The effect of pilocarpine on salivary constituents in patients with chronic graft-versus-host disease

Chronic graft-versus-host disease (cGVHD) is a complex clinical entity with various target organs, including the salivary glands. Oral pilocarpine (Sa lagen (R)), 30 mg/day, can ameliorate cGVHD-induced xeroslomia and improve the flow rate from the major salivary glands. The purpose here was to evalu ate the effect of this drug at 30 mg/day on salivary biochemical and immuno logical composition in cGVHD patients. Significantly higher concentrations of salivary sodium (Na), magnesium (Mg), total protein, albumin, epidermal growth factor (EGF) and total IgG, accompanied by a concomitant increase in total IgA which did not reach significance, were observed in cGVHD patient s in comparison with controls, in both resting and stimulated conditions (p < 0.05), while salivary potassium, calcium and phosphate were not altered. Two weeks of oral pilocarpine, at 30 mg/day, resulted in normalization of the altered salivary biochemical and immunological composition in the cGVHD patients. Oral pilocarpine was able to reduce and normalise the elevated N a, Mg, total protein, albumin, EGF, IgG and IgA concentrations in both rest ing and stimulated conditions. The ability of oral pilocarpine to normalise and reverse the salivary biochemical and immunological alterations induced by cGVHD parallels its known stimulatory effect on salivary flow rates. As the biochemical and immunological composition of saliva provides its prote ctive antimicrobial characteristics, the ability of pilocarpine to abrogate cGVHD salivary gland abnormalities may be of clinical significance. (C) 20 01 Elsevier Science Ltd. All rights reserved.