Papel de receptores CXCR2 na mucusite intestinal induzida por irinotecano

Abstract

Introduction: Irinotecan is an anticancer agent used in first and second line treatment protocols for colorectal cancer. However, a major side effect associated with irinotecan, intestinal mucositis, has negatively impacted on patient’s quality of life and limiting the therapeutic outcome. The literature reports the involvement of several inflammatory mediators in the pathogenesis of intestinal mucositis, including IL-1, IL-18, IL-33, nitric oxide and several others, whose pharmacological inhibition prevents neutrophil infiltration and leads to mucositis improvement. However, the role of chemokine receptors that are important to neutrophil recruitment, such as CXCR2, in intestinal mucositis is unknown. Aims: To study the role of CXCR2 receptors in the pathogenesis of irinotecan-induced intestinal mucositis. Methods: Male C57BL/6 mice (n = 6) were divided into groups and injected with either saline (5ml / kg, ip) or irinotecan (75, 90, 105 or 120 mg/kg ip) for 4 days. The dose of 120 mg/kg reproduced the inflammatory condition of mucositis, so it was used in association with SB225002, a CXCR2 antagonist. Body mass variation, diarrhea scores and leukocyte count were recorded. Following euthanasia, intestinal samples were collected for histopathological analysis, mieloperoxidase activity (MPO), IL-1β, KC and IFN-γ levels. In addition, the length of the small intestine was measured so was the weight of its solid contents. Bacteremia was further carried out. Additionally, we measured the expression of CXCR2 and CCR2 receptors on neutrophils surface. We also performed the in vitro chemotaxis assay, using neutrophils isolated from bone marrow of mice treated with IRI or IRI + SB225002 (Study approval number: 58/14). Results: IRI produced a significant (P <0.05) weight loss and leukopenia in all doses tested. However, only the doses of 105 and 120 mg/kg reduced (P<0.05) the villus/crypt ratio and increased (P<0.05) neutrophil infiltration (MPO assay). None of the doses promoted diarrhea. The dose of 120 mg/kg was the best in reproducing the typical histopathological damage seen during intestinal mucositis, thus this dose was chosen for further analysis. The treatment with SB225002 did not protect the animals from the weight loss, leukopenia, histopathological damage (measured by the villus/crypt ratio), reduction of the small intestine length or weight reduction of the small intestine content induced by IRI. There was no difference between IRI or IRI + SB225002 groups in regard to these parameters. In regard to neutrophil infiltration, SB225002 prevented the increase in MPO activity as early as 24 hours post 1st dose of IRI (P<0.05) vs IRI group, but failed to do so in late mucositis. In addition, IRI led to CXCR2 internalization followed by an increased expression of CCR2 receptor on neutrophils harvested from IRI-treated mice. Accordingly, in vitro neutrophil migration towards MIP-2, a CXCR2 ligand, was reduced. We also observed that mice injected with IRI or SB225002+IRI showed bacteremia when compared to the saline group. Conclusion: CXCR2 receptors only participate in the early phases of intestinal mucositis, likely due to the downregulation of these receptors, which are replaced by CCR2 on the surface of neutrophils.