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Table 1 List of therapies under investigation for mucositis development prevention grouped accordingly to their mechanism of action

From: Oral mucositis: the hidden side of cancer therapy

Antioxidant agents Characteristics Mechanism of action References
Amifostine Phosphorylated aminosulfhydryl compound Promotes recruitment of ROS scavenger, reduces DNA strand breaks [65, 66]
Glutamine Amino acid Exerts antioxidant activities promoting glutathione synthesis [67,68,69,70,71]
Oral zinc supplement Essential mineral Prevents lipids peroxidation, replaces redox reactive metals, induces metallothionein synthesis [72,73,74,75,76,77]
Vitamin E Lipid soluble α-tocopherol Prevents tissue damages caused by the ROS release [78,79,80]
N-acetyl-cysteine N-acetyl derivative of the natural amino acid L-cysteine Exerts antioxidant activities promoting glutathione synthesis, myeloperoxidase activity, xanthine dehydrogenase and oxidase activity. [81, 82]
GC4419 Synthetic manganese-based drug Counteracts superoxide dismutase activity [83]
Inhibitors of inflammation and cytokines production Characteristics Mechanism of action References
Turmeric Flowering plant belonging to Curcuma longa Counteracts NF- κB activiy [84]
Clonidine lauriad mucoadhesive buccal tablets Tablets contain high concentrations of an anti-inflammatory active principle (clonidine) Inhibits NF-κB activity and the downstream pro-inflammatory cytokines-mediated signal [85]
SMAD7 over expression Gene encoding the nuclear protein Smad7 that binds the E3 ubiquitin ligase SMURF2 Impairs TGF-β1 that NF-κB activities in mice model (K5.Smad7) irradiated [86]
Benzydamine hydrochloride rinses Indazole non-steroidal anti-inflammatory drug Inhibits the activity and the production of pro-inflammatory cytokines, TNF-α and IL-1β [87, 88]
Pentoxifylline Xanthine derivative Impairs NF-κB activity and inhibits TNF-α and IL-1β action [89, 90]
Dusquetide (SGX942) 5-amino acid innate defence regulator (IDR) peptide Modulates immune innate pro-inflammatory response [91]
Multi target natural agents Characteristics Mechanism of action References
Honey Honey topical application Attenuates burns and pressure wounds. [92,93,94,95]
Manuka and Kanuka essential oils Mix of essential oil from Leptospermum scoparium and Kunzea ericoides Anti-inflammatory, analgesic and anti-micotic and -bacterial activities [96]
Chinese traditional herbs 1-Extract of Indigowood root
2-Extract of Rhodiola algida
1-Anti-inflammatory and antiviral activities
2-Stimulates the immuno system
[97, 98]
Chamomile mouthwash infusion of powdered flower in water Anti-inflammatory, analgesic and anti-micotic and -bacterial activities [99, 100]
Aloe vera gel Juice of succulent plant species of the genus Aloe Promotes wound healing [101]
MF 5232 (Mucotrol®) Oral poliherbal gel wafer Analgesic, wound healing and anti oxidant properties [102]
Traumeel S® Homeophatic complex mouthwash Unknown mechanism of action [103]
Physical intervention Characteristics Mechanism of action Reference
Low-levels laser therapy (LLLT) Monochromatic laser at low intensity Promotes regeneration of damaged-tissue [73, 83]
Oral cryotherapy ice chips, ice cubes, ice lollipops Promotes local vasoconstriction, thus leading to a reduction exposure of mucosa to chemotherapy [73, 81, 104]
Oral care Standardized oral care and frequent oral cavity examination by oral care experts Prevents infections [105]
Lactobacillus Probiotic Preserves mucosal intestinal architecture [106, 107]