These observations may primarily suggest that oxidative stress induced by chronic and acute γ-
radiation is significantly more mutagenic in MYH and MTH1 deficient cells than in cells lacking
the expression of either MTH1 or MYH or in wild type cells. The interpretation of the results
could be as follows; once deficient cells in MYH and MTH1 are exposed to an elevated level of
oxidative stress due to radiation exposure and at the same time have elevated levels of modified
dNTPs in the cytoplasm (due to low levels of MTH1), they will be extremely sensitive in terms
of mutations. As we compare the results in paper I and in the present study, it appears that in the
stress condition lack of one protein (either MYH or MTH1) in TK6 cells could be compensated
by the action of the other in terms of cell growth and mutations. This may lead us to conclude
that MYH and MTH1 back each other up in response to radiation-induced oxidative damage.
However, due to the limitations of the transfection assay, the expression levels of MYH and
MTH1 proteins were not equally down regulated. Therefore, the proportional involvement of
each protein in prevention of mutations is not clear. Importantly, as mutations in MYH have been
related to development of colorectal cancer, our study could possibly be of help to better
understand the pathogenesis or prevention of this cancer.

31. 31
Main findings in paper II:
 MYH and MTH1 proteins cooperatively protect TK6 cells against radiation-induced
mutations.
 We suggest that the activity/expression level of MTH1 should be considered in parallel
with MYH activity/expression for studies related to MYH-associated diseases.
 Mutation induction by γ- radiation in TK6 cells is not dose rate dependent.
Paper III
Adaptive response induced by different dose rates of γ-radiation in MCF-10A cells
Radiation-induced adaptive response is one of the controversial aspects of radiation protection
research. Despite decades of investigation, there is still uncertainty about the radiation condition
and mechanisms under which adaptive response could be induced. Therefore, in this study, we
aimed at investigating dose rates that could possibly induce adaptive response. MCF-10A cells
were pre-exposed to acute (24 Gy/h) or chronic (1.4 or 4.1 mGy/h) γ-radiation to give an
accumulated dose of 50 mGy. Following 2 hours of incubation time, the cells were exposed to
doses between 0 to 5 Gy challenging doses and were analyzed for clonogenic survival and mutant
frequency.
The clonogenic survival results showed that acute or chronic pre-exposures to 50 mGy γ-
radiation do not induce any adaptive response in MCF-10A cells that could be detected after
subsequent exposures to (1-5 Gy) challenging doses. In contrast to survival level, the frequency
of mutants was significantly reduced when MCF-10A cells were exposed to 50 mGy adapting
dose at 1.4 mGy/h and challenged by 1 Gy, as compared to cells exposed to only 1 Gy. In a

32. 32
separate experiment, MCF-10A cells were exposed to 0.1 and 1.0 Gy γ- radiation administered
acutely (24 Gy/h) and chronically (1.4 or 4.1 mGy/h) for the investigation of dose rate effect at
the mutation level. The results showed no dose rate effect.
Induction of adaptive response, mutation frequency, by lowering the dose rate of the adapting
dose could be due to an enhanced repair capacity, antioxidant activity or even change in
chromatin conformation that may be induced during protracted radiation exposure. The induction
of some signaling pathways, possibly due to the increased levels of ROS induced by low dose
rate exposure, may trigger activation of DNA repair genes that leads to repair of DNA damages
induced by a high challenging dose. The variation of adaptive response in our results depending
on endpoints, absence at survival and presence at mutation level, is in agreement with the data
found in other studies. This variability may have different explanations e.g. the radiation-induced
lethal lesions and/or their repair are possibly different from those leading to mutations. Another
explanation for this discrepancy assumes that mutation induction and cell death are not
necessarily related. Cells may preferentially repair the lethal lesions rather than mutations.
However, due to the variability of adaptive response depending on endpoint, cellular systems and
radiation conditions the mechanisms behind it remain elusive. The interesting outcome of this
study is the absence of a dose rate effect at the levels of clonogenic survival and mutation which
confirms our previous finding in paper I and II. Nevertheless, adaptive response at the level of
mutation seems to be dose rate dependent; the lower the dose rates the lower the frequency of
mutants.
Main findings in paper III:
 Exposure to low dose γ-radiation, 50 mGy, at a dose rate as low as 1.4 mGy/h can induce
an adaptive response in MCF-10A cells at the level of mutation.
 Low dose rate γ-radiation does not induce adaptive response at the survival level in MCF-
10A cells.
 Overall, a dose rate effect is absent at the level of mutation in MCF-10A cells.

33. 33
Paper IV
Reduction of 8-oxo-dGTP in the nucleotide pool by hMTH1 leads to reduction in mutations in
the human lymphoblastoid cell line TK6 exposed to UVA
In this study, the impact of UVA-induced oxidative stress and the role of the hMTH1 protein
were investigated. TK6 cells were transfected using shRNA to stably down regulate the
expression level of hMTH1. The transfection efficiency was validated by Western blot analysis.
The expression level of hMTH1 in transfected cells was down regulated to 12% of that in wild
type cells. Cells were exposed to different doses of UVA and analyzed for clonogenic survival,
mutant frequency, extracellular and intracellular levels of 8-oxo-dG, and the concentration of dG
in the nucleotide pool.
The results from the clonogenic survival assays did not indicate a significant difference between
the two cell types. The LD50 values were 34 and 39 kJ/m² for transfected and wild type cells,
respectively. The mutant analysis data demonstrated a significantly increased mutant frequency
in transfected and wild type cells after 29 kJ/m² UVA exposure in comparison to non-exposed
cells. Interestingly, the UVA-induced increase of mutant frequency in transfected cells was
significantly higher than that in wild type cells. However, at 18 kJ/m², the mutant frequency in
transfected cells was not significantly different compared to wild type cells. Regarding the level
of intracellular dG, our data indicated that there was no difference between transfected and wild
type cells in non-exposed conditions. Interestingly, the 8-oxo-dG content in the nucleotide pool
increased significantly with increasing dose in the transfected cells. On the contrary, in wild type
cells the cytoplasmic level of 8-oxo-dG decreased significantly at 29 kJ/m² in comparison to that
in transfected cells.
These observations indicate that transfected cells, due to the lack of hMTH1 have a reduced
capacity to dephosphorylate 8-oxo-dGTP, causing elevated levels of it in the nucleotide pool

34. 34
whereas wild type cells with the help of hMTH1 activity are able to dephosphorylate 8-oxo-
dGTP and excrete it outside the cell (the observed reduction of 8-oxo-dG).
In contrast to the results in this study (UVA exposure), the data in paper I (γ-radiation exposure)
did not result in any significantly different mutant frequency between hMTH1-transfected and
wild type cells. We may explain this discrepancy induced by different radiation qualities by
comparing the doses of UVA and γ-radiation used in these experiments. In UVA exposures, the
administered doses (18 and 29 kJ/m²) were approximately 50% and 80% of the LD50 dose and in
γ-radiation exposures the doses (0.5 and 1.0 Gy) were 150% and 200% of the LD50 dose,
respectively. This may suggest that the role of hMTH1 in handling oxidative stress in the
nucleotide pool is more pronounced at a certain level of free radicals and above that level, cells
may cope with stress conditions through other mechanisms. According to the previous findings in
our group [76] the expression of hMTH1 in response to free radicals induced by γ-radiation
saturates around the doses of 30-50 mGy. In other words, at 0.5 or 1.0 Gy of γ-radiation where
we do not observe any protective role for hMTH1 at mutation level, cells may have sensed some
signals due to the high level of free radicals and have triggered activation of alternative repair
proteins in the nucleotide pool or in the nucleus.
Main findings in paper IV:
 The hMTH1 protein protects TK6 cells against mutations induced by UVA radiation.
 The nucleotide pool is a significant target for the mutagenic effect of UVA.

35. 35
Concluding remarks
Oxidative stress, due to the involvement in mutagenicity and cancer, is a risk factor for human
health. As it has also been shown, other kinds of illnesses such as neurodegenerative diseases,
ageing and diabetes may arise from oxidative stress [117, 118]. Therefore, studies on factors
inducing stress and understanding the mechanisms that protect humans from deleterious effects
of ROS need to be taken into consideration. UVA and γ-radiation are potent inducers of oxidative
stress. Formation of 8-oxo-dG as a consequence of the action of ROS on DNA bases is a
potential risk for mutation induction; mainly G:C to T:A and A:T to C:G transversions in human
cells. The nucleotide pool sanitization and the base excision repair enzymes, MTH1 and MYH
respectively, are two of the key proteins that can prevent mutations induced by excess levels of
ROS.
According to the data presented in paper IV, we suggest a protective role of MTH1 in
mutagenicity of UVA and propose that the nucleotide pool is a significant target for ROS as
elevated levels of 8-oxo-dGTP were observed in MTH1-downregulated cells after exposure to
UVA. The cooperative action of MTH1 and MYH in preventing mutations induced by low and
high dose rates of γ-radiation observed in paper I and II indicates that these two proteins back
each other up against deleterious effects of oxidative stress. This finding may be useful for
understanding the biology of cancer, especially colorectal cancer, which is suggested to arise
from mutations in the MYH gene.
The dose rate dependence for adaptive response that was found in paper III against mutagenicity
of γ-radiation in MCF-10A cells, while no such effect was found at the survival level, will need
further studies to be explained but may have the potential to identify relevant endpoints for an
adaptive response in relation to risk. Indeed, due to the variability of response depending on
endpoints, further investigations are necessary to establish a universal condition under which
adaptive response could be induced.

36. 36
The lack of a dose rate effect for mutagenicity of γ-radiation that is repeatedly observed in this
thesis (paper I, II and III) may be an important point for radiation protection research. Our
finding suggests a dose and dose rate effectiveness factor (DDREF) of around 1 for stochastic
effects of γ-radiation.
Ongoing and future studies
Gene expression profiling of MTH1, OGG1 and antioxidant enzymes HMOX1 and TXNRD1
after exposure to low dose rates of γ-radiation
To understand the cellular responses that deal with different levels of oxidative stress induced by
low dose rates of γ-radiation, the expression level of some repair (MTH1 and OGG1) and
antioxidant (HMOX1 and TXRND1) genes are being monitored at the mRNA level using real-
time PCR. TK6 cells have been exposed to 1.4, 5.0 or 15.0 mGy/h γ-radiation and sampled after
3, 24 hours and 1 week. The analysis of the real-time PCR data is underway.
Epigenetic changes induced by chronic γ-radiation in human fibroblasts
As growing evidences indicate that epigenetic modifications are among the delayed effects of
ionizing radiation (IR), it may be suggested that IR-induced genome instability and
transgenerational effects may be epigenetically mediated. Understanding the epigenetic
mechanisms related to low dose and low dose rate radiation may also provide valuable
information with significant implications in radiation protection and cancer prevention. To
investigate the possible epigenetic modifications induced by γ-radiation, human fibroblasts have
been exposed to 1.0 Gy at 4.1 mGy/h. The cells have been sub-cultured and repeatedly collected
from 3 hours up to 28 days post-irradiation. The global expression levels of DNA
methyltransferases: DNMT1, DNMT3a and DNMT3b are planned to be measured with real-time
PCR tools.
For future studies, characterization of the mutation types at the thymidine kinase locus induced
by low dose rate γ-radiation in hMYH and/or hMTH1 down regulated cells using sequencing

37. 37
techniques may shed more light on the mechanisms behind chronic IR mutagenesis. To further
understand the relation between oxidative stress and carcinogenesis especially colorectal cancer,
a combination of in vitro and in vivo studies that focus on the role of MTH1 and MYH in stress
condition could be beneficial. Investigating the status of MYH and MTH1 as well as antioxidant
genes in colorectal cancer patients may help finding solutions for cancer prevention in susceptible
individuals. Moreover, studies related to dietary antioxidants could be a complementary
investigation for cancer prevention.
Acknowledgments
This thesis was funded by the Swedish Radiation Safety Authority (SSM) and the FP7 project
EpiRadBio. I am grateful for their financial support.
I would like to thank my supervisor Siamak Haghdoost for giving me the opportunity to start my
PhD in his group. Siamak, I am very thankful for your guidance, patience and help in the lab, for
your trust in my ideas and for your effort in educating me. I enjoyed doing research under your
supervision. Being involved in the world of the nucleotide pool is all because of you.
I am very grateful to Andrzej Wojcik, my co-supervisor. Andrzej, fruitful discussions with you
have taught me a lot about radiobiology. Your knowledge, wise behaviour and friendly character
has made you the perfect supervisor.
I would like to especially thank Mats Harms-Ringdahl. Mats, thank you for your excellent
advices, help and discussions. Thank you for the time you spent in reading and commenting my
writings. The attention you pay to all of us, the warm and friendly group you have created, your
funny jokes, and the positive energy that you spread throughout the group is brilliant and
unbelievable.
Siv Osterman-Golkar, thank you for all the help in proofreading my writings. Without your smart
and precise comments, I would not be able to find my mistakes.

38. 38
Asal Fotouhi, studying and working with you made my PhD time very exciting and fun. Teaching
duties without your help in translating and teamwork would be impossible. Thank you for your
help and kindness in the lab and all the fun we had together.
Traimate Sangsuwan, thank you for your indescribable patience in helping me whenever I needed
(to find cells, software problems and in the lab). Without your Western blot analysis my projects
would not have proceeded.
Sara Skiöld, thank you for your help and patience in teaching me 2D-Gels. I will try to save the
late nights and time you spent on the project. It was very fun to share the S.A.T.S. office and
coffee clubs with a super nice person like you. I miss working with you.
Ainars Bajinskis, thank you for your help in the lab, finding funds, booking trips, sharing the
S.A.T.S. office and nice coffee clubs. Especially enjoyed access to your “Ainarspedia” facilitated
searching.
Eliana Beltran, thank you for all the PCR and real time-PCR help. Late working and non-working
hours with you were so fun.
Marta, thank you for all the chromosomal aberration scorings. It was a pleasure to be a colleague
and friend with you.
Marina Ilic, thank you for reading my thesis and being such fantastic friend and colleague.
Alice Sollazzo, Elina Staff, Karl Brehwens, Lei Cheng, and Ramesh Yentrapalli thank you for the
good time we had together in the lab and also apart from the lab.
Sara Eriksson, thanks for your help in qPCR and the PhD dissertation to-do list. I hope we see
each other more often in the neighborhood.
Daniel Vare, thank you for your help in scintillation.
Harald Eriksson, coffee clubs without your company would not be fun.

39. 39
Never ending thanks to my parents for the love, support, strength, and encouragement they gave
me throughout my life. You were and will always be the first and the most important people in
my life.
Countless thanks to my brothers, Arash and Ashkan, for their love and support. Having you two
means having everything.
To my friends, thank you for all the times you stood by me and gave me energy to live happier.
To my grandparents, I always thank you. Rest in peace. Grandfather, you knew what I did not
know!
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