Mucositis is a common adverse effect from chemotherapy that cause markedly reduced life quality, and especially pediatric patient are vulnerable. Bovine colostrum contains high amounts of bioactive factors and studies on piglets indicate that it may be highly effective as treatment.
Chemotherapy-induced mucositis
Gastrointestinal toxicity, also known as mucositis, is a common chemotherapy-induced adverse effect complication that may cause nausea, pain, diarrhea, vomiting, together with an increased risk of infections from bacteria or pathogens due to mucosal barrier injury in the alimentary tract. All these symptoms lead to a markedly reduced quality of life and a potentially increasing mortality (Pontoppidan et al., 2015).
Toxic side effects on the gastrointestinal tract can be a limiting factor on the dose or the duration of the chemotherapy treatment. Actions to protect gastrointestinal tissues and promote their recovery could benefit the use of higher doses of chemotherapy, with greater potential for cure (Playford et al., 2000).
Childhood cancer
Chemotherapy induced toxicity is a complication for nearly all chemotherapy patient, regardless of age, but pediatric patients are extreme cases as they experience additional sever challenges due to their specific nutritional needs for growth and development (Ward et al., 2014).
Acute Lymphoblastic Leukemia (ALL) is the most common cancer in childhood and accounts for roughly 25% of all diagnosis. It is the most frequent cause of death from cancer in children. Since 1948 cure rates have improved greatly over time from approximately 10% in the 1960s to 90% today. But as the cure rates have improved greatly, the intensity of the treatment is limited by the toxicity of the chemotherapy. Many patients suffer from severe side effects of the chemotherapy and 2-5 % of patients die from treatment-related complications, mostly due to chemotherapy-induced toxicity and immune suppression (Hunger & Mulligan, 2015). 40-100% of all pediatric leukemia patients experience mucositis, depending on the disease, type of drug, dose, dosing schedule and individual factors (Sonis, 2010).
Bovine colostrum against mucositis in pediatric patients
The bioactive factors in bovine colostrum stimulating or regulating growth of intestinal tissue in bovine colostrum may promote the integrity of the epithelium and repair of gut tissue, while antimicrobial proteins and peptides may have direct antimicrobial and endotoxin-neutralizing effects and reduce gut inflammation and microbial translocation. All these effects are beneficial for patients suffering from chemotherapy-induced mucositis (Rathe et al., 2014).
Recent studies have proven the efficiency of bovine colostrum in reducing chemotherapy-induced toxicity in the gut in piglets, resulting in less vomiting, higher intestinal function and lower tissue inflammation (Pontoppidan et al., 2015; Shen et al., 2016; Shen et al., 2016). Given the great feasibility of piglets as models for gastrointestinal immaturity in preterm infants and chemotherapy induced gastrointestinal toxicity in children, these results highlight the great potential in bovine colostrum as a diet supplement to minimize the adverse effects of chemotherapy in pediatric patients (Sangild et al., 2013; Shen et al., 2016) and potentially also in adult patients.
References
Hunger, S. P. & Mulligan, C. G. (2015) Acute Lymphoblastic Leukemia in children. The New England Journal of Medicine, 373(16), 1541-1552.
Playford, R. J., Macdonald, C. E. & Johnson, W. S. (2000) Colostrum and milk-derived peptide growth factors for the treatment of gastrointestinal disorders. The American Journal of Clinical Nutrition, 72(1), 5-14.
Pontoppidan, P. E. L., Shen, R. L., Cilieborg, M. S., Jiang, P., Kissow, H., Petersen, B. L., Thymann, T., Heilmann, C., Müller, K. & Sangild, P. T. (2015) Bovine colostrum modulates myeloablative chemotherapy-induced gut toxicity in piglets. The Journal of Nutrition: Nutrition and Diseases, 145(7), 1472-1480.
Rathe, M., Müller, K., Sangild, P. T. & Husby, S. (2014) Clinical applications of bovine colostrum therapy: a systematic review. Nutrition Reviews, 72(4), 237-254.
Sangild, P. T., Thymann, T., Schmidt, M., Stoll, B., Burrin, D. G. & Buddington, R. K. (2013) Invited review: The preterm pig as a model in pediatric gastroenterology. Journal of Animal Science, 91(10), 4713-4729.
Shen, R. L., Pontoppidan, P. E., Rathe, M., Hansen, C. F., Buddington, R. K., Heegaard, P. M. & Sangild, P. T. (2016) Milk diets influence doxorubicin-induced intestinal toxicity in piglets. American Journal of Physiology – Gastrointestinal and Liver Physiology, 311(2), G324-333.
Shen, R. L., Rathe, M., Jiang, P., Pontoppidan, P. E., Heegaard, P. M. Müller, K. & Sangild, P. T. (2016) Doxorubicin-induced gut toxicity in piglets fed bovine milk and colostrum. Journal of Pediatric Gastroenterology and Nutrition, 63(6), 698-707.
Sonis, S. T. (2010) Regimen-related gastrointestinal toxicities in cancer patients. Current Opinion in Supportive and Palliative Care, 4, 26-30.
Ward, E., DeSantis, C., Robbins, A., Kohler, B. & Jemal, A. (2014) Childhood and adolescent cancer statistics, 2014. A Cancer Journal for Clinicians, 64(2), 83-103.
Weaver, D. M., Tyler, J. W., VanMetre, D. C., Hostetler, D. E. & Barrington, G. M. (2000) Passive transfer of colostral immunoglobulins in calves. Journal of Veterinary Medicine, 14(6), 569-577.
