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Jiang C, Wang H, Xia C, Dong Q, Chen E, Qiu Y, Su Y, Xie H, Zeng L, Kuang J, Ao F, Gong X, Li J, Chen T. A randomized, double-blind, placebo-controlled trial of probiotics to reduce the severity of oral mucositis induced by chemoradiotherapy for patients with nasopharyngeal carcinoma. Cancer 2018; 125:1081-1090. [PMID: 30521105 DOI: 10.1002/cncr.31907] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/04/2018] [Accepted: 10/29/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the effect of a probiotic combination on the severity of oral mucositis (OM), which is a common, unpreventable complication induced by radiochemotherapy in patients with nasopharyngeal carcinoma who undergo concurrent radiochemotherapy (CCRT). METHODS Eligible patients (n = 99) with locally advanced nasopharyngeal carcinoma who were undergoing CCRT were randomly assigned (2:1) to receive a probiotic combination or placebo during radiochemotherapy, and the incidence of severe OM (grade 3 or higher) was the primary endpoint. RESULTS Patients taking the probiotic combination showed a significant reduction in the severity of OM. The incidences of grade 0, 1, 2, and 3 OM in the placebo group and the probiotic combination group were 0% and 12.07%, 0% and 55.17%, 54.29% and 17.24%, and 45.71% and 15.52%, respectively. Furthermore, CCRT greatly lowered the number of immune cells, whereas the probiotic combination markedly lowered the reduction rates of CD4+ T cells (76.59% vs 52.85%; P < .05), CD8+ T cells (62.94% vs 29.76%; P < .05), and CD3+ T cells (69.72% vs 45.49%; P < .05) in an A-CCRT-P (after treatment with radiotherapy plus chemotherapy plus the probiotic combination) group. High-throughput sequencing results indicated that CCRT had obviously disturbed the intestinal diversity of patients in an A-CCRT (after treatment with radiotherapy plus chemotherapy plus a placebo) group, whereas the probiotic combination distinctly restored the microbial diversity in the A-CCRT-P group toward that of healthy people and a B-CCRT-P (before the treatment of radiotherapy plus chemotherapy plus the probiotic combination) group. CONCLUSIONS A probiotic combination significantly enhances the immune response of patients and reduces the severity of OM through modification of gut microbiota.
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Affiliation(s)
- Chunling Jiang
- Department of Radiation Oncology, Jiangxi Cancer Hospital, Nanchang, People's Republic of China.,Medical College of Nanchang University, Nanchang, People's Republic of China
| | - Huan Wang
- Institute of Translational Medicine, Nanchang University, Nanchang, People's Republic of China
| | - Chaofei Xia
- Institute of Translational Medicine, Nanchang University, Nanchang, People's Republic of China
| | - Qing Dong
- Department of Radiation Oncology, Jiangxi Cancer Hospital, Nanchang, People's Republic of China
| | - En Chen
- Department of Radiation Oncology, Jiangxi Cancer Hospital, Nanchang, People's Republic of China
| | - Yang Qiu
- Department of Radiation Oncology, Jiangxi Cancer Hospital, Nanchang, People's Republic of China
| | - Yong Su
- Department of Radiation Oncology, Jiangxi Cancer Hospital, Nanchang, People's Republic of China
| | - Honghui Xie
- Department of Radiation Oncology, Jiangxi Cancer Hospital, Nanchang, People's Republic of China
| | - Lei Zeng
- Department of Radiation Oncology, Jiangxi Cancer Hospital, Nanchang, People's Republic of China
| | - Jie Kuang
- School of Public Health, Nanchang University, Nanchang, People's Republic of China
| | - Fan Ao
- Department of Radiation Oncology, Jiangxi Cancer Hospital, Nanchang, People's Republic of China
| | - Xiaochang Gong
- Department of Radiation Oncology, Jiangxi Cancer Hospital, Nanchang, People's Republic of China
| | - Jingao Li
- Department of Radiation Oncology, Jiangxi Cancer Hospital, Nanchang, People's Republic of China.,Medical College of Nanchang University, Nanchang, People's Republic of China
| | - Tingtao Chen
- Institute of Translational Medicine, Nanchang University, Nanchang, People's Republic of China
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Carvalho R, Vaz A, Pereira FL, Dorella F, Aguiar E, Chatel JM, Bermudez L, Langella P, Fernandes G, Figueiredo H, Goes-Neto A, Azevedo V. Gut microbiome modulation during treatment of mucositis with the dairy bacterium Lactococcus lactis and recombinant strain secreting human antimicrobial PAP. Sci Rep 2018; 8:15072. [PMID: 30305667 PMCID: PMC6180057 DOI: 10.1038/s41598-018-33469-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/20/2018] [Indexed: 12/19/2022] Open
Abstract
Mucositis is an inflammatory condition of the gut, caused by an adverse effect of chemotherapy drugs, such as 5-fluorouracil (5-FU). In an attempt to develop alternative treatments for the disease, several research groups have proposed the use of probiotics, in particular, Lactic Acid Bacteria (LAB). In this context, the use of recombinant LAB, for delivering anti-inflammatory compounds has also been explored. In previous work, we demonstrated that either Lactococcus lactis NZ9000 or a recombinant strain expressing an antimicrobial peptide involved in human gut homeostasis, the Pancreatitis-associated Protein (PAP), could ameliorate 5-FU-induced mucositis in mice. However, the impact of these strains on the gut microbiota still needs to be elucidated. Therefore, in the present study, we aimed to characterize the effects of both Lactococci strains in the gut microbiome of mice through a 16 S rRNA gene sequencing metagenomic approach. Our data show 5-FU caused a significant decrease in protective bacteria and increase of several bacteria associated with pro-inflammatory traits. The Lactococci strains were shown to reduce several potential opportunistic microbes, while PAP delivery was able to suppress the growth of Enterobacteriaceae during inflammation. We conclude the strain secreting antimicrobial PAP was more effective in the control of 5-FU-dysbiosis.
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Affiliation(s)
- Rodrigo Carvalho
- Federal University of Minas Gerais (UFMG-ICB), Belo Horizonte, MG, Brazil.
| | - Aline Vaz
- Federal University of Minas Gerais (UFMG-ICB), Belo Horizonte, MG, Brazil
| | | | - Fernanda Dorella
- Federal University of Minas Gerais (UFMG-ICB), Belo Horizonte, MG, Brazil
| | - Eric Aguiar
- Federal University of Bahia (UFBA), Salvador, BA, Brazil
| | - Jean-Marc Chatel
- Micalis Institute, INRA, AgroParisTech, Université Paris-Saclay, Jouy-en-Josas, France
| | - Luis Bermudez
- Micalis Institute, INRA, AgroParisTech, Université Paris-Saclay, Jouy-en-Josas, France
| | - Philippe Langella
- Micalis Institute, INRA, AgroParisTech, Université Paris-Saclay, Jouy-en-Josas, France
| | - Gabriel Fernandes
- Fiocruz - Centro de Pesquisa Renê Rachou, Belo Horizonte, MG, Brazil
| | | | | | - Vasco Azevedo
- Federal University of Minas Gerais (UFMG-ICB), Belo Horizonte, MG, Brazil
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