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Graft-versus-Host Disease

Effect of pilocarpine hydrochloride on unstimulated whole saliva flow rate and composition in patients with chronic graft-versus-host disease (cGVHD)

Abstract

A double-blind, placebo-controlled study was conducted to evaluate the effect of orally administered pilocarpine on unstimulated whole-saliva flow and composition in 28 patients with chronic graft-versus-host disease (cGVHD). Thirteen patients were treated with pilocarpine of 20 mg/day orally for 7 days, and 15 patients with placebo. Unstimulated whole saliva was collected in the morning on four occasions (30 min before pilocarpine or placebo intake, and 1 h, 1 day and 7 days after the first intake). Significantly, higher salivary flow rates, and sodium and total protein outputs were observed in the second samples of pilocarpine-treated patients compared with controls, whereas calcium and IgA outputs were not altered. Changes in these parameters were not significant in the third and fourth samples, although they were higher in the pilocarpine group. Patients who had received pilocarpine expressed satisfaction with their treatment. These data suggest that pilocarpine may improve salivary flow rate and the feeling of xerostomia in patients with cGVHD.

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References

  1. Souza LN, Carneiro MA, de Azevedo WM, Gomez RS . Vascular endothelial growth factor (VEGF) and chronic graft-versus-host disease (cGVHD) in salivary glands of bone marrow transplant (BMT) recipients. J Oral Pathol Med 2004; 33: 13–16.

    Article  CAS  Google Scholar 

  2. Sullivan KM, Shulman HM, Storb R, Weiden PL, Witherspoon RP, McDonald GB et al. Chronic graft-versus-host disease in 52 patients: adverse natural course and successful treatment with combination immunosuppression. Blood 1981; 57: 267–276.

    CAS  PubMed  Google Scholar 

  3. Singhal S, Mehta J, Rattenbury H, Treleaven J, Powles R . Oral pilocarpine hydrochloride for the treatment of refractory xerostomia associated with chronic graft-versus-host disease. Blood 1995; 85: 1147–1148.

    CAS  PubMed  Google Scholar 

  4. Nagler RM, Nagler A . Pilocarpine hydrochloride relieves xerostomia in chronic graft-versus-host disease: a sialometrical study. Bone Marrow Transplant 1999; 23: 1007–1011.

    Article  CAS  Google Scholar 

  5. Alborghetti MR, Correa ME, Adam RL, Metze K, Coracin FL, de Souza CA et al. Late effects of chronic graft-vs. host disease in minor salivary glands. J Oral Pathol Med 2005; 34: 486–493.

    Article  CAS  Google Scholar 

  6. Soares AB, Faria PR, Magna LA, Correa MEP, de Sousa CA, Almeida OP et al. Chronic GVHD in minor salivary glands and oral mucosa: histopathological and immunohistochemical evaluation of 25 patients. J Oral Pathol Med 2005; 34: 368–373.

    Article  CAS  Google Scholar 

  7. Schaefer UW, Beelen DW . Bone Marrow Transplantation, 2nd edn. Karger Basel: Germany, 1996, pp 86–89.

    Google Scholar 

  8. Fox PC, van der Ven PF, Baum BJ, Mandel ID . Pilocarpine for the treatment of xerostomia associated with salivary gland dysfunction. Oral Surg Oral Med Oral Pathol 1986; 61: 243–248.

    Article  CAS  Google Scholar 

  9. Navazesh M . Methods for collecting saliva. Ann NY Acad Sci 1993; 694: 72–77.

    Article  CAS  Google Scholar 

  10. Thomas L . Clinical Laboratory Diagnostics, 1st edn. TH-Books verlagsgesellschaft: Frankfurt, 1998, pp 644–647, 241–247, 231–241, 131–137, 664–678.

    Google Scholar 

  11. Gindler EM, King JD . Rapid colorimetric determination of calcium in biologic fluids with methylthymol blue. Am J Clin Pathol 1972; 58: 376–382.

    Article  CAS  Google Scholar 

  12. Mandel ID . The functions of saliva. J Dent Res 1987; 66: 623–627.

    Article  Google Scholar 

  13. Mandel ID . The role of saliva in maintaining oral homeostasis. J Am Dent Assoc 1989; 119: 298–304.

    Article  CAS  Google Scholar 

  14. Slomiany B, Murty VL, Piotrowski J, Slomiany A . Salivary mucins in oral mucosal defense. Gen Pharmacol 1996; 27: 761–771.

    Article  CAS  Google Scholar 

  15. Humphrey SP, Williamson RT . A review of saliva: normal composition, flow, and function. J Prosthet Dent 2001; 85: 162–169.

    Article  CAS  Google Scholar 

  16. Navazesh M . Dry mouth: aging and oral health. Compend Contin Educ Dent 2002; 23: 41–48.

    PubMed  Google Scholar 

  17. Narhi TO . Prevalence of subjective feelings of dry mouth in the elderly. J Dent Res 1994; 73: 20–25.

    Article  CAS  Google Scholar 

  18. Levy S, Nagler A, Okon S, Marmary Y . Parotid salivary gland dysfunction in chronic graft-versus-host disease (cGVHD): a longitudinal study in a mouse model. Bone Marrow Transplant 2000; 25: 1073–1078.

    Article  CAS  Google Scholar 

  19. Nagler RM, Nagler A . Sialometrical and sialochemical analysis of patients with chronic graft-versus-host disease – a prolonged study. Cancer Invest 2003; 21: 34–40.

    Article  CAS  Google Scholar 

  20. Nagler R, Barness-Hadar L, Lieba M, Nagler A . Salivary antioxidant capacity in graft versus host disease. Cancer Invest 2006; 24: 269–277.

    Article  CAS  Google Scholar 

  21. Guchelaar HJ, Vermes A, Meerwaldt JH . Radiation-induced xerostomia: pathophysiology, clinical course and supportive treatment. Support Care Cancer 1997; 5: 281–288.

    Article  CAS  Google Scholar 

  22. Aragona P, Di Pietro R, Spinella R, Mobrici M . Conjunctival epithelium improvement after systemic pilocarpine in patients with Sjogren's syndrome. Br J Ophthalmol 2006; 90: 166–170.

    Article  CAS  Google Scholar 

  23. Davies AN, Singer J . A comparison of artificial saliva and pilocarpine in radiation-induced xerostomia. J Laryngol Otol 1994; 108: 663–665.

    Article  CAS  Google Scholar 

  24. Davies AN, Daniels C, Pugh R, Sharma K . A comparison of artificial saliva and pilocarpine in the management of xerostomia in patients with advanced cancer. Palliat Med 1998; 12: 105–111.

    Article  CAS  Google Scholar 

  25. Fox PC . Systemic therapy of salivary gland hypofunction. J Dent Res 1987; 66: 689–692.

    Article  Google Scholar 

  26. Singhal S, Powles R, Treleaven J, Rattenbury H, Mehta J . Pilocarpine hydrochloride for symptomatic relief of xerostomia due to chronic graft-versus-host disease or total-body irradiation after bone-marrow transplantation for hematologic malignancies. Leuk Lymphoma 1997; 24: 539–543.

    Article  CAS  Google Scholar 

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Correspondence to F Agha-Hosseini.

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Agha-Hosseini, F., Mirzaii-Dizgah, I., Ghavamzadeh, L. et al. Effect of pilocarpine hydrochloride on unstimulated whole saliva flow rate and composition in patients with chronic graft-versus-host disease (cGVHD). Bone Marrow Transplant 39, 431–434 (2007). https://doi.org/10.1038/sj.bmt.1705621

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