Abstract
Cancer patients receiving chemotherapy often develop mucositis as a direct result of their treatment. Recently, the intestinal microbiota has attracted significant attention in the investigation of the pathobiology of mucositis, with a number of studies investigating the effects of chemotherapeutic agents on the microbiota. With significant effects on the intestinal microbiota occurring following the administration of chemotherapy, there is now interest surrounding the downstream pathological effects that may be associated with the altered intestinal ecology. This review seeks to identify links between signalling pathways previously demonstrated to have a role in the development of mucositis, and the altered intestinal microbiota.
Highlights
Cancer patients receiving chemotherapy often develop mucositis as a direct result of their treatment. It is a major oncological problem reported in approximately 40% of patients undergoing standard dose chemotherapy and in almost all patients receiving high dose chemotherapy and stem cell transplantation. This condition was originally thought to be limited to the mucous membranes throughout the alimentary tract, more recent research has indicated that other tissue layers and the luminal contents and its inhabitants are likely to be involved [1]
The role of the microbiota in the development of chemotherapy induced mucositis has been investigated on a number of levels, including roles in the above-mentioned 5-phase model of mucositis developed by Sonis [12,13,24]
The constant residence of microbes in the intestine results in constant exposure to toll like receptor (TLR) ligands, including peptidoglycans, lipopolysaccharide (LPS) and bacterial DNA. These ligands result in a state of low-grade inflammation [31,32,33], and the bacteria are processed so parts can be transported intracellularly, allowing binding to NOD receptors
Summary
Cancer patients receiving chemotherapy often develop mucositis as a direct result of their treatment. It is a major oncological problem reported in approximately 40% of patients undergoing standard dose chemotherapy and in almost all patients receiving high dose chemotherapy and stem cell transplantation. This condition was originally thought to be limited to the mucous membranes throughout the alimentary tract, more recent research has indicated that other tissue layers and the luminal contents and its inhabitants are likely to be involved [1]. Clinical symptoms of intestinal mucositis are the result of ulceration, and include abdominal pain, nausea, vomiting, bloating, diarrhoea, constipation, and subsequent weight loss [1]
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