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Relationship: 2810


A descriptive phrase which clearly defines the two KEs being considered and the sequential relationship between them (i.e., which is upstream, and which is downstream). More help

Oxidative Stress leads to Increase, Oxidative DNA damage

Upstream event
The causing Key Event (KE) in a Key Event Relationship (KER). More help
Downstream event
The responding Key Event (KE) in a Key Event Relationship (KER). More help

Key Event Relationship Overview

The utility of AOPs for regulatory application is defined, to a large extent, by the confidence and precision with which they facilitate extrapolation of data measured at low levels of biological organisation to predicted outcomes at higher levels of organisation and the extent to which they can link biological effect measurements to their specific causes.Within the AOP framework, the predictive relationships that facilitate extrapolation are represented by the KERs. Consequently, the overall WoE for an AOP is a reflection in part, of the level of confidence in the underlying series of KERs it encompasses. Therefore, describing the KERs in an AOP involves assembling and organising the types of information and evidence that defines the scientific basis for inferring the probable change in, or state of, a downstream KE from the known or measured state of an upstream KE. More help

AOPs Referencing Relationship

AOP Name Adjacency Weight of Evidence Quantitative Understanding Point of Contact Author Status OECD Status
Deposition of energy leading to occurrence of cataracts adjacent Moderate Low Vinita Chauhan (send email) Open for citation & comment

Taxonomic Applicability

Latin or common names of a species or broader taxonomic grouping (e.g., class, order, family) that help to define the biological applicability domain of the KER.In general, this will be dictated by the more restrictive of the two KEs being linked together by the KER.  More help
Term Scientific Term Evidence Link
human Homo sapiens Moderate NCBI
mouse Mus musculus Moderate NCBI
rat Rattus norvegicus Moderate NCBI
bovine Bos taurus Moderate NCBI

Sex Applicability

An indication of the the relevant sex for this KER. More help
Sex Evidence
Unspecific Moderate

Life Stage Applicability

An indication of the the relevant life stage(s) for this KER.  More help
Term Evidence
All life stages Moderate

Key Event Relationship Description

Provides a concise overview of the information given below as well as addressing details that aren’t inherent in the description of the KEs themselves. More help

Oxidative stress refers to a state in which the amount of reactive oxygen (ROS) and nitrogen (RNS) species overwhelms the cell’s antioxidant defense system. This loss in redox homeostasis can lead to oxidative damage to proteins, lipids, and nucleic acids (Schoenfeld et al., 2012; Tangvarasittichai & Tangvarasittichai, 2018; Turner et al., 2002). ROS are molecules with oxygen as the functional center and at least one unpaired electron in the outer orbits. Although less common than ROS, RNS can also induce oxidative stress (Cadet et al., 2012; Tangvarasittichai & Tangvarasittichai, 2018).  

Organisms contain a defense system of antioxidants to help manage ROS levels. Antioxidant measures consist of antioxidant enzymes, vitamins and minerals that catalyze the conversion of ROS to non-toxic molecules such as water and O2. When an antioxidant system is overwhelmed by the amount of ROS, the cell can enter a state of oxidative stress (Balasubramanian, 2000; Ganea & Harding, 2006; Karimi et al., 2017).  

Unmanaged oxidative stress can damage vital macromolecules such as DNA leading to oxidative DNA damage. This can be divided into two categories, damage caused by one ROS, and damage caused by at least two ROS associating with the DNA in the space of one to two helix turns. The first scenario initiates DNA-protein cross-links, inter and intrastrand links, and tandem base lesions, while the second scenario produces more complicated lesions, known as oxidatively generated clustered lesions (ODCLs). These can include single and double strand breaks, abasic sites, and oxidized bases (Cadet et al., 2012) which can cause chromosomal aberrations, cytotoxicity, and oncogenic transformations (Stohs, 1995) as well as structural changes to the DNA, such as blocking polymerases (Zhang et al., 2010).  

8-oxo-7,8-dihydro-2’-deoxyguanosine (8-oxodG) lesions are the most common and best-studied, as such they are often used as a marker of oxidative DNA damage (Tangvarasitichai & Tangvarasittichai, 2018). 

Cells possess DNA repair mechanisms that help repair the damage, but these processes are not perfect (Eaton, 1995; Ainsbury et al., 2016; Markkanen, 2017). Furthermore, certain types of lesions, such as DNA double strand breaks, are more complex to repair (Schoenfeld et al, 2012), leading to increased oxidative DNA damage.  

Evidence Collection Strategy

Include a description of the approach for identification and assembly of the evidence base for the KER. For evidence identification, include, for example, a description of the sources and dates of information consulted including expert knowledge, databases searched and associated search terms/strings.  Include also a description of study screening criteria and methodology, study quality assessment considerations, the data extraction strategy and links to any repositories/databases of relevant references.Tabular summaries and links to relevant supporting documentation are encouraged, wherever possible. More help

The strategy for collating the evidence to support the relationship is described in Kozbenko et al 2022. Briefly, a scoping review methodology was used to prioritize studies based on a population, exposure, outcome, endpoint statement.

Evidence Supporting this KER

Addresses the scientific evidence supporting KERs in an AOP setting the stage for overall assessment of the AOP. More help

Overall Weight of Evidence: Moderate 

Biological Plausibility
Addresses the biological rationale for a connection between KEupstream and KEdownstream.  This field can also incorporate additional mechanistic details that help inform the relationship between KEs, this is useful when it is not practical/pragmatic to represent these details as separate KEs due to the difficulty or relative infrequency with which it is likely to be measured.   More help

When a cell is exposed to oxidative stress, DNA lesions can be induced. There are various repair systems that will attempt to repair the damage sometimes successfully, and other times inadequately or inefficiently, in this case oxidative DNA damage will persist. Furthermore, if there are too many lesions, the DNA repair system may be overwhelmed. A low level of damage is always found in healthy cells, but this amount increases under oxidative stress (Lee et al., 2004). It has been estimated that human cells have 70 000 lesions per day, mostly due to ROS produced during normal metabolism and base hydrolysis (Amente et al., 2019). These lesions can be DNA breaks, but there are also other types such as oxidized bases. Furthermore, while ROS induces DNA breaks, it can also be caused by other processes, or be an intermediate in DNA repair. As a result, oxidized nucleotides are generally a more accurate indicator of oxidative stress (Collins, 2014).  

Oxidative stress affects different nitrogenous bases differently. For example, guanine (G) has a lower redox potential, causing it to be more vulnerable to oxidation compared to other nitrogenous bases. This leads to increased amounts of oxidized G products, relative to other forms of damage, Furthermore, ribonucleotides can also be oxidized, to the point where dGTP is more vulnerable to oxidation than G (Markkanen, 2017). Certain compounds such as hydroxyl radical generation systems and adriamycin-iron complexes will bind to and form ROS in association with DNA, therefore inducing site-specific DNA damage (Stohs, 1995).  

Additionally, cells that are actively dividing are more sensitive to oxidative DNA damage (Sacca et al., 2009). A few studies have also found that single stranded DNA (ssDNA) is more likely to be oxidized than double stranded DNA (dsDNA). This indicates that persistent ssDNA sites, such as Z-DNA, stable R-loops, cruciforms, quadruplexes, or intramolecular triplexes might have higher incidences of oxidative damage (Amente et al., 2019).  

Cells use three main methods to repair and prevent oxidative DNA damage. Firstly, enzymes such as Mut homologue 1, 2, 3, and Nudix-type 5 (MTH1, MTH2, MTH3, and NUDT5) are used to remove oxidized nucleotides before they can be incorporated into DNA. Another method is switching between replicative polymerases and DNA polymerase γ (Polγ) during replication when an 8-oxo-G lesion is encountered. This allows the replicative machinery to bypass the lesion. The third method is the base excision repair (BER) pathway, which is the major DNA repair pathway for base damage and has two general sub paths. The first is the short patch, where only the damaged nucleotides are replaced. The other is the long patch, which replaces a group of 2 to 12 nucleotides (Markkanen, 2017). For mitochondrial DNA (mtDNA), which is more sensitive to oxidative damage than nuclear DNA (Yakes & Van Houten, 1997), BER involves three main enzymes. 8-oxoguanine DNA glycosylase 1 (OGG1) removes 8-OHdG lesions, which are caused by the incorporation of 8-oxodGTP. AP endonuclease 1 (APE1) is an AP endonuclease that increases OGG1 turnover and adds a nick to the DNA, preparing it for further repair processes. Finally, DNA polymerase γ (Polγ) adds new nucleotides where the older ones were removed (Zhang et al., 2010). Another kind of BER pathway is SSBR (single strand break repair). When two SSBs are in juxtaposition, they can form DSBs, which are detrimental (Caldecott, 2024; Pfeiffer et al., 2000). 

Different lesions are also repaired differently and can cause varying amounts of damage. For example, DNA single strand breaks are usually repaired quickly (Collins, 2014), while double strand breaks are more complicated and are therefore, less likely to be repaired correctly (Schoenfeld et al, 2012). More details on these processes are reviewed in Markkanen (2017). Overall the mechanism to oxidative stress leading to oxidative DNA damage is well accepted and understood. 

Uncertainties and Inconsistencies
Addresses inconsistencies or uncertainties in the relationship including the identification of experimental details that may explain apparent deviations from the expected patterns of concordance. More help

No evidence. 

Known modulating factors

This table captures specific information on the MF, its properties, how it affects the KER and respective references.1.) What is the modulating factor? Name the factor for which solid evidence exists that it influences this KER. Examples: age, sex, genotype, diet 2.) Details of this modulating factor. Specify which features of this MF are relevant for this KER. Examples: a specific age range or a specific biological age (defined by...); a specific gene mutation or variant, a specific nutrient (deficit or surplus); a sex-specific homone; a certain threshold value (e.g. serum levels of a chemical above...) 3.) Description of how this modulating factor affects this KER. Describe the provable modification of the KER (also quantitatively, if known). Examples: increase or decrease of the magnitude of effect (by a factor of...); change of the time-course of the effect (onset delay by...); alteration of the probability of the effect; increase or decrease of the sensitivity of the downstream effect (by a factor of...) 4.) Provision of supporting scientific evidence for an effect of this MF on this KER. Give a list of references.  More help
Modulating Factor (MF) MF Specification Effect(s) on the KER Reference(s)
Age  Increased age Increased levels of oxidative DNA damage, partly due to decreased antioxidant levels, meaning that the removal of ROS occurs more slowly, increasing the level of oxidative damage. Moreover, in humans, after about forty to fifty years, a barrier forms in the lens of the eye that decreases intracellular antioxidant transportation. Normally, antioxidants circulate via a current in the cytoplasm of lens fiber cells. However, as the age of the organism increases, the cytoplasm of these cells becomes stiffer. Small molecules such as H2O2 and the superoxide anion can diffuse through, but larger molecules, such as glutathione, cannot enter the barrier. As a result, the core of the lens has a decreased antioxidant concentration, making it more vulnerable to oxidative damage. Furthermore, the amount of protein and mRNA corresponding to important mitochondrial BER enzymes decreases with age, causing a decrease in DNA repair ability and therefore an increase in DNA damage in the mitochondria.  Stohs, 1995; Lee et al., 2004; Martinez et al., 2010; Pendergrass et al., 2010; Zhang et al., 2010; Ainsbury et al., 2016; Tangvarasittichai & Tangvarasittichai, 2018 
H Increased concentration  Decreased level of oxidative DNA damage. Schoenfeld et al., 2012 
Antioxidants  Increased concentration Reviews have found that about 50% of studies examined showed a decrease in base oxidation, but the other half show no change.  Turner et al., 2002; Møller & Loft, 2006; Hoelzl et al., 2009 
Lipoic acid  Increased concentration Decreased level of oxidative DNA damage.  Turner et al., 2002 
Acetyl carnitine  Increased concentration Decreased level of oxidative DNA damage.  Turner et al., 2002 
Ubiquinone Q-9  Increased concentration Decreased level of oxidative DNA damage.  Turner et al., 2002 
Hydroquinone  Increased concentration Decreased level of oxidative DNA damage.  Turner et al., 2002 
Folate  Increased concentration Decreased level of oxidative DNA damage.  Turner et al., 2002 
Aged garlic extracts  Increased concentration Decreased level of oxidative DNA damage.  Turner et al., 2002 
Response-response Relationship
Provides sources of data that define the response-response relationships between the KEs.  More help
Information regarding the approximate time-scale of the changes in KEdownstream relative to changes in KEupstream (i.e., do effects on KEdownstream lag those on KEupstream by seconds, minutes, hours, or days?). More help
Known Feedforward/Feedback loops influencing this KER
Define whether there are known positive or negative feedback mechanisms involved and what is understood about their time-course and homeostatic limits. More help

Not identified 

Domain of Applicability

A free-text section of the KER description that the developers can use to explain their rationale for the taxonomic, life stage, or sex applicability structured terms. More help

This KER is plausible in all life stages, sexes, and organisms with DNA. The majority of the evidence is from in vivo studies conducted in male and female adult mice and rats. No in vitro evidence was found to support the relationship. 


List of the literature that was cited for this KER description. More help

Ainsbury, E. A. et al. (2016), “Ionizing radiation induced cataracts: Recent biological and mechanistic developments and perspectives for future research”, Reviews in mutation research, Vol. 770, Elsevier. 

Amente, S. et al. (2019), “Genome-wide mapping of 8-oxo-7,8-dihydro-2’-deoxyguanosine reveals accumulation of oxidatively-generated damage at DNA replication origins within transcribed long genes of mammalian cells”, Nucleic Acids Research 2019, Vol. 47/1, Oxford University Press, England, 

Cadet, J. et al. (2012), “Oxidatively generated complex DNA damage: tandem and clustered lesions”, Cancer letters, Vol. 327/1, Elsevier Ireland Ltd, Ireland, 

Cadet, J., and& Davies, K.J. A (2017). “Oxidative DNA damage & repair: An introduction. Free radical biology & medicine” Vol.107, 2-12 

Caldecott K. W. (2024). “Causes and consequences of DNA single-strand breaks”. Trends in biochemical sciences, Vol 49/1, 68–78.  

Collins, A. R. (2014), “Measuring oxidative damage to DNA and its repair with the comet assay”, Biochimica et biophysica acta. General subjects, Vol. 1840/2, Elsevier B.V., 

Eaton, J. W. (1995), “UV-mediated cataractogenesis: a radical perspective”, Documenta ophthalmologica, Vol. 88/3-4, Springer, Dordrecht, 

Hoelzl, C. et al. (2009), “Use of single cell gel electrophoresis assays for the detection of DNA-protective effects of dietary factors in humans: Recent results and trends”, Mutation Research, Vol. 681/1, Elsevier, 

Kozbenko, T. et al. (2022), “Deploying elements of scoping review methods for adverse outcome pathway development: a space travel case example”, International Journal of Radiation Biology, 1–12. 

Lee, J., N, Koo and D. B. Min (2004), “Reactive oxygen species, aging, and antioxidative nutraceuticals”, Comprehensive reviews in food science and food safety, Vol. 3/1, Blackwell Publishing Ltd, Oxford, 

Markkanen, E. (2017), “Not breathing is not an option: How to deal with oxidative DNA damage”, DNA repair, Vol. 59, Elsevier B.V., Netherlands, 

Martinez, G. and R. U. de Longh (2010), “The lens epithelium in ocular health and disease”, The international journal of biochemistry & cell biology, Vol. 42/12, Elsevier B. V, Netherlands, 

Møller, P. and Loft, S. (2006), “Dietary antioxidants and beneficial effect on oxidatively damaged DNA”, Free Radical Biology and Medicine, Elsevier, 

Pendergrass, W. et al. (2010), “X-ray induced cataract is preceded by LEC loss, and coincident with accumulation of cortical DNA, and ROS; similarities with age-related cataracts”, Molecular vision, Vol. 16, Molecular Vision, United States, pp. 1496-1513 

Pfeiffer, P. et al. (2000),. “Mechanisms of DNA double-strand break repair and their potential to induce chromosomal aberrations”,. Mutagenesis, Vol.15(4).  

Sacca, S. C. et al. (2009), “Gene-environment interactions in ocular diseases”, Mutation research – fundamental and molecular mechanisms of mutagenesis, Vol. 667/1-2, Elsevier, Amsterdam, 

Schoenfeld, M. P. et al. (2012), “A hypothesis on biological protection from space radiation through the use of new therapeutic gases as medical counter measures”, Medical gas research, Vol. 2/1, BioMed Central Ltd, India, 

Stohs, S. J. (1995), “The role of free radicals in toxicity and disease”, Journal of Basic and Clinical Physiology and Pharmacology, Vol. 6/3-4, Freund Publishing House Ltd, 

Tangvarasittichai O. and S. Tangvarasittichai (2018), “Oxidative stress, ocular disease and diabetes retinopathy”, Current Pharmaceutical Design, Vol. 24/40, 

Turner, N. D. et al. (2002), “Opportunities for nutritional amelioration of radiation-induced cellular damage”, Nutrition, Vol. 18/10, Elsevier Inc, New York, 

Yakes, F. M. and B. Van Houten (1997), “Mitochondrial DNA damage is more extensive and persists longer than nuclear DNA damage in human cells following oxidative stress”, Cell Biology, Vol. 94, The National Academy of Sciences of the USA, United States, pp. 514-519 

Zhang, Y. et al. (2010), “Oxygen-induced changes in mitochondrial DNA and DNA repair enzymes in aging rat lens”, Mechanisms of ageing and development, Vol. 131/11, Elsevier Ireland Ltd, Clare,