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The Intestinal Redox System and Its Significance in Chemotherapy-Induced Intestinal Mucositis. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:7255497. [PMID: 35585883 PMCID: PMC9110227 DOI: 10.1155/2022/7255497] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/04/2022] [Accepted: 04/09/2022] [Indexed: 12/12/2022]
Abstract
Chemotherapy-induced intestinal mucositis (CIM) is a significant dose-limiting adverse reaction brought on by the cancer treatment. Multiple studies reported that reactive oxygen species (ROS) is rapidly produced during the initial stages of chemotherapy, when the drugs elicit direct damage to intestinal mucosal cells, which, in turn, results in necrosis, mitochondrial dysfunction, and ROS production. However, the mechanism behind the intestinal redox system-based induction of intestinal mucosal injury and necrosis of CIM is still undetermined. In this article, we summarized relevant information regarding the intestinal redox system, including the composition and regulation of redox enzymes, ROS generation, and its regulation in the intestine. We innovatively proposed the intestinal redox “Tai Chi” theory and revealed its significance in the pathogenesis of CIM. We also conducted an extensive review of the English language-based literatures involving oxidative stress (OS) and its involvement in the pathological mechanisms of CIM. From the date of inception till July 31, 2021, 51 related articles were selected. Based on our analysis of these articles, only five chemotherapeutic drugs, namely, MTX, 5-FU, cisplatin, CPT-11, and oxaliplatin were shown to trigger the ROS-based pathological mechanisms of CIM. We also discussed the redox system-mediated modulation of CIM pathogenesis via elaboration of the relationship between chemotherapeutic drugs and the redox system. It is our belief that this overview of the intestinal redox system and its role in CIM pathogenesis will greatly enhance research direction and improve CIM management in the future.
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Salivary inflammatory mediators as biomarkers for oral mucositis and oral mucosal dryness in cancer patients: A pilot study. PLoS One 2022; 17:e0267092. [PMID: 35476641 PMCID: PMC9045655 DOI: 10.1371/journal.pone.0267092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/01/2022] [Indexed: 12/31/2022] Open
Abstract
Oral mucositis (OM) is a common side effect in patients with cancer receiving chemotherapy and radiotherapy; however, no salivary mediator is known to be associated with OM. We aimed to determine candidate salivary inflammatory mediators potentially associated with OM in patients with cancer. To this end, we compared the relationships between OM grade, oral mucosal dryness, and inflammatory mediators (Interleukin (IL)-1β, IL-6, IL-10, IL-12p70, tumor necrosis factor (TNF), prostaglandin E2, and vascular endothelial growth factor) in patients with cancer and in healthy volunteers (HV). We collected saliva samples from 18 patients with cancer according to the following schedule: 1) within 14 days of treatment initiation, 2) within 3 days of OM occurrence, 3) when OM was improved or got worsened, and 4) within 7 days after chemotherapy completion. The oral care support team determined the OM grade at each sample collection point based on CTCAE version 5.0. Salivary inflammatory mediator concentrations were detected using cytometric bead array or enzyme-linked immunoassay. We compared oral mucosal dryness in pre- and post-index patients with cancer to that in HV (n = 33) using an oral moisture-checking device. Fourteen of eighteen patients experienced OM (four, grade 3 OM; four, grade 2 OM; six, grade 1 OM). IL-6, IL-10, and TNF salivary concentrations were significantly increased in the post-index group compared to those in the pre-index group (p = 0.0002, p = 0.0364, and p = 0.0160, respectively). Additionally, salivary IL-6, IL-10, and TNF levels were significantly higher in the post-index group than in the HV group (p < 0.0001, p < 0.05, and p < 0.05, respectively). Significant positive correlations were observed between OM grade and salivary IL-6, IL-10, and TNF levels (p = 0.0004, r = 0.4939; p = 0.0171, r = 0.3394; and p = 0007, r = 0.4662, respectively). Oral mucosal dryness was significantly higher in the HV than in the pre- and post-index groups (p < 0.001). Our findings suggest that salivary IL-6, IL-10, and TNF levels may be used as biomarkers for OM occurrence and grade in patients with cancer. Furthermore, monitoring oral mucosal dryness and managing oral hygiene before cancer treatment is essential.
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Ferreira AS, Macedo C, Silva AM, Delerue-Matos C, Costa P, Rodrigues F. Natural Products for the Prevention and Treatment of Oral Mucositis-A Review. Int J Mol Sci 2022; 23:ijms23084385. [PMID: 35457202 PMCID: PMC9030892 DOI: 10.3390/ijms23084385] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 02/06/2023] Open
Abstract
Cancer, a major world public health problem, is associated with chemotherapy treatments whose administration leads to secondary concerns, such as oral mucositis (OM). The OM disorder is characterized by the presence of ulcers in the oral mucosa that cause pain, bleeding, and difficulty in ingesting fluids and solids, or speaking. Bioactive compounds from natural sources have arisen as an effective approach for OM. This review aims to summarize the new potential application of different natural products in the prevention and treatment of OM in comparison to conventional ones, also providing a deep insight into the most recent clinical studies. Natural products, such as Aloe vera, Glycyrrhiza glabra, Camellia sinensis, Calendula officinalis, or honeybee crops, constitute examples of sources of bioactive compounds with pharmacological interest due to their well-reported activities (e.g., antimicrobial, antiviral, anti-inflammatory, analgesic, or wound healing). These activities are associated with the bioactive compounds present in their matrix (such as flavonoids), which are associated with in vivo biological activities and minimal or absent toxicity. Finally, encapsulation has arisen as a future opportunity to preserve the chemical stability and the drug bioa vailability of bioactive compounds and, most importantly, to improve the buccal retention period and the therapeutic effects.
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Affiliation(s)
- Ana Sofia Ferreira
- REQUIMTE/LAQV—Instituto Superior de Engenharia do Porto, Rua Dr. António Bernardino de Almeida 431, 4249-015 Porto, Portugal; (A.S.F.); (C.M.); (A.M.S.); (C.D.-M.)
| | - Catarina Macedo
- REQUIMTE/LAQV—Instituto Superior de Engenharia do Porto, Rua Dr. António Bernardino de Almeida 431, 4249-015 Porto, Portugal; (A.S.F.); (C.M.); (A.M.S.); (C.D.-M.)
| | - Ana Margarida Silva
- REQUIMTE/LAQV—Instituto Superior de Engenharia do Porto, Rua Dr. António Bernardino de Almeida 431, 4249-015 Porto, Portugal; (A.S.F.); (C.M.); (A.M.S.); (C.D.-M.)
| | - Cristina Delerue-Matos
- REQUIMTE/LAQV—Instituto Superior de Engenharia do Porto, Rua Dr. António Bernardino de Almeida 431, 4249-015 Porto, Portugal; (A.S.F.); (C.M.); (A.M.S.); (C.D.-M.)
| | - Paulo Costa
- UCIBIO—Applied Molecular Biosciences Unit, MedTech-Laboratory of Pharmaceutical Technology, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal;
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Francisca Rodrigues
- REQUIMTE/LAQV—Instituto Superior de Engenharia do Porto, Rua Dr. António Bernardino de Almeida 431, 4249-015 Porto, Portugal; (A.S.F.); (C.M.); (A.M.S.); (C.D.-M.)
- Correspondence: ; Tel.: +351-22-83-40-500
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Recent development of aptamer conjugated chitosan nanoparticles as cancer therapeutics. Int J Pharm 2022; 620:121751. [DOI: 10.1016/j.ijpharm.2022.121751] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/26/2022] [Accepted: 04/11/2022] [Indexed: 12/18/2022]
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Vasileiou PVS, Siasos G, Gorgoulis VG. Molecular biomarkers in cardio-oncology: Where we stand and where we are heading. Bioessays 2022; 44:e2100234. [PMID: 35352831 DOI: 10.1002/bies.202100234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/01/2022] [Accepted: 03/15/2022] [Indexed: 11/08/2022]
Abstract
Until recently, cardiotoxicity in the setting of a malignant disease was attributed solely to the detrimental effects of chemo- and/or radio-therapy to the heart. On this account, the focus was on the evaluation of well-established cardiac biomarkers for the early detection of myocardial damage. Currently, this view has been revised. Cardiotoxicity is not restricted to a single organ but instead affects the endothelium as a whole. Indeed, it has come into light that not only cancer therapy but also malignant cells per se can impair the cardiovascular system, through a paracrine and endocrine mode of action. Even more intriguingly, a clear interplay between molecular pathways involved in cancer and cardiovascular disease has become prevalent, suggesting a common nominator that governs the pathophysiology of these two entities. Taken together, our strategy in the quest of novel biomarkers in the emerging field of cardio-oncology should be critically reshaped.
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Affiliation(s)
- Panagiotis V S Vasileiou
- Molecular Carcinogenesis Group, Department of Histology and Embryology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gerasimos Siasos
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassilis G Gorgoulis
- Molecular Carcinogenesis Group, Department of Histology and Embryology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Faculty Institute for Cancer Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.,Biomedical Research Foundation of the Academy of Athens, Athens, Greece.,Center for New Biotechnologies and Precision Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Faculty of Health and Medical Sciences, University of Surrey, Surrey, UK
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Effect of Honey on Pediatric Radio/Chemotherapy-Induced Oral Mucositis (R/CIOM): A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:6906439. [PMID: 35341151 PMCID: PMC8956378 DOI: 10.1155/2022/6906439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/28/2022] [Indexed: 02/05/2023]
Abstract
Background As a common side effect of radio/chemotherapy, oral mucositis severely affects patients' quality of life. Honey has been recommended for adults with radio/chemotherapy-induced oral mucositis (R/CIOM), but its effect for pediatric patients has not been systematically evaluated. Therefore, the aim of this systematic review and meta-analysis was to illuminate whether honey is effective in treating pediatric R/CIOM. Methods Two authors searched electronic databases including PubMed, Embase, the Cochrane Library, Web of Science, and Scopus to identify relevant studies, published in English. Then, the outcomes data was extracted from eligible studies and pooled in the meta-analysis. Results Totally, five studies containing 316 patients were included in our systematic review and meta-analysis. The result indicated that honey intervention significantly reduced the recovery time (MD = −5.10, 95% CI [−9.60, −0.61], P < 0.001, I2 = 98%, random-effect model) in pediatric patients. Honey also reduced the occurrence of all grades of R/CIOM (RR = 0.19, 95% CI [0.12, 0.30], P < 0.001, I2 = 0%, fixed-effect model) and the occurrence of grade III and grade IV R/CIOM (RR = 0.18, 95% CI [0.08, 0.41], P < 0.001, I2 = 7%, fixed-effect model), and the sensitivity analysis showed the results were stable and robust. Conclusion Therefore, honey could be a competent candidate for the complementary treatment of pediatric R/CIOM.
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Al-Qadami G, Van Sebille Y, Bowen J, Wardill H. Oral-Gut Microbiome Axis in the Pathogenesis of Cancer Treatment-Induced Oral Mucositis. FRONTIERS IN ORAL HEALTH 2022; 3:881949. [PMID: 35419563 PMCID: PMC8996059 DOI: 10.3389/froh.2022.881949] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Oral mucositis (OM) is one of the most common and debilitating oral complications of cancer treatments including chemotherapy, radiotherapy, and hematopoietic stem cell transplantation. It is associated with severe pain and difficulties in chewing, swallowing, and speech. This leads to impairment of basic oral functions and could result in unplanned treatment interruption or modification. As such, OM negatively impacts both patients' quality of life as well as tumor prognostic outcomes. Understanding pathways underlying OM pathogenesis help identify new targets for intervention or prevention. The pathophysiology of OM has been widely studied over past decades with several pathways related to oxidative stress, inflammation, and molecular and cellular signaling being implicated. In this mini-review, we will discuss the emerging role of the oral-gut microbiome axis in the development of OM. Particularly, we will elaborate on how the alterations in the oral and gut microbiota as well as intestinal dysfunction caused by cancer treatments could contribute to the pathogenesis of OM. Further, we will briefly discuss the potential methods for targeting the oral-gut microbiome axis to improve OM outcomes.
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Affiliation(s)
- Ghanyah Al-Qadami
- School of Biomedicine, University of Adelaide, Adelaide, SA, Australia
| | | | - Joanne Bowen
- School of Biomedicine, University of Adelaide, Adelaide, SA, Australia
| | - Hannah Wardill
- School of Biomedicine, University of Adelaide, Adelaide, SA, Australia
- Precision Medicine Theme (Cancer), South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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Chang HP, Huang MC, Lei YP, Chuang YJ, Wang CW, Sheen LY. Phytochemical-rich vegetable and fruit juice alleviates oral mucositis during concurrent chemoradiotherapy in patients with locally advanced head and neck cancer. J Tradit Complement Med 2022; 12:488-498. [PMID: 36081822 PMCID: PMC9446194 DOI: 10.1016/j.jtcme.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/19/2022] [Accepted: 03/23/2022] [Indexed: 01/08/2023] Open
Abstract
Background Objective Methods Results Conclusion Section Taxonomy The blended vegetable and fruit juice (VFJ) was rich in total polyphenols and carotenoids. In head and neck cancer patients, the VFJ was significantly associated with a lower risk of chemoradiotherapy-induced ulcerative oral mucositis. VFJ is healthy, safe, and effective dietary strategy against oral mucositis.
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Bansal R, Park H, Taborda CC, Gordillo C, Mapara MY, Assal A, Uhlemann AC, Reshef R. Antibiotic Exposure, Not Alloreactivity, Is the Major Driver of Microbiome Changes in Hematopoietic Cell Transplantation. Transplant Cell Ther 2022; 28:135-144. [PMID: 34958974 PMCID: PMC8923982 DOI: 10.1016/j.jtct.2021.12.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 12/31/2022]
Abstract
Both autologous hematopoietic cell transplantation (auto-HCT) and allogeneic hematopoietic cell transplantation (allo-HCT) are associated with significant alterations in the intestinal microbiome. The relative contributions of antibiotic use and alloreactivity to microbiome dynamics have not yet been elucidated, however. There is a lack of data on the kinetics of microbiome changes beyond 30 days post-transplantation and how they might differ between different transplantation modalities. A direct comparison of the differential effects of auto-HCT and allo-HCT on the microbiome may shed light on these dynamics. This study was conducted to compare intestinal microbial diversity between auto-HCT recipients and allo-HCT recipients from pre-transplantation to 100 days post-transplantation, and to examine the effect of antibiotics, transplant type (auto versus allo), and conditioning regimens on the dynamics of microbiome recovery. We conducted a longitudinal analysis of changes in the intestinal microbiome in 35 patients undergoing HCT (17 auto-HCT, 18 allo-HCT) at 4 time points: pre-conditioning and 14, 28, and 100 days post-transplantation. Granular data on antibiotic exposure from day -30 pre-transplantation to day +100 post-transplantation were collected. Pre-transplantation, allo-HCT recipients had lower α-diversity in the intestinal microbiome compared with auto-HCT recipients, which correlated with greater pre-transplantation antibiotic use in allo-HCT recipients. The microbiome diversity declined at days +14 and +28 post-transplantation in both cohorts but generally returned to baseline by day +100. Conditioning regimen intensity did not significantly affect post-transplantation α-diversity. Through differential abundance analysis, we show that commensal bacterial taxa involved with maintenance of gut epithelial integrity and production of short-chain fatty acids were depleted after both auto-HCT and allo-HCT. In our dataset, antibiotic exposure was the major driver of post-transplantation microbiome changes rather than alloreactivity, conditioning intensity, or immunosuppression. Our findings also suggest that interventions to limit microbiome injury, such as limiting the use of broad-spectrum antibiotics, should target the pre-transplantation period and not only the peri-transplantation period.
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Affiliation(s)
- Rajat Bansal
- Blood and Marrow Transplantation and Cell Therapy Program,
Columbia University Irving Medical Center,Division of Hematologic Malignancies and Cellular
Therapeutics, University of Kansas Medical Center
| | - Heekuk Park
- Division of Infectious Diseases, Columbia University Irving
Medical Center
| | - Cristian C Taborda
- Columbia Center for Translational Immunology, Columbia
University Irving Medical Center
| | - Christian Gordillo
- Blood and Marrow Transplantation and Cell Therapy Program,
Columbia University Irving Medical Center,Columbia Center for Translational Immunology, Columbia
University Irving Medical Center
| | - Markus Y Mapara
- Blood and Marrow Transplantation and Cell Therapy Program,
Columbia University Irving Medical Center,Columbia Center for Translational Immunology, Columbia
University Irving Medical Center
| | - Amer Assal
- Blood and Marrow Transplantation and Cell Therapy Program,
Columbia University Irving Medical Center
| | | | - Ran Reshef
- Blood and Marrow Transplantation and Cell Therapy Program, Columbia University Irving Medical Center, New York, New York; Columbia Center for Translational Immunology, Columbia University Irving Medical Center, New York, New York.
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Lee CT, Galloway TJ. Pathogenesis and Amelioration of Radiation-Induced Oral Mucositis. Curr Treat Options Oncol 2022; 23:311-324. [PMID: 35244887 PMCID: PMC8931694 DOI: 10.1007/s11864-022-00959-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/29/2022]
Abstract
OPINION STATEMENT Oral mucositis (OM) causes significant detriment to patient quality of life. Despite advances in RT, chemotherapy, and surgery for HNC which have led to improved local control and survival, management of certain toxicities such as OM have not kept pace. Numerous strategies have emerged with demonstrable benefit in preventing severe OM. However, ones which are not only effective, but practical and affordable to implement are rare. For example, infusion of growth factors or free radical scavengers, and daily treatment of intra-oral sites with lasers are supported by high-quality evidence but have not become widely adopted. It falls to familiarity of the physician with the available preventative measures and ultimately, patient preference in accepting which strategies for OM amelioration are used. In this review, we present a pathophysiological-based review of prevention techniques available for reducing the incidence and duration of severe OM.
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Affiliation(s)
- Charles T. Lee
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Thomas J. Galloway
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
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Evaluation of the antiapoptotic and anti-inflammatory properties of chitosan in methotrexate-induced oral mucositis in rats. Mol Biol Rep 2022; 49:3237-3245. [PMID: 35064410 DOI: 10.1007/s11033-022-07158-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Methotrexate (MTX), a chemotherapeutic agent, is known to cause oral mucositis. Chitosan has been shown to have a protective effect in inflammatory animal models. This research aimed to examine the protective effect of chitosan against oral mucositis caused by MTX. METHODS AND RESULTS Wistar albino rats were randomly divided into three groups. Control (n = 8), (saline via oral gavage for 5 days), MTX (n = 8), (60 mg/kg single dose MTX intraperitoneally on the 1st day and for the following 4 days saline via oral gavage), and MTX + chitosan (n = 8), (1st day single dose 60 mg/kg MTX intraperitoneally and followed with 200 mg/kg chitosan via oral gavage for 4 days). After 24 h of the last dose, the animals were euthanised. Blood, tongue, buccal and palatal mucosa tissues were collected. Serum interleukin 1-beta (IL1-β), tumour necrosis factor-alpha (TNF-α), matrix metalloproteinase (MMP-1, and MMP-2) activities, tissue bcl-2/bax ratio and the expression of caspase-3 (casp-3), and casp-9 were detected. The tissues were also examined histologically. Serum TNF-α, IL1-β, MMP-1 and MMP-2 activities and tissue casp-3 and casp-9 activities significantly increased but the bcl-2/bax ratio significantly decreased in the MTX group compared those of the control group. Histologically, diffuse inflammatory cells were observed in MTX group. However, In the MTX + chitosan group, all the values were close to those of the control group. CONCLUSION It was demonstrated that chitosan has a protective effect against oral mucosal damage caused by MTX. Thus, it may be a candidate agent against MTX induced oral mucositis.
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Yilmaz E, Azizoglu ZB, Aslan K, Erdem S, Haliloglu Y, Suna PA, Yay AH, Deniz K, Tasdemir A, Per S, Unal E, Karakukcu M, Patiroglu T. Therapeutic effects of vitamin D and IL-22 on methotrexate-induced mucositis in mice. Anticancer Drugs 2022; 33:11-18. [PMID: 34348356 DOI: 10.1097/cad.0000000000001128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mucositis is a common side effect of cancer therapies and transplant conditioning regimens. Management of mucositis involves multiple approaches from oral hygiene, anti-inflammatory, anti-apoptotic, cytoprotective, and antioxidant agents, to cryo-therapy, physical therapy, and growth factors. There is room for novel, affordable treatment options, or improvement of currently available therapies. Vitamin D has been shown to regulate mucosa-resident cell populations such as Th17 or innate lymphoid cells and critical mucosal cytokine IL-22; however, their therapeutic potential has not been put to test in preclinical mouse models. In this study, we aimed to test the therapeutic potential of vitamin D injections and IL-22 overexpression in a murine model of chemotherapy-induced mucositis. Balb/c mice were given daily intraperitoneal injections of vitamin D. Mucositis was induced by methotrexate. Another group received IL-22 plasmid via hydrodynamic gene delivery. Weight loss and intestinal histopathology, intestinal levels of cytokines IL-22, IL-17A, GM-CSF, IL-23, IFN-γ, TNF-α, and IL-10, and number of intestinal lamina propria B cell, neutrophil, and total innate lymphoid cells were quantified. Daily vitamin D injections ameliorated intestinal inflammation and elevated intestinal IL-22 levels compared with control groups. Temporal overexpression of IL-22 by hydrodynamic gene delivery slightly increased intestinal IL-22 but failed to confer significant protection from mucositis. To our knowledge, this is the first experimental demonstration in an animal model of mucositis of therapeutic use of vitamin D and IL-22 supplementation and our results with vitamin D suggest it may have merit in further trials in human mucositis patients.
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Affiliation(s)
- Ebru Yilmaz
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Erciyes University School of Medicine
| | - Zehra Busra Azizoglu
- Molecular Biology and Genetics, Betül-Ziya Eren Genome and Stem Cell Center (GENKOK)
- Department of Medical Biology, Erciyes University, School of Medicine
| | - Kubra Aslan
- Molecular Biology and Genetics, Betül-Ziya Eren Genome and Stem Cell Center (GENKOK)
- Department of Medical Biology, Erciyes University, School of Medicine
| | - Serife Erdem
- Molecular Biology and Genetics, Betül-Ziya Eren Genome and Stem Cell Center (GENKOK)
- Department of Medical Biology, Erciyes University, School of Medicine
| | - Yesim Haliloglu
- Molecular Biology and Genetics, Betül-Ziya Eren Genome and Stem Cell Center (GENKOK)
- Department of Medical Biology, Erciyes University, School of Medicine
| | - Pinar Alisan Suna
- Department of Histology and Embryology, Erciyes University, School of Medicine
| | - Arzu Hanim Yay
- Molecular Biology and Genetics, Betül-Ziya Eren Genome and Stem Cell Center (GENKOK)
- Department of Histology and Embryology, Erciyes University, School of Medicine
| | - Kemal Deniz
- Department of Pathology, Erciyes University, School of Medicine
| | | | - Sedat Per
- Department of Chemistry and Chemical Processing Technologies, Kayseri University, Mustafa Çikrikçioğlu Vocational School
- Department of Biology, Faculty of Arts and Science, Yozgat Bozok University, Yozgat, Turkey
| | - Ekrem Unal
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Erciyes University School of Medicine
- Molecular Biology and Genetics, Betül-Ziya Eren Genome and Stem Cell Center (GENKOK)
| | - Musa Karakukcu
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Erciyes University School of Medicine
| | - Turkan Patiroglu
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Erciyes University School of Medicine
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Elad S, Yarom N, Zadik Y, Kuten-Shorrer M, Sonis ST. The broadening scope of oral mucositis and oral ulcerative mucosal toxicities of anticancer therapies. CA Cancer J Clin 2022; 72:57-77. [PMID: 34714553 DOI: 10.3322/caac.21704] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 01/15/2023] Open
Abstract
Oral mucositis (OM) is a common, highly symptomatic complication of cancer therapy that affects patients' function, quality of life, and ability to tolerate treatment. In certain patients with cancer, OM is associated with increased mortality. Research on the management of OM is ongoing. Oral mucosal toxicities are also reported in targeted and immune checkpoint inhibitor therapies. The objective of this article is to present current knowledge about the epidemiology, pathogenesis, assessment, risk prediction, and current and developing intervention strategies for OM and other ulcerative mucosal toxicities caused by both conventional and evolving forms of cancer therapy.
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Affiliation(s)
- Sharon Elad
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York
| | - Noam Yarom
- Sheba Medical Center, Tel Hashomer, Israel
- School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehuda Zadik
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Michal Kuten-Shorrer
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York
- Tufts University School of Dental Medicine, Boston, Massachusetts
| | - Stephen T Sonis
- Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
- Primary Endpoint Solutions, Waltham, Massachusetts
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Shao W, Chen R, Lin G, Ran K, Zhang Y, Yang J, Pan H, Shangguan J, Zhao Y, Xu H. In situ mucoadhesive hydrogel capturing tripeptide KPV: the anti-inflammatory, antibacterial and repairing effect on chemotherapy-induced oral mucositis. Biomater Sci 2021; 10:227-242. [PMID: 34846053 DOI: 10.1039/d1bm01466h] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The self-healing of chemotherapy-induced oral mucositis is difficult in practice because of both local bacterial infection and severe inflammation. Herein, in situ mucoadhesive hydrogels (PPP_E) were successfully prepared by using temperature-sensitive PLGA-PEG-PLGA (PPP) as a matrix and epigallocatechin-3-gallate (EGCG) with inherent antibacterial activity as an adhesion enhancer. A series of PPP_E precursor solutions with various EGCG concentrations (1%, 2% and 5%) were prepared by fixing the PPP concentration at 25%. EGCG slightly decreased the sol-gel transition temperature and shortened the sol-gel transition time of the PPP hydrogel. Moreover, the incorporation of EGCG could significantly increase the tissue adhesion properties of the PPP hydrogel at 37 °C. PPP_2%E displayed a suitable gelation temperature (36.2 °C), gelation time (100 s) and storage modulus (48 Pa). Tripeptide KPV as a model drug was easily dissolved in cold PPP_2%E precursor solution to prepare KPV@PPP_2%E hydrogel. The anti-inflammatory activity and promotion of cell migration potential by KPV in PPP-2% E hydrogel were well maintained. Moreover, KPV@PPP_2%E exhibited strong antibacterial efficacy against S. aureus. PPP_2%E precursor solution rapidly transformed to a hydrogel and adhered to the wound surface for 7 hours when administrated to the gingival mucosa of rats. Treatment with KPV@PPP_2%E hydrogel greatly improved the food intake and body weight recovery of rats with chemotherapy-induced oral mucositis. Moreover, the tissue morphology of the ulcerated gingiva after application of KPV@PPP_E hydrogel was also well repaired by promoting CK10 and PCNA expression. In addition, the inflammatory cytokines including IL-1β and TNF-α were significantly inhibited by KPV@PPP_2%E hydrogel while IL-10 was up-regulated. KPV@PPP_2%E hydrogel also had an anti-bacterial effect on MRSA-infected gingival ulcer wounds, which resulted in the obvious inhibition of infiltration by inflammatory cells into submucosal tissues. Conclusively, KPV@PPP_E may be a promising practical application for cancer patients with chemotherapy-induced oral mucositis.
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Affiliation(s)
- Weifeng Shao
- Department of pharmaceutics, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou City, Zhejiang Province 325035, China.
| | - Rui Chen
- Department of pharmaceutics, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou City, Zhejiang Province 325035, China.
| | - Gaolong Lin
- Department of pharmaceutics, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou City, Zhejiang Province 325035, China.
| | - Kunjie Ran
- Department of pharmaceutics, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou City, Zhejiang Province 325035, China.
| | - Yingying Zhang
- Department of pharmaceutics, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou City, Zhejiang Province 325035, China.
| | - Jiaojiao Yang
- Department of pharmaceutics, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou City, Zhejiang Province 325035, China.
| | - Hanxiao Pan
- Department of pharmaceutics, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou City, Zhejiang Province 325035, China.
| | - Jianxun Shangguan
- Department of pharmaceutics, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou City, Zhejiang Province 325035, China.
| | - Yingzheng Zhao
- Department of pharmaceutics, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou City, Zhejiang Province 325035, China.
| | - Helin Xu
- Department of pharmaceutics, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou City, Zhejiang Province 325035, China.
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Savassi B, Cordeiro BF, Silva SH, Oliveira ER, Belo G, Figueiroa AG, Alves Queiroz MI, Faria AMC, Alves J, da Silva TF, Campos GM, Esmerino EA, Rocha RS, Freitas MQ, Silva MC, Cruz AG, Vital KD, Fernandes SO, Cardoso VN, Acurcio LB, Jan G, Le Loir Y, Gala-Garcia A, do Carmo FLR, Azevedo V. Lyophilized Symbiotic Mitigates Mucositis Induced by 5-Fluorouracil. Front Pharmacol 2021; 12:755871. [PMID: 34955828 PMCID: PMC8703075 DOI: 10.3389/fphar.2021.755871] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/01/2021] [Indexed: 11/22/2022] Open
Abstract
Mucositis is an adverse effect of cancer chemotherapies using 5-Fluorouracil (5-FU). It is characterized by mucosal inflammation, pain, diarrhea, and weight loss. Some studies reported promising healing effects of probiotic strains, when associated with prebiotics, as adjuvant treatment of mucositis. We developed a lyophilized symbiotic product, containing skimmed milk, supplemented with whey protein isolate (WPI) and with fructooligosaccharides (FOS), and fermented by Lactobacillus casei BL23, Lactiplantibacillus plantarum B7, and Lacticaseibacillus rhamnosus B1. In a mice 5-FU mucositis model, this symbiotic lyophilized formulation was able to reduce weight loss and intestinal permeability. This last was determined in vivo by quantifying blood radioactivity after oral administration of 99mTc-DTPA. Finally, histological damages caused by 5-FU-induced mucositis were monitored. Consumption of the symbiotic formulation caused a reduced score of inflammation in the duodenum, ileum, and colon. In addition, it decreased levels of pro-inflammatory cytokines IL-1β, IL-6, IL-17, and TNF-α in the mice ileum. The symbiotic product developed in this work thus represents a promising adjuvant treatment of mucositis.
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Affiliation(s)
- Bruna Savassi
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Bárbara F. Cordeiro
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Sara H. Silva
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Emiliano R. Oliveira
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Giovanna Belo
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | | | - Ana Maria Caetano Faria
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Juliana Alves
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Tales Fernando da Silva
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Gabriela Munis Campos
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Erick A. Esmerino
- Faculdade de Veterinária, Universidade Federal Fluminense (UFF), Niterói, Brazil
| | - Ramon S. Rocha
- Faculdade de Veterinária, Universidade Federal Fluminense (UFF), Niterói, Brazil
- Departamento de Alimentos, Ciência e Tecnologia Do Rio de Janeiro (IFRJ), Instituto Federal de Educação, Rio de Janeiro, Brazil
| | - Monica Q. Freitas
- Faculdade de Veterinária, Universidade Federal Fluminense (UFF), Niterói, Brazil
| | - Marcia C. Silva
- Departamento de Alimentos, Ciência e Tecnologia Do Rio de Janeiro (IFRJ), Instituto Federal de Educação, Rio de Janeiro, Brazil
| | - Adriano G. Cruz
- Departamento de Alimentos, Ciência e Tecnologia Do Rio de Janeiro (IFRJ), Instituto Federal de Educação, Rio de Janeiro, Brazil
| | - Kátia Duarte Vital
- Departamento de Análises Clínicas e Toxicológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Simone O.A. Fernandes
- Departamento de Análises Clínicas e Toxicológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Valbert N. Cardoso
- Departamento de Análises Clínicas e Toxicológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Leonardo Borges Acurcio
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Gwénaël Jan
- INRAE, STLO, Institut Agro, Agrocampus Ouest, Rennes, France
| | - Yves Le Loir
- INRAE, STLO, Institut Agro, Agrocampus Ouest, Rennes, France
| | - Alfonso Gala-Garcia
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Faculdade de Odontologia, Universidade Federal da Bahia (UFBA), Salvador, Brazil
| | - Fillipe Luiz R. do Carmo
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- INRAE, STLO, Institut Agro, Agrocampus Ouest, Rennes, France
| | - Vasco Azevedo
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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Oliveira MMB, de Araújo AA, Ribeiro SB, de Sales Mota PCM, Marques VB, da Silva Martins Rebouças C, Figueiredo JG, Barra PB, de Castro Brito GA, de Carvalho Leitão RF, Guerra GCB, de Medeiros CACX. Losartan improves intestinal mucositis induced by 5-fluorouracil in mice. Sci Rep 2021; 11:23241. [PMID: 34853351 PMCID: PMC8636633 DOI: 10.1038/s41598-021-01969-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 11/01/2021] [Indexed: 02/07/2023] Open
Abstract
Intestinal mucositis (IM) is a common side effect of 5-fluorouracil (5-FU)-based chemotherapy, which negatively impacts therapeutic outcomes and delays subsequent cycles of chemotherapy resulting in dose reductions and treatment discontinuation. In search of new pharmacological alternatives that minimize your symptoms, this work set out to study the effect of losartan (LOS), a receptor type I (AT1) angiotensin II antagonist, on intestinal mucositis induced by 5-FU. Intestinal mucositis was induced by a single intraperitoneal administration of 5-FU (450 mg/kg) in Swiss mice. Losartan (5, 25 or 50 mg/kg) or saline was orally administered 30 min before 5-FU and daily for 4 days. On 4th day, the animals were euthanized and segments of small intestine were collected to evaluate histopathological alterations (morphometric analysis), concentration of inflammatory cytokines, oxidative stress markers and genic expression of NF-κB p65, Fn-14 and TWEAK. Weight evaluation and changes in leukogram were also analyzed. 5-FU induced intense weight loss, leukopenia and reduction in villus height compared to saline group. Losartan (50 mg/kg) prevented 5-FU-induced inflammation by decreasing in the analyzed parameters compared to the 5-FU group. Our findings suggest that 50 mg/kg of losartan prevents the effects of 5-FU on intestinal mucosa in mice.
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Affiliation(s)
| | - Aurigena Antunes de Araújo
- Post Graduate Program in Pharmaceutical Science, Post Graduate Program Dental Sciences, Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | - Susana Barbosa Ribeiro
- Junior Postdoctoral Student CNPq-Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | | | | | | | - Jozi Godoy Figueiredo
- Department of Biochemistry, Faculty of Vale do São Lourenço (EDUVALE), Jaciara, MT, Brazil
| | - Patrícia Batista Barra
- Post Graduate Program in Biology Teaching in National Network-PROFBIO, Department of Biomedical Sciences, State University of Rio Grande do Norte (UERN), Mossoró, RN, Brazil
| | - Gerly Anne de Castro Brito
- Post Graduate Program Morphofunctional Sciences, Post Graduate Program Medical Sciences, Department of Morphology, Faculty of Medicine, Federal University of Ceará (UFC), Fortaleza, CE, Brazil
| | - Renata Ferreira de Carvalho Leitão
- Post Graduate Program Morphofunctional Sciences, Department of Morphology, Faculty of Medicine, Federal University of Ceará (UFC), Fortaleza, CE, Brazil
| | - Gerlane Coelho Bernardo Guerra
- Post Graduate Program Biochemistry and Molecular Biology, Post Graduate Program Pharmaceutical Science, Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | - Caroline Addison Carvalho Xavier de Medeiros
- Post Graduate Program Biotechnology-RENORBIO, Post Graduate Program Biochemistry and Molecular Biology, Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil.
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67
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Comparative study of royal jelly, propolis, and photobiomodulation therapies in 5-fluorouracil-related oral mucositis in rats. Support Care Cancer 2021; 30:2723-2734. [PMID: 34822003 DOI: 10.1007/s00520-021-06660-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE This study aimed to evaluate the effects and mechanisms of action of royal jelly (RJ) and propolis compared to photobiomodulation therapy (PBMT) in an animal model of 5-fluorouracil-related oral mucositis (OM). METHODS Seventy-two male Wistar rats were randomly allocated to four groups (n = 18 each): control (no treatment), PBMT (intraoral laser, 6 J/cm2), RJ, and propolis. On days 0 and 2, the animals received an injection of 5-fluorouracil (5-FU). The buccal mucosa was scratched (days 3 and 4) and the treatments were initiated on day 5. Six animals of each group were euthanized on days 8, 10, and 14. Phytochemical analysis (thin-layer chromatography, TLC) and clinical, histopathological, and immunohistochemical analysis of pS6, pAKT, and NF-κB were performed, and oxidative stress markers were also investigated. RESULTS TLC revealed the presence of large amounts of sucrose (Rf 0.34) in RJ and of flavonoids in propolis. Lower clinical OM scores were observed on day 8, and improved morphological data were observed on day 10 in the PBMT, RJ, and propolis groups (p < 0.05). On day 8, immunoexpression of pS6, pAKT, and NF-κB was increased compared to control. On day 14, reduced glutathione (GSH) antioxidant levels were increased in the propolis group compared to control (p < 0.05). CONCLUSIONS Our results showed that RJ and propolis, as well as PBMT, are effective in the treatment of OM. Considering that some patients who develop OM do not have access to PBMT, the present study demonstrated that topical application of RJ and propolis may be an important alternative for the treatment of OM.
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68
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Shetty SS, Maruthi M, Dhara V, de Arruda JAA, Abreu LG, Mesquita RA, Teixeira AL, Silva TA, Merchant Y. Oral mucositis: Current knowledge and future directions. Dis Mon 2021; 68:101300. [PMID: 34758917 DOI: 10.1016/j.disamonth.2021.101300] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Oral mucositis secondary to head and neck chemoradiation displays a complex molecular pathogenesis involving epithelial and microvascular injury, release of pro-inflammatory cytokines, and host-microbiome communications. These processes lead to oxidative stress and the release of reactive oxygen species that stifle the structural integrity of the oral mucosa, with emergence of erosions and ulcers. The consequences are malnutrition, psychological/psychiatric symptoms, poor quality of life, and occurrence of opportunistic infections. The latter pose a major challenge due to the risk of interruption of anti-neoplastic therapy, tumour recurrence and, ultimately, death. This article aims to present the clinical characteristics, molecular pathogenesis, and an overview of the predisposing factors and current management of oral mucositis. It is anticipated that the future direction of the management of oral mucositis will focus on evidence-based prehabilitation and pre- and per-chemoradiation therapy monitoring.
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Affiliation(s)
- Sameep S Shetty
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, A Constituent of MAHE, Manipal 576104, India.
| | - Meghana Maruthi
- Department of Dental Rehabilitative Oncology, HealthCare Global Enterprises Ltd., Bangalore, India.
| | - Vasantha Dhara
- Consultant Maxillofacial Surgeon, Hyderabad, Telangana, India.
| | - José Alcides Almeida de Arruda
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, room 3202 D, CEP: 31.270-910, Belo Horizonte, Minas Gerais, Brazil.
| | - Lucas Guimarães Abreu
- Department of Child's and Adolescent's Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Ricardo Alves Mesquita
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Antonio Lucio Teixeira
- Faculdade Santa Casa BH, Belo Horizonte, Brazil. Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
| | - Tarcília Aparecida Silva
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, room 3204, CEP: 31.270-910, Belo Horizonte, Minas Gerais, Brazil.
| | - Yash Merchant
- Consultant Maxilofacial Surgeon, Pune, Maharashtra, India.
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Oral Mucositis in Cancer and Potential Use of Omega-3 Free Fatty Acids in Its Management: A Review. Biomedicines 2021; 9:biomedicines9111531. [PMID: 34829760 PMCID: PMC8615276 DOI: 10.3390/biomedicines9111531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 12/01/2022] Open
Abstract
Oral mucositis (OM) is a painful condition caused by chemotherapeutic or radiotherapeutic cancer treatments, occurring in patients with different tumour characteristics and locations. OM greatly impacts a patient’s quality of life and cancer recovery. Current OM management strategies are not providing sufficient prevention and treatment; new approaches to injury management are needed. Studies on the benefit of omega-3 free fatty acids (FFA) in human health have increased significantly in recent years. FFA properties have been studied extensively, including their potential therapeutic use in inflammatory conditions. However, omega-3 FFA’s use as a supplementary treatment for OM has not been clinically tested. Preliminary evidence suggests that utilising FFA to manage OM could be a useful strategy for lesion management, assisting with healthy oral mucosa recovery. This review will describe the incidence, risk factors, biology of OM and the current treatment strategies, leading to a discussion of the utility of omega-3 FFA as a novel therapeutic agent for OM.
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70
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da Silva Ferreira AR, Märtson AG, de Boer A, Wardill HR, Alffenaar JW, Harmsen HJM, Tissing WJE. Does Chemotherapy-Induced Gastrointestinal Mucositis Affect the Bioavailability and Efficacy of Anti-Infective Drugs? Biomedicines 2021; 9:biomedicines9101389. [PMID: 34680506 PMCID: PMC8533339 DOI: 10.3390/biomedicines9101389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/24/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022] Open
Abstract
Antimicrobial prophylaxis is increasingly being used in patients with hematological malignancies receiving high-dose chemotherapy and hematopoietic stem cell transplantation (HSCT). However, few studies have focused on the potential impact of gastrointestinal mucositis (GI-M), a frequently observed side effect of chemotherapy in patients with cancer that affects the gastrointestinal microenvironment, on drug absorption. In this review, we discuss how chemotherapy leads to an overall loss of mucosal surface area and consequently to uncontrolled transport across the barrier. The barrier function is depending on intestinal luminal pH, intestinal motility, and diet. Another factor contributing to drug absorption is the gut microbiota, as it modulates the bioavailability of orally administrated drugs by altering the gastrointestinal properties. To better understand the complex interplay of factors in GI-M and drug absorption we suggest: (i) the longitudinal characterization of the impact of GI-M severity on drug exposure in patients, (ii) the development of tools to predict drug absorption, and (iii) strategies that allow the support of the gut microbiota. These studies will provide relevant data to better design strategies to reduce the severity and impact of GI-M in patients with cancer.
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Affiliation(s)
- Ana Rita da Silva Ferreira
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, NL-9713-GZ-1 Groningen, The Netherlands; (A.R.d.S.F.); (A.d.B.)
| | - Anne-Grete Märtson
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, NL-9713-GZ-1 Groningen, The Netherlands;
| | - Alyse de Boer
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, NL-9713-GZ-1 Groningen, The Netherlands; (A.R.d.S.F.); (A.d.B.)
| | - Hannah R. Wardill
- Department of Pediatrics, The University of Groningen, University Medical Center Groningen, NL-9713-GZ-1 Groningen, The Netherlands; (H.R.W.); (W.J.E.T.)
- Adelaide Medical School, The University of Adelaide, Adelaide, SA 5005, Australia
- Precision Medicine (Cancer), South Australian Health and Medical Research Institute, Adelaide, NSW 5005, Australia
| | - Jan-Willem Alffenaar
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia;
- Westmead Hospital, Westmead, Sydney, NSW 2145, Australia
- Marie Bahshir Institute of Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW 2006, Australia
| | - Hermie J. M. Harmsen
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, NL-9713-GZ-1 Groningen, The Netherlands; (A.R.d.S.F.); (A.d.B.)
- Correspondence: ; Tel.: +31-50-3615186
| | - Wim J. E. Tissing
- Department of Pediatrics, The University of Groningen, University Medical Center Groningen, NL-9713-GZ-1 Groningen, The Netherlands; (H.R.W.); (W.J.E.T.)
- Princes Maxima Centre for Pediatric Oncology, NL-3584-CS-25 Utrecht, The Netherlands
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Zhao G, Williams J, Washington MK, Yang Y, Long J, Townsend SD, Yan F. 2'-Fucosyllactose Ameliorates Chemotherapy-Induced Intestinal Mucositis by Protecting Intestinal Epithelial Cells Against Apoptosis. Cell Mol Gastroenterol Hepatol 2021; 13:441-457. [PMID: 34607083 PMCID: PMC8688723 DOI: 10.1016/j.jcmgh.2021.09.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Intestinal mucositis, a severe complication of antineoplastic therapeutics, is characterized by mucosal injury and inflammation in the small intestine. Therapies for the prevention and treatment of this disease are needed. We investigated whether 2'-fucosyllactose (2'-FL), an abundant oligosaccharide in human milk, protects intestinal integrity and ameliorates intestinal mucositis. METHODS A mouse small intestinal epithelial (MSIE) cell line, mouse enteroid cultures, and human gastrointestinal tumor cell lines (AGS and HT29) were co-treated with the chemotherapy agent 5-fluorouracil (5-FU) and 2'-FL. Mice were injected intraperitoneally with 5-FU to induce intestinal mucositis. 2'-FL was administered in the drinking water to mice before (pretreatment) or concurrently with 5-FU injection. Body weight and pathologic changes were analyzed. RESULTS 2'-FL alleviated 5-FU inhibition of cell growth in MSIE cells, but not in AGS and HT29 cells. The 5-FU-induced apoptosis in MSIE cells and enteroids was suppressed by 2'-FL. Compared with 5-FU treatment alone, 2'-FL pretreatment protected against body weight loss, and ameliorated inflammation scores, proinflammatory cytokine production, shortening of villi, epithelial cell apoptosis, goblet cell loss, and tight junctional complex disruption in the small intestine. 2'-FL concurrent treatment had less of an effect on intestinal mucositis than 2'-FL pretreatment. Interestingly, no effect of 2'-FL was observed on 5-FU-induced S-phase arrest in MSIE, AGS, and HT29 cells. Neither pretreatment nor concurrent treatment with 2'-FL affected 5-FU-induced inhibition of proliferation in MSIE cells. CONCLUSIONS This study shows a novel direct effect of 2'-FL in protecting small intestinal epithelial cells against apoptosis stimulated by 5-FU, which may contribute to prevention of 5-FU-induced intestinal mucositis.
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Affiliation(s)
- Gang Zhao
- Department of Pediatrics, Nashville, Tennessee
| | | | - M. Kay Washington
- Department of Pathology, Microbiology and Immunology, Nashville, Tennessee
| | - Yaohua Yang
- Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jirong Long
- Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Fang Yan
- Department of Pediatrics, Nashville, Tennessee,Department of Cell and Developmental Biology, Vanderbilt University, Nashville, Tennessee,Correspondence Address correspondence to: Fang Yan, MD, PhD, Department of Pediatrics, Vanderbilt University Medical Center, 2215 Garland Avenue, MRB IV, Room 1035, Nashville, Tennessee 37232-0696. fax: (615) 343-5323.
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Arafat EA, El-Khair SMA, Elsamanoudy AZ, Shabaan DA. Study of the Possible Alleviated Role of Atorvastatin on Irinotecan-Induced Lingual Mucosal Damage: Histological and Molecular Study. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:9690047. [PMID: 34630855 PMCID: PMC8497104 DOI: 10.1155/2021/9690047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/05/2021] [Accepted: 09/03/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Oral mucositis is the most debilitating and troublesome adverse effect of irinotecan (CPT-11) treatment. It adversely affects the patient quality of life. The aim of this work was to study the histological, immunohistochemical, and molecular changes in the oral mucosa by CPT-11 and the possible alleviated role of atorvastatin. METHODS Rats were randomly divided into control, CPT-11-treated group, and CPT-11+ atorvastatin-treated group. At the end of the experiment, the anterior two-thirds of the tongue was dissected out and divided into two parts: one part for light microscopic examination and the second for molecular study. RESULTS CPT-11-treated group revealed loss of normal mucosal organization, areas of ulceration and inflammation, and loss of architecture of lingual papillae. A significant decrease in immunohistochemical and molecular gene expression of Ki-67 and antiapoptotic Bcl-2 levels was observed. A significant increase in NF-κB immunohistochemical and mRNA gene expression level and a nonsignificant increase in Nrf2 gene expression were detected. Coadministration of atorvastatin showed remarkable improvement in the histopathological picture with a significant increase in Ki-67 and Bcl-2, a significant decrease in NF-κB protein and gene expression, and a significant increase in Nrf2 gene expression. CONCLUSION Atorvastatin substantially attenuates CPT-11-induced oral mucositis through the initiation of the antiapoptotic gene, modulation of the inflammatory, and antioxidant gene expression.
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Affiliation(s)
- Eetmad A Arafat
- Histology and Cell Biology Department, Faculty of Medicine, Mansoura University, Egypt
| | - S M Abo El-Khair
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Mansoura University, Egypt
| | - A Z Elsamanoudy
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Mansoura University, Egypt
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Dalia A Shabaan
- Histology and Cell Biology Department, Faculty of Medicine, Mansoura University, Egypt
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Homa-Mlak I, Brzozowska A, Mlak R, Szudy-Szczyrek A, Małecka-Massalska T. Neutrophil-to-Lymphocyte Ratio as a Factor Predicting Radiotherapy Induced Oral Mucositis in Head Neck Cancer Patients Treated with Radiotherapy. J Clin Med 2021; 10:4444. [PMID: 34640462 PMCID: PMC8509431 DOI: 10.3390/jcm10194444] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The objective of this research conducted in head and neck cancer (HNC) patients was the assessment of the relationship between neutrophil-to-lymphocyte ratio (NLR) and the incidence of severe radiotherapy (RT) induced oral mucositis (OM), as well as overall survival (OS). METHODS The study involved 207 patients in advanced stages (III-IV) of HNC. RTOG/EORTC scale was used to assess OM. The pre-treatment NLR was specified as the absolute neutrophil count divided by the absolute lymphocyte count. RESULTS Starting from second to seventh week of RT, we observed a significant, positive correlation between NLR values and OM grade. From the second to seventh week of RT, higher NLR values were related with significant increases (from 2- to over 24-fold) in the risk of occurrence of more severe OM (multivariate analysis confirmed its independent influence). Moreover, multivariate analysis for survival revealed that both higher TNM stage (HR = 1.84; p = 0.0043) and higher NLR values (HR = 1.48; p = 0.0395) were independent prognostic factors. CONCLUSION NLR is a simple and accurate parameter that is useful in the evaluation of the risk of more severe OM, as well as an independent prognostic factor of OS in patients subjected to RT due to HNC.
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Affiliation(s)
- Iwona Homa-Mlak
- Department of Human Physiology, Medical University of Lublin, Radziwiłłowska 11, 20-080 Lublin, Poland; (R.M.); (T.M.-M.)
| | - Anna Brzozowska
- Department of Oncology, Medical University of Lublin, Jaczewskiego 7, 20-090 Lublin, Poland;
| | - Radosław Mlak
- Department of Human Physiology, Medical University of Lublin, Radziwiłłowska 11, 20-080 Lublin, Poland; (R.M.); (T.M.-M.)
| | - Aneta Szudy-Szczyrek
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-081 Lublin, Poland;
| | - Teresa Małecka-Massalska
- Department of Human Physiology, Medical University of Lublin, Radziwiłłowska 11, 20-080 Lublin, Poland; (R.M.); (T.M.-M.)
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A Perspective on the Role of Microbiome for Colorectal Cancer Treatment. Cancers (Basel) 2021; 13:cancers13184623. [PMID: 34572850 PMCID: PMC8468110 DOI: 10.3390/cancers13184623] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Colorectal cancer is the third most diagnosed cancer worldwide and contributes significantly to global mortality and morbidity. The gut microbiome, composed of the trillions of microbes endemic to the human gastrointestinal tract, has been shown to be implicated in colorectal cancer oncogenesis; however, the roles of microbiota and dysbiosis in CRC treatment remain poorly understood. This review sought to characterize this relationship and in doing so, identify how these interactions may inform future treatments in the form of synbiotics designed to alter the host microbiota to achieve optimized treatment outcomes. Abstract In healthy hosts, trillions of microbes colonise the gut and oral cavity in a well-balanced state, maintaining a mutually beneficial relationship. Loss of this balance, termed dysbiosis, is strongly implicated in the pathogenesis of colorectal cancer (CRC). However, the roles of microbiota and dysbiosis in CRC treatment remain poorly understood. Recent studies suggest that the gut microbiota has the ability to affect the host response to chemotherapeutic agents by enhancing drug efficacy, promoting chemoresistance and mediating chemotherapy-induced toxicity and side effects via a variety of mechanisms. Several other studies have also proposed manipulation of the microbiota to optimise CRC treatment. In this review, we summarise the current advancement of knowledge on how microbiota and CRC treatments interact with each other and how this interaction may shed some light on the development of personalised microbiota manipulations that improve CRC treatment outcomes.
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Miknevicius P, Zulpaite R, Leber B, Strupas K, Stiegler P, Schemmer P. The Impact of Probiotics on Intestinal Mucositis during Chemotherapy for Colorectal Cancer: A Comprehensive Review of Animal Studies. Int J Mol Sci 2021; 22:ijms22179347. [PMID: 34502251 PMCID: PMC8430988 DOI: 10.3390/ijms22179347] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/26/2021] [Accepted: 08/21/2021] [Indexed: 02/07/2023] Open
Abstract
Colorectal cancer (CRC) is the second most commonly diagnosed cancer in females (incidence 16.4/10,000) and the third in males (incidence 23.4/10,000) worldwide. Surgery, chemotherapy (CTx), radiation therapy (RTx), or a combined treatment of those are the current treatment modalities for primary CRC. Chemotherapeutic drug-induced gastrointestinal (GIT) toxicity mainly presents as mucositis and diarrhea. Preclinical studies revealed that probiotic supplementation helps prevent CTx-induced side effects by reducing oxidative stress and proinflammatory cytokine production and promoting crypt cell proliferation. Moreover, probiotics showed significant results in preventing the loss of body weight (BW) and reducing diarrhea. However, further clinical studies are needed to elucidate the exact doses and most promising combination of strains to reduce or prevent chemotherapy-induced side effects. The aim of this review is to overview currently available literature on the impact of probiotics on CTx-induced side effects in animal studies concerning CRC treatment and discuss the potential mechanisms based on experimental studies’ outcomes.
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Affiliation(s)
- Povilas Miknevicius
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerpl. 2, 8036 Graz, Austria; (P.M.); (R.Z.); (B.L.); (P.S.)
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania;
| | - Ruta Zulpaite
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerpl. 2, 8036 Graz, Austria; (P.M.); (R.Z.); (B.L.); (P.S.)
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania;
| | - Bettina Leber
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerpl. 2, 8036 Graz, Austria; (P.M.); (R.Z.); (B.L.); (P.S.)
| | - Kestutis Strupas
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania;
| | - Philipp Stiegler
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerpl. 2, 8036 Graz, Austria; (P.M.); (R.Z.); (B.L.); (P.S.)
- Correspondence: ; Tel.: +43-316-385-84094
| | - Peter Schemmer
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerpl. 2, 8036 Graz, Austria; (P.M.); (R.Z.); (B.L.); (P.S.)
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Shen SR, Chen WJ, Chu HF, Wu SH, Wang YR, Shen TL. Amelioration of 5-fluorouracil-induced intestinal mucositis by Streptococcus thermophilus ST4 in a mouse model. PLoS One 2021; 16:e0253540. [PMID: 34310611 PMCID: PMC8312939 DOI: 10.1371/journal.pone.0253540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 06/07/2021] [Indexed: 01/11/2023] Open
Abstract
Intestinal mucositis is a commonly encountered toxic side effect in patients undergoing 5-fluorouracil (5-FU)-based chemotherapy. Numerous studies have shown that probiotics enable improving chemotherapy-induced intestinal mucositis, but the beneficial effects of probiotics differ depending on the strain. Therefore, in the present studies we suggest that S. thermophilus ST4 separated from raw milk may assess mucoprotective activity in 5-FU-induced intestinal mucositis. In our causal-comparative study design, fifteen mice were randomized assigned into three groups (n = 5/each group): control group, 5-FU group and 5-FU+S. thermophilus ST4 group. The control group was orally administrated saline only, and the 5-FU group was followed by intraperitoneal injection of 5-FU for 3 days after 10-day saline administration, and the 5-FU+S. thermophilus ST4 group was intragastrically subjected for S. thermophilus ST4 once per day during the whole experiment, starting from the first day of the experiment, followed by 5-FU intraperitoneal injection for 3 days after 10-day S. thermophilus ST4 pretreatment. Diarrhea score, pro-inflammatory cytokines serum levels, intestinal histopathology and short chain fatty acid were assessed. Here, we demonstrated the beneficial effects of S. thermophilus ST4 derived from raw milk against 5-FU-induced intestinal mucositis, including body weight reduction, appetite loss and diarrhea. Intrinsically, S. thermophilus ST4 effectively maintained epithelium structure in small intestines and colons as well as reduced the intestinal inflammation. Besides, S. thermophilus ST4 significantly increased the expression of acetic acid, reinforcing the muco-protective effects. In conclusion, our results demonstrate that S. thermophilus ST4 supplementation ameliorates 5-FU-induced intestinal mucositis. This suggests probiotic may serve as an alternative therapeutic strategy for the prevention or management of 5-FU-induced mucositis in the future.
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Affiliation(s)
- Siou-Ru Shen
- Center for Biotechnology, National Taiwan University, Taipei, Taiwan
- Syngen Biotech Co., Ltd., Tainan, Taiwan
| | - Wei-Jen Chen
- Syngen Biotech Co., Ltd., Tainan, Taiwan
- Graduate Institute of Management, Minghsin University of Science and Technology, Hsinchu, Taiwan
| | | | | | - Yu-Ru Wang
- Center for Biotechnology, National Taiwan University, Taipei, Taiwan
- Department of Plant Pathology and Microbiology, National Taiwan University, Taipei, Taiwan
| | - Tang-Long Shen
- Center for Biotechnology, National Taiwan University, Taipei, Taiwan
- Department of Plant Pathology and Microbiology, National Taiwan University, Taipei, Taiwan
- * E-mail:
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Sauruk da Silva K, Carla da Silveira B, Bueno LR, Malaquias da Silva LC, da Silva Fonseca L, Fernandes ES, Maria-Ferreira D. Beneficial Effects of Polysaccharides on the Epithelial Barrier Function in Intestinal Mucositis. Front Physiol 2021; 12:714846. [PMID: 34366901 PMCID: PMC8339576 DOI: 10.3389/fphys.2021.714846] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/30/2021] [Indexed: 12/11/2022] Open
Abstract
Intestinal mucositis is a clinically relevant side effect of anticancer therapies. It is experienced by 60–100% of patients undergoing treatment with high doses of chemotherapy, radiation therapy, and bone marrow transplantation. Intestinal mucositis can manifest as pain, weight loss, inflammation, diarrhea, rectal bleeding, and infection; affecting normal nutritional intake and intestinal function. It often impacts adherence to anticancer therapy as it frequently limits patient’s ability to tolerate treatment, causing schedule delays, interruptions, or premature discontinuation. In some cases, local and systemic secondary infections are observed, increasing the costs toward medical care and hospitalization. Several strategies for managing mucositis are available which do not always halt this condition. In this context, new therapeutic strategies are under investigation to prevent or treat intestinal mucositis. Polysaccharides from natural resources have recently become promising molecules against intestinal damage due to their ability to promote mucosal healing and their anti-inflammatory actions. These effects are associated with the protection of intestinal mucosa and regulation of microbiota and immune system. This review aims to discuss the recent advances of polysaccharides from natural resources as potential therapies for intestinal mucositis. The source, species, doses, treatment schedules, and mechanisms of action of polysaccharides will be discussed in detail.
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Affiliation(s)
- Karien Sauruk da Silva
- Instituto de Pesquisa Pelé Pequeno Príncipe, Faculdades Pequeno Príncipe, Curitiba, Brazil.,Programa de Pós-graduação em Biotecnologia Aplicada à Saúde da Criança e do Adolescente, Faculdades Pequeno Príncipe, Curitiba, Brazil
| | - Bruna Carla da Silveira
- Instituto de Pesquisa Pelé Pequeno Príncipe, Faculdades Pequeno Príncipe, Curitiba, Brazil.,Programa de Pós-graduação em Biotecnologia Aplicada à Saúde da Criança e do Adolescente, Faculdades Pequeno Príncipe, Curitiba, Brazil
| | - Laryssa Regis Bueno
- Instituto de Pesquisa Pelé Pequeno Príncipe, Faculdades Pequeno Príncipe, Curitiba, Brazil.,Programa de Pós-graduação em Biotecnologia Aplicada à Saúde da Criança e do Adolescente, Faculdades Pequeno Príncipe, Curitiba, Brazil
| | - Liziane Cristine Malaquias da Silva
- Instituto de Pesquisa Pelé Pequeno Príncipe, Faculdades Pequeno Príncipe, Curitiba, Brazil.,Programa de Pós-graduação em Biotecnologia Aplicada à Saúde da Criança e do Adolescente, Faculdades Pequeno Príncipe, Curitiba, Brazil
| | - Lauany da Silva Fonseca
- Instituto de Pesquisa Pelé Pequeno Príncipe, Faculdades Pequeno Príncipe, Curitiba, Brazil.,Programa de Pós-graduação em Biotecnologia Aplicada à Saúde da Criança e do Adolescente, Faculdades Pequeno Príncipe, Curitiba, Brazil
| | - Elizabeth Soares Fernandes
- Instituto de Pesquisa Pelé Pequeno Príncipe, Faculdades Pequeno Príncipe, Curitiba, Brazil.,Programa de Pós-graduação em Biotecnologia Aplicada à Saúde da Criança e do Adolescente, Faculdades Pequeno Príncipe, Curitiba, Brazil
| | - Daniele Maria-Ferreira
- Instituto de Pesquisa Pelé Pequeno Príncipe, Faculdades Pequeno Príncipe, Curitiba, Brazil.,Programa de Pós-graduação em Biotecnologia Aplicada à Saúde da Criança e do Adolescente, Faculdades Pequeno Príncipe, Curitiba, Brazil
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Bezerra PMM, Sampaio MEA, Dos Santos FG, Ribeiro ILA, Santiago BM, de Sousa SA, Valença AMG. The effectiveness of an oral health education and prevention program on the incidence and severity of oral mucositis in pediatric cancer patients: a non-randomized controlled study. Support Care Cancer 2021; 29:7877-7885. [PMID: 34189606 DOI: 10.1007/s00520-021-06387-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 06/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate the effectiveness of an Oral Health Education and Prevention Program (OHEPP) on the incidence and severity of oral mucositis (OM) in pediatric cancer patients. The OHEEP was a ludic strategy for promoting oral health and monitoring the oral health condition. METHODS We compared the incidence and severity of OM in patients who attended the OHEPP against those under similar conditions who did not receive educational interventions. Both groups were examined for 6 weeks by calibrated examiners (k > 0.8) using the modified Oral Assessment Guide (OAG). A total of 14 patients aged 2 to 18 years were included in each group and matched for sex, age, tumor type, and treatment modality. The incidence and severity of OM were compared using the chi-squared test (α = 5%), and the relative risk and effectiveness of the OHEPP were calculated with a statistical power of 0.97. Differences in total OAG scores between the groups were determined by the Mann-Whitney test (α = 5%). RESULTS There was a higher incidence of OM in patients who did not attend the OHEPP (P = 0.005), and the relative risk of developing OM was significantly lower in OHEPP attendants (RR: 0.73; CI 0.60-0.92). No difference in the occurrence of severe OM was observed. OHEPP reduced the risk of developing OM by 1.4-fold, with an effectiveness of 27%. There was a difference in total OAG scores (P = 0.041). CONCLUSION Participation in OHEPP was an effective measure to reduce the incidence of OM in pediatric cancer patients.
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Affiliation(s)
- Paula Maria Maracajá Bezerra
- Postgraduate Program in Dentistry, Federal University of Paraíba, Campus - I Cidade Universitária, João Pessoa, PB, 58051-900, Brazil.
| | - Maria Eduarda Alves Sampaio
- Postgraduate Program in Dentistry, Federal University of Paraíba, Campus - I Cidade Universitária, João Pessoa, PB, 58051-900, Brazil
| | - Fabio Gomes Dos Santos
- Postgraduate Program in Dentistry, Federal University of Paraíba, Campus - I Cidade Universitária, João Pessoa, PB, 58051-900, Brazil
| | - Isabella Lima Arrais Ribeiro
- Postgraduate Program in Dentistry, Federal University of Paraíba, Campus - I Cidade Universitária, João Pessoa, PB, 58051-900, Brazil
| | - Bianca Marques Santiago
- Postgraduate Program in Dentistry, Federal University of Paraíba, Campus - I Cidade Universitária, João Pessoa, PB, 58051-900, Brazil
| | - Simone Alves de Sousa
- Postgraduate Program in Dentistry, Federal University of Paraíba, Campus - I Cidade Universitária, João Pessoa, PB, 58051-900, Brazil
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Wysocka-Słowik A, Gil L, Ślebioda Z, Kręgielczak A, Dorocka-Bobkowska B. Oral mucositis in patients with acute myeloid leukemia treated with allogeneic hematopoietic stem cell transplantation in relation to the conditioning used prior to transplantation. Ann Hematol 2021; 100:2079-2086. [PMID: 34117519 PMCID: PMC8285359 DOI: 10.1007/s00277-021-04568-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/04/2021] [Indexed: 11/02/2022]
Abstract
This study was designed to investigate the frequency and severity of oral mucositis in patients with acute myeloid leukemia after allogeneic hematopoietic cell transplantation, in relation to the type of conditioning used. Eighty patients diagnosed with acute myeloid leukemia were assigned to two groups based on the conditioning regimen used before transplantation. The intensity of oral inflammatory lesions induced by chemotherapy (oral mucositis) was evaluated according to a 5-point scale recommended by World Health Organization. Oral mucosa was investigated in all patients before the transplantation and during two subsequent stages of the post-transplantation procedure in relation to the conditioning regimen used. Mucositis in the oral cavity was observed in the majority of patients (66%) in the first week after transplantation, whereas the largest percentage of patients suffering oral lesions (74%) occurred in the second week after transplantation. A significantly higher percentage of patients with mucositis was observed in the group which underwent myeloablation therapy (74% of MAC and 50% of RIC patients in the first week; 83% of MAC and 53% of RIC patients in the second examination).The severity of mucositis after transplantation was higher in the MAC patients compared to the RIC patients. The highest mean value of the mucositis index was recorded in the second week in the MAC group (1.59). In AML sufferers receiving allo-HSCT, oral mucositis is a significant complication of the transplantation. This condition is more frequent and more severe in patients after treatment with myeloablation therapy.
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Affiliation(s)
- Aleksandra Wysocka-Słowik
- Department of Gerodontology and Oral Pathology, Poznan University of Medical Sciences, Bukowska 70, 60-812, Poznań, Poland
| | - Lidia Gil
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Szamarzewskiego 84, 60-569, Poznań, Poland
| | - Zuzanna Ślebioda
- Department of Gerodontology and Oral Pathology, Poznan University of Medical Sciences, Bukowska 70, 60-812, Poznań, Poland.
| | - Agnieszka Kręgielczak
- Department of Gerodontology and Oral Pathology, Poznan University of Medical Sciences, Bukowska 70, 60-812, Poznań, Poland
| | - Barbara Dorocka-Bobkowska
- Department of Gerodontology and Oral Pathology, Poznan University of Medical Sciences, Bukowska 70, 60-812, Poznań, Poland
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Segers C, Mysara M, Claesen J, Baatout S, Leys N, Lebeer S, Verslegers M, Mastroleo F. Intestinal mucositis precedes dysbiosis in a mouse model for pelvic irradiation. ISME COMMUNICATIONS 2021; 1:24. [PMID: 36737646 PMCID: PMC9723693 DOI: 10.1038/s43705-021-00024-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/12/2021] [Accepted: 05/25/2021] [Indexed: 02/07/2023]
Abstract
Pelvic radiotherapy is known to evoke intestinal mucositis and dysbiosis. Currently, there are no effective therapies available to mitigate these injuries, which is partly due to a lack of insight into the events causing mucositis and dysbiosis. Here, the complex interplay between the murine host and its microbiome following pelvic irradiation was mapped by characterizing intestinal mucositis along with extensive 16S microbial profiling. We demonstrated important morphological and inflammatory implications within one day after exposure, thereby impairing intestinal functionality and inducing translocation of intraluminal bacteria into mesenteric lymph nodes as innovatively quantified by flow cytometry. Concurrent 16S microbial profiling revealed a delayed impact of pelvic irradiation on beta diversity. Analysis of composition of microbiomes identified biomarkers for pelvic irradiation. Among them, members of the families Ruminococcaceae, Lachnospiraceae and Porphyromonadaceae were differentially affected. Altogether, our unprecedented findings showed how pelvic irradiation evoked structural and functional changes in the intestine, which secondarily resulted in a microbiome shift. Therefore, the presented in vivo irradiation-gut-microbiome platform allows further research into the pathobiology of pelvic irradiation-induced intestinal mucositis and resultant dysbiosis, as well as the exploration of mitigating treatments including drugs and food supplements.
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Affiliation(s)
- Charlotte Segers
- Interdisciplinary Biosciences group, Belgian Nuclear Research Centre SCK CEN, Mol, Belgium
- Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Mohamed Mysara
- Interdisciplinary Biosciences group, Belgian Nuclear Research Centre SCK CEN, Mol, Belgium
| | - Jürgen Claesen
- Interdisciplinary Biosciences group, Belgian Nuclear Research Centre SCK CEN, Mol, Belgium
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - Sarah Baatout
- Interdisciplinary Biosciences group, Belgian Nuclear Research Centre SCK CEN, Mol, Belgium
- Department of Biotechnology, University of Ghent, Ghent, Belgium
| | - Natalie Leys
- Interdisciplinary Biosciences group, Belgian Nuclear Research Centre SCK CEN, Mol, Belgium
| | - Sarah Lebeer
- Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Mieke Verslegers
- Interdisciplinary Biosciences group, Belgian Nuclear Research Centre SCK CEN, Mol, Belgium
| | - Felice Mastroleo
- Interdisciplinary Biosciences group, Belgian Nuclear Research Centre SCK CEN, Mol, Belgium.
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Wang Y, Li J, Zhang H, Zheng X, Wang J, Jia X, Peng X, Xie Q, Zou J, Zheng L, Li J, Zhou X, Xu X. Probiotic Streptococcus salivarius K12 Alleviates Radiation-Induced Oral Mucositis in Mice. Front Immunol 2021; 12:684824. [PMID: 34149727 PMCID: PMC8213397 DOI: 10.3389/fimmu.2021.684824] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/17/2021] [Indexed: 02/05/2023] Open
Abstract
Background Oral mucositis is the most common oral complication of cancer patients receiving radiotherapy and/or chemotherapy, leading to poor quality of life. Limitations of the current interventions on radiation-induced oral mucositis (RIOM) urge the development of novel therapeutics. Here, we evaluated the treatment outcome of probiotic Streptococcus salivarius K12 on RIOM mice, and oral microbiota that is associated with the progress of RIOM was further investigated. Methods An experimental RIOM mouse model was established, and S. salivarius K12 was applied to the mouse oral cavity daily. Histological analyses were performed to evaluate the severity of oral mucositis and the treatment outcome of S. salivarius K12. The oral microbiota of mice was further analyzed by 16S rRNA sequencing, microbial culture and qPCR. Results Irradiation induced conspicuous mucositis in the oral cavity of mice. S. salivarius K12 treatment was beneficial for the healing of RIOM, as reflected by reduced ulcer size, increased basal layer epithelial cellularity and mucosal thickness, and elevated epithelial proliferation and attenuated apoptosis. RIOM mice presented significant oral microbial dysbiosis, with an overgrowth of oral anaerobes. S. salivarius K12 treatment reconstituted the oral microbiota and decreased the abundance of oral anaerobes of RIOM mice. In addition, S. salivarius K12 treatment inhibited NI1060 in Pasteurella genus and downregulated the expression of nitrate reductase. Conclusions S. salivarius K12 treatment can alleviate RIOM and reconstituted the dysbiotic oral microbiota in mice. S. salivarius K12 may represent a promising adjuvant treatment to improve the quality of life of cancer patients receiving radiotherapy.
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Affiliation(s)
- Yan Wang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jiatong Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Haonan Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xin Zheng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jiantao Wang
- State Key Laboratory of Biotherapy, Department of Lung Cancer Center and Department of Radiation Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyue Jia
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xian Peng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Qian Xie
- Department of Endodontics, College of Dentistry, University of Illinois at Chicago, Chicago, IL, United States
| | - Jing Zou
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Liwei Zheng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jiyao Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xin Xu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Clinical Research Center for Oral Diseases of Sichuan Province, Chengdu, China
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Andersen MCE, Johansen MW, Nissen T, Nexoe AB, Madsen GI, Sorensen GL, Holmskov U, Schlosser A, Moeller JB, Husby S, Rathe M. FIBCD1 ameliorates weight loss in chemotherapy-induced murine mucositis. Support Care Cancer 2021; 29:2415-2421. [PMID: 32918133 DOI: 10.1007/s00520-020-05762-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/08/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Chemotherapy-induced gastrointestinal toxicity is a common adverse event during chemotherapeutic treatment. No uniformly applicable strategies exist to predict, prevent, or treat gastrointestinal toxicity. Thus, a goal of mucositis research is to identify targets for therapeutic interventions and individualized risk prediction. Fibrinogen C domain containing 1 (FIBCD1) is a transmembrane protein expressed in human intestinal epithelial cells with functions in the innate immune system. Previous observations have shown that FIBCD1 ameliorates dextran sulfate sodium (DSS)-induced intestinal inflammation in vivo. We evaluated the effect of FIBCD1 in a murine model of chemotherapy-induced gastrointestinal toxicity and inflammation. METHODS Transgenic (Tg) mice overexpressing FIBCD1 in the intestinal epithelium (Fibcd1Tg) and wild-type (WT) littermates (C57BL/6N) were randomized to receive an intraperitoneal injection of doxorubicin 20 mg/kg or saline and were terminated 2 or 7 days after the injection. Gastrointestinal toxicity was evaluated by weight change, intestinal length, villus height/crypt depth, and histological mucositis score. Expression of inflammatory markers (IL-6, IL-1β, and Tnfα) was measured by quantitative real-time PCR in intestinal tissue samples. RESULTS Following doxorubicin treatment, WT mice exhibited an increased weight loss compared with Tg littermates (p < 0.001). No differences between genotypes were seen in mucositis score, intestinal length, villus height/crypt depth, or IL-6, IL-1β, and Tnfα expression. CONCLUSION Our findings suggest that FIBCD1 could ameliorate chemotherapy-induced gastrointestinal toxicity by reducing weight loss; however, the mechanism of this possible protective effect remains to be defined warranting additional investigations.
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Affiliation(s)
- Maria C E Andersen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense C, Denmark
- Department of Cancer and Inflammation Research, University of Southern Denmark, Odense, Denmark
| | - Malene W Johansen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense C, Denmark
- Department of Cancer and Inflammation Research, University of Southern Denmark, Odense, Denmark
| | - Thomas Nissen
- Department of Cancer and Inflammation Research, University of Southern Denmark, Odense, Denmark
| | - Anders B Nexoe
- Department of Cancer and Inflammation Research, University of Southern Denmark, Odense, Denmark
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
| | - Gunvor I Madsen
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Grith L Sorensen
- Department of Cancer and Inflammation Research, University of Southern Denmark, Odense, Denmark
| | - Uffe Holmskov
- Department of Cancer and Inflammation Research, University of Southern Denmark, Odense, Denmark
| | - Anders Schlosser
- Department of Cancer and Inflammation Research, University of Southern Denmark, Odense, Denmark
| | - Jesper B Moeller
- Department of Cancer and Inflammation Research, University of Southern Denmark, Odense, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mathias Rathe
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense C, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
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Sougiannis AT, VanderVeen BN, Davis JM, Fan D, Murphy EA. Understanding chemotherapy-induced intestinal mucositis and strategies to improve gut resilience. Am J Physiol Gastrointest Liver Physiol 2021; 320:G712-G719. [PMID: 33471628 PMCID: PMC8202195 DOI: 10.1152/ajpgi.00380.2020] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Intestinal mucositis remains one of the most debilitating side effects related to chemotherapy. The onset and persistence of mucositis is an intricate physiological process involving cross-communication between the specific chemotherapeutic drug, the immune system, and gut microbes that results in a loss of mucosal integrity leading to gut-barrier dysfunction. Intestinal mucositis has a severe impact on a patient's quality of life and negatively influences the outcome of treatment. Most importantly, intestinal mucositis is a major contributor to the decreased survival rates and early onset of death associated with certain chemotherapy treatments. Understanding the pathophysiology and symptomology of intestinal mucositis is important in reducing the negative consequences of this condition. Prophylaxis, early diagnosis, and proper symptom management are essential to improved survival outcomes in patients with cancer. This review focuses on the pathobiology of intestinal mucositis that accompanies chemotherapy treatments. In addition, we will discuss the therapeutic potential of select strategies that have shown promise in mitigating chemotherapies' off-target effects without hampering their anticancer efficacy.NEW & NOTEWORTHY Intestinal mucositis, or damage to the intestinal mucosa, is a common side effect of chemotherapy. In this review, we describe the pathobiology of intestinal mucositis that is associated with chemotherapy treatments. In addition, we discuss the efficacy of several potential therapeutic strategies that have shown some potential in alleviating chemotherapies' off-target effects.
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Affiliation(s)
- Alexander T. Sougiannis
- 1Department of Pathology, Microbiology and Immunology, School of Medicine, University of South Carolina, South Carolina,2College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Brandon N. VanderVeen
- 1Department of Pathology, Microbiology and Immunology, School of Medicine, University of South Carolina, South Carolina,3AcePre, LLC, Columbia, South Carolina
| | - J. Mark Davis
- 3AcePre, LLC, Columbia, South Carolina,4Department of Exercise Science, Arnold School of Public Health, University of South Carolina, South Carolina
| | - Daping Fan
- 3AcePre, LLC, Columbia, South Carolina,5Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, South Carolina
| | - E. Angela Murphy
- 1Department of Pathology, Microbiology and Immunology, School of Medicine, University of South Carolina, South Carolina,3AcePre, LLC, Columbia, South Carolina
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Ramos-Pinto MB, de Lima Gusmão TP, Schmidt-Filho J, Jaguar GC, Martins MD, Alves FA. Intraoral versus extraoral photobiomodulation therapy in the prevention of oral mucositis in HSCT patients: a randomized, single-blind, controlled clinical trial. Support Care Cancer 2021; 29:6495-6503. [PMID: 33905011 DOI: 10.1007/s00520-021-06228-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/15/2021] [Indexed: 11/30/2022]
Abstract
To compare the efficacy of intraoral and extraoral photobiomodulation (PBM) protocols for the prevention of oral mucositis (OM) in hematopoietic stem cell transplantation (HSCT) patients. A total of 60 patients was randomized into intraoral PBM (IOPBM) and extraoral PBM (EOPBM) groups. Both PBM protocols were well tolerated and no side effects were observed. EOPBM session times were one fourth of IOPBM durations. Of 60 patients, 35 (58.3%) developed ulcerated OM between day +3 and day +12. No intergroup difference was observed in OM healing times (p = 0.424). The lateral border of the tongue was the most common site affected in both groups. However, the incidence of mucositis on buccal mucosa was significantly reduced in the EOPBM group (p = 0.021). Young patients (OR.5.35, 95%CI 0.94-30.4, p = 0.058) and those who had received myeloablative conditioning (OR.55.1, 95%CI 2.69-1129.3, p = 0.009) were more likely to develop ulcerated OM, whereas autologous HSCT recipients (OR 0.079, 95% CI 0.009-0.67, p = 0.021) had a lower probability of developing ulcerated OM independent of PBM protocol. EOPBM protocol was as effective as IOPBM in the management of OM in HSCT patients, with the advantage of shorter treatment sessions. Trial registration number: RBR-7nww56. Date of trial registration submission: 30th September 2019.
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Affiliation(s)
| | | | | | | | - Manoela Domingues Martins
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Fábio Abreu Alves
- Stomatology Department, A.C. Camargo Cancer Center, Sao Paulo, Brazil. .,Stomatology Department, School of Dentistry, Sao Paulo University, Sao Paulo, Brazil. .,Departamento de Estomatologia, AC Camargo Cancer Center, R: Prof. Antônio Prudente, 211, Bairro: Liberdade, São Paulo, SP, CEP: 01509-900, Brazil.
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85
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Cadoná FC, Dantas RF, de Mello GH, Silva-Jr FP. Natural products targeting into cancer hallmarks: An update on caffeine, theobromine, and (+)-catechin. Crit Rev Food Sci Nutr 2021; 62:7222-7241. [PMID: 33890518 DOI: 10.1080/10408398.2021.1913091] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Natural products have been studied to reveal new therapies against human dysfunctions since they present several medicinal properties. Caffeine, theobromine and (+)-catechin are remarkable natural agents in the class of methylxanthines and flavonoids. These bioactive molecules have several biological activities, for instance, antioxidant, anti-inflammatory, and antitumor capacity. In this sense, studies focusing on these molecules have been performed to discover new treatments against diseases, such as cancer. Cancer is a serious public health problem worldwide responsible for more than 70% of all deaths globally. Industrialized products associated with a sedentary lifestyle and a diet low in antioxidants are related to neoplasms development. Unfortunately, many types of cancers are extremely aggressive and untreatable since, in many cases, they are resistant to chemotherapy. Therefore, revealing new strategies to block cancer growth is one of the biggest challenges to science. In this context, despite the known anticancer actions of caffeine, theobromine and (+)-catechin, it is still essential to elucidate the causal antitumor mechanism of these molecules by analyzing the dysfunctional cancer pathways associated with the hallmarks of cancer. Hence, this review aims to describe the anticancer activity of caffeine, theobromine, and (+)-catechin against the different hallmarks and enabling characteristics of cancer.
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Affiliation(s)
- Francine C Cadoná
- Post-graduate Program in Health and Life Sciences, Franciscan University, Santa Maria, RS, Brazil
| | - Rafael Ferreira Dantas
- Laboratory of Experimental and Computational Biochemistry of Drugs (LaBECFar), Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Gabriela Haas de Mello
- Post-graduate Program in Health and Life Sciences, Franciscan University, Santa Maria, RS, Brazil
| | - Floriano Paes Silva-Jr
- Laboratory of Experimental and Computational Biochemistry of Drugs (LaBECFar), Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Khan M, Sherwani S, Khan S, Alouffi S, Alam M, Al-Motair K, Khan S. Insights into Multifunctional Nanoparticle-Based Drug Delivery Systems for Glioblastoma Treatment. Molecules 2021; 26:molecules26082262. [PMID: 33919694 PMCID: PMC8069805 DOI: 10.3390/molecules26082262] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 12/21/2022] Open
Abstract
Glioblastoma (GB) is an aggressive cancer with high microvascular proliferation, resulting in accelerated invasion and diffused infiltration into the surrounding brain tissues with very low survival rates. Treatment options are often multimodal, such as surgical resection with concurrent radiotherapy and chemotherapy. The development of resistance of tumor cells to radiation in the areas of hypoxia decreases the efficiency of such treatments. Additionally, the difficulty of ensuring drugs effectively cross the natural blood-brain barrier (BBB) substantially reduces treatment efficiency. These conditions concomitantly limit the efficacy of standard chemotherapeutic agents available for GB. Indeed, there is an urgent need of a multifunctional drug vehicle system that has potential to transport anticancer drugs efficiently to the target and can successfully cross the BBB. In this review, we summarize some nanoparticle (NP)-based therapeutics attached to GB cells with antigens and membrane receptors for site-directed drug targeting. Such multicore drug delivery systems are potentially biodegradable, site-directed, nontoxic to normal cells and offer long-lasting therapeutic effects against brain cancer. These models could have better therapeutic potential for GB as well as efficient drug delivery reaching the tumor milieu. The goal of this article is to provide key considerations and a better understanding of the development of nanotherapeutics with good targetability and better tolerability in the fight against GB.
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Affiliation(s)
- Mohd Khan
- Department of Chemistry, College of Sciences, University of Ha’il, Ha’il 2440, Saudi Arabia
- Molecular Diagnostic and Personalised Therapeutics Unit, University of Ha’il, Ha’il 2440, Saudi Arabia; (S.A.); (K.A.-M.)
- Correspondence: or
| | - Subuhi Sherwani
- Department of Biology, College of Sciences, University of Ha’il, Ha’il 2440, Saudi Arabia; (S.S.); (M.A.)
| | - Saif Khan
- Department of Basic Dental and Medical Sciences, College of Dentistry, University of Ha’il, Ha’il 2440, Saudi Arabia;
| | - Sultan Alouffi
- Molecular Diagnostic and Personalised Therapeutics Unit, University of Ha’il, Ha’il 2440, Saudi Arabia; (S.A.); (K.A.-M.)
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, University of Ha’il, Ha’il 2440, Saudi Arabia
| | - Mohammad Alam
- Department of Biology, College of Sciences, University of Ha’il, Ha’il 2440, Saudi Arabia; (S.S.); (M.A.)
| | - Khalid Al-Motair
- Molecular Diagnostic and Personalised Therapeutics Unit, University of Ha’il, Ha’il 2440, Saudi Arabia; (S.A.); (K.A.-M.)
| | - Shahper Khan
- Interdisciplinary Nanotechnology Centre, Aligarh Muslim University, Aligarh 202002, U.P., India;
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87
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Aprile G, Basile D, Giaretta R, Schiavo G, La Verde N, Corradi E, Monge T, Agustoni F, Stragliotto S. The Clinical Value of Nutritional Care before and during Active Cancer Treatment. Nutrients 2021; 13:nu13041196. [PMID: 33916385 PMCID: PMC8065908 DOI: 10.3390/nu13041196] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 12/18/2022] Open
Abstract
Malnutrition and muscle wasting are frequently reported in cancer patients, either linked to the tumor itself or caused by oncologic therapies. Understanding the value of nutritional care during cancer treatment remains crucial. In fact, cancer-associated sarcopenia plays a key role in determining higher rates of morbidity, mortality, treatment-induced toxicities, prolonged hospitalizations and reduced adherence to anticancer treatment, worsening quality of life and survival. Planning baseline screening to intercept nutritional troubles earlier, organizing timely reassessments, and providing adequate counselling and dietary support, healthcare professional may positively interfere with this process and improve patients' overall outcomes during the whole disease course. Several screening tools have been proposed for this purpose. Nutritional Risk Screening (NRS), Mini Nutritional Assessment (MNA), Patient Generated Subjective Global Assessment (PG-SGA) are the most common studied. Interestingly, second-level tools including skeletal muscle index (SMI) and bioelectric impedance analysis (BIA) provide a more precise assessment of body composition, even if they are more complex. However, nutritional assessment is not currently used in clinical practice and procedures must be standardized in order to improve the efficacy of standard chemotherapy, targeted agents or even checkpoint inhibitors that is potentially linked with the patients' nutritional status. In the present review, we will discuss about malnutrition and the importance of an early nutritional assessment during chemotherapy and treatment with novel checkpoint inhibitors, in order to prevent treatment-induced toxicities and to improve survival outcomes.
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Affiliation(s)
- Giuseppe Aprile
- Department of Oncology, AULSS8 Berica, 36100 Vicenza, Italy; (D.B.); (R.G.)
- Correspondence: ; Tel.: +39-0444753906
| | - Debora Basile
- Department of Oncology, AULSS8 Berica, 36100 Vicenza, Italy; (D.B.); (R.G.)
| | - Renato Giaretta
- Department of Oncology, AULSS8 Berica, 36100 Vicenza, Italy; (D.B.); (R.G.)
| | - Gessica Schiavo
- Clinical Nutritional Unit, AULSS8 Berica, 36100 Vicenza, Italy;
| | - Nicla La Verde
- Department of Oncology, PO Sacco, ASST Fatebenefratelli Sacco, 20131 Milano, Italy;
| | - Ettore Corradi
- Clinical Nutritional Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy;
| | - Taira Monge
- Clinical Nutrition, S. Giovanni Battista Hospital, 10126 Torino, Italy;
| | - Francesco Agustoni
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Silvia Stragliotto
- Department of Oncology, Istituto Oncologico Veneto—IRCCS, 31033 Padova, Italy;
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López-Tofiño Y, Vera G, López-Gómez L, Girón R, Nurgali K, Uranga JA, Abalo R. Effects of the food additive monosodium glutamate on cisplatin-induced gastrointestinal dysmotility and peripheral neuropathy in the rat. Neurogastroenterol Motil 2021; 33:e14020. [PMID: 33112027 DOI: 10.1111/nmo.14020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 08/30/2020] [Accepted: 10/01/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cisplatin is an antineoplastic drug known to produce intense vomiting, gastric dysmotility, and peripheral neuropathy. Monosodium glutamate (MSG) is a flavor enhancer with prokinetic properties potentially useful for cancer patients under chemotherapy. Our aim was to test whether MSG may improve gastrointestinal motor dysfunction and other adverse effects induced by repeated cisplatin in rats. METHODS Male Wistar rats were exposed or not to MSG (4 g L-1 ) in drinking water from week 0 to 1 week after treatment. On the first day of weeks 1-5, rats were treated with saline or cisplatin (2 mg kg-1 week-1 , ip). Gastrointestinal motility was measured by radiological methods after first and fifth administrations, as well as 1 week after treatment finalization. One week after treatment, the threshold for mechanical somatic sensitivity was recorded. Finally, samples of stomach, terminal ileum and kidneys were evaluated in sections using conventional histology. The myenteric plexus was immunohistochemically evaluated on distal colon whole-mount preparations. KEY RESULTS Monosodium glutamate prevented the development of cisplatin-induced neuropathy and partially improved intestinal transit after the fifth cisplatin administration with little impact on gastric dysmotility. MSG did not improve the histological damage of gut wall, but prevented the changes induced by cisplatin in the colonic myenteric plexus. CONCLUSION AND INFERENCES Our results suggest that MSG can improve some dysfunctions caused by anticancer chemotherapy in the gut and other systems, associated, at least partially, with neuroprotectant effects. The potentially useful adjuvant role of this food additive to reduce chemotherapy-induced sequelae warrants further evaluation.
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Affiliation(s)
- Yolanda López-Tofiño
- Department of Basic Health Sciences, University Rey Juan Carlos (URJC), Alcorcón, Spain.,High Performance Research Group in Physiopathology and Pharmacology of the Digestive System (NeuGut), University Rey Juan Carlos (URJC), Alcorcón, Spain
| | - Gema Vera
- Department of Basic Health Sciences, University Rey Juan Carlos (URJC), Alcorcón, Spain.,High Performance Research Group in Physiopathology and Pharmacology of the Digestive System (NeuGut), University Rey Juan Carlos (URJC), Alcorcón, Spain.,Unidad Asociada aI+D+i al Instituto de Química Médica, IQM (CSIC), Madrid, Spain
| | - Laura López-Gómez
- Department of Basic Health Sciences, University Rey Juan Carlos (URJC), Alcorcón, Spain.,High Performance Research Group in Physiopathology and Pharmacology of the Digestive System (NeuGut), University Rey Juan Carlos (URJC), Alcorcón, Spain
| | - Rocío Girón
- Department of Basic Health Sciences, University Rey Juan Carlos (URJC), Alcorcón, Spain.,Unidad Asociada aI+D+i al Instituto de Química Médica, IQM (CSIC), Madrid, Spain.,High Performance Research Group in Experimental Pharmacology (PHARMAKOM), University Rey Juan Carlos (URJC), Alcorcón, Spain
| | - Kulmira Nurgali
- Institute for Health and Sport, Victoria University, Melbourne, Vic., Australia.,Australian Institute for Musculoskeletal Science (AIMSS), Melbourne, Vic., Australia.,Department of Medicine Western Health, The University of Melbourne, Vic., Australia
| | - Jose A Uranga
- Department of Basic Health Sciences, University Rey Juan Carlos (URJC), Alcorcón, Spain.,High Performance Research Group in Physiopathology and Pharmacology of the Digestive System (NeuGut), University Rey Juan Carlos (URJC), Alcorcón, Spain
| | - Raquel Abalo
- Department of Basic Health Sciences, University Rey Juan Carlos (URJC), Alcorcón, Spain.,High Performance Research Group in Physiopathology and Pharmacology of the Digestive System (NeuGut), University Rey Juan Carlos (URJC), Alcorcón, Spain.,Unidad Asociada aI+D+i al Instituto de Química Médica, IQM (CSIC), Madrid, Spain
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Koppelmann T, Pollak Y, Ben-Shahar Y, Gorelik G, Sukhotnik I. The Mechanisms of the Anti-Inflammatory and Anti-Apoptotic Effects of Omega-3 Polyunsaturated Fatty Acids during Methotrexate-Induced Intestinal Damage in Cell Line and in a Rat Model. Nutrients 2021; 13:nu13030888. [PMID: 33801889 PMCID: PMC8000946 DOI: 10.3390/nu13030888] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/22/2021] [Accepted: 03/01/2021] [Indexed: 12/16/2022] Open
Abstract
Background: The aim of this study was to examine the anti-inflammatory and anti-apoptotic patterns of omega-3 polyunsaturated fatty acids (n-3 PUFAs) during methotrexate (MTX) induced intestinal damage in cell culture and in a rat model. Methods: Non-treated and treated with MTX HT 29 and HCT116cells were exposed to increasing doses of n-3 PUFAs and cell viability was evaluated using PrestoBlue® assay. Male Sprague-Dawley rats were divided into 4 experimental groups: Control rats, CONTR+n-3 PUFA rats that were treated with oral n-3 PUFA, MTX rats were treated with MTX given IP, and MTX+n-3 PUFA rats were treated with oral n-3 PUFA before and following injection of MTX. Intestinal mucosal parameters and mucosal inflammation, enterocyte proliferation and apoptosis, TNF-α in mucosal tissue and plasma (ELISA), NF-κB, COX-2, TNF-α, Fas, FasL, Fadd, Bid, Bax and Bcl-2gene and protein levels were determined 72 h following MTX injection. Results: Exposure of HT 29 and HCT116cells to n-3 PUFA attenuated inhibiting effects of MTX on cell viability. MTX-n-3 PUFA rats demonstrated a lower intestinal injury score and enhanced intestinal repair. A significant decrease in enterocyte apoptosis in MTX+n-3 PUFA rats was accompanied by decreased TNF-α, FAS, FasL, FADD and BID mRNA levels. Decreased NF-κB, COX-2 and TNF-α levels in mucosa was accompanied by a decreased number of IELs and macrophages. Conclusions: n-3 PUFAs inhibit NF-κB/COX-2 induced production of pro-inflammatory cytokines and inhibit cell apoptosis mainly by extrinsic pathway in rats with MTX-induced intestinal damage.
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Affiliation(s)
- Tal Koppelmann
- Laboratory of Intestinal Adaptation and Recovery, Department of Paediatric Surgery, Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann st, Tel Aviv 6423906, Israel; (T.K.); (Y.P.); (Y.B.-S.)
| | - Yulia Pollak
- Laboratory of Intestinal Adaptation and Recovery, Department of Paediatric Surgery, Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann st, Tel Aviv 6423906, Israel; (T.K.); (Y.P.); (Y.B.-S.)
| | - Yoav Ben-Shahar
- Laboratory of Intestinal Adaptation and Recovery, Department of Paediatric Surgery, Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann st, Tel Aviv 6423906, Israel; (T.K.); (Y.P.); (Y.B.-S.)
| | - Gregory Gorelik
- Dept Pathology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel;
| | - Igor Sukhotnik
- Laboratory of Intestinal Adaptation and Recovery, Department of Paediatric Surgery, Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann st, Tel Aviv 6423906, Israel; (T.K.); (Y.P.); (Y.B.-S.)
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 69978, Israel
- Correspondence: or
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90
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Immune Modulation Effects of Lactobacillus casei Variety rhamnosus on Enterocytes and Intestinal Stem Cells in a 5-FU-Induced Mucositis Mouse Model. Gastroenterol Res Pract 2021; 2021:3068393. [PMID: 33564301 PMCID: PMC7850847 DOI: 10.1155/2021/3068393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 11/10/2020] [Accepted: 01/04/2021] [Indexed: 12/20/2022] Open
Abstract
Background Intestinal mucositis remains one of the most deleterious side effects in cancer patients undergoing chemotherapy. We hypothesize that the probiotics could preserve gut ecology, ameliorate inflammation, and protect epithelia via immune modulations of enterocytes and intestinal stem cells. Our aim is to characterize these changes and the safety of probiotics via a 5-fluorouracil- (5-FU-) induced intestinal mucositis mouse model. Methods 5-FU-injected BALB/c mice were either orally administrated with saline or probiotic suspension of Lactobacillus casei variety rhamnosus (Lcr35). Diarrhea scores, serum proinflammatory cytokines, and T-cell subtypes were assessed. Immunostaining analyses for the proliferation of intestinal stem cells CD44 and Ki67 were processed. Samples of blood and internal organs were investigated for bacterial translocation. Results Diarrhea was attenuated after oral Lcr35 administration. Serum proinflammatory cytokines were significantly increased in the 5-FU group and were reversed by Lcr35. A tremendous rise of the CD3+/CD8+ count and a significant decrease of CD3+CD4+/CD3+CD8+ ratios were found in the 5-FU group and were both reversed by Lcr35. 5-FU significantly stimulated the expression of CD44 stem cells, and the expression was restored by Lcr35. 5-FU could increase the number of Ki67 proliferative cells. No bacterial translocation was found in this study. Conclusions Our results showed that 5-FU caused intestinal inflammation mainly via Th1 and Th17 responses. 5-FU could stimulate stem cells and proliferation cells in a mouse model. We demonstrate chemotherapy could decrease immune competence. Probiotics were shown to modulate the immune response. This is the first study to analyze the immune modulation effects and safety of Lactobacillus strain on enterocytes and intestinal stem cells in a mouse model.
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91
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Effectiveness of phytotherapeutics in the prevention and treatment of 5-fluorouracil-induced oral mucositis in animal models: A systematic review. Arch Oral Biol 2021; 123:104998. [PMID: 33485111 DOI: 10.1016/j.archoralbio.2020.104998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This systematic review evaluated the effect of phytotherapeutics in the treatment and prevention of 5-fluorouracil (5-FU)-induced oral mucositis (OM) in animal models. DESIGN A search was performed in PubMed/Medline, CENTRAL (The Cochrane Library), EMBASE, and Web of Science, including studies published up to January 2020. Only articles investigating the chemoinduction of OM by 5-FU in animal models were included. Eligibility was evaluated and data were extracted from the eligible studies following the predefined PICO questions. The Cochrane Collaboration Risk of Bias Assessment tool was used to evaluate the quality of the included studies. RESULT A total of 503 articles were retrieved and 13 were included. The hamster was the animal model used in all included studies. The treatment method ranged from the topical application of ointment (n = 3), gel (n = 5) and extract (n = 3) to the oral ingestion of the phytotherapeutics (n = 3). Chamomilla recutita L. (n = 3) and Pistacia atlantica (n = 3) were the most used therapeutic agents. Although all studies were classified as high risk of bias, all of them reported promising results regarding the use of phytotherapeutics in the management of OM, including lower clinical and histopathological scores as well as healing, anti-inflammatory, antimicrobial, and antioxidant activities. CONCLUSION Despite the high risk of bias of the studies, phytotherapy is a promising alternative for the treatment of 5-FU-induced OM, showing interesting results in terms of tissue healing and anti-inflammatory, antimicrobial and antioxidant activity.
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Alhussain A, Alkhayal Z, Ayas M, Abed H. Prevalence and risk factors of oral mucositis in paediatric patients undergoing haematopoietic stem cell transplantation. Oral Dis 2021; 28:657-669. [PMID: 33453145 PMCID: PMC9291549 DOI: 10.1111/odi.13777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/19/2020] [Accepted: 01/03/2021] [Indexed: 11/26/2022]
Abstract
Background A complete understanding of oral mucositis (OM) is crucial to develop appropriate interventions to aid in the successful overall health outcome of paediatric patients undergoing haematopoietic stem cell transplantation (HSCT). Aims This study aimed at determining the prevalence and severity of OM and at identifying the predictive factors that might aggravate OM at one‐week, two‐week and three‐week post‐HSCT. Methods This retrospective, hospital‐based study reviewed the medical records of 170 paediatric patients, summarising the patients’ characteristics using descriptive statistics. Binary logistic regression was used to identify factors associated with the development of OM. Results At one‐week post‐HSCT, 41% of 140 patients (n = 49) had developed OM, this was reduced at two‐week (n = 36, 33%) and three‐week (n = 13, 19%) post‐HSCT. Univariate logistic regression revealed that patients with cancer (OR = 0.16, 95% CI = 0.05–0.54; p‐value = .003) had a significantly lower prevalence of OM. Younger patients with an average age of 7.9 years old (OR = 0.85, 95% CI = 0.75–0.97; p‐value = 0.013) and the presence of GvHD (OR = 2.37, 95% CI = 1.03–5.45, p‐value = 0.042) were significantly related to a higher prevalence of OM. Multivariable logistic regression confirmed that the risk of OM is lower in patients with cancer compared to those with immunodeficiency syndromes or hereditary blood diseases (OR = 0.18, 95% CI = 0.04–0.77; p‐value = .021). Conclusions This study identified a significantly lower prevalence of OM in patients with cancer compared to other conditions and that young recipients and those who developed GvHD were more likely to have OM.
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Affiliation(s)
- Abdulmalik Alhussain
- North of Riyadh Dental Centre, Central Second Health Cluster, Riyadh, Saudi Arabia
| | - Zikra Alkhayal
- Department of Dentistry, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mouhab Ayas
- Department of Paediatric Haematology/Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Hassan Abed
- Department of Basic and Clinical Oral Sciences, Faculty of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia
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Barbosa-Lima R, Kameo SY, Amorim BF, Ramos MJO, Costa JDS, Marinho PML, Sawada NO, Moura Silva G. Occurrence of oral mucositis in women during oncological treatment of breast cancer in the Brazilian Northeast. REVISTA CIÊNCIAS EM SAÚDE 2020. [DOI: 10.21876/rcshci.v10i4.1040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objective: To describe the occurrence of oral mucositis (OM) in women undergoing cancer treatment for breast cancer (BC). Methods: This is a retrospective, quantitative, and analytical study in medical records of women diagnosed with BC in an oncology service. Clinical data were collected regarding the occurrence and severity of OM according to the World Health Organization criteria and the cancer treatment experienced by the participants. Results: 196 women were included. Of these, 97 (49.5%) developed OM, 43.4% of which were grade 1 or 2 (low or moderate). The occurrence was higher in white women (OR 1.93; 95% CI 1.04 - 3.57; p = 0.035), with metastatic breast cancer (OR 5.46; 95% CI 1.79 - 16.64; p = 0.002) and who experienced taxane agents at some point during chemotherapy (OR 2.26; 95% CI 1.12 - 4.56; p = 0.02). The mean severity of OM in the entire sample was 0.8 ± 1.0, and in the affected women was 1.7 ± 0.7. The difference in the severity of OM by the variables was observed only among women with grade 2 and grade 3 fatigue (p = 0.03). Conclusions: OM is a common mucocutaneous toxicity in women with BC. Despite the low severity observed, care for women with BC undergoing cancer treatment must consider the possible risks and complications associated with OM, adopting strategies to prevent, monitor, and treat them.
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Abstract
AbstractMucositis is an inflammation of the gastrointestinal mucosa resulting from high doses of radio/chemotherapy treatment and may lead to interruption of antineoplasic therapy. Soluble fibres, like pectin, increase SCFA production, which play a role in gut homoeostasis and inflammation suppression. Due to the properties of pectin, the aim of the present study was to evaluate the effect of a high-fibre (HF) diet on chemotherapy-induced mucositis in a murine model. C57/BL6 mice received control (AIN93M), HF, low/zero fibre (LF) diets for 10 d prior to mucositis challenging with irinotecan (75 mg/kg), or they were treated with acetate added to drinking water 5 d prior to and during the mucositis induction. Mice that received the HF diet showed decreased immune cells influx and improved histopathological parameters in the intestine, compared with mice that received the normal diet. Furthermore, the HF diet decreased intestinal permeability induced in the mucositis model when compared with the control group. This effect was not observed for acetate alone, which did not improve gut permeability. For instance, mice that received the LF diet had worsened gut permeability, compared with mice that received the normal diet and mucositis. The effects of the HF and LF diets were shown to modulate the intestinal microbiota, in which the LF diet increased the levels of Enterobacteriaceae, a group associated with gut inflammation, whereas the HF diet decreased this group and increased Lactobacillus and Bifidobacterium (SCFA producers) levels. In conclusion, the results demonstrated the importance of dietary fibre intake in the modulation of gut microbiota composition and homoeostasis maintenance during mucositis in this model.
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96
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Kabiru CM, Karimi PN, Nyamu DG, Weru IW. Drug therapy problems and health related quality of life among patients with colorectal cancer in a Kenyan tertiary health facility. J Oncol Pharm Pract 2020; 27:428-434. [PMID: 33236676 DOI: 10.1177/1078155220971024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Colorectal cancer is the third most common form of cancer in males and the second in females globally. The ill-health due to cancer and use of multiple therapies may result in drug related problems and also affect the health-related quality of life of the patients. OBJECTIVE To characterize drug therapy problems and health-related quality of life among patients with colorectal cancer at Kenyatta National Hospital.Methodology: A descriptive prospective cross-sectional study design was used and simple random sampling utilized to select seventy- one participants. The participants were interviewed and their responses captured using World Health Organisation Quality of Life-BREF and a structured questionnaire. The data were analysed using STATA version 15.0. Data was summarized using descriptive statistic such as mean, range and standard deviation. Association between variables was determined using linear regression model at 0.05% level of significance. Ethical approval was granted by the relevant authorities to conduct the study. RESULTS Patients were predominantly females (52.1%), had a mean age of 55.9± 14.4 years. The main drug therapy problems were adverse drug reactions (45.1%). Approximately two thirds (67.6%) of the participants complained of gastrointestinal problems followed by cardiovascular diseases (29.6%). Quality of life assessment indicated that psychological health had the highest score at 60.5%. On linear regression analysis, the presence of anemia (p = 0.021), coverage (p = 0.038), and cardiovascular problems (p = 0.034) were significantly associated with the overall health-related quality of life. CONCLUSION The health-related quality of life was is dependent on several patient related factors. Interventions regarding prevention of drug therapy problems should be considered alongside other measures used to manage colorectal cancer.
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Affiliation(s)
| | - Peter N Karimi
- Department of Pharmaceutics and Pharmacy Practice, The University of Nairobi, Nairobi, Kenya
| | - David G Nyamu
- Department of Pharmaceutics and Pharmacy Practice, The University of Nairobi, Nairobi, Kenya
| | - Irene W Weru
- Pharmacy division, Kenyatta National hospital Nairobi, Kenya
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Pulito C, Cristaudo A, Porta CL, Zapperi S, Blandino G, Morrone A, Strano S. Oral mucositis: the hidden side of cancer therapy. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2020; 39:210. [PMID: 33028357 PMCID: PMC7542970 DOI: 10.1186/s13046-020-01715-7] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/21/2020] [Indexed: 02/07/2023]
Abstract
Inflammation response of epithelial mucosa to chemo- radiotherapy cytotoxic effects leads to mucositis, a painful side effect of antineoplastic treatments. About 40% of the patients treated with chemotherapy develop mucositis; this percentage rises to about 90% for head and neck cancer patients (HNC) treated with both chemo- and radiotherapy. 19% of the latter will be hospitalized and will experience a delay in antineoplastic treatment for high-grade mucositis management, resulting in a reduction of the quality of life, a worse prognosis and an increase in patient management costs. Currently, several interventions and prevention guidelines are available, but their effectiveness is uncertain. This review comprehensively describes mucositis, debating the impact of standard chemo-radiotherapy and targeted therapy on mucositis development and pointing out the limits and the benefits of current mucositis treatment strategies and assessment guidelines. Moreover, the review critically examines the feasibility of the existing biomarkers to predict patient risk of developing oral mucositis and their role in early diagnosis. Despite the expression levels of some proteins involved in the inflammation response, such as TNF-α or IL-1β, partially correlate with mucositis process, their presence does not exclude others mucositis-independent inflammation events. This strongly suggests the need to discover biomarkers that specifically feature mucositis process development. Non-coding RNAs might hold this potential.
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Affiliation(s)
- Claudio Pulito
- Oncogenomic and Epigenetic Unit, IRCCS, Regina Elena National Cancer Institute, Rome, Italy
| | - Antonio Cristaudo
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Caterina La Porta
- Center for Complexity and Biosystems, Department of Environmental Science and Policy, University of Milan, via Celoria 26, 20133, Milano, Italy.,CNR - Consiglio Nazionale delle Ricerche, Istituto di Biofisica, via Celoria 26, 20133, Milano, Italy
| | - Stefano Zapperi
- Center for Complexity and Biosystems, Department of Physics, University of Milan, Via Celoria 16, 20133, Milano, Italy.,CNR - Consiglio Nazionale delle Ricerche, Istituto di Chimica della Materia Condensata e di Tecnologie per l'Energia, Via R. Cozzi 53, 20125, Milano, Italy
| | - Giovanni Blandino
- Oncogenomic and Epigenetic Unit, IRCCS, Regina Elena National Cancer Institute, Rome, Italy
| | - Aldo Morrone
- Scientific Director Office, San Gallicano Institute, Rome, Italy
| | - Sabrina Strano
- SAFU Laboratory, Department of Research, Advanced Diagnostic, and Technological Innovation, IRCCS, Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00144, Rome, Italy.
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Batista VL, da Silva TF, de Jesus LCL, Coelho-Rocha ND, Barroso FAL, Tavares LM, Azevedo V, Mancha-Agresti P, Drumond MM. Probiotics, Prebiotics, Synbiotics, and Paraprobiotics as a Therapeutic Alternative for Intestinal Mucositis. Front Microbiol 2020; 11:544490. [PMID: 33042054 PMCID: PMC7527409 DOI: 10.3389/fmicb.2020.544490] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 08/24/2020] [Indexed: 12/12/2022] Open
Abstract
Intestinal mucositis, a cytotoxic side effect of the antineoplastic drug 5-fluorouracil (5-FU), is characterized by ulceration, inflammation, diarrhea, and intense abdominal pain, making it an important issue for clinical medicine. Given the seriousness of the problem, therapeutic alternatives have been sought as a means to ameliorate, prevent, and treat this condition. Among the alternatives available to address this side effect of treatment with 5-FU, the most promising has been the use of probiotics, prebiotics, synbiotics, and paraprobiotics. This review addresses the administration of these "biotics" as a therapeutic alternative for intestinal mucositis caused by 5-FU. It describes the effects and benefits related to their use as well as their potential for patient care.
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Affiliation(s)
- Viviane Lima Batista
- Laboratório de Genética Celular e Molecular (LGCM), Departamento de Biologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Tales Fernando da Silva
- Laboratório de Genética Celular e Molecular (LGCM), Departamento de Biologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Luís Cláudio Lima de Jesus
- Laboratório de Genética Celular e Molecular (LGCM), Departamento de Biologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Nina Dias Coelho-Rocha
- Laboratório de Genética Celular e Molecular (LGCM), Departamento de Biologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Fernanda Alvarenga Lima Barroso
- Laboratório de Genética Celular e Molecular (LGCM), Departamento de Biologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Laisa Macedo Tavares
- Laboratório de Genética Celular e Molecular (LGCM), Departamento de Biologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Vasco Azevedo
- Laboratório de Genética Celular e Molecular (LGCM), Departamento de Biologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Pamela Mancha-Agresti
- Laboratório de Genética Celular e Molecular (LGCM), Departamento de Biologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Faculdade de Minas, FAMINAS-BH, Belo Horizonte, Brazil
| | - Mariana Martins Drumond
- Laboratório de Genética Celular e Molecular (LGCM), Departamento de Biologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Centro Federal de Educação Tecnológica de Minas Gerais (CEFET/MG), Departamento de Ciências Biológicas, Belo Horizonte, Brazil
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Keefe DMK, Bateman EH. Potential Successes and Challenges of Targeted Cancer Therapies. J Natl Cancer Inst Monogr 2020; 2019:5551349. [PMID: 31425592 DOI: 10.1093/jncimonographs/lgz008] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/29/2019] [Accepted: 04/19/2019] [Indexed: 01/15/2023] Open
Abstract
The concept and realization of targeted anticancer therapy (TAT) have existed for at least two decades and continue to expand rapidly. It has become clear that there is no "magic bullet" to cure cancer and that even TATs are unlikely to be successful as single agents, necessitating combination with chemotherapy, radiotherapy, or even other targeting agents. The other promise that has not been fulfilled by TAT is that of reduced toxicity. It was thought that by targeting receptors on or within cells, rather than particular phases of the cell cycle, TATs would not be toxic. However, it turns out that the targets also exist on or within normal cells and that there is even cross-reactivity between receptors on nontarget tissues. All of this results in toxicity, the mechanism of which are the same as the mechanism of action of the drugs, making toxicity reduction or prevention very difficult. This leads to new toxicities with new targeted treatments. Nevertheless, all of the above should not detract from the obvious successes of targeted agents, which have turned several acutely fatal cancers into chronic diseases and rendered some hitherto untreatable cancers into treatable diseases.
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Affiliation(s)
- Dorothy M K Keefe
- Mucositis Research Group, Discipline of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - Emma H Bateman
- Mucositis Research Group, Discipline of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
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Anderson PM, Lalla RV. Glutamine for Amelioration of Radiation and Chemotherapy Associated Mucositis during Cancer Therapy. Nutrients 2020; 12:nu12061675. [PMID: 32512833 PMCID: PMC7352314 DOI: 10.3390/nu12061675] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 02/07/2023] Open
Abstract
Glutamine is a major dietary amino acid that is both a fuel and nitrogen donor for healing tissues damaged by chemotherapy and radiation. Evidence supports the benefit of oral (enteral) glutamine to reduce symptoms and improve and/or maintain quality of life of cancer patients. Benefits include not only better nutrition, but also decreased mucosal damage (mucositis, stomatitis, pharyngitis, esophagitis, and enteritis). Glutamine supplementation in a high protein diet (10 grams/day) + disaccharides, such as sucrose and/or trehalose, is a combination that increases glutamine uptake by mucosal cells. This increased topical effect can reduce painful mucosal symptoms and ulceration associated with chemotherapy and radiation in the head and neck region, esophagus, stomach and small intestine. Topical and oral glutamine seem to be the preferred routes for this amino acid to promote mucosal healing during and after cancer treatment.
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Affiliation(s)
- Peter M. Anderson
- Cleveland Clinic Pediatric Hematology/Oncology and Bone Marrow Transplant, Pediatric Institute and Taussig Cancer Institute, Cleveland, OH 44195, USA
- Correspondence: ; Tel.: +1-216-308-2706
| | - Rajesh V. Lalla
- UConn Health, School of Dental Medicine, Farmington, CT 06030 USA;
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