Prebiotics a potential means to ameliorate acute intestinal injury and to diminish the risk of chronic radiation enteritis

• Main Author: Hamad, A.
• Published: University College London (University of London) 2014
• Subjects: 610
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.626683

Radiotherapy and chemo-radiotherapy increasingly often achieve cure in gynaecological and prostate cancer, but radiation enteritis/proctitis remains a problem in acute phases of treatment in more than 70% of patients. In most cases this resolves rapidly, but in at least 5% of patients it persists or re-presents as chronic radiation damage. This may be progressive and is associated with diarrhoea, rectal bleeding, incontinence, and poor quality of life. It has engaged surprisingly little attention. Standard management during radiotherapy includes a low fibre diet. Although this may reduce some acute symptoms it also deprives the bowel of fibre-derived short chain fatty acids which (particularly butyrate) are its essential nutrients. We hypothesised that possible advantages of fibre avoidance are outweighed by less restrained damage to the mucosa, and perhaps by a longer-term insult which in some patients leads to chronic radiation bowel disease. The proposed work explores the provision of short chain fatty acids to the bowel and the importance of short chain fatty acids in angiogenesis. Our meta-analysis has shown that probiotics may have a role in prevention of radiation-induced sequelae. We have been able to encapsulate short chain fatty acids in alginate beads and have successfully used these beads to deliver short chain fatty acids to the chick chorio-allantoic membrane assay model; the beads have the potential for future colon-specific delivery in man. Our results have shown that propionate may increase angiogenesis. The study on effect of Androgen Deprivation Therapy (ADT) on gut microbiota has shown that Androgen Deprivation Therapy before radiotherapy in patients undergoing radiotherapy for prostate cancer does not have a dramatic effect on their microbiota. Our trial with fructooligosaccharide is an ongoing trial where fructooligosaccharide is given prophylactically in a blinded, placebo-controlled fashion to patients undergoing pelvic irradiation for gynaecological and prostate malignancy. It will serve as a pilot study for the postulated influence of fructooligosaccharide on late-stage chronic radiation disease.