{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:25:33Z","timestamp":1792686333699,"version":"4.5.0"},"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T00:00:00Z","timestamp":1747958400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100018627","name":"Science and Technology Support Plan for Youth Innovation of Colleges and Universities of Shandong Province of China","doi-asserted-by":"publisher","award":["BY2018kJ07"],"award-info":[{"award-number":["BY2018kJ07"]}],"id":[{"id":"10.13039\/501100018627","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec005\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To investigate the efficacy of Nintedanib in treating acute and chronic radiation-induced lung injury and its mechanism of action.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec006\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A radiation-induced lung injury model was established in mice using 6MV X-rays at 18Gy to irradiate the lungs. The mice were randomly divided into four groups: control group, radiation therapy group, low-dosage Nintedanib\u2009+\u2009radiation therapy group, and high dosage Nintedanib\u2009+\u2009radiation therapy group. The mice were euthanized on day 14 and 3 months post-radiation to observe changes in acute and chronic inflammation and the expression of related proteins.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec007\">\n<jats:title>Results<\/jats:title>\n<jats:p>Compared to the radiation therapy group, the low and high-dosage Nintedanib groups showed varying degrees of improvement in mental state, responsiveness, food and water intake, and fur condition. During the acute inflammatory phase, HE staining revealed inflammatory changes in the lung tissues of both Nintedanib groups, but the pathology was less severe than in the radiation group, with the high-dosage group showing more significant reduction. Serum levels of IL-6, TNF-\u03b1 and TGF-\u03b21 were significantly reduced (P\u2009&lt;\u20090.05), suggesting that Nintedanib can decrease the expression of serum inflammatory factors. The percentage of Smad2-positive area in the low and high-dosage Nintedanib groups was (7.395\u2009\u00b1\u20090.90)% and (5.577\u2009\u00b1\u20091.56)%, respectively, both significantly lower than the radiation group (P\u2009&lt;\u20090.05). At 3 months post-radiation, Masson\u2019s trichrome staining showed that the Ashcroft score in the Nintedanib groups was significantly lower than in the radiation group (P\u2009&lt;\u20090.05). There were statistically significant differences between the low and high-dosage groups in the percentage of Smad2 and \u03b1SMA-positive areas and the levels of serum TGF-\u03b21 (all P\u2009&lt;\u20090.05), and both were significantly lower compared to the radiation group (P\u2009&lt;\u20090.05).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec008\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>(1) Nintedanib can improve the general condition of mice with acute and chronic radiation-induced lung injury and reduce pathological damage to lung tissue. (2) Nintedanib may exert a protective effect on mice with acute and chronic radiation-induced lung injury by downregulating the TGF-\u03b21\/Smad2 signaling pathway, thereby inhibiting inflammatory and fibrotic responses.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0324339","type":"journal-article","created":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T17:52:51Z","timestamp":1748022771000},"page":"e0324339","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Effect and mechanism of Nintedanib on acute and chronic radiation-induced lung injury in mice"],"prefix":"10.1371","volume":"20","author":[{"given":"Kun","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Ren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7116-9797","authenticated-orcid":true,"given":"Yujie","family":"Zhai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,5,23]]},"reference":[{"issue":"1","key":"pone.0324339.ref001","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s12890-020-01376-4","article-title":"Radiation-induced lung injury: current evidence","volume":"21","author":"M Arroyo-Hern\u00e1ndez","year":"2021","journal-title":"BMC Pulm Med"},{"key":"pone.0324339.ref002","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.trsl.2019.03.006","article-title":"Cellular senescence and radiation-induced pulmonary fibrosis","volume":"209","author":"Y He","year":"2019","journal-title":"Transl Res"},{"key":"pone.0324339.ref003","doi-asserted-by":"crossref","first-page":"506","DOI":"10.3389\/fimmu.2017.00506","article-title":"Immunological aspect of radiation-induced pneumonitis, current treatment strategies, and future prospects","volume":"8","author":"A Kainthola","year":"2017","journal-title":"Front Immunol"},{"issue":"4","key":"pone.0324339.ref004","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1148\/rg.244035160","article-title":"Effects of radiation therapy on the lung: radiologic appearances and differential diagnosis","volume":"24","author":"YW Choi","year":"2004","journal-title":"Radiographics"},{"key":"pone.0324339.ref005","first-page":"585","article-title":"Scarred lungAn update on radiation-induced pulmonary fibrosis","volume":"7","author":"N Jarzebska","year":"2020","journal-title":"Front Med (Lausanne)"},{"issue":"10082","key":"pone.0324339.ref006","doi-asserted-by":"crossref","first-page":"1941","DOI":"10.1016\/S0140-6736(17)30866-8","article-title":"Idiopathic pulmonary fibrosis","volume":"389","author":"L Richeldi","year":"2017","journal-title":"Lancet"},{"key":"pone.0324339.ref007","doi-asserted-by":"crossref","first-page":"997","DOI":"10.2147\/DDDT.S288369","article-title":"The Effect of Nintedanib on T-Cell activation, subsets and functions","volume":"15","author":"K Ubieta","year":"2021","journal-title":"Drug Des Devel Ther"},{"issue":"4","key":"pone.0324339.ref008","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1007\/s10753-023-01825-2","article-title":"Nintedanib Ameliorates Bleomycin-induced pulmonary fibrosis, inflammation, apoptosisand oxidative stress by modulating PI3K\/Akt\/mTOR pathway in mice","volume":"46","author":"L Pan","year":"2023","journal-title":"Inflammation"},{"key":"pone.0324339.ref009","doi-asserted-by":"crossref","first-page":"115403","DOI":"10.1016\/j.biopha.2023.115403","article-title":"Nintedanib inhibits normal human vitreous-induced epithelial-mesenchymal transition in human retinal pigment epithelial cells","volume":"166","author":"Y Yin","year":"2023","journal-title":"Biomed Pharmacother"},{"issue":"3","key":"pone.0324339.ref010","first-page":"552","article-title":"Radiation-induced lung injury - what do we know in the era of modern radiotherapy?","volume":"27","author":"M Konkol","year":"2022","journal-title":"Rep Pract Oncol Radiother"},{"issue":"5","key":"pone.0324339.ref011","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1159\/000477172","article-title":"Combined stimulation with Interleukin-18 and Interleukin-12 potently induces Interleukin-8 production by natural killer cells","volume":"9","author":"SM Poznanski","year":"2017","journal-title":"J Innate Immun"},{"key":"pone.0324339.ref012","doi-asserted-by":"crossref","first-page":"3264","DOI":"10.1111\/jcmm.13230","article-title":"Polydatin alleviated radiation-induced lung injury through activation of Sirt3 and inhibition of epithelial-mesenchymal transition","volume":"21","author":"K Cao","year":"2017","journal-title":"J Cell Mol Med"},{"issue":"4","key":"pone.0324339.ref013","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1016\/S0360-3016(00)00482-X","article-title":"Dose-dependent induction of transforming growth factor beta (TGF-beta) in the lung tissue of fibrosis-prone mice after thoracic irradiation","volume":"47","author":"CE Rube","year":"2000","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"8","key":"pone.0324339.ref014","doi-asserted-by":"crossref","first-page":"2460","DOI":"10.3390\/ijms19082460","article-title":"TGF-\u03b2 Signaling in lung health and disease","volume":"19","author":"A Saito","year":"2018","journal-title":"Int J Mol Sci"},{"key":"pone.0324339.ref015","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.tranon.2018.09.009","article-title":"Advances in molecular mechanisms and treatment of radiation-induced pulmonary fibrosis","volume":"12","author":"Z Chen","year":"2019","journal-title":"Transl Oncol"},{"issue":"6","key":"pone.0324339.ref016","doi-asserted-by":"crossref","first-page":"721","DOI":"10.3109\/01902149809099592","article-title":"Expression of TNF and the necessity of TNF receptors in bleomycin-induced lung injury in mice","volume":"24","author":"LA Ortiz","year":"1998","journal-title":"Exp Lung Res"},{"issue":"1","key":"pone.0324339.ref017","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1186\/s12890-023-02424-5","article-title":"Single-cell sequencing analysis fibrosis provides insights into the pathobiological cell types and cytokines of radiation-induced pulmonary fibrosis","volume":"23","author":"Z Sun","year":"2023","journal-title":"BMC Pulm Med"},{"key":"pone.0324339.ref018","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1111\/j.1538-7836.2004.01085.x","article-title":"Oxidative stress in atherogenesis and arterial thrombosis: the disconnect between cellular studies and clinical outcomes. J","volume":"3","author":"NR Madamanchi","year":"2005","journal-title":"Thromb Haemost"},{"key":"pone.0324339.ref019","doi-asserted-by":"crossref","first-page":"774807","DOI":"10.3389\/fimmu.2021.774807","article-title":"Crossed pathways for radiation-induced and immunotherapy-related lung injury","volume":"12","author":"Z Zhang","year":"2021","journal-title":"Front Immunol"},{"issue":"4","key":"pone.0324339.ref020","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1667\/RR1882.1","article-title":"Early alterations in cytokine expression in adult compared to developing lung in mice after radiation exposure","volume":"173","author":"CJ Johnston","year":"2010","journal-title":"Radiat Res"},{"issue":"6","key":"pone.0324339.ref021","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1667\/RR3031.1","article-title":"Cytokines in radiobiological responses: a review","volume":"178","author":"D Schaue","year":"2012","journal-title":"Radiat Res"},{"issue":"4","key":"pone.0324339.ref022","first-page":"893","article-title":"Bleomycin-induced interstitial pulmonary disease in the nude, athymic mouse","volume":"120","author":"SV Szapiel","year":"1979","journal-title":"Am Rev Respir Dis"},{"issue":"4","key":"pone.0324339.ref023","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1136\/jcp.41.4.467","article-title":"Simple method of estimating severity of pulmonary fibrosis on a numerical scale","volume":"41","author":"T Ashcroft","year":"1988","journal-title":"J Clin Pathol"},{"key":"pone.0324339.ref024","doi-asserted-by":"crossref","first-page":"1718","DOI":"10.1056\/NEJMoa1908681","article-title":"Nintedanib in progressive fibrosing interstitial lung diseases","volume":"381","author":"K Flaherty","year":"2019","journal-title":"N Engl J Med"},{"issue":"3","key":"pone.0324339.ref025","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1038\/nrm3758","article-title":"Molecular mechanisms of epithelial-mesenchymal transition","volume":"15","author":"S Lamouille","year":"2014","journal-title":"Nat Rev Mol Cell Biol"},{"key":"pone.0324339.ref026","article-title":"Nintedanib-\u03b1V\u03b26 integrin ligand conjugates reduce TGF\u03b2-induced EMT in human non-small cell lung cancer","volume":"24","author":"E Andrucci","journal-title":"Int J Mol Sci"},{"issue":"2","key":"pone.0324339.ref027","doi-asserted-by":"crossref","DOI":"10.1111\/jcmm.18052","article-title":"Antioxidant therapy against TGF-\u03b2\/SMAD pathway involved in organ fibrosis","volume":"28","author":"S Ghafouri-Fard","year":"2024","journal-title":"J Cell Mol Med"},{"issue":"22","key":"pone.0324339.ref028","doi-asserted-by":"crossref","DOI":"10.1091\/mbc.E20-08-0536","article-title":"Fibroblast to myofibroblast transition is enhanced by increased cell density","volume":"32","author":"MT Doolin","year":"2021","journal-title":"Mol Biol Cell"},{"issue":"1","key":"pone.0324339.ref029","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1111\/j.1478-3231.2005.01192.x","article-title":"Therapeutic strategies against TGF-beta signaling pathway in hepatic fibrosis","volume":"26","author":"X Liu","year":"2006","journal-title":"Liver Int"},{"key":"pone.0324339.ref030","doi-asserted-by":"crossref","first-page":"109409","DOI":"10.1016\/j.intimp.2022.109409","article-title":"Nintedanib alleviates pulmonary fibrosis in vitro and in vivo by inhibiting the FAK\/ERK\/S100A4 signalling pathway","volume":"113","author":"W Yang","year":"2022","journal-title":"Int Immunopharmacol"},{"key":"pone.0324339.ref031","article-title":"Effects of nintedanib on symptoms in patients with progressive pulmonary fibrosis","volume":"63","author":"M Wijsenbeek","journal-title":"Eur Respir J"},{"issue":"2","key":"pone.0324339.ref032","doi-asserted-by":"crossref","first-page":"307","DOI":"10.21037\/tlcr-22-108","article-title":"Exploration of radiation-induced lung injury, from mechanism to treatment: a narrative review","volume":"11","author":"Y Yan","year":"2022","journal-title":"Transl Lung Cancer Res"},{"key":"pone.0324339.ref033","doi-asserted-by":"crossref","first-page":"120518","DOI":"10.1016\/j.lfs.2022.120518","article-title":"Amifostine analog, DRDE-30, alleviates radiation induced lung damage by attenuating inflammation and fibrosis","volume":"298","author":"A Arora","year":"2022","journal-title":"Life Sci"},{"key":"pone.0324339.ref034","doi-asserted-by":"crossref","first-page":"109431","DOI":"10.1016\/j.exer.2023.109431","article-title":"The anti-scar effect of tyrosine-kinase inhibitor nintedanib in experimental glaucoma filtration surgery in rabbits","volume":"229","author":"R Y\u00fcksel","year":"2023","journal-title":"Exp Eye Res"},{"key":"pone.0324339.ref035","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1124\/jpet.117.244129","article-title":"Triple angiokinase inhibitor nintedanib directly inhibits tumor cell growth and induces tumor shrinkage via blocking oncogenic receptor tyrosine kinases","volume":"364","author":"F Hilberg","year":"2018","journal-title":"J Pharmacol Exp Ther"},{"key":"pone.0324339.ref036","first-page":"262","article-title":"Alveolar macrophage phagocytosis-evading inhaled microgels incorporating nintedanib-PLGA nanoparticles and pirfenidone-liposomes for improved treatment of pulmonary fibrosis","volume":"33","author":"WT Lee","year":"2023","journal-title":"Bioact Mater"},{"issue":"5","key":"pone.0324339.ref037","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1016\/S2213-2600(20)30062-X","article-title":"Progress in the treatment of pulmonary fibrosis","volume":"8","author":"M Wijsenbeek","year":"2020","journal-title":"Lancet Respir Med"},{"issue":"6","key":"pone.0324339.ref038","doi-asserted-by":"crossref","DOI":"10.1152\/ajplung.00304.2017","article-title":"Nintedanib reduces pulmonary fibrosis in a model of rheumatoid arthritis-associated interstitial lung disease","volume":"314","author":"EF Redente","year":"2018","journal-title":"Am J Physiol Lung Cell Mol Physiol"},{"key":"pone.0324339.ref039","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1016\/j.ijid.2021.05.055","article-title":"Efficacy and safety of nintedanib for pulmonary fibrosis in severe pneumonia induced by COVID-19: An interventional study","volume":"108","author":"Y Umemura","year":"2021","journal-title":"Int J Infect Dis"},{"key":"pone.0324339.ref040","article-title":"Pulmonary function and chest computed tomography (CT) scan findings after antifibrotic treatment for COVID-19-related pulmonary fibrosis","volume":"23","author":"JMJ Lomanta","year":"2022","journal-title":"Am J Case Rep"},{"issue":"6","key":"pone.0324339.ref041","doi-asserted-by":"crossref","first-page":"1987","DOI":"10.1007\/s11255-023-03892-8","article-title":"A protective role of nintedanib in peritoneal fibrosis through H19-EZH2-KLF2 axis via impeding mesothelial-to-mesenchymal transition","volume":"56","author":"W Zhong","year":"2024","journal-title":"Int Urol Nephrol"},{"issue":"10","key":"pone.0324339.ref042","article-title":"Nintedanib ameliorates osteoarthritis in mice by inhibiting synovial inflammation and fibrosis caused by M1 polarization of synovial macrophages via the MAPK\/PI3K-AKT pathway","volume":"37","author":"J Yan","year":"2023","journal-title":"FASEB J"},{"key":"pone.0324339.ref043","doi-asserted-by":"crossref","first-page":"149387","DOI":"10.1016\/j.bbrc.2023.149387","article-title":"Investigating the therapeutic effects and mechanisms of roxadustat on peritoneal fibrosis based on the TGF-\u03b2\/Smad pathway","volume":"693","author":"L Wang","year":"2024","journal-title":"Biochem Biophys Res Commun"},{"key":"pone.0324339.ref044","doi-asserted-by":"crossref","first-page":"2487","DOI":"10.3390\/ijms19092487","article-title":"Roles of the TGF-\u03b2-VEGF-C pathway in fibrosis-related lymphangiogenesis","volume":"19","author":"H Kinashi","year":"2018","journal-title":"Int J Mol Sci"},{"key":"pone.0324339.ref045","doi-asserted-by":"crossref","first-page":"461","DOI":"10.3389\/fphar.2017.00461","article-title":"Targeting TGF-\u03b2 Mediated SMAD Signaling for the Prevention of Fibrosis","volume":"8","author":"KL Walton","year":"2017","journal-title":"Front Pharmacol"},{"issue":"6","key":"pone.0324339.ref046","doi-asserted-by":"crossref","first-page":"1895","DOI":"10.1016\/S0002-9440(10)65703-3","article-title":"Altered balance between matrix metalloproteinases and their inhibitors in experimental biliary fibrosis","volume":"153","author":"AE Kossakowska","year":"1998","journal-title":"Am J Pathol"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0324339","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T17:52:58Z","timestamp":1748022778000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0324339"}},"subtitle":[],"editor":[{"given":"Ruo","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,5,23]]},"references-count":46,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5,23]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0324339","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,23]]}}}