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ORIGINAL RESEARCH ARTICLE

Chemotherapy-Induced Diarrhea Is Associated with Changes in the Luminal Environment in the DA Rat

Andrea M. Stringer^*,,1, Rachel J. Gibson^*,, Richard M. Logan^*,, Joanne M. Bowen^*,, Ann S-J Yeoh^*,, Jaimi Burns^* and Dorothy M. K. Keefe^*,

^* Department of Medical Oncology, Royal Adelaide Hospital, South Australia 5000, Australia; Department of Medicine, University of Adelaide, Adelaide 5005, South Australia, Australia; and Oral Pathology, Dental School, Faculty of Health Sciences, University of Adelaide, Adelaide 5005, South Australia, Australia

To whom requests for reprints should be addressed at ¹ Department of Medical Oncology, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia 5000, Australia. E-mail: andrea.stringer{at}imvs.sa.gov.au

The microflora of the gastrointestinal tract (GIT) are a complex ecosystem, performing a number of beneficial functions. Irinotecan causes both early and late diarrhea, the latter possibly caused, in part, by changes in the microflora of the GIT. Female DA rats were given atropine subcutaneously, prior to a single 200 mg/kg intraperitoneal dose of irinotecan. Animals were monitored for diarrhea and killed at 30 and 60 mins, 2, 6, 12, 24, 48, and 72 hrs after chemotherapy administration. Control rats received no treatment. Fecal samples and stomach, jejunum, and colon samples were collected and stored at –70°C until required. Standard microbiological culture techniques were used to grow and isolate the flora. Biochemical tests were used to identify the bacteria. The level of growth was noted for relative comparison between time points and graded accordingly. Early diarrhea was observed in the rats from 2–6 hrs after treatment, after which time the diarrhea resolved. Late onset diarrhea was apparent 72 hrs after treatment. Changes were seen in the flora of the stomach, jejunum, colon and feces. The majority of microflora changes were seen 6, 12, and 24 hrs after treatment, with a relative increase or decrease in the presence of bacteria in comparison with control rats. In some rats bacteria were not observed at all time points, and different bacteria not seen in control animals were identified in rats treated with irinotecan. These changes were observed up to 72 hrs after treatment. In conclusion, irinotecan treatment causes changes in the flora of the stomach, jejunum, colon, and feces of rats and is associated with the development of diarrhea. These changes in flora may have systemic effects and in particular may contribute to the development of chemotherapy-induced mucositis.

Key Words: irinotecan • chemotherapy • diarrhea • intestinal microflora • electrolytes

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