Document Type : Review Article
Authors
1
Department of Clinical Pharmacy, Nasser Institute for Research and Treatment, Cairo, Egypt
2
Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, 11566, Egypt
3
Department of Adult Oncology, Nasser Institute for Research and Treatment, Cairo, Egypt
Abstract
Oral mucositis (OM) is one of the most frequent complications affecting colorectal cancer (CRC) patients receiving 5-fluorouracil (5-FU). According to recent studies, the release of inflammatory cytokines like tumor necrosis factor-alpha (TNF-alpha) and the generation of reactive oxygen species (ROS) may play a significant role in the development of mucosal injury and progression of OM. Statins have been reported to have pleiotropic effects including anti-inflammatory and antioxidant activity. Hence, they might play a protective role against 5-FU-induced OM. This review aims to discuss the evidence from preclinical and clinical studies regarding the potential benefits of statins in this area. The Egyptian Knowledge Bank, Google Scholar, and PubMed databases were searched for published preclinical and clinical articles describing the anti-inflammatory antioxidant activity of statins and their potential role in the prevention of 5-FU-induced OM from English sources. Research was performed using different keywords: such as, “pathophysiology of 5-FU-induced oral mucositis”, “inflammatory cytokine and 5-FU-induced oral mucositis”, “oxidative stress and 5-FU-induced oral mucositis”, “pleotropic effect of statins OR (3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors)”, “statins in 5-FU-induced oral mucositis”. Relevant resources were extracted using source source-pulling method of the references. Multiple studies have proven the anti-inflammatory and antioxidant properties of statins as demonstrated in different inflammatory disorders models such as cardiovascular, renal, and pulmonary diseases. It has been shown that statins can inhibit nuclear factor kappa-B (NF-KB) which consequently inhibits the subsequent cascade of inflammatory cytokines release such as TNF-alpha in addition to the reduction of ROS such as malondialdehyde (MDA). The effects of various types of statins on mucositis in animal and human models have been investigated and the results were promising. Statins could be a potential candidate for the prevention of OM through their pleiotropic effects. Further additional clinical studies are required to provide evidence about the potential therapeutic benefits of statins in the prevention of 5-FU-induced OM in CRC patients.
Methods: The Egyptian Knowledge Bank, Google Scholar and PubMed databases were searched for published preclinical and clinical articles describing the anti-inflammatory antioxidant activity of statins and their potential role in the prevention of 5-FU induced OM from English sources. Research was performed using different key words: such as, “pathophysiology of 5-FU induced oral mucositis”, “inflammatory cytokine and 5-FU induced oral mucositis”, “oxidative stress and 5-FU induced oral mucositis”, “pleotropic effect of statins OR (3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors)”, “statins in 5-FU induced oral mucositis”. Relevant resources were extracted using source pulling method of the references.
Findings: Multiple studies have proven the anti-inflammatory and antioxidant properties of statins. It showed that statins can inhibit nuclear factor kappa-B (NF-KB) which consequently inhibits the subsequent cascade of inflammatory cytokines release such as TNF-alpha plus the reduction of ROS such as malondialdehyde (MDA). The effects of statins on mucositis in animal and human models have been investigated and the results were promising.
Keywords
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