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Li C, Xie J, Wang J, Cao Y, Pu M, Gong Q, Lu Q. Therapeutic effects and mechanisms of plant-derived natural compounds against intestinal mucositis. Front Pharmacol 2022; 13:969550. [PMID: 36210837 PMCID: PMC9533105 DOI: 10.3389/fphar.2022.969550] [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: 06/15/2022] [Accepted: 09/05/2022] [Indexed: 01/26/2023] Open
Abstract
Intestinal mucositis is a clinically related adverse reaction of antitumor treatment. Majority of patients receiving high-dose chemical therapy, radiotherapy, and bone-marrow transplant suffer from intestinal mucositis. Clinical manifestations of intestinal mucositis mainly include pain, body-weight reduction, inflammatory symptom, diarrhea, hemoproctia, and infection, which all affect regular nutritional input and enteric function. Intestinal mucositis often influences adherence to antitumor treatment because it frequently restricts the sufferer’s capacity to tolerate treatment, thus resulting in schedule delay, interruption, or premature suspension. In certain circumstances, partial and general secondary infections are found, increasing the expenditures on medical care and hospitalization. Current methods of treating intestinal mucositis are provided, which do not always counteract this disorder. Against this background, novel therapeutical measures are extremely required to prevent and treat intestinal mucositis. Plant-derived natural compounds have lately become potential candidates against enteric injury ascribed to the capacity to facilitate mucosal healing and anti-inflammatory effects. These roles are associated with the improvement of intestinal mucosal barrier, suppression of inflammatory response and oxidant stress, and modulation of gut microflora and immune system. The present article aims at systematically discussing the recent progress of plant-derived natural compounds as promising treatments for intestinal mucositis.
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Affiliation(s)
- Cailan Li
- Department of Pharmacology, Zunyi Medical University, Zhuhai Campus, Zhuhai, China
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, China
- Key Laboratory of Basic Pharmacology of Guizhou Province and School of Pharmacy, Zunyi Medical University, Zunyi, China
| | - Jianhui Xie
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiahao Wang
- Department of Pharmacology, Zunyi Medical University, Zhuhai Campus, Zhuhai, China
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, China
- Key Laboratory of Basic Pharmacology of Guizhou Province and School of Pharmacy, Zunyi Medical University, Zunyi, China
| | - Ying Cao
- Department of Pharmaceutical Sciences, Zunyi Medical University, Zhuhai Campus, Zhuhai, China
| | - Min Pu
- Department of Pharmaceutical Sciences, Zunyi Medical University, Zhuhai Campus, Zhuhai, China
| | - Qihai Gong
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, China
- Key Laboratory of Basic Pharmacology of Guizhou Province and School of Pharmacy, Zunyi Medical University, Zunyi, China
- *Correspondence: Qihai Gong, ; Qiang Lu,
| | - Qiang Lu
- Department of Pharmaceutical Sciences, Zunyi Medical University, Zhuhai Campus, Zhuhai, China
- *Correspondence: Qihai Gong, ; Qiang Lu,
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Tanaka Y, Shimokawa T, Harada K, Yoshida K. Effectiveness of elemental diets to prevent oral mucositis associated with cancer therapy: A meta-analysis. Clin Nutr ESPEN 2022; 49:172-180. [PMID: 35623809 DOI: 10.1016/j.clnesp.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS During chemo- or radiotherapy, oral mucositis is associated with severely affected nutrition, prolonged hospital stays, increased risk of infections, death, hindered cancer treatment, and compromised patient prognosis. Although oral mucositis management is critical, no preventive methods have been firmly established. Nutritional therapy with the oral amino acid-rich elemental diet (ED) Elental® may prevent body composition changes and oral mucositis as dose-limiting toxicities of cancer therapy. This meta-analysis evaluated the effectiveness of ED for the prevention of grade ≥2 oral mucositis in patients with cancer undergoing chemotherapy or radiotherapy. METHODS A PubMed literature search for randomized clinical trials and/or observational studies in English was conducted. Odds ratios and their confidence intervals were calculated, and fixed- or random-effects models applied. RESULTS Of 24 relevant studies, nine conducted in Japan (including 445 patients) were subjected to a meta-analysis. Heterogeneity was 56%. Using a random-effects model, the resulting odds ratio (95% confidence interval) was 0.25 (0.10, 0.61). Funnel plot analysis showed no publication bias. There was no heterogeneity by study design, but esophageal cancer exhibited heterogeneity. The respective odds ratios (fixed-effects model) were 0.10 (0.03, 0.30) for observational studies and 0.48 (0.28, 0.82) for randomized control trials. The odds ratio (confidence interval) using a random-effects model was 0.35 (0.12, 0.99) for esophageal cancer; using a fixed-effects model, odds ratios were 0.07 (0.02, 0.29) for gastroenterological cancer and 0.26 (0.04, 1.60) for oral cancers. CONCLUSIONS The ED reduced the risk of developing oral mucositis, regardless of study design. The effectiveness was more marked in patients with gastroenterological cancer followed by esophageal cancer; ED was not effective in patients with oral cancer.
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Affiliation(s)
- Yoshihiro Tanaka
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, Gifu, 501-1194, Japan.
| | - Toshio Shimokawa
- Department of Medical Data Science, Graduate School of Medicine, Wakayama Medical University, Wakayama, 641-8509, Japan.
| | - Koji Harada
- Department of Oral and Maxillofacial Surgery, Yamaguchi University Graduate School of Medicine, Ube, 755-8505, Japan.
| | - Kazuhiro Yoshida
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, Gifu, 501-1194, Japan.
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Tanaka Y, Takeuchi H, Nakashima Y, Nagano H, Ueno T, Tomizuka K, Morita S, Emi Y, Hamai Y, Hihara J, Saeki H, Oki E, Kunisaki C, Otsuji E, Baba H, Matsubara H, Maehara Y, Kitagawa Y, Yoshida K. Effects of an elemental diet to reduce adverse events in patients with esophageal cancer receiving docetaxel/cisplatin/5-fluorouracil: a phase III randomized controlled trial-EPOC 2 (JFMC49-1601-C5). ESMO Open 2021; 6:100277. [PMID: 34626918 PMCID: PMC8511839 DOI: 10.1016/j.esmoop.2021.100277] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 01/11/2023] Open
Abstract
Background Oral mucositis (OM) is an unpleasant adverse event in patients receiving chemotherapy. A prospective feasibility study showed that elemental diet (ED), an oral supplement that does not require digestion, may prevent OM. Based on this, we established a central review system for oral cavity assessment by dental oncology specialists blinded to background data. We used this system to elucidate the preventive effect of an ED against OM in patients with esophageal cancer receiving docetaxel, cisplatin, and 5-fluorouracil (DCF) therapy. Patients and methods In this phase III, multicenter, parallel-group, controlled trial, patients consuming a normal diet orally were randomly assigned (1 : 1) to receive two cycles of DCF with (group A) or without (group B) an ED (Elental® 160 g/day). We assessed the incidence of grade ≥2 OM evaluated by two reviewers, changes in body weight, prealbumin, C-reactive protein, and DCF completion rate based on ED compliance. Results Of the 117 patients randomly assigned to treatment, four failed to start treatment and were excluded from the primary analysis; thus, groups A and B comprised 55 and 58 patients, respectively. There were no significant differences in background characteristics. Grade ≥2 OM was observed in eight (15%) and 20 (34%) patients in groups A and B, respectively (P = 0.0141). Changes in body weight and prealbumin during the two DCF cycles were significantly higher in group A than B (P = 0.0022 and 0.0203, respectively). During the first cycle, changes in C-reactive protein were significantly lower in group A than B (P = 0.0338). In group A (receiving ED), the DCF completion rate was 100% in patients with 100% ED compliance and 70% in patients failing ED completion (P = 0.0046). Conclusions The study findings demonstrate that an ED can prevent OM in patients with esophageal cancer receiving chemotherapy. Patients receiving docetaxel, cisplatin, and 5-fluorouracil (DCF) chemotherapy commonly develop oral mucositis (OM). An elemental diet (ED) was able to prevent OM in patients with esophageal cancer receiving DCF. Grade ≥2 OM was observed in 15% of patients receiving the ED versus 34% of those not receiving the ED (P = 0.0141). Body weight was maintained in the ED group, and hematologic toxicities were lower, compared with the non-ED group. The DCF completion rate significantly correlated with ED compliance (P = 0.0046).
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Affiliation(s)
- Y Tanaka
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - H Takeuchi
- Department of Surgery, School of Medicine, Hamamatsu University, Hamamatsu, Japan
| | - Y Nakashima
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - H Nagano
- Gastroenterological, Breast and Endocrine Surgery, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - T Ueno
- Department of Dentistry, National Cancer Center Hospital, Tokyo, Japan
| | - K Tomizuka
- Department of Dentistry, Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - S Morita
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Y Emi
- Department of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Y Hamai
- Department of Surgical Oncology, Hiroshima University Hospital, Hiroshima, Japan
| | - J Hihara
- Department of Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - H Saeki
- Department of General Surgical Science, Gunma University, Maebashi, Japan
| | - E Oki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - C Kunisaki
- Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama, Japan
| | - E Otsuji
- Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - H Baba
- Department of Gastroenterological Surgery, Kumamoto University, Kumamoto, Japan
| | - H Matsubara
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Y Maehara
- Director, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan
| | - Y Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - K Yoshida
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, Gifu, Japan.
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Hudita A, Radu IC, Galateanu B, Ginghina O, Herman H, Balta C, Rosu M, Zaharia C, Costache M, Tanasa E, Velonia K, Tsatsakis A, Hermenean A. Bioinspired silk fibroin nano-delivery systems protect against 5-FU induced gastrointestinal mucositis in a mouse model and display antitumor effects on HT-29 colorectal cancer cells in vitro. Nanotoxicology 2021; 15:973-994. [PMID: 34213984 DOI: 10.1080/17435390.2021.1943032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Colorectal cancer (CRC), is the second cause of cancer-related deaths worldwide is one of the most prevalent types of cancers. Conventional treatment continues to rely on surgery, chemotherapy, and radiotherapy, but for advanced cases, adjuvant chemotherapy remains the main approach for improving surgical outcomes and lower the disease recurrence probability. Chemotherapy-induced gastrointestinal (GI) toxicity is the main dose-limiting factor for many chemotherapeutic regimens, including 5-FU, and one of the biggest oncological challenges. Up to 40% of the patients receiving 5-FU get mucositis, 10-15% of which develop severe symptoms. In this context, our study aimed to develop a bioinspired nanosized drug delivery system as a strategy to reduce 5-FU associated side effects, such as GI mucositis. To this end, SF-based nanoparticles were prepared and characterized in terms of size and morphology, as well as in terms of in vitro antitumoral activity on a biomimetic colorectal cancer model by investigation of apoptosis, DNA fragmentation, and release of reactive oxygen species. Additionally, the capacity of the SF-based nanocarriers to offer intestinal protection against 5-FU-induced GI mucositis was evaluated in vivo using a mouse model that mimics the chemotherapy-associated gut mucositis occurring in colorectal cancer. Our studies show that silk fibroin nanoparticles efficiently deliver 5-FU to tumor cells in vitro while protecting against drug-induced GI mucositis in a mouse model.
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Affiliation(s)
- A Hudita
- Department of Biochemistry and Molecular Biology, University of Bucharest, Bucharest, Romania
| | - I C Radu
- Advanced Polymer Materials Group, University Politehnica of Bucharest, Bucharest, Romania
| | - B Galateanu
- Department of Biochemistry and Molecular Biology, University of Bucharest, Bucharest, Romania
| | - O Ginghina
- Department of Surgery, "Sf. Ioan" Clinical Emergency Hospital, Bucharest, Romania.,Faculty of Dental Medicine, Department II, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - H Herman
- Institute of Life Science, Vasile Goldis Western University of Arad, Arad, Romania
| | - C Balta
- Institute of Life Science, Vasile Goldis Western University of Arad, Arad, Romania
| | - M Rosu
- Institute of Life Science, Vasile Goldis Western University of Arad, Arad, Romania
| | - C Zaharia
- Advanced Polymer Materials Group, University Politehnica of Bucharest, Bucharest, Romania
| | - M Costache
- Department of Biochemistry and Molecular Biology, University of Bucharest, Bucharest, Romania
| | - E Tanasa
- University Politehnica of Bucharest, Bucharest, Romania
| | - K Velonia
- Department of Materials Science and Technology, University of Crete, Heraklion, Greece
| | - A Tsatsakis
- Department of Toxicology and Forensic Sciences, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - A Hermenean
- Institute of Life Science, Vasile Goldis Western University of Arad, Arad, Romania
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Katada C, Fukazawa S, Sugawara M, Sakamoto Y, Takahashi K, Takahashi A, Watanabe A, Wada T, Ishido K, Furue Y, Harada H, Hosoda K, Yamashita K, Hiki N, Sato T, Ichikawa T, Shichiri M, Tanabe S, Koizumi W. Randomized study of prevention of gastrointestinal toxicities by nutritional support using an amino acid-rich elemental diet during chemotherapy in patients with esophageal cancer (KDOG 1101). Esophagus 2021; 18:296-305. [PMID: 33009977 DOI: 10.1007/s10388-020-00787-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/25/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND This randomized study was designed to evaluate the clinical effect of an elemental diet during chemotherapy in patients with esophageal cancer. METHODS The inclusion criteria were as follows: (1) esophageal squamous cell carcinoma, (2) stage IB-IV, (3) schedule to receive docetaxel, cisplatin, and 5-fluorouracil (DCF chemotherapy), (4) 20-80 years old, (5) performance status of 0-2, (6) oral intake ability, and (7) written informed consent. Patients were divided into two groups: the elemental supplementary group and the non-supplementary group. Patients received ELENTAL® (160 g/day) orally 9 weeks after the start of chemotherapy. Primary endpoint was the incidence of grade 2 or higher gastrointestinal toxicity according to the Common Terminology Criteria for Adverse Events, version 4.0. Secondary endpoints were the incidence of all adverse events and the evaluation of nutritional status. RESULTS Thirty-six patients in the elemental supplementary group and 35 patients in the non-supplementary group were included in the analysis. The incidence of grade 2 or higher gastrointestinal toxicity and all grade 3 or 4 adverse events did not differ significantly between the groups. In the elemental supplementary group, the body weight (p = 0.057), muscle mass (p = 0.056), and blood levels of transferrin (p = 0.009), total amino acids (p = 0.019), and essential amino acids (p = 0.006) tended to be maintained after chemotherapy. CONCLUSION Nutritional support provided by an amino acid-rich elemental diet was ineffective for reducing the incidence of adverse events caused by DCF chemotherapy in patients with esophageal cancer.
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Affiliation(s)
- Chikatoshi Katada
- Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan.
| | - Saeko Fukazawa
- Department of Nutrition, Kitasato University Hospital, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Mitsuhiro Sugawara
- Department of Pharmacy, Kitasato University Hospital, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Yasutoshi Sakamoto
- Kitasato Clinical Research Center, Kitasato University School of Medicine, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Kaoru Takahashi
- Department of Nursing, Kitasato University Hospital, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Akiko Takahashi
- Department of Nursing, Kitasato University Hospital, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Akinori Watanabe
- Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Takuya Wada
- Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Kenji Ishido
- Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Yasuaki Furue
- Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Hiroki Harada
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Kei Hosoda
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Keishi Yamashita
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
- Division of Advanced Surgical Oncology, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Naoki Hiki
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Teruko Sato
- Department of Nutrition, Kitasato University Hospital, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Takafumi Ichikawa
- Department of Pathological Biochemistry, School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Masayoshi Shichiri
- Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Satoshi Tanabe
- Department of Advanced Medicine Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
| | - Wasaburo Koizumi
- Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato Minami, Sagamihara, 252-0374, Japan
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Oh NS, Lee JY, Kim YT, Kim SH, Lee JH. Cancer-protective effect of a synbiotic combination between Lactobacillus gasseri 505 and a Cudrania tricuspidata leaf extract on colitis-associated colorectal cancer. Gut Microbes 2020; 12:1785803. [PMID: 32663105 PMCID: PMC7524312 DOI: 10.1080/19490976.2020.1785803] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Previously, a synbiotic combination of probiotic Lactobacillus gasseri 505 (LG) and a new prebiotic, Cudrania tricuspidata leaf extract (CT) in fermented milk, designated FCT, showed an in vitro immunomodulatory effect and antioxidant activity. Although synbiotic combination might have cancer-protective effects, these activities have not been fully validated in vivo. Ten-week treatment of LG, CT, or FCT to azoxymethane (AOM)/dextran sodium sulfate (DSS)-induced colitis-associated colorectal cancer (CAC) mouse model reduced both the incidence of colonic tumors and damage to the colonic mucosa effectively, suggesting a cancer-protective effect. To understand these, biomarkers associated with inflammation, colon barrier, apoptosis, and cancer cell proliferation were monitored in AOM/DSS group versus LG/CT/FCT groups. A synbiotic combination (FCT) down-regulated pro-inflammatory cytokines (TNF-α, IFN-γ, IL-1β, and IL-6) and inflammation-associated enzymes (iNOS and COX-2), and up-regulated anti-inflammatory cytokines (IL-4 and IL-10). In addition, colon barrier experiment revealed that biomarkers of mucus layer (MUC-2 and TFF3) and tight junction (occludin and ZO-1) were up-regulated. Subsequent apoptosis experiment showed that pro-apoptotic factors (p53, p21, and Bax) were up-regulated and anti-apoptotic factors (Bcl-2 and Bcl-xL) were down-regulated. Furthermore, comparative metagenome analysis of gut microbiota revealed that Staphylococcus decreased but Lactobacillus, Bifidobacterium, and Akkermansia increased, supporting their protective effects, accompanied by increased short-chain fatty acids (SCFAs). Taken together, the FCT administration showed cancer-protective effects by reducing the risk of colitis-associated colon cancer via regulation of inflammation, carcinogenesis, and compositional change of gut microbiota. Consequently, the synbiotic combination (FCT) could be a novel potential health-protective natural agent against CAC.
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Affiliation(s)
- Nam Su Oh
- Department of Food and Biotechnology, Korea University, Sejong, South Korea
| | - Ji Young Lee
- Department of Biotechnology, College of Life Sciences and Biotechnology, Korea University, Seoul, South Korea
| | - You-Tae Kim
- Department of Food Science and Biotechnology, Graduate School of Biotechnology, Kyung Hee University, Yongin, South Korea
| | - Sae Hun Kim
- Department of Biotechnology, College of Life Sciences and Biotechnology, Korea University, Seoul, South Korea,Sae Hun Kim 145 Anam-ro, Seongbuk-gu, Seoul 02841, South Korea
| | - Ju-Hoon Lee
- Department of Food Science and Biotechnology, Graduate School of Biotechnology, Kyung Hee University, Yongin, South Korea,CONTACT Ju-Hoon Lee 1732 Deogyeong-daero, Giheung-gu, Yongin-si, Gyeonggi-do 17104, South Korea
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7
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Fideles LDS, de Miranda JAL, Martins CDS, Barbosa MLL, Pimenta HB, Pimentel PVDS, Teixeira CS, Scafuri MAS, Façanha SDO, Barreto JEF, Carvalho PMDM, Scafuri AG, Araújo JL, Rocha JA, Vieira IGP, Ricardo NMPS, da Silva Campelo M, Ribeiro MENP, de Castro Brito GA, Cerqueira GS. Role of Rutin in 5-Fluorouracil-Induced Intestinal Mucositis: Prevention of Histological Damage and Reduction of Inflammation and Oxidative Stress. Molecules 2020; 25:molecules25122786. [PMID: 32560278 PMCID: PMC7356626 DOI: 10.3390/molecules25122786] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/12/2020] [Accepted: 06/14/2020] [Indexed: 02/07/2023] Open
Abstract
Intestinal mucositis, characterized by inflammatory and/or ulcerative processes in the gastrointestinal tract, occurs due to cellular and tissue damage following treatment with 5-fluorouracil (5-FU). Rutin (RUT), a natural flavonoid extracted from Dimorphandra gardneriana, exhibits antioxidant, anti-inflammatory, cytoprotective, and gastroprotective properties. However, the effect of RUT on inflammatory processes in the intestine, especially on mucositis promoted by antineoplastic agents, has not yet been reported. In this study, we investigated the role of RUT on 5-FU-induced experimental intestinal mucositis. Swiss mice were randomly divided into seven groups: Saline, 5-FU, RUT-50, RUT-100, RUT-200, Celecoxib (CLX), and CLX + RUT-200 groups. The mice were weighed daily. After treatment, the animals were euthanized and segments of the small intestine were collected to evaluate histopathological alterations (morphometric analysis); malondialdehyde (MDA), myeloperoxidase (MPO), and glutathione (GSH) concentrations; mast and goblet cell counts; and cyclooxygenase-2 (COX-2) activity, as well as to perform immunohistochemical analyses. RUT treatment (200 mg/kg) prevented 5-FU-induced histopathological changes and reduced oxidative stress by decreasing MDA concentrations and increasing GSH concentrations. RUT attenuated the inflammatory response by decreasing MPO activity, intestinal mastocytosis, and COX-2 expression. These results suggest that the COX-2 pathway is one of the underlying protective mechanisms of RUT against 5-FU-induced intestinal mucositis.
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Affiliation(s)
- Lázaro de Sousa Fideles
- Department of Morphology, Faculty of Medicine, Federal University of Ceará, s/n Delmiro of Farias Street, Porangabuçu Campus, Fortaleza 60416-030, Brazil; (L.d.S.F.); (C.d.S.M.); (M.L.L.B.); (H.B.P.); (P.V.d.S.P.); (C.S.T.); (J.E.F.B.); (A.G.S.); (G.A.d.C.B.); (G.S.C.)
| | - João Antônio Leal de Miranda
- Department of Morphology, Faculty of Medicine, Federal University of Ceará, s/n Delmiro of Farias Street, Porangabuçu Campus, Fortaleza 60416-030, Brazil; (L.d.S.F.); (C.d.S.M.); (M.L.L.B.); (H.B.P.); (P.V.d.S.P.); (C.S.T.); (J.E.F.B.); (A.G.S.); (G.A.d.C.B.); (G.S.C.)
- Correspondence: ; Tel.: +55-85-3366-8492
| | - Conceição da Silva Martins
- Department of Morphology, Faculty of Medicine, Federal University of Ceará, s/n Delmiro of Farias Street, Porangabuçu Campus, Fortaleza 60416-030, Brazil; (L.d.S.F.); (C.d.S.M.); (M.L.L.B.); (H.B.P.); (P.V.d.S.P.); (C.S.T.); (J.E.F.B.); (A.G.S.); (G.A.d.C.B.); (G.S.C.)
| | - Maria Lucianny Lima Barbosa
- Department of Morphology, Faculty of Medicine, Federal University of Ceará, s/n Delmiro of Farias Street, Porangabuçu Campus, Fortaleza 60416-030, Brazil; (L.d.S.F.); (C.d.S.M.); (M.L.L.B.); (H.B.P.); (P.V.d.S.P.); (C.S.T.); (J.E.F.B.); (A.G.S.); (G.A.d.C.B.); (G.S.C.)
| | - Helder Bindá Pimenta
- Department of Morphology, Faculty of Medicine, Federal University of Ceará, s/n Delmiro of Farias Street, Porangabuçu Campus, Fortaleza 60416-030, Brazil; (L.d.S.F.); (C.d.S.M.); (M.L.L.B.); (H.B.P.); (P.V.d.S.P.); (C.S.T.); (J.E.F.B.); (A.G.S.); (G.A.d.C.B.); (G.S.C.)
| | - Paulo Vitor de Souza Pimentel
- Department of Morphology, Faculty of Medicine, Federal University of Ceará, s/n Delmiro of Farias Street, Porangabuçu Campus, Fortaleza 60416-030, Brazil; (L.d.S.F.); (C.d.S.M.); (M.L.L.B.); (H.B.P.); (P.V.d.S.P.); (C.S.T.); (J.E.F.B.); (A.G.S.); (G.A.d.C.B.); (G.S.C.)
| | - Claudio Silva Teixeira
- Department of Morphology, Faculty of Medicine, Federal University of Ceará, s/n Delmiro of Farias Street, Porangabuçu Campus, Fortaleza 60416-030, Brazil; (L.d.S.F.); (C.d.S.M.); (M.L.L.B.); (H.B.P.); (P.V.d.S.P.); (C.S.T.); (J.E.F.B.); (A.G.S.); (G.A.d.C.B.); (G.S.C.)
| | | | | | - João Erivan Façanha Barreto
- Department of Morphology, Faculty of Medicine, Federal University of Ceará, s/n Delmiro of Farias Street, Porangabuçu Campus, Fortaleza 60416-030, Brazil; (L.d.S.F.); (C.d.S.M.); (M.L.L.B.); (H.B.P.); (P.V.d.S.P.); (C.S.T.); (J.E.F.B.); (A.G.S.); (G.A.d.C.B.); (G.S.C.)
- Christus University Center (Unichristus), 133 Adolfo Gurgel Street, Fortaleza 63010-475, Brazil;
| | | | - Ariel Gustavo Scafuri
- Department of Morphology, Faculty of Medicine, Federal University of Ceará, s/n Delmiro of Farias Street, Porangabuçu Campus, Fortaleza 60416-030, Brazil; (L.d.S.F.); (C.d.S.M.); (M.L.L.B.); (H.B.P.); (P.V.d.S.P.); (C.S.T.); (J.E.F.B.); (A.G.S.); (G.A.d.C.B.); (G.S.C.)
- Scafuri Institute of Human Sexuality, 1513 Republic of Lebanon Street, Varjota, Fortaleza 60175-222, Brazil;
| | - Joabe Lima Araújo
- Department of Genetics and Morphology, s/n Darcy Ribeiro University Campus, University of Brasília, Brasília-DF 70910-900, Brazil;
| | - Jefferson Almeida Rocha
- Medicinal Chemistry and Biotechnology Research Group (QUIMEBIO), Federal University of Maranhão (UFMA), São Bernardo/MA 65550-000, Brazil;
| | - Icaro Gusmão Pinto Vieira
- Technological Development Park, Federal University of Ceará, Humberto Monte Avenue, 2977, Pici Campus, Fortaleza 60440-900, Brazil;
| | - Nágila Maria Pontes Silva Ricardo
- Department of Organic and Inorganic Chemistry, Federal University of Ceará, Pici Campus, Fortaleza 60440-900, Brazil; (N.M.P.S.R.); (M.d.S.C.); (M.E.N.P.R.)
| | - Matheus da Silva Campelo
- Department of Organic and Inorganic Chemistry, Federal University of Ceará, Pici Campus, Fortaleza 60440-900, Brazil; (N.M.P.S.R.); (M.d.S.C.); (M.E.N.P.R.)
| | - Maria Elenir Nobre Pinho Ribeiro
- Department of Organic and Inorganic Chemistry, Federal University of Ceará, Pici Campus, Fortaleza 60440-900, Brazil; (N.M.P.S.R.); (M.d.S.C.); (M.E.N.P.R.)
| | - Gerly Anne de Castro Brito
- Department of Morphology, Faculty of Medicine, Federal University of Ceará, s/n Delmiro of Farias Street, Porangabuçu Campus, Fortaleza 60416-030, Brazil; (L.d.S.F.); (C.d.S.M.); (M.L.L.B.); (H.B.P.); (P.V.d.S.P.); (C.S.T.); (J.E.F.B.); (A.G.S.); (G.A.d.C.B.); (G.S.C.)
| | - Gilberto Santos Cerqueira
- Department of Morphology, Faculty of Medicine, Federal University of Ceará, s/n Delmiro of Farias Street, Porangabuçu Campus, Fortaleza 60416-030, Brazil; (L.d.S.F.); (C.d.S.M.); (M.L.L.B.); (H.B.P.); (P.V.d.S.P.); (C.S.T.); (J.E.F.B.); (A.G.S.); (G.A.d.C.B.); (G.S.C.)
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Abstract
PURPOSE OF REVIEW Alimentary mucositis is a severe dose limiting side effect of chemotherapy and radiotherapy. Mucin expression and secretion are associated with mucositis. This article aims to review current studies involving mucin and mucositis. RECENT FINDINGS Mucins have been shown to alter mucositis severity and key targets associated with mucositis. First, interventions increasing mucin content has been associated with reduce damage associated with mucositis. Second, mucins have also been shown to protect microbiota from radiation-induced damage. Finally, mucins have also been shown to be involved in lumen epithelial barrier interactions altering signalling for cell proliferation, motility, and the inhibition of apoptosis. SUMMARY The current studies suggest that mucin expression prior to and during mucositis may be very important in reducing the severity of mucositis and further research into the area is warranted.
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Sanz-Paris A, Martinez-García M, Martinez-Trufero J, Lambea-Sorrosal J, Calvo-Gracia F, López-Alaminos ME. Oligomeric Enteral Nutrition in Undernutrition, due to Oncology Treatment-Related Diarrhea. Systematic Review and Proposal of An Algorithm of Action. Nutrients 2019; 11:nu11081888. [PMID: 31412681 PMCID: PMC6722903 DOI: 10.3390/nu11081888] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/09/2019] [Accepted: 08/09/2019] [Indexed: 12/19/2022] Open
Abstract
Oncology treatment-related diarrhea and malnutrition appear together in oncological patients because of the disease itself, or the treatments that are administered for it. Therefore it is essential to carry out a nutritional treatment. Enteral nutrition formulas, containing peptides and medium chain triglycerides, can facilitate absorption in cases of malabsorption. There are few references to the use of enteral nutrition in the clinical society guidelines of patient management with oncology treatment-related diarrhea (OTRD). A bibliographic review of the studies with oligomeric enteral nutrition in OTRD found only nine studies with chemotherapy (all with the same oligomeric formula in which oral mucositis improves, while the rest of the outcomes show different results), and eight studies with radiotherapy (with different products and very heterogeneous results). We hereby present our action algorithm to supplement the diet of OTRD patients with an oligomeric enteral nutrition formula. The first step is the nutritional assessment, followed by the assessment of the functional capacity of the patient’s intestine. With these two aspects evaluated, the therapeutic possibilities available vary in degrees of complexity: These will range from the usual dietary recommendations, to supplementation with oral oligomeric enteral nutrition, along with complete enteral nutrition with oligomeric formula, and up to potentially total parenteral nutrition.
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Affiliation(s)
- Alejandro Sanz-Paris
- Department of Endocrinology and Nutrition, Miguel Servet Hospital, 50009 Zaragoza, Spain.
- Instituto de Investigación Sanitaria Aragón (IIS Aragon), 50009 Zaragoza, Spain.
| | - María Martinez-García
- Department of Endocrinology and Nutrition, Miguel Servet Hospital, 50009 Zaragoza, Spain
| | | | | | - Fernando Calvo-Gracia
- Department of Endocrinology and Nutrition, University Clinic Hospital, 50009 Zaragoza, Spain
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10
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Protective Effect of Cashew Gum (Anacardium occidentale L.) on 5-Fluorouracil-Induced Intestinal Mucositis. Pharmaceuticals (Basel) 2019; 12:ph12020051. [PMID: 30987265 PMCID: PMC6630449 DOI: 10.3390/ph12020051] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/27/2019] [Accepted: 03/15/2019] [Indexed: 12/12/2022] Open
Abstract
Intestinal mucositis is a common complication associated with 5-fluorouracil (5-FU), a chemotherapeutic agent used for cancer treatment. Cashew gum (CG) has been reported as a potent anti-inflammatory agent. In the present study, we aimed to evaluate the effect of CG extracted from the exudate of Anacardium occidentale L. on experimental intestinal mucositis induced by 5-FU. Swiss mice were randomly divided into seven groups: Saline, 5-FU, CG 30, CG 60, CG 90, Celecoxib (CLX), and CLX + CG 90 groups. The weight of mice was measured daily. After treatment, the animals were euthanized and segments of the small intestine were collected to evaluate histopathological alterations (morphometric analysis), levels of malondialdehyde (MDA), myeloperoxidase (MPO), and glutathione (GSH), and immunohistochemical analysis of interleukin 1 beta (IL-1β) and cyclooxygenase-2 (COX-2). 5-FU induced intense weight loss and reduction in villus height compared to the saline group. CG 90 prevented 5-FU-induced histopathological changes and decreased oxidative stress through decrease of MDA levels and increase of GSH concentration. CG attenuated inflammatory process by decreasing MPO activity, intestinal mastocytosis, and COX-2 expression. Our findings suggest that CG at a concentration of 90 mg/kg reverses the effects of 5-FU-induced intestinal mucositis.
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11
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Editorial: Knowledge of gastrointestinal toxicity mechanisms is paving the way for improved assessment and management of patient supportive care. Curr Opin Support Palliat Care 2019; 13:111-113. [PMID: 30883402 DOI: 10.1097/spc.0000000000000424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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12
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Volynets V, Rings A, Bárdos G, Ostaff MJ, Wehkamp J, Bischoff SC. Intestinal barrier analysis by assessment of mucins, tight junctions, and α-defensins in healthy C57BL/6J and BALB/cJ mice. Tissue Barriers 2016; 4:e1208468. [PMID: 27583194 DOI: 10.1080/21688370.2016.1208468] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/21/2016] [Accepted: 06/25/2016] [Indexed: 12/23/2022] Open
Abstract
The intestinal barrier is gaining increasing attention because it is related to intestinal homeostasis and disease. Different parameters have been used in the past to assess intestinal barrier functions in experimental studies; however most of them are poorly defined in healthy mice. Here, we compared a number of barrier markers in healthy mice, established normal values and correlations. In 48 mice (24 C57BL/6J, 24 BALB/cJ background), we measured mucus thickness, and expression of mucin-2, α-defensin-1 and -4, zonula occludens-1, occludin, junctional adhesion molecule-A, claudin-1, 2 and -5. We also analyzed claudin-3 and fatty acid binding protein-2 in urine and plasma, respectively. A higher expression of mucin-2 protein was found in the colon compared to the ileum. In contrast, the α-defensins-1 and -4 were expressed almost exclusively in the ileum. The protein expression of the tight junction molecules claudin-1, occludin and zonula occludens-1 did not differ between colon and ileum, although some differences occurred at the mRNA level. No age- or gender-related differences were found. Differences between C57BL/6J and BALB/cJ mice were found for α-defensin-1 and -4 mRNA expression, and for urine and plasma marker concentrations. The α-defensin-1 mRNA correlated with claudin-5 mRNA, whereas α-defensin-4 mRNA correlated with claudin-3 concentrations in urine. In conclusion, we identified a number of murine intestinal barrier markers requiring tissue analyses or measurable in urine or plasma. We provide normal values for these markers in mice of different genetic background. Such data might be helpful for future animal studies in which the intestinal barrier is of interest.
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Affiliation(s)
- Valentina Volynets
- Department of Nutritional Medicine, University of Hohenheim , Stuttgart, Germany
| | - Andreas Rings
- Department of Nutritional Medicine, University of Hohenheim , Stuttgart, Germany
| | - Gyöngyi Bárdos
- Department of Nutritional Medicine, University of Hohenheim , Stuttgart, Germany
| | - Maureen J Ostaff
- University of Colorado, Anschutz Medical Campus , Denver, CO, USA
| | - Jan Wehkamp
- Department of Internal Medicine, University of Tübingen , Tübingen, Germany
| | - Stephan C Bischoff
- Department of Nutritional Medicine, University of Hohenheim , Stuttgart, Germany
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