The relationship between oral mucositis and levels of pro-inflammatory cytokines in serum and in gingival crevicular fluid in allogeneic stem cell recipients.

PURPOSE: Oral mucositis (OM) is a severe side effect of conditioning for allogeneic hematopoietic stem cell transplantation (HSCT). The aim of the present study was to investigate the relationship between oral mucositis and the levels of pro-inflammatory cytokines-both in serum and in gingival crevicular fluid (GCF), in relation to different conditioning regimens. METHODS: We analyzed the levels of pro-inflammatory cytokines IL-1ß, TNF-α, IL-6, and IL-7, as well as anti-inflammatory cytokine IL-10 in gingival crevicular fluid (GCF) and in serum from 43 HSCT patients. Twenty-five received reduced intensity conditioning (RIC) and 18 received myeloablative conditioning (MAC). Cytokine levels were determined in GCF and serum before the start of conditioning, and 1 week and 1 month after HSCT. All patients experienced OM with a median score of 2.1 and median peak on day 11. RESULTS: There was a significant correlation between OM and MAC (p = 0.035). There were no significant differences in GCF volume at the three time points examined. The levels of IL-6 in GCF increased 1 week after transplantation and then returned to baseline (p < 0.001). The levels of IL-10 in GCF decreased after HSCT (p < 0.001) and remained unchanged. The levels of IL-6 in serum significantly (p < 0.001) increased 1 week after HSCT and decreased to baseline levels after 1 month. The levels of IL-10 in serum significantly (p = 0.02) increased 1 month after HSCT. CONCLUSION: No correlations between cytokine levels in gingival crevicular fluid and oral mucositis were observed. There was a correlation between severity of OM score and increase in IL-6 in serum. No correlations between cytokine levels in gingival crevicular fluid and in serum were observed.

Reduced intensity conditioning and oral care measures prevent oral mucositis and reduces days of hospitalization in allogeneic stem cell transplantation recipients.

PURPOSE: Oral mucositis (OM) is a side effect of intensive chemotherapy and radiation and has been reported to affect 75-100% of hematopoietic stem cell transplantation (HSCT) recipients. The purpose of this study was to compare the incidence of OM in patients conditioned with myeloablative conditioning (MAC) to reduced-intensity conditioning (RIC) and to determine the effect of a new oral care protocol. METHODS: The study involved 171 HSCT recipients, with hematological malignancies transplanted between 2007 and 2011. Median age of the patients was 50 years (range 12-71). Ninety-nine (58%) received RIC and 72 received MAC. Clinical features of OM were recorded from day -3 before to day +25 after HSCT using the World Health Organization (WHO) scoring system and the oral mucositis assessment score (OMAS). RESULTS: Overall, 87% of the patients developed OM of any severity, which peaked on days 10-11. The mean WHO score was 1.7. In multivariate analysis, the severity of OM was associated with MAC (relative hazard (RH) 1.57, 95% confidence interval (CI) 1.37-1.80, p < 0.001), all donor-recipient gender combinations except female-to-male (RH = 1.26, 95% CI 1.10-1.4, p = 0.001), and early year of HSCT (RH = 0.84, 95%CI 0.7-0.96, p = 0.013). There was a correlation between long hospitalization and OM (day 15, r = 0.31, p < 0.001). There was a good correlation between the WHO and OMAS scoring systems for OM (r = 0.74, p < 0.001). CONCLUSIONS: Oral mucositis was reduced in patients treated with RIC and in patients treated during recent years, when oral care was intensified. Increased scores of OM prolonged hospitalization.

Experimental endocarditis in the rat secondary to septic arthritis induced by Staphylococcus aureus.

OBJECTIVE: To develop a modified model for experimental infective endocarditis (IE) in the rat. The goal was to induce a primary infectious focus in the temporomandibular joint (TMJ) of a rat. Hematogenous translocation of the bacteria to the traumatized aortic valve was desired. METHODS: Catheterization of the right carotid artery through the aortic valve was performed 7 days after induction of arthritis, which was done by intra-articular injection of glucocorticosteroid (triamcinolone acetonide, 1 mg) and intravenous challenge with 107 CFU Staphylococcus aureus. RESULTS: TMJ arthritis could be induced by intra-articular triamcinolone acetonide followed by intravenous bacterial challenge. Joints not given glucocorticosteroid were not affected. Only rats with arthritis developed IE subsequent to catheterization as a result of bacteremia generated from the arthritis. CONCLUSIONS: The present model may serve as a complement to the conventional method for induction of IE, in which a high intravenous challenge has to be given. In the present model, IE was instead the result of a continuous low level of bacteremia from an infectious focus in the TMJ. This model mimics the natural development of IE in patients, and may assist as a setting for prophylactic and therapeutic trials.