Intestinal stem cells in radiation-induced intestinal injury: mechanisms and therapeutic targets

Radiation-induced intestinal injury (RIII) is a common adverse reaction of pelvic radiotherapy. There is no effective treatment method yet. Intestinal stem cells (ISCs) can differentiate into various intestinal cell types. ISCs play an indispensable role in intestinal repair and functional reconstruction after RIII. This review focuses on the effects of radiation on ISCs, their influencing factors, changes in related signaling pathways following radiation, and potential therapeutic targets. The aim is to provide a theoretical basis and new research direction for studying mechanisms and targeted intervention strategies for RIII.

A comprehensive literature search was conducted in PubMed, Web of Science for studies published from 2010 to 2025. The search strategy combined keywords and controlled vocabulary terms related to ionizing radiation, intestinal stem cells, injury/repair mechanisms.

The injury and repair of ISCs are precisely regulated by signaling pathways such as Wnt, Notch, BMP, and EGF, and depend on support from the intestinal stem cell niche. Factors such as radiation dose rate, age, sex, and diet also significantly influence the radiation response of ISCs. This review summarizes the factors and regulatory pathways that influence ISC damage induced by ionizing radiation and explains potential mechanisms. It offers a direction for future research on preventing and controlling RIII through ISCs.