Establishment of a standardized rat model of chronic radiation proctitis and preliminary evaluation of its association with tubulin

doi:10.3748/wjg.v32.i26.118923

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Jul 14, 2026; 32(26): 118923
Published online Jul 14, 2026. doi: 10.3748/wjg.v32.i26.118923

Establishment of a standardized rat model of chronic radiation proctitis and preliminary evaluation of its association with tubulin

Yu Chang, Rong Sun, Wei Juan, Zheng Xu, Hao-Yu Xu, Ke Zen, Ji Xuan

Yu Chang, Ji Xuan, Department of Gastroenterology, Jinling Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing 21002, Jiangsu Province, China

Rong Sun, Department of Radiation Oncology, Jinling Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing University, Nanjing 21000, Jiangsu Province, China

Wei Juan, Hao-Yu Xu, Ji Xuan, Department of Gastroenterology, Jinling Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing University, Nanjing 21000, Jiangsu Province, China

Zheng Xu, State Key Laboratory of Pharmaceutical Biotechnology, Department of Gastroenterology, Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing University, Nanjing 21000, Jiangsu Province, China

Ke Zen, School of Life Sciences, Nanjing University, Nanjing 210023, Jiangsu Province, China

Co-first authors: Yu Chang and Rong Sun.

Co-corresponding authors: Ke Zen and Ji Xuan.

Author contributions: Chang Y and Sun R contribute equally to this study as co-first authors; Zen K and Xuan J contribute equally to this study as co-corresponding authors; Chang Y and Xuan J designed the research study; Chang Y and Xu HY performed the research; Xu Z contributed new reagents and analytic tools; Chang Y analyzed the data and wrote the manuscript; all authors have read and approved the final manuscript.

Institutional animal care and use committee statement: All procedures involving animals were reviewed and approved by the Institutional Animal Care and Use Committee of the Eastern Theater Command General Hospital (Approval No. DZ24WYXKT 001).

Conflict-of-interest statement: The authors declare that none of them have any conflicts of interest in relation to the present publication.

ARRIVE guidelines statement: The authors have read the ARRIVE guidelines, and the manuscript was prepared and revised according to the ARRIVE guidelines.

Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at xuanji@nju.edu.cn.

Corresponding author: Ji Xuan, Department of Gastroenterology, Jinling Clinical Medical College, Nanjing University of Chinese Medicine, No. 305 Zhongshan East Road, Nanjing 210002, Jiangsu Province, China. xuanji@nju.edu.cn

Received: January 22, 2026
Revised: February 26, 2026
Accepted: March 17, 2026
Published online: July 14, 2026
Processing time: 162 Days and 16.3 Hours

Abstract

BACKGROUND

Chronic radiation proctitis (CRP), a major complication of pelvic radiotherapy, lacks effective treatments and a standardized animal model that recapitulates its late fibrotic and angiogenic pathologies.

AIM

To establish a model that recapitulates the features of human CRP and to investigate the mechanisms of irreversible tissue damage.

METHODS

Rats were randomized into a control group and single-dose irradiation groups (12.5-37.5 Gy). Rectal injury was assessed via 6-month continuous endoscopic observation, the modified Vienna Rectoscopy Score, and histological analysis. Additionally, rectal tissues were analyzed for cytoskeletal protein alterations.

RESULTS

Acute mucosal injury was reversible at doses below 20 Gy. In the 20-35 Gy groups, persistent radiation proctitis, marked telangiectasia, and severe mucosal fibrosis indicated irreversible injury. Furthermore, cytoskeletal proteins, particularly tubulin, decreased sharply at doses ≥ 20 Gy. Vascular endothelial growth factor was mildly upregulated mainly in the deep tissue layers during the acute phase, whereas it was significantly increased in the mucosa of the highdose groups during the chronic phase.

CONCLUSION

Single-dose radiation (20-35 Gy) induces CRP. Reduced tubulin expression marks the early transition to chronic injury (P < 0.0001).

Keywords: Chronic radiation proctitis; Endoscopic views; Endoscopic scoring; Tubulin; Rat model

Core Tip: Chronic radiation proctitis can be induced by a single dose of 20-35 Gy irradiation, which simplifies the modeling procedure while recapitulating two major human pathological features: Telangiectasia and progressive fibrosis. The formation of chronic injury is associated with the destruction of microtubule protein, the low expression of tubulin at 2 weeks after irradiation can serve as an early indicator for the transition of rectal toward chronic radiation injury. After radiation without intervention, around the eighth week, chronic manifestations such as capillary dilation would appear. The observation period for the therapeutic effect should be extended to at least 8 weeks.