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ORIGINAL RESEARCH Table of Contents   
Year : 2008  |  Volume : 19  |  Issue : 3  |  Page : 213-218
Effects of radiation and α-tocopherol on saliva flow rate, amylase activity, total protein and electrolyte levels in oral cavity cancer


1 Department of Biotechnology, Sri Ramachandra College of Biomedical Science, Technology and Research, Sri Ramachandra University and Research Institute, Porur, Chennai - 600 116, India
2 Department of Biochemistry and Molecular Biology, University of Madras, Guindy Campus, Chennai - 600 025, Tamil Nadu, India

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Date of Submission06-Jun-2007
Date of Decision28-Jan-2008
Date of Acceptance30-Jan-2008
 

   Abstract 

Objective: The objective of the present study was to evaluate early and late effects of radiation and a-tocopherol on the secretion rate of saliva and on selected saliva salivary parameters in oral cavity cancer patients.
Patients & Methods: Eighty-nine histologically confirmed oral cavity cancer patients (OCC) were enrolled in the study. Resting whole saliva was collected before, during and at the end of the radiation therapy (RT) and simultaneous supplementation with α - tocopherol to the radiation treated patients (RT + AT).
Results: Salivary flow rate, pH, amylase activity, total protein, sodium and potassium were analyzed. Increased pH, potassium and decreased flow rate, amylase activity, protein content and sodium were observed in 6 weeks of radiation treated patients when compared to OCC patients. A significant improvement of those parameters was observed on α - tocopherol supplementation in RT + AT patients.
Conclusion: Supplementation with α - tocopherol improves the salivary flow rate thereby, maintains salivary parameters.

Keywords: Electrolytes, oral cavity cancer, salivary flow rate, radiotherapy, α-Tocopherol

How to cite this article:
Chitra S, Shyamala Devi C S. Effects of radiation and α-tocopherol on saliva flow rate, amylase activity, total protein and electrolyte levels in oral cavity cancer. Indian J Dent Res 2008;19:213-8

How to cite this URL:
Chitra S, Shyamala Devi C S. Effects of radiation and α-tocopherol on saliva flow rate, amylase activity, total protein and electrolyte levels in oral cavity cancer. Indian J Dent Res [serial online] 2008 [cited 2017 Oct 21];19:213-8. Available from: http://www.ijdr.in/text.asp?2008/19/3/213/42953
Saliva has a number of beneficial functions in the oral cavity like lubrication, protection of mucosal integrity and antimicrobial activity. [1] While under normal physiological conditions, the protective functions of saliva remain intact, they seem to be disturbed in oral cavity cancer (OCC). [2] Altered salivary gland function can provoke unpleasant oral symptoms but equally insidious is the absence of symptoms which may result in the cancer going undiagnosed. Radiation effects on salivary glands are of particular interest in clinical radiotherapy of head and neck tumors, where the reduced flow rate and the altered composition of saliva result in distress, often irreversible complications such as oral dryness, hampered oral functioning, nocturnal oral discomfort, burning mouth, impeded social activities and a susceptibility to oral infections and dental caries. [3] Significant salivary flow reduction develops after the irradiation of salivary glands in the treatment of head and neck cancer. The average salivary flow rate decreases by 57% after one week of radiation, by 67% after six weeks of radiation and by 95% after three years of treatment. [4] Generally, the damage is irreversible in patients who receive doses ≥6000 cGy. [5]

The parotid glands are more radiosensitive than the submandibular or sublingual glands. [6] Radiation effects on parotid gland tissue are mainly responsible for xerostomia and associated side effects. Disruption of mucosal integrity as a direct effect of radiation therapy, demonstrates enhanced sensitivity to physical, chemical and microbial insults in the mouth. Pain and discomfort associated with hyposalivation and mucositis, may affect a patient's nutritional intake, oral function and quality of life. [7] OCC patients undergoing radiation therapy not only show drastically decreased quantities of saliva, but also show qualitative changes such as altered viscosity, pH, immunoglobulin and electrolyte levels of saliva. [8]

Radiation therapy inflicts tremendous damage to healthy cells surrounding tumor cells in OCC patients. However, there are specific nutrients, flavonoids and herbs that have been shown to protect the body against cancer radiation therapy. Antioxidant therapy is beneficial to avoid the damage caused by radiotherapy in OCC patients. Vitamin E can protect against mutagenic and/or carcinogenic effects of ionizing radiation in both animals and cell culture. [9] Radioprotection by vitamin E against salivary dysfunction [10] and pulmonary fibrosis [11] were studied in irradiated rats. In the present study, a universally accepted antioxidant and free radical scavenger, α-tocopherol was used as a supplementary agent to reduce the toxic side effects of radiation in OCC patients.

The hypothesis of the present study was that saliva flow rate and concentrations of protein, a-amylase and electrolytes may be disturbed in salivary glands by the physiological effects caused by radiation therapy of OCC. Therefore, on the basis of previous data, our aim was to evaluate the effects of a-tocopherol (AT) on resting whole saliva secretion rates, pH and concentrations of salivary amylase, proteins and electrolytes in patients before, during and after RT and RT + AT.


   Materials and Methods Top


Histologically confirmed patients presenting at the Government Arignar Anna Memorial Cancer Research Institute and Hospital in Kancheepuram, Tamil Nadu, India, were included in this cancer clinical trial. OCC patients (age mean SD = 50 15 years) - 54 males and 35 females, had cancer in various sites such as the cheek (n = 28), alveolus (n = 17), tongue (n = 13), floor of the mouth (n = 11), lip (n = 8), palate (n = 7) and retromolar trigone (n = 5). The patients had various habits of chewing tobacco (n = 48), smoking tobacco (n = 29), and alcohol consumption (n = 12). Tumor staging was done according to the Tumor Nodular Metastasis (TNM) classification of the UICC (Union International Contre Le Cancer) into stages: I (n = 4), II (n = 16), III (n = 29) and IVA (n = 40) [Table 1]. All people gave informed consent prior to their inclusion in the study and a medical practitioner monitored the whole experiment. Studies were performed in accordance with the ethical standards of the Institution.

All 89 OCC patients were considered to be in group 1 before radiation. This group was randomly divided into two groups, i.e., 2 (a and b) and 3 (a and b). Group 2a consisted of OCC patients treated with three weeks of radiation (n = 52) (non AT group) and group 2b consisted of OCC patients treated with six weeks of radiation. (n = 52). Group 3a consisted of OCC patients treated with three weeks of RT and simultaneously supplemented with a-tocopherol (RT + AT) (n = 37) (RT + AT group) for three weeks. Group 3b consisted of OCC patients treated with six weeks of RT and simultaneously supplemented with a-tocopherol (RT + AT) (n = 37) (RT + AT group) for six weeks during the entire period of radiotherapy [Flow chart 1]. RT was given with the aid of a Telecobalt beam using anterior and lateral wedge pair or lateral parallel portals (Gammatron - 60 CO; Theraton-780 - 60 CO; Phoenix - 60 CO) at a dosage of 6000 cGy in five fractions per week for a period of six weeks. α-Tocopherol (Bio-E capsules) was given at a dosage of 400 IU per day for six weeks from the first day of RT to the end of the treatment in RT + AT patients.

Collection of saliva samples

Patients were not allowed to smoke/chew tobacco or drink alcohol during the entire period of radiotherapy. Collection of saliva took place at the end of third (2a) and sixth (2b) weeks of radiation treatment. Similarly in group 3, sampling was done at the end of third (3a) and sixth(3b) weeks of radiation treatment, simultaneously supplemented with α-Tocopherol. The participants had to refrain from eating and drinking water for a minimum of 90 minutes before saliva collection. The whole resting saliva was collected into wide-mouthed graduated tubes over a 30 min period according to the method of Navazesh et al. [12]

Biochemical assays

The saliva flow rate (in milliliters/minute) of resting whole saliva was measured immediately after saliva collection. Salivary pH was determined by using a pH meter and the flow rate was measured according to the method of Epstein et al. [13] The samples were centrifuged at 1200 g for 10 min at 4C. Aliquots of centrifuged saliva needed for the analysis were transferred to eppendorf vials and stored at -20C until analysis. All the samples were analyzed within 15 days of collection. Salivary a-amylase was assayed according to a slight modification of the method of Bernfeld [14] and total protein concentration was measured by using the Lowry method. [15] Sodium and potassium concentrations were analyzed using an atomic absorption spectrophotometer (Perkin and Elmer 2380).

Statistical analysis

Statistical analysis of the data was performed using the Mann-Whitney 'U' test and P ≤ 0.05 was considered as statistically significant. [16]


   Results Top


Salivary flow rate, pH, a-amylase activity and total protein, sodium and potassium levels were analyzed. Decreases in the activity of α-amylase, flow rate and protein levels (P < 0.001) and nonsignificant increases in pH and potassium levels (P < 0.05) were observed during radiation treatment in group 2a (RT) patients when compared to group 1 patients. A significant improvement in pH, potassium (P < 0.01) levels, flow rate (P < 0.001) and sodium (P < 0.05) levels was observed after three weeks of a-tocopherol supplementation in group 3a (RT + AT) patients when compared to group 2a patients [Figure 1],[Figure 2],[Figure 3],[Figure 4],[Figure 5],[Figure 6].

Decreases in the activity of a-amylase, flow rate and protein levels (P < 0.001) and increases in pH (P < 0.001) and potassium levels (P < 0.01) were observed in group 2b patients when compared to group 1 patients after six weeks of radiation treatment. A significant improvement in pH, flow rate, potassium (P < 0.001) levels, activity of amylase (P < 0.01) protein and sodium (P < 0.05) levels was observed after six weeks of α-tocopherol supplementation in group 3b group patients when compared to group 2b patients. Supplementation with α-tocopherol improves the salivary flow rate and thus restores the salivary parameters to normal levels [Figure 1],[Figure 2],[Figure 3],[Figure 4],[Figure 5],[Figure 6].


   Disscussion Top


High uptake of glucose by tumor cells and subsequent anaerobic glycolysis leads to lactic acid production, which may be the reason for the low pH (acidic environment) observed in the oral cavity of OCC patients in the present study. Although the pH was higher in the oral cavities of RT patients (three and six weeks of treatment) than in OCC patients, it still remains in the acidic range. Higher lactic acid levels as a consequence of regressing tumors and the release of lactate dehydrogenase result in cell damage, decreased salivary flow rate and negligible buffering capacity may be the underlying causes of the acidic pH in the oral cavities of RT patients.

Decreased salivary gland function in OCC manifests itself as a reduction in salivary flow rate in the oral cavity, oropharynx and hypopharynx. The salivary flow rate was found to be lowered in RT patients. Thus, xerostomia (a marked reduction in salivary gland secretion) can result from the inflammatory and degenerative effects of ionizing radiation on salivary gland parenchyma, especially the serous acinar cells. [17],[18] Radiation-induced salivary gland dysfunction is associated with decreased salivary flow. [19] Hyposalivation is progressive and persistent in RT patients. Salivary flow measurably decreases within a week after starting radiation treatment and diminishes progressively with continued treatment. [20] Irreversible decrease in the flow rate may be related to a loss of tissue integrity and alterations in the intralobular nerve endings, rather than to a reduced potential of the glandular tissue. [21] Unstimulated whole salivary flow rate < 0.1 ml/min is considered to be indicative of xerostomia. [22] Xerostomia was observed after six weeks of radiation treatment in the present study.

Changes in the plasma membranes of acinar cells may also be the cause of disturbed signal transduction after irradiation, particularly as the polyunsaturated fatty acyl chains of membrane phospholipids may be readily damaged by irradiation. [23] High levels of potassium and low levels of sodium in the saliva of OCC and RT patients could be due to radiotherapy-related demineralization. Osteoradionecrosis is a serious complication for patients who receive radiation for head and neck tumors. [17]

The high activity of amylase and total protein content in OCC patients however, can be explained by the lower volume of secreted saliva rather than by the rate of protein synthesis in the salivary glands. This approach has been used in a number of studies [19],[20],[21] to analyze the effect of a systemic factor on the synthesis of salivary proteins and subsequent salivary composition.

Amylase is synthesized primarily in the acinar cells and less consistently in the proximal cells of the intercalated ducts; hence, gingival cervical fluid, a route of entrance for some salivary proteins, does not contribute to amylase levels. [24] Therefore, salivary amylase is a good indicator of the function of salivary glands, and hence, of the general health of the salivary glands. Increased activity of α-amylase observed in OCC patients might be due to an increase in the number of acinar cells in the parotid gland. Higher secretion of α-amylase has been reported in pathological conditions and/or inflammation. [25] Decreased a-amylase activity was observed after six weeks of radiation treatment probably due to a reduction in the number of acinar cells, incomplete tissue regeneration and late stromal effects such as delayed vascular damage due to radiation. The parotid gland is more radiosensitive [26] and the amount of serous secretion is directly proportional to the amylase content. [27] The changes observed in both salivary concentration and rate of secretion reflect radiation-induced disturbances in the acinar protein synthesis. α-amylase is also strongly affected by changes in the flow rate and total protein concentration [28] as observed in this study.

Reversal of changes in pH, flow rate, a-amylase as well as in protein, sodium and potassium levels were observed on α-tocopherol supplementation. The enhancement in the salivary secretion rate reflects an improvement in tissue repair and a recovery of the injured cells or a repopulation of the glandular tissue. Antioxidant vitamins have been known to cause extensive morphological changes in tumorigenic acinar cells and can also cause significant growth inhibition in vitro. [29] Vitamin E can protect against the carcinogenic effects of ionizing radiation induced in animals and cell culture. [9] Radioprotection against salivary dysfunction [10] by vitamin E was studied in irradiated rats. Our observation was consistent with others' findings.


   Conclusion Top


To conclude the present study, hyposalivation (xerostomia) results within six weeks of treatment in RT patients. A reduced salivary flow rate in the oral cavity of RT patients, may promote the growth of microbial flora and causes difficulty in speech, swallowing and ultimately, affects the patient's quality of life. a-tocopherol increases the salivary flow rate and and maintains the oral environment in OCC patients treated with radiotherapy.


   Acknowledgments Top


This work was supported by the Indian Council for Medical Research, New Delhi and Bio E capsules were provided by the American Remedies, Chennai and also the help rendered by Dr. Koteeswaran, Dental Surgeon with out which was not possible is gratefully acknowledged.

 
   References Top

1.Zelles T, Purashotham KR, Macauley SP, Oxford GE, Humphreys-Beher MG. Saliva and growth factors, the fountain of youth resides in us all. J Dent Res 1995;74:1826-32.  Back to cited text no. 1    
2.Dutta SK, Orestes M, Vengulekur S, Kwo P. Ethanol and human saliva: Effect of chronic alcoholism on flow rate, composition, and epidermal growth factor. Am J Gastroenterol 1992;87:350-4.  Back to cited text no. 2  [PUBMED]  
3.Fox PC, Van der Van PF, Sonies BC, Weiffenbaum JM, Baum BJ. Xerostomia: Evaluation of a symptom with increasing significance. J Am Dent Assoc 1985;110:519-25.  Back to cited text no. 3    
4.Dose AM. The symptom experience of mucositis, stomatitis and xerostomia. Semin Oncol Nurs 1995;11:248-55.  Back to cited text no. 4  [PUBMED]  
5.Berger AM, Kilroy TJ. Oral complications of cancer therapy. In : Berger A, Portenoy RK, Weissman DE, editors. Principles and practice of supportive oncology, Philadelphia: Lippincott - Raven; 1998. p. 223.  Back to cited text no. 5    
6.Srephens LC, Schulthesis IE, Small SM, Ang KK. Peters LJ. Response of parotid organ culture to radiation. Radiat Res 1989;120:140-53.  Back to cited text no. 6    
7.Dumbrigue HB, Sandow PL, Nguyen KT, Humphreys-Beher MG. Salivary epidermal growth factor levels decrease in patients receiving radiation therapy to the head and neck. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:710-6.  Back to cited text no. 7    
8.Berger AM, Kilroy TJ. Oral complications. In : DeVita Berger A, Portenoy RK, Weissman DE, editors. Principles and practice of supportive oncology, Philadelphia: Lippincott-Raven; 1998. p. 223.  Back to cited text no. 8    
9.Dirier A, Akmansu M, Bora H, Gurer M. The effect of vitamin E on acute skin radiation caused by radiotherapy. Clin Exp Dermatol 2007;32:571-3.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]
10.Flavia Maria DM, Anjos Pontual ML, Almeida SM, Boscolo FN, Tabchoury CP, Novaes PD. Evaluation of radioprotective effect of vitamin E in salivary dysfunction in irradiated rats. Arch Oral Biol 2006;51:96-101.  Back to cited text no. 10    
11.Bese NS, Munzuroglu F, Uslu B, Arbak S, Yesiladali G, Sut N, Altug, T, Ober A.* Vitamin E protects the rats against the development of radiation -induced pulmonary fibrosis. Clin Oncol 2007;19:260-264.  Back to cited text no. 11    
12.Navazesh M, Christensen C, Brightman V. Clinical criteria for the diagnosis of salivary gland hypofunction. J Dent Res 1992;71:1363-9.  Back to cited text no. 12  [PUBMED]  [FULLTEXT]
13.Epstein JB, Emerton S, Guglietta A, Le N. Assessment of epidermal growth factor in oral secretions of patients receiving radiation therapy for cancer. Oral Oncol 1997;33:359-63.  Back to cited text no. 13  [PUBMED]  [FULLTEXT]
14.Bernfeld P. Amylase alpha and beta. Methods Enzymol 1955;1:149-58.  Back to cited text no. 14    
15.Lowry OH. Roseborough NJ, Fair AL, Randall RJ. Protein measurement with the Folin phenol reagent. J Biol Chem 1951;193:265-75.  Back to cited text no. 15    
16.Mann HB, Whitney DR. On a test of whether one of two random variables is stochastically larger than the other. Math Stat 1947;18:50-60.  Back to cited text no. 16    
17.Valdez IH, Atkinson JC, Ship JA, Fox PC. Major salivary gland dysfunction in patients with radiation-induced xerostomia: Flow rates and sialochemistry. Int J Radiat Oncol Biol Phys 1993;25:41-7.  Back to cited text no. 17  [PUBMED]  
18.Chomette G, Auriol M, Vaillant JM, Bertrand JC, Chenal C. Effects of irradiation on the submandibular gland of the rat. Virchows Arch Pathol Anat 1981;391:291-9.  Back to cited text no. 18  [PUBMED]  
19.Konnings AW. Effects of heat and irradiation on mammalian cells. Radiat Phys Chem 1987;30:339-49.  Back to cited text no. 19    
20.Brandzaeg P, Fjellanger I, Gjeruldsen ST. Human secretory immunoglobulins IgA: Salivary secretions from individuals with normal or low levels of serum immunoglobulins. Scand J Haematol Suppl 1970;12:3-83.  Back to cited text no. 20    
21.Mandel ID, Barr CE, Turgeon L. Longitudinal study of parotid saliva in HIV - 1 infection. J Oral Pathol Med 1992;21:209-13.  Back to cited text no. 21  [PUBMED]  
22.van der Reijden WA, van der Kwaak JS, Veerman EC, Nieuw Amerongen AV. Analysis of the concentration and output of whole salivary constituents in patients with Sjogren's syndrome. Eur J Oral Sci 1996;104:335-40.  Back to cited text no. 22  [PUBMED]  
23.Lenander LM, Puhakka T, Makela MJ, Vilja P, Ruuskanen O, Tenovuo J. Effects of the common cold and intranasal fluticasone propionate treatment on mucosal host defense assessed by human saliva. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:695-9.  Back to cited text no. 23    
24.Lenander LM, Ihalin R, Lahteenoja H. Changes in whole saliva in patients with celiac disease. Arch Oral Biol 2000;45:347-54.  Back to cited text no. 24    
25.Seifert G, Donath K. Morphology of salivary gland diseases. Arch Otolaryngol 1976;213:111-8.  Back to cited text no. 25    
26.Shannon LL, Trodahl JN, Starcke EN. Radiosensitivity of the human parotid gland. Proc Soc Exp Biol Med 1978:157:50-3.  Back to cited text no. 26    
27.Visink A, Gravenmade EJ, Ligeon EE, Konning AW. A functional and chemical study of radiation effects on rat parotid and submandibular-sublingual glands. Radiat Res 1990;124:259-65.  Back to cited text no. 27    
28.Rantonen PJ, Meurman HJ. Correlations between total protein, lysozyme, immunoglobulin, amylase and albumin in stimulated whole saliva during day time. Acta Odontol Scand 2000;58:160-5.  Back to cited text no. 28    
29.Prasad KN, Kumar R. Effect of individual and multiple antioxidant vitamins on growth and morphology of human non-tumorigenic and tumorigenic parotid acinar cells in culture. Nutr Cancer 1996;26:11-9.  Back to cited text no. 29  [PUBMED]  

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Correspondence Address:
S Chitra
Department of Biotechnology, Sri Ramachandra College of Biomedical Science, Technology and Research, Sri Ramachandra University and Research Institute, Porur, Chennai - 600 116
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.42953

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