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European Journal of Cancer (Oxford,... Sep 2021To update the 2015 clinical practice guideline for the prevention of oral mucositis in pediatric cancer or hematopoietic stem cell transplant (HSCT) patients. (Review)
Review
PURPOSE
To update the 2015 clinical practice guideline for the prevention of oral mucositis in pediatric cancer or hematopoietic stem cell transplant (HSCT) patients.
METHODS
We performed seven systematic reviews of mucositis prevention. Three reviews included randomized controlled trials (RCTs) conducted in pediatric and adult patients evaluating cryotherapy, keratinocyte growth factor (KGF) or photobiomodulation therapy with a focus on efficacy. Three reviews included studies of any design conducted in pediatric patients evaluating these same interventions with a focus on adverse events and feasibility. One review included all RCTs of any intervention for mucositis prevention in pediatric patients. Primary outcome was severe oral mucositis.
RESULTS
We included 107 unique studies of cryotherapy (22 RCTs and 4 pediatric studies); KGF (15 RCTs and 12 pediatric studies); photobiomodulation therapy (29 RCTs and 8 pediatric studies) and any intervention (31 pediatric RCTs). Effects on severe mucositis reduction from RCTs were cryotherapy risk ratio (RR) 0.49 and 95% confidence interval (CI) 0.31-0.76; palifermin RR 0.81 and 95% CI 0.69-0.95 and photobiomodulation therapy RR 0.40 and 95% CI 0.27-0.60. Cryotherapy was not feasible in young children while photobiomodulation therapy was feasible across age groups. Palifermin was associated with adverse effects.
CONCLUSIONS
Cryotherapy should be used for older cooperative pediatric patients who will receive short infusions of melphalan or 5-fluorouracil. Intraoral photobiomodulation therapy (620-750 nm spectrum) should be used in pediatric patients undergoing autologous or allogeneic HSCT and for pediatric head and neck carcinoma patients undergoing radiotherapy. Palifermin should not be used routinely in pediatric cancer or HSCT patients.
Topics: Adult; Child; Cryotherapy; Hematopoietic Stem Cell Transplantation; Humans; Low-Level Light Therapy; Neoplasms; Oropharynx; Practice Guidelines as Topic; Radiotherapy; Stomatitis
PubMed: 34252760
DOI: 10.1016/j.ejca.2021.05.013 -
Cell Sep 2021SARS-CoV-2 infection can cause severe respiratory COVID-19. However, many individuals present with isolated upper respiratory symptoms, suggesting potential to constrain...
SARS-CoV-2 infection can cause severe respiratory COVID-19. However, many individuals present with isolated upper respiratory symptoms, suggesting potential to constrain viral pathology to the nasopharynx. Which cells SARS-CoV-2 primarily targets and how infection influences the respiratory epithelium remains incompletely understood. We performed scRNA-seq on nasopharyngeal swabs from 58 healthy and COVID-19 participants. During COVID-19, we observe expansion of secretory, loss of ciliated, and epithelial cell repopulation via deuterosomal cell expansion. In mild and moderate COVID-19, epithelial cells express anti-viral/interferon-responsive genes, while cells in severe COVID-19 have muted anti-viral responses despite equivalent viral loads. SARS-CoV-2 RNA host-target cells are highly heterogenous, including developing ciliated, interferon-responsive ciliated, AZGP1 goblet, and KRT13 "hillock"-like cells, and we identify genes associated with susceptibility, resistance, or infection response. Our study defines protective and detrimental responses to SARS-CoV-2, the direct viral targets of infection, and suggests that failed nasal epithelial anti-viral immunity may underlie and precede severe COVID-19.
Topics: Adult; Aged; Bystander Effect; COVID-19; Cohort Studies; Female; Humans; Immunity; Male; Middle Aged; Nasopharynx; RNA, Viral; Respiratory Mucosa; SARS-CoV-2; Severity of Illness Index; Transcription, Genetic; Viral Load
PubMed: 34352228
DOI: 10.1016/j.cell.2021.07.023 -
Developmental and Comparative Immunology Aug 2021Immunoglobulins (Igs) are complex glycoproteins that play critical functions in innate and adaptive immunity of all jawed vertebrates. Given the unique characteristics... (Review)
Review
Immunoglobulins (Igs) are complex glycoproteins that play critical functions in innate and adaptive immunity of all jawed vertebrates. Given the unique characteristics of mucosal barriers, secretory Igs (sIgs) have specialized to maintain homeostasis and keep pathogens at bay at mucosal tissues from fish to mammals. In teleost fish, the three main IgH isotypes, IgM, IgD and IgT/Z can be found in different proportions at the mucosal secretions of the skin, gills, gut, nasal, buccal, and pharyngeal mucosae. Similar to the role of mammalian IgA, IgT plays a predominant role in fish mucosal immunity. Recent studies in IgT have illuminated the primordial role of sIgs in both microbiota homeostasis and pathogen control at mucosal sites. Ten years ago, IgT was discovered to be an immunoglobulin class specialized in mucosal immunity. Aiming at this 10-year anniversary, the goal of this review is to summarize the current status of the field of fish Igs since that discovery, while identifying knowledge gaps and future avenues that will move the field forward in both basic and applied science areas.
Topics: Animals; Fish Diseases; Fish Proteins; Fishes; Immunity, Mucosal; Immunoglobulins; Lymphoid Tissue; Mucous Membrane; Vaccination
PubMed: 33785432
DOI: 10.1016/j.dci.2021.104079 -
Frontiers in Immunology 2020Due to direct contact with aquatic environment, mucosal surfaces of teleost fish are continuously exposed to a vast number of pathogens and also inhabited by high... (Review)
Review
Due to direct contact with aquatic environment, mucosal surfaces of teleost fish are continuously exposed to a vast number of pathogens and also inhabited by high densities of commensal microbiota. The B cells and immunoglobulins within the teleost mucosa-associated lymphoid tissues (MALTs) play key roles in local mucosal adaptive immune responses. So far, three Ig isotypes (i.e., IgM, IgD, and IgT/Z) have been identified from the genomic sequences of different teleost fish species. Moreover, teleost Igs have been reported to elicit mammalian-like mucosal immune response in six MALTs: gut-associated lymphoid tissue (GALT), skin-associated lymphoid tissue (SALT), gill-associated lymphoid tissue (GIALT), nasal-associated lymphoid tissue (NALT), and the recently discovered buccal and pharyngeal MALTs. Critically, analogous to mammalian IgA, teleost IgT represents the most ancient Ab class specialized in mucosal immunity and plays indispensable roles in the clearance of mucosal pathogens and the maintenance of microbiota homeostasis. Given these, this review summarizes the current findings on teleost Igs, MALTs, and their immune responses to pathogenic infection, vaccination and commensal microbiota, with the purpose of facilitating future evaluation and rational design of fish vaccines.
Topics: Animals; Fish Diseases; Fish Proteins; Fishes; Gills; Host-Pathogen Interactions; Immunity, Mucosal; Immunization; Immunoglobulin D; Immunoglobulin M; Immunoglobulins; Lymphoid Tissue; Microbiota; Mucous Membrane; Organ Specificity; Peyer's Patches; Vaccination
PubMed: 33123139
DOI: 10.3389/fimmu.2020.567941 -
Ear, Nose, & Throat Journal Jul 2020
Topics: Cheek; Diagnosis, Differential; Female; Humans; Medical Illustration; Middle Aged; Mucositis; Palate, Soft; Pharyngeal Diseases; Pharynx; Plasma Cells; Singing
PubMed: 31072192
DOI: 10.1177/0145561319849001 -
The Oncologist Aug 2008Unplanned radiation treatment breaks and prolongation of the radiation treatment time are associated with lower survival and locoregional control rates when radiotherapy... (Review)
Review
Unplanned radiation treatment breaks and prolongation of the radiation treatment time are associated with lower survival and locoregional control rates when radiotherapy or concurrent chemoradiotherapy is used in the curative treatment of head and neck cancer. Treatment of head and neck cancer is intense, involving high-dose, continuous radiotherapy, and often adding chemotherapy to radiotherapy. As the intensity of treatment regimens has escalated in recent years, clinical outcomes generally have improved. However, more intensive therapy also increases the incidence of treatment-related toxicities, particularly those impacting the mucosal lining of the oral cavity, pharynx, and cervical esophagus, and results in varying degrees of ulcerative mucositis. Ulcerative mucositis is a root cause of unscheduled radiation treatment breaks, which prolongs the total radiation treatment time. Alterations in radiotherapy and chemotherapy, including the use of continuous (i.e., 7 days/week) radiotherapy to ensure constant negative proliferative pressure, may improve efficacy outcomes. However, these approaches also increase the incidence of ulcerative mucositis, thereby increasing the incidence of unplanned radiation treatment breaks. Conversely, the reduction of ulcerative mucositis to minimize unplanned breaks in radiotherapy may enhance not only tolerability, but also efficacy outcomes. Several strategies to prevent ulcerative mucositis in radiotherapy for head and neck cancer have been evaluated, but none have demonstrated strong efficacy. Continued investigation is needed to identify superior radiation treatment regimens, technology, and supportive care that reduce unplanned radiation treatment breaks with the goal of improving clinical outcomes in head and neck cancer.
Topics: Carcinoma, Squamous Cell; Dose-Response Relationship, Radiation; Head and Neck Neoplasms; Humans; Mouth Mucosa; Oral Ulcer; Radiotherapy Dosage; Stomatitis; Time Factors; Treatment Outcome; Withholding Treatment
PubMed: 18701763
DOI: 10.1634/theoncologist.2008-0024 -
Wiadomosci Lekarskie (Warsaw, Poland :... 2021Intensive studies on properties of synthetic compounds are simultaneously conducted with studies on the effectiveness and safety of drugs derived from natural compounds.... (Review)
Review
Intensive studies on properties of synthetic compounds are simultaneously conducted with studies on the effectiveness and safety of drugs derived from natural compounds. These drugs have been effectively used for years in dentistry, in treatment of inflammatory conditions of the oral cavity and in laryngology, in treatment of pharyngeal inflammatory conditions. The subject of this article is a compilation of studies conducted on medicinal products containing composed ethanolic extract as an active substance, and obtained from: chamomile capitulum (Matricaria recutita L.), oak bark (Quercus spp.), sage leaf (Salvia officinalis L.), arnica herb (Arnica spp.), calamus rhizome (Acorus calamus L.), peppermint herb (Mentha piperita L.), thyme herb (Thymus spp.) Preclinical studies confirmed that a particular tested plant extract exhibits antimicrobial (antibacterial, antifungal and antiprotozoal) as well as anti-inflammatory, immunomodulatory and astringent properties. Under clinical conditions, it was confirmed that drugs containing the analysed extract used in periodontology, in prevention and complex treatment of gingivitis, periodontitis as well as diseases of oral mucosa (but also the throat) of viral, bacterial, fungal and protozoal aetiology significantly improved the effectiveness of therapy, shortened the treatment and improved the patients' quality of life. The above preparations used in dental surgery contributed to faster tissue regeneration, more quickly relieved pain and swelling after a surgery or difficult dentition. Furthermore, drugs containing the above-mentioned extract can also be successfully used for oral cavity decontamination in the case of various diseases of teeth or the oral and pharyngeal mucosa. The tested composed herbal extract (CHE), applied in the form of a mouthwash and in the form for topical application with benzocaine content (CHEB), is a component of drugs which are great alternatives to widely used synthetic drugs. They are characterised with high effectiveness, comparable to that of synthetic agents, and a higher safety profile. Results of pharmacological and clinical studies justify their use in both prevention and treatment of inflammatory diseases of the gums, periodontium, oral cavity and pharynx.
Topics: Gingivitis; Humans; Mucous Membrane; Pharynx; Plant Extracts
PubMed: 34459780
DOI: No ID Found -
Journal of Cancer Research and... Apr 2023This study aimed to estimate the fitting parameters of sigmoidal dose-response (SDR) curve of radiation-induced acute oral and pharyngeal mucositis in head-and-neck (H...
PURPOSE/OBJECTIVE(S)
This study aimed to estimate the fitting parameters of sigmoidal dose-response (SDR) curve of radiation-induced acute oral and pharyngeal mucositis in head-and-neck (H and N) cancer patients treated with Intensity Modulated Radiation Therapy (IMRT) for the calculation of normal tissue complication probability (NTCP).
MATERIALS AND METHODS
Thirty H-and-N cancer patients were enrolled to model the SDR curve for oral and pharyngeal mucositis. The patients were evaluated weekly for acute radiation-induced (ARI) oral and pharyngeal mucositis toxicity, and their scoring was performed as per the common terminology criteria adverse events version 5.0. The radiobiological parameters, namely n, m, TD50, and γ50 were calculated from the fitted SDR curve obtained from the clinical data of H-and-N cancer patients.
RESULTS
ARI toxicity for oral and pharyngeal mucosa in carcinoma of H-and-N cancer patients was calculated for the endpoint oral mucositis and pharyngeal mucositis. The n, m, TD50, and γ50 parameters from the SDR curve of Grade 1 and Grade 2 oral mucositis were found to be [0.10, 0.32, 12.35 ± 3.90 (confidence interval [CI] 95%) and 1.26] and [0.06, 0.33, 20.70 ± 6.95 (CI 95%) and 1.19] respectively. Similarly for pharyngeal mucositis, n, m, TD50, and γ50 parameters for Grade 1 and Grade 2 were found to be [0.07, 0.34, 15.93 ± 5.48 (CI. 95%) and 1.16 ] and [0.04, 0.25, 39.02 ± 9.98(CI. 95%) and 1.56] respectively.
CONCLUSION
This study presents the fitting parameters for NTCP calculation of Grade 1 and Grade 2 ARI toxicity for the endpoint of oral and pharyngeal mucositis. The provided nomograms of volume versus complication and dose versus complication for different grades of oral mucositis and pharyngeal mucositis help radiation oncologists to decide the limiting dose to reduce the acute toxicities.
Topics: Humans; Mucositis; Stomatitis; Head and Neck Neoplasms; Radiotherapy, Intensity-Modulated; Radiation Injuries; Mouth Mucosa; Carcinoma, Squamous Cell
PubMed: 37147947
DOI: 10.4103/jcrt.jcrt_504_21 -
Developmental and Comparative Immunology Mar 2019The human olfactory system is a mucosal surface and a major portal of entry for respiratory and neurotropic pathogens into the body. Understanding how the human... (Comparative Study)
Comparative Study Review
The human olfactory system is a mucosal surface and a major portal of entry for respiratory and neurotropic pathogens into the body. Understanding how the human nasopharynx-associated lymphoid tissue (NALT) halts the progression of pathogens into the lower respiratory tract or the central nervous system is key for developing effective cures. Although traditionally mice have been used as the gold-standard model for the study of human nasal diseases, mouse models present important caveats due to major anatomical and functional differences of the human and murine olfactory system and NALT. We summarize the NALT anatomy of different animal groups that have thus far been used to study host-pathogen interactions at the olfactory mucosa and to test nasal vaccines. The goal of this review is to highlight the strengths and limitations of each animal model of nasal immunity and to identify the areas of research that require further investigation to advance human health.
Topics: Animals; Disease Models, Animal; Host-Pathogen Interactions; Humans; Immunity; Infections; Lymphoid Tissue; Mice; Nasopharynx; Nose Diseases; Olfactory Bulb; Olfactory Mucosa
PubMed: 30513304
DOI: 10.1016/j.dci.2018.11.022 -
International Journal of... Oct 2011Adenoids are constantly exposed to viral and bacterial agents as well as to allergens. They play a major role in the upper airways immunity, being effector organs in... (Review)
Review
Adenoids are constantly exposed to viral and bacterial agents as well as to allergens. They play a major role in the upper airways immunity, being effector organs in both mucosal-type and systemic-type adaptive immunity. Because of both their immunological function and their specific location, adenoids are considered to be as reservoirs of viruses and bacteria. Reiterative infections may therefore contribute both to Eustachian tube dysfunction and to tissue hypertrophy. Nasal endoscopy is a key diagnostic tool to detect both adenoid hypertrophy and adenoiditis. Moreover, such a procedure may be very helpful in detecting bacterial biofilms that could justify the concomitant presence of recurrent episodes of otitis media, chronic and occult sinusitis in children. Even though the connection between allergies and adenoidal diseases is not completely clear, allergic diseases cause an inflammatory state that influences adenoidal tissue as well, configuring the picture of allergic adenoiditis, a condition in which adenoid tissue exhibit numerous IgE positive mast cells. Several studies are still needed to better understand the relationship between allergies and infections and the influence they play on adenoids during childhood.
Topics: Adenoids; Child; Endoscopy; Humans; Hypersensitivity; Otitis Media; Sinusitis
PubMed: 22032778
DOI: 10.1177/03946320110240S401