Salivary immunoglobulins in cancer patients with chemotherapy-related oral mucosa damage

Efficacy and mechanism of Baicao Fuyanqing suppository on mixed vaginitis based on 16S rRNA and metabolomics

Background

Mixed vaginitis is the infection of the vagina by at least two different pathogens at the same time, both of which contribute to an abnormal vaginal environment leading to signs and symptoms. Baicao Fuyanqing suppository (BCFYQ) is a Miao ethnomedicine, used to treat various vaginitis. The aim of this study was to investigate the efficacy and possible mechanism of BCFYQ in the treatment of mixed vaginitis based on 16S rRNA high-throughput sequencing and metabonomics.

Methods

Escherichia coli and Candida albicans were used to establish mixed vaginitis model in SD rats. Three groups of low, medium and high doses (0.18/0.36/0.64 g.kg-1) were established, and administered vaginally once a day for 6 consecutive days. After the last administration, vaginal pH and IL-1β, IL-2, IL-13 and IgA levels were measured, and the vaginal tissue was examined pathologically. In addition, the vaginal flora was characterised by 16S rRNA, and endogenous metabolites in the vaginal tissue were detected by UHPLC-Q-Exactive MS.

Results

Compared with the model group, BCFYQ can reduce the vaginal pH of rats, make it close to the normal group and improve the damaged vaginal epithelial tissue. The results of ELISA showed that BCFYQ decreased the levels of IL-1 β and IL-2 and increased the levels of IL-13 and IgA (P<0.05). In addition, BCFYQ may increase the abundance of vaginal flora, especially Lactobacillus. The differential metabolite enrichment pathway suggests that the therapeutic mechanism of BCFYQ is mainly related to lipid metabolism and amino acid metabolism.

Conclusion

Our research shows that BCFYQ has a good therapeutic effect on mixed vaginitis. It repairs the damaged vaginal mucosa by regulating the vaginal flora and lipid metabolism disorders to improve the local immune function of the vagina and inhibit the growth and reproduction of pathogens.

5-Fluorouracil induces inflammation and oxidative stress in the major salivary glands affecting salivary flow and saliva composition

This study aimed to elucidate the effect of 5-fluorouracil (5-FU) on the histological aspects of the major salivary glands, salivary flow and saliva composition using an established oral mucositis model in hamsters. Oral mucositis was induced by two intraperitoneal administrations of 5-FU in two consecutive days (60 and 40mg/kg), followed by cheek pouch mucosa scratch, on day 4. The Pilocarpine-stimulated salivary flow was measured 4 and 10days after the first 5-FU injection. Salivary glands were harvested for histopathological analysis, measurement of inflammatory cells, quantification of pro-inflammatory cytokines (TNF-α and IL-1β), investigation of cell death and cell proliferation. Oxidative stress and oxidative defense system were also investigated in the salivary gland tissues using MDA (malondialdehyde), nitrite, non-protein sulfhydryl groups (NP-SH), SOD (superoxide dismutase) and CAT (catalase). In addition, the CAT and lysozyme activities and the IgA and SOD levels were evaluated in the saliva samples. 5-FU significantly reduced the pilocarpine-stimulated salivary flow rate on the 4th experimental day, associated with an increase in the SOD levels in saliva. Recovery of the salivary flow and SOD were observed on day 10, when an increase in the saliva lysozyme levels was detected. In addition, 5-FU promoted vacuolization in parotid (P) and periductal edema in submandibular (SM) gland, combined with an increase in the inflammatory cells influx, mostly observed on the 4th day in SM gland and on 4th and 10th days in P. Oxidative stress was found mostly on day 10 in SM, SL and P glands, associated with release of proinflammatory cytokines, observed in SM and SL glands, but not in P. 5-FU induces an inflammatory response in the major salivary glands, most observed ten days after its first injection, which may contribute to the major salivary glands hypofunction, leading to alterations in the salivary flow rate and composition.

Prevalence of Oral Complications occurring in a Population of Pediatric Cancer Patients receiving Chemotherapy

Multiagent chemotherapy, radiotherapy, or a combination of both are the contemporary methods of cancer treatment. With medical advancements, though cure rates have increased considerably, focus is now shifted to the potential early and late complications of the same. The aim of this study was to assess the early oral complications in pediatric patients receiving chemotherapy. Sixty-two children with cancer undergoing chemotherapy with the mean age of 7.42 ± 3.6 years were included in the study. The various types of malignancies and oral problems during chemotherapy were recorded in the subjects. The most commonly encountered malignancy was acute lymphoblastic leukemia at 35.5%. Various oral and associated complications like mucosal inflammation with ulcerations, oral pain, xerostomia, and secondary infections were commonly seen, with mucositis being the most commonly observed complication in 58.1% of the subjects undergoing chemotherapy. Clinical importance of timely medical and dental interventions by a multidisciplinary team involving a pediatric dentist at different stages of anticancer treatment is also emphasized to minimize discomfort, increase treatment compliance, and improve the quality of life of pediatric patients.

5-Fluorouracil Infusion Reduces Gut-Associated Lymphoid Tissue Cell Number and Mucosal Immunoglobulin A Levels

BACKGROUND

Anticancer drugs have been demonstrated to affect gut mucosal morphology and cause gastrointestinal symptoms. We hypothesized that even small doses of 5-fluorouracil (5-FU) would reduce gut-associated lymphoid tissue (GALT) mass and function.

METHODS

Mice underwent IV cannulation and received continuous infusion of normal saline or 10 mg/kg of 5-FU for 5 days. GALT cell numbers, phenotypes, and mucosal immunoglobulin A (IgA) levels were measured.

RESULTS

During the infusion, there were no significant differences in food intake or body weight change between the 2 groups. Cell yields from the intraepithelial space and lamina propria of the small intestine were lower in the 5-FU than the control group. The lamina propria CD4/CD8 ratio was reduced in the 5-FU compared with the control group. Intestinal and respiratory tract IgA levels were lower in the 5-FU than in the control group.

CONCLUSIONS

A small dose of 5-FU reduces GALT cell number and mucosal IgA levels, regardless of food intake.

Prevalence of Oral Complications occurring in a Population of Pediatric Cancer Patients receiving Chemotherapy

Multiagent chemotherapy, radiotherapy, or a combination of both are the contemporary methods of cancer treatment. With medical advancements, though cure rates have increased considerably, focus is now shifted to the potential early and late complications of the same. The aim of this study was to assess the early oral complications in pediatric patients receiving chemotherapy. Sixty-two children with cancer undergoing chemotherapy with the mean age of 7.42 ± 3.6 years were included in the study. The various types of malignancies and oral problems during chemotherapy were recorded in the subjects. The most commonly encountered malignancy was acute lymphoblastic leukemia at 35.5%. Various oral and associated complications like mucosal inflammation with ulcerations, oral pain, xerostomia, and secondary infections were commonly seen, with mucositis being the most commonly observed complication in 58.1% of the subjects undergoing chemotherapy. Clinical importance of timely medical and dental interventions by a multidisciplinary team involving a pediatric dentist at different stages of anticancer treatment is also emphasized to minimize discomfort, increase treatment compliance, and improve the quality of life of pediatric patients.

How to cite this article:

Gandhi K, Datta G, Ahuja S, Saxena T, Datta AG. Prevalence of Oral Complications occurring in a Population of Pediatric Cancer Patients receiving Chemotherapy. Int Int J Clin Pediatr Dent 2017;10(2):166-171.

Multicenter randomized trial of chewing gum for preventing oral mucositis in children receiving chemotherapy

The properties of saliva led us to hypothesize that the salivary flow increase induced by gum chewing might protect the oral mucosa from lesions due to cancer chemotherapy. We conducted a multicenter randomized trial to evaluate the efficacy of chewing gum in preventing oral mucositis in 145 children receiving chemotherapy regimens expected to induce WHO grade 3-4 oral mucositis in at least 30% of patients. Patients were allocated at random to standard oral care with or without 5 gum pieces per day. No overall reduction in severe oral mucositis occurred in the gum arm (51%) compared with the standard arm (44%). VIDE, COPADM, and multidrug intensive chemotherapy caused severe oral mucositis in 75% of patients in both arms. In patients receiving less toxic regimens, a decrease in WHO grade 1-4 oral mucositis was noted in the gum arm compared with the standard arm (49% vs. 72%, P=0.03). In the multivariate analysis, the risk of oral mucositis was related only to the type of chemotherapy regimen, suggesting that further strategies for preventing oral mucositis could be mainly based on these criteria.

Mucositis prevention by improved dental care in acute leukemia patients

GOALS OF WORK

The aim of the present study was to evaluate the effects of the intensive dental care protocol in preventing oral complications in acute leukemia patients.

PATIENTS AND METHODS

Thirty-four patients hospitalized for induction remission therapy for acute leukemia were randomly assigned to one of two groups, whether to receive intensive dental care protocol or not. The intensive dental care group of patients received dental treatment and plaque and calculus removal prior to chemotherapy and supervised oral hygiene measures during chemotherapy. The limited dental care group of patients did not receive prechemotherapy dental care. Groups were comparable in age, sex, and antineoplastic treatment received. Patients were examined after admission to the hospital; at the initiation of the chemotherapy; and 7, 14, 21, and 28 days after initiation of therapy. Positive data about subjective difficulties were taken by anamnesis. Oral hygiene index (OHI) and gingival index (GI) were used to assess the periodontal status of the patients. The severity of mucositis was evaluated according to WHO classification.

MAIN RESULTS

The results of this study pointed out lower mean values of GI and lower mean values of mucositis score in the intensive dental care group of patients during the whole period of examination. Although the differences in mean values were not statistically significant on most of the examination days, intensive dental care group of patients developed less severe and less painful oral complications compared to the limited dental care group of patients.

CONCLUSION

We conclude that proper dental care and preventive measures both before and during chemotherapy can be beneficial to these patients.

Randomized controlled trial of pilocarpine hydrochloride for the moderation of oral mucositis during autologous blood stem cell transplantation

Pilocarpine hydrochloride has been reported to increase salivation and decrease oral mucositis in patients receiving head and neck radiotherapy, but there is only one report of its use in a cancer chemotherapy patient population. This prospective, double-blinded, randomized, placebo-controlled trial was undertaken to determine the efficacy of pilocarpine for the moderation of oral mucositis during autologous blood stem cell transplantation. Subjects were randomized to receive a 5 mg tablet of pilocarpine, or a placebo, during and following chemotherapy. Subjects were seen every other day and evaluated for gingival, oral, and oropharyngeal mucositis; nutrition; oral hygiene; eating; speaking; sleeping; pain at rest and/or with swallowing; and mouth dryness. We recorded the mean and highest scores and duration of problems, along with white blood cell counts and differentials, and the use of systemic narcotics for oral mucosal pain. We enrolled and randomized 36 subjects, and there were no statistically or clinically significant differences for the primary outcome of severity of mucositis and no clinically significant differences in any of the other outcome measures. Pilocarpine has no benefit for the moderation of the incidence, severity, or duration of mucositis in patients receiving autologous blood stem cell transplantation.

Salivary carcinoembryonic antigen as an inflammatory marker

In this study we examined concentration of carcinoembryonic antigen (CEA) in paired saliva and serum samples from healthy individuals and patients with periodontal disease. CEA concentration was determined immunoradiometrically using highly specific anti-CEA antibodies. The salivas from periodontally healthy subjects revealed CEA concentrations with median value of 62 mg/L. Distribution of salivary CEA concentrations in patients with periodontal diseases were very broad with median values: 74 mg/L (stage I), 84 mg/L (stage II), 240 mg/L (stage III) and 412 mg/L (necrotizing ulcerative periodontitis-NUP). Analysis of the obtained values indicated statistically significant increase in salivary CEA, in subjects with periodontal diseases. Metronisadole treatment in patients with NUP leads to statistically significant decrease in salivary CEA. The results obtained suggested salivary CEA as a potential marker of the alterations of periodontium.

The role of salivary function in modulating chemotherapy-induced oropharyngeal mucositis: a review of the literature

Oropharyngeal mucositis is a common and significant complication of cancer chemotherapy and limits the delivery of chemotherapy, affects the quality of life, and increases the cost of care. Oral mucositis caused by cancer chemotherapy is associated with specific agents, but the origin of oral mucositis is poorly understood. These drugs may have direct toxic effects on the rapidly dividing cells of the oral mucosa and on cellular elements of the connective tissue. Microbial flora may play a role in the development of ulcerative mucositis. Chemotherapy may be directly toxic and affect the mucosa by systemic circulation and may be related to secretion of some chemotherapeutic drugs in the saliva, resulting in topical exposure to the oral environment. Other potential mechanisms include reduced saliva volume and change in saliva constituents that may affect epithelial maintenance and repair, the physiology of the oral microflora, and the interaction between the oral flora and the epithelium. Improved understanding of the mechanisms whereby specific chemotherapeutic agents cause mucositis may lead to management approaches that will reduce the incidence and severity of mucositis, improving quality of life and ensuring delivery of the necessary chemotherapy to improve cancer cure rates.

Management and long-term complications of pediatric cancer

The impact of recently intensified and novel therapies for the treatment of childhood cancer has been an increased number of survivors and an increase in the number of treatment complications among survivors. Thus, it is important for the primary care practitioner to be aware of not only acute but chronic complications of therapy, including the possibility of second malignancies. Long-term follow-up is essential, and continuous education of patients and health care personnel is an important aspect for the complete success of treatment. Primary care practitioners also need to incorporate other subspecialties in the management of these patients to ensure that they receive complete evaluation and treatment.