Effect of vitamin A on intestinal mucosal injury in pediatric patients receiving hematopoietic stem cell transplantation
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RESEARCH NOTE
Effect of vitamin A on intestinal mucosal injury in pediatric patients receiving hematopoietic stem cell transplantation and chemotherapy: a quasai‑randomized trial Ploy Pattanakitsakul, Nalinee Chongviriyaphan, Samart Pakakasama and Nopporn Apiwattanakul*
Abstract Objective: Vitamin A is involved in maintenance of gut mucosal integrity and normal immune function. However, it is unclear whether these functions of vitamin A have any beneficial effects in patients undergoing hematopoietic stem cell transplantation (HSCT). In this study, we aimed to examine the potential protective effect of vitamin A supplementation on gastrointestinal (GI) mucosal integrity in HSCT recipients using plasma citrulline as a surrogate marker of intestinal integrity. Results: We performed a quasi-randomized trial in 30 pediatric patients undergoing HSCT. Half (n = 15) of the patients received a single high dose of vitamin A (200,000 IU) before the conditioning regimen was given, and half (n = 15) did not. Clinical data of patients who developed post-transplant complications were recorded for 60 days after HSCT. There were no significant differences in mean plasma citrulline levels on day 7 after HSCT between the treatment and control groups (5.8 vs. 5.9 µmol/L, respectively). The incidence of mucositis and other complications were not different between the two groups within 60 days of HSCT. Vitamin A supplementation prior to HSCT in pediatric patients had no clinical benefit in protecting GI mucosal integrity. Keywords: Vitamin A supplementation, Citrulline, Hematopoietic stem cell transplantation, Mucosal injury, Pediatrics Introduction Infection is a major cause of morbidity and mortality during the neutropenic phase in patients undergoing hematopoietic stem cell transplantation (HSCT) [1, 2]. Approximately 40% of stem cell transplant patients develop mucositis following the intensive chemotherapy. In addition to prolonged severe neutropenia, mucosal barrier injury in the gastrointestinal (GI) tract poses additional risks of local bacterial infection and septicemia during the pre-engraftment period [3–9].
*Correspondence: [email protected] Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok 10400, Thailand
Mucositis that occurs following conditioning chemotherapy in these patients is found throughout the GI tract and is generally not directly detectable. Thus, many studies have used plasma citrulline as a noninvasive biomarker of intestinal mucosal damage. Citrulline is an amino acid mainly produced by enterocytes of the small bowel. Decreased levels of plasma citrulline are correlated with significant epithelial small bowel loss [10–12]. Vitamin A plays an essential role in maintaining gut mucosal integrity and immune function [13]. In previous studies of newly diagnosed children with malignancy, vitamin A-deficient patients tended to have more serious febrile episodes, oral mucositis and infections compared with children
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