Skip to main content

Advertisement

SpringerLink
Log in

Intestinal permeability, vitamin A absorption, alpha-tocopherol, and neopterin in patients with rectal carcinoma treated with chemoradiation

  • Original Paper
  • Published:
Medical Oncology Aims and scope Submit manuscript

Abstract

Although gastrointestinal toxicity is one of the most common side effects of anticancer therapy, the diagnosis and assessment of this toxicity still depend mostly on anamnestic data. Measurement of intestinal permeability is one of potential methods of non-invasive laboratory evaluation of gastrointestinal toxicity. The aim of the present study was to investigate intestinal permeability, vitamin A absorption, serum alpha-tocopherol, and urinary neopterin in patients with rectal carcinoma treated with chemoradiation. We have studied intestinal permeability, vitamin A absorption, serum alpha-tocopherol, and urinary neopterin in 17 patients with rectal carcinoma treated with chemoradiation. Urinary lactulose, mannitol, and xylose were measured by capillary gas chromatography, and serum alpha-tocopherol, retinol, retinyl esters, and urinary neopterin were determined by high-performance liquid chromatography. Lactulose/mannitol ratio was increased 5 and 6 weeks after the start of the treatment. Serum alpha-tocopherol was decreased significantly throughout the course of treatment, but no significant changes were observed in postprandial serum concentrations of retinyl esters or in the concentrations of urinary neopterin. A correlation was observed between baseline parameters of intestinal permeability and urinary neopterin. The measurement of intestinal permeability using the lactulose/mannitol test may represent a sensitive tool in the detection of changes associated with chemoradiation in patients with rectal carcinoma. The therapy is also associated with a decrease of alpha-tocopherol.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Sauer R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351:1731–40.

    Article  PubMed  CAS  Google Scholar 

  2. Wolmark N, et al. Randomized trial of postoperative adjuvant chemotherapy with or without radiotherapy for carcinoma of the rectum: National Surgical Adjuvant Breast and Bowel Project Protocol R-02. J Natl Cancer Inst. 2000;92:388–96.

    Article  PubMed  CAS  Google Scholar 

  3. Melichar B, Dvorak J, Hyspler R, Zadak Z. Intestinal permeability in the assessment of intestinal toxicity of cytotoxic agents. Chemotherapy. 2005;51:336–8.

    Article  PubMed  CAS  Google Scholar 

  4. Bjarnason I, Macpherson A, Hollander D. Intestinal permeability: an overview. Gastroenterology. 1995;1995:1566–81.

    Article  Google Scholar 

  5. Uil JJ, et al. Clinical implications of the sugar absorption test: intestinal permeability test to assess mucosal barrier function. Scand J Gastroenterol. 1997;32:70–8.

    Article  Google Scholar 

  6. DeMeo MT, Mutlu EA, Keshavarzian A, Tobin MC. Intestinal permeation and gastrointestinal disease. J Clin Gastroenterol. 2002;34:385–96.

    Article  PubMed  Google Scholar 

  7. Melichar B, et al. Intestinal permeability and vitamin A absoption in patients with chemotherapy-induced diarrhea. Am J Clin Oncol. 2008;31:580–4.

    Article  PubMed  CAS  Google Scholar 

  8. Urbanek L, et al. Optimization and validation of a high performance liquid chromatography method for the simultaneous determination of vitamins A and E human serum using monolithic column and diode-array detection. Anal Chim Acta. 2006;573–574:267–72.

    Article  PubMed  CAS  Google Scholar 

  9. Urbanek L, et al. Development and validation of a liquid chromatography method for the simultaneous determination of alpha-tocopherol, retinol and retinyl esters in human serum using a monolithic column for the monitoring of anticancer therapy side effects. J Sep Sci. 2006;29:2485–93.

    Article  PubMed  CAS  Google Scholar 

  10. Borel P, et al. Processing of vitamin A and E in the human gastrointestinal tract. Am J Physiol Gastrointest Liver Physiol. 2001;280:G95–103.

    PubMed  CAS  Google Scholar 

  11. Melichar B, et al. Urinary neopterin in patients with ovarian cancer. Pteridines. 2006;17:145–53.

    CAS  Google Scholar 

  12. Melichar B, Hyspler R, Kalabova H, Urbanek L, Krcmova L. Gastrointestinal permeability—a parameter of possible prognostic importance in metastatic colorectal carcinoma. Pteridines. 2008;19:19–22.

    CAS  Google Scholar 

  13. Melichar B, et al. Serum alpha-tocopherol, retinol and neopterin during paclitaxel/carboplatin chemotherapy. Anticancer Res. 2007;27:4397–401.

    PubMed  CAS  Google Scholar 

  14. Cermanova M, et al. Urinary neopterin and microalbuminuria in patients treated by low-density lipoprotein apheresis. Pteridines. 2005;16:174–83.

    CAS  Google Scholar 

  15. Kohout P, Cerman J, Bratova M, Zadak Z. Small bowel permeability in patients with cytostatic therapy. Nutrition. 1999;15:546–9.

    Article  PubMed  CAS  Google Scholar 

  16. Daniele B, et al. Effect of chemotherapy with 5-fluorouracil on intestinal permeability and absorption in patients with advanced colorectal cancer. J Clin Gastroenterol. 2001;32:228–30.

    Article  PubMed  CAS  Google Scholar 

  17. de la Maza MP, et al. Acute nutritional and intestinal changes after pelvic radiation. J Am Coll Nutr. 2001;20:637–42.

    Google Scholar 

  18. Vigneulle RM, Rao S, Fasano A, MacVittie TJ. Structural and functional alterations of the gastrointestinal tract following radiation-induced injury in the rhesus monkey. Digest Dis Sci. 2002;47:1480–91.

    Article  PubMed  Google Scholar 

  19. Melichar B, et al. Intestinal permeability in patients with chemotherapy-induced stomatitis. J Cancer Res Clin Oncol. 2001;127:314–8.

    Article  PubMed  CAS  Google Scholar 

  20. Harrison EH, Hussain MM. Mechanisms involved in the intestinal digestion and absorption of dietary vitamin A. J Nutr. 2001;131:1405–8.

    PubMed  CAS  Google Scholar 

  21. Johnson EJ, et al. Evaluation of vitamin A absorption by using oil-soluble and water-miscible vitamin A preparations in normal adults and in patients with gastrointestinal disease. Am J Clin Nutr. 1992;55:857–64.

    PubMed  CAS  Google Scholar 

  22. Debier C, Larondelle Y. Vitamins A and E: metabolism, roles and transfer to offspring. Br J Nutr. 2005;93:153–74.

    Article  PubMed  CAS  Google Scholar 

  23. McMillan DC, et al. The relationship between reduced vitamin antioxidant concentrations and the systemic inflammatory response in patients with common solid tumours. Clin Nutr. 2002;21:161–4.

    Article  PubMed  CAS  Google Scholar 

  24. Mayland C, Allen KR, Degg TJ, Bennet M. Micronutrient concentrations in patients with malignant disease: effect of the inflammatory response. Ann Clin Biochem. 2004;41:138–41.

    Article  PubMed  CAS  Google Scholar 

  25. McMillan DC, Sattar N, Talwar D, O’Reilly DS, McArdle CS. Changes in micronutrient concentrations following anti-inflammatory treatment in patients with gastrointestinal cancer. Nutrition. 2000;16:425–8.

    Article  PubMed  CAS  Google Scholar 

  26. Faure H, et al. 5-hydroxymethyluracil excretion, plasma TBARS and plasma antioxidant vitamins in adriamycin-treated patients. Free Rad Biol Med. 1996;20:979–83.

    Article  PubMed  CAS  Google Scholar 

  27. Jonas RC, et al. Plasma antioxidant status after high-dose chemotherapy: a randomized trial of parenteral nutrition in bone marrow transplantation patients. Am J Clin Nutr. 2000;72:181–9.

    PubMed  CAS  Google Scholar 

  28. High KP, et al. Low plasma concentrations of retinol and alpha-tocopherol in hematopoietic stem cell transplant recipients: the effect of mucositis and the risk of infection. Am J Clin Nutr. 2002;76:1358–66.

    PubMed  CAS  Google Scholar 

  29. Faber M, Coudray C, Hida H, Mousseau M, Favier A. Lipid peroxidation products, and vitamin and trace element status in patients with cancer before and after chemotherapy, including adriamycin. A preliminary study. Biol Trace Elem Res. 1995;47:117–23.

    Article  PubMed  CAS  Google Scholar 

  30. Kennedy DD, et al. Low antioxidant vitamin intakes are associated with increases in adverse effects of chemotherapy in children with acute lymphoblastic leukemia. Am J Clin Nutr. 2004;79:1029–36.

    PubMed  CAS  Google Scholar 

  31. Delanian S, Porcher R, Balla-Mekias S, Lefaix JL. Randomized, placebo-controlled trial of combined pentoxifylline and tocopherol for regression of superficial radiation-induced fibrosis. J Clin Oncol. 2003;21:2545–50.

    Article  PubMed  CAS  Google Scholar 

  32. Pace A, et al. Neuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy. J Clin Oncol. 2003;21:927–31.

    Article  PubMed  CAS  Google Scholar 

  33. Melichar B, Solichová D, Freedman RS. Neopterin as an indicator of immune activation and prognosis in patients with gynecological malignancies. Int J Gynecol Cancer. 2006;16:240–52.

    Article  PubMed  CAS  Google Scholar 

  34. Wachter H, Fuchs D, Hausen A, Reibnegger G, Werner ER. Neopterin as marker for activation of cellular immunity: immunologic basis and clinical application. Adv Clin Chem. 1989;27:81–141.

    Article  PubMed  CAS  Google Scholar 

  35. Melichar B, et al. Urinary neopterin in patients with advanced colorectal carcinoma. Int J Biol Markers. 2006;21:190–8.

    PubMed  CAS  Google Scholar 

  36. Tatzber F, et al. Elevated serum neopterin levels in atherosclerosis. Atherosclerosis. 1991;89:203–8.

    Article  PubMed  CAS  Google Scholar 

  37. Weiss G, et al. Increased concentrations of neopterin in carotid atherosclerosis. Atherosclerosis. 1994;106:263–71.

    Article  PubMed  CAS  Google Scholar 

  38. Melicharova K, et al. Urinary neopterin in patients with diabetes mellitus and foot ulcers. Pteridines. 2007;18:128–31.

    CAS  Google Scholar 

  39. Melichar B, et al. Urinary neopterin, hemoglobin and peripheral blood cell counts in breast carcinoma patients treated with dose-dense chemotherapy. Anticancer Res. 2008;28:2389–96.

    PubMed  CAS  Google Scholar 

  40. Reibnegger G, et al. Neopterin as a prognostic indicator in patients with carcinoma of the uterine cervix. Cancer Res. 1986;46:950–5.

    PubMed  CAS  Google Scholar 

  41. Steinberg D. Oxidative modification of LDL and atherogenesis. Circulation. 1997;95:1062–71.

    PubMed  CAS  Google Scholar 

  42. Keaney JF, et al. Vascular incorporation of alpha-tocopherol prevents endothelial dysfunction due to oxidized LDL by inhibiting protein kinase C stimulation. J Clin Invest. 1996;98:386–94.

    Article  PubMed  CAS  Google Scholar 

  43. Salonen JT, et al. Antioxidant Supplementation in Atherosclerosis Prevention (ASAP) study: randomized trial of the effect of vitamins E and C on 3-year progression of carotid atherosclerosis. J Intern Med. 2000;248:377–86.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study was supported by the grant of the Internal Grant Agency of the Czech Republic NR9096-4 and Research Project MZO 00179906.

Author information

Authors and Affiliations

  1. Department of Oncology & Radiotherapy, Charles University Medical School and Teaching Hospital, Hradec Králové, Czech Republic

    Josef Dvořák, Bohuslav Melichar & Hana Kalábová

  2. Department of Gerontology & Metabolic Care, Charles University Medical School and Teaching Hospital, Hradec Králové, Czech Republic

    Radomír Hyšpler, Lenka Krčmová, Lubor Urbánek, Markéta Kašparová & Dagmar Solichová

  3. Department of Analytical Chemistry, Charles University School of Pharmacy, Hradec Králové, Czech Republic

    Lenka Krčmová, Lubor Urbánek & Markéta Kašparová

  4. Department of Oncology, Palacký University Medical School and Teaching Hospital, I.P. Pavlova 6, 775 20, Olomouc, Czech Republic

    Bohuslav Melichar

Authors
  1. Josef Dvořák
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bohuslav Melichar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Radomír Hyšpler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lenka Krčmová
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lubor Urbánek
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hana Kalábová
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Markéta Kašparová
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Dagmar Solichová
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bohuslav Melichar.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dvořák, J., Melichar, B., Hyšpler, R. et al. Intestinal permeability, vitamin A absorption, alpha-tocopherol, and neopterin in patients with rectal carcinoma treated with chemoradiation. Med Oncol 27, 690–696 (2010). https://doi.org/10.1007/s12032-009-9270-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12032-009-9270-4

Keywords

Search

Navigation