Kinetics of neutrophil extracellular traps and cytokines in oral mucositis and Candida infection

Objective: This study investigated the concentrations of neutrophil extracellular traps (NET) and salivary cytokines (IL-1 beta, IL-6, IL-8/CXCL8, TNF, and TGF-beta 1) in patients undergoing chemotherapy and their associations with oral mucositis (OM) and Candida infection.Materials and Methods: This prospective longitudinal study performed at a Brazilian service included 60 adults diagnosed with hematolymphoid diseases. Saliva samples were collected on days D0, D3, D10, and D15. Cytokines were analyzed by ELISA and NET formation by identification of the myeloperoxidase-DNA complex. Oral Candida spp. was cultured.Results: OM occurred in 43.3% of patients and oral candidiasis in 20%. However, 66% of individuals had positive cultures for C. albicans. Higher concentrations of IL-6, IL-8/CXCL8, and TNF and lower concentrations of TGF-beta 1 were observed in patients with OM. C. albicans infection contributed to the increase in IL-8/CXCL8, TGF-beta 1, and TNF. Individuals with OM or with oral candidiasis had significant reductions in NET formation. In contrast, individuals with C. albicans and with concomitant C. albicans and OM exhibited higher NET formation.Conclusion: The kinetics of cytokine levels and NET formation in chemotherapy-induced OM appears to be altered by Candida infection, even in the absence of clinical signs of oral candidiasis.