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Ibrahim SS, Hassanein FEA, Zaky HW, Gamal H. Clinical and biochemical assessment of the effect of glutamine in management of radiation induced oral mucositis in patients with head and neck cancer: Randomized controlled clinical trial. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101827. [PMID: 38493953 DOI: 10.1016/j.jormas.2024.101827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/01/2024] [Accepted: 03/14/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND This study aimed to evaluate the effect of oral glutamine suspension on salivary levels of transforming growth factor beta 1 (TGF-β1), a cytokine involved in inflammation and Tumor progression, and the severity of radiation-induced oral mucositis (RIOM) in head and neck cancer patients. This is the first study to investigate the impact of glutamine on TGF-β1 levels in head and neck cancer patients with radiation induced oral mucositis (RIOM). METHODS In this randomized controlled clinical trial, 50 HNC patients were enrolled and received either glutamine oral suspension or maltodextrin as a placebo from the baseline of RIOM to the end of radiotherapy. Salivary TGF-β1 levels were measured at baseline and after treatment. Also, RIOM was assessed using the World Health Organization (WHO) Oral Toxicity Scale, the Oral Mucositis Assessment Scale (OMAS), the Pain Visual Analog Scale (Pain-VAS), the incidence of opioid use, and body mass index (BMI). RESULTS Glutamine significantly reduced salivary TGF-β1 levels and improved RIOM symptoms, such as pain, opioid use, and weight loss. The reduction of TGF-β1 levels was associated with the improvement of RIOM severity. CONCLUSION Glutamine may modulate the inflammatory response and enhance wound healing in RIOM by decreasing salivary TGF-β1 levels. These findings support the use of glutamine as a potential intervention for RIOM and nutritional support for improving radiation sensitivity. TRIAL REGISTRATION This study was registered on clinicalTrials.gov with identifier no. NCT05856188.
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Affiliation(s)
- Suzan S Ibrahim
- Oral Medicine, Periodontology, and Oral Diagnosis, Faculty of Dentistry, Ain Shams University, Cairo, Egypt; Faculty of Oral and Dental medicine, Nahda university, Beni Suef, Egypt
| | - Fatma E A Hassanein
- Oral Medicine, Periodontology, and Oral Diagnosis, Faculty of Dentistry, Ain Shams University, Cairo, Egypt; Faulty of Dentistry, King Salman International University, El-Tur, Egypt.
| | - Hany W Zaky
- Radiation Oncology, Ahmed Maher Teaching Hospital, Cairo, Egypt
| | - Hadeel Gamal
- Oral Medicine, Periodontology, and Oral Diagnosis, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
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Khalil M, Hamadah O, Saifo M, Khalil H, Adi M, Alabeedi F, Kujan O. Effect of Photobiomodulation on Salivary Cytokines in Head and Neck Cancer Patients with Oral Mucositis: A Systematic Review. J Clin Med 2024; 13:2822. [PMID: 38792366 PMCID: PMC11122140 DOI: 10.3390/jcm13102822] [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: 03/16/2024] [Revised: 04/11/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Oral mucositis is a common and distressing side effect of head and neck oncology treatment. Photobiomodulation therapy can be utilized to prevent and treat oral mucositis. Its impact on salivary cytokines has yet to be thoroughly investigated. This is the first systematic review aiming to evaluate the effect of photobiomodulation on salivary cytokines in patients undergoing anticancer treatment. Methods: Numerous data resources, from the Web of Science, Embase, ScienceDirect, PubMed, Cochrane Library, and Scopus were sought. Articles published up until February 2024 were included if they met the following inclusion criteria: clinical trials reporting the effect on salivary cytokines in patients undergoing anticancer therapy. The methodological quality was assessed using several appraisal tools. Results: Four studies were deemed eligible for inclusion. All the studies were conducted in Brazil and used an InGaAlP diode laser with a wavelength of 660 nm. The included studies had a relatively low risk of bias. The head and neck cancer patients' salivary cytokines that were assessed by the studies, along with photobiomodulation therapy, included IL-12p70, TNF-α, IL-6, IL-8, IL-10, CXCL8, and IL-1β. The results varied among the studies. Conclusions: Our results show that photobiomodulation demonstrated positive results for reducing the severity of OM in all the included studies. Among the examined salivary cytokines, IL-6 is the most relevant cytokine for oral mucositis development and severity. A variation in the cytokine levels between the studies was noted due to differences in the type of anticancer treatment and saliva sampling.
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Affiliation(s)
- Marwa Khalil
- Department of Oral Medicine, Faculty of Dental Medicine, Damascus University, Damascus P.O. Box 30621, Syria; (M.K.); (O.H.)
| | - Omar Hamadah
- Department of Oral Medicine, Faculty of Dental Medicine, Damascus University, Damascus P.O. Box 30621, Syria; (M.K.); (O.H.)
- The Higher Institute for Laser Research and Applications, Damascus University, Damascus P.O. Box 30621, Syria
| | - Maher Saifo
- Faculty of Medicine, Medical Oncology, Damascus University, Damascus P.O. Box 30621, Syria;
- Albairouni University Hospital, Damascus University, Damascus P.O. Box 30621, Syria
| | - Hasan Khalil
- Department of Microbiology and Biochemistry, Tishreen University, Lattakia P.O. Box 2230, Syria;
| | - Mowaffak Adi
- Shining Horizons Dental Center, Inaya Medical Colleges, Riyadh 13541, Saudi Arabia;
| | - Faris Alabeedi
- UWA Dental School, The University of Western Australia, Nedlands, WA 6009, Australia;
| | - Omar Kujan
- UWA Dental School, The University of Western Australia, Nedlands, WA 6009, Australia;
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Ali J, Khan AU, Shah FA, Ali H, Islam SU, Kim YS, Khan S. Mucoprotective effects of Saikosaponin-A in 5-fluorouracil-induced intestinal mucositis in mice model. Life Sci 2019; 239:116888. [DOI: 10.1016/j.lfs.2019.116888] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/13/2019] [Accepted: 09/17/2019] [Indexed: 01/20/2023]
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Kianian F, Karimian SM, Kadkhodaee M, Takzaree N, Seifi B, Adeli S, Harati E, Sadeghipour HR. Combination of ascorbic acid and calcitriol attenuates chronic asthma disease by reductions in oxidative stress and inflammation. Respir Physiol Neurobiol 2019; 270:103265. [PMID: 31404684 DOI: 10.1016/j.resp.2019.103265] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 07/24/2019] [Accepted: 08/02/2019] [Indexed: 11/29/2022]
Abstract
Airway inflammation and oxidative stress are the two major characteristics of asthma pathogenesis. Therefore, this study evaluated the protective effects of ascorbic acid in combination with calcitriol on the oxidative damages and inflammation in asthma model. All animals, except in the control group, were sensitized and challenged with ovalbumin. One day after the last challenge, samples of bronchoalveolar lavage fluid was collected for the assessment of total white blood cell counts and differential count of white blood cell and plasma was used for the measurement of pro-oxidant/antioxidant balance level. Lung tissue samples were also stored for examining peribronchial inflammatory cell infiltration, phosphorylated nuclear factor-kappa B expression and measurement of malondialdehyde level. Induction of asthma caused significant increases in total white blood cell counts, percentage of neutrophils and eosinophils and a decrease in the percentage of lymphocytes. Moreover, asthma resulted in significant increases of peribronchial inflammatory cell infiltration, phosphorylated nuclear factor-kappa B expression and malondialdehyde level. However, no significant changes were observed in pro-oxidant/antioxidant balance level with the induction of asthma. Co-administration of low doses of ascorbic acid and calcitriol returned all to the levels measured before sensitization and challenge. Combination of low doses of ascorbic acid with calcitriol improves mouse asthma model by a possible additive effects through the decrease of oxidative stress and inflammation.
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Affiliation(s)
- Farzaneh Kianian
- Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Morteza Karimian
- Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehri Kadkhodaee
- Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasrin Takzaree
- Department of Anatomy and Histology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Behjat Seifi
- Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheila Adeli
- Electrophysiology Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Harati
- Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Sadeghipour
- Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Ariyawardana A, Cheng KKF, Kandwal A, Tilly V, Al-Azri AR, Galiti D, Chiang K, Vaddi A, Ranna V, Nicolatou-Galitis O, Lalla RV, Bossi P, Elad S. Systematic review of anti-inflammatory agents for the management of oral mucositis in cancer patients and clinical practice guidelines. Support Care Cancer 2019; 27:3985-3995. [PMID: 31286230 DOI: 10.1007/s00520-019-04888-w] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/22/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this systematic review was to update the clinical practice guidelines for the use of anti-inflammatory agents in the prevention and/or treatment of oral mucositis. METHODS A systematic review was conducted by the Multinational Association of Supportive Care in Cancer/ International Society of Oral Oncology (MASCC/ISOO) subcommittee on mucositis guideline update. The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. The findings were added to the database used to develop the clinical practice guidelines published in 2014. Based on the evidence level, one of the following three guideline determinations was possible: recommendation, suggestion, and no guidelines. RESULTS A total of 11 new papers across five interventions were examined. The recommendation for the use of benzydamine mouthwash for the prevention of radiotherapy-induced mucositis remained unchanged. New suggestion for the use of the same for prevention of mucositis associated with chemoradiotherapy was made. No guideline was possible for any other anti-inflammatory agents due to inadequate and/or conflicting evidence. CONCLUSIONS Of the anti-inflammatory agents studied for oral mucositis, the evidence supports the use of benzydamine mouthwash in the specific populations listed above. Additional well-designed research is needed on other (class of agents) interventions and in other cancer treatment settings.
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Affiliation(s)
- Anura Ariyawardana
- College of Medicine and Dentistry, James Cook University, Cairns, Australia. .,Metro South Oral Health, Brisbane, Australia.
| | - Karis Kin Fong Cheng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Abhishek Kandwal
- Department of Dental Surgery, Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himalayn University, Dehradun, Uttarakhand, India
| | - Vanessa Tilly
- Dental Oncology Service, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Abdul Rahman Al-Azri
- Dental and OMFS Department, Oral Pathology and Medicine, Al-Nahdha Hospital, Ministry of Health, Muscat, Oman
| | - Dimitra Galiti
- Dental School, National and Kapodistrian University of Athens, Athens, Greece
| | - Karen Chiang
- Pharmacy Department, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Anusha Vaddi
- Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Vinisha Ranna
- Department of Oral and Maxillofacial Surgery, The Mount Sinai Hospital, New York, NY, USA
| | | | - Rajesh V Lalla
- Section of Oral Medicine, University of Connecticut School of Dental Medicine, Farmington, CT, USA
| | - Paolo Bossi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health-Medical Oncology, ASST-Spedali Civili, University of Brescia, Brescia, Italy
| | - Sharon Elad
- Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
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van Leeuwen SJM, Potting CMJ, Huysmans MCDNJM, Blijlevens NMA. Salivary Changes before and after Hematopoietic Stem Cell Transplantation: A Systematic Review. Biol Blood Marrow Transplant 2019; 25:1055-1061. [PMID: 30710684 DOI: 10.1016/j.bbmt.2019.01.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 01/21/2019] [Indexed: 12/11/2022]
Abstract
Severe oral problems, including oral mucositis (OM) and xerostomia, often occur after conditioning therapy for hematopoietic stem cell transplantation (HSCT). Saliva plays a major role in protecting the oral mucosa and teeth. Alterations in salivary flow rate or salivary components resulting in decreased salivary defence mechanisms may affect oral/mucosal health and may influence the severity of OM. A systematic review was conducted to assess the current scientific knowledge on changes in salivary function and composition before and after HSCT. All English or Dutch articles examining salivary flow rate or salivary components before and after HSCT were included after title/abstract selection by 2 independent reviewers (weighted κ = .91). After quality assessment and exclusion of all research groups with both children age <14 years and adults, 33 articles were included for data analysis. Overall, the salivary flow rate was decreased at several days and months after HSCT. Although several salivary components were studied, most components were examined in only 1 or 2 studies with different patient populations or at different time points after HSCT. At 7 days after HSCT, albumin and proinflammatory cytokines were increased, whereas secretory IgA and components of the salivary antioxidant system were decreased. Secretory IgA levels were still reduced at 1 month after HSCT but returned to pre-HSCT values at 6 months after HSCT. Lactoferrin, secretory leukocyte protease inhibitor, and β2-microglobulin levels were increased at 6 months after HSCT. Our findings show that changes in saliva reflect an inflammatory response occurring immediately after HSCT, followed by evidence of increased salivary antimicrobial defense mechanisms by 6 months after HSCT.
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Affiliation(s)
| | - Carin M J Potting
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Nicole M A Blijlevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
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Medeiros ADC, Azevedo ÍM, Lima ML, Araújo Filho I, Moreira MD. Effects of simvastatin on 5-fluorouracil-induced gastrointestinal mucositis in rats. ACTA ACUST UNITED AC 2018; 45:e1968. [PMID: 30379218 DOI: 10.1590/0100-6991e-20181968] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 08/28/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE simvastatin has pleiotropic anti-inflammatory and immunomodulatory effects potentially usefull to prevent chemotherapy-induced gastrointestinal mucositis. Studies on this are scarce. This study aimed to examine the effects of simvastatin on gastric and intestinal mucositis after 5-fluorouracil (5-FU) treatment in rats. METHODS rats weighing 270±18g were divided into two groups. The 5-FU+saline group (5-FU/SAL) rats were treated with 5-FU (50mg/kg) plus 0.9% saline orally (gavage) once daily for five days. The 5-FU+simvastatin (5-FU/SIMV) group was treated with 5-FU (50mg/kg), plus simvastatin (10mg/kg), in the same way. The rats were euthanased on the sixth day, then their stomach and intestine were photographed and removed for exams. Dosages of serum TNF-a, IL-1ß, IL-6 and histopathology were done for stomach and intestine. RESULTS body-weight was significantly lower in rats treated with 5-FU+saline than the weight loss of the 5-FU/SIMV group rats. TNF-a expression was lower in 5-FU/SIMV group (172.6±18pg/ml) than in 5-FU/SAL (347.5±63pg/ml). Serum IL-1b was lower in 5-FU/SAL group (134.5±23pg/ml) than in 5-FU/SIMV (48.3±9pg/ml). Serum IL-6 was 61.8±15pg/ml in 5-FU/SIMV and 129.4±17pg/ml in 5-FU/SAL groups. These differences were significant (p<0.05). Mucosal damage in stomach and jejunum were observed in rats receiving 5-FU alone. In the stomach and jejunum, simvastatin caused significant protective effects against 5-FU-induced mucosal injury. CONCLUSION simvastatin attenuated gastric and intestinal mucositis related to 5-FU therapeutics in animal model. These data encourage forthcoming clinical studies addressing the usefulness of statins in the prevention and treatment of gastrointestinal mucositis.
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Affiliation(s)
- Aldo da Cunha Medeiros
- Universidade Federal do Rio Grande do Norte, Departamento de Cirurgia, Natal, RN, Brasil
| | - Ítalo Medeiros Azevedo
- Universidade Federal do Rio Grande do Norte, Departamento de Cirurgia, Natal, RN, Brasil
| | - Marília Leite Lima
- Universidade Federal do Rio Grande do Norte, Departamento de Cirurgia, Natal, RN, Brasil
| | - Irami Araújo Filho
- Universidade Federal do Rio Grande do Norte, Departamento de Cirurgia, Natal, RN, Brasil
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Nishikawa K, Aoyama T, Oba MS, Yoshikawa T, Matsuda C, Munemoto Y, Takiguchi N, Tanabe K, Nagata N, Imano M, Oshiro M, Fukushima R, Kataoka M, Morita S, Tsuburaya A, Mishima H, Kono T, Sakamoto J. The clinical impact of Hangeshashinto (TJ-14) in the treatment of chemotherapy-induced oral mucositis in gastric cancer and colorectal cancer: Analyses of pooled data from two phase II randomized clinical trials (HANGESHA-G and HANGESHA-C). J Cancer 2018; 9:1725-1730. [PMID: 29805697 PMCID: PMC5968759 DOI: 10.7150/jca.24733] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/04/2018] [Indexed: 11/06/2022] Open
Abstract
Background: The current pooled analysis evaluated the efficacy of Hangeshashinto (TJ-14) in the prevention and/or treatment of chemotherapy-induced oral mucositis (COM) in gastric cancer and colorectal cancer using two prospective, multi-institutional, randomized, double-blind, placebo-controlled phase II trials. Patients and Methods: HANGESHA-G and HANGESHA-C randomly assigned patients with gastric cancer or colorectal cancer who developed moderate to severe COM (grade ≥1) during any cycle of chemotherapy to receive either TJ-14 or a placebo as a double-blind trial. The patients received a placebo or TJ-14 for four to six weeks, according to the chemotherapy regimen, from the start of their next course of chemotherapy. The primary endpoint was the incidence of grade ≥2 COM in the protocol treatment course, and the secondary endpoints were the time to disappearance of COM and the incidence of adverse events. Results: The pooled population included 181 patients. The incidence of grade ≥2 COM in the TJ-14 group was 55.7% (49 patients), while that in the placebo group was 53.8% (50 patients); there was no significant difference between the two groups (p=0.796). The median time to remission of grade ≥2 COM to grade <1 was 8 days in the TJ-14 group and 15 days in the placebo group (p= 0.072). The hazard ratio was 1.54 [1.02 to 2.31] in favor of TJ-14. Treatment with TJ-14 was associated with marginally significant reduction in the duration of severe grade ≥2 COM in comparison to patients receiving placebo indicating the effect of TJ-14 in reducing the severity of COM. Conclusion: The present-pooled analysis showed that TJ-14 had a treatment effect in gastric cancer and colorectal cancer patients with COM in comparison to a placebo. Further phase III studies with a larger sample size are needed to clarify the protective effects of TJ-14 against COM.
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Affiliation(s)
| | - Toru Aoyama
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center
| | - Mari S Oba
- Department of Biostatistics and Epidemiology, Yokohama City University
| | | | - Chu Matsuda
- Department of Gastrointestinal Surgery, Osaka University
| | | | | | - Kazuaki Tanabe
- Department of Gastroenterological and Transplant Surgery, Hiroshima University
| | | | | | | | | | | | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University
| | | | | | - Toru Kono
- Department of Surgery, Asahikawa Medical University
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Kirk J, Shah N, Noll B, Stevens CB, Lawler M, Mougeot FB, Mougeot JLC. Text mining-based in silico drug discovery in oral mucositis caused by high-dose cancer therapy. Support Care Cancer 2018; 26:2695-2705. [PMID: 29476419 DOI: 10.1007/s00520-018-4096-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/04/2018] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Oral mucositis (OM) is a major dose-limiting side effect of chemotherapy and radiation used in cancer treatment. Due to the complex nature of OM, currently available drug-based treatments are of limited efficacy. OBJECTIVES Our objectives were (i) to determine genes and molecular pathways associated with OM and wound healing using computational tools and publicly available data and (ii) to identify drugs formulated for topical use targeting the relevant OM molecular pathways. METHODS OM and wound healing-associated genes were determined by text mining, and the intersection of the two gene sets was selected for gene ontology analysis using the GeneCodis program. Protein interaction network analysis was performed using STRING-db. Enriched gene sets belonging to the identified pathways were queried against the Drug-Gene Interaction database to find drug candidates for topical use in OM. RESULTS Our analysis identified 447 genes common to both the "OM" and "wound healing" text mining concepts. Gene enrichment analysis yielded 20 genes representing six pathways and targetable by a total of 32 drugs which could possibly be formulated for topical application. A manual search on ClinicalTrials.gov confirmed no relevant pathway/drug candidate had been overlooked. Twenty-five of the 32 drugs can directly affect the PTGS2 (COX-2) pathway, the pathway that has been targeted in previous clinical trials with limited success. CONCLUSIONS Drug discovery using in silico text mining and pathway analysis tools can facilitate the identification of existing drugs that have the potential of topical administration to improve OM treatment.
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Affiliation(s)
- Jon Kirk
- Department of Oral Medicine, Cannon Research Center, Carolinas HealthCare System, Charlotte, NC, USA.,Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Nirav Shah
- Department of Oral Medicine, Cannon Research Center, Carolinas HealthCare System, Charlotte, NC, USA
| | - Braxton Noll
- Department of Oral Medicine, Cannon Research Center, Carolinas HealthCare System, Charlotte, NC, USA
| | - Craig B Stevens
- Department of Oral Medicine, Cannon Research Center, Carolinas HealthCare System, Charlotte, NC, USA
| | - Marshall Lawler
- Department of Oral Medicine, Cannon Research Center, Carolinas HealthCare System, Charlotte, NC, USA
| | - Farah B Mougeot
- Department of Oral Medicine, Cannon Research Center, Carolinas HealthCare System, Charlotte, NC, USA
| | - Jean-Luc C Mougeot
- Department of Oral Medicine, Cannon Research Center, Carolinas HealthCare System, Charlotte, NC, USA. .,Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, Charlotte, NC, USA.
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Marcussen M, Skrubbeltrang C, Bødker JS, Christiansen I, Bøgsted M, Dybkær K, Bergmann OJ, Johnsen HE. A systematic review of molecular responses to cancer therapy in normal human mucosa. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:355-366. [PMID: 29042035 DOI: 10.1016/j.oooo.2017.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 07/24/2017] [Accepted: 08/01/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Cancer therapy-induced inflammation of oral and gastrointestinal mucosae affects patients nonuniformly. Preventive strategies are limited; no biomarker exists for pretreatment identification of patients likely to be severely affected. Animal models are preferred for studying molecular responses in mucosae during chemotherapy, but translation into clinical practice is difficult. We performed a systematic review to retrieve articles that described molecular changes in human mucosae during cancer therapy. STUDY DESIGN We searched MEDLINE and Ovid Embase searches for studies reported in the English language literature from January 1990 to November 2016 and studies referenced in selected articles, which analyzed mucosae from patients at risk of developing mucositis during cancer therapy. Two authors extracted data according to predefined data fields, including study quality indicators. RESULTS We identified 17 human studies on chemotherapy (n = 9) and radiotherapy (n = 8), but no studies on targeted therapy. Studies were heterogeneous with regard to patient cohorts, analysis methods, cancer treatments, biopsy timings, and correlations to clinical mucositis. Consequently, a meta-analysis was not feasible. CONCLUSIONS Few human studies described the molecular responses of the normal mucosa to cancer therapy. Studies were heterogeneous and had sparse correlations to clinical mucositis. We proposed a model for acquiring data on treatment- and disease-specific phenotypes and transcriptomes for predictive or preventive initiatives.
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Affiliation(s)
- Mette Marcussen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | | | - Julie Støve Bødker
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Ilse Christiansen
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
| | - Martin Bøgsted
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark; Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
| | - Karen Dybkær
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark; Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
| | - Olav Jonas Bergmann
- School of Dentistry, Faculty of Health Science, Aarhus University; Aarhus, Denmark
| | - Hans Erik Johnsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark; Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
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11
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Silva VCD, Leitão RFDC, Brito GADC, Martins CDS, Freire GE, Aragão KS, Wanderley CWDS, Freitas MRD. Role of the route of leukotrienes in an experimental model of oral mucositis induced by 5-fluorouracil 1. Acta Cir Bras 2017; 32:712-725. [PMID: 29019589 DOI: 10.1590/s0102-865020170090000004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 08/20/2017] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To investigate the participation of cysteinyl leukotrienes in the pathophysiology of oral mucositis. METHODS Oral mucositis was induced in hamsters using 5-fluorouracil (5-FU; 60 and 40 mg/kg; i.p., on days 1 and 2, respectively, and with excoriations in jugal mucosa on day 4). Montelukast (10, 20, or 40 mg/kg/d; gavage), MK886 (3 mg/kg/d, i.p.), or saline or celecoxib (7.5 mg/kg/d; i.p.) was administered 1 h prior to 5-FU and daily, until the fourth (MK886) or tenth day, when the animals were euthanized and their jugal mucosa was collected for macroscopic, histopathological, and immunohistochemical evaluation. RESULTS Neither montelukast nor MK-886 prevented the oral mucositis induced by 5-FU, as observed by histopathological evaluation. In addition, we did not find significant differences in the expression of inducible nitric oxide synthase-2, cyclooxygenase-2, or interleukin (IL)-1β between the experimental and control groups. However, we did observe a significant decrease in tumor necrosis factor (TNF)-α expression for all doses of montelukast; we also observed a significant decrease in IL-10 with 40 mg/kg/d and MK 886. CONCLUSIONS Cysteinyl leukotrienes do not play an important role in experimental oral mucositis induced by 5-FU. There is a modulating action specifically on TNF-α.
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Affiliation(s)
- Viviane Carvalho da Silva
- Fellow PhD degree, Postgraduate Program in Medical and Surgical Sciences, Department of Surgery, School of Medicine, Universidade Federal do Ceará (UFCE), Fortaleza-CE, Brazil. Conception and design of the study, acquisition and interpretation of data, statistics analysis, manuscript preparation, final approval
| | - Renata Ferreira de Carvalho Leitão
- PhD, Postgraduate Program in Morphofunctional Sciences, Department of Morphology, School of Medicine, UFCE, Fortaleza-CE, Brazil. Acquisition and interpretation of data, histopathological examinations, manuscript preparation
| | - Gerly Anne de Castro Brito
- PhD, Postgraduate Program in Morphofunctional Sciences, Department of Morphology, School of Medicine, UFCE, Fortaleza-CE, Brazil. Acquisition and interpretation of data, histopathological examinations, manuscript preparation
| | - Conceição da Silva Martins
- PhD, Postgraduate Program in Morphofunctional Sciences, Department of Morphology, School of Medicine, UFCE, Fortaleza-CE, Brazil. Acquisition and interpretation of data, histopathological examinations, manuscript preparation
| | - Gildenio Estevam Freire
- Fellow Master degree, Postgraduate Program in Morphofunctional Sciences, Department of Morphology, School of Medicine, UFCE, Fortaleza-CE, Brazil. Acquisition and interpretation of data, manuscript preparation
| | - Karoline Saboia Aragão
- PhD, Laboratory of Inflammation and Cancer Pharmacology (LAFICA), UFCE, Fortaleza-CE, Brazil. Conception and design of the study, acquisition and interpretation of data, manuscript preparation
| | | | - Marcos Rabelo de Freitas
- PhD, Postgraduate Program in Medical and Surgical Sciences, Department of Surgery, Faculty of Medicine, UFCE, Fortaleza-CE, Brazil. Conception and design of the study, interpretation of data, manuscript preparation, final approval
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Al-Asmari AK, Khan AQ, Al-Asmari SA, Al-Rawi A, Al-Omani S. Alleviation of 5-fluorouracil-induced intestinal mucositis in rats by vitamin E via targeting oxidative stress and inflammatory markers. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2017; 13:377-385. [PMID: 27682716 DOI: 10.1515/jcim-2016-0043] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/11/2016] [Indexed: 11/15/2022]
Abstract
BackgroundIntestinal mucositis is a major concern related with cancer therapy. It is well established that overproduction of reactive oxygen species and inflammatory mediators plays vital role in the pathogenesis of mucositis. The aim of the study was to investigate the modulatory effect of vitamin E (vit. E) on 5-fluorouracil (5-FU)-induced intestinal mucositis by targeting oxidative stress and inflammatory markers in rats. MethodsRats were randomly divided into four groups of six animals each. All four-group animals received normal standard diet and water throughout the experimental period which last up to 10 days. Rats were gavaged with vit. E (300 mg/kg b. wt.) daily for 10 days (day 1-10) and were given intraperitoneal injection of 5-FU (150 mg/kg b. wt.) or saline (control) on day 8 to induce mucositis. Results We found that vit. E supplementation ameliorated 5-FU-induced lipid peroxidation, myeloperoxidase activity, activation of nuclear factor κB, expression of cyclooxygenase-2, inducible nitric oxide synthase and mucin depletion. Vit. E administration also attenuated 5-FU-induced histological anomalies such as neutrophil infiltration, loss of cellular integrity, villus and crypt deformities. ConclusionsFindings of the study suggest that vit. E inhibits 5-FU-induced mucositis via modulation of oxidative stress, activation of redox sensitive transcription factor and its downstream targets.
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Effect of photobiomodulation therapy on reducing the chemo-induced oral mucositis severity and on salivary levels of CXCL8/interleukin 8, nitrite, and myeloperoxidase in patients undergoing hematopoietic stem cell transplantation: a randomized clinical trial. Lasers Med Sci 2017; 32:1801-1810. [DOI: 10.1007/s10103-017-2263-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 06/11/2017] [Indexed: 12/16/2022]
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Maria OM, Eliopoulos N, Muanza T. Radiation-Induced Oral Mucositis. Front Oncol 2017; 7:89. [PMID: 28589080 PMCID: PMC5439125 DOI: 10.3389/fonc.2017.00089] [Citation(s) in RCA: 212] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 04/21/2017] [Indexed: 01/11/2023] Open
Abstract
Radiation-induced oral mucositis (RIOM) is a major dose-limiting toxicity in head and neck cancer patients. It is a normal tissue injury caused by radiation/radiotherapy (RT), which has marked adverse effects on patient quality of life and cancer therapy continuity. It is a challenge for radiation oncologists since it leads to cancer therapy interruption, poor local tumor control, and changes in dose fractionation. RIOM occurs in 100% of altered fractionation radiotherapy head and neck cancer patients. In the United Sates, its economic cost was estimated to reach 17,000.00 USD per patient with head and neck cancers. This review will discuss RIOM definition, epidemiology, impact and side effects, pathogenesis, scoring scales, diagnosis, differential diagnosis, prevention, and treatment.
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Affiliation(s)
- Osama Muhammad Maria
- Faculty of Medicine, Experimental Medicine Department, McGill University, Montreal, QC, Canada
- Radiation Oncology Department, Jewish General Hospital, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Nicoletta Eliopoulos
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
- Faculty of Medicine, Surgery Department, McGill University, Montreal, QC, Canada
| | - Thierry Muanza
- Faculty of Medicine, Experimental Medicine Department, McGill University, Montreal, QC, Canada
- Radiation Oncology Department, Jewish General Hospital, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
- Oncology Department, McGill University, Montreal, QC, Canada
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Hangeshashinto (TJ-14) prevents radiation-induced mucositis by suppressing cyclooxygenase-2 expression and chemotaxis of inflammatory cells. Clin Transl Oncol 2017; 19:1329-1336. [PMID: 28516399 DOI: 10.1007/s12094-017-1672-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 05/05/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Radiation-induced oral mucositis is the most common side effect of radiotherapy in head and neck cancer; however, effective modalities for its prevention have not been established. In this study, we evaluated the effectiveness of Hangeshashinto (TJ-14), a Japanese herbal medicine, for preventing radiation-induced mucositis and elucidated its effect on inflammatory responses, including inflammatory cell chemotaxis and cyclooxygenase-2 (COX2) expression, in an animal model. METHODS Syrian hamsters, 8-9 weeks old, were enrolled in this study. Animals were irradiated with a single 40 Gy dose to the buccal mucosa. Hamsters freely received a treatment diet mixed with 2% TJ-14 or a normal diet daily. The therapeutic effect was determined based on the visual mucositis score, body weight, and histological examination of infiltrated neutrophils and COX2 expression. RESULTS TJ-14 significantly reduced the severity of mucositis. The percentage with severe mucositis (score ≥3) was 100% in the untreated group and 16.7% in the TJ-14 group (P < 0.05). There was no difference in body weight change between the groups; however, weight gain in the untreated group tended to be suppressed compared to that in the TJ-14 group during the peak period of mucositis. In addition, TJ-14 inhibited the infiltration of neutrophils and COX2 expression in irradiated mucosa (P < 0.05). CONCLUSIONS TJ-14 reduced the severity of mucositis in an animal model by suppressing the inflammatory response. Because TJ-14 is inexpensive and its safety is established, it is a promising candidate for the standard treatment of radiation-induced mucositis in cancer patients.
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Marcussen M, Bødker JS, Christensen HS, Johansen P, Nielsen S, Christiansen I, Bergmann OJ, Bøgsted M, Dybkær K, Vyberg M, Johnsen HE. Molecular Characteristics of High-Dose Melphalan Associated Oral Mucositis in Patients with Multiple Myeloma: A Gene Expression Study on Human Mucosa. PLoS One 2017; 12:e0169286. [PMID: 28052121 PMCID: PMC5215401 DOI: 10.1371/journal.pone.0169286] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 12/14/2016] [Indexed: 11/19/2022] Open
Abstract
Background Toxicity of the oral and gastrointestinal mucosa induced by high-dose melphalan is a clinical challenge with no documented prophylactic interventions or predictive tests. The aim of this study was to describe molecular changes in human oral mucosa and to identify biomarkers correlated with the grade of clinical mucositis. Methods and Findings Ten patients with multiple myeloma (MM) were included. For each patient, we acquired three buccal biopsies, one before, one at 2 days, and one at 20 days after high-dose melphalan administration. We also acquired buccal biopsies from 10 healthy individuals that served as controls. We analyzed the biopsies for global gene expression and performed an immunohistochemical analysis to determine HLA-DRB5 expression. We evaluated associations between clinical mucositis and gene expression profiles. Compared to gene expression levels before and 20 days after therapy, at two days after melphalan treatment, we found gene regulation in the p53 and TNF pathways (MDM2, INPPD5, TIGAR), which favored anti-apoptotic defense, and upregulation of immunoregulatory genes (TREM2, LAMP3) in mucosal dendritic cells. This upregulation was independent of clinical mucositis. HLA-DRB1 and HLA-DRB5 (surface receptors on dendritic cells) were expressed at low levels in all patients with MM, in the subgroup of patients with ulcerative mucositis (UM), and in controls; in contrast, the subgroup with low-grade mucositis (NM) displayed 5–6 fold increases in HLA-DRB1 and HLA-DRB5 expression in the first two biopsies, independent of melphalan treatment. Moreover, different splice variants of HLA-DRB1 were expressed in the UM and NM subgroups. Conclusions Our results revealed that, among patients with MM, immunoregulatory genes and genes involved in defense against apoptosis were affected immediately after melphalan administration, independent of the presence of clinical mucositis. Furthermore, our results suggested that the expression levels of HLA-DRB1 and HLA-DRB5 may serve as potential predictive biomarkers for mucositis severity.
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Affiliation(s)
- Mette Marcussen
- Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, Aalborg, Denmark
- Clinical Cancer Research Center, Aalborg University Hospital, Sdr. Skovvej 15, Aalborg, Denmark
- Department of Haematology, Aalborg University Hospital, Hobrovej 18–22, Aalborg, Denmark
- * E-mail:
| | - Julie Støve Bødker
- Clinical Cancer Research Center, Aalborg University Hospital, Sdr. Skovvej 15, Aalborg, Denmark
- Department of Haematology, Aalborg University Hospital, Hobrovej 18–22, Aalborg, Denmark
| | - Heidi Søgaard Christensen
- Clinical Cancer Research Center, Aalborg University Hospital, Sdr. Skovvej 15, Aalborg, Denmark
- Department of Haematology, Aalborg University Hospital, Hobrovej 18–22, Aalborg, Denmark
| | - Preben Johansen
- Department of Pathology, Aalborg University Hospital, Ladegaardsgade 3, Denmark
| | - Søren Nielsen
- Department of Pathology, Aalborg University Hospital, Ladegaardsgade 3, Denmark
| | - Ilse Christiansen
- Department of Haematology, Aalborg University Hospital, Hobrovej 18–22, Aalborg, Denmark
| | - Olav Jonas Bergmann
- School of Dentistry, Faculty of Health Science, Aarhus University; Vennelyst Boulevard 9, Aarhus, Denmark
| | - Martin Bøgsted
- Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, Aalborg, Denmark
- Clinical Cancer Research Center, Aalborg University Hospital, Sdr. Skovvej 15, Aalborg, Denmark
- Department of Haematology, Aalborg University Hospital, Hobrovej 18–22, Aalborg, Denmark
| | - Karen Dybkær
- Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, Aalborg, Denmark
- Clinical Cancer Research Center, Aalborg University Hospital, Sdr. Skovvej 15, Aalborg, Denmark
- Department of Haematology, Aalborg University Hospital, Hobrovej 18–22, Aalborg, Denmark
| | - Mogens Vyberg
- Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, Aalborg, Denmark
- Clinical Cancer Research Center, Aalborg University Hospital, Sdr. Skovvej 15, Aalborg, Denmark
- Department of Pathology, Aalborg University Hospital, Ladegaardsgade 3, Denmark
| | - Hans Erik Johnsen
- Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, Aalborg, Denmark
- Clinical Cancer Research Center, Aalborg University Hospital, Sdr. Skovvej 15, Aalborg, Denmark
- Department of Haematology, Aalborg University Hospital, Hobrovej 18–22, Aalborg, Denmark
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Song M, Baik HW, Hong SG, Sung MK. Wheat bran arabinoxylan supplementation alleviates 5-fluorouracil induced mucositis and myelosuppression in BALB/c mice. J Funct Foods 2016. [DOI: 10.1016/j.jff.2015.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Use of Chamomilla recutita in the Prevention and Treatment of Oral Mucositis in Patients Undergoing Hematopoietic Stem Cell Transplantation. Cancer Nurs 2015; 38:322-9. [DOI: 10.1097/ncc.0000000000000194] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Al-Asmari AK, Khan AQ, Al-Qasim AM, Al-Yousef Y. Ascorbic acid attenuates antineoplastic drug 5-fluorouracil induced gastrointestinal toxicity in rats by modulating the expression of inflammatory mediators. Toxicol Rep 2015; 2:908-916. [PMID: 28962429 PMCID: PMC5598240 DOI: 10.1016/j.toxrep.2015.06.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/06/2015] [Accepted: 06/07/2015] [Indexed: 12/22/2022] Open
Abstract
Damage to the mucous membrane is a serious issue associated with chemotherapy. Gastrointestinal (GI) toxicity is complex and multistep process and unregulated production of reactive oxygen species (ROS) and inflammatory mediators play vital role in the development of GI toxicity. In the present study we have investigated the attenuating potential of vitamin C (vit. C) on 5 fluorouracil (5-FU) induced GI toxicity by targeting oxidative stress and inflammatory markers in Sprague Dawley (SD) rats. Rats were gavaged with vit. C (500 mg/kg b. wt.) or vehicle daily (day 1-10) and were given intraperitoneal injection of 5-FU (150 mg/kg b. wt.) or saline (control) on day 8 to induce mucositis. We found that vit. C supplementation attenuated 5-FU induced lipid peroxidation, myeloperoxidase (MPO) activity, activation of NF-kB and expression of COX-2. Histological observations further supported the protective potential of vit. C against 5-FU induced intestinal anomalies such as neutrophil infiltration, loss of cellular integrity, villus and crypt deformities. Thus the biochemical, molecular and histological findings of the present study demonstrate that oxidative stress and inflammation play vital role in 5-FU induced GI toxicity and the inhibitory potential of vit. C is may be due to the modulation of oxidative stress, activation of redox sensitive transcription factor and also its downstream target molecules.
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Matsuda C, Munemoto Y, Mishima H, Nagata N, Oshiro M, Kataoka M, Sakamoto J, Aoyama T, Morita S, Kono T. Double-blind, placebo-controlled, randomized phase II study of TJ-14 (Hangeshashinto) for infusional fluorinated-pyrimidine-based colorectal cancer chemotherapy-induced oral mucositis. Cancer Chemother Pharmacol 2015; 76:97-103. [PMID: 25983022 PMCID: PMC4485889 DOI: 10.1007/s00280-015-2767-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 05/05/2015] [Indexed: 01/30/2023]
Abstract
Purpose
Hangeshashinto (TJ-14, a Kampo medicine), which reduces the level of prostaglandin E2 and affects the cyclooxygenase activity, alleviates chemotherapy-induced oral mucositis (COM). We conducted a double-blind, placebo-controlled, randomized comparative trial to investigate whether TJ-14 prevents and controls COM in patients with colorectal cancer. Methods Ninety-three patients with colorectal cancer who developed moderate-to-severe COM (WHO grade ≧1) during any cycle of chemotherapy using FOLFOX, FOLFIRI, and/or XELOX treatment were randomly assigned to receive either TJ-14 (n = 46) or placebo (n = 47). Patients received the administration of placebo or TJ-14 for 2 weeks at the start of the next course of chemotherapy. Patients were assessed three times per week for safety and for COM incidence and its severity using the WHO grading.
Results Ninety eligible patients (TJ-14; 43, placebo; 47) per protocol set analysis were included in the analysis after the key-opening. Although the incidence of grade ≧2 oral mucositis was lower for patients treated with TJ-14 compared to those treated with placebo, there was no significant difference (48.8 vs. 57.4 %; p = 0.41). The median duration of grade ≧2 mucositis
was 5.5 versus 10.5 days (p = 0.018). No difference in other treatment toxicity was observed between the two groups, and patients exhibited high compliance in dosing administration. Conclusion The present study results did not meet the primary endpoint. However, TJ-14 demonstrated a significant effect in the treatment of grade ≧2 mucositis in patients with colorectal cancer compared to the placebo.
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Affiliation(s)
- Chu Matsuda
- Department of Surgery, Osaka General Medical Center, Osaka, Japan
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Oton-Leite AF, Silva GBL, Morais MO, Silva TA, Leles CR, Valadares MC, Pinezi JCD, Batista AC, Mendonça EF. Effect of low-level laser therapy on chemoradiotherapy-induced oral mucositis and salivary inflammatory mediators in head and neck cancer patients. Lasers Surg Med 2015; 47:296-305. [DOI: 10.1002/lsm.22349] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Angélica F. Oton-Leite
- Department of Oral Medicine (Oral Pathology); Dental School; Federal University of Goiás; Goiânia Goiás 74605-220 Brazil
| | - Geisa Badauy L. Silva
- Department of Oral Medicine (Oral Pathology); Dental School; Federal University of Goiás; Goiânia Goiás 74605-220 Brazil
| | - Marília O. Morais
- Department of Oral Medicine (Oral Pathology); Dental School; Federal University of Goiás; Goiânia Goiás 74605-220 Brazil
| | - Tarcília A. Silva
- Department of Oral Medicine (Oral Pathology); Dental School; Federal University of Minas Gerais; Belo Horizonte Minas Gerais 31270-901 Brazil
| | - Cláudio R. Leles
- Department of Prevention and Oral Rehabilitation, Dental School; Federal University of Goiás; Goiânia Goiás 74605-220 Brazil
| | - Marize Campos Valadares
- Laboratory of Cellular Pharmacology and Toxicology; Faculty of Pharmacy; Federal University of Goiás; Goiânia Goiás 74605-220 Brazil
| | - Juliana Castro D. Pinezi
- Radiotherapy Department of the Araújo Jorge Hospital; Association of Cancer Combat of Goiás; Goiânia Goiás 74605-070 Brazil
| | - Aline C. Batista
- Department of Oral Medicine (Oral Pathology); Dental School; Federal University of Goiás; Goiânia Goiás 74605-220 Brazil
| | - Elismauro F. Mendonça
- Department of Oral Medicine (Oral Pathology); Dental School; Federal University of Goiás; Goiânia Goiás 74605-220 Brazil
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Martin J, Howard SC, Pillai A, Vogel P, Naren AP, Davis S, Ringwald- Smith K, Buddington K, Buddington RK. The weaned pig as a model for Doxorubicin-induced mucositis. Chemotherapy 2014; 60:24-36. [PMID: 25341697 PMCID: PMC7762628 DOI: 10.1159/000365725] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 07/03/2014] [Indexed: 01/23/2023]
Abstract
BACKGROUND Chemotherapy-induced mucositis (CIM) complicates cancer therapy and limits maximum tolerated doses and efficacy. Rodent models do not reproducibly mimic clinical CIM, so alternative models are needed. METHODS CIM severity was assessed after weaned pigs were treated with doxorubicin (5 and 3.75 mg/kg) using clinical observations, laboratory parameters and gastrointestinal structure and functions. Bovine colostrum was provided as an experimental intervention to the pigs treated receiving the 3.75 mg/kg dose. RESULTS Doxorubin at 3.75 mg/kg decreased food intake and weight gain (p < 0.05) and caused diarrhea and vomiting that coincided with damage to the small intestine mucosa based on histological scoring (p < 0.05). It resulted in higher serum TNF-α concentrations, increased chloride secretion and reduced brush border membrane disaccharidase activities and carrier-mediated glucose uptake (all p < 0.05). The gastrointestinal damage and dysfunction resemble the clinical and laboratory features of CIM in humans; these can be partially prevented by providing cow colostrum. CONCLUSION The weaned pig is a relevant large animal for studying CIM and evaluating existing and experimental interventions for mucositis.
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Affiliation(s)
- Jamee Martin
- Department of Health and Sport Sciences, University of Memphis, Memphis, Tenn., USA
| | - Scott C. Howard
- Department of Oncology and International Outreach Program, Memphis, Tenn., USA
| | - Asha Pillai
- Department of Bone Marrow Transplantation and Cellular Therapy, Memphis, Tenn., USA
| | - Peter Vogel
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, Tenn., USA
| | - Anjaparavanda P. Naren
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Steven Davis
- Department of Abbott Nutrition, Columbus, Ohio, USA
| | - Karen Ringwald- Smith
- Department of Clinical Nutrition, St. Jude Children’s Research Hospital, Memphis, Tenn., USA
| | - Karyl Buddington
- Department of Animal Care Facilities, University of Memphis, Memphis, Tenn., USA
| | - Randal K. Buddington
- Department of Health and Sport Sciences, University of Memphis, Memphis, Tenn., USA
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Svanberg A, Öhrn K, Birgegård G. Caphosol(®) mouthwash gives no additional protection against oral mucositis compared to cryotherapy alone in stem cell transplantation. A pilot study. Eur J Oncol Nurs 2014; 19:50-3. [PMID: 25224595 DOI: 10.1016/j.ejon.2014.07.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 07/14/2014] [Accepted: 07/17/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate if adding Caphosol(®), a mouthwash solution, to oral cryotherapy (OC) further protects against oral mucositis (OM), a toxic painful complication to high dose chemotherapy. METHOD The study was a randomised, controlled, study design. Patients ≥16 years scheduled for allogeneic stem cell transplantation were included consecutively and randomised to experimental group receiving OC combined with Caphosol(®) (n = 20) or control group receiving OC only (n = 20). OC was given from start to end of HDCT. Caphosol(®), from day 0 to day 21. RESULT There were no significant differences regarding age or gender between the groups. Mucositis was assessed with the World Health Organisation (WHO) grading scale. Pain was assessed with a 10 cm visual analogue scale (VAS) from 0 = no pain to 10 = worst imaginable pain. Start and duration of therapy with pain relieving drugs, serum C-reactive protein values, and number of days of hospitalisation were collected from the medical records. Data on OM, oral pain, use of i.v. opioids and total parenteral nutrition were collected during 22 days. There was no significant difference between the groups on OM, oral pain, use of i.v. opioids or TPN between the groups. CONCLUSION The study showed no additional effect of combining Caphosol(®) with OC.
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Affiliation(s)
- Anncarin Svanberg
- Inst for Medical Sciences, Faculty of Medicine, Uppsala University, Sweden.
| | - Kerstin Öhrn
- Department of Health and Social Sciences, Dalarna University, Sweden
| | - Gunnar Birgegård
- Inst for Medical Sciences, Faculty of Medicine, Uppsala University, Sweden
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Randomized double-blind placebo-controlled trial of celecoxib for oral mucositis in patients receiving radiation therapy for head and neck cancer. Oral Oncol 2014; 50:1098-103. [PMID: 25151488 DOI: 10.1016/j.oraloncology.2014.08.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 08/04/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Oral mucositis (OM) is a painful complication of radiation therapy (RT) for head and neck cancer (H&NC). OM can compromise nutrition, require opioid analgesics and hospitalization for pain control, and lead to treatment interruptions. Based on the role of inflammatory pathways in OM pathogenesis, we investigated effect of cyclooxygenase-2 (COX-2) inhibition on severity and morbidity of OM. METHODS In this double-blind placebo-controlled trial, 40 H&NC patients were randomized to daily use of 200 mg celecoxib or placebo, for the duration of RT. Clinical OM, normalcy of diet, pain scores, and analgesic use were assessed 2-3 times/week by blinded investigators during the 6-7 week RT period, using validated scales. RESULTS Twenty subjects were randomized to each arm, which were similar with respect to tumor location, radiation dose, and concomitant chemotherapy. In both arms, mucositis and pain scores increased over course of RT. Intention-to-treat analyses demonstrated no significant difference in mean Oral Mucositis Assessment Scale (OMAS) scores at 5000 cGy (primary endpoint). There was also no difference between the two arms in mean OMAS scores over the period of RT, mean worst pain scores, mean normalcy of diet scores, or mean daily opioid medication use in IV morphine equivalents. There were no adverse events attributed to celecoxib use. CONCLUSIONS Daily use of a selective COX-2 inhibitor, during period of RT for H&NC, did not reduce the severity of clinical OM, pain, dietary compromise or use of opioid analgesics. These findings also have implications for celecoxib use in H&NC treatment regimens (NCT00698204).
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Silva GBL, Sacono NT, Othon-Leite AF, Mendonça EF, Arantes AM, Bariani C, Duarte LGL, Abreu MHN, Queiroz-Júnior CM, Silva TA, Batista AC. Effect of low-level laser therapy on inflammatory mediator release during chemotherapy-induced oral mucositis: a randomized preliminary study. Lasers Med Sci 2014; 30:117-26. [PMID: 25037968 DOI: 10.1007/s10103-014-1624-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 06/22/2014] [Indexed: 01/09/2023]
Abstract
Patients undergoing hematopoietic stem cell transplantation (HSCT) are submitted to a conditioning regimen of high-dose chemotherapy, with or without radiation therapy, which usually results in oral ulcerations and mucosal barrier breakdown. Oral mucositis (OM) is a common and debilitating toxicity side effect of autologous and allogeneic HSCT. The aim of this study was to evaluate the effect of low-level laser therapy (LLLT) on the severity of OM and inflammatory mediator (TNF-α, IL-6, IL-1β, IL-10, TGF-β, metalloproteinases, and growth factors) levels in saliva and blood of HSCT patients. Thirty patients were randomly assigned to two groups: control (n = 15) and laser (n = 15). LLLT was applied from the first day of the conditioning regimen until day 7 post-HSCT (D + 7). Saliva and blood were collected from patients on admission (AD), D-1, D + 3, D + 7, and on marrow engraftment day (ME). Clinical results showed less severe OM in the laser group (p < 0.05). The LLLT group showed increased matrix metalloproteinase 2 (MMP-2) levels in saliva on D + 7 (p = 0.04). Significant differences were also observed for IL-10 on D + 7 and on ME in blood plasma, when compared to the control group (p < 0.05). No significant differences were seen in saliva or blood for the other inflammatory mediators investigated. LLLT was clinically effective in reducing the severity of chemotherapy-induced OM in HSCT patients, and its mechanism of action does not seem to be completely linked to the modulation of pro- or anti-inflammatory cytokines, growth factors or matrix metalloproteinases.
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Affiliation(s)
- Geisa Badauy Lauria Silva
- Hematopoietic Stem Cell Transplant Unit, Araújo Jorge Hospital, Associação de Combate ao Câncer de Goiás, Goiânia, Goiás, Brazil
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Fleming S, Harrison SJ, Blombery P, Joyce T, Stokes K, Seymour JF, Prince HM, Ritchie D. The choice of multiple myeloma induction therapy affects the frequency and severity of oral mucositis after melphalan-based autologous stem cell transplantation. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 14:291-6. [PMID: 24629850 DOI: 10.1016/j.clml.2014.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 02/06/2014] [Accepted: 02/11/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION/BACKGROUND Mucositis is a common complication of high-dose melphalan (HDM) used before autologous stem cell transplantation (ASCT) for multiple myeloma (MM). Mucositis rates are influenced by previous chemotherapy (CT) exposure. We examined the effect of induction therapy before ASCT on ASCT mucositis rates. PATIENTS AND METHODS Patients undergoing first 200 mg/m(2) HDM ASCT were assessed. Those receiving < 200 mg/m(2), or those with previous ASCT were excluded. Patients were evaluated depending on type of induction therapy (CT, immunomodulatory drug [IMiD], or proteasome inhibitor [PI]) before ASCT. A case record review was performed and data collected on response to induction, rates of Grade 3/4 mucositis, and days of total parenteral nutrition (TPN) or parenteral opiate analgesia. RESULTS One hundred twenty-eight patients with ASCT were assessed. Induction therapy was CT- (n = 62), IMiD- (n = 51), or PI-based (n = 15) therapy. Patient characteristics were overall similar, including median age, MM stage, and CD34(+) cell dose. IMiD-based therapy patients had lower rates of mucositis (33% vs. 53%; P = .03) and less opiate requirements (10% vs. 31%; P = .02) compared with those treated with CT. Rates of mucositis and opiate use in the PI group were not different to the CT cohorts (33% vs. 53%; P = .6 and 13% vs. 31%; P = .13), likely due to concurrent anthracycline exposure. TPN usage was similar (CT, 42%; IMiD, 35%; and PI, 20%), as was neutropenia duration and antibiotic usage. CONCLUSION Patients treated with IMiD-based regimens before HDM ASCT had significantly lower rates of mucositis than those treated with CT-based therapy. There were too few patients who received PI therapy to evaluate the effect.
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Affiliation(s)
| | - Simon J Harrison
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; University of Melbourne, Victoria, Australia
| | - Piers Blombery
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Trish Joyce
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Kerrie Stokes
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - John F Seymour
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; University of Melbourne, Victoria, Australia
| | - H Miles Prince
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; University of Melbourne, Victoria, Australia
| | - David Ritchie
- The Royal Melbourne Hospital, Victoria, Australia; Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; University of Melbourne, Victoria, Australia
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Kono T, Kaneko A, Matsumoto C, Miyagi C, Ohbuchi K, Mizuhara Y, Miyano K, Uezono Y. Multitargeted Effects of Hangeshashinto for Treatment of Chemotherapy-Induced Oral Mucositis on Inducible Prostaglandin E2 Production in Human Oral Keratinocytes. Integr Cancer Ther 2014; 13:435-45. [DOI: 10.1177/1534735413520035] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Objective. Chemotherapy-induced oral mucositis (COM) is characterized by painful inflammation with prolonged damage that involves the pathological pain-evoking prostaglandin E2 (PGE2). We previously found that gargling with hangeshashinto (HST), a traditional Japanese medicine, was effective for the treatment of COM. However, little is known regarding the mechanisms. Our aim was to identify the active ingredients and clarify the characteristic effects of HST on the PGE2 system. Methods. Prostanoids produced by human oral keratinocytes (HOK) stimulated with IL-1β were measured by enzyme immunoassay. Active ingredients that regulate PGE2 production were identified and quantified by liquid chromatography–tandem mass spectrometry (LC-MS/MS) and a culture system of HOK cells. Results. Inducible PGE2, PGD2, and PGF2α, metabolites of cyclooxygenase (COX) pathways, were reduced by HST (10-300 µg/mL) without inducing cytotoxicity. The active ingredients of HST were quantified by LC-MS/MS, and [6]-shogaol, [6]-gingerol, wogonin, baicalein, baicalin, and berberine were shown to reduce PGE2 production. A mixture of these 6 ingredients at concentrations equal to 300 µg/mL of HST strongly suppressed PGE2 production to the same level as HST. [6]-Shogaol and [6]-gingerol did not decrease COX-2 mRNA expression and mostly inhibited PGE2 metabolic activity in an assay using intact HOK cells, suggesting that they regulate PGE2 synthesis at the posttranscriptional level. Wogonin, baicalin, and berberine inhibited expression of COX-2 mRNA without affecting PGE2 metabolic activity. Moreover, wogonin, but not [6]-shogaol, suppressed phosphorylation of mitogen-activated protein kinases (p38s and JNKs). Conclusions. These lines show that HST includes several PGE2-regulating ingredients that have different mechanisms and can function as a multicomponent and multitarget agent for treatment of COM, indicating that HST may be beneficial in a new medical strategy for COM treatment.
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Affiliation(s)
- Toru Kono
- Hokkaido University, Sapporo, Japan
- Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Atsushi Kaneko
- Tsumura Research Laboratories, Tsumura and Co, Inashiki-gun, Ibaraki, Japan
| | - Chinami Matsumoto
- Tsumura Research Laboratories, Tsumura and Co, Inashiki-gun, Ibaraki, Japan
| | - Chika Miyagi
- Tsumura Research Laboratories, Tsumura and Co, Inashiki-gun, Ibaraki, Japan
| | - Katsuya Ohbuchi
- Tsumura Research Laboratories, Tsumura and Co, Inashiki-gun, Ibaraki, Japan
| | - Yasuharu Mizuhara
- Tsumura Research Laboratories, Tsumura and Co, Inashiki-gun, Ibaraki, Japan
| | - Kanako Miyano
- National Cancer Center Research Institute, Chuo-ku, Tokyo, Japan
| | - Yasuhito Uezono
- National Cancer Center Research Institute, Chuo-ku, Tokyo, Japan
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Freitas ACC, Campos L, Brandão TB, Cristófaro M, Eduardo FDP, Luiz AC, Marques MM, Eduardo CDP, Simões A. Chemotherapy-induced oral mucositis: effect of LED and laser phototherapy treatment protocols. Photomed Laser Surg 2014; 32:81-7. [PMID: 24476495 DOI: 10.1089/pho.2013.3576] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Over the last few decades, many studies have focused on the effect of lasers on the management of oral mucositis in oncologic patients treated with chemotherapy and/or radiotherapy. However, the effect of light-emitting diode (LED) has been poorly studied, and was not compared with that of laser phototherapy (LPT). For this reason, the aim of the present study was to clinically compare the effect of these two therapies on chemotherapy-induced oral mucositis (CIOM) and pain. METHODS Forty patients with CIOM were divided into two groups: G1, patients treated with LPT; G2, patients treated with LED. The treatment was administered during 10 consecutive days, with exception of weekends. LPT was applied using an InGaAlP laser (660 nm/40 mW/6.6 J cm-(2)/0.24 J per point/0.036 cm(2) of spot size). LED phototherapy was applied using 0.24 J per point/80 mW/630 nm/1 cm(2) of spot size. CIOM was assessed during each session in accordance to the World Health Organization (WHO) score. The patient self-assessed pain was scored on a visual analog scale (VAS). RESULTS The mean VAS and WHO scores were significantly smaller in the LED group (p<0.05). However, both groups required the same number of days to reach score zero for mucositis and pain (p>0.05). Moreover, in the group with severe mucositis (score III), there was a lower frequency of patients with complete healing and pain relief, with the exception of analgesia in G2, in which almost all patients were completely relieved from pain. CONCLUSIONS These findings suggest that LED therapy is more effective than LPT in the treatment of COIM, with the parameters used in the present study.
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Affiliation(s)
- Ana Carolina Carneiro Freitas
- 1 Departamento de Biomateriais e Biologia Oral, Faculdade de Odontologia - Universidade de São Paulo , São Paulo, SP, Brazil
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Thorpe D, Stringer A, Butler R. Chemotherapy-induced mucositis: The role of mucin secretion and regulation, and the enteric nervous system. Neurotoxicology 2013; 38:101-5. [DOI: 10.1016/j.neuro.2013.06.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 06/13/2013] [Accepted: 06/23/2013] [Indexed: 01/19/2023]
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Topical thalidomide gel in oral chronic GVHD and role of in situ cytokine expression in monitoring biological activity. Bone Marrow Transplant 2012; 48:610-1. [PMID: 23000649 DOI: 10.1038/bmt.2012.178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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A randomized, double-blind, placebo-controlled trial of misoprostol for oral mucositis secondary to high-dose chemotherapy. Support Care Cancer 2011; 20:1797-804. [PMID: 21964618 DOI: 10.1007/s00520-011-1277-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 09/13/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE Misoprostol, a synthetic analog of prostaglandin E1, has anti-inflammatory and mucosa-protecting properties. The objective of this study was to evaluate the efficacy of misoprostol oral rinse in reducing the severity of oral mucosal injury caused by high-dose chemotherapy. METHODS The study used a randomized, double-blind, placebo-controlled, parallel-group design. Oncology patients receiving myeloablative high-dose chemotherapy, in preparation for a hematopoietic stem cell transplant, were randomized to misoprostol or placebo rinse. The primary outcome measure was the severity of oral mucositis, measured using the modified Oral Mucositis Index. Additional outcome measures included the severity of mouth pain (measured using a Visual Analog Scale and the Pain Affect Faces Scale), duration of hospital stay, and days on total parenteral nutrition. RESULTS This study was originally planned to accrue 160 subjects but was terminated early due to revised sponsor research priorities. The intent-to-treat population consisted of 22 subjects randomized to misoprostol rinse and 26 subjects randomized to placebo rinse. There was no significant difference between the two groups in mucositis or pain severity. In both groups, duration of hospital stay was approximately 19 days, and number of days on total parenteral nutrition was 17-18 days. There were no serious adverse events attributable to misoprostol rinse. CONCLUSIONS Although this study did not find a beneficial effect of a misoprostol rinse in mucositis secondary to high-dose chemotherapy, the small sample size limits the strength of this conclusion. Given the proposed importance of the prostaglandin pathway in the pathogenesis of oral mucositis, additional studies are warranted.
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Role of bone marrow-derived monocytes/macrophages in the repair of mucosal damage caused by irradiation and/or anticancer drugs in colitis model. Mediators Inflamm 2011; 2010:634145. [PMID: 21274263 PMCID: PMC3022216 DOI: 10.1155/2010/634145] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2010] [Revised: 11/18/2010] [Accepted: 12/07/2010] [Indexed: 12/31/2022] Open
Abstract
Mucosal damage is a common side effect of many cancer treatments, especially radiotherapy and intensive chemotherapy, which often induce bone marrow (BM) suppression. We observed that acetic acid- (AA-) induced mucosal damage in the colon of mice was worsened by simultaneous treatment with irradiation or 5-FU. However, irradiation 14 days prior to the AA treatment augmented the recovery from mucosal damage, suggesting that the recovery from BM suppression had an advantageous effect on the mucosal repair. In addition, BM transplantation also augmented the recovery from AA-induced mucosal damage. We further confirmed that transplanted BM-derived cells, particularly F4/80+Gr1+ “inflammatory” monocytes (Subset 1), accumulated in the damaged mucosal area in the early healing phase, and both of Subset 1 and F4/80+Gr1− “resident” monocytes (Subset 2) accumulated in this area in later phases. Our results suggest that monocytes/macrophages contribute to the mucosal recovery and regeneration following mucosal damage by anticancer drug therapy.
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Kono T, Satomi M, Chisato N, Ebisawa Y, Suno M, Asama T, Karasaki H, Matsubara K, Furukawa H. Topical Application of Hangeshashinto (TJ-14) in the Treatment of Chemotherapy-Induced Oral Mucositis. World J Oncol 2011; 1:232-235. [PMID: 29147213 PMCID: PMC5649748 DOI: 10.4021/wjon263w] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2010] [Indexed: 12/26/2022] Open
Abstract
Background The optimal treatment of chemotherapy-induced oral mucositis is not well established. A recent study showed that hangeshashinto (TJ-14) might be useful for periodontal disease via downregulating pro-inflammatory prostaglandins in the cyclooxygenase pathway in human. Our study aimed to determine whether TJ-14 is effective in the management of chemotherapy-induced oral mucositis. Methods Fourteen patients afflicted with chemotherapy-induced oral mucositis during mFOLFOX6 or FOLFIRI treatment for metastasis of advanced colorectal cancer were randomly assigned to topical TJ-14 treatment thrice daily for 7 days. Patients prepared a 50 ml solution with 2.5 g of TJ-14 dissolved in tap water and rinsed their oral mucosa for more than 5 seconds and then expectorated it. TJ-14 was also topically applied with a cotton pellet on the mucosal lesions. The severity of oral mucositis was evaluated using the Common Terminology Criteria for Adverse Events version 4 before and after one-week TJ-14 treatment. Results After the one-week topical treatment with TJ-14, thirteen of the fourteen patients (92.8 %) showed improvements in oral mucositis, with significantly decreased mean CTCAE grades (P = 0.0012). Compared to baseline, none of the patients' CTCAE grades worsened. The compliance of TJ-14-treatment was good and side effects from TJ-14 were not observed. Conclusions Topical application of TJ-14 may have therapeutic effects in patients with chemotherapy-induced oral mucositis via downregulation of pro-inflammatory prostaglandins. A prospective, randomized, controlled, double-blind studies are necessary to confirm the findings of this open-label, pilot study.
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Affiliation(s)
- Toru Kono
- Division of Gastroenterologic and General Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Machiko Satomi
- Division of Chemotherapy, Higashi-Asahikawa Hospital, Asahikawa, Japan.,Department of Hospital Pharmacy and Pharmacology, Asahikawa Medical University, Asahikawa 078-8510, Japan
| | - Naoyuki Chisato
- Division of Gastroenterologic and General Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Yoshiaki Ebisawa
- Division of Gastroenterologic and General Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Manabu Suno
- Department of Hospital Pharmacy and Pharmacology, Asahikawa Medical University, Asahikawa 078-8510, Japan
| | - Toshiyuki Asama
- Division of Gastroenterologic and General Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa, Japan.,Division of Chemotherapy, Higashi-Asahikawa Hospital, Asahikawa, Japan
| | - Hidenori Karasaki
- Division of Gastroenterologic and General Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Kazuo Matsubara
- Department of Hospital Pharmacy and Pharmacology, Asahikawa Medical University, Asahikawa 078-8510, Japan
| | - Hiroyuki Furukawa
- Division of Gastroenterologic and General Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa, Japan
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Abstract
It has been slightly more than a decade since the classic mechanistic paradigm that defined the pathogenesis of mucositis was revised. A five-stage sequence of linked biological events forms the basis for our current understanding of how regimen-related mucosal injury occurs. The first stage is the initiation phase, although the gateway to toxicity has been the least studied. This essay proposes new thoughts on the phase's components, how they might interact, and how they present new opportunities for treatment interventions and mucositis risk prediction.
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Affiliation(s)
- S T Sonis
- Harvard/Farber Cancer Center, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Blondin JM, Abu-Hasaballah KS, Tennen H, Lalla RV. Electronic versus paper diaries: a pilot study of concordance and adherence in head and neck cancer patients receiving radiation therapy. HEAD & NECK ONCOLOGY 2010; 2:29. [PMID: 20955592 PMCID: PMC2972290 DOI: 10.1186/1758-3284-2-29] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 10/18/2010] [Indexed: 12/28/2022]
Abstract
Background Interactive Voice Response Systems (IVRS) and other electronic data collection methods have begun to replace conventional paper diaries as a way to capture daily patient reports. However, these methods have not been compared in head and neck (H&N) cancer patients receiving radiation therapy. Methods 15 subjects with H&N cancer were asked to complete daily IVRS calls and daily paper diaries during radiation therapy. We compared response consistency and comparative adherence across the two methods. Results 86.1% (1920/2231) of participants' responses were consistent between IVRS and paper diaries. 79.5% of the expected number of paper diaries were completed, compared to 66.2% of IVRS phone calls. Conclusions In this pilot study of H&N cancer patients undergoing radiation therapy, concordance was high between responses recorded by paper diaries and IVRS. Although adherence appeared to be higher for the paper diaries, it is possible that they may not have been completed at the proper time.
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Affiliation(s)
- Joseph M Blondin
- School of Dental Medicine, University of Connecticut Health Center, Farmington, CT, USA
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