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Zinc deficits, mucositis, and mucosal macrophage perturbation

is there a relationship?

Thomsen, Michaela; Vitetta, Luisa,b

Current Opinion in Clinical Nutrition & Metabolic Care: September 2019 - Volume 22 - Issue 5 - p 365–370
doi: 10.1097/MCO.0000000000000588
NUTRITION AND THE GASTROINTESTINAL TRACT: Edited by M. Isabel T.D. Correia and André Van Gossum

Purpose of review Mucositis is a common and therapy-limiting adverse effect of cancer treatments including radiotherapy, chemotherapy, and immunotherapy. The optimal zinc formulation, dosage, and timing of administration warrant further research as does the efficacious prevention of febrile mucositis that predisposes to febrile neutropenia.

Recent findings Metaanalyses concluded that zinc sulfate failed to significantly reduce the incidence or severity of chemotherapy-induced oral mucositis, whereas polaprezinc was associated with a significant reduction. Three new trials were published in 2018. The first trial found that zinc sulfate reduced the incidence and severity of chemotherapy-induced oral mucositis. The second reported that polaprezinc reduced oral mucositis in pediatric patients receiving high-dose chemotherapy for hematopoietic stem cell transplantation. The third trial demonstrated efficacy for a zinc lozenge for postoperative sore throat induced by an endotracheal intubation.

Summary Zinc deficits, dietary or induced by cancer, are common in patients with cancer. Febrile mucositis may better describe the condition linking mucositis with febrile neutropenia. Febrile mucositis disrupts treatment and may be life-threatening. A paradigm shift is needed for a more comprehensive understanding of febrile mucositis. Zinc effects on the thymic immunological network and T lymphocytes during chemoradiotherapy regimens also warrant further investigation.

aThe University of Sydney, Sydney Medical School

bMedlab Clinical Ltd., Sydney, New South Wales, Australia

Correspondence to Professor Luis Vitetta, 66 McCauley Street, Alexandria, NSW 2015 Australia. Tel: + 61 2 8188 0311; fax: + 61 2 9699 3347; e-mail:,

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