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Potential prevention: Aloe vera mouthwash may reduce radiation-induced oral mucositis in head and neck cancer patients

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Abstract

In recent years, more head and neck cancer patients have been treated with radiotherapy. Radiation-induced mucositis is a common and dose limiting toxicity of radiotherapy among patients with head and neck cancers. Patients undergoing radiation therapy for head and neck cancer are also at increased risk of developing oral candidiasis. A number of new agents applied locally or systemically to prevent or treat radiationinduced mucositis have been investigated, but there is no widely accepted prophylactic or effective treatment for mucositis. Topical Aloe vera is widely used for mild sunburn, frostbites, and scalding burns. Studies have reported the beneficial effects of Aloe gel for wound healing, mucous membrane protection, and treatment of oral ulcers, in addition to antiinflammatory, immunomudulation, antifungal, scavenging free radicals, increasing collagen formation and inhibiting collagenase. Herein the author postulates that oral Aloe vera mouthwash may not only prevent radiation-induced mucositis by its wound healing and antiinflammatory mechanism, but also may reduce oral candidiasis of patients undergoing head and neck radiotherapy due to its antifungal and immunomodulatory properties. Hence, Aloe vera mouthwash may provide an alternative agent for treating radiation-induced oral mucositis and candidiasis in patients with head and neck cancers.

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References

  1. Rubin RL, Doku HC. Therapeutic radiology—the modalities and their effects on oral tissues. J Am Dent Assoc 1976;92:731–739.

    PubMed  CAS  Google Scholar 

  2. Floyd BR. Oral care of the oral radiation therapy patient. Dent Hyg 1979;52:577–579.

    Google Scholar 

  3. Beumer J, Curtis T, Harrison RE. Radiation therapy of the oral cavity: sequelae and management. Head Neck Surg 1979;1:301–312.

    Article  PubMed  Google Scholar 

  4. Trott KR. Cell population and overall treatment time. Int J Radiat Oncol Bio Phys 1990;19:1071–1075.

    Article  CAS  Google Scholar 

  5. Carl W, Emrich LS. Management of oral mucositis during local radiation and systemic chemotherapy: a study of 98 patients. J Prosthet Dent 1991;66:361–369.

    Article  PubMed  CAS  Google Scholar 

  6. Pakfetrat A, Mansourian A, Momen-Heravi F, Delavarian Z, Momen-Beitollahi J, Khalilzadeh O, et al. Comparison of colchicine versus prednisolone in recurrent aphthous stomatitis: a double-blind randomized clinical trial. Clin Invest Med 2010;33:189–195.

    Google Scholar 

  7. Xing JM, Li FF. Purification of aloe polysaccharides by using aqueous two-phase extraction with desalination. Nat Prod Res 2009;23:1424–1430.

    Article  PubMed  CAS  Google Scholar 

  8. Rajasekaran S, Sivagnanam K, Subramanian S. Mineral contents of Aloe vera leaf gel and their role on streptozotocininduced diabetic rats. Biol Trace Elem Res 2005;8:185–195.

    Article  Google Scholar 

  9. Gupta R, Flora SJ. Protective value of Aloe vera against some toxic effects of arsenic in rats. Phytother Res 2005;19:23–28.

    Article  PubMed  Google Scholar 

  10. Baechler BJ, Nita F, Jones L, Frestedt JL. A novel liquid multi-phytonutrient supplement demonstrates DNA-protective effects. Plant Foods Hum Nutr 2009;64:81–85.

    Article  PubMed  CAS  Google Scholar 

  11. Portugal-Cohen M, Soroka Y, Ma’or Z, Oron M, Zioni T, Brégégère FM, et al. Protective effects of a cream containing Dead Sea minerals against UVB-induced stress in human skin. Exp Dermatol 2009;18:781–788.

    Article  PubMed  CAS  Google Scholar 

  12. Langmead L, Makins RJ, Rampton DS. Anti-inflammatory effects of Aloe vera gel in human colorectal mucosa in vitro. Aliment Pharmacol Ther 2004;19:521–527.

    Article  PubMed  CAS  Google Scholar 

  13. Hunter D, Frumkin A. Adverse reactions to vitamin E and Aloe vera preparations after dermabrasion and chemical peel. Cutis 1991;47:193–196.

    PubMed  CAS  Google Scholar 

  14. Hosseinimehr SJ, Khorasani GA, Zamani P, Ghasemi M, Ahmadi A. Effect of Aloe cream versus silver sulfadiazine for healing burn wounds in rats. Acta Dermatovenerol Croat 2010;18:2–7.

    PubMed  Google Scholar 

  15. Khorasani GA, Ahmadi A, Hosseinimehr SJ, Ahmadi A, Taberi AR, Fathi HR. The effects of Aloe vera cream on splitthickness skin graft donor site management: a randomized, blinded, placebo-controlled study. Wounds 2011;23:44–48.

    Google Scholar 

  16. Barrantes E, Guinea M. Inhibition of collagenase and metalloproteinases by aloins and Aloe gel. Life Sci 2003;72:843–850.

    Article  PubMed  CAS  Google Scholar 

  17. Yusuf S, Agunu A, Diana M. The effect of Aloe vera A. Berger (Liliaceae) on gastric acid secretion and acute gastric mucosal injury in rats. J Ethnopharmacol 2004;93:33–37.

    Article  PubMed  Google Scholar 

  18. Rodriguez-Bigas M, Cruz NI, Suarez A. Comparative evaluation of Aloe vera in the management of burn wounds in guinea pigs. Plast Reconstr Surg 1988;81:386–389.

    Article  PubMed  CAS  Google Scholar 

  19. Visuthikosol V, Chowchuen B. Effect of Aloe vera gel to healing of burn wound: a clinical and historic study. J Med Assoc Thai 1995;78:403–409.

    PubMed  CAS  Google Scholar 

  20. Roberts DB, Travis EL. Acemannan-containing wound dressing gel reduces radiation-induced skin reactions in C3H mice. Int J Radiat Oncol Biol Phys 1995;32:1047–1052.

    Article  PubMed  CAS  Google Scholar 

  21. Lee CK, Han SS, Shin YK, Chung MH, Park YI, Lee SK, et al. Prevention of ultraviolet radiation-induced suppression of contact hypersensitivity by Aloe vera gel components. Int J Immunopharmacol 1999;21:303–310.

    Article  PubMed  CAS  Google Scholar 

  22. Byeon SW, Pelley RP, Ullrich SE, Waller TA, Bucana CD, Strickland FM. Aloe barbadensis extracts reduce the production of interleukin-10 after exposure to ultraviolet radiation. J Invest Dermatol 1988;110:811–817.

    Article  Google Scholar 

  23. Strickland FM, Pelley RP, Kripke ML. Prevention of ultraviolet radiation-induced suppression of contact and delayed hypersensitivity by Aloe barbadensis gel extract. J Invest Dermatol 1994;102:197–204.

    Article  PubMed  CAS  Google Scholar 

  24. Heggers JP, Robson MC, Manavalen K, Weingarten MD, Carethers JM, Boertman JA, et al. Experimental and clinical observations on frostbite. Ann Emerg Med 1987;16:1056–1062.

    Article  PubMed  CAS  Google Scholar 

  25. Miller MB, Koltai PJ. Treatment of experimental frostbite with pentoxifylline and Aloe vera cream. Arch Otolaryngol Head Neck Surg 1995;121:678–680.

    Article  PubMed  CAS  Google Scholar 

  26. Syed TA, Ahmad SA, Holt AH, Ahmad SA, Afzal M. Management of psoriasis with Aloe vera extract in a hydrophilic cream: a placebo-controlled, double-blind study. Trop Med Int Health 1996;1:505–509.

    Article  PubMed  CAS  Google Scholar 

  27. Davis RH, Maro NP. Aloe vera and gibberellin: antiinflammatory activity in diabetes. J Am Podiatr Med Assoc 1989;79:24–26.

    PubMed  CAS  Google Scholar 

  28. Davis RH, Stewart GJ, Bregman PJ. Aloe vera and the inflamed synovial pouch model. J Am Podiatr Med Assoc 1992;82:140–148.

    PubMed  CAS  Google Scholar 

  29. Brossat JY, Ledeaut JY, Ralamboranto L, Rakotovao LH, Solar S, Gueguen A, et al. Immunostimulating properties of an extract isolated from Aloe vahombe. 2. Protection in mice by fraction F1 against infections by Listeria monocytogenes, Yersinia pestis, Candida albicans and Plasmodium berghei. Arch Inst Pasteur Madagascar 1981;48:11–34.

    PubMed  CAS  Google Scholar 

  30. Womble D, Helderman JH. Enhancement of alloresposiveness of human lymphocytes by acemannan (Carrisyn). Int J Immunopharmacol 1988;10:967–974.

    Article  PubMed  CAS  Google Scholar 

  31. Peng SY, Norman J, Curtin G, Corrier D, McDaniel HR, Busbee D. Decreased mortality of Norman murine sarcoma in mice treated with the immunomodulator, acemannon. Mol Biother 1991;3:79–87.

    PubMed  CAS  Google Scholar 

  32. Karaca K, Sharma JM, Nordgren R. Nitric oxide production by chicken macrophages activated by acemannan, a complex carbohydrate extracted from Aloe vera. Int J Immunopharmacol 1995;17:183–188.

    Article  PubMed  CAS  Google Scholar 

  33. Hart LA, Nibbering PH, Barselaar MT, Dijk H, Berq AJ, Labadie RP. Effects of low molecular constituents from Aloe vera gel on oxidative metabolism and cytotoxic and bactericidal activities of human neutrophils. Int J Immunopharmacol 1990;12:427–434.

    Article  PubMed  Google Scholar 

  34. Kim H, Lee B. Inhibition of benzo(a)pyrene-DNA adduct formation by Aloe Barbadensis Miller. Carcinogenesis 1997;18:771–776.

    Article  PubMed  CAS  Google Scholar 

  35. Yagi A, Kabash A, Mizuno K, Moustafa SM, Khalifa TI, Tsuji H. Radical scavenging glycoprotein inhibiting cyclooxygenase-2 and thromboxane A2 synthase from Aloe vera gel. Planta Med 2003;69:269–271.

    Article  PubMed  CAS  Google Scholar 

  36. Su CK, Mehta V, Ravikumar L, Shah R, Pinto H, Halpern J, et al. Phase II double-blind randomized study comparing oral Aloe vera versus placebo to prevent radiation-related mucositis in patients with head-and-neck neoplasms. Int J Radiat Oncol Biol Phys 2004;60:171–177.

    Article  PubMed  Google Scholar 

  37. Barrantes E, Guinea M. Inhibition of collagenase and metalloproteinases by aloins and Aloe gel. Life Sci 2003;72:843–850.

    Article  PubMed  CAS  Google Scholar 

  38. Maze G, Terpolilli RN, Lee M. Aloe vera extract prevents aspirin-induced acute gastric mucosal injury in rats. Med Sci Res 1997;25:765–766.

    CAS  Google Scholar 

  39. Rees TD. Oral ulcers remedy gets FDA clearance. J Am Dental Assoc 1994;125:1308–1310.

    Google Scholar 

  40. Plemons JM, Rees TD, Binnie WH, Wright JM, Guo I, Hall JE. Evaluation of acemannan in the treatment of recurrent aphthous stomatitis. Wounds 1994;6:40–45.

    Google Scholar 

  41. Heggie S, Bryant GP, Tripcony L, Keller J, Rose P, Glendenning M, et al. A phase III study on the efficacy of topical Aloe vera gel on irradiated breast tissue. Cancer Nurs 2002;25:442–451.

    Article  PubMed  Google Scholar 

  42. Davis R, Kabbani J, Maro N. Aloe vera and wound healing. J Am Podiatr Med Assoc 1987;77:165–169.

    PubMed  CAS  Google Scholar 

  43. Davis RH, Leitner MG, Russo JM, Byrne ME. Wound healing: oral and topical activity of Aloe vera. J Am Podiatr Med Assoc 1989;79:559–562.

    PubMed  CAS  Google Scholar 

  44. Tizard I, Busbee D, Maxwell B, Kem MC. Effects of acemannan, a complex carbohydrate, on wound healing in young and aged rats. Wounds 1994;6:201–209.

    Google Scholar 

  45. Babaee N, Mansourian A, Momen-Heravi F, Moghadamnia A, Momen-Beitollahi J. The efficacy of a paste containing Myrtus communis (Myrtle) in the management of recurrent aphthous stomatitis: a randomized controlled trial. Clin Oral Invest 2010;14:65–70.

    Article  Google Scholar 

  46. Momen-Beitollahi J, Mansourian A, Momen-Heravi F, Amanlou M, Obradov S, Sahebjamee M. Assessment of salivary and serum antioxidant status in patients with recurrent aphthous stomatitis. Med Oral Patol Oral Cir Bucal 2010;15: e557–561.

    Article  PubMed  Google Scholar 

  47. Wei A, Shibamoto T. Antioxidant/lipoxygenase inhibitory activities and chemical compositions of selected essential oils. J Agric Food Chem 2010;58:7218–7225.

    Article  PubMed  CAS  Google Scholar 

  48. Davis SC, Perez R. Cosmeceuticals and natural products: wound healing. Clin Dermatol 2009;27:502–506.

    Article  PubMed  Google Scholar 

  49. Reynolds T, Dweck AC. Aloe vera leaf gel: a review update. J Ethnopharmacol 1999;68:3–37.

    Article  PubMed  CAS  Google Scholar 

  50. Sarabia JEL, Clares VPR, Clares RAR, Hernandez VP. Anti-inflammatory activity and healing of rectal ointment Aloe vera L. Rev Cubana Plant Med 1999;4:106–109.

    Google Scholar 

  51. Kuzuya K, Tamai I, Beppu H, Shimpo K, Chihara T. Determination of aloenin, barbaloin and isobarbaloin in Aloe species by micellar electrokinetic chromatography. J Chromatogr 2001;752:91–97.

    Article  CAS  Google Scholar 

  52. Chithra P, Sajithlal BG. Chandrakasan G. Influence of Aloe vera on the healing of dermal wounds in diabetic rats. J Ethnopharmacol 1998;59:195–201.

    Article  PubMed  CAS  Google Scholar 

  53. Davis RH, Di Donato JJ, Hartman GM, Haas RC. Antiinflammatory and wound healing activity of a growth substance in Aloe vera. J Am Pediatr Med Assoc 1994;84:77–81.

    CAS  Google Scholar 

  54. Davis RH, Rosenthal KY, Cesario LR, Rouw GA. Processed Aloe vera administered topically inhibits inflammation. J Am Podiatr Med Assoc 1989;79:395–397.

    PubMed  CAS  Google Scholar 

  55. Thompson JE. Topical use of Aloe vera derived allantoin gel in otolaryngology. Ear Nose Throat J 1991;70:119.

    PubMed  CAS  Google Scholar 

  56. Chithra P, Sajithlal GB, Chandrakasan G. Influence of Aloe vera on the glycosaminoglycans in the matrix of healing dermal wounds in rats. J Ethnopharmacol 1998;59:179–186.

    Article  PubMed  CAS  Google Scholar 

  57. Salazar-Sánchez N, López-Jornet P, Camacho-Alonso F, Sánchez-Siles M. Efficacy of topical Aloe vera in patients with oral lichen planus: a randomized double-blind study. J Oral Pathol Med 2010;39:735–740.

    Article  PubMed  Google Scholar 

  58. Mansourian A, Momen-Heravi F, Saheb-Jamee M, Esfehani M, Khalilzadeh O, Momen-Beitollahi J. Comparison of Aloe vera mouthwash with triamcinolone acetonide 0.1% on oral lichen planus: a randomized double-blinded clinical trial. Am J Med Sci 2011;342:447–451.

    Article  PubMed  Google Scholar 

  59. Madhav NV, Shakya AK, Shakya P, Singh K. Orotransmucosal drug delivery systems: a review. J Control Release 2009;140:2–11.

    Article  PubMed  CAS  Google Scholar 

  60. Puataweepong P, Dhanachai M, Dangprasert S, Sithatani C, Sawangsilp T, Narkwong L, et al. The efficacy of oral Aloe vera juice for radiation induced mucositis in head and neck cancer patients: a double-blind placebo-controlled study. Asian Biomed 2009;3:375–382.

    Google Scholar 

  61. Ramirez-Amador V, Silverman S Jr, Mayer P, Tyler M, Quivey J. Candidal colonization and oral candidiasis in patients undergoing oral and pharyngeal radiation therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;84:149–153.

    Article  PubMed  CAS  Google Scholar 

  62. Fotos PG, Hellstein JW. Candida and candidosis. Dent Clin North Am 1992;36:857–878.

    PubMed  CAS  Google Scholar 

  63. Haveman CW, Redding SW. Dental management and treatment of xerostomic patients. Texas Dent J 1998;115:43–56.

    PubMed  CAS  Google Scholar 

  64. Rossie KM, Taylor J, Beck FM, Hodgson SE, Blozis GG. Influence of radiation therapy on oral Candida albicans colonization: a quantitative assessment. Oral Surg Oral Med Oral Pathol 1987;64:698–701.

    Article  PubMed  CAS  Google Scholar 

  65. Chen TY, Webster JH. Oral Monilia study on patients with head and neck cancer undergoing multimodality therapy. Cancer 1974;34:246–249.

    Article  PubMed  CAS  Google Scholar 

  66. Silverman S Jr, Luangjarmekorn L, Greenspan D. Occurrence of oral Candida in head and neck cancer patients. J Oral Med 1984;39:194–196.

    PubMed  Google Scholar 

  67. Hussain M, Kish JA, Crane L, Uwayda A, Cummings G, Ensley JF, et al. The role of infection in the morbidity and mortality of patients with head and neck cancer undergoing multimodality therapy. Cancer 1991;67:716–721.

    Article  PubMed  CAS  Google Scholar 

  68. Cengiz M, Ozyar E, Ozturk D, Akyol F, Atahan IL, Hayran M. Sucralfat in the prevention of radiation-induced oral mucositis. J Clin Gastroenterol 1999;28:40–43.

    Article  PubMed  CAS  Google Scholar 

  69. Gava A, Ferrarese F, Tonetto V, Coghetto F, Marazatta G, Zorat PL. Can the prophylactic treatment of mycotic mucositis improve the time of performing radiotherapy in head and neck tumors? Radiol Med 1996;91:452

    PubMed  CAS  Google Scholar 

  70. Byeon SW, Pelley RP, Ullrich SE, Waller TA, Bucana CD, Strickland FM. Aloe barbadensis extracts reduce the production of interleukin-10 after exposure to ultraviolet radiation. J Invest Dermatol 1998;110:811–817.

    Article  PubMed  CAS  Google Scholar 

  71. Strickland FM. Immune regulation by polysaccharides: implications for skin cancer. J Photochem Photobiol B 2001;63:132–140.

    Article  PubMed  CAS  Google Scholar 

  72. Lindblad WJ, Thul J. Sustained increase in collagen biosynthesis in acemannan impregnated PVA implants in the rat (abstract). Wound Repair Regen 1994;2:84.

    Google Scholar 

  73. Sabeh F, Wright T, Norton SJ. Isozymes of superoxide dismutase from Aloe vera. Enzyme Protein 1996;49:212–221.

    PubMed  CAS  Google Scholar 

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Ahmadi, A. Potential prevention: Aloe vera mouthwash may reduce radiation-induced oral mucositis in head and neck cancer patients. Chin. J. Integr. Med. 18, 635–640 (2012). https://doi.org/10.1007/s11655-012-1183-y

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