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Lymphoid cell DNA is the primary molecular target for total lymphoid irradiation (TLI), a therapeutic approach used to achieve systemic immunosuppression. TLI involves the delivery of ionizing radiation to lymphoid tissues, including the lymph nodes, spleen, and thymus, while shielding non-lymphoid organs (Strober et al., 1984). The radiation interacts with the DNA of lymphocytes, causing various lesions such as single-strand breaks, double-strand breaks, and base modifications (Redon et al., 2010). These DNA lesions trigger complex signaling cascades, including the activation of p53, which can lead to cell cycle arrest or apoptosis if the damage is irreparable. Because lymphocytes are highly sensitive to DNA damage, TLI effectively depletes the pool of circulating and tissue-resident immune cells. This depletion is utilized clinically to prevent the rejection of allogeneic organ transplants and to manage severe autoimmune conditions like rheumatoid arthritis and systemic lupus erythematosus (Myerson et al., 2014). While effective, the non-specific nature of DNA damage within the targeted field poses long-term risks, including the potential for secondary malignancies and chronic susceptibility to infections.
Induction of ionizing radiation-mediated DNA strand breaks (single-strand and double-strand) and oxidative base damage, leading to the activation of DNA damage response pathways, cell cycle arrest, and apoptosis in lymphoid cells.
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