Neuropatia autonômica induzida por cisplatina e vincristina em ratos : estudo funcional, eletrofisiológico e morfológico

Abstract

Introduction: Chemotherapeutic agents are chemical compounds used for the treatment of cancer. The efficacy of chemotherapy is limited by its side effects such as nephro, neuro, hepato and ototoxicity. Cisplatin and vincristine are chemotherapy drugs and their use is limited by peripheral neuropathy with autonomic, sensory and/or motor involvement. Aims: We evaluated the effect of cisplatin and vincristine on the gastric emptying (GE), gastrointestinal (GI) transit of liquid, baroreflex function, thermal and mechanical withdrawal latencies, electrophysiological parameters of sympathetic neurons and morphology of nerve and muscle tissues in rats. Methods: Vincristine sulphate, cisplatin or saline were injected into the tail vein. Cisplatin was administered at doses of 0.5 mg/Kg (5 doses), 1 mg/kg (2-5 doses) or 2 mg/kg (1, 2 or 5 doses) daily and vincristine was administered at the doses of 50 µg/kg (5 doses), 100µg/kg (2-5 doses) or 150 µg/kg (1, 2 or 5 doses) every other day, both drugs administered in male Wistar rats (200-250g). Next day, they were gavage-fed with a test meal (0.5 mg/ml of phenol red in 5% glucose solution) and were sacrificed 10 minutes later. The recovery of phenol red in the stomach and intestine was determined by spectrophotometry. Peak values of basal mean arterial pressure (MAP) and heart rate (HR) after i.v. phenylephrine 5 mg/kg and atropine 0.5 mg/kg were used to evaluate the baroreflex responses. Animals were subjected to hot plate testing to evaluate changes in the thermal pain threshold and for the assessment of mechanical threshold and allodynia, an dynamic plantar aesthesiometer based on the von Frey filament principle was used. Differences were evaluated by One-Way ANOVA with P<0.05. Results: Cisplatin increased the GE of liquid with doses ≥ 2 mg/Kg by 59.7-77.4% and this GE delay was not present two weeks after the treatment with 5 doses of cisplatin at 1 mg/kg. Vincristine increased the GE of liquid with doses ≥ 250 µg/kg by 54.5 – 69.3% and this GE delay was not present one week after the treatment with 5 doses of vincristine at 150 µg/kg. Cisplatin also enhanced baroreflex gain possibly by increasing sympathetic activity. Phenylephrine-induced bradycardia was enhanced suggesting sympathetic dysfunction and after infusion of atropine (0.5 mg/kg) heart rate changes related this drug infusion were still more prominent in cisplatin-treated rats than controls. Cisplatin changed the excitability of sympathetic neurons of the superior cervical ganglion and the morphology of autonomic and somatic ganglia and the vargus nerve in rats. Vincristine enhanced the HR reduction induced by phenylephrine and atropine (P<0.05). Conclusion: Our results demonstrated that cisplatin and vincristine induced autonomic neuropathy courses with delayed GE, altered baroreflex responses and increased colonic weight. Cisplatin altered mechanical threshold but not thermal, and autonomic neuropathy preceded this changes, in rats treated with vincristine sensory neuropathy preceded and outlasted the autonomic changes.