Lactoferrin supplementation may alleviate chemotherapy-induced taste, smell abnormalities

Daily lactoferrin supplementation may alleviate taste and smell abnormalities experienced by individuals with cancer who undergo chemotherapy, according to study results.

This approach also appeared to improve patients’ oral immunity, results showed.

“Sixty to 70% of patients with cancer who undergo chemotherapy experience some type of taste or smell disorder,” Susan E. Duncan, PhD, RD, professor of food science and technology at Virginia Tech and associate director of the Virginia Agricultural Experiment Station, told HemOnc Today. “If this can bring some relief to them, I think it has the potential to give them a more positive attitude.”

Duncan and colleagues evaluated the feasibility of lactoferrin supplementation as a treatment for chemotherapy-induced taste and smell abnormalities (TSA), the underlying mechanism for which had not been established..

The analysis included 19 individuals with cancer with established TSA after chemotherapy administration, as well as 12 healthy individuals.

All study participants received supplementation with lactoferrin — a protein found in milk — in the form of three 250-mg tablets daily for 30 days.

Researchers collected saliva at three timepoints: at baseline, on day 30 of lactoferrin supplementation, and 30 days after lactoferrin supplementation ended.

Investigators analyzed participants’ TSA levels, salivary proteome and salivary minerals at each treatment stage.

Results showed an association between high TSA level and high concentration of salivary iron and loss of critical salivary immune proteins.

Lactoferrin supplementation significantly reduced salivary iron (P = .025), increased abundance of salivary -amylase and Zn--2-GP (P < .05), and contributed to twofold or greater changes in immune proteins, including immunoglobulin heavy chain, annexin A1 and proteinase inhibitor.

Researchers also observed increased abundance of -amylase and SPLUNC2 at 30 days after lactoferrin supplementation among individuals with cancer (P < 0.05).

Results also showed a significant reduction in total TSA score among individuals who underwent chemotherapy (P < 0.001).

HemOnc Today spoke with Duncan about this study, the implications of the results, and the next steps for research.

Question: What prompted this study?

Answer: Several of the authors either have had cancer or have had loved ones who have had cancer. My husband had cancer, and he experienced taste and odor abnormalities during treatment. We were already studying metallic flavor perceptions in the oral cavity, and this was one of those personal and professionally interesting questions.

Q: How did you conduct the study?

A: Researchers collected salivary samples. We analyzed them for a number of chemical parameters, including the protein content that is described in the paper, and illustrated changes we observed. We also measured TSA by a self-reported scorecard-type approach and calculated it independently.

Q: What did you find?

A: We saw a decrease in salivary iron due to lactoferrin. Iron as a mineral is a pro-oxidant, and it creates this oxidation process that often results in a metallic taste. The immuno-protein composition among individuals with cancer had been altered, due to either their malignancy or their therapy. After lactoferrin supplementation, abundance of several of those important immuno-proteins increased. We don’t know exactly what this means yet, but we think it is valuable to illustrate there is an opportunity for supplementation to reduce TSA.There is a caution that comes with the realization that this is a small pilot study, and it included patients with different types of cancer who received different types of therapies. So, although this study is illustrative of this approach’s potential, it is not a guarantee of benefit.

Q: What might explain the variability between patients?

A: Salivary composition is highly variable from person to person. We don’t have the concentrations from when study participants were in a healthy state, so that is a limitation.

Q: Why did you choose to study lactoferrin?

A: Lactoferrin is a molecule that is found broadly in nature. It is in saliva, blood and milk. It is known for binding to iron and other molecules responsible for oxidative promotion.

Q: What are the next steps for research?

A:We are trying to secure funding. We would like to conduct a much larger study and focus on having a critical number of participants. We would like to do this as broadly as possible, but we may have to target specific cancer types. For example, it could focus on head and neck cancer, given therapies are directly affecting tissues in or close to the oral cavity.

Q: What specific questions do you hope to answer ?

A: There are several logical questions. Are there other molecules that could be of interest? Are there markers that oncologists could assess to determine whether a patient is at greater risk for these abnormalities? How urgent is this study for physicians and patients undergoing chemotherapy?

Q: What is the difference between lactoferrin supplementation and milk consumption?

A: A lot of people who responded to these initial findings said they would start drinking more milk, but we did not study milk as a delivery mechanism for lactoferrin. Importantly, lactoferrin is found in very low concentration in milk. I don’t know what the equivalent would be for milk consumption and lactoferrin supplementation, but it’s far more milk than one can readily drink on a daily basis.

Q: Is there anything else you would like to mention?

A: Food is an important part of life. Although treating the cancer is most important, recognizing that — during a time of stress — having something that provides comfort and provides an opportunity to have a sense of normality is hugely valuable. It is important to the patient’s — and their families’ — psychological, emotional and physical status. If this allows patients to enjoy food and the comfort, community and camaraderie that comes with it, it may help give them the energy and emotional resilience they need to push through and come out on the other side of treatment with a positive outcome. – by Scott Buzby

Reference:

Wang A, et al. Food Funct. 2018;doi:10.1039/c8fo00813b.

For more information:

Susan E. Duncan, PhD, RD , can be reached at duncans@vt.edu.

Disclosures: The Virginia Agricultural Experiment Station, National Institute of Food and Agriculture’s Hatch program, U.S. Department of Agriculture, Virginia Tech Water Interface Interdisciplinary Graduate Education Program and Wake Forest Baptist Comprehensive Cancer Center provided funding for this study. The authors report no relevant financial disclosures.