Functional impairment in submandibular gland of rats induced by 5-fluorouracil and calcium leucovorin.

One of the main clinical problems during chemotherapy is the occurrence of severe systemic toxicities, including those related to the stomatognathic system, which contribute to reducing the patient's quality of life. The most frequent oral complications are mucositis, dysgeusia, inflammation, gingival bleeding and decreased salivary flow or hyposalivation, a factor that predisposes to xerostomia, and other local complications that alter the homeostasis of the system. The purpose of this study was to evaluate the functional activity of salivary glands in Wistar rats subject to chemotherapy by measuring salivary flow, glycogen levels and glandular tissue response to autonomic nervous system agonists. Five experimental groups were used: 1) Control group fed "ad libitum"; 2) 5-fluorouracil (20 mg/kg body weight); 3) Calcium leucovorin (10 mg/kg body weight); 4) 5-fluorouracil + calcium leucovorin (20 and 10 mg/kg, respectively) by intraperitoneal injection for five consecutive days and 5) control with paired diet. Groups 1 and 5 did not receive drugs. Treatment with fluorouracil + leucovorin produced an increase in stimulated salivary flow and a higher response to increasing doses of beta agonists compared to other experimental groups. In both groups treated with cytostatic drugs, blocking of glycogen consumption at the end of the experimental period was observed. Our work suggests that salivary secretion may be affected by a dual mechanism: the first would be toxicity induced by 5-FU, which would cause depression of the process of glucose utilization. The second mechanism would affect the sympathetic autonomic reflex arc. In this instance, the synergistic action of 5-FU + LV would have a negative effect on the nerve activity with a reduction of salivary secretion. This would explain the hyposalivation, cited by several authors in patients undergoing the 5-FU + LV scheme in the treatment of colon carcinoma.

Functional impairment in submandibular gland of rats induced by 5-fluorouracil and calcium leucovorin

One of the main clinical problems during chemotherapy is the occurrence of severe systemic toxicities, including those related to the stomatognathic system, which contribute to reducing the patient's quality of life. The most frequent oral complications are mucositis, dysgeusia, inflammation, gingival bleeding and decreased salivary flow or hyposalivation, a factor that predisposes to xerostomia, and other local complications that alter the homeostasis of the system. The purpose of this study was to evaluate the functional activity of salivary glands in Wistar rats subject to chemotherapy by measuring salivary flow, glycogen levels and glandular tissue response to autonomic nervous system agonists. Five experimental groups were used: 1) Control group fed "ad libitum"; 2) 5-fluorouracil (20mg/ kg body weight); 3) Calcium leucovorin (10 mg/kg body weight); 4) 5-fluorouracil + calcium leucovorin (20 and 10 mg / kg, respectively) by intraperitoneal injection for five consecutive days and 5) control with paired diet. Groups 1 and 5 did not receive drugs. Treatment with fluorouracil + leucovorin produced an increase in stimulated salivary flow and a higher response to increasing doses of beta agonists compared to other experimental groups. In both groups treated with cytostatic drugs, blocking of glycogen consumption at the end of the experimental period was observed. Our work suggests that salivary secretion may be affected by a dual mechanism: the first would be toxicity induced by 5-FU, which would cause depression of the process of glucose utilization. The second mechanism would affect the sympathetic autonomic reflex arc. In this instance, the synergistic action of 5-FU + LV would have a negative effect on the nerve activity with a reduction of salivary secretion. This would explain the hyposalivation, cited by several authors in patients undergoing the 5-FU+LV scheme in the treatment of colon carcinoma.

Uno de los principales problemas clinicos durante la quimioterapia es la aparicion de graves efectos toxicos sistemicos, incluidos los relacionados con el sistema estomatognatico, que contribuyen a la reduccion de la calidad de vida del paciente. Las complicaciones orales mas frecuentes son la mucositis, disgeusia, inflamacion, sangrado gingival y la disminucion del flujo salival o hiposalivacion, un factor que predispone a la xerostomia, y otras complicaciones locales que alteran la homeostasis del sistema. El objetivo de este estudio fue evaluar la actividad funcional de las glandulas salivales de ratas Wistar sometidas a quimioterapia, a traves de la medicion del flujo salival, los niveles de glucogeno y la respuesta del tejido glandular a agonistas del sistema nervioso autonomo. Se utilizaron cinco grupos experimentales: 1) Control con alimentacion "ad libitum"; 2) 5 - fluorouracilo (20 mg / kg de peso corporal); 3) Leucovorina calcica (10 mg/ kg de peso corporal); 4) 5 - fluorouracilo + leucovorina calcica (20 y 10 mg / kg, respectivamente) por via intraperitoneal durante cinco dias consecutivos, y 5) control con dieta apareada. Grupos 1 y 5 no recibieron drogas. El tratamiento con 5 - fluorouracilo + leucovorina produjo un aumento de flujo salival estimulado y una mayor respuesta a dosis crecientes de agonistas beta en comparacion con otros grupos experimentales. En ambos grupos tratados con citostaticos, se observo bloqueo del consumo de glucogeno al final del periodo. Nuestro trabajo sugiere que la secrecion salival puede estar afectada por un doble mecanismo: el primero seria la toxicidad inducida por 5-FU que causaria depresion del proceso de utilizacion de la glucosa. El segundo mecanismo afectaria el arco reflejo autonomo simpatico. En este caso, la accion sinergica de ambos farmacos de 5-FU + LV repercutiria negativamente sobre la actividad nerviosa con una reduccion de la secrecion salival. Esto explicaria la hiposalivacion citada por varios autores en pacientes sometidos al esquema 5-FU + LV en el tratamiento del carcinoma colorrectal.

Oral signs of intravenous chemotherapy with 5-Fluorouracil and Leucovorin calcium in colon cancer treatment.

UNLABELLED: Several studies have shown how cytostatics may cause hypofunction of salivary glands but failed to elucidate any potentially related side effects. Keeping in mind the sialochemical assistance and the role of saliva on the homeostasis of the stomatognathic system, the aim of this study was to establish potential gland disorders in patients submitted to 5- Fluorouracil (5-Fu) and Leucovorin calcium (LV) as well as their correlation with certain oral health disorders that diminish the quality of life. MATERIALS AND METHODS: the focus of this research was observational and longitudinal. Twenty-five patients diagnosed with colon cancer at an initial, intermediate and late phase submitted to specifically devised therapy were assessed. Clinical history, oral health indexes and basal or stimulated saliva samples were recorded. RESULTS: Basal and stimulated flow dropped in the intermediate stage. Stimulated saliva pH decreased during treatment. On basal saliva, urea, sodium and potassium rose during the intermediate phase. Löe and Silness rates as well as simplified bleeding increased during therapy but reverted by the end of the treatment. Depth index of the vestibular gingival sulcus rose during the intermediate phase but did not return. CONCLUSION: This treatment caused functional salivary gland disorders as evidenced by basal and stimulated hyposialia, and acidification of stimulated saliva pH during the intermediate phase. Increase in basal urea may be due to proteic catabolism arising from plasma or glands. Variation in Na+ and K+ of basal saliva concentrates might be assumed as a possible duct disorder. Recovery of bleeding and Löe and Silness rates may point to a transient inflammatory effect associated to a decrease in salivary flow. Increase in the depth rates of the periodontal vestibular sulcus could be correlated with a higher risk of periodontal disease.