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Kang Y, Xiong Y, Lu B, Wang Y, Zhang D, Feng J, Chen L, Zhang Z. Application of In Situ Mucoadhesive Hydrogel with Anti-Inflammatory and Pro-Repairing Dual Properties for the Treatment of Chemotherapy-Induced Oral Mucositis. ACS APPLIED MATERIALS & INTERFACES 2024; 16:35949-35963. [PMID: 38970482 DOI: 10.1021/acsami.4c03217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/08/2024]
Abstract
Chemotherapy-induced oral mucositis (CIOM) is a prevalent complication of chemotherapy and significantly affects the treatment process. However, effective treatment for CIOM is lacking due to the unique environment of the oral cavity and the single effect of current drug delivery systems. In this present study, we propose an innovative approach by combining a methacrylate-modified human recombinant collagen III (rhCol3MA) hydrogel system with hyaluronic acid-epigallocatechin gallate (HA-E) and dopamine-modified methacrylate-alginate (AlgDA-MA). HA-E is used as an antioxidant and anti-inflammatory agent and synergizes with AlgDA-MA to improve the wet adhesion of hydrogel. The results of rhCol3MA/HA-E/AlgDA-MA (Col/HA-E/Alg) hydrogel demonstrate suitable physicochemical properties, excellent wet adhesive capacity, and biocompatibility. Notably, the hydrogel could promote macrophage polarization from M1 to M2 and redress human oral keratinocyte (HOK) inflammation by inhibiting NF-κB activation. Wound healing evaluations in vivo demonstrate that the Col/HA-E/Alg hydrogel exhibits a pro-repair effect by mitigating inflammatory imbalances, fostering early angiogenesis, and facilitating collagen repair. In summary, the Col/HA-E/Alg hydrogel could serve as a promising multifunctional dressing for the treatment of CIOM.
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Affiliation(s)
- Yujie Kang
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong 510280, P. R. China
| | - Yahui Xiong
- Department of Burn, Wound Repair & Reconstruction, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, P. R. China
- Guangdong Provincial Engineering Technology Research Center of Burn and Wound Accurate Diagnosis and Treatment Key Technology and Series of Products, Sun Yat-sen University, Guangzhou, Guangdong 510080, P. R. China
- Institute of Precision Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, P. R. China
| | - Bingxu Lu
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong 510280, P. R. China
| | - Yunyi Wang
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong 510280, P. R. China
| | - Danya Zhang
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong 510280, P. R. China
| | - Jinghao Feng
- Guangzhou Panyu Central Hospital, Guangzhou, Guangdong 511400, P. R. China
| | - Lei Chen
- Department of Burn, Wound Repair & Reconstruction, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, P. R. China
- Guangdong Provincial Engineering Technology Research Center of Burn and Wound Accurate Diagnosis and Treatment Key Technology and Series of Products, Sun Yat-sen University, Guangzhou, Guangdong 510080, P. R. China
- Institute of Precision Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, P. R. China
| | - Zhaoqiang Zhang
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong 510280, P. R. China
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Bowen J, Cross C. The Role of the Innate Immune Response in Oral Mucositis Pathogenesis. Int J Mol Sci 2023; 24:16314. [PMID: 38003503 PMCID: PMC10670995 DOI: 10.3390/ijms242216314] [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: 10/07/2023] [Revised: 11/11/2023] [Accepted: 11/12/2023] [Indexed: 11/26/2023] Open
Abstract
Oral mucositis (OM) is a significant complication of cancer therapy with limited management strategies. Whilst inflammation is a central feature of destructive and ultimately ulcerative pathology, to date, attempts to mitigate damage via this mechanism have proven limited. A relatively underexamined aspect of OM development is the contribution of elements of the innate immune system. In particular, the role played by barriers, pattern recognition systems, and microbial composition in early damage signaling requires further investigation. As such, this review highlights the innate immune response as a potential focus for research to better understand OM pathogenesis and development of interventions for patients treated with radiotherapy and chemotherapy. Future areas of evaluation include manipulation of microbial-mucosal interactions to alter cytotoxic sensitivity, use of germ-free models, and translation of innate immune-targeted agents interrogated for mucosal injury in other regions of the alimentary canal into OM-based clinical trials.
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Affiliation(s)
- Joanne Bowen
- School of Biomedicine, University of Adelaide, Adelaide 5005, Australia;
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Tugizov S. Virus-associated disruption of mucosal epithelial tight junctions and its role in viral transmission and spread. Tissue Barriers 2021; 9:1943274. [PMID: 34241579 DOI: 10.1080/21688370.2021.19432749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Oropharyngeal, airway, intestinal, and genital mucosal epithelia are the main portals of entry for the majority of human pathogenic viruses. To initiate systemic infection, viruses must first be transmitted across the mucosal epithelium and then spread across the body. However, mucosal epithelia have well-developed tight junctions, which have a strong barrier function that plays a critical role in preventing the spread and dissemination of viral pathogens. Viruses can overcome these barriers by disrupting the tight junctions of mucosal epithelia, which facilitate paracellular viral penetration and initiate systemic disease. Disruption of tight and adherens junctions may also release the sequestered viral receptors within the junctional areas, and liberation of hidden receptors may facilitate viral infection of mucosal epithelia. This review focuses on possible molecular mechanisms of virus-associated disruption of mucosal epithelial junctions and its role in transmucosal viral transmission and spread.
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Affiliation(s)
- Sharof Tugizov
- Department of Medicine, School of Medicine, University of California-San Francisco, San Francisco, CA, USA
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4
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Tugizov S. Virus-associated disruption of mucosal epithelial tight junctions and its role in viral transmission and spread. Tissue Barriers 2021; 9:1943274. [PMID: 34241579 DOI: 10.1080/21688370.2021.1943274] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Oropharyngeal, airway, intestinal, and genital mucosal epithelia are the main portals of entry for the majority of human pathogenic viruses. To initiate systemic infection, viruses must first be transmitted across the mucosal epithelium and then spread across the body. However, mucosal epithelia have well-developed tight junctions, which have a strong barrier function that plays a critical role in preventing the spread and dissemination of viral pathogens. Viruses can overcome these barriers by disrupting the tight junctions of mucosal epithelia, which facilitate paracellular viral penetration and initiate systemic disease. Disruption of tight and adherens junctions may also release the sequestered viral receptors within the junctional areas, and liberation of hidden receptors may facilitate viral infection of mucosal epithelia. This review focuses on possible molecular mechanisms of virus-associated disruption of mucosal epithelial junctions and its role in transmucosal viral transmission and spread.
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Affiliation(s)
- Sharof Tugizov
- Department of Medicine, School of Medicine, University of California-San Francisco, San Francisco, CA, USA
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5
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Imafuku K, Kamaguchi M, Natsuga K, Nakamura H, Shimizu H, Iwata H. Zonula occludens-1 demonstrates a unique appearance in buccal mucosa over several layers. Cell Tissue Res 2021; 384:691-702. [PMID: 33635425 DOI: 10.1007/s00441-021-03425-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 01/24/2021] [Indexed: 02/07/2023]
Abstract
Tight junctions (TJs) firmly seal epithelial cells and are key players in the epithelial barrier. TJs consist of several proteins, including those of the transmembrane claudin family and the scaffold zonula occludens (ZO) family. Epithelial tissues are exposed to different conditions: to air in the stratified epithelium of the skin and to liquids in the monolayer of the intestine. The TJs in stratified oral mucosal epithelium have remained insufficiently elucidated in terms of distributions, appearances and barrier functions of TJ proteins in normal buccal mucosa. We investigated these and ZO-1 and claudin-1 were found to be expressed in the top third and in the bottom three quarters of the mucosal epithelium. ZO-1 in the buccal mucosa was found to have an irregular linear appearance. ZO-1 in the buccal mucosa continuously existed in several layers. Electron microscopy revealed the buccal mucosa to have kissing points. In a biotin permeation assay that sought to investigate inside-outside barrier function, the biotin tracer penetrated several ZO-1 layers but did not pass through all the ZO-1 layers. We found that the oral mucosal cell knockdown of TJP1 or CLDN1 resulted in decreases of TER but no significant change in FITC-dextran leakage. Our results suggest that the distribution and appearance of ZO-1 in the buccal mucosa differ from those in the skin. We were unable to prove barrier function in this study but we did show barrier function against small molecules in vivo and against ions in vitro.
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Affiliation(s)
- Keisuke Imafuku
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, 060-8638, Sapporo, Japan
| | - Mayumi Kamaguchi
- Department of Oral Diagnosis and Medicine, Faculty of Medicine and Graduate School of Dental Medicine, Hokkaido University, Kita 13, Nishi 7, Kita-ku, Sapporo, 060-8586, Japan.,Lübeck Institute of Experimental Dermatology, University of Lübeck, Building B9 Ratzeburger Allee 160, 23562, Lubeck, Germany
| | - Ken Natsuga
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, 060-8638, Sapporo, Japan
| | - Hideki Nakamura
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, 060-8638, Sapporo, Japan
| | - Hiroshi Shimizu
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, 060-8638, Sapporo, Japan
| | - Hiroaki Iwata
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, 060-8638, Sapporo, Japan.
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Thomsen M, Clarke S, Vitetta L. The role of adjuvant probiotics to attenuate intestinal inflammatory responses due to cancer treatments. Benef Microbes 2018; 9:899-916. [PMID: 30232908 DOI: 10.3920/bm2017.0172] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chemotherapy and radiotherapy treatment regimens for gastrointestinal, peritoneal and pelvic tumours can disrupt the intestinal microbiome and intestinal epithelia. Such disturbances can provoke symptoms such as diarrhoea, nausea and vomiting. Chemotherapy and radiotherapy induced gastrointestinal toxicity aggravating intestinal microbiome dysbiosis is postulated to adversely alter the intestinal microbiome, with a consequent induced pro-inflammatory effect that disrupts the intestinal microbiome-epithelia-mucosal immunity axis. Although not widely recognised, the intestinal mucosa is the largest and most densely and dynamically populated immune-environment. Cancer treatment adverse effects that affect intestinal and mucosal cells inadvertently target and disrupt resident intestinal macrophages, the cells that marshal immune activity in the intestinal mucosa by shaping pro-inflammatory and anti-inflammatory activities to control and eradicate infectious insults and maintain local homeostasis. Pathobionts (bacteria capable of pathogenic pro-inflammatory activity) and noxious environmental and bacterial antigens use the intestinal epithelia and gap junctions as a point of entry into the systemic circulation. This translocation movement promotes toxic sequelae that obstruct intestinal macrophage functions resulting in uncontrolled local and systemic pro-inflammatory activity, loss of phagocytic function and loss of expression of tight junction proteins. Probiotic bacteria as an adjunctive treatment shows efficacy in ameliorating enteropathies such as mucositis/diarrhoea resulting from chemotherapy or radiotherapy regimens. As such we posit that an important benefit that warrants a further focused research effort is the administration of adjuvant probiotics to help reduce the incidence of febrile neutropenia.
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Affiliation(s)
- M Thomsen
- 1 The University of Sydney, School of Medicine, Faculty of Medicine and Health, NSW 2006, Australia
| | - S Clarke
- 1 The University of Sydney, School of Medicine, Faculty of Medicine and Health, NSW 2006, Australia.,2 Northern Clinical School, Kolling Institute of Medical Research, Pacific Hwy, St Leonards NSW 2065, Australia
| | - L Vitetta
- 1 The University of Sydney, School of Medicine, Faculty of Medicine and Health, NSW 2006, Australia.,3 Medlab Clinical Ltd., 66 McCauley St., Sydney, 2006 NSW, Australia
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Gruber S, Frings K, Kuess P, Dörr W. Protective effects of systemic dermatan sulfate treatment in a preclinical model of radiation-induced oral mucositis. Strahlenther Onkol 2018; 194:675-685. [PMID: 29497792 PMCID: PMC6008363 DOI: 10.1007/s00066-018-1280-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 02/08/2018] [Indexed: 01/05/2023]
Abstract
PURPOSE Oral mucositis is a frequent, dose-limiting side effect of radio(chemo)therapy of head-and-neck malignancies. The epithelial radiation response is based on multiple tissue changes, which could offer targets for a biologically tailored treatment. The potential of dermatan sulfate (DS) to modulate radiation-induced oral mucositis was tested in an established preclinical mucositis model. METHODS Irradiation was either applied alone or in combination with daily DS treatment (4 mg/kg, subcutaneously) over varying time intervals. Irradiation comprised single dose irradiation with graded doses to the lower tongue surface or daily fractionated irradiation of the whole tongue. Fractionation protocols (5 × 3 Gy/week) over one (days 0-4) or two weeks (days 0-4, 7-11) were terminated by an additional local single dose irradiation to a defined treatment field on the lower tongue surface to induce the mucosal radiation response. The additional single dose irradiation (top-up) on day 7 (after one week of fractionation) or day 14 (after 2 weeks of fractionation) comprised graded doses in order to generate full dose-effect curves. Ulceration of the epithelium of the lower tongue, corresponding to confluent mucositis, was analysed as clinically relevant endpoint. Additionally, the time course parameters, latent time and ulcer duration were analysed. RESULTS DS treatment significantly reduced the incidence of ulcerations. DS application over longer time intervals resulted in a more pronounced reduction of ulcer frequency, increased latent times and reduced ulcer duration. CONCLUSION DS has a significant mucositis-ameliorating activity with pronounced effects on mucositis frequency as well as on time course parameters.
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Affiliation(s)
- Sylvia Gruber
- Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria.
- Department of Radiation Oncology, Applied and Translational Radiobiology (ATRAB), Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Katharina Frings
- Department of Radiation Oncology, Applied and Translational Radiobiology (ATRAB), Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Platform Radiooncology and Nuclear Medicine, Department for Companion Animals and Horses, University of Veterinary Medicine of Vienna, Vienna, Austria
| | - Peter Kuess
- Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
- Department of Radiation Oncology, Applied and Translational Radiobiology (ATRAB), Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Wolfgang Dörr
- Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
- Department of Radiation Oncology, Applied and Translational Radiobiology (ATRAB), Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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8
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Khan S, Wardill HR, Bowen JM. Role of toll-like receptor 4 (TLR4)-mediated interleukin-6 (IL-6) production in chemotherapy-induced mucositis. Cancer Chemother Pharmacol 2018; 82:31-37. [PMID: 29845394 DOI: 10.1007/s00280-018-3605-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/22/2018] [Indexed: 12/12/2022]
Abstract
Despite significant advances in our ability to treat cancer, cytotoxic chemotherapy continues to be the mainstay treatment for many solid tumours. Chemotherapy is commonly associated with a raft of largely manageable adverse events; however, gastrointestinal (GI) toxicity (also termed mucositis) remains a significant challenge with little in the way of preventative and therapeutic options. The inability to manage GI complications likely reflects our incomplete understanding of its aetiology and the idiosyncrasies of each chemotherapeutic agent. This review highlights aims to provide a narrative for the involvement of Toll-like receptor (TLR4) in the development of chemotherapy-induced GI mucositis, an already emerging theme within this field. Particular focus will be placed upon the signalling interaction between TLR4 and interleukin (IL)-6. This parallels recent preclinical findings showing that TLR4 knockout mice, which are protected from developing severe GI mucositis, completely lack an IL-6 response. As such, we suggest that this signalling pathway presents as a novel mechanism with potential for therapeutic intervention.
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Affiliation(s)
- S Khan
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Hannah R Wardill
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia.
- Centre for Nutrition and Gastrointestinal Disease, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, 5000, Australia.
| | - J M Bowen
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
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Stansborough RL, Al-Dasooqi N, Bateman EH, Bowen JM, Keefe DMK, Logan RM, Yeoh ASJ, Yeoh EEK, Stringer AM, Gibson RJ. Matrix metalloproteinase expression is altered in the small and large intestine following fractionated radiation in vivo. Support Care Cancer 2018; 26:3873-3882. [PMID: 29754212 DOI: 10.1007/s00520-018-4255-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 05/06/2018] [Indexed: 01/27/2023]
Abstract
PURPOSE Radiotherapy-induced gut toxicity (RIGT) is associated with significant diarrhoea, pain and rectal bleeding. Matrix metalloproteinases (MMPs) have been reported to be involved in chemotherapy-induced gut toxicity and RIGT following single-dose irradiation in vivo. We therefore proposed MMPs would be involved in the pathobiology of RIGT following fractionated irradiation. METHODS Dark Agouti rats were treated with fractionated radiation (3 × 2.5 Gy/week for 6 weeks). Rats were killed at 3, 6 and 15 weeks to represent acute and chronic toxicities. Sections of jejunum and colon were immunostained for MMP-1, MMP-2, MMP-9 and MMP-14. Relative mRNA expression in jejunum and colon was quantified by RT-PCR for MMP-1, MMP-2, MMP-9 and MMP-14. Western blotting was also conducted on jejunum and colon tissue collected at week 6 to determine protein levels of pro- and active MMP-2. RESULTS MMP-2 total protein levels, determined by western blotting, significantly increased in both the jejunum (p = 0.0359) and the colon (p = 0.0134) 6 weeks into the fractionated radiation schedule. MMP-1, MMP-2, and MMP-14 mRNA expression significantly increased in the jejunum. MMP-2 mRNA expression was also significantly increased in the colon. Immunostaining of MMP-2 was observed to be increased in both crypt enterocytes and the lamina propria. CONCLUSIONS MMP-2 plays a role in the pathobiology of gastrointestinal toxicities following fractionated irradiation. Whilst MMP-1 and MMP-14 mRNA expression was increased, this occurred only in the jejunum, suggesting MMPs are differentially involved in RIGT depending on the intestinal region. Further studies are needed to elucidate the role these mediators play in the development and potentiation of RIGT.
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MESH Headings
- Animals
- Dose Fractionation, Radiation
- Dose-Response Relationship, Radiation
- Female
- Gastrointestinal Diseases/etiology
- Gastrointestinal Diseases/genetics
- Gene Expression Regulation, Enzymologic/radiation effects
- Intestinal Mucosa/metabolism
- Intestinal Mucosa/pathology
- Intestinal Mucosa/radiation effects
- Intestine, Large/metabolism
- Intestine, Large/pathology
- Intestine, Large/radiation effects
- Intestine, Small/metabolism
- Intestine, Small/pathology
- Intestine, Small/radiation effects
- Matrix Metalloproteinases/genetics
- Matrix Metalloproteinases/metabolism
- Radiation Dosage
- Radiation Injuries/genetics
- Radiation Injuries/pathology
- Rats
- Rats, Transgenic
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Affiliation(s)
- Romany L Stansborough
- Adelaide Medical School, University of Adelaide, North Terrace, Adelaide, 5005, Australia.
| | - Noor Al-Dasooqi
- Adelaide Medical School, University of Adelaide, North Terrace, Adelaide, 5005, Australia
- Division of Health Sciences, University of South Australia, Adelaide, Australia
| | - Emma H Bateman
- Adelaide Medical School, University of Adelaide, North Terrace, Adelaide, 5005, Australia
| | - Joanne M Bowen
- Adelaide Medical School, University of Adelaide, North Terrace, Adelaide, 5005, Australia
| | - Dorothy M K Keefe
- Adelaide Medical School, University of Adelaide, North Terrace, Adelaide, 5005, Australia
| | - Richard M Logan
- Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Ann S J Yeoh
- Adelaide Medical School, University of Adelaide, North Terrace, Adelaide, 5005, Australia
| | - Eric E K Yeoh
- Adelaide Medical School, University of Adelaide, North Terrace, Adelaide, 5005, Australia
| | - Andrea M Stringer
- Division of Health Sciences, University of South Australia, Adelaide, Australia
| | - Rachel J Gibson
- Adelaide Medical School, University of Adelaide, North Terrace, Adelaide, 5005, Australia
- Division of Health Sciences, University of South Australia, Adelaide, Australia
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Campos JC, Cunha JD, Ferreira DC, Reis S, Costa PJ. Challenges in the local delivery of peptides and proteins for oral mucositis management. Eur J Pharm Biopharm 2018; 128:131-146. [PMID: 29702221 DOI: 10.1016/j.ejpb.2018.04.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 04/21/2018] [Accepted: 04/23/2018] [Indexed: 12/20/2022]
Abstract
Oral mucositis, a common inflammatory side effect of oncological treatments, is a disorder of the oral mucosa that can cause painful ulcerations, local motor disabilities, and an increased risk of infections. Due to the discomfort it produces and the associated health risks, it can lead to cancer treatment restrains, such as the need for dose reduction, cycle delays or abandonment. Current mucositis management has low efficiency in prevention and treatment. A topical drug application for a local action can be a more effective approach than systemic routes when addressing oral cavity pathologies. Local delivery of growth factors, antibodies, and anti-inflammatory cytokines have shown promising results. However, due to the peptide and protein nature of these novel agents, and the several anatomic, physiological and environmental challenges of the oral cavity, their local action might be limited when using traditional delivering systems. This review is an awareness of the issues and strategies in the local delivery of macromolecules for the management of oral mucositis.
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Affiliation(s)
- João C Campos
- UCIBIO, REQUIMTE, Laboratory of Pharmaceutical Technology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Portugal(1).
| | - João D Cunha
- UCIBIO, REQUIMTE, Laboratory of Pharmaceutical Technology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Portugal(1)
| | - Domingos C Ferreira
- UCIBIO, REQUIMTE, Laboratory of Pharmaceutical Technology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Portugal(1)
| | - Salette Reis
- LAQV, REQUIMTE, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, Portugal(1)
| | - Paulo J Costa
- UCIBIO, REQUIMTE, Laboratory of Pharmaceutical Technology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Portugal(1)
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Marcussen M, Skrubbeltrang C, Bødker JS, Christiansen I, Bøgsted M, Dybkær K, Bergmann OJ, Johnsen HE. A systematic review of molecular responses to cancer therapy in normal human mucosa. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:355-366. [PMID: 29042035 DOI: 10.1016/j.oooo.2017.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 07/24/2017] [Accepted: 08/01/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Cancer therapy-induced inflammation of oral and gastrointestinal mucosae affects patients nonuniformly. Preventive strategies are limited; no biomarker exists for pretreatment identification of patients likely to be severely affected. Animal models are preferred for studying molecular responses in mucosae during chemotherapy, but translation into clinical practice is difficult. We performed a systematic review to retrieve articles that described molecular changes in human mucosae during cancer therapy. STUDY DESIGN We searched MEDLINE and Ovid Embase searches for studies reported in the English language literature from January 1990 to November 2016 and studies referenced in selected articles, which analyzed mucosae from patients at risk of developing mucositis during cancer therapy. Two authors extracted data according to predefined data fields, including study quality indicators. RESULTS We identified 17 human studies on chemotherapy (n = 9) and radiotherapy (n = 8), but no studies on targeted therapy. Studies were heterogeneous with regard to patient cohorts, analysis methods, cancer treatments, biopsy timings, and correlations to clinical mucositis. Consequently, a meta-analysis was not feasible. CONCLUSIONS Few human studies described the molecular responses of the normal mucosa to cancer therapy. Studies were heterogeneous and had sparse correlations to clinical mucositis. We proposed a model for acquiring data on treatment- and disease-specific phenotypes and transcriptomes for predictive or preventive initiatives.
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Affiliation(s)
- Mette Marcussen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | | | - Julie Støve Bødker
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Ilse Christiansen
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
| | - Martin Bøgsted
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark; Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
| | - Karen Dybkær
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark; Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
| | - Olav Jonas Bergmann
- School of Dentistry, Faculty of Health Science, Aarhus University; Aarhus, Denmark
| | - Hans Erik Johnsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark; Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
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12
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Van Sebille YZ, Gibson RJ, Wardill HR, Ball IA, Keefe DM, Bowen JM. Dacomitinib-induced diarrhea: Targeting chloride secretion with crofelemer. Int J Cancer 2017; 142:369-380. [DOI: 10.1002/ijc.31048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 08/21/2017] [Accepted: 08/31/2017] [Indexed: 12/13/2022]
Affiliation(s)
| | | | - Hannah R. Wardill
- Discipline of Physiology; Adelaide Medical School, University of Adelaide; Australia
| | - Imogen A. Ball
- Discipline of Physiology; Adelaide Medical School, University of Adelaide; Australia
| | - Dorothy M.K. Keefe
- Discipline of Physiology; Adelaide Medical School, University of Adelaide; Australia
| | - Joanne M. Bowen
- Discipline of Physiology; Adelaide Medical School, University of Adelaide; Australia
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Asikainen PJ, Dekker H, Sirviö E, Mikkonen J, Schulten EAJM, Bloemena E, Koistinen A, Ten Bruggenkate CM, Kullaa AM. Radiation-induced changes in the microstructure of epithelial cells of the oral mucosa: A comparative light and electron microscopic study. J Oral Pathol Med 2017; 46:1004-1010. [PMID: 28865083 DOI: 10.1111/jop.12639] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The microplicae is a typical structure of the epithelial cell surface of the oral mucosa. The cell surface is potentially of great significance, as it provides the underlying basis for the protective function of the salivary pellicle. The aim of this study was to investigate whether radiation therapy affects the surface morphology of the superficial cells of the human oral mucosa in patients who have received radiotherapy for oral cancer. MATERIAL AND METHODS Oral mucosal tissue samples from 91 patients were collected during dental implant surgery or ablative surgery. Study group 1 consisted of 28 patients who underwent dental implant surgery after radiotherapy. Group 2 consisted of five patients who developed osteoradionecrosis. Group 3 consisted of eight oral cancer patients without radiotherapy. Group 4 consisted of 50 clinically healthy subjects as controls. The samples were studied with scanning electron microscopy and compared with both light and transmission electron micrographs. RESULTS Radiation therapy (RT) induces breakage and destruction in the microplicae morphology and declines the density of the microplicae surface structures. In some of the irradiated cells, the microplicae were completely vanished, especially in patients who developed osteoradionecrosis. In non-irradiated tissue, the microplicae of the superficial epithelial cells were intact in all cases. CONCLUSION Scanning electron microscopy, in contrast to light microscopy, appears to be a useful tool to reveal the condition of superficial oral mucosal cells. In respect of the possible pathogenesis of osteoradionecrosis, the radiation-induced damage of the microplicae and its influence on the mucosal salivary pellicle is discussed.
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Affiliation(s)
| | - Hannah Dekker
- Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Ellinoora Sirviö
- Faculty of Health Sciences, Institute of Dentistry, School of Medicine, University of Eastern, Kuopio, Finland
| | - Jopi Mikkonen
- Faculty of Health Sciences, Institute of Dentistry, School of Medicine, University of Eastern, Kuopio, Finland.,Faculty of Science and Forestry, SIB-labs, University of Eastern Finland, Kuopio, Finland
| | - Engelbert A J M Schulten
- Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Elisabeth Bloemena
- Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Arto Koistinen
- Faculty of Science and Forestry, SIB-labs, University of Eastern Finland, Kuopio, Finland
| | - Chris M Ten Bruggenkate
- Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Arja M Kullaa
- Faculty of Health Sciences, Institute of Dentistry, School of Medicine, University of Eastern, Kuopio, Finland.,Research Group of Oral Health Sciences, Faculty of Medicine, University of Oulu, and Oulu University Hospital, Oulu, Finland.,Educational Dental Clinic, Kuopio University Hospital, Kuopio, Finland
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14
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Stansborough RL, Bateman EH, Al-Dasooqi N, Bowen JM, Keefe DMK, Yeoh ASJ, Logan RM, Yeoh EEK, Stringer AM, Gibson RJ. Fractionated abdominal irradiation induces intestinal microvascular changes in an in vivo model of radiotherapy-induced gut toxicity. Support Care Cancer 2017; 25:1973-1983. [PMID: 28175996 DOI: 10.1007/s00520-017-3601-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 01/23/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Radiotherapy-induced gut toxicity (RIGT) is associated with diarrhoea, pain and rectal bleeding and can occur as an acute or chronic toxicity. The microvasculature has been shown to be altered in the development of RIGT; however, the features are not yet characterized. We hypothesized that apoptosis of microvascular cells would occur early in the gastrointestinal tract following fractionated irradiation, followed by late microvascular changes, including sclerosis and telangiectasis. METHODS Female Dark Agouti rats were treated with a 6-week fractionated radiation schedule of 3 × 2.5 Gy doses per week localized to the abdomen. At 3, 6 and 15 weeks, the intestines were assessed for markers of acute and chronic injury including morphological changes, collagen deposition, apoptosis and proliferation. RESULTS Apoptosis of microvascular cells significantly increased at 6 and 15 weeks in the jejunum (p = 0.0026 and p = 0.0062, respectively) and at 6 and 15 weeks in the colon (p < 0.0001 and p = 0.0005, respectively) in rats receiving fractionated radiation to the abdomen. Histopathological changes of the colon microvasculature were also seen from week 3, including thickening of the lamina propria and dilated, thickened, telangiectatic vessels. CONCLUSIONS Findings of this study provide evidence of regional and timing-specific changes in the intestinal microvasculature in response to fractionated radiotherapy which may play a role in development of both acute and chronic RIGT.
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Affiliation(s)
- Romany L Stansborough
- School of Medicine, University of Adelaide, North Terrace, Adelaide, 5005, Australia.
| | - Emma H Bateman
- School of Medicine, University of Adelaide, North Terrace, Adelaide, 5005, Australia
| | - Noor Al-Dasooqi
- School of Medicine, University of Adelaide, North Terrace, Adelaide, 5005, Australia
- Division of Health Sciences, University of South Australia, Adelaide, Australia
| | - Joanne M Bowen
- School of Medicine, University of Adelaide, North Terrace, Adelaide, 5005, Australia
| | - Dorothy M K Keefe
- School of Medicine, University of Adelaide, North Terrace, Adelaide, 5005, Australia
| | - Ann S J Yeoh
- School of Medicine, University of Adelaide, North Terrace, Adelaide, 5005, Australia
| | - Richard M Logan
- School of Medicine, University of Adelaide, North Terrace, Adelaide, 5005, Australia
| | - Eric E K Yeoh
- School of Medicine, University of Adelaide, North Terrace, Adelaide, 5005, Australia
| | - Andrea M Stringer
- School of Medicine, University of Adelaide, North Terrace, Adelaide, 5005, Australia
- Division of Health Sciences, University of South Australia, Adelaide, Australia
| | - Rachel J Gibson
- School of Medicine, University of Adelaide, North Terrace, Adelaide, 5005, Australia
- Division of Health Sciences, University of South Australia, Adelaide, Australia
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15
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Ben Lagha A, Grenier D. Black tea theaflavins attenuate Porphyromonas gingivalis virulence properties, modulate gingival keratinocyte tight junction integrity and exert anti-inflammatory activity. J Periodontal Res 2016; 52:458-470. [PMID: 27549582 DOI: 10.1111/jre.12411] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Over the last 10 years, bioactive plant food compounds have received considerable attention in regard to their beneficial effects against periodontal disease. In this study, we investigated the effects of black tea theaflavins (TFs) on the virulence properties of Porphyromonas gingivalis and gingival keratinocyte tight junction integrity. In addition, the effects of black tea TFs on the nuclear factor-κB (NF-κB) signaling pathway and proinflammatory cytokine/matrix metalloproteinase (MMP) secretion by monocytes/macrophages were assessed. MATERIAL AND METHODS Virulence factor gene expression in P. gingivalis was investigated by quantitative real-time PCR. A fluorescence assay was used to determine P. gingivalis adherence to, and invasion of, a gingival keratinocyte monolayer. Tight junction integrity of gingival keratinocytes was assessed by determination of transepithelial electrical resistance. Proinflammatory cytokine and MMP secretion by P. gingivalis-stimulated macrophages was quantified by ELISA. The U937-3xκB-LUC monocyte cell line transfected with a luciferase reporter gene was used to monitor NF-κB activation. Gelatin degradation was monitored using a fluorogenic assay. RESULTS Black tea TFs dose-dependently inhibited the expression of genes encoding the major virulence factors of P. gingivalis and attenuated its adherence to gingival keratinocytes. A treatment of gingival keratinocytes with black tea TFs significantly enhanced tight junction integrity and prevented P. gingivalis-mediated tight junction damage as well as bacterial invasion. Black tea TFs reduced the secretion of interleukin (IL)-1β, tumor necrosis factor-α, IL-6, chemokine (C-X-C) ligand 8, MMP-3, MMP-8 and MMP-9 by P. gingivalis-stimulated macrophages and attenuated the P. gingivalis-mediated activation of the NF-κB signaling pathway. Lastly, black tea TFs inhibited gelatin degradation by MMP-9. CONCLUSION This study provides clear evidence that black tea TFs represent promising multifunctional therapeutic agents for prevention and treatment of periodontal disease.
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Affiliation(s)
- A Ben Lagha
- Oral Ecology Research Group, Faculty of Dentistry, Laval University, Quebec City, QC, Canada
| | - D Grenier
- Oral Ecology Research Group, Faculty of Dentistry, Laval University, Quebec City, QC, Canada
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16
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Wardill HR, Bowen JM, Van Sebille YZ, Secombe KR, Coller JK, Ball IA, Logan RM, Gibson RJ. TLR4-Dependent Claudin-1 Internalization and Secretagogue-Mediated Chloride Secretion Regulate Irinotecan-Induced Diarrhea. Mol Cancer Ther 2016; 15:2767-2779. [DOI: 10.1158/1535-7163.mct-16-0330] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/15/2016] [Indexed: 11/16/2022]
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17
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Wardill HR, Gibson RJ, Van Sebille YZ, Secombe KR, Logan RM, Bowen JM. A novel in vitro platform for the study of SN38-induced mucosal damage and the development of Toll-like receptor 4-targeted therapeutic options. Exp Biol Med (Maywood) 2016; 241:1386-94. [PMID: 27037276 DOI: 10.1177/1535370216640932] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 02/19/2016] [Indexed: 01/03/2023] Open
Abstract
Tight junction and epithelial barrier disruption is a common trait of many gastrointestinal pathologies, including chemotherapy-induced gut toxicity. Currently, there are no validated in vitro models suitable for the study of chemotherapy-induced mucosal damage that allow paralleled functional and structural analyses of tight junction integrity. We therefore aimed to determine if a transparent, polyester membrane insert supports a polarized T84 monolayer with the phenotypically normal tight junctions. T84 cells (passage 5-15) were seeded into either 0.6 cm(2), 0.4 µm pore mixed-cellulose transwell hanging inserts or 1.12 cm(2), 0.4 µm pore polyester transwell inserts at varying densities. Transepithelial electrical resistance was measured daily to assess barrier formation. Immunofluoresence for key tight junction proteins (occludin, zonular occludens-1, claudin-1) and transmission electron microscopy were performed to assess tight junction integrity, organelle distribution, and polarity. Reverse transcription-polymerase chain reaction was performed to determine expression of toll-like receptor 4 (TLR4). Liquid chromatography was also conducted to assess SN38 degradation in this model. Polyester membrane inserts support a polarized T84 phenotype with functional tight junctions in vitro. Transmission electron microscopy indicated polarity, with apico-laterally located tight junctions. Immunofluorescence showed membranous staining for all tight junction proteins. No internalization was evident. T84 cells expressed TLR4, although this was significantly lower than levels seen in HT29 cells (P = .0377). SN38 underwent more rapid degradation in the presence of cells (-76.04 ± 1.86%) compared to blank membrane (-48.39 ± 4.01%), indicating metabolic processes. Polyester membrane inserts provide a novel platform for paralleled functional and structural analysis of tight junction integrity in T84 monolayers. T84 cells exhibit the unique ability to metabolize SN38 as well as expressing TLR4, making this an excellent platform to study clinically relevant therapeutic interventions for SN38-induced mucosal damage by targeting TLR4.
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Affiliation(s)
- Hannah R Wardill
- Discipline of Anatomy and Pathology, School of Medicine, University of Adelaide, South Australia 5005, Australia
| | - Rachel J Gibson
- Discipline of Anatomy and Pathology, School of Medicine, University of Adelaide, South Australia 5005, Australia
| | - Ysabella Za Van Sebille
- Discipline of Physiology, School of Medicine, University of Adelaide, South Australia 5005, Australia
| | - Kate R Secombe
- Discipline of Physiology, School of Medicine, University of Adelaide, South Australia 5005, Australia
| | - Richard M Logan
- School of Dentistry, University of Adelaide, South Australia 5005, Australia
| | - Joanne M Bowen
- Discipline of Physiology, School of Medicine, University of Adelaide, South Australia 5005, Australia
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