Nagler Rafael, Barness-Hadar Liat, Lieba Merav, Nagler Arnon
Oral and Maxillofacial Surgical Department, Oral Biochemistry Laboratory and Salivary Clinic, Rambam Medical Center, Faculty of Medicine, Technion Institute, Haifa, Israel.
Cancer Invest. 2006 Apr-May;24(3):269-77. doi: 10.1080/07357900600634013.
Stem cell transplantation (SCT)-related salivary gland injury and dysfunction result in local and systemic manifestations that may be long lasting and are associated with a high rate of morbidity and increased risk of infection. The salivary antioxidant system may have a major protective role. We, therefore, assessed salivary antioxidant capacity and function in 30 patients who had undergone SCT: 18 males and 12 females whose median age was 36 years (range: 7-58). Salivary gland function was assessed by sialometric and biochemistry means, which included measuring total protein, secretory IgA (SIgA) and the antioxidants peroxidase, uric acid (UA), and total antioxidant status (TAS) in the collected saliva. In patients who developed graft versus host disease (GVHD), we observed a significant decrease of the salivary flow rate, from 0.74 +/- 0.14 ml/minute to 0.19 +/- 0.08 ml/min, pre- and post-SCT, respectively (p < 0.01) with no recovery. In contrast, in patients who underwent autologous or allogeneic SCT and did not develop GVHD, salivary flow rates returned to normal 3-5 months posttransplantation. GVHD also resulted in a concomitant reduction of the salivary protein content and the salivary antioxidant capacity. The TAS levels in the saliva of the GVHD patients were found to be significantly reduced, to about one-third of the base-line value (P < 0.02). The concomitant reduction in salivary flow rate, protein content, and antioxidant capacity may well explain the GVHD-induced oral and gastrointestinal tract (GIT) mucositis, as the saliva constantly swallowed into the GIT losses its usual antioxidant protective roles. In conclusion, our findings may point at a possible new mechanism for the pathogenesis of oral and intestinal mucositis in pre-GVHD patients. Therapy with artificial saliva and free radical scavengers and/or antioxidants (administered either systemically or via oral rinses) thus, may be of clinical relevance.
干细胞移植（SCT）相关的唾液腺损伤和功能障碍会导致局部和全身表现，这些表现可能持续很长时间，且发病率高、感染风险增加。唾液抗氧化系统可能具有主要的保护作用。因此，我们评估了30例接受SCT患者的唾液抗氧化能力和功能：18例男性和12例女性，中位年龄为36岁（范围：7 - 58岁）。通过唾液测量和生化方法评估唾液腺功能，包括测量收集唾液中的总蛋白、分泌型免疫球蛋白A（SIgA）以及抗氧化剂过氧化物酶、尿酸（UA）和总抗氧化状态（TAS）。在发生移植物抗宿主病（GVHD）的患者中，我们观察到唾液流速显著降低，SCT前后分别从0.74±0.14毫升/分钟降至0.19±0.08毫升/分钟（p < 0.01），且未恢复。相比之下，接受自体或异基因SCT且未发生GVHD的患者，唾液流速在移植后3 - 5个月恢复正常。GVHD还导致唾液蛋白含量和唾液抗氧化能力同时降低。发现GVHD患者唾液中的TAS水平显著降低，降至基线值的约三分之一（P < 0.02）。唾液流速、蛋白含量和抗氧化能力的同时降低很可能解释了GVHD诱导的口腔和胃肠道（GIT）粘膜炎，因为不断吞咽到GIT中的唾液失去了其通常的抗氧化保护作用。总之，我们的发现可能指出了GVHD前期患者口腔和肠道粘膜炎发病机制的一种可能新机制。因此，使用人工唾液和自由基清除剂和/或抗氧化剂（全身给药或通过口腔冲洗）进行治疗可能具有临床意义。
