Diet modulates the toxicity of cancer chemotherapy in rats

The effects of diet and folate status on cyclophosphamide or 5-fluorouracil toxicity were studied in Fischer 344 rats maintained on either a cereal-based diet or a purified diet (AIN-93G). The rats fed the purified diet were divided into 3 groups: folate deficient (no dietary folic acid), folate replete (2 mg folic acid/kg diet), and high folate (2 mg folic acid/kg diet plus 50 mg/kg body weight folic acid intraperitoneally daily). The LD50 for cyclophosphamide was significantly higher for the cereal diet than for the purified diets, but there was no difference among the purified diets. Deaths were predicted by dose, diet, white blood cell count, and BUN on Day 4 after treatment. In the saline-treated rats fed the purified diet, hepatic total glutathione levels increased in the following order: folate deficient < folate replete < high folate. There was no significant difference in aldehyde dehydogenase activities or of microsomal P450 levels in livers from rats on the different diets. In the rats treated with 5-fluorouracil, the high folate rats developed more severe anemia, azotemia, and leukopenia than the other groups. Weight, white blood cell count, hematocrit, and BUN were important predictors of death. The kidneys from rats fed the cereal-based diet were histologically normal, but rats ingesting the purified diet had increasing renal pathology that correlated with folate intake. These results indicate that diet has an important influence on the toxicity of cyclophosphamide and 5-fluorouracil and that folate status modulates hepatic glutathione levels, which is a major cellular defense against oxidant and alkylating agent damage.