Avaliação clínica e molecular do efeito do laser de baixa intensidade na prevenção da mucosite oral em pacientes submetidos a transplante de medula óssea
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2014-02-21
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Universidade Federal de Goiás
Resumo
Patients undergoing hematopoietic stem cell transplantation (HSCT) are submitted to a
conditioning regimen of high-dose chemotherapy, which usually results in oral
ulcerations. Oral mucositis (OM) is a common, painful and debilitating toxicity side
effect of autologous and allogeneic HSCT. Currently, there is no intervention that is
completely successful in preventing OM. Low-level laser therapy (LLLT) has been
reported to produce basic effects such as anti-inflammatory activity, biomodulation and
analgesia, however the biochemical responses are not well understood. The aim of this
study was to evaluate the effect of LLLT on the severity of chemotherapy-induced OM
and on inflammatory mediator concentration in saliva and blood in HSCT patients.
Twenty-five patients were randomly assigned to 2 groups: control and laser. The laser
group (n=11) received the hospital oral hygiene protocol, and low-intensity laser
irradiation (660 nm, 40 mW, 4J/cm2
) was applied from the first day of the conditioning
regimen until D+7. The control group (n=14) received only the hospital oral hygiene
protocol. The severity of OM (WHO scale) was scored from D0 to day 20 after
transplantation (D+20). Saliva and blood were collected from all patients on admission
and one day before the transplantation (D-1), on days 3 and 7 after transplantation (D+3
and D+7) and on marrow engraftment day (ME). The concentration of inflammatory
mediators (TNF-α, IL-6, IL-1β, IL-10, TGF-β, EGF, FGF, VEGF, MMP2/TIMP-2,
MMP9/TIMP-2) were measured using the enzyme-linked immunosorbent assay
(ELISA) test. Clinical results showed less severe OM in the laser group (p < 0.05). On
analysing the inflammatory mediators, the LLLT group showed increased
MMP2/TIMP2 levels in saliva on D+7 (p = 0.04). In addition, significant differences
were also observed for IL-10 in blood plasma on D+7 and on ME, when compared to
the control group (p < 0.05). No significant differences in saliva and blood were
observed for the other inflammatory mediators investigated. We concluded that LLLT
was clinically effective in reducing the severity of chemotherapy-induced OM in HSCT
patients, and that its mechanism of action does not seem to be completely linked to the
modulation of pro- or anti-inflammatory cytokines, growth factors or matrix
metalloproteinases.
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SILVA, G. B. L. Avaliação clínica e molecular do efeito do laser de baixa intensidade na prevenção da mucosite oral em pacientes submetidos a transplante de medula óssea. 2014. 81 f. Tese (Doutorado em Ciências da Saúde) - Universidade Federal de Goiás, Goiânia, 2014.