Abstract
ObjectiveVitamin A is involved in maintenance of gut mucosal integrity and normal immune function. However, it is unclear whether these functions of vitamin A have any beneficial effects in patients undergoing hematopoietic stem cell transplantation (HSCT). In this study, we aimed to examine the potential protective effect of vitamin A supplementation on gastrointestinal (GI) mucosal integrity in HSCT recipients using plasma citrulline as a surrogate marker of intestinal integrity.ResultsWe performed a quasi-randomized trial in 30 pediatric patients undergoing HSCT. Half (n = 15) of the patients received a single high dose of vitamin A (200,000 IU) before the conditioning regimen was given, and half (n = 15) did not. Clinical data of patients who developed post-transplant complications were recorded for 60 days after HSCT. There were no significant differences in mean plasma citrulline levels on day 7 after HSCT between the treatment and control groups (5.8 vs. 5.9 µmol/L, respectively). The incidence of mucositis and other complications were not different between the two groups within 60 days of HSCT. Vitamin A supplementation prior to HSCT in pediatric patients had no clinical benefit in protecting GI mucosal integrity.
Highlights
Infection is a major cause of morbidity and mortality during the neutropenic phase in patients undergoing hematopoietic stem cell transplantation (HSCT) [1, 2]
Plasma vitamin A at day 7 after HSCT did not reach a level considered toxic (> 100 μg/dL) [20] in either group (Fig. 1a). This preliminary trial on vitamin A supplementation in pediatric patients undergoing HSCT did not show a beneficial effect of vitamin A on intestinal mucosal integrity
While vitamin A supplementation in this study did not rescue this effect, it did show a tendency of beneficial effects in terms of reduced duration of diarrhea and febrile neutropenia
Summary
Infection is a major cause of morbidity and mortality during the neutropenic phase in patients undergoing hematopoietic stem cell transplantation (HSCT) [1, 2]. 40% of stem cell transplant patients develop mucositis following the intensive chemotherapy. Mucositis that occurs following conditioning chemotherapy in these patients is found throughout the GI tract and is generally not directly detectable. Many studies have used plasma citrulline as a noninvasive biomarker of intestinal mucosal damage. Citrulline is an amino acid mainly produced by enterocytes of the small bowel. Decreased levels of plasma citrulline are correlated with significant epithelial small bowel loss [10,11,12]
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