Therapeutic effects of andiroba (Carapa guianensis Aubl) oil, compared to low power laser, on oral mucositis in children underwent chemotherapy: A clinical study

The Effect of Oral Care Intervention in Mucositis Management Among Pediatric Cancer Patients: An Updated Systematic Review

Background

Chemotherapy-induced mucositis is inflammation that develops in the oral mucosal due to anticancer treatment. Mucositis has negative consequences that may lead to distress in pediatric patients, resulting in escalated expenses, diminished quality of life, hindrance in cancer therapy, and decreased survival rates. However, despite the numerous methods, oral care protocols are suggested for implementation in the pediatric population despite a lack of high-level evidence studies, particularly regarding which appropriate oral care agents should be administered.

Purpose

This systematic review aimed to identify the effect of oral care intervention in mucositis management among pediatric cancer patients.

Methods

Studies were published between 2014 and 2023 from five databases: PubMed, Embase, Medline, ScienceDirect, and Scopus. They were identified using a search strategy to identify relevant studies that identify oral care interventions for managing mucositis in children with cancer. This study used the Joanna Briggs Institute (JBI) critical appraisal tools to assess the quality of the studies and followed the recommended reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.

Results

Eight studies met the inclusion criteria, including seven RCTs and one quasi-experimental study. Oral care interventions involving tooth brushing, mouthwash, and lip care are performed entirely or partially. The frequency of oral care ranges from two to six times daily, and the duration of intervention is from 5 days to six weeks. Oral care interventions using honey, olive oil, Aloe Vera, Andiroba, and salivary enzyme toothpaste are beneficial to lower the severity of mucositis, reduce pain, minimize mucositis duration, and reduce the use of analgesics, but not significantly improve the child's quality of life. However, Caphosol mouthwash did not significantly reduce mucositis.

Conclusion

Our study highlights that oral care intervention using effective agents integratively, including honey, olive oil, Aloe vera, Andiroba, and salivary enzyme toothpaste, is essential to manage chemotherapy-induced mucositis among children.

Systematic Review Registration

PROSPERO registration number was CRD42023456278.

Valorization of Carapa guianensis Aubl. seeds treated by compressed n-propane

This study evaluated the oil content obtained from andiroba seeds by pressurized n-propane at different conditions of temperature (25, 35, and 45 °C) and pressure (40, 60, and 80 bar), and conventional extraction technique using n-hexane as the solvent. Kinetic extraction curves were fitted using Sovová's mathematical model. The chemical characterization of the oil was reported as well as the protein content in the extraction by-product. Pressurized extractions conducted at 25 °C provided the highest oil recovery (~45 wt%) from the seeds. The increase in pressure at 25 ºC favored obtaining oil with higher Stigmasterol contents, however, the Squalene content was higher in the oil obtained at 40 bar. The oils with the highest concentration phenolic compounds and antioxidant activity were obtained at 80 bar. Extraction with n-propane provided oils with higher levels of phenolic compounds, however, with antioxidant activity similar to conventional extraction. For all evaluated extractions, the product showed a predominance of oleic and palmitic acids, with similar values of oxidative stability. The extraction of the by-product with the highest soluble protein content was obtained under mild processing conditions (25 °C and 40 bar) with n-propane.

Effects of andiroba oil (Carapa guianensis aublet) on the immune system in inflammation and wound healing: A scoping review

ETHNOPHARMACOLOGICAL RELEVANCE

Andiroba seed oil (Carapa guianensis Aubl.) is widely used by traditional populations in tropical countries, especially in the Brazilian Amazon, because of its anti-inflammatory, antirheumatic, antiseptic, healing and antipyretic properties, among others, which makes it useful for the treatment, mainly, of skin afflictions and wounds.

AIM OF THE STUDY

To describe the modulation of the immune system by andiroba oil (Carapa guianensis Aubl.) in inflammation and wound healing.

MATERIALS AND METHODS

A scoping review was performed, following the recommendations of the Joanna Briggs Institute (JBI) and PRISMA for Scoping Reviews (PRISMA-ScR). As inclusion criteria, in vitro, in vivo, ex vivo, and clinical studies were selected, in Portuguese, English, or Spanish, in thirteen databases of published studies, gray literature, and references of the included studies, which deal with immune modulation by andiroba oil in the context of the various therapeutic applications that make use of its anti-inflammatory and wound healing properties. The selection of information sources was carried out by two independent reviewers between November 2022 and January 2023. The process of data extraction and evidence analysis was conducted by four pairs of independent reviewers between January and February 2023.

RESULTS

22 sources of evidence were included in this scoping review, mostly scientific articles published between 2005 and 2021 with in vivo sampling. The evidence suggests that andiroba oil reduces inflammation and promotes the healing of wounds of multiple etiologies by reducing leukocyte infiltration, increasing phagocytic activity, enhancing interleukin and inflammatory cytokine activity, promoting fibroblast recovery, increasing growth factors, reducing apoptotic cells, promoting reepithelialization, as well as promoting angiogenesis, reducing edema, and stimulating the production of glucocorticoids that alleviate pain. Additionally, different formulations of the oil (such as nanoemulsions, films and gels) are more effective in modulating inflammation and wound healing compared to in natura oil.

CONCLUSIONS

Evidence in the literature suggests that andiroba oil (Carapa guianensis Aubl.) has positive effects on immune modulation in inflammation and wound healing, which makes it a biocompound with high therapeutic potential.

Double-blind, vehicle-controlled clinical investigation of peptide OS-01 for skin rejuvenation

INTRODUCTION

Senescent cells contribute to age-related tissue deterioration, including the skin, which plays important roles in overall health and social interactions. This study aimed to assess the effects of the senotherapeutic peptide, OS-01 (a.k.a. Pep 14), on skin.

METHODS

A 12-week split-face, double-blinded, vehicle-controlled study involving 22 participants was conducted. The OS-01-containing formulation was applied to one side of the face, while the other side received an identical control formulation lacking the peptide. Skin characteristics were assessed using instrumental measurements, expert clinical grading, and subjective questionnaires.

RESULTS

Results showed that the OS-01 formulation significantly improved one aspect of skin barrier function, as evidenced by reduced trans-epidermal water loss compared to both baseline and vehicle control. Expert grading and Antera 3D image analysis revealed a reduction in wrinkle appearance and indentation in the periorbital area, and improved skin texture and radiance on both sides of the face, with the OS-01-containing formulation demonstrating superior results. Participants also perceived improvements in skin hydration, smoothness, radiance, and overall appearance.

CONCLUSION

The findings suggest that the OS-01 formulation promotes skin health by strengthening the skin barrier, protecting against dehydration, reducing the appearance of wrinkles, and improving skin texture and radiance. These effects are likely attributed to the senotherapeutic properties of OS-01 in reducing cellular senescence and its associated detrimental effects.

Oral Mucositis Management in Children under Cancer Treatment: A Systematic Review

Children undergoing antineoplastic treatment often present severe side effects due to the dosage and duration of treatments, with oral mucositis emerging as one of the most prevalent and painful inflammatory conditions. There is a growing body of evidence on therapeutic interventions such as cryotherapy, low-level laser therapy, and natural compounds for this condition. The aim of this systematic review was to identify and compare therapies for the management of cancer treatment-induced oral mucositis in pediatric patients. From 2655 articles obtained in initial searches, 39 articles were considered in this systematic review, after applying inclusion/exclusion criteria. Low-level laser therapy, palifermin, honey, and zinc demonstrated reductions in oral mucositis incidence, duration, severity, and pain reported by the patient. Although there are several therapies in place for the prevention and treatment of oral mucositis in children, evidence of their efficacy is still inconclusive to establish accurate clinical protocols.

Bioactive limonoids from Carapa guianensis seeds oil and the sustainable use of its by-products

Carapa guianensis (Andiroba, Meliaceae) is considered a multipurpose tree. In Brazil, Indigenous people have used it as insect repellent and in the treatment of various diseases. Most biological activities and popular uses are attributed to limonoids, which are highly oxygenated tetranortriterpenoids. More than 300 limonoids have been described in Meliaceae family. Limonoids from Andiroba oil have shown high anti-inflammatory and anti-allergic activities in vivo, by inhibiting platelet activating factors and many inflammatory mediators such as IL-5, IL-1β and TNF-α. It also reduced T lymphocytes, eosinophils and mast cells. In corroboration with the wide popular use of Andiroba oil, no significant cytotoxicity or genotoxicity in vivo was reported. This oil promotes apoptosis in a gastric cancer cell line (ACP02) at high concentrations, without showing mutagenic effects, and is suggested to increase the body's nonspecific resistance and adaptive capacity to stressors, exhibit some antioxidant activity, and protect against oxidative DNA damages. Recently, new methodologies of toxicological assays have been applied. They include in chemico, in vitro, in silico and ex vivo procedures, and take place to substitute the use of laboratory animals. Andiroba by-products have been used in sustainable oil production processes and as fertilizers and soil conditioners, raw material for soap production, biodegradable surfactants and an alternative natural source of biodegradable polymer in order to reduce environmental impacts. This review reinforces the relevance of Andiroba and highlights its ability to add value to its by-products and to minimize possible risks to the health of the Amazonian population.

Twenty-year analysis of photobiomodulation clinical studies for oral mucositis: a scoping review

OBJECTIVE

Our objective was to review the first 20 years of photobiomodulation (PBM) clinical studies for oral mucositis (OM) mitigation.

STUDY DESIGN

A scoping review screened controlled clinical studies. The PBM devices, protocols, and clinical outcomes were analyzed.

RESULTS

Seventy-five studies met the inclusion criteria. The first study dated from 1992, and the term "PBM" was first published in 2017. Public services, placebo-controlled randomized trials, and patients with head and neck chemoradiation were predominant among included studies. Prophylactic red intraoral laser protocols were mostly used. Comparing the outcomes of all protocols was unfeasible due to missing treatment parameters and nonhomogeneous measurements.

CONCLUSIONS

The main barrier to optimizing clinical protocols of PBM for OM was the lack of standardization in clinical studies. Although PBM use is now globally present in oncology settings and generally marked by good outcomes reported, additional randomized clinical trials with well-described methods are necessary.

Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology-ASCO Guideline

PURPOSE

The aim of this joint guideline is to provide evidence-based recommendations to practicing physicians and other health care providers on integrative approaches to managing pain in patients with cancer.

METHODS

The Society for Integrative Oncology and ASCO convened an expert panel of integrative oncology, medical oncology, radiation oncology, surgical oncology, palliative oncology, social sciences, mind-body medicine, nursing, and patient advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2021. Outcomes of interest included pain intensity, symptom relief, and adverse events. Expert panel members used this evidence and informal consensus to develop evidence-based guideline recommendations.

RESULTS

The literature search identified 227 relevant studies to inform the evidence base for this guideline.

RECOMMENDATIONS

Among adult patients, acupuncture should be recommended for aromatase inhibitor-related joint pain. Acupuncture or reflexology or acupressure may be recommended for general cancer pain or musculoskeletal pain. Hypnosis may be recommended to patients who experience procedural pain. Massage may be recommended to patients experiencing pain during palliative or hospice care. These recommendations are based on an intermediate level of evidence, benefit outweighing risk, and with moderate strength of recommendation. The quality of evidence for other mind-body interventions or natural products for pain is either low or inconclusive. There is insufficient or inconclusive evidence to make recommendations for pediatric patients. More research is needed to better characterize the role of integrative medicine interventions in the care of patients with cancer.Additional information is available at https://integrativeonc.org/practice-guidelines/guidelines and www.asco.org/survivorship-guidelines.

A Review of Potential Use of Amazonian Oils in the Synthesis of Organogels for Cosmetic Application

New strategies for the delivery of bioactives in the deeper layers of the skin have been studied in recent years, using mainly natural ingredients. Among the strategies are organogels as a promising tool to load bioactives with different physicochemical characteristics, using vegetable oils. Studies have shown satisfactory skin permeation, good physicochemical stability mainly due to its three-dimensional structure, and controlled release using vegetable oils and low-molecular-weight organogelators. Within the universe of natural ingredients, vegetable oils, especially those from the Amazon, have a series of benefits and characteristics that make them unique compared to conventional oils. Several studies have shown that the use of Amazonian oils brings a series of benefits to the skin, among which are an emollient, moisturizing, and nourishing effect. This work shows a compilation of the main Amazonian oils and their nutraceutical and physicochemical characteristics together with the minority polar components, related to health benefits, and their possible effects on the synthesis of organogels for cosmetic purposes.

Natural Products for the Prevention and Treatment of Oral Mucositis-A Review

Cancer, a major world public health problem, is associated with chemotherapy treatments whose administration leads to secondary concerns, such as oral mucositis (OM). The OM disorder is characterized by the presence of ulcers in the oral mucosa that cause pain, bleeding, and difficulty in ingesting fluids and solids, or speaking. Bioactive compounds from natural sources have arisen as an effective approach for OM. This review aims to summarize the new potential application of different natural products in the prevention and treatment of OM in comparison to conventional ones, also providing a deep insight into the most recent clinical studies. Natural products, such as Aloe vera, Glycyrrhiza glabra, Camellia sinensis, Calendula officinalis, or honeybee crops, constitute examples of sources of bioactive compounds with pharmacological interest due to their well-reported activities (e.g., antimicrobial, antiviral, anti-inflammatory, analgesic, or wound healing). These activities are associated with the bioactive compounds present in their matrix (such as flavonoids), which are associated with in vivo biological activities and minimal or absent toxicity. Finally, encapsulation has arisen as a future opportunity to preserve the chemical stability and the drug bioa vailability of bioactive compounds and, most importantly, to improve the buccal retention period and the therapeutic effects.

Synthesis and Characterization of Natural Polymeric Membranes Composed of Chitosan, Green Banana Peel Extract and Andiroba Oil

Chitosan comprises polymeric macromolecules with technical and biological properties that have been used in biomedical healing applications requiring anti-microbial and anti-inflammatory capacities worldwide. In the tropical regions, green banana peel extract and andiroba oil are considered natural products with wound healing properties. The present study, for the first time, synthesized chitosan/green banana peel extract/andiroba oil (CGA) membranes and analyzed them using scanning electron microscopy (SEM) and the swelling and moisture tests. The CGA membranes together with control membranes of plain chitosan and chitosan plus green banana peel extract, were characterized by contact angle measurement, X-ray diffraction (XRD) and differential scanning calorimetry (DSC). Macroscopic analysis showed significant differences in color and transparency caused by the number of decoction days used for extract preparation and the oil content. SEM observations disclosed the formation of two phases, lipid and polymer, in the CGA. The number of decoction days and the andiroba oil content were inversely related to the swelling moisture uptake. All membranes were found to be hydrophilic with contact angles less than 90°. The incorporation of plant extract and oil promoted the appearance of related XRD peaks. DSC curves revealed a reduction in the enthalpy of the CGA membranes compared with plain chitosan, which might be attributed to the evaporation of the natural extract and oil. Based on these findings, the studied newly synthesized membranes demonstrated a potential for healing epithelial lesions.