Envolvimento da interleucina-18 (IL-18) na patogênese da mucosite gastrointestinal induzida pelo cloridrato de irinotecano (CPT-11)

Abstract

The term GIM refers to the adverse effects of cancer chemotherapy on mucosal surfaces, affecting different portions of the alimentary tract. 15% to 40% of patients in chemotherapy present some degree of mucositis. By now, much of GIM pathophysiology remains unknown. IL-18 is a pleiotropic cytokine that exerts regulatory functions over the immune system and is also involved in inflammation. Purpose: The aim of the present study was to elucidate the involvement of IL-18 in the pathogenesis of CPT-11-induced mucositis. Materials and methods: Male IL-18 wild type (Wt) or IL-18 knockout (KO) Balb/C mice received CPT-11 (60mg/kg/day, i.p.) or vehicle (0.5ml, i.p.) in a four day schedule. A group of IL-18Wt also received IL-18 binding protein (IL-18Bp, 200 µg, i.p., 1h before CPT-11). Animals were sacrificed on the fifth day. The following parameters were assessed: histologycal analysis, diarrhea, survival curve, leucogram, myeloperoxidase (MPO) activity assay, ileum levels of TNF-α and IL-1β by ELISA, immunohistochemistry for TNF-α and IL-1β and contractility assay. Results: IL-18Wt animals receiving CPT-11 presented diarrhea and intense histological alterations in the ileum (shortening of villi, flattening and vacuolization of enterocytes, cript necrosis and the presence of inflammatory infiltrate). There was also increased MPO activity, increased levels of TNF-α and IL-1β and strong immunostaining for TNF-α and IL-1β in the ileum. In addition, the CPT-11 treated mice presented increased intestinal contractility when stimulated with cholinergic drugs (bethanecol, BCh and acetylcholine, ACh). In contrast, IL-18KO animals treated with the same dose of CPT-11 presented less diarrhea and less intestinal histological alterations. There was no increase in MPO activity nor in TNF levels, but in IL-1 levels. In addition, TNFα and IL-1β immunostaining was weaker IL-18KO animals. Also, the intestinal contractility in IL-18KO animals was not exarcerbated after a cholinergic challenge. IL-18Wt animals receiving CPT-11 and IL-18Bp did not present significant diarrhea and there was no significant alterations on intestinal contractility after Ach administration. Although MPO activity was not increased in IL-18Bp treated animals, the ileal mucosa presented moderate to severe histological alterations. Conclusion: IL-18 participates in the CPT-11-induced GIM. IL-18Bp attenuates some inflammatory (cell infiltrate) and functional (diarrhea and contractility) events of CPT-11-induced GIM. The contractility alterations in CPT-11 treated animals seem to have an inflammatory related component.