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van Leeuwen SJM, Proctor GB, Staes A, Laheij AMGA, Potting CMJ, Brennan MT, von Bültzingslöwen I, Rozema FR, Hazenberg MD, Blijlevens NMA, Raber-Durlacher JE, Huysmans MCDNJM. The salivary proteome in relation to oral mucositis in autologous hematopoietic stem cell transplantation recipients: a labelled and label-free proteomics approach. BMC Oral Health 2023; 23:460. [PMID: 37420206 PMCID: PMC10329372 DOI: 10.1186/s12903-023-03190-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/30/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Oral mucositis is a frequently seen complication in the first weeks after hematopoietic stem cell transplantation recipients which can severely affects patients quality of life. In this study, a labelled and label-free proteomics approach were used to identify differences between the salivary proteomes of autologous hematopoietic stem cell transplantation (ASCT) recipients developing ulcerative oral mucositis (ULC-OM; WHO score ≥ 2) or not (NON-OM). METHODS In the TMT-labelled analysis we pooled saliva samples from 5 ULC-OM patients at each of 5 timepoints: baseline, 1, 2, 3 weeks and 3 months after ASCT and compared these with pooled samples from 5 NON-OM patients. For the label-free analysis we analyzed saliva samples from 9 ULC-OM and 10 NON-OM patients at 6 different timepoints (including 12 months after ASCT) with Data-Independent Acquisition (DIA). As spectral library, all samples were grouped (ULC-OM vs NON-OM) and analyzed with Data Dependent Analysis (DDA). PCA plots and a volcano plot were generated in RStudio and differently regulated proteins were analyzed using GO analysis with g:Profiler. RESULTS A different clustering of ULC-OM pools was found at baseline, weeks 2 and 3 after ASCT with TMT-labelled analysis. Using label-free analysis, week 1-3 samples clustered distinctly from the other timepoints. Unique and up-regulated proteins in the NON-OM group (DDA analysis) were involved in immune system-related processes, while those proteins in the ULC-OM group were intracellular proteins indicating cell lysis. CONCLUSIONS The salivary proteome in ASCT recipients has a tissue protective or tissue-damage signature, that corresponded with the absence or presence of ulcerative oral mucositis, respectively. TRIAL REGISTRATION The study is registered in the national trial register (NTR5760; automatically added to the International Clinical Trial Registry Platform).
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Affiliation(s)
- S J M van Leeuwen
- Department of Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - G B Proctor
- Centre for Host Microbiome Interactions, King's College London Dental Institute, London, UK
| | - A Staes
- VIB Proteomics Core, VIB Center for Medical Biotechnology, Ghent, Belgium
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - A M G A Laheij
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C M J Potting
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M T Brennan
- Department of Oral Medicine/Oral and Maxillofacial Surgery, Atrium Health Carolinas Medical Centre, NC, Charlotte, USA
- Department of Otolaryngology/Head and Neck Surgery, Wake Forest University School of Medicine, NC, Winston-Salem, USA
| | - I von Bültzingslöwen
- Department of Oral Microbiology and Immunology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - F R Rozema
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M D Hazenberg
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Hematopoiesis, Sanquin Research, Amsterdam, The Netherlands
| | - N M A Blijlevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J E Raber-Durlacher
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M C D N J M Huysmans
- Department of Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
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van Leeuwen SJM, Proctor GB, Laheij AMGA, Potting CMJ, Smits O, Bronkhorst EM, Hazenberg MD, Haverman TM, Brennan MT, von Bültzingslöwen I, Raber-Durlacher JE, Huysmans MCDNJM, Rozema FR, Blijlevens NMA. Significant salivary changes in relation to oral mucositis following autologous hematopoietic stem cell transplantation. Bone Marrow Transplant 2021; 56:1381-1390. [PMID: 33420397 PMCID: PMC8189903 DOI: 10.1038/s41409-020-01185-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 11/23/2020] [Accepted: 12/01/2020] [Indexed: 11/15/2022]
Abstract
The aim of this multicentre, longitudinal study was to determine salivary changes in relation to oral mucositis (OM) in multiple myeloma patients following high-dose melphalan and autologous hematopoietic stem cell transplantation (ASCT). Unstimulated and stimulated whole-mouth saliva samples (UWS and SWS) were collected before ASCT, 1×/wk during the hospitalisation phase, and 3 and 12 months post-ASCT. During the hospitalisation period OM was scored 3×/wk (WHO system). Flow rate, pH, total protein concentration (Nanodrop), albumin, lactoferrin, neutrophil defensin-1 (HNP1), total IgA and S100A8/A9 (ELISA) were determined. Mixed models were used to evaluate differences between ulcerative (u)OM (≥2 WHO, n = 20) and non-uOM (n = 31) groups. Until 18 days after ASCT, flow rate, pH, total IgA and HNP1 levels decreased in UWS and/or SWS, while log lactoferrin levels were significantly increased (UWS: p = 0.016 95% CI [0.36, 3.58], SWS: p < 0.001 95% CI [1.14, 3.29]). Twelve months post-ASCT, salivary protein levels were similar to baseline except for log total IgA, which was higher (UWS: p < 0.001 95% CI [0.49, 1.29], SWS: p < 0.001 95% CI [0.72, 1.45]). No differences between uOM and non-uOM groups were observed. Changes in salivary proteins indicated an inflammatory reaction in salivary glands coinciding with mucosal and systemic reactions in response to high-dose melphalan.
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Affiliation(s)
- S J M van Leeuwen
- Radboud Institute for Health Sciences, Department of Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - G B Proctor
- Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College, London, UK
| | - A M G A Laheij
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands.,Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - C M J Potting
- Radboud Institute for Health Sciences, Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - O Smits
- Radboud Institute for Health Sciences, Department of Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - E M Bronkhorst
- Radboud Institute for Health Sciences, Department of Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M D Hazenberg
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - T M Haverman
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - M T Brennan
- Department of Oral Medicine, Atrium Health's Carolinas Medical Centre, Charlotte, NC, USA
| | - I von Bültzingslöwen
- Department of Oral Microbiology and Immunology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J E Raber-Durlacher
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M C D N J M Huysmans
- Radboud Institute for Health Sciences, Department of Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - F R Rozema
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - N M A Blijlevens
- Radboud Institute for Health Sciences, Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
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Potting CMJ, Uitterhoeve R, Op Reimer WS, Van Achterberg T. The effectiveness of commonly used mouthwashes for the prevention of chemotherapy-induced oral mucositis: a systematic review. Eur J Cancer Care (Engl) 2006; 15:431-9. [PMID: 17177899 DOI: 10.1111/j.1365-2354.2006.00684.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Daily chlorhexidine mouthwash is often recommended for preventing chemotherapy-induced oral mucositis. Povidone-iodine, NaCl 0.9%, water salt soda solution and chamomile mouthwash are also recommended. However, the effectiveness of these mouthwashes is unclear. Therefore, we performed a systematic review to assess the effectiveness of mouthwashes in preventing and ameliorating chemotherapy-induced oral mucositis. Based on study quality, three out of five randomized controlled trials were included in a meta-analysis. The results failed to detect any beneficial effects of chlorhexidine as compared with sterile water, or NaCl 0.9%. Patients complained about negative side-effects of chlorhexidine, including teeth discoloration and alteration of taste in two of the five studies on chlorhexidine. The severity of oral mucositis was shown to be reduced by 30% using a povidone-iodine mouthwash as compared with sterile water in a single randomized controlled trial. These results do not support the use of chlorhexidine mouthwash to prevent oral mucositis.
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Affiliation(s)
- C M J Potting
- Department of Haematology, Radboud University Nijmegen Medical Centre, the Netherlands.
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Potting CMJ, Blijlevens NAM, Donnelly JP, Feuth T, Van Achterberg T. A scoring system for the assessment of oral mucositis in daily nursing practice. Eur J Cancer Care (Engl) 2006; 15:228-34. [PMID: 16882117 DOI: 10.1111/j.1365-2354.2005.00644.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nurses take care of patients around the clock, so they are in an ideal position to observe and record the signs and symptoms of oral mucositis. This requires a valid, reliable scoring instrument that is easy to use. The objectives of this study were to summarize the scoring instruments that are available, to develop a new Nijmegen Nursing Mucositis Scoring System (NNMSS) and to evaluate this new instrument. A systematic review was undertaken in which 21 scoring instruments were reviewed and compared. None of the instruments studied satisfied the criteria that were established beforehand. The six most common items from the systematic review were selected for the new instrument. To test the NNMSS, pairs of experienced nurses assessed the oral cavity of 26 patients independently. Inter-observer reliability (Kappa), correlation between items (Spearman's rank-order correlations) and internal consistency of the instrument (Cronbach's alpha) were calculated. The usability was evaluated with a questionnaire. Cohen's weighted Kappa was within an acceptable range. Almost all correlations were statistically significant and in the predicted direction. The Cronbach's alpha coefficient indicated sufficient internal consistency. All nurses found the NNMSS user-friendly and suitable for day-to-day care. The NNMSS can be used as a valid, reliable and usable instrument in daily nursing practice.
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Affiliation(s)
- C M J Potting
- The Department of Haematology, Radboud University, Nijmegen Medical Centre, Nijmegen, the Netherlands.
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