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Staruch M, Speth MM, Neyer P, Riesterer O, Aebersold DM, Stieb S. Radiation-associated changes in saliva composition of head and neck cancer patients: A systematic review. Radiother Oncol 2024; 196:110279. [PMID: 38648994 DOI: 10.1016/j.radonc.2024.110279] [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: 09/08/2023] [Revised: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024]
Abstract
Xerostomia is a common radiation-associated toxicity in patients with head and neck cancer. Although several studies examined the decrease in saliva production due to radiotherapy (RT) and investigated the factors associated with this side effect, little is known about the change in radiation-associated saliva composition. This systematic review is the first to summarize existing data and give an overview of the change in pH/buffer capacity, electrolytes, proteins, enzymes, and mucins due to radiation to the salivary glands. Literature search was performed in PubMed and Embase with 47 articles finally eligible for the review, analyzing the saliva composition at several time points before, during and/or after RT, or comparing findings in irradiated patients to a healthy control group. Overall, RT leads to a substantial decrease in salivary pH and buffer capacity. For sodium, chloride and calcium ion, as well as amylase, an increased concentration or activity during RT was reported in most of the studies, followed by a subsequent decrease either already during RT or after the end of treatment. Different trends have been described for the total protein concentration during and after RT. Lactoferrin, however, increased considerably, especially in the first phase of RT. Mucin 5B (MUC5B) concentrations showed a slight increase during RT and concentrations around baseline values again six months post-radiotherapy.
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Affiliation(s)
- Michal Staruch
- Radiation Oncology Center KSA-KSB, Cantonal Hospital Aarau, Aarau, Switzerland; Department of Radiation Oncology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Marlene M Speth
- Otorhinolaryngology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Peter Neyer
- Department of Laboratory Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Oliver Riesterer
- Radiation Oncology Center KSA-KSB, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Daniel M Aebersold
- Department of Radiation Oncology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Sonja Stieb
- Radiation Oncology Center KSA-KSB, Cantonal Hospital Aarau, Aarau, Switzerland.
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2
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Khalil M, Hamadah O, Saifo M, Khalil H, Adi M, Alabeedi F, Kujan O. Effect of Photobiomodulation on Salivary Cytokines in Head and Neck Cancer Patients with Oral Mucositis: A Systematic Review. J Clin Med 2024; 13:2822. [PMID: 38792366 PMCID: PMC11122140 DOI: 10.3390/jcm13102822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/11/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Oral mucositis is a common and distressing side effect of head and neck oncology treatment. Photobiomodulation therapy can be utilized to prevent and treat oral mucositis. Its impact on salivary cytokines has yet to be thoroughly investigated. This is the first systematic review aiming to evaluate the effect of photobiomodulation on salivary cytokines in patients undergoing anticancer treatment. Methods: Numerous data resources, from the Web of Science, Embase, ScienceDirect, PubMed, Cochrane Library, and Scopus were sought. Articles published up until February 2024 were included if they met the following inclusion criteria: clinical trials reporting the effect on salivary cytokines in patients undergoing anticancer therapy. The methodological quality was assessed using several appraisal tools. Results: Four studies were deemed eligible for inclusion. All the studies were conducted in Brazil and used an InGaAlP diode laser with a wavelength of 660 nm. The included studies had a relatively low risk of bias. The head and neck cancer patients' salivary cytokines that were assessed by the studies, along with photobiomodulation therapy, included IL-12p70, TNF-α, IL-6, IL-8, IL-10, CXCL8, and IL-1β. The results varied among the studies. Conclusions: Our results show that photobiomodulation demonstrated positive results for reducing the severity of OM in all the included studies. Among the examined salivary cytokines, IL-6 is the most relevant cytokine for oral mucositis development and severity. A variation in the cytokine levels between the studies was noted due to differences in the type of anticancer treatment and saliva sampling.
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Affiliation(s)
- Marwa Khalil
- Department of Oral Medicine, Faculty of Dental Medicine, Damascus University, Damascus P.O. Box 30621, Syria; (M.K.); (O.H.)
| | - Omar Hamadah
- Department of Oral Medicine, Faculty of Dental Medicine, Damascus University, Damascus P.O. Box 30621, Syria; (M.K.); (O.H.)
- The Higher Institute for Laser Research and Applications, Damascus University, Damascus P.O. Box 30621, Syria
| | - Maher Saifo
- Faculty of Medicine, Medical Oncology, Damascus University, Damascus P.O. Box 30621, Syria;
- Albairouni University Hospital, Damascus University, Damascus P.O. Box 30621, Syria
| | - Hasan Khalil
- Department of Microbiology and Biochemistry, Tishreen University, Lattakia P.O. Box 2230, Syria;
| | - Mowaffak Adi
- Shining Horizons Dental Center, Inaya Medical Colleges, Riyadh 13541, Saudi Arabia;
| | - Faris Alabeedi
- UWA Dental School, The University of Western Australia, Nedlands, WA 6009, Australia;
| | - Omar Kujan
- UWA Dental School, The University of Western Australia, Nedlands, WA 6009, Australia;
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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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Harada K, Ferdous T, Fujiwara R, Watanabe K, Mizukami Y, Mishima K. An elemental diet protects mouse salivary glands from 5‑fluorouracil‑induced atrophy. Oncol Lett 2022; 23:178. [PMID: 35464303 PMCID: PMC9025579 DOI: 10.3892/ol.2022.13298] [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: 10/02/2021] [Accepted: 02/14/2022] [Indexed: 11/18/2022] Open
Abstract
An elemental diet (ED) reduces adverse effects of chemotherapy, including oral mucositis, in patients with cancer. However, the detailed mechanism(s) of the healing effects of an ED remains unclear. In the present study, the protective effects of the ED, Elental®, were examined against 5-fluorouracil (5-FU)-induced oral mucositis and salivary gland atrophy in mice. Mucositis was induced in female ICR mice by injection of 5-FU. The mice were orally administered Elental® (ED group) or saline (control group). After treatment, the mice body weight, salivary gland weight and the histological changes in the salivary gland granular duct area were monitored. The mice body weight remained stable in the ED group, but was significantly decreased in the control group. Moreover, the salivary gland weight was higher in the ED group compared with the control group. In addition, the salivary gland granular duct area cells were larger in the ED group compared with the control group. Whole transcriptome analysis and network analysis were conducted to understand the mechanisms of action of Elental® against oral mucositis. Whole transcriptome analysis and Ingenuity Pathways Analysis data suggested that Elental® contributed to the recovery of mitochondrial function in 5-FU-damaged salivary glands. Immunohistochemical analysis of salivary gland tissue demonstrated that the expression of cytochrome c oxidase subunit 4 and epidermal growth factor were higher in the ED group compared with the control group. Next, the rate of apoptosis in the salivary glands was examined using terminal deoxynucleotidyl transferase-mediated nick end labeling (TUNEL) assays. The number of TUNEL-positive cells in the salivary glands was lower in the ED group compared with the control group. These findings suggested that Elental® may protect mouse salivary glands from 5-FU-induced atrophic changes, which suggests that ED treatment may improve xerostomia and alleviate oral mucositis in patients with cancer receiving 5-FU-based chemotherapy.
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Affiliation(s)
- Koji Harada
- Department of Oral and Maxillofacial Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755‑8505, Japan
| | - Tarannum Ferdous
- Department of Oral and Maxillofacial Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755‑8505, Japan
| | - Rieko Fujiwara
- Department of Oral and Maxillofacial Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755‑8505, Japan
| | - Kenji Watanabe
- Center for Gene Research, Yamaguchi University, Ube, Yamaguchi 755‑8505, Japan
| | - Yoichi Mizukami
- Center for Gene Research, Yamaguchi University, Ube, Yamaguchi 755‑8505, Japan
| | - Katsuaki Mishima
- Department of Oral and Maxillofacial Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755‑8505, Japan
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Fujiwara R, Harada K, Ferdous T, Mishima K. Amino Acids May Have Protective Effects on Salivary Glands of 5-FU-administered Mice. In Vivo 2022; 36:198-205. [PMID: 34972715 DOI: 10.21873/invivo.12691] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND/AIM This study aimed to identify the most useful components of Elental® in the treatment of 5-fluorouracil (FU)-induced mucositis and salivary gland atrophy in mice. MATERIALS AND METHODS Mice (except the control group) were intraperitoneally injected with 5-FU. The mice received saline (control group and 5-FU group), dextrin (Dextrin group), amino acids (17AA group), or Elental® (Elental® group). RESULTS The volume and weight of salivary glands was higher in 17AA and Elental® groups compared to 5-FU group. The number of mucous glands was higher, whereas the number of damaged granular ductal epithelial cells was lower in the salivary glands of all groups except the 5-FU group. Salivation was also decreased in the 5-FU group compared to the other groups. CONCLUSION Amino acids could be the most effective components of Elental® for protecting mouse salivary glands from 5-FU-induced atrophic changes, and might be useful in the treatment of oral mucositis in cancer patients.
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Affiliation(s)
- Rieko Fujiwara
- Department of Oral and Maxillofacial Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Koji Harada
- Department of Oral and Maxillofacial Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Tarannum Ferdous
- Department of Oral and Maxillofacial Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Katsuaki Mishima
- Department of Oral and Maxillofacial Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
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Manzato MC, de Santi F, da Silva AAS, Beltrame FL, Cerri PS, Sasso‐Cerri E. Cimetidine-induced androgenic failure causes cell death and changes in actin, EGF and V-ATPase immunoexpression in rat submandibular glands. J Anat 2021; 239:136-150. [PMID: 33713423 PMCID: PMC8197950 DOI: 10.1111/joa.13408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 01/18/2023] Open
Abstract
Submandibular gland (SMG) is responsive to androgens via androgen receptor (AR). We verified whether cimetidine induces androgenic dysfunction in SMG, and evaluated the structural integrity, cell death and immunoexpression of actin, EGF and V-ATPase in androgen-deficient SMG. Male rats received cimetidine (CMTG) and control animals (CG) received saline. Granular convoluted tubules (GCTs) diameter and number of acinar cell nuclei were evaluated. TUNEL and immunofluorescence reactions for detection of AR, testosterone, actin, EGF and V-ATPase were quantitatively analysed. In CG, testosterone immunolabelling was detected in acinar and ductal cells cytoplasm. AR-immunolabelled nuclei were observed in acinar cells whereas ductal cells showed AR-immunostained cytoplasm, indicating a non-genomic AR action. In CMTG, the weak testosterone and AR immunoexpression confirmed cimetidine-induced androgenic failure. A high cell death index was correlated with decreased number of acinar cells, GCTs diameter and EGF immunoexpression under androgenic dysfunction. Actin immunofluorescence decreased in the SMG cells, but an increased and diffuse cytoplasmic V-ATPase immunolabelling was observed in striated ducts, suggesting a disruption in the actin-dependent V-ATPase recycling due to androgenic failure. Our findings reinforce the androgenic role in the maintenance of SMG histophysiology, and point to a potential clinical use of cimetidine against androgen-dependent glandular tumour cells.
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Affiliation(s)
- Mariane Castro Manzato
- Department of Morphology, Genetics, Orthodontics and Pediatric DentistrySchool of DentistrySão Paulo State University (Unesp)AraraquaraBrazil
| | - Fabiane de Santi
- Department of Morphology and GeneticsFederal University of São PauloSão PauloBrazil
| | - André Acácio Souza da Silva
- Department of Morphology, Genetics, Orthodontics and Pediatric DentistrySchool of DentistrySão Paulo State University (Unesp)AraraquaraBrazil
| | - Flávia L. Beltrame
- Department of Morphology and GeneticsFederal University of São PauloSão PauloBrazil
| | - Paulo S. Cerri
- Department of Morphology, Genetics, Orthodontics and Pediatric DentistrySchool of DentistrySão Paulo State University (Unesp)AraraquaraBrazil
| | - Estela Sasso‐Cerri
- Department of Morphology, Genetics, Orthodontics and Pediatric DentistrySchool of DentistrySão Paulo State University (Unesp)AraraquaraBrazil
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Oliveira EMD, Guieiro RS, Cruz BL, Aguiar MCFD, Silva JMD, Silva TA, Caldeira PC. Salivary molecules of bone remodeling and tissue repair after head and neck radiotherapy. Braz Oral Res 2021; 35:e079. [PMID: 34161416 DOI: 10.1590/1807-3107bor-2021.vol35.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/03/2021] [Indexed: 08/29/2023] Open
Abstract
Head and neck radiotherapy causes quantitative and qualitative changes in saliva. The objective of this case-control study was to evaluate the salivary biomarkers associated with bone remodeling and tissue repair in patients submitted to radiotherapy for head and neck cancer treatment, compared with non-irradiated individuals. Total unstimulated saliva was collected for ELISA assay analysis of receptor activator for nuclear factor κ B (RANK) and its ligand (RANK-L), osteoprotegerin, matrix metalloproteinase-9/ tissue inhibitor of metalloproteinase-2, vascular endothelial growth factor, and epidermal growth factor. Statistics were performed, and revealed that salivary RANK (p = 0.0304), RANK-L (p = 0.0005), matrix metalloproteinase-9/ tissue inhibitor of metalloproteinase-2 (p = 0.0067), vascular endothelial growth factor (p = 0.0060), and epidermal growth factor (p < 0.0001) were reduced in patients, compared with the control group. Osteoprotegerin did not differ between the groups (p = 0.3765). Salivary biomarkers did not differ according to radiotherapy completion time (p > 0.05). In conclusion, the lower output of the salivary molecules - essential for bone remodeling and tissue repair - may disrupt tissue homeostasis and play a role in the pathogenesis of the radiotherapy-induced deleterious effects in the oral cavity.
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Affiliation(s)
- Eduardo Morato de Oliveira
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Surgery and Pathology, Belo Horizonte, MG, Brazil
| | - Rafael Soares Guieiro
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Surgery and Pathology, Belo Horizonte, MG, Brazil
| | - Bárbara Lima Cruz
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Surgery and Pathology, Belo Horizonte, MG, Brazil
| | - Maria Cássia Ferreira de Aguiar
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Surgery and Pathology, Belo Horizonte, MG, Brazil
| | - Janine Mayra da Silva
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Surgery and Pathology, Belo Horizonte, MG, Brazil
| | - Tarcília Aparecida Silva
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Surgery and Pathology, Belo Horizonte, MG, Brazil
| | - Patrícia Carlos Caldeira
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Surgery and Pathology, Belo Horizonte, MG, Brazil
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Kawahara K, Hiraki A, Arita H, Takeshita H, Hirosue A, Matsuoka Y, Sakata J, Obayashi Y, Nakashima H, Hirayama M, Nagata M, Yoshida R, Shinohara M, Nakayama H. Role of serum amylase and salivary cytokines in oral complications during chemoradiotherapy. Oral Dis 2020; 27:1564-1571. [PMID: 33079418 DOI: 10.1111/odi.13686] [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: 08/08/2020] [Revised: 09/20/2020] [Accepted: 10/09/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate whether serum amylase can predict the recovery of salivary volume and determine the correlation of the level of cytokines, including epidermal growth factor, hepatocyte growth factor and keratinocyte growth factor, with oral mucositis during chemoradiotherapy for oral cancer. SUBJECTS AND METHODS This study included 84 patients treated with preoperative chemoradiotherapy followed by curative surgery, following a phase II study protocol. We measured and analysed the correlation of the stimulated saliva volume, serum amylase and cytokines in resting saliva at baseline and 1 month after chemoradiotherapy with oral mucositis levels. RESULTS We observed a negative correlation between the serum amylase level at the beginning of chemoradiotherapy and the stimulated saliva volume at 1 month after chemoradiotherapy (p = .03). Epidermal growth factor in resting saliva was significantly reduced after chemoradiotherapy (p < .01). The incidence of severe oral mucositis during chemoradiotherapy was significantly higher and negatively associated with the epidermal growth factor and keratinocyte growth factor levels (p = .04, p = .05). CONCLUSIONS The serum amylase level at the beginning of chemoradiotherapy may be a predictor of the recovery of the saliva volume. Furthermore, cytokines such as epidermal growth factor and keratinocyte growth factor in resting saliva affect the development of oral mucositis during chemoradiotherapy.
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Affiliation(s)
- Kenta Kawahara
- Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Akimitsu Hiraki
- Section of Oral Oncology, Department of Oral and Maxillofacial Surgery, Fukuoka Dental College, Fukuoka, Japan
| | - Hidetaka Arita
- Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hisashi Takeshita
- Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Akiyuki Hirosue
- Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yuichiro Matsuoka
- Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Junki Sakata
- Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yuko Obayashi
- Section of Oral Oncology, Department of Oral and Maxillofacial Surgery, Fukuoka Dental College, Fukuoka, Japan
| | - Hikaru Nakashima
- Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Mayumi Hirayama
- Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Masashi Nagata
- Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Ryoji Yoshida
- Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | | | - Hideki Nakayama
- Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Pulito C, Cristaudo A, Porta CL, Zapperi S, Blandino G, Morrone A, Strano S. Oral mucositis: the hidden side of cancer therapy. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2020; 39:210. [PMID: 33028357 PMCID: PMC7542970 DOI: 10.1186/s13046-020-01715-7] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/21/2020] [Indexed: 02/07/2023]
Abstract
Inflammation response of epithelial mucosa to chemo- radiotherapy cytotoxic effects leads to mucositis, a painful side effect of antineoplastic treatments. About 40% of the patients treated with chemotherapy develop mucositis; this percentage rises to about 90% for head and neck cancer patients (HNC) treated with both chemo- and radiotherapy. 19% of the latter will be hospitalized and will experience a delay in antineoplastic treatment for high-grade mucositis management, resulting in a reduction of the quality of life, a worse prognosis and an increase in patient management costs. Currently, several interventions and prevention guidelines are available, but their effectiveness is uncertain. This review comprehensively describes mucositis, debating the impact of standard chemo-radiotherapy and targeted therapy on mucositis development and pointing out the limits and the benefits of current mucositis treatment strategies and assessment guidelines. Moreover, the review critically examines the feasibility of the existing biomarkers to predict patient risk of developing oral mucositis and their role in early diagnosis. Despite the expression levels of some proteins involved in the inflammation response, such as TNF-α or IL-1β, partially correlate with mucositis process, their presence does not exclude others mucositis-independent inflammation events. This strongly suggests the need to discover biomarkers that specifically feature mucositis process development. Non-coding RNAs might hold this potential.
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Affiliation(s)
- Claudio Pulito
- Oncogenomic and Epigenetic Unit, IRCCS, Regina Elena National Cancer Institute, Rome, Italy
| | - Antonio Cristaudo
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Caterina La Porta
- Center for Complexity and Biosystems, Department of Environmental Science and Policy, University of Milan, via Celoria 26, 20133, Milano, Italy.,CNR - Consiglio Nazionale delle Ricerche, Istituto di Biofisica, via Celoria 26, 20133, Milano, Italy
| | - Stefano Zapperi
- Center for Complexity and Biosystems, Department of Physics, University of Milan, Via Celoria 16, 20133, Milano, Italy.,CNR - Consiglio Nazionale delle Ricerche, Istituto di Chimica della Materia Condensata e di Tecnologie per l'Energia, Via R. Cozzi 53, 20125, Milano, Italy
| | - Giovanni Blandino
- Oncogenomic and Epigenetic Unit, IRCCS, Regina Elena National Cancer Institute, Rome, Italy
| | - Aldo Morrone
- Scientific Director Office, San Gallicano Institute, Rome, Italy
| | - Sabrina Strano
- SAFU Laboratory, Department of Research, Advanced Diagnostic, and Technological Innovation, IRCCS, Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00144, Rome, Italy.
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10
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Stempniewicz A, Ceranowicz P, Warzecha Z. Potential Therapeutic Effects of Gut Hormones, Ghrelin and Obestatin in Oral Mucositis. Int J Mol Sci 2019; 20:ijms20071534. [PMID: 30934722 PMCID: PMC6479885 DOI: 10.3390/ijms20071534] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 12/16/2022] Open
Abstract
Chemotherapy and/or head and neck radiotherapy are frequently associated with oral mucositis. Oral pain, odynophagia and dysphagia, opioid use, weight loss, dehydration, systemic infection, hospitalization and introduction of a feeding tube should be mentioned as the main determinated effect of oral mucositis. Oral mucositis leads to a decreased quality of life and an increase in treatment costs. Moreover, oral mucositis is a life-threatening disease. In addition to its own direct life-threatening consequences, it can also lead to a reduced survival due to the discontinuation or dose reduction of anti-neoplasm therapy. There are numerous strategies for the prevention or treatment of oral mucositis; however, their effectiveness is limited and does not correspond to expectations. This review is focused on the ghrelin and obestatin as potentially useful candidates for the prevention and treatment of chemo- or/and radiotherapy-induced oral mucositis.
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Affiliation(s)
- Agnieszka Stempniewicz
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, Grzegórzecka 16 St., 31-531 Krakow, Poland.
| | - Piotr Ceranowicz
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, Grzegórzecka 16 St., 31-531 Krakow, Poland.
| | - Zygmunt Warzecha
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, Grzegórzecka 16 St., 31-531 Krakow, Poland.
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11
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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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Azuma N, Katada Y, Sano H. Deterioration in saliva quality in patients with Sjögren's syndrome: impact of decrease in salivary epidermal growth factor on the severity of intraoral manifestations. Inflamm Regen 2018; 38:6. [PMID: 29657585 PMCID: PMC5890343 DOI: 10.1186/s41232-018-0062-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 02/26/2018] [Indexed: 11/23/2022] Open
Abstract
Background Sjögren’s syndrome (SS) is a chronic inflammatory autoimmune disease characterized by lymphocytic infiltration of the exocrine glands, especially the salivary and lacrimal glands. As a result of salivary gland dysfunction, most patients with SS have xerostomia related to a reduced salivary flow rate. In addition to the discomfort due to xerostomia, dry mouth can cause various intraoral manifestations such as refractory stomatitis, ulcer, and atrophic changes in the oral mucosa and tongue, and the patient’s quality of life (QoL) is severely impaired. These manifestations are believed to be caused mainly by a decrease in the clearance in the oral cavity owing to hyposalivation. However, because saliva has several beneficial physiological effects on the intraoral environment, qualitative changes in sialochemistry should also be considered a cause of the refractory intraoral manifestations in SS. Main text Salivary epidermal growth factor (EGF) is considered an important cytoprotective factor against injuries. It contributes to wound healing in the oral cavity and to maintenance of mucosal integrity in the oral cavity and gastrointestinal tract. We evaluated changes in salivary EGF levels and assessed the association between salivary EGF levels and the severity of intraoral manifestations in patients with SS. The following novel findings were obtained: (1) salivary EGF levels in SS patients were significantly lower than those in non-SS patients; (2) salivary EGF levels as well as the salivary flow rate decreased with the progression of SS; (3) with prolonged SS disease duration, salivary EGF levels decreased more rapidly than the salivary flow rate; and (4) decreases in salivary EGF levels significantly correlated with exacerbation of the oral health-related QoL in patients with SS. Conclusions The deterioration in saliva quality as well as lower intraoral clearance by hyposalivation could play a role in the pathogenesis of refractory intraoral manifestations in patients with SS. Our findings suggest a new target for therapeutic intervention for SS.
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Affiliation(s)
- Naoto Azuma
- 1Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501 Japan
| | - Yoshinori Katada
- Division of General Medicine, Department of Internal Medicine, Sakai City Medical Center, 1-1-1 Ebaraji-cho, Nishi-ku, Sakai, 593-8304 Japan
| | - Hajime Sano
- 1Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501 Japan
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Eckley CA, Dos Anjos Corvo MA, Sardinha LR, Liquidato B, Rizzo LV. Salivary epidermal growth factor concentrations in patients with Sjögren syndrome and laryngopharyngeal reflux. EAR, NOSE & THROAT JOURNAL 2018. [PMID: 28636735 DOI: 10.1177/014556131709600602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Sjögren syndrome was chosen as a clinical model to study acinar salivary deficiencies in the development of laryngopharyngeal reflux (LPR). The objective of this prospective cohort study was to compare salivary epidermal growth factor (EGF) concentrations of patients with Sjögren syndrome with and without LPR and gastroesophageal reflux disease (GERD) with normal controls. LPR was diagnosed with positive scores on the Reflux Symptom Index and Reflux and Reflux Finding Score, corroborated by esophagogastroduodenoscopy and/or 24-hour pH-metry. Salivary EGF concentrations of both unstimulated and mechanically stimulated saliva were established using enzyme-linked immunosorbent assay, and the significance level was set at 95%. Twenty-one patients and 19 controls were studied. All patients had LPR and 60% also had GERD. The mean salivary EGF concentration of unstimulated and stimulated saliva in the control group was 1,751.37 pg/ml and 544.76 pg/ml, respectively. Unstimulated and stimulated salivary EGF concentrations in the study group were 2,534.65 pg/ml and 920.69 pg/ml, respectively. These differences were not statistically significant. Body mass index, presence of erosive esophagitis, or severity of hyposalivation did not significantly influence salivary EGF concentrations. LPR and GERD are highly prevalent in patients with Sjögren syndrome. Unlike previous studies in which significant EGF deficiencies were found in patients with reflux laryngitis and GERD, patients with Sjögren syndrome seem to have reflux caused by a decrease in clearance capacity and not in specific salivary components.
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Affiliation(s)
- Claudia A Eckley
- Department of Otolaryngology, Santa Casa School of Medicine and Hospitals, Av. Vereador José Diniz 3457, cj 501, São Paulo, Brazil.
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Tao Z, Gao J, Qian L, Huang Y, Zhou Y, Yang L, He J, Yang J, Wang R, Zhang Y. Factors associated with acute oral mucosal reaction induced by radiotherapy in head and neck squamous cell carcinoma: A retrospective single-center experience. Medicine (Baltimore) 2017; 96:e8446. [PMID: 29390253 PMCID: PMC5815665 DOI: 10.1097/md.0000000000008446] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To investigate risk factors for acute oral mucosal reaction during head and neck squamous cell carcinoma radiotherapy.A retrospective study of patients with head and neck squamous cell carcinoma who underwent radiotherapy from November 2013 to May 2016 in Anhui Provincial Cancer Hospital was conducted. Data on the occurrence and severity of acute oral mucositis were extracted from clinical records. Based on the Radiation Therapy Oncology Group (RTOG) grading of acute radiation mucosal injury, the patients were assigned into acute reaction (grades 2-4) and minimum reaction (grades 0-1) groups. Preradiotherapy characteristics and treatment factors were compared between the 2 groups. Multivariate logistic regression analysis was used to detect the independent factors associated with acute oral mucosal reactions.Eighty patients completed radiotherapy during the study period. Oral mucosal reactions were recorded as 25, 31, and 24 cases of grades 1, 2, and 3 injuries, respectively. Significant differences between acute reaction and minimum reaction groups were detected in cancer lymph node (N) staging, smoking and diabetes history, pretreatment platelet count and T-Helper/T-Suppressor lymphocyte (Th/Ts) ratio, concurrent chemotherapy, and total and single irradiation doses.Multivariate analysis showed that N stage, smoking history, single dose parapharyngeal irradiation, and pretreatment platelet count were independent risk factors for acute radiation induced oral mucosal reaction. Smoking history, higher grading of N stage, higher single dose irradiation, and lower preirradiation platelet count may increase the risk and severity of acute radiation oral mucosal reaction in radiotherapy of head and neck cancer patients.
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Affiliation(s)
- Zhenchao Tao
- Anhui Provincial Cancer Hospital
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Jin Gao
- Anhui Provincial Cancer Hospital
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Liting Qian
- Anhui Provincial Cancer Hospital
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Yifan Huang
- Anhui Provincial Cancer Hospital
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Yan Zhou
- Anhui Provincial Cancer Hospital
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Liping Yang
- Anhui Provincial Cancer Hospital
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Jian He
- Anhui Provincial Cancer Hospital
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Jing Yang
- Anhui Provincial Cancer Hospital
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Ru Wang
- Anhui Provincial Cancer Hospital
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Yangyang Zhang
- Anhui Provincial Cancer Hospital
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
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Normando AGC, Rocha CL, de Toledo IP, de Souza Figueiredo PT, dos Reis PED, De Luca Canto G, Guerra ENS. Biomarkers in the assessment of oral mucositis in head and neck cancer patients: a systematic review and meta-analysis. Support Care Cancer 2017. [DOI: 10.1007/s00520-017-3783-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kaczor-Urbanowicz KE, Martin Carreras-Presas C, Aro K, Tu M, Garcia-Godoy F, Wong DT. Saliva diagnostics - Current views and directions. Exp Biol Med (Maywood) 2016; 242:459-472. [PMID: 27903834 DOI: 10.1177/1535370216681550] [Citation(s) in RCA: 238] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
In this review, we provide an update on the current and future applications of saliva for diagnostic purposes. There are many advantages of using saliva as a biofluid. Its collection is fast, easy, inexpensive, and non-invasive. In addition, saliva, as a "mirror of the body," can reflect the physiological and pathological state of the body. Therefore, it serves as a diagnostic and monitoring tool in many fields of science such as medicine, dentistry, and pharmacotherapy. Introduced in 2008, the term "Salivaomics" aimed to highlight the rapid development of knowledge about various "omics" constituents of saliva, including: proteome, transcriptome, micro-RNA, metabolome, and microbiome. In the last few years, researchers have developed new technologies and validated a wide range of salivary biomarkers that will soon make the use of saliva a clinical reality. However, a great need still exists for convenient and accurate point-of-care devices that can serve as a non-invasive diagnostic tool. In addition, there is an urgent need to decipher the scientific rationale and mechanisms that convey systemic diseases to saliva. Another promising technology called liquid biopsy enables detection of circulating tumor cells (CTCs) and fragments of tumor DNA in saliva, thus enabling non-invasive early detection of various cancers. The newly developed technology-electric field-induced release and measurement (EFIRM) provides near perfect detection of actionable mutations in lung cancer patients. These recent advances widened the salivary diagnostic approach from the oral cavity to the whole physiological system, and thus point towards a promising future of salivary diagnostics for personalized individual medicine applications including clinical decisions and post-treatment outcome predictions. Impact statement The purpose of this mini-review is to make an update about the present and future applications of saliva as a diagnostic biofluid in many fields of science such as dentistry, medicine and pharmacotherapy. Using saliva as a fluid for diagnostic purposes would be a huge breakthrough for both patients and healthcare providers since saliva collection is easy, non-invasive and inexpensive. We will go through the current main diagnostic applications of saliva, and provide a highlight on the emerging, newly developing technologies and tools for cancer screening, detection and monitoring.
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Affiliation(s)
| | | | - Katri Aro
- 1 School of Dentistry, Center for Oral/Head & Neck Oncology Research, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Michael Tu
- 1 School of Dentistry, Center for Oral/Head & Neck Oncology Research, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Franklin Garcia-Godoy
- 3 College of Dentistry, University of Tennessee Health Science Center, Bioscience Research Center, Memphis, TN 38163, USA
| | - David Tw Wong
- 1 School of Dentistry, Center for Oral/Head & Neck Oncology Research, University of California at Los Angeles, Los Angeles, CA 90095, USA
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Eckley CA, Michelsohn N, Rizzo LV, Tadokoro CE, Tadakoro CE, Costa HO. Salivary Epidermal Growth Factor Concentration in Adults with Reflux Laryngitis. Otolaryngol Head Neck Surg 2016; 131:401-6. [PMID: 15467608 DOI: 10.1016/j.otohns.2004.01.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE: The mechanisms involved in the muco-sal alterations of laryngopharyngeal reflux (LPR) have not been well established. Reports indicate a decrease in the salivary epidermal growth factor (EGF) of patients with reflux esophagitis, but there are no reports of its behavior in LPR. Our objective was to determine the salivary concentration of EGF in adults with LPR. STUDY DESIGN AND SETTING: Salivary EGF concentration of 26 patients with LPR and 20 healthy controls was determined using a commercially available ELISA kit. Patients with LPR were graded according to endoscopic and laryngoscopic criteria. RESULTS: Salivary EGF concentration was significantly lower in the LPR group when compared with controls ( P = 0.002). No correlation between the severity of laryngeal findings or esophagitis and salivary EGF concentration could be determined. CONCLUSIONS: The decreased salivary concentration of EGF in adults with LPR suggests that a deficiency in this polypeptide could be associated to the disease.
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Affiliation(s)
- Claudia A Eckley
- Otolaryngology Department, Santa Casa School of Medicine of São Paulo, Brasil.
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18
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Radiotherapy-induced miR-223 prevents relapse of breast cancer by targeting the EGF pathway. Oncogene 2016; 35:4914-26. [PMID: 26876200 PMCID: PMC5028421 DOI: 10.1038/onc.2016.23] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 11/04/2015] [Accepted: 12/18/2015] [Indexed: 12/17/2022]
Abstract
In breast cancer (BC) patients, local recurrences often arise in proximity of the surgical scar, suggesting that response to surgery may have a causative role. Radiotherapy (RT) after lumpectomy significantly reduces the risk of recurrence. We investigated the direct effects of surgery and of RT delivered intraoperatively (IORT), by collecting irradiated and non-irradiated breast tissues from BC patients, after tumor removal. These breast tissue specimens have been profiled for their microRNA (miR) expression, in search of differentially expressed miR among patients treated or not with IORT. Our results demonstrate that IORT elicits effects that go beyond the direct killing of residual tumor cells. IORT altered the wound response, inducing the expression of miR-223 in the peri-tumoral breast tissue. miR-223 downregulated the local expression of epidermal growth factor (EGF), leading to decreased activation of EGF receptor (EGFR) on target cells and, eventually, dampening a positive EGF-EGFR autocrine/paracrine stimulation loop induced by the post-surgical wound-healing response. Accordingly, both RT-induced miR-223 and peri-operative inhibition of EGFR efficiently prevented BC cell growth and reduced recurrence formation in mouse models of BC. Our study uncovers unknown effects of RT delivered on a wounded tissue and prompts to the use of anti-EGFR treatments, in a peri-operative treatment schedule, aimed to timely treat BC patients and restrain recurrence formation.
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Influence of an elemental diet on 5-fluorouracil-induced morphological changes in the mouse salivary gland and colon. Support Care Cancer 2015; 24:1609-16. [DOI: 10.1007/s00520-015-2947-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 09/14/2015] [Indexed: 12/15/2022]
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20
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Gomes CC, Ramos-Perez FMDM, Perez DEDC, Novaes PD, Bóscolo FN, Almeida SMD. Radioprotective effect of vitamin E in parotid glands: a morphometric analysis in rats. Braz Dent J 2015; 24:183-7. [PMID: 23969903 DOI: 10.1590/0103-6440201301781] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Accepted: 05/07/2013] [Indexed: 01/09/2023] Open
Abstract
The aim of this study was to evaluate the radioprotective effect of vitamin E on rat parotid glands by morphometric analysis. Sixty male rats were divided into 5 groups (n=6): control, in which animals received olive oil solution; olive oil/irradiated, in which animals received olive oil and were irradiated with a dose of 15 Gy of gamma radiation; irradiated, in which animals were irradiated with a dose of 15 Gy gamma radiation; vitamin E, which received α-tocopherol acetate solution; vitamin E/irradiated, which received α-tocopherol acetate solution before irradiation with a dose of 15 Gy gamma rays. Half of the animals were euthanized at 8 h, and the remaining at 30 days after irradiation. Both parotid glands were surgically removed and morphometric analysis of acinar cells was performed. Data were subjected to two-way ANOVA and Tukey's test (α=0.05). Morphometric analysis showed a significant reduction in the number of parotid acinar cells at 30 days in olive oil/irradiated and irradiated groups. In groups evaluated over time a significant reduction was shown at 30 days in olive oil/irradiated and irradiated groups, indicating that ionizing radiation caused tissue damage. The vitamin E/irradiated group presented more acinar cells than the irradiated group, but no statistically significant difference was observed (p>0.05). In conclusion, vitamin E seems to have failed as a radioprotective agent on acinar cells in rat parotid glands.
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Affiliation(s)
- Carolina Cintra Gomes
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
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21
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Lee JB, Shin B, Lee SH, Lee BY, Kim TH, Kim MG, Yoo SD. Exposure assessment of epidermal growth factor to various tissues in mice after intravenous and subcutaneous administration. ACTA ACUST UNITED AC 2015; 67:1519-27. [PMID: 26255780 DOI: 10.1111/jphp.12464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 06/15/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVES This study was conducted to examine the tissue distribution of human recombinant epidermal growth factor (EGF) after multiple intravenous and subcutaneous injections in mice. METHODS Male BALB/c mice were divided into (1) EGF 1 mg/kg intravenous dose, (2) EGF 5 mg/kg intravenous dose, (3) drug-free intravenous control, (4) EGF 1 mg/kg subcutaneous dose, (5) EGF 5 mg/kg subcutaneous dose and (6) drug-free subcutaneous control groups. EGF and drug-free dosing solutions were injected by intravenous and subcutaneous injections once a day for 3 days. EGF concentrations in serum and tissues of kidney, liver, lung, small intestine and tongue were determined by ELISA. KEY FINDINGS As the intravenous and subcutaneous doses were increased from 1 to 5 mg/kg, serum Cmax and area under the concentration-time curve (AUC) values were increased dose-proportionally. In lung, tongue and small intestine, increases in AUC were dose-proportional after intravenous injections, but greater than dose-proportional after subcutaneous injections. The fold-increases in Cmax and AUC values were lowest in liver and highest in kidney. CONCLUSION Based on Cmax and AUC data, the systemic exposure achieved by subcutaneous injections was comparable with that achieved by intravenous injections.
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Affiliation(s)
- Jong Bong Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Beomsoo Shin
- College of Pharmacy, Catholic University of Daegu, Gyeongbuk, South Korea
| | - Sang Ho Lee
- Pharmaceutical Research Institute, Daewoong Pharmaceutical Corporation, Yongin, South Korea
| | - Bong Yong Lee
- Pharmaceutical Research Institute, Daewoong Pharmaceutical Corporation, Yongin, South Korea
| | - Tae Hwan Kim
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Min Gi Kim
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Sun Dong Yoo
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
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Azuma N, Katada Y, Kitano S, Sekiguchi M, Kitano M, Nishioka A, Hashimoto N, Matsui K, Iwasaki T, Sano H. Rapid decrease in salivary epidermal growth factor levels in patients with Sjögren's syndrome: A 3-year follow-up study. Mod Rheumatol 2015; 25:876-82. [DOI: 10.3109/14397595.2015.1034941] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Naoto Azuma
- Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Yoshinori Katada
- Division of Kidney, Metabolism and Immunity, Department of Internal Medicine, Sakai City Hospital, Sakai, Japan
| | - Sachie Kitano
- Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Masahiro Sekiguchi
- Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Masayasu Kitano
- Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Aki Nishioka
- Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Naoaki Hashimoto
- Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
- Hashimoto Clinic for Rheumatic Diseases, Osaka, Japan
| | - Kiyoshi Matsui
- Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Tsuyoshi Iwasaki
- Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
- Division of Pharmacotherapy, Department of Pharmacy, School of Pharmacy, Hyogo University of Health Sciences, Kobe, Japan
| | - Hajime Sano
- Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
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Oton-Leite AF, Silva GBL, Morais MO, Silva TA, Leles CR, Valadares MC, Pinezi JCD, Batista AC, Mendonça EF. Effect of low-level laser therapy on chemoradiotherapy-induced oral mucositis and salivary inflammatory mediators in head and neck cancer patients. Lasers Surg Med 2015; 47:296-305. [DOI: 10.1002/lsm.22349] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Angélica F. Oton-Leite
- Department of Oral Medicine (Oral Pathology); Dental School; Federal University of Goiás; Goiânia Goiás 74605-220 Brazil
| | - Geisa Badauy L. Silva
- Department of Oral Medicine (Oral Pathology); Dental School; Federal University of Goiás; Goiânia Goiás 74605-220 Brazil
| | - Marília O. Morais
- Department of Oral Medicine (Oral Pathology); Dental School; Federal University of Goiás; Goiânia Goiás 74605-220 Brazil
| | - Tarcília A. Silva
- Department of Oral Medicine (Oral Pathology); Dental School; Federal University of Minas Gerais; Belo Horizonte Minas Gerais 31270-901 Brazil
| | - Cláudio R. Leles
- Department of Prevention and Oral Rehabilitation, Dental School; Federal University of Goiás; Goiânia Goiás 74605-220 Brazil
| | - Marize Campos Valadares
- Laboratory of Cellular Pharmacology and Toxicology; Faculty of Pharmacy; Federal University of Goiás; Goiânia Goiás 74605-220 Brazil
| | - Juliana Castro D. Pinezi
- Radiotherapy Department of the Araújo Jorge Hospital; Association of Cancer Combat of Goiás; Goiânia Goiás 74605-070 Brazil
| | - Aline C. Batista
- Department of Oral Medicine (Oral Pathology); Dental School; Federal University of Goiás; Goiânia Goiás 74605-220 Brazil
| | - Elismauro F. Mendonça
- Department of Oral Medicine (Oral Pathology); Dental School; Federal University of Goiás; Goiânia Goiás 74605-220 Brazil
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Azuma N, Katada Y, Kitano S, Sekiguchi M, Kitano M, Nishioka A, Hashimoto N, Matsui K, Iwasaki T, Sano H. Correlation between salivary epidermal growth factor levels and refractory intraoral manifestations in patients with Sjögren's syndrome. Mod Rheumatol 2013; 24:626-32. [DOI: 10.3109/14397595.2013.850766] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Naoto Azuma
- Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine,
Nishinomiya, Hyogo, Japan
| | - Yoshinori Katada
- Division of Allergy and Clinical Immunology, National Hospital Organization Osaka-Minami Medical Center,
Kawachinagano, Osaka, Japan
| | - Sachie Kitano
- Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine,
Nishinomiya, Hyogo, Japan
| | - Masahiro Sekiguchi
- Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine,
Nishinomiya, Hyogo, Japan
| | - Masayasu Kitano
- Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine,
Nishinomiya, Hyogo, Japan
| | - Aki Nishioka
- Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine,
Nishinomiya, Hyogo, Japan
| | - Naoaki Hashimoto
- Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine,
Nishinomiya, Hyogo, Japan
- Hashimoto Clinic for Rheumatic Diseases,
Chuo-ku, Osaka, Japan
| | - Kiyoshi Matsui
- Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine,
Nishinomiya, Hyogo, Japan
| | - Tsuyoshi Iwasaki
- Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine,
Nishinomiya, Hyogo, Japan
- Division of Pharmacotherapy, Department of Pharmacy, School of Pharmacy, Hyogo University of Health Sciences,
Chuo-ku, Kobe, Japan
| | - Hajime Sano
- Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine,
Nishinomiya, Hyogo, Japan
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Pimenta Amaral TM, Campos CC, Moreira dos Santos TP, Leles CR, Teixeira AL, Teixeira MM, Bittencourt H, Silva TA. Effect of salivary stimulation therapies on salivary flow and chemotherapy-induced mucositis: a preliminary study. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:628-37. [PMID: 22668621 DOI: 10.1016/j.oooo.2011.10.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 10/06/2011] [Accepted: 10/15/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the effect of salivary stimulation therapies on the salivary flow, oral mucositis, and salivary cytokine levels in patients receiving allogeneic hematopoietic stem cell transplantation. STUDY DESIGN Thirty-five eligible patients were randomized into 4 groups: control, mechanical sialogogue, transcutaneous electrical nerve stimulation (TENS) sialogogue, and combined mechanical/electrical sialogogue. Saliva was collected from patients before transplantation and at days 3, 7, and 14 after transplantation. The volume was measured and salivary cytokines were assessed using enzyme-linked immunosorbent assay. RESULTS By day 14, resting and stimulated salivary flow levels were diminished. Resting salivary flow rates decreased the most in the control and mechanical groups. In contrast, TENS alone or in combination with mechanical stimulatory therapy benefited the patients. TENS-treated patients showed increase in resting salivary flow. Also, the groups treated with TENS had fewer patients affected by grades 3 and 4 mucositis, and less mucositis was associated with better patient survival (P = .027). CONCLUSIONS TENS-associated salivary stimulation therapies minimized the reduction of salivary flow and prevented severe chemotherapy-induced oral mucositis.
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Affiliation(s)
- Tânia Mara Pimenta Amaral
- Department of Oral Pathology, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Singh V, Bhat GS, Bhat KM. A rare case of unusual gingival enlargement post radiotherapy. J Indian Soc Periodontol 2011; 15:280-3. [PMID: 22028519 PMCID: PMC3200028 DOI: 10.4103/0972-124x.85676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 05/08/2011] [Indexed: 11/04/2022] Open
Abstract
Oral changes following radiotherapy are not uncommon. Oral mucositis, alteration in salivary gland function, radiation caries, and gingival changes have all been reported following radiotherapy and chemotherapy. The gingival changes seen after radiotherapy may be unusual and often cause diagnostic dilemma. Metastasis to the gingiva has also to be ruled out in these cases. A 30-year-old female patient presented with enlargement of the gingiva of 6 months' duration and lower lip swelling of 7 months' duration. She was a known case of carcinoma of nasopharynx and had received radiotherapy and chemotherapy. Based on the history, the clinical appearance of the gingiva, and the other oral changes we considered both post-radiotherapy gingival enlargement and secondary metastasis to gingiva as possibilities. An incisional biopsy was performed (internal bevel gingivectomy). The histopathological report did not reveal any metastatic changes. Thus, we diagnosed post-radiotherapy gingival enlargement. For the multiple carious teeth, extraction and root canal treatment was carried out as necessary. The patient was referred to the department of Oral and Maxillofacial Surgery for management of swelling of the lips, which was diagnosed as lymphedema of the lip. Gingival enlargement is rare post radiotherapy. Such nonplaque-associated gingival enlargement in a patient who has undergone radiotherapy should be subjected to biopsy and histopathological examination to distinguish between secondary metastasis and post-radiation changes.
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Affiliation(s)
- Vishal Singh
- Department of Periodontics, Manipal College of Dental Sciences, Manipal, Karnataka, India
| | - G. Subraya Bhat
- Department of Periodontics, Manipal College of Dental Sciences, Manipal, Karnataka, India
| | - K. Mahalinga Bhat
- Department of Periodontics, Manipal College of Dental Sciences, Manipal, Karnataka, India
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Schapher M, Wendler O, Gröschl M. Salivary cytokines in cell proliferation and cancer. Clin Chim Acta 2011; 412:1740-8. [PMID: 21736875 DOI: 10.1016/j.cca.2011.06.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 06/19/2011] [Accepted: 06/21/2011] [Indexed: 01/08/2023]
Abstract
While the presence of multiple systemic steroids, amines and peptides in saliva has been reported, other hormones of the circulation do not appear in saliva. Substances present within saliva may be classified in different groups: first, those which passively display blood plasma concentrations and constitute a promising alternative to evaluate certain systemic parameters. Second, molecules which seem to play a more active, regulatory role within the upper gastrointestinal tract. Concerning the latter, a growing awareness, especially with regards to salivary peptides has been established. Up to now, understanding the distinct effects of salivary peptides known so far is in its infancy. Various publications, however, emphasize important effects of their presence. Salivary peptides can influence inflammatory processes and cell proliferation in epithelia of the upper digestive tract. These include transforming growth factors (TGFs), epidermal growth factors (EGFs), vascular endothelial growth factors (VEGFs) as well as amines such as melatonin. Of those, candidate cytokines like interleukin 8, tumor necrosis factors (TNFs) and leptin are involved in neoplastic activities of salivary glands and the oral cavity. The exact mechanisms of action are not yet completely understood, but their presence can be utilized for diagnostic purposes. Salivary gland tumors in patients may, in certain circumstances, be identified by saliva diagnostics. Saliva samples of the concerned patients, for instance, reveal significantly higher leptin concentrations than those of healthy individuals. Numerous studies postulate that, beside single indicators, the establishment of salivary hormone profiles may assist clinicians and researchers in detecting tumors and other pathologies of the oral cavity, including adjacent tissues, with high sensitivity and specificity.
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Affiliation(s)
- Mirco Schapher
- University of Erlangen-Nuremberg, Department of Otorhinolaryngology, Head and Neck Surgery, Germany.
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Murdoch-Kinch CA, Russo N, Griffith S, Braun T, Eisbruch A, D'Silva NJ. Recovery of salivary epidermal growth factor in parotid saliva following parotid sparing radiation therapy: a proof-of-principle study. ACTA ACUST UNITED AC 2011; 111:64-70. [PMID: 21176822 DOI: 10.1016/j.tripleo.2010.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 08/28/2010] [Accepted: 09/02/2010] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although radiation therapy (RT) causes permanent xerostomia, parotid-sparing radiation therapy (PSRT) ensures recovery of saliva quantity over time. Salivary epidermal growth factor (EGF) is produced primarily by parotid glands. OBJECTIVES The aim of this study was to determine whether salivary EGF can be detected in parotid saliva after PSRT and whether protein secretion is time dependent. STUDY DESIGN Salivary EGF concentration (pg/mL) was determined by enzyme-linked immunosorbent assay in stimulated parotid saliva before RT and at 3, 6, and 12 months after RT from 22 patients with head and neck cancer treated with PSRT. RESULTS Saliva samples were from 17 men and 5 women (age ranges 23-70 years and 46-71 years, respectively). At 6 months after RT, EGF concentration was 407 pg/mL lower than at baseline (P = .045). Twelve months after PSRT, parotid glands produce substantial amounts of EGF and other proteins, eventually approximating pre-RT levels, with recovery of salivary function. CONCLUSIONS This proof-of-principle study shows that even proteins in picogram quantities, such as EGF, can be detected in saliva after PSRT.
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Affiliation(s)
- Carol Anne Murdoch-Kinch
- Department of Oral and Maxillofacial Surgery/Hospital Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI 48109, USA
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Oh H, Seong J, Kim W, Park S, Koom WS, Cho NH, Song M. Recombinant human epidermal growth factor (rhEGF) protects radiation-induced intestine injury in murine system. JOURNAL OF RADIATION RESEARCH 2010; 51:535-541. [PMID: 20657160 DOI: 10.1269/jrr.09145] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This study was to investigate whether rhEGF protects radiation induced intestine injury without compromising antitumor effect of radiation in murine system. A radiation induced intestinal injury model was established in mice by whole body irradiation. Using this model, 4 groups were set; control, rhEGF (100 µg/kg intraperitoneally), radiation (10 Gy), and a combination (rhEGF and radiation). The level of apoptosis and proliferation were analyzed by TUNEL assay and proliferation cell nuclear antigen (PCNA) immunohistochemical staining, respectively, as well as observation of survival and body weight change. A tumor growth delay assay was performed using murine syngeneic tumors; one radioresistant tumor, HCa-I and one radiosensitive tumor, MCa-K. In the radiation induced intestinal injury model, the 10 Gy group had significantly more weight loss with less number of crypt cells and higher apoptosis than the 8 Gy group. Using 10 Gy model, radioprotective effect of rhEGF was tested. Addition of rhEGF improved not only the body weight loss but also survival following radiation. It also induced suppression of apoptosis as well as increase of PCNA expression and recovery of villi. rhEGF did not enhance the tumor growth after radiation exposure in the tested tumors. These findings suggest that combination of exogenous rhEGF and radiation can be a new anticancer strategy by protecting radiation-induced intestinal injury without alleviating antitumor effect of radiation.
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Affiliation(s)
- Haejin Oh
- Department of Radiation Oncology, Brain Korea 21 Project for Medical Science, Yonsei University Health System, Seoul, Korea
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Fischer DJ, Epstein JB. Management of patients who have undergone head and neck cancer therapy. Dent Clin North Am 2008; 52:39-60, viii. [PMID: 18154864 DOI: 10.1016/j.cden.2007.09.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Patients who undergo treatment for head and neck cancers often suffer from acute or late reactions to therapy. Severity of these oral complications may be based on the location and extent of tumor, as well as the type and extent of treatment. Some complications are transient, whereas others require a lifetime of management secondary to damage that results in permanent dysfunction. Patients who have a history of head and neck cancers are also at an increased risk for recurrences or second malignancies, and therefore require close follow-up. Dental professionals should provide preventive and supportive care, including education and symptom management, for patients experiencing oral complications related to cancer therapy, and should closely monitor patients' level of distress, ability to cope, and treatment response.
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Affiliation(s)
- Dena J Fischer
- Department of Oral Medicine and Diagnostic Sciences, University of Illinois at Chicago College of Dentistry, 801 South Paulina Street, MC 838, Chicago, IL 60612-7213, USA.
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Lee SW, Jung KI, Kim YW, Jung HD, Kim HS, Hong JP. Effect of epidermal growth factor against radiotherapy-induced oral mucositis in rats. Int J Radiat Oncol Biol Phys 2007; 67:1172-8. [PMID: 17336218 DOI: 10.1016/j.ijrobp.2006.10.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2006] [Revised: 08/04/2006] [Accepted: 10/26/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE We tested the efficacy of oral recombinant human epidermal growth factor (rhEGF) against radiation-induced oral mucositis in a rat model. METHODS AND MATERIALS Each of 35 Sprague-Dawley rats, 7 to 8 weeks of age and weighing 178 +/- 5 grams, was irradiated once in the head region with 25 Gy, using a 4-MV therapeutic linear accelerator at a rate of 2 Gy/min. The irradiated rats were randomly divided into four groups: those receiving no treatment (Group 1), those treated with vehicle only three times per day (Group 2), and those treated with 50 microg/mL (Group 3), or 100 microg/mL (Group 4) rhEGF three times per day. RESULTS Rats were monitored for survival rate and daily activity, including hair loss, sensitivity, and anorexia. We found that survival rate and oral intake were significantly increased and histologic changes were significantly decreased in the rhEGF-treated rats. There was no difference, however, between rats treated with 50 microg/mL or 100 microg/mL rhEGF. CONCLUSION These findings suggest that orally administered rhEGF decreased radiation-induced oral mucositis in rats.
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Affiliation(s)
- Sang-Wook Lee
- Department of Radiation Oncology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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von Bültzingslöwen I, Brennan MT, Spijkervet FKL, Logan R, Stringer A, Raber-Durlacher JE, Keefe D. Growth factors and cytokines in the prevention and treatment of oral and gastrointestinal mucositis. Support Care Cancer 2006; 14:519-27. [PMID: 16775647 DOI: 10.1007/s00520-006-0052-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2006] [Accepted: 02/21/2006] [Indexed: 10/24/2022]
Abstract
GOALS OF WORK Growth factors and cytokines may be useful in preventing chemotherapy (CT)- and radiotherapy (RT)-induced oral and gastrointestinal mucositis. Two systematic reviews of the medical literature on growth factors and cytokines for the amelioration of CT- and RT-induced mucositis throughout the alimentary tract were performed by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology. The aim of these evidence-based scientific reviews was to critically evaluate the literature and create evidence-based guidelines for the use of growth factors and cytokines in the prevention or treatment of CT- and RT-induced mucositis. METHOD The two reviews covered articles on clinical trials from January 1966 through May 2002 and preclinical studies from June 2002 through May 2005, respectively. The systematic review process was based on a well-established method for evaluating scientific literature. MAIN RESULTS The number of articles in the first review was 29. In the second review, 23 articles were evaluated, 14 preclinical and 9 clinical studies. It was concluded from the first review that there was no sufficient evidence to provide any recommendations for clinical practice guidelines regarding growth factors and cytokines. From the second review, a guideline could be presented recommending the use of recombinant human keratinocyte growth factor-1 (palifermin) to prevent oral mucositis in patients receiving high-dose CT and total body irradiation followed by stem cell transplantation for haematological malignancies. A guideline could also be provided suggesting that granulocyte macrophage colony-stimulating factor mouthwash not be used for the prevention of oral mucositis in the transplant setting with high-dose CT and autologous or allogeneic stem cell transplantation. CONCLUSIONS These systematic reviews have provided clarity and shown exciting new results. Further studies will provide new options for this debilitating side-effect of cancer therapy.
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Affiliation(s)
- Inger von Bültzingslöwen
- Department of Oral Medicine, Sahlgrenska Academy, Göteborg University, P.O. Box 450, 405 30, Göteborg, Sweden.
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Balicki R, Grabowska SZ, Citko A. Salivary epidermal growth factor in oral cavity cancer. Oral Oncol 2005; 41:48-55. [PMID: 15598585 DOI: 10.1016/j.oraloncology.2004.06.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2004] [Accepted: 06/03/2004] [Indexed: 10/26/2022]
Abstract
Salivary epidermal growth factor (EGF) effect on oral cancer biology is unknown. We examined changes in minute volumes of whole resting and stimulated saliva, EGF concentration and its output (ELISA) in whole resting and stimulated saliva before and 2 weeks after surgical treatment in oral carcinoma patients compared to the control group. After stimulation salivary flow increased both in the control (P=0.003) and in the patients group--before (P=0.007) and after surgery (P=0.005). Higher stimulated saliva volume levels were observed before surgery than in post-treatment patients (P=0.032). A trend was seen with increasing EGF salivary concentrations after tumour excision both in resting (P=0.508) and stimulated (P=0.647) saliva. A similar ascending tendency of EGF output in stimulated saliva of post-treatment patients was observed (P=0.878). Decreased levels of EGF concentration in saliva before and its contrary tendency after surgical treatment may suggest an important role of EGF in oral cancer tumourogenesis.
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Affiliation(s)
- R Balicki
- Department of Maxillofacial Surgery, Medical University of Bialystok, M.C. Sklodowskiej 24a, 15-276 Bialystok, Poland.
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Jahovic N, Güzel E, Arbak S, Yeğen BC. The healing-promoting effect of saliva on skin burn is mediated by epidermal growth factor (EGF): role of the neutrophils. Burns 2004; 30:531-8. [PMID: 15302417 DOI: 10.1016/j.burns.2004.02.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2004] [Indexed: 10/26/2022]
Abstract
Local skin trauma induces inflammatory responses resulting in local tissue and distant organ injury. EGF, a polypeptide hormone, mainly produced in saliva, is one of the major accelerators in wound healing. Wistar albino rats of both sexes received either bovine serum albumin or EGF (10 microg/kg) subcutaneously before a circular (18 mm diameter) partial thickness burn was induced. Afterwards, some rats were placed in separate cages to prevent licking, while the others were caged together to allow wound-licking. Treatments were continued for 5 more days and on the 5th day animals were decapitated. Histopathological analysis of skin damage and dermal myeloperoxidase (MPO) activity, as an index for neutrophil activity, were evaluated. Oxidant injury to the liver and intestines was determined by measuring glutathione (GSH) and malondialdehyde (MDA) levels, as well as MPO activity. The results demonstrate that healing of the burn wound on the skin is accelerated by both wound-licking and EGF administration, which also attenuated tissue neutrophil accumulation, suggesting the role of neutrophils as the source of mediators involved in delayed epithelial regeneration. Moreover, local dermal burn results in oxidant injury to the liver, concomitant with significant elevations in hepatic and intestinal GSH levels. Exogenous administration of EGF at physiological doses had no effect on inflammatory responses of the distant organs, while allowing the rats to lick the wound reduced the oxidant injury to the liver. Since saliva or EGF enhances skin wound healing, topical use of EGF-rich artificial saliva merits consideration for its use in burn patients.
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Affiliation(s)
- Nermina Jahovic
- Department of Physiology, Marmara University School of Medicine, Istanbul 34668, Turkey
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Abstract
Chemotherapy and radiotherapy, whilst highly effective in the treatment of neoplasia, can also cause damage to healthy tissue. In particular, the alimentary tract may be badly affected. Severe inflammation, lesioning and ulceration can occur. Patients may experience intense pain, nausea and gastro-enteritis. They are also highly susceptible to infection. The disorder (mucositis) is a dose-limiting toxicity of therapy and affects around 500 000 patients world-wide annually. Oral and intestinal mucositis is multi-factorial in nature. The disruption or loss of rapidly dividing epithelial progenitor cells is a trigger for the onset of the disorder. However, the actual dysfunction that manifests and its severity and duration are greatly influenced by changes in other cell populations, immune responses and the effects of oral/gut flora. This complexity has hampered the development of effective palliative or preventative measures. Recent studies have concentrated on the use of bioactive/growth factors, hormones or interleukins to modify epithelial metabolism and reduce the susceptibility of the tract to mucositis. Some of these treatments appear to have considerable potential and are at present under clinical evaluation. This overview deals with the cellular changes and host responses that may lead to the development of mucositis of the oral cavity and gastrointestinal tract, and the potential of existing and novel palliative measures to limit or prevent the disorder. Presently available treatments do not prevent mucositis, but can limit its severity if used in combination. Poor oral health and existing epithelial damage predispose patients to mucositis. The elimination of dental problems or the minimization of existing damage to the alimentary tract, prior to the commencement of therapy, lowers their susceptibility. Measures that reduce the flora of the tract, before therapy, can also be helpful. Increased production of free radicals and the induction of inflammation are early events in the onset of mucositis. Prophylactic administration of scavengers or anti-inflammatories can partially counteract or limit some of these therapy-mediated effects, as can the use of cryotherapy. The regular use of mouthwashes, mouth coatings, antibiotics and analgesics is essential, prior to and during loss and ablation of the epithelial layer. Granulocyte-macrophage colony-stimulating factor/granulocyte colony-stimulating factor or the use of laser light therapy may aid restitution and repair. Glutamine supplements may be beneficial in the repair/recovery phase.
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Affiliation(s)
- M Duncan
- Rowett Research Institute, Bucksburn, Aberdeen, UK
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Eckley CA, Costa HO. Estudo da concentração salivar do fator de crescimento epidérmico em indivíduos com laringite crônica por refluxo laringofaríngeo. ACTA ACUST UNITED AC 2003. [DOI: 10.1590/s0034-72992003000500002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
INTRODUÇÃO: A Doença do Refluxo Gastroesofágico (DRGE), chegando até a faringe e laringe, pode cursar com intensa inflamação local e rica sintomatologia (Refluxo Laringofaríngeo RLF). Os estudos atuais não foram capazes de provar que o ácido refluído é o causador das alterações visualizadas na laringite crônica. O Fator de Crescimento Epidérmico (EGF) é um polipeptídeo produzido pelas glândulas salivares, sendo implicado na indução do crescimento epitelial, na inibição da secreção gástrica e na aceleração da cicatrização. Deficiência salivar deste fator foi encontrada na esofagite de refluxo, mas não há relatos sobre a concentração salivar de EGF em indivíduos com RLF. OBJETIVO: Determinar a concentração salivar do EGF em indivíduos com RLF. FORMA DE ESTUDO: Caso controle. CASUÍSTICA E MÉTODO: A concentração salivar de EGF de 39 indivíduos com RLF e 20 controles normais foi estudada pela técnica de ELISA. O RLF foi diagnosticado por história e exame videolaringoscópico característicos. Os 39 pacientes com RLF foram estratificados de acordo com os achados de endoscopia digestiva (com ou sem esofagite associada) e de acordo com a intensidade da laringite crônica. Foram, também, submetidos a manometria esofágica e pH-metria esofágica de 24 horas com dois canais. RESULTADOS: Constatou-se uma concentração de EGF significativamente menor nos indivíduos com RLF quando comparados aos controles normais (p=0,002). Não houve diferença estatisticamente significante na concentração salivar de EGF entre os indivíduos com RLF, nem em relação à presença de esofagite, nem quanto à intensidade da laringite. CONCLUSÕES: Este estudo sugere que uma deficiência na concentração salivar do Fator de Crescimento Epidérmico pode estar associada à patogenia da DRGE, e que este polipeptídeo poderia ser um co-fator na gênese do RLF.
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Kaufman E, Lamster IB. The diagnostic applications of saliva--a review. CRITICAL REVIEWS IN ORAL BIOLOGY AND MEDICINE : AN OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION OF ORAL BIOLOGISTS 2003; 13:197-212. [PMID: 12097361 DOI: 10.1177/154411130201300209] [Citation(s) in RCA: 536] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This review examines the diagnostic application of saliva for systemic diseases. As a diagnostic fluid, saliva offers distinctive advantages over serum because it can be collected non-invasively by individuals with modest training. Furthermore, saliva may provide a cost-effective approach for the screening of large populations. Gland-specific saliva can be used for diagnosis of pathology specific to one of the major salivary glands. Whole saliva, however, is most frequently used for diagnosis of systemic diseases, since it is readily collected and contains serum constituents. These constituents are derived from the local vasculature of the salivary glands and also reach the oral cavity via the flow of gingival fluid. Analysis of saliva may be useful for the diagnosis of hereditary disorders, autoimmune diseases, malignant and infectious diseases, and endocrine disorders, as well as in the assessment of therapeutic levels of drugs and the monitoring of illicit drug use.
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Affiliation(s)
- Eliaz Kaufman
- Division of Periodontics, Columbia University, School of Dental and Oral Surgery, 630 West 168th Street, PH-7E, Room 110, New York, NY 10032, USA.
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Vissink A, Jansma J, Spijkervet FKL, Burlage FR, Coppes RP. Oral sequelae of head and neck radiotherapy. CRITICAL REVIEWS IN ORAL BIOLOGY AND MEDICINE : AN OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION OF ORAL BIOLOGISTS 2003; 14:199-212. [PMID: 12799323 DOI: 10.1177/154411130301400305] [Citation(s) in RCA: 559] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In addition to anti-tumor effects, ionizing radiation causes damage in normal tissues located in the radiation portals. Oral complications of radiotherapy in the head and neck region are the result of the deleterious effects of radiation on, e.g., salivary glands, oral mucosa, bone, dentition, masticatory musculature, and temporomandibular joints. The clinical consequences of radiotherapy include mucositis, hyposalivation, taste loss, osteoradionecrosis, radiation caries, and trismus. Mucositis and taste loss are reversible consequences that usually subside early post-irradiation, while hyposalivation is normally irreversible. Furthermore, the risk of developing radiation caries and osteoradionecrosis is a life-long threat. All these consequences form a heavy burden for the patients and have a tremendous impact on their quality of life during and after radiotherapy. In this review, the radiation-induced changes in healthy oral tissues and the resulting clinical consequences are discussed.
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Affiliation(s)
- A Vissink
- Department of Oral and Maxillofacial Surgery, University Hospital, PO Box 30.001, 9700 RB Groningen, The Netherlands.
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Abstract
This review illustrates, through a series of case histories, how oral medicine insights aid the diagnosis and management of patients with excessive tooth wear. The cases reviewed are drawn from the records of 500 southeast Queensland patients referred to the author over a 12 year period. Patients most at risk of dental erosion have work and sports dehydration, caffeine addiction, gastro-oesophageal reflux, asthma, diabetes mellitus, hypertension or other systemic diseases or syndromes that predispose to xerostomia. Saliva protects the teeth from the extrinsic and intrinsic acids which cause dental erosion. Erosion, exacerbated by attrition and abrasion, is the main cause of tooth wear. These cases illustrate that teeth, oral mucosa, salivary glands, skin and eyes should be examined for evidence of salivary hypofunction and attendant medical conditions. Based on comprehensive oral medicine, dietary analyses and advice, it would seem patients need self-management plans to deal with incipient chronic tooth wear. The alternative is the expensive treatment of pain, occlusal damage and pulp death required to repair the effects of acute severe tooth wear.
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Affiliation(s)
- W G Young
- School of Dentistry, The University of Queensland, St Lucia
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