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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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Meirovitz A, Gross M, Cohen S, Popovtzer A, Barak V. Effect of irradiation on cytokine production in cancer patients. Int J Biol Markers 2022; 37:360-367. [PMID: 35929109 DOI: 10.1177/03936155221116388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Irradiation, which affects cytokine secretion, is used to treat cancer patients. Cytokine levels have correlations to disease parameters, serving as biomarkers for patients. We aim to explore the effect of irradiation on cytokine production both in vitro (using lymphocytes from healthy donors) and in vivo (using serum levels of head and neck cancer patients following irradiation) and correlating them to mucositis severity/need for percutaneous endoscopic gastroscopy (PEG) tube installation. METHODS Cytokine production by cultured lymphocytes from healthy donors, in vitro, following irradiation of 5 or 10 Gy. In addition, blood from 23 patients with head and neck cancers, irradiated by 60-72G in vivo, were assessed for inflammatory cytokines (tumor necrosis factor (TNF)α, interleukin (IL)-6, IL-8, IL-18), the anti-inflammatory cytokine IL-10, and the general marker sIL-2R. Following radiation, selected patients who were developing mucositis were treated by PEG tube installation. Changes in cytokine levels were studied as predictive biomarkers of response to therapy/PEG tube installation. Cytokine production levels were measured using ELISAs kits. RESULTS Irradiation decreased the levels of all tested cytokines, most notably IL-6 and IL-8, proportional to irradiation dose. In patients, increases in cytokine levels, correlated with mucositis severity and potentially the need for PEG tube installation. CONCLUSIONS Irradiation decreased the levels of all cytokines of healthy lymphocytes in a dose-dependent manner, especially those of IL-6 and IL-8. This study shows a correlation between high and increasing levels of inflammatory cytokines, sIL-2R, plus radiation toxicity and the need for PEG. The reduction of cytokine levels after radiotherapy predicts that PEG will not be required. Thus, our study shows that cytokine changes are predictive biomarkers in head and neck cancer patients.
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Affiliation(s)
- Amichay Meirovitz
- Oncology and Head and Neck Departments, 58884Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Menachem Gross
- Oncology and Head and Neck Departments, 58884Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shani Cohen
- Oncology and Head and Neck Departments, 58884Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aron Popovtzer
- Oncology and Head and Neck Departments, 58884Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Vivian Barak
- Oncology and Head and Neck Departments, 58884Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Paldor M, Levkovitch-Siany O, Eidelshtein D, Adar R, Enk CD, Marmary Y, Elgavish S, Nevo Y, Benyamini H, Plaschkes I, Klein S, Mali A, Rose-John S, Peled A, Galun E, Axelrod JH. Single-cell transcriptomics reveals a senescence-associated IL-6/CCR6 axis driving radiodermatitis. EMBO Mol Med 2022; 14:e15653. [PMID: 35785521 PMCID: PMC9358397 DOI: 10.15252/emmm.202115653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 12/22/2022] Open
Abstract
Irradiation‐induced alopecia and dermatitis (IRIAD) are two of the most visually recognized complications of radiotherapy, of which the molecular and cellular basis remains largely unclear. By combining scRNA‐seq analysis of whole skin‐derived irradiated cells with genetic ablation and molecular inhibition studies, we show that senescence‐associated IL‐6 and IL‐1 signaling, together with IL‐17 upregulation and CCR6+‐mediated immune cell migration, are crucial drivers of IRIAD. Bioinformatics analysis colocalized irradiation‐induced IL‐6 signaling with senescence pathway upregulation largely within epidermal hair follicles, basal keratinocytes, and dermal fibroblasts. Loss of cytokine signaling by genetic ablation in IL‐6−/− or IL‐1R−/− mice, or by molecular blockade, strongly ameliorated IRIAD, as did deficiency of CCL20/CCR6‐mediated immune cell migration in CCR6−/− mice. Moreover, IL‐6 deficiency strongly reduced IL‐17, IL‐22, CCL20, and CCR6 upregulation, whereas CCR6 deficiency reciprocally diminished IL‐6, IL‐17, CCL3, and MHC upregulation, suggesting that proximity‐dependent cellular cross talk promotes IRIAD. Therapeutically, topical application of Janus kinase blockers or inhibition of T‐cell activation by cyclosporine effectively reduced IRIAD, suggesting the potential of targeted approaches for the treatment of dermal side effects in radiotherapy patients.
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Affiliation(s)
- Mor Paldor
- The Goldyne-Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Orr Levkovitch-Siany
- The Goldyne-Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Dana Eidelshtein
- The Goldyne-Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Revital Adar
- The Goldyne-Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Claes D Enk
- Department of Dermatology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Yitzhak Marmary
- The Goldyne-Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Sharona Elgavish
- Info-CORE, Bioinformatics Unit of the I-CORE, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yuval Nevo
- Info-CORE, Bioinformatics Unit of the I-CORE, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hadar Benyamini
- Info-CORE, Bioinformatics Unit of the I-CORE, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Inbar Plaschkes
- Info-CORE, Bioinformatics Unit of the I-CORE, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shiri Klein
- The Goldyne-Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Alex Mali
- Department of Pathology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Stefan Rose-John
- Institut für Biochemie, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Amnon Peled
- The Goldyne-Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Eithan Galun
- The Goldyne-Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Jonathan H Axelrod
- The Goldyne-Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
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Moreira LB, Silva CBD, Geraldo-Martins VR, Frade FMF, Santiago Beraldo M, Nogueira RD. Presence of Streptococcus mutans and interleukin-6 and -10 in amniotic fluid. J Matern Fetal Neonatal Med 2022; 35:9463-9469. [PMID: 35176954 DOI: 10.1080/14767058.2022.2042245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM To evaluate the presence of Streptococcus mutans (SM), main pathogen of dental caries, interleukin-6 and -10 in samples of amniotic fluid (AF) and clinical and oral data of the healthy pregnancy, to investigate the SM exposition in intrauterine life and to elucidate the presence of antibodies to SM in newborns' saliva (SA) with undetectable levels of this microorganism described in the previous study. METHODS The study involved the participation of 26 women with term deliveries and without gestational complications. General health data were collected through a questionnaire applied to the participants. The volunteers were examined orally, the caries experience (decayed, missing, and filled teeth (DMFT) scores) was calculated and unstimulated SA was collected. The acquisition of AF was performed during cesarean sections and stocked on ice. The analysis of the presence of SM-DNA was performed by real-time PCR assays with specific primers. Levels of IL-6 and IL-10 were performed by ELISA with specific kits for these interleukins in the AF samples. RESULTS 69.2% of the AF samples had detectable SM, and 65% of the women had the bacteria in the AF and SA at the same time. There was a positive association between the presence of SM in AF and a report of not going to the dentist frequently (p<.05). There was no statistically significant difference between the frequency of AF with or without detection of MS and active caries (p>.05). However, the DMFT scores of women with positive AF for SM were higher than that of women without detectable MS (p<.05). IL-6 levels were higher than IL-10 in AF (p<.05). There were no significant differences in the levels of interleukins between samples with detectable SM or in AF and even with clinical data analysis (p>.05). CONCLUSIONS The AF samples have SM in quantifiable levels, probably associated with the greatest caries experience, and seen by the highest DMFT index. Interleukin levels were not related to the presence of MS. The presence of SM in AF may explain the mucosal immune stimulation of newborn children by the previous detection of salivary antibodies against SM.
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Arifa RDN, Brito CB, de Paula TP, Lima RL, Menezes‐Garcia Z, Cassini‐Vieira P, Vilas Boas FA, Queiroz‐Junior CM, da Silva JM, da Silva TA, Barcelos LS, Fagundes CT, Teixeira MM, Souza DG. Eosinophil plays a crucial role in intestinal mucositis induced by antineoplastic chemotherapy. Immunology 2021; 165:355-368. [DOI: 10.1111/imm.13442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 12/01/2021] [Accepted: 12/15/2021] [Indexed: 12/01/2022] Open
Affiliation(s)
- Raquel D N Arifa
- Laboratory of Microorganism‐Host Interaction Department of Microbiology
| | - Camila B Brito
- Laboratory of Microorganism‐Host Interaction Department of Microbiology
| | - Talles P de Paula
- Laboratory of Microorganism‐Host Interaction Department of Microbiology
| | - Renata L Lima
- Laboratory of Microorganism‐Host Interaction Department of Microbiology
| | | | | | | | - Celso M Queiroz‐Junior
- Department of Oral Pathology and Surgery Faculty of Dentistry Universidade Federal de Minas Gerais Belo Horizonte, Minas Gerais Brazil
| | - Janine M da Silva
- Department of Oral Pathology and Surgery Faculty of Dentistry Universidade Federal de Minas Gerais Belo Horizonte, Minas Gerais Brazil
| | - Tarcília A da Silva
- Department of Oral Pathology and Surgery Faculty of Dentistry Universidade Federal de Minas Gerais Belo Horizonte, Minas Gerais Brazil
| | | | - Caio T. Fagundes
- Laboratory of Microorganism‐Host Interaction Department of Microbiology
- Center for Drug Research and Development of Pharmaceuticals
| | - Mauro M Teixeira
- Center for Drug Research and Development of Pharmaceuticals
- Department of Biochemistry and Immunology Institute of Biological Sciences
| | - Daniele G. Souza
- Laboratory of Microorganism‐Host Interaction Department of Microbiology
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6
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Rühle A, Wiedenmann N, Fennell JT, Mix M, Ruf J, Stoian R, Thomsen AR, Vaupel P, Baltas D, Grosu AL, Nicolay NH. Interleukin-6 as surrogate marker for imaging-based hypoxia dynamics in patients with head-and-neck cancers undergoing definitive chemoradiation-results from a prospective pilot trial. Eur J Nucl Med Mol Imaging 2021; 49:1650-1660. [PMID: 34773163 PMCID: PMC8940848 DOI: 10.1007/s00259-021-05602-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022]
Abstract
Purpose Intratumoral hypoxia increases resistance of head-and-neck squamous cell carcinoma (HNSCC) to radiotherapy. [18F]FMISO PET imaging enables noninvasive hypoxia monitoring, though requiring complex logistical efforts. We investigated the role of plasma interleukin-6 (IL-6) as potential surrogate parameter for intratumoral hypoxia in HNSCC using [18F]FMISO PET/CT as reference. Methods Within a prospective trial, serial blood samples of 27 HNSCC patients undergoing definitive chemoradiation were collected to analyze plasma IL-6 levels. Intratumoral hypoxia was assessed in treatment weeks 0, 2, and 5 using [18F]FMISO PET/CT imaging. The association between PET-based hypoxia and IL-6 was examined using Pearson’s correlation and multiple regression analyses, and the diagnostic power of IL-6 for tumor hypoxia response prediction was determined with receiver-operating characteristic analyses. Results Mean IL-6 concentrations were 15.1, 19.6, and 31.0 pg/mL at baseline, week 2 and week 5, respectively. Smoking (p=0.050) and reduced performance status (p=0.011) resulted in higher IL-6 levels, whereas tumor (p=0.427) and nodal stages (p=0.334), tumor localization (p=0.439), and HPV status (p=0.294) had no influence. IL-6 levels strongly correlated with the intratumoral hypoxic subvolume during treatment (baseline: r=0.775, p<0.001; week 2: r=0.553, p=0.007; week 5: r=0.734, p<0.001). IL-6 levels in week 2 were higher in patients with absent early tumor hypoxia response (p=0.016) and predicted early hypoxia response (AUC=0.822, p=0.031). Increased IL-6 levels at week 5 resulted in a trend towards reduced progression-free survival (p=0.078) and overall survival (p=0.013). Conclusion Plasma IL-6 is a promising surrogate marker for tumor hypoxia dynamics in HNSCC patients and may facilitate hypoxia-directed personalized radiotherapy concepts. Trial registration The prospective trial was registered in the German Clinical Trial Register (DRKS00003830). Registered 20 August 2015 Supplementary Information The online version contains supplementary material available at 10.1007/s00259-021-05602-x.
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Affiliation(s)
- Alexander Rühle
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nicole Wiedenmann
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jamina T Fennell
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Mix
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Juri Ruf
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Raluca Stoian
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andreas R Thomsen
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Peter Vaupel
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dimos Baltas
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anca-L Grosu
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nils H Nicolay
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany. .,German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Pinto CM, Horta LS, Soares AP, Carvalho BA, Ferreira E, Lages EB, Ferreira LAM, Faraco AAG, Santiago HC, Goulart GAC. Nanoencapsulated Doxorubicin Prevents Mucositis Development in Mice. Pharmaceutics 2021; 13:1021. [PMID: 34371713 PMCID: PMC8329927 DOI: 10.3390/pharmaceutics13071021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 12/26/2022] Open
Abstract
Doxorubicin (DOX), a chemotherapy drug successfully used in the therapy of various types of cancer, is currently associated with the mucositis development, an inflammation that can cause ulcerative lesions in the mucosa of the gastrointestinal tract, abdominal pain and secondary infections. To increase the safety of the chemotherapy, we loaded DOX into nanostructured lipid carriers (NLCs). The NLC-DOX was characterized by HPLC, DLS, NTA, Zeta potential, FTIR, DSC, TEM and cryogenic-TEM. The ability of NLC-DOX to control the DOX release was evaluated through in vitro release studies. Moreover, the effect of NLC-DOX on intestinal mucosa was compared to a free DOX solution in C57BL/6 mice. The NLC-DOX showed spherical shape, high drug encapsulation efficiency (84.8 ± 4.6%), high drug loading (55.2 ± 3.4 mg/g) and low average diameter (66.0-78.8 nm). The DSC and FTIR analyses showed high interaction between the NLC components, resulting in controlled drug release. Treatment with NLC-DOX attenuated DOX-induced mucositis in mice, improving shortening on villus height and crypt depth, decreased inflammatory parameters, preserved intestinal permeability and increased expression of tight junctions (ZO-1 and Ocludin). These results indicated that encapsulation of DOX in NLCs is viable and reduces the drug toxicity to mucosal structures.
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Affiliation(s)
- Cristiane M. Pinto
- Department of Pharmaceutics, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (C.M.P.); (A.P.S.); (E.B.L.); (L.A.M.F.); (A.A.G.F.)
| | - Laila S. Horta
- Department of Biochemistry and Immunology, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (L.S.H.); (H.C.S.)
| | - Amanda P. Soares
- Department of Pharmaceutics, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (C.M.P.); (A.P.S.); (E.B.L.); (L.A.M.F.); (A.A.G.F.)
- Department of Biochemistry and Immunology, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (L.S.H.); (H.C.S.)
| | - Bárbara A. Carvalho
- Department of General Pathology, Biological Science Institute, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (B.A.C.); (E.F.)
| | - Enio Ferreira
- Department of General Pathology, Biological Science Institute, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (B.A.C.); (E.F.)
| | - Eduardo B. Lages
- Department of Pharmaceutics, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (C.M.P.); (A.P.S.); (E.B.L.); (L.A.M.F.); (A.A.G.F.)
| | - Lucas A. M. Ferreira
- Department of Pharmaceutics, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (C.M.P.); (A.P.S.); (E.B.L.); (L.A.M.F.); (A.A.G.F.)
| | - André A. G. Faraco
- Department of Pharmaceutics, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (C.M.P.); (A.P.S.); (E.B.L.); (L.A.M.F.); (A.A.G.F.)
| | - Helton C. Santiago
- Department of Biochemistry and Immunology, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (L.S.H.); (H.C.S.)
| | - Gisele A. C. Goulart
- Department of Pharmaceutics, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil; (C.M.P.); (A.P.S.); (E.B.L.); (L.A.M.F.); (A.A.G.F.)
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Eom KY, Wee CW, Song C, Kim IA, Kim JS, Kim K, Suh DH, No JH, Kim YB, Park JS. The association between diarrhea and serum cytokines in patients with gynecologic cancer treated with surgery and pelvic chemoradiotherapy. Clin Transl Radiat Oncol 2021; 29:60-64. [PMID: 34159263 PMCID: PMC8203500 DOI: 10.1016/j.ctro.2021.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/10/2021] [Accepted: 05/30/2021] [Indexed: 12/02/2022] Open
Abstract
Gastrointestinal symptoms including diarrhea and constipation are common in patients with gynecologic cancer receiving pelvic chemoradiotherapy. There was an increase of serum IL-6 levels in patients with ≥grade 2 diarrhea during pelvic chemoradiotherapy. Serum IL-1β and TNFα levels did not change during pelvic chemoradiotherapy. Radiotherapy-related and clinical factors affect the development of chemoradiotherapy-induced diarrhea.
Purpose We investigated whether serum cytokines including Interleukin (IL)-1β, IL-6 and tumor necrosis factor alpha (TNFα) are increased during pelvic chemoradiotherapy (CRT) in patients with gynecologic malignancies, and sought to identify prognostic factors for the development of diarrhea during pelvic CRT. Materials and methods Patients with cervical or endometrial cancer receiving postoperative pelvic CRT were eligible for this prospective study. Patients were evaluated weekly during CRT for symptoms, including diarrhea and constipation. Serum cytokine levels were measured using immunoassays 1 week before CRT, and at week 3 and 5–6 during CRT. Radiotherapy-related parameters such as mean dose, minimum dose, and maximum dose to the small bowel were also analyzed. Multivariate logistic regression analysis was used to assess factors associated with development of enteritis symptoms. Results Twenty-six patients were enrolled, all of whom were eligible for symptom and dosimetric parameter evaluation; 24 were eligible for cytokine level measurement. Cytokine levels did not differ between patients with and without diarrhea before CRT. IL-6 levels increased during CRT, and were significantly higher in patients with diarrhea ≥grade 2 than in those with grade 0–1 at week 5–6 (6.771 ± 2.657 pg/mL vs. 3.396 ± 0.499 pg/mL, p = 0.046). Serum IL-1β and TNFα levels did not change during CRT. Diarrhea before CRT and the maximum dose to the small bowel were independent prognostic factors for CRT-induced diarrhea in the multivariate analysis. Conclusions There was an increase of serum IL-6 levels in patients with ≥grade 2 diarrhea during pelvic CRT. Serum IL-1β and TNFα levels did not change during CRT. Radiotherapy-related and clinical factors affect the development of diarrhea during pelvic CRT.
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Affiliation(s)
- Keun-Yong Eom
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Corresponding author at: Department of Radiation Oncology, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Republic of Korea.
| | - Chan Woo Wee
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Changhoon Song
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - In Ah Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae-Sung Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kidong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae Hong No
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yong Beom Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jeong Su Park
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Xia C, Jiang C, Li W, Wei J, Hong H, Li J, Feng L, Wei H, Xin H, Chen T. A Phase II Randomized Clinical Trial and Mechanistic Studies Using Improved Probiotics to Prevent Oral Mucositis Induced by Concurrent Radiotherapy and Chemotherapy in Nasopharyngeal Carcinoma. Front Immunol 2021; 12:618150. [PMID: 33841399 PMCID: PMC8024544 DOI: 10.3389/fimmu.2021.618150] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/10/2021] [Indexed: 12/11/2022] Open
Abstract
Earlier evidence has proven that probiotic supplements can reduce concurrent chemoradiotherapy (CCRT)-induced oral mucositis (OM) in nasopharyngeal cancer (NPC). The incidence of severe OM (grade 3 or higher) was the primary endpoint in this study. We first enrolled 85 patients with locally advanced NPC who were undergoing CCRT. Of them, 77 patients were finally selected and randomized (1:1) to receive either a probiotic cocktail or placebo. To investigate the protective effects and the mechanism of probiotic cocktail treatment on OM induced by radiotherapy and chemotherapy, we randomly divided the rats into the control (C) group, the model (M) group, and the probiotic (P) group. After treatment, samples from the tongue, blood, and fecal and proximal colon tissues on various days (7th, 14th, and 21st days) were collected and tested for the inflammatory response, cell apoptosis, intestinal permeability, and intestinal microbial changes. We found that patients taking the probiotic cocktail showed significantly lower OM. The values of the incidence of 0, 1, 2, 3, and 4 grades of OM in the placebo group and in the probiotic cocktail group were reported to be 0, 14.7, 38.2, 32.4, and 14.7% and 13.9, 36.1, 25, 22.2, and 2.8%, respectively. Furthermore, patients in the probiotic cocktail group showed a decrease in the reduction rate of CD3+ T cells (75.5% vs. 81%, p < 0.01), CD4+ T cells (64.53% vs. 79.53%, p < 0.01), and CD8+ T cells (75.59 vs. 62.36%, p < 0.01) compared to the placebo group. In the rat model, the probiotic cocktail could ameliorate the severity of OM, decrease the inflammatory response, cause cell apoptosis and intestinal permeability, and restore the structure of gut microbiota to normalcy. In conclusion, the modified probiotic cocktail significantly reduces the severity of OM by enhancing the immune response of patients with NPC and modifying the structure of gut microbiota. Clinical Trial Registration: The Clinical Trial Registration should be the NCT03112837.
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Affiliation(s)
- Chaofei Xia
- National Engineering Research Center for Bioengineering Drugs and Technologies, Institute of Translational Medicine, Nanchang University, Nanchang, China
| | - Chunling Jiang
- Department of Radiation Oncology, Jiangxi Cancer Hospital, Nanchang, China.,NHC Key Laboratory of Personalized Diagnosis and Treatment of Nasopharyngeal Carcinoma (Jiangxi Cancer Hospital of Nanchang University), Nanchang, China
| | - Wenyu Li
- National Engineering Research Center for Bioengineering Drugs and Technologies, Institute of Translational Medicine, Nanchang University, Nanchang, China
| | - Jing Wei
- National Engineering Research Center for Bioengineering Drugs and Technologies, Institute of Translational Medicine, Nanchang University, Nanchang, China
| | - Hu Hong
- National Engineering Research Center for Bioengineering Drugs and Technologies, Institute of Translational Medicine, Nanchang University, Nanchang, China
| | - Jingao Li
- Department of Radiation Oncology, Jiangxi Cancer Hospital, Nanchang, China.,NHC Key Laboratory of Personalized Diagnosis and Treatment of Nasopharyngeal Carcinoma (Jiangxi Cancer Hospital of Nanchang University), Nanchang, China
| | - Liu Feng
- Department of Radiation Oncology, Jiangxi Cancer Hospital, Nanchang, China.,NHC Key Laboratory of Personalized Diagnosis and Treatment of Nasopharyngeal Carcinoma (Jiangxi Cancer Hospital of Nanchang University), Nanchang, China
| | - Hong Wei
- Precision Medicine Institute, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hongbo Xin
- National Engineering Research Center for Bioengineering Drugs and Technologies, Institute of Translational Medicine, Nanchang University, Nanchang, China
| | - Tingtao Chen
- National Engineering Research Center for Bioengineering Drugs and Technologies, Institute of Translational Medicine, Nanchang University, Nanchang, China
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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: 124] [Impact Index Per Article: 31.0] [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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Martins AFL, Morais MO, Sousa-Neto SS, Oton-Leite AF, Pereira CH, Valadares MC, Freitas NMA, Batista AC, Leles CR, Mendonça EF. The Effect of Photobiomodulation on Nitrite and Inflammatory Activity in Radiotherapy-Induced Oral Mucositis: A Randomized Clinical Trial. Lasers Surg Med 2020; 53:671-683. [PMID: 32997817 DOI: 10.1002/lsm.23328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/29/2020] [Accepted: 09/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES To investigate pro- and anti-inflammatory cytokines and nitrite salivary levels in patients with head and neck cancer receiving photobiomodulation therapy (PBMT) associated with a Preventive Oral Care Program (POCP), for prevention and control of oral mucositis (OM) during radiotherapy (RT) associated or not with chemotherapy protocol. STUDY DESIGN/MATERIALS AND METHODS In this randomized double-blinded clinical trial, 48 patients were randomly assigned to two groups: PBMT (n = 25) and Control (n = 23). In the PBMT group, patients were submitted to PBMT associated with the POCP. In the Control group, patients were submitted only to the POCP. Saliva samples were collected in the 1st (baseline), 7th, 14th, 21st, and 30th sessions of RT, and the levels of interleukin-6 (IL-6), IL-8, IL-10, IL-12p70, IL-1β, and tumoral necrosis factor-α (TNF-α) were measured using the cytometric bead array. Nitrite levels were measured by colorimetric method. OM was assessed using the World Health Organization and the National Cancer Institute scales. RESULTS Patients in the PBMT group presented less severe OM. PBMT tended to stabilize nitrite concentration levels during the RT regimen. The IL-1β concentration was associated with higher OM scores. PBMT promoted an increase in IL-12p70, TNF-α, and IL-10 concentration. CONCLUSION PBMT was effective in the prevention and control of severe OM, and its mechanism of action may be related to a better balance of inflammatory response that may favor injury control. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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Affiliation(s)
- Allisson F L Martins
- Laboratório de Patologia Oral da, Faculdade de Odontologia da, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, 74605-220, Brazil.,Departamento de Radioterapia do Hospital de Câncer Araújo Jorge. R. 239, 206, Setor Universitário, Goiânia, Goiás, 74175-120, Brazil
| | - Marília O Morais
- Setor de Odontologia do Hospital de Câncer Araújo Jorge. R. 239, 206-Setor Universitário, Goiânia, Goiás, 74175-120, Brazil.,Departamento de Radioterapia do Hospital de Câncer Araújo Jorge. R. 239, 206, Setor Universitário, Goiânia, Goiás, 74175-120, Brazil
| | - Sebastião S Sousa-Neto
- Laboratório de Patologia Oral da, Faculdade de Odontologia da, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, 74605-220, Brazil.,Departamento de Radioterapia do Hospital de Câncer Araújo Jorge. R. 239, 206, Setor Universitário, Goiânia, Goiás, 74175-120, Brazil
| | - Angélica F Oton-Leite
- Setor de Odontologia do Hospital de Câncer Araújo Jorge. R. 239, 206-Setor Universitário, Goiânia, Goiás, 74175-120, Brazil.,Departamento de Radioterapia do Hospital de Câncer Araújo Jorge. R. 239, 206, Setor Universitário, Goiânia, Goiás, 74175-120, Brazil
| | - Carlos H Pereira
- Laboratório de Patologia Oral da, Faculdade de Odontologia da, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, 74605-220, Brazil.,Departamento de Radioterapia do Hospital de Câncer Araújo Jorge. R. 239, 206, Setor Universitário, Goiânia, Goiás, 74175-120, Brazil
| | - Marize C Valadares
- Laboratório de Farmacologia e Toxicologia Celular da, Faculdade de Farmácia da, Universidade Federal de Goiás, 5ª Avenida Esquina com Rua 240, s/n. Setor Universitário, Goiânia, Goiás, 74605-170, Brazil.,Departamento de Radioterapia do Hospital de Câncer Araújo Jorge. R. 239, 206, Setor Universitário, Goiânia, Goiás, 74175-120, Brazil
| | - Nilceana M A Freitas
- Departamento de Radioterapia do Hospital de Câncer Araújo Jorge. R. 239, 206, Setor Universitário, Goiânia, Goiás, 74175-120, Brazil.,Laboratório de Patologia Oral da, Faculdade de Odontologia da, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, 74605-220, Brazil
| | - Aline C Batista
- Departamento de Radioterapia do Hospital de Câncer Araújo Jorge. R. 239, 206, Setor Universitário, Goiânia, Goiás, 74175-120, Brazil.,Departamento de Prevenção e Reabilitação Oral da, Faculdade de Odontologia da, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, 74605-220, Brazil
| | - Cláudio R Leles
- Departamento de Radioterapia do Hospital de Câncer Araújo Jorge. R. 239, 206, Setor Universitário, Goiânia, Goiás, 74175-120, Brazil.,Laboratório de Patologia Oral da, Faculdade de Odontologia da, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, 74605-220, Brazil
| | - Elismauro F Mendonça
- Departamento de Radioterapia do Hospital de Câncer Araújo Jorge. R. 239, 206, Setor Universitário, Goiânia, Goiás, 74175-120, Brazil.,Laboratório de Patologia Oral da, Faculdade de Odontologia da, Universidade Federal de Goiás, Avenida Universitária Esquina com 1ª Avenida, s/n. Setor Universitário, Goiânia, Goiás, 74605-220, Brazil
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Polymorphism of TNFRSF1 A may act as a predictor of severe radiation-induced oral mucositis and a prognosis factor in patients with head and neck cancer. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:283-291.e2. [PMID: 32561252 DOI: 10.1016/j.oooo.2020.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/12/2020] [Accepted: 05/16/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the relationship between single nucleotide polymorphism (SNP) (-135 T>C) of TNFRSF1 A and the frequency of occurrence and severity of oral mucositis (OM) in patients with head and neck cancer (HNC) treated with radiotherapy (RT). STUDY DESIGN This retrospective, cohort study included 60 patients with HNC treated with intensity-modulated radiation therapy (IMRT). TNFRSF1 A SNP analysis (-135 T>C) was performed by using molecular probes (TaqMan, ThermoFisher Scientific, Waltham, MA) in DNA isolated from peripheral blood (QIAamp DNA MiniKit; Qiagen, Germantown, MD). RESULTS CC genotype was related to 4.5-fold higher risk of grade 2 OM after the second week of RT. Similarly, CC carriers had a significantly higher risk of severe (grade 3) OM after the fourth (6-fold) and fifth (7.5-fold) weeks of RT. The CC genotype of the TNFRSF1 A gene was significantly correlated with a higher risk of shorter overall survival (OS) (> 37 months follow-up period; hazard ratio [HR] = 2.78). CONCLUSIONS SNP (-135 T>C) of the TNFRSF1 A gene may act as a predictor of OM occurrence in patients with HNC treated with IMRT. The studied SNP may also serve as a prognostic factor in such cases.
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Cardoso LM, Pansani TN, Hebling J, de Souza Costa CA, Basso FG. Photobiomodulation of inflammatory-cytokine-related effects in a 3-D culture model with gingival fibroblasts. Lasers Med Sci 2020; 35:1205-1212. [PMID: 32030556 DOI: 10.1007/s10103-020-02974-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 01/31/2020] [Indexed: 12/26/2022]
Abstract
The aim of this study was to assess the effects of IL-6 and IL-8 cytokines on human gingival fibroblasts (HGF) cultured in a 3-D model and the possible photobiomodulation (PBM) of such effects by low-level laser therapy. In complete culture medium (DMEM), HGF from a healthy patient were seeded in a type I collagen matrix inserted into 24-well plates. After 5 days of incubation, the cytokines were added or not to serum-free DMEM, which was applied to the cell-enriched matrices. Then, PBM was performed: three consecutive irradiations using LaserTable diode device (780 nm, 0.025 W) at 0.5 J/cm2 were delivered or not to the cells. Twenty-four hours after the last irradiation, cell viability and morphology, gene expression, and synthesis of inflammatory cytokines and growth factors were assessed. The histological evaluation demonstrated that, for all groups, matrices presented homogeneous distribution of cells with elongated morphology. However, numerous cytokine-exposed cells were rounded. IL-6 and IL-8 decreased cell viability, synthesis of VEGF, and gene expression of collagen type I. PBM enhanced cell density in the matrices and stimulated VEGF expression, even after IL-6 challenge. Reduced TNF-α synthesis occurred in those cells subjected to PBM. In conclusion, PBM can penetrate collagen matrix and stimulate HGF, highlighting the relevance of this research model for further phototherapy studies and in vitro biomodulation of the healing process.
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Affiliation(s)
- Laís Medeiros Cardoso
- Department of Physiology and Pathology, Araraquara School of Dentistry, UNESP, R. Humaita, 1680, Araraquara, SP, Brazil
| | - Taisa Nogueira Pansani
- Department of Physiology and Pathology, Araraquara School of Dentistry, UNESP, R. Humaita, 1680, Araraquara, SP, Brazil
| | - Josimeri Hebling
- Department of Pediatric Dentistry, Araraquara School of Dentistry, UNESP, Araraquara, SP, Brazil
| | - Carlos Alberto de Souza Costa
- Department of Physiology and Pathology, Araraquara School of Dentistry, UNESP, R. Humaita, 1680, Araraquara, SP, Brazil
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Astradsson T, Sellberg F, Berglund D, Ehrsson YT, Laurell GFE. Systemic Inflammatory Reaction in Patients With Head and Neck Cancer-An Explorative Study. Front Oncol 2019; 9:1177. [PMID: 31750257 PMCID: PMC6848384 DOI: 10.3389/fonc.2019.01177] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 10/18/2019] [Indexed: 12/17/2022] Open
Abstract
Aim: To assess the longitudinal pattern of pro-inflammatory cytokines and growth factors in serum up to 1 year following treatment for head and neck cancer. Materials and Methods: Patients with newly diagnosed, curable head and neck cancer were included (n = 30). The most common subsite was oropharynx (n = 13) followed by oral cavity (n = 9). Blood was drawn from all patients at regular intervals (before treatment, 7 weeks after the start of the treatment, and at 3 months and 1 year after termination of treatment) and analyzed for cytokines (Il-1β, Il-2, Il-4, Il-5, Il-6, Il-8, Il-10, GM-CSF, TNF-α, and IFN-γ) and growth factors (G-CSF, FGF-2, EGF, and VEGF). Results: The time point of the peak level of pro-inflammatory cytokines was 7 weeks after start of treatment which corresponded for the majority of patients with termination of radiotherapy or chemoradiotherapy. Patients undergoing chemoradiotherapy exhibited a significant increase of IL-1β, IL-6, and IL-10 at 7 weeks as compared to pre-treatment levels. At 1 year after termination of treatment four patients experienced recurrence of disease while 26 patients were considered disease-free. The patients with recurrence had significantly higher levels of IL-1β, IL-6, IL-8, and IL-10 at 7 weeks after the start of treatment than patients without recurrence. Correlated with T stadium patients with T3-T4 had higher levels of IL-1β and IL-8 than patients with T1-T2 7 weeks after the start of treatment. Conclusions: The observed immune response in this explorative study demonstrates that chemoradiotherapy may induce not only a local treatment effect on the immune system but also effects far outside the irradiated field. The result of the study indicates that analysis of a pro-inflammatory panel of cytokines in serum at 7 weeks after the start of treatment could be of prognostic value in patients with head and neck cancer. Further study of a larger cohort could help identify patients at larger risk for recurrent disease with measurements of pro-inflammatory cytokines under and after treatment.
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Affiliation(s)
| | - Felix Sellberg
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - David Berglund
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
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Nigella sativa Oil Mouth Rinse Improves Chemotherapy-Induced Oral Mucositis in Patients with Acute Myeloid Leukemia. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3619357. [PMID: 31781612 PMCID: PMC6875195 DOI: 10.1155/2019/3619357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/30/2019] [Accepted: 09/14/2019] [Indexed: 01/20/2023]
Abstract
Objective The present study aims at evaluating the beneficial effect of Nigella sativa (NS) oil mouth rinse in the management of chemotherapy- (CT-) induced oral mucositis (OM) in patients with acute myeloid leukemia (AML). Methods Fifty-four AML patients were participated in this study and randomly allocated to either the test group or a control group. The patients of the test group received NS oil mouth rinse during 28-day CT, while the participants of the control group received a "magic mouthwash" formula. The primary outcome of this study was the incidence and severity of CT-induced OM in terms of erythema and ulcer. The secondary outcomes were the pain severity score, swallowing function, and the salivary concentrations of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α). Results NS oil mouth rinse attenuated the progression of CT-induced OM compared with the control formula (AUC = 5.9 vs. 38.4, P < 0.05) and significantly decreased the erythema and ulceration scores (AUC of total OMAS = 11.4 vs. 85.9, P < 0.001) compared with the magic mouthwash formula. It also reduced the pain score and enabled all the participants of this group to consume normal food during treatment. It significantly decreased salivary IL-6 (AUC = 7376 vs. 16599, P < 0.001), while the changes of TNF-α levels were not significant (AUC = 676.9 vs. 885.2, P > 0.05). Conclusions NS oil mouth rinse is effective in attenuating the severity of CT-induced OM and improves the pain and swallowing function in AML patients.
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Wulff-Burchfield E, Dietrich MS, Ridner S, Murphy BA. Late systemic symptoms in head and neck cancer survivors. Support Care Cancer 2019; 27:2893-2902. [PMID: 30554277 PMCID: PMC6597600 DOI: 10.1007/s00520-018-4577-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 11/27/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE Neuroinflammation and central sensitization from cancer and its therapy may result in chronic systemic symptoms (CSS) such as fatigue, sleep disturbance, chronic widespread pain, mood disorders, neuropsychiatric symptoms, and temperature dysregulation. We undertook a cross-sectional study of CSS in head and neck cancer (HNC) survivors to determine their frequency, severity, and impact. METHODS HNC patients without evidence of recurrence who were at least 12 months post-treatment completed a one-time battery of self-report measures including the Vanderbilt Head and Neck Symptom survey plus the General Symptom Subscale, the Body Image Quality of Life Inventory, Neurotoxicity Rating Scale, the Profile of Mood States, and a five-item quality of life measure. RESULTS One hundred five patients completed the surveys. Forty-eight point four percent of patients experienced one or more moderate-to-severe systemic symptom. The frequency of individual symptoms was between 20% and 56% with almost half of patients rating symptoms as moderate-to-severe in intensity. Low and high systemic symptom burden populations were identified. Previously undescribed chronic neuropsychiatric symptoms were also found to be frequent and severe. The vigor score on the POMS was low. Body image was not adversely impacted. At least 40% of HNC survivors have diminished quality of life, and up to 15% have a poor quality of life. CONCLUSIONS CSS are common among HNC survivors and are frequently moderate to severe in intensity. Of note, previously underrecognized neuropsychiatric symptoms were endorsed by a significant cohort of patients warranting further study. Quality of life was diminished in a significant cohort.
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Affiliation(s)
- Elizabeth Wulff-Burchfield
- Department of Medicine, Divisions of Medical Oncology and Palliative Medicine, University of Kansas Medical Center, 2330 Shawnee Mission Pkwy, MS 5003, Westwood, KS, 66205, USA.
| | - Mary S Dietrich
- Center for Quantitative Sciences, Vanderbilt University School of Medicine, 2220 Pierce Ave, 571 Preston Research Building, Nashville, TN, 37232, USA
- School of Nursing, Vanderbilt University Medical Center, 461 21st Ave South, Nashville, TN, 37240, USA
| | - Sheila Ridner
- School of Nursing, Vanderbilt University Medical Center, 461 21st Ave South, Nashville, TN, 37240, USA
| | - Barbara A Murphy
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, 2220 Pierce Avenue, 777 Preston Research Building, Nashville, TN, 37232, USA
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The relationship between TNF-α gene promoter polymorphism (- 1211 T > C), the plasma concentration of TNF-α, and risk of oral mucositis and shortening of overall survival in patients subjected to intensity-modulated radiation therapy due to head and neck cancer. Support Care Cancer 2019; 28:531-540. [PMID: 31076897 PMCID: PMC6954128 DOI: 10.1007/s00520-019-04838-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 04/24/2019] [Indexed: 01/06/2023]
Abstract
Purpose Radiotherapy (RTH) usually combined with chemotherapy (C-RTH) is the main method of treatment in head and neck cancer (HNC). The most common complication of RTH is oral mucositis (OM). At a certain stage of RTH, it occurs in almost all patients, often lead to discontinuation of treatment. Tumour necrosis factor alpha (TNF-α) is a cytokine secreted during inflammatory process accompanying RTH and the development of cancer itself. Single nucleotide polymorphism (SNP) of the TNF-α promoter region can potentially affect the function or expression of this cytokine, and thus modulate the risk of occurrence and intensity of OM and shortening of overall survival (OS). Methods The study group consisted of 62 patients with HNC in whom intensity-modulated radiation therapy (IMRT) technique was applied. The plasma TNF-α level was assessed using the ELISA Kit. Genotyping was performed using a real-time PCR method. Results HNC patients with the CC genotype of TNF-α (− 1211 T > C) have higher TNF-α plasma concentrations than those with T allele (10.70 vs 9.62 ng/ml). Patients with the 3rd degree of OM have significantly higher TNF-α levels after 5th (10.40 vs 9.45 ng/ml) and 7th (10.32 vs 9.60 ng/ml) week of RTH. CC genotype was related to a higher risk of 3rd degree OM development in the last weeks of RTH (5th, OR = 7.33; 7th, OR = 23.15). Conclusions High TNF-α plasma concentration and CC genotype of TNF-α are related to the higher risk of more severe OM in patients irradiated due to HNC. High TNF-α plasma concentration and CC genotype of TNF-α are independent prognostic factors for patients subjected to RTH due to HNC. Electronic supplementary material The online version of this article (10.1007/s00520-019-04838-6) contains supplementary material, which is available to authorized users.
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Yu H, Wu H, Wang W, Jolly S, Jin JY, Hu C, Kong FMS. Machine Learning to Build and Validate a Model for Radiation Pneumonitis Prediction in Patients with Non-Small Cell Lung Cancer. Clin Cancer Res 2019; 25:4343-4350. [PMID: 30992302 DOI: 10.1158/1078-0432.ccr-18-1084] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 12/29/2018] [Accepted: 04/12/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Radiation pneumonitis is an important adverse event in patients with non-small cell lung cancer (NSCLC) receiving thoracic radiotherapy. However, the risk of radiation pneumonitis grade ≥ 2 (RP2) has not been well predicted. This study hypothesized that inflammatory cytokines or the dynamic changes during radiotherapy can improve predictive accuracy for RP2. EXPERIMENTAL DESIGN Levels of 30 inflammatory cytokines and clinical information in patients with stages I-III NSCLC treated with radiotherapy were from our prospective studies. Statistical analysis was used to select predictive cytokine candidates and clinical covariates for adjustment. Machine learning algorithm was used to develop the generalized linear model for predicting risk RP2. RESULTS A total of 131 patients were eligible and 17 (13.0%) developed RP2. IL8 and CCL2 had significantly (Bonferroni) lower expression levels in patients with RP2 than without RP2. But none of the changes in cytokine levels during radiotherapy was significantly associated with RP2. The final predictive GLM model for RP2 was established, including IL8 and CCL2 at baseline level and two clinical variables. Nomogram was constructed based on the GLM model. The model's predicting ability was validated in the completely independent test set (AUC = 0.863, accuracy = 80.0%, sensitivity = 100%, specificity = 76.5%). CONCLUSIONS By machine learning, this study has developed and validated a comprehensive model integrating inflammatory cytokines with clinical variables to predict RP2 before radiotherapy that provides an opportunity to guide clinicians.
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Affiliation(s)
- Hao Yu
- Biomedical Engineering, Shenzhen Polytechnic, Shenzhen, China.,BioHealth Informatics, School Of Informatics and Computing, Indiana University - Purdue University Indianapolis, Indianapolis, Indiana
| | - Huanmei Wu
- BioHealth Informatics, School Of Informatics and Computing, Indiana University - Purdue University Indianapolis, Indianapolis, Indiana
| | - Weili Wang
- University Hospitals/Cleveland Medical Center, Seidman Cancer Center and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Shruti Jolly
- Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Jian-Yue Jin
- University Hospitals/Cleveland Medical Center, Seidman Cancer Center and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Chen Hu
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Feng-Ming Spring Kong
- University Hospitals/Cleveland Medical Center, Seidman Cancer Center and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio. .,Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Department of Clinical Oncology, The University of Hong Kong and Shenzhen Hospital, Hong Kong, China
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19
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Kiewiet MBG, Dekkers R, van Gool MP, Ulfman LH, Groeneveld A, Faas MM, de Vos P. Identification of a TLR2 Inhibiting Wheat Hydrolysate. Mol Nutr Food Res 2018; 62:e1800716. [PMID: 30354027 PMCID: PMC6646915 DOI: 10.1002/mnfr.201800716] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/01/2018] [Indexed: 12/25/2022]
Abstract
SCOPE Wheat hydrolysates are used in medical nutrition to provide undernourished patients a readily digestible protein source, for instance to recover from chemotherapy-induced intestinal mucosal inflammation. Since many hydrolysates of different sources can modulate the immune system, likely via Toll-like receptors (TLRs), it is hypothesized that also wheat hydrolysates might interact with TLR signaling, which could be a way to prevent intestinal inflammation and damage. METHODS AND RESULTS The capacity of three wheat hydrolysates to modulate immunity by interfering with TLR signaling is determined. All wheat hydrolysates have TLR modulating effects but only one has strong TLR2 inhibiting effects, attenuating both TLR2/1 and TLR2/6 signaling in a reporter cell system. This is likely induced by direct TLR2-ectodomain binding, as confirmed by ELISA. Furthermore, this TLR2 blocking hydrolysate reduces IL-6 production in human dendritic cells. Application of reversed-phase-ultra HPLC combined with MS reveals that the presence of peptide WQIPEQSR is associated with the observed TLR2 inhibiting capacity. CONCLUSION The study demonstrates TLR2-inhibiting capacities of a wheat hydrolysate. The findings provide a good start for further research to investigate whether this hydrolysate might contribute to the management of intestinal mucosal inflammation in cancer patients receiving chemotherapy.
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Affiliation(s)
- Mensiena B G Kiewiet
- Immunoendocrinology, Division of Medical Biology, Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700, RB, Groningen, The Netherlands
| | - Renske Dekkers
- FrieslandCampina, Stationsplein 4, 3818, LE, Amersfoort, The Netherlands
| | - Martine P van Gool
- FrieslandCampina, Stationsplein 4, 3818, LE, Amersfoort, The Netherlands
| | - Laurien H Ulfman
- FrieslandCampina, Stationsplein 4, 3818, LE, Amersfoort, The Netherlands
| | - Andre Groeneveld
- FrieslandCampina, Stationsplein 4, 3818, LE, Amersfoort, The Netherlands
| | - Marijke M Faas
- Immunoendocrinology, Division of Medical Biology, Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700, RB, Groningen, The Netherlands.,Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, 9713, GZ, Groningen, The Netherlands
| | - Pau de Vos
- Immunoendocrinology, Division of Medical Biology, Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700, RB, Groningen, The Netherlands
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20
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Wang S, Campbell J, Stenmark MH, Stanton P, Zhao J, Matuszak MM, Ten Haken RK, Kong FM. A model combining age, equivalent uniform dose and IL-8 may predict radiation esophagitis in patients with non-small cell lung cancer. Radiother Oncol 2018; 126:506-510. [PMID: 29496281 PMCID: PMC5874799 DOI: 10.1016/j.radonc.2017.12.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 12/28/2017] [Accepted: 12/28/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE To study whether cytokine markers may improve predictive accuracy of radiation esophagitis (RE) in non-small cell lung cancer (NSCLC) patients. MATERIALS AND METHODS A total of 129 patients with stage I-III NSCLC treated with radiotherapy (RT) from prospective studies were included. Thirty inflammatory cytokines were measured in platelet-poor plasma samples. Logistic regression was performed to evaluate the risk factors of RE. Stepwise Akaike information criterion (AIC) and likelihood ratio test were used to assess model predictions. RESULTS Forty-nine of 129 patients (38.0%) developed grade ≥2 RE. Univariate analysis showed that age, stage, concurrent chemotherapy, and eight dosimetric parameters were significantly associated with grade ≥2 RE (p < 0.05). IL-4, IL-5, IL-8, IL-13, IL-15, IL-1α, TGFα and eotaxin were also associated with grade ≥2 RE (p < 0.1). Age, esophagus generalized equivalent uniform dose (EUD), and baseline IL-8 were independently associated grade ≥2 RE. The combination of these three factors had significantly higher predictive power than any single factor alone. Addition of IL-8 to toxicity model significantly improves RE predictive accuracy (p = 0.019). CONCLUSIONS Combining baseline level of IL-8, age and esophagus EUD may predict RE more accurately. Refinement of this model with larger sample sizes and validation from multicenter database are warranted.
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Affiliation(s)
- Shulian Wang
- State Key Laboratory of Molecular Oncology, Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Radiation Oncology, GRU Cancer Center and Medical College of Georgia, Augusta, GA, United States
| | - Jeff Campbell
- Department of Radiation Oncology, GRU Cancer Center and Medical College of Georgia, Augusta, GA, United States
| | | | - Paul Stanton
- Department of Radiation Oncology, GRU Cancer Center and Medical College of Georgia, Augusta, GA, United States
| | - Jing Zhao
- Department of Radiation Oncology, GRU Cancer Center and Medical College of Georgia, Augusta, GA, United States
| | - Martha M Matuszak
- Department of Radiation Oncology, University of Michigan, United States
| | | | - Feng-Ming Kong
- Department of Radiation Oncology, GRU Cancer Center and Medical College of Georgia, Augusta, GA, United States; Department of Radiation Oncology, Indiana University, United States.
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21
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Cechinel‐Zanchett CC, Boeing T, Somensi LB, Steimbach VMB, Campos A, Krueger CDMA, Schultz C, Sant'ana DDMG, Cechinel‐Filho V, Mota da Silva L, Faloni de Andrade S. Flavonoid‐rich fraction of
Bauhinia forficata
Link leaves prevents the intestinal toxic effects of irinotecan chemotherapy in IEC‐6 cells and in mice. Phytother Res 2018; 33:90-106. [DOI: 10.1002/ptr.6202] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/23/2018] [Accepted: 09/05/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Camile Cecconi Cechinel‐Zanchett
- Programa de Pós‐graduação em Ciências Farmacêuticas, Núcleo de Investigações Químico‐Farmacêuticas (NIQFAR) Universidade do Vale do Itajaí—UNIVALI Itajaí Santa Catarina Brazil
| | - Thaise Boeing
- Programa de Pós‐graduação em Ciências Farmacêuticas, Núcleo de Investigações Químico‐Farmacêuticas (NIQFAR) Universidade do Vale do Itajaí—UNIVALI Itajaí Santa Catarina Brazil
| | - Lincon Bordignon Somensi
- Programa de Pós‐graduação em Ciências Farmacêuticas, Núcleo de Investigações Químico‐Farmacêuticas (NIQFAR) Universidade do Vale do Itajaí—UNIVALI Itajaí Santa Catarina Brazil
| | - Viviane Miranda Bispo Steimbach
- Programa de Pós‐graduação em Ciências Farmacêuticas, Núcleo de Investigações Químico‐Farmacêuticas (NIQFAR) Universidade do Vale do Itajaí—UNIVALI Itajaí Santa Catarina Brazil
| | - Adriana Campos
- Programa de Pós‐graduação em Ciências Farmacêuticas, Núcleo de Investigações Químico‐Farmacêuticas (NIQFAR) Universidade do Vale do Itajaí—UNIVALI Itajaí Santa Catarina Brazil
| | - Clarissa de Medeiros Amorm Krueger
- Programa de Pós‐graduação em Ciências Farmacêuticas, Núcleo de Investigações Químico‐Farmacêuticas (NIQFAR) Universidade do Vale do Itajaí—UNIVALI Itajaí Santa Catarina Brazil
| | - Cristiany Schultz
- Department of Morphological Sciences State University of Maringá Maringá Paraná Brazil
| | | | - Valdir Cechinel‐Filho
- Programa de Pós‐graduação em Ciências Farmacêuticas, Núcleo de Investigações Químico‐Farmacêuticas (NIQFAR) Universidade do Vale do Itajaí—UNIVALI Itajaí Santa Catarina Brazil
| | - Luísa Mota da Silva
- Programa de Pós‐graduação em Ciências Farmacêuticas, Núcleo de Investigações Químico‐Farmacêuticas (NIQFAR) Universidade do Vale do Itajaí—UNIVALI Itajaí Santa Catarina Brazil
| | - Sérgio Faloni de Andrade
- Programa de Pós‐graduação em Ciências Farmacêuticas, Núcleo de Investigações Químico‐Farmacêuticas (NIQFAR) Universidade do Vale do Itajaí—UNIVALI Itajaí Santa Catarina Brazil
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22
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Impact of CYP genotype and inflammatory markers on the plasma concentrations of tramadol and its demethylated metabolites and drug tolerability in cancer patients. Eur J Clin Pharmacol 2018; 74:1461-1469. [PMID: 30051214 DOI: 10.1007/s00228-018-2527-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 07/16/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE Clinical responses to oral tramadol show a large variation in cancer patients. This study aimed to evaluate the impacts of cytochrome P450 (CYP) genotype and serum inflammatory markers on the plasma concentrations of tramadol and its demethylated metabolites and drug tolerability in cancer patients. METHODS The predose plasma concentrations of tramadol and its demethylated metabolites were determined at day 4 or later in 70 Japanese cancer patients treated with oral tramadol. The CYP genotypes, serum interleukin-6 (IL-6) and C-reactive protein (CRP) levels, and the duration of tramadol treatment were evaluated. RESULTS The CYP2D6 genotype did not affect the plasma tramadol concentration. The plasma concentration of O-desmethyltramadol and its ratio to tramadol were lower in the CYP2D6 intermediate and poor metabolizer (IM + PM) group than in the normal metabolizer (NM) group (P = 0.002 and P = 0.023). The plasma concentration of N-desmethyltramadol and its ratio to tramadol were higher in the CYP2D6 IM + PM group than in the NM group (P = 0.001 and P = 0.001). The CYP2B6*6 and CYP3A5*3 alleles had no effect on the plasma concentrations of tramadol and its demethylated metabolites. The serum IL-6 and CRP levels were inversely correlated with the plasma concentration ratios of N-desmethyltramadol to tramadol and of N,O-didesmethyltramadol to O-desmethyltramadol. The serum IL-6 level was associated with the treatment duration of oral tramadol. CONCLUSIONS The CYP2D6 genotype but not the CYP2B6 and CYP3A5 genotypes affected the plasma concentrations of O- and N-desmethyltramadol through alteration of the tramadol metabolic pathway. The serum IL-6 level was associated with N-demethylation activity and tramadol tolerability.
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23
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Najafi M, Motevaseli E, Shirazi A, Geraily G, Rezaeyan A, Norouzi F, Rezapoor S, Abdollahi H. Mechanisms of inflammatory responses to radiation and normal tissues toxicity: clinical implications. Int J Radiat Biol 2018; 94:335-356. [DOI: 10.1080/09553002.2018.1440092] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Masoud Najafi
- Radiology and Nuclear Medicine Department, School of Paramedical Sciences, Kermanshah University of Medical Science, Kermanshah, Iran
| | - Elahe Motevaseli
- Department of Molecular Medicine, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Shirazi
- Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghazale Geraily
- Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Abolhasan Rezaeyan
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Farzad Norouzi
- Science and Research Branch, Azad University, Tehran, Iran
| | - Saeed Rezapoor
- Department of Radiology, Faculty of Paramedical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Abdollahi
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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24
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Wopken K, Bijl HP, Langendijk JA. Prognostic factors for tube feeding dependence after curative (chemo-) radiation in head and neck cancer: A systematic review of literature. Radiother Oncol 2018; 126:56-67. [DOI: 10.1016/j.radonc.2017.08.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 08/07/2017] [Accepted: 08/21/2017] [Indexed: 12/31/2022]
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25
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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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26
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Cinausero M, Aprile G, Ermacora P, Basile D, Vitale MG, Fanotto V, Parisi G, Calvetti L, Sonis ST. New Frontiers in the Pathobiology and Treatment of Cancer Regimen-Related Mucosal Injury. Front Pharmacol 2017. [PMID: 28642709 PMCID: PMC5462992 DOI: 10.3389/fphar.2017.00354] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Mucositis is a common complication of chemotherapy, radiotherapy and targeted agents. It often affects compliance to anticancer therapies as it frequently causes schedule delays, interruptions or discontinuations of treatment. Moreover, the economic impact related to the management of mucositis is topical and several estimations of additional hospital costs due to this clinical condition have been recently reported. The ability to determine risk factors for mucositis, to early detect its onset, to assess correctly the degree of this toxicity and to plan its multidisciplinary management are all key elements to guarantee the quality of life of patients and to avoid useless dose reduction or interruption of treatment. The pathogenesis of mucositis is multifactorial and it is classily subdivided into oral and gastrointestinal mucositis according to its anatomic presentation. Treatment and patients’ related factors might help in predicting the frequency and the potential degree of symptoms onset. Here we discuss about clinical presentation and pathogenesis of mucositis in relation to different kinds of treatments. Moreover, we focus on therapeutic and prevention strategies, describing past and present management according to international guidelines and the most promising new data about agents potentially able to further improve the treatment of mucositis in the next future.
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Affiliation(s)
- Marika Cinausero
- Department of Oncology, University and General HospitalUdine, Italy
| | - Giuseppe Aprile
- Department of Oncology, University and General HospitalUdine, Italy.,Department of Oncology, San Bortolo General HospitalVicenza, Italy
| | - Paola Ermacora
- Department of Oncology, University and General HospitalUdine, Italy
| | - Debora Basile
- Department of Oncology, University and General HospitalUdine, Italy
| | - Maria G Vitale
- Department of Oncology, University and General HospitalUdine, Italy
| | | | - Giuseppe Parisi
- Department of Oncology, University and General HospitalUdine, Italy
| | - Lorenzo Calvetti
- Department of Oncology, San Bortolo General HospitalVicenza, Italy
| | - Stephen T Sonis
- Divisions of Oral Medicine, Brigham and Women's Hospital, BostonMA, United States.,Dana-Farber Cancer InstituteBoston, MA, United States.,Biomodels LLC, WatertownMA, United States
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27
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Ramírez-Amador V, Zambrano JG, Anaya-Saavedra G, Zentella-Dehesa A, Irigoyen-Camacho E, Meráz-Cruz N, Ponce de León-Rosales S. TNF as marker of oral candidiasis, HSV infection, and mucositis onset during chemotherapy in leukemia patients. Oral Dis 2017; 23:941-948. [PMID: 28403570 DOI: 10.1111/odi.12677] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/09/2017] [Accepted: 04/05/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess changes in the salivary expression of IL-1α, IL-1β, IL-2, IL-6, IL-10, IL-17, and TNF in acute leukemia (AL) patients before and during chemotherapy, and its association with HSV infection, oral candidiasis (OC), and oral mucositis (OM) onset. METHODS Cohort study in AL patients >15 years starting induction chemotherapy at a Mexican oncological center (2013-2014). Onset of oral lesions (OLs) was assessed during follow-up, and saliva was obtained at baseline, at visit 2 (days 4-12), and at visit 3 (days 13-21) after chemotherapy, treated with a protease inhibitor and stored at -70°C. An enzyme-linked immunosorbent assay was performed. Cox proportional hazards regression models were constructed to estimate hazard ratios and its 95% CI (HR, 95% CI) for OL development. RESULTS Forty-one patients were followed up, and 17 (41.5%) developed OLs. OL patients had higher baseline salivary IL-1α than those without lesions (p = 0.040). During visit 2, OL patients had higher levels of IL-1α (p = 0.033), IL-1β (p = 0.016), IL-6 (p = 0.035), and TNF (p = 0.019) than those who did not develop OLs. Patients with HSV infection, OC, and OM showed higher salivary TNF levels during follow-up (HR: 3.52, 95% CI: 1.35-9.14, p = 0.010). CONCLUSION AL patients undergoing chemotherapy with high salivary TNF levels were more likely to develop HSV infection, OC, and OM.
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Affiliation(s)
- V Ramírez-Amador
- Master's Course in Oral Pathology and Oral Medicine, Universidad Autónoma Metropolitana-Xochimilco, Mexico City, México
| | - J G Zambrano
- Master's Course in Oral Pathology and Oral Medicine, Universidad Autónoma Metropolitana-Xochimilco, Mexico City, México
| | - G Anaya-Saavedra
- Master's Course in Oral Pathology and Oral Medicine, Universidad Autónoma Metropolitana-Xochimilco, Mexico City, México
| | - A Zentella-Dehesa
- Biochemical Unit, Department of Genomic Medicine and Environmental Toxicology, Biomedical Research Institute, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Universidad Nacional Autónoma de México, Mexico City, México
| | - E Irigoyen-Camacho
- Master's Course in Oral Pathology and Oral Medicine, Universidad Autónoma Metropolitana-Xochimilco, Mexico City, México
| | - N Meráz-Cruz
- Liason Unit of the Faculty of Medicine, Instituto Nacional de Medicina Genómica, Universidad Nacional Autónoma de México, Mexico City, México
| | - S Ponce de León-Rosales
- Clinical Epidemiology Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Brzozowska A, Powrózek T, Homa-Mlak I, Mlak R, Ciesielka M, Gołębiowski P, Małecka-Massalska T. Polymorphism of Promoter Region of TNFRSF1A Gene (-610 T > G) as a Novel Predictive Factor for Radiotherapy Induced Oral Mucositis in HNC Patients. Pathol Oncol Res 2017; 24:135-143. [PMID: 28401452 PMCID: PMC5736772 DOI: 10.1007/s12253-017-0227-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/03/2017] [Indexed: 11/24/2022]
Abstract
Every year, about 650 thousand new cases of Head and Neck Cancer (HNC) are diagnosed globally. Apart from surgery, radiotherapy (RTH), chemotherapy (CHT) or its combination is used in the treatment of HNC. One of the most frequent complications and, at the same time, limitations of RTH is oral mucositis (OM). Proinflammatory cytokines (including TNF-α) play a key role in the development of OM. Genetic alterations, i.e. single nucleotide polymorphisms (SNPs) within genes encoding for receptors for TNF (ie. TNFRSF1A) may change their function. The aim of this study was to investigate relationship between a polymorphism of TNFRSF1A and occurrence and severity of acute reaction after RTH for HNC patients. Data from 58 HNC patients (stages I-IV) were analyzed. All of them were irradiated using IMRT technique with doses 50-70Gy. Oral mucositis (OM) was evaluated according to RTOG/EORTC guidelines. DNA from HNC patients were isolated from whole blood and genotypes were determined by sequencing method. Patients with TT or GT genotype demonstrated higher risk of manifestation of grade 3 OM in 5th week of RTH (p=0.041; OR=9.240; 95% CI: 1.101–77.581) compared to GG carriers. Similarly, high risk of grade 3 OM in patients with T allele presence was noted in 6th week (p=0.030; OR=10.50; 95%CI:1.257–87.690) and in 7th week (p=0.008; OR=5.625; 95% CI: 1.584–19.975) of treatment compared to patients with GG homozygote. Our results indicate an association between SNP of TNFRSF1A (rs4149570) gene and risk of more severe OM related to radiation therapy for HNC patients.
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Affiliation(s)
- Anna Brzozowska
- Department of Oncology, Medical University of Lublin, Jaczewskiego 7, 20-090, Lublin, Poland.
| | - Tomasz Powrózek
- Department of Human Physiology, Medical University of Lublin, Radziwiłłowska 11, 20-080, Lublin, Poland
| | - Iwona Homa-Mlak
- Department of Human Physiology, Medical University of Lublin, Radziwiłłowska 11, 20-080, Lublin, Poland
| | - Radosław Mlak
- Department of Human Physiology, Medical University of Lublin, Radziwiłłowska 11, 20-080, Lublin, Poland
| | - Marzanna Ciesielka
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8, 20-090, Lublin, Poland
| | - Paweł Gołębiowski
- Department of Oncology, Medical University of Lublin, Jaczewskiego 7, 20-090, Lublin, Poland
| | - Teresa Małecka-Massalska
- Department of Human Physiology, Medical University of Lublin, Radziwiłłowska 11, 20-080, Lublin, Poland
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29
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Wang S, Campbell J, Stenmark MH, Zhao J, Stanton P, Matuszak MM, Ten Haken RK, Kong FMS. Plasma Levels of IL-8 and TGF-β1 Predict Radiation-Induced Lung Toxicity in Non-Small Cell Lung Cancer: A Validation Study. Int J Radiat Oncol Biol Phys 2017; 98:615-621. [PMID: 28581403 DOI: 10.1016/j.ijrobp.2017.03.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 03/02/2017] [Accepted: 03/07/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE AND OBJECTIVES We previously reported that the combination of mean lung dose (MLD) and inflammatory cytokines interleukin-8 (IL-8) and transforming growth factor-β1 (TGF-β1) may provide a more accurate model for radiation-induced lung toxicity (RILT) prediction in 58 patients with non-small cell lung cancer (NSCLC). This study is to validate the previous findings with new patients and to explore new models with more cytokines. METHODS AND MATERIALS One hundred forty-two patients with stage I-III NSCLC treated with definitive radiation therapy (RT) from prospective studies were included. Sixty-five new patients were used to validate previous findings, and all 142 patients were used to explore new models. Thirty inflammatory cytokines were measured in plasma samples before RT and 2 weeks and 4 weeks during RT (pre, 2w, 4w). Grade ≥2 RILT was defined as grade 2, and higher radiation pneumonitis or symptomatic pulmonary fibrosis was the primary endpoint. Logistic regression was performed to evaluate the risk factors of RILT. The area under the curve (AUC) for the receiver operating characteristic curves was used for model assessment. RESULTS Sixteen of 65 patients (24.6%) experienced RILT2. Lower pre IL-8 and higher TGF-β1 2w/pre ratio were associated with higher risk of RILT2. The AUC increased to 0.73 by combining MLD, pre IL-8, and TGF-β1 2w/pre ratio compared with 0.61 by MLD alone to predict RILT. In all 142 patients, 29 patients (20.4%) experienced grade ≥2 RILT. Among the 30 cytokines measured, only IL-8 and TGF-β1 were significantly associated with the risk of RILT2. MLD, pre IL-8 level, and TGF-β1 2w/pre ratio were included in the final predictive model. The AUC increased to 0.76 by combining MLD, pre IL-8, and TGF-β1 2w/pre ratio compared with 0.62 by MLD alone. CONCLUSIONS We validated that a combination of mean lung dose, pre IL-8 level, and TGF-β1 2w/pre ratio provided a more accurate model to predict the risk of RILT2 compared with MLD alone.
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Affiliation(s)
- Shulian Wang
- Department of Radiation Oncology, Georgia Regents University Cancer Center and Medical College of Georgia, Augusta, Georgia; Department of Radiation Oncology, Cancer Hospital and Cancer Institution, Chinese Academy of Medical Sciences, Beijing, China
| | - Jeff Campbell
- Department of Radiation Oncology, Georgia Regents University Cancer Center and Medical College of Georgia, Augusta, Georgia
| | - Matthew H Stenmark
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Jing Zhao
- Department of Radiation Oncology, Georgia Regents University Cancer Center and Medical College of Georgia, Augusta, Georgia
| | - Paul Stanton
- Department of Radiation Oncology, Georgia Regents University Cancer Center and Medical College of Georgia, Augusta, Georgia
| | - Martha M Matuszak
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Randall K Ten Haken
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Feng-Ming Spring Kong
- Department of Radiation Oncology, Georgia Regents University Cancer Center and Medical College of Georgia, Augusta, Georgia; Department of Radiation Oncology, Indiana University, Indianapolis, Indiana.
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Mangoni M, Sottili M, Gerini C, Desideri I, Bastida C, Pallotta S, Castiglione F, Bonomo P, Meattini I, Greto D, Olmetto E, Terziani F, Becherini C, Delli Paoli C, Trombetta L, Loi M, Biti G, Livi L. A PPAR gamma agonist protects against oral mucositis induced by irradiation in a murine model. Oral Oncol 2016; 64:52-58. [PMID: 28024724 DOI: 10.1016/j.oraloncology.2016.11.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 11/17/2016] [Accepted: 11/28/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Due to its anti-inflammatory, antifibrotic and antineoplastic properties, the PPAR gamma agonist rosiglitazone is of interest in prevention and therapy of radiation-induced toxicities. We aimed to evaluate the radioprotective effect of rosiglitazone in a mouse model of radiation-induced oral mucositis. MATERIAL AND METHODS Oral mucositis was obtained by irradiation of the oral region of C57BL/6J mice, pretreated or not with rosiglitazone. Mucositis was assessed by macroscopic scoring, histology and molecular analysis. Tumor xenograft was obtained by s.c. injection of Hep-2 cells in CD1 mice. Tumor volume was measured twice a week to evaluate effect of rosiglitazone alone and combined with radiotherapy. RESULTS Irradiated mice showed typical features of oral mucositis, such as oedema and reddening, reaching the peak of damage after 12-15days. Rosiglitazone markedly reduced visible signs of mucositis and significantly reduced the peak. Histological analysis showed the presence of an inflammatory cell infiltrate after irradiation; the association with rosiglitazone noticeably reduced infiltration. Rosiglitazone significantly inhibited radiation-induced tnfα, Il-6 and Il-1β gene expression. Rosiglitazone controlled the increase of TGF-β and NF-kB p65 subunit proteins induced by irradiation, and enhanced the expression of catalase. Irradiation and rosiglitazone significantly reduced tumor volume as compared to control. Rosiglitazone did not protect tumor from the therapeutic effect of radiation. CONCLUSION Rosiglitazone exerted a protective action on normal tissues in radiation-induced mucositis. Moreover, it showed antineoplastic properties on head-neck carcinoma xenograft model and selective protection of normal tissues. Thus, PPAR gamma agonists should be further investigated as radioprotective agents in head and neck cancer.
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Affiliation(s)
- Monica Mangoni
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Mariangela Sottili
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy.
| | - Chiara Gerini
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Isacco Desideri
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Cinzia Bastida
- Medical Physic Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Stefania Pallotta
- Medical Physic Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Francesca Castiglione
- Department of Clinical and Experimental Medicine, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Pierluigi Bonomo
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Icro Meattini
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Daniela Greto
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Emanuela Olmetto
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Francesca Terziani
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Carlotta Becherini
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Camilla Delli Paoli
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Laura Trombetta
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Mauro Loi
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Giampaolo Biti
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Lorenzo Livi
- Radiotherapy Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
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Bossi P, Bergamini C, Miceli R, Cova A, Orlandi E, Resteghini C, Locati L, Alfieri S, Imbimbo M, Granata R, Mariani L, Iacovelli NA, Huber V, Cavallo A, Licitra L, Rivoltini L. Salivary Cytokine Levels and Oral Mucositis in Head and Neck Cancer Patients Treated With Chemotherapy and Radiation Therapy. Int J Radiat Oncol Biol Phys 2016; 96:959-966. [PMID: 27745982 DOI: 10.1016/j.ijrobp.2016.08.047] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 08/04/2016] [Accepted: 08/29/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE We assessed the presence of salivary cytokines, their modulation during chemoradiation therapy (CTRT), and their association with oral mucositis severity in patients with head and neck cancer (HNC). METHODS AND MATERIALS The present prospective observational study enrolled 55 patients with locally advanced HNC requiring CTRT. We also studied 10 healthy volunteers and 10 patients with other cancers. The salivary levels of 13 cytokines were analyzed. We constructed a cytokine predictive score of oral mucositis severity. RESULTS The baseline salivary cytokine levels were not associated with the severity of treatment-induced oral mucositis. The cytokine levels overall increased during treatment, especially in patients with worse mucositis. In particular, on univariable analysis, an increase of interleukin (IL)-1β (area under the curve [AUC] 0.733; P=.009), IL-6 (AUC 0.746; P=.005), and tumor necrosis factor-α (AUC 0.710; P=.005) at the third week of treatment was significantly associated with the development of severe oral mucositis. On multivariable analysis, the predictive score based on the IL-1β and IL-6 changes from baseline to week 3 was an early strong predictor of higher grade oral mucositis. CONCLUSIONS The treatment of HNC patients with concurrent CTRT induces a significant increase in the salivary levels of IL-1β, IL-6, and tumor necrosis factor-α, all positively associated with the severity of mucosal toxicity. A greater increase of IL-1β and IL-6 3 weeks after treatment initiation is predictive of worse oral mucositis, representing a potential tool for the early identification of patients at risk.
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Affiliation(s)
- Paolo Bossi
- Department of Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Cristiana Bergamini
- Department of Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rosalba Miceli
- Clinical Epidemiology and Trial Organization Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Agata Cova
- Unity of Immunotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ester Orlandi
- Radiotherapy 2 Unity, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Resteghini
- Department of Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Locati
- Department of Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Salvatore Alfieri
- Department of Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Martina Imbimbo
- Department of Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberta Granata
- Department of Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luigi Mariani
- Clinical Epidemiology and Trial Organization Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Veronica Huber
- Unity of Immunotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Anna Cavallo
- Department of Physics and Radiation Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lisa Licitra
- Department of Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Licia Rivoltini
- Unity of Immunotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Basso FG, Soares DG, Pansani TN, Cardoso LM, Scheffel DL, de Souza Costa CA, Hebling J. Proliferation, migration, and expression of oral-mucosal-healing-related genes by oral fibroblasts receiving low-level laser therapy after inflammatory cytokines challenge. Lasers Surg Med 2016; 48:1006-1014. [DOI: 10.1002/lsm.22553] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2016] [Indexed: 01/20/2023]
Affiliation(s)
- Fernanda G. Basso
- Araraquara School of Dentistry; UNESP-Univ. Estadual Paulista; Araraquara, SP 14.801-903 Brazil
| | - Diana G. Soares
- Araraquara School of Dentistry; UNESP-Univ. Estadual Paulista; Araraquara, SP 14.801-903 Brazil
| | - Taisa N. Pansani
- Araraquara School of Dentistry; UNESP-Univ. Estadual Paulista; Araraquara, SP 14.801-903 Brazil
| | - Lais M. Cardoso
- Araraquara School of Dentistry; UNESP-Univ. Estadual Paulista; Araraquara, SP 14.801-903 Brazil
| | - Débora L. Scheffel
- Araraquara School of Dentistry; UNESP-Univ. Estadual Paulista; Araraquara, SP 14.801-903 Brazil
| | | | - Josimeri Hebling
- Araraquara School of Dentistry; UNESP-Univ. Estadual Paulista; Araraquara, SP 14.801-903 Brazil
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33
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Economopoulou P, Agelaki S, Perisanidis C, Giotakis EI, Psyrri A. The promise of immunotherapy in head and neck squamous cell carcinoma. Ann Oncol 2016; 27:1675-85. [PMID: 27380958 DOI: 10.1093/annonc/mdw226] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 05/29/2016] [Indexed: 01/05/2023] Open
Abstract
Squamous cell cancers of the head and neck (HNSCC) comprise a diverse group of malignancies that includes tobacco-related tumors in addition to an increasing number of human papillomavirus-associated cancers. Independently of cause, there is a growing body of evidence supporting that the immune system plays a pivotal role in HNSCC development, as tumor cells evade immunosurveillance by exploiting inhibitory checkpoint pathways that suppress anti-tumor T-cell responses. HNSCC cells have the ability to manipulate the immune system through a variety of different mechanisms, forcing it to promote tumor growth and spread. Over the last decade, discoveries in immunologic research resulted in increased understanding of complex interactions between HNSCC and the host immune system as well as T-cell regulatory mechanisms, promoting the development of a variety of novel immunotherapies. Following the availability of novel immunotherapeutic strategies, the challenge for clinicians is to understand how and in which clinical setting to use these agents in order to provide greater clinical benefit for patients. Combination of immunotherapies with standard treatment approaches also represents an evolving field of research. Herein, we provide a comprehensive review of immune escape mechanisms in HNSCC, as well as current immunotherapy approaches under investigation.
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Affiliation(s)
- P Economopoulou
- Department of Internal Medicine, Section of Medical Oncology, Attikon University Hospital, National Kapodistrian University of Athens, School of Medicine, Athens
| | - S Agelaki
- Department of Medical Oncology, University Hospital of Heraklion, Heraklion Laboratory of Tumor Biology, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - C Perisanidis
- Department of Maxillofacial and Oral Surgery, Medical University of Vienna, Vienna, Austria
| | - E I Giotakis
- Department of Otorhinolaryngology, Facial Plastic and Reconstructive Surgery, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - A Psyrri
- Department of Internal Medicine, Section of Medical Oncology, Attikon University Hospital, National Kapodistrian University of Athens, School of Medicine, Athens
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Marmary Y, Adar R, Gaska S, Wygoda A, Maly A, Cohen J, Eliashar R, Mizrachi L, Orfaig-Geva C, Baum BJ, Rose-John S, Galun E, Axelrod JH. Radiation-Induced Loss of Salivary Gland Function Is Driven by Cellular Senescence and Prevented by IL6 Modulation. Cancer Res 2016; 76:1170-80. [PMID: 26759233 DOI: 10.1158/0008-5472.can-15-1671] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 11/19/2015] [Indexed: 11/16/2022]
Abstract
Head and neck cancer patients treated by radiation commonly suffer from a devastating side effect known as dry-mouth syndrome, which results from the irreversible loss of salivary gland function via mechanisms that are not completely understood. In this study, we used a mouse model of radiation-induced salivary hypofunction to investigate the outcomes of DNA damage in the head and neck region. We demonstrate that the loss of salivary function was closely accompanied by cellular senescence, as evidenced by a persistent DNA damage response (γH2AX and 53BP1) and the expression of senescence-associated markers (SA-βgal, p19ARF, and DcR2) and secretory phenotype (SASP) factors (PAI-1 and IL6). Notably, profound apoptosis or necrosis was not observed in irradiated regions. Signs of cellular senescence were also apparent in irradiated salivary glands surgically resected from human patients who underwent radiotherapy. Importantly, using IL6 knockout mice, we found that sustained expression of IL6 in the salivary gland long after initiation of radiation-induced DNA damage was required for both senescence and hypofunction. Additionally, we demonstrate that IL6 pretreatment prevented both senescence and salivary gland hypofunction via a mechanism involving enhanced DNA damage repair. Collectively, these results indicate that cellular senescence is a fundamental mechanism driving radiation-induced damage in the salivary gland and suggest that IL6 pretreatment may represent a promising therapeutic strategy to preserve salivary gland function in head and neck cancer patients undergoing radiotherapy.
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Affiliation(s)
- Yitzhak Marmary
- Goldyne-Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Revital Adar
- Goldyne-Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Svetlana Gaska
- Goldyne-Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Annette Wygoda
- Department of Oncology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Alexander Maly
- Department of Pathology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Jonathan Cohen
- Department of Otolaryngology/Head and Neck Surgery, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Ron Eliashar
- Department of Otolaryngology/Head and Neck Surgery, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Lina Mizrachi
- Goldyne-Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Carmit Orfaig-Geva
- Goldyne-Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Bruce J Baum
- Molecular Physiology and Therapeutics Branch National Institute of Dental and Craniofacial Research, NIH, Bethesda, Maryland
| | - Stefan Rose-John
- Institut für Biochemie, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Eithan Galun
- Goldyne-Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Jonathan H Axelrod
- Goldyne-Savad Institute of Gene Therapy, Hadassah Hebrew University Hospital, Jerusalem, Israel.
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35
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Zhang H, Wang M, Shi T, Shen L, Liang L, Deng Y, Li G, Zhu J, Wu Y, Fan M, Deng W, Wei Q, Zhang Z. TNF rs1799964 as a Predictive Factor of Acute Toxicities in Chinese Rectal Cancer Patients Treated With Chemoradiotherapy. Medicine (Baltimore) 2015; 94:e1955. [PMID: 26559268 PMCID: PMC4912262 DOI: 10.1097/md.0000000000001955] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Acute toxicity is the main dose-limiting factor in the chemoradiotherapy of rectal cancer patients and depends on several pro-inflammatory factors, including interleukin-1 (IL-1), IL-6, and tumor necrosis factor-alpha (TNF-α). It is unknown whether genetic factors, such as single-nucleotide polymorphisms (SNPs) in the IL-1, IL-6, and TNF genes, are also associated with acute toxicity in the process.We genotyped 5 potentially functional SNPs in these 3 genes (TNF rs1799964, TNF rs1800629, IL-6 rs1800796, and IL-1 rs1143623, IL-1 rs1143627) and estimated their associations with severe acute radiation injury (grade ≥2) in 356 rectal cancer patients.We found a predictive role of the TNF rs1799964 T variant allele in the development of acute injury (for CT vs CC: adjusted odds ratio [OR] = 4.718, 95% confidence interval [CI] = 1.152-19.328, P = 0.031; for TT vs CC: adjusted OR = 4.443, 95% CI = 1.123-17.581, P = 0.034). In the dominant model, for CT/TT vs CC, the adjusted OR = 4.132, 95% CI = 1.069-15.966, and P = 0.04.Our results suggested that genetic variants in the TNF gene may influence acute injury in rectal cancer patients treated with chemoradiotherapy and may be a predictor for personalized treatment. Additional larger and independent studies are needed to confirm our findings.
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Affiliation(s)
- Hui Zhang
- From the Department of Radiation Oncology (HZ, LS, LL, GL, JZ, YW, MF, WD, ZZ); Cancer Institute, Fudan University Shanghai Cancer Center, Shanghai, China (MW, YD, QW); Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina (QW); Department of Obstetrics and Gynocology, Zhongshan Hospital (TS); and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China (HZ, MW, LS, LL, YD, GL, JZ, YW, MF, WD, ZZ)
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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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37
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Basso FG, Pansani TN, Soares DG, Scheffel DL, Bagnato VS, de Souza Costa CA, Hebling J. Biomodulation of Inflammatory Cytokines Related to Oral Mucositis by Low-Level Laser Therapy. Photochem Photobiol 2015; 91:952-6. [PMID: 25735212 DOI: 10.1111/php.12445] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 02/24/2015] [Indexed: 11/28/2022]
Abstract
This study evaluated the effects of LLLT on the expression of inflammatory cytokines related to the development of oral mucositis by gingival fibroblasts. Primary gingival fibroblasts were seeded on 24-well plates (10(5) cells/well) for 24 h. Fresh serum-free culture medium (DMEM) was then added, and cells were placed in contact with LPS (Escherichia coli, 1 μg mL(-1)), followed by LLLT irradiation (LaserTABLE-InGaAsP diode prototype-780 nm, 25 mW) delivering 0, 0.5, 1.5 or 3 J cm(-2)². Cells without contact with LPS were also irradiated with the same energy densities. Gene expression of TNF-α, IL-1β, IL-6 and IL-8 was evaluated by Real-Time PCR, and protein synthesis of these cytokines was determined by enzyme-linked immunosorbent (ELISA) assay. Data were statistically analyzed by the Kruskal-Wallis test, complemented by the Mann-Whitney test (P < 0.05). LPS treatment increased the gene expression and protein synthesis of TNF-α, IL-6 and IL-8, while the expression of IL-1β was not affected. For LPS-treated groups, LLLT promoted significant decreases in the expression of TNF-α, IL-6, and IL-8 at 1.5 J cm(-2) and 3 J cm(-2). These results demonstrate that LLLT promoted a beneficial biomodulatory effect on the expression of inflammatory cytokines related to oral mucositis by human gingival fibroblasts.
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Affiliation(s)
- Fernanda G Basso
- Araraquara School of Dentistry, UNESP - Univ. Estadual Paulista, Araraquara, Brazil
| | - Taisa N Pansani
- Araraquara School of Dentistry, UNESP - Univ. Estadual Paulista, Araraquara, Brazil
| | - Diana G Soares
- Araraquara School of Dentistry, UNESP - Univ. Estadual Paulista, Araraquara, Brazil
| | - Débora L Scheffel
- Araraquara School of Dentistry, UNESP - Univ. Estadual Paulista, Araraquara, Brazil
| | | | | | - Josimeri Hebling
- Araraquara School of Dentistry, UNESP - Univ. Estadual Paulista, Araraquara, Brazil
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Pre-therapy mRNA expression of TNF is associated with regimen-related gastrointestinal toxicity in patients with esophageal cancer: a pilot study. Support Care Cancer 2015; 23:3165-72. [PMID: 25814442 DOI: 10.1007/s00520-015-2696-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 03/09/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE Esophageal cancer has a high mortality rate, and its multimodality treatment is often associated with significant rates of severe toxicity. Effort is needed to uncover ways to maximize effectiveness of therapy through identification of predictive markers of response and toxicity. As such, the aim of this study was to identify genes predictive of chemoradiotherapy-induced gastrointestinal toxicity using an immune pathway-targeted approach. METHODS Adults with esophageal cancer treated with chemotherapy consisting of 5-fluorouracil and cisplatin and 45-50 Gy radiation were recruited to the study. Pre-therapy-collected whole blood was analyzed for relative expression of immune genes using real-time polymerase chain reaction (RT-PCR). Gene expression was compared between patients who experienced severe regimen-related gastrointestinal toxicity vs. those experiencing mild to moderate toxicity. RESULTS Blood from 31 patients were analyzed by RT-PCR. Out of 84 immune genes investigated, TNF was significantly elevated (2.05-fold, p = 0.025) in the toxic group (n = 12) compared to the non-toxic group (n = 19). Nausea and vomiting was the most commonly documented severe toxicity. No associations between toxicity and response, age, sex, histology, or treatment were evident. CONCLUSIONS This study supports evidence of TNF as a predictive biomarker in regimen-related gastrointestinal toxicity. Confirming these findings in a larger cohort is warranted.
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Piskunov AK, Nikitin KV, Potapov AA. Cellular and molecular mechanisms of radiation-induced brain injury: can peripheral markers be detected? ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2015; 79:90-96. [PMID: 25945381 DOI: 10.17116/neiro201579190-96] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Investigation of the mechanisms of radiation-induced brain injury is a relevant fundamental objective of radiobiology and neuroradiology. Damage to the healthy brain tissue is the key factor limiting the application of radiation therapy in patients with nervous systems neoplasms. Furthermore, postradiation brain injury can be clinically indiscernible from continued tumor growth and requires differential diagnosis. Thus, there exists high demand for biomarkers of radiation effects on the brain in neurosurgery and radiobiology. These markers could be used for better understanding and quantifying the effects of ionizing radiation on brain tissues, as well as for elaborating personalized therapy. Despite the high demand, biomarkers of radiation-induced brain injury have not been identified thus far. The cellular and molecular mechanisms of the effect of ionizing radiation on the brain were analyzed in this review in order to identify potential biomarkers of radiation-induced injury to nervous tissue.
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Affiliation(s)
- A K Piskunov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - K V Nikitin
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A A Potapov
- Burdenko Neurosurgical Institute, Moscow, Russia
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The relationship between oral mucositis and levels of pro-inflammatory cytokines in serum and in gingival crevicular fluid in allogeneic stem cell recipients. Support Care Cancer 2014; 23:1749-57. [DOI: 10.1007/s00520-014-2538-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 11/21/2014] [Indexed: 10/24/2022]
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Silva GBL, Sacono NT, Othon-Leite AF, Mendonça EF, Arantes AM, Bariani C, Duarte LGL, Abreu MHN, Queiroz-Júnior CM, Silva TA, Batista AC. Effect of low-level laser therapy on inflammatory mediator release during chemotherapy-induced oral mucositis: a randomized preliminary study. Lasers Med Sci 2014; 30:117-26. [PMID: 25037968 DOI: 10.1007/s10103-014-1624-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 06/22/2014] [Indexed: 01/09/2023]
Abstract
Patients undergoing hematopoietic stem cell transplantation (HSCT) are submitted to a conditioning regimen of high-dose chemotherapy, with or without radiation therapy, which usually results in oral ulcerations and mucosal barrier breakdown. Oral mucositis (OM) is a common and debilitating toxicity side effect of autologous and allogeneic HSCT. The aim of this study was to evaluate the effect of low-level laser therapy (LLLT) on the severity of OM and inflammatory mediator (TNF-α, IL-6, IL-1β, IL-10, TGF-β, metalloproteinases, and growth factors) levels in saliva and blood of HSCT patients. Thirty patients were randomly assigned to two groups: control (n = 15) and laser (n = 15). LLLT was applied from the first day of the conditioning regimen until day 7 post-HSCT (D + 7). Saliva and blood were collected from patients on admission (AD), D-1, D + 3, D + 7, and on marrow engraftment day (ME). Clinical results showed less severe OM in the laser group (p < 0.05). The LLLT group showed increased matrix metalloproteinase 2 (MMP-2) levels in saliva on D + 7 (p = 0.04). Significant differences were also observed for IL-10 on D + 7 and on ME in blood plasma, when compared to the control group (p < 0.05). No significant differences were seen in saliva or blood for the other inflammatory mediators investigated. LLLT was clinically effective in reducing the severity of chemotherapy-induced OM in HSCT patients, and its mechanism of action does not seem to be completely linked to the modulation of pro- or anti-inflammatory cytokines, growth factors or matrix metalloproteinases.
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Affiliation(s)
- Geisa Badauy Lauria Silva
- Hematopoietic Stem Cell Transplant Unit, Araújo Jorge Hospital, Associação de Combate ao Câncer de Goiás, Goiânia, Goiás, Brazil
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Lewis SL, Brody R, Touger-Decker R, Parrott JS, Epstein J. Feeding tube use in patients with head and neck cancer. Head Neck 2014; 36:1789-95. [DOI: 10.1002/hed.23538] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2013] [Indexed: 11/09/2022] Open
Affiliation(s)
- Sherri L. Lewis
- James A. Haley Veteran's Affairs Hospital; Tampa Florida
- University of Medicine and Dentistry of New Jersey; Newark New Jersey
| | - Rebecca Brody
- University of Medicine and Dentistry of New Jersey; School of Health Related Professions; Newark New Jersey
| | - Riva Touger-Decker
- University of Medicine and Dentistry of New Jersey; School of Health Related Professions; Newark New Jersey
| | - James S. Parrott
- University of Medicine and Dentistry of New Jersey; School of Health Related Professions; Newark New Jersey
| | - Joel Epstein
- City of Hope; Oral Medicine Division of Otolaryngology and Head and Neck Surgery; Duarte California
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Malnutrition assessment in patients with cancers of the head and neck: A call to action and consensus. Crit Rev Oncol Hematol 2013; 88:459-76. [DOI: 10.1016/j.critrevonc.2013.06.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 05/02/2013] [Accepted: 06/05/2013] [Indexed: 01/01/2023] Open
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Czerninski R, Basile JR, Kartin‐Gabay T, Laviv A, Barak V. Cytokines and tumor markers in potentially malignant disorders and oral squamous cell carcinoma: a pilot study. Oral Dis 2013; 20:477-81. [DOI: 10.1111/odi.12160] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 06/17/2013] [Accepted: 06/23/2013] [Indexed: 01/14/2023]
Affiliation(s)
- R Czerninski
- Department of Oral Medicine Hebrew University‐Hadassah School of Dental Medicine Jerusalem Israel
| | - JR Basile
- Department of Oncology and Diagnostic Sciences University of Maryland Dental School Baltimore MD USA
| | - T Kartin‐Gabay
- Department of Oral Medicine Hebrew University‐Hadassah School of Dental Medicine Jerusalem Israel
| | - A Laviv
- Department of Oral and Maxilifacial Surgery Hebrew University Hadassah, School of Dental Medicine Jerusalem Israel
| | - V Barak
- Immunology Laboratory for Tumor Diagnosis Hadassah Medical Center Jerusalem Israel
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Ye Y, Carlsson G, Agholme MB, Karlsson-Sjöberg J, Yucel-Lindberg T, Pütsep K, Modéer T. Pretherapeutic plasma pro- and anti- inflammatory mediators are related to high risk of oral mucositis in pediatric patients with acute leukemia: a prospective cohort study. PLoS One 2013; 8:e64918. [PMID: 23741421 PMCID: PMC3669020 DOI: 10.1371/journal.pone.0064918] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Accepted: 04/21/2013] [Indexed: 01/08/2023] Open
Abstract
Objective This prospective study evaluated clinical risk indicators as well as pro- and anti- inflammatory mediators at the time of malignancy diagnosis in relation to chemotherapy-related oral mucositis in pediatric population. Methods Patients (n = 104) under 18 years of age with primary malignancies and undergoing chemotherapy were included. Potential risk indicators were analyzed using binary logistic regression with oral mucositis as the outcome. In a subgroup (n = 35), plasma samples at the time of malignancy diagnosis were analyzed for inflammatory cytokines and an antimicrobial protein pro-LL-37 (hCAP18). Results In the multivariable model, type of malignancy diagnosis was significantly associated with oral mucositis, with highest risk of oral mucositis in patients with acute leukemia compared to those with lymphoma or solid tumors. At the time of malignancy diagnosis, plasma from patients with acute leukemia displayed higher concentrations (P<0.05) of IL-6, IL-8, IL-10, and TNF-α and lower levels of pro-LL-37 (P<0.001). Conclusions The results imply that pretherapeutic high levels of inflammatory cytokines and low levels of pro-LL-37 in plasma might contribute to the high incidence of oral mucositis in patients with acute leukemia. These findings may add to our understanding of the predispositions to oral mucositis in children with malignancies.
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Affiliation(s)
- Ying Ye
- Division of Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
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IBS, NERD and functional dyspepsia are immuno-neuronal disorders of mucosal cytokine imbalances clinically reversible with high potency sucralfate. Med Hypotheses 2012; 80:230-3. [PMID: 23265358 DOI: 10.1016/j.mehy.2012.11.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 11/25/2012] [Indexed: 02/08/2023]
Abstract
Irritable bowel syndrome (IBS), non-erosive reflux disorder (NERD), and functional dyspepsia (FD) are best classified as immuno-neuronal disorders of the mucosa or functional mucosal syndromes (FMS). Each appears to be clinically reversible using high potency sucralfate (HPS). In FMS of the GI tract, postprandial nausea, altered motility, discordant peristalsis, vomiting, diarrhea, and hyperalgesia are the clinical expressions of a mucosal imbalance between pro-inflammatory cytokines of up-regulated intra-epithelial lymphocytes (IELs) and feedback anti-inflammatory cytokines tasked with moderating the antigenic response of IELs. Normal functioning GI tract requires an operative balance between pro-inflammatory and anti-inflammatrory cytokines, a balance governed by locally expressed growth factors. The surface concentration of sucralfate can be enhanced 7-23-fold by suspending it in a select concentration of cations and multi-dentate cationic chelators. Increased surface concentration of sucralfate facilitates novel dose effects which include efficient activation of growth factors, quiescence of gated-nociceptor firing and resultant restoration of normal GI function.
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Multhoff G, Radons J. Radiation, inflammation, and immune responses in cancer. Front Oncol 2012; 2:58. [PMID: 22675673 PMCID: PMC3366472 DOI: 10.3389/fonc.2012.00058] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 05/18/2012] [Indexed: 12/12/2022] Open
Abstract
Chronic inflammation has emerged as one of the hallmarks of cancer. Inflammation also plays a pivotal role in modulating radiation responsiveness of tumors. As discussed in this review, ionizing radiation (IR) leads to activation of several transcription factors modulating the expression of numerous mediators in tumor cells and cells of the microenvironment promoting cancer development. Novel therapeutic approaches thus aim to interfere with the activity or expression of these factors, either in single-agent or combinatorial treatment or as supplements of the existing therapeutic concepts. Among them, NF-κB, STAT-3, and HIF-1 play a crucial role in radiation-induced inflammatory responses embedded in a complex inflammatory network. A great variety of classical or novel drugs including nutraceuticals such as plant phytochemicals have the capacity to interfere with the inflammatory network in cancer and are considered as putative radiosensitizers. Thus, targeting the inflammatory signaling pathways induced by IR offers the opportunity to improve the clinical outcome of radiation therapy by enhancing radiosensitivity and decreasing putative metabolic effects. Since inflammation and sex steroids also impact tumorigenesis, a therapeutic approach targeting glucocorticoid receptors and radiation-induced production of tumorigenic factors might be effective in sensitizing certain tumors to IR.
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Affiliation(s)
- Gabriele Multhoff
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München Munich, Germany
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Valdagni R, Vavassori V, Rancati T, Fellin G, Baccolini M, Bianchi C, Cagna E, Gabriele P, Mauro F, Menegotti L, Monti AF, Stasi M, Fiorino C. Increasing the risk of late rectal bleeding after high-dose radiotherapy for prostate cancer: The case of previous abdominal surgery. Results from a prospective trial. Radiother Oncol 2012; 103:252-5. [DOI: 10.1016/j.radonc.2012.03.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 03/23/2012] [Accepted: 03/26/2012] [Indexed: 11/25/2022]
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Machon C, Thezenas S, Dupuy AM, Assenat E, Michel F, Mas E, Senesse P, Cristol JP. Immunonutrition before and during radiochemotherapy: improvement of inflammatory parameters in head and neck cancer patients. Support Care Cancer 2012; 20:3129-35. [DOI: 10.1007/s00520-012-1444-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 03/12/2012] [Indexed: 01/09/2023]
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Meyer F, Fortin A, Wang CS, Liu G, Bairati I. Predictors of Severe Acute and Late Toxicities in Patients With Localized Head-and-Neck Cancer Treated With Radiation Therapy. Int J Radiat Oncol Biol Phys 2012; 82:1454-62. [DOI: 10.1016/j.ijrobp.2011.04.022] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 02/16/2011] [Accepted: 04/08/2011] [Indexed: 11/12/2022]
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