1
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Jørgensen MR. Pathophysiological microenvironments in oral candidiasis. APMIS 2024. [PMID: 38571459 DOI: 10.1111/apm.13412] [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: 01/15/2024] [Accepted: 03/20/2024] [Indexed: 04/05/2024]
Abstract
Oral candidiasis (OC), a prevalent opportunistic infection of the oral mucosa, presents a considerable health challenge, particularly in individuals with compromised immune responses, advanced age, and local predisposing conditions. A considerable part of the population carries Candida in the oral cavity, but only few develop OC. Therefore, the pathogenesis of OC may depend on factors other than the attributes of the fungus, such as host factors and other predisposing factors. Mucosal trauma and inflammation compromise epithelial integrity, fostering a conducive environment for fungal invasion. Molecular insights into the immunocompromised state reveal dysregulation in innate and adaptive immunity, creating a permissive environment for Candida proliferation. Detailed examination of Candida species (spp.) and their virulence factors uncovers a nuanced understanding beyond traditional C. albicans focus, which embrace diverse Candida spp. and their strategies, influencing adhesion, invasion, immune evasion, and biofilm formation. Understanding the pathophysiological microenvironments in OC is crucial for the development of targeted therapeutic interventions. This review aims to unravel the diverse pathophysiological microenvironments influencing OC development focusing on microbial, host, and predisposing factors, and considers Candida resistance to antifungal therapy. The comprehensive approach offers a refined perspective on OC, seeking briefly to identify potential therapeutic targets for future effective management.
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Affiliation(s)
- Mette Rose Jørgensen
- Section of Oral Pathology and Oral Medicine, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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2
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Mauramo M, Tonoz N, Halter J, Joseph B, Waltimo T. Oral Candida carriage and resistance against common antifungal agents in hematopoietic stem cell transplantation recipients. Support Care Cancer 2024; 32:185. [PMID: 38393420 PMCID: PMC10891237 DOI: 10.1007/s00520-024-08396-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 02/18/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE Allogeneic hematopoietic stem cell transplant (HSCT) recipients receiving long-term and high-dose immunosuppressive medications suffer commonly from oral candida infections. This prospective cohort study examined oral fungal carriage in HSCT recipients and screened the susceptibility against commonly used antifungal agents. An increasing oral occurrence of Candida spp. and the development of resistance against clinically administered fluconazole were hypothesized. METHODS Two hundred HSCT recipients were included and followed up for 2 years post-HSCT. Oral microbiological specimens were analyzed with matrix-assisted laser desorption/ionization-time of flight mass spectrometry assays (MALDI-TOF). The colorimetric method was applied for the susceptibility testing by commercially available Sensititre YeastOne (SYO®, TREK Diagnostics Systems, Thermo-Fisher, UK). RESULTS The prevalence of oral Candida spp. carriage increased statistically significantly after a year post-HSCT being 30, 26, 35, 44, and 47%, pre-HSCT, 3, 6, 12, and 24 months post-HSCT, respectively. Altogether, 169 clinical oral Candida strains were isolated. Fourteen Candida spp. were identified, and C. albicans was predominant in 74% of the isolates pre-HSCT with a descending prevalence down to 44% 2 years post-HSCT. An increasing relative proportion of non-albicans species post-HSCT was evident. No development of resistance of C. albicans against fluconazole was found. Instead, a shift from C. albicans towards non-albicans species, especially C. dubliensis, C. glabrata, and relatively seldom found C. krusei, was observed. CONCLUSION Oral Candida carriage increases after HSCT. Instead of the expected development of resistance of C. albicans against fluconazole, the relative proportion of non-albicans strains with innate resistance against azole-group antifungals increased.
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Affiliation(s)
- Matti Mauramo
- Department for Oral Health & Medicine, UZB University Centre for Dental Medicine Basel, University of Basel, Basel, Switzerland.
- Department of Pathology, University of Helsinki and Helsinki University Hospital, HUS, Diagnostiikkakeskus, Patologia, PL 400, 00029 HUS, Helsinki, Finland.
| | - Nurgül Tonoz
- Department for Oral Health & Medicine, UZB University Centre for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Jörg Halter
- Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Betsy Joseph
- Saveetha Dental College and Hospitals, Saveetha Institute of Medical And Technical Sciences, Chennai, India
| | - Tuomas Waltimo
- Department for Oral Health & Medicine, UZB University Centre for Dental Medicine Basel, University of Basel, Basel, Switzerland
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3
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Czajka KM, Venkataraman K, Brabant-Kirwan D, Santi SA, Verschoor C, Appanna VD, Singh R, Saunders DP, Tharmalingam S. Molecular Mechanisms Associated with Antifungal Resistance in Pathogenic Candida Species. Cells 2023; 12:2655. [PMID: 37998390 PMCID: PMC10670235 DOI: 10.3390/cells12222655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023] Open
Abstract
Candidiasis is a highly pervasive infection posing major health risks, especially for immunocompromised populations. Pathogenic Candida species have evolved intrinsic and acquired resistance to a variety of antifungal medications. The primary goal of this literature review is to summarize the molecular mechanisms associated with antifungal resistance in Candida species. Resistance can be conferred via gain-of-function mutations in target pathway genes or their transcriptional regulators. Therefore, an overview of the known gene mutations is presented for the following antifungals: azoles (fluconazole, voriconazole, posaconazole and itraconazole), echinocandins (caspofungin, anidulafungin and micafungin), polyenes (amphotericin B and nystatin) and 5-fluorocytosine (5-FC). The following mutation hot spots were identified: (1) ergosterol biosynthesis pathway mutations (ERG11 and UPC2), resulting in azole resistance; (2) overexpression of the efflux pumps, promoting azole resistance (transcription factor genes: tac1 and mrr1; transporter genes: CDR1, CDR2, MDR1, PDR16 and SNQ2); (3) cell wall biosynthesis mutations (FKS1, FKS2 and PDR1), conferring resistance to echinocandins; (4) mutations of nucleic acid synthesis/repair genes (FCY1, FCY2 and FUR1), resulting in 5-FC resistance; and (5) biofilm production, promoting general antifungal resistance. This review also provides a summary of standardized inhibitory breakpoints obtained from international guidelines for prominent Candida species. Notably, N. glabrata, P. kudriavzevii and C. auris demonstrate fluconazole resistance.
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Affiliation(s)
- Karolina M. Czajka
- Medical Sciences Division, NOSM University, 935 Ramsey Lake Rd., Sudbury, ON P3E 2C6, Canada; (K.M.C.); (K.V.); (C.V.); (R.S.); (D.P.S.)
| | - Krishnan Venkataraman
- Medical Sciences Division, NOSM University, 935 Ramsey Lake Rd., Sudbury, ON P3E 2C6, Canada; (K.M.C.); (K.V.); (C.V.); (R.S.); (D.P.S.)
- School of Natural Sciences, Laurentian University, Sudbury, ON P3E 2C6, Canada;
| | | | - Stacey A. Santi
- Health Sciences North Research Institute, Sudbury, ON P3E 2H2, Canada; (D.B.-K.); (S.A.S.)
| | - Chris Verschoor
- Medical Sciences Division, NOSM University, 935 Ramsey Lake Rd., Sudbury, ON P3E 2C6, Canada; (K.M.C.); (K.V.); (C.V.); (R.S.); (D.P.S.)
- School of Natural Sciences, Laurentian University, Sudbury, ON P3E 2C6, Canada;
- Health Sciences North Research Institute, Sudbury, ON P3E 2H2, Canada; (D.B.-K.); (S.A.S.)
| | - Vasu D. Appanna
- School of Natural Sciences, Laurentian University, Sudbury, ON P3E 2C6, Canada;
| | - Ravi Singh
- Medical Sciences Division, NOSM University, 935 Ramsey Lake Rd., Sudbury, ON P3E 2C6, Canada; (K.M.C.); (K.V.); (C.V.); (R.S.); (D.P.S.)
- Health Sciences North Research Institute, Sudbury, ON P3E 2H2, Canada; (D.B.-K.); (S.A.S.)
| | - Deborah P. Saunders
- Medical Sciences Division, NOSM University, 935 Ramsey Lake Rd., Sudbury, ON P3E 2C6, Canada; (K.M.C.); (K.V.); (C.V.); (R.S.); (D.P.S.)
- Health Sciences North Research Institute, Sudbury, ON P3E 2H2, Canada; (D.B.-K.); (S.A.S.)
| | - Sujeenthar Tharmalingam
- Medical Sciences Division, NOSM University, 935 Ramsey Lake Rd., Sudbury, ON P3E 2C6, Canada; (K.M.C.); (K.V.); (C.V.); (R.S.); (D.P.S.)
- School of Natural Sciences, Laurentian University, Sudbury, ON P3E 2C6, Canada;
- Health Sciences North Research Institute, Sudbury, ON P3E 2H2, Canada; (D.B.-K.); (S.A.S.)
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4
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Delaney C, Alapati S, Alshehri M, Kubalova D, Veena CLR, Abusrewil S, Short B, Bradshaw D, Brown JL. Investigating the role of Candida albicans as a universal substrate for oral bacteria using a transcriptomic approach: implications for interkingdom biofilm control? APMIS 2023; 131:601-612. [PMID: 37170476 DOI: 10.1111/apm.13327] [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: 03/03/2023] [Accepted: 04/21/2023] [Indexed: 05/13/2023]
Abstract
Candida albicans is frequently identified as a colonizer of the oral cavity in health and has recently been termed a "keystone" commensal due to its role on the bacterial communities. However, the role that C. albicans plays in such interactions is not fully understood. Therefore, this study aimed to identify the relationship between C. albicans and bacteria associated with oral symbiosis and dysbiosis. To do this, we evaluated the ability of C. albicans to support the growth of the aerobic commensal Streptococcus gordonii and the anaerobic pathogens Fusobacterium nucleatum and Porphyromonas gingivalis in the biofilm environment. RNA-Sequencing with the Illumina platform was then utilized to identify C. albicans gene expression and functional pathways involved during such interactions in dual-species and a 4-species biofilm model. Results indicated that C. albicans was capable of supporting growth of all three bacteria, with a significant increase in colony counts of each bacteria in the dual-species biofilm (p < 0.05). We identified specific functional enrichment of pathways in our 4-species community as well as transcriptional profiles unique to the F. nucleatum and S. gordonii dual-species biofilms, indicating a species-specific effect on C. albicans. Candida-related hemin acquisition and heat shock protein mediated processes were unique to the organism following co-culture with anaerobic and aerobic bacteria, respectively, suggestive that such pathways may be feasible options for therapeutic targeting to interfere with these fungal-bacterial interactions. Targeted antifungal therapy may be considered as an option for biofilm destabilization and treatment of complex communities. Moving forward, we propose that further studies must continue to investigate the role of this fungal organism in the context of the interkingdom nature of oral diseases.
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Affiliation(s)
- Christopher Delaney
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Glasgow Biofilm Research Network (www.glasgowbiofilms.ac.uk), Glasgow, UK
| | - Susanth Alapati
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Glasgow Biofilm Research Network (www.glasgowbiofilms.ac.uk), Glasgow, UK
| | - Muhanna Alshehri
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Glasgow Biofilm Research Network (www.glasgowbiofilms.ac.uk), Glasgow, UK
| | - Dominika Kubalova
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Glasgow Biofilm Research Network (www.glasgowbiofilms.ac.uk), Glasgow, UK
| | - Chandra Lekha Ramalingham Veena
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Glasgow Biofilm Research Network (www.glasgowbiofilms.ac.uk), Glasgow, UK
| | - Sumaya Abusrewil
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Glasgow Biofilm Research Network (www.glasgowbiofilms.ac.uk), Glasgow, UK
| | - Bryn Short
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Glasgow Biofilm Research Network (www.glasgowbiofilms.ac.uk), Glasgow, UK
| | | | - Jason L Brown
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Glasgow Biofilm Research Network (www.glasgowbiofilms.ac.uk), Glasgow, UK
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5
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Lyons KM, Cannon RD, Beumer J, Bakr MM, Love RM. Microbial Analysis of Obturators During Maxillofacial Prosthodontic Treatment Over an 8-Year Period. Cleft Palate Craniofac J 2023; 60:1426-1441. [PMID: 35642284 DOI: 10.1177/10556656221104940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of the study was to investigate the microbial colonization (by Candida species, anaerobic and facultative anaerobic bacteria) of maxillary obturators used for the restoration of maxillary defects, including during radiotherapy. Retrospective cohort study. Fifteen patients requiring a maxillary obturator prosthesis had swabs of their obturators and adjacent tissues taken at different stages of their treatment over a period of 8 years. Identification of microbial species from the swabs was carried out using randomly amplified polymorphic DNA polymerase chain reaction (RAPD PCR) analysis, checkerboard DNA-DNA hybridization, CHROMagar Candida chromogenic agar, and DNA sequencing. Candida species were detected in all patients and all patients developed mucositis and candidiasis during radiotherapy which was associated with an increase in colonization of surfaces with Candida spp., particularly C albicans. Microbial colonization increased during radiotherapy and as an obturator aged, and decreased following a reline, delivery of a new prosthesis, or antifungal treatment during radiotherapy. Microbial colonization of maxillary obturators was related to the stage of treatment, age of the obturator material, radiotherapy and antifungal medications, and antifungal treatment may be recommended if C albicans colonization of palatal tissues is greater than 105 colony-forming units per cm2 following the first week of radiotherapy.
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Affiliation(s)
- Karl M Lyons
- Department of Oral Rehabilitation and Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Richard D Cannon
- Department of Oral Sciences and Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - John Beumer
- Division of Advanced Prosthodontics, School of Dentistry, University of California, Los Angeles, CA, USA
| | - Mahmoud M Bakr
- School of Medicine and Dentistry, Griffith University, Queensland, Australia
| | - Robert M Love
- School of Medicine and Dentistry, Griffith University, Queensland, Australia
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6
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Al-Manei K, Sobkowiak MJ, Nagadia RH, Heymann R, Sällberg Chen M, Özenci V. Mycobiota profile of oral fungal infections in head and neck cancer patients receiving radiotherapy: A 6-year retrospective MALDI-TOF mass spectrometry study. Oral Oncol 2023; 146:106556. [PMID: 37611433 DOI: 10.1016/j.oraloncology.2023.106556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/14/2023] [Accepted: 08/13/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVES Head and neck cancer (HNC) impairs patient immunity and increases susceptibility to oral fungal infections (OFIs). Effectively treating such infections requires accurate identification of the causative pathogens. This study aimed to characterize the mycobiota profile of OFIs in HNC patients undergoing radiation treatment (RT). MATERIALS AND METHODS A 6-year retrospective analysis of oral mucosal samples from HNC patients with a history of RT and OFIs between 2014 and 2019 was conducted using Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) profiling. Samples from the Clinical Microbiology Laboratory at Karolinska University Hospital were evaluated for mycobiota diversity and species co-occurrence patterns in the ongoing-RT and post-RT groups. RESULTS A total of 190 oral fungi (88% Candida, 5% Pichia) were isolated from 162 HNC patients receiving RT. In the ongoing-RT group, the emergent non-albicans Candida (NAC) species; F. solani and C. jadinii, were detected for the first time. The dominant pathogens in both ongoing and post-RT groups were C. albicans, C. glabrata, P. kudriavzevii, C. parapsilosis, and C. tropicalis, as shown by Venn analysis. Network analysis revealed greater fungi diversity and multi-species co-occurrence in the ongoing-RT group. C. albicans commonly co-occurred with C. glabrata in both ongoing-RT (21%) and post-RT groups (30%). CONCLUSION MALDI-TOF MS identified a wide range of oral fungal species in HNC patients receiving RT. While C. albicans remains the most prevalent OFIs pathogen, multi-species co-occurrence and novel NACs were noted. Understanding the ecological interactions among these causative pathogens could significantly advance the development of effective therapeutics for treating OFIs in HNC patients.
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Affiliation(s)
- Khaled Al-Manei
- Unit of Oral Diagnostics and Surgery, Department of Dental Medicine, Karolinska Institutet, Huddinge 14104, Sweden; Division of Endodontics, Department of Restorative Dental Science, College of Dentistry, King Saud University, Riyadh 11545, Saudi Arabia
| | - Michał Jacek Sobkowiak
- Unit of Oral Diagnostics and Surgery, Department of Dental Medicine, Karolinska Institutet, Huddinge 14104, Sweden
| | - Rahul Harshad Nagadia
- Unit of Oral Diagnostics and Surgery, Department of Dental Medicine, Karolinska Institutet, Huddinge 14104, Sweden; Department of Head and Neck Surgery, National Cancer Centre Singapore, and Singapore General Hospital, Singapore; Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore, Singapore
| | - Robert Heymann
- Unit of Oral Diagnostics and Surgery, Department of Dental Medicine, Karolinska Institutet, Huddinge 14104, Sweden; Medical Unit for Reconstructive Plastic- and Craniofacial Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Margaret Sällberg Chen
- Unit of Oral Diagnostics and Surgery, Department of Dental Medicine, Karolinska Institutet, Huddinge 14104, Sweden.
| | - Volkan Özenci
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Huddinge 14104, Sweden; Department of Clinical Microbiology F72, Karolinska University Hospital, Huddinge 14104, Sweden.
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7
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Kulchar RJ, Singh R, Ding S, Alexander E, Leong KW, Daniell H. Delivery of biologics: Topical administration. Biomaterials 2023; 302:122312. [PMID: 37690380 PMCID: PMC10840840 DOI: 10.1016/j.biomaterials.2023.122312] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/27/2023] [Accepted: 08/31/2023] [Indexed: 09/12/2023]
Abstract
Biologics are unaffordable to a large majority of the global population because of prohibitively expensive fermentation systems, purification and the requirement for cold chain for storage and transportation. Limitations of current production and delivery systems of biologics were evident during the recent pandemic when <2.5% of vaccines produced were available to low-income countries and ∼19 million doses were discarded in Africa due to lack of cold-chain infrastructure. Among FDA-approved biologics since 2015, >90% are delivered using invasive methods. While oral or topical drugs are highly preferred by patients because of their affordability and convenience, only two oral drugs have been approved by FDA since 2015. A newly launched oral biologic costs only ∼3% of the average cost of injectable biologics because of the simplified regulatory approval process by elimination of prohibitively expensive fermentation, purification, cold storage/transportation. In addition, the cost of developing a new biologic injectable product (∼$2.5 billion) has been dramatically reduced through oral or topical delivery. Topical delivery has the unique advantage of targeted delivery of high concentration protein drugs, without getting diluted in circulating blood. However, only very few topical drugs have been approved by the FDA. Therefore, this review highlights recent advances in oral or topical delivery of proteins at early or advanced stages of human clinical trials using chewing gums, patches or sprays, or nucleic acid drugs directly, or in combination with, nanoparticles and offers future directions.
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Affiliation(s)
- Rachel J. Kulchar
- Department of Basic and Translational Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia PA 19104, USA
| | - Rahul Singh
- Department of Basic and Translational Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia PA 19104, USA
| | - Suwan Ding
- Department of Biomedical Engineering, Columbia University, New York City NY 10032, USA
| | - Elena Alexander
- Department of Biomedical Engineering, Columbia University, New York City NY 10032, USA
| | - Kam W Leong
- Department of Biomedical Engineering, Columbia University, New York City NY 10032, USA
| | - Henry Daniell
- Department of Basic and Translational Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia PA 19104, USA
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8
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Heimlich FV, de Arruda JAA, Pereira NM, Faria LDS, Abreu LG, Ferreira MVL, Kakehasi FM, Travassos DV, Silva TA, Mesquita RA. Proposal of a prophylactic photobiomodulation protocol for chemotherapy-induced oral and oropharyngeal mucositis: a randomized clinical trial. Lasers Med Sci 2023; 38:245. [PMID: 37889325 DOI: 10.1007/s10103-023-03916-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023]
Abstract
Photobiomodulation therapy (PBMT) is widely used in oncology settings, but lack of assessment standardization is the main barrier to optimization of clinical protocols. This study analyzed three PBMT protocols for preventing oral and oropharyngeal mucositis (OM) in patients undergoing chemotherapy (CT) and/or hematopoietic stem cell transplantation (HSCT). This is a preliminary randomized blind clinical trial. Group 1 received intraoral prophylactic PBMT, Group 2 received intraoral and oropharyngeal PBMT, and Group 3 received intraoral, oropharyngeal, and extraoral PBMT. The applications were from the first day of CT to day + 10. Clinicodemographic data, CT regimens, types of HSCT, hematological exams, occurrence/severity of OM, odynophagia, and OM-related opportunistic infections were assessed. Sixty participants (age range: 18-74 years) were included; 70% of them underwent CT and 30% HSCT. About 43.3% of patients had OM, while odynophagia was reported by 23.3%. Both Groups 1 and 2 revealed better results. Multivariate analysis showed that HSCT directly influenced the occurrence of OM. Individuals who had undergone allogeneic HSCT were 1.93 times more likely to develop OM (p < 0.001). Group 3 exhibited a higher frequency of OM, albeit of lower grades. This group consisted of half the population who had undergone HSCT, had the highest percentage of melphalan use, and had the lowest mean leukocyte count. The three proposed protocols were effective in preventing and reducing OM, with good tolerance and no reported adverse effects. PBMT is a safe and effective approach to OM prophylaxis in adults undergoing CT/HSCT.
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Affiliation(s)
- Fernanda Vieira Heimlich
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - José Alcides Almeida de Arruda
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Nickolas Mendes Pereira
- Multiprofessional Integrated Residency in Health, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Larissa Dos Santos Faria
- Multiprofessional Integrated Residency in Health, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lucas Guimarães Abreu
- Department of Child and Adolescent Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marcus Vinícius Lucas Ferreira
- Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Fabiana Maria Kakehasi
- Department of Pediatrics, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Denise Vieira Travassos
- Multiprofessional Integrated Residency in Health, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Department of Social and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Tarcília Aparecida Silva
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Multiprofessional Integrated Residency in Health, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ricardo Alves Mesquita
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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9
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Winocur-Arias O, Zlotogorski-Hurvitz A, Ben-Zvi Y, Chaushu G, Edel J, Vered M, Kaplan I. The profile of chronic hyperplastic candidiasis: a clinico-pathological study. Virchows Arch 2023; 483:527-534. [PMID: 37615705 DOI: 10.1007/s00428-023-03628-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
The aims of this study were investigation of clinical presentation, systemic factors, and long-term malignant transformation rate in chronic hyperplastic candidiasis versus leukoplakia. This is a retrospective case-controlled study of cases with chronic hyperplastic candidiasis and leukoplakia without dysplasia, diagnosed between 2000 and 2013. A database was created, and all additional biopsies from the same cases were searched up to 2022, for records of oral malignant transformation. Associations between microscopic diagnoses and clinical features of lesions and clinical outcomes of patients were performed. A study database included 116 patients, allocated to the group diagnosed with chronic hyperplastic candidiasis (CHC-group, 62) and to the group of leukoplakia without dysplasia (LKP-group, 54). Tongue and buccal mucosa were most frequently recorded in both groups. In CHC-group, significantly fewer cases presented as white lesions compared to LKP-group (P < 0.001); more were ulcerated or exophytic (P = 0.006 and P = 0.003, respectively). History of head and neck malignancy was significantly more frequent in CHC-group (P = 0.005), as were chemotherapy, (P = 0.019) radiotherapy (P = 0.0265), and immune-related conditions (P = 0.03). Within the follow-up period (2000-2022), in CHC-group, two cases (3.2%) had malignant transformation at the site of original biopsy, one was recurrence of previous carcinoma. In LKP-group, two cases (3.7%) had newly diagnosed carcinoma and one at the site of original biopsy; no significant differences were found between groups. In conclusion, medical background of immune-related conditions, head and neck malignancy, radiotherapy, and chemotherapy may play a role in predisposing for chronic hyperplastic candidiasis. Malignant transformation rate within CHC-group was low, and similar to that within LKP-group, representing a lower transformation rate than expected.
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Affiliation(s)
- Orit Winocur-Arias
- Department of Oral Pathology, Oral Medicine and Maxillofacial Imaging, Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ayelet Zlotogorski-Hurvitz
- Department of Oral Pathology, Oral Medicine and Maxillofacial Imaging, Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Oral Maxillofacial Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Yehonatan Ben-Zvi
- Department of Oral Maxillofacial Surgery, Rabin Medical Center, Petah Tikva, Israel
- Department of Oral Maxillofacial Surgery, Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gavriel Chaushu
- Department of Oral Maxillofacial Surgery, Rabin Medical Center, Petah Tikva, Israel
- Department of Oral Maxillofacial Surgery, Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jeremy Edel
- Department of Oral Pathology, Oral Medicine and Maxillofacial Imaging, Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Marilena Vered
- Department of Oral Pathology, Oral Medicine and Maxillofacial Imaging, Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilana Kaplan
- Department of Oral Pathology, Oral Medicine and Maxillofacial Imaging, Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Pathology, Rabin Medical Center, Petah Tikva, Israel
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10
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Sasarom M, Wanachantararak P, Chaijareenont P, Okonogi S. Biosynthesis of copper oxide nanoparticles using Caesalpinia sappan extract: In vitro evaluation of antifungal and antibiofilm activities against Candida albicans. Drug Discov Ther 2023; 17:238-247. [PMID: 37612046 DOI: 10.5582/ddt.2023.01032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Synthesis of nanoparticles using natural organic substances has attracted more attention due to avoiding inorganic toxicity. This work aimed to synthesize copper oxide nanoparticles (CuONPs) using Caesalpinia sappan heartwood extract as a reducing agent. The effects of pH of synthesis reaction were investigated. The obtained CuONPs were characterized using UV-visible spectroscopy, Fourier transform infrared spectroscopy, scanning electron microscopy, and energy dispersive X-ray spectroscopy. Their particle size, size distribution, and zeta potential were determined using photon correlation spectrophotometry. Candida albicans is a major cause of chronic fungal infections due to its biofilms leading to severe drug resistance problems. In this study, in vitro antifungal and antibiofilm activities as well as killing kinetics of the synthesized CuONPs against C. albicans were investigated. Additionally, fungal biofilm was observed by using confocal laser scanning microscopy. The results showed that the pH of the synthesis reaction played an important role in the physicochemical properties and antifungal activities of the obtained CuONPs. CuONPs synthesized at pH 10 and 12 showed the relatively small and narrow size distribution with high negative zeta potential and time-dependent killing kinetics. Confocal laser scanning microscopy confirms obvious fungal biofilm reduction and increased fungal cell death after exposure to CuONPs. These findings suggest the optimal pH of CuONPs synthesis using C. sappan extract as a reducing agent. The results on antifungal and antibiofilm activities indicate that the obtained CuONPs can be a promising agent for treating fungal infection.
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Affiliation(s)
| | | | - Pisaisit Chaijareenont
- Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellent inPharmaceutical Nanotechnology, Chiang Mai University, Chiang Mai, Thailand
| | - Siriporn Okonogi
- Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellent inPharmaceutical Nanotechnology, Chiang Mai University, Chiang Mai, Thailand
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11
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Lin Y, Li S, Mo C, Liu H, Bi J, Xu S, Jia B, Liu C, Liu Z. Oral microbial changes and oral disease management before and after the treatment of hematological malignancies: a narrative review. Clin Oral Investig 2023; 27:4083-4106. [PMID: 37071220 DOI: 10.1007/s00784-023-05021-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/04/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVES Patients with hematological malignancies have dynamic changes in oral microbial communities before and after treatment. This narrative review describes the changes in oral microbial composition and diversity, and discusses an oral microbe-oriented strategy for oral disease management. MATERIALS AND METHODS A literature search was performed in PubMed/Medline, Web of Science, and Embase for articles published between 1980 and 2022. Any articles on the changes in oral microbial communities in patients with hematological malignancies and their effects on disease progression and prognosis were included. RESULTS Oral sample detection and oral microbial sequencing analysis of patients with hematological malignancies showed a correlation between changes in oral microbial composition and diversity and disease progression and prognosis. The possible pathogenic mechanism of oral microbial disorders is the impairment of mucosal barrier function and microbial translocation. Probiotic strategies, antibiotic strategies, and professional oral care strategies targeting the oral microbiota can effectively reduce the risk of oral complications and the grade of severity in patients with hematological malignancies. CLINICAL RELEVANCE This review provides dentists and hematologists with a comprehensive understanding of the host-microbe associated with hematologic malignancies and oral disease management advice.
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Affiliation(s)
- Yunhe Lin
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Siwei Li
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Chuzi Mo
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Hongyu Liu
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Jiaming Bi
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Shuaimei Xu
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Bo Jia
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Chengxia Liu
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Zhongjun Liu
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510515, Guangdong, China.
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12
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Ghadimi F, Rodrigues CF, Mohammadi SR, Roudbary M, Dos Santos AL, Aslani P, Nikoomanesh F. Oral candidiasis in patients with kidney transplantation in Iran: prevalence and antifungal susceptibility pattern. Future Microbiol 2023; 18:715-722. [PMID: 37665236 DOI: 10.2217/fmb-2022-0179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
Aim: This study aimed to identify Candida species recovered from the oral cavity of patients with kidney transplantation. Materials & methods: Two swabs were taken from the oral cavities of 40 patients before and after transplantation, cultured on Sabouraud dextrose agar, and yeasts identified. Antifungal drug susceptibility testing was performed with fluconazole and itraconazole. Results: Candida glabrata was the most frequently isolated species in patients, followed by Candida albicans and Rhodotorula. C. glabrata isolates from patients before transplantation were resistant to fluconazole, whereas C. albicans was fluconazole-resistant both before and after transplantation. Conclusion: The importance of non-albicans Candida species in the oral cavity of patients sheds light on performing antifungal tests for achieving the best outcome to prevent therapeutic failure.
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Affiliation(s)
- Fardad Ghadimi
- Department of Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, 14115111, Iran
| | - Célia F Rodrigues
- TOXRUN - Toxicology Research Unit, Cooperativa de Ensino Superior Politécnico e Universitário - CESPU, 4585-116 Gandra PRD, Portugal
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology & Energy, Faculty of Engineering, University of Porto, Rua Dr Roberto Frias, 4200-465 Porto, Portugal
- ALiCE - Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr Roberto Frias, 4200-465 Porto, Portugal
| | - Shahla Roudbar Mohammadi
- Department of Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, 14115111, Iran
| | - Maryam Roudbary
- Department of Parasitology & Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, 1449614535, Iran
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW2145, Australia
| | - André Ls Dos Santos
- Department of General Microbiology, Microbiology Institute, Federal University of Rio de Janeiro, 21941901, Brazil
| | - Peyman Aslani
- Department of Parasitology & Mycology, Faculty of Medicine, Aja University of Medical Sciences, Tehran, 1411718541, Iran
| | - Fatemeh Nikoomanesh
- Infectious Disease Research Center, Birjand University of Medical Sciences, Birjand, 9717853577, Iran
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13
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Abed H. Dental considerations for head and neck cancer: A clinical review. Saudi Dent J 2023; 35:476-486. [PMID: 37520601 PMCID: PMC10373080 DOI: 10.1016/j.sdentj.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/10/2023] [Accepted: 05/14/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Radiotherapy is one of the treatment modalities for the treatment of head and neck cancer (HNC). However, it leads to the development of chronic and acute side effects. These side effects impact negatively on the patient's quality of life and oral functioning. This clinical review aims to provide basic information about HNC, understand the impact of radiotherapy on oral health, and explain the role of dental care providers for HNC patients during the pre-and post-radiotherapy time. Materials and Methods Electronic databases (i.e., PubMed, Scopus, and Google Scholar) were searched using defined keywords. The main inclusion criteria were any studies describing "dental management of patients with head and neck cancer" and "dental management of patients treated with radiotherapy." Results Thematic analysis was used to summaries the findings of the included studies (n = 102) into main headings and subheadings. All studies were published between 1970 and 2023. Conclusion The number of HNC patients is increasing. This necessitates the need for raising the awareness of dental care providers to the side-effects of HNC therapy which includes treatment with radiotherapy, chemotherapy, and/or surgery. Dental care providers should understand the common side-effects and their treatments besides their role in the pre- (i.e., dental extraction of teeth with poor prognosis and maintaining good oral hygiene) and post- (i.e., oral rehabilitation and post-HNC dental care) radiotherapy dental care.
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14
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Golestannejad Z, Khozeimeh F, Najafizade N, Tabesh A, Faghihian E, Maheronnaghsh M, Kheirkhah M, Hosseini SM, Sadeghalbanaei L, Jamshidi M, Chermahini AA, Saberi Z, Pakravan F, Dehghan P, Emamibafrani M, Amini N, Tadayon F. Comparison of oral candidiasis characteristics in head-and-neck cancer patients before and during radiotherapy. Dent Res J (Isfahan) 2023; 20:63. [PMID: 37388299 PMCID: PMC10300268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/16/2022] [Accepted: 03/05/2023] [Indexed: 07/01/2023] Open
Abstract
Background Patients undergoing head-and-neck radiotherapy are susceptible to Candida colonization and infection. This study aimed to identify oral Candida species type (ST), colony count (CC), and oropharyngeal candidiasis (OPC) in head-and-neck cancer patients, undergoing radiotherapy, before and 2 weeks after radiation. Materials and Methods In this quasi-experimental study, head-and-neck cancer patients undergoing radiotherapy (up to 6000 cGy) were recruited. Samples were taken before and 2 weeks after radiation therapy (RT). CC was assigned using Sabouraud dextrose agar culture medium and morphological studies were performed to confirm OPC. For identification, polymerase chain reaction-restriction fragment length polymorphism was performed. Data were analyzed using Chi-square-test and kappa coefficient. P < 0.05 was considered statistically significant. Results Twenty-one of 33 patients were Candida positive. The detected fungal species included Candida albicans (60%), Candida tropicalis (22%), Candida glabrata (9%), and other species (9%). Following RT, OPC and CC changed significantly (P = 0.003 and P = 0.001, respectively), whereas ST did not significantly change (P = 0.081). Two new species (Candida krusei and Candida parapsilosis) were detected after the intervention. The OPC, CC, and ST changes after RT were not significantly related to malignancy site or radiation dose (P > 0.05). Conclusion The present study showed that OPC, CC, and ST were not related to the malignancy site. Following RT, OPC and CC changed significantly, while ST showed no significant change. The radiation dose and malignancy site had no effects on the OPC, CC, or ST alterations following RT.
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Affiliation(s)
- Zahra Golestannejad
- Department of Oral and Maxillofacial Medicine, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Faezeh Khozeimeh
- Department of Oral and Maxillofacial Medicine, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nadia Najafizade
- Department of Radiation Oncology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Adel Tabesh
- Department of Oral and Maxillofacial Medicine, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Faghihian
- Department of Oral and Maxillofacial Medicine, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrnoush Maheronnaghsh
- Department of Mycology and Parasitology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahnaz Kheirkhah
- Department of Mycology and Parasitology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sayed Mohsen Hosseini
- Department of Biostatistics and Epidemiology, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Leila Sadeghalbanaei
- Department of Orthodontics, Dental Students Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mina Jamshidi
- Department of Periodontics, Dental Students Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Amiri Chermahini
- Department of Endodontics, Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Zahra Saberi
- Department of Oral and Maxillofacial Medicine, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fahimeh Pakravan
- Department of Oral and Maxillofacial Medicine, Dental Implants Research Center, School of Dentistry, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parvin Dehghan
- Department of Mycology and Parasitology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Emamibafrani
- Department of Dentist, Dental Students Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nima Amini
- Department of Pediatric Dentistry, School of Dentistry, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Faezeh Tadayon
- Department of Dentist, Dental Students Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
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15
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MacAlpine J, Robbins N, Cowen LE. Bacterial-fungal interactions and their impact on microbial pathogenesis. Mol Ecol 2023; 32:2565-2581. [PMID: 35231147 PMCID: PMC11032213 DOI: 10.1111/mec.16411] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/14/2022] [Accepted: 02/18/2022] [Indexed: 11/27/2022]
Abstract
Microbial communities of the human microbiota exhibit diverse effects on human health and disease. Microbial homeostasis is important for normal physiological functions and changes to the microbiota are associated with many human diseases including diabetes, cancer, and colitis. In addition, there are many microorganisms that are either commensal or acquired from environmental reservoirs that can cause diverse pathologies. Importantly, the balance between health and disease is intricately connected to how members of the microbiota interact and affect one another's growth and pathogenicity. However, the mechanisms that govern these interactions are only beginning to be understood. In this review, we outline bacterial-fungal interactions in the human body, including examining the mechanisms by which bacteria govern fungal growth and virulence, as well as how fungi regulate bacterial pathogenesis. We summarize advances in the understanding of chemical, physical, and protein-based interactions, and their role in exacerbating or impeding human disease. We focus on the three fungal species responsible for the majority of systemic fungal infections in humans: Candida albicans, Cryptococcus neoformans, and Aspergillus fumigatus. We conclude by summarizing recent studies that have mined microbes for novel antimicrobials and antivirulence factors, highlighting the potential of the human microbiota as a rich resource for small molecule discovery.
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Affiliation(s)
- Jessie MacAlpine
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, M5G 1M1, Canada
| | - Nicole Robbins
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, M5G 1M1, Canada
| | - Leah E. Cowen
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, M5G 1M1, Canada
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16
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Kibwana UO, Manyahi J, Kamori D, Mushi M, Mwandigha AM, Majigo M. Predominance of non- Candida albicans species oral colonisation among patients on anticancer therapy: findings from a cross-sectional study in Tanzania. BMJ Open 2023; 13:e070003. [PMID: 37085309 PMCID: PMC10124273 DOI: 10.1136/bmjopen-2022-070003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVES This study aimed to determine the oral carriage prevalence of Candida species and identify factors associated with the carriage of Candida species among patients with cancer on treatment. DESIGN A hospital-based cross-sectional study. SETTING The study was conducted at a tertiary-level cancer hospital Ocean Road Cancer Institute (ORCI), Dar es Salaam, Tanzania. PARTICIPANTS We enrolled 196 participants who consented to join the study. Oral swabs were collected from all participants and inoculated onto Sabouraud dextrose agar supplemented with 50 mg/mL gentamicin and 50 mg/mL chloramphenicol, and chromogenic agar for phenotypic identification of Candida species. PRIMARY OUTCOME The study reported the high prevalence of oral carriage of Candida species among patients with cancer on treatment at the tertiary-level cancer hospital in Dar es Salaam, Tanzania. RESULTS A total of 196 participants were enrolled in the study. The overall oral carriage of Candida species was 37.8% (74/196). The prevalence was higher among patients undergoing chemotherapy and radiotherapy (44.4%) than those in monotherapy (13.3% chemotherapy, 20% radiotherapy). Candida krusei was the most common isolated species, 48.6% (36/74). Head and neck (adjusted OR (aOR) 15.09, 95% CI 3.05 to 74.59, p=0.00), gastrointestinal (aOR 14.14, 95% CI 2.25 to 88.63, p=0.00) malignancies and diabetes (aOR 3.18, 95% CI 1.03 to 9.77, p=0.04) were factors independently associated with oral carriage of Candida species. CONCLUSION The oral carriage of Candida species among patients with cancer receiving treatment at ORCI is high, mainly due to C. krusei species. This is alarming since C. krusei has intrinsic resistance to fluconazole, a common antifungal agent used to manage adult fungal infections. Therefore, efforts should be put into conducting regular check-ups for such opportunistic pathogens as they can lead to subsequent infections. Furthermore, studies conducted to determine the antifungal profile of the causative agents are warranted since different causative agents might have different profiles.
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Affiliation(s)
- Upendo Ozeniel Kibwana
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Joel Manyahi
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Doreen Kamori
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Martha Mushi
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Ambele M Mwandigha
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mtebe Majigo
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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17
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Monsen RE, Kristoffersen AK, Gay CL, Herlofson BB, Fjeld KG, Hove LH, Nordgarden H, Tollisen A, Lerdal A, Enersen M. Identification and susceptibility testing of oral candidiasis in advanced cancer patients. BMC Oral Health 2023; 23:223. [PMID: 37072843 PMCID: PMC10111683 DOI: 10.1186/s12903-023-02950-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/06/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Patients with advanced cancer are prone to develop different opportunistic oral infection due to anti-cancer treatment or the malignancies themselves. Studies of oral fungal samples show an increased prevalence of non-Candida albicans species in mixed oral infections with Candida albicans. Non-C. albicans and C. albicans are associated with varying degrees of resistance to azoles, which may have implications for treatment. This study aimed to assess the diversity and antifungal susceptibility of Candida species detected in the oral cavity. METHODS An observational study with microbiological analysis was conducted. Clinical fungal isolates were collected from patients in a hospice unit in 2014-2016. Isolates were re-grown on chromID® Candida plates in 2020. Single colony of each species was re-cultivated and prepared for biochemical identification with a VITEK2® system and verified by gene sequencing. Etest was performed on RPMI agar, and the antifungals fluconazole, amphotericin B, anidulafungin and nystatin were applied. RESULTS Fifty-six isolates from 45 patients were identified. Seven different Candida species and one Saccharomyces species were detected. The results of biochemical identification were confirmed with sequencing analysis. Thirty-six patients had mono infection, and nine out of 45 patients had 2-3 different species detected. Of C. albicans strains, 39 out of 40 were susceptible to fluconazole. Two non-C. albicans species were resistant to fluconazole, one to amphotericin B and three to anidulafungin. CONCLUSION C. albicans was the predominant species, with a high susceptibility to antifungal agents. Different Candida species occur in both mono and mixed infections. Identification and susceptibility testing may therefore lead to more effective treatment and may prevent the development of resistance among patients with advanced cancer. TRAIL REGISTRATION The study Oral Health in Advanced Cancer was registered at ClinicalTrials.gov (#NCT02067572) in 20/02/2014.
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Affiliation(s)
- Ragnhild Elisabeth Monsen
- Department for Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1089 Blindern, 0317, Oslo, Norway.
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway.
| | | | - Caryl L Gay
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
- Department of Family Health Care Nursing, University of California, San Francisco, USA
| | - Bente Brokstad Herlofson
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
- Unit of Oral and Maxillofacial Surgery, Department of Otorhinolaryngology - Head and Neck Surgery Division for Head, Neck and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
| | - Katrine Gahre Fjeld
- Department of Cariology and Gerodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Lene Hystad Hove
- Department of Cariology and Gerodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Hilde Nordgarden
- National Resource Centre for Oral Health in Rare Disorders, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Anita Tollisen
- Unger-Vetlesens Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Anners Lerdal
- Department for Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1089 Blindern, 0317, Oslo, Norway
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Morten Enersen
- Institute of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
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18
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Kim Y, Ku HM, Jun MK. Knowledge Evaluation of Oral Diseases and Perception of Cooperation with Dental Experts for Oral Care of Nurses in Intensive Care Units in Korea: A Preliminary Study. NURSING REPORTS 2023; 13:528-538. [PMID: 36976700 PMCID: PMC10051949 DOI: 10.3390/nursrep13010048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/12/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
The aim of this study was to identify the status of education and knowledge concerning oral diseases for oral care as they relate to intensive care unit (ICU) nurses, as well as to investigate the perception of oral care education and practice, as led by dental experts. This study conducted a self-report survey consisting of 33 questions on education and knowledge about oral diseases, as well as perception of dental expert-led education and practice, targeting 240 nurses in the ICU. Finally, 227 questionnaires were analyzed, and 75.3% of the participants were staff nurses, and 41.4% were in the medical ICU. In the area of education and knowledge of major oral diseases, more than 50% of the respondents treating gingivitis, periodontitis, and dental caries did not complete dental education, and it was found that more than half of the respondents were unable to distinguish diseases of the mouth. It was recognized that more than half of nurses required dental expert-led education and practice. In this study, the education and knowledge of oral diseases of ICU nurses were found to be insufficient, and the need for the cooperation of dental experts was high. Therefore, collaboration to improve oral care practical guidelines for realistically applicable ICU patients will be needed.
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Affiliation(s)
- Yesel Kim
- Department of Dental Hygiene, Jeonju Kijeon College, Jeonju 54989, Republic of Korea
| | - Hye-Min Ku
- Department of Preventive Dentistry & Public Oral Health, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul 03722, Republic of Korea
| | - Mi-Kyoung Jun
- Department of Dental Hygiene, Dongnam Health University, Suwon 16328, Republic of Korea
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19
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Śledzińska A, Śledzińska P, Bebyn M, Komisarek O. Title: Chemotherapy-Induced Oral Complications and Prophylaxis Strategies. Cancer Invest 2023:1-24. [PMID: 36892292 DOI: 10.1080/07357907.2023.2188558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Cancer is currently a significant therapeutic challenge and is frequently connected with numerous adverse effects. Despite many improvements in chemotherapy, oral complications are common, leading to poor quality of life and chemotherapeutic dose reduction, which impair survival. This review summarizes the most common dental complications in patients receiving chemotherapy. We mainly focus on oral mucositis as it is a major cause of dose-limiting toxicity. Furthermore, oral candidiasis, viral infections, and xerostomia will be discussed. Conclusions: preventing complications is significantly more important than treating them. All patients beginning systemic anticancer treatment should undergo a thorough oral examination and get appropriate prophylaxis.
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Affiliation(s)
- Aleksandra Śledzińska
- Faculty of Medicine, Poznan University of Medical Sciences, Fredry 10, 61-701 Poznań, Poland
| | - Paulina Śledzińska
- Molecular Oncology and Genetics Department, Innovative Medical Forum, The F. Lukaszczyk Oncology Center, 85-796 Bydgoszcz, Poland
| | - Marek Bebyn
- Molecular Oncology and Genetics Department, Innovative Medical Forum, The F. Lukaszczyk Oncology Center, 85-796 Bydgoszcz, Poland
| | - Oskar Komisarek
- Department of Maxillofacial Orthopedics and Orthodontics, Fredry 10, 61-701 Poznań University of Medical Sciences, Poznan, Poland
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20
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de Vasconcellos Ferreira PM, Gomes MDCMF, Almeida ACSM, Cornélio JS, Arruda TJ, Mafra A, Nunes MHS, Salera RB, Nogueira RF, Sclauser JMB, Drummond-Lage AP, Rezende BA. Evaluation of oral mucositis, candidiasis, and quality of life in patients with head and neck cancer treated with a hypofractionated or conventional radiotherapy protocol: a longitudinal, prospective, observational study. Head Face Med 2023; 19:7. [PMID: 36890527 PMCID: PMC9992900 DOI: 10.1186/s13005-023-00356-3] [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: 11/03/2022] [Accepted: 03/05/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, recently, Radiotherapy (RT) protocols requiring fewer sessions (hypofractionated) have been used to shorten RT treatment and minimize patient exposure to medical centers, and decrease the risk of SARS-CoV-2 infection. METHODS This longitudinal, prospective, observational study aimed to compare the quality of life (QoL) and the incidence of oral mucositis and candidiasis in 66 patients with head and neck cancer (HNC) who undergo a hypofractionated RT protocol (GHipo), total of 55 Gy for 4 weeks, or a conventional RT protocol (GConv), total of 66 - 70 Gy for 6 - 7 weeks. PURPOSE To assess the incidence and severity of oral mucositis, the incidence of candidiasis, and QoL were evaluated using the World Health Organization scale, clinical evaluation, and the QLC-30 and H&N-35 questionnaires, respectively, at the beginning and the end of RT. RESULTS The incidence of candidiasis did not show differences between the two groups. However, at the end of RT, mucositis had a higher incidence (p < 0.01) and severity (p < 0.05) in GHipo. QoL was not markedly different between the two groups. Although mucositis worsened in patients treated with hypofractionated RT, QoL did not worsen for patients on this regimen. CONCLUSIONS Our results open perspectives for the potential use of RT protocols for HNC with fewer sessions in conditions that require faster, cheaper, and more practical treatments.
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Affiliation(s)
| | | | | | - Júlia Soares Cornélio
- School of Medical Sciences of Minas Gerais, Alameda Ezequiel Dias, Belo Horizonte, 27530130-110, Brazil
| | - Thiago Jardim Arruda
- Mario Penna Institute, 901, Joaquim Candido Filho, Belo Horizonte, 30320-420, Brazil
| | - Arnoldo Mafra
- Mario Penna Institute, 901, Joaquim Candido Filho, Belo Horizonte, 30320-420, Brazil
| | | | - Rafael Borges Salera
- Mario Penna Institute, 901, Joaquim Candido Filho, Belo Horizonte, 30320-420, Brazil
| | | | | | - Ana Paula Drummond-Lage
- School of Medical Sciences of Minas Gerais, Alameda Ezequiel Dias, Belo Horizonte, 27530130-110, Brazil
| | - Bruno Almeida Rezende
- School of Medical Sciences of Minas Gerais, Alameda Ezequiel Dias, Belo Horizonte, 27530130-110, Brazil.
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Sharma G, Razeghi Kondelaji MH, Sharma GP, Hansen C, Parchur AK, Shafiee S, Jagtap JM, Fish B, Bergom C, Paulson E, Hall WA, Himburg HA, Joshi A. X-ray and MR Contrast Bearing Nanoparticles Enhance the Therapeutic Response of Image-Guided Radiation Therapy for Oral Cancer. Technol Cancer Res Treat 2023; 22:15330338231189593. [PMID: 37469184 PMCID: PMC10363893 DOI: 10.1177/15330338231189593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 05/09/2023] [Accepted: 06/27/2023] [Indexed: 07/21/2023] Open
Abstract
INTRODUCTION Radiation therapy for head and neck squamous cell carcinoma is constrained by radiotoxicity to normal tissue. We demonstrate 100 nm theranostic nanoparticles for image-guided radiation therapy planning and enhancement in rat head and neck squamous cell carcinoma models. METHODS PEG conjugated theranostic nanoparticles comprising of Au nanorods coated with Gadolinium oxide layers were tested for radiation therapy enhancement in 2D cultures of OSC-19-GFP-luc cells, and orthotopic tongue xenografts in male immunocompromised Salt sensitive or SS rats via both intratumoral and intravenous delivery. The radiation therapy enhancement mechanism was investigated. RESULTS Theranostic nanoparticles demonstrated both X-ray/magnetic resonance contrast in a dose-dependent manner. Magnetic resonance images depicted optimal tumor-to-background uptake at 4 h post injection. Theranostic nanoparticle + Radiation treated rats experienced reduced tumor growth compared to controls, and reduction in lung metastasis. CONCLUSIONS Theranostic nanoparticles enable preprocedure radiotherapy planning, as well as enhance radiation treatment efficacy for head and neck tumors.
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Affiliation(s)
- Gayatri Sharma
- Centre for Medical Biotechnology, Amity Institute of Biotechnology, Amity University, Noida, Uttar Pradesh, India
| | | | - Guru P. Sharma
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Christopher Hansen
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Abdul K. Parchur
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Shayan Shafiee
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Brian Fish
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Carmen Bergom
- Department of Radiation Oncology, Washington University, St Louis, MO, USA
| | - Eric Paulson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - William A. Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Heather A. Himburg
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Amit Joshi
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI, USA
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22
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Karajacob AS, Azizan NB, Al-Maleki ARM, Goh JPE, Loke MF, Khor HM, Ho GF, Ponnampalavanar S, Tay ST. Candida species and oral mycobiota of patients clinically diagnosed with oral thrush. PLoS One 2023; 18:e0284043. [PMID: 37068057 PMCID: PMC10109505 DOI: 10.1371/journal.pone.0284043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/22/2023] [Indexed: 04/18/2023] Open
Abstract
Overgrowth of Candida yeasts in the oral cavity may result in the development of oral thrush in immunocompromised individuals. This study analyzed the diversity and richness of the oral mycobiota of patients clinically diagnosed with oral thrush (OT), follow-up of oral thrush patients after antifungal therapy (AT), and healthy controls (HC). Oral rinse and oral swab samples were collected from 38 OT patients, 21 AT patients, and 41 healthy individuals (HC). Pellet from the oral rinse and oral swab were used for the isolation of oral Candida yeasts on Brilliance Candida Agar followed by molecular speciation. ITS1 amplicon sequencing using Illumina MiSeq was performed on DNA extracted from the oral rinse pellet of 16 OT, 7 AT, and 7 HC oral rinse samples. Trimmed sequence data were taxonomically grouped and analyzed using the CLC Microbial Genomics Module workflow. Candida yeasts were isolated at significantly higher rates from oral rinse and swab samples of OT (68.4%, p < 0.001) and AT (61.9%, p = 0.012) patients, as compared to HC (26.8%). Predominance of Candida albicans specifically, was noted in OT (60.5%, p < 0.001) and AT (42.9%, p = 0.006) vs. HC (9.8%), while non-albicans Candida species was dominant in HC. Analysis of oral mycobiota from OT patients showed the presence of 8 phyla, 222 genera, and 309 fungal species. Low alpha diversity (Shannon index, p = 0.006; Chao-1 biased corrected index, p = 0.01), varied beta diversity (Bray-Curtis, p = 0.01986; Jaccard, p = 0.02766; Weighted UniFrac, p = 0.00528), and increased relative abundance of C. albicans (p = 3.18E-02) was significantly associated with the oral mycobiota of OT vs. HC. This study supported that C. albicans is the main etiological agent in oral thrush and highlights the association of fungal biodiversity with the pathophysiology of oral thrush.
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Affiliation(s)
| | - Nuramirah Binti Azizan
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | - Joanne Pei En Goh
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Mun Fai Loke
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Hui Min Khor
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Gwo Fuang Ho
- Department of Clinical Oncology, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Sasheela Ponnampalavanar
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Sun Tee Tay
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Zaongo SD, Ouyang J, Isnard S, Zhou X, Harypursat V, Cui H, Routy JP, Chen Y. Candida albicans can foster gut dysbiosis and systemic inflammation during HIV infection. Gut Microbes 2023; 15:2167171. [PMID: 36722096 PMCID: PMC9897780 DOI: 10.1080/19490976.2023.2167171] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Candida albicans (C. albicans) is a ubiquitous fungal commensal component of the human microbiota, and under certain circumstances, such as during an immunocompromised state, it may initiate different types of infection. Moreover, C. albicans continuously and reciprocally interacts with the host immune system as well as with other elements of the gut microbiota, thus contributing significantly to both gut homeostasis and host immunity. People living with HIV (PLWH), including those receiving antiretroviral therapy, are characterized by a depletion of CD4 + T-cells and dysbiosis in their gut. C. albicans colonization is frequent in PLWH, causing both a high prevalence and high morbidity. Gut barrier damage and elevated levels of microbial translocation are also fairly common in this population. Herein, we take a closer look at the reciprocity among C. albicans, gut microbiota, HIV, and the host immune system, thus throwing some light on this complex interplay.
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Affiliation(s)
- Silvere D Zaongo
- Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China,Clinical Research Center, Chongqing Public Health Medical Center, Chongqing, China
| | - Jing Ouyang
- Clinical Research Center, Chongqing Public Health Medical Center, Chongqing, China
| | - Stéphane Isnard
- Infectious Diseases and Immunity in Global Health Program, Research Institute, McGill University Health Centre, Montréal, QC, Canada,Chronic Viral Illness Service, McGill University Health Centre, Montréal, QC, Canada,Canadian HIV Trials Network, Canadian Institutes for Health Research, Vancouver, British Columbia, Canada
| | - Xin Zhou
- Clinical Research Center, Chongqing Public Health Medical Center, Chongqing, China,Cancer Center, Medical Research Institute, Southwest University, Chongqing, China
| | - Vijay Harypursat
- Clinical Research Center, Chongqing Public Health Medical Center, Chongqing, China
| | - Hongjuan Cui
- Cancer Center, Medical Research Institute, Southwest University, Chongqing, China
| | - Jean-Pierre Routy
- Infectious Diseases and Immunity in Global Health Program, Research Institute, McGill University Health Centre, Montréal, QC, Canada,Chronic Viral Illness Service, McGill University Health Centre, Montréal, QC, Canada,Division of Hematology, McGill University Health Centre, Montréal, QC, Canada
| | - Yaokai Chen
- Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China,Clinical Research Center, Chongqing Public Health Medical Center, Chongqing, China,CONTACT Yaokai Chen Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
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The role of the speech and language therapist in the rehabilitation of speech, swallowing, voice and trismus in people diagnosed with head and neck cancer. Br Dent J 2022; 233:801-805. [DOI: 10.1038/s41415-022-5145-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022]
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25
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Pispero A, Lombardi N, Manfredi M, Varoni EM, Sardella A, Lodi G. Oral infections in oral cancer survivors: A mini-review. FRONTIERS IN ORAL HEALTH 2022; 3:970074. [PMID: 36338574 PMCID: PMC9634540 DOI: 10.3389/froh.2022.970074] [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: 06/15/2022] [Accepted: 09/29/2022] [Indexed: 01/24/2023] Open
Abstract
The oral cancer survivors are a group of special individuals whose disease affect anatomical structures with a key role in identity and communication and a fundamental role in basic human functions such as speaking, eating, swallowing and breathing. Thus, quality of life of these individuals can be impaired by the consequences of disease and treatments, in particular surgery and radiotherapy. Among others, infectious conditions of any nature, bacterial, viral, fungal, are a frequent finding among oral cancer survivors. In fact, the peculiar systemic and local conditions of these subjects are known to significantly modify the microbiota, which, besides facilitating opportunistic infections, can affect the cancer microenvironment, as well as alter the effects of the anti-cancer therapies. Similarly, mouth infections can also affect the prognosis of oral cancer survivors. Among the opportunistic infections, fungal are the most common infections affecting these subjects, since neutropenia resulting from cancer, as well as chemotherapy and/or radiotherapy treatments, promote the shift from the carrier state of Candida species, to pathogen state. Treatment of oral candidiasis can be difficult in oral cancer survivors, and good evidence supports clotrimazole as the most effective for prevention, and fluconazole as the one with the best risk-benefit profile. Probiotics, although promising, need better evidence to be considered an effective treatment or preventive measure.
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Affiliation(s)
- Alberto Pispero
- Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, Università Degli Studi di Milano, Milan, Italy
| | - Niccolò Lombardi
- Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, Università Degli Studi di Milano, Milan, Italy,Correspondence: Niccolò Lombardi
| | - Maddalena Manfredi
- Dipartimento di Medicina e Chirurgia, Centro di Odontoiatria, Università di Parma, Parma, Italy
| | - Elena Maria Varoni
- Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, Università Degli Studi di Milano, Milan, Italy
| | - Andrea Sardella
- Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, Università Degli Studi di Milano, Milan, Italy
| | - Giovanni Lodi
- Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, Università Degli Studi di Milano, Milan, Italy
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Mahalakshmi K, Sankari SL, Kumar VN. Absence of zygomycetes in the oral niche of patients with oral squamous cell carcinoma and oral potentially malignant disorders. J Oral Maxillofac Pathol 2022; 26:553-554. [PMID: 37082050 PMCID: PMC10112075 DOI: 10.4103/jomfp.jomfp_44_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/28/2022] [Indexed: 04/22/2023] Open
Abstract
Mucormycosis is a fungal infection which has been regrouped under emerging infectious disease. In this COVID-19 pandemic, the incidence of mucormycosis has been reported in many parts of India. Systemic condition that weakens one's immune systems like uncontrolled diabetes, chemotherapy or chronic long-term illness poses a grave threat for this fungal infection. Patients with oral cancer and precancer remain at significant risk for developing severe infections regardless of significant developments in therapy. Few studies have reported that this opportunistic fungal pathogen may be cultured from the oral cavity. Our findings disprove the oral carriage of filamentous fungi (Zygomycetes) among the group of patients with oral squamous cell carcinoma, oral potentially malignant disorders who are susceptible to immunological deficits and healthy subjects. This finding strongly supports that the oral niche of healthy as well as the patients with oral lesions do not harbour this filamentous fungi.
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Affiliation(s)
- Krishnan Mahalakshmi
- ,Department of Microbiology, Research Lab for Oral-Systemic Health, Sreebalaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Sankar Leena Sankari
- Department of Oral Pathology and Microbiology, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Venkatesan Naveen Kumar
- ,Department of Microbiology, Research Lab for Oral-Systemic Health, Sreebalaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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27
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Monteiro DR, Pessan JP. Nanocarriers of antifungal drugs: possible strategies to overcome antimicrobial resistance. Future Microbiol 2022; 17:1199-1202. [PMID: 35984414 DOI: 10.2217/fmb-2022-0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Douglas R Monteiro
- Postgraduate Program in Health Sciences, University of Western São Paulo (UNOESTE), Presidente Prudente/São Paulo, 19050-920, Brazil.,Department of Preventive & Restorative Dentistry, São Paulo State University (Unesp), School of Dentistry, Araçatuba, Araçatuba/São Paulo, 16015-050, Brazil
| | - Juliano P Pessan
- Department of Preventive & Restorative Dentistry, São Paulo State University (Unesp), School of Dentistry, Araçatuba, Araçatuba/São Paulo, 16015-050, Brazil
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28
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Molecular Mapping of Antifungal Mechanisms Accessing Biomaterials and New Agents to Target Oral Candidiasis. Int J Mol Sci 2022; 23:ijms23147520. [PMID: 35886869 PMCID: PMC9320712 DOI: 10.3390/ijms23147520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 02/04/2023] Open
Abstract
Oral candidiasis has a high rate of development, especially in immunocompromised patients. Immunosuppressive and cytotoxic therapies in hospitalized HIV and cancer patients are known to induce the poor management of adverse reactions, where local and systemic candidiasis become highly resistant to conventional antifungal therapy. The development of oral candidiasis is triggered by several mechanisms that determine oral epithelium imbalances, resulting in poor local defense and a delayed immune system response. As a result, pathogenic fungi colonies disseminate and form resistant biofilms, promoting serious challenges in initiating a proper therapeutic protocol. Hence, this study of the literature aimed to discuss possibilities and new trends through antifungal therapy for buccal drug administration. A large number of studies explored the antifungal activity of new agents or synergic components that may enhance the effect of classic drugs. It was of significant interest to find connections between smart biomaterials and their activity, to find molecular responses and mechanisms that can conquer the multidrug resistance of fungi strains, and to transpose them into a molecular map. Overall, attention is focused on the nanocolloids domain, nanoparticles, nanocomposite synthesis, and the design of polymeric platforms to satisfy sustained antifungal activity and high biocompatibility with the oral mucosa.
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The effects of a combination oral spray (Mucosamin®) for the prevention of oral mucositis in pediatric patients undergoing hematopoietic stem cell transplantation: a double blind randomized clinical trial. Support Care Cancer 2022; 30:7963-7972. [PMID: 35732749 DOI: 10.1007/s00520-022-07231-y] [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: 03/29/2022] [Accepted: 06/14/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Oral mucositis (OM) is a frequent complication of conditioning regimens for hematopoietic stem cell transplantation (HSCT). Damage to the nuclear and non-nuclear materials of the mucosal cells by the production of Reactive Oxygen Species (ROS) and proinflammatory cytokines could result to development and progression of OM. Previous studies have shown the effectiveness of !!!Mucosamin® oral spray in the management of pain and acceleration of OM healing. The aims of the current study were to evaluate prophylactic effects of Mucosamin® oral spray in reducing the incidence and severity of OM in pediatric patients undergoing allogeneic HSCT. METHOD The current study was designed as a double-blind, placebo-controlled randomized clinical trial. Sixty patients were enrolled in the study and received placebo or Mucosamin® spray. Patients in both groups used sprays 4 times daily. Product application was begun at the time of initiation of conditioning regimen and was continued for 14 days. RESULTS Mucosamin® significantly reduced incidence and severity of OM compared to the placebo (P values: 0.027 and 0.035, respectively). This product could also decrease OM duration and delay OM onset (P values: 0.007 and 0.006, respectively). CONCLUSION Mucosamin® could effectively reduce incidence, severity, and duration of OM and delay OM onset in pediatric patients undergoing allogeneic HSCT. TRIAL REGISTRATION The study protocol was registered in the Iranian Registry of Clinical Trials under the registry number IRCT20190917044805N1.
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Vistoso Monreal A, Polonsky G, Shiboski C, Sankar V, Villa A. Salivary Gland Dysfunction Secondary to Cancer Treatment. FRONTIERS IN ORAL HEALTH 2022; 3:907778. [PMID: 35757443 PMCID: PMC9218178 DOI: 10.3389/froh.2022.907778] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/12/2022] [Indexed: 11/14/2022] Open
Abstract
The number of cancer survivors are increasing and so are the oral toxicities from cancer therapy. Most patients receiving treatment for cancer develop some form of oral adverse events including, but not limited to, mucositis, opportunistic infections, dry mouth, and/or osteonecrosis of the jaw. One of the most common complications from head and neck cancer radiation therapy is salivary gland dysfunction (SGD). SGD is an umbrella term that includes the subjective sensation of dry mouth (xerostomia) and hyposalivation (objective reduction of the salivary flow rate). Dry mouth in cancer patients may lead to functional defects (e.g., eating, speaking, and swallowing), increase the risk of dental caries and oral candidiasis, and can have a negative effect on the nutritional and psychological status of the patients. The aim of this mini review was to summarize the current criteria for diagnosis and management of SGD associated with cancer treatment.
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Affiliation(s)
- Anette Vistoso Monreal
- Department of Orofacial Sciences, University of California, San Francisco, San Francisco, CA, United States
- *Correspondence: Anette Vistoso Monreal
| | - Gregory Polonsky
- General Practice Residency, Department of Oral and Maxillofacial Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Caroline Shiboski
- Department of Orofacial Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Vidya Sankar
- Department of Diagnostic Sciences, Tufts University, Boston, MA, United States
| | - Alessandro Villa
- Department of Orofacial Sciences, University of California, San Francisco, San Francisco, CA, United States
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Saul-McBeth J, Dillon J, Launder D, Hickey M, Yi EMC, Daboul Y, Biswas P, Salari E, Parsai EI, Conti HR. Radiation Exposure Perturbs IL-17RA-Mediated Immunity Leading to Changes in Neutrophil Responses That Increase Susceptibility to Oropharyngeal Candidiasis. J Fungi (Basel) 2022; 8:jof8050495. [PMID: 35628751 PMCID: PMC9144824 DOI: 10.3390/jof8050495] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/02/2022] [Accepted: 05/06/2022] [Indexed: 12/18/2022] Open
Abstract
Fungal infections caused by Candida albicans are a serious problem for immunocompromised individuals, including those undergoing radiotherapy for head and neck cancers. Targeted irradiation causes inflammatory dysregulation and damage to the oral mucosa that can be exacerbated by candidiasis. Post-irradiation the cytokine interleukin-17 (IL-17) protects the oral mucosae by promoting oral epithelial regeneration and balancing the oral immune cell populations, which leads to the eventual healing of the tissue. IL-17 signaling is also critical for the antifungal response during oropharyngeal candidiasis (OPC). Yet, the benefit of IL-17 during other forms of candidiasis, such as vulvovaginal candidiasis, is not straightforward. Therefore, it was important to determine the role of IL-17 during OPC associated with radiation-induced inflammatory damage. To answer this question, we exposed Il17ra−/− and wild-type mice to head-neck irradiation (HNI) and OPC to determine if the IL-17 signaling pathway was still protective against C. albicans. HNI increased susceptibility to OPC, and in Il17ra−/− mice, the mucosal damage and fungal burden were elevated compared to control mice. Intriguingly, neutrophil influx was increased in Il17ra−/− mice, yet these cells had reduced capacity to phagocytose C. albicans and failed to clear OPC compared to immunocompetent mice. These findings suggest that radiotherapy not only causes physical damage to the oral cavity but also skews immune mediators, leading to increased susceptibility to oropharyngeal candidiasis.
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Affiliation(s)
- Jessica Saul-McBeth
- Department of Biological Sciences, University of Toledo, Toledo, OH 43606, USA; (J.S.-M.); (J.D.); (D.L.); (M.H.); (E.M.-C.Y.); (Y.D.); (P.B.)
| | - John Dillon
- Department of Biological Sciences, University of Toledo, Toledo, OH 43606, USA; (J.S.-M.); (J.D.); (D.L.); (M.H.); (E.M.-C.Y.); (Y.D.); (P.B.)
| | - Dylan Launder
- Department of Biological Sciences, University of Toledo, Toledo, OH 43606, USA; (J.S.-M.); (J.D.); (D.L.); (M.H.); (E.M.-C.Y.); (Y.D.); (P.B.)
| | - Maura Hickey
- Department of Biological Sciences, University of Toledo, Toledo, OH 43606, USA; (J.S.-M.); (J.D.); (D.L.); (M.H.); (E.M.-C.Y.); (Y.D.); (P.B.)
| | - Elise Mein-Chiain Yi
- Department of Biological Sciences, University of Toledo, Toledo, OH 43606, USA; (J.S.-M.); (J.D.); (D.L.); (M.H.); (E.M.-C.Y.); (Y.D.); (P.B.)
| | - Yusuf Daboul
- Department of Biological Sciences, University of Toledo, Toledo, OH 43606, USA; (J.S.-M.); (J.D.); (D.L.); (M.H.); (E.M.-C.Y.); (Y.D.); (P.B.)
| | - Priosmita Biswas
- Department of Biological Sciences, University of Toledo, Toledo, OH 43606, USA; (J.S.-M.); (J.D.); (D.L.); (M.H.); (E.M.-C.Y.); (Y.D.); (P.B.)
| | - Elahheh Salari
- Department of Radiation Oncology, Division of Medical Physics, The University of Toledo, Toledo, OH 43606, USA; (E.S.); (E.I.P.)
| | - E. Ishmael Parsai
- Department of Radiation Oncology, Division of Medical Physics, The University of Toledo, Toledo, OH 43606, USA; (E.S.); (E.I.P.)
| | - Heather R. Conti
- Department of Biological Sciences, University of Toledo, Toledo, OH 43606, USA; (J.S.-M.); (J.D.); (D.L.); (M.H.); (E.M.-C.Y.); (Y.D.); (P.B.)
- Correspondence:
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Yong CW, Robinson A, Hong C. Dental Evaluation Prior to Cancer Therapy. FRONTIERS IN ORAL HEALTH 2022; 3:876941. [PMID: 35510226 PMCID: PMC9058061 DOI: 10.3389/froh.2022.876941] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
A comprehensive oral examination and dental care prior to the start of cancer therapy is the standard of care in many cancer centers. This is because good oral health will likely minimize the undesirable complications such as opportunistic infections during cancer therapy. As the considerations differ between anti-neoplastic regimens, this chapter discusses the indications and rationale when planning and executing a treatment plan for patients undergoing various cancer therapies.
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Affiliation(s)
- Chee Weng Yong
- Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Andrew Robinson
- Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Catherine Hong
- Discipline of Orthodontics and Paediatric Dentistry, Faculty of Dentistry, National University of Singapore, Singapore, Singapore
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Al-Qadami G, Van Sebille Y, Bowen J, Wardill H. Oral-Gut Microbiome Axis in the Pathogenesis of Cancer Treatment-Induced Oral Mucositis. FRONTIERS IN ORAL HEALTH 2022; 3:881949. [PMID: 35419563 PMCID: PMC8996059 DOI: 10.3389/froh.2022.881949] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Oral mucositis (OM) is one of the most common and debilitating oral complications of cancer treatments including chemotherapy, radiotherapy, and hematopoietic stem cell transplantation. It is associated with severe pain and difficulties in chewing, swallowing, and speech. This leads to impairment of basic oral functions and could result in unplanned treatment interruption or modification. As such, OM negatively impacts both patients' quality of life as well as tumor prognostic outcomes. Understanding pathways underlying OM pathogenesis help identify new targets for intervention or prevention. The pathophysiology of OM has been widely studied over past decades with several pathways related to oxidative stress, inflammation, and molecular and cellular signaling being implicated. In this mini-review, we will discuss the emerging role of the oral-gut microbiome axis in the development of OM. Particularly, we will elaborate on how the alterations in the oral and gut microbiota as well as intestinal dysfunction caused by cancer treatments could contribute to the pathogenesis of OM. Further, we will briefly discuss the potential methods for targeting the oral-gut microbiome axis to improve OM outcomes.
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Affiliation(s)
- Ghanyah Al-Qadami
- School of Biomedicine, University of Adelaide, Adelaide, SA, Australia
| | | | - Joanne Bowen
- School of Biomedicine, University of Adelaide, Adelaide, SA, Australia
| | - Hannah Wardill
- School of Biomedicine, University of Adelaide, Adelaide, SA, Australia
- Precision Medicine Theme (Cancer), South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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Srivastava D, Yadav A, Naqvi S, Awasthi H, Fatima Z. Efficacy of Flavonoids in Combating Fluconazole Resistant Oral Candidiasis. Curr Pharm Des 2022; 28:1703-1713. [PMID: 35331090 DOI: 10.2174/1381612828666220324140257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/21/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Candida is an opportunistic fungus often present in the oral mucosa. In the compromised immune system, it may become pathogenic and cause oral candidiasis. This infection is more common with Candida albicans; though, non-albicans Candida spp also have significant relevance. Current treatment guidelines include polyenes, azoles and echinocandins, where fluconazole is the primary therapeutic option. However, both inherited and acquired resistance to fluconazole is exhaustively reported. The development of resistance has resulted in the worsening of the original and re-emergence of new fungal diseases. Thus, the development of an anti-candidiasis therapy with a satisfactory outcome is the urgent need of the hour. OBJECTIVE This review article aims to stimulate the research in establishing the synergistic efficacy of various flavonoids with fluconazole to combat the resistance and develop an effective pharmacotherapy for the treatment of oral candidiasis. Further, in this article, we discuss in detail the mechanisms of action of fluconazole, along with the molecular basis of development of resistance in Candida species. METHOD PubMed and other databases were used for literature search. RESULTS The designing of natural drugs from the plant- derived phytochemicals are the promising alternates in modern medicine. The challenge today is the development of alternative anti- oral candidiasis drugs with increased efficacy, bioavailability and better outcome which can combat azole resistance. Identifying the flavonoids with potential antifungal action at low concentrations seems to meet the challenges. CONCLUSION Phyto-active constituents, either alone or in combination with conventional antibiotics may be an effective approach to deal with global antimicrobial resistance. The efficacy of herbal therapy for decades suggests that bacteria, fungi, and viruses may have a reduced ability to adapt and resistance to these natural antimicrobial regimes.
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Affiliation(s)
- Dipti Srivastava
- Amity Institute of Pharmacy, Lucknow, Amity University Uttar Pradesh, Sector 125,Noida,201313,India
| | - Aarti Yadav
- Amity Institute of Pharmacy, Lucknow, Amity University Uttar Pradesh, Sector 125,Noida,201313,India
| | - Salma Naqvi
- Department of Biomedical Sciences, College of Medicine, Gulf Medical University, Ajman, UAE
| | - Himani Awasthi
- Amity Institute of Pharmacy, Lucknow, Amity University Uttar Pradesh, Sector 125, Noida, 201313, India
| | - Zeeshan Fatima
- Amity Institute of Pharmacy, Lucknow, Amity University Uttar Pradesh, Sector 125, Noida,201313, India
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Jones JA, Chavarri-Guerra Y, Corrêa LBC, Dean DR, Epstein JB, Fregnani ER, Lee J, Matsuda Y, Mercadante V, Monsen RE, Rajimakers NJH, Saunders D, Soto-Perez-de-Celis E, Sousa MS, Tonkaboni A, Vissink A, Yeoh KS, Davies AN. MASCC/ISOO expert opinion on the management of oral problems in patients with advanced cancer. Support Care Cancer 2022; 30:8761-8773. [PMID: 35717462 PMCID: PMC9633484 DOI: 10.1007/s00520-022-07211-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/07/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE The Palliative Care Study Group in conjunction with the Oral Care Study Group of the Multinational Association for Supportive Care in Cancer (MASCC) formed a sub-group to develop evidence-based guidance on the management of common oral problems in patients with advanced cancer. METHODS This guidance was developed in accordance with the MASCC Guidelines Policy. A search strategy for Medline was developed, and the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were explored for relevant reviews and trials, respectively. Guidance was categorised by the level of evidence, and "category of guideline" (i.e., "recommendation", "suggestion" or "no guideline possible"). RESULTS Twelve generic suggestions (level of evidence - 5), three problem-specific recommendations and 14 problem-specific suggestions were generated. The generic suggestions relate to oral hygiene measures, assessment of problems, principles of management, re-assessment of problems and the role of dental/oral medicine professionals. CONCLUSIONS This guidance provides a framework for the management of common oral problems in patients with advanced cancer, although every patient requires individualised management.
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Affiliation(s)
- Jac A. Jones
- grid.416224.70000 0004 0417 0648Royal Surrey County Hospital, Guildford, UK
| | - Yanin Chavarri-Guerra
- grid.416850.e0000 0001 0698 4037Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - David R. Dean
- grid.34477.330000000122986657Department of Oral Medicine, University of Washington/Seattle Cancer Care Alliance, Seattle, USA
| | - Joel B. Epstein
- grid.50956.3f0000 0001 2152 9905City of Hope Comprehensive Cancer Center, Duarte & Cedars Sinai Health System, Los Angeles, USA
| | | | - Jiyeon Lee
- grid.15444.300000 0004 0470 5454College of Nursing & Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - Yuhei Matsuda
- grid.411621.10000 0000 8661 1590Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | | | - Ragnhild Elisabeth Monsen
- grid.5510.10000 0004 1936 8921Department of Medicine, Lovisenberg Diaconal Hospital & Department for Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - Natasja J. H. Rajimakers
- grid.470266.10000 0004 0501 9982Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Deborah Saunders
- grid.436533.40000 0000 8658 0974Department of Dental Oncology, Health Services North, Northern Ontario School of Medicine, Sudbury, Canada
| | - Enrique Soto-Perez-de-Celis
- grid.416850.e0000 0001 0698 4037Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Mariana S. Sousa
- grid.117476.20000 0004 1936 7611IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Arghavan Tonkaboni
- grid.411705.60000 0001 0166 0922Department of Oral Medicine, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Arjan Vissink
- grid.4830.f0000 0004 0407 1981Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Keng Soon Yeoh
- Special Needs Dental Unit, South Australia Dental Service, Adelaide, Australia
| | - Andrew N. Davies
- grid.8217.c0000 0004 1936 9705Trinity College Dublin, University College Dublin & Our Lady’s Hospice Dublin, Trinity College Dublin, Dublin, Ireland
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Maruoka Y, Michiwaki Y, Sekiya H, Kurasawa Y, Natsume N. What does oral care mean to society? Biosci Trends 2022; 16:7-19. [DOI: 10.5582/bst.2022.01046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Yutaka Maruoka
- Oral and Maxillofacial Surgery, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yukihiro Michiwaki
- Division of Special Dentistry and Oral Surgery, Japanese Red Cross Musashino Hospital, Musashino, Japan
| | - Hideki Sekiya
- Department of Oral Surgery, School of Medicine, Toho University, Tokyo, Japan
| | - Yasuhiro Kurasawa
- Oral and Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nagato Natsume
- Division of Research and Treatment for Oral and Maxillofacial Congenital Anomalies, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
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Dharman S, Keziah VS, Maragathavalli G. Assessment of onset and progression of chemoradiotherapy induced oral complications in head and neck cancer patients - A prospective study. JOURNAL OF INDIAN ACADEMY OF ORAL MEDICINE AND RADIOLOGY 2022. [DOI: 10.4103/jiaomr.jiaomr_3_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Xiao Y, Yuan P, Sun Y, Xu Y, Deng X, Wang X, Liu R, Chen Q, Jiang L. Comparison of topical antifungal agents for oral candidiasis treatment: a systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 133:282-291. [PMID: 34924340 DOI: 10.1016/j.oooo.2021.10.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/21/2021] [Accepted: 10/11/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To compare the efficacy and safety of topical antifungal drugs for oral candidiasis in adults and children. STUDY DESIGN Databases were searched from their inception to December 2020. The inclusion criterion was randomized controlled trials comparing topical antifungal agents. The primary outcomes were clinical response and mycological cure rates. The secondary outcomes were adverse reaction incidence and relapse rate. RESULTS In adults with oral candidiasis, fluconazole showed a better clinical response rate than clotrimazole (P = 0.001; risk ratio [RR], 1.14), but a similar mycological cure rate (P = 0.57; RR, 1.03). There was no significant difference in clinical response and mycological cure rates with either fluconazole and amphotericin B (clinical: P = 0.47, RR, 0.96; mycological: P = 0.99, RR, 1.00) or with either itraconazole and clotrimazole (clinical: P = 0.51, RR, 1.06; mycological: P = 0.45, RR, 1.32). For immunocompetent patients, fluconazole was superior to clotrimazole in terms of clinical response rate. For immunosuppressed patients, clotrimazole and itraconazole presented similar clinical response and mycological cure rates, but the relapse rate with itraconazole was lower than that with clotrimazole. In infants, miconazole and nystatin showed similar clinical response rates (P = 0.36; RR, 1.23), whereas miconazole presented a superior mycological cure rate (P = 0.03; RR, 4.03). CONCLUSIONS Fluconazole and amphotericin B are recommended as topical antifungal agents for adults with oral candidiasis. Existing studies tend to recommend fluconazole for immunocompetent patients and itraconazole for immunosuppressed patients, whereas miconazole is recommended for infants.
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Affiliation(s)
- Yanxuan Xiao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Peiyang Yuan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yutong Sun
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yiming Xu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoting Deng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Xianwen Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Rui Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Qianming Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Lu Jiang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
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Villar CC, Dongari-Bagtzoglou A. Fungal diseases: Oral dysbiosis in susceptible hosts. Periodontol 2000 2021; 87:166-180. [PMID: 34463992 DOI: 10.1111/prd.12378] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The oral cavity is colonized by a large number of microorganisms that are referred to collectively as the oral microbiota. These indigenous microorganisms have evolved in symbiotic relationships with the oral mucosal immune system and are involved in maintaining homeostasis in the oral cavity. Although Candida species are commonly found in the healthy oral cavity without causing infection, these fungi can become pathogenic. Recents advances indicate that the development of oral candidiasis is driven both by Candida albicans overgrowth in a dysbiotic microbiome and by disturbances in the host's immune system. Perturbation of the oral microbiota triggered by host-extrinsic (ie, medications), host-intrinsic (ie, host genetics), and microbiome-intrinsic (ie, microbial interactions) factors may increase the risk of oral candidiasis. In this review, we provide an overview of the oral mycobiome, with a particular focus on the interactions of Candida albicans with some of the most common oral bacteria and the oral mucosal immune system. Also, we present a summary of our current knowledge of the host-intrinsic and host-extrinsic factors that can predispose to oral candidiasis.
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Affiliation(s)
- Cristina Cunha Villar
- Division of Periodontics, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Anna Dongari-Bagtzoglou
- Department of Oral Health and Diagnostic Sciences, University of Connecticut School of Dental Medicine, Farmington, CT, USA
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Abstract
Abstract
Current therapies for Head and Neck cancer treatment are extremely advanced. Though, they cause oral complications which have deleterious effects on basic life functions, affect oral and overall health, may lead to significant morbidity and treatment discontinuation and have an impact on survivorship and quality of life. As new therapies are introduced, a new spectrum of oral complications is rising, compromising the mucosal integrity and the salivary function, that may not be recognized, reported and treated properly. Oral complications, often permanent and extremely painful, may include mucositis, xerostomia, dysgeusia, infections, trismus and fibrosis, risk of dental disease and necrosis of the jaw, neurosensory disorders and when targeted therapies and immunotherapy are involved, aphthoid and lichenoid lesions can also be reported. Increased awareness is required for the prevention and management of these complications, which can be best provided by a multidisciplinary team.
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Chitapanarux I, Wongsrita S, Sripan P, Kongsupapsiri P, Phakoetsuk P, Chachvarat S, Kittidachanan K. An underestimated pitfall of oral candidiasis in head and neck cancer patients undergoing radiotherapy: an observation study. BMC Oral Health 2021; 21:353. [PMID: 34271901 PMCID: PMC8285796 DOI: 10.1186/s12903-021-01721-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/07/2021] [Indexed: 12/05/2022] Open
Abstract
Background Oral candidiasis is a common problem associated with head and neck radiation therapy (RT) consequences being pain, burning sensation, taste change, and systemic infection. There are difficulties in differentiating between oral candidiasis and radiation induced oral mucositis. We conducted a prospective study to explore the incidence of clinical oral candidiasis and evaluate the accuracy of diagnosis among head and neck cancer (HNC) patients receiving RT or concurrent chemoradiotherapy (CCRT). Methods This study included 86 HNC patients who had no clinical signs or symptoms of oral candidiasis. Oral mucosa and tongue swabs were carried out and analyzed three times by fungal cultures at the following time points: (1) before RT, (2) at the time of clinically diagnosed candidiasis or during RT at between the 15th–17th fraction (whichever occurred first), and (3) at the end of RT. The accuracy of clinical oral candidiasis was explored and confirmed by fungal colonization techniques. The incidence and risk factors associated with fungal colonization before and throughout the treatment were analyzed. Results The overall incidence of clinical oral candidiasis was 53.5% throughout the course of RT. Confirmation of fungal colonization was found in 39.5%, 65.9%, and 57.7% of cases before RT, during RT, and end of RT, respectively. The accuracy of the diagnosis using only clinical presentation was demonstrated in 60%, 50%, and 52% before RT, during RT, and end of RT, respectively. Logistic regression analysis showed that age, CCRT, and using 2% viscous lidocaine solution were independent risk factors for fungal colonization. Conclusions The results of this study demonstrated an underestimation of clinical oral candidiasis before and throughout the course of radiotherapy from using only clinical sign and symptoms. Crucial attention to detail and testing in the oral examination could improve decision making for detection of oral candidiasis in HNC patients receiving RT or CCRT.
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Affiliation(s)
- Imjai Chitapanarux
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. .,Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Somying Wongsrita
- Division of Radiation Oncology, Maharaj Nakornratchasima Hospital, Nakornratchasima, Thailand
| | - Patumrat Sripan
- Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | | | | | | | - Kittikun Kittidachanan
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Saul-McBeth J, Dillon J, Lee A, Launder D, Kratch JM, Abutaha E, Williamson AA, Schroering AG, Michalski G, Biswas P, Conti SR, Shetty AC, McCracken C, Bruno VM, Parsai EI, Conti HR. Tissue Damage in Radiation-Induced Oral Mucositis Is Mitigated by IL-17 Receptor Signaling. Front Immunol 2021; 12:687627. [PMID: 34220843 PMCID: PMC8248500 DOI: 10.3389/fimmu.2021.687627] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/31/2021] [Indexed: 01/13/2023] Open
Abstract
Oral mucositis (OM) is a treatment-limiting adverse side effect of radiation and chemotherapy. Approximately 80% of patients undergoing radiotherapy (RT) for head and neck cancers (HNC) develop OM, representing a major unmet medical condition. Our understanding of the immunopathogenesis of OM is limited, due in part to the surprising paucity of information regarding healing mechanisms in the oral mucosa. RNAseq of oral tissue in a murine model that closely mimics human OM, showed elevated expression of IL-17 and related immune pathways in response to head and neck irradiation (HNI). Strikingly, mice lacking the IL-17 receptor (IL-17RA) exhibited markedly more severe OM. Restoration of the oral mucosa was compromised in Il17ra-/- mice and components associated with healing, including matrix metalloproteinase 3, 10 and IL-24 were diminished. IL-17 is typically associated with recruitment of neutrophils to mucosal sites following oral infections. Unexpectedly, in OM the absence of IL-17RA resulted in excessive neutrophil recruitment and immunopathology. Instead, neutrophil activation was IL-1R-driven in Il17ra-/- mice. Blockade of IL-1R and depletion of neutrophils lessened the severity of damage in these mice. Overall, we show IL-17 is protective in OM through multiple mechanisms including restoration of the damaged epithelia and control of the neutrophil response. We also present a clinically relevant murine model of human OM to improve mechanistic understanding and develop rational translational therapeutics.
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Affiliation(s)
- Jessica Saul-McBeth
- Department of Biological Sciences, University of Toledo, Toledo, OH, United States
| | - John Dillon
- Department of Biological Sciences, University of Toledo, Toledo, OH, United States
| | - Aaron Lee
- Department of Radiation Oncology, Division of Medical Physics, The University of Toledo, Toledo, OH, United States
| | - Dylan Launder
- Department of Biological Sciences, University of Toledo, Toledo, OH, United States
| | - Jacqueline M. Kratch
- Department of Biological Sciences, University of Toledo, Toledo, OH, United States
| | - Eanas Abutaha
- Department of Biological Sciences, University of Toledo, Toledo, OH, United States
| | | | | | - Grace Michalski
- Department of Biological Sciences, University of Toledo, Toledo, OH, United States
| | - Priosmita Biswas
- Department of Biological Sciences, University of Toledo, Toledo, OH, United States
| | - Samuel R. Conti
- Department of Biological Sciences, University of Toledo, Toledo, OH, United States
| | - Amol C. Shetty
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Carrie McCracken
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Vincent M. Bruno
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, United States
| | - E. Ishmael Parsai
- Department of Radiation Oncology, Division of Medical Physics, The University of Toledo, Toledo, OH, United States
| | - Heather R. Conti
- Department of Biological Sciences, University of Toledo, Toledo, OH, United States
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Ingrosso G, Saldi S, Marani S, Wong AYW, Bertelli M, Aristei C, Zelante T. Breakdown of Symbiosis in Radiation-Induced Oral Mucositis. J Fungi (Basel) 2021; 7:jof7040290. [PMID: 33921294 PMCID: PMC8068946 DOI: 10.3390/jof7040290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 01/06/2023] Open
Abstract
Oral mucositis is an acute side effect of radiation therapy that is especially common with head and neck cancer treatment. In recent years, several studies have revealed the predisposing factors for mucositis, leading to the pre-treatment of patients to deter the development of opportunistic oral fungal infections. Although many clinical protocols already advise the use of probiotics to counteract inflammation and fungal colonization, preclinical studies are needed to better delineate the mechanisms by which a host may acquire benefits via co-evolution with oral microbiota, probiotics, and fungal commensals, such as Candida albicans, especially during acute inflammation. Here, we review the current understanding of radiation therapy-dependent oral mucositis in terms of pathology, prevention, treatment, and related opportunistic infections, with a final focus on the oral microbiome and how it may be important for future therapy.
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Affiliation(s)
- Gianluca Ingrosso
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy; (G.I.); (S.M.); (C.A.)
- Radiation Oncology Section, Perugia General Hospital, 06129 Perugia, Italy;
| | - Simonetta Saldi
- Radiation Oncology Section, Perugia General Hospital, 06129 Perugia, Italy;
| | - Simona Marani
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy; (G.I.); (S.M.); (C.A.)
- Radiation Oncology Section, Perugia General Hospital, 06129 Perugia, Italy;
| | - Alicia Y. W. Wong
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, 141 86 Stockholm, Sweden;
| | | | - Cynthia Aristei
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy; (G.I.); (S.M.); (C.A.)
- Radiation Oncology Section, Perugia General Hospital, 06129 Perugia, Italy;
| | - Teresa Zelante
- Pathology Section, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy
- Correspondence: ; Tel.: +39-075-585-8236
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Abstract
Of all the oral sensations that are experienced, "metallic" is one that is rarely reported in healthy participants. So why, then, do chemotherapy patients so frequently report that "metallic" sensations overpower and interfere with their enjoyment of food and drink? This side-effect of chemotherapy-often referred to (e.g., by patients) as "metal mouth"-can adversely affect their appetite, resulting in weight loss, which potentially endangers (or at the very least slows) their recovery. The etiology of "metal mouth" is poorly understood, and current management strategies are largely unevidenced. As a result, patients continue to suffer as a result of this poorly understood phenomenon. Here, we provide our perspective on the issue, outlining the evidence for a range of possible etiologies, and highlighting key research questions. We explore the evidence for "metallic" as a putative taste, and whether "metal mouth" might therefore be a form of phantageusia, perhaps similar to already-described "release-of-inhibition" phenomena. We comment on the possibility that "metal mouth" may simply be a direct effect of chemotherapy drugs. We present the novel theory that "metal mouth" may be linked to chemotherapy-induced sensitization of TRPV1. Finally, we discuss the evidence for retronasal olfaction of lipid oxidation products in the etiology of "metal mouth." This article seeks principally to guide much-needed future research which will hopefully one day provide a basis for the development of novel supportive therapies for future generations of patients undergoing chemotherapy.
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Affiliation(s)
- Alastair J M Reith
- Oxford Medical School, Medical Sciences Division, John Radcliffe Hospital, UK
| | - Charles Spence
- Crossmodal Research Laboratory, Department of Experimental Psychology, Oxford University, UK
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Hardy J, Haywood A, Rickett K, Sallnow L, Good P. Practice review: Evidence-based quality use of corticosteroids in the palliative care of patients with advanced cancer. Palliat Med 2021; 35:461-472. [PMID: 33499759 DOI: 10.1177/0269216320986717] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND It would be unusual for a patient with advanced cancer not to be prescribed corticosteroids at some stage of their disease course for a variety of specific and non-specific indications. AIM The aim of this practice review was to provide a pragmatic overview of the evidence supporting current practice and to identify areas in which further research is indicated. DESIGN A 'state-of-the-art' review approach was used to examine the evidence supporting the use of corticosteroids for the management of cancer-related complications and in symptom control, in the context of known risks and harms to inform quality use of this medicine. We developed 'Do', 'Do not', and 'Don't know' recommendations based on current literature and identified areas for future investigation and research. DATA SOURCES We searched MEDLINE, EMBASE and the Cochrane library from inception to 14th October 2020. Our initial search limited to reviews, reviews of reviews, randomised controlled trials (RCTs) and controlled trials was supplemented by supporting literature as appropriate. RESULTS Evidence to support common practice in the use of corticosteroids is lacking for most indications. This is in the context of strong evidence for the potential for significant toxicity and poor quality use of medicine. CONCLUSION Guidelines recommending the widespread use of corticosteroids should acknowledge the poor evidence base supporting much current dogma. Quality research is essential not only to define the role of corticosteroids in this context but to ensure good prescribing practice.
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Affiliation(s)
- Janet Hardy
- Mater Health, Brisbane, SEQ, Australia.,Mater Research Institute - University of Queensland (UQ), Brisbane, QLD, Australia
| | - Alison Haywood
- Mater Research Institute - University of Queensland (UQ), Brisbane, QLD, Australia.,School of Pharmacy and Pharmacology, Griffith University, Gold Coast, QLD, Australia
| | - Kirsty Rickett
- University of Queensland Library - Mater Misericordiae Hospital, Brisbane, QLD, Australia
| | - Libby Sallnow
- St Christopher's Hospice and UCL Marie Curie Palliative Care Department, London, UK.,St Vincent's Private Hospital Brisbane, Brisbane, QLD, Australia
| | - Phillip Good
- Mater Health, Brisbane, SEQ, Australia.,Mater Research Institute - University of Queensland (UQ), Brisbane, QLD, Australia.,St Vincent's Private Hospital Brisbane, Brisbane, QLD, Australia
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Nicolatou-Galitis O, Bossi P, Orlandi E. The role of benzydamine in prevention and treatment of chemoradiotherapy-induced mucositis. Support Care Cancer 2021; 29:5701-5709. [PMID: 33649918 PMCID: PMC8410701 DOI: 10.1007/s00520-021-06048-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/04/2021] [Indexed: 02/04/2023]
Abstract
Purpose To discuss the role of benzydamine in the prevention and treatment of radiation-induced oral mucositis (OM) in head and neck (H&N) cancer patients. This document represents an expert opinion paper on indications and key-role aspects in OM pathogenesis, prevention and treatment. Oral mucositis OM represents a common side effect of chemotherapy (CHT) and radiotherapy (RT). It consists in a painful erythema involving the oral cavity mucosa, which may progress to ulceration. Five biologically dynamic phases are considered crucial in mucositis: “initiation, signalling, amplification, ulceration and healing”. Oral environment and microbiota are fundamental in mucositis development being involved in susceptibility to infections and in ulceration consequences. Different agents against mucositis have been studied and the use of benzydamine is strongly supported in literature. The Multinational Association of Supportive Care in Cancer and International Society for Oral Oncology (MASCC/ISOO) guidelines recommend its use for the prevention of OM in H&N patients undergoing RT and RT/CHT. Benzydamine Benzydamine is a local anti-inflammatory drug with analgesic properties. It can decrease TNF-α, IL-1β and prostaglandin synthesis, also inhibiting leukocyte-endothelial interactions, neutrophil degranulation, vasodilation and vascular permeability. Literature agrees on the beneficial effects of benzydamine in preventing and reducing oral mucositis severity in H&N cancer patients undergoing RT/CHT. Conclusions Mucositis represents a major concern in H&N cancer patients and a clinical and economical issue. A multimodal and multidisciplinary approach is needed for its management. International guidelines recommend benzydamine for OM prevention and treatment in H&N cancer patients, but further “real world” trials should be designed.
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Affiliation(s)
| | - Paolo Bossi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health-Medical Oncology, University of Brescia, ASST-Spedali Civili, Brescia, Italy.
| | - Ester Orlandi
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
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Abstract
In the last decades, Candida albicans has served as the leading causal agent of life-threatening invasive infections with mortality rates approaching 40% despite treatment. Candida albicans (C. albicans) exists in three biological phases: yeast, pseudohyphae, and hyphae. Hyphae, which represent an important phase in the disease process, can cause tissue damage by invading mucosal epithelial cells then leading to blood infection. In this review, we summarized recent results from different fields of fungal cell biology that are instrumental in understanding hyphal growth. This includes research on the differences among C. albicans phases; the regulatory mechanism of hyphal growth, extension, and maintaining cutting-edge polarity; cross regulations of hyphal development and the virulence factors that cause serious infection. With a better understanding of the mechanism on mycelium formation, this review provides a theoretical basis for the identification of targets in candidiasis treatment. It also gives some reference to the study of antifungal drugs.
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Affiliation(s)
- Hui Chen
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China.,Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China.,Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Biao Ren
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
| | - Lei Cheng
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China.,Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Clinical Characteristics and Manifestations of Fungal Esophagitis: A Single-Center Experience in South China. Gastroenterol Res Pract 2021; 2021:8869494. [PMID: 33531895 PMCID: PMC7834832 DOI: 10.1155/2021/8869494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/22/2020] [Accepted: 01/05/2021] [Indexed: 11/17/2022] Open
Abstract
Fungal esophagitis is a common infectious disease, although the pathogenic clinical characteristics remain incompletely clear, especially in South China. The goal of this study was to investigate the pathogenic clinical characteristics of fungal esophagitis and the efficacy of different therapeutic strategies at a tertiary hospital in South China. A retrospective study was conducted from January 2007 to December 2017. Data from 113,390 patients who were treated in the endoscopic unit were retrieved and analyzed. To further understand the pathogen and risk factors for fungal esophagitis, we performed a case-control analysis of 101 patients and 202 controls. Of the 113,390 patients, 932 (0.82%) were positive. The annual detection rate ranged from 0.345% to 1.106%, showing an initially increasing and subsequently decreasing trend. The patients' median age was 49 years (range from 8 to 85), and most were men (615/932, 65.99%). Candida albicans was found in samples collected from 36 patients, without any drug-resistant strains. Age (P = 0.018), malignancy (OR = 4.031, 95% CI: 1.562~10.407), cigarette smoking (OR = 3.017, 95% CI: 1.645~5.533), and the use of antibiotics (OR = 2.178, 95% CI: 1.078~4.400) or immunosuppressants (OR = 6.525, 95% CI: 1.089~39.105) were independently associated with esophageal candidiasis. Fluconazole had a better curative effect than nystatin (OR = 4.047, 95% CI: 1.282~12.772) or simple observation (OR = 8.91, 95% CI: 2.61~30.49). In conclusion, fungal esophagitis primarily affects men and elderly individuals; it develops in the setting of malignancy, smoking, and certain previous medication use. Candida albicans is the most common pathogen and is sensitive to antifungal agents. Fluconazole has a good therapeutic effect.
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Damrongrungruang T, Panpitakkul P, Somudorn J, Sangchart P, Mahakunakorn P, Uthaiwat P, Daduang J, Panyatip P, Puthongking P, Priprem A. Glutaryl Melatonin Niosome Gel for Topical Oral Mucositis: Anti- Inflammatory and Anticandidiasis. Curr Drug Deliv 2021; 17:195-206. [PMID: 31969103 DOI: 10.2174/1567201817666200122162545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/24/2019] [Accepted: 01/07/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Glutaryl melatonin, which is synthesized from melatonin and is a pineal glandderived neurohormone with anti-inflammatory and anti-oxidant properties, was comparatively investigated for its potential use as a topical anti-inflammatory agent. OBJECTIVE Glutaryl melatonin, synthesized and screened for in vitro anti-candidiasis and in vitro and in vivo anti-inflammatory activities, was formulated as a niosome gel for topical oral evaluation in 5- fluorouracil-induced oral mucositis in mice. METHODS In vitro anti-fungal activity in Candida albicans, in vitro anti-inflammatory activity in Escherichia coli liposaccharide-induced RAW cells and in vivo anti-inflammatory activity using a croton oilinduced ear edema model in ICR mice were investigated. Mucositis in mice (n= 6/group, 10-week-old mice) was induced by intraperitoneal injections of 5-fluorouracil, and the mice were subjected to a topical oral application of niosome gel containing melatonin (2% w/w) or glutaryl melatonin (2% w/w) and were compared with mice subjected to blank, fluocinolone acetonide (0.5% w/w) and control conditions. RESULTS Glutaryl melatonin, at a 14.2 mM concentration, showed the highest fungicidal effect on C. albicans using the broth dilution method, indicating a nonsignificant difference from 1 μM of nystatin (p = 0.05). Nitric oxide, interleukin-6 and tumor necrosis factors were analyzed by ELISA. Liposaccharide-induced RAW cells were significantly reduced by glutaryl melatonin (p < 0.01). Ear edema inhibition of glutaryl melatonin was significant 1 h after application compared with that of melatonin (p = 0.03). Food consumption and body weight of the 5-fluorouracil-treated mice were significantly lower than those of the normal mice before all treatments (p < 0.05). Differences in the amount of licking behavior, which were observed in the control group for 5 min, were noticeable in the 5- fluorouracil-treated mice but not in the mice treated with the glutaryl melatonin niosome gel. CONCLUSION Glutaryl melatonin exhibited mild anti-candidiasis and anti-inflammatory properties. The incorporation of glutaryl melatonin in a niosome gel formulation, demonstrated the potential for topical oral applications to reduce oral discomfort caused by 5-fluorouracil treatment in mice.
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Affiliation(s)
- Teerasak Damrongrungruang
- Division of Oral Diagnosis, Department of Oral Biomedical Sciences, Faculty of Dentistry, Khon Kaen University, 123 Mittraphap Road, Amphur Muang, Khon Kaen, 40002, Thailand.,Melatonin Research Group, Khon Kaen University, 123 Mittraphap Road, Amphur Muang, Khon Kaen, 40002, Thailand
| | - Panjaree Panpitakkul
- Faculty of Dentistry, Khon Kaen University, 123 Mittraphap Road, Amphur Muang, Khon Kaen, 40002, Thailand
| | - Jirachaya Somudorn
- Faculty of Dentistry, Khon Kaen University, 123 Mittraphap Road, Amphur Muang, Khon Kaen, 40002, Thailand
| | - Pimpitchaya Sangchart
- Melatonin Research Group, Khon Kaen University, 123 Mittraphap Road, Amphur Muang, Khon Kaen, 40002, Thailand.,Graduate School, Khon Kaen University, 123 Mittraphap Road, Amphur Muang, Khon Kaen, 40002, Thailand
| | - Pramote Mahakunakorn
- Melatonin Research Group, Khon Kaen University, 123 Mittraphap Road, Amphur Muang, Khon Kaen, 40002, Thailand.,Faculty of Pharmaceutical Sciences, Khon Kaen University, 123 Mittraphap Road, Amphur Muang, Khon Kaen, 40002, Thailand
| | - Prangtip Uthaiwat
- Melatonin Research Group, Khon Kaen University, 123 Mittraphap Road, Amphur Muang, Khon Kaen, 40002, Thailand.,Department of Clinical Chemistry, Faculty of Associated Medical Sciences, Khon Kaen University, 123 Mittraphap Road, Amphur Muang, Khon Kaen, 40002, Thailand
| | - Jureerut Daduang
- Department of Clinical Chemistry, Faculty of Associated Medical Sciences, Khon Kaen University, 123 Mittraphap Road, Amphur Muang, Khon Kaen, 40002, Thailand
| | - Panyada Panyatip
- Melatonin Research Group, Khon Kaen University, 123 Mittraphap Road, Amphur Muang, Khon Kaen, 40002, Thailand.,Graduate School, Khon Kaen University, 123 Mittraphap Road, Amphur Muang, Khon Kaen, 40002, Thailand
| | - Ploenthip Puthongking
- Melatonin Research Group, Khon Kaen University, 123 Mittraphap Road, Amphur Muang, Khon Kaen, 40002, Thailand.,Faculty of Pharmaceutical Sciences, Khon Kaen University, 123 Mittraphap Road, Amphur Muang, Khon Kaen, 40002, Thailand
| | - Aroonsri Priprem
- Melatonin Research Group, Khon Kaen University, 123 Mittraphap Road, Amphur Muang, Khon Kaen, 40002, Thailand.,Faculty of Pharmaceutical Sciences, Khon Kaen University, 123 Mittraphap Road, Amphur Muang, Khon Kaen, 40002, Thailand
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Haverman TM, Raber-Durlacher JE, Raghoebar II, Rademacher WMH, Rozema FR, Hazenberg MD, Epstein JB, Treister NS. Oral chronic graft-versus-host disease: What the general dental practitioner needs to know. J Am Dent Assoc 2020; 151:846-856. [PMID: 33121606 DOI: 10.1016/j.adaj.2020.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/13/2020] [Accepted: 08/03/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Long-term survivors of allogeneic hematopoietic cell transplantation will increasingly seek care from dental providers. METHODS The authors highlight the importance of minimizing oral symptoms and complications associated with oral chronic graft-versus-host-disease (cGVHD). RESULTS Chronic GVHD is the result of an immune response of donor-derived cells against recipient tissues. Oral cGVHD can affect the mucosa and damage salivary glands and cause sclerotic changes. Symptoms include sensitivity and pain, dry mouth, taste changes, and limited mouth opening. Risk of developing caries and oral cancer is increased. Food intake, oral hygiene, and dental interventions can represent challenges. Oral cGVHD manifestations and dental interventions should be managed in close consultation with the medical team, as systemic treatment for cGVHD can have implications for dental management. CONCLUSIONS General dental practitioners can contribute substantially to alleviating oral cGVHD involvement and preventing additional oral health deterioration. PRACTICAL IMPLICATIONS Frequent examinations, patient education, oral hygiene reinforcement, dry mouth management, caries prevention, and management of dental needs are indicated. In addition, oral physical therapy might be needed. Invasive dental interventions should be coordinated with the transplantation team. Screening for oral malignancies is important even years after resolution of GVHD symptoms. Management of the oral manifestations of cGVHD might require referral to an oral medicine professional.
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