Novel therapeutic potential for the herbal preparation, STW 5: Prophylactic measure against intestinal mucositis induced by radiation

Patients undergoing radiotherapy frequently suffer from intestinal mucositis, necessitating discontinuation of treatment. The pathogenesis of the condition involves production of pro-inflammatory cytokines and reactive oxygen metabolites as well as increased apoptosis leading to loss of intestinal structure and function1. To date there is no adequate prophylactic measure to guard against the development of mucositis. STW 5 is a preparation consisting of 9 standardized herbal extracts of Iberis amara, Melissa officinalis, Matricaria recutita, Carum carvi, Mentha piperita, Angelica archangelica, Silybum marianum, Chelidonium majus, and Glycyrrhiza glabra. It was shown to have potent activity in intestinal inflammatory disorders,2,3, making it an attractive candidate to study its usefulness in mucositis. The latter was induced experimentally in rats by exposing them to whole body irradiation from a Caesium 137 source at a radiation dose of 6 Gray. Three days later, rats developed signs of intestinal inflammation, judged by histological examination and measurement of relevant parameters in intestinal homogenates and serum. STW5 (2 – 10 ml/Kg) was given orally for 5 days before and 2 days after exposure. Animals were sacrificed 24h later. Treatment with STW 5 led to a reduction in histological changes and guarded against the radiation-induced rise in inflammation markers: TNFα and myeloperoxidase in jejunal homogenates. Radiation led to a rise in TBARS, and a reduction in glutathione and protein content of the homogenates. Biomarkers of intestinal tissue injury: plasma diamineoxidase was raised while citrulline4 was significantly reduced. Apoptosis was evidenced by a rise in cytosolic calcium, depletion of mitochondrial cytochrome c and B-cell lymphoma 2. The derangement in all these parameters was largely prevented by STW 5. The findings may pave the way to a new therapeutic approach in the management of radiation induced mucositis.

Keywords: STW 5, radiation, mucositis, herbal, prophylaxis.

References:

1Wong TC et al (2006)J Pain Symptom Manage. 32, 27 – 37, 2Khayyal MT et al (2006) Phytomedicine. 13 Suppl 5, 56 – 66, 3Schempp H et al (2006) Phytomedicine. 2006;13 Suppl 5, 36 – 44 4Lutgens L and Lambin P (2007) World J. Gastroenterol., 13, 3033 – 3042