Clinical and biochemical assessment of the effect of glutamine in management of radiation induced oral mucositis in patients with head and neck cancer: Randomized controlled clinical trial

Suzan S Ibrahim; Fatma E A Hassanein; Hany W Zaky; Hadeel Gamal

doi:10.1016/j.jormas.2024.101827

Clinical and biochemical assessment of the effect of glutamine in management of radiation induced oral mucositis in patients with head and neck cancer: Randomized controlled clinical trial

J Stomatol Oral Maxillofac Surg. 2024 Mar 15:101827. doi: 10.1016/j.jormas.2024.101827. Online ahead of print.

Authors

Suzan S Ibrahim¹, Fatma E A Hassanein², Hany W Zaky³, Hadeel Gamal⁴

Affiliations

¹ Oral Medicine, Periodontology, and Oral Diagnosis, Faculty of Dentistry, Ain Shams University, Cairo, Egypt; Faculty of Oral and Dental medicine, Nahda university, Beni Suef, Egypt.
² Oral Medicine, Periodontology, and Oral Diagnosis, Faculty of Dentistry, Ain Shams University, Cairo, Egypt; Faulty of Dentistry, King Salman International University, El-Tur, Egypt. Electronic address: fatmahassanein@dent.asu.edu.eg.
³ Radiation Oncology, Ahmed Maher Teaching Hospital, Cairo, Egypt.
⁴ Oral Medicine, Periodontology, and Oral Diagnosis, Faculty of Dentistry, Ain Shams University, Cairo, Egypt.

PMID: 38493953
DOI: 10.1016/j.jormas.2024.101827

Abstract

Background: This study aimed to evaluate the effect of oral glutamine suspension on salivary levels of transforming growth factor beta 1 (TGF-β1), a cytokine involved in inflammation and Tumor progression, and the severity of radiation-induced oral mucositis (RIOM) in head and neck cancer patients. This is the first study to investigate the impact of glutamine on TGF-β1 levels in head and neck cancer patients with radiation induced oral mucositis (RIOM).

Methods: In this randomized controlled clinical trial, 50 HNC patients were enrolled and received either glutamine oral suspension or maltodextrin as a placebo from the baseline of RIOM to the end of radiotherapy. Salivary TGF-β1 levels were measured at baseline and after treatment. Also, RIOM was assessed using the World Health Organization (WHO) Oral Toxicity Scale, the Oral Mucositis Assessment Scale (OMAS), the Pain Visual Analog Scale (Pain-VAS), the incidence of opioid use, and body mass index (BMI).

Results: Glutamine significantly reduced salivary TGF-β1 levels and improved RIOM symptoms, such as pain, opioid use, and weight loss. The reduction of TGF-β1 levels was associated with the improvement of RIOM severity.

Conclusion: Glutamine may modulate the inflammatory response and enhance wound healing in RIOM by decreasing salivary TGF-β1 levels. These findings support the use of glutamine as a potential intervention for RIOM and nutritional support for improving radiation sensitivity.

Trial registration: This study was registered on clinicalTrials.gov with identifier no. NCT05856188.

Keywords: Glutamine; Head and neck cancer; Oral mucositis; TGF-β1; Transforming growth factor beta 1.

Associated data

ClinicalTrials.gov/NCT05856188